§ 2.43 p.m.
§ LORD SANDFORD rose to call attention to the urgent need for more and better residential care for many different groups of people in need, and in particular to the recommendations of the Williams Committee concerning the provision of trained staff for all types of homes and hostels; and to move for Papers. The noble Lord said: My Lords, I beg leave to move the Motion standing in my name upon the Order Paper. Whether or not your Lordships feel passionately about residential care, I think you will agree that at any rate it makes a change from Transport. But our reasons for putting this Motion down go rather deeper than that. I say "our reasons" because this Motion, although nominally in my name, is combined with one in the name of my noble friend Lord Grenfell, who is to speak later in this debate. Our reasons for putting our Motions down are literally as stated in the Motion: to call attention to residential care. We de so because we believe strongly that this vital sector in our social services deserves a great deal more attention than it gets, and that those who work in this sector merit a higher place in public esteem than they at present enjoy. That is the main reason for putting down this Motion.
§ We are both grateful to the "usual channels", who have found it possible at this time of the year, this busy season in the Parliamentary year, to spare a Wednesday for a debate upon this subject. I look forward with a good deal of confidence when I look at the list of distinguished noble Lords, and no fewer than five noble Baronesses, who are to follow me; I am confident that this will be a day well spent. Of course, the true judges of this are those who are in residential care and will be in residential care in ten or twenty years' time, for whose provision our policies now need to be shaped.
§ Here, perhaps, at the beginning, I ought to try to define what I have in mind as coming within the terms of this Motion on residential care, and to make a suggestion about what might be the bounds of our debate. The homes and hostels I have in mind are those which 946 are provided for the people who, for one reason or another, cannot live in their own homes and whose need is primarily for social care and support. I suggest that hospitals, which provide mainly medical care, fall outside the bounds of our debate; and I hope that we shall manage to keep off Sans Everything and all that, which is very much in the public eye at the moment but not. I suggest, within the bounds of this debate. I would suggest that prisons, although providing residential care of a sort, also are outside the bounds of this debate, because the care they provide is mainly custodial; and also places such as Eton and Winchester and universities are outside it, because, although they are residential, they provide mainly education. That is their main object. Also outside this debate, perhaps, are those hostels which, although they are very important, provide only accommodation and do not seek to provide social care of any other kind.
§ However, closely connected with many hospitals are convalescent homes and halfway houses for the mentally disordered patients; there are approved schools which, although providing education, also provide care of the kind we are considering. There are homes for mothers with illegitimate babies, rehabilitation hostels for drug addicts and alcoholics—and all this range of specialised establishments I think come on the borders of our debate. But, at the centre of it all, occupying most of the stage, are the homes for the elderly, children's homes, and homes for the chronically sick and handicapped in mind and in body. These are the people, I suggest, with whom we are chiefly concerned when we talk of residential care, and these are the people whose wellbeing in the future will testify to the value or otherwise of this debate.
§ In a moment I will, if I may, survey in rather more detail the present provision of such homes and hostels as these as a background to our debate, but before I do so I am sure that your Lordships would like me to pay tribute at this point to the National Council of Social Service who commissioned this Report which we are discussing. I am now a member of the National Council of Social Service, but I was not at the time this Report was put in hand, and therefore 947 I am not inhibited by any sense of modesty in complimenting them upon discerning the need for this Report. Our thanks should, of course, be extended to Lady Williams herself and the members of her Committee who did the work, and to the Gulbenkian Foundation who financed it.
§ Still more—and this, I am sure, will be endorsed over and over again as the debate proceeds—should we register now our tremendous admiration for those people, unsung heroes if there ever were, who day by day work in residential homes, caring with such compassion and skill, for children in every kind of serious trouble; severely handicapped of all ages; and caring for the frailest and oldest of our old people. I am sure that we should want to pay a very warm tribute to the staff of the homes where all this work is done.
§ This brings me to my second reason for putting down this Motion. It is that because it is Conservative policy to concentrate cash and care on those who need it most, and not to spread it thinly and, we would feel, ineffectively over everyone, including those who are able to look after themselves, that we on this side are especially concerned with residential homes and hostels where so many of the neediest are to be found.
§ I fear that, at the moment at any rate, it is unrealistic to expect much in the way of financial provision for this work from this Government. In fact we have already seen that their handling of the economy has had the effect, and is still having the effect, of severely cutting back existing local authority programmes in this field. For instance, the powers that this Government were proposing in the Health Service and Public Health Bill which we had in this House a few weeks ago, to make better provision for the elderly in their care, were already stillborn for lack of funds when this Bill was before us. Furthermore, provision of hostels for offenders convicted of drunkenness and for prisoners discharged on parole, both of which are called for by the Criminal Justice Act 1967, have not yet materialised, and it is hard to see how the further community homes called for in the White Paper Children in Trouble can be provided under present economic conditions.
§ However, we can at least ask Her Majesty's Government one thing. We 948 can ask that the design and blueprint for expansion be worked out and prepared so that a Government who are able to provide the wherewithal for all this can get on with the job. What I hope we shall not hear at the end of this debate are words which I fear may be written on too many dockets in the Ministries concerned in this matter—such phrases as, "Action in this matter will have to wait for the Seebohm Committee Report". I know that this Report is to come out in a few days' time, but it will be a long time before it has been studied and can be implemented. The Report which we are discussing to-day has been out for a year, and it should be possible to get on with the work of implementing its recommendations. We do not want to be told that we must wait for the Green Paper on the reform of the administration of the Health Service, though that certainly will have a bearing on the subject. We do not want to hear that we must wait for the Maud Committee's Report on local government, although this, too, will have a bearing on it. We do not want to be told that we must wait until the social services have been co-ordinated by Mr. Houghton, Mr. Gordon Walker or Mr. Crossman. This will have a bearing on it, too. But whatever people say, the Report clearly shows that we must have more of these homes and hostels, we must have them soon, and that we must have more trained staff to run them, as I shall seek to show now.
§ Let us make a start by looking at the provision of residential care for the elderly—the largest group of people we have to deal with in this field. Let me say first of all how useful it was to be reminded by an article in The Times on June 28 that the very large number of old people who are in homes to-day does not imply any weakening or failure in family care and affection. A huge majority of old people who have families are still cared for well by those families. This in turn pays a tribute to the quality of our domiciliary services. I believe that it may well be possible to improve those domiciliary services, but even if we do we have to reckon with the fact that the number of old people who are in care is growing, and the proportion of the population of old people who need to be in residential care is also growing.949
§ I understand that the noble Baroness, Lady Wootton of Abinger, will be talking about these demographic factors later in the debate, so I will not develop them at length now, but 3.6 per cent. of our old people over 65 are in homes and hostels, and this is 3.6 per cent. of a very large and growing number. The fact is that on December 31, 1966, there were 80,000 old people of 65 and over living in local authority homes, 28,000 in homes run by voluntary bodies, and 16,000 in registered private homes. I have obtained all these figures from the National Old People's Welfare Council. As your Lordships know, local authorities, who are responsible for the care of the elderly, are required to make forecasts ten years ahead. Their latest projections are published in Command Paper 3022 of June, 1966, and they indicate that future local authority provision for old people's homes will need to rise from a total of 90,000 to 150,000 by 1975. That is one figure that we have to reckon with.
§ Similarly in the case of provision of residential care for the handicapped. There are 8,000 places currently available for the physically handicapped and chronically sick—and I believe that the noble Lord, Lord Amulree, will expand a little on this aspect—and there is provision for 3,000 in homes for the mentally disordered. The latter figure needs to rise to 16,500 by 1975. Those figures come from paragraphs 77, 78 and 79 of the same Command Paper, 3022.
§ Places for children in need of residential care—that is to say, those who have to be in care but for whom fostering is not suitable or for whom foster-parents are not available locally, number 35,000, according to the report of the Children's Department of July, 1967. But the Children's Department do not appear to go in for forward planning—or if they do, they do not publish the figures—so that we have no future forecast to compare with the Ministry of Health's figures. If the noble Baroness, Lady Serota, can fill in that information later, it may be useful to know what the plans are in that connection.
§ In any case, the fact that more homes and hostels are needed stands out clearly enough, without looking any more closely into similar statistics for the smaller groups, such as approved schools (with 8,000 places); homes for unmarried 950 mothers and their babies (70,000 a year)—and perhaps either one or both of the right reverend Prelates may say something on this a little later; probation hostels (720 places); after-care hostels (334 places), or any other hostels which many feel need to be rapidly developed, such as rehabilitation centres for drug addicts and alcoholics. There is no need to go into these: all this provision is important but it is small in relation to the first items.
§ It stands out quite clearly from what I have said that more provision of homes and hostels is needed, and needed urgently, to provide properly even for the elderly who are with us now, whose needs are fairly accurately known and whose numbers can be fairly precisely predicted. This takes no account of the needs of the growing groups of younger people for whom this sort of provision now seems to be necessary: delinquent boys, unmarried mothers, probationers, discharged prisoners, and so on. And the demand for more and better homes, which I hope those figures demonstrate, points in turn to the need for more trained staff to man them. According to the local authority projections in the health and welfare fields alone, we need to increase the staff from 15,000 to 26,000, an increase of 11,000, by 1975.
§ According to the Williams Committee, whose wider survey covers almost the whole field, we shall need between 18,000 and 20,000 more staff within the next decade. Having seen the demand for hostels, let us look at the present staffing position as it has been revealed by this Report. Everywhere one looks there are already extremely disturbing features, not in the least hopeful for the rapid expansion that I have demonstrated to be required. Deputy wardens' posts in local-authority old people's homes are at present 15 per cent. to 20 per cent. undermanned. That is straight out of the latest Ministry of Health Annual Report, Table 51. Seventy per cent. of all full-time care staff in local authority children's homes have no formal qualifications for their work (Williams Report, page 62), and this is the department which at least does something in the way of providing training for the staff of their residential homes. Eighty per cent. of all full-time care staff in old people's homes have no formal qualifications for their work (Williams Report, page 45). About 951 25 per cent. of full-time care staff have to be replaced annually to make good wastage (Williams Report, page 94).
§ But more ominous in the long run than any of these are the factors which apply right across the board of residential homes and hostels. One-third of all the present staff are over 50, and two-thirds of that staff are unmarried women—and, as your Lordships know, unmarried women are now becoming an extinct race. If we could find a way of stopping young people from getting married, or from getting married so soon, we could solve two problems at once. We could man the bachelor Army that the noble and gallant Field Marshal Viscount Montgomery is so often advocating, and we could run all these homes as well. But unfortunately these single states of life are getting very unpopular and the fashion does not show any signs of changing, so we must look elsewhere.
§ We can look at the analysis that Lady Williams and her Committee have made in their Report as to the causes of these shortages and shortcomings in the staffs of our residential homes. In addition to the lack of spinsters, which we cannot do much about, the Committee find six further factors at work. One I have already mentioned—I think probably the most important—that is, the lack of public esteem for the work being done. The second is the lack of training courses and facilities; third, the lack of career structure; fourth, the isolation of the staff from normal social life; fifth, poor accommodation (not in every case, but in some), and lack of privacy off duty; sixth, unco-ordinated recruiting policies in this field and the whole social work field generally. I hope that other noble Lords and noble Ladies who follow me will go into one or more of these factors fairly thoroughly. I can only comment briefly on one or two.
§ On this question of the lack of public esteem for this kind of work, I venture to think that we have not yet fully emerged from the attitudes of earlier days when lunatics, felons, vagrants and paupers were dealt with by lock and key, locked up and kept out of public sight and attention. I do not think we fully appreciate the work of enlightenment that is still to be done in acquainting ourselves and the public at large of 952 the social problems in our society that we so easily pass by day by day, unthinking, or perhaps because we recognise that they are too difficult for us. I am sure that compassion is not lacking; it abounds, and it abounds particularly in the younger generation. It is a knowledge of what can be done and what is being done that is lacking in the community.
§ Then there is the question of lack of professional training in residential care. It is really rather surprising, is it not? that on the twentieth birthday of the National Health Service our frailest old people and our most difficult young children, the most deprived young children, should be in the care of staff in local authority homes of whom three-quarters or more are untrained for the work that they are doing. This means, of course, that a great deal of valiant effort and selfless devotion is having less good effect than it could have. The provision of training was therefore properly the subject to which the Williams Committee chiefly addressed itself, and I hope many of your Lordships will, too. I will not say much about this aspect myself, but I personally am not entirely convinced that a course as long as two years is needed for preparation for this kind of work. I am not qualified to say more on this subject, and I know that many others of your Lordships are qualified and will comment.
§ The provision of this training requires co-ordination between no less than three Ministries, the Ministry of Education, on whom it falls to provide the courses, the Ministry of Health, with their responsibility for the homes for old people, and the mentally and physically handicapped, and the Home Office, who are responsible for the Children's Department and for the hostels and homes associated with the penal system. This co-ordination is no doubt extremely difficult to achieve, but what is the Minister for the co-ordination of the social services for if it is not for this sort of thing? This Government have had a Minister holding that brief ever since they were elected. Have we not been paying first Mr. Houghton, then Mr. Gordon Walker and now Mr. Crossman to do exactly this, that is, to co-ordinate the social services. If they have made any contribution to the solution of these problems, this, I suggest, is the moment 953 for the noble Baroness to tell us about it, because frankly it does not seem to me that so far there has been much progress. I cannot detect any progress since this Report was published a year ago, but if there is any I ask the noble Baroness to tell us about it now.
§ I think the House will look forward to hearing in mare detail about training for residential work from other noble Lords, notably Lord Morris of Grasmere, who is Chairman of the Council for Training in Social Work. We should have liked to hear from the noble Baroness, Lady Serota, speaking from her experience as a member of the Central Council for Training in Child Care. We are going to hear from her as a member of the Front Bench opposite, which may not be quite the same thing; but never mind. It is clear that one very important aspect of all future professional social work training—case work, training in community work and residential care work—will need to be on how to make the best use and how to work well with volunteers. We shall need all the volunteers we can get to work alongside the professional staff in these homes and hostels, and we shall need all the talents they have. I am looking forward very much to hearing what the noble Baroness, Lady Swanborough, with all her experience in this field, has to say about that.
§ I turn now to career structure. The Williams Committee have many positive and useful things to say on this particular subject. I want to comment on only one feature. If that Committee imply, as they seem to me to do (for instance on page 163), that there is a complete career for a full-time trained professional social worker in res dential work alone. I must say, with the greatest respect to the eminent members who made up the Committee, that I think they are mistaken. There are, thank God, many splendid men and women who have a vocation and who have natural gifts for this kind of work, and training will make those gifts better still. There are people like this who can, and will, and do stick, to this work all their working lives. Heaven knows how they do it! But they do; and we should be grateful for it, and we should reward them for that service. But I believe it is unrealistic to see this life-long vocation to residential 954 work appealing to the majority of young entrants to the social services.
§ In any case, is it sensible, just at this stage, when the present fragmented strands into which social work is it present divided—pobation service, children's service, local authority health and welfare services, and so on—are being drawn together, when a united Social Work Department has already been enacted for Scotland, when it is being adopted in the Greater London boroughs, and I have no doubt something on these lines is about to be recommended by the Seebohm Committee, to encourage the establishment of a new distinct residential care service? Perhaps I misread the Williams Committee here, but I should not want to go too far in this direction. I would rather say that spells in residential work should come to be seen as forming part of normal and necessary phases in the career of any good all-round professional social welfare worker, at a time when all-roundness is perhaps the quality in a social worker most to be esteemed.
§ I find it hard to see how it is possible now, or how it can be possible later on, for anybody in social work to shoulder high responsibility in any branch of that field without some experience of residential care. Still less will it be possible for somebody to be the head of a unified social work department in a large local authority unless he has had experience of this sort. I hope that this is a point that other noble Lords, more qualified to speak on it than I am, will look into more thoroughly.
§ A word on recruiting for this kind of work. I hope we shall hear about this from noble Lords whose work keeps them day by day in closer contact than I am with young people who are at the point of deciding how to spend their lives. I believe that a young person who looks towards the social service for a career—and thank goodness many of them do!—sees ahead of him a veritable jungle of choices. If he is lucky, he will have heard of the Social Work Advisory Service, and been much helped by their advice and counsel. Otherwise, his choice and his progress and his fate will hang to a quite astonishing degree on chance. It is not in the least to be wondered at that so few new entrants into the social service end up, first shot, in the sphere where their true vocation 955 lies. This again has a considerable bearing on the staffing of our residential homes.
§ My Lords, there is a great deal more that I could say on this topic, but I feel that I have had my share of time now. I hope that I have provided a background to our debate, and a few jumping-off points for other noble Lords who will want to deal with particular aspects. It is, of course, unrealistic to expect any single debate, even in your Lordships' House, to achieve much in itself. I shall rest well content if this one plays a small part in a much larger process.
§ This is a process in which I believe we are at this moment all caught up and involved. It is that stage of evolution in the Welfare State in which the thought is less and less the rather mercenary one of how we can pay others to take care of our difficult problems for us. The wish now, I believe, is for a Welfare State to which people turn, not only when they want something out of it, but also to put something in. This is the spirit of the citizen army that was tapped so effectively in the near past to man the Civil Defence, the Home Guard, the Observer Corps, the R.N.V.R. and the Territorial Army. It is a spirit that has been thoughtlessly and tragically quenched to-day, but not yet snuffed out. I believe that these homes and hostels spread throughout our cities and our towns are points in the Welfare State around which, with skill and imagination, this spirit of citizen service could be re-kindled. If it is, these places will not lack for hearts and hands to support them. My Lords, I beg to move for Papers.
§ 3.15 p.m.
§ LORD AMULREE
My Lords, I am pleased that the noble Lord, Lord Sandford, has given me this opportunity to say a few words about a section of our community which does not receive a great deal of attention. On a number of occasions hitherto I have stressed in your Lordships' House the matter of the care of the elderly. I do not propose to make much reference to them in what I am going to say this afternoon. The noble Lord, Lord Sandford, has referred to them, and from time to time I shall be bringing up this point. The people I want to talk about to-day are those in 956 need of care and attention between, shall we say, the ages of 18 and 60. That age group as a classification is not a particularly sound one, and one could find many people on either side of it who are in need. One cannot be precise about classification when one is dealing with people.
Some of these younger and middle-aged people in need of care can quite properly be taken care of by the existing geriatric services, by the old people's services because they are suffering from infirmities which are best dealt with by people doing that kind of work. But there are a large number of such an age who are at present being taken care of by these services when this should not be so at all. Some of your Lordships may have seen a television programme not long ago about a girl who at the age of 16 was attacked by rheumatoid arthritis and who was put into a geriatric ward, where she stayed for 25 years among people old enough to be her grandmother. I think she has now been moved into some more normal accommodation.
Only to-day I was told of another case, that of a young man in the Royal Air Force, who suffered a severe injury in a car accident. He was a young man of 24; he had made a fair recovery, but his condition is such that he needs to be somewhere where he can be taken care of. He is not a sick man; he is a severely physically handicapped man. At the present time he is being moved around from one geriatric ward to another, living entirely with people of 70 and more, and with the prospect that that state of affairs will continue.
These are the people I want to draw to your Lordships' attention. We refer to them in the rather uncomfortable phrase "the young chronic sick." The only true word about that is that they are young. It does not mean that they are sick. If they were sick they would need to be in hospital. The word "chronic" is a word I do not quite understand the meaning of. But I think it is fairly well recognised what kind of people I have in mind. It is difficult to find out the total number of people in this category in the country. One has some idea of the number of places available for their care. I have the honour to be associated with the Royal Hospital and Home for Incurables at Putney, where we take in 250 people. There is 957 a similar home at Streatham. The Jewish community hare a home which is not quite so big. Then there are places like the Cheshire Homes, which take care of about 1,300 people. There may be more in the country—I do not know. I have not myself made a complete survey of them, and these are the only ones I have come across.
If I may turn to the medical side for just a moment, these people are for the most part suffering from long-term neurological diseases, or from diseases of their bones and joints, which means they cannot walk; and they are suffering from arthritis of some sort. The fact that you are suffering from either of these two long-term categories of complaints, does not mean, to repeat what I said before, that you are a really sick person and need to be in hospital; but you do need a fair amount of very skilled attention and care to enable you to carry on some kind of normal life.
The other day I put down a Question Not for Oral Answer in your Lordships' House about the number of patients of this type in National Health Service hospitals, and the noble Lord, Lord Kennet, in a Written Answer, stated that last year there were just over 4,000 people in beds of this type, with a waiting list of 664. This waiting list is something that I find very difficult to understand because, to come back to the one place about which I know a good deal—the Royal Hospital, Putney—we have there a waiting list of about a couple of years. So a waiting list of patients is really a meaningless figure, since if it is necessary to wait two years quite a number of doctors do not bother to put down the names of their patients.
I am told that the Ministry of Health has been carrying out a survey of these younger chronic sick—call them what you will—patients, in the country. I think this was begun in the spring of last year, 1967, and one wonders whether the noble Baroness, when she replies, will be able to tell us whether this report is going to be published, and, if it is, when; because, I repeat once more, one of the really sad things about these people is that they do not need to be in hospital. Inquiries have been made in various parts of the country, and one finds people who have been in hospital for 15 years, 20 years, and even longer. The average time for some of these 958 younger people in hospital in one area is about eight years.
The first time I addressed your Lordships was in October, 1946, and I then referred to the fact that people have been kept in these long-stay hospitals for far longer than they need—10, 15, 20 years. I am now addressing your Lordships again, in July, 1968, and I am afraid that I have to say exactly, the same thing now as I said in October, 1946. A certain amount is being done by the Regional Hospital Boards and by the Government for the care of these people. The North-West Metropolitan Regional Hospital Board, for example, have a little department of 26 beds at Danesbury, near Welwyn, and we learn that it has 32 beds, called "contractual" beds, which means that they are in a nursing home taken on by contract.
For the treatment of these people it is quite often an advantage to employ the services of the geriatric physician, because he knows more about the care of long-stay, sick and non-sick people; but they should certainly not be in the same wards as the old folk. There has been some evidence that a large number of these patients I am talking about could be discharged. I think that probably about one-third, or more, could be, provided there was somewhere for them to go, and provided some assistance was available in their own homes.
When one looks into that question, however, the answer given is that they cannot be discharged right away because the assistance is not available. That is why I am so pleased that the noble Lord, Lord Sandford, has brought up the question, "Where are we going to recruit people?" I know that a lot is done by home-helps, and a lot is done by physiotherapy; but we shall need more. Where the new recruits are to come from needs some enormous rationalisation of the problem; but I think it will be required.
Turning to the centre for spinal injuries at Stoke Mandeville, there are there quite a number of people who could live a productive life in hostels, rather than a life in bed, but they require a large number of skilled orderlies to help thorn to get up, with their toilet, and that sort of thing—more than there are available now. If they cannot get that, they lie in bed and are lost to the community, and 959 are not being reproductive in any way. So that is one end of the scale.
May I now, briefly, refer to the training of staff? This is always a difficult problem, because the staff have to deal with people requiring very differing standards of skill, ranging from the very nearly sick to the very nearly well. If I may revert for one moment to the elderly, the National Old People's Welfare Council runs a series of training courses for matrons and wardens for old people's homes. Each course lasts for 14½, weeks; it is partly theoretical and partly practical, the latter being undertaken partly in a home and partly in a geriatric department. These courses have been quite successful. Very nearly 400 people have taken these courses since they began in 1950. Most of them are middle-aged people, 40-plus, and more and more come from the employing welfare authorities who get these people to take the course. The National Old People's Welfare Council would like to extend the training, as the noble Lord has said, to one year, with a certificate at the end; and the purpose of that would be that they would get a nationally negotiated increased rate of pay, in the same way as wardens who have a nursing certificate.
The Williams Committee recommend two years' training, except for the staff concerned with the elderly and the physically and socially handicapped. Where it would be for one year. I share Lord Sandford's apprehension that two years is rather a long period of training, and one wonders whether it is not going to be a form of proliferation of more social services. There has been a certain amount of criticism that some of these homes for the near-sick employ trained nurses as matrons. It is thought wrong by some people—and I would agree—that nurses should be employed in normal residential homes. The Royal College of Nursing have said that a nurse should not be used to look after healthy people—and again I agree. But where is the dividing line if you are going to deal with severely handicapped people, whether they be young or whether they be old? I think that quite often the employment of retired nurses in one of these homes is a very good preventive measure, and they can do useful work without the strain of being on the staff of a hospital. My Lords, I must 960 apologise for having talked rather longer than I generally do, but I feel that this is a very important subject.
§ 3.29 p.m.
§ BARONESS SUMMERSKILL
My Lords, one of the most attractive features of this House is the fact that we have the time and the opportunity to discuss topics of general interest such as the one we have before us to-day. The only difference, I think, between to-day's debate and many others in which I have taken part is that although on previous occasions one has always felt that perhaps there could be an element of controversy injected somewhere, or perhaps a difference of opinion, to-day, surely, no one on either side of the House could find anything to disagree with in the contention that there is an urgent need for more residential care, or could oppose the recommendations of the Williams Committee.
My Lords, this is a vast subject. As was said by the noble Lord who initiated this debate, there are all kinds of hostels, homes and institutions throughout the country, large ones and small ones, for various categories of sick or disabled people, or healthy people who are homeless. I intend to deal with only two aspects of the matter—the conditions obtaining in homes for old people and those obtaining in homes for the unmarried mother and her illegitimate child. This question of the aged, of course, is going to be with us for many years because our expectation of life is increasing. But with our increasing expectation of life, unfortunately the disabilities of old age remain constant. While the scientists promise us that they may increase our expectation of life to, perhaps, 100 years in a comparatively short time, they cannot at the same time undertake to diminish the disabilities which accompany old age. Therefore, the pressure from overcrowded families to find accommodation for their aged members is increasing all the time, and the harassed general practitioner spends much of his time telephoning institutions, hostels and hospitals, trying in desperation to transfer an old patient who may still have a expectation of life of many years to some home because the family cannot afford the room or cannot tackle those disabilities which accompany old age.
961 There are many fine old houses which we could convert, but the problem is to find adequate staff. The Williams Committee recommended that we should find new sources of recruitment among older women, men and married couples. This conclusion, of course, is based on the fact that young women are difficult to secure and that the labour turnover is very high. I noted in this Report that nearly 40 per cent. of all old people's homes had had at least two heads in the five years preceding the inquiry, and that the annual wastage was equal to one quarter of the total staff employed. I think the noble Lord mentioned that fact.
My Lords, in view of the nature of this inquiry—and it took a long time and covered a vast field—I was very surprised to discover that salary scales were outside the terms of reference of the Committee. But I was glad to see that in her Report Lady Williams, in her wisdom, gave some details which are, of course, of tremendous importance. She commented:The pay cheque is so important an incentive that we believe we ought to point out some of the existing factors in the situation which cause dissatisfaction".I am very pleated that Lady Williams had the courage to go outside her terms of reference in this way. It was because she knew, of course, that this was a cardinal point. She gave certain figures. I know figures are boring, and I propose to quote only two. Local authorities advertise salaries which vary from £455 to £840 as a starting salary for a deputy head in a 50- or 60-bedded home, and therefore it is not surprising that there is a good deal of "shopping around." I may say that those are her words: she is using the current jargon. My Lords, £455 a year in a 50- or 60-bedded home! A young girl in an office can get this pay.
§ SEVERAL NOBLE LORDS: More!
§ BARONESS SUMMERSKILL
That makes my case stronger. We were told by the noble Lord that within the next few years we shall want 20,000 more social workers. Do not let us be mealy-mouthed about this. Let us face up to the fact that, in the future, girls who will have had the opportunity of a higher education will not be willing, whatever training you offer them, to give their lives in 962 return for a remuneration which is so absolutely ludicrous. Compare it with, for instance, the salaries paid to those in charge of some small establishment in business with the qualities you want for this kind of job. And what are the duties, even if they have no training? The qualities these people need are, of course, very important. In the first place, they are expected to be physically strong, because there is physically arduous work to do. They also have to have an understanding of emotional and psychological problems, combined with infinite patience and kindness.
Although the noble Lord talked about training—and there is much about training in this book—I attach much more importance to the qualities of the mind than to academic training. When we talk about the training of individuals for the homes for babies I cannot help thinking that no mother ever has training to become a mother, but we have a lot of successful mothers. None of these marvellous women who keep their old mother or father in their homes have ever had training in geriatrics, but they know the meaning of kindness, gentleness, sweetness and attention. These are the kind of people we want to recruit. In view of that, I am not surprised that Lady Williams says in the Report that the Committee had been struck by the amount of "sheer goodness" they encountered, and by the sympathy and humanity shown by so many in the approach to their jobs despite difficult conditions.
If this debate is to serve any useful purpose we must ask whether, in view of the miserable salaries which have been quoted, the community is not exploiting this goodness, with the result that those who would be prepared to undertake this work are failing to respond to any advertisement. This week, in this Fouse, the Prices and Incomes Bill has reached its final stages, and we have been told that it seeks to do what is socially just and that the public interest is to be considered in wage settlements. Surely, my Lords, it is time that the Prices and Incomes Board evaluated goodness in the context of this Report and fixed a wage structure for those who possess qualities which transform the lives of those aged men and women who for many years have increased the productivity of the nation. Yet I know that no action will be taken, 963 because we have to be realists. We have just had a strike of women machinists. Those women did not strike in a precipitate fashion: the matter had been discussed for ten months. The women we are talking about now of course will never strike: they will never take any action. It is because they themselves will make no protest whatsoever, and because any protest on their behalf must come front Parliament, that I am afraid that in those places where wages are determined this matter will still go on and the staff which is so very badly needed in these institutions will not be forthcoming.
The excellent little book Mother and Baby Homes, by Jill Nicholson—which, together with the Williams Report, is beautifully written, and those responsible for both are to be congratulated—portrays the same picture. She reminds us that, "In residential care the staff is the service", and the type of service that the mother and baby homes can offer will depend more on the number and quality of staff that they are able to attract than on any other single factor. I would remind my noble friend that she does not talk about training; she talks about human qualities—those are the things that matter in these homes. Of course, we all know that the central figure of any home, if she is to be effective, if she takes the centre, is the matron. But, unfortunately, matrons these days are so short of help that they are having to undertake all the chores, even the gardening, the cooking, the cleaning. Because a matron has such a high standard, if she sees any of these things have been neglected she is inclined to deal with them. She should be free to give advice and comfort to the unmarried mothers who need her assistance.
The staffing in these homes is not unique. All types of residential institutions face similar situations of gravity; because I am afraid—and I say this very strongly—that the conditions of service are a national disgrace. These are the people who are forgotten. These are the people who have no pressure groups because they are the kind of people who are servants. They themselves know what is wrong. There was only one matron who, when questioned about this matter of salary, said that low salaries are an advantage because they ensured that the staff worked not for financial 964 interest but through concern for the life and souls of those whom God sends to them. Only one matron of all those questioned on salaries said that. The other matrons recognised that if they were to have good workers these workers must be properly remunerated. I would remind noble Lords that there were some matrons in the past who used similar arguments to justify paying young probationer nurses a few shillings a week, expecting them to work unlimited hours.
But those days are past. We must adopt a new attitude. I have never heard a matron suggesting to a doctor that his reward should be found in his concern for the lives and souls of those whom God sends. While this view may have been expressed by only one matron of those questioned, nevertheless, it is her philosophy which the authorities throughout the country have tacitly accepted by underpaying their staffs. It is therefore not surprising that the fund of good will of those people to serve is becoming exhausted—to the detriment of those compelled to spend their lives in our homes and hostels.
§ 3.44 p.m.
THE LORD BISHOP OF LEICESTER
My Lords, we are grateful to the noble and reverend Lord for opening this subject. I think that to-day, in view of the philanthropic aspect of his speech, we will claim the epithet "reverend"; and if there were any small political barbs wrapped somewhere in his speech, to those can be attached the other epithet. We are also very grateful to the National Council of Social Service for launching this inquiry and, of course, to Professor Lady Williams and her colleagues for the excellent Report they have given. I was pleased and proud to see that a member of the Committee was a matron of one of our old people's homes in Loughborough which is part of my diocese. I look back with pleasure on the visits I have paid to that particular home.
I hope that those who have produced this Report will understand if it takes the community, of which we are one of the organs of expression, a little time to adjust themselves to all that we have learned from it. I find myself that each of these Reports takes me a stage along a kind of process of dialectical education. When I read almost every one of them my first thought was that this is an 965 enormous glimpse of the obvious. But when I have recovered from that first impression, which is just a kind of laziness and inertia, I find myself continually going back to these Reports for clear definitions and well-authenticated facts. I am certain that we shall all know much more about this matter when we have digested this Report—and what goes for us goes for the country as a whole.
I should like to say one or two things about the main Report, Caring for People; but I shall try to keep my remarks brief on this because I know that the right reverend Prelate the Bishop of Blackburn is going to deal with this question of the elderly. I shall give most of my time to the question of the mother and baby homes. I think we shall all accept the main contentions of the main Report, at any rate, we shall be convinced that the objects that they had in front of them are ones we must pursue, either in their way or, if we can discover them, in better ways. But when we say we accept them that does not mean that we accept them uncritically. Part of this whole process is that we shall be stimulated to find our own answers to these questions and to try them against the background of the answers which they have worked out over a considerable period of time.
I think there are just two questions that we naturally ask ourselves about this main Report. Frankly, I do not claim to know the answers to them, but it is part of the task to ask the questions. There is, first of all, the question of training. Here I must say that I have tremendous sympathy with the noble Baroness who has just spoken on this matter. I feel, as she feels, that personalities, aptitude and temperament are really more important than anything that can be achieved by training. But I hope it will not be thought invidious if I ask the noble Baroness whether it is not our age which makes us think like this. Whether or not the new generation is going to insist on some kind of formal recognition of the abilities and expertise that they are acquiring, I notice in the Church, as well as in many other branches of life, that everybody insists on having every possible letter after his name. If we are going to have "C.R.C." (Certificate in Residential Care) added to the list of these titles, then perhaps it will do no 966 harm and the day may come when it is taken just as much for granted as "S.R.N." This seems to be life and we have to face it.
I think we are rather doubtful—I am myself—about how far this generic training for such widely divergent work as the care of the old people or delinquent children can really be brought under any kind of umbrella. But I suppose there are certain things all these people need. They all need food and beds, and if these things can be brought together in some form of introductory generic training, I think it will be a splendid thing. This may tie up with what the noble Lord, Lord Sandford, said about the length of training, because perhaps it would not be necessary to give so long as two years if this generic part of the training were seen in the realistic light that I think it necessary to bring to bear upon it.
There is another difficulty about the proposals in the Report. I raise this matter only with great hesitation, but the common theme of the whole Report is caring for people. The point occurs to me, and I know it has occurred to others, whether for some part of the clientele, so to speak, for which we are preparing the very idea of caring for them may be counterproductive. I notice, for instance, that there are a number of people who go into old people's homes in a perfectly normal and healthy condition; they are hardly at the stage of needing what is professionally called "care". They need the ordinary services of accommodation, of course, but if there is too much caring for them as "cases", that very thing may to some extent turn them into cases. When I visit old people's homes, as I frequently do, I See so often a room, a lounge, where there are rows of old people round three sides of a square, many of them, apparently, in a very quiet and passive state of mind. One wonders whether there could be any different approach, something that would provide more for their independence, which would help them to keep their independence longer. One wonders whether this would not in fact give them a fuller life for a longer period of their life, than sometimes happens now.
I may say, my Lords, that both these points are brought out in the Report, 967 both poles of this argument. It says in one place that the staff ought to have more training so that they can be more expert in managing human relationships. I think this is a rather dangerous phrase, this idea of "managing" people. I think that it just slipped into the Report; perhaps it was an unguarded expression. But elsewhere the Report says also, quite plainly, that the object in all this care is the scope for the full development and expression of personality, and I think that is the part of this Report that I should want to emphasise, rather than the excessive emphasis upon the psychological training needed to manage people. I fully realise that there are other sections of this work where these words are entirely appropriate, and one can fully understand that.
If I may, I will move on for a few minutes to the other Report, Mother and Baby Homes to which reference has been made by the noble Baroness, Lady Summerskill. Here, as many of your Lordships will know, the Churches have a very considerable share of responsibility. It does so happen that 86 per cent. of the homes for mothers and babies are under one religious organisation or another and a very large proportion is, of course in one way or another under the care of the Church of England. I have collected a few statistics and although they are boring to listen to, they are important for the record; so perhaps I may mention that there are 86 mother and baby homes with approximately 1,200 beds under the auspices of the Church of England. They divide into those homes which are the direct responsibility of the Diocesan Councils for Social Work and those that have varying degrees of autonomy.
I think that your Lordships will be interested to know that seven dioceses now provide flats and bed-sitting room accommodation for mothers who wish to keep their babies, and seven others have joined with interested local bodies to set up housing associations to provide housing for unsupported mothers. Many people thought that this was a very much needed extension of those particular services so that the mothers in these homes should not be confronted with the rather stark choice of bringing up their babies tinder impossible conditions and almost 968 having to consider adoption as the only possible alternative. Many of those in charge and in important positions in these mother and baby homes have nursing qualifications. There has been a tendency to go for nursing qualifications because this seemed to be at any rate some sort of relevant qualification, but there are schemes going forward now, in consultation with the National Institute for Social Work Training, for an experimental course of training for residential work. This is being done at the Josephine Butler College in Liverpool.
In matters of staff conditions the Churches are always trying to improve the standards, and I think I may mention just one example in my own diocese where we have been able for some years to pay our workers—they happen to be what we call "outdoor workers"—at local authority rates, and more and more dioceses are trying to do this. The Church of England actually expends about £1 million a year on this type of service for unmarried mothers, but it is only fair to say that about 40 per cent. of that comes from voluntary sources and the rest comes from subsidised fees and from local authority grants.
Before I sit down, I should like to say a word about the atmosphere in these homes because this is discussed in a very fair and reasonable way in Jill Nicholson's book. Of course, a chapter had to be written about religion in the homes. It is always—I was going to say just a little amusing, but it is entertaining to professional religionists to see non-professional religionists trying to talk about it and to describe it; but I must say that this is done very fairly and objectively in the book. It raises the question of the changing attitudes to illegitimate pregnancies in our country. It seems as though there is something about this that always produces an unfortunate reaction somewhere. In the old days there was the punitive element in penitentiary or reforming hostels. I think I can say that that has almost entirely disappeared and there is hardly any evidence left for it in this particular book. We are told that nowadays this is accepted as part of life and all this moral opprobrium no longer attaches, nor ought to attach, to it. Yet the fact is that the community as a whole 969 is very slow to adjust its public policy to the human problems arising in this way.
It is sometimes said that it is unfair that these girls and women should find themselves, in practice, almost compelled to go to homes with a religious foundation, where, however kindly it may be done, there is inevitably a desire to give these girls something in the way of emotional and spiritual help to adjust themselves to their new situation, besides giving them the necessary physical amenities that they want and must have. It is inevitable that there should be this kind of spiritual note. But if the community is in any way resentful of this, if it thinks that this is a bad thing, let it get going and provide homes without this; and then we shall begin to see which can render the best service to our people. But let us give the Church the credit for having done at least something, of having gone into this field and stayed in it, often at great difficulty and cost to itself.
If I may keep your Lordships one more minute, I would say that there may be some line of progress in the organisation of this work of mother-and-baby homes along the lines of the White Paper, Children in Trouble. Noble Lords who are familiar with it will know that it is proposed in this Paper that community homes for young people in difficulty should be divided, rather in the same way as the Church of England schools were divided under the 1944 Act—that is to say, into those that were controlled by the local authorities and those that are still controlled by the Church and are aided financially in their work. It is suggested that this division for community homes might be a helpful one. If so, I think it might well be thought of in connection with mother-and-baby homes.
We may come to a point when all these homes are registered and inspected. Some could be controlled by the local authority, or whatever was the appropriate body to do so, and those that remain in the direct control of some religious or voluntary body ought to be registered oily if that control is exercised by a body of some national or area status, so that none of them would be left under the control of small and narrow-based boards of governors. I 970 am sorry to have kept your Lordships so long, but we are grateful for the opportunity for discussing these matters that are very near to our hearts.
§ 4.3 p.m.
§ BARONESS SWANBOROUGH
My Lords, like other speakers I should like to pay tribute to the noble Lord, Lord Sandford, for giving us the opportunity of debating a problem about which many of us feel deeply. I personally should like to pay tribute also to the Williams Committee and especially to the Chairman, Lady Williams, for the amount of labour and care they gave to considering all the matters they had before them. Like the noble Baroness, Lady Summers-skill, I am delighted that Lady Williams went beyond her terms of reference. I think that the amount of trouble taken in looking into the retaining, training and recruitment of staff will immediately give to many people a better understanding of the problems that exist today. I should like to pay a special tribute of very real feeling for the way that Lady Williams has mentioned the dedication of the people who have been the protagonists in the field, the wardens and assistant wardens, and for the way she has recognised the sacrifice that they have been prepared to make in order to establish something that they feel is right and which all of us admire them for having done so.
This afternoon I should like to speak only on the question of the elderly, although the responsibilities that I hold go into other fields connected with this particular problem. I speak with real personal knowledge of voluntary work in this field. The body I am connected with, the W.R.V.S., are responsible for running 26 residential clubs, nursing homes and after-care homes, dealing with a total number of 690 persons. The responsibility carried by the W.R.V.S. in this is second only to the work of that great and wonderful body, the Salvation Army. In addition to this, we manage 959 tenancies situated in 111 houses for 35 local authorities. This experience has taught me that residential care certainly demands basic knowledge and that this is common to all forms of residential care. It is obvious that qualified persons who have this basic knowledge can move from one section 971 to the other, and that with these basic principles well in the front of their minds they can be of immense value, whether it be in the care of children, of disabled persons or in any other homes of the same sort.
I believe that if we can get a basic training, young people will accept the challenge of working for children in care, for the disabled and for the mentally ill, and that it would be for the more mature and older people to go into the field of care of the elderly. All thoughtful people, by which I mean all people who really have studied the subject and considered it in any way whatever, recognise the need for some form of training and also the need for grading for large scale work at local government level. But apprehension is felt by some of us in regard to a too uniform pattern. If such a pattern of training were insisted upon, it might be unsuitable for the smaller homes, those which are often run by voluntary bodies. I say this because obviously local authority salary scales must conform both to qualifications and training and must demand more rigid patterns, which clearly bring with them rules and regulations. If one has been occupied in this field at all one realises very early how wide the challenge is, how far reaching it can be. I, personally, welcome the suggestion of a basic form of training, but I would express the sincere hope that those of experience, ability and devotion might also have the opportunity to work and to be of service.
There is a vast difference between local authority homes and those run by the voluntary bodies. I think that the voluntary bodies too often forget that the local authorities carry the responsibility for the vast bulk of residential homes and that they do splendid work year by year, which all of us who have watched them have been staggered to see going from strength to strength. They forget sometimes that the local authorities have the problem of being obliged to provide those who have a particular need, while voluntary bodies are in a position to determine their spheres of selection. This is a big problem and one too easily overlooked, and as chairman of a voluntary body I know that I should say, "Mea culpa." In the service I am associated with, we have found that for the variety of types of homes which we run it is necessary 972 to have a variety of types of warden. We have discovered that one of the qualities to seek in a warden, as the noble Barones, Lady Summerskill, indicated, is a knowledge of what help is required and where to get skilled assistance. The best warden is undoubtedly the one who, knowing most, has the compassion and the understanding to allow a sense of flexibility to dominate the trained aspect of his approach.
Voluntary homes have the advantage of being very much more flexible in their manoeuvring than local authority homes, but nevertheless should, I believe, be liable to certain general fundamental regulations. This, I think, is what the right reverend Prelate meant when he spoke a few moments ago. I feel that voluntary homes, through their flexibility, should recognise that they have a charter of enterprise and that their voluntary character provides them with the opportunity of new undertakings. Whether starting up fresh possibilities or new ideas or investigating original methods, the opportunity is there for the voluntary bodies to undertake.
I suppose that too often we forget that the determining factor in every case must be the residents' need, and we should be deluding ourselves if we did not recognise from the start that ultimately all undertakings depend on financial analysis—practical running of the house, sensible housekeeping, whether it be feeding, laundry, heating or any of the other rather boring day-to-day matters that are essential component parts of the home. And the best manager, whether warden or matron, knows where to look for help, be it to the psychiatrist, to the chaplain, to the district nurse, the chiropodist or to the voluntary worker. I know that the contribution of voluntary work is unlimited and depends on the call which is given. Volunteers, to do a really good job, should know what is required, why it is needed, and where it is wanted. For volunteers, too, a form of training is necessary and should be undertaken because the fact never to be forgotten is that the service to the resident must be of a very high standard.
Volunteers can help with work within the home—trolley service, tea duties, flower arrangements, linen repairs, hairdressing and hobbies, taking the residents 973 to church, relief help at meal times, providing drives, and so on and so forth. But, above all, their value is that they bring the outside world into the home. Volunteers can help also with account keeping (so long as I do not have to do it), gardening, shopping, visiting, and practically any extra work that is required. But voluntary work should be requested in the right way from the voluntary bodies concerned. Volunteers should, to my mind, be used as a team with the volunteer group responsible for continuity of service. Particular jobs or pieces of work should be given to the volunteer in charge, and continuous interest and participation maintained by the challenge of imaginative performance. Skills of every kind abound among volunteers and according to the call into the surrounding area comes the echo back again.
Too many homes for the elderly, as the right reverend Prelate remarked, are to-day treating their residents as aged babies, instead of demanding from them a contribution of mind and performance which would, according to the most eminent geriatricians of the day, be far more advantageous from the point of view of the residents themselves. If an old people's home is to be like a large family, it is necessary that a happy and cheerful atmosphere should be dominant. To achieve this, it is essential that a really comfortable home be provided to the warden and the assistant warden, and not just one that is adequate. If a warden is to continue on the job, he or she must have a home of his own within the whole make-up. The contribution of wardens and of their assistants cannot be evaluated, because there is no measure that can weigh human understanding, kindness and generosity.
The fact that the young of to-day are aware of their worth, as has been mentioned more than once, their worth in salary, does not to my mind mean that they are less dedicated to the job. They mind, they care, and they want to help. And it is our responsibility to ensure that they have the opportunity. I believe that there is scope for immediate action, and I should like to see that action taking the shape of establishing at once a central register of men and women who are wardens, matrons and assistant wardens. I am quite sure that 974 relief and holiday wardens, if listed centrally, would provide a longed-for assistance to all hostels and homes; and I trust that this debate can, with the help of all the speakers to-day, be productive of something tangible and really useful.
§ 4.16 p.m.
THE LORD BISHOP OF BLACKBURN
My Lords, following the noble Baroness, and unable to speak with the same authority and experience, I wish to confine my remarks on this important Motion, for which we are indebted to the noble Lord, Lord Sandford, to the position of old people in homes and hostels. This is a matter that presents problems of which we have already been made aware in the present, and which will reach alarming proportions in ten years time unless some action, immediate action, is taken on the recommendations of the Williams Committee.
But first I must crave the indulgence of your Lordships that if, through any lack of knowledge or through inexperience, I trespass on the proprieties of this House in addressing your Lordships for the first time I may be forgiven. Secondly, I think that perhaps I ought to declare some interest, because in a few months' time I shall qualify, so I am told by the Williams Committee, to be an "old person", having reached the tremendous age of 65. Therefore, I am a potential candidate for one of these homes or hostels, though I recognise that there may be others of your Lordships well ahead of me in any queue which may exist. I understand that there are queues for these homes and hostels, and that this is part of the problem with which we have to deal.
I must confess that I was surprised to learn from the Williams Committee Report that there are a quarter of a million men, women and children in residential accommodation in over 7,000 homes provided by local authorities, voluntary agencies or private homes, of whom some 120,000 are old people. If the question is asked, as it is sometimes, "Why are these people not being cared for by their own kith and kin?", it is of interest to know that 40 per cent. of the residents (we must not call them "inmates") have never been married, and 59 per cent. have no surviving children.
975 Nevertheless, it is questionable whether, by and large, old people are receiving the care and attention that should be afforded to them by members of their families, unless we are to fall behind less civilised peoples, whom we sometimes condemn on other grounds, and in particular the African. The African has much to teach us about family loyalties and devotion, for there is always a place in the kraal for any member of the family, however remote he or she may be, if that person is in need or is destitute.
I believe that we can learn something from these people, and I hope that in this age of affluence greater care and regard may be given to the older generation by those whose primary responsibility it is, and that they should not lean upon the State—although, as we have been reminded already, there are occasions when specialist attention is needed: where the old people have no home, or no family, as I have already said.
The care of the older generation has been greatly improved; indeed, I go so far as to say that it has been revolutionised. The large institutions are giving place to hostels and homes, and 60 per cent. of the people in the care of local authorities are in homes which accommodate fewer than 70 persons. This is good. I have too many sad memories of visiting aged people in large institutions when, if not in bed, they were herded in some vast room, sitting around the wall, dressed exactly alike, despondent, bored, unable to move without assistance, which was not always available. But, thank God, this position has changed, and the situation in the modern hostel and home is wonderfully different, with men and women sharing the same sitting rooms; with a proper dining room; television; often a garden; and they are allowed to wear their own clothes, and to have their own private knick-knacks about them. This is something for which great tribute should be paid to those who have been responsible for these improvements.
This problem of the old is one, as your Lordships have been reminded, which will press more hardly upon us. Statistics are not very reliable, but it appears that in the next ten years the older generation in this nation will increase by one-and-three-quarter million.
976 Of that number it is estimated that an additional 68,000 will require residential care. I have said that statistics are not reliable: for example, they do not take into account the fact that, with so large a number of additional voters, pensions may be increased—as I hope they will. And it will then be possible, we hope, for a larger number, with extra domiciliary help—I refer to such organisations as the W.R.V.S., home-helps, meals-on-wheels, and so on—to remain in their own homes.
But an additional 68,000 residents calls for extra staff; and again the numbers seem to vary. The Williams Report refers to 5,400, but the number really ought to be 10,000; and the noble Lord, Lord Sandford, spoke in terms of 20,000. That is the magnitude of the problem; and what we need is not only additional staff, but, as has already been emphasised, trained staff. Your Lordships will have been surprised to hear—if you were not shocked, as I was—that 80 per cent. of the staff in hostels and homes are unqualified; and the proportion is much higher in local authority hostels than in private and voluntary homes. This is a matter that demands immediate action, and it is a pressing concern in the recommendations of the Williams Committee.
I believe that this question of recruitment is directly related to training. It is only when we provide proper training that they will receive that salary of which the noble Baroness has just spoken so movingly and so affectingly, so that those who work in these homes may be properly trained, and paid a proper salary, and so that this may become an adequate profession for many young people to follow. This will cost money, but it will be money well spent, and money which we owe to the older generation, most of whom have borne the brunt of two world wars; some of whom were active in the First World War and probably all suffered in some way through it, and in the bombing of the Second World War. In their lives they have been largely denied the affluence and the comfort that belongs to their children, and I suggest that we owe them something to make full and proper provision for them in their old age.
I should like to say one final thing, and that relates to the responsibility of the community towards these homes and 977 hostels in different parts of the country. It is customary for a local committee to be formed, but these committees vary greatly in their effectiveness. It is hoped that more personal interest can be taken by neighbours in the residents of those homes and hostels; that they might sometimes be invited into private homes for meals; that voluntary assistance might be given to enable the staff to take certain time off; that help might be given in the gardens and elsewhere about the premises.
There are many ways in which help can be given, and it is the churches, in addition to other voluntary agencies, who should be doing more in this field. In my own diocese and see towns we are giving our attention to the matter of caring for the aged, both in their own homes and in hostels provided for them. Caring for People is the title of the Report of the Williams Committee—a first-rate title which is a challenge to us all. Caring for people—this must ever be the aim and motive of our legislation, our political concerns and the planning of our modern society. It is people that matter. Lose sight of that fact and, as history has shown, we are heading for totalitarianism, inhumanity and eventual disaster.
§ 4.28 p.m.
§ BARONESS WOOTTON OF ABINGER
My Lords, although the fact has been modestly concealed on the circulated list of speakers, we recognise that the speech we have just heard from the right reverend Prelate was his maiden appearance. This modesty will not prevent me from expressing on your Lordships' behalf, in my capacity as a non-professional non-religionist, how much we appreciate his contribution to-day and with what lively expectation we look forward to hearing him in the future.
I should like to say a few words about the extremely acute phase into which we are now passing in regard to the care of the elderly in residential homes. This phase is going to be exceptionally acute in the next ten years or so, some of the reasons for which have been touched upon by previous speakers. In the first place, the number of old people in the community will increase. The number of persons over 65 will increase by about 1,650,000 by 1980; but it is not altogether the over-65s who make the most urgent demand upon residential accommoda- 978 tion. I think perhaps evidence of that is the fact that if we look up the ages of the speakers who have taken part in this debate so far, we should find that many of them are still outside residential homes for the aged. It is when we come to the over-80s that the demand is most urgent; and by 1980 there is likely to be over a quarter of a million more persons over the age of 80. A quarter of a million people take a great deal of looking after. It has already been mentioned, as is indeed pretty obvious, that the keenest demand for residential institutions in old age comes from people who have no homes of their own. They are unmarried women, and they are widowed women and widowers who have no surviving children or whose children for one reason or another are not available to look after them.
It will occur in the next ten years or so that there will be an exceptionally large number, by present-day standards, of unmarried women reaching the age at which they may look for residential accommodation. The women who were born in the first decade of this century and did not marry are three times as great a proportion of the marriageable population as the women of to-day. About 15 per cent. of the women born in the first decade of this century for one reason or another did not marry, whereas the figure has now fallen to 5 per cent. and indeed, as has been mentioned, the spinster is rapidly becoming an extinct species. For all those reasons the next few years are going to be years of excessive stress in provision for the old, and let us remind ourselves that, after all, the care of the aged is probably to most people the least attractive of these services of caring for people. It is the one that requires the greatest dedication. And it is also numerically very much the largest.
The number of old people who now stand to be cared for in residential institutions is just about double the number of children in care in institutions. On the present ratio of staffing in old people's institutions, which is a ratio of about 6.3 residents to one staff, a staff of over 20,000 is required. On the same ratio, by the middle 1970s a staff of 26,000 will be required, and if the ratio should be reduced to 4.3 residents to every member of staff the number would rise to 38,000. 979 That is to say, we should need nearly double the staff who are now working in residential institutions for the aged. We certainly do need a very much higher staffing ratio. You cannot read any account of conditions or see any of these institutions for yourself without realising that the staff is everywhere inadequate in numbers. So, so far as the aged are concerned, the next five or ten years are going to be especially stressful.
So far as children are concerned, it is rather difficult to forecast. There will be an increase in the number of children by 1980. The number of children under 18 by the mid-1970s will have increased from 15,200,000 to about 17 million, and I suppose we must assume that probably about the same proportion of these children will be in the care of local authorities as at present. It is difficult to forecast that, because there are very great differences between one part of the country and another—differences which are not solely due to greater care in sifting applications in different areas but are due equally to the greater pressure caused by the different conditions in different areas—but if we were to reckon on the children who are now in care in local authorities and are not boarded out, and if we add to them the boys and girls in approved schools, and if we add to them the 22,000 children in special schools for the handicapped, physically or mentally handicapped or educationally subnormal and so on—all residential members of those schools—together we should come to a total of about 64,000 children. Those 64,000 children would require, if they are to be looked after even on the present ratio, an extra staff of something of the order of between 1,500 and 2,000 extra to the staff working with the children at the moment. The other large categories are the mentally ill and the rather miscellaneous categories of mother and baby homes and special homes of other kinds. These are comparatively much smaller but they are still substantial numbers.
As regards the mentally ill or mentally subnormal, the fashion of the day has been to press for what is known as community care. I myself am inclined to think that this has perhaps been rather overdone, that what it has meant has been that people have been turned out of 980 institutions and landed upon their families, sometimes having no families to be landed upon, when they were not really fit to take their places in the world; and we shall probably be seeing in the next few years some return to the idea that people who are seriously mentally disordered, either by mental deficiency or because of mental illness, do need institutional care rather more than perhaps we have hitherto recognised. I think we have put a great deal of stress upon some families by returning to them their mentally disordered members before they were really able to take their place in the community. There is evidence that a considerable increase in the number of mentally disordered persons in institutions is expected. When we see that in their ten-year programmes the local authorities are planning a five-fold increase in their provision on this account, that, I think, is not evidence that we are going to be five times as deficient in our mental capacity in the future; it is rather evidence that we are recognising that the need for institutional care is greater perhaps than we have hitherto seen.
All that is on the side of the demand for places in institutions. But we are also coming to a stressful period because of shortage of supply, and that is going to be especially acute for the very reason I mentioned earlier; namely, that more women are marrying younger than ever before and for that reason we are going to have a shortage of the single women who have been the mainstay of every kind of institution. I think it has already been mentioned in this debate that about two-thirds of all employees in all kinds of homes are single women and that one-third of the staffs are already over 50. These single women will no longer be available, and therefore the main problem, I think, which has faced this Committee was: Where are we to find the people to do this work? I think the Committee have made a number of very valuable suggestions, suggestions of how people may perhaps return to this work after marriage; how people in middle life who have been married and whose children have grown up may return to it; and it may make an appeal to young people before they embark upon their later careers. I think that the Committee have also made valuable suggestions in showing how, even now, 981 quite a number of residential institutions are largely staffed by non-resident staffs and this may be developed further.
But the main proposal that the Committee have to make in this context is that there should be training for a career in service in residential institutions, and it is proposed that there should be a two-year training period for this. I myself find it a little difficult to go along with that. I think it is disturbing how much we are fragmenting training for social work. We have the Training Council for Probation and After-care; we have the Training Council for Child Care; we have the Training Council for Health and Welfare, and we might have to have yet another council for training in residential institutions. I should have thought myself that it might have been a happier approach if it came to be regarded as normal for people who are trained in social work to spend part of their career in residential institutions and part of it externally in extra-mural work. This is an alternative approach, and I should have thought it would have made a bigger appeal to people contemplating going in for social work.
I cannot help thinking that with a two-year training period and with the prospect of spending all your working life in an institution, the picture that we could present to the recruits might not be very attractive, and for that reason I should very much prefer that we should, as it were, weave in the residential work with the non-residential work. I do not for a moment deny that there are special qualities required in residential work, and I think some people might wish to spend all their careers in it. But I think that for most people variety would be more attractive.
I agree entirely with the Committee that training is essential and that you can raise the prestige of an occupation only if you insist upon certain qualifications. But I have some hesitation as to whether a two-year training period for residential work does not rather over-state what there is to learn in this field otherwise than by experience. Certainly there are some things which are peculiar to residential work: the making of a community out of a number of persons who happen to be living under one roof; the performance of all those functions which are naturally undertaken in the family, where relationships are made from the 982 time the child is born. It performs that kind of service, and makes a unity out of a group living together, perhaps a group from quite different backgrounds and interests and tastes.
There are things to be learned, but I greatly doubt whether they world take quite so long as is projected. However, these are matters that can be worked out "in the wash". What is immediately apparent, surely, is that there is going to be an extremely stressful period, and we are most grateful to the noble Lord, Lord Sandford, for having called your Lordships' attention to this.
§ 4.42 p.m.
My Lords, I must in the first place apologise to my noble friend Lord Sandford, and to the House, that I was unable to be in my place at the start of the debate; but I had a long-standing engagement to be host at the opening of a new special training school at Queen's Mary's Hospital for Children, donated by the Drapers' Company.
I am extremely grateful to my noble friend that he has agreed to merge into one our two Motions. The two Motions are ideally suited. My noble friend is calling attention to the staffing of hostels, while my Motion stresses the urgent need for hostels with special reference to the mentally handicapped. I fully realise that what I have to say will cover many fields of handicap, but as I am sure that noble Lords will be covering these I propose to restrict myself to that handicap of which I have first-hand knowledge.
Everything possible is being done in our hospitals for the mentally subnormal, but there can be no doubt whatsoever that we are fighting a losing battle in real community care. In nearly all cases our hospitals are grossly overcrowded, old-fashioned and quite unsuitable for the forward looking policy of this age and the increasing number of patients who require our care. Noble Lords will know that the increase is not due to more handicapped children being born than in the past, but to the fact that, owing to modern medicine, patients are living to a far greater age.
Overcrowding, a shortage of staff and unsuitable buildings inevitably tend to make more difficult the essential training of the patients, some of whom might be 983 able to live again in the community if that training were available. Hence, we get the fact that their stay in hospital, in spite of the wonderful work which is done, tends to become custodial rather than remedial. The most important period of training for the subnormal is when the patient is of tender years, and it is at this stage that the small home or hostel can be of such tremendous advantage, as the best can be brought out of each child and maybe a lifetime in hospital can be avoided. Professor Tizard carried out an experiment which became widely known as the Brooklands Experiment, which took place in a small hospital in Reigate, now under my care, and in the Fountain Hospital at Tooting Bec, now disbanded. A small group of 16 children at Brooklands and a larger group of 50 at the Fountain, as far as possible equal in their I.O. rating, were selected and given similar training. It was proved undoubtedly that the 16 children with the more family upbringing at Brooklands and better staff ratio, which is possible in a small hospital, did far better than those at the Fountain, in spite of all the wonderful work done there—and indeed the work was wonderful.
We still have 16 children at Brooklands who attend a new purpose-built special training school in the grounds, and there is no doubt that this is the ideal in the treatment of the mentally subnormal child. Every endeavour must be made to assist a great number of children who will benefit by this method of education, by the acquisition or building of small homes or hostels with accommodation for anything from 10 to 40. I am convinced that where this can be done the whole of their future lives will be changed for the better.
I have spoken on many occasions of the deep distress felt by the families of mentally subnormal children, and I do not intend to go over the same ground again, except to reiterate that the helpless frustration of those families who are unable to get their children into hospitals is something of which we, in all parts of the House, must take urgent and deeply sympathetic note. There are others who, through a deep devotion to their children, have kept them in their homes for many years and are now of advanced age, and have the dreadful worry over the future of their child when 984 they are gone. I have a number of letters from such people, and only in some cases have I been able to give material help.
Statistics are in many cases misleading, and I realise that mine are now out of date, but the National Society for Mentally Handicapped Children have informed me that at December 31, 1966, the number of handicapped persons under 65 years of age accommodated in local authority homes and hostels was 11,406. Yet in spite of the fact that mental sub-normality is numerically higher than all other handicaps added together, only 1,908 places have been provided in the whole of England and Wales for children and adults, and less than 900 of these were for mentally handicapped children under 16. There can be no doubt that unless something is done in the near future—apart from the occurrence of death—our admissions to hospitals for the subnormal will come to a dead stop. It is vital that there should be a flow-through, and I cannot for the life of me see how this can be done without either an intensive hospital building programme, at a prohibitive price, or by the much more realistic scheme of acquiring or building small homes and hostels, where those who do not need hospital care can be accommodated, in the hope that many may eventually be able to live in the community while others will remain in the hostel in a happy family circle.
I fully realise that building land is at a premium, and it is at this stage that I should like to put some suggestions to Her Majesty's Government. The two large hospitals in my group are situated in lovely grounds, with ample space which could be used for hostels. One of these is the Queen Mary's Hospital for Children at Carshalton, the other St. Ebba's Hospital for adults, at Epsom. Surely some of this land can be used for hostels, not connected physically with the hospital but naturally having the doctors handy in case of need. There must be many hospitals in our countryside that have land attached which could be used for this purpose. The hostels could be devised to suit the needs of the hospital in whose ground they are built—in other words, mental hospitals, mental cases; geriatric hospitals, geriatric cases, and hence assist the ever-growing need for the housing of all types of handicapped persons in surroundings which will not only make them 985 happy but will, in many cases, rehabilitate them.
My Lords, there are rumours that a number of cottage hospitals are to be closed. It is unlikely that these could be used for private residential purposes, but would not some of them be ideal for the larger type of hostel, giving community care to many on a family basis? It is possible that the larger type of hospital might be adapted to care for several types of handicap, if they are too big for one in any one area. Again there must be in our cities and towns, and in the country, some properties which could easily be adapted to this kind of community care, and which, because they are not suitable for private residential purposes, could be acquired at a reasonable cost.
I can assure your Lordships that I know what I am talking about, as, apart from Queen Mary's and St. Ebba's, of 736 beds and 700 beds respectively, both in beautiful grounds and blessed with wonderful staff to look after the patients, I have in the group at Streatham two small hospitals which might be classified as hostels, one for 80 girls and one for 20 girls, some of whom come over daily to help in Queen Mary's; at Reigate the Brooklands Home, which I have already spoken about, and a happy little home for 40 blind or partially blind mentally handicapped children just across the road. At Hastings I have a hospital for 40 mentally handicapped boys who are being taught agriculture and the many facets of occupational and industrial therapy.
My Lords, you may reasonably ask me on what grounds I am complaining. I am not complaining, as I am blessed with a first-class group which is, to my mind, a pattern. But I have also a waiting list of something like 120 children who are awaiting accommodation in my group. This number in one group of hospitals, if the figure is commensurate with the waiting lists in other groups with subnormal hospitals—and I have reason to believe that this is so—indicates the formidable number of families near to breaking point with subnormal children who cannot be placed in hospital.
Just to keep the record straight, I must admit that I have a number of beds vacant on the pædiatric side of Queen Mary's Hospital for Children, 986 which is a comprehensive hospital. But as we are having our theatres upgraded to deal with the ever-increasing requirements of surgery for children at the very tender age of a few days, or even a few hours, I would not in all faith give these over to the subnormal, as the operations to be undertaken are those in which we hope to prevent both death and mental subnormality. These delicate operations are for spina bifida and hydrocephalus, in both of which we are having success now, and we hope for more and more success in the future. I have an estimate that, throughout the group, 50 of my patients would be suitable for hostels.
My Lords, it is on this case that I stand. I believe it is a case whica cannot, in all humanity, be ignored. In conclusion, may I say that the building or acquisition of hostels must go hand in hand with the training of staff, which is of paramount importance. It is on this that I firmly support my noble friend in the theme of his debate as I know that he will support me in my plea.
§ 4.55 p.m.
§ LORD JACKSON OF BURNLEY
My Lords, I also should like to thank the noble Lord, Lord Sandford, for introducing so well a discussion on this very important and revealing Report. Your Lordships may perhaps be a little surprised that I, an engineer, should intrude into this debate. I hope that I may give some little justification for doing so in the next few minutes. To me the Williams Report revealed with stark clarity, and to a degree of which I myself was quite unaware, what a large number of people in this country, young as well as old, are literally dependent on the services of people lying outside their own families. I hope that the reading of this Report will generate a widespread feeling of gratitude to the good people who devote the whole or a part of their time to caring for the least fortunate and most dependent members of our community.
Clearly, as the Report says, these good people would not do so if they were not inspired and motivated by deeper considerations than their own material well-being and their career prospects. On the other hand, it seems to me equally clear that the work to be done will not be done as well as it 987 needs to be done, and the scale of recruitment and the maintenance of essential interest and enthusiam will not be assured, unless the work does, in fact, afford good career prospects and is based on a scheme of training and of qualification which is commensurate with the responsibilities to be carried and unless these schemes of training are assured of public recognition in keeping with their importance.
I have been privileged to spend the greater part of my life in organising or assisting in the education and training of young people for the engineering industry, from the craft and operative levels up to the professional level. The engineering environment is, of course, very different from that of residential homes, but I suggest that the basic principles governing the preparation of young people for responsible service in residential homes are basically the same.
The Report mentions, and several speakers have mentioned, the scale of recruitment which is going to be required during the next decade, but it also makes the point that these new recruits will be able to perform the duties that are required of them only if they are afforded a wider range of understanding and of skill than has so far been assured. In my experience within the engineering industry, and as I have observed the situation outside, the recruitment position is intimately related to that of further education and training. I suggest that as other sectors provide for the further education and training of their recruits, as they are now doing on a very extensive scale, those sectors which make little or no provision will find the recruitment of good young people a matter of increasing difficulty. In consequence the work will be done less well than it needs to be done.
I am not competent, of course, to comment on the schemes of training which are outlined in the Report and I therefore cannot comment favourably or otherwise on what, for example, the noble Baroness, Lady Wootton, said, but there are two comments on the Report that I should like to make. The first perhaps goes beyond the scope of the Report and I hope your Lordships will not feel that it is irrelevant. It concerns 988 the fact that our knowledge and understanding of the physical, mental, and psychological characteristics and illnesses of human beings is making rapid progress as a result of research into the physical, biological, and human sciences. My impression is, however, that the situation in respect of the human sciences is much less satisfactory than that of the physical and biological sciences, and for several reasons.
The first is that the problems in the human sciences are much more difficult to define and the human material on which the research is to be conducted is much more complex and much less stable than are the physical, chemical or biological materials which are of interest to the chemist, physicist and biologist. Secondly, and no doubt because of the scientific complexity—and perhaps one might say scientific untidiness—of the human sciences, in my opinion the human sciences are not yet attracting anything like enough really first-class researchers. The third point, which may have a bearing on the second, is that we are devoting far too little of our national research effort to the human sciences.
At present we are spending close on £1,000 million a year on research and development, mainly within the physical and biological sciences in industry, Government establishments and the universities. Of this £1,000 million, I doubt whether we are spending more than £20 million a year in research into the human sciences. In consequence, the already immense discrepancy which exists between our ability to progress in the physical and biological sciences and their associated technologies and our ability or inability to understand and alleviate the impact of this progress on the community is growing rapidly. This causes me as a scientist and engineer very great concern. This is not to say I do not want the sciences and engineering to progress, but I have the feeling that if we concentrate, as we are now doing, so dominantly on that progression, the consequences will be serious.
Your Lordships may feel that this has nothing to do with residential homes. I suggest it has a great deal to do with the kind of problems that arise for study and solution within residential homes. The point I want to make is, whether or not in an intimate analysis I endorse wholly the suggestions for the qualifying courses 989 for young people outlined in the Report, I would want to argue that beyond a certain stage this is not enough; that it will be necessary for the young people so qualified to pursue at stages during their careers further studies which will enable them to take advantage of the progress which I have remarked is occurring within these related sciences. In other words, in this field, as in others, we must recognise that the attainment of a certificate or diploma in early life is not the end of the educational process, but is merely the end of a first phase of a continuing process which extends throughout a career.
The second point concerns the Committee's proposal for the establishment of a national council for training in social work and residential care, which would embrace the three existing Councils and cater also for a corresponding council presumably in residential care. I was, of course, quite unaware of these Councils before reading the Report, and I cannot comment on their adequacy or otherwise, but it seems to me to reveal another example of our remarkable national ability to fragment the approach to our national problems. The engineering profession has been an outstanding example of this fragmentation, yet it took the important step a few years ago of creating a Council of Engineering Institutions with the responsibility for co-ordinating the activities of 13 of the existing specialist institutions. Moreover, within the Ministry of Labour (I suppose I should now describe it otherwise) there has been established a Central Training Council with the responsibility for co-ordinating the activities of more than twenty industrial training boards and for ensuring a common approach where possible to the resolution of related problems. Surely this can be taken as an example of what ought to happen in the field we are discussing this afternoon.
In conclusion, having endorsed the suggestion that there shall be such a council, I should like to say that it is important for the Government to accept the recommendations of the Williams Report, but that if they do net feel able to do so they must as a matter of urgency say what they think should be done and how they propose to set about doing it. I believe as the noble Baroness, Lady Wootton, said, that we are approaching a situation of increasing complexity, difficulty and 990 danger and that this must no longer be left so unattended.
§ 5.5 p.m.
§ LORD SOPER
My Lords, I should like to add my congratulations to the right reverend Prelate, the Lord Bishop of Blackburn, who unfortunately is no longer physically present, though I have some theological justification for feeling that he may not be entirely out of rapport with what I am saying. I should like to thank the noble Lord, Lord Sandford, for introducing this Motion and to congratulate him on the fact that already in this debate it has become evident that the two points of his pronged Motion have been established beyond any peradventure. There is urgent need for more and better residential care, as has been iterated and reiterated. Whatever may be the particular percentages in the demand for that greater care, the massive evidence produced by my noble friend Lady Wootton of Abinger was surely quite conclusive and coercive.
The other and equally important issue which has received attention, and with justification, is that in this increased need there is also a paramount case for looking at the paucity of the kind of training which is now available, the increasing scarcity of those who will be available to profit by it, and the extreme urgency of the case if we are in any way to deal with those who in the next few years will be requiring the kind of residential care to which this Motion addresses itself.
I will confine what I have to gay to one aspect of this problem which needs the most careful scrutiny, though I may not be able this afternoon to give it that scrutiny which is demanded. Before we can provide better residential care and the kind of adequate training for those who will be responsible for that care, we must look very carefully it the end processes and end products, as we like to think of them, of the hostels we seek to fill and to equip.
One of the most endearing qualities of the Williams Report is its humility. Time and again, when it does not know it says so. I felt the rebuke of this because, as a voluntary worker over many years, I know, particularly in the case of caring for old people, how easy it is for us to assume that we know what 991 they want and that we intend to give them what they ought to enjoy—and they will enjoy it, or we will know the reason why! So we put them in houses in the country where they can hear the birds, and smell the flowers. We put them in adequate premises and we say "Enjoy yourselves". But we do not first ask whether they would prefer to smell asphalt and watch the buses go by, rather than to smell the flowers and listen to the birds. I am beginning to realise that the occasions which provide adequate accommodation, help, friendliness and care are very much nearer those which were mentioned by the noble Baroness, Lady Swanborough.
May I give an illustration of what I mean? The other day, in a hostel for old people in Drury Lane, for which I am responsible, an old lady got into a bath. But, having enjoyed her bath, she found she could not get out of it. This called for a rescue operation and for a selective employment of those who were to undertake the task of rescue. Very soon the hostel was full of all kinds of people, including a large posse of police from Bow Street. These people, including the lady herself who was extricated from her bath, had a "whale of a time", which made their summer. They enjoyed themselves no end, and this is no trivial exercise in reminiscence but speaks to a greath truth.
My Lords, we do not have to care for these people so much as to provide them with a world of events. It is the nonevent that is the curse of old life. It is not that we have to prepare games for them to play, or even a television set for them to watch. What we have to do is to see that something is happening. It is extraordinary how they enjoy the moderate enthusiasm of taking either a great interest or even a partial interest in what is happening. It is the non-event, all the year round, and the cold in winter which are the supreme curse of the kind of accommodation which hitherto has been provided for old people. I say this because, before we are adequately trained to care for them or to look after them, it is of the most peremptory necessity that we should try to get inside their minds—and perhaps some of us are acquiring, at least in age, that capacity and expertise which in younger and earlier days we did not possess.
992 I am sure that, in the case of old people's residential care, on the whole the larger the number of people the better. The reverse order applies, I think, when dealing with children. But this, once again, is part of the process of providing the event; of providing those who are there with the opportunity of taking some interest, not necessarily in a countryside to which they are not accustomed, but in a life which they are most anxious to protract if only as a spectator. To watch them in Drury Lane, as we do, looking out of the window of a quite small hostel, and see the obvious enjoyment they take from this kind of eventful life, is to realise that this is one of the characteristics of an effective kind of care, or an effective kind of residential opportunity, for old people.
I turn now to another aspect of this problem of which I have some practical knowledge, and that is the care for unmarried mothers and their babies. I am sure that the hostel is "out"—that is to say, the hostel in the old sense of the word, where there was a common room where the care of those within that hostel, the unmarried mothers and their babies, was mainly in the charge of the matron or the warden. I believe that, before we can know how we can adequately meet the increasing need, shall we say, for unmarried mothers and their babies in hostels in the future, we must look more carefully than we have done at the kind of "bed-sit", in which there is a maximum of responsibility put upon the mother and, at the same time, the maximum care provided for the child when she is at work.
In the hostel for which I am responsible we have a fully equipped nursery where children can be cared for during the day, and a full expectation of the care that the mother will take of her child when she comes back from work. This is the kind of world in which the mother in Israel, rather than the matron, is the required person in authority. This is the kind of world in which we find the maximum success among those who have long since, I think, become allergic to the idea of hostel life, but in what is very much nearer the kind of protected housing, the kind of opportunity, from which these girls and their babies may profit.
I turn to another field, and I hope that I shall not be thought of as having a 993 bee in my beret about alcoholics, but this subject has not been mentioned today. I beg leave to remind your Lordships that there are more than 500,000 of them in this country at the moment—and that figure is the male population. We have just started a hostel for female alcoholics. I have no idea how many there are, but I imagine it is a very large number, because the ability to hide a bottle in a wardrobe in the bedroom means that much more secret drinking among women alcoholics is prevalent.
What I have to say on this subject is not on the general theme. What I have to say is that I hope very much that Her Majesty's Government will be able to press on with the scheme for the second-stage care. I am not at all sure that we do not at the moment have a proliferation of hostels for the first-stage drying-out process of alcoholics. How heartily I agree with the last speaker, that there has been fragmentation in this field with all kinds of people getting in on the act, so to speak—and some of them not with great expertise!
What is probably more necessary than the drying-out process, which I suspect can eventually be done much better in some clinic in a hospital, is the provision of a kind of protected hostel, or protected domiciliary opportunity to those who are not yet strong enough to stand upon their feet—indeed, there is no cure for alcoholism, only a protracted convalescence—but who will remain with a great probability of normal life and temperance—indeed, of total abstinence—if they have some kind of protection in a hostel or a house in which they will again have opportunities to care for themselves, but with somebody upon whom they can rely and to whom they can turn in their various times of stress.
I mention these facts to deal with the problem as I am sure the noble Lord, Lord Sandford, desires we should deal with it; that is to say, to make practical suggestions in order that more and better hostels and better residential care may be provided. We also need to make provision so that the training may be adequate to the tasks which we regard as optimum, and to understand with greater clarity what are the end-products, what are the purposes and what are the changes that have emerged in an understanding of these problems among those 994 who have had long experience in trying to deal with them. This is very germane to the main topic.
I finish with one other comment. Certain references have been made to the Church, and most of them have been complimentary. Here is one field in which there is already a reservoir of potential training and help. It rests in the seminaries and the theological colleges, as well as in the ministries of the various Churches. One of the problems of the Church to-day, is that we have so confined our ministries to certain pious places and pious noises ti at we have occluded the possibilities of the kind of ministries which are probably more needed than some of those which, historically, have been the pattern of our churchmanship.
Let me put it this way. A minister in the Methodist Church is not allowed, except under very special conditions, to serve other than in a circuit. Were it possible in the Church to which I belong, as it is beginning to be possible in the Church of England, and has long been possible in the Church of Rome, for a minister or a priest to conceive his calling as being a calling to some kind of residential care in one of the opportunities of which we are now thinking, then there would be the opportunity and the demand that in his seminary training he would have an opportunity of learning those problems, and of seeing the kind of opportunities that now are prevented from his sight or are shut off from him, because there is no provision made within the general constitution of the Church for him to exercise such a ministry.
I was expensively educated at the better of the two great universities, I was pitchforked into the Old Kent Road, and I found that I had been sedulously prepared to answer questions which nobody was asking. The questions that people are asking, and which are being asked in this debate, have to do with a very different world from that of Sunday observance and the Tuesday prayer meeting and the occasions of piety.
I suggest, as one of the contributions to this theme and to this discussion this afternoon, that within the Church there is an already fertile field. The re is already a reservoir (to change the metaphor) of potential help, and it meets one of the requirements to which a good 995 deal of reference has already been made: that those who, for instance, as Methodist ministers go out into a particular job do not regard themselves as committed to that job for life. In fact, John Wesley made it a provision that nobody could stay more than three years in a particular appointment. It may very well appeal within the useful ministry of many ministers that they should for a time serve their Lord and their generation within the kind of hostels and residential care provision of which we have been thinking this afternoon.
There are many other things which have to be done. I should like to ask Her Majesty's Government how soon there can be a pressing on with the provision of moneys for the setting up of second-stage hostels. I hope that this will not be too far distant. But I understand some of the problems, and I only wish to ventilate what I believe to be a real concern, to congratulate those who have taken part in this debate, and to believe that in the future we shall not need fewer of these residential opportunities but many more of them, and I hope very much that we shall be equipped to meet them.
§ 5.20 p.m.
§ LORD SANDYS
My Lords, I should like to add my thanks to my noble friend Lord Sandford for giving us this wonderful opportunity to discuss the Williams Report. I should particularly like to express my gratitude to him for having cast the terms of his Motion sufficiently wide as to include both the original Motion of the noble Lord, Lord Grenfell, and contributions from a very wide spectrum of opinion within the House. It is always a great pleasure to follow the noble Lord, Lord Soper. From these Benches, if I may be allowed to say so, we admire his fluency, his insight and, above all, his lucidity in exposition. I hope that perhaps one day I may be able to face your Lordships without a sheaf of notes, but I fear that day is very far distant.
My Lords, I should declare an interest as President of the Worcestershire Branch of the British Red Cross Society; and I shall confine my remarks to Red Cross activities within the field of care of old people. With your Lordships' indulgence, perhaps I may begin with a short story. At the end of the war a British Red Cross 996 relief team was engaged in tracing children separated from their parents. Some had just come out of hiding in the mountains and caves in Northern Greece. The leader of the team, a pædiatrician, was busily engaged writing instructions on labels and attaching them to the children's clothing, if they had any, and a number of V.A.D.s were carrying out the instructions to the best of their ability. But one young V.A.D. was having great difficulty in following them, because in a very large number of cases there was a recurring three-letter phrase, "T.L.C.", attached to a list of prescriptions. She asked the pædiatrician, "What is all this about—T.L.C.? Is it a mouthwash, a drug or something or other?" The pediatrician smiled, and said, "No, it is not a mouthwash, and it is something much better than a drug. It stands for 'tender loving care '—one thing which these children need".
This is the subject of your Lordships' debate this afternoon: caring for a quarter of a million people at present in homes, about half of whom are over 80. The noble Baroness, Lady Wootton of Abinger, has given us ample warning of the alarming way in which this total will rise, and I should like to give some indication of the way in which the British Red Cross Society is attempting, in its own way, to meet this need. The Red Cross began their work in the field of residential care by opening homes for the homeless, for those who had been bombed out, especially the wheel-chair cases, the very frail and the almost totally disabled. To-day, the scope of Red Cross homes covers a whole range of different types of home.
I hope that, with the indulgence of the House, I may be allowed to read out a catalogue, simply from the point of view of maintaining the record. There are 22 old people's homes in existence, mostly long-stay, three of which are run by the Joint Committee of the British Red Cross Society and St. John's Ambulance; two Red Cross homes are administered by the King Edward's Hospital Fund for London, which takes old people, including those discharged from geriatric wards; there are two flatlet schemes; one home for convalescing children under the age of ten; one school for handicapped girls; three homes for chronic sick, including one in Scotland; three holiday 997 homes and five settlements for disabled ex-Servicemen. So far as the old people's homes are concerned, the scheme began on the assumption that the age on entry would be around 60, but it has now increased very sharply, and the average age of entry, as has been mentioned this afternoon, is much closer to 80. From time to time the bedridden are exchanged with patients out of geriatric wards, and this is a particularly useful two-way traffic—an exchange of patients. Very often a patient in a geriatric ward is not sufficiently well to go home but can go into an old people's home, where a sufficiency of nursing and other professional care is available; and a bedridden person for whom the home can no longer fully cope goes to take his or her place in the geriatric ward. This has been a useful scheme, and has a very good record attached to it.
In most of the Red Cross homes the matrons or wardens, or whatever particular post they fill—the persons in charge—are trained up to an S.R.N. standard, but they are also encouraged to attend the 14-week courses mentioned by the noble Lord, Lord Amulree, being run by the National Old People's Welfare Council. These have been running for the last 15 years, and are financed out of the King George VI Fund. I should like to stress again the importance of training. Let us look at the Williams Report, Chapter 10, page 189; there are a few remarks that I should like to read. The final paragraph on that page, under item (iv), says:We have made many recommendations which we believe would go far to deal with these difficulties but there is one group of recommendations which we believe to be supremely important—this is concerned with training. We do not believe that training is a universal cure for all the problems to which we call attention; but we are quite certain that it is an essential element in any constructive plan for coping with them. This kind of skilled work cannot be clone properly without adequate training, and incidentally good training also promotes recruitment and helps to make possible a reasonable career structure".I feel, my Lords, that it is the recruitment element which is so important, and in this particular field of recruitment my noble friend Lord Sandford, in his opening remarks in the debate, laid special stress on the enthusiasm he felt for volunteers and certificated auxiliaries in this field. Courses are held all the time at the Red 998 Cross National Training Centre for home nursing and first aid, mothercraft and mental health, to enable members to assist in nursing, and some 10,000 candidates were successful last year in adult nursing and about 8,000 in junior nursing. The voluntary helper comes into so many different aspects in helping in old people's homes—the very young Red Cross cadet links; children aged between 5, 6 and 7. These children have a very important part to play. Every Saturday, in the Oxfordshire branch of the Red Cross Society, groups of these children go into the old people's homes and carry out exactly what the noble Lord, Lord Soper, was telling us about. They create activity. Some of them talk to the old people. The relationship of grandmother-grandchild, or grandfather-grandchild, is stimulated. They have contacts with the outside world. They are bringirg life into the home. They are probably running errands, exchanging books and doing all kinds of things. The old people greatly look forward to these Saturday morning gossip sessions.
§ LORD ARWYN
Will the noble Lord allow me to intervene? It is a question of human attitudes. We are concerned with attitudes.
§ LORD SANDYS
I do not quite follow the suggestion of the noble Lord on human attitudes. The attitude I was trying to suggest was a relationship between the young volunteer and the old people in the homes. Perhaps this is especially relevant when we take into consideration the observations of the right reverend Prelate the Bishop of Leicester, who told us that so often old people were grouped dozing quietly around the fire—and I am sure this is our general experience. The young people are very much activity-creators, and it is through them that a great deal of the stimulus will come from voluntary work in this particular field. Members' groups of the Red Cross have another role to play. Particularly is this so of the professionally qualified, those who have some qualification for teaching handicrafts and who can promote activities, who can get old people to knit, perhaps to make clothes, to enter into activities which will produce relief goods which may be used by the Red Cross and other societies in other situations, perhaps in Biafra, perhaps in Vietnam or in Jordan, or for 999 a disaster in Europe. Old people can help. This is a theme which I feel especially important. If the young volunteers can promote activities, I am sure that they will get a response.
My Lords, in closing, I should like to make one final request of the noble Baroness, Lady Serota. Where a curriculum for a later date is to be drawn up, either by a Government body or in coordination with the National Council of Social Services, I should like to ask that special attention be paid to the needs and aspirations in this field from the standpoint of the voluntary societies. I feel myself closely in sympathy with what the noble Baroness, Lady Summerskill, has said. I hope that the Government will closely consult with the volunteer societies to promote the kind of curriculum, the length of course, to which so many noble Lords have drawn our special attention.
§ 5.32 p.m.
§ LORD CHORLEY
My Lords, the noble Lord, Lord Sandford, gave us a very able analysis both of this Report and of the rather wider background against which it is presented. I must confess that I should have liked his speech much better if he had not quite deliberately introduced Party political points which, in my view, were quite uncalled for. I suppose that speaking from the Front Opposition Bench he felt that he was under some duty to do so; but I agree with the noble Baroness, Lady Summerskill—who, unfortunately, is not in her place—who expressed the view that this is a matter into which Party politics ought not to enter. In any event, the noble Lord, Lord Sandford, exploded his own case against the present Government because almost all the statistics that he quoted from the Williams Report related to that period when the Conservatives were in power. When he was pointing out that the staffs of these children's hostels and the staffs of the homes for the aged were quite untrained, and ought to have been trained, he was in fact referring to the time when the Conservatives were in power and when we were told at the General Election, "You never had it so good". I do not propose to pursue the Party political aspect of this matter any 1000 more; but I felt it right that somebody should point out how it was introduced into this discussion.
I should like also to say that I found myself very much in sympathy with the noble Lord, Lord Jackson of Burnley, when, as a scientist of distinction and an engineer, he said that too much money was being spent on science and not enough on what he called the human studies—by which I took it that he meant the social sciences. As one who has spent most of his working life in institutions where those are the sciences which we try to study on the very small amount of money provided by the Government—small, that is, when compared with the money provided for the natural and physical sciences—I felt myself much in agreement with what he said. I feel that until much greater efforts are put into research into the social sciences, until all this side of human life is much more carefully considered, and in a much more scholarly manner, we shall not make the progress that we must if we are to produce a first-rate civilisation.
My Lords, as this debate has gone on I have found that almost all the best passages of the Williams Report have been picked out for comment. The noble Lord, Lord Sandford, naturally, batting first, was able to score quite a number of boundaries in this direction. This Report is quite rich in "nuggets" which one marks as one goes through its pages. My copy was very much marked; but as time went on, I found that most of my selected passages were quoted by other speakers. I particularly noted the phrase "sheer goodness", which I thought was a very encouraging description of the attitude found by the Williams Committee in these homes. This, of course, was seized upon by the noble Baroness, Lady Summerskill. The right reverend Prelate the Bishop of Blackburn made a speech which I should have enjoyed even more than I did if he had not filched (if that is not too strong a word) so many of the expressions that I also had underlined for the purpose of reading to your Lordships. I thought of him as a thieving jackdaw at one stage; and then I reflected that I myself, as I had read through the Report, had hoped to be just such a thieving jackdaw.
I hope that your Lordships will therefore forgive me, if, in working my way 1001 through the notes that I had prepared for this speech, I fumble a little—for I do not want to repeat too much of what has been said by earlier speakers. I shall concentrate my remarks on the old-age aspect of the problem, which is the one picked upon by most speakers this afternoon. Many of your Lordships have an interest in this matter from that point of view. I should myself think it quite unnecessary to declare it in the way that the right reverend Prelate did—although I find myself with an even greater interest from that point of view than his.
The position as I see it, to put it shortly—and this, I hope, summarises a great deal of what has been said this afternoon—is that of looking after the aged; of ensuring that they have a modicum of comfort; of seeing that those who have borne the heat of the day continue to derive some interest and obtain some value from their lives in old age. It is really to the securing of that end that this admirable Committee have devoted their research and attention. It is a problem which until recently did not arouse a great deal of interest in the community. There were not so many old people about, especially among the less well-to-do sections of the community, who mostly worked themselves out long before age had made life a burden to them. Such old people as there were mainly lived with their own families and their grownup children, and were looked after by them.
The position in the modern affluent society is very different. It is still to a substantial extent true that a great number of old people are looked after by their own families and live with them, but now there are many more of these old people and in many cases their families are no longer in a position to look after them as in the past. Indeed, it is surprising to find how many of these old people have no families. That point has been made and underlined by a number of speakers, and I do not propose to emphasise it further.
Many of these old people live by themselves, and in a sense this is a very good thing. But often this continues long after the old people are no longer fit to do so, and an appreciable number of them die by themselves in loneliness without comfort or succour from their families or even from their neighbours. Cases 1002 of this kind must be known to many of your Lordships. I have known several of them; they are very distressing and bring out the need for much greater care in a dramatic and very unpleasant sort of way. This is not just sentimentality; it is one of the hard realities of modern life, if I may say so—one of the very hard realities. Because these cases come more and more to the knowledge of people it is being more and more realised that at a certain stage many of these old people must be accommodated in residential homes or at any rate enjoy a great deal more caring for thaw they have been able to get in the past.
My Lords, I should not like to pass from the Williams Committee Report without adding my tribute, although I do not want to repeat what has been said. It is one of the first attempts to size up the problem and face it, and that is done in a very courageous and outstanding way. The first point which must have attracted the attention of everyone who has read the Report and is concerned with this problem, is how very alarming it has become in recent years. This is an aspect of the matter which has been ably discussed, particularly by the noble Baroness, Lady Wootton of Abinger, and I do not think there is any need for me to say any more about it, except that it is a typical problem of the Welfare State. It is the sort of difficulty which arises from the need for a new class of social worker which is being met with at all sorts of different points in connection with the Welfare State. That side of the matter needs emphasising because it is one example of the type of situation which exists in a number of other spheres in our modern community.
It is clearly best—and I am nor, sure that this has been brought out quite as emphatically as it might have been—that people should fend for themselves so long as they can do so effectively, provided always that it does not place an intolerable burden upon them. It is very easy to understand the reluctance of many old people to move out of their own bed-sitting room, or tiny flat, or small cottage in the country, where they have been fending for themselves; and it is right and proper that so long as possible they should be encouraged to remain there. But there comes a stage with many of 1003 them when, if they are left alone, they sink into indescribable squalor, and quite a number of them die in loneliness in the way I have described.
A great deal could be done by the provision of bed-sitting rooms and tiny fiats in large houses, where the occupants could be looked after and helped by a residential caretaker with the necessary qualifications. I have been impressed by quite a number of houses of this kind which I have visited. Several have been established by humanist associations on the lines I have described. Here old people do a great deal for themselves, but may be helped in many ways. To visit one of these places is very encouraging because one finds that the people there are so happy.
The Williams Committee was well aware of the importance of this side of the matter and paid a deserved tribute to such organisations as the W.R.V.S. which organises such admirable forms of help as "Meals on Wheels". I have had personal experience of this work which undoubtedly has brought tremendous relief and pleasure into the lives of many old people who find it difficult to keep themselves going, to do their shopping, cook their meals and to look after themselves.
My Lords, we come to the question of staffing, with which the Williams Committee was particularly concerned. That has been excellently discussed and the great difficulties have been brought out by many speakers. The only point I wish to make is that obviously to a large extent the difficulty is one of finance. As the noble Baroness, Lady Summerskill, said, we are competing with commercial organisations which can pay a girl who has just left school as much as a local authority expects to pay a deputy warden in one of these homes, and it is nor good enough. I am very much of the view that the Williams Committee was absolutely right when it said that service of this kind must be made a proper career of a professional character, with proper pay, conditions of service, proper holidays and all that side of it which no self-respecting workers in industry would go without, and which their trade unions would see that they got.
Finally, I should like to say a few words about the question of training. I do not propose to discuss in detail the 1004 carefully worked out proposals of the Williams Committee. They have the impress of the knowledge and experience of my old colleague at the London School of Economics, Miss Clement Brown, now of the National Institute for Training in Social Work, who was a member of the Williams Committee. Largely as the result of the sensationalism of the Press, the L.S.E. figures in the public mind as a place of sit-down strikes by students, and indeed of all-round revolutionary activities by students. But quietly and calmly behind the scenes, unnoticed by the Press, which is not interested in this sort of thing, solid and valuable work goes on. In particular, the contribution of the School over the last generation to the education and training of social workers has been an achievement of outstanding importance. There it was that the criminologist, Dr. Hermann Mannheim, one of Hitler's most valuable gifts to us, first taught penology to probation officers, and there, too, in the 1930s Miss Clement Brown was a leader in the movement for giving social workers a thorough academic education in the social sciences. The value of the course which she organised in psychiatric social work was appreciated immediately by the progressive local authorities concerned with these matters, and the people who passed through her course were immediately snapped up.
Within my own experience, pretty well every type of social work has started on an amateur basis. The first probation officers I had to work with as a magistrate were complete amateurs, and that is not so long ago. They were devoted to their work, and in spite of lack of knowledge and training did a remarkably good job. But the present probation service is altogether different. It is a fine organisation which has been built up in the period since the end of the war.
In their Report the Williams Committee propose a similar corps of trained men and women to care for the veterans who have retired after serving the community during their adult lives. What is needed is something for men and women to take up as a career, and for which they can qualify themselves by going through a course of training and making themselves fit for the work. The career of caring for people clearly has a most attractive ring about it. It calls 1005 for idealism and devotion; but idealism and devotion by themselves are not enough. Preparation and study and hard work are all called for. I hope that the Government have decided already to accept the advice of the Williams Committee, and that we shall hear to-day that steps will soon be taken to secure its implementation.
§ 5.53 p.m.
§ LORD MORRIS OF GRASMERE
My Lords, at this time of the evening I shall not keep your Lordships long. I ought to declare an interest. I am chairman of two statutory independent training councils, the Council for Training in Social Work and the Council for Training Health Visitors. I am also chairman of a local government training board, a comparatively new board parallel to and in some ways similar to the training boards set up under the Industrial Training Act, but in fact set up by the local government world itself. It is a voluntary board but it is 90 per cent. supported. Part of the duty of this board is to secure proper arrangements for training in those parts of the local government service where training has so far not played its proper part.
I want to concentrate my remarks on training, but first I should like to say one or two words about the position of old people in this country and the future, because this has a great deal to do with the question of training. As one would expect of a Committee chaired by Lady Williams, the Report gives a good and lively picture of the position of old people and a good ground from which to try and extrapolate the future. More than 95 per cent. of old people are not in residential homes. Between 80 and 90 per cent. are helped in some way by their relatives. Some fantastically high proportion—I am afraid I cannot give your Lordships the figure—live some kind of independent life of their own and do not retire from it until within three weeks of their death. All this is right and what should be. It owes a great deal to the development of the domiciliary services and, in particular, because there are so many old people so widely dispersed, to the tremendous number of voluntary workers.
There has been a more recent study than the Williams Report comparing what is done in three countries—the 1006 United States, Denmark and this country. Its figures give us a clear idea of the bone structure, so to speak, of the old people's world, and in all these figures this country comes out well compared with the United States and Denmark, and rather better, if anything, on the most important matters. This has a great bearing on training and on the future supply of staff. It is fairly clear that, with the modern psychology of social work and our general approach to social welfare, the likelihood of our putting into institutions old people who ought not to be there is not great. We have to accept, of course, that the estimates of the lack of provision of institutions and homes for old people are underestimates. One of the things which follows from what I have been saying about the general structure, and from what the Report tells us, is that the position is constantly changing. The noble Baroness, Lady Wootton of Abinger, gave us some other figures, notably with regard to single women who were born at the beginning of the century and are likely to live their last years and die as single women. We have to understand that there will be changes in the demographic situation, in the medical situation, and in the economic situation.
Against this general background, I should like to say a few words about training. I do not want to go into detail about the content of training. I have been so much concerned with studying this and hearing people talk about it for several years that if I went into this question I could easily be very boring to your Lordships. But I should like to say this. The noble Lord, Lord Soper, congratulated Lady Williams and her Committee on the humility of the Report in many respects. It is also necessary—and Lady Williams brings this out—to show a little humility about training. Training for this kind of work has not been going very long. With regard to the academic side of training, the sociological and other aspects, these are well established and it is a question of deciding how much of each is needed and how to fit them in, what you can do without, and so on.
Those who are going to work in the social work field will find very great benefit from the advance of knowledge in these matters. They will have learned all sorts of things in general, with the 1007 help of the scientists and others who have studied these subjects. They are thus given a good idea how to find out what they have to find out. So much for the academic content. This sometimes gives rise to certain difficulties, but they are not insuperable.
The professional element in training is not so simple, and this is where the humility comes in. We have not been doing this for such a long time—even the L.S.E. has not been doing it for all that length of time. Of course, it depends on studying the results achieved by the most successful workers, who must themselves have achieved their success in a very large measure without any professional training and who have to try to pass on to beginners, and to people who have not had the opportunity for study or instruction some of the principles—and indeed some of the secrets, or, if you like, some of the tricks of the trade. All that requires a certain amount of humility. There is much in this field that changes very rapidly because of changing circumstances: in this case, for instance, the populations of the residential homes themselves.
The point was made by the noble Lord, Lord Sandford, and also by several other noble Lords, about the mobility of these workers and the importance of this mobility. Training will not achieve very much without a career structure. A tremendous amount of study on training in this country has been done fairly recently, because the recognition of the value of training came very late in the day. Indeed, there have been some signs in your Lordships' House this afternoon that there are still a great many people who do not believe in training. It is quite clear, however, that we shall not get very far in training unless there is a career structure.
In addition, everyone who has thought of this in late years has come more and more to see that so many branches of this kind of work have a closeness to one another which has not always been recognised but will have to be recognised if the total service to the community is to be good. One might mention, in this connection, children's work, social work connected with schools, health visitors' work, the work of psychiatric social workers, the work of almoners and social work in the welfare services. All these workers 1008 are really part of a pattern in this great world of social work. They must know one another; they must have a lot in common and a common basic training, so that they can talk to one another; and they ought to be mobile.
In addition, there must be people with the gift for organising front-line work in the field of social work or in the homes, as staff members, and also people with originality, brain power, experience and the capacity for seeing the whole picture, for studying the work, and so on. Those who are charged with organising the training need a great deal of research and intelligence and a recognition of what is needed for this particular kind of work. Unless proper study is undertaken and the results evaluated, there can be no advance.
I said earlier that people do not really believe in training—or that great numbers of people still do not believe in it. It must not be forgotten, however, that although there have been magnificent homes for old people—some of them, indeed, absolutely splendid and although remarkable work has been done, compared to which work in the average home is not in the same world, nevertheless we know perfectly well that the social field work under modern approaches is far better than that which used to be done in the past. It has more courage, more confidence; it is based on much more knowledge, and it has moved broadly in what unkind people call a "permissive", or perhaps one might say libertarian, direction, to try to make the best of the energies and activities of those people one is trying to serve. What these people want to do is to live their own lives, perform their own tasks; and under modern approaches people can help old people to live that kind of life in a much better way than was possible under the older approaches.
One of the most spectacular changes that has taken place in our time—indeed, "revolution" would not be too strong a word to use—concerns the primary school. When one visits a primary school these days one has a very good chance of finding 40 children in a class, all of them busily engaged on their own ploys, with the teacher nowhere in sight. This change has come about in a comparatively small number of years by training, not by accident or the general 1009 influence of philasophical approaches to a large number of young women: it has been done by the colleges. One eventually finds the teacher, and asks how long she has been out of college; and in all probability the answer will be that she has been out of college for 18 months or two years. All this has been done by training, and would not have happened in earlier times.
Similarly, both with the residential homes and with field work old people, under modern approaches, and especially with the help of training, can be given a degree of independence and of "going their own way" which formerly people would have been terrified to attempt. One has to bear in mind that when people had no training, and were chosen because they were sensible and knowledgeable about what I might call the "hotel side" of the business, especially where local authorities and voluntary bodies were concerned, the only hope was from general organisers and experts on the economic and hotel side. They did not have prophets, philosophers, guides and friends on the points that really mattered.
What it is necessary to remember, when thinking of old people, roost of whom have never lived close to strangers—at any rate, with the closeness that one finds in a small home—and many of whom are terrified of going into this sort of life for the first time, is that it is essential to treat them in an expansive and libertarian way, a way which people trained in more old-fashioned ideas would never have had the courage to attempt. Old-fashioned, untrained people in this sort of world will do very much what they understand has always been done before.
My Lords, that is all I want to say about the training. May I now say a word about the organisation of training? Lady Williams' Committee says that there are at present three Councils concerned in training in this field—and this is being pretty narrow in counting the number of Councils—and she rightly thinks that unless there is somebody that really goes into this whole matter we shall not get a good training established, especially bearing in mind the change in the world. But she says that it really is a nonsense to have three Councils training in this field, then to have to introduce a fourth Council in order to 1010 get the proper work done on the training that is required, and doing all the work of getting together with the colleges all round the country: helping them to produce the courses which are the best they can produce, in the light of their staffing; helping to provide them with placements for the practical work in homes and elsewhere—proved people, and of course by definition almost certainly not trained, but nevertheless good people, to supervise them during their periods of practical work.
All this has to be looked at, especially for the residential care workers. It is surely a nonsense to add a fourth Council. Lady Williams' Committee surely rightly recommends that there ought to be a Council to deal with all four—but perhaps going even wider. She also recommends (and in this I strongly agree) that it ought to be independent. If it is to be any use, and the services concerned are to be under three Ministries, such a Council will need to be independent. We do not know yet what the Seebohm Committee will report about this—though presumably the Government know—but it is vital that the Government should make up their minds quickly, and one hopes generously on the ideas side. For the moment I am not talking about finance but about ideas.
At first sight the Williams Committee are surely quite right in saying that there should be one comprehensive Council. So long as the services remain under different Ministries it is hardly thinkable that there should be a satisfactory Council which was not independent in regard to its own training work. But it the Government will not have that, I suppose there would have to be a fourth Council. In any case I suppose it would take some time to establish, and the Williams Committee say that in the meantime the three existing Councils ought, by co-operation, to get together a Council or Committee which should be given the resources and told to get on with this work, pending the time when there is a comprehensive Council.
This can be done and the chairmen of the three Councils are in pretty close touch. So also are the staffs—although, of course, co-operation of this kind is not particularly easy when it comes to getting on quickly, partly because the Councils are not in comparable positions. The Council for Training in Social Work is 1011 an independent Council with an independent chairman appointed by the Privy Council. The other two Councils are Advisory Councils to the Home Office, and if you talk about action, speaking for an independent statutory Council to the other Councils, you find yourself really talking to the Home Office. I do not want to go into any details about this, but I just mention that it is not easy for this co-operation to be as efficient and as quick as we should like it to be. I hope that the Government will see the necessity of making up their minds with some speed about the question of a comprehensive Council in the future, even if the Seebohm Report does not give any really firm and clarion guidance about it.
May I end briefly on this last note? The establishment of training for particular kind of work can—and it is not the least of the services that can be given—affect climates of opinion, and these are most important, especially with old people—indeed, with any branch of people who are adult. Many of my family no doubt think that when people reach my age they are, to all intents and purposes, children again. But we are not children, and we do not want to be treated as children. But if the opinion of city councils and county councils and borough councils, and indeed the general opinion, expects everything to be tidy and shipshape, highly organised and kept straight along old-fashioned lines, the homes will deliver what they are expected to deliver, the staff will have to be more and more authoritarian, more and more regimentarian, and so on. The modern approaches will produce results only if staff are aware, through training; and they will be able to produce their results only if those who can put the fear of God into the staff in homes have sensible views in modern times about the degree of freedom and libertarianism that should exist. This is one of the most important developments to which training can contribute, but this sort of development will not come without training.
§ 6.18 p.m.
§ BARONESS STOCKS
My Lords, in view of the extraordinarily informative, and indeed constructive, contribution which the noble Lord, Lord Morris of Grasmere, has made to this debate—he knows an awful lot about training, and 1012 if there is anything he does not know then Lady Morris does—I will keep off the subject of training and also refrain from sympathising with the doubts expressed by the noble Baroness, Lady Wootton of Abinger, concerning the two years' course.
I want to deal with the shadow which seems to me to hang over the whole of this problem. It is expressed in all the literature that I have received during the last few weeks, and indeed all the literature that I have read. It is the problem of staff shortage, training or no training. The noble Baroness, Lady Summerskill, put her finger on one aspect of that; namely, the salary aspect. She described most vividly the difference between what can be earned by serving your fellow human beings and what can be earned in an office, perhaps in the employment of the great and growing advertising industry or the betting industry, as the case may be. It would need a great deal of money to bring the salaries of residential staffs and social workers up to a competitive level which would prevent school leavers, and indeed university leavers, from flocking into offices as secretaries.
There are reasons other than salaries. There are the office hours, with some sort of status, and the expectation that you will not find yourself up against difficult and unhappy personal problems and personal contacts. On the other hand, you can find yourself with happy personal contacts. It does not always work out, but the expectation is always there. That can account for the preference of young school leavers and university leavers going into business, quite apart from the question of salary.
There is another element in the situation that one notices, and that is the growing reluctance of women, young or old or middle-aged, to accept residential jobs. Before I retired from being the principal of a resident college a good many years ago I noticed that it was more and more difficult to find members of the university staff who were prepared to accept residency as part of their duty. You meet it in colleges, old people's homes, homes for unmarried mothers, hotels and in private life. For the most part people do not want resident jobs.
Here we have a sort of wilderness, a bafflement, on the question of staffing. 1013 Are there any growing points at all? I think possibly there is one. I recently had experience of hospital life, and in time I learned something about the hierarchy: at the top the S.R.N.s with their three years' training; the S.E.N.s with their two years' training; the pupil nurses and student nurses in training; the auxiliaries; and the orderlies, who were cheerful, talkative, nice cockney charwomen. The sisters, the S.R.N.s and the S.E.N.s, knew exactly what they were being trained for and what range of duties they might expect when trained. The auxiliaries were not trained; they trained on the job.
What was interesting was that some of them had achieved a nursing skill in certain jobs which was really unsurpassed, even by a highly trained nurse. The skill with which they could get a post-operative patient into and out of a bath was quite remarkable. But they learned it on the job. These auxiliaries were married women, mostly with grown up children. Many were working part time, and some of them were prepared for night duty. That is where I think the growing point is to be sought, among the middle-aged married women, in the search for staff for this kind of social work. There you have an army which is likely in the future not to diminish, but to grow, partly because women marry earlier, and partly because, thanks to family planning, they can, so to speak, concentrate their childbearing years. And one hopes that in future they will be the better able to carry out this work when we have more nursery schools. There is likely to be more of them in the future. I am quite certain that the old people's homes, the mothers' and children's homes—in fact, all kinds of homes—will have to look to those auxiliaries among married women, and that may be the salvation of the staff shortage.
§ 6.24 p.m.
§ THE EARL OF CORK AND ORRERY
My Lords, it may be that some noble Lords at some time or other have sung, perhaps under strong emotion or military stress or after dinner, the words of that ancient song of the English "We'd be far better off in a home." Perhaps those of us who sang that did not really believe at the time that it was true. But it may be true one of these 1014 days for almost any of us. With this cheering thought in mind I should like to fix my eye on one particular small corner of the vast field that foals the subject of this debate and of the Williams Report.
I speak without any claim to skilled or specialised knowledge. Therefore, I am conscious that I may turn out to be less than constructive, and for that reason I shall attempt not to be verbose. Another reason for brevity is that what have to say is probably depressing. I shall repeat no statistics, because these have been enormously and ably deployed by other noble Lords who have spoken before me. I will make only three remarks. One is in connection with homes for the aged, which primarily are many and diverse in character. It is an enormously increasing number of people for whose needs they cater, while, on the other hand, the number of those who are most suitable for their staffing, the single woman, is dwindling enormously. That is not in itself a very illuminating statement, because we know that the whole population is increasing, and therefore the elderly are naturally increasing as well.
The point I wish to make is that the very old are increasing in number at a particularly high rate and for reasons for which man himself is chiefly responsible. I refer, of course, to the achievements of medical science in combating disease. People do not die of tuberculosis as they did only a few years ago and doctors have declared successful war on pneumonia—"the old man's friend" No doubt this kind of process will continue with great benefit to all—well, nearly all. The marvels of science, in general, and of medical science, in particular, impinge upon us all with the deadly and precise inevitability of machine gun bullets. The longer we live, the more likely we are to be hit: but not necessarily to be killed. Therein lies the rub.
It is among the sad imbalances of our age that science has learned to heal many of the ills of old age, but not to cure them; to prolong life, but not to restore to vigour and health. This imbalance, in turn, has led to the science (if that is the right: word) of geriatrics—looking after the old. "Looking after", which in the end, I am afraid, means little more than making for them as bearable as possible the life to which the skill of our 1015 scientists and doctors has condemned them. Of course, I am not thinking of all the old. Some live on as merry as crickets. For example, my own grandfather at the age of 80 odd was knocked down by a boy on a box tricycle in Queensgate; he was knocked unconscious, taken to St. George's Hospital, where he promptly kicked up a row because he found that the nurses had taken away his trousers to prevent him from escaping.
The fact remains that few retain their faculties of body, mind and senses in very old age, and of those who do not, we must face the fact that some, to put it bluntly, will be better off in a home. The question is: How much better off will they be? With this question we come face to face with the whole problem of staffing and training. But any small thoughts that I may have had on this subject at the beginning of this debate have long since wilted under the authority of noble Lords who have spoken.
There is, however, more to it, my Lords, than a matter of simple increase in the number of the aged and infirm, on the one hand, and the staffing and training, on the other. I would invite your Lordships to consider a special situation, of one who has perhaps no helpful children, who has outlived his friends and contemporaries, and finds himself inevitably in a strange place, among strangers, perhaps helpless, probably confused emotionally, defeated in his life-long hope of never becoming a burden to others. It is probable, I dare say, that most of us have had some experience of this sort of thing, and know something of the kind of sadness that it brings. What I would invite your Lordships to consider is this: that the sadness is brought about in many cases by science itself, and we, as sponsors of and subscribers to the Welfare State, must accept our share of the responsibility for it.
Moreover, our share of responsibility is increasing all the time. No longer can we breathe a pious "Kismet" and hope that our luck will turn out to be better. For quite apart from the selfishness of such an attitude, the chances are increasing every day that our luck will not be better, that we shall survive the ills and dangers that beset us long enough to outlive our ability to live anywhere but in 1016 a home. This is part of the price we have to pay for the coming of age of man. Wittingly or unwittingly we have obeyed the injunction:Ask and it shall be given you;Seek and ye shall find;Knock and it shall be opened unto you.So much has been opened, so much revealed, that we have in our hands many treasures, including the power of self-destruction, but not the secret of perpetual youth. Many of the more repulsive forecasts of Aldous Huxley's Brave New World are already upon us, to such an extent that there exists a genuine and imminent possibility of semi-synthetic man. I make a point of the prefix "semi"; we can get new limbs, new eyes, lungs, liver, kidneys, hearts, until half the mechanism of our bodies is replaced by young new spare parts, indestructible within the terms of our own natural lives. But no new endocrine system, no new recuperative powers, no new brain.
The age has dawned in which men and women may live on with mental faculties gradually atrophying to an age beyond the term of their natural lives; that is to say, to an age beyond that at which they might have received natural and merciful release if their bodies had not been improved by the fitting of spare parts. These are the ones whom the machine-gun bullets of science hit but do not kill. These are the new old of the future, the slowly vegetating semi-indestructibles whom we see beginning even now to add a new possibility of horror to the shadows at the end of life. We have invented for the most excellent and humanitarian reasons new dimensions of suffering for precisely those whom we would wish to shield and whose only hope of release lies in the death from which we have shielded them. It is too late now to put the clock back; the age of "spare-part surgery" dawned some time ago.
I do not go so far as to suggest that the fitting of spare parts is going to fill up the nursing homes, the homes for the aged and the geriatric wards. But I most emphatically do suggest and believe that the problem of the helpless old who can no longer live at home is about to increase at a rate not hitherto experienced; and not only to increase in sheer point of numbers but also to 1017 change in kind, and to change for the worse.
How we are to meet this challenge is a question of the utmost urgency. The problems of qualifications of staff and their training must be faced as one of the great public responsibilities of the age. For the age that has produced antibiotics, mass radiology and transplants, and made them available at the public expense, has a resulting duty to alleviate the inevitable sufferings which these boons produce for the few. For the few, but for the increasing many, I believe that to every noble Lord in this Chamber and to every man and woman and child in the country one might reasonably say:Send not to know for whom the nightmare waits.It waits for thee.
§ 6.35 p.m.
§ LORD RITCHIE-CALDER
My Lords, most of the things I had it in mind to say have been said very effectively and in extenso. But I want to follow the noble Earl, Lord Cork and Orrery, in his prognostications about the future, and indeed my noble friend Lady Wootton has given us the demographic picture. At the same time I should like to pick up what the noble Baroness, Lady Stocks, has said and point out that there is going to be an age of great opportunity, of extended leisure. I am relying on the noble Lord, Lord Jackson of Burnley, and his engineers to provide all the material advantages of life. But there is going to be an abundance of leisure, a positive burden of leisure.
Also I think we are underestimating (and I think this is something that has been brought out this afternoon) the still existing idealism of the young people. In my experience—and it is a fairly close experience of young people and their interests and their dedication—there is a genuine demand for a life of service. I do not mean—I was going to say in the old pious sense, but I am sure the right reverend Prelates will not misunderstand me. It is not that kind of thing. They are really rather fed up with the sense of a pay-packet existence, that in fact all they are supposed to be living for is material satisfaction.
I believe that if we really went out for what we have been discussing to-day 1018 with a constructive and dynamic programme of social service, as emphasised by Lord Jackson and others, from the point of view of a real status and career-service of research and so forth, we could count on the younger generation for all the reinforcements we are going to need if we are to give the care for which the Williams Report asks and which we are all aware is needed. In fact in this process we should have available people who are going to be the young middle-aged, not the old, who are going to be pensioned before their life is begun in the sense that the industrial machine, productivity itself, will have taken care of their needs. I am talking now of ten or twenty years from now. We can count on people who will have need for, and must have, the satisfaction of service. It will be the only thing left to do. I believe that they will do it, and I believe that the noble Baroness, Lady Stocks, will get the recruits she wants if we provide a system of training and a proper understanding of the problems.
I think the Report made clear that we do not quite understand the nature of the problems we are trying to satisfy, and here I reinforce what my noble friend Lord Soper said: that we ought to know what we are doing it for. Human satisfaction can in fact be achieved only by understanding the nature of human beings, and therefore what we are discussing to-day, with gratitude to the noble Lord, Lord Sandford, and the Williams Committee, is in fact an inspiring technical challenge to our technical day and age.
§ 6.37 p.m.
§ LORD DONALDSON OF KINGS-BRIDGE
My Lords, as last man in I will be as quick as I can. The debate has been extremely interesting and has concentrated mostly on the biggest problem considered by the Williams Report, that is, the problem of old people, with some reference to children. The noble Lord in his opening remarks invited us to follow our special interests, and I hope your Lordships will not be impatient with me if I go down one sector in the spectrum in front of you, that is residential care in general, and discuss briefly one particular angle where think the general recommendations cannot be fully accepted just as they stand.
1019 I speak of the provision and staffing of hostels of various kinds for adult discharged prisoners. The Williams Report did not go into this question at all deeply, but included the words "discharged prisoner" two or three times, and here and there spoke of social inadequates. Certainly it recommends that people working in both kinds of homes and hostels should receive the same training; that is to say, in old people's homes or children's homes or after-care homes they should receive the same training. I am not at all satisfied that this view will do, except perhaps so far as preliminary training is concerned. On the other hand, I respect the Committee's determination to avoid a proliferation of independent and inadequate bodies each insisting on its own little empire. We are only a small part of the problem, some 100 hostels out of the 7,000 which Lady Williams estimated there are throughout the country, so even if we need a little special treatment it may not be too disastrous.
The noble Lord, Lord Sandford, called for more and better residential care. Immediately we find ourselves in a slightly different category. I agree that more hostels are needed for after-care, but I should be hard put to it to recommend exactly what kind. The ones which seem to work the best, like Norman House, need such special staff that they are constantly running into trouble on this account and cater for a strictly limited number of men. This is one of the desperate troubles of all the attempts to help men coming out of prison. Each experiment inevitably becomes selective and exclusive, concentrating on the cases that they find they can help, and passing on to someone else the ones that do not fit in. As about half the people concerned are awkward cases, there is a great problem of what to do with them next. I do not think this problem is at all typical of the old people's homes or children's homes, which form the bulk of the recommendations of the Williams Report. The provision for such people and such homes works well; and, as the noble Lord says, it is a question of providing more and better. In our case it is not as easy as that.
May I, by way of background explain that I am the Chairman of the National Association for the Care and Resettle- 1020 ment of Offenders, familiarly known as NACRO, and we have as membership nearly all voluntary bodies concerned in this particular field of aftercare. Many of these voluntary bodies are concerned with running hostels. We differ from the homes that are the main subject of the Williams Report in that our clients are, or have been, delinquents. This means that in most cases they are socially inadequate. But it also means that they tend to bear a deep resentment against the society which has convicted and punished them, and they are therefore extremely intractable material.
The noble Lord's Motion refers particularly to training. One of the first things we did when we began to function a couple of years ago was to set up a Committee on training for hostel staff under the chairmanship of Dr. Derek Miller, and its recommendations were passed to the Home Office, at their request, last December. Our Committee had the Williams Report in front of them before they finished their labours, and they particularly endorsed the pre-suppositions on which it is based, which are so clearly stated in the first chapter, and especially the five main reasons for providing training at all for residential work. So there was a great deal in common.
Our Committee diverged, however, from the Williams Committee in one or two ways. They thought, as did my noble friend Lady Wootton, that their emphasis on a two year, full-time course in residential care was a somewhat longterm, ideal conception of what is required, and had only limited relevance to the present urgent situation, at any rate so far as our corner of the field is concerned. In work with offenders, social deviants and the socially handicapped, it probably makes more sense to link up training within this specialised area of work across the boundary between residential and non-residential work, rather than link it up within the residential field along the whole spectrum from children's to old people's homes. Cross movement between residential and field work, the Committee thought, would provide a better career structure, and this would mean linking up hostels for offenders with the probation and aftercare service and perhaps with prison and borstal work. The remarkable performance of prison officers at Grendon as potential social workers is here relevant.
1021 Our Committee's immediate recommendations to meet the temporary emergency I will not go into in detail, except to say that the first one, which was a day release course for three terms in a year for people already at work in hostels, has in fact now been arranged with the Tavistock Centre and will begin in the autumn. The difficulty in all these things, of course, is getting them paid for. We hope that the noble Lord, Lord Stonham —I should like the noble Baroness on the Front Bench to notice this remark—will be able to persuade the Treasury to pay for this and future courses. But we cannot wait for Treasury approval, which gets more and more like waiting for the Second Coming as crisis succeeds crisis, so we have pledged some of our own meagre funds to make sure that a start is made. I think the Treasury will have to finance this in the end, because clearly it cannot in itself be financed, and the whole thing will break down unless they do. I think they know this; it is just that they keep putting it off. This is something we hope the noble Lord will deal with.
We believe that in addition to training it is essential for centres and hostels of this kind to have continuing support and advice, and this should be part of the training. Training should, in our opinion, consist first of all of an induction course, then day release courses, refresher courses, and all the time constant support and advice from skilled people. We believe that money has to be put aside to pay a consultant psychiatrist and people of that kind who can be brought in. There is usually a liaison probation officer. On the Committee there is often a lawyer and an accountant. These people can give support to the people while they are learning the job.
There are a great many difficulties which I will not go into, but which are obvious. Some universities require certain levels of education before they will accept people. All hostel wardens do not have these levels. Distance is a great problem. In the case of induction courses, the few people who will come forward for training may not please the committee members who are looking for a hostel warden. We visualise being stuck, if we are not careful, with several highly trained people whom nobody 1022 wants. There are many difficulties, and no one can be expected to undertake training unless he can see a job clearly at the end of it. So I think we shall have to make provision for some grant in lieu of salary while a job is being found.
Our only serious divergence from the Williams Report is, as I have said, that we should like our wardens to be linked with the probation and after-care service rather than with other types of residential workers, so that opportunities for promotion would point in the direction of probation rather than residential work. We think that a few years in a hostel at any one time—this is a point which I think Baroness Wootton made—is enough for most people, and that a change to field work is desirable. We also think that it will be possible to draw on a wider area of recruitment if the residential period is regarded as an experience leading to something further, or following upon other things, rather than in a way of life in itself.
A few years ago the probation service took over the prison welfare officers, and a fine job has been made of it. I personally should like to see, in ten years' time, all after-care hostel wardens as a part of the probation service, and many probation officers going through a spell of residential work at some time in their career. This will not happen to-morrow, however, and meanwhile some training must be given. We are starting something, as I said, "out of the blue", which will be a beginning in our particular field. We shall go ahead on our own, but we look forward to total co-operation with whatever child is born of the Williams Report; and we hope that eventually our candidates may be able to take year one as laid down by Williams and year two as laid down by NACRO in their two year course.
May I end by saying that of course the noble Baroness, Lady Summerskill, is right. Without a reasonable salary no training will produce recruits: but I think we can say that training is a necessary if not a sufficient condition. I am grateful to Lady Williams for her excellent Report. I am grateful to the noble Lord, Lord Sandford, for starting this debate, and for allowing me to explore this corner of this particular problem.
§ 6.49 p.m.
§ BARONESS ELLIOT OF HARWOOD
My Lords, I shall not delay the House for many minutes, but we have been waiting for this debate for quite a long time and I want to add my thanks to Lady Williams and her Committee for this admirable Report. Not only is it interesting, but it is highly readable. That is not always the case with Reports that are written about social work, as we all know, rather to our cost.
I should also like to say that I think the National Institute for Social Work Training has in this series of books done something for social work training which is badly needed in this country, and which has never been done before. I remember well in the early days—so long ago now that I do not care to refer to them—when I was a student at the L.S.E. the books we were given to read on these subjects were nearly always written by Americans. For many years there was no real series of books on various aspects of social work, written in this country, for students and for the general public. And this is a most readable book.
There are now eleven of these books, all of them well worth looking at and all of them of a very high standard. And for this we are indebted to Professor Huws Jones, who is the head of the National Institute for Social Work Training, and Dame Eileen Younghusband, who has pioneered so much work training in social work. I do not want to go over any of the ground which has been gone over in this debate, because I think that almost every aspect of this work has been mentioned. I am deeply interested in it. My own interest lies very largely in that of local authority work in the appointment of child-care officers, of people for running children's homes, and also, to some extent, for old people's welfare as well.
The noble Baroness, Lady Summerskill, is absolutely right on the subject of the salaries and the status, as it were, of the recruits we want to get into this work. Many a time I have tried on my own county council, when we were making appointments, to persuade people that the salaries we were offering were quite inadequate. But the difficulty is that these salaries are controlled by the J.I.C. or whichever union is concerned in the 1024 appointment of these people, and one can only be guided by the rates, the wage structure agreed between local authorities and the union's representative. I think that there is a terrible lag behind in these particular salaries as compared to others in local authority services; and if any of us here, in what we have been talking about to-day, can do anything to help to speed up a review of the salaries of residential and social work people in local government, I think we shall have done a very useful job indeed.
The noble Baroness, Lady Stocks, is right when she says that we have to look at new fields for recruitment, and particularly in the suggestion she made about married people who perhaps have time to spare and whose families may well be grown up. Of course, these are just the people for whom everybody is looking in a great many other fields, so we are not the only competitor for the help and services of those people.
It comes also down to the point of training, of which the noble Lord, Lord Morris of Grasmere, and many other noble Lords have spoken. I support most wholeheartedly what Lady Williams and her Committee have said on the subject of a uniform basic training. Some years ago, with the help of Dame Eileen Young-husband and the Carnegie Trust, of which I was a member and now a Chairman, we financed the first geriatric training course in social work at the London School of Economics. That was a good long time ago. I think it has now been copied throughout the whole of the social work schools in universities throughout the country, and I am sure it has been a tremendous asset in the training of social workers that the basic training is now agreed by all the different social works schools. I think the same thing could be done for residential training. It is recommended in the chapter on training in this Report, and I very much hope that one of the results of this debate will be that we shall see this suggestion put forward by the Williams Committee taken up by either the Government or the independent training committee that is to be appointed.
Finally, my Lords, I feel this is such an important Report, and this debate is so important, that we may be seeing something which may revolutionise this type of work, in the same way as we 1025 remember what was done by the Webbs and what was done by the Curtis Committee in connection with child welfare. This is a most important Report, and this is a most important debate. I hope that your Lordships' words will carry outside this Chamber. I am quite sure that if they do we shall have done something very useful in connection with this vitally important service, this service of residential care of all kinds in the country to-day.
§ 6.55 p.m.
§ BARONESS SEROTA
My Lords, I am confident that the House, with its usual generosity, will appreciate the magnitude of the task that falls to me to-day in replying to what the noble Baroness, Lady Elliot of Harwood, has just so rightly said is such an important debate. We are all deeply indebted to the noble Lord, Lord Sandford, for the opportunity to discuss the problems involved in making adequate and appropriate provision for the residential care of various groups as an integral part of our social services. May I just say that my only regret—and perhaps I had better say this immediately and dispose of it—is that the noble Lord, Lord Sandford, who put down this Motion and offered us this opportunity to debate such an important subject, was the only noble Lord to add political barbs to his arguments.
It is not for me to lecture the House to-night on the post-war development of our social services, but it is not unknown to many of us that the present legislative framework of our social services was established in 1948 by a Labour Government, and that it took a Labour Government, twenty years later, to set up a full-scale inquiry into our personal social services; namely, the Seebohn Committee, to ensure that we could develop an effective family service. I can only say to the noble Lord, Lord Sandford, that if the only problems facing our personal social services to-day, particularly in the residential field, were the result of the last two years' misdemeanours of a Labour Government, they would be relatively small ones.
I, together with colleagues, was responsible for some years in London for the care of some 9.000 children deprived of a normal life, and I remember the many occasions when I came on my knees across the river to the then Home Secre- 1026 tary begging, for capital monies to develop the Children's Service. I well remember being told on one occasion that the £40,000 we needed to rebuild three Nissen huts to provide proper teaching facilities in one of our senior approved schools represented one-fifth of the total national capital building programme for approved schools at that time. This was in 1959. I feel, therefore, that it was unwise to have started off this debate in that particular tone, although the noble Lord, Lord Sandford, as he got deeper into his subject seemed to forget the Bench from which he was speaking and talked to us as a human being concerned with the wellbeing of others.
All noble Lords who have taken part in this debate to-day spoke with almost unrivalled knowledge and experience, and with compassion and understanding of the particular areas of their concern. With all the humility of one who could well be described to-day as a "poacher turned gamekeeper", may I thank all who have contributed to the debate, and particularly congratulate the right reverend Prelate, the Bishop of Blackburn, on the contribution he made in his maiden speech to our thinking in this sphere. Perhaps I ought also to congratulate the noble Lord, Lord Soper, on his elevation—or is it descent?—on to the Bishops' Benches. I myself, and I know Her Majesty's Government, are only too aware of the problems involved and of the need to make effective provision for those in need, either for short or long periods, of some form of residential care. Nor am I unfamiliar with the many difficulties now facing local authorities and voluntary organisations in providing residential accommodation, and the strains and stresses that this places on the staff who have the day-to-day, and sometimes the night-to-night, task of caring for people.
All have expressed their indebtedness to the distinguished Committee, under the chairmanship of Professor Lady Williams, for their Report, which was sponsored by the National Council of Social Service and made possible by the generous support of the Gulbenkian Foundation. To many of us it has been a pleasure to know that the Chairman of the Committee has been sitting and listening to this debate to-day together with many of her colleagues. I hope that they have felt that their labours from 1027 1962 until 1967 have at least borne some fruit in the debate we have had in your Lordships' House to-day.
I do not propose to detain the House at this hour, when we have other business to deal with, by attempting to cover every aspect of residential care which has been touched upon in the course of the debate. I shall confine myself to trying to deal with some of the main issues which have been raised and answer them so far as I can. If I fail to pick up any particular point raised, I shall pursue them later in correspondence or in discussion with the noble Lords concerned.
As our services have developed over the years it has become clear that residential care is one of the methods that we can employ to meet the needs of people whose care is the responsibility of that particular service. Clearly, there is a need to develop a flexible relationship between residential care and other forms of care; and this point has been brought out in our debate to-day. Many noble Lords have made different suggestions varying from additional day care to domiciliary care and support. The noble Lord, Lord Soper, made an interesting suggestion about a form of sheltered housing for the unmarried mother and her child, rather than the original kind of residential institutions which were developed in the past. We need to consider questions over the whole range of services provided—medical, educational and social—for these particular groups in our community.
The noble Lord, Lord Sandford, in his opening remarks accepted the point that residential work is part of the wider social services in the community. One's conclusions here are reinforced if we glance back at the origins of some of the older residential care establishments where in the last 20 years increasing emphasis has been placed on the integration of residential care with services provided for people in their own homes and with other forms of care, such as boarding-out.
At this point, I might venture to suggest an answer to the question posed by the noble Baroness, Lady Wootton of Abinger, on this point. She noted that the interests of your Lordships in the care of the elderly were possibly related to their own age levels, and she also 1028 mentioned that many noble Lords survived in a community as opposed to being in need of residential care. Possibly your Lordships' House provides a unique form of day care which assists your Lordships to stay in the community rather than having to go into residential care!
If one considers the child-care field, the developments arising from the Report of the Curtis Committee in 1947, and the subsequent Children Act, growing out into preventive work in the community, the development of new forms of residential care for children, resulted in the 1963 Children and Young Persons Act (I give the noble Lord, Lord Sandford, that one), which embodied in legislation the experience of children's departments which had been developing for a number of years towards preventive work. All these factors place a growing emphasis on the need to keep our young and our old people in the community so far as possible. Similarly only in this last Session in Parliament we have extended the original duty of providing accommodation under the National Assistance Act 1948 through the Health Services and Public Health Bill. This now becomes one facet of a general duty upon local authorities to promote the welfare of the elderly.
I well remember the discussions on the Committee stage of that Bill, and I also remember, as I am sure does my noble friend Lady Phillips, the debate which we had, on the initiative of the noble Baroness, Lady Brooke, who urged the Government to encourage local authorities to board out elderly people and to use their new powers under the new Bill to do so. Similarly, in the services originally conceived as non-residential, those dealing with offenders on probation and with discharged prisoners, it is now recognised increasingly, as we have heard from the noble Lord, Lord Donaldson, that supporting residential facilities are essential either to assist the offender in the community with his personal and social problems or to assist in his rehabilitation from a custodial situation. One is also aware of the care of the under-fives. Here many see the need coming to consider together the provision of day nurseries in the community and residential provision for young children under the age of five who cannot be cared for in their own homes.
1029 In reply to the plea of the noble Lord, Lord Sandford, that the Government should not attempt to fob off this problem, I can assure him that this is not the position. It is difficult for many of us at this moment of time to consider the subject of this debate in isolation. Rather should we regard it as a very valuable preliminary to the further discussion of the local authority personal social services which your Lordships may wish to hold when the Report of the Committee under the Chairmanship of Mr. Frederic Seebohm is available. This Committee, of which I myself had the honour to be a member during most of its deliberations, was appointed jointly by my right honourable friends the Home Secretary, the Secretary of State for Education and Science, the Minister of Housing and Local Government, and the Minister of Health, to review the organisation and responsibilities of local authority personal social services and to recommend what changes, if any, are desirable to secure an effective family service.
I was very interested in the comments of the right reverend Prelate, the Bishop of Blackburn, who so rightly reminded us in his speech of the role of the family in the community in providing care with domiciliary support from our social services or residential care on a short-stay basis. The Seebohm Committee began hearing evidence early in 1966. Its Report is now imminent and we hope that it will be presented to Parliament before the House rises for the Summer Recess. Its work has a close bearing on many of the problems which have been before us this afternoon. In the public sector most of the residential establishments are provided by services whose organisations have been reviewed by the Seebohm Committee. It is most unlikely that the Committee did not consider the role of the voluntary organisations since voluntary effort and voluntary participation were highly relevant to the Committee's terms of reference.
I know that many of your Lordships have particular interests in the voluntary field and are anxious to develop voluntary effort in association with statutory bodies. Given that we are shortly to have the Seebohm Report, which embraces so many of the aspects upon which we have touched to-day, none of us at this stage can claim to form a final view on any suggestion, including those put forward 1030 by the Williams Committee. This is not to say that no progress can be made—indeed, I agree that the need for action is urgent. But I shall indicate in a few moments that although the recommendations of the Williams Committee will be considered by the Government, and presumably also by local authorities and voluntary bodies, who are closely involved, this will and must be done within the broader context of the Seebohm Committee's Report. But that dces not mean that we must now stand still.
All noble Lords who have spoken, certainly those who are concerned to develop the different forms of residential care which are so necessary as part of our social services, would not have 'wished in any way to-day to imply that although other forms of care in the community are being developed, residential care is less important. Quite the contrary. And noble Lords have made the point so effectively that I need stress it no further. We all know that the mere we develop other forms of social care, the more the people cared for in residential establishments will be those with special needs and difficulties which the establishments must be equipped to meet. I speak from a close acquaintance with the work of residential staffs, especially in the child-care field. In the 20 years since the passing of the Children Act the development of boarding-out and of preventive work has meant that the staff in our children's homes are now having to deal with more difficult behavioural problems because certain problems are being solved in different ways and children are not being received into our homes for the reasons for which they were being received in the past. This is a most exacting task—perhaps the: most exacting one of all in the field of social service—and we all pay tribute to the work of the staff.
There appears to be some difference between noble Lords who have spoken on whether this work requires something more than good nature and kindness. Opinion seemed somewhat divided. The noble Baroness, Lady Summerskill, who apologises for her absence at the moment and is, I believe, returning to us from another meeting, said, quite rightly, that what matters here is the quality of care, and that the quality of care is determined by the quality of the staff. But she did not quite accept that quality comes partly 1031 from individual qualities and partly from training, too.
It is not enough in this field to be good and kind. Some of the elderly, senile inhabitants of our old people's homes are extremely difficult and trying people, while the little girls in our children's homes do not all have golden hair and blue eyes. Thus, our residential care staff have an extraordinarily difficult task, and a task which grows more difficult the more we develop our services. They must surely be assisted by the skills which many of us believe are needed, and which can be acquired only through the right kind of training, in addition to their personal qualities of devotion, patience, love and compassion, which are essential if the work is to be sustained for any period. We all join with the noble Lord, Lord Sandford, in agreeing that our aim must surely be to support and strengthen the staff, and our thanks go out to all of them for all they continuously do for those in their care, with or without training.
The Motion before the House to-day suggests that there is a need for more and better training. The noble Lord, Lord Donaldson of Kingsbridge, reminded us that we needed more, but we were still not certain what was better. There was complete unanimity that we need more residential provision for the elderly; and here the demographic projections of the noble Baroness, Lady Wootton of Abinger, really proved that there is no doubt whatever that we shall need greater provision for the care of the elderly. She also, quite rightly, raised certain doubts about whether one could equally project the future requirements of children.
We know more accurately what the elderly situation is going to be, but we are not quite so certain about the future in regard to services for the care of children. The number of children and young persons, like the number of elderly, is expected to rise, and, as the noble Baroness, Lady Wootton of Abinger, reminded us, in ten years' time there will be about 2 million more people under the age of 18 than there are now. However, if history is any guide this does not necessarily mean that there will be an increased demand for residential care for children, although it may alter the nature of the demand.
1032 In 1959 there were 12 million people in the population under 18 years of age. The number of children accommodated in local authority homes and hostels on March 31, 1959, was 21,043, while in voluntary homes there were about 17,000, making a total of some 38,000. The corresponding total in March, 1967, was 33,000, although the number under 18 in the population had risen by over 1 million. This is not to deny that in some cases there is a shortage of places, and that additional places of particular kinds are undoubtedly required. But it illustrates that residential care is one among several methods employed to meet the needs of children, and that the growing contribution of forms of help which avoid a child's removal from home must not be underrated.
In view of the concern of the House about the provision for the elderly, I thought it might be interesting to your Lordships to know the present position in relation to the provision of places. In terms of absolute numbers—and I give the figures for England and Wales—the places provided by local authorities for the elderly rose from 90,000 in 1962 to an estimated figure of 107,000 in March this year. In terms of the ratio of places per 1,000 elderly people, despite a rise in elderly population, there has been an improvement from 16.1 in 1962 to an estimated 17.4 in March this year. Within this large programme there has been a welcome reduction in the number of places in former workhouses, whose stones still smell of the principle of less eligibility on which they are built, and which I think we shall all be glad to see the back of as soon as possible.
We are indebted to the Williams Committee for the first estimate of staffing ratios in these homes. Their survey of local authorities' homes showed that the ratio of residents to what they described as "care staff" was 1 to 6.1. They made no concrete recommendations on staff ratios, but implied that about 1 to 5.2 might be realistic. Official statistics of staff for 1967 show that the ratio of heads and deputy-heads of homes and attendants to all residents in homes, including some who were not elderly, was 1 to 5.2. These are averages, and the situation clearly varies in different parts of the country and from institution to institution.
1033 But there is—and I think this is very gratifying, when you think of the sustained efforts that have been made by so many people in this field—a substantial increase each year in the net number of places provided. It has been possible in the recent revision of capital programmes to avoid a further cut-back, and there is reason to hope for future advance. The past and future increases imply an annual increase of between 100 and 200 senior posts required, and there are inevitably difficulties in filling them all. The local authorities' plans for development envisage some 150,000 places by 1976, and it is likely that when they revise them next they will maintain this target. If our economy improves, it will be a realistic one, but it will mean a great increase in staff itself to which any improvement in ratios or quality will represent an added problem.
Before going on to the two major issues—namely, recruitment and training—which are central to the Report of the Williams Committee, I should like to reply to particular points raised by noble Lords in relation to specific services. We listened to the moving plea of the noble Lord, Lord Grenfell, for mentally handicapped children with very deep concern. He told us of the situation in the field with which he is so familiar, and of the 120 children en his waiting list for admission. He pointed out that if adequate hostels could be provided in the community for mentally subnormal children he could release much needed hospital beds to take in those on his waiting list. He also reminded us, so rightly, that in a society which is making such rapid advances in the field of medical knowledge, care and treatment, we must expect more of our spina bifida babies to survive and more of our old people to go on living longer. He made a plea for small homes and hostels, and in agreeing with him we will also have to find, train and recruit the staff for these hostels, before we can relieve the situation in relation to hospital beds.
The noble Lord, Lord Amulree, asked about the progress of the study relating to the young chronic sick. He will be glad to know that the results of the survey that was carried out in 1967 have now been incorporated by my right honourable friend into a Memorandum 1034 on the care of younger chronic sick patients in hospitals. This has recently—and I can hand the noble Lord a copy—been issued to all hospital authorities and local authorities for information.
May I now turn to the two major problems posed by Williams relating to staffing? No one who is familiar in any way with the administration of residential establishments dissents from their finding that there is great difficulty in recruiting and, perhaps, even more particularly, in retaining staff, especially—and this is crucial—staff who have to live in. We are so often inclined to forget that residence is a part of tae job, and that this involves a burden for staff—sometimes some personal sacrifice of their own private family lives. Many noble Lords have made points in relation to this particular problem of how to recruit care staff. All would agree about the need to attract into these services the mature married woman who has had the experience and knowledge of life involved in bringing up her own family. We know what she can bring to this kind of work. Many of us also see the need to attract young people into this service, and to equip them to do it. The young deal very well with the elderly, and in my view the elderly can often help the young. I am a great believer in cross-fertilisation here, in terms of caring staff.
A number of points have been made on these questions which all of us will wish to read—I nearly said "at leisure", but perhaps I should say "with care But so many specific points have been made that if I tried to reply to them all your Lordships would never get on to next Business. Nor is dinner being served to-night. But there was one particular point raised both by the right reverend Prelate the Bishop of Leicester and the noble Baroness, Lady Summerskill. They wondered whether a qualification was necessary for this job. On reflection, and possibly having studied this debate, I hope they would conclude that there is such a need here. We accept the, need for kindness in caring, but I think the majority view throughout the debate has been that we also needed skills and that we need to attract new skills into these particular forms of social service.
1035 When we come to the question of recruitment, pay, and conditions of service, I hope I shall not be accused of "passing the buck" when I say that these are matters primarily for the employers—the local authorities and the voluntary organisations. Moreover, the development of proper ancillary facilities and accommodation for the staff—Lady Reading made this point very effectively in the debate—is one of the keys not only to recruitment but also to the retention of staff. More married couples need to be attracted to this work. We cannot expect them to deprive their own families of a normal family life by not providing them with proper accommodation. If we do, we cannot expect them to stay.
Many local authorities and voluntary organisations, of course, recognise the need to improve staff accommodation, although at times such provision reduces the number of places available for residents when staff occupy parts of the accommodation previously used by residents. I freely accept that in the short-term current policies in relation to prices and incomes may restrict the kind of development that many of your Lordships would undoubtedly wish to see in this particular field, but we would all of us accept the views of those noble Lords who have said that the time must soon come when we stop depriving people of a proper salary simply because they are devoted to their jobs and have a sense of vocation. I hope Her Majesty's Government will not feel I am committing them too far here, but we know that for years and years many members of these services have in fact been underpaid—although not undervalued.
When we come to the question of training, perhaps at this hour I need scarcely remind your Lordships of what exists at the moment. We have one course for the N.N.E.B. certificate for work with children under five, training staff to care for children in day nurseries, in nursery schools and classes, as well as in residential nurseries. There are about 2,000 students a year who gain the N.N.E.B. certificate Then, for work with older children we have the one-year basic residential course which has been developed by the Central Training Council in Child Care since it was established following the recommendations of the Curtis Committee. We should 1036 also not forget the training efforts of the voluntary organisations—the National Old People's Welfare Council and also the National Association for Mental Health.
Our problem in the training field has really fallen into two separate sections as the debate has proceeded. First of all, there are the short-term considerations. Here we must all be quite realistic and accept that the possibilities of a very rapid expansion of training, particularly training leading to a professional qualification, are limited not merely by current financial considerations but—and it could well be that in the longterm this may prove the most difficult part of the exercise—by the difficulty of finding qualified tutors and qualified supervisors to develop the necessary courses. A further very real difficulty has already occurred in connection with the full-time child-care courses; namely, that of attracting students to training which involves residence away from home. This is a point which we have to bear in mind when we are considering the suggestions of the noble Baroness, Lady Stocks, and others in relation to the recruitment of older married women.
Women who have families must be offered training opportunities from which they can benefit while they are at home. They wish to be at home—quite rightly, in my view—to give their children tea; to be available in the school holidays, and occasionally they need to be home if one of their family is sick. This training must therefore be made available on a part-time and geographically acceptable basis if you are to attract the mature recruit.
I should have thought that our most immediate need was to provide some degree of training for the many staff in post—the noble Lord, Lord Sandford, gave us the figures—who for one reason or another cannot take a full-time course. A beginning has already been made, as many noble Lords are aware, in the development of part-time courses, and if the educational bodies concerned can get a good response in the localities where these have been started—and I understand the signs are encouraging—we can expect, I think, some useful developments here. A further immediate need—and this was mentioned by the noble Lord, Lord Ritchie-Calder—is to stimulate an active interest in residential work 1037 among young people who, when they leave school, are too young to undertake it, except in the nursery field.
This 16 to 18 gap is a major problem. If you go to careers conventions organised by teachers there is very little that these services can offer the school-leaver. This is why the preliminary child care training courses were developed for this age group. They have been expanding very rapidly, and this is the way for young people who are now staying on at school, in the main until 16, to fit themselves for the residential caring services by undertaking training as part of their further education. Although it has yet to be proved, it is surely likely that the young girls who undertake this training will have the kind of foundation which will enable them to come back into the service when their own families are grown up and will feel drawn back to the work for which they were trained before they started bringing up their own families. These courses could be a valuable investment in the future.
The next most pressing need, my Lords, I would suggest, is to devise a form of training which would enable students to obtain a recognised professional qualification without having to live away from home. I have made this point already and I am sure that the Williams Committee were fully aware of it. Many of the present staff employed in our residential care establishments are suited to professional training; but cannot take it because it requires full-time study, including residence in selected establishments where facilities for supervised practical training are available. The difficulties of providing non-resident students with training in residential work to a professional standard speak for themselves. It may be that this problem is not capable of solution. But it is being examined, and efforts are being made to overcome it. It could be one of the possible future bottlenecks in the development of training.
Next, my Lords, there is the difficult question of adjusting training to the fact, which is well known and is a point made by the Williams Committee very effectively, that many residential staff feel obliged after some years in the work to make a change. This is something perfectly understandable when we ask so much of our caring staff. We ask some 1038 of them to be mothers and grandmothers and then mothers and grandmother; again in rapid succession. Most of us have to go through this but once. Simile r conditions apply in the homes for elderly people. We have staff caring for the elderly with love and affection, until they die. Surely it should be possible for people who feel the need for change to be able to change from residential work to field work or from one kind of residential work to another. The question here really is: could a broader initial training on generic lines make it easier for the student later in his career to adapt to different work and to a different work situation? Various noble Lords have suggested that there is room for experiment here.
The noble Marchioness, Lady Reading, was anxious that we should not develop too rigid a pattern. Other noble Lords made similar comments. The noble Baroness, Lady Wootton of A binger, wondered whether the development of the training programme was not too fragmented and whether we should think more in terms of marrying the residential with the non-residential training. There is room for experiment here and I think that all would accept that. The Enfield College of Technology are now endeavouring, in co-operation with another college, to mount a two-year course in residential work in which the students, although specialising eventually in one form of residential work or another, would be given an acquaintance with several types of work. I am glad to be able to say that the chairman of the Committee whose Report we are considering to-day, Professor Lady Williams, has accepted the chairmanship of an advisory committee formed by the College to consider this course.
Planning is as yet, I know, at a preliminary stage and no date for inviting applications from students has yet been settled. The three Training Councils involved are represented as observers. Other colleges are considering similar experiments. Another possibility might be to combine training in residential work with children with training for field work with children. This is the kind of point that the noble Baroness, Lady Wootton, raised and to which I have already referred. These measures which would be practicable with the resources available 1039 are the subject of continuing consideration by the Departments responsible for these services and the three Training Councils involved.
I should like now to turn to long-term developments in training. So far, I have concentrate on the immediate steps taken to train people in the services and to get more people into the service. Without in any way underrating the quality of the work of the existing staffs or their devotion, which all of us regard as beyond praise, we must accept that if eventually all the residential services are to reach a satisfactory standard, a long-term training programme is undoubtedly required. How far, and at what rate, an expansion of training can be achieved depends largely on what resources central Government, the local authorities and the voluntary organisations decide to make available for this particular purpose. The Williams Committee devoted great thought and made careful and precise recommendations on how a long-term training programme could be organised and on the form that it should take. I should like to comment briefly on their central recommendations on these two points.
The standard form of training recommended by the Committee is a two-year full-time course covering all types of residential work but providing specialist options in the second year. The organisation recommended is a new national council which would assume, by legislation or by arrangement, some or all of the functions of the three Councils at present respectively concerned with training in the health and welfare services, the children's and certain education services and the probation and after-care service. The noble Lord, Lord Morris of Grasmere, made certain comments about the organisation of training, and the noble Lord, Lord Sandford, asked about the co-ordination of the various services. We all know the history of the development of these Councils and the reasons for them; and all of us must know, equally, that this is hardly a subject that the Seebohm Committee could have ignored. I must ask noble Lords to be patient and not to attempt to jump the gun at this point, as most of the staffs within the province of the Williams Committee are members of services 1040 whose reorganisation is being considered by the Seebohm Committee. The Government see the two major proposals of the Williams Committee to which I have referred as most useful contributions to the consideration of wider problems from which they cannot be separated. I hope that all noble Lords will agree with me, for the reasons I have given, that the Seebohm Committee, whose Report is to come so shortly, must be the foundation on which we can build our thinking.
I have little doubt—indeed, I have certain knowledge—that they will have specific recommendations to make about training and the organisation of training. Moreover, changes in the organisation of training for residential staffs cannot be considered apart from changes in the organisation of training for field staffs: and neither can properly be considered apart from changes in the organisation of the services themselves. Whether a training system is to cater for one service or several and, if so, which—and here I was very interested in the point raised by the noble Lord, Lord Donaldson, in relation to the links between after-care hostels for offenders and the probation and after-care service—is vital to any question of major reallocation of responsibility for training.
Moreover, consideration of the Seebohm Report must involve some review of the objectives of the services concerned and, therefore, of the roles which the various groups of staff should be expected to fulfil. This surely is the only sound basis for conclusions on what training the staff require and how far different groups of staff require different training. I can assure noble Lords, and I can assure the noble Lord, Lord Sandford, who initiated this debate, that the Williams Committee suggestions about reorganisation of training will be considered as part of the wider question of reorganisation of the services as soon as the Seebohm Report is available.
My Lords, I have felt extremely conscious, concerning the galaxy of talent in this debate, of my own inadequacy in summing up the various points made. Perhaps that, above all, what has come out of the debate is that none of us is complacent. This is surely the important feature of it all. However highly 1041 developed our services are compared with other parts of the world—and we are extremely fortunate in our social services—nevertheless we cannot afford to be complacent.
One of the most interesting speeches made in this debate was that of the noble Lord, Lord Jackson of Burnley. He has apologised for leaving the House in view of a public commitment, but I was glad that he brought into our consideration the essential point about the need for research into the social services. It is not enough for us to want to provide more care. The noble Lord, Lord Donaldson of Kingsbridge, rightly said that we need to provide effective care and there is at present little research in this field. It was naturally pleasing to me, as an ex-student of the London School of Economics, to hear the noble Lord, Lord Chorley, say what a great contribution that institution had made to the development of knowledge in the field of social administration and the social work services, but the London School of Economics would be the first educational institution to admit that there are great gaps in our knowledge in this field which we need to fill. We need more research and m pre knowledge before we can really know how these services should be developed.
My Lords, I hope that the noble Lord, Lord Sandford, will feel that this debate has been of value. If it has served to stress the community's responsibility for caring for these vulnerable groups, either in their own homes with support and assistance, or in institutions, it will surely have served a very useful purpose and form a very valuable background for the Government when they come to consider the recommendations of the Seebohm Committee.
§ 7.42 p.m.
§ LORD SANDFORD
My Lords, it only remains for me to repeat and reinforce our thanks and congratulations to Lady Williams and her Committee who have provided such a valuable and essential background to 'his debate, and to thank noble Lords and noble Baronesses who have taken part, especially the noble Baroness, Lady Serota, who wound up the debate for the Government.All 1042 Members of your Lordships' House who have taken part added in a signal way from their diverse experience to the achievement of the object we had in mind in putting down the Motion.
The debate has, I am sure, achieved its object in giving this important subject an airing in public. It has achieved its object in obtaining from the Government an assurance that there will, at any rate, be continual thought addressed to this subject; and I think it has achieved its object by drawing from the noble Baroness, Lady Serota, as much of an assurance as it was reasonable to expect in the special circumstances in which she spoke; namely, as a member of a Committee which has not reported and as a Front Bench speaker for a Government which has not had an opportunity to consider the Seebohm Committee Report. It was as full an assurance as could reasonably be expected, that is, that action will follow when that Report has been received and studied.
My Lords, it is tempting to go on to comment on some, if not all, of the speeches that were made in the debate, but waiting to come on to the centre of the stage we have the majesty of the law and we must not keep them waiting unduly. There is, however, one temptation which, as one of the junior and inferior clergy, I cannot resist. It is the temptation to congratulate the right reverend Prelate who made his maiden speech on this occasion and added such a notable contribution to the debate. We hope very much that he will be with us on many future occasions and contribute further. I should also like to add my congratulations to the noble Lord, Lord Soper, on the "Episcopal mitre" which was set on his head by the noble Lord, Lord Jackson of Burnley. It was "jumping the gun" a little, but it will t e there before very long. With that, my Lords, I beg leave to withdraw the Motion.
§ Motion for Papers, by leave, withdrawn.