HL Deb 18 March 1959 vol 215 cc17-20

2.37 p.m.

LORD AMULREErose to ask Her Majesty's Government what is their interpretation of the definition of the word "invalid" for the purposes of the National Health Service, particularly in relation to elderly sick, when they come under the domiciliary services. The noble Lord said: My Lords, the reason I put down this Question is that there seems to be a certain amount of uncertainty as to the correct interpretation of Section 29 of the National Assistance Act, 1948. That section says: A local authority shall have power to make arrangements for promoting the welfare of persons to whom this section applies, that is to say persons who are blind, deaf or dumb, and other persons who are substantially or permanently handicapped by illness, injury or congenital deformity. Section 31 of the same Act says: A local authority may make contributions to the funds of any voluntary organisation whose activities consist in or include the provision of recreation or meals for old people. Section 28 of the National Health Service Act, 1946, says: A local health authority may, with the approval of the Minister, and to such extent as the Minister may direct, make arrangements for the purpose of the prevention of illness, the care of persons suffering from illness or mental defectiveness, or the after-care of such persons. Then, at the conclusion of the section, it says: A local authority may, with the approval of the Minister, contribute to any voluntary organisation formed for any such purpose as aforesaid. Of the sections I have quoted, Section 31 of the National Assistance Act is quite simple to understand, because it deals with the provision of meals for old people. Where difficulty arises is over the responsibility of the health department and the welfare department of the local authority where illness is concerned. This may particularly affect voluntary organisations. For example, if a person requires a meal to be delivered in his home and that person comes within the term "old person" as defined in Section 31 of the National Assistance Act, the local authority may determine that a recommendation for the meal be dealt with by the welfare department, the person being disabled and infirm, rather than sick, and that an "old person" requires a meal under a health department grant only if that person is suffering from some specific condition needing a specific diet. The borderline between health and sickness in old people is extremely difficult to define, and an extremely important thing for all elderly people in need of some care is that they should get food which has been prepared with some proper nutritional aspect in view. At the present time, it can be interpreted that an "old person" is not entitled to a special "invalid", nutritionally prepared, meal, whereas a younger person can be.

My own interest, which I must declare to your Lordships, is that I am closely connected with a body called Invalid Meals for London. This body supplies meals upon a medical certificate, either from the patient's general practitioner or from the hospital, for either special diets and special conditions or for an invalid diet specially prepared with due consideration to its being well-balanced and, at the same time, one prepared with special attention to the nutritional problems and principles involved.

One local authority, the London County Council, make a substantial grant towards our fund, and they accept medical certificates whether they are for specific conditions or for people who are requiring the general invalid "meal for their illness. Of course the large proportion of the people we supply are old people, and many, if not most, of them suffer from some degree of malnutrition: their state of nourishment and condition of nutrition is not as sound as it might be. Another authority will give a grant only if a special diet is ordered for a certain specific condition.

What is really needed, I think, is some definition of the words "illness", "invalid", "sickness" and "infirmity"; because it seems to me that the great point at issue is: when do the elderly sick become infirm and disabled, and when do the prevention of illness and the provision of after-care begin and end? To put a purely legal point of view, when does Section 29 of the National Assistance Act take over from Section 28 of the National Health Service Act? At the same time, my Lords, I would ask: is it the function of an old people's organisation to provide meals for elderly people who have some degree of illness? Surely if people are confined to their house, which implies some degree of invalidism or infirmity, they should be the responsibility of the health department where their proper nutrition can be regarded as part of their medical treatment. For that implies that that person has probably been under the care of a general practitioner and, therefore, should benefit from the personal health services provisions of Section 28 of the National Health Service Act.

The point that I am raising may sound a little abstruse, but I feel that it is extremely important, in view of the changing age structure of our population. One wants to see that the aged do not get unduly prejudiced. At present they seem to fall between these two Acts of Parliament which run parallel and never seem to meet very closely. This lack of definition may also create difficulty when an elderly person who needs some care and attention is discharged from hospital, for it is difficult for the doctor to know exactly whether that person should be discharged to the local authority, as part of the after-care services in Section 28 of the National Health Service Act, or whether the patient can go to the old people's welfare associations—which in London can be covered by the metro politan boroughs —who can assist voluntary organisations under Section 31 of the Act. These are the points I wished to raise. I am sorry if I have taken rather long, but I gave the noble Earl, Lord Onslow, notice of this rather difficult Question and I hope he will be able to give me some kind of reply.

2.46 p.m.

THE EARL OF ONSLOW

My Lords, I am very grateful to the noble Lord, who did speak to me about this Question earlier. I should like to tell the House that although the word "invalid" is not actually used in the National Health Service Act, domiciliary services can be provided by local authorities for the prevention of illness and the care and aftercare of persons suffering from illness. in my view these powers include the giving of financial support to the invalid meals service of the noble Lord's organisation and others. I believe that there is one organisation quite well known throughout the country, known as "Meals on Wheels". But it is the business of the local health authorities to decide what assistance they will give.

I can give the noble Lord some comfort in this matter, I believe, in that in many parts of the country this service, like that of his organisation, is widely used by local authorities, who have power, both under Section 28 of the National Health Service Act and under Section 31 of the National Assistance Act, which he mentioned, to subscribe to any organisation undertaking this kind of work, including the provision of meals. While local authorities are not empowered to provide meals themselves, they are given powers to contribute to any organisation that does so. I understand that there is nothing to prevent the permissive powers under Section 28 of the National Health Service Act, 1946, and Section 31 of the National Assistance Act, 1948, from running complementary to each other, to assist the noble Lord's organisation or any similar organisation. I hope that I have given the noble Lord the Answer he wants.

LORD AMULREE

My Lords, with the leave of the House I should like to thank the noble Lord for his very full reply, which I will study in the OFFICIAL REPORT to-morrow.