CARE OF OLD PEOPLE

HL Deb 18 April 1951 vol 171 cc341-76

3.19 p.m.

Debate resumed.

LORD KERSHAW

My Lords, I am sure we have all listened with great interest to what the noble Lord, Lord Saltoun, has said, and it may be convenient for me to say at this moment that the Government are prepared to accept the Resolution as it appears on the Order Paper. I must make the reservation, however, that we do not accept all or many of the conclusions to which the noble Lord appears to have come. Perhaps I may be permitted to say at the outset, since the noble Lord has quoted a number of rather sad and distressing cases or incidents, that it might have been better if he had given us an opportunity of looking into them. We should then have been prepared to give whatever information might follow an examination of the particulars and the details.

We welcome the noble Lord's speech on this subject. He dealt with it at some length about twelve months ago and I could not help feeling that a good part of what he said to-day was said then. While we welcome constructive criticism—and the suggestions made by the noble Lord will be sympathetically considered—the solving of this problem still remains a very real and sometimes distressing matter. We admit that. The main burden of the noble Lord's speech this afternoon is that since the abolition of the relieving officer under the old Poor Law, there is a gap in the services under the various Ministries which now have to deal with these matters. The noble Lord seems to credit the relieving officer with having known, in some mysterious fashion, every single case of hardship within his district, so that at the psychological moment he could provide the service or attention which was needed by anybody in that area. Such was not the case. The noble Lord also seems to suppose that the relieving officer was under a duty to ferret out such cases. Again, such was not the case. Broadly speaking, the relieving officer could be aware only of the cases which were brought to his notice, and with which he had occasion to come into contact. I think the figures that I propose to quote, both now and a little later, will show that the noble Lord is quite "at sea" in giving the full credit that he does give to the old system.

Before the war, of 50,000,000 people, including about 7,000,000 of pensionable age, the number (including the depend-ants) receiving relief was about 1,000,000, of whom fewer than 500,000 were of pensionable age. A mere sum in arithmetic will indicate that that represents about 7 per cent. of the people who were of pensionable age, and under the purview of the relieving officer. Therefore, however good the relieving officers were (and many of them were extremely good and sympathetic), they could not possibly have the comprehensive knowledge that the noble Lord has attributed to them. There is no doubt in our minds that the National Assistance officers are in touch with far more people through the administration of National Assistance and the non-contributory old-age pension, than the old relieving officer ever could be, and in particular a very much larger proportion still of the old people. So that the noble Lord's impression, that in the old days there could not exist a case of hardship and loneliness and distress, without its coming to the knowledge of the relieving officer, is entirely wrong.

LORD SALTOUN

I do not want to interrupt, but I did not say any of that, did I?

LORD KERSHAW

I think the noble Lord has said that the absence of a relieving officer of the type which was known under the old Poor Law system was the real reason for some of the cases that he has quoted this afternoon. We deny that. It is true that under the Poor Law some of the recipients had to visit the Poor Law officer once a week; but surely no one would suggest that that was a very pleasant matter. Surely the purpose of the visit was to find out whether these people were still in need of relief. I cannot for a moment accept the proposition that those people looked with joy upon those visits, however frequent or infrequent they might have been. On the contrary, they would probably feel considerable anxiety as to whether at the end of the interview they would again receive the money payments that they had been receiving.

I am not here to condemn the old system, however. There would not be much profit in going into that matter. Let us look at the present system. In 1927 I happened to be associated rather closely with what afterwards became known as the Blanesburgh Committee on Unemployment Insurance, and I remember that at the first meeting of that Committee Lord Blanesburgh called attention to the considerable agitation that was then taking place in the Press about the abuses of the unemployment insurance system. Lord Blanesburgh said, "We must find out whether this is true, because if there is this amount of abuse it may be that we shall have to take note of it, and deal with it in the recommendations in our Report." So a very extensive and intensive study was made. A microcosm of the whole of the claimants at that time was made, and, if my memory is correct, some 300,000 to 400,000 cases were traced right back to the homes and work of these people. As a result it was found (again I am speaking from memory) that the cases which would have warranted any sort of disciplinary action were fewer than the fingers on my hands.

I remember quite well that at the next meeting of that Committee Lord Blanesburgh, in remarking that this agitation of the Press was not founded on fact. said something like this—I think these were almost his words: "It is our duty as a Committee to frame a scheme of unemployment insurance which will enable the unemployed person to receive his money with the same dignity and self-respect as he would draw out his own savings from the Post Office Savings Bank." That was an entirely new approach to the subject of unemployment insurance, and I remember well that the Blanesburgh Committee altered fundamentally the whole basis of that scheme, which previously had been a kind of slate club scheme, a tontine scheme. What happens with regard to these pension and supplementary allowances is this. The case having been decided, the person goes to the Post Office and gets his money, to use the words of Blanesburgh, "with the same dignity as he would draw out his savings from the Post Office Savings Bank." That means a very great deal. I suppose that most noble Lords must know of people who are receiving supplementary assistance and pensions, people who would never have gone to the Poor Law if that had been the place to which they had to go.

The noble Lord may quite properly hold that the administration of the Poor Law was nothing like so bad as was thought by popular imagination. The National Assistance Board know the qualities of the men who were relieving officers. Many of them are in the service of the Board to-day. They are doing their work with the same humanity and sympathy that they showed before. Moreover, many of us know personally people who were members of boards of guardians in the old days, and whose care and thought for the old and sick was beyond reproach. So there is no purpose in saying that the old system was as bad as it was reckoned to be. But the fact remains—and it is a matter that I cannot emphasise too much, because some of us on this side of the House saw the administration at pretty close quarters—that the fear and the hatred of the old system was a very real thing in the minds of the people. Unemployment and poverty were regarded in those days as a sin and a crime. We have left all that behind now, and I would not dare to claim any Party credit for that new approach to the subject by the whole nation.

In the light of that fact, can it be wondered at that under the new scheme it was decided to clear out the old system lock, stock and barrel? It was the desire of all that there should be nothing in the new scheme which should even remotely suggest to the people concerned that the relieving officer, or someone like him, was connected with it. Nothing must remain to remind the people of the past, and it is absurd, if I may say so with respect, to pretend that the change from poor relief to supplementary pensions was not welcomed by the aged people. I believe that the noble Lord has claimed —I do not think he has done so this afternoon, but he has in the past—that there was an impassioned cry that we were better off under the Poor Law. That —again with great respect—is an absurd statement of the position to-day as com-pared with that which existed previously.

Let me give the noble Lord another figure—I think it is even more significant than the one I gave a few moments ago. And, perhaps I ought to say here that my noble friend Lord Shepherd will deal a little more closely with figures, when he comes to reply to the debate. I should like noble Lords to notice the figure which I am about to give, because I think that it completely disposes of at least one part of Lord Saltoun's argument. Of the 1,000,000 old people who applied for and received supplementary pensions in August, 1940, when the National Assistance Board began, 700,000 were people who had preferred to "make do" without relief, though the amounts of the supplementary pensions awarded showed without any doubt that many of them must have been in very great distress. They preferred to suffer that distress, rather than apply to the Poor Law at that time. The vast majority of old people neither want nor need to come under official supervision in the way the noble Lord desires. If his idea with regard to local welfare officers is that, in order to avoid an occasional tragedy, such as those which he has quoted to-day, we must have officers snooping to find them out then I say that the people would not tolerate it. And no matter how beneficent the purpose of this officer might be, there is no doubt whatever that the purpose would be misunderstood and the people would be resentful.

Probably, the most constructive suggestions put forward by the noble Lord are to the effect that there should be better co-ordination between the Government Departments which have to deal with this matter. It would perhaps be too strong to say that he spoke scornfully of voluntary service, but at any rate he was not enthusiastic about it. It would be just as well, I think, for us to realise that we are expecting the greatest possible value from the services of the voluntary agencies that we know. Friends and neighbours, and local old people's welfare centres and clubs, are likely to discover cases of the kind of which the noble Lord spoke very much more easily than the officer of any authority. The noble Lord seemed to suggest that since he spoke last year no progress has been made in this direction. Let me tell him and the House that there are at this moment 600 county and local welfare committees at work, and more are continually being formed. The increase has been by 100 since the noble Lord spoke twelve months ago. These committees play an important part in focusing public interest and concern upon the welfare of old people. For many old people, the friendliness and companionship engendered and fostered by these committees and clubs has banished the loneliness which was the bane of their advancing years.

Good progress has been made in providing small homes for those no longer able to lead independent lives and who need care and attention. If I remember rightly, I expressed my personal view, when I spoke last year on this subject, that this question of segregating old people into homes needed careful watching. I could think of nothing more tragic than the herding of these old people together so that they would have the sorrow of losing colleagues who passed on, as people must when they reach the ages of which we are speaking. But between the end of the war and the present time, 300 local authority homes accommodating 8,000 people have been opened in England and Wales, and about another 300 are in course of preparation. In addition, there are 600 similar homes sustained by voluntary effort, and that number is being added to constantly.

The shortage of hospital beds is, I suppose, the one feature of this problem that nearly defies solution. There are 50,000 beds for these patients in England and Wales—and that is, of course, considerably short of the total requirements estimated in the surveys of this subject made during the war. But it is extremely difficult at the present time to make any substantial addition to that number. Questions of labour, materials, finance and all the difficulties that exist at the present time, militate against any great advance in that direction. The hospital boards are doing their best to open new chronic sick units, by changing the use of other units no longer required for their original purpose. I may, perhaps, interpolate here that I happen to be a governor of one of the hospitals, and I believe that a meeting of doctors and lay people is to be held on Monday next for the express purpose of examining the use of existing bed accommodation.

Another interesting advance which has-been developing recently is the more-accurate diagnosis of elderly people. I have no doubt that the noble Lord, Lord Amulree, knows more about this matter than I do. It has been shown, I am advised, that as much as 40 per cent, of the so-called chronic sick can be rendered fit for discharge after rehabilitation ser-vices have been applied. However, at this point, when they are fit to leave the hospital or chronic sick bed, another difficulty arises: there is nowhere to send them. The matter is being examined at this moment, and it is hoped that to some degree the problem may be mitigated by exchanging people who have been in chronic beds and who are certified as fit to be taken out with people in homes who need more medical care and attention.

Then there have been established bed bureaux, machinery for making sure that over a large area the best possible use is made of the beds in that area. These bed bureaux are being added to constantly. An interesting experiment which is at the moment being made in a few areas is the provision of hospital and specialist services at the homes of the chronic sick persons—for example, domiciliary consultant visits, a full range of out-patient diagnostic and treatment services to which the patient is brought by ambulance or other transport, the ser-vices of medico-social visitors and laundry facilities provided by the hospitals themselves. I admit that there is need for closer co-operation between the various agencies concerned with these people, and I make a present of this to the noble Lord. I have no doubt he will be glad to know that a special committee of the Central Health Service Council, which advises the Minister of Health, have been considering this matter, and my right honourable friend is hoping to receive their recommendations shortly.

To sum up: no one would claim that the care of the aged does not at the moment present great difficulties. There is severe pressure on the number of beds available in hospitals and welfare homes. Home helps and nursing services are not equal to the demands made upon them. But it is claimed, most emphatically—and I think the noble Lord agreed it is so— that the National Health Service, the local authorities and voluntary efforts are all working hard to overcome these difficulties and to make the maximum provision possible for the benefit of the aged. Every endeavour is being made to increase the degree of co-operation between the various forms of service, and it can be said with confidence that throughout the country there is an increasing awareness of the importance of co-operation, not simply to avoid overlapping and waste of effort, important as that is, but with the more positive desire to ensure that the limited resources available are deployed to the fullest advantage of aged persons in need.

I may be forgiven for saying that I am interested in a survey that is being made throughout the country amongst those who suffer from cancer, mostly old people. We are anxious to know how these sufferers are faring in their own homes. As an example of the value of voluntary ser-vice, it would be an inspiration to every member of your Lordships' House to go to the offices of the survey and see there, night after night, City typists and City-clerks giving their services for hours on end, doing the necessary clerical work. Over 400 young women are giving their spare time to this work. It is all going in the direction the noble Lord, Lord Saltoun, desires: to finding out what is really happening to these people. I think the noble Lord. Lord Amulree, is associated with that movement.

I hope that I have shown that the various departments of public administration are alive to the necessary developments. There is no doubt that improvements are taking place continuously, and I am optimistic enough to say that they all add up to an ultimate solution of the problem which worries the noble Lord. It would be impertinent for me to attempt to discourage him from the task he has set himself, but I would ask him to keep things in a reasonable perspective. The beneficient revolution which has taken place, and which some of us have been trying to bring about for half a century, is something to be proud of, not something that should be decried. I do not say the noble Lord was decrying it. but I could not help feeling that whoever heard his speech or reads it would be given the impression that things are pretty bad for these people. As I said twelve months ago, they are infinitely better than when these social services began.

I would finish on this note. Forty-seven years ago almost to the day I made my first speech in public, and I came across the notes of that speech a year or two ago. It dealt with the horrible conditions under which the people in my Lancashire village were living and with the horror that the unemployed miners had of the Poor Law, and I advocated then, forty-seven years ago, that the Poor Law should be abolished and something more humane put in its place. Our interest in this question did not begin yesterday; it began half a century ago, and some of us have been working all that time to establish the present system. We know there are defects. If, within three years of beginning a vast scheme of this kind, touching every man. woman and child in the kingdom, we did not find that the machinery was running a little tight here and there, it would be a miracle, We welcome the noble Lord's interest in calling attention to any of these weaknesses. We shall continue to improve; we shall not be complacent about the defects. But, and this is my closing word, we are really proud of the services which this nation— I do not say Party, but nation—has pro-vided to help the sick and needy of all ages.

3.49 p.m.

LORD AMULREE

My Lords, it gives me great pleasure to follow the encouraging speech which the noble Lord, Lord Kershaw, replying for the Government, has just made. I agree with a great deal of what he says, but nevertheless I should like to support the remarks of the noble Lord, Lord Saltoun. I agree that a great deal of work is being done and that people are trying hard to make this new social plan—it is more than an experiment, it is a new social revolution—a success. There are one or two points I should like to bring out which follow on what the noble Lord, Lord Saltoun, said in introducing his Motion. One point in what he said which I can confirm is that the number of people who may finally appear in that "black book" which he carries about is considerable. That is why I should like to support him in saying that it would be an advantage if somebody could be officially appointed to find out about conditions among the sick and infirm poor—I am not talking so much about the poor who can get about by themselves.

My work has taken place in one metropolitan borough. During the last two years we have come across no fewer than fourteen people whose cases were reported to the local authority by their friends and neighbours and in two instances by their doctors, and who, had they not been so reported, would undoubtedly one day have been found dead in bed—or probably they would not have been found in bed, but only in their apartments. We managed to admit those fourteen people to hospital, but four of them were in so tragic a state that they died within twenty-four hours. It was during the winter; they were frail and old, and death was undoubtedly due to cold and exposure. It was certainly not due to poverty in every case, because one man of about 75 years of age, who lived by himself— he was not a very attractive old man; he had quarrelled with his family, and would not have them near him—certainly was not poor: he had £26 in his pocket, and subsequent inquiries showed that with one pension from his firm and another from the State, he was receiving about £6 a week. We found him in time merely because the local sanitary inspector visited the house where he lived because of an outbreak of infectious disease. This man was not reported by his friends, because he had none, nor by his neighbours, because they obviously did not like him very much.

I agree with the noble Lord, Lord Kershaw, that the National Assistance Board officers now see far more people than they did before, although I sometimes wonder whether they are seeing the right people, and whether some of those who should be seen are not seen because it is left to the pensioner to seek out the Board and not to the Board to search out the pensioner. I support the noble Lord in suggesting that somebody might take on that work. I do not want to create more officials—we certain have enough of them—but I should like the Assistance Board officers, if possible, to enlarge their work. They have already increased the scope of their tasks and now take care of the affairs of a larger number of pensioners, but I should like them, so far as possible, to be made responsible for all old-age pensioners, whether those pensioners apply for supplementary pensions or not. It would not entail a great deal of investigation among people who do not need looking after, because by making a few inquiries in a street one can usually find out whether persons are living in unfortunate circumstances by themselves.

When dealing with the question of old age in general, there is one ring which must be broken completely: namely, that which says that if there is no room in the hospital, then there is no room in the institution—call it welfare home, institution, ex-workhouse, or what you will. Prompt admission to hospital will nearly always ensure prompt discharge. That principle is as true for old people as it is for the young. One is told that some of these chronic sick hospitals have long waiting lists up to twelve months. But that is fairly meaningless, because if somebody is sick and has to wait twelve months in his home, the physical and mental deterioration by the time he is admitted is such that either nothing much can be done for him, or a long stay in hospital is entailed. It may seem contrary for me to start with the sick, but I feel that that is the real point at issue. When people grow old there is no sharp dividing line between being sick and being well, and, as I have said, a short spell in hospital at the right time may often lead to many years of comparative health in the person's own home, and that is a state of affairs which we want to encourage.

The noble Lord said that there are about 50,000 beds available for the old and chronic sick but that a certain number cannot be used at the present time because of the shortage of staff. I entitrely agree that it is impossible to provide any more hospital beds at the present moment, but I would suggest that the number of beds which we have now is probably sufficient for the needs of the aged population. When the surveys were made, it was estimated that something like two beds per thousand (I have not the figures with me) were needed for the chronic sick. That would mean a large increase in the number of beds, from I believe, 50,000 to 100,000. Obviously that is something we cannot expect now and, as I say, I am not at all sure that it is necessary. In some of the hospitals where the old and chronic sick patient is properly treated, it has been found that a greatly reduced number of beds can cope with the same population as before. The places which I have in mind have been able in the course of a few years to cut down the number of beds to about one-third, or even one-quarter, of the total, and yet deal with the same population— indeed, with rather a bigger population, because there are probably more people of pensionable age. We need to encourage the proper use of the beds that are avail-able. I venture, very rashly, to prophesy to your Lordships that in five or ten years' time it will be unnecessary to provide more beds, even for a vastly older population than we have now. In talking of the old days, before the appointed day, it is curious to note that most of the new techniques, new methods and new ideas in treating the chronic sick and old came from what were originally Poor Law hospitals. I do not want to stress the point, but it is nevertheless a fact.

One of the difficulties at present in securing admission to hospital is that they are very full, particularly during the winter months. I found out the other day from the Emergency Bed Service that during the four bad months—namely. November, December. January and February— whereas of people, under 50 years of age about 95 per cent, were admitted to hospital quite quickly, with people between 50 and 60 years of age the figure dropped to about 80 per cent., between 60 and 70 to about 70 per cent., and between 70 and 80 to about 60 per cent. When a man has turned 80 the chances of his admission dropped to 50 per cent. I think that is a very definite statement of the difficulties. They are fairly authentic figures, because they cover the whole of Greater London with a population of several million.

We have been told in the past—I had not intended to bring up this point—that the National Health Service Act will take care of the old people. It has not done a great deal in that direction so far, as the figures show. There has been an improvement in the last ten years; it is not a very big improvement, but it is enough to show that things are not quite so bad as they were in 1949. It shows, too, that there is a big gap before we come anywhere near solving the problem. I was very surprised to find that there is a proposal in one London hospital to shut down two wards of about sixty beds, used at the present time for the chronic sick and the aged people, and to transfer the wards to a nearby hospital. The wards are to be changed into a lecture theatre and laboratories. I should have thought that one would try to encourage the authorities to make every possible bed available for old people. One can see the effects of this difficulty in another way. About a week ago, I visited one of the ex-London workhouses, where they have many able-bodied people and many infirm people. They had been forced to start two wards, totalling fifty-two beds, one for males and one for females, for the acute sick in that institution. It makes me think that the wheel is turning lull circle. It was about a hundred years ago when we first started building infirmaries in the "well-regulated workhouses" of 1834; that was the start of the mixed institution which we do not like, and which we hope we shall not see again. There is another mixed institution starting in the middle of this town. That again is indicative of the shortage of beds; and means that one should do all one possibly can to en-courage the use of these beds to the best advantage.

There is another point to which the noble Lord referred. It is difficult to gain admission to hospitals, and it is equally difficult to get people out of hospitals. There are several reasons for that. One is that we have not the number of hostels available to which to send them. It may not be possible to build many, because we have not much money in the country, and we have to make use of the existing facilities. I suggest that there should be a certain amount of flexibility between these two very fine Acts of Parliament— the National Assistance Act and the National Health Service Act. I am sure that it was never the intention that they should be driven in parallel lines. As the noble Lord knows, parallel lines never meet, and it was intended that these two Acts should meet from point to point. As a matter of fact the administration of these Acts is too rigid, and I should like to put in a plea for much more flexibility.

May I refer for one moment to the old system? I know that the noble Lord said that the Poor Law needed to go, and that it had to be cleared out. I entirely agree. The last thing I wish to see is anything approaching Poor Law. But there were one or two principles in the Poor Law which were not too bad. There was the mixed institution, with its workhouse on one side and its infirmary on the other. They were run by the same authority. The medical superintendent of the infirmary was generally the medical officer to the workhouse. It was possible, if a person was sick or became a bit frail, to remove him without bother into the infirmary. If he recovered he could be moved back to the workhouse. During the winter months, a large number of people moved from the workhouse to the infirmary and back again. I do not want to suggest the use again of mixed institutions, but I think they embodied a very fine principle. There was no administrative difficulty about transferring persons to the infirmary when they were sick, and back again when they recovered. That is what I mean when I say that there is a lack of flexibility.

It is largely, I believe, a financial difficulty, because if patients are sick they are paid under the National Health Act. and if they are well by the local authority. There is a certain amount of trouble in finding the finance, but I imagine that difficulty could largely be met by a little firm encouragement from the central office. There are one or two rather curious reasons for the present situation. At the present time, children have no obligation to support their parents—though I do not want to go into the moral side of that. At present, we have several old patients in my hospital; they lived by themselves and they could not carry on alone. They came under our care, and now that they are a good deal better they could leave. They are not fit to go and live alone in their one room, but they have families who could take them without great difficulty. The families are not living in one room, but in quite reasonable circumstances and with reasonable accommodation. They refuse to take them. That means that I have four or five people occupying beds who need not be there. That is rather a deplorable thing, and in time it will cause a vast amount of clogging up of beds.

I should like to put forward the idea that there might be some means of compelling these people to take their parents when they have recovered, in cases where there is nowhere else for them to go. We cannot get them into an institution, and there are not enough of these halfway houses. Therefore, they have to occupy an expensive hospital bed. It is much more expensive to keep them in hospital than in some kind of institution or home. The noble Lord may have seen in The Times about a fortnight ago an article on halfway houses. These have just been started by the King Edward's Hospital Fund, and they are meant for people who do not need to be treated in hospital but who are not well enough to go to their homes. In these places they can live a more or less normal life, and yet remain under the medical umbrella and receive their treatment. There are now about four or five of these halfway houses now open, and I think that they are quite comfort-able places. When the patients go there they receive their 16s. a week for the first year. When they are well enough to be transferred to a home under the National Assistance. Act, then 21s. of their pension is given up for their maintenance, and they receive only 5s. Nobody is going to be very eager to change a comfortable residence and 16s. a week for a residence where he gets only 5s. That is another thing which makes it more difficult to get patients to go out under the regional board.

There is one other point that I should like to raise. There have been suggestions that, pending the time when the hospital service can take in these people and the beds are free, there should be some means of securing, subject to a medical certificate, compulsory admission to a hospital for a short period. That proposal has a certain amount to be said for it. There should also be compulsory admission to an institution or home. We cannot place the whole of the burden on the hospitals, or they will get clogged up. Nurses and doctors are already run off their feet, and the patient would suffer. I was going to say a word about the way of preventing people from becoming ill, but that may arise more properly when we are talking about the new pension rates. I would add a tribute to the extremely fine work which the voluntary organisations are doing in visiting the old people's homes, clubs, and so on. One of the prime causes of mental and spiritual decay is having nothing to do. and continued employment is good for both body and mind.

4.12 p.m.

THE LORD ARCHBISHOP OF YORK

My Lords, I shall, I suppose, pass as one of the old people. Happily, I am still at work and I have the utmost sympathy and concern for the old people, who in many instances are living in poverty and loneliness, without any real interest in life. I am therefore very grateful to the noble Lord who has introduced this subject. He showed great knowledge of the subject, and great sympathy with the old people; and the result of his initiative is that we are having an extremely interesting and sympathetic discussion about some of the matters which concern old people. I agree with the noble Lord who spoke from the Government Front Bench that the position has improved very greatly, compared to what it was many years ago. The old age pension, for one thing, has improved the position; and, as has already been said, there is a large number of voluntary societies which are doing very good work indeed in connection with old people. The old have nothing to look forward to. I can remember how, as a curate, I used to visit the workhouses, which were full of old people, crowded together, gloomy, unhappy and querulous. They had little relief in their lives, and of all the visits that I used to make those were the ones I dreaded most. I am speaking of some-thing like fifty years ago. Things have improved enormously since then; and the Act to which reference has already-been made has brought about a great advance.

The noble Lord who initiated the debate was right in stressing that the problem is still a great one, and one which is tending to increase, for we are becoming an older nation. The elderly may be a burden on the younger generation. In one great town in the North, I am told, there are over 60,000 people over the age of sixty. I am told that in another town 10 per cent, of the population consist of aged people. In another city the proportion is something like 12 per cent. These figures will increase in the future. Therefore, this is a matter which requires the most serious consideration. Reference was made by the noble Lord, Lord Amulree, to the fact that young people sometimes evade their responsibility towards their parents. Many of the younger people now go out to work, however, and are no longer able to look after the old people as in the past. We therefore have before us a great problem, one which will require most careful consideration.

There are three lines of approach. The first is perhaps rather different from anything which has been said so far in this debate. I think it is most important that a large number of small houses should be built for the older people—in the country especially. One frequently finds an old man and his wife living alone in the cottage in which they have brought up a large family. That cottage could probably hold a larger number of people than these two. But it would be cruel indeed to move the old couple out of the cottage and away from the neighbourhood in which they have lived for many years. Many of these couples themselves feel that the house is too large for them, and they would like to move to a smaller place in the district in which they have all their friends. In a lesser degree, this is also the position in the towns. In the past, many local authorities did set aside a certain number of their houses for older people, but in many cases, owing to the great pressure of the housing problem, that policy has been suspended. It might help the housing problem, and the old people too, if more small houses could be built for old people. as I have suggested, so that they may still have a home of their own.

The next point to which I wish to refer has already been touched upon. There are many old people who like to live by themselves; they do not wish to mix with other people; they do not wish to enter an institution. They are rather lonely people. When their health is good and the weather favourable, all is well. But when they are laid up and the weather is bad, they may easily find themselves in a position of great difficulty. Some of the cases of old persons dying, to which the noble Lord, Lord Saltoun referred, may well have been due purely to such circumstances as these. When the weather is good, an old person is able to go and fetch his or her rations, coal, and so forth; but in case of illness or very bad weather trouble arises. Unless some systematic arrangement is made, some of these old people may be in a position of great suffering. A great deal has been done already by local authorities, and also by private organisations, in the way of home helps, and this scheme has been very good so far as it has gone; but it has not been anything like sufficient. For instance, in one big city arrangements are made to take warm meals to these old men and women on one or two days of the week. I am told by some of the voluntary organisations which undertake this work that a whole fleet of cars is required to take these meals round, instead of the few cars which serve at present. That side of the work seems to need a great deal of developing and strengthening.

My third point is one which has been touched upon so much already that I need not spend more than a moment or two on it. I am thinking of the people who are not ill enough for a hospital, but who are certainly not well enough to take care of themselves beyond a certain point. They are unreliable; they are subject to giddiness or to weakness in some form or other; and they cannot always be regarded as responsible if left to themselves. On the other hand, as I say, they are certainly not cases for the hospital. It is therefore a matter of urgency that more of these halfway houses should be pro-vided. The Times, in the excellent article already referred to, used the expression "halfway houses" in rather a different connection. The article, I think, was referring to a place to which a patient could go after discharge from the hospital, and when in need of a few weeks' further treatment before going to a welfare hostel. I think something more than that is meant by "halfway house," something rather more permanent, where the people can go and have a certain amount of supervision, possibly for the rest of their lives.

There is one further point that I wish to make, partly arising from something which has already been said—that is, the importance of older people having some interest in life. It was remarkable to hear that something like 40 per cent, of those who have been rehabilitated (I dislike that word) and have been through that kind of treatment have been restored to normal health. But there is a deeper problem. May I illustrate it in this way? When I was a curate and vicar in Portsmouth, where there is a large dockyard, it always used to be said that the best workers would die shortly after they retired. Often that proved perfectly true: in many cases they died a few months or a year or two after their retirement. But after a time (I was living in the same place for a great many years) I noticed a difference. The men who had some other interest in life besides their work—it might be religion or politics, or pigeons or rabbits, or something like that, so long as they had some other interest which they could carry over to the time of retirement—retained their vitality and, to a large extent, their physical vigour. I wish that the voluntary societies, who do so well, could do more to prepare people for the period of old age, so that when they give up their ordinary work they may be able to carry into their retirement some interest which will keep them alive and give them a real interest in life. I am sure that we all feel a profound concern for, and the greatest sympathy with, these old people in retirement, who are often in consider-able mental and physical difficulties, and who in the past have done useful service for their country. We are all most anxious to help them in any way we can.

4.23 p.m.

LORD CALVERLEY

My Lords, I can speak only of what I find in the North of England. I am glad that the noble Lord, Lord Amulree. has mentioned that there is need for greater flexibility with the hospital boards. In my own home town, there are 150 aged people with chronic ailments waiting for beds, whilst only ten are acute cases of the aged sick. I appeal to the Front Bench to urge upon the new Minister of Health that there should be an inquiry into the co-ordination of some of these local, ex-municipal hospitals. The medical officer of health feels frustrated when the hospital which he has seen grow up is taken over by a regional board with palatial offices in, say, Harrogate. He has 150 aged people chronically sick and he cannot do anything for them. One medical officer of health only last Friday said: "Many medical officers of health are feeling a sense of frustration in the new set-up." It is not too late for such an inquiry to be made.

Mention has been made of housing schemes by the most reverend Primate. Again I speak only for the North of England, but I can say that in every housing scheme for the last six years provision has been made for small bungalow houses for the aged, because we want these old people to carry on in their own homes. Going back to the days of the old Board and Commission, I always remember with pride an enlightened board of guardians building a little community where there was even a seat facing another seat for the next-door neighbour, so that the old folk could sit and have a good gossip. The noble Lord, Lord Saltoun, is a little too pessimistic: we have been making great progress. With regard, for instance, to hostels, a certain type of person with gregarious instincts does not like to be herded in the old workhouse. I notice that in the city of Leeds eight hostels are already in being and working. Six hundred aged people are being catered for in mansions which were the mansions of the rich until a few years ago. The rich people have gone; they have migrated to better places, I hope. Similar arrangements have been made by the West Riding County Council. The Bradford council, again an authority with vision, has been able to do the same. Therefore, the noble Lord, Lord Saltoun, need not be too pessimistic that all is lost, because this country does more for the aged than does any other nation upon the face of the earth. That is the reason why the population of persons aged sixty-five and upwards has doubled during the last decade. In one sense it is a tragedy but. on the other hand, it is a living testimony to the public-spiritedness of the people of this country.

It was suggested by the noble Lord, Lord Amulree, that now that the descendants of the aged are not legally responsible for them (which is true) there is a falling off in observing one of the Ten Commandments: Thou shalt honour thy father and thy mother. These young folk cannot make the excuse that they are short of money. Indeed, their parents themselves have bigger pensions, and are going to have bigger pensions still. On that point, again I would request the Front Bench to ask His Majesty's Government, when they are implementing the scheme for larger pensions on October 1, to make those pensions retrospective to September 1, so that the old people can purchase a few bags of coal before the winter sets in.

Then there is a sort of frustration between the regional boards, with their 100 per cent, grants of cash, bucketsful of money and every social service, and the local authority, which receives only 50 per cent. The local Chancellor of the Exchequer says: "I am not going to view with any enthusiasm an extension of your work, because it means that the rates will go up." He is to be excused for that. I think the Minister of Health should in-crease the 50 per cent, health services grant to local authorities. One or two social services have actually been shut down—but those are connected with child welfare, and therefore I will not digress by mentioning them in this speech. The noble Lord, Lord Saltoun. emphasised the lack of contact in visits. I remember the tough old relieving officer; he had to be tough with some of the people with whom he had to deal. As a small boy I myself had a narrow escape from coming into his clutches. I have in my hand a postcard which is stamped and sent to every person over 65 years of age in the city of Leeds. Fifteen thousand of these cards have been sent out, and the idea could be copied all over the countryside.

LORD SALTOUN

I do not want to interrupt the noble Lord, but I should like to point out to him that in the whole of my remarks I never used the phrases "Poor Law" or "relieving officer." I never referred to the old Poor Law.

LORD CALVERLEY

I do not want to be unkind to the noble Lord, but that was the idea he gave to some of us. However, I want to go on to deal with the positive side—what is being done in our great progressive cities. Each pensioner has thirteen voluntary agencies to choose from in regard to the darning of socks, the cleaning of a house, making a bed or doing a bit of washing. These old people have only to ask for a welfare officer to call. They put their name and address on the card, and put it in the postbox. By this scheme great work is being done. Along with the postcard is sent a nice human letter telling these aged people that there is a message to all old-age pensioners from a very human welfare service officer. The noble Lord wants more welfare service officers. The local Chancellor of the Exchequer, however. says that if he "sets them on," he will get only a 50 per cent, grant, though if the matter comes under the hospital board, which has money to burn, he will receive a grant of 100 per cent. I want to bring that point to the attention of the new Minister of Health, in order to see whether he can do anything.

My only other point is this. So far as I have found out, the average woman over sixty loves making a little cake; it occupies her mind. I wish the Minister of Food, instead of deluging the countryside with 1 lb 6 oz. of sweets each month to every man, woman and child, would give an extra 4 oz. of fat to the aged. Some of us have a sweet tooth, and would like a nice home-baked cake. My Lords, I have scrapped most of my notes, because there are one or two other noble Lords to speak, and I will close with, I trust, the not altogether vain hope that the Front Bench will take notice of this debate, and even of the cautionary stories of the noble Lord, Lord Saltoun. I am glad that he did not read out of his ''black book," otherwise he would have taken a long time. But I should like at some time to have a look at his "black book" and then, if it is very cautionary, we will send it to give nightmares to the new Minister of Health.

4.34 p.m.

LORD CAWLEY

My Lords, I wish to comment only on one particular point that has been raised by two or three speakers to-day—namely, the feeling of apprehension that the bed accommodation formerly open in hospitals to the aged poor is being filled up by surgical and medical cases, and that the improvement which is claimed in our health services is being achieved partly at the expense of the old people. A good deal has been said on this subject to-day, but I happen to have come across a case which called the matter vividly to my attention. I am the chairman of the Assistance Board advisory committee in Manchester. A few weeks ago, in my ex-officio office as chairman, I was attending one of the sub-committees, and the most extraordinary case came to our notice. Usually, most of the cases coming before these advisory sub-committees are cases of human wreckage, with which the officers of the Assistance Board, with all their energy and devotion, have been unable to deal; and often the committee themselves cannot decide what to do, though I am pleased to say that in some cases they succeed in finding a way out of the difficulty. On this occasion, however, we heard of a most extraordinary case. A young man with a good working record was brought before the subcommittee. We were informed—in fact, he told us so himself later—that he refused to go out and work because his mother was sick and he had to attend to her.

This was a very distressing case, the sort of thing that unfortunately does occur with a number of old people; it was a case of the utter physical and functional breakdown of the body. It was a case which it was hard and disagreeable to nurse, and one in which it would be impossible to get a neighbour to look after the patient. We were informed by the officer of the Board that no room could be found for this woman in any institution; that the doctor and the Assistance Board officer had done their best, and still the woman was left in the same position. The son was quite willing, indeed anxious, that his mother should go into an institution; but as a good son, he felt that he could not leave her to exist in the filthy conditions in which, if she did not receive attention, she would have to live. In this case there seems to have been a complete lack of liaison between the Assistance Board and the hospital authorities. In many ways, that is the reason why this Motion has been brought forward. This case was so interesting that I thought I should bring it to your Lordships' attention. I have no great knowledge of the officer who dealt with the case, but I think he could not have failed to do all he could, because it would have been greatly against his interests to bring into publicity, and to the knowledge of the sub-committee, a case in which he himself had not per-formed his part.

Having spent twenty years as a Poor Law guardian, and while I am on my feet, I should like to thank Lord Kershaw publicly, although he is absent at the moment, for the kind words that he used in regard to those of us who have been guardians and relieving officers. I do not hanker for the return of the Poor Law, and I realise that any new system must be faulty in some respects; but in a case like the one I have mentioned, I think that under the old Poor Law there would have been immediate admission to a Poor Law infirmary. In this particular district, the City of Salford, there was a big institution, and in the old days this woman would have been sent straight there. I know that there has been improvement in a number of directions, but I think that it is urgently necessary to do something to avoid cases of this nature occurring.

4.40 p.m.

THE LORD BISHOP OF LEICESTER

My Lords, this is the first time I have spoken in your Lordships' House, and I know that you will grant me your indulgence. It is not such a formidable occasion as it might have been, coming as it does towards the end of the debate, when your Lordships, I am sure, will not wish much more to be said. But I feel that it is right, after my experience, extending since my early days in East London and embracing pastoral work in a county so greatly concerned with the care of old people, to say one or two things, even though they may be almost entirely to support, or rather to express my agreement with, the speech of the most reverend Primate the Lord Archbishop of York. Quite shortly, there are three general observations that I would put before your Lordships.

First, I should like to record in the House not only our sympathy with many old people but also our admiration for the very great contribution which they, by their courage and patience, bring to the whole of our national life. If I may speak simply from personal experience, I find that again and again. It has been my custom during the last few years on nearly every Sunday in spring and summer to go to a country parish in the evening, and to visit six or seven homes —simple homes, where old people who cannot get about are to be found. If only I had recorded from the beginning the wisdom that I have learned and received, it would have been a most valuable record. This is an age of statistics and information and memoranda, but I believe that it is still, as it has always been, among old people in the simple homes, where there has been steadfast rectitude of character, that that kind of wisdom, which makes all the difference to a small community, is to be found. I should like to give my record of witness to that.

Secondly, I wish to emphasise what I think has already been said as to the need for co-ordinating the various social services. Great as is the assistance which the State and the local authorities can give, nothing can take the place of the understanding, the pastoral and sympathetic personal friendliness and wise counsel which is given voluntarily, again and again, particularly in the country parishes, by the country clergy and the ministers and members of the congregations. Among all forms of voluntary service an important part is that great pastoral work of the Christian Church which I believe is being discharged in these very difficult days as conscientiously as ever it has been. Of course, the conditions in the towns are entirely different from those in the villages. With the immense population of a modern parish in a great city, it becomes almost impossible, with the best will in the world, for the few clergy and their helpers to supply that kind of visitation and friendship which they wish to do, and which is so much welcomed where it can be given. That must always be a first duty of the Christian Church, and I am sure that the clergy for whom I should like to speak would be glad to feel that this subject is being so sympathetically considered in this House to-day.

My third point—and it is one which has already been touched upon by the most reverent Primate the Lord Archbishop of York—is this. Those of us who come into contact with the old people's clubs—for example, the Evergreen Clubs, of which we have sixteen in Leicester, with a very large membership of old-age pensioners—can bear witness to the fact that that kind of voluntary organisation seems to be supplying exactly what old people need at the present time. They look forward to coming out from their loneliness and their boredom to meet with their friends. At these clubs, perhaps sixty, eighty or a hundred men or women, or men and women together, meet on one afternoon of the week; and the voluntary effort of supplying that kind of social friendship and contact with the wider world which is to be found in the clubs is something by which I am certain old people benefit, and which they welcome very much. That is all I wish to say; I just wanted to bear witness to those facts.

4.46 p.m.

VISCOUNT SWINTON

My Lords, this debate has covered the ground so well that more speeches are hardly needed. The subject, however, is one of such importance that perhaps the debate ought not to close without a brief and modest contribution from this Front Bench. At any rate, it gives me the opportunity of congratulating most sincerely the right reverend Prelate on a model maiden speech. I think we can say of the speech of my noble friend who introduced this Motion that it was sympathetic, informed, and balanced—and it lost nothing by being balanced. But I think we shall all agree that the problems which he raised in his moving speech ought to be considered—greatly as we all sympathise with him—not only in the light of the present economic situation, but also, even more, in relation to the changing agestructure of the population. I think that some word ought to be said about that in this debate, because I do not feel that the extraordinary change which is taking place is really appreciated in the country. A hundred years ago, for every person over 65 years of age there were thirteen people of working age. To-day, the figure I believe is one to six. and the statisticians tell us that in twenty-five years' time, with the present expectation of life, it will be one to four. And the position is even more serious than those figures show, because what we call the working population includes all housewives, who have a great deal to do looking after their homes and families, and it also includes women over 60 years of age who have opted to retire.

It is a physical and a financial problem. On the pre-Budget rate of pension, I think I am right in saying (Lord Shepherd will correct me if I am wrong) that the cost of retirement pensions was in the region of £300,000,000 a year, and the estimate which I have had is that even on the pre-Budget rate those pensions would rise to something like £500,000,000 a year in 1975. The Budget has—quite rightly, I think—added £39,000,000 in a full year. These are formidable figures, and they do not make hard cases any less hard; but they do, I think, show the importance of confining our proposals to cases of real need. And that was where Lord Saltoun's speech, I felt, was realistic and responsible. Those figures also emphasise how very important it is that those who can should remain at work and increase the national output. I think we are all better for remainins at work. As the most reverend Primate said, when some of the best workers retire, they soon die unless they have a hobby or something to do. A great many people would be both happier and better in health if, like some of us who are getting on, they still continued in harness. Everything should be done by employers and workers to encourage the older people in every way they can. I am sure it is possible. I was given an example the other day of an engineering firm where the postal department, which a few years ago was run almost entirely by juveniles, has now become the grandfathers' department. The average age is 67, and I am told that the efficiency is higher than it was before. Those of us round about that age can well understand that being so.

We have also to see what can be done, within our means, to help. It came out in one aspect or another in speech after speech in this debate, that the care of the aged and the partially infirm aged is a peculiarly personal service. I was interested in what the noble Lord, Lord Amulree, said, about finding that the younger generation, who could quite well do so, were unwilling to take their aged relatives into their homes. While I am sure there are cases of that kind, I have, on the other hand, been impressed, particularly in the country, by the readiness of young people to take into their homes parents who are not only aged but aged and very infirm, though they make more work than the whole of the rest of the family. It would be an evil day, morally as well as financially, if we tried to detract from or discourage the personal service given by children to their parents and old relatives.

I am sure we can do a tremendous amount by helping and encouraging voluntary organisations, to which a de-served tribute has been paid. Help to these organisations may be both effective and economical. With them a little money goes a long way. As with the voluntary services, in the case of the public authorities personal knowledge and the personal touch are all important. I am not going to enter into a controversy over the old and the modern. What we have to do is to keep the best of the old while bringing in what is good in the new. In work of this sort we do not want centralisation and a sealed pattern. This is not the occasion, certainly not the hour, on which to debate the reform of local government, but I will say this: the more humane the service, the more local should be the administration. Whether the noble Lord, Lord Saltoun, was right about his local officer or not, I do not know, and I am not going to argue about that; but in principle I am sure he was right. It is local knowledge and sympathy that count. I want to add my plea about housing. I hope that housing will always include, and increasingly include, small houses for old people. It is true, as the most reverend Primate said, that in many country districts, by building a few small houses we could enable old people to vacate the large ones which they are occupying now. We should not be building these little houses at the expense of young married couples beginning family life. In many cases the two programmes will be complementary, and we shall be making it possible for the old people and the young couples to live in the kind of houses in which they ought to live.

I would touch on only one other subject. I am told that the functions of a number of charitable trusts, founded to assist old people in some way or another, are now obsolete. If a trust is exhausted, the trustees can go to the Charity Commission and have a scheme to apply the trust to what lawyers call cy-pres. But that may be too narrow. In the interests of the whole community it would be much the better course to give wider discretion in applying these trusts. It might be much more effective, if the number of trusts which are wholly or partly exhausted is substantial, to amalgamate several of them so that in a fairly wide district they could make the best use of their funds. It might be that certain almshouses could be converted into half-way houses or into hostels to relieve the pressure on the hospitals. I do not know how much there is in that suggestion, but I think it is worth following up. I am sure we cannot deal with this matter in any sealed-pattern way. We want to use such resources as we have and can scrape together and associate them with all the voluntary service that can be undertaken. Then, without a great deal of expenditure, we might achieve a great reform. We are all grateful to the noble Lord, Lord Saltoun, for having initiated this debate. Although the noble Lord, Lord Kershaw, was a little critical of some of the things Lord Saltoun said, I think the Government were sympathetic, on the whole, to the general tenor of his proposals and were—for them—unusually open-minded in their approach to the subject. Well, the noble Lord has had that effect on the Government: he has done more than many of us have been able to do.

5.0 p.m.

LORD SHEPHERD

My Lords, before I embark on the few remarks that I intend to make, I feel that I should make a brief reply to the point just raised by the noble Viscount, Lord Swinton, about charitable trusts. At this moment an inter-Departmental Committee, sitting under the chairmanship of Lord Nathan, are studying the question of charitable trusts, and I believe that the matter of obsolete trusts is amongst them. If that is the case, then the noble Viscount's point will undoubtedly be borne in mind. I want to give my meed of praise to the noble Lord, Lord Saltoun, for the speech which he made in the House to-day, and for the careful preparation of which it gave evidence; and I do not wish to call into question the motives that prompted him 1o make it. I do not agree entirely with the suggestions that he has made, but on the whole there is not a great distance separating us one from the other. I should also like to add my word of welcome to the right reverend Prelate the Lord Bishop of Leicester, who to-day made his first speech in your Lordships' House. I sincerely trust that it will not be the last speech that we may hear from him, and that he may be encouraged to come amongst us more often, if that be possible.

I do not think a lengthy speech is required from me, because only a few points call for mention in a winding-up speech. I should first of all like to deal with what the noble Lord said about hard cases, in order that I may put into proper perspective the position of the National Assistance Board, and, secondly, to deal with the matter of co-ordination, which is the real subject that we are supposed to be discussing to-day, but of which, I am afraid, we have heard too little. The few figures that I am about to give on the National Assistance Board are not too many, but they will be sufficient: to give your Lordships a real impression of the activities of that Board. In 1948 the number of allowances made weekly was (in round figures) 842,000; in March of this year the number of such allowances was 1,383,000, again in round figures— that is to say, there was an increase in that short period of more than 500,000. The proportion of old people to be found amongst those receiving those weekly allowances is very high indeed. In 1948, out of a total of under 1,000,000 payments, old people received 628,000. Since that time, there has been an enormous increase, and the number of old people now in receipt of weekly allowances is 812,000, rising to 850,000. Therefore, the National Assistance Board, by the very nature of the work they are carrying on, are having a great contact—far greater than ever existed before—with the elderly people in our country.

Of the 850,000 old people who are in receipt of allowances, the following figures apply: 700,000 arc persons in receipt of retirement pensions; 100,000 more are in receipt of non-contributory pensions; and 50,000 of the allowances are accounted for by people who have not qualified for either kind of pension. In addition the National Assistance Board have the responsibility of administering the noncontributory pensions scheme. There is, of course, a certain amount of overlapping between the two great functions relating to old people, probably reckoned at 100,000, but if due allowance is made for that, and the two allowances are added together, the Assistance Board, it will be found, are in contact with 1,150,000 aged persons. I suggest to noble Lords, with those figures in mind, that the work of the National Assistance Board is infinitely greater than that which the Poor Law authorities ever had to face, and that their experience of the problems of the aged must for that reason be infinitely greater, too.

It may interest noble Lords to know that every person who applies to the Public Assistance Board for assistance is visited at the address which the applicant gives. Whether he is visited on a number of occasions depends entirely on the case. Where the person is naturally healthy, and able to go to the Post Office for his pension or allowance without difficulty, there is every reason in the world why he should do so. But where the person is infirm, other visits may be made by members of the staff of the Ministry. Last year the total of such visits was in the neighbour- hood of 5,000,000. That figure has to be remembered in relation to any suggestion that may be made that the Board are falling down on their task, and are not carrying out work originally intended. I know that the noble Lord, Lord Saltoun, has not suggested that, and I do not accuse him of doing so; but I am afraid that if we allow these bad cases of his to cloud the field of publicity we may be doing an injustice to the Board.

I now come to points raised by Lord Saltoun concerning administration; of inquiries to be made by members of the staff of the Board, whether authority ought to be vested in one man or whether we ought to depend, as the noble Viscount, Lord Swinton, has suggested, on voluntary services. Personally, I do not think it would be possible at the moment, in view of the labour situation in the country, to find sufficient extra staff to carry out the suggestion first mentioned by the noble Lord. He might make, for consideration by the Ministry, a suggestion that I have had made to me elsewhere, that the staff of the Board should be divided up on a parish basis, and that, that having been done, some member of the staff should be placed in charge of each parish. But even if it were possible to do that, there would still be great need of the services of the voluntary worker.

Noble Lords may think it strange that in these days a Labour Minister should be asking for a continuation and development of voluntary services, because it is sometimes suggested that we have never been in favour of it. That, however, is entirely wrong. What we have said in former days is that in continuous matters of this kind one cannot leave everything to voluntary service, because voluntary service is moved by apathy and enthusiasm alternately.

LORD SALTOUN

That is just what I was saying.

LORD SHEPHERD

But if there is the skeleton of the organisation, clothed in authority and blessed with voluntary service, then it is possible to provide the close network for that which needs to be attended to in the community. We are doing everything we can by co-operation to make use of voluntary workers in finding out the cases which need treatment. There is another reason why we should depend as much as we can on voluntary service for discovering applicants for assistance. The noble Lord will understand that the members of the Assistance Board and their employees are not only representatives of the community; they are also representatives of Parliament. They have to administer the law, and in that respect they have to give decisions. If, therefore, the applicants can be brought to them for judgment—a judgment benevolent and sympathetic—it might be the best way of dealing with the responsibilities of the Board.

Now I want to say something about co-ordination. Co-ordination, I take it, is to involve not merely the services rendered by the National Assistance Board but also those given by the local health authorities and the hospitals. May I say here, in parenthesis, that the local health authorities are now finding increasing numbers to employ in connection with their own services? Noble Lords might like to know that at the end of 1949 the number of health visitors employed was 5,852, the number of home nurses employed was 8,283, and the number of domestic helps—which has shown a great increase—totalled 18,655. Co-ordination must relate to the activities of all these bodies, including the hospital services. I am not sure where the noble Lord, Lord Saltoun, stands in this respect. He has suggested the appointment of an officer with authority. I cannot see how that could be accomplished and carried out with success. Surely, it would be better that we should seek the co-ordination of the authorities responsible for policy and functions, and if that can be secured it will then be for the co-ordinated authority, or the co-ordinated bodies resulting, to decide what their servants are going to be. But the noble Lord may rest assured that on this subject, although we are not entirely clear what he wants, and although we may not eventually agree with him, we are now convinced of the need for co-ordination.

I have here a note which I should like to read for purposes of clarity. The Central Health Services Council are still considering the question of co-operation, and it is therefore impossible to give any indication at all of what their recommendations to the Minister will be. It is known that a number of committees, with varying structures and functions, have already been set up in various parts of the country, for the purpose of securing greater co-ordination within the Health Service. Pending the recommendations of the Central Council, the Minister of Health does not wish to take any definite line on what form the machinery for co-operation should best take, but generally he is strongly in favour of all efforts directed to this end. Noble Lords may therefore rest assured that if there is a favourable report, action will be taken in order to bring about, if need be from the top, the co-ordination which seems to be essential.

In order to indicate to your Lordships what the Minister has in mind when he gives a welcome to the action which has taken place in various localities, perhaps I may quote from a recent meeting of which I had cognisance, where the subject before the meeting had some bearing on this matter. The Hendon Group Hospital Management Committee found themselves in very great difficulty with the chronic sick. What beds they had at their disposal for this purpose were filled, and there was a waiting list of more than 200 needing treatment. The Committee therefore sought consultation with other bodies around, in order to find out whether, by helping one another, they could get rid of the immediate difficulty and give more attention to those who sought entry. Let me give your Lordships a description of the meeting which was called. There were representatives of the Middlesex County Council: there was the county welfare officer, representatives from the health committee of the council, the assistant county treasurer, and representatives from the welfare committee of the county. In addition, the medical officers of health for Harrow, Hendon, and Wembley attended, and the National Assistance Board Regional Office also sent a representative. Further, a number of voluntary organisations who have been co-operating locally also sent people. The point to be considered was how to get more people into the hospital by getting more people out. That was the difficulty.

When the meeting was brought together and considered the great problem involved, it branched out in all kinds of subjects—the meals-on-wheels service; county homes; home helps; home nurs- ing; short- and long-stay beds; the supply of bed linen to chronic cases at their own homes and the establishment of a liaison committee. There was some difficulty as to whether that liaison committee was to be on a borough or a county basis. The question of a transport service, the question of payment for taking old people into other people's homes, and for financial aid to voluntary organisations, were also discussed. This conference appointed a committee of officers to go into the points which had been raised and a meeting of that body has been held. The agenda is of interest and covered (a) what additional facilities are required; (b) who should provide such facilities; (c) what assistance voluntary organisations could give; (d) what financial assistance could be afforded to the voluntary organisations, and (e) what additional facilities might be necessary, and by whom they should be supplied. The agenda also dealt with district nurses, home helps, sitters-in, meals-on-wheels, supplies of linen and the washing of linen. That is the kind of development that the Minister is regarding with pleasure and expectancy, because he realises that conditions in the country vary from area to area. A cast-iron scheme of co-ordination from the centre might not always fit; and the Minister is looking for lines on which future co-ordination may be both suitable and possible.

I have only one other point, I think, to which to reply, and that is a matter raised by the noble Lord, Lord Saltoun, respecting the payments of three or four guineas, which he mentioned on the last occasion, as a payment to the sons and daughters of elderly people for keeping the old people in their care. That is a suggestion on which the Minister does not look with approval. There are several reasons for that. First, it would be a higher rate of payment than that which would be given to an old couple who had to keep house for themselves. Secondly, it might have to be given in cases where the home was not a desirable one—the noble Lord knows that we could not trust all cases of that kind. It was also felt not to be proper, in cases of sons and daughters, that in these times of great financial stringency for the country there should be a profit made out of the keeping of old people. But in other ways, where it can be done, the allowances, which now have the force of law in this country, will be forthcoming. In addition, in proper cases a rent allowance is payable. I do not think I need say more. We have had a good, harmonious, and agreeable debate. Once again I thank the noble Lord for having raised the subject, and assure him that the work which he has done will not be lost sight of in the discussions now taking place.

5.23 p.m.

LORD SALTOUN

My Lords, I wish to express very deep gratitude to those noble Lords who have helped and supported me and, in particular, to the noble Lord, Lord Amulree, whose knowledge and experience are so profound, and to the most reverend Primate. I should also like to thank the right reverend Prelate for making his maiden speech in support of my Motion, and in doing so in such a handsome and competent manner, if he will allow me to say so. I also wish to thank the noble Viscount, Lord Swinton, for his blessing, which I receive with gratitude.

The noble Lord, Lord Kershaw, however, made some points which I think ought to be answered. He gave a very pretty exhibition of how he would have knocked me down if I had put myself in the position which he expected me to. He, like any other noble Lord who is interested in this matter, has had the opportunity of reading this book, and no doubt he has read a number of reports in which coroners engaged in some particularly unpleasant cases have said roundly that things were better under the old Poor Law. I was careful not to mention the old Poor Law or the old relieving officer, because I did not wish it said that I wanted the old Poor Law back. I do not think it is a good defence for His Majesty's Government, when this system which we are all anxious to improve is under question, to say that I want the old Poor Law back. I wish to make it clear that I am not trying to achieve that object. The noble Lord said that local officers could not be empowered to find out these cases without there being "snooping," and that the work should be done by volunteers. But how are volunteers going to do it, except by "snooping"—by finding out? I have had one of the best Poor Law officers to take me round and show me how he works. If the noble Lord wants to know how the work is done I can tell him, and how a district is kept clean and sweet by personal work.

The noble Viscount, Lord Swinton, was right in what he said about the changing structure of the population. I did not touch on that aspect of the matter because I was afraid of detaining your Lordships. I may add that what the noble Lord, Lord Shepherd, said on that subject gave me a great deal of pleasure. The reason why I said that Assistance Board officers have not quite the same experience is simply because they have a more limited function. Expand their function and their ability will grow with experience. The Assistance Board have all the staff needed at present to do the work. What I am proposing is an economy of staff. County welfare committees can reduce their staffs, for some of the work can be done at headquarters. With regard to what the noble Lord said about authority to appoint local officers who are able to deal with all the departments, that is a case in which I think legislation may be necessary. With these comments, and in view of the assurance that the noble Lord, Lord Shepherd, has given me that this matter is receiving the serious attention of the Government, and that what we have said this afternoon will not go unnoticed, I once more tender my thanks to all noble Lords concerned.

On Question, Motion agreed to.