HL Deb 22 April 1964 vol 257 cc748-845

2.38 p.m.

LORD AMULREE rose to call the attention of Her Majesty's Government to the need for a further study of the Welfare Services to ensure that the best use is made of the limited number of people involved; and to move for Papers. The noble Lord said: My Lords, I put down this Motion to draw your Lordships' attention to the Welfare Services in the country because I thought the time had come when we might look at these services rather carefully to see, not whether they could be improved—I think they are extremely good as they are now—but whether we were making the most economical use of the limited number of trained staff who are available now and will be available in the future, and to find out whether some of the services could be changed from the point of view of the changing society in which we live at the present time.

Welfare work goes back a very long way. In fact, as your Lordships realise, it is the descendant of the various charitable activities which were carried out until the first Welfare Services started. The great point about welfare, which I think makes it of particular interest, is that it is universal. There is practically nobody, or very few people, who will not be in need of some kind of Welfare Service in the course of his life. It does not matter whether people are poor, it does not matter whether they are rich, they will all be in need of some help in the same way—and that is where the Welfare Services come in to do what they possibly can. To go back to the former mediæval imagery which was expressed in our churches when they painted pictures on the walls, the Welfare Services were then comprised of what were called the Seven Acts of Mercy, and it is by carrying out the kind of work which those pictures implied at the time that we can expect to get the best Welfare Services we possibly can in the country.

I am afraid that, for the purpose of my Motion, I must go back in history just a short time to explain what is at the back of some of my disquiet. What I should like to do is to mention some of the more important of the Welfare Services of the country, and to show the way they started—not quite so much the way they developed as the way they started. The first body I should like to take, which I think is one of those which go back the furthest, is the district nurses. They were started in Liverpool in 1859 by a kind and philanthropic gentleman called William Rathbone. The work which they do is of enormous value, and there are at the present time about 10,000 of these nurses working with the various local authorities in the country. The next group I should like to mention is the health visitors. These, again, were started up in the North. They came from Manchester and Salford, and they began in 1862. But it was not until 1892, thirty years after they began, that one of the local authorities, the County Council of Buckinghamshire, saw fit to employ a health visitor for the purposes of their maternity and child welfare work, and health visitors did not become statutory workers, I think I am right in saying, for counties and county boroughs until the National Health Service Act was passed in 1946. They account for quite a lot of trained nurses. There are at the present time about 1,000 full-time, and about 6,000 part-time, health visitors.

The only other official body I wish to refer to—and this is not so easy to do—is the social workers. They really began in 1895 when the first almoner was appointed to the Royal Free Hospital, and it was not until 1906 that they became officially recognised when the London County Council appointed case workers to look after the school meals service. Then, at the same time as all this, there were a great many charitable organisations in existence, of which I should like to mention one, the Charity Organisation Society, which was founded in 1869 and employed in doing case work on a voluntary basis. By that I mean that they were employed in visiting people and seeing if they could assist those in trouble. They have come to be called the Family Welfare Association, but their very good work continues still.

It may appear rather uncharitable not to refer to more charitable organisations, but I should be taking up too much of your Lordships' time if I were to do so. I am quite sure that some of the noble Lords speaking after me will bring to your attention the work that is being done by the charitable organisations. So, if it is in order, I propose not to say anything more about them at the present time. By what I have said about the way these various services started one can see where some of their weaknesses lie and where some of the difficulties arise to which I want to draw attention this afternoon.

They were started singly, in one place, to deal with one particular problem; but the expansion of their work during the last hundred years or so means that they now do far more than was foreseen by their founders. Their work has extended and the work of the various bodies overlaps far more than it did. One wonders sometimes whether there is not a certain lack of co-ordination in the work—co-ordination which would not necessarily make the work more efficient, but make it possible to do the same amount of work with not quite the same number of staff and people travelling around the country making inquiries of people in need of the welfare services.

I will give an example of what I mean. I will take the present position of health visitors. They were started originally, as I have said, in the North Country from the point of view of dealing with maternity and child welfare. They visited and advised mothers on the bringing-up of children. They saw the children and they taught the mothers what they ought to do to get the children treated if they were sick. They must have played a very great part in the great reduction of infantile mortality which occurred in this country, during the last ten, twenty or thirty years. But things became difficult for them because their duties were increased by the National Health Service Act, 1946.

They were given, among other things, the duty of visiting aged persons to see if they required help. That is why I begin to wonder whether things have gone quite right. I was looking at the reports of two large county councils. I saw that one county council has a staff of 97 who paid about 83,000 visits in respect of maternity and child welfare services; whereas for the old people they paid only 4,000 visits. The second county council has a staff of 418. The total number of visits paid in respect of maternity and child welfare was 670,000-odd; whereas for old people there were about 15,000. So one wonders whether in that particular work the health visitors had not got more than they could do at the present time, taking into account the great deal of work that they do for maternity and child welfare. Therefore, the work put on to them by Parliament cannot possibly be carried out in quite a satisfactory fashion. As a result of the work I do in London, I am sure there is a necessity for far more visiting of old people to find out what is wrong than is taking place at the present time.

There is a movement now for the work of the health visitors to be rather changed and for them to work with the general practitioner rather than with the local authorities. They would then visit patients in a doctor's practice and report back to him if they found something wrong, and they would be able to tell him what local authority or voluntary welfare services were available. But they would do no nursing. That is a scheme which has been tried in several parts of the country. In some parts it has gone down well, and in others not so well. I cannot begin to explain why these differences occur, but they cer- tainly do. It is true that in some parts of the country practitioners do not like it and do not want it. Another thing which I think is a pity is that we have these extremely well-trained nurses working in a purely advisory capacity and not doing any form of nursing at all, or, if they do, only of the minimum type. That is why I feel that the position of the health visitors is not quite so satisfactory as it might be.

The next body I would take are the district nurses. I must declare an interest, because for some time I have been a member of the Executive Committee of that body. I find that the work they do is of very great value, both in saving the time of general practitioners and in giving encouragement and healing to patients in their illnesses. I think that this is shown by the large number of visits they pay. If I may come back for a second to my two councils, I would say that the first has a staff of 156, who paid 214,000 visits, and the second a staff of 546, who paid 1,500,000 visits, in the course of a year.

There is a suggestion, which has been widely talked about, that district nurses should in some way be attached to general practitioners. I do not think that that would make a very satisfactory arrangement. Suppose each general practitioner were given one-quarter of the time of a district nurse, that would absorb completely the services of all the district nurses in the country. They would then be working for the general practitioners and would not be able to visit patients who were not under their general practitioner.

The first point I want to suggest to your Lordships is that we are getting to a stage when some kind of nurse is going to be attached to the general practitioner, and I wonder whether it is not time to think of the possibility of training some different kind of nurse. I do not mean by that that we should make a third part of the local hierarchy (if I may call it that), because I think that would be too much for the nursing profession to supply, but I wonder whether the whole work of the district nurses and health visitors should not he gone into very carefully. That is what I mean when I call in my Motion for a further study of the Welfare Services: that their work should be studied so that we can really find out whether what was a proper and good thing to do in the 'sixties of last century is a good thing to do in the 'sixties of the present century. I think there is scope for some kind of reorganisation.

The other type of welfare work is that of social workers, who also do a great deal of extremely good work, both in hospitals and in working for the local authorities. But, again, their position is a trifle muddled and confused. I have been looking up the details of the training of social workers. When I saw the hook they give out, which contains all the particulars of training, I found such an enormous number of training schemes that one's mind could not absorb quite what was going on. There are university courses that give a degree in social work called by varying names. There are university courses which give a certificate of some kind. And there are six universities which give what we might call a basic training course and then offer a postgraduate diploma in particular kinds of social work, child care, mental health and so on.

One would have thought that this was the right kind of way to deal with training these extremely important people in future, but the matter has been complicated because a year or two past a report was published on the training of social workers, the Younghusband Report, in which it was suggested that social workers could do a two-year course of training and should then be employed by the local authorities. This has been successful up to a point, except that there have not been quite enough people available for training in the field work. But the number of people who are taking these training courses is going up. In 1963 there were 56 people qualified and by 1966 it is expected that there will be 164, which shows quite a fair increase.

The bulk of those who are being trained at the present time have been seconded by the local authorities from their staffs in the hope that they will come back again when they have finished their training. But that is merely a hope, because local authorities have no guarantee that those who are trained under the Younghusband scheme will not go somewhere else. I think I am right in saying that the fact that local authorities are not given grants for training these social workers also makes it difficult for them. The giving of grant was discussed when the Report was discussed in Parliament and during the Bill on the training of social workers, but, so far as I remember, Parliament turned it down.

Those who do a two-year training course tend to be looked down upon by those who have had full university training or have trained for a good deal longer. That is something we cannot fail to expect. It is human nature, I think, that we tend to regard people not so well trained as ourselves as being not quite so good as we are, though they may be doing good work and are excellent people.

I wonder whether it would not be possible for some of these trained social workers to work in hospitals under the Regional Hospital Boards, rather than that they should all be kept under the local authorities. Again, this is something that some of my colleagues will not like my saying very much, but I think the sometimes in hospitals there is a certain amount of waste of the skill and training of almoners. The almoners are extremely well trained and skilful. They are very good indeed. But I should have thought that it might be possible not to employ so many almoners by having some of these Younghusband-trained people working under them. Because one finds peculiar things going on even now. People still go to the almoner's department to talk about pensions and about money being paid, work which in my opinion should really be done by the finance department.

The point should be gone into carefully, because when the hospitals first started to employ almoners there was nobody else to do that kind of work. It is a practice that has grown up and it has not been changed, so that in quite a number of hospitals it is carried on still. We now find that patients coming into hospital who appear to have no particular social problem are not seen by the almoner: she sees only the patients referred to her. That again is a rather bad thing, because if people of this kind are to be employed, they must be able to talk to all patients in hospital, and not merely to those who are referred to them by the medical or nursing staff.

There is a third point which occurs to me, thinking over the services of the county generally, and that is whether there is not a great deal of time wasted—perhaps I should say, spent—on visiting in their homes people who do nor need to be so visited, and who would possibly prefer to come and consult somebody without having too much visiting and seeing what is going on in the home. One or two attempts have been made to deal with this problem, but they have not been copied, and one presumes that they have not been successful. However, it seems to me that it should be possible to arrange for people who wish to do so to consult in a clinic someone in authority. If they are growing old, or are in trouble or in need, they should be able to come up to one of the local authorities and there find someone who will deal with their problems, and thus avoid having people going into their homes, which some of them do not very much enjoy. If this applied to me, I doubt if I should enjoy it. Whether the service to which I refer should be staffed by one of the health staff or one of the practitioners in the neighbourhood could be discussed in detail when such a principle had been established by one big local authority to see how it worked.

Then, again, one wonders whether the time has not come for far more of the local authority work to be co-ordinated under one department of the local authority. I do not like things being centralised too much—no doubt one could go in for a great deal of centralisation—but it seems to me that it might be of some advantage if the local authorities were to appoint possibly the medical officer of health as the co-ordinating person for all the social services. If that could not be done, it might be necessary to appoint some new officer for the local authority, although I do not particularly want to see this, because the number of people at the top in local authorities should, in my view, be kept down to a minimum.

To mention a rather controversial matter, I think that what is needed is to have somebody to whom people can go for advice or help at any hour of the day or night. I do not suggest going back to the relieving officer, with all the implications of the Poor Law; not do I want to say an unkind word about the work done by the National Assistance Board since it was started. But there would, I feel, be an advantage in having somebody not too much involved in other matters to whom people could go from time to time, wherever they were. In recent times there has been a great movement in the country to combine the health and welfare work of the local authorities. This idea has been popular, and it has gone ahead well. But there are a number of major authorities who do not do this at the moment. I know that the Minister approves of this, and encourages it a great deal; but it seems to me to be one of the things that could be encouraged even more.

I would go even a little further. I should like to see some of the beds that are made available by local authorities for the frail, the infirm and the elderly transferred from the local authorities to the Regional Hospital Boards. That, I believe, would do a great deal of good in a number of ways, of which I will mention one or two quite briefly to your Lordships. One of the dangers is that we are tending to get standards of medical care such as we had in the old Poor Law institutions. The Minister has quite rightly suggested that, when people get very old and have what may be called an interminable illness, it should not be necessary to transfer them from a place they know to a hospital. I entirely agree with that point of view, but I feel that if they are not under some medical umbrella we may well not get things done which could be done to prolong life and improve the condition of patients, simply because they are not seen by the right people.

The other point is the administrative difficulty that arises if people need to be transferred from beds under the Health Service to beds under the local authority. A good deal of transferring has to be done from time to time. In many cases it is an enormous job to get it done, and sometimes many months pass, due to various administrative difficulties, before a transfer is effected. That, I feel, is a second good reason for transferring some of the beds from local authorities to Regional Hospital Boards.

The third reason is that if we had the administration under the same authority we should not need so many beds as we do now, because a more economical use could be made of them; more people could be treated properly and returned to their homes, where they would be far more comfortable and better taken care of. That was a point mentioned by the Porritt Committee, about which I initiated a debate in your Lordships' House not so very long ago. They suggested that accommodation for those who needed it should be organised by the area health boards which it was proposed should be set up. That covers what I want to say about what I might call the medical welfare services.

I should like to refer now, quite briefly, to one more county service. I do not want to go into it at too great length, because we had a debate on it last December on a Motion moved by the noble Baroness, Lady Swanborough. I want to talk about probation and after-care. This is one of the most important services to which we should devote our attention, and I feel that it will do no harm to mention it once more. That again, if one can go back in history for a short while, really started in England—I do not want to go too far back—with the police court missionaries in 1876, but they, I think I am right in saying, were to deal with cases of drunkenness, and they did not do a great deal more than that. They did extremely good work under most difficult conditions. It was not until 1907 that the first Probation of Offenders Act came in, and that was introduced by a member of my Party, the late Lord Samuel, when he was Under-Secretary at the Home Office. They have done very good work indeed, but I think they have now had far too much work put on their shoulders, as indeed was mentioned in the debate to which I have already referred.

The point I want to make is that you have various people dealing with the potential criminal and the criminal who has come out of prison. I am sorry to call him a criminal, because it is a word I do not like, but is the only word I can think of.




I thank the noble Earl. We have a comparatively new service which has started, called the Prison Welfare Officers' Service, which seems to be doing extremely good work in the prisons where they are. But once again, there are far too few members, and one would like to see their work—although I do not know whether it is humanly possible—much more tied up with that of the probation officers, and to see possibly the probation officers doing a spell inside the prisons with the prison welfare officers, and a good deal more change and co-ordination made in that service. That ties up again with what is going to become of the delinquents when they come out of prison. Quite a large number go back to their homes, but there are those who have nowhere to go, and who want some kind of hostel care and attention for quite a long time. Some may be able to cope with life again when they have been there for a month or two, but again some may need much longer than that. I think that is one of the Welfare Services that could be studied and expanded at the present time, because that seems to me one of the great ways of coping with delinquents at the present time.

I am afraid that I have been talking to your Lordships far too long, but I want to come to the voluntary services. I think that if you are not going to mention the voluntary services when you are dealing with welfare you are really not talking about the kind of work that is being done, because I think the Welfare Services would not be possible if there were not a great deal of voluntary effort working with them. I am sure that all would gain a great deal from what these voluntary workers do, and I think often one can obtain the best work from voluntary workers when they work in connection with some of the trained staff, which is possibly paid. What one would like to see is far more voluntary workers coming along to work with the trained staff, because then we should go a long way to improving our services and getting a far more satisfactory state of affairs.

There are many old prejudices to be overcome in the welfare world. I think what I have said about the way they started shows why some of these pre- judices have arisen. People were going along doing one particular job, and they could not really see further than the job they were doing. That is entirely changed now, but in the course of the change a good deal of frustration and irritation among the various services has taken place, and that is why I suggested that it might be possible to study the services again to see whether some kind of change should not be carried out.

There is one other point I should like to mention, and that is whether it would not be possible to bring as many of the services as we can under one Government Department. Some are run by the Ministry of Health; some, I think, by the Ministry of Education, and some by the Home Office. I should like to see things taken away from the Home Office and given to the Ministry of Health, because although we may have the kindest people at the Home Office—and I am sure they are as good as they can be—the Home Office is associated in people's minds with something penal. It may be wrong, but that is the fact. This is one thing which we want to avoid if we are to have a satisfactory Welfare Service.

The number of people needing welfare will grow: it is going to grow enormously. The services will need a great deal of expansion. We have not a large number of trained staff, or people who can be trained, available; and we can get a successful service only by running it economically and intelligently. I referred at the beginning of my speech to the Seven Works of Mercy being a common feature of mediaeval churches. I do not want to see them transferred or altered into what was another picture in mediaæval churches, the Four Last Things. I beg to move for Papers.

3.17 p.m.


My Lords, your Lordships are indebted to the noble Lord, Lord Amulree, for the opportunity he has given us this afternoon of discussing the development of these important services. We are indebted to him also for the interesting survey which he gave us of the birth and growth of these Welfare Services. I do not think there was much in what the noble Lord said with which most of us would disagree.

I am not sure that I should follow the noble Lord in the solution which he proposes for what has been one of the most persistent problems of the Hospital Service—the elderly person living in residential accommodation of the local authority, who at one time is in need of medical care, and at another time is not. Of course, in the old days the solution was a simple one. There was no difficulty whatever in transferring the elderly person from the chronic ward in the institution to the sick ward. It presents much greater difficulties to-day. I am not at all sure that the solution proposed by the noble Lord, that the residential accommodation in which these elderly people are found should he transferred to the Hospital Service, is the right one. I do not think that is the right solution at all or, indeed, a very practical one. The difficulty arises from the fact that an old person at one time may be in need of medical care, and at another time may not.

The noble Lord in terms of his Motion this afternoon has laid emphasis on the need for study. A good deal of study is being devoted to the working of the social services. Research projects are being actively pursued by many different bodies in many different places. The new universities have thrown themselves enthusiastically into the work of teaching what has come to be called "sociology" and into the work of research. If their enthusiasm sometimes gets a little ahead of their capacity or their resources, many of these research projects have nevertheless added much to our knowledge of the working of these services and the results which have been attained by them.

I think what is certain is that Government Departments which are engaged in administering the Welfare Services, or in supervising the administration of Welfare Services by other authorities, will have to undertake research on a much broader scale than the scale which has hitherto been regarded as sufficient. Work on research, after all, cannot be left entirely in the hands of private individuals and private bodies. At present the organisation of research work within the Government Departments who have responsibility for these services tends to be of a rather casual character.

To-day one has a situation in the administration of the social services which did not exist before the war. There are to-day great administrative Departments in the Government directly responsible for administering a Welfare Service. That was something which hardly happened before the war. It was brought about by the changes which took place at the end of the war. As the services which these Departments administer grow in scale and become more complex, it is, I think, increasingly essential that these Departments should undertake research investigations into the services for which they are responsible. It may be that the first step should be the appointment of a director of research within the Departments.

One of the difficulties that I have always experienced in the administration of the social services is that it is very difficult to bring to people's notice what social services are available to assist them. Most people are completely ignorant of the social services and do not find out much about them until the need for a service has arisen. I think that in this connection posters are not of much value and I doubt whether leaflets and pamphlets are of any great value either. People tend to throw leaflets straight into the wastepaper basket—and that, no doubt, is the right place for many of the leaflets which reach us—but it makes it difficult for many people who need to know of these services to be made aware of the fact that a service does exist for them.

Far and away the best form of publicity that you can get is the publicity that the B.B.C. can give. There is no doubt that a very short broadcast passage is worth all the posters, pamphlets and leaflets that any Department can possibly produce. The B.B.C. has been very helpful in this matter. There are the Sunday lunch-time talks under the title "Can I help You?" which have been a means of bringing to the notice of people the social services intended to help them and of which they were otherwise completely ignorant; and there have been subjects dealt with in "Panorama" which have been very valuable to those who are responsible for administering these services. But I am bound to say that the B.B.C. must recognise that they are in danger of losing the confidence of important sections of the community, who are beginning to wonder whether the objectivity of the service is quite as complete and comprehensive as it once was. Apart from that criticism, I am sure that the B.B.C. has certainly afforded very great assistance to those responsible for administering the social services.

My Lords, there are only one or two of the services to which I propose to make any reference in detail. The noble Lord has dealt very fully with most of the health services allied to the National Health Service and I should like to make one or two observations about what always seems to me to be the most difficult welfare service which local authorities have to administer: that is, the service of providing accommodation. I am not speaking of housing accommodation; I am speaking of the obligation which the welfare authorities have to provide accommodation for elderly folk, about which the noble Lord has spoken and no doubt other noble Lords will speak in the course of this debate and about which I do not therefore propose to say very much.

The other form of accommodation which they have an obligation to provide is temporary accommodation, which is required mainly by the families who have conic to be called "problem" families. These families have usually been evicted from their homes for one reason or another. Many of them have been evicted from local authority houses for non-payment of rent, and many, of course, have been evicted from privately-owned houses which are mostly furnished and to which control has never applied. They present the local authority with a very special and extremely difficult problem. I am quite sure that the first essential step in preventing a family from sinking down into the "problem" family class is to prevent their being evicted. Local authorities, I know, go quite a long way when rent is in arrears to try to avoid eviction. I am never entirely satisfied that they could not go a little further.

This subject is so complex and so varied in its application as between one district and another that I think that some body like the Central Housing Advisory Committee, who some years ago published a very valuable pamphlet on unsatisfactory tenants, might be invited to look at this question again and see whether any means can be found of ensuring that the rent was paid without the family having to be evicted first. I am quite confident that eviction is the first step on the downward ladder to "problem" family status.

This problem, of course, is a problem of varying intensity. In some parts of the country it is acute. In some parts of the country it seems almost not to exist. I was looking at the statistics of accommodation provided for this purpose by local authorities in different parts of the country. The difference between towns in the South and the South-East of England and the larger towns in the industrial North is quite surprising. In the London regional hospital area—that is the area for which I have figures—the London County Council is providing now 22 units with accommodation for 989 families, and they evidently anticipate that this is a problem which will be capable only of long-term solution, because they provide that in six years' time there will be 38 units providing accommodation for 3,472 families.

I turn to two large county boroughs in the North of England. I find that one has provided only one unit with accommodation for seven families. They anticipate that for the next five years their requirements will be met by two units accommodating 12 families. And in a big town in the Midlands six units are provided with accommodation for 59 families; and it is anticipated that in five years' time the numbers will be increased to eight units accommodating 97 families. So this problem, although it is an acute and a very distressing problem in its manifestations, is one which appears to be very largely a localised problem. Whether that is so, as these figures suggest, or not I do not know. But it presents the Welfare Services with one of the most difficult tasks they have to perform, and I should have thought it would be possible for some better guidance to be given to diem along the lines which I have suggested: that means might be found for paying the rent, getting the arrears reduced at least a little, without having to make an eviction order.

I turn for a moment to another class of accommodation. It is rather astonishing that in the very valuable collection of statistics of these services which was published a short time ago by the Ministry of Health, no information appears to have been collected about common lodging houses. The supervision of common lodging houses is one of the oldest public health functions of local authorities. I believe it dates back to the first Public Health Act in 1875. Many of these common lodging houses of course, belong to private owners. I think that your Lordships could hardly conceive the degree of squalor and degradation which exists in some of these places. There is, I believe, a very much greater need for lodging houses than the local authorities at present are prepared to concede.

Most of the larger cities do provide lodging houses, although the power to provide lodging houses is relatively recent. But many of the authorities obtained special powers to do that, and they have done it. The municipal lodging houses are, as one would expect, well managed, very simple, in many ways austere, but they meet their purpose. Outside the municipal lodging houses there are the very large lodging houses provided by voluntary organisations. The Salvation Army has for many years been the leading voluntary organisation in the provision of accommodation of this sort, and the Church Army provides excellent accommodation in many places for a rather different type of man. Both these bodies, if I may say so without presumption, seem to me to be doing a most excellent job. But they do not meet, and they cannot be expected to meet, the complete need for lodging houses, and I should like to see among the local authorities keener recognition of the need for these places.

Before I conclude I should like to make one or two observations about the costs of these services. I wonder whether it is wise to allow so great a proportion of the costs of these services to be met from the rates, as is the case at present. The expenditure on the Welfare Services is at present overwhelmingly rate-borne. It is quite true that probably some modification may be required in the figures that are available to take account of the general Exchequer grant; but generally speaking the position remains that these services are overwhelmingly paid for from the rates. With the best will in the world, a local authority may find it difficult to raise some of the services to the standard which is desired to-day without imposing an undue burden on their rates. In those circumstances I think it might well be considered whether some proportion of the costs of these services, which are, after all, adjuncts to the National Health Service, ought not to be undertaken by the central Government.

3.38 p.m.


My Lords, I am sure that the whole House would wish to thank the noble Lord, Lord Amulree, for giving us the opportunity of debating welfare, I think in its broadest aspects. We all know of the noble Lord's brilliant work in the field of geriatrics, and I quite understand that this afternoon he should have concentrated specifically on welfare services as seen by medical people. But we should, I think, recognise this afternoon (and the noble Lord who has just spoken has led the way) that welfare, in its broadest sense, concerns four Government Departments. I propose to limit my remarks to some aspects of the social services where I consider there are serious gaps, despite the fact that the Government have had their attention directed to these gaps by various Committees of Inquiry. Indeed, during the last few years, when we have had debates similar to this, initiated by noble Lords on both sides of the House, we have stressed the importance of increasing the welfare services to those people who are in the most desperate need.

I would in the first place say (I must repeat this) that some of the discontent felt by the general practitioners, and some of the pressure on the hospitals, stems from the failure to provide the ancillary workers in the domiciliary services such as the noble Lord mentioned. He agrees that there is a great shortage of these people who can help the medical men and women in the country. Let me take one important example. It is significant that this morning we were told that the Ministry of Health have issued a report giving the cost of the various items of the Health Service, and that this report men- tioned the heavy cost of the Mental Health Service and the services dealing with the neurotic. I hope that your Lordships will not think that I am being disparaging, but it is said that every one of us has some element of neurosis in our makeup.

In the Mental Health Service there is a national shortage of psychiatric social workers, and it is now proposed that grants which had previously been available to them as students, irrespective of age, are to be brought into line with the grants paid to first degree students. This will mean that the workers whom the Ministry of Health have sought to encourage will be dependent upon their parents, although a large number are accepted at 24 years of age, after they have completed two years' social work experience. I should like to ask the noble Marquess, when he comes to reply (I have a few questions to which I should like to have the answers), how the Minister can reconcile this new attitude of the Ministry with the pressing need for more psychiatric social workers. We all know that if we are to empty our institutions of these tragic people who have some mental disability, we must in the first place have the psychiatric social workers who can do this priceless fieldwork.

Now I should like to turn to the maternity services. I have raised this matter again and again in the last two years, and I ask your Lordships to forgive me if I am guilty of tedious repetition. But although the Minister of Health accepted the recommendations of the Cranbrook Committee in 1959, they have still not been implemented. In order to meet the need for maternity accommodation, the Minister has recommended—I think he met representatives from the L.C.C. a few months ago—the introduction of early-discharge schemes, and I understand that an increasing number are taking place every year. This means the early discharge of the mother from the hospital, sometimes within 24 hours of the birth of the baby. I say that this is a retrograde step, opposed to the interests both of the mother and of the child. The baby needs training, particularly with regard to feeding, and the mother needs an adequate rest. We are becoming a bottle-fed nation. I am beginning to think that while a woman is adapted to feed a baby certain parts of her anatomy will soon become vestigial structures if this goes on.

When a woman is discharged in this manner she is immediately beset, on returning home, with all the worries of the household. In fact, mother is expected to conduct the housekeeping from the bed: she is given her purse, which she keeps under the pillow. I have seen this so many times. Her life then starts all over again, with all the day-to-day worries, and she is subjected to a strain which is detrimental to her health and that of her child. I would emphasise here that there is another part to childbirth. Not only must we ensure that the mother is delivered safely, but we much also ensure that she is protected afterwards from the impact of the household.

Further serious comment on perinatal mortality has come from the Committee sponsored by the National Birthday Trust Fund. They presented a most serious Report, and I have not noticed that the present Minister of Health, or his predecessor, has rejected their findings. When I mention these findings now they may sound rather horrific; but I can only say that this survey was made by some of the most eminent specialists in the country and, so far as I have read, the Minister of Health has not rejected their findings. The perinatal survey expresses the opinion that there are 100 unnecessary infant deaths a week. Its recommendations include sufficient beds in fully staffed hospitals, maternity units, and immediate steps to increase the number of midwives.

The Report states—this has been said over and over again—that the staff shortage results from overwork and underpayment. If we are to be guided by the perinatal survey, which, as I say, was conducted by many eminent people, then in the two years in which the midwives have been negotiating for better pay 10,000 babies have died unnecessarily. The midwives negotiated. they got a little increase, but still they have not been given what they asked for. It has been estimated that to pay the midwives adequately might cost the country an extra £1½ million. Is that too big a price to pay? We have seen lately in the Press the profit made by Ferranti—£3 million of profits, which was ignored.

These women have been asking for better pay year after year, and now we find a kind of passive resistance: they refuse to go out and do this physically hard and exhausting work unless society recognises their work.

Driving to-day in the traffic of London and other big towns, we have sometimes to avoid a little woman in blue on a bicycle with a black bag fixed to the back of it. This is one of the finest workers in the Welfare Services, going to deliver a child. For the sake of the mother and the child, when this woman arrives, having negotiated the traffic, she must be cool, calm and collected; and this is the shabby way society treats her. She is pot vocal; she has not got a big pressure group; she does her duty, and society seems to say "So long as you do that and do not make a fuss, we are not going to do anything more about it".

The perinatal survey recommended that each midwife should have a small van—I suppose we should call it a "mini-van". That is an excellent idea. It also recommended that she should have proper equipment, and be instructed in emergency resuscitation. It is a short-sighted policy to try to get the maternity services on the cheap. Apart from the waste to the nation of these potentially healthy babies, there is the huge cost of maintaining in institutions the maimed and often mentally deficient patients who survived a difficult birth but whose brain may have lacked oxygen at a vital moment because of lack of medical skill. These are the findings of the perinatal survey. Of course we cannot assess the toll in human unhappiness involved in this.

Now I turn to another aspect of maternity. It is still a cause for concern that unmarried mothers tend to seek antenatal care later than married women do, and that the illegitimate child has a greater chance of being born prematurely than the legitimate child. I am glad to learn that that fine organisation the National Council for the Unmarried Mother and Child are now considering the changes necessary in the legal and social policy we adopt towards our unmarried mothers. On an average 37,000 illegitimate babies have been born annually since 1955. In London, where I admit the circumstances are rather different, because these girls can come to London and remain anonymous, the ratio of illegitimate to all live births has risen from 7.7 per cent. in 1955 to 14.1 per cent. in 1962, and in 1961, 5 per cent. of the babies were born to girls under sixteen years of age.

Again, this is a social problem which we are inclined to ignore, but it cannot be entirely divorced from the increase in venereal disease. Your Lordships will recall that last month the newspapers gave great prominence to the report of the British Medical Association which was concerned with measures to combat venereal disease, particularly among young people. It was given prominence for a day or two, but then, so far as one knows, was forgotten. At any rate, little more has been heard about it. It seems that the community does not like facing reality about its sexual behaviour. Perhaps when the noble Marquess conies to reply he can tell us what action the Ministry of Health is taking following this most serious report. The report revealed that from 1951 to 1962 the population increased by 6.5 per cent., but the incidence of sexually transmitted diseases increased by 73 per cent. But, of course, these figures reveal but a part of the problem, because they relate only to patients seen at venereal disease clinics, and exclude those treated by general practitioners, those treated privately, and those in the Armed Forces. Young people below 25 present a particular problem, for they contribute about 40 per cent. of the total increase of infections in women.

The report quite rightly does not blame the young man or young woman. It blames society as a whole for blurring the essential values. The fact is, as I think, that promiscuity is glamorised by adults; it is glamorised every day on television, and there is all this pornography—and we are told the country is swamped with it—coming from America. The adolescent amateur seeks to ape the adult, and ends up in a squalid little adventure with disastrous results. The point is that when a boy or girl has got into this very serious trouble all the expensive apparatus of the various Welfare Services is set in action. Doctors, health visitors, clinics, moral welfare societies all come in immediately and try to help. But it is not enough to provide an ambulance service. We must provide an antidote to the insidious influence inside or out- side families before it begins to affect the child's behaviour.

What happens now? Society tries to shift the blame. It says, "Let the teachers teach these boys and girls (boys and girls in their last two years at school, looking like young men and women) about the dangers of sexual intercourse; the dangers of venereal disease; the risk of becoming pregnant at an early age." The overworked teachers quite understandably say, "This is not our job. This is the parents' job." Well, the parents are either indifferent or find the topic embarrassing. It is quite remarkable that it is not only the parents of a child in a working-class area who appear to find this topic embarrassing. The most extraordinary thing is that one finds fathers unable to talk to their sons about these things. We must not expect cocksure youth before they are hurt to seek advice. It is no good setting up some kind of organisation to which we think the adolescent can go, and then sit back comforted in the thought that we have done something. We have just set up one more committee. We have taken a room somewhere in a crowded neighbourhood and said, "Let's name it the Advice Centre", or some euphemism of that kind, and have told them to go there.

Somebody must take this knowledge to the adolescent. I was very impressed when yesterday I heard my noble friend Lord Willis say that the greatest success in the field of crime had been achieved by sending a police officer to the schools, during the last year or two of school life, to tell the boys and girls just what they may expect if they engage in petty crime. He said that the result had been remarkable. I think that, in the same way, if we are to help these children effectively we must take the information to them—somebody who can look them in the eye, not hedge on any aspect of the subject, and somebody whom they trust. We have already heard that ordinary welfare workers are in short supply, and they are not equipped to do this.

I would suggest that the part-time services of a large number of married women doctors, who have dependent children and therefore cannot now take a full-time job, should be used. These boys and girls have been treated by women doctors in the clinics as children and therefore they trust them; they are not shy with them and are prepared to accept advice. I would attach a new kind of school visitor. This particular doctor would not be there for the purpose of making a physical examination. She would be chosen because she could tackle this difficult problem. I suggest that she could go there and could talk to them without feeling any embarrassment, and she could do that because it is her life and she has been trained in these things.

Moreover, she would not be prejudiced against any boy or girl because of his or her unruly behaviour in the school. We must have someone who would see these young men and women, not knowing their background or how they behaved, but knowing that they should be equipped with some very important information before they faced contemporary adult life—a life charged with so much temptation of a kind which we did not envisage some years ago. Therefore, a piece of constructive advice I should like to contribute to this debate is that this new kind of school visitor for this particular purpose could be introduced without delay, because there is an available supply and, in my opinion, this matter brooks no delay.

3.58 p.m.


My Lords, I should like to join with the noble Baroness in thanking the noble Lord who has introduced this important matter. I should like also to express to the noble Baroness what I am sure is the feeling of the House—a note of gratitude for the fine, authoritative and moving speech which she has just made and for which I know many of us are extremely grateful. Like her, I should like to take the opportunity of mentioning another gap in the general services which the nation provides in dealing with a particular social problem. The matter receives a passing reference in the document Health and Welfare in paragraph 133. The fact that it is only a passing reference is, I feel, symptomatic of the way in which the nation approaches this problem.

The matter I wish to put before your Lordships is the plight of the alcoholic, the research into the nature and treatment of his disease. We must be clear what we are talking about, for the alcoholic is not necessarily, or in essence, the heavy drinker, the "boozer", or the drunkard. The alcoholic is the compulsive drinker. The World Health Organisation has defined him as: the excessive drinker whose dependence upon alcohol has attained such a degree that it shows a noticeable mental disturbance or interference with his bodily and mental health, his inter-personal relations and his smooth social and economic functioning: or he shows the prodromal signs of such developments. He therefore requires treatment. In other words, the alcoholic is a drug addict.

His situation is a pathetic one. The people most likely to fall victim are those who are sensitive, idealists, ambitious, imaginative. All too often they follow a rake's progress from relief or social drinking to heavy drinking, with warning signs of brain damage; then to drinking into insensibility and, finally, to the chronic stage. It represents a breakdown of the whole personality. Those who have held honoured and responsible positions become dishonest, furtive, dirty, unreliable. They are prepared to jeopardise everything in order to get the alcohol for which they crave. They will sacrifice the happiness of their homes and the welfare of their children. They become victims to nameless fears, they lose their self respect, they are indifferent to the humiliation which they bring on their relatives and their friends. Their state is most pitiable.

What is the extent of the problem which they present? It is not easy to make an exact calculation, since by the very nature of the condition those who are victims are ashamed of themselves and do not readily reveal their degradation. The World Health Organisation has adopted what is known as the Jellinek formula, and in those countries where it is possible to assess statistics accurately the figures have proved to be on the conservative side. Applied to this country, the Jellinek formula produces the figure for England and Wales that one in every 100 is an alcoholic; in other words, that there are 400,000 alcoholics in Great Britain, of whom a quarter—100,000—are in the last stages of the disease, showing marked physical and mental deterioration. Some hold that these figures are exaggerated, others that they understate the case, but many experts consider them to be about correct.

These, my Lords, are terrible figures—400,000 alcoholics, of whom one-quarter are in ay advanced stage of deterioration. Measured in terms of their social consequences they represent a vast waste of people whom we can little afford to abandon, for, as I have said, alcoholics are often those who start out with high ideals; they are the perfectionists. The figures represent a serious wastage in manpower. In the United States of America they reckon that 3 per cent. of the labour force is rendered useless through alcoholism. Alcoholism is the main cause of the break-up of marriages, and where it is tolerated the children grow up in an atmosphere of insecurity and humiliation. The cost to the State is considerable, both in hospital treatment and in support of the family. Many alcoholics spend long periods in mental hospitals and in prisons. The loss to society, to the professions, to industry, through alcoholism must be great. It is a very real social problem.

What can be done to stem this tragic tide? The first thing is to establish the clear recognition that alcoholism is a disease treatable by the medical profession. The situation has been bedevilled by the moralistic attitude and the lack of understanding which society has so often adopted. I yield to no one in my admiration of what has been achieved by the temperance movement in this country. My own grandfather founded the Church of England Temperance Society, which was the parent of the National Police Court Mission, itself the parent to the probation service. But too often that movement has suggested that this is essentially or wholly a moral problem and that it can be solved by an effort of the will. That is not so. Alcoholism often finds its origin in human frailty, but when it has obtained a grip upon a person then neither moral exhortation nor punishment can be the right treatment it needs.

Of course, there must be a continuing effort of the will, but it needs the medical man as well. It is also the case that the alcoholic can seldom, if ever, be cured, in the sense that he can be the same man as he was before he became an alcoholic. He may have done himself some irreparable physical or mental damage. He may never touch alcohol again without the danger of triggering off the whole process once more. But he can be, in many cases, rehabilitated and become a respectable and useful citizen once more, but only so long as he is recognised to be a sick person who must be treated as such.

In the battle to persuade public opinion to acknowledge this truth, a major advance was achieved in the publication in 1962 by the Ministry of Health of Memorandum H M.(62)43 on the hospital treatment of alcoholism, which commended to hospital authorities the need for providing facilities for the treatment of alcoholics, as recommended by the Standing Medical and Standing Mental Health Advisory Committees and endorsed by the Central Health Services Council. That document represented an important breakthrough, for, for too long this aspect of medicine has been a Cinderella. Is there not some significance in the fact that, in the recently published Report on the medical services from a Committee under the chairmanship of Sir Arthur Porritt, although a number of ancillary medical services were represented I could find no mention of treatment for alcoholics?

My first question, therefore, is to ask to what extent the recommendations of that Memorandum have been implemented. If my figures are correct, there are fewer than 40 hospitals in the National Health Service offering facilities for treatment. These facilities vary a good deal in the expert and specialised nature of their treatment. Many of them are situated in mental hospitals, which are not necessarily the best places for such treatment. I hope that the Ministry of Health will look at the situation carefully, and encourage the establishment of specialised units in general hospitals in much greater numbers.

But clearly in this debate we should be more concerned with the wider aspects of treatment and rehabilitation. For alcoholism represents so complete a breakdown of the personality that its redemption needs the co-operation of all who are concerned with the well-being of society and of the individuals within it. Doctors, clergy, welfare workers, probation officers, must all make their contribution and work together to a common end. Much is already being done. Alcoholics Anonymous has blazed a trail in bringing the techniques of group therapy to bear upon the problem. The country has reason to be grateful to its members for their unselfish service. The Church Army and the Salvation Army, and such expert institutions as the Reginald Carter Foundation here in London, are doing much in the realm of treatment and personal counselling to help the victims of this disease. The recently-created National Council on Alcoholism is making a start in coordinating information and in doing constructive thinking on a comprehensive scale. It aims, among other efforts, to set up regional information centres from which information may go out and where general advice may be given.

These activities are all to the good, but they are only a beginning towards the understanding of a very big and complex problem. We cannot be content in this respect, as the noble Lady has said in other respects, merely to pick up the bits and pieces. We need a comprehensive national programme of education in which agencies of government, welfare services and voluntary effort are co-ordinated. There is need for education on the dangers and treatment of alcoholism, so I understand, in the medical schools. Children at school should be warned of the dangers. Medical officers of health should be encouraged to support the establishment of clinics and information centres. The voluntary services should be alerted to the importance of a recognition of the symptoms and the appropriate means of treatment. Financial aid should be available from national sources for the National Council on Alcoholism, and on a wider scale from local authorities for local effort.

My Lords, all the evidence suggests that this problem of alcoholism is a growing one, and the dangers are especially acute among young people. Unless we enlist in a planned policy the service of all agencies concerned to halt its progress, we shall be laying up for ourselves a legacy of wasted life and wasted energy. One way or another the Government receive a lot of revenue from alcoholic liquor. I hope that they will plough back a great deal more than they do now in order to encourage voluntary and professional action in the solution of a great social evil.

4.13 p.m.


My Lords, I join with all noble Lords who have spoken in expressing grateful thanks to the noble Lord, Lord Amulree, for introducing this debate, and for giving us this opportunity of discussing an extremely important subject. As so often happens in your Lordships' House, all those taking part so far have, I am quite sure without pre-arrangement, devoted their attention to particular aspects of the Welfare Services; and already, even if no other useful word were spoken in this debate (although I am sure noble Lords who follow me will have a lot to say which will be of great use), we could now say that, if the Government had any real determination to tackle this problem, the suggestions already made would be of very great value indeed.

Although, according to the Motion moved by the noble Lord, we are asked to devote our attention to suggesting ways for the better use, or the best use, of the limited resources available for the Welfare Services, I feel one must begin by protesting at the pitiful inadequacy of the forces available, particularly the manpower forces, for these services. My noble friend Lady Summerskill made brief reference to the Mental Health Services. I feel that the 1959 Act, of which we hoped so much, will prove a delusion and, indeed, a swindle on the mentally afflicted until we have in the community the means of providing the domiciliary care and attention which were promised when that Act was passed.

The last issue of the Ministry of Labour Gazette shows that there are 27,596 vacanies for professional and scientific workers which cannot be filled. Of these, 19,539 are vacancies for women—and this, of course, would include nurses and midwives, to whom my noble friend referred. I would say to my noble friend that those who have responsibility for the administration of hospitals, including maternity units, are resolutely determined to ignore or resist the pressure which is put on us to discharge mothers and babies within 24 hours; and I would also say to my noble friend that her own profession can do a very great deal in resisting this pressure if consultants in charge of maternity units resolutely refuse to discharge mothers before it is safe to do so.

My Lords, a total of nearly 30,000 unfilled vacancies is a frightening total, and in my experience the position is getting worse. When we debated this question nearly two years ago, reference was made to the acute shortage of medical auxiliaries, radiographers, physiotherapists, occupational therapists, almoners, psychiatric social workers and the like. The shortage then varied from a minimum of 20 per cent. to a maximum of 42 per cent., and it is even worse now. Like my noble friend, I have become really tired of saying that the salaries paid to these medical auxiliaries, who are vital to the Welfare Services, are far too low—extremely low compared with the earnings of unskilled people in other callings. Unless the Government make radical changes quite soon, I think we shall have an insoluble problem on our hands.

It is imperative to realise that the Health and Welfare Services will not recruit the large numbers of people needed to build up for the future until it is recognised that some kind of career structure must be created and a great many more training schemes introduced. For example, only ten days ago, at the Annual Conference of Child-care Officers, it was estimated that the services would require at least 600 new entrants a year. But the training provisions will provide only 300—half the number needed.

There must also be an adequate provision for proper training allowances, because it is not enough to promise a good job at the end of training. A girl of 17 or 18 can find herself earning £400 or £500 a year in industry, and with the training allowances that are at present available we just cannot attract sufficient recruits into the Welfare Services. We have got to the stage where, struggle as we may, we count ourselves very fortunate if, at the end of the day, we are no worse off. Indeed, in London we are confronted with a new situation of a declining population in central London and an increased population on the perimeter; and, with the considerable difficulties that there are, people just will not travel long distances when they have to face so much traffic chaos and delays in travelling into London. They will get jobs near to their homes.

I think the only answer is to reorganise existing services, so as to enable a concentration of skilled personnel, wherever possible, to operate a particular department efficiently. It is therefore a matter of crucial importance to the efficiency, economy and well-being of the Welfare State that the available resources should be used to the maximum benefit of those in need of them. I think, therefore, that this makes imperative a careful study of the operation of our existing services, and it is especially necessary for the adequate servicing of chronic as distinct from acute conditions, and to facilitate the rehabilitation of those suffering from different degrees of disability.

I would add a word or two to what the noble Lord, Lord Amulree, said about old people, and then devote my remarks to the special needs of the mentally-handicapped people of all ages. I would emphasise at once that I am not speaking about the mentally-ill but the mentally-handicapped whose problems and needs are not so much psychiatric as educational. I think that, even with the resources we have, a good deal can be done for old people if hospitals will do more; and, in doing so, they may have to disregard some of the instructions given to them.

In my London group of five hospitals we have a geriatric hospital of some 300 beds. Four or five years ago we established a modern group laundry which enables us to do something like the fantastic number of 30,000 or 40,000 pieces of laundry a week; and we are even taking in other groups' washing. But it has enabled us, I am glad to say, through the social welfare departments of the two or three boroughs which form our catchment area, to undertake the laundering of washing for old people who are incontinent. This includes not merely those in hospital, but those who live round about.

I know that this subject may sound rather sordid, but it is one of the great difficulties and one of the things which imposes such a burden on the home. If help of this kind can be provided it makes it possible to keep these people longer as only potential patients—because eventually, if they live, they will become patients in that hospital. It is an economic use of resources both of manpower and of money. In old age the distinction between being well and being ill is often blurred, and the decline into illness is frequently gradual. It is quickened sometimes by the stresses that arise: through living alone, or living without sympathy, help and care; or by having to bother with catering for oneself and by other domestic matters. All these contribute to the gradual onset of incapacity, and frequently to its accompanying illnesses.

The noble Lord, Lord Amulree, spoke about the need for far more domiciliary visits to aged people. I am sure that matter is extremely important, because loneliness among old people is such a tragic thing and is a very important factor in furthering their rapid deterioration. If we can provide some services in the home, and from the hospitals, to postpone hospital entry, it is cheaper and reduces the pressure on the waiting lists.

Many of the great social changes in house and living standards, and in the pattern of neighbourhood life, intensify the loneliness of the aged, in spite of many improvements to living through better social conditions. Often their neighbours and also their own families—certainly the part of London that I am thinking of—live in new, self-contained units, instead of in the tenement rooms of shared houses; and many of the younger people are too busy with full-time employment to have time to be neighbourly. In many cases, old people suffer real neglect and are badly in need of help and care. In this particular area the shortage of home help workers is quite acute, so the plight of some of the old people in their homes is deteriorating very greatly.

In this same hospital that I have spoken of we have tried to meet this need by starting a day club, both for people living outside it and also for in-patients. This is an excellent thing for the patients in the hospital who are less ambulant—though not much—than those who live outside; and it is very good for both kinds of old people, especially those who still live at home, to get a communal daily meal, an interesting occupation and entertainment, as well as medical supervision, at quite a small cost to us. Generally speaking, they help each other very much indeed.

This is a simple enough scheme, and not very costly; but the financial help provided for geriatric needs is very difficult to come by. We have had—I was going to say the devil's own job, but I will say an awful job, to get £1,500 for essential lavatories and a few ramps to the lavatories for old people; and we have had to go to the King's Fund for £2,000 to make the hall decent. This is such a comparatively small amount of money to do such a great deal of good. I think that all this is terribly short-sighted. I would draw the Minister's attention to the fact that in these hospitals we make sure that we have on our house committees full-time social workers employed in the borough or boroughs. This means that we have immediate contact all the time, so that it all becomes virtually the same service, although under two different authorities and two different Government Departments. I commend that suggestion to the Minister as one that might be found generally useful.

I will now ask your Lordships to consider the question of mental subnormality, which presents a clear example of the extent to which the integration and co-ordination of the various services is of such paramount importance, if the individual is to receive the help and support which he needs and which it is within our competence to give. Unfortunately, in my view, the tripartite form of the Health Service has become a major impediment to efficiency, and it is high time that we considered how to overcome it. This is an operational problem, and the first step towards its solution is operational research. There must be, first, a full assessment of all resources available: of the hospital service; of the local authority services in health, welfare and education; from the general practitioner and from the voluntary societies. Secondly, there must be joint planning, so that more effective co-operation can be established between these various agencies. Thirdly, there must be a study of the requirements: of the real needs of the individual needing help, and, indeed, of the help that his family needs.

The problem is to harness the resources we have in order to achieve the maximum benefit, and in order to use the skilled personnel available to the best advantage. I believe that these multi-disciplinary techniques involve a team approach, and it is in these terms that we must plan our services and distribute the experienced staff at present available. The training programme for new recruits and auxiliaries to our social services must be adapted to the idea of working together as a team. I think the team structure is replacing the old hierarchical structure which was characteristic of the hospitals of the past. We need specialists who can work with social workers and teachers, and social workers and teachers who can work with consultants. Above all, we need teams of differently-skilled people equipped to work not only with the disabled individual but also with his family and relatives, and even with his employer. I am speaking particularly of the mentally handicapped. Available resources vary too much in different areas for a single plan to be imposed everywhere, but the resources which exist in every area can be coordinated through joint planning and they must be related to the real requirements of those in need of them.

I think the official policy of domiciliary care will succeed only if the Welfare Services in the community are developed in the greatest co-operation with the special knowledge of the consultant and the special need of the "consumer". Lack of co-ordination would be grossly uneconomic. The unhappy failure to provide adequate services in the community increases the demand on the hospital services for residential care, which is much more expensive, both in money and skilled labour, than if we looked after these people in the community. The length of stay in hospital is intimately related to the services in the community which are available to a patient on his discharge and to those looking after him. We should not send a patient out into the world unless we are satisfied he can be looked after. We can make better use of our hospital beds if we provide better services in the community and if those services are planned jointly with the hospital specialists by the authorities concerned. This not only applies to the mentally handicapped; it is also relevant to the old people.

The health and welfare services can only use parents and relatives as auxiliaries and colleagues in caring for the mentally subnormal if they are prepared to treat them as co-operators in the service and as members of the therapeutic or rehabilitation team. We must make available to them the advice, practical help and knowledge necessary to enable them to care for the disordered in the community at home. The parents are often unpaid nurses and they should be given the same access to specialist help and guidance as nurses in hospital. If we are going to use unpaid people, willing as they may be, let us see that they are trained.

Subnormality is one of the largest problems confronting the Welfare Services and one of the most neglected. We have made some progress, but further improvement is impeded by lack of coordination. Let me give one or two examples. Day nursery provision for the pre-school handicapped child is essential to relieve the strain on the mother and to provide an opportunity for gradual diagnosis and assessment of the child's educational needs. The nursery group could be invaluable as an observation centre, if it was linked with a common centre in each area, through which all the agencies concerned with expert advice and guidance, ascertainment, assessment and supervision were co-ordinated, for it is in these first years that the basis of further treatment has to be planned. Then, short-stay care is often hard to find. Better provision for temporary care is needed, if the mother is to have an occasional break or if she herself is ill or if the rest of the family are to have a holiday.

Further vocational and social training should be available for the older handicapped child. He will be doubly handicapped if it is not available. Above all, there is urgent need for hostel accommodation for subnormal adults who are viable in the community and can pay their way, provided there is somewhere they can live. It is shameful to think that we still allow the sub- normal person who has lived perfectly well at home to go into an institution when his parents can no longer look after him, merely because society fails to provide an alternative home for him. Institutions are not intended to be living units. Partially disabled people, the handicapped and the aged are social beings like ourselves. Hospitals do not meet their social needs and were never designed to do so. It is deplorable that we do not yet have hostels for the handicapped adult who cannot live on his own.

There should be far greater flexibility in residential care. It should be available on a daily, weekly, monthly or term basis, according to the needs of the individual child. The parents of a child in care or in hospital should not be treated as though they had abdicated their role as parents. They should have the same mutually co-operative and helpful relationship with the hospital staff that good parents expect to have with the teaching staff responsible for their children at school. Another suggestion I would make to the noble Marquess, Lord Lothian, is that parents of mentally handicapped children should be considered for membership of house committees of institutions for the mentally handicapped and, indeed, for membership of hospital group management committees. I am sure that they could have a valuable contribution to make.

Resources vary in different areas, and local circumstances make an all-over blueprint impossible, but in each area some common centre or focal point should be established through which all necessary services can be co-ordinated. The voluntary services, of course, have a great contribution to make to the Welfare Service and the National Society for Mentally Handicapped Children, of which I am Chairman—an office bequeathed to me by my noble friend Lord Longford some time ago—has a wide experience of the needs and problems of the subnormal person. But we find that much of our time and resources is devoted to the providing of services which are at present lacking entirely and which we think should he provided by central or local government.

For example, the Society has an industrial training centre at Slough for young adults and it is pioneering methods of training designed to further the social development of the trainee. But now that the scheme is working well and coming to fruition, one of our problems is that local authorities are not ready to assure us that when these young people we have trained go hack to their homes, there are the necessary services in their area to look after them to the limited extent for which they will still need care.

We have plans in hand for a rural training unit, run on similar lines, designed to give the subnormal specific rural skills. Another unit is planned for horticultural training, for an industry in which open employment is both feasible and available for the mentally subnormal. These are only three of something like 15 projects which we have in hand, and every single one of these is to supply a need which is very real and very great but for which there is as yet apparently no glimmer of a determination by the central Government to provide the badly needed resources. It seems extraordinary that it has to be left to a voluntary society, not only to take the lead but also to do almost all the work, in an essential matter of this kind.

Those of us who do not ourselves have a mentally handicapped child can have little idea of the stress this problem creates for the family, who love him and strive to help the child to learn how to live with this disability. The relatives of the mentally disordered are in the position of having a highly skilled job to do, without the advantage of the special training and of the supporting team that the hospital staff has to support and guide it. Subnormality is not a problem which the neighbours know much about, because it is hidden away from them. It is not even a problem which the general practitioner knows much about. It is a specialised problem, and the parents get little specialised help or advice.

Professor Illingworth, of the Chair of Child Health at the University of Sheffield, wrote the other day: It is difficult and almost impossible in the busy out-patient department to give parents all the help they need with regard to the problems of their mentally sub-normal child. It is difficult, not only because of the considerable amount of time necessary to help each parent, but also because the problems are so deep and complex, and often so individual in each family, that it is easy for the doctor to think he has dealt with the matter in full, when in fact he has only touched the fringe of the problem, and he has totally failed to understand the real feelings of the parents. There is not a chair of retardology in any university in this country; there is scarcely any teaching hospital which has a clinic where a consultant pædiatrician can meet the parents of retarded children and help them. My Society has a responsibility to provide specialised counsel and advice to parents. It is directly available to them, and it is also used by the other agencies dealing with the case. The specialist dealing with the child, who has not time to help the parents with their own great stress and anxiety, can call on this service. It is amongst the resources available that can be called on to help. It is provided through the devoted efforts of some 25,000 afflicted parents.

We have some resources—considerable resources, if you like—but still all too few. Our greatest lack is co-ordination, integration and joint planning. We cannot use the resources we have to the maximum benefit unless hospital, local authority and voluntary services cease to be regarded as separate empires and operate as a single, integrated service. In practice, of course, sometimes they do; but, generally speaking, the problem is to establish the means to begin to plan jointly. The financial obstacles are great, but not insuperable. We could do so much more with what we have if we were not obliged to pursue separate, uneconomic planning in a vacuum.

My Society represents a large group of "consumers"—250,000 of them. I ask the noble Marquess to tell us when the Government will begin to cater for them. When will they give a dynamic lead and get all concerned to act in the realisation that the Health and Welfare Services exist to benefit people and are not run for the sake of the authorities whose responsibility it is to organise them? We cannot afford to parcel out our resources and dissipate them in separate packages. The need for decisive action is, I submit, urgent, and I hope the Minister can assure us that the necessary action will be taken soon.

4.44 p.m.


My Lords, the noble Lord, Lord Amulree, has initiated what has proved to be already a wide-ranging debate, far from being limited, as might have been thought from the actual wording of his Motion, to the detailed problems of manpower. We shall all remember the plain words of the noble Baroness, Lady Summerskill. It is certainly a fact that the Churches, so far as they are concerned, are fully alerted to the gravity of the problem upon which she touched, although we are under no illusions about the range of our direct influence, and we understand fully that there are large numbers who can be reached only in other ways. Her suggestion about visitors to the schools is one that I personally feel is well worth following up. The only immediate modification that I would make about the proposal is that these visits and lectures should not be too much in the nature of a cautionary tale, in the sense of being purely negative and building up fear, but, as I am sure she would be the first to agree, should be positive in their content and open up for the young people the positive advantages to health and happiness of a properly ordered sex life.

We are also glad that this debate gave an opportunity to my brother the Lord Bishop of Chester to make his important speech on alcoholism. We have seen that subject on the Order Paper under "No Day Named" for a very long time, getting nearer and nearer to the top, but never quite getting there; and the noble Lord, Lord Amulree, has certainly done a service to that particular branch of social concern by giving my brother a convenient opportunity to speak. I hope—and I am sure others agree—that the fact that his speech took place in the context of a long, wide-ranging debate will in no way reduce from the importance that will be attached to it by those who have to follow these matters.

If I may say just one word, following the noble Lord, Lord Stonham, about the laundry service, I am sure that the town in which I live, Leicester, is by no means the only one which has this service, but I can certainly testify to its extreme usefulness. The service is run by a co-operative effort between the local authorities, the W.V.S. and the old people's welfare associations. It is now well established and is deeply appreciated over a wide area of the population.

I questioned one word when reading the Motion of the noble Lord, Lord Amulree, and that was where it refers to "the need for a further study". I wondered about the word "a", and whether it was likely to lead to a demand for another early full-scale Report, on the lines of the many Reports that we have already had. I felt that, if that were so, we might be taken along a wrong path just at this moment, in that I am not sure whether we have reached the time when we are ready for a completely new step: in other words, whether we have consolidated the land that we have already claimed, or tried to claim, through recent Reports and studies.

I believe that there are certain moments of vision in the life of a country, each one of which can, and often does, result in some direct step forward in the matters of social welfare. One of the obvious historical cases that at once comes to mind is the Elizabethan period, which found itself confronted with the problem of the beggars, sturdy or otherwise, and in order to deal with them had to produce its first Poor Law laws. It has only recently struck my mind that the old nursery rhyme raises the whole dilemma of social action in these matters: The beggars are coming to town, Some gave them white bread, some gave them brown, Some gave them the horsewhip And drove them out of town.


Plum cake, they gave them.


That is another version.

There was in my version of the rhyme the dilemma of the social welfare approach and, so to speak, the criminal responsibility approach. We are still confronted with this dilemma, as I shall hope to show in a few moments. In the nineteenth century, it was the plain, obvious needs of physical ailments that struck people; and that, of course, is still going on. I find myself repeatedly attending centenary meetings or seventy-fifth anniversary meetings of various societies for the blind or the crippled. These were the things that struck the imagination of the nineteenth century.

Since the last war, we have the new vision of a Welfare Service covering, so far as we can see it, every aspect of human need, although, as we have heard this afternoon, there are still very large gaps. As we try to measure up to those needs we have had our Younghusband Report, the Ingleby Report, and all the others. My impression is that we are still in a fluid state in these social services, and that we have a great deal to master as we try to work out the schemes that have been put before us. These are enormous documents, and it takes a long time for them to be translated into action. However, in the meanwhile, we have to go on making continuous study of these services and of our use of the limited manpower available.

I wonder whether we have made sufficient progress along the lines that were indicated in both the Younghusband Report and the Ingleby Report—what one might call a general practice approach to social service. The Ingleby Report asked for these family bureaux where general problems of any kind could be opened up. The Younghusband Report had a place for the general-purpose social worker. I believe that if we could do more about that kind of thing, we should be attacking this problem at a vital spot, because we should then be making sure that people get to the right place and the right people at the right time. That, surely, would be a help in the economy of effort.

Meanwhile, of course, we want co-ordination. That is a word which is easy to say, but difficult to translate into action. One of the things we need, as a first step to it, I think, is better communication and more easy contact. There are many barriers to this kind of contact between professional workers of different kinds. One of the chief barriers is that they all have their special language—it can be called jargon by those who do not happen to use it. This different language is a real barrier, as, for instance, between the psychiatric social worker and the health visitor, to mention just two obvious examples. I believe that manpower would be saved if we were able to take a non-judgmental attitude over a wider area of these social problems.

I have talked a good deal to our own social workers in my own area, people working with the Family Service Unit and bodies of that kind. Their impression is that society is still a little too insistent on what I might term the educational aspect of its treatment of welfare cases, to the detriment of the human compassionate need that is obviously there. The kind of examples they give are the application of what is called the wage-stop, the rule whereby people can get from the National Assistance Board only what they would have been able to earn had they been physically and mentally fit to earn it. I am told that in cases of large families, this works out to the detriment of the family concerned, although one can easily see what is intended by the regulation. There are also strict rules about the maintenance of the double family—the man who, through the irregularity of his life, finds himself supporting two families at the same time. There are, I understand, distinct limits as to how far the children can receive the fullest help and support. One can see that obviously the nation does not want to encourage people to have several families at the same time; and that view has to be balanced against the human need of the children who already exist.

The home-help system is one that would bring about considerable economy in the use of more technically trained manpower if more generous help could be given; if cases could be brought more easily into the group which qualifies for home-help. And that, of course, would in turn require more home-helps. Altogether, under this heading we have to see that failings of personality and character are just as real handicaps as obvious physical limitations. In my view, society will have to accept that and plan its services accordingly.

I should like to say just a word about the relations between the Churches and welfare work. I am sure I speak for all Churches when I say that we welcome the obvious awareness in the Home Office and elsewhere of the service that can be rendered, and could be rendered more effectively, by religious communities, and by a better and more organised policy of good-neighbourliness. We welcome the Home Office circular, on Section 1 on the Children and Young Persons Act, 1963, in which there is a definite invitation to Churches to nominate people who will work with the local authority in family welfare of a general friendly character, and I am sure the Churches want to do what they can to follow that up.

The clergy have a part to play in all this work, which I believe is to be touched upon later by the right reverend Prelate, the Lord Bishop of Wakefield. I will just say this. We sometimes notice a reticence on the part of Government Departments and other authoritative bodies to mention clergy and ministers among those who may help in difficult situations. We get used to the list of doctors, psychiatric social workers, probation workers and so on, but we do not even see the clergy put in that list. That is no doubt our own fault. Evidently, there is in the minds of a good many the feeling that parsons, in the very nature of their work, are bound to be what is called judgmental. I do not believe that this is necessarily true. I think that in the course of years, indeed, centuries, the clergy must have picked up a considerable amount of wisdom and experience, and we should hope that they will be regarded as among those who have some contribution to make in these matters.

Finally, I would stress the fact that we had better accept the need for an overall expansion of workers in the social services. Parkinson's Law must be seen to be not only a joke but also a fact of life, and I think we might get ourselves into a better frame of mind about all this if all of us could see that, once we have embarked upon this great project of providing a social welfare service, we have at that time committed ourselves to a continuously growing army of workers. It is not easy to get them, to train them or pay for them, but if we can all see together that this is something we have to do, it will, I think, help the atmosphere.

I think it was the noble Lord, Lord Stonham, who mentioned that probably 600 new child care officers are needed every year, so far as we can calculate the need. That is only one branch of this tremendous work that we have to cover. If we can see this as something that is bound to grow and bound to make a continually increasing demand upon society as society takes a stricter view of its duties in relation to every branch of needy person in the community, I think that perhaps we shall be better placed to deal with it.

Finally, my Lords, I would mention that there is always a balance to be struck between providing an adequate casualty service and that bracing atmosphere of reward and even punishment, without which character and good standards of life cannot easily develop. We are told in our history books that the monasteries not only relieved beggars but also created them. We do not want to fall into that trap, although it is very difficult not to, but even if we have to create a few in relieving a lot, we are going to choose to relieve a lot. But these two sides of our needs will always have to be held in tension. The needs for both sides will be voiced by different persons and by different Parties, or perhaps by the same Parties sitting in different parts of the Houses of Parliament at different times. But, whatever may be said on either side about this double problem, in the end it has to be dealt with by an act of statesmanship which does justice to both sides of the argument, and it is in that spirit that I would ask Her Majesty's Government to approach this matter.

5.2 p.m.


My Lords, the right reverend Prelate the Lord Bishop of Leicester said that the clergy tend to get left out of the list. I must say that when I am making my little list of social institutions I always put churches and public houses together, and I am never quite sure which to put first. Now I am not very sure whether the right reverend Prelate the Lord Bishop of Chester will approve of me at all. It so happens that I have been waiting for his speech on alcohol for a long time and, like an ass, I was having tea when he was talking about alcohol. I must apologise to him. I was hoping he was still going to make his speech. I am sorry that I missed it.

It used to be said that you needed a bench of six Bishops before you could open Joanna Southcott's Box. There were six Bishops on their Benches a minute ago—but, alas!, three of them have gone, because I want to open Joanna Southcott's Box for a minute in reference to the Motion of the noble Lord, Lord Amulree, as I do not like welfare services—I suppose I am the only person here who does not—and I do not like them because they represent failure. I admire intensely the people who work in the welfare services; I think they are some of the most wonderful people in the world; but we ought to look forward to the day when the number of clients of the welfare services will not grow.

We are all going to be using the welfare services some time, said the noble Lord, Lord Amulree. I think this is awful. I really think this is a shocking attitude, and I would entirely disagree with him. I think we want to try to teach and help people not to need the welfare services. I loathe illness, but we have to have health services. I loathe poverty and I loathe the things we have to deal with in the welfare services, and I look forward to the days when we are going to get rid of those things. I think that is perhaps what we ought to be thinking about a little more. I disagreed with a great many of the remarks of the noble Lord, Lord Amulree, but I am sorry he is not here for me to disagree with him. I will talk about something else just in case he comes back in about five minutes' time.

I was out this morning with a friend of mine, a first-class general practitioner in South London, and I said to him, "Tell me straight off which are the welfare services which you use, and list them roughly in the order of value to you and your patients as you see them." Here is what he said, and I thought it was rather an interesting and good judgment. First, he said, come the health visitors and the district nurses. He valued both those extremely highly. Secondly came the Meals-on-Wheels service. He said that this was "one of the most valuable things for my old people"—and he regarded them as his old people. He linked that, he said, with the Invalid Meals service, which delivers special meals to people in their homes. Then, he said, came the mental welfare officers and children's welfare officers, and incidentally, of course, he mentioned the home helps earlier on when he was speaking about district nurses and health visitors.

Then he mentioned the National Society for the Prevention of Cruelty to Children. I was surprised because I had a prejudice against the National Society for the Prevention of Cruelty to Children because I thought that they prosecuted people for neglecting their children, but he told me that I was wrong and that their aim always is to keep the family together. He then said that he could not remember the name of the next organisation but he referred to them as, "Those wonderful people who supply the bedding and furniture after the family have smashed theirs up". He was referring to the Family Service Units. I would agree with him: he was absolutely right.

Then he mentioned the local Old People's Welfare Association and all that they did; the chiropody service as being enormously valuable for old people; and, finally, the women police officers. Actually, he mentioned one more group of people whom he admired very much, the National Assistance Board, whom he said did splendid work and were always ready to send someone out to somebody's home when a person was in real difficulty. There I would disagree with the noble Lord, Lord Amulree. Although it is obviously desirable to keep old people mobile, to keep them going to centres and to a place where they can get a meal for as long as you possibly can, rather than to take it to them, there comes a point at which people need help in their homes; and, thank goodness! there are people who take meals to their homes and are not unwilling to go. Many of those old people are most deserving and valuable folk.

The noble Lord, Lord Amulree, in his Motion calls for a further study of the welfare services. I would ask for a further study of the people who use the welfare services, and I would ask particularly for a regular, annual statistical survey to be carried out by the Government Social Survey (they have the machinery) of the extent of the need for welfare services, so that we have a picture of how much is needed in terms of the nation as a whole—it can be done perfectly well on a sampling basis—to set against what is available in the way of welfare workers. I should have thought that that was a simple social study which the Government could carry out for an expenditure of under £10,000 a year, which would give us a most valuable indication of where we were going and whether we were going on in the right direction.

Now I see my noble friend Lord Amulree has returned, so I can have a "go" at him with a good conscience. He had some remarks to make about health visitors, and may I say I agree in principle with what he was saying? But his point of criticism, as I gather, was that the health visitors spend an enormous amount of time visiting mothers and children and far too little time visiting old people. I think he got hold of some rather old-fashioned county councils or county boroughs to quote from, because I believe progressive and sensible county boroughs and counties, in my experience, practise or enable their health visitors to practise selective health visiting of children and do not try to make the enormous number of statutory visits that they are supposed to make to every mother and child; because if they try to make the statutory visits they waste an immense amount of time visiting people who do not need visiting, whereas they should be visiting, as he said, the old and sick and the people who are in need of social help.

He asked, why not let the health visitors nurse? In the rural areas the health visitors do usually nurse; that is to say, they are combined district nurse, health visitor, midwives. They are excellent people. But it is only fair to say that they do less health visiting work, less of the social side of their work, because they have to do so much curative work and midwifery. So, on balance, I have reached the conclusion that it is not a good idea to encourage a health visitor to be a nurse as well. I think she is the most valuable kind of social worker, and I would keep her as that. I am absolutely certain that the proper thing to do is to leave her in her work with the general practitioner and let her work from his surgery.

The standard objection is that the general practitioner does not look after a clear-cut area; he looks after a scattered population, and the next general practitioner has another scattered population. If you link the health visitor with them, she does not get a nice, clear-cut administrative area. But in fact it works perfectly well in all the places I know where it has been tried, and where the health visitor has been given a room in a group practice centre the system has worked like a charm. We have done it for eight years in Harlow in all the group practices, and more and more local authorities are doing it with general practitioners all over the country. I have not heard of a single case where it has not been a tremendous success. It is no good having a tea party where they get together. This is day-to-day work. The general practitioner must use the health visitor as his social worker.

I disagree with what the noble Lord said about district nurses. He said that if district nurses were attached to general practitioners there would be about a quarter of a district nurse per general practitioner, and this would not be very good. As a matter of fact, this is what does happen. I would say there is a quarter of a district nurse per general practitioner, and it works very well. There is inevitably tremendous coordination between district nurse and general practitioner, and in almost every case the district nurse is brought into operation because the general practitioner asks for her.

No problem arises from the district nurse working in the same place as the general practitioner, along with the health visitor. We have probably just about enough district nurses to do this, and it would in fact work very well. The noble Lord, Lord Amulree, wanted to have a new kind of nurse. I do not think this is necessary. I think they are both pretty good, both doing very well, and both will do better when they are given a chance to work in partnership with the doctors, as they are already increasingly doing.

I want to turn for a moment to the customers, the users, and to a very interesting remark of the noble Lord, Lord Ilford, about the road to the "problem family". All the customers are ill; they are either physically ill or mentally ill or socially ill or economically ill. These are the people that these welfare services are operating to help. Some of these people are in need of temporary help, and they are fairly easy problems. When it is an acute situation, where an immediate tragedy occurs, welfare help may be needed; but if it is a short-term affair the acute episode is not too bad.

It is the long-term episode that presents difficulty: the episode that goes on either for the rest of one's life because one has a chronic disease or has become ill in old age, or the cases about which my noble friend Lord Stonham was speaking, where one has one member of the family who presents, and will go on presenting, a problem throughout life. These are coped with very often by the relatives, and I think we must do more to teach ourselves to help ourselves. I greatly admire the many families who look after and bring up mentally defective children quite wonderfully, with almost no help from outside people; because the real work has to be done by the people who look after them. And it is the same with families looking after old people. We cannot all be busy employing somebody else to look after our problems.

But there is a group of people who are completely hopeless at looking after themselves, and these at the extreme are the "problem families" to which the noble Lord, Lord Ilford, made reference. I remember a few years ago I was on the North of the Tyne and was visiting some very slummy areas there with the local doctors. I asked what percentage of the people in those slummy areas were problem families. They were real, dilapidated, derelict, slummy places. The local doctors said, "It is very interesting. In this area, when we started in practice, about 40 per cent. or 50 per cent. of the families were problem families. Then the council built a council estate about a mile away, and the children from these slummy areas migrated into the council estate very largely, and there the rate was about 10 per cent. of problem families. Then the council after this war built a better council estate and the children of the second generation moved to the new estate, and there the rate was 2 per cent. of problem families."

I am quite sure that a great deal of the problem of "problem families" is soluble by housing, simply by decent housing. But there remains an irreducible amount of about 2 per cent. who are really true problems. They are extremely difficult, the 1 per cent. to 2 per cent. of social failures who just cannot cope. Their histories are very interesting. The noble Lord, Lord Ilford, knows much more about it than I do. But the kind of history one has is that they are not over-endowed intellectually; they are usually very simple people; they are very lacking in energy; they never hold jobs down very long and they often "chuck" the job as soon as it shows any signs of being difficult. The mother in many cases had to get married at an early age. She has no idea of either self-control or birth-control, and she simply goes on producing children. She manages with one or two or three or four, and then comes a point when she cracks completely.

These families never cook at all; they simply eat out of the packet on the table, and the only thing one can say is, "Thank goodness! for school meals, because at least the kids get one decent meal a day." If you look at these "mums" they are almost all anæmic; they never eat meal, except out of a pie or a sausage roll. They are the people who are the real challenge. They are the people for whom the family service units, and if I may say so, the health visitors, the district nurses, home-helps, and all the rest of them, have done so much; and they need constant help. But we can, if we rehouse, if we build a decent society, get our problem down to 1 per cent. or 2 per cent.

The noble Lord, Lord Ilford, said that eviction sometimes turned the scale. That is true enough; but often these people are evicted because they are like that. I have thought that what we ought to do is to build special houses for them; not push them into the worst houses that we have, but build a special kind of house, one which is indestructible and which could be hosed down once a week; with a concrete backyard, if you like, and with destroyable curtains. Give them new curtains when they need them—new furniture when they need it. They are people who fill up the beds with bugs; they live in rags. Give them decent things, and go on replenishing these. Give them constant hot water. To obtain constant hot water is one of the things they cannot cope with.

But all this means spending more money: more money to build these easy-to-cope-with houses in which they cannot go wrong—because these people of whom I am talking can go wrong almost anywhere. They will tear down a bannister: we must give them one that they cannot tear down. We could design a house they cannot "muck up", and then teach them, gradually re-educating them back to being properly social living families. But they present the challenge—and they are a challenge, not only to the doctor and to the social workers, but to my noble friends Lord Stonham and Lord Longford, when they are dealing with their petty criminals who comprise so many of our prison population.

I would say one word about loneliness and old people. Again, I think that we as a society ought to feel ourselves responsible for this. I know that when we house families in our New Town of Harlow we try to house their old people as well. Many of them do not want to come. They want to stay in their old environment, and one cannot blame them. But we do build suitable homes, and I am pleased to say that a considerable number do come and do not go back again. Quite a number like it and are happy. Even when the old people stay behind, at least half, nearly two-thirds, of the families in Harlow are in regular contact with their "mums" and "dads", going back every week or fortnight to see them. I think we all have a duty to go and see our old people regularly. Many old people want to be on their own and not with their in-laws. They want to be useful and used, and they do not want to be a responsibility. But, that being so, I think we have a responsibility to do all we can to make the evening of their lives good.

5.25 p.m.


My Lords, I speak from a different angle from anyone else, because I speak from the specialised angle of those who are engaged in voluntary service. The interest that all voluntary workers have in the welfare services of the country has been accentuated and much deepened since they have learned something about the laws behind the welfare services of the country and the local application of those laws. If I were to begin to talk to your Lordships in regard to housing or probation work, about old people, home-helps, or "Meals on Wheels", the work in hospitals or for children, about problem families, or the derelict, you would still be here to-morrow. As I recognise that one of my chief duties is to be brief, I will do none of these things.

But I would say at once, taking up the noble Lord, Lord Taylor, that all welfare work, as I see it, is for the lonely. In some way or other, the people for whom we are endeavouring either to legislate or to organise—or, indeed, to do the practical work—are all lonely. I am not one of those people who are keen on social studies; I prefer the practical application, and I rather dislike the idea that on a specimen number of people you can get an answer on which it is completely possible to act.

What we have to examine to-day is, where are we going? I can only feel that all of us, if we think deeply, are grateful to the noble Lord, Lord Amulree, for having put down this Motion, so that we can have the opportunity of hearing the many speakers who have participated. I wonder where we are going. I hope that it is towards the ultimate of domiciliary care for those who require it, and the lack of institutionalisation on a long-term basis. This aim, I am proud to feel, in this country is dictated entirely by the humane outlook of the men and women who are responsible for charting these seas. I am quite convinced that as we reached this ideal of domiciliary care, we did not have before us the financial gain it would mean for the country. In spite of this fact, there is no question that ultimately, if we could develop domiciliary care in the way it can be developed, it would make a great saving nationally, from the financial point of view, and I am convinced that the co-ordination we require could be achieved.

I am quite convinced (and I travel a good deal: I have just come back from the United States of America) that our Welfare Services are the finest in the world. But I think that in order to get the Welfare Services up to their maximum in the way of performance it is necessary for us to integrate voluntary service into statutory aid. The difference of voluntary service on a post-war basis is that volunteers have recognised that charitable patronage is of the past and that statutory aid is the order of the present; and if this be so, the integration of voluntary work into statutory obligation is something which is of vital importance to the nation.

It has been said by an eminent man that voluntary service is the mortar between the bricks of officialdom. I think this is a good way to look at it. I think that voluntary workers must learn to work to statutory aid in a way that is acceptable and contributory. It was in 1962 that local authorities were asked by the then Minister of Health to consider whether more could be done by voluntary organisations, and they were asked also to set up machinery for this purpose. The question as to how far this has been done is one that is often raised. But I should like to say that we should be both unfair and ungenerous if we did not recognise that the great change in the care of old people came as a direct result of the protagonist of the day, Aneurin Bevan, when he asked for the care of old people in residential units in the way he did.

Many people thought it would never be possible. To-day, county councils are housing old people in residential units at a cost of £7 10s. a week, and achieve an occupancy of over 90 per cent. This is a tremendous occupancy when one realises the rate of turnover in these residential units. This means that the nation owes a great debt of gratitude to local authorities who run these residential homes in a way which is far removed from the institutionalisation of the past. I have visited these residential homes up and down the country, and I think that we should be very proud of the progress which there has been in recent years in this direction. At the same time it is necessary to recognise that between 30 and 40 per cent. of the old people housed in residential units are housed by one or other voluntary organisation.

One of the things we have to look at extremely carefully, and guide with great dexterity, is the fact that more and more voluntary organisations working to local authorities should be steered in the way in which their work can be of value to the community and not merely a ploy on their own. The result of the 1962 circular has been somewhat patchy, but with stimulation from those who are interested, and with a little imagination on the part of others, a great deal can he done. There is still a tremendous untapped pool of people to work, and organisation is important in this direction as well as the ideal of what people can do if they have the opportunity to be allowed the privilege of service.

Voluntary bodies to-day like to work direct to the local authority. They like to be given the responsibility for a job, and to carry it out in a responsible way, having their own methods of handling recruitment, training, and the ultimate carrying through of the job. This I would state, from my own point of view as Chairman of W.V.S., in connection with such things as the original organisation of the home-helps and the working of the "Meals on Wheels" service, which so far as my own organisation is concerned is at the moment delivering 5 million meals a year. Volunteers can carry out many jobs which can release professionally trained people—ordinary day-to-day jobs, so that the professionally skilled can do the difficult tasks and carry through those things that need great training in their undertaking. One of the things that are necessary is for volunteers to recognise that "Their's not to reason why," but their's to do the odds and ends of jobs, unless they wish to take the trouble to become fully qualified, either by testing or by training.

I should like to pay two personal tributes. One to the right reverend Prelate the Lord Bishop of Chester who, I am sure, in his speech on alcoholism, did something for all of us in putting very clear responsibility on every single thinking person. He said that no effort could be too great. I have a belief that if one sees the need for a job and does not carry it through, the sin is one's own. Therefore no effort can be too great, and nothing can be too much to do in this direction. I believe the finest thing we could get out of to-day's debate would be permission and backing to try a series of experiments on a scale that would show results.

Here I would pay my second tribute, to my noble and respected friend, Lady Summerskill. What she said was so tremendously vital, and surely if we try some experiments on this basis we should be able to show a pattern which could subsequently be copied all over the country. The noble Baroness said a great deal about midwives, and she said that as one saw them one realised their strength. One of the things she omitted to say was that a midwife is on call 24 hours out of the 24, and very often works endless hours, in the most difficult circumstances and without very much help. To-day, thank God, people are judged by performance and no longer by their "wrappings". For this reason, the district nurse and the midwife are locally the best-loved, the best-respected, and indeed the finest in the whole of the team, because they spend themselves most lavishly for the people they are endeavouring to serve. I consider that the solution to the problem, as has been said by two or three speakers this afternoon, lies in getting a team to work together and getting them to divest themselves of personal interest and hope of glorification. To get this, obviously much must he done.

The practical thing I should like to see out of this is something I know a good deal about in relation to the work of one of the sections of the service to which I belong. Residential homes for the elderly throughout the country operate in all kinds of ways, but the preoccupation of every single residential home is what is to happen to old people when they are too sick to be nursed in the home and when it is impossible to get them into a hospital. I have discussed this problem with hospital authorities up and down the country. I believe that in recent years hospitals have grown into much finer organisations than they have ever been before and that their handling of patients is first-class. But many patients could be allowed to come out of hospital if there were a place for them to go to. We hear this again and again. It is not a No. 1 skilled nursing home that is wanted, but a place to which they could go, where they could be looked after and cared for, so as to empty the bed in the hospital.

This is a serious matter from a national point of view, when there are queues of people waiting to go into hospital. If we could act on this question of houses where the very frail could go and where, perhaps, little by little they could be made fit to be once more members of the community, we should be accomplishing a tremendous piece of work. But the difficulty here is entirely financial. The local authority has great burdens to meet, and it must always be remembered that local authority members actually live in their constituency. They are not able to come to Whitehall. They have to live with people knocking on their doors, and therefore are very averse to adding a penny to the rate.

If houses of this sort, which we all want, are to be put into operation, I believe that it will be necessary for the central Government to bear the expense, and therefore they would have to come under the Hospital Plan, rather than under the local authority. I would strongly advocate that this should be done, for it is a question which needs to be solved. It needs courage in its handling, but if a solution were found, it would give great help to overloaded hospitals and would shorten the queues of people waiting to go into hospital.

None of us would be debating this question if we did not care about the subject. None of us would be worthy of being members of our community unless we played our part in the whole. It is so great a tragedy that one has to feel that one is doing something almost wrong in advocating a measure which will mean a new rule in order to rectify something which has been wrong in the past. I am convinced that what we need is to find a new word for welfare. I am equally convinced that we must find some sort of variable by which it can be measured. If Treasuries can understand only figures, then a variable that can be translated into figures must be found. Because unless we can do this, the practical work which is ready in abundance in the country will not be able to be integrated into the statutory aid, and the nation will suffer.

I believe that what has been said, either directly or indirectly, by previous speakers this afternoon is the answer to our problem. It is that each man and woman who can be made to think should begin to regard himself or herself as part of a team, a team which belongs to the community, and should realise that each one taking responsibility within the community will be playing his part in achieving what we all want—that is, the beginning of an era in which people can look at themselves with self-respect, where, if they need domiciliary care, they can have it, and where people do not have to wait in queues to obtain the help which legislation affords them but which practical implementation cannot give them.

5.41 p.m.


My Lords, I think the attendance of the six Lords Spiritual necessary for the opening of Joanna Southcott's Box shows at any rate that this subject, which the noble Lord, Lord Amulree, has raised, is of very great concern to the Churches, and, in the same way as my brother Bishop the Lord Bishop of Leicester warned the House, I want, for just a few minutes, to look at it from the point of view of the Churches. A diocesan Bishop is, by his appointment, made into a kind of welfare officer—though not in the generally accepted sense of the term—and it is from this point of view that I want to look at the whole of this subject.

The technical term for the kind of responsibility which is given to him is the cure of souls. This does not mean as it was made to mean in Nazi Germany, and still means in the areas where dialectic materialism prevails, caring only for the people in the hereafter. It means, of course, the care of the whole person in this life and caring about the conditions under which the whole person lives and works here and now. The face-to-face case work has to be delegated to the incumbents of the parishes in the Bishop's diocese, and by implication, of course, as we have been thinking just now, to all the lay members. Of special concern to him, necessarily, are all those in the community who in this transitory life are in trouble, sorrow, need, sickness, or any other adversity"— which covers the whole of the welfare services which we are thinking about.

The origins of our services, as the noble Lord, Lord Amulree, indicated, lie precisely in this ministry, through the charitable societies which have really stemmed from it in all periods of our history. What has been happening in this century can be described as the very remarkable taking up by the State of this whole inheritance of community care which clergy and laity have, I suppose, always in the past exercised in terms of the simple, unprofessional Christian works of mercy. Either some form of professional, statutory service has been introduced, or some voluntary society with trained or partially-trained workers has been encouraged. So this is all being developed now; and the diocesan Bishop, and therefore the parish priest, of course, finds himself with a whole host of colleagues—not by any means all professing Christians, of course—who work within one of the statutory or voluntary services.

These services, together with what the Churches do in their own way, form a whole network of pastoral care, and it is about pastoral care that we have been thinking ever since this debate opened. It is from this point of view that one speaks. Whether it is the health services and the hospital services, whether it is education, whether it is local government, whether it is community services in a new area, or whether it is the provision of home helps that you are thinking about, there one finds one's colleagues—and I am speaking from the clergy's point of view—in pastoral care. This may, of course, take you into rather strange and unexpected company—unexpected by the other person who is confronted by a Bishop who thinks this way—as happened on one occasion when I was visiting a parish in order to meet some such colleagues. I ventured to call on the local small sewage plant where only one man was in charge and I must confess that he found it a trifle odd when I was discussing his job with him from the point of view of his being a colleague. Nevertheless, here was community care in a very real sense, and I use that illustration in order to show how extensive this is.

To come to the welfare services in the stricter sense, however, it is the problem of recruitment which I think is very much on one's mind. What goes to the making of the person who will take up some form of this many-sided work as a career? In what one might call the primitive stage of all this, you drew on a sense of vocation, on the desire to help one's neighbour, on the ordinary motives which lie behind Christian service which you expect to find in a society dominated for centuries by Christian principles. This is obviously no longer the state of the nation to the same extent as it was. Yet it is clear that in all forms of social work, whether undertaken by the State or by the voluntary societies, whether it is individual case work or group work or community service that you are thinking of, you look for men and women with some real sense of vocation, with some real concern for persons as persons, prepared to be trained to do skilled work and give skilled help in various forms to people at considerable cost to themselves; men and women of reliable character as well as of intelligence.

Though I hope this will not go on for very much longer without the rewards of a fairly high salary and the knowledge that welfare work ranks high in the general estimation, alas! this is not true yet. In fact, in the great Reports on Royal Commissions and other bodies in recent years, which have been mentioned, the qualifications looked for, both in full-trained and in partially-trained officers, have sometimes read rather like the qualifications looked for by the Church in an ordinand. This, from my point of view, is only to be expected since so much of the work that has to be done is an extension, to professionally qualified lay men and women, of the Church's pastoral care. But the pool from which such people are naturally to be drawn, because of their upbringing, is not all that deep: nor is it as extensive, proportionately to the rest of the population, as it once was.

So it seems to me that we have to think deeply about the aims of education, with this whole development of the Welfare Services and of a Welfare Society in mind. It is not only a question of putting the various careers now open, and the possible forms of voluntary service, before young people in school, important though that is—and I am delighted to find that my own West Riding authority is giving some thought to it—but rather the bigger question of the nature of the society which young people are being educated to live in and to serve, and how they are to be initiated into it.

I cannot help referring to the influence upon our Civil Services, both home and (though one must not mention it nowadays) colonial, and upon the choice of many a man's career, of the ideals which have informed what is (not always in all quarters favourably) regarded as the public school system. Many, I am afraid, will admit that to-day it is upon the job with good prospects, for which you are being equipped, rather than upon the community which you are being educated to live in and serve, that our educational system seems to lay the greater emphasis. It is when one listens to the figures which the noble Lord, Lord Stonham, quoted, of the vacant posts, that one thinks of what is being done to put into the minds of the people who are growing up the validity of this whole thing, and thoughts of a career and vocation of service to the community through the various statutory or voluntary societies.

Lastly, there is the question of the best use of our limited number of people, and of looking at it from the point of view with which I started. The question of co-ordination has already been referred to. In the field of child care another lead has been given in this matter of co-ordination, and in the Ministry's circular of last September which my brother Lord Bishop mentioned explicit mention was made of the need to make really effective links with the clergy and laity of the Churches. This is the point I want to emphasise, my Lords. I see great advantage in a much wider and much less timid recognition of the place which the parish priest has in the whole set-up of the Welfare Services, though he is, of course, independent of them. He is inescapably involved with the care of the aged, with the whole problem of community care of the mentally handicapped and with young people of all sorts and conditions; and he is constantly in people's homes, of whatever kind they may be. He is also the person in the local community who has a certain amount of authority to give a pastoral oversight to his lay colleagues in the services, similar to the pastoral oversight which a Bishop must give to his clergy.

I see a new relationship between Church and State being evolved here: a partnership different from anything that has ever been known before. For, with the extension of the total cure of souls, the care of the whole person, to trained and partially trained social workers in the various fields of welfare service, the ordained minister now has his place alongside the other workers as one professionally trained to help people at the particular level of pastoral care for which his office stands. A mutual recognition of each other's professional qualifications and special functions by all the workers in this field, including the ordained minister, is what seems to me to be called for to-day, in order that there may be as full and effective co-operation as possible.

This calls, of course, for some considerable reshaping of the professional training of the clergy, as well as the adaptation of traditional ways to the rapidly changing pattern of welfare. It also calls (and this comes into our whole scheme of training) for the inclusion of instruction in the proper and distinctive part which the ordained ministry has to play in the total pastoral care of individuals in any training course that is planned for social workers. As yet, it happens too seldom that the clergy are recognised as essential partners in any co-ordinated team.

I hope, my Lords, that there will not be any misunderstanding of what I have tried to say. One has no thought here of the advantage which might accrue to the Church from such a development of cooperation between Church and State in this form. There is nothing self-regarding about it at all, of course: this is co-operation in service to the community. And co-operation demands intelligent mutual respect for the different skills that are called for in this service to people. It does, however, say that no Welfare Service can be comprehensive which does not take account of the whole person, and we must include the spirit, as well as the mind and the body, so long as our country is not officially committed to a materialist philosophy. Taken all in all, I think that such a way of looking at this problem leads one to believe that co-operation in this particular sense must influence for good both the recruiting and training of future workers, and the present deployment and use of those who, often working against great odds, serve their fellow men with such skill and devotion.

6.0 p.m.


My Lords, the right reverend Prelate said just now that the clergy did not always get its due place in the list. There are four of us on the list to-day, compared with three doctors; so that I think your Lordships may feel that on this occasion we have had more than our fair share. It is the family, friends and neighbours that I want to take as the theme for what I have to say for the next few minutes.

Before developing that theme, however, I should like to make it quite clear that in tackling the subject in this way I do not doubt for one moment that in our advanced, sophisticated and complex society we still need the full range of highly trained, skilled and specialised people in the social services. I am quite certain that we need more of them; I am quite certain that more of them need more training, and I entirely agree with the noble Lord, Lord Amulree, that more study is needed on the subject of their training. But I do not want to develop that aspect further, because it is my conviction that there will be no end to the number of welfare workers we require in the social services, and no hope of getting the best out of them, if we do not at the same time take pains to harness to the social services the families, neighbours and friends who all have their part to play.

The work of the social services is with the families rather than with individuals. That concept is, I think, well established. It has perhaps not yet been fully applied; and more could be said about it. I want to start by suggesting that, while strengthening and developing the social services, we must also strengthen, prepare and train the families themselves to grapple with the complications of modern life and to play their part in partnership with the social services. Where family life is sound, many problems with which the social services would otherwise have to deal do not arise.

There has been talk this afternoon, as there was bound to be, about juvenile delinquency and about illegitimacy. These problems, where they arise, can only too often be traced back to a breakdown somewhere in the family.

Where family life is sound, there are few social problems for which the expert help of the social services is required that, in the end, cannot best be tackled, with the help of experts, by the family within the family. However advanced our geriatric services become, they can never fully take the place of the full range of care and love for the elderly that can be given by a well-knit family; although, of course, it is perfectly true that there may be many cases in which the expert specialised social services can help.

The problems of mentally-handicapped children, which have also been mentioned this afternoon, call for very expert guidance. But in a great number of cases the treatment and special upbringing needed is best administered, with expert guidance, by the family within the family. Where family life is sound, there is a great deal for which the statutory social services are responsible that can be done by the family on their behalf. I think for instance of foster families that help by fostering children who would otherwise be in public care.

The Royal Commission on London Government discovered that the Hertfordshire County Council, with 1,000 children in care, had entirely dispensed with nurseries and relied on foster families to look after the children in care for them. The same Commission also discovered that the cost of looking after a child in a local authority home ran at about something over £7 a week, while the cost of looking after a child in a foster family was something under £2 a week. These figures may be slightly higher now; but this is an interesting comparison.

It follows from all this that, whatever we may now think or plan or do about social services, and particularly what we do towards developing of family social services and family welfare workers, we should also think, plan and do something, about the families themselves; about the husbands, wives and parents; their training and preparation for modern life, and (to use the social services jargon) their conditions of service. It seems to me to be of at least as much importance to strengthen family life to meet the challenge of living in the 1960s as to strengthen the social services themselves.

What in fact do we do? Of course we see that all parents-to-be are given a good and basic general education. We try to see that they are provided with decent houses—and the importance of doing this has already been stressed. We try to see that there is work for them; we try to keep the cost of living steady, and to see that there is no lack of expert advice to young inexperienced mothers in the upbringing of their children. All this is good, so far as it goes. But the question I would draw to the attention of your Lordships is what we do specifically to prepare parents for their job, as such; for the duties of married life and of parenthood. I am afraid that the real truth is that we do very little.

Much can be done, and of course is done, at home, at school and elsewhere, to help prepare young people to understand and cope with family life. The noble Baroness, Lady Summerskill, has mentioned the importance of one particular form of training—in sex. A good deal is being done; but a good deal is also being done to hinder the educational work of this kind by certain television programmes, by books and literature which we should be very glad to be without. But I believe that a uniquely favourable opportunity for service to young people comes when a couple become engaged. At any rate, this is my own personal experience as a minister in the Church of England. There are something like one-third of a million marriages a year in England and Wales. Half of these take place in the churches of the Church of England or of Wales; others in churches of other denominations, and some in registry offices. It is my experience that virtually all engaged couples—and I can think of only one exception in my own experience in the last year—are only too glad to embark upon as thorough a course of systematic preparation for family life, marriage and parenthood as can be devised for them.

Unfortunately, with the other commitments of parish life, it is often so little that one can do. I have not yet worked in a particularly large parish and, fortunately, I have worked with a fair-sized staff. I may give engaged couples rather more than a fair share of my time but, on average, each couple who are to be married I seldom see more than five times: once on their own, to put up the banns; three times, in company with other couples, for a general discussion, and once more for a rehearsal of the wedding service. But this seems all that one can fit in. Other clergy may be more successful in combining this with other aspects of their work; but I do not believe that this work ought to depend—as it seems only too often to do so—on the clergy alone, even though it falls to us—and we cannot escape that—to solemnise about a quarter of the million marriages that occur every year. In this field it seems to me that specially trained counsellors should be working in partnership with us—as indeed they are; but, sad to say, not yet to any significant extent.

I understand that the National Marriage Guidance Council, the largest organisation in the field, the Catholic Marriage Advisory Council and the Family Discussion Bureau between them have established counsellors for this preparatory training for married life, based on 150 centres all over the country, but so far a mere two or three thousand out of the quarter of a million couples being married every year have the benefit of their wisdom and experience in their preparation for family life. So may I start by pleading for whatever financial and other support from Central Government is most needed by them, to enable the National Marriage Guidance Council and other bodies of similar standing to expand and extend so far and so fast as they can, consistent with the maintenance of their present high standards.

At the moment, we are in the rather absurd situation of paying about £21 million towards looking after children in public care, and about £3½ million in helping people to get divorces, and paying to the National Marriage Guidance Council and similar organisations £46,000. I think that these figures show clearly that we have this whole problem out of perspective; and I very much hope that, when he comes to reply, the Minister may be able to hold out offers of rather more help in this direction.

May I now turn to good neighbours and develop a little the point raised by the right reverend Prelate the Lord Bishop of Leicester in his speech a little earlier. No one denies the part played by good neighbours in the social services but, as with the family, the rôle of the good neighbour is so ancient, so traditional, so basic, that with the development of these modern social services, the part of the good neighbour has been pushed out to the edge of the pattern. I think that now opinion is shifting back to a rather wiser view and we should do all that we can to speed it on.

An illustration of what I mean can be seen if we read what the Younghushand Report of 1959 said about neighbours, and notice, not particularly the words used, but the general tone. The Report said: The good neighbour is a voluntary worker, though she may never have thought of herself in that way. I hope that she never will. Later on in the same paragraph, the Report says: there will always be room and need for the good neighbour in the social services. In that sentence, and in a lot of others, I think we can detect the assumed pre-eminence of the trained, statutory professional in relation to the mere good neighbour. That was in 1959. In 1962, listen to these words from Miss Aves. the Chief Welfare Officer of the Ministry of Health, who said: The emphasis in the whole development of the social services to-day puts the good neighbour into the centre of the picture. She goes on: We know that there is not only a place but a crying demand for help from every person of goodwill. That is much more the sort of stuff we want to hear, and I am sure that she is right.

In this connection, one of the most sensible things that have been done by the Ministry of Health, which has already been mentioned by the noble Baroness, Lady Swanborough, is to address the local authorities as they did in the terms of the three circulars of 1962 calling for closer partnership between the statutory and voluntary social services in their areas. This is one step in the right direction. As the noble Baroness said, this sort of partnership can well be extended and must be fostered. The Royal Commission on London Government focused attention on another partnership that needs to be encouraged. In Chaper XI of their Report they make a powerful plea for a better partnership between the separate statutory social services themselves— the health, welfare and children's services. All these have been mentioned already in our debate and are important. But, in my view, there still remains the need to carry all this co-ordination and partnership right down to street level in the community, and to do this the good neighbour simply has to be brought into the picture and into the partnership.

It is here that I believe the Churches have a distinctive part to play, especially in those places where they have managed to co-ordinate their activities, particularly their pastoral activities, through councils of churches. I think that it is now a fairly widespread practice, one which I have certainly met a good deal and a growing one for the churches, at any rate in the larger parishes, and in those which have stewardship campaigns, to appoint representatives from their own congregations as street wardens or agents in each street or locality, with responsibility for keeping an eye on thirty or fifty households. They have the duty of getting to know people, keeping in touch with them, being ready to help them or to arrange help for them if need be. These good neighbours do not need to be fully trained welfare workers, but they need to have a grasp of the social and welfare services which are available. In passing, if I may, I would disagree with my noble friend Lord Ilford when he said that information about the welfare services can be had only from leaflets and the B.B.C. I think that we ought not to overlook the services of the Citizens' Advice Bureaux in providing this sort of information.

Good neighbours who are trained and organised by the Churches in this way are the sort of people the community needs if it is to meet the four points mentioned in the Ingleby Report as essential for preventive social services. These four points were to detect the need, to investigate and to diagnose, to arrange treatment, and to make known what help is available. These are the essential ingredients of preventive social services. I do not believe that there are any welfare workers, however well trained, who can be so well placed, with their ears so well to the ground, as the good neighbour living in the same street; nor do I believe there is any other social service agency with greater resources than the Churches for co- ordinating this work at street level. After all, we have branches in every city, town and village in the country, and already have an established practice of meeting together at least once a week. Therefore, I welcome the move to put the good neighbour back into the centre of social services. I should like to commend to your Lordships every step that gives effect to the intention to do this, and to record my conviction that the Churches together, as and when they have got some measure of co-ordination among themselves, have a real rôle to play here.

My last plea, which is a short one, is that in all this we should keep our view of the social services in perspective. Here I am taking up a point which was raised by my noble friend Lord Taylor. It is easy to get over-excited and enthusiastic about the welfare services and to get over-busy in social service. I have a little biblical illustration here, which I am a little chary of using in such distinguished company. Martha, if your Lordships remember, was distracted—encumbered with much serving; and yet, rather surprisingly, she was less commended for all her activity than her seemingly rather idle sister. I do not think this means that we should do less for those in need. It does not mean that there is no need for a community to care for all its members who are handicapped, disabled, lonely, elderly or deranged and so on. But I think it is a warning that we must all, and especially those of us closely engaged in social service, beware of a rather nasty sort of paternalism towards the people we are trying to help.

Paternalism, if carried too far, has a deadly effect on good plain friendship, and it must not be allowed to intrude upon it or replace it. This means, I think, that a community planning and providing social services such as we have been talking about to-day must also come to think and plan beyond them; to seek to provide for needs which are deeper and wider than the rather specific ones about which we have been talking.

I believe that, in the long run, it is at least as important for the building up of the healthy life of our towns and cities and of the wholesome life of the citizens who live and work in them that we should everywhere, side by side with the things we have been talking about, have an abundant supply and ample choice of flourishing societies, clubs and leagues of every kind: coffee bars, bowling alleys, pubs and so on; clubs for every sort of specialist, from the model-aeroplane enthusiast to the bird watcher; places where people can meet in large numbers or in tiny groups in pursuit of some common interest; where they can meet, in fact, to learn and develop the art of real friendship.

There obviously must be strict limits to the amount of public money that can be spent on these private activities. But what can be done should be done; and it must be encouraged, because this sort of development has a good and lasting effect on the social life of our towns and cities. There are plenty of splendid organisations dedicated to the advancement of sport and many other of the leisure activities, of which I have cited a few examples. But there is still, perhaps, the need for some overall approach to the planned provision of adequate leisure activities throughout the community—and I very much welcome the fact that before long we are to have a debate on leisure.

It seems to me that the Councils of Social Service, where they exist or are being established, are admirably constituted for developments of this kind: and where they are established they may well already have gained useful experience in this field which they ought to endeavour to share and extend. The social services, as we think of them now, are certainly playing a valuable part in our society. They are an essential part of any modern civilised State, and we shall all wish to join in expressing gratitude to those who are working in them, those who have brought them to the high pitch at which they already stand and those who desire to develop them further. We must encourage them to do what they can. But, at the same time, I would join with my noble friend Lord Taylor and say that I believe that the best guide of all for the further development of the social services is to recognise that the less we have to depend upon them, and the more we are able to count on the help of families, neigh- bours and friends when we are in trouble, the better we shall be.

6.25 p.m.


My Lords, I must apologise for bothering your Lordships twice in two days, and explain that this is due to advice that I received from my noble friends on this side of the House. I was told by some of them that the most difficult thing to do was to make one's maiden speech, while another group said that the most difficult speech was that which one made after a maiden speech. So I decided to take the two more or less together at one leap.

I hope your Lordships will forgive me if I take a more critical, and perhaps a little more political, attitude than has so far been expressed in the debate. I believe that this is a serious problem and one that has great political connotations. The Fisher Group and the Council for Children's Welfare as far back as 1957 used words to this effect; that present-day social service arrangements, as they affect the family, are characterised by delay, duplication, lack of continuity purely haphazard situations as to needs and remedies, and finally by a tragic and tremendous waste of human happiness and public money. I do not think there is any reason to believe that the situation is any better to-day than it was then.

I noticed that over the week-end Mr. Selwyn Lloyd announced with some pride that the number of people in this country earning between £15 and £40 a week, after tax, had increased from 2,300,000 in 1954 to 10 million to-day. That fact is correct. But I think he ought also to have added that, according to the latest figures to hand, after eleven years of his Government, nearly 5 million people in this country are living on National Assistance. That, to me, is a shocking fact. Twenty-four per cent. of all retirement pensioners are forced to apply for additional aid from National Assistance, and nearly three-quarters of all National Assistance allowances are paid to supplement inadequate benefits.

This illustrates one plain fact—namely, that the gap between those at the top and those at the bottom is growing wider, and we cannot afford to be complacent about this. The means test, which was the horror of so many people in the 'thirties, has come back to us in the 'sixties, and these 5 million people have to surrender some of their privacy, no matter how tactful, kind and understanding the National Assistance Board officials may be—and most of them are—in order to live at a subsistence level.

What is needed, in my view, is a different approach at the top to welfare and social security. Too much of the present-day welfare organisation has grown up out of charitable organisations—charities; and it is coloured by the old Victorian approach from the top: that is, helping only the deserving poor; the "soup and blankets" atmosphere; the paternal attitude mentioned by the noble Lord who has just spoken. The Government and many other people seem to be paralysed with fear at the thought that people will take advantage; that they will become workshy and live free on the great benefits the State can provide. In fact, the National Assistance Board themselves admit that only a tiny percentage of people do this. I am always amused at this criticism, because it is never applied to the hundreds of thousands of people who live on unearned incomes.

It is a sad reflection on the British people that they should think in this way, because the fact is that there are something like 750,000 people who, according to latest estimates, are too proud to apply for National Assistance, but who would do so were it not for this fact. They are also too sensitive. They can tell the patronising attitude a mile off, and they object to this subtle atmosphere that is very often created when these well-meaning people come round; they feel, in a sense, like second-class citizens. I am not in any way attacking the excellent work of many thousands of voluntary social workers. But the plain fact is that, to many working class and poor people, this is the attitude and the atmosphere they soak up.

I remember that when I was a boy, when we had contact with odd charity workers, we felt this attitude. We were polite while they were there, but as soon as they went we said what "toffee noses" they were, because there was always the attitude of "they". We were the "they". There was some subtle judgment implied in their attitude to which sensible people react and reject. One of the most poignant phrases I have ever heard was in a play called The Match Girls, about the Bryant and May match girls in their strike at the end of the last century, when one of the women, after having been to a soup kitchen, said "It's a funny thing, but the rich think that the poor like soup." This to me sums up the "soup and blankets" attitude.

I think it is time we buried this terrible word "charity", because it has become nauseating, and the attitude of mind that goes with it. I think we ought to break from this, and see this as a social and national problem. We ought to see that welfare and social security is a right in any civilised society. Voluntary work can go hand in hand with the statutory organisation, but by and large it must be regarded as a right and not as something that is handed out as a dole and not as something which, to qualify for, you have to pass a means test.

The second step, to my mind, is to introduce a general and genuine national plan, something along the following lines. First of all, we should increase the National Insurance and Unemployment benefits to at least half-pay level. Secondly, we should introduce a genuine superannuation scheme to allow workers to retire on half pay. This is good enough for many people in the Civil Service and executives in industry, and it should be good enough for everybody. We should bring in an income guarantee for existing pensioners so that they will be guaranteed a minimum income as of right, without National Assistance, without the shame of having to give up some of their privacy.

If we are asked whether we can pay for it, let me tell your Lordships that at the moment the employers in England pay at least eight and a half times less than Italian employers in social security payments, at least six times less than the French, and if we exempted from payments everybody who was earning the national average wage, and took more from those who can afford it, it could be paid for, as has been proved in France, Italy and other countries. This would enable the National Assistance Board to resume its original function, which is as a safety net—this was how Beveridge saw it—for those few people, those problem families, who slipped through social security. It would provide a virtual families income policy which would iron out a great many of the problems with which our social workers have to deal. At the moment the National Assistance Board is not a safety net, it is a sack in which we catch too many people.

Even with this, there would be a need for buffer services to protect people against genuine misfortune. Here again, we need to get rid of the attitude that it is the fault, in some way, of these poor people when they are in trouble. A man cannot help being sick and applying for sick pay. He perhaps gets it, and also some money from the National Health Service, which helps him. But this provides him with only a certain level of assistance. He perhaps has hire-purchase payments and various other commitments to meet. If that sickness is prolonged, then he finds himself in really genuine difficulties, and it is not his fault. Here we have a situation of absolute chaos when it comes to some of the real problem families.

It was discovered that there was one family which had contacts over a period of time with the education welfare officer—he used to be called the school board man in my time—the police, the National Assistance Board, the housing officer, the children's officer, the health visitor, the rent collector, the home help and also, and not surprisingly, the local bench of magistrates. In addition, they had contact with the factory welfare officer, a marriage guidance counsellor, an adoption society, and a solicitor. It must have been like Euston Station at times in their kitchen. Your Lordships can imagine the confusion which existed in the minds of people like that. That, of course, is an exaggerated case. But I think it is probably quite true that many families have three or four different organisations, and three or four different social workers, at some time or another trying to solve or sort out their problems.

There is a plain case for merging many of these services into one, and creating a good family service. The main job of this family service, it seems to me, would be concerned with the social well-being of the family, and preventive social service. It would take over the existing children departments and its prime concern would be with families with children. It would work in close co-operation with health, education and youth services, as well as with child guidance clinics, probation officers, almoners, the National Assistance Board, housing departments et cetera, and it would be responsible for the health, care and well-being of pre-school children, home helps, help for handicapped children, the reception of homeless families, and so forth. A family service which saw, as some speakers have indicated, that the problem started with the family, and that it was no use curing one limb of it, or attempting to cure one limb of it, but that you had to get at the root, I think would help. It would make much better use of the existing personnel and avoid duplication.

I should also like to see, taking up the point of the last speaker, a massive increase in the number of Citizens' Advice Bureaux. There are not enough of these. Many boroughs have not one at all, and they are absolutely invaluable organisations. But what is needed also is co-ordination and leadership from the top, and this is not forthcoming. What we want, and what I think the Labour Party would do if it were in power, is to form a Ministry of Social Security to introduce a national plan. The Government have announced an intention of putting forward a ten-year Plan for health and welfare. This long view does not solve the problem, and bears as much relation to a real plan as a mouse to an elephant. It is suggested that the local authorities should spend £220 million on capital account and raise their annual expenditure from £111 million to £163 million by 1972; that more old people's homes should be built, more hostels for the mentally ill and sick, and that there should be an increase in maternity services and child welfare.

This is all very encouraging and all very good, but it has all been left to 146 local authorities to work out with little or no national guidance. There has been no real attempt to co-ordinate local plans, or to suggest the degree of expansion, or to give real leadership. The result is a hotch-potch of varying proposals. In one county it will be possible, for instance, to have ten times as many home helps as in the county next door. What is needed, clearly, is real leadership from the top, which can provide a plan and which can knit all the 146 individual plans into a national and co-ordinated scheme.

I am sorry if I have spoken with some bitterness about this, but our social security system was once a system of which we could be proud, and in which we led the world. In the last few years it has been allowed to run down, and the proposals that have been put forward by the Government do not show any indication whatsoever that it will be run up again. I believe that this is due, as I said at the beginning, to the basic difference in attitude: they are fearful that people will want to take something for nothing. If ever a subject needed some urgent change so that we get a national plan, this is it.

6.40 p.m.


My Lords, I am very happy to take part in a debate initiated so delightfully by the noble Lord, Lord Amulree, and to follow the noble Lord, Lord Willis. I am glad that he expressed his views so uncompromisingly, and I can assure him that many, perhaps all, of them are ideas which are widely held, as he knows, throughout the Labour Movement.

A number of speakers have addressed us with great first-hand knowledge and feeling. I am in accord with the noble Lord, Lord Willis, in venturing to remind the noble Marquess who is to reply that he is called on to reply for the Government; so he cannot mind if we subject the record of the Government to a rather sharp review—at any rate, that seems to be my function in these closing remarks. I wish the noble Marquess well in what I think is his first major speech; I know that he possesses qualities of heart and head which will help him in his difficult, perhaps impossible, task.

I think we must all be pleased to think that the clergy—the higher clergy and the less high clergy, clergy in full dress and clergy in disguise—were represented in such force this afternoon. I cannot remember an occasion when such a high proportion of the speakers possessed such strong ecclesiastical qualifications. That seems to me all to the good. My noble friend Lady Summerskill told me that she thought perhaps in some debate on divorce the clergy were just as strong.

I feel that it is an agreeable sign of the times that it is not merely in one of these rather negative discussions as to what is and what is not sinful that the clergy should be taking the lead, but in a constructive debate of this sort should be so much to the fore. They have addressed us in a memorable way to-day.

It is a pleasure to me that they were so delighted with the speech of my noble friend Lady Summerskill. I find in these latter days that her speeches and those of the clergy are usually indistinguishable—I had better move away a little, I think, from my noble friend. One might have thought that their traditional and progressive ideas on morality would be further apart; but not at all. I think that where the family is concerned, and above all, where the mother and child are concerned, there is an agreeable identity of view.

Obviously, in these remarks I must not attempt more than other speakers have attempted in covering the whole field of social services. I was particularly struck by what the noble Lord, Lord Willis, said about a family service, but I feel a little precluded from going further into that because of certain studies in which I and other of my colleagues are involved.

There was one thing, among other interesting things, said by my noble friend Lord Taylor which, so to speak, confirms my reason for offering a thought to your Lordships about family allowances. The noble Lord, Lord Taylor, suggested that to a large extent the "problem" families could be assisted, and that their problems would be to a great extent ended if we had a better housing programme. I think there is a tremendous lot of force in that. But I am sure he would agree, and that other of your Lordships would agree, that, if we are talking about the families in greatest distress—it starts perhaps with physical distress but passes over into other distress—we could not leave the whole subject without referring to the fact that this distress tends to be concentrated among the large families. Various speakers, including the noble Lord, Lord Sandford, who made such an interesting speech, were, I think, well aware of this.

The noble Lord, Lord Willis, invoked the name of Sir William Beveridge (later, of course, Lord Beveridge), whom I assisted for three years, and I cannot help recalling that Sir William Beveridge in 1942, in his Report which was so widely acclaimed, proposed a family allowance of 8s. a week for each child after the first. That would have meant 10s. 6d. by 1946; but, in fact, in that year it was found possible to grant only 5s., which was less than half, by that time, of what Sir William Beveridge had in mind. It is a very strange thing that the greatest inspiration behind the whole movement for family allowances has come from bachelors and spinsters. The greatest names perhaps are those of Sir William Beveridge and Miss Eleanor Rathbone. Perhaps I had better not follow up that line of thought. At any rate, the allowances granted in 1946 were by that time half what Sir William Beveridge had recommended.

Since then National Insurance benefits have gone up seven times, national distress rates eleven times, but family allowances only twice. The present rates of 8s. for the second child and 10s. for the third and subsequent children, are worth less than the 5s. of 1946 and, therefore, are a great deal less than half of what were intended by Sir William Beveridge, which had general approval in 1942.

This is something that has been said by various speakers in various ways, but it is an aspect which should be brought out. I refer to the fact that there is not only a large and growing gap between rich and poor, but a large and growing gap between the standards of living of families of different sizes. The arrival of each additional child into a working class family means a further drop in living standards. As has recently been pointed out, in this situation we have no right to be so surprised if large families have less adequate diets, show more symptoms of physical and mental ill-health, have higher rates of delinquency and mental breakdown.

I hope and believe that a Labour Government would do much more than is now being done to remove this grave blot on our conscience. Certainly the Labour Party has promised to reorganise family allowances, graduating them according to the age of the child, with a particularly steep rise to the school-leaving age. It may be said that this is taking us away from the Welfare Services, but others have moved away from the strict wording of the noble Lord's Motion. In any event, when we are discussing welfare and talking of the poorer classes, it seems quite impossible to do so without attending to the fact that the need occurs most obviously among those large families whom, on the whole, we have failed to help since the war to the extent expected by most of us when the war came to an end.

The next demand I would make of the Government, if not to-day then perhaps on other occasions, is that we should have more clarification about their whole philosophy. We know that they take pride in their so-called "Ten-Year Health and Welfare Plan", about which we have not heard very much to-day—indeed, we have heard surprisingly little. I do not know whether the noble Marquess is going to dwell on its virtues. Their pride, if they feel pride in that Plan, is hardly justified. In the first place the Plan proposes that particular services at least should grow more slowly in the next ten years than they have grown in the last five. In the second place this great Health and Welfare Plan is really nothing more than a concoction of the plans of local authorities, with no guiding principles and common standards.

Therefore, we on our side of the House insist that these plans must be not only strengthened, but co-ordinated and standardised, particularly where the community care for the elderly and mentally disordered are concerned. We shall lay down standards of what constitutes an adequate service; we shall need to re-cast the Plan on that basis, and we shall earmark grants for those services. That is something we demanded when the Mental Health Bill was going through the House. That was resisted then, and it has been resisted since, but we shall insist on earmarked grants. We do not think that without that it will ever be possible to get the expansion which even the Government themselves have considered.

In the field of ideas we are entitled to look for much more clarification about the meaning of prevention. Here I venture, very timidly, to differ from the actual wording of what my noble friend Lord Taylor said. But I am not sure whether he was absolutely serious when he looked to the time when we should get rid of Welfare Services altogether. He went on so quickly to explain that we must take more active steps to help those in distress that in general I thought perhaps he was not speaking in full seriousness.


My Lords, I was only hoping—indeed, I still hope—that the day will come when we shall not need these Services. That they are inadequate at the present time I would not for one moment deny; and that they should be improved I would agree wholeheartedly.


I do not suppose there is any real difference between us, but of course the stress many of us are laying now, and that is being laid, on paper, by the Government, is on prevention and not just cure, and in the development of the preventive services one assumes there will be scope for any period one can foresee. I would ask the noble Marquess if he can tell us anything of the Government's ideas about prevention. This is quite a new concept in legislation, but now under the Mental Health Act and the Children's Act lip-service is paid to the idea of prevention. It is all still in a very vague state, and perhaps he will say what they have in mind when they preach prevention and what they expect the local authorities to do which they have not done hitherto.

Then there is community care. Of course, it is a very fine idea, but as I have ventured to say before in this House, and as better men than I have said, in itself it is remarkably ambiguous. It could be a snare and a delusion. What does it mean? It may mean passing responsibility from the State to the local authorities, and then passing it further to the community at large. Well, of course, if the local authorities play their part, and the community at large—that means the millions of citizens—play their part, then the end could be a noble outcome. But it could mean passing the buck on the part of those who are well qualified and well trained, and who in fact carry out the responsibility in the way the noble Lord, Lord Willis, said, in a direction that may lead nowhere. And I feel that up to the present we have not been told half clearly enough what is even intended by community care. It is obvious that in anything that means community care there must be close co-operation between the local authorities and the voluntary bodies.

Now that the noble Marchioness, Lady Reading, has returned, I would pay tribute to the astonishing work she has herself achieved in the voluntary field. There are other noble Lords who are also achieving a great deal in that area. The noble Lord, Lord Stonham, for example, is chairman of the National Society for Mentally Handicapped Children, and similar functions are performed by other noble Lords. Still there is perhaps no one in the country who has quite the noble Marchioness's right to speak on voluntary services. I wonder whether she agrees with me that it is not clear, and no one from the Government side has made it clear, what part the voluntary bodies are supposed to play in most of these activities.

The National Council for Social Service is, of course, as usual, playing a highly educational part, and last year the Standing Conference of the Councils of Social Service brought together a conference of local authorities and voluntary organisations. I have read the report of that very significant conference, and it is fairly obvious that the local authorities and the voluntary bodies are both equally not clear as to what form this co-operation should take. At any rate, that is how it seems to me on reading the report. It would be helpful (but I agree it is difficult at the end of the debate to-day) if the noble Marquess, Lord Lothian, would explain a little more exactly how this co-operation is to take place with a view to community care.

Having asked for clarification of that kind, I come back once again to the simple, ineluctable problem of obtaining many more social workers. It is not only a question of numbers, but it is very largely a question of numbers, and the numbers involved should not be exaggerated. We are dealing in quite small figures and yet they seem to be more than we can manage. If we take the forecasts of the needs of manpower, which are more or less official, we find that we need more than 300,000 teachers, over 50,000 doctors, over 160,000 nurses. When we reach the services we are discussing this afternoon, or most of them, we drop to figures of an altogether different order, which ought to be very easily within our compass.

In 1960, for example, there were something over 1,300 child care officers. It is estimated that to meet the increased demand for preventive work there will need to be recruited 350 new staff, plus 200 to meet wastage—say, 550 a year child care officers. That may sound a lot and may be beyond our achievement, but, of course, it is a small figure compared with the number of doctors and teachers and nurses required. Nevertheless, that figure has in fact been nowhere near reached. From February, 1963, to January, 1964, only 165 child care officers were trained, which is less than a third of the number required. So we are falling down pretty badly on that front.

In the probation service (and I am not talking much about penal questions to-day, if only because I speak on them rather often in this House) the total to-day is of the order of 2,000—I think about 2,100 probation officers, against 300,000 teachers. There are plans on foot to expand this figure of 2,100 to something like 2,750 by 1966, and that is not a very daring project. We all know that the service is really grossly over-worked, and we know that heavy new burdens are being placed on it every day, and I think in a sense rightly placed on the service or on the expanded probation and after-care service; but I would point out that this project for 2,750 probation officers by 1966 includes only a token contribution for the expansion into a probation and aftercare service. We should need something, even on this reckoning, very much larger than 2,750. All this, apparently, is still being worked out. My own conclusion is that the target is totally inadequate and the methods being adopted to achieve the target are more inadequate still.

It is the same story when we turn to local authority health and welfare departments. Whatever the precise calculation, no one questions the need for an increase in the number of social workers, and no one, I imagine, supposes that at the present rate we are going to obtain as many as we need in the next few years. I have one illustration from Cheshire. The Cheshire County Council estimate they will need to double the health and welfare staff, and other counties will try to double, and more than double, their staffs. But while it is better to draw up ambitious programmes than, so to speak, do nothing, these programmes are not worth the paper they are written on unless there is a completely different approach to recruitment and training. Although we are talking of quite small numbers—a few hundreds here and two or three thousand there—we are really talking of the men and women who occupy the moral keypoints in the Welfare State, and whether the Welfare State succeeds or fails depends on this comparatively small group, and depends on us in the sense that it is for us to say whether we are now going to make the effort to recruit and train these people.

Before I close I would say briefly what I think should be done, and one must speak generally about a number of services which are not quite identical. I will speak in headlines. In the first place, there should be much more adequate publicity, much more urgent call from the higher levels for social workers, and it should be backed up throughout the official world—that is to say, start at the very top, launched by the Prime Minister, in conjunction with other Ministers, and carried through to the officials whose job in life is directly concerned with recruiting. I am afraid I have not found much welcome given in recent years to those who try to do social work. Speaking broadly, I have found the opposite: I have found a number of most promising young people "choked off" when they tried to join welfare services. Obviously one cannot generalise too far, but I am afraid that has been my experience right up to the present day.

I agree that when a personal case is brought to the Minister—I brought one to the Home Secretary, a very hardworking Minister, the other day—he will take immense trouble. But how many recruits or younger people interested in a rather bewildered way in rendering social service can have their case taken to a Minister? One cannot depend on that personal degree of interest. I must not weary the House, but I could give you many examples.

An Army major wanted to join the probation service. He is in fact serving with great success in it, but he found it extraordinarily hard to get in. Then, I remember that some years ago a lady who had been most successful in business, who gave up all her money to enter an enclosed convent, but who came out again with the goodwill of the authorities because they thought that her destiny lay in the world, found it virtually impossible to get into the probation service. When I told a member of the probation service afterwards about this lady, who had been most successful in business and was respected in the convent, the probation officer concerned shook her head and said, "Clearly, a very insecure type." She may have squeezed her way in had she gone on trying, but there was no sort of welcome for her.

It is this kind of attitude which must be altered if we are to make headway on the scale required. Therefore, linked with the publicity there should be an advisory information centre which should maintain a register of people available and publicise the profession of social work in general and of these particular vocations one by one. On the financial side, it is a truism that all these social workers are underpaid, and it is a truism, I suppose, that we shall go on exploiting them. It is shocking, but I am not asking for an immediate revolution, although one should go on working for it. But, leaving aside the question of a great improvement in remuneration—these people are not primarily concerned with that—I would say that the least we ought to do is to provide much more adequate maintenance grants while students are training for social work. Sometimes, of course, the student is a middle-aged person with a family. I think that a social research council is essential—I know that Lord Taylor would support that idea—to find out where the shortages exist and where they can be met most effectively.

Finally, there must be, for the first time, a truly adequate national programme of recruitment and training. With great respect to the noble Lord, Lord Amulree, and the Motion, with which of course I sympathise, I am afraid that we shall not get far forward, nor very fast, by shuffling and reshuffling the existing resources. I say that with the greatest respect. The Government must accept the responsibility for a great and immediate expansion in all the different types of training, both inside the universities and in the other colleges. I cannot say that I find any such signs of urgency on the part of the Government at the present time. It is partly a question of money, partly a question of maintenance, and partly a question of energy. Unless these three attributes are forthcoming in much larger quantities, then I am afraid the noble Marquess will have an impossible task in front of him.

But when all is said and done, we are aware that great sums of money, great administrative steps, marvellous Governments and even more marvellous Oppositions, are not in the end going to settle it. The real achievement must come about through the influence of dedicated men and women, whether full-time professional workers or volunteers, who place themselves alongside those who need their help. I am sure that this debate will have helped their work, whatever the immediate outcome. In the long run, it is bound to have helped their work; and we shall therefore, I hope, have played a small part in relieving and preventing distress, possibly even in rescuing human lives—possibly even, if I may say so with great respect in front of the Bishops, in saving human souls.

7.5 p.m.


My Lords, like other noble Lords who have spoken, I feel that we are all highly indebted to the noble Lord, Lord Amulree, for giving the House this opportunity of discussing this most important and human subject, which concerns every one of us and every single person in the country. As was to be expected, the debate has ranged widely over many fields, and I will do my best, without, I hope, taking too long, to cover most of the points that have been raised. I am most grateful for the suggestions that have been put forward, and I give your Lordships an assurance that they will be most carefully and constructively considered.

It is my task to-day, in replying to the debate, to give some account of the state of the Welfare Services and the support that the Government are giving them. Perhaps I may first be permitted a personal note. For many years as a member of my local county council I saw something, as it were, of the receiving end of these Welfare Services. Now that I have been privileged to be transported from the outskirts to the nerve centre of these activities, I should like to say how exciting it has been for a newcomer to discover the dramatic developments that have been taking place throughout the whole range of the Welfare Services.

We all know—the noble Earl referred to it a moment ago—that in this, as in many other activities, Governmental and otherwise, the economic straitjacket is a factor to be considered. For myself, I think that the Welfare Services have been stretching this straitjacket considerably in the past few years. We should remember (I think the figure has been quoted already) that in 1949–50 the revenue expenditure of local authorities on these services was £39 million; in 1961–62 it was £103 million, and by 1971–72, at the prices that were obtaining in 1962 it is expected to be something in the region of £163 million.

In interpreting the term "Welfare Services" in the wide sense, it is undoubtedly the case that, with the general expansion of the social services, shortages of skilled manpower and womanpower are a problem that must cause concern. This problem is rightly being studied by the National Council of Social Service. The Council's Annual Report for 1961–62 puts the problem well. It says: The developments of the educational, health and welfare services are making increasing demands upon the full-time services of men and women. The need for careful selection and training of staff is crucial to the future of all of them. Each one is a competitor for the limited available labour. A general examination of the total needs is an essential step to a better appraisal of the problems and to sounder planning. With a grant from the Nuffield Foundation and the co-operation of members of the staff of the London School of Economics, a study is being made now of staffing needs in particular sectors of the social services as they may be expected to develop in response to current trends and policies. The Council's 1962–63 Report tells us that work on this study is progressing and that the first phase has been completed. Nothing has yet been published, of course, but I am quite certain that the Report of the inquiry will be a most useful addition to our knowledge of the call the social services will be making on skilled manpower and womanpower during the coming years. Naturally, we already have a good idea of what these needs will be, and before attempting to answer as many as possible of the points that have been raised I should like to state again to your Lordships a little of the knowledge which we already possess. Some of these figures have already been discussed in the debate to-day, and I hope your Lordships will forgive me if I briefly run through some of them.

If I might first take the local authority health and welfare services in England and Wales, the Ten Year Plan (which has come in for a certain amount of criticism in the last two speeches), published a year ago, provided for a 45 per cent. increase in the staff employed. This sounds a large increase, but there is no real reason to think that it is not capable of achievement. For one thing, the absolute numbers concerned are not large—apart from home-helps where there is a proposed increase in strength from 25,000 to 37,000—that is, in whole-time equivalents. Indeed, except for that, and for the staff of the residential accommodation and ambulance staff, each of the groups totals under 10,000. Thus in 1972 the planned numbers of health visitors are 7,600; of home nurses, 9,800, and of social workers 4,900—all in whole-time equivalents. Secondly, an increase of roughly 4½ per cent. per year is not seriously out of line with the actual increase achieved during the previous five years, which is estimated at about 4 per cent. per year.

I do not wish to bore your Lordships by quoting examples from every branch of the local authority services but I should like to refer to two which have been mentioned already, the Probation Service and the Child Care Service, if only to illustrate that it is not only in the health and welfare services that increases in staff are anticipated. The Departmental Committee on the Probation Service which reported at the end of 1961 gave special attention to the shortage of probation officers, and recommended that the Probation Service should be brought up to a strength of 2,000 in the near future, and that a further increase to 2,750 might be necessary in the next few years.

Since that Report the Service has increased by over 300 officers and at present numbers 2,070. Nearly 200 students now in training will be ready for appointment during this year. The aim, as the noble Earl, Lord Longford, told us, is to bring the service during 1966 up to the target of 2,750 set by the Departmental Committee. I would go along with him in saying that I do not think that this is by any means the end of the road. The output of trained child care officers rose from 50 in 1960 to 171 in 1963; it is expected that about 190 will complete their training this year. The Government recognise that still further expansion is necessary in this field if the need for child care officers is to be met.

May I turn to training arrangements? These are all the time being improved. Thus new training councils for health visitors and social workers were established in 1962, first under the chairmanship of Sir John Wolfenden and now under that of Sir Charles Morris. Both have made an excellent start with their work and the number of training places for social workers is being quickly increased. A new Training Council for the staff of training centres for the mentally subnormal has just been established under the chairmanship of Lady Adrian and is now hard at work. A committee set up by the National Council of Social Service, under the chairmanship of Lady Williams, is studying the staffing of residential homes; this study will necessarily include the training of the staff. A Working Party under the chairmanship of Dr. Millar, the Medical Officer of Health for Birmingham, is examining the training of ambulance staff. These are some of the things that are going on now to improve training arrangements for people participating in the social services in their widest sense.

The noble Lord, Lord Amulree, at the beginning of the debate made it quite plain that he, for one, is not happy with the training which social workers receive. As he has mentioned them in particular, it might be as well if I devoted a little time to reminding him (though I am sure he does not need it) of the two types of training now available for a person who wishes to take on social work, in the hope that I may convince him that his worst fears will not be realised. First there is training in the universities, to which he alluded. The Report of the Working Party on Social Workers in the Local Authority Health and Welfare Services, the Young-husband Report, envisaged that university-trained social workers, working in local authorities, would undertake or advise on case work in problems of special difficulty. The Working Party hoped to see such workers employed throughout the various health and welfare services.

At the same time they recognised that the main range of social work required in these departments consisted of helping people whose problems, although not of special difficulty, required help by a trained social worker. They therefore recommended a new type of two-year full-time training in social work to be established at colleges of further education, and the establishment of a Council for Training in Social Work to approve courses, and to award a new national certificate in social work to those successfully completing training. The Council for Training in Social Work established by legislation in 1962 promotes and approves courses of general training in social work, what we call Younghusband Courses, for those working in local authority health, including mental health, and welfare departments.

There are now ten two-year full-time courses in existence and a special full-time one-year course. In the autumn of this year five more new courses will open. The numbers on each course vary between 11 to 20 students. For new entrants, and those in posts wishing to train, these courses at colleges of further education are two years in duration, but shorter courses and courses including some part-time study will be promoted for more experienced staff in posts in the services. Officers with this training will undertake the main range of social work required in the health and welfare departments and there is no reason why they should be "poor relations", as Lord Amulree seemed to hint. Indeed, my understanding is that the new training and the first officers who have completed it have been warmly welcomed by all the existing social work associations.

The noble Lord, Lord Amulree, has also mentioned the rôle of the health visitor vis-à-vis the social worker and the home nurse. The assumption that the functions of the health visitor and of the social worker are very similar arises because the scope of the health visitor's duties increasingly takes account of social factors; and merging the two grades might at first sight seem advantageous because of insufficient staff in both services. Certainly there is no denying that local health and welfare authorities are faced with demands on both the health visiting and social work services greater than these services can meet. In trying to strike a proper balance, many authorities divert their health visitors to social work. There is no actual bar to this being done since no clear distinctions have been drawn between the two grades; the functions of health visitors and social workers overlap and at present the social work services are largely staffed by workers without a specific training in social work.

As the noble Lord will know, the health visitor's basic qualifications are in nursing and midwifery, with post qualification training in the principles and practice of the preventive health services, including health education. But both she and the social worker are being trained for different tasks, the health visitors being predominantly concerned with the maintenance of good health and the social worker with social support in a wide range of situations into which health considerations may or may not enter. This distinction is reflected in the establishment of separate training councils, one for health visitors and one for social workers, under the Health Visiting and Social Work (Training) Act, 1962. Although the pressure on both the health visiting and social work services is at present considerable, and so far the number of trained social workers is small, we look forward to a time when there are sufficient health visitors and trained social workers to meet the essential needs of each service. True progress lies not in merging the functions of health visitors and social workers, but in ensuring that each can make her particular contribution to solving the problems that arise—often in collaboration with each other.

The need to recruit more health visitors and to relieve them of duties which can be undertaken by less qualified staff indicates that it would be unwise to divert health visitors from their present duties to relieve home nurses. The pressure on the home nursing service has on the whole become easier since 1957, partly due to the increase in the numbers by about 6 per cent. to a total of 7,774 whole-time equivalent staff at the end of 1962. The pressure may increase again as the numbers of persons aged 65 and over, and particularly of those aged 75 and over, are rising rapidly. But if this occurs, we should look to an increase in the numbers of home nurses, and to help from less highly trained ancillary staff to provide an adequate service, rather than to the use of still more highly trained health visitors for home nursing duties.

My Lords. I will turn to another subject raised by the noble Lord, Lord Amulree; that is, the question of people receiving too many specialised visitors. It is asked whether the number could be reduced by better co-ordination, and it is even suggested that it would be better if visiting were replaced in a large measure by sessions at clinics and advice centres which the individual needing a service would have to attend. I agree with the noble Lord: I certainly think that over-visiting is to be deplored. But, of course, there are a great many specialised needs that require a visit from someone with special training. The doctor, home nurse, home teacher of the blind, mental health officer, housing manager and National Assistance Board officer cannot, in practice, all be rolled into one, or even two. What is important, I feel, is not so much to cut down the number of specialised visitors as to ensure that they all work together and towards a common aim. The need for this co-operation is an ever-recurrent theme, and we have heard it all the way through this debate this afternoon. It received a great deal of attention in the Report of the Annis Gillie Committee on the field of work of the family doctor. This put much emphasis on the close working together of the family doctor and the local authority domiciliary staff, and I am sure your Lordships will agree about that.

I turn now to the possibility of replacing visiting by clinics and advice centres. Certainly it is more economical, when circumstances are appropriate, for the individual to go to the service than for the service to be brought to the individual. Thus mothers and young children can sometimes be more economically helped by the local authority services at clinics than individually in their own homes. But very often a home visit is the essence of the matter. The home background may have to be seen—for example, in assessing the social need for a confinement to take place in hospital. An even commoner case is where the individual is old—possibly even housebound—or handicapped or ill. In such cases it is only by a visit that the needed service—be it medical or nursing attention, a cooked meal, help with some practical problem, or perhaps just a social call—can be given. Indeed, in the great majority of cases, particularly where the individual is old and frail, the real trouble, I feel, is not so much over-visiting as the reverse, with consequent isolation, loneliness and possible deterioration. In such cases, surely, the need is for more, not less, visiting by people able to give assistance, ranging from the specialised and skilled service to the simple help a voluntary caller can give, even if it is just to go and cheer a person up.

My Lords, I should like at this point to make it quite plain that local health authorities can provide advisory clinics for the elderly under their general powers for the prevention of illness. With my right honourable friend's approval some authorities are doing so. There are, for example, a number of such clinics in Middlesex, including one at Teddington. The clinics are largely experimental at the present stage, and more experience is needed before their value can be fully assessed. The emphasis here is on advice and on the prevention of illness and infirmity, and such clinics are in no way intended to replace the responsible work of the general practitioner. They are, in fact, more in the nature of advisory centres than clinics.

The noble Lord, Lord Amulree, put forward the suggestion that some of the accommodation provided by local authorities under Part III of the National Assistance Act might with benefit be transferred to the hospital authorities. About ten years ago the Ministry of Health evolved an interpretation of the division of responsibility between hospitals and local authorities for the care of old people who cannot be looked after in their own homes. It would take far too long to give your Lordships the detail of the interpretation, but in broad terms it made it clear that there are some circumstances—for example, what they call short-terminal illness—in which old people can properly be given nursing care in welfare homes. But at the same time it established that the responsibilities of the hospital include the prolonged nursing care of bedridden old people who may need little or no medical attention.

Needless to say, there have been arguments about the application of the interpretation to individual cases, and some difficulties have arisen. These have, however, been least where the hospital and local authority people concerned have taken a realistic view of the situation and have recognised that the need is not to argue about boundaries, but to make the best use of available local resources, be they hospital, local authority, or voluntary. A much greater difficulty has arisen from the growth in the numbers of old people, especially the very old. This has meant that there are more and more very frail elderly people, who are not bedridden but need a great deal of nursing care. A particular complication—and this was a point which the noble Lord, Lord Ilford made—is that old people move from one category to another and back again very frequently, so that borderlines become blurred.

The care of these growing numbers of frail old people is a very large and growing problem. Its implications are being studied, and it may be that further guidance will have to be issued to the hospitals and local authorities. In this connection, we are very glad to know that the National Corporation for the Care of Old People, in collaboration with the Government Departments con- cerned, is now considering promoting a comprehensive study of the needs of the elderly for various kinds of service and accommodation. If this proceeds—and we hope it will—it will be a great help to all concerned. While I appreciate the point of view of the noble Lord, Lord Amulree, in this matter, I must say that I think that in the meantime it would be a mistake to assume that the right course is an enlargement of the sphere of responsibility of the hospital authorities. Still less would it be right to suggest that the time has yet come for local authority premises to be transferred to the hospital authorities.

Government spokesmen have many times in the past paid tribute to the contribution made by the voluntary organisations to the welfare services in this country. This does not deter me from saying a word or two on my own account. I welcome this, my first, opportunity of expressing my appreciation of the rôle played by the voluntary services. I can assure the House that the Government fully recognise the vital part played by all the voluntary bodies in the health and welfare and in many other fields. I was highly interested in the most remarkable speech made by the noble Marchioness, Lady Reading. I should like to assure her that I will consider her points very carefully, and I also undertake to pass them on to my right honourable friend.

It is known that many local authorities work in close partnership with voluntary organisations in their area, and there is encouraging evidence of a general expansion of voluntary work. In some instances there is a formal agency arrangement, under which a voluntary body acts as the authority's agent. In others the arrangements are less formal, but the authority gives help with finance, premises, staff or in other ways: the provision of a kitchen from which a voluntary body can operate a meals-on-wheels service is a good practical example. Every encouragement will be given to the extension of arrangements of this sort. As the pattern of the welfare services becomes more complex, it surely becomes even more essential to find a means whereby local authorities and voluntary services can co-operate even more fully with each other.

To turn for a minute to the speech of the right reverend Prelate the Lord Bishop of Chester, he treated us to an admirable discussion on the subject of the disease of alcoholism. I should like to thank him for presenting his views on this sad problem in such a discerning manner, and also for his advice to your Lordships as to how it may be overcome. As your Lordships will expect, no reliable estimate of the national incidence of alcoholism is available, but the number of admissions to National Health Service hospitals in England and Wales for the treatment of alcoholism and alcoholic psychosis has risen from 775 in 1953, to an estimated 3,600 in 1962. It does not follow that this increase in the number of admissions necessarily implies an increased incidence of alcoholism, for the demand for treatment often rises as facilities are developed.

It is true that many patients suffering from alcoholism are treated in hospitals without special facilities for alcoholics. In 1962, my right honourable friend the Minister of Health commended to hospital authorities the advice of his Standing Medical and Mental Health Advisory Committees that treatment for alcoholism and alcoholic psychosis should, as far as possible, be given in specialised units. The initial aim is to have one unit in each Hospital Board area, and this provision will be increased if the scale of demand makes it necessary. The latest information I have is that there are nine units in operation, three of them in the London area. Other units are planned or are under consideration. In expanding their facilities Hospital Boards have to relate the needs of alcoholics to other urgent priorities for development, but considerable progress is being made, and my right honourable friend will do all he can to encourage expansion.

I feel an important contribution can he made in this field by general practitioners, local health authorities and voluntary bodies. It is part of a doctor's terms of service to take all necessary steps to enable his patients to obtain hospital treatment. If, therefore, an alcoholic's first approach to the National Health Service is to his general practitioner, the arrangements ensure that the full facilities of all branches of the Service are brought into play. The rôle of the local health authorities is to refer to general practitioners those cases of alcoholism which come to their attention, often through domiciliary visits made by local authority officers for other purposes; to provide supportive services for the social care or after-care of patients who are receiving or have received hospital treatment, either as out-patients or in-patients, or are under the care of general practitioners—these services may include domiciliary visits, clubs or clinics, help in finding suitable places in which to live if they have no homes to go to, or even providing a residential hostel or assisting voluntary societies in doing so—and to help to make information available about statutory and voluntary services in the locality.

The contribution made by voluntary bodies to this problem is particularly valuable. The best known voluntary organisation, as the right reverend Prelate said, is Alcoholics Anonymous. The very important contribution that this organisation makes was recognised by the Minister in the circular issued in 1962, which advised hospital authorities that it would be necessary for their special units to run out-patient clinics and to co-operate in after-care with Alcoholics Anonymous. During the course of his speech, the right reverend Prelate referred to the recently-formed National Council on Alcoholism. I wholeheartedly welcome the advent of the National Council. Its aims and endeavours command wide respect, and it is the policy of Her Majesty's Government to give it and other similar voluntary organisations full encouragement. We are in close touch with the Council over the whole range of its activities, and two officials from my Department attend its meetings as observers.

I should like to conclude my remarks on this subject by saying that the Government are aware that the alcoholic needs encouragement to seek treatment at an early stage, and to persist in the treatment. They are also aware that progress in dealing with the disease depends to a great extent on the understanding, sympathy and co-operation, not only of relatives and friends but of the public at large. I should like to think, my Lords, that as a result of this debate the position may have been made a little clearer to the public outside, and that its attitude towards alcoholism may be influenced a little more in the direction in which I think we all agree it is actually moving now.

The hour is late and I do not want to keep your Lordships. I should like to thank the noble Baroness, Lady Summerskill, for what she said on the question of V.D. Perhaps I might say to her that the Government also welcome very much the B.M.A.'s report. One of its suggestions was the stepping up of public education in this matter, not only from the Government point of view but through the establishment of local committees sponsored by the medical profession, and to publicise it by means of lectures, services and so on. I am also very grateful to her for her suggestion about the school health visitors. I will bring that to the attention of my right honourable friends the Minister for Education and the Minister of Health. I think it is something which might be very valuable indeed.

The noble Lord, Lord Sandford, referred to grants to the National Marriage Guidance Council, the Catholic Marriage Advisory Council and the Family Discussion Bureau. The position is that the Exchequer grants given each year to these organisations, which are doing, if I may say so, such very good, instructive work, are reviewed from time to time. Their value is appreciated; and, although I am afraid I cannot say any more than that to him tonight, I hold out the hope that possibly something may happen which will please him in the future.

The noble Earl, Lord Longford, asked me at one point in his speech what "prevention" meant, or what the Government considered "prevention" meant. I think the answer is that it really includes health education, vaccination, immunisation and that sort of thing: the looking out for physical and mental troubles before they occur—troubles which can be avoided if remedial action is taken in advance. There is nothing more sinister to it than that.


My Lords, I hope it is a good deal more far-reaching. I will not interrupt further, but I think that is a very narrow interpretation of the phrase, which has been used by Ministers in quite a different and much wider way on many occasions.


It is an interpretation of the phrase, I think, and perhaps we can leave it there for the time being. I think that possibly the greatest criticism of the services which has been made during the debate this afternoon is of the lack of co-ordination, and I do not doubt for one minute that cases can be produced to substantiate these claims. I think it would be fair to say, however, that members of the various social services—from the child-care officer and the education welfare officer to the social worker and health visitor—are already well aware that close co-ordination is essential in the interests of the people they are trying to help. It may well be that the present high standard of liaison between the various branches is not high enough. I think we all recognise that; and, this being the case, the Government, I can pledge, will most certainly do all they can to see that an even greater measure of co-ordination than has been achieved is sought after in the future. I think it is one of the most important things that needs doing in the whole range of the welfare services.

However, I think we should also be careful in a field so wide as this, if there are deficiencies, failures and omissions that justify creative inquiry, not to underestimate or to minimise the achievements of these fine people who staff and administer the social services. We have heard to-day several very wise, informed and constructive speeches, and I apologise to your Lordships if I have not answered quite all the points raised; but I will certainly read the speeches again to-morrow with the greatest care and interest, and I will take note of any points I have not mentioned to your Lordships to-night.

My Lords, we all realise that need and suffering will always be with us, to some extent; also, that the opportunities to relieve it are virtually limitless. But, at the same time, I think we can say that in the last ten years or so we have made good the claim that their alleviation is no longer what it was in the past—at the whim of income. It is now the right of citizenship, and not of money, which ensures adequate protect- tion and help in most areas of distress and misfortune. To achieve this even more fully will be our aim.

7.39 p.m.


My Lords, I should like to thank the noble Marquess for the very friendly and kind reply he has given to my Motion. I take a good deal of comfort from the kindly words he has used about co-ordination of the various services. But I feel that the time will come when a certain amount of the accommodation at present in the hands of the local authorities will change from where it is.

At this hour I do not want to take up more time in replying to the noble Marquess, but I would take the opportunity of thanking those noble Lords who spoke on the Motion that I put down. I particularly framed my Motion in vague terms, so that people could talk freely about particular subjects of interest to them. At the same time, I am grateful for the support I got from a number of Churchmen, including the noble Lord, Lord Sandford. I would thank them very much for their support, and beg leave to withdraw my Motion.

Motion for Papers, by leave, withdrawn.