§ 2.40 p.m.
§ LORD BEVERIDGE rose to call attention to the social and human problems of old age as noted in the Report of the Committee presided over by Sir Thomas Phillips (Cmd. 9333); and to move for Papers. The noble Lord said: My Lords, following the Report of the Committee presided over by Sir Thomas Phillips and the proposals of the Government last December for increasing the rates of pensions, when many rates of insurance pensions were under consideration, I think it was generally agreed on all sides of the House that at some later date there ought to be an occasion for discussing the social and human problems of old age, irrespective of the rates of pensions. These social and human problems were not within the scope of the Phillips Committee. They were concerned with the economic and financial aspects of old age, and above all with the rates of pensions and the conditions of pensions. But in one section of their Report, they did note most of the problems.
§ I should like to present the social and human problems of old age to your Lordships as arising in the main through two general facts. The first general fact is the nature of age itself, the fact that age brings decay. The decay of the faculties, both physical and mental, is inevitable in the end, but utterly uncertain in the rate at which it comes, its incidence and severity. I think I cannot illustrate the uncertainty of how old age will bring the faculties to an end better than by referring briefly to what happened in Athens 2,500 years ago. It is generally understood that, in the main, lyric poetry is a product of youth. I think it is an undoubted fact that the finest lyric poetry ever written, or I think ever will be written, in the world was written by the tragedian Sophocles, at the age of 90, in his play, ædipus at Colonus. And Sophocles was not unique in going on writing tragic poetry and lyric poetry in those choruses in old age. Actually, all three of the great Greek poets—æschylus, Sophocles and Euripides—were persons of pensionable age when they were producing their best known masterpieces. Whether they had pensions or whether they had recourse to assistance, I cannot say; but æschylus produced the Oresteia, Euripides, the 80 Bacchœ—a play which I remember with great joy because I got a First-Class upon it at Oxford many years ago—when they were between 75 and 80 years of age, and Sophocles produced the Philoctetes at 87, and this other play to which I have referred when he was already 90.
§ But the Greeks were not only famous in those days as dramatists at old age. At that time they enjoyed the leadership of a remarkable statesman, Pericles. He, I am sorry to say, died before he attained full pensionable age, but he was near it, and he undoubtedly made one of the finest speeches of his life, and the finest at that time, when he was nearing pensionable age. There was another maker of orations in Greece, Isocrates, who made his masterpiece in orations when he was 98. Unfortunately, owing to his unhappiness at what happened to his native city of Athens, he decided at the age of 98 that the time had come for him to commit suicide—otherwise, so far as one can see, he would be living still. We know all about that kind of thing in this country to-day. We have our Pericles, who goes on being a statesman and a maker of orations regardless of age. We know that old age does not destroy faculties at the normal time when a pension is due. Unfortunately, though, we also know that, sooner or later, decline must come. Decline of faculties is uncertain in time, but inevitable; and decline of faculties makes increasing care by others in the last years of life as necessary as in the first years of life. That is the first fact: the inevitability of decline through age and the extreme uncertainty as to the stages by which it will come about.
§ The second general factor is not one which we share with ancient Greece, though we share it with some other countries; it is that, owing to changes in the birth and death rates in the past seventy years, the age structure of our population in Britain has changed fundamentally. At the beginning of this century, in 1901, we had 2¼ million people of pensionable age, 12 million children under 15 and 22 million people of working age. The 2¼ million of pensionable age represented one to every ten of working age, and one to every 5½ children. In 1951, we had 6¾ million persons of pensionable age, about the same number—22 million—of working age, and fewer than 6 million children. In other words, there were only 81 three persons of working age to look after every pensionable person, as compared with the ten at the beginning of the century.
§ But if we look forward, the picture becomes rather grim. In the year 1979 (thank heaven, unless I live to be 100, I shall not see it!) there will be 9½ million persons of pensionable age—that is, nearly twice as many persons of pensionable age as there are children under 15—and there will still be approximately the same number of persons of working age, about 24 million. There will, in fact, be fewer than three people, perhaps two-and-a-half people, of working age for every one of pensionable age. That growth in the number of pensionable persons, which will clearly bring us over the 10 million mark before the century ends, means a great and growing cost of pensions. The Chancellor of the Exchequer will have to find for pensions something like £500 million a year from taxation, over and above what is paid for by national insurance.
§ But the problem of pensions is not mainly one of money. My main thesis is that the economic and social problems of the aged are not soluble by the simple methods of the so-called Beveridge Report on National Insurance, by the handing out of money to the pensioners and of subsistence pensions to the pensioners. Those are desirable and necessary thins to-day, but that leaves the economic and social problems of the aged largely untouched. I was looking at a Report that I made on voluntary action some eight or nine years ago, and I noted that there, in dealing with the problem of the aged I had already come to the conclusion—and I want to emphasise it to-day—that their problems are not soluble by giving them money. Many of the old have money, and more of them have money than had it in the past. What they need, however, is care of many and different kinds, care of a perpetual changing amount and character. It may range from the care required by those chronically sick in hospital, through occasional medical and nursing treatment, to perhaps no care at all—that is, to total independence. That is the uncertain and difficult problem about age: it is largely a problem of discovering just what care is needed.82
§ Of course, the natural agent for giving care to the 10 million old people we shall have in 1979 is the family—the children whom they have brought into the world and who naturally may be expected to give, and do in fact give, most of the care that old people need. But, through the change of population structure which I have just described, the family today is not physically as capable of covering the ground as completely as it was before. In the days when for every pair of grandparents there might be four or five children, each with their own consorts, those four or five children might well divide in turn the task of looking after the grandparents. Now there may be only one or two couples of working age to look after each grandparent. We know, of course, as a fact of human life, that it is not always the son who wants to look after his father; it is not always certain that his wife will want to look after his father, and still less is it certain that she will want to look after her mother-in-law. There are difficult problems of human adjustment owing to the decline in the number of working-age families in relation to the old people who have to be kept—fewer children to each ageing person. The family cannot do all that it did before, and that means that the Government have to come in, nationally and locally. It means, I think, at least this much: that neighbours have to help by voluntary action, independent of Governments. I will illustrate that point in a moment.
§ In considering what should be done about dealing with the economic and social problems of old age, I think it is obvious and natural to say—as I believe our present Minister of Health has said on more than one occasion—that the aim or policy should be to keep the elderly so far as possible in their own homes. I agree with that view, but it needs a good deal of comment, and I should like to introduce my comment upon it by a reference to a meeting which I attended recently in London of the League of Hospital Friends, people who organise looking after old people in hospitals. I heard there three of the most deeply moving speeches that I have ever heard in my life. One was concerned with a problem irrelevant to this present issue—that of the people in mental homes, and the need for help from outside for them; 83 the second concerned the problem of what happens in a rapidly growing suburb of London; and the third related to the problem of the aged sick and the chronic sick. That was a speech given by Dr. Brooke, who is the consulting physician to the Southampton group of hospitals. When, as I hope, the report of that conference is published, I trust many of your Lordships will take the opportunity of reading it, particularly that speech of Dr. Brooke. His thesis was that home is the right agent, other things being equal, as the Minister has said.
§ But the home is also the scene of many tragedies, largely concealed. His plea was that the League of Hospital Friends should enlarge their activities to deal with the aged sick and the chronic sick, not only in the hospitals but in the homes outside the hospitals. He gave many moving instances. We can all repeat many instances of miserable old people struggling to look after one another. One, I remember, was an old gentleman of eighty-four who was devoting himself to doing all the washing and other services needed for his neighbour, aged seventy-nine, living in a condemned house next door to him. Dr. Brooke gave a list of these tragedies which came only gradually by chance to the knowledge of the hospital authorities, who then had to struggle desperately hard to rescue people from the inadequate care that they were getting.
§ It is the right policy to get the aged sick and the chronic sick treated so far as possible in their own homes, but there are three conditions for making the home the right place for the aged and the chronic sick. The first is that there should be adequate machinery for discovering the growing failure of strength which makes transfer to a hospital or other more serious treatment necessary. That should be discovered before it leads to a human tragedy. The only Government organisation in touch with the aged is, in fact, the National Assistance Board. It does its work excellently. But the National Assistance Board has only 1¼ million old people on its books, and there are 7 million elderly persons. Broadly, the figures are 7 million pensionable persons, 4¼ million of them receiving pensions and 1¼ million of those pensioners receiving help from the National 84 Assistance Board. In the case of all the other pensioners who do not come to the Assistance Board, and all the people who are not pensioners at all, there is not at the moment any automatic means of discovering the conditions in their homes before they become tragedies.
§ I suggest that somehow or other there should be some known person in every neighbourhood to whom neighbours can report a case where there is need for more care than is being given at the moment. Whether that should be the medical officer of health, or whether it should be some voluntary agency, I am not concerned to say. There clearly should be means of discovering trouble before it becomes a tragedy. That is urgent, because, among other things, of the rapid growth in the number of old people living by themselves. There are at the present moment something like 1 million elderly persons living by themselves. The figures given in the Phillips Committee Report for 1951 were 750,000 elderly women and 170,000 elderly men. Those figures are for 1951, and the million mark is clearly within sight. That is the first thing: that there must be some means, if we keep people in their homes—and naturally we all want to do that—of discovering when they cannot any longer be kept in their homes or in the conditions in which they live.
§ The second condition is that for the old people who are trying to live in their homes, even if they are not so far declining in strength that they ought to go to hospital or have continuous nursing, there should be adequate home help for the tasks of their homes. There should, in fact, be much fuller domiciliary services than are at present available. It is the fact, of course, that the provision of home-helps is one of the functions of local authorities but there are to-day, in comparison with these 7 million elderly persons in this country, just 30,000 home-helps, of whom 3,000 are full-time and 26,000 are part-time workers. That is a ludicrously small figure for the needs of these old people living alone, most of them trying to live in their own homes. So we need adequate home-helps. Moreover, that adequate home help must be available within the material means of the old people who have to be helped. That is my second condition. Those are the two important conditions—discovery of trouble before it becomes tragedy and 85 the provision of adequate help for home tasks, so that many more old people can enjoy it.
§ The third condition is, I suggest, that there should be a determined attempt to maintain the occupation and interest in life of the old people, to give them something worth living for. Incidentally, that brings back to my mind one of the tragedies—because it is, in a sense, a minor tragedy—reported by Dr. Brooke. One of the old people was a man of a very lively mind and devoted to listening to the B.B.C. His wireless went out of order and he found himself unable to put it right or to travel to anyone who could put it right. I regard a loss of that kind of interest as a tragedy of happiness, if not of physical need.
§ Whilst we should keep as many people as we can in their homes on these conditions, we recognise also that there must be some halfway houses between the hospital that provides full treatment for a hospital case and the home, where these people can live with the kind of help that I have indicated. We need these halfway homes, if only to keep out of hospital the people who are able to stay out of hospital and so leave room there for those who must go to hospital. We all know that today there are long waiting lists of people to go to hospital, and we ought to have homes in which those who need some treatment, though not full hospital treatment, can get it.
§ There is a section under the National Assistance Act, and also under the National Health Service Act, which enables the Ministry of Health and local authorities to establish these homes for elderly people. That section has been very largely used. I believe it is true to say that there is hardly a local authority which has not established some kind of home, what is called a small home, for elderly people. In addition, there are many voluntary agencies which try to deal with this problem. But whatever the agency, whether it be a local authority or a voluntary agency, there are, I think, certain conditions that have to be satisfied by any building in which old people are housed before it can be called a home. Homes should be real homes, and not institutions without privacy, as I have seen them, with one sitting-room for everybody, with a shared dormitory—often making it impossible for the people living there 86 to keep any of their own possessions. It is having their own possessions that the old people value. It is not a home if you have to share your dormitory with somebody whom you never saw before, changing from time to time, or if there is just one sitting-room where you have to listen to the noise of the wireless or whatever else the majority may want, whether you want it or not, and where you cannot keep your own possessions.
§ As regards these homes that the local authorities have established and into which a great deal of thought and care have gone, I cannot help feeling that a home with only one room (and there are thirty-five such homes) is hardly a home at all. Another thing which I think has to be laid down about these homes is that they should not be in places so remote that visiting by neighbours is difficult; and yet there is a natural tendency for that to happen. In this country, many houses in country districts are now becoming unavailable for ordinary life by people who had them before, and it is natural to turn them, or to try to turn them, into homes for the aged. But, if they are far away from all possible visitors, that means cutting off the old people in them from their relations and friends.
§ I go on to say this. The local authorities' homes are excellent so far as they go, but they are not always homes. Also, they do not come to the old people as of right. I suggest that what is needed when one looks forward to one's old age is that as many people as possible should feel a certainty that, when they come to real old age and cannot live wholly by themselves, they will have some kind or right to a home with service, and without necessarily passing through all the apparatus of the Assistance Board and proving their poverty. Here, I believe, is something that voluntary agencies and, in particular, bodies like the friendly societies and the insurance offices, might well undertake. I shall come back to that particular point in a moment.
§ In preparing a Report which I made on voluntary action about seven or eight years ago, I remember that I made it with the help of a number of assessors, one of whom happened, I may say, to be my wife. She suggested that in this provision of homes with service, which one could get as of right because one 87 had contributed in advance for it by insurance, lay one of the excellent fields for activity of the industrial life offices. The industrial life offices used to provide funeral benefit. Now that that has become unnecessary, I very much hope that they will consider the possibility of providing something for the long stage that takes place before the funeral and for which something is needed even more than for the funeral. That suggestion was not adopted then in my Report, but I would now commend this to my old friends and old enemies of the industrial life offices. In my time, I have said many hard things about them, but I would take back every harsh thing I ever said of them if they would set themselves, with their money and organisation, to make it easy for every working person while of working age, if he so desired, to pay a contribution which would entitle him, when he came to need it, to a real home into which he could put all his possessions, and in which he would be certain of the service he will come to need. In some ways the industrial life offices are well fitted for that task. They have a great organisation for visiting homes. That organisation could be used for helping to discover what is needed by old people as they pass from complete independence to the need for more and more care.
§ The suggestion I have made brings me back to the question of money. I have mentioned the industrial life offices because they are people with large sums of money. Though the problem of the aged is not soluble by handing out money to them, it is not soluble without some money as well. There are many interesting problems which arise in regard to money. One is mentioned in paragraph 260 of the Phillips Committee Report, where the Committee discuss the division between national and local finance and suggest that while a person in hospital would be wholly paid for out of national funds, a person out of hospital receiving domiciliary and nursing service would be paid for out of the rates, and that might set up a bias in local authorities, who might try to keep in hospital people who ought to be out, instead of making it easy for them to come out. I admit that there is there a certain theoretical argument which should be examined; I doubt whether in fact it is more than 88 a theoretical argument. I believe that most local authorities would be only too willing, if they could, to give the domiciliary and other services which would enable people to stay out of hospital, even if it cost something in rates which they would not have to pay if the man or woman went into hospital. That is a theoretical point, but no doubt the Government will consider it.
§ Let me come to another question involving finance—the question of chiropody. This was the subject of a Parliamentary Question and Answer in another place on November 22 last. A number of local authorities are asking for permission to provide chiropody service as part of the National Health Service, but the Answer that was given on behalf of the Minister of Health was that though, in many cases, the need for chiropody treatment, and the benefit that it would confer upon the old, was recognised, the Government, with their strict limitation upon the amount that could be spent upon the health services could not find any more money for this purpose. In other words, they could not find any more money for an admittedly desirable purpose and one that would increase the happiness and comfort of the aged. The Government said that they had other, greater, priorities for the Health Service.
§ That leads me to suggest that the Government might look at another item upon which they are spending a great deal of money for the aged—namely, the cheapening of tobacco for all pensioners. That particular item costs £14 million a year; that is the actual figure to-day. Chiropody would cost £1 million; that was the figure given by the Minister of Health on November 22. I suggest that to refuse £1 million for chiropody for the old, including, incidentally, a large proportion of women, and to spend £14 million on cheapening tobacco—I hope it all goes to the old; I am not sure whether it does, or what happens to it—is a wrong priority, and I hope the Government will look into it. There are many objections to this subsidising of tobacco. There are many more important things to subsidise.
§ Home-helps in relation to these millions of old people number 30,000. They have to be paid for at the rate of something like 2s. 6d. or 3s. per hour, unless an old person goes to the Public Assistance 89 authorities, which a great number of them do not want to do. If I were subsidising anything for the old, I would much rather subsidise home-helps, to enable people to get them cheaper, than subsidise tobacco which most of the old people do not want. Most of the aged are women who do not need tobacco; yet they can get it if they want it. I suggest that this is a problem of finance that might well be looked into.
§ That is almost all I have to say about finance, and nearly all that I have to say to-day, but I come to one final point which arises out of this problem of the old, as I have tried to put it before your Lordships—namely, the need for concerted action on this, the greatest social problem of our time. It is a problem which calls for concerted action because the needs of the aged are neither uniform nor stable, nor easy to discover; the more independent they are, the less one can discover. Yet the needs are there, and if we let the needs go unattended it will be a failure of our civilisation. The needs of the aged are very different, ranging from complete hospital treatment to some nursing treatment, from living in their homes with home-helps, to needing perhaps nothing more than occupation and companionship and an interest in life. Because they are so varied, we have to deal with them by a number of different agencies, but all those agencies should work together. There must be concerted action at the centre. By that, I do not mean that there should be appointed a Minister for Old Age, but I should like to feel certain that all the Government Departments and all the agencies—voluntary agencies and others outside—would concert their policies by some kind of committee at the centre. Secondly, there needs to be concerted action locally, between the hospitals, the general practitioners, the National Assistance Board, the local authorities with their many different services, and the voluntary agencies of all kinds. Let there be no jealousy about getting anyone else in to help in this matter; the whole task is too big for anyone to refuse help of any kind.
§ Finally we have to make a call to the ordinary citizens to help in dealing with this problem of the aged. First and foremost, there is the call to the family. I 90 do not think that for most families this is easy, but let it be realised that the existence of the Welfare State does not mean that one can hand over one's family responsibilities to the State. Family responsibilities now include the care of the old, as they have always included the care of the young. Apart from that, I hope that many people, not yet elderly but who are approaching old age—many more people than at present—will be able to give to old people in their homes help in their domestic tasks and in all the other tasks in which they need assistance. Let that be taken as a job for many more people. They will be mainly women of from 50 or 60 onwards, perhaps widows who now retire on widows' pensions. I should like to see many more offering to work in the homes of old people. There is a call for help to citizens, as well as to the Government, to local authorities and to existing voluntary agencies. This whole problem of the aged is a test of our services. I hope that we shall know how to accept the test, and that Her Majesty's Government will lead us. No Government can do it all, but I hope Her Majesty's Government will lead us successfully to ensure that all the aged, at all stages, get the care they need and all the happiness they can still have in their lives. I beg to move for Papers.
§ 3.22 p.m.
§ EARL JOWITT
My Lords, I rise for a moment to offer an apology. It had been arranged that my noble friend Lord Macdonald of Gwaenysgor should follow the noble Lord, Lord Beveridge, in this debate. Unfortunately, owing to some misunderstanding, that was an impossible arrangement for him and he has had to leave. In these circumstances I suggest that my noble friend, Lord Wise, who was to have spoken later, might follow now, taking the place of the noble Lord, Lord Macdonald of Gwaenysgor, the noble Lord, Lord Burden, later taking the place of the noble Lord, Lord Wise. Since I am on my feet, may I just say to a very old friend, Lord Beveridge (after all, the Beveridge Report was made to me, for I was then Minister of National Insurance) with what great interest I have listened to him. I hope that his words of wisdom will not be wasted, and I am sure that Her Majesty's Government must give a lead on the lines which the noble Lord has indicated.
§ 3.24 p.m.
§ LORD WISE
My Lords, it is my first pleasure to congratulate the noble Lord who has moved this Motion upon his interest in this matter and his references to the old folk. With much that he has said I am in entire agreement. My knowledge of the old Greeks and others is not extensive, but my experience with old folk in this country has been fairly wide and I have a great desire that things should be right with them. I was particularly interested in what the noble Lord said with regard to hospital treatment and home-helps. I am also concerned that, so far as possible, old people should be kept in their own homes and that, when they have to go to homes for the aged, particular care and attention should be given to them.
It will be obvious to all noble Lords that this is one of the most important problems likely to come under our consideration. I was particularly struck by the statement of the noble Lord that this problem can be solved and righted to our satisfaction only by concerted action. As he remarked, the problems of old age are not entirely confined to the solution of financial and economic troubles. The aged have to meet other stresses and strains—ill-health, the lessening of their mental and physical faculties, frequently loneliness in their homes, feeding and other domestic difficulties. These and similar difficulties facing the aged may overwhelm those who, in earlier years, conscientiously carried out their allotted duties in their calling and to whom the means of provision for old age have never been sufficiently available. Through beneficial advances in social services in recent years we have been able to allocate to pensioners and others various measures of allowances to help to meet their needs; but such allowances have, unfortunately, sometimes been all too readily governed by national financial stringency and such other restrictions as have been imposed upon pension recipients from time to time. In the past, perhaps quite properly, that procedure may have been considered the best for our national purpose; but I am not sure that in present-day life and thought, which change frequently, the practices of past years can meet immediate needs and circumstances.
Unfortunately, those of our old people who are financially and physically weakest seem to have suffered most and 92 continue to do so. Not all have been fortunate participants in superannuation schemes or been able to provide for old age by endowment policies; not all have been able to save for the inevitable rainy day. These beneficial advantages have in many cases been denied, owing to the often heavy expense of bringing up a family, or of ill-health which comes all too frequently, or misfortunes of other kinds, like unemployment or underpaid employment or inability to achieve financial and other success. Having worked as hard as others, and played their part in the national life, such people find, when old age comes, that declining days necessitate the aid of specified national pensions, grants or allowances. Some noble Lords may not agree with my view, but I believe a suitable and adequate reward for services rendered to the community should be forthcoming as a right to all when the time comes for retirement.
In mentioning the Report, I wish to pay a tribute to the Committee which compiled it. It is full of interest. It shows a real intention to put before the country matters of great importance. I do pay that tribute, with all humility, to the chairman and his fellow-members of the Committee. Doubt is expressed in the Report about when the time for retirement should be. There is a difference of opinion among members of the Committee. The sponsors of the majority recommendations on this point may have been impressed by a feeling that national expenditure upon pensions will rise. They suggest the raising of the receiving ages for pensions, but I hope that this suggestion will not meet with general approval. In paragraph 191 of the Report, the thought is expressed that such a proposal is likely to meet with strenuous and sincere opposition. I am sure that that will be the case, because I think that it would be a very backward movement on our part if, for the sake of financial expediency or otherwise, we should raise the receiving ages for pensions.
Nevertheless, there are anomalies in the present structure, and pensions are often delayed by reason of these anomalies. I do not think that welfare matters should be so inevitably tied to financial considerations and restrictions as they are at the present time. If a nation is worth its salt, it can afford to make proper provision for the welfare of its people and for the enjoyment by all of a full and 93 active life. We are all, in a manner of speaking, servants of the community, and whatever we do—whether we are housewives (and I think that in this connection I must put them first), manual workers, tradesmen, manufacturers, civil servants, officials, agriculturists, teachers, domestics or even politicians—we all give some service to our fellow men. For that reason we should all, upon retirement, be entitled to a pension from the State. It may be said that in some instances no financial contribution would have been made by the recipients, but I assure your Lordships that all adults, both now and in the past, have been taxpayers, either directly or indirectly; and though they may not until recent years have made any contributions towards pension by way of the purchase of stamps, all have, in the past, done what has been asked of them in regard to taxation, and thus have assisted in no small measure in the payment of pensions to the various people who have received them and will receive them in the future.
In the fullness of time, when our expenditure upon preparations for war can be seriously curtailed—and I hope that that time is not far distant—and when we have overcome and survived the present tensions, I hope that these insurance benefits, which, as I have stated, are not now received because no contribution has been made, may be given to all, and that the present method of collection of contributions may be dispensed with and payments for pensions may be a matter of contribution by direct taxation. It may not be possible at the moment, but I hope a time will come when that will be brought about. Some mention is made in the Report of the future cost and future commitments. The noble Lord, Lord Beveridge, has mentioned the year 1979 and years later than that. I hope that by that time we shall have got rid of the present difficulties and the present tensions, and that this country of ours, and, in fact, the entire world, will be in a better state of prosperity, productivity and progress than it is in even at the present time. But, whatever the cost may then be, I hope that we shall be able—and I am sure we shall—to meet our liabilities and our obligations to the pensioners. In that connection, it must not be overlooked that, whatever be the pension we allot or allocate to pensioners and others, the weekly sum of money is 94 inevitably spent amongst the productive or distributive trades or elsewhere. So, by divers ways, it returns, through taxation, or by other spending, or by other production, back into the national resources. I feel certain in my own mind that when the time comes for an increase in benefits to the aged population, this country will be in a position to foot the bill.
I wish to conclude with just one appeal to the Government. The question of public assistance arises in the Report, and, in that connection I was particularly struck by an article which appeared yesterday in the Daily Herald—I make no apology for mentioning the paper—on the difficulties which are being experienced by pensioners who are now in receipt of National Assistance to augment their existing pensions, and who will, when the new pensions come into force shortly, not receive the full amount of those particular pensions. The point is that whatever additional amount is received by way of pension, that amount will be deducted from the National Assistance which is now being given to them. That subject came up in our previous pensions debate, and it seemed as though the Government were making a comparatively small contribution by the fact that they were likely to reduce their commitments in regard to National Assistance. I hope that when the noble Earl replies he will be able to assure us that those who seek National Assistance, even though they may receive additional pensions, will be treated generously. For the benefit of them all, I hope he will be able to say that if they are in difficulties when their new pensions are received and certain National Assistance money is deducted, they can have their cases reopened by the National Assistance Board, and that they will not be worse off from the point of view of the extra cost of living than they are at the present time.
§ 3.41 p.m.
§ VISCOUNT SOULBURY
My Lords, my excuse for breaking a rather long silence and taking part in this debate is that some years ago I had the honour to be Chairman of the Assistance Board, as it was then called, and during those years, between 1941 and 1948, I was naturally brought into close contact and was deeply concerned with the social 95 and human problems mentioned in the Phillips Report and to which the noble Lord, Lord Beveridge, has drawn attention in his Motion. The noble Lord prefaced his observations by reminding your Lordships of some of the great Greek dramatists who composed their masterpieces at a very advanced age. I cannot for the moment recollect any exact modern parallel, but I can recollect that when I was at the Assistance Board one of the Board's clients, aged 96, relinquished his supplementary pension in order that he might take up the occupation of a part-time jobbing gardener.
The noble Lord, Lord Beveridge, has pointed out that the Phillips Report does not concern itself, and could not concern itself, with the social and human problems, but was concerned with the economic and financial side, although in paragraph 61 there are valuable references to those aspects. Similarly, the noble Lord, Lord Beveridge, in the Report always associated with his name, confined himself to the insurance aspect and to the exposition of the financial and administrative measures necessary for comprehensive social security. It is a pity that, so far as I know, there has been no recent Committee or Commission which has reported on the social and human problem of old age, and it might well be worth while considering whether such a Commission should not be appointed to deal with them. In the noble Lord's Report there is one paragraph which showed that he clearly foresaw that these problems would arise. Perhaps I may quote from it:In view of the increasing number of old persons, there is probably considerable scope for experimentation with and development of services connected with the recreation and welfare of the old, including special housing facilities.Before the Beveridge Report saw the light of day, experimentation had been started in the provision of houses, while schemes for the establishment of a number of small hostels, something in the nature of halfway houses, were set on foot. They owed their origin, in the first instance, to the fact that a number of old people, who hitherto had had the services of, and had been dependent upon, their children or grandchildren, had to be looked after because their children or grandchildren were called up for war 96 service or war work, so that these people became an immediate problem. By 1943, about halfway through the war, a number of hostels had been established under the auspices of the National Council for Social Service, entirely by voluntary effort. The Assistance Board had no power to purchase or construct or equip them, but what the Board did was to undertake to make up the income of any approved pensioner to 30s. a week, so as to enable that pensioner to pay his charges when he was admitted to a hostel. I use the word "approved" advisedly, because these hostels were not nursing homes or hospitals: they were not suited for those who required hospital treatment, or long, careful and skilful nursing, or for those who were bedridden; they were rather for the somewhat frail, slightly feeble, sickly and tired, who were finding it more than they could manage to carry on in their own homes without any help from their children.
At that time, the only alternative accommodation available for that class of old age pensioner was accommodation in large institutions run by public authorities. They had considerable disadvantages. With the best will in the world, in institutions accommodating at least 100 old people, restrictions, regulations and disciplinary precautions were inevitable, and for that reason alone they were not at all popular; and I hope they are no longer in use. On the other hand, the small hostels (I am talking about the ones I know) were something like small hotels or boarding-houses, or even had one-roomed flats where, in some cases, pensioners could have their own furniture; and they could pay their charges as if they were living in a boarding-house or residential hotel. So far as my recollection goes, there were no dormitories, and I am sorry to hear that it has been necessary to have hostels in which dormitory arrangements are in force, because I entirely agree that it is a severe hardship on these people to undergo such proximity with others whom they may not know. In those days, I may add, we took good care that the hostels were not remote, because, as the noble Lord, Lord Beveridge, pointed out, one of the difficulties of old people living in hostels is that sometimes they cannot see friends and relatives. In nearly all cases, these 97 hostels were in or near the outskirts of towns.
Later on, the National Assistance Act, 1948, made local authorities responsible for the provision of accommodation for old people. The good work of the voluntary bodies was recognised because local authorities were enabled to carry out their responsibilities by entrusting them to voluntary bodies as their agents. I think the success of this experiment is shown by the fact that in England and Wales to-day there are over 600 hostels run by voluntary bodies, and something like 1,000 run by public authorities; so that, between public authorities and voluntary bodies, there is a fairy wide range of accommodation and facilities for those who need care and attention and who cannot fend for themselves.
There was another experiment I saw, and perhaps the noble Earl, Lord Selkirk, when he replies, will be able to tell me whether it has been extended. In Darlington the local authority had built a number of small bungalows or cottages around a square, which took on the appearance of a quadrangle of a college at Oxford or Cambridge. There was a community centre at one side, where the college hall might be, and the matron lived at the entrance, where the porter's lodge might be. It looked a very attractive set-up, and I was much impressed. I should be interested to know whether this experiment has been repeated. The only drawback it had was that such a set-up inevitably tended to segregate and isolate the old people, and I think that is something which we should always avoid. I am sure your Lordships will entirely agree with the statement in the Phillips Report that where old people have to change their homes, as they often have to do when their homes become too large, so far as possible the change should be made in such a way as not to involve isolation of the old people from the young. Where new housing estates are being put up, local authorities should scatter about them, so far as they can, a number of smaller dwellings, to prevent isolation and segregation of the old. That, I think, the local authorities are doing.
As the noble Lord, Lord Beveridge, has rightly pointed cut and indeed, as the Phillips Report stresses, if the old people are to be kept in their homes—and it has always been everybody's policy to do 98 that if possible—there must be domiciliary services, because a great many of the old people require some domestic help. We all know how difficult it is in any walk of life to get such help, and neither the local authorities nor the Assistance Board—and I am sure there is no more humane or sympathetic body of administrators in the world—can guarantee a supply of domestic help. Obviously, priority for the help required should rest upon the relatives of the old people, if they are living near enough. The home-help services are of great assistance in that direction, but they are inadequate, and so are kindly neighbours. Frankly, I do not know what the solution to that problem is. We can only do our best and hope that more and more people will find it possible to give help to old people whose failing years and strength make that help essential.
There is a rather disquieting paragraph in the Phillips Report where the Committee draw attention to the striking increase in recent years in the number of old age pensioners who are living entirely alone and who, as the Report says, "may be in great loneliness." The noble Lord, Lord Beveridge has already referred to that matter. The figure given in the Phillips Report is about 900,000, but it may well be 1 million to-day. The Phillips Report says that the counterpart of that change is the greater isolation of the elderly from their relatives. In the Beveridge Report the noble Lord mentioned five problems to be dealt with—he called them the "Five giant evils"—want, disease, ignorance, squalor and idleness. I should be inclined to add, as a sixth, loneliness. That is one of the gravest afflictions of advanced old age, particularly in any case where death has broken a lifelong partnership of a man and wife and left the survivor without a companion, or when, as happens in so many cases, the old man or woman looks around and finds that all the old familiar faces are gone. I remember being shown a copy of a note amongst Robert Louis Stevenson's papers after his death. The note was just this:Desiderata: 1. Good Health. 2. £200–£300 a year. 3. Oh, du liebe Gott, Friends.That brings me to a subject that has not yet been mentioned—namely, the provision of recreation for the old; and recreation, of course, includes companionship. Here again an experiment was 99 tried in the war, and I am not at all sure how far it has gone. It owed a great deal to the initiative of a Member of another place, and it consisted of setting up clubs for old people, which I believe were called "Darby and Joan Clubs." I opened several of them, and I was very much struck by the way in which they appealed to and satisfied the needs of the old people living in the vicinity, many of whom took a hand in managing the club. I trust that there has been some development on those or similar lines, and, if possible, I should like to know what it is.
The prestige and reputation of a civilised community rests in a high degree upon its treatment of and care for the aged. In an uncivilised, barbarous community they are considered a burden upon the remainder, useless mouths, consumers and not producers, and they are got rid of. A famous English writer has told us that amongst a primitive people a knock on the head with a club or a stool is the equivalent of an old age pension. He tells a story of an elderly African chief who implored a European visitor to give him some hair dye, because his hair was going grey and he knew what that meant to him. The hair dye, unhappily, was not forthcoming, and in a very short time the younger warriors dispatched him. In the East respect, reverence, and, indeed, veneration for the old people is almost proverbial, and particularly so in China. I hope that the new régime has done nothing to disturb that. In the country in the East of which I have some small acquaintance, if a family neglected its old people that family met with the condemnation, censure and contempt of its neighbours. I am not sure that in the West the family unit has ever been quite so strong as in the East, where, indeed, family ties are the most binding of all ties. Sometimes I have wondered whether when the State took over in large part the financial obligations of the family for the support of its aged members, that might not have weakened the feeling of responsibility and the sense of obligation which the younger members had in other regards to look after and maintain the general social comfort and happiness of their aged relatives. I was glad to read in the Phillips Report that there is no evidence that family ties are weaker than they used to be; it would be tragic if it were otherwise. I hope that those 100 responsible for old people, and particularly their relatives, will always bear in mind the pathetic prayer of the psalmist:Cast me not off in the time of old age;when I am old and grey-headed, O God, forsake me not.
§ 3.59 p.m.
My Lords, I suggest that no discussion in your Lordships' House, on whatever subject it might be, could be initiated by anyone with a greater recognised knowledge of his subject than that which the noble Lord, Lord Beveridge, can bring to this discussion to-day. I speak as a layman in this extremely difficult and technical matter, and therefore with some considerable hesitation. But I would suggest that hesitation in a matter such as this, which in some form or another concerns every single one of us, is something that should be avoided, since hesitation could easily lapse into a convenient way of escape or avoidance of the problem. It is a subject to which we all have obligations. We must all interest ourselves in it, and not least, I suggest, those of us—and there are many in your Lordships' House—who are concerned in one way or another with industry. It is along those lines that I want to make one or two observations which I hope will be pertinent.
I listened with the greatest interest and respect to what the noble Lord, Lord Beveridge, said. One could not but feel moved by the sympathy with which he covered a great many aspects of this problem. I want to confine my remarks rather to the parts of the Report which deal with those older men and women—I suppose one might say, for the most part, those between 65 and 70—who can be given some form of work, because I would suggest that, if properly arranged, that work could do a great deal to relieve the loneliness to which my noble friend Lord Soul-bury referred. It could also do a great deal to maintain their interest, and I am sure your Lordships will agree that interest and health go close together. It could also do a great deal to ensure that these older people receive the attention which they require and which they would not necessarily get if living alone in their small houses.
I should like, in the first place, to give three reasons why I think this problem is the concern of industry. I know that 101 of late years industry has been giving an increasing amount of consideration and thought to the problem of the older men and women. The first reason comes under the heading of the words mentioned in the Motion, "the human and social reasons." I put this first most emphatically, because I believe that every good employer must be deeply concerned—if he is not, he ought to be; but I believe that most are—with the well-being, as they grow older, of the men and women who have worked with him and for him in years gone by. I emphasise that point, and I wish to underline it as much as I possibly can, lest the next point that I am going to make may be taken as suggesting that industry's only concern is a mercenary one: what can industry get out of the older men and women by giving them a certain amount of work, perhaps at too low wages? I say at once that that is not the purpose of industry as a whole to-day. There may be, I readily grant, a few less scrupulous employers, but we find less scrupulous people in every walk of life. But I do not think a general criticism of industry on those lines would be either true or fair; in fact I would say quite definitely that industry has—and I believe to an increasing extent—a very soft spot for its older employees.
The second reason why I feel that this problem concerns industry is that the country to-day cannot afford to lose the help of those older men, with knowledge and skill and, as often as not, great loyalty to the firms for whom they have been working. One sees frequently in the Press these days—only last week I noticed it—mention of the shortage of skilled labour. As the country finds itself to-day, I suggest that this is a matter that has to be carefully considered. It would be folly to adhere to an arbitrary retirement age which, however appropriate or convenient it may have been considered before the war, is not necessarily so to-day.
I listened with great care to what the noble Lord, Lord Wise, said, and I recognise that the suggestion of the Phillips Report for a retirement age of 68 is a controversial one. But if that suggestion were to be agreed upon, then two important factors must not be overlooked. The first is that nothing must be done that would in any way jeopardise, or 102 appear to jeopardise, the promotion of younger men and women, because if it did, it would be no help to the older men and women who all stand to gain by the prosperity of industry. The second important point is that we must not lose sight of the possibility that less favourable employment conditions than we are enjoying to-day may occur at some time in the future. I know that all political Parties endorse that famous White Paper on Employment Policy, which was issued shortly after the end of the war, to see what could be done to guard against unemployment. Whilst I personally am not in any way defeatist, or even worse, in this matter, I think we have to be realistic on that point when we consider further employment of older men. Having said that, I am sure we shall all recognise that it is unnatural for anyone to have to cut himself oft arbitrarily, at a certain age, from the interests he has enjoyed and lived with all his life. I am sure that, even in your Lordships' House, there must be many who would have first-hand experience of that.
The third point that affects industry very closely indeed is this question of cost—the cost, shall we say, in twenty-five years' time. The Report goes into that question in great detail and refers to the prodigious cost that the present scheme will involve in 1979 or 1980, even if the normal retirement date were raised to 68. I should like to read from the Report one or two lines which affect this situation. Paragraph 141 says:The provision that can be made in future for pensions must depend largely upon the success with which the nation increases its total production. …It goes on further down to say:It has been put to us that it might be reasonable to assume a continuing improvement"—that is an improvement of productivity—over the next 25 years at the rate about 1½ per cent. per annum.That would be equivalent to nearly 50 per cent. over 25 years. The Committee say that thatwould be by far the most important single factor tending to case the burden of providing for old age.That increased output can be achieved only by the cumulative outcome of the efforts of employers and employed who 103 find improved ways of doing things. It is therefore quite clear that in this matter a major degree of responsibility for the care of the old must now rest, and must continue to rest, on industry.
In the light of those observations, it seems to me that there is everything to be said for encouraging older men and women to stay on in their work as long as they find themselves able to do so. That may mean full-time work for some, and for others a shorter time—perhaps even flexible hours, as they may feel well this week and not so well next week. The work may be done in less exacting jobs than those which they were doing when they came to normal retirement years, but at least in some job where their skill and loyalty can be used, and where, as is mentioned by Professor Cairncross in the Report, they can "learn to retire slowly." In that respect, so far from its being the wish of a cruel industrial taskmaster to raise the age of pension in order that he may get something for nothing, I believe that for many old people it would mean a welcome postponement of an unhappy day.
I am rather fortified in that view by the Report of the Departmental Inquiry which was set up by the Ministry of Pensions and National Insurance. Out of 19,000 older men and women who were questioned, I see that six out of every ten who had passed the pension-able age were still in work, which, to my mind, showed a considerable desire on the part of many to go on doing something of value and interest if they possibly could. There is no doubt that Her Majesty's Government have not been behind in this matter, for they have set up the Standing Advisory Committee on the Employment of Older People. I understand that, as a result of the First Report published by that Committee, many industrial firms have gone out of their way to make modified employment conditions for old people and special provisions of one kind and another. There are, I believe, a great number of firms who have done good work in that way. One firm that particularly comes to my mind, a world-famous firm with headquarters at Derby whom some of your Lordships may still be able to afford to patronise, have created, I know, what I think they call "twilight clubs," where the 104 supervisor no longer supervises but is given work which he can conveniently do and which earns him a very satisfactory income indeed. I must say that I look forward to the further report which I understand that that Committee is due to produce in due course.
As a result of those observations, I wonder very much whether my noble friend, when he comes to reply, will be able to tell us in any way what Her Majesty's Government's view is on the general findings of the Phillips Report. Perhaps he could also say how Her Majesty's Government view the reservation of Professor Cairncross's addition. It semes to me that there is something to be said for that point of view. Your Lordships will remember that he does away with the earnings rule and the question of increments, and that makes the whole situation much simpler. There must be some advantage in having a pension arrangement which can be easily understood by all. I am certain that though some of the present provisions may seem easy to your Lordships to understand, there are many would-be pensioners who do not really understand what the situation is for them.
Whether or not the retirement age of 68 is accepted in due course, it must take time to be brought into use. In the meantime, there are questions that one ought to ask. What can be done in the meantime to encourage more men and women to take up part-time work that is congenial to them? There are two points I particularly want to raise here. Both of them are dealt with at considerable length in the Phillips Report. The first is the question of the earnings rule. I see that the Phillips Committee recommended that there should be no change in the earnings limit of £2. I regret very much indeed that recommendation, especially as I understand from the Report that the savings of the Government as the result of that rule amount to only about £1½ million, which is a very small amount considering the large figures with which we have to deal. After all, the £2 figure was originally £1; it was raised to £2 in 1951. Surely it would be true to say that the cost of living and the general level of wages since 1951 have changed substantially. If £2 was an appropriate figure then, surely it is an incorrect figure today. I see that in another place on Monday of this week the Minister was asked 105 whether he was considering an increase of the earnings limit. He said then [OFFICIAL REPORT, Commons, Vol. 538 (No. 57), col. 1724] that he had no ideas of that kind "in mind at the moment." I know that my noble friend cannot give me an answer now, but, if that matter could be looked into again, it is a suggestion that many of us in industry think would do a considerable amount of good, even if only in a small way.
The other point I want to mention regarding the interim period is this question of increments. I gather that after some discussion the Committee agreed against making any change in this respect and that the maximum increment that a man could add to his pension by working on from 65 to 70 and forgoing his pension for that period was only 15s. a week. Of course, if the Cairncross proposals were agreed to the point would not arise; but, assuming that that were not so, I would suggest that here again we have a matter which ought to be looked into very carefully. To use the words of the Report, I am not suggesting "that increments should be based on the principle of exact actuarial equity"—(paragraph 200). That would be extremely complicated, and unreasonably so. I do suggest, however, that there should be an increase on the 15s.
I have made a brief calculation, leaving out consideration of interest, and it seems to me that, for every year that a man postpones his pension, he has to live, when he finally retires, a further two and a half years to get back a sum anywhere near the amount of money that he has forgone by giving up his pension and continuing in full work. That shows that there would be a greater inducement to continue working if the increments were increased, although I must admit, with some surprise, that the Phillips Report says it is wrong to assume that the object of these increments is to give insured persons an incentive to remain at work. The Report says at paragraph 201:Their object is commonly thought to be to give insured persons an incentive to remain at work rasher than retire on pension, but it is clear from the evidence that they have little effect of this kind.However, I would make only one other point on this question of increments, and it is this: that I recognise that my argument that they should be increased 106 depends very much on whether in the job that the man is given to do between the ages of 65 and 70 he is really giving value for money, or whether the job can be regarded as something in recognition of past services.
My Lords, I have nothing further I want to add on this subject. Obviously, this is a prodigious problem, the solution of which cannot easily be defined. At any rate, the rather narrow aspect that I have considered seems to me to depend on two things: first, the ability of the country, together with the Government of the day, to go on increasing its productivity; and secondly, our willingness in industry to go out of our way to see how the older men and women can be usefully, congenially and happily employed according to their particular capacities. Because I believe that industry is conscious of this responsibility and is giving a good deal of thought to it, I have ventured to address your Lordships.
§ 4.21 p.m.
§ LORD AMULREE
My Lords, there is just one of the social and human aspects of old age to which should like briefly to draw your Lordships' attention. I am afraid it barely comes within the terms of the Motion which the noble Lord, Lord Beveridge, has introduced, because it is a point which is only briefly referred to in the Phillips Report which we are now considering. The problem to which I wish to refer is that of finding out in time when an old person is in need of some kind of care and attention and assistance: what we can do to prevent people from going on so long that, when they are found to need assistance of some sort, they have gone downhill so far that they need assistance at a much more expensive rate than before. The kind of people I refer to are mainly those people who are becoming rather feeble and who live by themselves.
The reason this problem has been brought home to me rather strongly is that for the last six years I have been working fairly consistently in a London borough. I am working on the medical side, and I propose to give your Lordships figures takers from a specially selected sample of the population—namely, those, who are seeking admission to hospital. The borough in which I work is not a large one; it has a population of 140,000 people. During the last six 107 months, roughly 200 people from among the particular group of people I am talking about, the old age pensioners of 60 and 65, have applied for admission to hospital. It is difficult to define what type of people they are, but they are the type who, in the old days, would have gone into the poor law hospital rather than into the voluntary hospital. I cannot go further than that.
Of this total of 200 applications, 90 were from people living by themselves. About 50 of the 90 were living perfectly comfortably and well, and it is the remaining 40—one-fifth of the total number—to whom I wish to refer, because they were living in standards of neglect, dirt and squalor such as one would not have believed possible in a London borough in 1955. Most of them were starving—that is perhaps rather a strong word; at any rate they were so neglected that they needed a lot of good food, a lot of tidying up and cleaning up. But, when they had had that, they could then have gone back, rehabilitated enough to take up some kind of normal life again. The tragic thing is that in only six months, in one London borough, 40 people were living in such conditions. If one applies that proportion to the rest of the country, as I think one is justified in doing, what an enormous reservoir of human misery there must be!
Whilst I have no solution to this problem, I wonder whether Her Majesty's Government, or the noble Earl who is to reply—perhaps it is rather unfair to fire this question at him without any notice—can indicate what one can do to stop this sort of thing. It does not appear only on the medical side, because in the borough where I have worked they have one of the most co-operative local authorities that I know. An enormous amount of work, with a large amount of visiting and investigation, is done. I was talking to the medical officer of health at the town hall the other day, and he told me that he found the same kind of conditions among people who applied for help to the town hall as among those who applied to the hospital. We have worked together there for six years. Either we have not been working very satisfactorily or this is a continuously recurring problem.
I do not know how to begin to tackle the source of the difficulty. One of the 108 difficulties, of course, is that there is nobody whose duty it is to go round and find out what is going on. I have great admiration for the work of the National Assistance Board, and for the people they employ, but I do not think they work on a big enough scale. I do not know what the trouble is but they do not seem to get down to this tragedy of people living by themselves. One reason is that when people live by themselves they become unpleasant and difficult, and tend to shut their door against others. I often wonder whether it is because they are lonely that they become difficult, or whether they are lonely because they have been difficult all along. That is something I cannot answer, but it does occur. The only means I have come across to get over that difficulty—I do not approve of it, nor do I think your Lordships would—is that there should be some kind of compulsory register of people when they reach 60 or 65, pensionable age. That would mean, I suppose, that, coincidental with the postman's knock in the morning, there would be the arrival of the inspector from the town hall to inquire whether the people were all right. I think their answer would be a very firm, "Go away." I do not think any purpose would be served by having such a register. I raise this important matter, however, because I should like some kind of reply from Her Majesty's Government as to whether they are considering this matter, and whether they can assist me by making any suggestion about what might be done to prevent some of these tragedies from occurring in the future.
§ 4.29 p.m.
My Lords, I cannot claim to be an expert on this subject, which is often termed the science of geriatrics; but, perforce, being a member of a local authority which has far more than the normal number of old people, and by reason of my connection with the housing association movement, I have learned a certain amount, and I certainly feel that I am in a position to say that the old will have cause to be grateful to the noble Lord, Lord Beveridge, for lending the great weight of his appearance and authority to the investigation of their needs. There has been a great revolution in the treatment of the old, nearly all for the better, since I first joined a small board of guardians about thirty 109 years ago. Nevertheless, in those days a relieving officer, if he was a humane man, as relieving officers often were, had one advantage which nobody seems to have today: he knew all aspects of the needs of the people under his care and he knew the people intimately as individuals. Now everything has become much more departmentalised. Assistance in money is supplied by the National Assistance Board; housing, in a rural area, by a district or borough council; and care and maintenance by the county council—that is, unless nursing and medical care is required, when responsibility comes under the regional hospital board, an entirely different body.
No doubt this is all much more scientific, but human beings do not readily divide themselves into categories for administrative convenience. As the Phillips Committee point out, this situation leads to a great number of borderline cases. While negotiations go on, while letters are written and committees are taking their decision, many of these borderline cases may, and do, suffer. This is particularly true where money and accommodation are involved. For some reason which is not clear, the Committee held that the question of relations between central and local finance was outside their terms of reference. That is a pity, because lack of money is one of the principal reasons why more is not being done. Noble Lords will know that rates have gone up enormously since the war. Homes for the aged are very expensive, and before embarking on any major scheme for building or adapting premises for the old, the local authority is inclined to consider the effect of such expenditure on ratepayers, many of whom are themselves old and impoverished.
The local authority may be quite wrong to allow such considerations to weigh. Paragraph 320 and others in the Report seem to suggest that the local authority should have no compunction about putting up rates, even if it is known that, as a result, more and more ratepayers will be forced to have recourse to National Assistance. In my own county there are a great number of retired people who, for many years, have come to live in the south of England on comparatively small pensions. Many of them are in a condition not far removed from that of those we are trying to benefit. Over a 110 million people are now having their rates paid by National Assistance. Notwithstanding this, nor the fact that the Phillips Committee say that a new approach to this problem is needed, many ratepayers have strong objection to having recourse to National Assistance. Some noble Lords may be old-fashioned enough to respect this attitude. I wonder whether my noble friend who is to reply has any comment to make upon this matter? To some it will be a new idea to suggest that we must say to ratepayers, "It does not really matter whether or not your rates go up, because if, as a result, you are, caused distress, you can always get National Assistance." Is that the attitude which a Conservative Government wish to take?
The difficulty in regard to rates is that welfare services are more expensive than any other form of social service, and whereas we get a 50 per cent. grant for education and health, we get virtually nothing for welfare. There are, of course, the contributions from inmates of old people's homes, paid out of old age pensions and so on; but that contribution does not amount to anything like 50 per cent. of the expenses. In my county it amounts to hardly 25 per cent. As welfare is one of the most important services which a local authority has to provide, this differentiation is difficult to understand. Perhaps my noble friend can explain what is the principle. I should feel much happier if there were a 50 per cent. grant, because major schemes could then be embarked upon without giving rise to the feeling that, as a result, a number of ratepayers would be forced to have recourse to National Assistance.
Local authorities are well aware of the need for more homes and even more aware of the need for more hospital accommodation for the chronic sick. I am told that there are over 4,000 cases scattered up and down the country where the need is really desperate—cases of the kind referred to by the noble Lord, Lord Amulree—but for whom there is no suitable accommodation. At the other end of the scale, local authorities are also well aware that when the old are comparatively able-bodied it is much better to keep them out of institutions. I entirely endorse what has been said on the value of home-helps and special forms of housing. We must be grateful to the 111 present Government for the encouragement and facilities they have given for these special forms of housing, and grateful, also, for the encouragement given to housing associations and similar voluntary bodies which are often the best agency for managing these types of housing. The noble Viscount, Lord Soulbury, has referred to the arrangement of a quadrangle of small cottages with a matron in charge. I know of a similar experiment. There are many other schemes, notably those for adapting and improving large houses, in which improvement grants have been extremely valuable.
Gratitude should be expressed to the people who run these voluntary bodies. In my own county we have a retired medical officer of health who has collected money and organised no fewer than five small homes. Though the net result may be small, the example is certainly inspiring. It is clear from the Report, and this debate, that we have a long way to go before we can say that our welfare services are perfect; but unless we have some great upheaval, such as a large measure of inflation, I cannot see why progress should not go on steadily. Coming, as I do, from an area to which many old people go to retire, I am certainly conscious of how vitally important it is for us that this progress should continue.
§ 4.40 p.m.
§ LORD BURDEN
My Lords, I am sure we are all deeply grateful to the noble Lord, Lord Beveridge, for initiating this debate. At the outset of his speech he gave us some instances of Greek genius that have come down to us through the ages, and he referred especially to men who had long passed the normal allotted span. But, if my recollection is correct, I believe that most, if not all, of Greek civilisation was based on slavery. At least, it is true to say that Plato and Aristotle justify or condone some form of slavery. I wonder whether there are any figures to show to what age those condemned to slavery lived, or whether they could equal anything like the ages quoted by the noble Lord, Lord Beveridge.
This debate undoubtedly has relation to the Phillips Report: time after time noble Lords have referred to that Report. But there is one recommendation in that 112 Report which I sincerely hope will not be implemented—that is the recommendation to raise the retirement age of women to 63. I have in mind particularly a number of women who were in our factories and workshops during the First World War, when the work was not so well organised or conducted as it is, more happily, to-day. In the nature of things, through the loss of men in the First World War, those women have been denied the normal happiness which flows from married life. Again, many of them were engaged in our factories and workshops in the Second World War, and no one will deny that wonderful contributions were made by women to the war efforts in both world wars. These women feel that they are entitled not to a later retirement age but to an earlier retirement age. They believe—and I have a measure of sympathy with their contention—that in their insurance contributions they are paying for benefits which, in the ordinary course of things, they will not be able to claim. They contend that widows and married women receive a larger measure of consideration; and for twenty years, under the self-sacrificing and devoted leadership of Miss White, of Bradford, they have been trying to get what appears to them to be elementary justice. For the Government to attempt to raise the retirement age for these women, would, I think, be adding insult to injury. If there is anything to be done, so far as retirement ages are concerned, I suggest that perhaps the right way of looking at it would be to confine it to new entrants into the National Insurance Scheme, or at least those who have been in it for only a limited number of years.
The noble Lord, Lord Beveridge, in his far-ranging and wise speech, made passing reference to the mental hospitals. Perhaps I ought to declare an interest here, because I happen to have the honour of being chairman of a hospital management committee responsible for a mental hospital—I believe the last one built in this country: it was opened in 1935 by the late Sir Kingsley Wood. And from my knowledge of the work there and in other such institutions, I wish to pay tribute to the devoted work which goes on in our mental hospitals today. No one, I think, can measure the advance which has been made in the treatment of mental illness. But I venture to say 113 that there are literally hundreds of men and women—particularly women—in our mental hospitals to-day who ought not to be there. They are there because there is nowhere, else for them to go.
This problem is related to that which has been referred to by the noble Viscount, Lord Gage. When these people leave the mental hospitals, if there are no relations to take them, any provision that has to be made for them has to be made by the local authority. But while one knows that local authorities have done a great deal in the provision of hospitals, or places of that kind, there is an urgent need for halfway houses—call them what you will—where these people could be accommodated, and receive a minimum of medical care and attention or nursing. While I am on that topic, I would reinforce what the noble Viscount, Lord Gage has said about the absolute necessity of looking into the financial relations between the local authorities and the Ministry of Health or the National Health services as quickly as possible. There is this gap. Local authorities, obviously, are reluctant to incur heavy financial expenditure at the present time. On the other hand, there are instances where there should be an exchange, so to speak, of cases in hospitals and cases which are in the local authorities' homes, so that a person can rapidly pass from the category of an elderly or aged person to that of a sick person requiring medical care and attention—institutional care, that is.
While I am on that question, I should like to make a passing reference to what are known as "Broadmoor cases" now in our mental homes. They are cases of patients who have been, quite rightly, sentenced to periods of detention during Her Majesty's pleasure. If it is felt at Broadmoor that they should be rehabilitated and brought back to mental health, they are sent to mental hospitals. I make no complaint about that idea; I believe that that is in line with modern treatment so far as those who are mentally afflicted are concerned, even if they have been sentenced to terms of detention. Prior to the appointed day for the coming into force of the National Health Service Act, the local authorities were reimbursed for that cost by the Home Office. Then, somehow or other, the responsibility for that maintenance was put on the regional hospital boards, whereas I 114 submit that it is a charge which ought to be borne by the Home Office Vote and not by the Ministry of Health. It is all very well to say that it comes out of the same pocket—that is perfectly true, and I can see the noble Earl's mind working along that line. But I know that the costs of these social services are closely examined, and it is only right and proper that every social service (if one can call detention in prison a social service) should be borne by the appropriate Department.
The noble Lord, Lord Beveridge, rightly said that the paying out of money is not the only thing, and perhaps not the principal thing, in dealing with the elderly. I could not agree more. In addition, I would say that it is very important not to become stereotyped; we must retain flexibility in dealing with old age, and must not try to get them all jammed into one mould. In this connection, I should like to mention an experiment made by the City Parochial Foundation, a body of which I have the honour to be a member. They built in Islington a place known as Isledon House for the aged and elderly, and they took care that the elderly were not segregated. On the top floors of this rectangular building, built round a beautiful garden, young couples are being accommodated, and it is a very real joy for those old people to see the young folk and the children in the garden. I am glad to say that the public spirit of the Corporation of the City of London has led there to take over financial responsibility for Isledon House and they are now running it and paying the Foundation an appropriate sum, leaving us free to experiment in some other direction.
As the noble Viscount, Lord Gage, said, the problem of finance is a very real one. I would suggest to the Minister of Health—I know that there has been a report on the subject—that the solving of the problem of finance in relation to the regional hospital boards and the local authorities is most urgent, and that someone ought to be deputed to get down to the job and work out the financial solution. It is not for me to suggest how, and by whom, this should be solved. It is our duty to point out that the problem exists, and it is for someone else to find the solution.
The noble Lord, Lord Beveridge, said that the principal way of dealing with 115 elderly people would be to keep them in their own homes. Of course, that would involve the provision of those services to which he referred, and also the cost of home-helps. Anyone in touch with doctors who practise in industrial areas will know of cases of old people living in their own homes with no one in contact with them except the doctor when he makes an occasional visit. I know of one case, which I believe I have mentioned to your Lordships before, where an old man living just outside the boundary of the City of London was ill and had only the doctor calling occasionally. The old man died, and when his corpse was discovered his face had been gnawed away by rats. That may be an extreme instance, but the fact remains that, though I cannot speak too highly of the humane and wonderful manner in which the National Assistance Board are interpreting the regulations, there is no one person in any local authority charged with the responsibility of seeking out and dealing with these cases. The much maligned relieving officer has gone, and a problem is not obliterated by saying that somebody else will take charge of it.
I think it was the noble Lord, Lord Beveridge, who said that all bodies who in some way or another have responsibility for old people should get together—regional hospital boards, local authorities and private voluntary agencies, who are still supplementing in commendable ways the efforts of statutory bodies. And long may their work continue, because they can do things which are outside the ambit of the provisions regulating the statutory bodies!
My Lords, would the noble Lord go even further and agree that they are doing a very great part of the work?
§ LORD BURDEN
I have no means of judging that. I pay tribute to the great work they are doing, and the noble Lord knows that I usually try to measure my words. Again we come up against the problem of finance. I believe that it would be illegal for regional hospital boards to take part in a conference of that kind and incur any expense—they would probably be surcharged by the district auditor. They are responsible under the Ministry for dealing with the sick, but I think they would be exceeding their 116 statutory authority. I see that the noble Earl shakes his head; but these bodies have to be careful, because the district auditors have wide powers and they are independent persons not responsible to any particular Ministry.
This has been an important debate, and no doubt we shall be assured that the Minister of Health and his Department will look carefully at what has been said. Again I express our gratitude to the noble Lord, Lord Beveridge, for giving us the benefit of his ripe wisdom and experience. Time after time in this debate it has been emphasised that the test of a civilisation is the way in which it looks after its old people. Perhaps the most important result of this debate, if anything flows from it—as I hope it will—will be that old age will not in future be regarded with the deep apprehension, and even terror, with which it is regarded by many people to-day, and that, in the days to come, the old people will be able to say, in the words of Browning:Grow old with me,The best is yet to be.
§ 5.0 p.m.
My Lords, in company with one or two other noble Lords, I confess to being very much a layman in this particular matter; in fact, my past concerns have been much more with the other end of the age scale, that is to say, with the young people. But the matter dealt with in this Report and in the Motion is of such growing importance, and the concern of all of us, that that must be my excuse for intervening in the debate. This Report has impressed me for two main reasons: first, because it emphasises the immense improvement in the lot of old people which has taken place during the last fifty years; and secondly because it sounds a necessary warning as to the need for watching carefully the changing conditions of life to-day as they affect old people, and the certainty that, as the preponderance of old over young increases, as unfortunately it is bound to do, this need will become even greater in the future. For confirmation of that one has only to look at paragraph 77 of the Report, where it is stated that in 1954 the growth in numbers of old people exceeded that of the young by 50 per cent., while the numbers in the active age groups hardly altered.
117 To my mind, the Report makes it quite clear that successive Governments who have tackled and legislated for the problem of old age have little to be ashamed of; indeed, to a mere layman, it is difficult to see, in the present state of the national economy, what more could be done at present from the centre. At the same time, we cannot become complacent about it, especially in view of the rise in the cost of living and the lower purchasing power of money, which probably affects the people we are talking about this afternoon more than any other people in the community. If the Government are doing all they can, I hope that the same can be said of local authorities. After all, when all is said and done, the care of the old people in the community is very much a question for the community itself—in other words, the concern of the good neighbour. I am glad to say that the organisation with which I have been concerned for a number of years has taken this very much to heart, and I think it would delight the noble Lord, Lord Beveridge, if he could see, as I have seen more than once, a small wolf cub, aged 10, going off with his little shopping basket and getting the groceries for an ancient dame of 85. It is a picture, perhaps, of dignity and impudence, but it is the sort of impudence that we want to encourage. This sort of thing is going forward with the girl guides and boy scouts, and with many other youth organisations throughout the country, because we regard it as a definite part of the training of the young to make them realise that they have responsibilities to the old people.
The question of housing has been mentioned a good deal this afternoon, and it is an important question from the point of view of the old people themselves. The Report says the evidence suggests that, in general, local authorities are aware of the need for special provision of housing. It world have been better if the Committee had been able to use the word "invariably," instead of the words "in general"; but I imagine that on the whole, though I have nothing to do with the working of any local association, from what one can observe in going about the country, they have the problems of old age very much in view—in fact, it could hardly be otherwise, I believe that in most housing estates 118 special provision is made in the way of small, easily run houses.
I believe that to be one of the most important features of the provision of housing for the aged, because so many old people are commendably house-proud and like to have their own little place, which they feel is their own home which they are running themselves, as long as they are able to run anything. It is true that a number of old people are lonely because they want to be lonely. Possibly they are the kind of people who never in their lives have got on very well with others. The noble Lord, Lord Amulree, would probably agree that there are cases—and from the point of view of the Welfare State they are most difficult cases to tackle—of old people who wish to be lonely and deliberately shut themselves away. It is this fact that causes the tragic sort of case to which the noble Lord, Lord Burden, has just referred.
It is important for local associations—and I think they now realise the fact—to divide the old people, from the housing point of view, into categories of those who are content to live as part of an old persons' community and those who wish, and are able, to carry on in their own little houses. They need a great deal of guidance, as we know, especially the more feeble among them. There is so much that can be done for them, but unless they are well advised they may not know what they are able to obtain in the way of National Assistance, National Insurance, home nursing, domestic help and so on. Whether, in the course of time, from the financial point of view, some simplification will be possible, I do not know. Of course, the old Poor Law was much simpler, but it had not the ramifications or the possibilities that we have at the present time. From the point of view of old people, it is rather a complicated matter for them to understand all that they can get, although, as we know, there are many people trying to advise them. Here I should like to pay a special tribute to that enormous body of voluntary helpers throughout the country who, day in and day out, carry out their job—and a magnificent job it is. The country owes them a great deal.
There is no doubt that since the First World War, and certainly during the last 119 decade or so, there has been a change in the structure of family life: younger people do not live as they used to in my young days, and they are not attached to the home roof to the extent that they used to be. This is due largely to the need for workers during the two wars, when many young people went to work on their own, right away from their homes, and got into the habit of living away from home. Perhaps in some cases that has led to a certain carelessness about the older members of their families. I hope that is not a common thing, but there may be a slight tendency that way which requires watching. Emigration to the Commonwealth, which has been so encouraged, may also have had something to do with the cutting up of the family life.
There is one other matter that I should like to mention and that is the question of men and women continuing work after the normal retiring age. Provided that suitable work is found for them, I can see nothing but good in it, and it is something that should be encouraged. After all, the expectation, not only of life but of healthy life, is so much greater now, and the will and ability to continue work is often as good a medicine as any which the National Health Service can supply. The multiplicity of skills of modern life, modern invention and modern manufacture, leave many loopholes into which an elderly person can be fitted and can find work. I am glad to see from the Report that there seems to be a growing tendency in this direction. It says in paragraph 93 that estimates show a rise, between 1950 and 1953, in the number of men over 65 employed of 10.5 per cent. and of women over 60 of over 21 per cent. I hope that that rise will continue. To my mind, it is an encouraging sign, and should continue, so long as it has no adverse effect upon the normal labour market, and I see no reason why that should be so.
Your Lordships, I know, will agree that this is a Report where a mere layman finds it difficult to make any constructive contribution. The fact remains that this is an urgent national problem and it is a growing problem. It is difficult to envisage the situation in 1979, about which the noble Lord, Lord Beveridge, spoke, when the preponderance of old age over youth will be so great. It is difficult to foreshadow 120 what we shall be able to do. I suppose it is a matter of gradually leading up to that point, of legislating up to it. Certainly we owe a debt to the old people. Many of them have lived useful lives, humbly, perhaps, and unrewarded; and so many of them have given the greatest gift in their power—children to serve the nation after them. It is a growing responsibility, and a nation-wide one, and I hope the nation will never forget it.
§ 5.13 p.m.
My Lords, as the noble Lords, Lord Beveridge, Lord Soulbury, Lord Amulree and Lord Burden have all emphasised the difficulty of discovery of cases, it is hardly necessary for me to emphasise it further. It is one of the worst problems we have to face in this business. I was interested to hear that the noble Lord, Lord Amulree, had applied his mind to it and thought of a way (which he disliked and I disliked) for overcoming it, because, owing to the lack of somebody who can discover these bad cases, horrible things occur and keep occurring, and we can never be sure that they will not continue.
With great deference to my noble friend Lord Soulbury, whose work has won him the affection of everybody who is interested in this subject, I think that probably the only people to-day who can possibly engage in the work of discovery are the members of the Assistance Board. I know they kick like salmon at the suggestion, but I think they are the only people who can do this, because they are regularly visiting people who are old already and who nearly always know who among their neighbours is getting into a condition when he or she will need care. I do not think there is anybody else. I was told long ago—I have told your Lordships this before—that it was a welfare officer's duty.
I went to a welfare officer, and he said, "My district is much too big. I could not possibly be responsible for discovery. I have to rely on my voluntary workers." I then went to the Council of Social Service, and said, "Some of these cases are pretty bad. Do you give your women a uniform?" After all, a uniform is more acceptable than a dirty old Burberry and a hair cover, when you are dealing with some of these bad cases. The answer I received was, "Of course not. Before you can get a voluntary worker regularly, you 121 must have a place cleaned up and made ship-shape and Bristol fashion." So between the voluntary worker and the welfare officer there is no duty recognised, and these cases go undiscovered. In parts of London there are voluntary workers who do this work. I know one very noble voluntary worker in North London who does a great deal of this work herself, but there is no single organisation or person charged with that duty. As everybody is in agreement about it, I will say no more.
I was interested in what the noble Lord, Lord Beveridge, said about chiropody. Many voluntary committees have instituted their own chiropody service and found it very valuable. With great respect to the noble Lord, Lord Beveridge, I submit that it is probably best that it should start as a voluntary service. I think one of the greatest values of having voluntary old people's welfare committees locally, is that they can try out what they find to be necessary and pave the way for it to become an official service. In many places, at any rate, that is in quite a good condition. Another need which I think is important relates to many old people who stay at work long after they have passed the retiring age. I know one old man—I think he is about 75 years old—who works perhaps three, four or more days a week. He does not work when he is not fit. The difficulty with him and with similar people, however, is that, having outlived his wife, he has nobody to look after him when he goes home. He has to make his own meal, and when he has done that he has to go to bed and he almost dies of boredom.
If one could get suitable accommodation for such a man—I do not mean a hostel, but something like the premises the noble Lord, Lord Burden, described—it would be a very good thing. But the difficulty, in London at any rate, is that no man who is in one of these voluntary homes or local authority hostels is allowed to go to work. That knocks on the head at once any solution of that kind for him. I daresay another solution will be found, but it is a difficulty which I think is liable to increase. I am told by my noble friend Lord Amulree that Exeter is the one place in Britain where a man can get accommodation of that kind and still go to work. I hope Her Majesty's Government will study what is 122 going on in Exeter with a view to effecting an improvement.
I believe everybody in this business feels that in the Minister he has a friend who is personally interested in his problem and who will help him in every possible way. I find that feeling everywhere I go, and I should like to express it here. There is only one other matter in the Report to which I should like to draw the attention especially of my noble friends opposite, because I think it goes to the root of what may be done in this matter. It is much more on the lines of what the noble Lord, Lord Rochdale, said. I quote the Phillips Report at paragraph 132, where it says:The National Insurance Fund is not self-supporting; there is a large prospective deficit. On pension account alone, a deficit already exists and might be increased at any time: it is open to any Government to announce an increase in benefit rates which its successors would have to finance, and it can, in doing so, add to the future liabilities of the State with a facility that makes even a war seem a laborious method of inflating the National Debt.That phrase, I believe, was put there on purpose to draw attention to the very serious nature of the statement. The Report goes on to discuss the prospects of an increase in the national wealth to meet the burdens that the calls of old age and all the calls of the Welfare State must entail on future generations.
The prospect is so tremendous that feel I must draw the attention of noble Lords opposite to what seems to me to be the only possible solution, namely, that, for the very sake of all those services in which they, with of us, and possibly more than most of us, are so deeply interested, they must relax their hostility to risk capital. I suggest that what I am saying is really something that was said in The Times yesterday in a very able article on the right-hand middle page. One can think of any number of industrial companies who are doing very good work, who are increasing their output, who are holding overseas markets in the face of cut-throat competition, whose wages bill has gone up, the price of whose materials has gone up, whose dividend has not moved and who could not make a new issue of risk capital if an opportunity came to extend their enterprise.
It is only if we use British enterprise in the highest possible degree and reward risk and enterprise that we can hope to 123 gain the money which is necessary to defray the account which the Welfare State is certain to lay upon future generations. The opposite will, and I am afraid must, lead to bankruptcy. I remember that once, in about 1930 or 1931, I was in Poland. Poland had had a very fine (I think it was) unemployment fund which had "gone broke." While they were all anxious to have the best possible welfare services that the country could afford, there was one thing on which they were quite determined: that they would never run the risk of "going broke," because they remembered the suffering it entailed. I hope that this country, with its vast interests and its enormous ageing population, will never have to face a problem of that kind. For that reason, I have made this appeal to my noble friends opposite.
§ 5.23 p.m.
§ LORD PETHICK-LAWRENCE
My Lords, by common consent we are all greatly indebted to the noble Lord, Lord Beveridge, and not only to him but to the other noble Lords on all sides of this House who have taken part in this interesting debate. But it is not only that we ourselves are indebted: the community of our country is indebted also, because, when these large subjects are brought into the light of day and discussed, that is a step towards things being done which afterwards work out to the good of the community as a whole. The noble Lord who has just sat down departed somewhat from the harmonious discussions we have been having by introducing a controversial subject. In this closing part of the debate, I do not propose to make any answer to him except to say this: we are all agreed that only by increasing the productivity of the country can the burdens that lie in front of us be met. On what precisely are the best ways of doing that we may not always see entirely eye to eye; but on the principle that you cannot eat a cake which you have not made, I think we may all agree to accept that fundamental doctrine.
A great deal of ground has been covered in this debate. Nearly all the important things about old age have been said. Therefore, I shall not detain your Lordships very long. There is, however, one aspect of the problem which it seems to me has not been fully covered, and before the noble Earl winds up the debate 124 I should like to say a few words about it. Most of the speakers have been talking of old age as if it were one stage in life. I do not think that is at all true: I think that old age consists of three or four stages in life which are entirely distinct. It may be that one leads to the other, or it may be that it does not, but the symptoms and treatment of one of these stages, in my view, are an entirely different matter from the symptoms and treatment of the others.
Let me put into some shape the idea that I am trying to convey to your Lordships. In the first place, there comes a time in the life of most men and women who pass through and are completing the prime of their life when it first becomes apparent to them that to continue a full day's work in the job that they have been doing for most of their life is becoming difficult. They find that they are very weary at the end of the day; they find their nerves, it may be, or their sinews unwilling to carry out their occupation. Therefore, they are, in a sense, becoming old. What do they require? They require perhaps not to be forced to work particularly long hours; they require some alleviation; and, in particular, they require in some cases financial assistance, because, with the best will in the world, they are not able to earn the full money which they earned in the days of their prime. That is the first stage of old age, and it can be cured entirely by some additional money coming into the house of the ageing person.
I may point out here that the situation is not entirely independent of the actual anno domini but one case may differ very much from another. One man or woman may be tired or weary and want to retire in the fifties; another may want to in the early sixties; another may want to at just about the pensionable age; yet another may not want to for ten or fifteen years beyond that time. There is evidence of this in the fact which has been mentioned over and over again—and it has been referred to again today—that there are a large number of people of pension-able age who are continuing, and do continue for quite a considerable number of years, to work full-time in their trade and earn full money, and earn the additional old age pension when the time of retirement comes, whenever that may be. That is the first stage.
125 The second stage is when a person can no longer make any substantial contribution to his own upkeep, when he wants to live almost exclusively on his pension, supplemented perhaps by the small sum which he is allowed to earn by some part-time work. Such people may be quite capable of looking after themselves in all the ordinary affairs of life. They may be living in one of those houses specially adapted for old people. They may require an occasional visit from a friend or a visitor, or even some State person to see that they are all right. They may, if they are obstinate and entirely on their own, through circumstances which are in no sense their fault, become the kind of person about whom my noble friends Lord Burden and Lord Saltoun, and others, have been talking this evening. Normally, however, they are quite capable of locking after themselves, and they do not require any special protection other than monetary help. A pension such as we have at the present time admirably meets their need.
Then we come to the third class of people—the third stage, it may be, of old age. Those are the people who are not capable of entirely looking after their own needs and who, because they cannot properly attend to their own ordinary needs if left entirely to themselves, must live either with relatives or in some old persons' home which is provided by various means. But the help that they require is still only of an ordinary kind. It need not in any sense be medical; it can be the help of quite ordinary people, with no medical knowledge, or the help of some home where the persons running it, though they may have a special ward or portion set aside for medical cases, in the main expect people to be looked after by ordinary persons.
Then we come to the fourth stage, where people, in the normal course of their day, are not able to look after themselves and where ordinary non-professional, non-medical attention is not enough; they need to go to hospitals or to nursing homes. Their incapacity, which may be either physical or mental, or both, may entirely unfit them to play anything like an ordinary part in the life of the community or their fellow human beings.
I have been constantly brought into contact with those four different stages 126 in what, lumped together, are termed "old age." As I have said, those four stages are quite different; they are distinguished by entirely different characteristics, and they require entirely different solutions. It seems to me that that point is not fully realised when all these people are classed together in the term "old age." Each has its problems. The problems, however, are entirely different problems. It may be that some people never reach old age in this sense. They may be 70 or 80 years of age and never reach the first stage of these difficulties; they may reach one of these stages, or they may be carried off by death coming quickly, before they reach any one of these stages of life or any part of such a stage. In my view, we shall meet the problems of old age fully and completely only if we understand the distinction between these different stages. I do not wish to take up any more of your Lordships' time, and with those brief words I, in common with other noble Lords, shall listen with interest to the reply of the noble Earl.
§ 5.35 p.m.
§ THE EARL OF SELKIRK
My Lords, I think we have had a notable discussion on this subject, and before I begin to reply, I would welcome back to our discussions the noble Viscount, Lord Soulbury—he has not taken part in the debates in your Lordships' House for a number of years. It it just about twelve months ago that the noble Lord, Lord Beveridge, introduced in this House a Motion on the subject of the retirement pension rate. As your Lordships know, the Government have taken action since then, in fact before Christmas, when, at the same time announcements were made in regard to National Assistance and war pensions. Next month, on April 25, the first payment will be made at the new retirement pension rates, and on May 19, the increased industrial injuries benefit will become payable.
I should like to make three comments at this point. First of all, the retirement pension to-day is at least as high in purchasing value as it ever was. The retirement pension has been increased by more than 50 per cent. since this Government came into power; it is to-day 75 per cent. higher than it was in 1946, which I think fully compensates for any increase in the cost of living. May I say to the noble 127 Viscount, Lord Gage, that there should be no doubt but that we believe in pensions as of right. But that does not mean to say that there will ever be a time when the National Assistance Board will not have to help some people over difficulties. The noble Lord, Lord Wise, I think, sought to confuse the National Assistance basic rate and the retirement pension rate. The noble Lord knows perfectly well that they are quite different. It is not fair to make a comparison between the two.
Apart from any other consideration, of course, National Assistance includes rent, as well as other payments, so that a comparison is not really apt. But I want the noble Lord to rest assured that there is provision in the regulations whereby, in special circumstances, the allowance may be adjusted appropriately to meet those circumstances. This power is fully used by the National Assistance Board, in regard to such things as special food for a sick person, laundry, or domestic assistance for an old person unable to do his or her own work. I am informed that this power was exercised in no fewer than 574,000 cases last year, so the noble Lord may take it that there is a certain amount of elasticity vested in the National Assistance Board.
§ THE EARL OF SELKIRK
I thank the noble Lord. I think we really took action at the first practicable and possible time. To have done so a few months before the Quinquennial Report and the Phillips Report were published would have been highly irresponsible. There might still have been something which was basically wrong in our whole approach to this subject. I think one of the advantages of the Phillips Report is that, whilst it has raised many criticisms of detail, it indicates that the general lines on which we are advancing are sound. I think it is important that we should bear that in mind, because we might have been quite a long way off the mark.
The third point I should like to mention is one which has been referred to by a number of noble Lords—namely, the size and the extent of the scheme which 128 we have now undertaken. Clearly, that is dependent on the general economic strength of the country. The Phillips Report says that we should be in a position to carry this burden provided that productivity increases by 1½ per cent. per year. And at present, the rise in productivity is not less than this figure. This means, I think beyond peradventure, that whatever Government are in power, the welfare of the old people is directly and necessarily linked with the general economic strength of the country. Unless that is assured, the purchasing power of pensions cannot and will not be maintained, no matter what cash figure may be affixed to it.
The noble Lord, Lord Beveridge, then turned to the broader question of the general facilities available to old people. What I should like to do is to analyse what noble Lords have said, and to try to see how far what we have done measures up to what we should like to do. I found the definitions given by the noble Lord, Lord Pethick-Lawrence, most interesting—they were not far from my own analysis of the stages of old age. What seems to me to be the essential, if I may use that term generally, in regard to old people to-day is that they should remain, first, useful; secondly, independent; and thirdly, wanted. May I explain in a little more detail what I mean? In the first instance, they should feel there is still some part that they can play in this world. Secondly, they should feel that they are in no way a burden to other people. Thirdly, they should feel that they remain welcome company, not only to their relatives but also to their fellow citizens. This is a field where the State can do only part of the work. All citizens must play their part if these objectives are to be attained.
Translating these ideas into practice, we should seek to enable old people to remain at work as long as possible. Secondly, we should enable them to remain in their own houses—and in this respect, cash pensions which enable people to do so, are of very great importance. Thirdly, whatever happens, they should never feel that they have ceased to be part of the community as a whole or that they have no contribution to make and that nobody wants them. But the question of staying at work has received a good deal of attention, and there have 129 been two Reports upon it, the Watkinson Report and the Report of the Departmental Inquiry of the Ministry of Pensions and National Insurance published last autumn. This is a matter essentially dependent on individual circumstances. The choice must be made by the individuals, but they can be helped by being provided with the opportunity of doing work within their power.
I was delighted to hear what my noble friend Lord Rochdale said. It is true that many industries are now realising that they must do away with the idea of a rigid retirement age and, so far as possible, must make available work of the kind which older people can do. The noble Lord, Lord Rochdale, raised the question of the rule relating to earnings, but this is essentially a retirement pension and not simply an old age pension. I am not satisfied with reasons which have been advanced for changing this rule. I believe that it is entirely right. The Government, as an employer, hive a considerable burden to bear, and although in regard to the Civil Service, 60 continues to be the minimum age of retirement, that is not now regarded as the normal retiring age. Officers between 60 and 65 who wish to stay on, and for whom there is useful work, can remain so long as they are fit and efficient. The most important factor in keeping old people at work is the maintenance of a high level of employment. Only with full employment can older people be given an opportunity of taking an active part in the work of the country.
The question of keeping old people in their own homes was emphasised by the noble Lord, Lord Beveridge, by my noble friend Lord Hampton, and by other speakers. It is fortunate that the number of houses available has increased, and that the number of houses suitable for accommodating old people has also increased. The Phillips Committee Report gives the figure for the six months to December, 1953: 8.4 per cent. of all new local authority houses were suitable for old people. The latest figure, for the six months to December, 1954, is 9 per cent., which shows that the importance of this provision is realised and that increasing emphasis is being placed upon it.
That is, so far, satisfactory; but the noble Lord, Lord Beveridge, and others, question whether the provision of assistance in the home is adequate. We are 130 dealing here with expanding services. A good deal of ground is covered. In the Home Nursing Service between 1948 and 1953 the number of nurses employed increased from 7,700 to 9,500—a notable expansion. The number of cases attended to increased by about 40 per cent. over the same period. The number of home-helps is to-day only 30,000, but it was only 11,000 in 1948. In a service of this kind, a 300 per cent. expansion in five years is not too bad, though I concede that the service is still inadequate.
There are also such services as sitters-in and night watchers provided by some local authorities, some of whom call on voluntary organisations such as the St. John Ambulance Brigade, the British Red Cross Society and St. Andrew's Society. There is also the laundry service which a growing number of local authorities provide for elderly people, particularly where it is felt that a domiciliary service of this kind would ease pressure on hospital beds. A "Meals on Wheels" service for sick and old people is provided, either directly by local authorities or through the W.V.S. and the British Red Cross. I understand that the London County Council provide a service of "Invalid kitchens of London." Nursing equipment is made available in the home, and there are health visitors who are mostly concerned with mothers with young children.
The noble Lord, Lord Beveridge, made particular reference to chiropody treatment and compared its cost with that of tobacco. No doubt this is an example of the unsatisfactory result of making benefits available to old people by coupon. I am afraid that we must look at it in that way, and we must clearly recognise that it would be very difficult in practice to withdraw such concessions at the present time. The noble Lord must not have the impression that there is no provision for chiropody. Chiropœdic treatment is available in hospitals and at a number of clinics taken over by local authorities. It is also available in the home, in some places, through the British Red Cross and St. John Ambulance and, I believe, St. Andrew's Society. Treatment is also given at a number of old people's homes provided under the National Assistance Act. The booklet of Health Services of Hammersmith, shows that the charge there is 2s. 6d. per treatment, or free if 131 the old person is receiving National Assistance. While I agree that the service remains inadequate, noble Lords should not have the impression that nothing is being done in this field.
Can the noble Earl say whether the Hammersmith service is provided by the local government or is a voluntary service?
§ THE EARL OF SELKIRK
It is organised by the local authority, and I believe it is run by Hammersmith. There was one matter on which some noble Lords spoke with great authority. I was greatly disturbed by what the noble Lord, Lord Amulree, said, because he speaks with real authority. Let us be quite clear. If a case is known of any one in need of assistance, there is no doubt that the National Assistance Board should be informed as early as possible. If domiciliary services are needed, then the local authority should be informed. It does not matter whether the Board or the local authority are informed, for if a person is found to be in need the appropriate authority will take action. The noble Lord raised a disturbing point; he wanted an automatic method of discovering people who are in hardship. Such a method is difficult to visualise. I am surprised at the story told by the noble Lord, Lord Amulree. I imagine none of those people were on National Assistance, for people who are receiving National Assistance are at least in touch with someone. We are now dealing with a number of people who are not receiving National Assistance but who for one reason or other have fallen on bad days.
§ LORD BEVERIDGE
That means one in seven. One in six of all elderly people is on National Assistance. Five out of six are not on National Assistance, and therefore they do not get dealt with by that method. Is that not so?
§ THE EARL OF SELKIRK
I appreciate the noble Lord's point. He may be right. There was some reference to the relieving officer. I do not think the relieving officer ever had the task of seeking out cases of hardship. He had the personal statutory duty of relieving need, but I do not think he ever had the duty of seeking out these cases.
I beg the noble Earl's pardon, but the relieving officer 132 certainly did have that responsibility, and he might be prosecuted if he failed in it. Every relieving officer I knew told me with pride that it was his duty.
§ LORD BURDEN
I can assure the noble Earl that whether it was or was not the statutory duty of these officers, it was accepted by every relieving officer with whom I have ever been in contact as his duty.
§ THE EARL OF SELKIRK
I think I am correct in saying that it was not a statutory duty. The statutory duty of the relieving officer was to relieve need. However, that is a matter relating to the past, and we do not need to pursue it further now. But surely this is a matter in which anyone, whether it be a neighbour or a general practitioner—or even a rent collector, for that matter—can act. They are in touch with these people and can report these cases. I wonder whether in fact the relieving officers were able to find all the cases. Is this an entirely new phenomenon—something that has never happened before? I find it difficult, with the best will in the world, to see how anyone could be charged with a duty which, because of its very nature, would be so difficult to perform. But why should not neighbours do this—or even ministers of religion, if they are in touch with the happenings in their parishes? I should have thought that if the duty of reporting these cases were clearly understood, the sort of things which have been mentioned should not happen. I am afraid that I cannot give the noble Lord a fuller reply than this. What I think should be clearly known is that where people are aware of distress they should report it, and either the local council or the National Assistance Board will take the necessary action.
There are, I suppose, two general criticisms. One is that the volume of assistance given by these domiciliary services is inadequate. As I have already said, they are expanding. Here is certainly a sphere for all those who are able and willing to enter into voluntary service: here is opportunity for them to play a full part. The nature of the work to be done is extremely varied. It varies from visiting people and relieving their loneliness to the more exacting tasks which need qualified personnel to carry them out.
133 The second point of criticism relates to co-ordination. There is a doubt in people's minds whether these different services are properly co-ordinated. It is felt that all the services should be, to some extent, co-ordinated. I think more is being done than is perhaps appreciated. What we want to avoid—and I am sure your Lordships will agree with this—is looking upon old people as a class by themselves. It is much better to regard old people as part of the community, and not simply as a segregated section. I think it is important that that should be clearly understood. Help is given to these people by various ad hoc services organised for the particular purposes. Whether it be housing accommodation, health services or hospital treatment that is required, the services are there and ready to play their part. My right honourable friend the Minister is aware of the need for closer co-operation in this field, and he does all that he can to encourage people in localities to come together. Any one who is able to assist in doing that, to assist in bringing about fuller co-ordination, will be performing a valuable public service if he comes forward to help. I think it would be wrong to assume that no such thing is taking place.
The noble Viscount, Lord Soulbury mentioned Darby and Joan clubs. There are about 4,000 of these clubs, of one character or another, in the country at the present time. They do not entirely provide what is needed, but they do afford meeting places for these old people. What is more important is the work of the old people's welfare committees under a central Committee. I believe that they include representatives of various authorities such as the medical officers of health, the welfare officers, the National Assistance officials and voluntary organisations such as the W.V.S. and the Red Cross.
§ LORD BURDEN
May I interrupt the noble Earl for one moment? I am sorry to do so, for I know haw difficult it is to continue a speech such as that which the noble Earl is making when there are frequent interruptions. We have, as the noble Earl has said, the good will of the Minister on this point of different agencies, shall I say, dovetailing together, so far as they can, without losing their separate existence. Would it be possible 134 for the Minister to consider the advisability of sending a further circular, say, to statutory bodies—not to voluntary bodies, because statutory bodies can more usefully get in touch with the voluntary bodies—calling attention to essential points of various kinds that have been stressed in this debate, and particularly dealing with the question, so far as regional hospital boards are concerned, of whether they will have any legal power to take any action in connection with this co-ordination of work? I believe that there has been a report of the Central Health Advisory Council on this very point, and that some action was taken after that. Now, I think, it is time that the matter was revived.
§ THE EARL OF SELKIRK
My Lords, I am sorry that I am not able to give the noble Lord an answer about regional boards, but he is probably right in what he says. What I can say is that the Minister will certainly consider what has been said. Whether he will think it advisable to send out a circular, or indeed what action he will take, I cannot say; but I think he will take some action as a result of the discussion in your Lordships' House to-day. I believe it is the fact that medical officers of health and hospital boards or hospital representative authorities do meet regularly. I also believe that it is hoped shortly to institute meetings between medical officers of health and general practitioners. It is hoped that they will come together in due course more or less as a matter of routine.
May I now move on to the next stage, which is that of people who cannot be retained in their homes. In cases where circumstances are such that old people can no longer remain in their homes—and sometimes that is inevitable—it is clearly necessary that residential facilities should be available. These cases come into the stage 3 to which the noble Lord, Lord Pethick-Lawrence, referred. They depend on family circumstances. In some cases the family can look after the old people, but in others they cannot do so. I have the honour—it is a curious addition to my office—of being chairman of Chelsea Hospital, which is, I suppose the oldest, and indeed it is still the finest, building of this particular character.
I can tell your Lordships this fact. Local authorities in England and Wales have provided 69,000 beds, of 135 which at least 50,000 are available for aged persons. The figure for Scotland is about 6,500. Since the end of the war some 800 new small homes, with accommodation for 23,000 people, have been opened by local authorities. There are registered over 1,200 small homes, of one character or another, with another 23,000 beds, so that there is a fair amount of accommodation available there. I had the pleasure last week of visiting two or three homes run by the L.C.C., and I was very much struck with the quality of the accommodation provided and, if I may say so, by the imagination with which these homes were decorated to make them appear attractive, light and airy.
The noble Viscount, Lord Soulbury, emphasised the need for quality, but I think he would have been satisfied if he had seen these homes, and I believe the noble Lord, Lord Beveridge, also would have been satisfied. In some cases the old people had retained their own furniture and in a great many cases they had retained many articles of personal interest, such as pictures and items of that character. Where old buildings are still in use, local authorities have been dividing up dormitories and providing cubicles, in order to make them more suitable accommodation. They are also encouraging the building of old people's homes where new housing estates are going up. I thought the noble Lord's suggestion about encouraging life insurance offices to build and run homes was interesting. One or two friendly societies already run homes for their own aged members, and I understand that with this object in view a Bill was recently introduced in another place to give powers on a wider basis.
The noble Viscount, Lord Gage, was worried about the financial arrangements. Let me say to him that when this new scheme was brought into being it was really part of a settlement by which the central Government took over Public Assistance and the hospitals, leaving the local authorities with responsibility for old people's homes, subject, admittedly, to not very generous, though quite substantial, assistance, both through national assistance towards the expense of running them and through housing subsidies for erecting new buildings. The noble Viscount may say that this is not very important, but is he really anxious to 136 abrogate all the powers of the local authorities in favour of central control? That is the direction in which he is going. I should have thought it very unwise for local authorities to ask the central Government always to meet the costs of such schemes.
My Lords, I do not think I went so far as that. What I asked was that welfare services should be put on the same basis as any other form of social service and we should ask for a 50 per cent. grant.
§ THE EARL OF SELKIRK
I am aware of that. I am afraid I went further than the noble Viscount and I accept his view, but if he asks for more help from the central Government, the independence of the local authorities will tend to be more and more undermined. I entirely agree that there is nothing like enough being done on these lines. But I am sure that those concerned will note what the noble Lord, Lord Beveridge, said about the quality of the buildings and about not building them in isolated places.
It has been suggested that possibly the structure of the services was making the ties of family weaker. This was not strongly pressed and I think most of us found satisfaction in the statement in the Phillips Report that they found no evidence of it. I believe that to-day we should re-echo the words used by King George V in his first speech after his accession to the Throne:The foundations of national glory are set in the homes of the people. They will only remain unshaken while the family life of our nation is strong, simple and pure.I would add one or two words about hospitals, because I think it is important to realise that recently, through the stronger economic position we are in, we have been able to announce additional expenditure of £15 million on hospitals. Old people will not directly benefit by this, but, none the less, it is a step in the right direction which I imagine will have a spreading effect and which will make more hospital accommodation available for older people. The position in hospitals is that whilst the number of beds available in England and Wales in 1951 was 507,000, that had increased by over 2,000 by the end of 1953. Of this number, however, 18,000 beds are closed through lack of staff. That is a very 137 serious matter, which has to be met. The number of beds occupied by the chronic sick in December, 1953, was 55,000, which is an increase of 3,500 over the previous four years. This is approximately 7½ per cent. of the total number of beds. In Scotland, the percentage is roughly the same.
The greater portion of these beds are certainly occupied by old people. As the noble Lord, Lord Beveridge, has emphasised, we are anxious that hospital accommodation should be made available where it can be used for a quicker turnover, and I think that is increasingly being done. For instance (these are rather dull statistics but I think they are important), in 1952, the number of beds for old people increased by 1.1 per cent., but the number of patients increased by 9.5 per cent. In 1953, the number of beds increased by 1.5 per cent. and the number of patients by 5.5 per cent. Of course, that is a cumulative figure, indicating a fairly rapid turnover. I have the figure for the Dundee Geriatric Unit: it shows that 45 per cent. of the patients admitted can be returned to a condition in which they no longer need hospital treatment. I mention this fact because I am certain it is much better not to leave the chronic sick in hospitals, which should be used to restore people who are unable to find treatment outside. Wherever it is possible to nurse people adequately at their homes, it is desirable that they should remain there.
The noble Lord, Lord Beveridge, is disturbed about the increasing number of old people. I believe that we can meet this point. The disturbing figure is not so much that of the increase of old people, but that of the increase of old age pensioners, which is a very much bigger figure. It may well be that with the National Health Service we have to-day the demand for institutional accommodation will not necessarily increase in direct proportion to the number of old people.
I am afraid that I have not done much more than run through the facilities available and the general policy which we have to deal with these problems, but I feel that it is essential, whatever action we take, that the old people should continue to feel part of the community, to remain useful, to remain independent and to remain wanted. That is an objective which 138 no doubt will take many years to achieve, It depends just as much on individuals as on the State. The Phillips Report is encouraging in this regard, and I think it indicates that the way we are going is probably sound and that the basis of our approach is right. Of course, we are going through a transitional period and we are ready to improve the position. It is for that reason that I am grateful to all noble Lords who have spoken to-day.
§ 6.8 p.m.
§ LORD BEVERIDGE
My Lords, after this long, memorable and most fruitful debate, I shall speak shortly. I should like to begin by expressing my delight (it is not really for me to thank them) that so many noble Lords have spoken on this occasion. I think they have helped to make it clear to the old people of this country that their problems and difficulties are of serious concern to Members of this House. I am sorry that I cannot say anything about all the speeches; I can only say that I heard most of them and I shall read them with the greatest possible interest in the OFFICIAL REPORT to-morrow.
I must just say a few words about the speech of the noble Earl, Lord Selkirk, who has replied for the Government. He made one brief reference to the last debate of a year or so ago when I spoke about retirement pensions. If the noble Lord will refer to the Report of that debate, I think he will not find any suggestion in my speech that the Government ought to have proceeded without waiting for the Phillips Committee Report. I said that they could hurry the Report. If the noble Earl will also refer to his speech, he will find that on that occasion he was highly discouraging about the possibility of the Government's doing anything whatever about pensions last year. Fortunately, the Government did much better than the noble Earl forecast. I congratulate them, and I hope that, in so far as his speech to-day has not been completely satisfactory on all points, they will repeat what happened on the last occasion and will be even better than the noble Earl has promised.
I want to differ fundamentally from the view the noble Earl has just expressed, that the concern is not really the growth in the number of old people but the growth in the number of pensioners. 139 That is a remark which perhaps would come appropriately from the Chancellor of the Exchequer, but not, I think, from the noble Earl, who, if he is speaking for any Minister, is speaking for the Minister of Health or the Minister of Pensions and National Insurance. My speech was concerned with other things than pensions—namely, the care that the old people need. Old people are likely to want care, whether or not they are pensioners, because whether or not they have a pension does not affect the rate at which their faculties decay, or their sudden passage from one class of the old to the other.
§ THE EARL OF SELKIRK
I think the noble Lord must have misunderstood what I said. What I intended to convey was that the difference between the number of pensioners to-day and the number in twenty-five years' time is a much sharper difference than that between the number of old people of to-day and the number of old people in twenty-five years' time. I do not say that it is not serious, or that it does not present a problem; but I do say that, in the way we are proceeding to-day, we hope to be able to meet the needs of the old people at that time.
§ LORD BEVERIDGE
I hope the Government will continue to improve on anything unfavourable that the noble Earl has said on this occasion. I would ask the Government to examine centrally, as a whole, the problem that has been laid before them to-day and with which they are familiar in many ways. I believe there is a case for co-ordination, because an old person in one particular class and degree of decay of faculties may at any moment pass to another, and we want to be sure that the appropriate body is ready to deal with him as he passes. I ask the Government to consider it centrally and together, and to let no question of departmental or sectional jealousy stand in the way of the co-operation of the different Departments, the local authorities and the voluntary agencies.
I hope they will not mind my putting three criticisms for their consideration. The noble Earl has emphasised the fact that old people ought to be encouraged to go on working and not discouraged from doing so. Would the Government once again consider whether, in the light of that statement, the present retirement 140 condition for pensioners, of which I was the inventor, is a right and necessary condition; that is to say, the rule about earnings that now applies? That is the point that was put by the noble Lord, Lord Rochdale. Secondly, would the Government ask themselves whether what is called "a small home" in the Ministry of Health Report—that is to say, a large house which used to house one family and is now housing thirty or forty people—is really a home or can be made into a home? That is about the average inhabitation of the houses which have been established. I ask the Government to look at that policy again. May I say how much I welcome, in that connection, the noble Earl's support for the suggestion which I threw out, that bodies like the industrial life offices and the friendly societies—I know that some of the, friendly societies do this—should deal with the problem of trying to get over to the people who are now working the certainty of having a home, with service, to retire to when they need to retire. I think there is a great need for voluntary action in that field, combining organisation, money and management.
I come now to my final point of criticism. I know that some chiropody service is being given, but unless the lady who answered in the other place for the Ministry of Health was saying what she did not believe, it is clear that chiropody is not getting as much attention as it ought to get in the interests of the old people themselves. The only reason given for that is lack of money, and that is why I still ask the Government to consider whether their priorities are right. I would go on and ask whether it is a right priority to keep home-helps as expensive as they are, when that service could be cheapened by subsidies, while at the same time you are giving away £14 million a year for tobacco. I would invite the Government to look again at a very trenchant article which appeared in The Times on this subject on, I think it was, March 1, or it may have been January 3, of this year. I believe they will find there is a real danger in the unfortunate step that was taken in 1947, and it is having the effect of giving the old people what they really do not need, and, on plea of that, denying them what they desperately need in the way of home help, chiropody and so on. That is all I have to ask the Government.
141 Finally, I would repeat that this problem of the old is a problem for the whole community and not for the Government only. I hope that children, if possible even more than in the past, will continue to look after their parents; I hope that neighbours will continue to do work as volunteers to help the old people; and finally, I hope that even more people who 142 are going on working after they could retire and who are still full of energy, will use that energy in helping the still older people to live in their own homes. I ask leave to withdraw my Motion for Papers.
§ Motion for Papers, by leave, withdrawn.
§ House adjourned at eighteen minutes past six o'clock.