NURSING HOMES BILL (Hansard, 25 April 1963)

LORD GRENFELL
My Lords, I beg to move that this Bill be read a second time, and I trust that it will be a peaceful haven from the last two days of strife. It is a simple Bill and is based on the Public Health Act, 1936, and the Public Health (London) Act, 1936. These two Acts empower the county and borough councils to register the premises of persons carrying on nursing homes, and provide for the inspection of these premises and for the keeping of certain records. The powers of the registering authority included the right to refuse or withdraw registration if they were not satisfied with the nursing home itself, but did not include any lesser sanction, such as fines, where unsatisfactory conditions were found. This Bill puts that matter right.
At the end of 1961 there were in England and Wales 1,136 nursing homes, providing 18,496 beds. It has been estimated that as many as 85 per cent. of the patients in nursing homes are over pensionable age, and the majority are over 80. It is well known that, owing to modern medicine, people live longer, and more nursing homes will be required. It would hence not be in the public interest to cancel a registration because a fault was found in a home if, by a lesser sanction, it could be brought home to the proprietors that the Government and the local authority intend to make sure that the old people are well cared for.
In a few moments I shall be taking your Lordships quickly through the clauses of the Bill, but prior to that there is one more outstanding difference from the earlier Acts to which I should like to draw your Lordships' attention. Under Sections 196 and 246 of the earlier Acts, 1310 local authorities were empowered to exempt from registration and inspection those nursing homes which were not run for a profit, and this became the normal practice. Since then public opinion, including the local authorities' associations, the L.C.C. and the Society of Medical Officers, has urged that these provisions for exemption contained in the Public Health Acts of 1936 should be repealed. It seems to me that those homes which are really reputable have no fear of inspection, and that those which are not—and I fear there are some—need to be brought within the scope of this Bill.
May I now turn to the clauses of the Bill, sponsored in another place by my honourable friend Mr. Alan Brown, to whom I am sure we are all grateful? Clause 1, subsection (1), empowers the Minister to make regulations to implement the earlier Acts, with the important addition, in subsection (1)(b), that power is given to local authorities to limit the number of persons who may be received in any one home. This is important, as there has been in the past a great deal of overcrowding, and there may be so at this moment. Subsection (1)(c) provides that contravention of failure to comply shall be an offence; and paragraph (d) empowers local authorities to institute proceedings in that case.
Subsection (2) empowers local authorities to impose a lesser sanction rather than cancellation of registration, about which I have already spoken, and lays down maximum fines. But it still retains the power to cancel registration should this be found desirable. Subsection (3) deals with the responsibility of persons under the Bill; and Subsection (4) with use of the Negative Resolution procedure of Parliament. Subsection (5) deals with exemptions, and this may need a nominal explanation. In the first place, mental homes are exempted as they are fully covered by regulations under the Mental Health Act, 1959. Secondly, Christian Science homes are exempted as it is not felt right that the Minister can be responsible for adults who fully accept Christian Science and wish to be treated in one of their homes.
Clause 2 repeals sections of the Public Health Act exempting non-profit-making homes and gives these homes one year's grace to put their homes in order if necessary. Hence, by this Bill, the nursing homes will come under the supervision 1311 which I believe your Lordships will agree is right and proper. The Bill does not extend to Scotland or Northern Ireland. Finally, I understand the Bill has the backing of all Parties in another place, and I trust your Lordships will give it a Second Reading and speedily pass it through the House. I beg to move.

§ BARONESS SUMMERSKILL
My Lords, I am quite sure we all recognise the sincerity and kindliness with which the noble Lord has introduced this Bill, but the House will agree with me that, while on the face of it we should approve of the principle, good Parliamentarians must examine the Bill for two very important reasons before it becomes good legislation. We should ask, in the first place, is it practicable? In the second place: is it enforceable? I always feel that British legislation is envied by the rest of the world because we take such care to examine any Bill from these aspects before putting any Act on the Statute Book. Noble Lords will agree that if an Act is not enforceable then it becomes a dead letter.
The principle of this Bill is one which we should all applaud. Indeed, it is something with which all persons in the country, whatever their age, should be concerned, because it is concerned with the process of aging. These nursing homes which are set up throughout the country now contain patients the majority of whom are over pensionable age; and we are living in an era when the expectation of life is increasing and the demand for nursing home accommodation will become more and more pressing. Undoubtedly, therefore, we should introduce safeguards to protect elderly people who are not suffering from any pathological condition but who, as age advances, cannot protect themselves adequately. They might enter one of these homes and be exploited by the proprietor who provides neither adequate equipment nor proper services for the aged person.
First of all, I am a little apprehensive as to whether this Bill might not become a dead letter: for this reason. Noble Lords will recall that the Public Health Act, 1936, made provisions for the registration and inspection of nursing homes. 1312 These were very wide provisions so that if these homes had been inspected adequately, thoroughly and regularly the Bill which the noble Lord has introduced would surely be unnecessary. For he is asking, in fact, for more inspection; he is asking that more attention should be focused on these homes; he is asking that the Minister should be able to introduce regulations which will enable local authorities to take further powers. If the local authorities already have the power of inspection and control, why have they not since 1936 observed that many of these places were overcrowded, that there was an element of exploitation in the less well-conducted nursing homes—though not, of course, in all? Why have they not taken advantage of these existing powers?
The first thing an inspector sees when he goes into a home is, perhaps, six or seven old women or old men crowded into a room, and perhaps being waited on or looked after by one domestic help—and this is not, I think, an overstatement of the conditions in some nursing homes. The reason for this is fairly simple. The inspectorate of most local authorities is grossly overworked, and they have not been able to undertake this work. In fact I think I am right in saying (and the noble Lord, Lord Newton will dissent if I am wrong) that at this moment the inspectors of the Public Health Inspectorate are demanding higher pay because they are so overworked that they have not even time to train more public health students and have not even time to do this very necessary work. So the first question I ask when I see this Bill is: will this ensure that the inspection is more thorough? Because however many regulations the Minister makes for the control, inspection and regulation of nursing homes, unless we have enough inspectors to go into the homes and say, "This is wrong" then, as I have already said, this new measure will become a dead letter. Every noble Lord here, though he may know little about the staffing of nursing homes, must know that it is very difficult to obtain domestic help in ordinary well-conducted homes and that there is a widespread shortage of domestic help for nurses. Is it proposed to meet the demand for more staff in any way? If this Bill is introduced it is suggested that the Minister shall have powers to lay down an optimum ratio of patients 1313 to nurses. If that is so, a nursing home could have twenty-five patients but, having taken them, would be required to have so many nurses and so many ancillary helpers. After laying down that power there is even greater pressure on domestic help for nurses.
The noble Lord must know that nursing old people is not always the kind of nursing that attracts nurses, and that overnight a nurse may leave; an ancillary worker may leave so that the ratios are upset. Does that mean that immediately the ratio is upset the superintendent, the manageress or matron must get rid of one of her patients? Here I suspect the practicability of this measure: it is rather like putting the curt before the horse. I would again remind the House that the present Government are often being charged with working in watertight compartments. While this Bill is accepted by the Minister of Health, another Department insists on maintaining the earnings rule which penalises widows, pensioners and those whose services may well be used in the domestic field in these nursing homes, and who will be necessary if this optimum ratio is established. Therefore, while the principle of the Bill is acceptable, the fact is that it will prove, abortive unless the Government make more domestic workers and nurses available.
I have already talked about the enforceabilty of legislation. If the letter of the law is enforced, then the aged person of small fixed income is compelled to find other accommodation, perhaps in a rather shabby boarding-house. I ask the noble Lord whether he has considered that point. Has he recognised that throughout the country are thousands of little boarding-houses, which are not, of course subject to the provisions of the Public Health Acts, and which cater for these elderly people? Will this Bill protect people who are obliged to leave a nursing home, because the matron has not observed these new provisions, and to go into a boarding-house?
If the proprietors of these boardinghouses, where the majority of lodgers are aged, reserve two rooms for either middle-aged or young people who are working the establishment is a boardinghouse and there is no control over it i whatsoever Because of the increase in the expectation of life, this kind of establish- 1314 ment is growing. In the London suburbs, and I presume in many seaside resorts, it is common for small boarding-houses to cater for the aged but not to be properly staffed. No rules or regulations govern these places—unless, of course, the aged are non compos mentis, in which case the mental welfare officer is called in. Then the proprietor of the boarding-house is only too anxious to call him in and remove such a lodger.
There is no question of rejecting this Bill, but I would point out to the noble Lord that what he is suggesting is not so easy to implement. I should like to give him an example of a case of an aged person living in one of these establishments over which there is no control, which perhaps points a principle. This is a case in which I was involved not long ago. An old lady of 76, with a dwindling income, took a room in a shabby boarding-house. She paid the proprietor regularly. Her hearing and her sight began to fail and her friends deserted her, so that at 78 she never left the house. Her simple food was brought to her room by an ever-changing daily domestic help. There was no resident help and no one on night duty. At 88, one morning she was found dead on the floor by the domestic help who had brought her breakfast. These boarding-houses are used because there is not sufficient accommodation in nursing homes, and often old persons with dwindling incomes feel that their prestige and status in the community is better if they go to live in a boardinghouse. Our protective legislation extends no protection to them.
The noble Lord believes, quite understandably, that this little Bill will change the whole face of the provisions for the elderly, but really it touches only the fringe of the problem. I would even say that his Bill will increase the number of so-called boarding-houses, when the nursing homes become subject to regulation. The noble Lords say that the first fine is £5, and the second £20. If the matron or proprietor of a nursing home finds that the local authority is being rather severe and inspectors are calling too often, she will reduce the number of the patients. And the little boarding-houses will flourish. This Bill will not solve the problems of our aging population. It is not easy, because the 1315 victims themselves are suffering from a process which does not make them more attractive. They are often obstinate and cantankerous, and as a result they are unwanted by their relations. Of course, we cannot deny them freedom of choice. While their mental processes are clear, we cannot direct where they shall go. We cannot legislate for people of any age group. We can make provision only for people who are suffering from certain symptoms.
I always like to be practical. What I feel we need is a register of the aged. I have suggested this time after time, and it has been rejected for all kinds of reasons. The first is that most people do not like to have their age revealed. I agree that it was so in Bible times. Those who are familiar with the Bible—I must confess that I am familiar with only one or two aspects of it, and this is one—will know that the age of women is never quoted. The age of only one woman is mentioned in the Bible, and she is Sarah, the wife of Abraham, and it is quoted to show the advanced age at which she was to become the mother of Isaac. We have changed since Biblical days. The aged woman in this country does not mind having her age revealed.
Therefore, let us do something practical, much more practical than merely to accept this Bill. Let us know where the aged are. Let the local authority know if they are in boarding-houses, so that they can go and give them a hand. And if they are in nursing homes, let them be registered. If they are living in one little room in a densely populated suburb, let us know where they are. All this is very important. While we must welcome this little Bill, I feel that it serves only to focus attention on the need for much more comprehensive measures which will help the aged to cope with the more tragic aspects of their struggle for survival.

§ LORD AMULREE
My Lords, I should like to give a more friendly welcome to the Bill than that of the noble Baroness, Lady Summerskill. I do not think that the noble Lord, Lord Grenfell, who moved the Second Reading, would suggest that this Bill will solve entirely the problems of the aged in our population, but I think with him that it will do something to improve the lot of a 1316 certain number of them. As the noble Baroness said, it will cover the large number of not very expensive nursing homes, where a considerable degree of overcrowding takes place and where the services are not entirely satisfactory. What I think this Bill will do is to enable attention to be focused upon these homes, and the fear of inspection in itself might encourage proprietors to try to put their houses in order and do something to improve matters.
The danger which I can see, as the noble Baroness explained, is this: what is going to become of people in a home if it has been found to be unsatisfactory and is shut down? What provision will be made for the unfortunate people who have been living in that home? I think that this is a problem we shall have to face up to very soon. But, in the meantime this Bill will do something to control the not very satisfactory nursing homes which do exist.
I should like to say a word about the register of old people mentioned by the noble Baroness. It would be an excellent thing if such a register could be formed. All sorts of objections have been raised in the past, but I do not think they are now valid. It may well be a difficult task, because the people that we want most to do something for are those who live often of choice a secluded life, but I certainly feel that it would be a great advantage if something could be done in the way of making a register of old people. In the meantime, this little Bill which is now before us will do something to help, and I am pleased to support the noble Lord in the Second Reading.

§ THE PARLIAMENTARY SECRETARY, MINISTRY OF HEALTH (LORD NEWTON)
My Lords, my noble friend Lord Grenfell described his small Bill as a peaceful haven after the strife of the last two days. He certainly explained it to us with great care and lucidity, and although various interesting wider topics have been raised, I do not think I need do more this afternoon than tell your Lordships that the Government welcome the Bill. I ought perhaps to emphasise that, in our judgment, it should not be regarded as implying a criticism of the vast majority of nursing homes, private or voluntary, which provide services and nursing care of a very high standard and undoubtedly meet a social need both humanely and efficiently. 1317 So far as I can see, file number of nursing homes that will be seriously affected by the regulations made under the Bill, if your Lordships pass it, will be few. That is, in part, an answer to some of the matters raised by the noble Baroness, Lady Summerskill. I hope that your Lordships will give this Bill a Second Reading.