§ 2.38 p.m.
§ BARONESS SWANBOROUGH rose to call attention to the need for an extension of "Meals on Wheels" schemes as a contribution to the care of the homebound, and to urge that local authorities should be authorised to provide kitchens and other equipment and facilities for voluntary bodies operating a "Meals on Wheels" service; and to move for Papers. The noble Baroness said: My Lords, historically, "Meals on Wheels" started with five meals delivered to old people living alone at the end of the war period, when it was hard to cope with rationing and with the difficulties of cooking. Those people who were trying to help such old persons consulted with the clerk to the local authority, obtained the rations and cooked the meals in their own kitchens, carried them in pannikins to the persons who required them, and thus helped solve a very small local problem. This was more than fifteen years ago, and proved so successful that more schemes sprang up, and the "Meals on Wheels" scheme, as it is known to-day, was born.
§ At the beginning, there was no name for the scheme, and there was doubt as to what its possibilities would be. The person receiving the meal had to warm it before it could be eaten, because it was impossible to deliver it hot. It then became clear that the recipient who was bedfast, or housebound, often found real difficulty in getting the meal warmed. In consequence, pannikin covers were made from old felt hats, or bits of quilts, or any material available at a time of strict rationing. Out of these materials was made a mufflike contraption which would keep the meal warm, or at any rate not congealed. From these very small trial 522 runs has come the "Meals on Wheels" service of to-day, which, so far as the Service to which I belong is concerned, delivers at the rate of 2½ million a year; and the rate is steadily mounting in numbers weekly.
§ The "Meals on Wheels" services of Great Britain are operated by a number of voluntary organisations. Naturally I can speak only for the organisation to which I belong, and I can give figures only for the one with which I am connected. I would in no way lay claim either to kudos or to responsibility for the rest of the schemes, but I have no hesitation in speaking of the Women's Voluntary Services—the W.V.S.—because the tables of the survey made for the Nuffield Trustees show that the W.V.S. are wholly responsible for 77 per cent. of the schemes, and actually operate in 86 per cent. of them. This gives a good cross-section of experience, and a great deal of knowledge, which has been painfully achieved and heavily paid for. Because of the nature of the work, a great deal has to be learnt through practical doing, and useful deductions have been reached only through actual day-to-day handling of the subject.
§ The Motion I am venturing to put forward in your Lordships' House to-day endeavours to get for the organisations operating this service the tools with which to do the job. We are convinced that, with sufficient equipment, the number of meals could be quickly stepped up and a much greater number of persons served. Volunteers and organisation are available, but the equipment and the premises are all too often lacking. From the point of view of voluntary organisations, it would be of infinite value if local authorities were to have some arrangement by which "Meals on Wheels" schemes could be simultaneously assisted, both under the National Assistance Act and under the National Health Service Act, in order that each and every scheme could be used to best advantage to help meet the needs of the sick and the handicapped, as well as those of the aged.
Section 31 of the National Assistance Act, 1948, states that
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".
§ The majority of "Meals on Wheels" schemes are operated under this Act for the benefit of people of pensionable age who for some reason or other are unable to provide adequate meals for themselves. These grants are provided from the rates, and for this purpose a local authority may be a county, county borough, county district or metropolitan borough, in England and Wales, or a county, town or district council in Scotland. The fact that two authorities, county and district, may contribute to the same scheme works well where there is co-operation between the two authorities; but in some cases it can lead to "passing the buck" and to parsimony. There can be a divergence of opinion between the county and the district. There can be a doubt in the mind of an authority both as to its rights and as to its responsibilities.
§ At present, local authorities, either county councils or district councils, or both, vary in the nature of the assistance they give. Some subsidise meals; some provide equipment; some buy and maintain vans. Some pay mileage allowances for cars; some equip and maintain premises where cooking can be done. In the case of the London County Council, for instance, they provide all the subsidies, and the metropolitan boroughs provide the equipment; in other counties, county and district councils share the cost between them.
§ So far as voluntary organisations can discover from their negotiations with local authorities, there is no clear ruling as to whether Section 31 enables local authorities to incur capital expenditure to provide kitchens, vans, et cetera, for voluntary bodies operating "meals on wheels" schemes, and in any event, under this Act, they are authorised to provide "meals on wheels" only to old people.
§ Under Section 28 of the National Health Service Act, 1946, a local health authority may make arrangements for the prevention of illness, the care of persons suffering from illness, mental defectives, or the after-car of such persons. Under subsection (3) of the section, local authorities may contribute to voluntary organisations formed for any purpose as aforesaid. The powers given under Section 28 vary from those 524 in the National Assistance Act, in that "local authority" means in this case only a county or county borough; or, in Scotland, a large burgh. And meals can be supplied to people of any age, if they are sick or likely to become sick for want of proper provision. Some of the old people who receive meals under the National Assistance Act would, in consequence, be disqualified from receiving meals under this Act.
§ Expenditure under this Act ranks for the general grant which local authorities receive to cover various services, under the Local Government Act, 1958. Thus county and county borough councils can now give grants to voluntary bodies for meals for people who need them for health reasons, without referring back to the Minister. The terms of Section 31 of the National Assistance Act, if strictly adhered to, would preclude the "Meals on Wheels" scheme which receives such a grant from serving a person who is either bedridden or homebound through illness and who is under pensionable age. It means, therefore, that "meals on wheels" can be provided for aged people, but not for those people who, by virtue of having the meal, would not need to be sent into hospital or who by the fact of having a meal available to them could come out of hospital sooner than they otherwise would. This does not apply, of course, to meals which are net subsidised by local authorities, but so far as the W.V.S. are concerned. 73 per cent. of schemes are subsidised by local authorities, though sometimes it is a very small subsidy—anything from 2d. to 1s. 6d. per meal. I am unable to give the figure of the grants given in regard to equipment by local authorities and of the percentage of them.
§ The scheme is difficult to operate from all points of view. From the local authority angle, the ability to provide a subsidy towards the meal itself is a comparatively easy thing to arrange in committee, but the question of a grant towards the cost of insulated equipment in which to carry the meal, for premises in which to cook the meal, or for transport to help with the distribution of the meal, presents a more complicated problem and one which may hold up a new scheme from getting into operation for many months.
§ The scheme is even more difficult for those who operate it. There are the 525 basic problems of food, in its purchasing, preparing and distribution; of transport, in its producing, timing and routing; of recipients, in their contacting, checking, authorising and maintaining, and of finance, in its obtaining, employing, checking and controlling. The ways in which local authorities help the work are so varied that central authoritative advice, would be most useful in helping to clear doubts and encourage forward movement. All those who spend much time in working on the mechanics of these schemes would like to pay tribute to the wonderful way in which, in many cases, local authorities have backed up the "Meals on Wheels" service and we are convinced that they have done so in spite of having to act in extremely difficult circumstances.
§ What I believe is urgently needed is to get the gap in local authority legislation closed. If this could be achieved; if it were possible for Her Majesty's Government to arrange to have the doubts and confusions removed, and the situation made clear as to the support to voluntary organisations which can be permitted, then I feel that the interpretation of this welter of existing local authority legislation could, and would, be used to real advantage. Those of us who are closely linked with the problem and see in it one more aid to home care, as opposed to institutionalisation, would be happy to know that Her Majesty's Government were prepared to communicate to local authorities advice on capital expenditure in regard to equipment, vans and kitchens—to be given or loaned to the voluntary body undertaking the job—as well as in regard to mileage costs, subsidising the meal and replacing equipment.
§ Personally—because I believe wholeheartedly in local government—I should be more than happy to see equipment, premises and transport owned by the local authority and lent to the voluntary body. I feel that this could be very valuable, in that it would vest in the local authority the obligation of constant inspection, which must be inherent in those who hold the local responsibility. I have recently, in the last few weeks, attended a large number of meetings of W.V.S. responsible members throughout England, and it is interesting to find that the great majority of their local authorities would wish to delegate 526 the responsibility to voluntary organisations, even if they were given powers to operate the scheme themselves. There will always be those authorities, of course, who will want to assume the right to operate the scheme themselves and who will feel able to undertake the financial obligation. Indeed, to-clay there are a very few who are operating in this way through Private Acts of Parliament.
§ For several years in the service to which I belong, we have felt that our immediate objective should be in the nature of four million meals a year. That has, of necessity, been an approximate figure, based on observations we have been able to make, and on deductions we have been able to draw from the general information available to us and from the figures which we keep in our own service. Therefore, as a service, we were very interested when we were informed by the National Corporation for the Care of Old People that the Nuffield Trustees had agreed to finance an inquiry into "Meals on Wheels" schemes. I must admit to your Lordships that I am one of those unrepentant people who do not believe in mass media surveys: I am slightly too understanding as to how figures can be used, to be convinced by the way they are used on me! But there is no question at all that the survey recently published contains some remarkable tables of figures which, if read by those who understand—and I must repeat, "by those who understand"—can give some very interesting indications of what we should look for as to the needs of the future.
§ The tables undoubtedly demonstrate, as all of us have always claimed, that the number of meals should increase. But I would draw your Lordships' attention to the fact that the figures are already nearly three years old and, moreover, that those figures have given base to a statement made by those who collated them which has already been disproved. The recommendation reads, as I understand it, that voluntary organisations would not be able to undertake further expansion and that, in consequence, the responsibility for the provision of "meals on wheels" should be placed on the local authorities. This statement was made from information gathered two and a half years 527 earlier, and facts have proved that it was a completely and utterly incorrect forecast.
§ The facts are that during the last week of June, 1958, 28,662 meals were delivered by the W.V.S., and during the last week of 1960, the figure had risen to 48,096. The number of schemes operated in 1958 by the W.V.S. was 347, and in 1960, 580. This would demonstrate that the scheme can be expanded through voluntary organisations, but this expansion cannot go forward at the rate it should do if the equipment with which to carry on the scheme is not available. In the 580 schemes we operate to-day, we are delivering 2½ million meals a year. The number of meals delivered in 1956 was 1,072,590; in 1957, 1,244,167; in 1958, 1,518,751; in 1959, 1,885,898 and in 1960, 2,308,770.
§ Few people can realise the infinite trouble and care that had to be taken in order to raise that number, little by little, to where it is to-day. These figures are kept centrally by the organisation to which I belong, being sent in by every locality via the region, and the backing in difficulty and the overcoming of troubles and problems has been a labour of great intensity and one which has required much patience. The meals are produced in a variety of ways. The sources include industrial canteens, school kitchens, cafés and cooking by volunteers in their own kitchens and, ideally, in a "meals-on-wheels" kitchen. Meals vary in suitability, and it is generally felt that only where there is a kitchen which is specially provided can the cooking and the menus be planned entirely to suit the recipients. We endeavour to provide as balanced a meal as possible, having regard to the likes of the recipients and, of course, to the cost. It is not possible to cater for exact medical diet, but a great deal of trouble is taken to give the persons who want it the sort of food that will be adequate and right for them.
§ At the start a number of schemes were delivering too few meals per person per week, and this was emphasised in the survey made for the Nuffield Trustees. The situation since then has improved, but there is still much room for further expansion. Owing to the hygiene regulations which were enforced in 1956, it 528 became imperative that meals be delivered at a certain temperature and, in consequence, it was necessary to acquire insulated equipment, which is very expensive. Insulated equipment has proved the answer to the delivering of the hot midday meal, and it is of paramount importance to have the right equipment if you are to deliver the hot means to the recipient.
§ Meals are delivered in a variety of ways: by car, by van, by bicycle, on occasion by pram, in one or two instances by wheelbarrow and sometimes on foot. The major cost of the whole scheme lies in the distribution, and this means transport. And in this regard it is interesting to note that an analysis of our own methods of delivery of "meals on wheels" shows the proportion of vehicles employed to be 50 per cent. vans and 50 per cent. private cars lent and driven by volunteers. Generally speaking, the vans are much more used in built-up areas and take up to 40 meals per round, which can be delivered in the required space of time of approximately one and a half hours. But the more scattered rounds are generally done by private cars, carrying twelve meals each, in equipment specially devised. The need in rural areas, where good neighbourliness exists to a greater degree, cannot be compared with the need in larger cities; but, nevertheless, it does exist. Routing has in every event to be carefully planned and supervised, and instructions have to be written out clearly and carefully, having been worked out with the utmost thought and with real care being taken in regard to both mileage and to check on waste.
§ Recipients are contacted through the health and welfare services of the local authority, including health visitors, district nurses and home helps; and througi hospital almoners, doctors, National Assistance Board officers, and those people who are in a position to recommend where investigation should be made—in fact, anyone whose work takes him or her among the elderly, the sick and the infirm in their own homes. I many areas all names received are passed to a department of the local authority, which means that they can keep in touch with the individuals and enable them to be assisted by any of the welfare services of which they are in need. The "meals on wheels" organiser has the responsi- 529 bility of reviewing the lists at stated intervals to ensure that nobody remains too long on the list if he or she no longer qualifies for the meal.
§ Voluntary organisations throughout Great Britain help financially, by giving equipment, as well as by assisting with transport. Industry and commerce have helped tremendously by either subsidising the meal, if obtained from the factory canteen, or subscribing towards a van or presenting a van outright. Members of women's organisations have helped not only as volunteers, but financially; and in this way, whether it be in driving or in delivering the meal, in cooking or in the staffing of the kitchens, in helping with the accounts or in peeling the vegetables, the contribution of Abe different volunteers who are ready to work within the community becomes something tangible in a service for those who require it.
§ My view is that if "meals on wheels" can be made into a real domiciliary service we can look to a future in which it will be unnecessary for as many people to be institutionalised as are at present, and in which those who wish to remain in their own homes will be helped to do so and to see out the rest of their lives in their own homes with their "bits and pieces" about them. We are in an age when people are looked after in so wonderful a way, due to the discoveries of science, that life is extended longer and longer. But it seems to me—and I say this with great sincerity—that mere extension of life without participation in living and the enjoyment of those things that make living worthwhile is not the only object one should have in mind. I should like to be able to think that, by supplying sufficient domiliciary services to those who require them, we can give to the persons who really need it an opportunity of living their lives out in that place in which they would like to be, instead of its being decided for them that, because their ageing bodies have reached a certain stage, they must live out the remainder of the time that that extension provides in a place which they neither wish to occupy nor desire to end their days in.
§ I have had some experience in the field of voluntary service, and I would affirm that to-day more voluntary service is being given in the country than ever before; and I would also state, without fear of contradiction, that 530 that voluntary service is being given by a greater number of people than before, in a greater variety of ways. If I am right—and I very much hope I am—then we need have no fear as to how voluntary workers will be found in the future. But because we live in an age where streamlining is the order of the day, and where the orderly progression of work on a planned basis is expected, it is necessary to integrate the service of volunteers into the work of local authorities. The scheme is complex to handle, because it entails so many things: the checking of the recipient; the delivery of the meal; the content of the meal; the period of time over which the meal should be delivered, and the finance and the continuity. Yet all of us who are engaged on this work love it because we are constantly realising the fact that it seems to reach the human being who really does need the assistance it brings.
§ The volunteers themselves are an interesting collection. Amongst the drivers you will find an ex-postman or a no-longer-serving admiral; a man who used to be on the delivery van of the coal merchant and a policeman or a fireman working off-duty days; women of leisure and women of no leisure; academic and housewife, professional and very humble, making the time by real self-sacrifice to do the job. Some of them work regularly; some of them work once a week and some work once a fortnight. And the same applies to the "mates" who deliver the meals. You will find side by side a person from a very comfortable, and indeed sometimes luxurious, home working as the "mate" to an old-age pensioner who is extremely hard up but has the liveliness and the attraction of being a member of the Cockney fraternity and, therefore, of being able to provide a very special contribution.
§ The volunteer who works on this sort of scheme is one who becomes dedicated very quickly because of the type of service she or he is giving. As they see the recipient and realise the situation in which that person is placed, they immediately begin to feel that there is nothing they would not do to help; and, because they are briefed to take note of what could be done in addition to the delivery of the meal, little by little a very great 531 deal of individual service can be provided to the individual recipient. However brief the visit, it is often an important factor in the day of the person receiving the meal, who may be alone for the rest of the 24 hours. Members delivering the meal obviously cannot stay to talk, but they are able to see what is wrong and report back to the centre so that appropriate follow-up can take place. And whether that follow-up be a regular visitor or books to read; a little gift of flowers or a doctor to call, reporting on a person who is obviously in need of attention or, most often, a district nurse to come and appraise the situation, a tremendous amount of local work is done with a minimum amount of fuss and flurry.
§ I have often been out on a round as a "mate", and once when we were delivering meals in the East End of London the recipient was an old and far from clean man. He looked at me and in a very irritated voice said: "You are six minutes late"; and then, giving me a second and even more disgusted look, he said: "And you are the wrong one, anyway". This quite obviously shows that there is a regularity in the delivery of the meal, and it also shows that there exists a "right one" to whose coming the old man really looked forward. If this be so; if, in fact we, the men and women who are working on this scheme, can in due course make something which is good enough to serve the people, I believe that a very useful domiciliary service could be added to the valuable ones that are already functioning.
§ Many of us, looking into the far distance, see on the horizon a life for people Where there will be little need for institutions and much opportunity for living and dying in one's own home. This is a hope which demands much work and very careful approach, as well as a great deal of patience in that approach. What we hope in the long view is that ultimately the home help will come in and do the domestic work for such people as are unable to look after themselves. She, in turn, would be backed by the "Meals on wheels" service, bringing a hot midday meal to those who are homebound or bedridden. This would, of course, be in support of that most wonderful of all people, the district nurse, who is the most reliable 532 and the most loved person in the community, and who comes second in value only to the doctor.
§ If this vision is right and could be implemented, then the comforts which, through a variety of circumstances, life may deny to the sick or the ageing person can be supplied in the community in a way Which would make life livable right up to the end instead of making it a heavy burden and a tragedy for so many people. It has been put on record for all time by a great master of the fates of the world that this country would undertake and carry through a seemingly impossible task if the tools were forthcoming. We, the workers in "Meals on Wheels", can do no more than humbly imitate him and ask for the tools. My Lords, I beg to move for Papers.
§ 3.12 p.m.
§ LORD LATHAM
My Lords, I am greatly pleased to have the opportunity of supporting the Motion which has been moved by the noble Baroness, Lady Swanborough, in a moving and impressive speech. She has raised a question which is one of the problems affecting the inarticulate aged. The "Meals on Wheels" Service is another attempt to meet one of the problems of old age. In the later nineteenth century, and early in this century, conditions were such that they could perhaps be described as the age of poverty and wretchedness. The problem then was not so much age, because in those days, which have been described as consisting of "dark and Satanic mills," on the whole people did not live long enough. Now, of course, happily, and very creditably to this country as well as to others, the span of life, as the noble Lady has said, has been much extended. But problems emerge, and now in many cases the problem that faces us is the poverty of age. Instead of being able to enjoy that sense of security and serenity in the eventide of life, for many thousands of old people it is in a very real sense—and one must unhappily admit it—a mere extension of wretchedness and loneliness: many of them unable to prepare the meats which they need; many of them without relatives and friends; homebound and alone. And loneliness can be a very terrifying circumstance.
533 Fifty years ago, the then Prime Minister of this country, Sir Henry Campbell-Bannerman, said that there were 11 million people living below the poverty line; and in those days the poor had a mortal fear of the workhouse. Now, many of them fear life itself. As I think the noble Lord, Lord Beveridge, said on one occasion, we have reached the stage when it is difficult to afford to be old, and that, unhappily, is the case with many of the aged in this country. "Meals on Wheels" is a service to provide, as the noble Lady has said, food and maintenance at the homes or where the people reside, other than, if it can be avoided, in institutions. These meals are mainly provided, with assistance from local authorities, by the local voluntary old people's welfare organisations and, notably by the Women's Voluntary Services, of which the noble Lady is the renowned head. But the expansion of this service, which is so valuable, is held up, I understand, for want of funds, equipment, and other necessary elements and requirements.
As I gather, the purpose of this Motion is to urge the Minister to grant powers generally to local authorities to assist and subsidise (if you care to use the word) voluntary organisations in carrying out this service. The noble Lady referred to the situation in London. As I understand it, "Meals on Wheels" services in London operate in each of the 28 metropolitan boroughs, but not in the City of London. The services are mainly provided by voluntary local old people's welfare organisations and, as I have said, by the Women's Voluntary Services and the British Red Cross. Under the powers of Section 31 of the National Assistance Act, 1948, the London County Council subsidises all dinner meals supplied by approved voluntary organisations to old people living within the administrative county, and there is a scale of subsidy. The borough councils exercise their powers in this behalf under Section 31 of the 1948 Act, making contributions towards the general cost of running the meals services—namely, to meet the cost of transport, wages, hot containers and other equipment, precisely those elements which are needed, and which were referred to by the noble Lady.
The borough councils of London have power to do this under Section 31, which runs as follows: 534A 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.The conjuncture of those two elements in life is perhaps rather entertaining. The "local authority" in this section includes the London County Council, the City of London and the metropolitan boroughs. During the financial year ended the 31st March, 1960, a total of 877,000 midday meals were supplied to old people in London under the scheme, including those which were served in luncheon clubs. As a tentative estimate, it is thought that those served under the "meals on wheels" scheme represented rather more than half that total. But one thing should be said, I think: that the London County Council estimated expenditure under this head for 1961–62 is some £50,000. It should be clearly understood that "meals on wheels" for old people must be distinguished from the delivered meals provided for many years past by "Invalid Meals for London". This is a voluntary body which provides special-diet meals for invalids of all ages, and for many years it received a grant-in-aid from the L.C.C., through its health committee.
As I understand it, there have been conversations between the local authority associations, the London County Council and the Minister with a view to giving all local authorities the same powers as are enjoyed and operated in London, including power for the local authorities to provide directly meals for old people. It was proposed in these conversations, as I am informed, to amend Section 31 of the National Assistance Act, 1948, to which I have already referred, under Which the borough councils of London and the L.C.C. at present operate, so that it applied to all local authorities. Discussions took place. There were apparently differences of opinion as to whether the Minister could reasonably ask that his approval should be sought in regard to the measure of charge to be made in respect of the meals supplied to persons already under benefit from National Assistance and in other cases. The local authority associations and the L.C.C. took the view that that was not a matter in which the Minister could properly claim to exercise control, and, so far as I can ascertain, the discussions broke down, and 535 nothing has been heard by the local authorities' associations or by the L.C.C. for about twelve months.
The position therefore remains that the local authorities are without this power. I suggest that, in a matter of this kind, the Minister should resume these discussions without delay and should not allow some peccadillo of status or administrative rights, or that kind of thing, to stand in the way of meeting the pathetic needs of these old people. After all, we must not allow these people to suffer and go hungry because of administrative disagreements. I have taken part in many administrative disagreements, but I hope that I have never been regardless of considerations of the kind which exist in respect of these old people.
What is the use of building one-room accommodation for these aged persons, at great cost, if the occupant is to go hungry because he or she is homebound? The consequence can, of course, be that these unfortunate people are driven into institutions, whereas, quite properly, in this country we are moving away from institutional provision. To take only the material point of view, the cost of providing accommodation in institutions is immense, and for the want of a, relatively speaking, small expenditure of money by the local authorities this additional cost of providing either single-roomed houses or flats, or institutions, would be avoided.
I hope that as a result of this Motion, and the discussion which is to take place in your Lordships' House this afternoon, the Minister may be moved to agree that local authorities should have the power to subsidise and provide equipment and transport, and things of that kind, in connection with this service, and that they should be encouraged so to do. It is a humanitarian service to these aged people among us who are homebound, so that they may eat in their own homes, as the noble Lady has said, and, with the aid of the other welfare services properly and very worthily provided by this country, may live out their remaining years in comfort and in happiness. I sincerely hope that the Minister will take a humanitarian view of this problem.
§ 3.28 p.m.
§ LORD AMULREE
My Lords, before adding what few words I am going to 536 say in support of the Motion so well moved by the noble Baroness, I feel that I must first declare a certain interest in regard to myself. In the first place, I am one of the Governors of the National Corporation for the Care of Old People, which was the body working under the Nuffield Trustees who arranged for the survey on "meals on wheals" to which the noble Baroness referred.
The second interest I have is that I was until the end of 1959 the Chairman of the body to which the noble Lord, Lord Latham, has referred, Invalid Meals for London, which has now become the responsibility of the London County Council. We did not take part in the survey to which the noble Baroness referred, for several reasons which I should like just to mention to your Lordships. In the first place the Invalid Meals was an entirely different service. We employed a wholly-paid staff: we served a large variety of special diets to people and we did not confine our attention to old people. Therefore, it did not seem a really comparable service to the "meals on wheels" which we have been hearing about.
The third interest I should declare is that I was until last year the President of the County of London branch of the British Red Cross Society, which again supplies meals in a number of boroughs of the County. There is one thing on which I think we shall all agree: that the "Meals on Wheels" service is the third great pillar in the tripod which serves to keep people in their own homes, the other two being the Home Help Service and the Home Nursing Service. If there is not a good meals service as well, it is difficult for those other two bodies to do their work properly. That is why I think one must give such great praise to the voluntary organisations and, in particular, to the W.V.S., for the way they started the "Meals on Wheels" service, and have maintained it and continue to give such a fine and expanding service.
But I should like to change the line of the debate a little and put to your Lordships some views of my own about the way I think the meals service should be run. I did, in fact, commit myself, with the assistance of one of my colleagues on the Invalid Meals service, in a short article which I wrote in the 537 British Medical Journal in the summer of 1958, and, so far as I can see, nothing has occurred since then to make me change radically the opinions I gave then. It would seem that there are two categories of persons who require meals in their own home. One, quite a short-term service, would deal with people who have been sick and require a meal to be brought in while they recover their strength—they may have been in hospital or sick in their own homes. It can be a great advantage if a short-term meal service is available so that they can recover before once again beginning to shop and cook for themselves and their families.
The second, which is really the more important, concerns the long-term cases. Again, I think they can be divided into two categories, the first being those who require for a long time, may be permanently, some special diet to keep themselves fit and to prevent their health breaking down and their having to require treatment or long admission to hospital. They would be people suffering from diabetes and gastric complaints and others who sometimes find it difficult to prepare suitable meals in their homes. If they could get a meal, provided by some body, which would comprise a suitable diet, it would be a good thing for them. Then there are the types of people who, because of frailty and infirmity generally, find it difficult to provide suitable meals for themselves in their own homes. From what I have said, your Lordships will see that I have in mind a comprehensive service which should be available on five days a week comprising both special and normal meals. It does not mean at all that every person taking a meal will want one on five days a week, but it should be available for those who do.
When one comes to the old people, I think it can be said—indeed, the noble Baroness mentioned this—that some will require special diets to fit their own particular wishes or diseases. One most interesting thing which emerged during the last full year when I was concerned with the Invalid Meals service, the year 1958, was that about a quarter of the people who were served with meals were under 65, which is quite a large percentage of the total. We also found that about half of the people over 65 who were recommended for meals by their 538 doctors or by hospitals required some kind of special diet. Some diets were not very complicated, others were quite difficult and complicated, such as diabetic diets for diabetes, diets for people with gastric trouble, various diets for heart diseases and so forth. So there is a good case for saying that a meals service requires some sort of medical background. In a great many cases people would be recommended to it by their general practitioner.
I do not want to be too insistent on the medical side, but. I think there must be a medical background to it. As the noble Baroness said, the meals must be recommended by a responsible person with some knowledge of the requirements of the individual concerned. At the same time, in conjunction with the services there should be someone having some knowledge of nutritional values and experience in planning well-balanced diets. I am sure the noble Baroness would agree with every word I say in that respect. The voluntary organisations have continued to provide this very good service for a long time. It is now expanding, but one wonders whether, as the noble Baroness said, it can continue to do it for much longer without some assistance from the local authorities.
I should like to support the noble Baroness in her plea that the local authorities should be empowered to provide equipment and encouraged to work with the voluntary organisations. At the same time, suppose there are parts of the world—after all, parts of the world vary; they are not all perfect—where it was not possible to obtain volunteers. Then, I think the local authority should be able to employ people to carry out some such service as I have suggested. At the present time one trouble as I think the noble Lord, Lord Latham, mentioned, is that there is a certain difficulty about the somewhat rigid lines of demarcation between Section 28 of the National Health Service Act and Section 31 of the National Assistance Act. Section 28 of the National Health Service Act enables local authorities to look after the care and after-care, among other things, of people who have been sick, or to prevent them from becoming sick, whereas under Section 31 of the National Assistance Act a local authority can contribute to the funds of a voluntary organisation supplying meals.
539 That we have heard before, and I do not want to go into it again, but I wonder whether it would not be more satisfactory for all concerned if a comprehensive meals service, such as I have described, were to come under Section 28 of the National Health Service Act. I think it has been provided by one or two local authorities under those powers, and one would like to see that power encouraged among other local authorities, because it brings the whole thing under the health committee of the council. Surely the provision of meals is primarily a health, rather than a welfare, function. If that is not a matter of general agreement among your Lordships, certainly it is my own opinion and I think it should be looked at in that way.
If I remember aright, a Private Member's Bill was introduced twice into another place to enable the National Assistance Act to be amended. I am afraid that Bill did not get very far; I do not think it even received a Second Reading, but I am not quite sure about that. It certainly did not proceed further than that stage. One is rather sorry that nothing more was done to take its place. I think I am right in saying that there was at one time some suggestion that Her Majesty's Government would introduce legislation to enable local authorities to provide meals—under what powers I do not know, because no Bill has ever appeared. I think the noble and learned Viscount, in answer to a Question by myself—
§ LORD LATHAM
My Lords, if I may intervene, I think it will be found that the Government intended to amend the National Assistance Act, 1948, in order to confer this power, but they have not done so.
LORD ST. OSWALD
My Lords, if I can assist noble Lords about this, I think that what the noble Lords are referring to is a Parliamentary Question in another place addressed to my right honourable friend at that time—that is to say, in November, 1959—in regard to which the then Minister of Health gave an undertaking to study the possibility of bringing in legislation for this purpose.
§ LORD AMULREE
My Lords, I should like to thank the noble Lord for reminding me of what occurred. That really covers most of what I wanted to say. I should like to conclude by continuing my plea that the service should be a part of the National Health Service, because of its enormously important preventive effect. It helps people to get fit in their own homes; it prevents people from collapsing, physically and mentally, and having to be removed to hospital, and it will take care of them when they come out. It will enable a larger number of people who want to be discharged from hospital to be discharged. Frequently they cannot be so discharged because the services are not available for them when they wish to go to their homes. As the noble Baroness said, the service can be a very costly one, and therefore it should be possible for people who can contribute to the cost to be asked to do so; but a large number of people are unable to do so and they should be provided with such meals, too. With those few words, I should very much like to support the Motion of the noble Baroness, and I trust we shall get a favourable reply from Her Majesty's Government.
§ 3.40 p.m.
§ LORD MERRIVALE
My Lords, the noble Baroness, Lady Swanborough, has raised an important matter to-day, and a very worthy cause, for it affects the daily lives of those who are less fortunate than ourselves and who, in the main, have reached the twilight of their existence. The Motion refers to those who are homebound, often because they are physically handicapped by weakness or blindness and also, in many cases because they are alone. Although I have not yet reached the age when one lives entirely on one's memories, I can appreciate the fact that loneliness can be one of the worst ailments of old age. That, coupled with the need of the aged for care and attention, are the reasons why I warmly support the noble Baroness's Motion to-day.
As other speakers have mentioned, Section 31 of the National Assistance Act, 1948, empowers local authorities to make grants to any voluntary organisation towards recreation or meals for old people; but the operative word in that section is "may" and not "shall". 541 I hope that to-day's debate will serve the purpose of highlighting in the minds of all members of local authorities the great importance of "meals on wheels" and also—and I think this is an important point—the valuable part that this service can play in the daily contact that exists between the voluntary worker and the recipients of these meals. The Outlines of a Survey on the Meals on Wheels Service published in October of last year gives a number of facts, figures and statistics, and I am glad that it stresses, too, the social value of this service. Can one be surprised that the Governors of the National Corporation for the Care of Old People should state in the foreword to their Report that a service of this kind should be available to all those who need it, when it is mentioned in this Report that over 25 per cent. of the recipients of these meals have no other visitors whatsoever during five days of the week: and these are all homebound elderly persons? Can one imagine the loneliness any person can feel, to be alone and homebound for at least five days in every week? I believe that that is a very important aspect of this service.
I do not agree, however, with all the recommendations of the Report. The noble Baroness mentioned one, but I should like to quote a particular paragraph with aspects of which I do not agree:It would seem that the possibility of voluntary organisations being so expanded as to meet the full demands of all older people in need of 'meals on wheels' is doubtful since the number of meals needed would be a minimum of four times the number at present served.I think one can discount those remarks if one considers very briefly the figures given by the noble Baroness, in which she showed the rate of increase in the number of meals supplied by the Women's Voluntary Services, which I believe is the most important voluntary organisation in this country. They serve 77 per cent. of all the "meals on wheels" and contribute to a further 9 per cent. of the other meals supplied to recipients of the service.
On the other hand, there are parts of the Report with which I am in complete agreement. I am very pleased to see that the Report mentions the fact that most local authorities are prepared to give some aid to voluntary "meals on 542 wheels" schemes, for instance in the form of subsidy. But it would seem to be more difficult to obtain from local authorities capital grants for transport, equipment and kitchens. I understand that while, in the London area, the amount of subsidy provided by the London County Council to the metropolitan boroughs is 1s. per meal, Lambeth Council, for instance, pay only 10d. towards the meals, the recipient paying another 10d. I might add that an extra 2d. provided by the local authority (that is, the Lambeth Borough Council) would assist the voluntary organisation to provide meals of better quality, quantity and variety.
In that area the meals supplied by the voluntary organisation are obtained from the Vauxhall Café. Your Lordships may be surprised that I mention the name of a commercial undertaking supplying these meals, but I do so because it is a commercial undertaking; and I spoke to the proprietor and was most gratified to see that she was a person who takes great interest in her work and, with only 1s. 8d. for each meal, does her utmost to provide first-class meals. To me they seemed very appetising. For instance, on the day I visited this restaurant there was fried fish and chip potatoes, as well as a pudding, being served for the "meals on wheels" service.
§ LORD MERRIVALE
No, I am afraid I did not, but I should have been very pleased to partake of such a meal.
§ LORD MERRIVALE
Last month, for instance, the total number of meals delivered in that area by the voluntary organisation—that is, the W.V.S.—was 2,356. That may be only a small portion of the total number of meals supplied, but it shows the number of meals that are supplied all over the country by the 580 schemes provided by the W.V.S.
I should not like to weary your Lordships with personal experiences, but I wish to refer to a few visits I made to the elderly recipients of these meals. I should particularly like to mention four visits I made. All of them were to old 543 people between 70 and 80 years of age. One poor old lady, living alone, could not come to the door because she lived on the first floor and the flight of stairs was too steep, and, in spite of the fact that she walked with the help of a cane, she was very unsteady on her feet. When I called she was a little disappointed that it was not her regular W.V.S. caller, but, all the same, she was delighted at the opportunity to speak with somebody who could take an interest in her welfare and in her wellbeing.
Another poor old lady living alone in a top-floor room pathetically explained to me that she was blind that day; that was the day I called. She tried on both of her pairs of spectacles which were on the table, because, although she told me there were days when she could see a little, on that day she could not see at all. She had tried both pairs of spectacles but could not see at all. It was pathetic, seeing this old lady who wished to see but could not; and she lived alone on this top floor. Another elderly person I visited was delighted to have a visitor, and she was particularly keen on showing me her room where she had accumulated an assortment of personal effects throughout the years. I could not help but notice some framed photographs of soldiers. She told me that they were photographs of brothers of hers, now dead.
Finally, I would mention one more elderly person I visited, because she was living in a basement; and a very dark basement, too, I might add. As one crossed the threshold of the front door, in spite of the fact that it was midday it was completely dark inside. Although when one went into the kitchen it was not quite so dark, it was still a very depressing place to live in. What struck me was that when she opened her cupboard to fetch a plate it seemed a depressingly bare cupboard, and, after that, when it was pointed out to her that she also needed a spoon, she seemed very hesitant as to where that spoon was. My Lords, I mention these facts purely to show, and I hope I have stressed (although your Lordships are no doubt well aware of it), that these elderly people do need help. They need people to take an interest in them and they need people to visit them. They 544 also need to have somebody to speak to and to feel that somebody can take an interest in their wellbeing.
It is particularly sad when one is dealing with people who are incapacitated. It is bad enough to be poor, but if also you are homebound it must be a very sad thing to end your life in that manner. Therefore, I think that anything we in this House can do towards urging Her Majesty's Government to stress this fact to local authorities should be done. Although I well know that they must be aware of the fact, as they cater for these elderly people, anything we can do should be done, and I must say that I hope the maximum will be done.
In conclusion, I trust, as I have just said, that Her Majesty's Government will give their full support to schemes demanding capital grants for the acquisition of the appropriate equipment whenever it is required; that is, for transport facilities such as have been asked for by the noble Baroness, and kitchen facilities and cooking facilities provided by the local authorities, whenever it is practicable. In some areas it may not be practicable at all, owing to shortage of space, but there must be areas where space could be allocated for kitchens to be set up so that these voluntary organisations could operate them on a voluntary basis. I mention that I should like to see the voluntary organisations operate these schemes, more so than the local authorities, because I think there is then personal contact between those who are served and the voluntary worker, somebody who is doing it purely out of feeling for his or her own countrymen or countrywomen. It is not a paid job and the voluntary workers do it because they feel they want to help others who are not so well off as themselves or who are in a more sorry plight. That is why I think that when somebody is doing it for a salary one cannot get the same personal feeling into the job. I sincerely hope that local authorities will appreciate that fact.
§ LORD LATHAM
My Lords, I hope that the noble Lord would agree that the servants of local authorities are not entirely bereft of human characteristics and human desires.
§ LORD MERRIVALE
No; I would not in any way believe they were at all: 545 it would not enter my mind in any way whatsoever. But I feel that one is more inclined to take an interest in someone else when one is not doing it for a salary. My Lords, with those few remarks—rather disjointed remarks, I am afraid—I warmly support the Motion of the noble Baroness.
§ 3.58 p.m.
§ LORD TAYLOR
My Lords, the noble Lord, Lord Merrivale, has been out and seen for himself what this problem is like, and I am very glad that he should have been and should have told your Lordships, because he is absolutely right. It is a very real human problem, and when you go and see what is happening in these homes where "meals on wheels" are being served you realise not only the value of the meals but the value of the warmth of human contact and friendship which goes with them. He reminded us that the Motion refers to the homebound. It does not make a ha'p'orth of difference if those people are homebound because they are old or because they are sick and not old: the problem is the same, except where a special diet is required, as the noble Lord, Lord Amulree, has reminded us. Special diets may be required by people who are old or young, whether they are under or over 65, and these are, therefore, really two separate problems.
One problem is that of the person at home requiring a special diet because he or she is diabetic or suffering from heart trouble or gastric trouble, as the case may be. That is a more specialised and more difficult problem. The second group are the homebound folk, whether homebound because they are getting old and very frail, or because they are suffering from some awful chronic disease of youth. Of course there are a number of folk like that who may be homebound in their 30's or 40's or 50's, and just as much in need of help and meals at home as are the old folk.
The great issue which the Motion puts before us—it is one which I think we ought to look at quite clearly—is whether this work should be done by voluntary organisations or by the local authorities. This is an exceedingly difficult problem to resolve, because both do excellent work. Sometimes one has a feeling that it is the voluntary bodies that do the better work, and sometimes vice versa. Let me give a few instances.
546 We have the situation of the Queen's Nurses—the home nurses to whom the noble Baroness referred. In some cases they are still run by Queen's Institutes, with a 95 per cent. grant from the local authorities; in other cases the local authority have taken over the Queen's Nurses and run them as a home nursing service, as a part of their public health services. Now it is very difficult to make an objective decision as to which is the better. I have a sort of "hunch" and feeling that I liked best the old Queen's Nursing Service, but I may be wrong. I know that there are many areas where nothing would have been done without the local authority's effort, and it would be quite wrong to stigmatise either the voluntary organisations or the local authorities as not doing the job. But I think that, where the job is being done, and is being increasingly well done, to take it away from a voluntary organisation for any reasons of statutory tidiness is a great mistake. I think that the W.V.S., and the other voluntary organisations, on a much smaller scale (because the great bulk of this work is done by the W.V.S.), have proved not only that they can do the job, but that they can do it increasingly, as is shown in the Report from the National Corporation for the Care of Old People.
Incidentally, this Report is based on a survey carried out by an organisation which I helped to build during the war—the Government Social Survey. This organisation was commissioned by the Nuffield Survey to do this excellent investigation, and the field work and the conclusions of this investigation are extremely interesting and extremely valuable. However, this Report has tacked on to it some recommendations which, as the noble Baroness, Lady Swanborough, has said, have been proved false by events. It so happens that the sociologist who did this job did not realise that the voluntary organisation could expand to deal with the situation as it has done.
One of the things I tried to find out when I read this Survey was what was the total demand for "meals on wheels". I think that at the time the Survey was being carried out there were about 20,500 people getting "meals on wheels". The Survey calculated that, assuming there was in every area an organisation giving "meals on wheels" 547 and that in those areas where there was no demand there existed the same demand as in the other areas, about 38,000 people would need "meals on wheels" throughout the whole country. I was very interested to hear what the noble Baroness, Lady Swanborough, had to say to-day, when she said, I think, that they have reached 48,000 meals a week. That is a very good achievement. Again, if your Lordships read this Survey, you will see that most "Meals on Wheels" services can manage only one meal a week, which is a great pity. The work must grow from that; the number of meals supplied must become two, three or four a week—and I am sure that it will. I am sure that it is simply a matter of building it up and getting it going. I think that the growth which has been achieved in the past two years is so spectacular that it would be a shame if the voluntary organisations were to feel that the better they did the work the more likely they were to lose it. That is a terrible and sad state of affairs, and is no incentive to do it well.
Now the Motion asks that… local authorities should be authorised to provide kitchens and other equipment and facilities for voluntary bodies …".I wonder if this is really needed, or whether, in fact, the power is not already available, provided that the Act is interpreted liberally. I do not think fresh legislation is needed. I think that what is needed is a "tough" directive from the Minister of Health or the Minister of Pensions, as the case may be, saying that it is within the local authorities' power, of course, to provide kitchens, transport, containers and so on. I think that that is all that is required.
One last point, my Lords. Judging from this Survey, the noble Baroness has had greater difficulties in certain types of areas. It looks as though it is hardest to get recruits for voluntary services not in the very poor areas but in the moderately poor areas—I see that the noble Baroness indicates what I take to be dissent. But I think that these areas are a "tough nut"; and if she has succeeded in the Islingtons as well as in the even poorer boroughs, then I think it is an amazing achievement. I hope—in fact I feel sure—that she and her organisation will be directing their attentions to making sure that they have 548 achieved a nation-wide coverage, with a pin-pointing of the bad areas and the difficult areas. So, my Lords, we all wish her well, and the service which she and her colleagues have done so much to create. We wish the local authorities well, and we hope that they will all do as well as the best of them is doing now. If they do that, then I do not think there will be any great difficulty lover the future of the "Meals on Wheels" service, and I am sure that old people everywhere will be appropriately grateful.
§ 4.7 p.m.
§ LORD AMHERST OF HACKNEY
My Lords, I should like wholeheartedly to support the Motion moved by the noble Baroness. I do so for two main reasons: first, because I think we are all convinced that the "Meals on Wheels" service makes a useful contribution to the care of the housebound; and, secondly, because where voluntary bodies are carrying out a worthwhile job and are carrying it out efficiently I feel that they should be given every possible encouragement.
On the question of the need and usefulness of the service, we have heard a lot to-day; and, of course, there is a lot in the Report on the "Meals on Wheels" service, and many examples have been given. I think that one quite interesting figure in the Report is that, of the recipients, 50 per cent. of the women do not get, on the days when they do not get the "Meals on Wheels" service, what the Survey considers to be an adequate meal. Of course, the importance of this service has again been recognised in Circular No. 10 of 1961, issued by the Ministry of Housing and Local Government, in which, in paragraph 13, on the subject of the provision of meals, local authorities are advised to consult with the voluntary bodies when building houses and accommodation for old people. That shows the importance which the Government attach to this side of the work.
As has been said, however, the schemes in existence cover only a small part of the population. The figure of the need has been given as being 6 million, and it has been said that in 1958 only 1¼ million meals were provided. The figure has, of course, gone up very considerable since then; but even so we all know that there are large areas which 549 are not at present covered. So the pro-lem that faces us is bow those meals are to be provided. We must, I think, differ from the survey when it says that the voluntary bodies were at that time extended more or less to their limits. The noble Baroness has given many figures to show how wrong was that forecast—and very striking figures they are.
Although the rise in the number of meals has been so spectacular, there are the difficulties which have been mentioned. One is not surprised that the voluntary bodies are coping with them so well, because it is, I think, quite extraordinary how many people there are in this country who, when there is a really worthy cause, are prepared to give of their time, particularly to serve it. After all, when you give a pound, how much it hurts you depends very much on how many pounds you have. But time, for all of us, is limited; and therefore I think time is one of the greatest things a person can give in service to his neighbours. I feel that the local authorities who are being assisted should be given every encouragement to supply the tools for which the noble Baroness has asked.
There is a tremendous difference between the attitudes of local authorities. As the noble Baroness has said, many provide practically the whole cost of the service. There are some who make only a token contribution, although most of them, I believe, are willing to subsidise the actual cast of the meal. Some make grants which cover the equipment as well. But the difficulties are not in the personnel, the volunteers, but in the organisation and supply of meals, in transportation, and in providing containers. I notice from the Report that in 1958 about one-fifth of the meals were cooked in the kitchens run by the various organisations; another one-fifth of the meals were obtained through the schools meals service. The schools meals service presents certain difficulties in that at certain times of the year, during the school holidays, the meals services close down. But, of course, the need of the old person, or the person who is otherwise unable to get a meal, is just as great during school holidays as it is during term times. Therefore there must be a very good case indeed for the organisation itself, whether the W.V.S. or 550 the Red Cross, to run its own kitchen. As the noble Lord, Lord Taylor, has said, it seems that the power for local authorities to supply the equipment is there: what is needed is a definite clarification from the Government of what the powers are.
My Lords, I do not want to add any more to this debate. It is a most important service about which we are talking. It makes use of a great fund of voluntary service, and it is in the interests of the housebound. It is a service which I feel, without any disrespect to the local authority services, can essentially be run on a voluntary basis. I feel that in making a contribution to the equipment of this service local authorities will be doing two most important things. One, as has been said before, is that they would be allowing old people, and people otherwise not able to do so, to live in their own homes. At the same time, by enabling those people to remain in their homes the local authorities will be saving a great deal of money which they would otherwise have to spend to maintain them in institutions. So it seems to me that this Motion, both from the point of view of the old people, the people who need help, and from the point of view of the local authority, is really good, sound common sense. I therefore support it wholeheartedly.
§ 4.17 p.m.
§ BARONESS SUMMERSKILL
My Lords, I wish to make only a few general observations, because I believe this debate has been fairly exhaustive. In the first place I would say this. I am sure the country will be very surprised, as have many of us here been surprised this afternoon, to learn that it is necessary at this stage to iron out the administrative difficulties Which the noble Baroness has so ably described. Personally, I confess I am shocked, and for this reason. In another place, year after year, we have discussed the hospitals bill for the Health Service. I think honourable Members on both sides of that House have endeavoured to make constructive contributions which they believe will enable the Minister to reduce the cost. I, with the concurrence of the last two or three Ministers, have emphasised the need to decentralise the Health Service so far as the hospitals are concerned. The cost of maintaining a patient in a hospital is so 551 great that it has been clear to all those concerned with the administration that, if hospital costs could be reduced, then it would effect a considerable saving.
I think the honourable Members on both sides of that House have arrived at the conclusion that, if a comprehensive domiciliary service could be established, consisting of a general practitioner, a district nurse, a home-help and a meals service, then this considerable pressure on the hospitals from the aged would be reduced. And here I would remind noble Lords that there is only a thin line between senility and a pathological condition. If the aged are neglected, invariably they become pathological, and then there is pressure on the hospitals by the relations. This is happening in every part of the country. It is one of the daily problems of the general practitioner, and it is a poignant problem for the relations. It is a very important matter to them, and they feel that the general practitioner should accede to their request, whereas the general practitioner knows that the hospitals are full. Consequently, year after year we have emphasised in these debates in another place the importance of a comprehensive domiciliary service. Last year we had yet another debate, and on each occasion the Minister of Health has accepted that this approach is the right one.
May I remind your Lordships that the cost of a hospital bed varies from £12 a week to £30 a week, according to the type of hospital? Therefore, when the noble Lady tells us of this modest request for a subsidy to be given universally—modest in the light of the colossal cost of the hospital service—it is truly amazing to learn that there have been administrative difficulties. My noble friend Lord Latham has informed the House that the County Councils Association has written him to say that… nothing has been heard from the Minister about the question of meals for old people in the past 12 months.This astounds me.
Your Lordships will recall that during this year the Minister of Health has thought it necessary to impose extra health charges which the aged have found onerous—that, I think, nobody will deny. We have been told that it 552 has been necessary to impose these health charges, because the cost of the Health Service is so great. Yet this afternoon we have heard put forward from both sides of your Lordships' House the means whereby the pressure on the hospital service could be reduced. And twelve months have been passed and no approach has been made by the Minister to the local authorities. I hope that in consequence of this debate this grave omission of the Minister will be rectified immediately, not only in the interests of the sick but also in the interest of the taxpayers, who are called upon to pay the large sum of money for our Health Services.
Perhaps it is a little unfortunate that this has been an ad hoc debate on the aged with regard to meals, because I am sure that the noble Lady will agree with me that the problem of the aged is not only one of meals. In a debate a few weeks ago, the noble Lord, Lord Beveridge, made a poignant speech describing the loneliness of the aged. I think that happiness for the aged, and for all age groups, can be achieved only if their personal relationships are satisfactory. Not only has this been discussed in your Lordships' House and in the House of Commons; there have been debates upon this throughout the country, and the newspapers have given a great deal of attention to it. The Daily Mirror, which has a wide circulation, dealt with it as "A frank report about a blot on our conscience."
Many people have been stimulated to come forward and help in this problem, like the noble Lord, Lord Merrivale, who must be congratulated on the visits which he has personally paid to the sick and aged. One excellent secretary of a Council of Social Service has told me that she has had grammar school girls, members of the Rotary Club and all kinds of people volunteering, but she emphasised that it is necessary to match the visitor to the old person. I would say to the noble Lady—and I am afraid that on this point I must disagree with her—that when she said that in the domiciliary service, which we are all anxious to help, it might be the home-help who would have to return to cook a meal—
§ BARONESS SWANBOROUGH
My Lords, the noble Baroness misunderstood me. I said that the home-help could be 553 supported—in other words, on the days the home-help was not there, meals could be supplied by "meals on wheels". Financially, it would be too extravagant for the home-help to produce a meal every day.
§ BARONESS SUMMERSKILL
My Lords, I think that this is an important point, because this debate may be read by members of voluntary organisations throughout the country. The point I want to make is that if we are to solve the problem of the aged, there must be somebody who is regarded as a friend by the aged person and who does not necessarily visit in a technical capacity. In view of the fact that the aged are sometimes a little stubborn, are very proud and difficult to approach, and that perhaps the person who brings a meal may be the only one who can storm the citadel of the lonely person in his or her room, the "meals on wheels" visitor might report on the kind of person who would be acceptable as a regular visitor. Even when the noble Lord, Lord Merrivale, who is a handsome man, goes to see an old lady, she looks at him and says that she does not want him and would prefer the W.V.S. lady. I am glad that the noble Lord took that affront in such a nice manner. I think he will agree with me that it is necessary for the aged to have somebody to visit them whom they will regard as a friend and who can help to plan their lives with regard to other visitors.
We must not be concerned only with the physical sustenance of the aged but equally with the provision of, let us say, spiritual pabulum. We could learn much from the East, where it is recognised that social security for the aged is related to the need for close association with the family unit. I do not often appeal to the Churches, but I feel that perhaps the Commandment, "Honour thy father and thy mother", might be expounded a little more in pulpits. I do not believe that in those days this was simply a religious exhortation; it was part of the social code of the East, which would ensure that old people received the kind of protection and care which they crave.
While we have a Welfare State which, in my opinion, is primarily concerned with material provisions, we must take every opportunity to emphasise the over- 554 riding need of every person for satisfactory personal relationships. I think that many of the people who are lonely would even be prepared to exchange a meal for a visit from somebody who could be understanding and thoughtful, and who preferably would he a relation. I believe that the question of meals for the aged is only one part of a much wider problem.
§ 4.29 p.m.
My Lords, this has been an unusual debate in that practically every speaker has said the same thing. I also wish to say the same thing but, having some responsibility for local affairs in the county in which the noble Baroness, Lady Swanborough, lives, I feel that in self-defence, if for nothing else, I should say to her that in Sussex we use the "meals on wheels" service fairly extensively. Over 20,000 meals were delivered in that county last year, the cost of the meal being between 1s. 3d. and 1s. 9d., and the amount of subsidy, including mileage grants, being about 6d. a meal.
I agree that, if Parliament is going to put on to local authorities the task of looking after the aged, it would be wise if it gave local authorities a considerable measure of discretion as to how they should do it. As has been said, we can build communal homes and provide home-helps and we can subscribe to voluntary bodies who provide these meals. It is quite true that a communal home is by far the most expensive and, according to modern science, as we have heard, it is the least desirable. By far the best thing is for old people to be surrounded by their own things and to receive help in their homes, and this "Meals on Wheels" service is a good way of providing such help.
But its efficiency varies from place to place and from time to time. I feel that local authorities should be given discretion to assist in various ways. It is natural that the Government should want to put in some form of safeguard to prevent abuses from creeping in, and I think that anything in the nature of free or subsidised meals supplied off the rates is something in regard to which safeguards are required. Nevertheless, if we apply the safeguards in too strict categories, we may do so in a way that makes it difficult to fit human beings into those cate- 555 gories. There is a distinction between people needing medical care, who come under the hospital board, and people who need care and attention, who come under the welfare services, and a distinction between the health services and the welfare services of the county council. And there is the question of who pays, as between the county council and the borough council.
The noble Lord, Lord Taylor, said that he thinks the power may be there, and the noble Baroness, Lady Summerskill, complains that the power is not there. I do not know who is right; but what I do know is that the matter is too complicated at present. In my county we may be a little stupid, but we have difficulty in wading through this jungle of regulations and law. I think these things should be made clear. I have no special knowledge of the legal side of this matter to suggest how it should be done, but I hope that my noble friend will give us some encouragement that we shall be given a little more discretion to help in this way.
§ LORD TAYLOR
My Lords, before the noble Viscount sits down, can he say whether his county council give grants for capital equipment to the voluntary bodies, or only subsidies for individual meals?
That is one of the points. I think capital equipment has been used by the education authority, but the food was more suitable for the young than the old. I do not think that we find it possible to provide that.
§ EARL WINTERTON
My Lords, may I ask my noble friend to make it clear that when he talks of the County of Sussex he refers to East Sussex and not West Sussex? They are two separate administrative counties. I believe that we in West Sussex have a "meals on wheels" service.
I hope they have. I said that the noble Baroness, Lady Swanborough, lived in East Sussex. I apologise for not differentiating between the two.
§ 4.34 p.m.
§ VISCOUNT BRIDGEMAN
My Lords, I apologise for having come so late to the debate and, for that reason, for intervening, but I do so at the suggestion of 556 the noble Lady who moved the Motion: She, who, if I may say so, wherever practicable, must be obeyed. I am not going to break the excellent sequence which my noble friend Lord Gage tells me has been followed, that everybody has said the same thing. My noble friend Lord Gage is one of our acknowledged experts on local government matters and, as we have heard, he has given an accurate picture of what the problem looks like from the local government level. Coming from Shropshire, I should like to add my plea to what he, coming from Sussex, has said—namely, that the local authorities should be given flexibility by the Minister in the handling of this problem. If I may say so, the problem is more urgent in Shropshire than in Sussex, because there we have country districts with remote cottages far away in the hills. It is a problem which is very hard for a civil servant who commutes from Surrey or maybe Sussex to understand in the way that we understand it when we are snowbound in the hills in the winter. Therefore, our need in Shropshire for flexibility is even greater than that which has been voiced by my noble friend in regard to Sussex.
At this stage of the debate I do not want to go into details, but simply to draw attention (I hope this has not been done already) to two principles which I think are followed out if the "Meals on Wheels" service is promoted and extended. The first principle is that old people or those who are in need should be attended to in their homes rather than be brought into welfare homes and institutions in the towns. Again, I come back to the country. It is one thing for an old lady to be taken from a house to the welfare home down the road; it is quite another matter for an old lady to be taken from her home in the country, before it is absolutely necessary, to a town which she does not understand, to spend the rest of her life in unfamiliar and maybe unpleasant surroundings. In a county like Shropshire we feel that problem acutely. While much more needs to be done, I feel that the answer to that problem is, to a great extent, provided by the service of "meals on wheels." Not only does it provide greater satisfaction to those whom it serves, but if one looks at it from the cold and calculated local government angle I am sure that it is better 557 value for money. Therefore, from both those angles, I feel we should support Lady Swanborough's plea for an extension of the "Meals on Wheels" service.
Then, as long as that "Meals on Wheels" service is operated by the W.V.S., I think that is carrying out another principle, which I would not say is accepted everywhere but is one that I strongly support—namely, that wherever possible a social service of this sort should be undertaken by a voluntary body and should not have to be handed over to the State. I cannot believe that this kind of service, which is so largely personal, is not best done by people who know the district and give their time to the work, maybe making some sacrifice in so doing. If that is so, then the right combination for this work is the voluntary worker in the Women's Voluntary Services going round to the people in their own homes and dealing with the personal problems of the people to whom she takes meals: but—and this, I think, is the right relationship between the voluntary organisation and the State—supported and backed financially in that, with all the encouragement that can be given, by the local authority. The local authority, in its turn, should be provided with the necessary funds, partly by rate-borne expenditure, no doubt, but partly also by a grant from the Government, not merely to assist the finances but as a token that the Government themselves think that this is the right way for the problem to be tackled, are interested in the problem being tacked and are anxious to see this vital part of the social services carried out as it should be carried out in these times. I therefore give my full support to the Motion moved by the noble Lady.
§ 4.39 p.m.
LORD ST. OSWALD
My Lords, there is undoubtedly more than enough material for one debate within the main subject of "Meals on Wheels". So much has been proved in the course of to-day's speeches and in the pages of this Report, the remarkable work of Miss Amelia Harris. There is no call for me to digress, in the course of my reply, from the specific subject under debate. I would only, in opening, ask your Lordships to consider the undoubted boon of a "Meals on Wheels" service 558 as part of what can be done, and should be done, for the comfort of elderly people or people otherwise immobilised and enfeebled, in our own society.
We see the Government's responsibility as existing in three co-ordinated forms. First, there is the provision of suitably designed housing, in the form of bungalows, flats or flatlets, with the service of a resident warden where necessary. An entire debate was devoted to this aspect in another place at the beginning of last month. All I intend to mention to-day are the figures for special housing for the aged. The number of one-bedroom dwellings completed in 1951 was 11,000; in 1960 it was 27,000. The White Paper, Housing in England and Wales, re-emphasises the priority which we give to this demand. Secondly, there is the assistance given through the domiciliary services: home nurses, domestic help, health visitors, sitters-in and others, such as chiropodists, who make life easier for those who, through age or physical incapacity, are limited in what they can do for themselves.
Thirdly, what most concerns us to-day, there is the Government's accepted duty to do all a Government can to ensure the co-operation between the statutory services I have described and those voluntary services provided by people, in whom we have every reason to feel pride as our compatriots: those who, out of the goodness of their hearts, will help in this work by visiting, helping With shopping, bathing, laundering and providing "meals on wheels". The vast majority of those engaged in this kind of work are giving their services free; some without organisation or system, as between neighbours, but many, of necessity, organised—and highly efficiently organised. Not every organisation founded on goodwill has been able to match its goodwill with efficiency. Those engaged on "Meals on Wheels" services, and on the whole wide range of personal services to the elderly in their own homes, back up their generosity with an impressive degree of efficiency. I do not think I should be considered out of order if, at this point, I pay my own tribute, among many, to the W.V.S., that body of which the noble Baroness is the leader and inspiration. The "Meals on Wheels" service is only one of the many to which that body and others 559 dedicate themselves, and all they undertake is supremely well done. It is that particular service of "Meals on Wheels" with which we are concerned to-day.
The recent Report concerning that service has come in for some mild criticism from the noble Baroness to-day, and I, thank heaven!, am not here as any sort of adjudicator on that issue. One thing we are all agreed upon is that the service needs expanding, and we are all seeking the best means of expanding it. Noble Lords have asked, quite reasonably, what the Government are going to do about it; and the noble Lord, Lord Amulree, asked, rather more suspiciously, what had happened to the Government's good intentions declared at the end of 1959, and what we have done to encourage the good intentions of a Member of another place who has twice introduced a Bill to amend Section 31 of the National Assistance Act, 1948. The sequence of efforts, all in the same direction, has been as follows. Mr. McLeavy, the Member for Bradford, East—my own county of the West Riding, I am happy to say—introduced his Bill in 1957, and it reached its Committee stage. He has now reintroduced a Bill identical to the original one, as amended in Committee, which has not yet come forward for Second Reading. I think I am right in saying that it was introduced under the Ten-Minute Rule.
In the meantime, on November 10, 1959—the occasion which the noble Lord, Lord Amulree, has in mind, I think—my right honourable friend, the then Minister of Health, gave an assurance in another place that the Government proposed introducing legislation on behalf of the elderly, with two inclusive purposes: first, to enable local authorities to use their privately run accommodation, and, secondly, to make direct provision of meals. Since then, we have had the very helpful Report of the Government Social Survey, to which great reference has been made to-day. My right honourable friend is now considering, in the light of discussion and of the Report, what will be the best way to give effect to that particular undertaking, and there is no doubt that your Lordships' views as expressed to-day will be of great help in the framing of legislation for "meals on wheels".
560 As the noble Baroness and others have pointed out, there is at the moment some confusion as to what powers the local authorities have under existing legislation to assist voluntary bodies. The main enabling Act is the National Assistance Act, which authorises district councils, as well as counties and county boroughs, to make contributions to the funds of any voluntary organisation whose activities consist in or include the provision of recreation or meals for elderly people. These powers are widely used. In addition a few local health authorities (counties and county boroughs) have included the provision of "meals on wheels" in their arrangements under the National Health Service Act, 1946, for the care of persons suffering from illness or its after effects.
I think that the phrase "suffering from illness or its after effects", is the limiting factor which prevents all cases from being dealt with under the National Health Act. That is what I understood to be the suggestion of the noble Lord, Lord Amulree. I will make myself quite clear on that: I think that that is the limiting factor which would prevent that particular section of the National Health Act from providing an authorisation for all cases. There are, if it is true, discrepancies as between local authorities throughout the country, and I may say, in case it is of any help, that if a local authority requests the Ministry's views of its (the local authority's) powers under an Act of Parliament, those views are always willingly given. Some local authorities, as we were reminded by the noble Lord, Lord Latham, such as the London County Council, have resolved this confusion by private Acts of Parliament of their own.
The noble Baroness, Lady Swan-borough, as well as my noble friends Lord Amherst of Hackney, Lord Gage, Lord Bridgeman and others, have asked us, with everybody's interest in mind, to have the doubts and confusions, where they exist, removed and the situation made clear as to what support can be permitted or authorised. I feel sure that what the noble Lady wants is something more than a mere interpretation of existing law. What we should all like to see is some advance upon what is possible under existing law. My Lords, this undertaking has already been given by the Government. I can assure the noble 561 Lord, Lord Latham (who has explained to me that he cannot be present) that there is no need for my right honourable friend to resume discussions on this subject. He is, in fact, in active consultation about it, and will to-morrow be absorbing, gratefully I know, the advice and encouragement given by your Lordships during this afternoon.
Perhaps I might take a minute or two in setting out what I see as the questions and considerations involved, on all of which we have had guidance and other assistance this afternoon. Our starting point is that the provision of meals to older and other frailer people is one of the welfare services which can contribute most to an independent life in the community. At the sane time, meals for sick persons at home also enable patients who might otherwise be in hospital to be treated in their own homes. The economic advantages of this were driven home by the noble Lord, Lord Amulree, and by the noble Baroness, Lady Summerskill. The work already done by the voluntary bodies has already shown something of the scope which still exists; it has also shown their willingness and ability to meet the demand. The advantages of a voluntary-staffed service have been stressed by noble Lords to-day. The noble Lord, Lord Taylor, can often convince me of almost anything, but he could not convince me in this to-day because I was already convinced. It seems to me something of which we can be particularly proud in our country, that it is probably easier to get people who will do these jobs for nothing than it would be to get paid workers. It is hard work, the sort of work that could appeal only to someone doing it for its own sake.
I have seen a little, scarcely worth mentioning, of the work of the W.V.S. "Meals on Wheels" service. My right honourable friend has seen a great deal more. During the past months, whenever he has had time, he has been out on the runs of "meals on wheels", acquainting himself at first hand with the problems of the service in different parts of the country. Even I, on a short run near my home, watched the joy with which the arrival of the "meals on wheels" is received, the joy that it brings into the lonely household; the visit, as it were, of a friend; the standing jokes, 562 the standing anxieties to be allayed with a reassuring word; the standing grievances to be soothed over with a sympathetic word: in each small household a different joke, a different anxiety, a different individual grievance—the landlord in one, relatives in another, even the Government, I daresay, in some households more than usually out of touch with affairs.
LORD ST. OSWALD
I mention the value of the visit not to obscure the value of the meal or its appreciation, which is very considerable, and here I am in complete agreement with my noble friend Lord Merrivale. To those of us who have known hunger, even over short periods, the benison of a hot meal attentively served is apt to be a long-remembered pleasure. I was a little surprised to react in the Report the suggestion that the food gets progressively colder during the run. On the run which I witnessed and took part in, the Hotlock system of food cabinet was being used, and in point of fact the food got hotter as it was going round, due to the effect of the burning charcoal in its compartment. I understand that this is the most popular system being used for delivering "meals on wheels". The quality and suitability of the meal must, of course, vary according to the method of providing it, and the difficulties of a regular provision vary also according to whether the meals come from a school kitchen closed between terms or from some other source. I can see the argument and the desire for providing separate equipment and premises, as well as vehicles, for the "Meals on Wheels" service. The noble Baroness can be sure that we will take that into account.
The question has been mooted in the Report as to whether the demand, now generally recognised as being very large, could be met in the main by the voluntary bodies supported, in terms of capital equipment as well as running subsidies, by local authorities. The noble Baroness has replied very positively that it could produce, and has produced, persuasive arguments; and having seen the noble Lady's organisation at work in other fields I am well convinced that when that organisation says it can do something it means that it can. Certainly the 563 need for expansion comes as no news to her, or to her organisation. I am aware that long before this Report was asked for her organisation had assessed the need at some 6 million meals a year, the same figure as arrived at by Miss Harris. They had also set their own target contribution at 4 million meals, at which point they would be able to look about and see how many more were required. On present proportions that seems to me very fair, because the W.V.S. is the largest though not the only organisation providing this service. There are also the 1,600 committees of the Old People's Welfare Committee throughout the country, and the Red Cross, which might also expect to expand given proper encouragement, and of course I agree that this encouragement must be directed to giving more meals to those already receiving meals, as well as to finding and providing for more recipients.
The results of even a relatively small assistance in terms of aid are really quite remarkable. I have only one first hand example which I collected on Friday in Yorkshire. A new van is about to be presented as a gift from the Lions' Club—a club of young businessmen of which I confess I had never heard before. They have raised £700 which they are presenting to their local W.V.S. branch, and this second van will have the following effects: it will enable persons at present receiving one meal per week to have two, if they wish it; it will enable meals to be served in areas not covered at present, and certain old people who enjoy the visits of "meals on wheels" members will have the opportunity of speaking for a longer period to the person who visits them.
My noble friend Lord Amherst of Hackney has asked how areas not at present served were to be covered, and that is one of the questions under consideration by my right honourable friend. What is very clear is that in these schemes, either to begin them or to enable them to function, the co-operation of both local authorities and voluntary bodies working in harmony and in mutual respect is an essential feature. My noble friend Lord Gage brought out that point, and it is abso- 564 lutely undeniable. This harmony exists in almost all parts of the country, to the great benefit of those in need and those who wish to help them. I was happy, though not surprised, to learn that since the Report was published Hertfordshire has established a "Meals on Wheels" service and has asked the W.V.S. to run it. This bears out the findings of the noble Baroness as expressed to-day.
There are two main reasons why the voluntary organisations do not like to act as their own recommending bodies. The first, and perhaps the less important, is that they can be taken advantage of, so that the limited service they are able to give may be stretched in a less necessary direction. The more important reason is that they can provide only one service, whereas the probability is that someone in need of "meals on wheels" is also in need of other services which only the local authority can provide. Moreover, as the service expands more help will be needed from the local authorities—in publicity and in listing those who require the service, as well as in subsidies to support the action taken. At present, I am told, 73 per cent. of the W.V.S. "meals on wheels" are subsidised as regards the food and cooking, but only a very small proportion as regards equipment and vehicles.
§ LORD TAYLOR
My Lords, may I interrupt the noble Lord for one moment? I think he is answering our question. He is saying, in fact, is he not, that the local authorities have the power to give equipment and premises, as well as vehicles, and that a proportion are doing so under the existing legislation.
LORD ST. OSWALD
What I am saying is this, and I think it has been brought out in the debate. Some local authorities interpret one Act or another as enabling them to do this and others do not. That is the confusion which I think troubles the noble Baroness, and which would trouble anyone interested in this subject. I am not entirely answering the noble Lord's question, as I always try to do. I am not enough of a Parliamentary lawyer to know. But the fact is that some local authorities consider that the terms of the Act do give this power; others are more doubtful. That is why I said that those 565 in doubt were free to go to the Ministry and ask its view, though I think not many do.
§ LORD TAYLOR
That is a most extraordinary situation. The local authority can go to the Ministry and the Ministry will give its guidance, but Members of your Lordships' House ask Her Majesty's Government for guidance and we cannot be given it. It is absolutely "nutty" to me.
LORD ST. OSWALD
If the noble Lord finds it extraordinary that I cannot give him guidance on every nuance of Parliamentary law, he does not know me as well as I thought he did.
§ BARONESS SUMMERSKILL
My Lords, I am sorry that we have interrupted the noble Lord, but this is the very essence of the question. If what the noble Lord says is the position, why was it that the County Councils Association informed the noble Lord, Lord Latham, that the Minister had failed to make any approach on this question for a year? If there is this ambiguity, why has not the Minister taken action on a very important matter?
LORD ST. OSWALD
My Lords, I hope that I have made one thing plain: although more than one noble Lord claims that nothing has been heard from the Ministry of Health on this subject for more than a year, a great deal has been heard inside the Ministry of Health; and, as we have seen, information is still coming in. This Report has come out and has been carefully studied. Your Lordships' debate this afternoon will be studied and, as I also mentioned, my right honourable friend has been studying on the ground itself what is required to be done. If confusion exists in any degree at the moment it is most important that any future legislation should not repeat that confusion. I have said, as have others, that it is in these two respects, in vehicles and in equipment, that the local bodies require most assistance. I should like to say that the return which the volunteers make for such support is beyond computing. The very fact that someone is giving his or her services free brings a ray of light, a sense of uplift, into a lonely person's life.
566 Before concluding, I should like to add one more reference to this problem of loneliness, on which Lord Merrivale, Lord Taylor and Lord Latham have all spoken most movingly. We are all liable to grow old—in fact, the only alternative that I know of is to expire; and I do not suppose that many of your Lordships are thinking in those terms. Old age inevitably brings a liability to loneliness, which some escape through the possession of younger relatives, younger friends, or perhaps of a young heart. It also brings a liability to uprooting—and to some this is even worse than loneliness.
There are degrees of uprooting. To move to another home which you can still invest with your own personality, taking your "bits and pieces" with you, in the phrase of the noble Baroness, may be only a short retreat. But when it comes to moving into some sort of institution, that is seen by many elderly people as a kind of surrender. I have seen this at first hand on my own estate in Yorkshire. A dictatorship might not respect or even countenance such impractical sentiment. But we, I think, must not only respect it but cherish it, because it is part of the spirit of our people, part of ourselves.
Recognising that most elderly people wish to live independently in their own homes for as long as they can, the Government's task is to help the local authorities to assist and encourage this, alleviating the physical and mental disadvantages as best we can between us. Within the means that have to be employed to this end, the "Meals on Wheels" service has a great importance and must be greatly expanded. We are persuaded that it can be expanded most effectively and economically by allowing the voluntary organisations to make their maximum possible contribution to it.
As this debate has illustrated, there has lately been a striking expansion in the provision of this service by the voluntary organisations, and this expansion is continuing. I am quite certain that it will go faster and further if the doubts attaching to the powers of local authorities under the National Assistance Act are removed, and if it is established that they can provide capital and equipment to the voluntary bodies en- 567 gaged in this work. That is certainly something which any future legislation on this subject should achieve. I hope that our recognition of this fact will give some comfort to the noble Baroness.
§ 5.4 p.m.
§ BARONESS SWANBOROUGH
My Lords, this is the first Motion I have ever moved, and it was with great trepidation that I undertook it, but I must agree with the noble Lord, Lord St. Oswald, that in fact comfort has come with his words, and I should like to thank him and all the speakers in the debate most wholeheartedly for their contribution to it. I would say to the noble Lord, Lord St. Oswald, that I feel that when he is investigating that question of the limitation he mentioned in regard to Lord Amulree's point it will be necessary to remember the prevention of sickness as well as the continuation of the treatment coming after sickness.
The interpretation he has given us of the contribution to the independence of life, the prevention of hospitalisation and the value of the individual on visit as well as the meal, is really the essential of the scheme that we have been discussing to-day. There is no question but that if we were to deliberate on all the different services required for the aged it would take us not just one afternoon's debate but a much longer time, and those of us who are anxiously trying to do what we can in this field would welcome such a debate very much indeed.
I hope most earnestly that the Report referred to several times to-day will not be taken as an obiter dictum in any way at all, because, as I have tried to show, with slight sarcasm and definite figures, a number of the statements in that Report are not as realistic as they could be to-day. One of the points brought up was that about one meal a week. That has been altered out of all recognition since nearly three years ago, when the inquiry for the Report was made. I beg your Lordships to understand that because a thing is printed it should not be taken as a new version of the Bible, and as a substitute for consulting those people who perhaps know something which has been gained with a great deal of trouble. I have tried this afternoon not to speak on behalf of my own organi- 568 sation—I feel that that would have been unfair and completely incorrect on my part—but I have had to use the illustration of the figures which are available to me. There are no national figures at this moment that can be quoted. Therefore, when I have mentioned the W.V.S., I have done so in order to prove a point, but, I hope, not to gain an advantage.
Lord Latham, who is well conversant with this scheme, brought up the point about fear of life itself, which I think is the background of the whole of the work for old people; and the question of the local authorities' association and the L.C.C. is one which, of course, is very forward in all our minds. Lord Amulree, being extremely man-like, just swept over the difficulties of diets and wanted them for all over the country. I echo his wish, but I am not a good enough housekeeper to promise him the answer. Lord Merrivale, with great understanding, has given us his views on loneliness and the need for care and attention, using those words in a different connotation to-day from that in which those of us who usually work with local authorities understand them to be used. He made one most useful contribution in saying that the operative word in Section 31 of the Act was "may" and not "shall".
I feel that Lord Taylor, as he always does, has brought the actual facts livingly before us in explaining how he sees the question of "meals on wheels"; but when he says that either the local authorities or the voluntary organisations should be empowered to take on "meals on wheels" I think perhaps he is making a mistake in the analogy of the district nurse. I agree that it should be "either/ or", but none of us has brought this matter down to a financial level, and it is the financial level which must ultimately come in on the question of "meals on wheels", because if the scheme should prove too expensive it would destroy itself. The expenditure on most of the schemes is from a combination of different funds: the county council, the district and so forth.
What Lord Amherst of Hackney said is a vital point on my plea. If we could have a clear view of what can be done communicated to the local authorities, then voluntary organisations, with the support of local authorities, could get 569 better coverage, and the difference in attitude between one local authority and another would be eliminated. Clarification and simplification would make all the difference to us all. The noble Baroness, Lady Summerskill, contributed in a way that I wish I could have done. I am entirely in agreement with her, because of course the visitor coming in succession to the person who has brought the "meal on wheels" is just as important as the meal. That visitor must be a human being, not someone who comes because they have to but because they want to, someone who will spend themselves generously and energetically in the service of the person they come to visit. I, like the noble Baroness, look forward to the day when domiciliary care can be more thoroughly provided for those who who need it, and less institutional care will be required. I am proud to feel that someone from East Sussex in the shape of the noble Viscount, Lord Gage, agrees that if local authorities could have the full instructions it would be much easier to go forward in assessing whether or not the grant should be made to voluntary organisations.
The noble Viscount, Lord Bridgeman, from scattered Shropshire wanted flexibility. My experience is that Shropshire takes and does not wait to be given. The two principles—leaving old people in their own homes and securing the finance—are the two basic ultimates which have to be watched, and finance is the most difficult of all. But ultimately the success of any domiciliary service must be in the integration of the voluntary worker into statutory responsibility; whether the responsibility is vested or statutorily conferred is not, I think, so important at this stage. Voluntary service to-day should be in a shape in which it can be tied up to local and central government in such a way that the human interpolation of man's and woman's contribution can be added to the financial backing and legal understanding of those in command.
I would say to your Lordships that since I have been in your Lordships' House I have learnt one thing to a tremendous extent: that is, the courtesy of the House itself. That has never been shown more than it has been to-day, both in support of, and in the kindness I have received in connection with, this Motion, 570 in the generosity of what has been said and in the way the whole debate has taken place. I beg leave to withdraw my Motion.
§ Motion for Papers, by leave, withdrawn.