Lords Sitting of 12 November 1969

Preamble
The House met at two of the clock: The LORD CHANCELLOR on the Woolsack.
Prayers—Read by the Lord Bishop of Coventry.

LORD CLARK
Sir Kenneth Mackenzie Clark, C.H., K.C.B., having been created Baron Clark, of Saltwood in the County of Kent, for life—Was, in his robes, introduced between the Lord Butler of Saffron Walden and the Lord Goodman.
LORD BERNSTEIN
Sidney Lewis Bernstein, Esquire, having been created Baron Bernstein, of Leigh in the County of Kent, for life—Was, in his robes, introduced between the Lord James of Rusholme and the Baroness Plummer, and made the solemn Affirmation.

TOURISM ACT AND HOTEL BUILDING GRANTS
2.25 p.m.
LORD INGLEWOOD: My Lords, I beg leave to ask the Question which stands in my name on the Order Paper.
[The Question was as follows:
To ask Her Majesty's Government how many grants have been paid to date for the building of new hotels or the extension of existing hotels respectively under the provisions of the Development of Tourism Act 1969, and what are the amounts so paid.]
THE MINISTER or STATE, BOARD OF TRADE (LORD BROWN): My Lords, I understand that the English, Scottish and Wales Tourist Boards are already actively engaged in dealing with applications under the provisions of the Development of Tourism Act. They are required by the Act to make a report on their activities every year, and the report will be laid before this House. Any other progress reports would be at the discretion
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of the Boards. The Act has given the Boards clear terms of reference as to when they are to report; it would be wrong to institute a precedent for pressing them to report more often.
LORD INGLEWOOD: My Lords, I thank the noble Lord for that reply, so far as it goes, which really is not very far. May I ask him whether he does not recall the most unusual pressure which the Government put on the Select Committee last July, making them sit day after day, on the ground that it was urgent to complete the consideration of that Bill before we rose because hotels were going bankrupt and the pipeline was full of urgent applications for grants? Is it so unreasonable that the Government should now be asked to give Parliament the four simple figures referred to in my Question?
LORD BROWN: My Lords, if the Bill had not become an Act before the beginning of August it could not have become so until towards the end of October. A further month would have elapsed before the Board of Trade could take action towards appointing the chairman and others; and it is therefore very doubtful whether any applications for grant could have been dealt with before January. In these circumstances, I think it was completely reasonable to request the members of the Committee, as I did, to get the Bill through, so that it could become an Act before the Recess. I do not think it would be appropriate, having delegated to the Tourist Boards authority for the administration of the scheme, to begin belying that policy by immediately asking the Boards to report when the Act itself lays down that they shall report annually. There is nothing to prevent the Boards from reporting more frequently if they feel that that is the appropriate thing to do.
LORD NUGENT OF GUILDFORD: My Lords, would it not be much more appropriate to give hotel companies the benefit of investment grants? And would not that have the additional advantage that it would save the noble Lord from being questioned on the subject?
LORD BROWN: My Lords, I should like to avoid being questioned but, with great respect, that is quite a different matter. The proposal that hotels should receive investment grants has received a

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good deal of attention, but for the moment the protagonists have lost that one.
LORD SANDYS: My Lords, is the noble Lord aware that his Department is the one in regard to which noble Lords have the greatest difficulty in obtaining a simple answer to a simple question?
LORD BROWN: My Lords, I am sorry, but I did not hear the beginning of the noble Lord's supplementary question.
LORD SANDYS: My Lords, is the noble Lord aware that his Department is the one in regard to which noble Lords have the greatest difficulty in obtaining a simple answer to a simple question, particularly when it relates to figures and facts?
LORD BROWN: My Lords, I am very sorry, but I did not hear the key words at the beginning of the noble Lord's expression of the same question, and I am still doubtful as to what is the intention of the question.
LORD SANDYS: My Lords, for the third time—and I very much regret that I am so inaudible to the noble Lord—is he aware that noble Lords find that his Department is most unwilling to give information, and that it is the Department with which they have the greatest difficulty in dealing? I have personal experience in this matter.
LORD BROWN: My Lords, I am afraid that I cannot accept the generalisation.

EAST-WEST RELATIONS AND N.A.T.O. MEETING
LORD BROCKWAY: My Lords, I beg leave to ask the Question which stands in my name on the Order Paper.
[The Question was as follows:
To ask Her Majesty's Government what were the conclusions of the special meeting of the North Atlantic Council called to discuss East-West relations.]
THE LORD PRIVY SEAL (LORD SHACKLETON): My Lords, 110 COM-muniquè was issued and the proceedings were, of course, confidential. But, as the Secretary-General said at his Press Conference after the meeting, speaking on
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behalf of all members of the Alliance, the Council
"provided the guidance needed for the final preparation of the Ministerial Meeting from 3 to 5 December."
LORD BROCKWAY: My Lords, while thanking my noble friend for that Answer, may I ask whether in those discussions there was a more constructive approach to the proposal for a European security conference, which has now also been so widely supported by Western Governments?
LORD SHACKLETON: My Lords, I do not accept that the NATO Powers have not taken a constructive view before. Indeed, they themselves had taken initiatives in this direction. I think that what the Secretary-General said sums up the position. He revealed the readiness of Alliance members to consider all possible procedures for negotiation of these issues, including a conference or series of conferences, provided that these are constructive and appropriate to the subject discussed. There was no desire to hold a conference for a conference's sake, but rather a strong determination to promote the careful preparation of all kinds of possible negotiations towards the resolution of the serious problems dividing Europe. I think that that is quite constructive.
LORD GLADWYN: My Lords, would not the noble Lord agree that the precondition for a successful East-West Conference would be the abandonment by the Soviet Government of what is called the Brezhnev doctrine?
LORD SHACKLETON: My Lords, I think that this raises other points. If we are going into negotiation I for one am not going to take up positions; but I am sure that the noble Lord is right.

DECIMAL COINAGE: THE 50p PIECE
2.33 p.m.
EARL FERRERS: My Lords, I beg leave to ask the Question which stands in my name on the Order Paper.
[The Question was as follows:
To ask Her Majesty's Government when they intend to replace the present 50-pence piece with a coin or note

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less readily confused with others already in circulation.]
LORD BESWICK: My Lords, experience shows that coins of a completely new specification are seldom popular when they are first introduced. Her Majesty's Government consider that it would be premature to come to any conclusions about the acceptability of the 50p coin before the public have had sufficient time to get used to it. They have made no plans to replace the coin.
EARL FERRERS: My Lords, while thanking the noble Lord for that Answer, though it was a disappointing one, may I ask whether he can say why, when the whole field of design was open, the designers designed, and the Government accepted, a design of a coin which was extraordinarily similar in size, in circumference, in thickness, in diameter, in colour and in weight to one already in circulation?
LORD BESWICK: My Lords, the noble Earl makes an assertion, and he is entitled to his opinion; but a good deal of experimentation was carried out before a decision was made. Many organisations were asked and tests were carried out. If the coin were to be bigger, it would be too big, and if smaller it would be the same size as a 10p piece. If the noble Earl looks at this coin, he will find that it is not unsatisfactory.
BARONESS BURTON OF COVENTRY: My Lords, is my noble friend aware that this really is not a case of the public not wishing to accept something new? Is he further aware that investigations beforehand were not made among people who had to deal with the handling of change? And may I ask him whether he would recommend that, if we have to have a new coin, we should have a hole bored through the middle of it, which would make it different from any other coin in circulation?
LORD BESWICK: My Lords, with respect, my noble friend is wrong in saying that no inquiries were made among people who had to handle coins. As a matter of fact, this was the first category of users to which the Decimal Currency Board went. It is interesting to know that those organisations who train their staffs in the use of coins have
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had absolutely no difficulty with the 50p piece. As to the idea of having a hole in the middle that, of course, would have given rise to design problems and I do not think we should have had such a handsome coin.
LORD WADE: My Lords, is the noble Lord in a position to say to what extent false 50p pieces are in circulation and what steps are being taken to minimise this additional hazard?
LORD BESWICK: My Lords, the usual steps are being taken against forgery, but it is a negligible problem in this case. The possibility of forging with a softer metal is remote, as the coin in a softer metal is easily detectable. It is not possible to press out the hard coin of cupro-nickel unless the forger went in for a "mini mint".
LORD INGLEWOOD: My Lords, may I ask the noble Lord whether he is aware of the grounds on which the Isle of Man came to the exact opposite conclusion and decided to produce an extremely handsome note for 50p?
LORD BESWICK: My Lords, I do not answer for the Isle of Man and I have no idea how they came to their conclusion. As to the production of a note, I would tell the noble Lord that even had there been no decimal coinage. on economic grounds alone the Government had decided that it was preferable to have a coin with an estimated life of 50 years rather than a note with an average life of under five months.
LORD CARRINGTON: My Lords, would not the noble Lord agree that if both Houses of Parliament had been allowed a free vote, the pound/half-cent system would have been defeated and this problem would not have arisen?
LORD BESWICK: My Lords, I am not sure that the problem would not have arisen, but I seem to recollect that the noble Lord was greatly concerned with the other question.
THE EARL OF CORK AND ORRERY: My Lords, is it true that the new coin is to be known as the "clanger"?
LORD LEATHERLAND: My Lords, does not my noble friend think that a lot of unnecessary fuss is being made about this question? Does he not also

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think that confusion could be avoided if people would put their new 50p pieces in one trouser pocket and the rest of their silver in another pocket? Moreover, as many women nowadays wear trousers, there would be no sex differentiation.
LORD BESWCK: My Lords, I am grateful to my noble friend for his usual common sense. I gather that there was an equal amount of fuss when we changed from a metal coin to a 10s. note. I believe that when we have had a little time to get used to the new coin, it will be a case of "familiarity breeds content."
EARL FERRERS: My Lords, is the noble Lord aware that the only difference between the 50p piece and the 10p piece is the fact that the 50p piece has seven sides to it It also has seven corners to it. Further, is the noble Lord aware that these coins collectively serve to rub holes in your trouser pockets That being the case, would the noble Lord agree that the pound in your pocket would devalue at a much greater rate than even the Government have been able to achieve?
LORD BESWICK: My Lords, leaving aside the expression of opinion on the latter part of the noble Earl's supplementary question the fact is that the 50p piece is larger than the 10p piece.
LORD HENLEY: My Lords does the noble Lord recollect whether there was any confusion between the half-sovereign and the farthing in mint condition?
LORD BESWICK: My memory does not go back to the farthing but I am certain that there is something in what the noble Lord says.
LORD CONESFORD: My Lords does not the noble Lord take some comfort from the fact that this coin is at least as popular as perpetual Summer Time?
LORD BESWICK: My Lords I derive some comfort from the fact that in a year or two the noble Lord will be saying what the Government say to-day.
LORD BARNBY: My Lords did the noble Lord say that the new coin would last up to 50 years? Could he give any reason why, contrary to custom, no date of issue is put on these coins?
LORD BESWICK: My Lords I suppose that that is a design question. I did
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not say that "I thought" the coin would last 50 years; that is the estimated life based on experience.
LORD AIREDALE: My Lords is it not rather extraordinary not to make the new coin the size of the half-crown, which is being withdrawn, instead of the size of the florin, which is being retained?
LORD BESWICK: My Lords, the noble Lord's question shows that he has not looked at the new coin. If noble Lords will take one out of their pockets, look at it and compare it with the 10p piece, they will see that the fact of the matter is that it is larger than the 10p piece, though not so large as the half-crown, which in the view of those who studied it is too large.

PARLIAMENTARY PAPERS: LABOUR DISPUTE
2.40 p.m.
LORD SHACKLETON: My Lords, with the leave of the House, and I hope in the absence of too much chinking of coins, I should like to make a further Statement about the situation at the Stationery Office and the position of Parliamentary Papers in your Lordships' House. Your Lordships will mostly be aware that neither the Minutes nor the Hansard of yesterday's proceedings are available in the Printed Paper Office as yet, although I understand that a number of copies of Hansard may be available in the Printed Paper Office in the course of the afternoon. Emergency arrangements, therefore, are in operation to meet essential Parliamentary requirements. Despite the pressing nature of the circumstances, I am sure the House will agree with me that the Parliament Office are to be congratulated on the steps they are taking, and will continue to take.
On the last occasion when we exchanged words on this subject the noble Lord, Lord Carrington, asked me whether I could say something on the nature of the dispute. For reasons that I indicated then, I do not want to be too far drawn, but I think it is right that I should tell the House that the difficulties at the St. Stephen's Press of the Stationery Office arise out of unofficial action on the part of a single chapel, following a return to work by the members of the chapels involved on the basis

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of an interim wage offer. Although there are some unresolved issues there is no official dispute and no official support for a go-slow. Nevertheless, the output is irregular and has resulted in the delay in the production of Parliamentary Papers. I can only repeat that a variety of measures have been taken to ensure in one way or another the continued supply of essential Papers, and I would, with apologies, ask your Lordships to help as much as possible by not placing too much of a burden, other than is essential, on the now diminished resources of the Printed Paper Office.
LORD CARRINGTON: My Lords, as usual, we are grateful to the noble Lord the Leader of the House for that Statement and explanation, and I join with him in thanking the Printed Paper Office and those who make it possible for the life of Parliament to continue at all. But he would be the first person to recognise that this is a very unsatisfactory situation. None of us can read what is said in another place; none of us knows even what has been said here if we were not in the Chamber. We do not know what is going to happen, because the Minutes of the day do not appear until the last moment. It is a situation which is profoundly unsatisfactory. The noble Lord tells us that this is the result of an unofficial strike. I do not want to make things any worse, but if Parliament is of any importance the Government should at some time take some steps to see that we get our Papers at the right time so that the life of Parliament can continue.
LORD SHACKLETON: My Lords, I agree that the situation is very unsatisfactory, and everything that the noble Lord has said I have already thought myself. I will not attempt to deceive the House that everything is going along all right. But the noble Lord is not entirely accurate; we have the Commons Hansard for yesterday. But I fully admit this difficulty. I am not attempting to do more than indicate that the Government are taking steps, and the House authorities, in particular, are taking steps, to provide the best service they can to Members of both Houses of Parliament. I agree that there are important issues. I can only report as accurately and truthfully as I can on the situation. I will certainly take note of what the noble Lord and other noble Lords have said. I may
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say that I myself have spent a good many hours trying to cope with this problem.

GOVERNMENT STATEMENTS
LORD BESWICK: My Lords, with the leave of the House I shall be making a Statement on future civil aviation policy at a convenient moment after half-past-three, after which my noble friend the Leader of the House will be making a Statement on the Ulster Defence Regiment.

PROCEDURE OF THE HOUSE
THE CHAIRMAN OF COMMITTEES (THE EARL OF LISTOWEL): My Lords, I beg to move the first Motion standing in my name on the Order Paper.
Moved, That a Select Committee be appointed to consider any proposals for alterations in the procedure of this House which may arise from time to time, and whether the Standing Orders do or do not require to be altered to effect such alterations; and that the Lords following, with the Lord Chancellor and the Chairman of Committees, be named of the Committee:

M. Salisbury,

E. Jellicoe,

E. Longford,

E. St. Aldwyn,

E. Swinton,

V. Colville of Culross,

V. Dilhorne,

V. Goschen,

L. Ailwyn,

L. Amulree,

L. Beswick,

L. Byers,

L. Caccia,

L. Carrington,

L. Champion,

L. Clwyd,

L. Henderson,

L. Henley,

L. Merthyr,

L. Morton of Henryton,

L. Rea,

L. Shackleton,

L. Shepherd,

L. Silkin,

L. Strang,

L. Wade,

L. Willis,

L. Wilberforce,

B. Wootton of Abinger.

That the Committee have leave to report from time to time.—(The Earl of Listowel.)
On Question, Motion agreed to.

HOUSE OF LORDS OFFICES
THE EARL OF LISTOWEL: My Lords, I beg to move the second Motion standing in my name on the Order Paper.
Moved, That the Select Committee on the House of Lords Offices be appointed; and that the Lords following, with the Lord Chancellor and the Chairman of Committees, be named of the Committee:

M. Cholmondeley,

M. Salisbury,

M. Willingdon,

E. Dundee,

E. Dundonald,

E. Jellicoe,

E. Longford,

E. St. Aldwyn,

E. Swinton,

V. Dilhorne,

V. Goschen,

V. Simonds,

L. Ailwyn,

L. Airedale,

L. Amulree,

L. Beswick,

L. Bowles,

B. Brooke of Ystradfellte.

L. Burden,

L. Byers,

L. Carrington,

L. Champion,

L. Chorley,

L. Conesford,

L. Denham,

L. Hawke,

L. Henderson,

L. Henley,

L. Hunt,

B. Hylton-Foster,

L. Inchyra,

L. Ironside,

L. Jessel,

L. Kennet,

B. Llewelyn-Davies of Hastoe,

L. Lucas of Chilworth,

L. Mancroft,

L. Morton of Henryton,

L. Newton,

L. Ogmore,

L. Rea,

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L. Reid,

L. Robertson of Oakridge,

L. Sainsbury,

L. Shackleton,

L. Shepherd,

L. Silkin,

L. Strang,

B. Summerskill,

B. Swanborough,

L. Wade,

B. Wootton of Abinger.

That the Committee have leave to report from time to time.—(The Earl of Listowel.)
On Question, Motion agreed to.

MENTAL HEALTH: ATTITUDES AND POLICY
2.45 p.m.
LORD O'HAGAN LORD O'HAGAN rose to call attention to contemporary attitudes to mental health; and to move for Papers. The noble Lord said: My Lords, when I was thinking how to start to-day's debate, I remembered that Christ said:
"I came that they may have life, and may have it more abundantly."
"They" include those people on the receiving end of the services that we shall be talking about this afternoon; for them life is not as abundant, as full, as it ought to be. We all know that even those who are seriously mentally ill or handicapped can be happy, can receive and give love. But the clouded mind stops its owner from joining in, from sharing properly in, the emotional, intellectual and spiritual side of life. I thought of saying that such people could not really belong. Of course, they belong to us, and from our compassion we must help as much as we can. But, my Lords, if the cloud in the mind is getting big, we cannot really belong to them: there is a great gap between our desire to give and their ability to receive.
How best we can give so that their lives may be made more abundant ought to be the mainspring of what is said to-day. That is why I have chosen the wording on the Order Paper—"attitudes". Are we prepared to co-ordinate our efforts to tackle social distress where it starts? What is our attitude? Are we prepared to pay for research, and follow it through? Or shall we just leave the hospitals to tidy away the also-rans who cannot take the technological

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age? So much of mental illness is an indictment of our society. Those who are not strong are put on the edge and pushed over by what we do to them; and when that fall has started, the way that we behave, is so important, whether as part of the hospital service, as relatives or in our ordinary lives. The frame of mind that we bring to bear on the problems of the people who might be us to-morrow can do so much to help or harm. As a concerned amateur, and as someone who as an undergraduate suffered from depression, I should like to touch on various points which I hope the more expert of your Lordships will expand.
First, prevention. The late Lord Feversham, then Chairman of the National Association for Mental Health, said in your Lordships' House on June 4, 1959:
"I have felt ever since this Bill"—
what is now the Mental Health Act—
'was published that it is little more than a half-hearted attempt at promoting the preventive services where, to my mind, the future of this whole subject lies."—[OFFICIAL REPORT, Vol. 216, col. 694].
He was quite right, my Lords. Prevention really is the Cinderella of a Cinderella service. One has only to look at Seebohm to see what could be done: general prevention to stop social decay; better housing and so on. More specifically, there should be better social services on tap for those likely to be under mental strain—the new widow or widower, and so on. The principle of special help for areas with special need is now well established. Mental health comes into that, too. I say, "Hear, hear!", to Seebohm's suggestions. Voluntary bodies do wonderful jobs, but more of the community needs to know more about mental health.
The Health Education Council, under the noble Baroness, Lady Birk, last year received £223,000 from Central Government to deal with things physical. The National Association for Mental Health received £10,000. Does that sum up the Government's attitude to mental health education? The recent Report on psychiatric nursing recommended that psychiatric nurses should more often go and talk to schools, associations and other such bodies. The idea was partly to help recruiting. But, like so many constructive
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efforts in this field, the good done in one way works another way, too. Those who heard a psychiatric nurse talk about her work would get a much more accurate picture of her job and her patients. The stigma of mental illness is on the way out. Every psychiatric bed in a general hospital—and I am pleased to see that the number of beds is going up—is another step towards making the attitude of the community more positive. The people inside the hospital are just ill. I, like the authors of the Seebohm Report, cannot specify exactly how to combat social distress. My disconnected suggestions prove that here is a subject crying out for research. But I can say that we ought to make our social safety nets better.
I will now discuss mental hospitals in more detail. I was sad to learn that of the money recently spent on 85 major building projects under the Department of Health and Social Security, both those completed in 1967–68, and those started since then, only 3·17 per cent. of the total was spent on schemes concerned with mental health. That was a drop on the previous year. But I really want this afternoon to talk about those who work in mental and subnormality hospitals. The obvious dedication of so many of them is perhaps the main reason why the hospital service is not collapsing. Certainly the idea of the therapeutic community betokens a splendid attitude to the patients; and, of course, new treatments have helped. But I am worried about the way the staff are treated. To my embarrassment I must praise Mr. Godfrey Winn for his article in the Daily Mail on Monday. One of the points he underlined in my mind was that even a really dedicated person may choose another form of service if pay and conditions in hospitals do not give the staff a chance to eat properly, to relax, or to concentrate on nursing and their job, rather than on the chores. We must treat the nurses and the other workers right if we expect them to treat the patients right. For, my Lords, not only is a happy hospital service the best recruitment policy, it is also best for the patients.
I cannot lay down the law about the way hospitals are organised or the way they should be controlled. I hope that it is not a choice between local parochialism, fights over who does what, and remote inflexibility. But however things are

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organised, a ward where there are over 100 beds (and there were still 32 in mental and subnormality hospitals in 1965, with 70-plus in 200 wards) must be nearer to the ideal of a broiler house than the ideal of a therapeutic community. Wards should have only 20 to 30 beds. I wonder whether there are so many huge wards now.
Great progress has been made towards making mental illness decent. On that score alone, I am sure that general hospitals catering for psychiatric patients are a good idea. A mother or daughter can say that a relation is at St. So-and-so's which has not the stigma of being "put away in a loony bin." Physically ill patients know at first hand that mentally ill patients recover. Then I should have thought that the special nature of psycho-geriatric patients, who now occupy some 43 per cent. of mental hospital beds, are normally better catered for in a general hospital where physical ailments can be quickly attended to—though I may well be wrong here. Let us continue the practice of making mental hospitals open and gay and, if possible, ensuring that they do not smell like hospitals. On the subject of complaints, I am glad to hear of the initiatives that are being taken. But are we going to get a really independent body to investigate complaints? Are we going to have a proper inspectorate? Both these would give great reassurance all round.
And so, my Lords, we come full circle, to the patient who returns to the community. We do homage to the idea of community care. The noble Baroness, Lady Brooke, told your Lordships about the pilgrim mothers who traipse from office to office—or give up. The services that exist must be accessible. Now that the responsibility is placed back on the shoulders of the community, the community must be given the chance to do its duty. I wonder whether it is in fact given that chance. I quoted Lord Feversham's gloomy foreboding about the preventive side. The community must also help those for whom prevention is too late. Seebohm says:
"The widespread belief that we have community care of the mentally disturbed is, for many parts of the country, still a sad illusion, and judging by published plans will remain so for years ahead."
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So, my Lords, we must salute the concept of community care. Certainly, we must have more hostels and halfway houses for those returned to the world; but they will need expert staff. Certainly, too, the community must be the focal point. Yet there were only 541 trained psychiatric social workers in England and Wales in 1968. Some areas are splendid: voluntary organisations complement official bodies; there is good liaison between general practitioners and the mental hospitals and the social workers. But other areas are just too feeble-minded to buckle down to the job.
I recently went round a hospital for the subnormal. A teenage girl was sitting on a bench swaying and crying—in fact she was screaming—as I came into the ward. Naturally the nurse said, "Sh-sh!" in quite a kind way. The girl stopped shrieking and said, "Sh-sh!" in answer. That was a remarkable advance; it was the first time that even such a link had been established. I came away from that hospital with an acute dilemma made more acute. I had seen wonderful work being done. Criticism, of course, undermines the morale of those whose job is with mental illness or subnormality, and it saps the public confidence. So often in the mass media there seems to be only one sort of news—bad news. On the other hand, we have evidence of inadequate services outside the hospital and unpleasant things inside the hospitals. I must ask, how typical is that splendid place that I visited? Of the mental and subnormality hospitals, how many more Elys are there? How many half Elys? Or part Elys? Although this country's care for the mentally ill is remarkably good, there are great variations. Perhaps the answer is a unified health service.
My Lords, I have left out a great deal with regard to research. I wonder whether all this processed rubbish that we read can really be of help to mental health. The special problems of subnormality I have hardly touched on, and I hope that noble Lords will fill in the gaps. I am sorry if I have been mean to the Government, or to their predecessors. I hope, too, that this country's steady progress towards a practical but compassionate attitude to mental health will continue. Perhaps what we say to-day will help. I beg to move for Papers.
3.0 p.m.
BARONESS BROOKE OF YSTRADFELLTE: My Lords, this afternoon we are debating so serious a problem that we all have reason to be grateful to the noble Lord, Lord O'Hagan, for his Motion and for creating an opportunity for free and frank discussion on this subject. This is no subject for Party political strife. Mental ailment is a disease which, in one or other of its manifestations, might attack any one of us at any moment. I wonder how many of us are acutely conscious of these grievous disabilities and feel that we ought to be making some contribution to their alleviation. How many of your Lordships have felt it your duty to visit mental hospitals and psychiatric units in an objective way, as the noble Lord, Lord O'Hagan, has recently done himself, to see for yourselves the size of the problem and the ways in which it is being tackled?
My interest in the whole field of mental health was aroused when I was a member of a Regional Hospital Board. When asked which of the various committees interested me, I asked to serve on the mental health committee, which was then under the chairmanship of Mr. Kenneth Robinson before he became Minister of Health. He was a first-rate chairman of that committee and I was sorry when he found himself too busy to continue. I chose the mental health committee for the simple reason that at that time I knew little about mental health or its treatment, and I wanted to learn.
Before deciding to visit my first mental hospital, and feeling a little apprehensive, I asked advice from an older and much wiser member of the Board, Sir Allen Daley, who as Medical Officer of Health to the London County Council had been responsible for all the mental hospitals under the L.C.C. before the National Health Service Act 1948. He urged me to visit the newest and most up-to-date purpose-built hospital in our region first, so that I could see the open-door technique and the various newer therapies in action—occupational, physical and industrial. To reassure me he added that, thanks to the use of sedative drugs, he did not think that I should find it as disturbing an experience as one might have feared. He was absolutely right, and as a result of that day spent at Shenley, a hospital that had been built
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in 1934, I grasped something of the problems facing the doctors, the nurses, the administrators and the ancillary workers.
Mental health, or rather mental ill-health, is an absorbing field in which tremendous advances have been made in treatment, drugs and attitudes of approach. A hundred years ago public opinion, uninformed and insensitive, regarded the lunatic asylums, into which all abnormal or subnormal people were relegated, as objects of ridicule or complete disinterest. The idiot was a clown in society, sometimes to be teased and to provide amusement; more often repellent and therefore to be hidden away from normal human contact and observation. To-day, thanks to modern legislation, research and experience, public opinion is a little more enlightened, the worst of the stigma that has attached to the whole subject of mental health has disappeared and much more intelligent attitudes towards it are developing.
But unhappiness is still prevalent, not only among the patients and their relatives and friends but also among the staff of the hospitals caring for them; and it is to this state of unhappiness that we should be bending our minds and giving our help. It is a lamentable fact that public opinion is awakened and shocked only by revelations such as those of the state of affairs that existed in the Ely mental hospital, which came to light last March as a result of the published report of a Committee of Inquiry set up by the Secretary of State to investigate allegations of various forms of misconduct on the part of members of the staff. It always grieves me when wide publicity is concentrated wholly upon something that has gone wrong. A picture is created in people's minds that this state of affairs is widespread. Friends and relatives of patients in similar hospitals think the worst, and the morale of the staff in those hospitals sinks like a stone in a well. So much excellent work is being done; so much real, loving care is being shown to so many patients. But this receives no publicity because it is not news. We were shocked, all of us, by the headlines, and many of us read the report of the inquiry and were amazed by what we read. But how many of us did anything about it? I should be grateful if the noble Baroness, Lady Serota, could tell us, when she comes

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to speak, how many of the 45 recommendations at the end of the Report of the Committee of Inquiry have been acted upon. Some, I know, are far-reaching and considerable in their implications of major reorganisation and new building; but some of the simpler, more practical ones I hope we shall hear have already been carried out.
This whole subject is so immense, and so many noble Lords have put their name down to speak, that I shall not attempt to cover the field but will concentrate on one part only: the large subnormality hospitals. Why is there unhappiness in so many of these? One of the reasons, to my mind, is the geographical isolation of so many of them. Built in the last century, they were placed on land which was cheap and easy to acquire and tucked away from the normal community life of the nearest town or village. The wards were vast; many of them still are. The sanitary arrangements were inadequate by modem standards and often some distance from the wards. The patients were segregated into sexes and the care of them all was mainly custodial, behind clanging doors, always kept locked, with padded cells for the more disturbed patients. The exterior of most of these hospitals was, and still is, austere, formidable and discouraging. To-day a great deal of the older horrors has been swept away, thanks to modern treatment and the realisation that vast numbers of patients in the long-stay subnormal hospitals can be trained to take their place in society again, earning their living, or some part of it, through sheltered workshops and sympathetically managed light industrial factories, and living in hostels away from the shadow of the old asylum.
Advances have been made in attempts to break up and subdivide the terrible old dormitories where no one could hope to retain his or her own individuality. The closely packed wards of Hogarthian appearance are disappearing. Many of the patients now have their own private locker by their bedside in which they can keep their personal possessions and their clothes. But too many are still without this obvious need, simply because there is not enough room for the lockers to stand in between the beds. In some wards the space is only a few inches and there
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is no other furniture at all. Can the noble Baroness give us any idea as to the number of patients who are still without a personal bedside locker, with all that that can mean to a man or a woman?
Clothing is another problem. All of us are conscious about what we wear. Attractive, well-designed clothes not only say something to other people; they do something to us. In some hospitals patients are being dressed in clothes fifty years behind the times. The women are not provided with any kind of foundation garment; clothes are common property. In others, real imagination is being used and varieties of material, colour and design are available, often for personal choice if the patient is capable of using it. Clothes much be designed for constant laundering and cleaning. With the tremendous advances that have been made in man-made, "mini-care" fibres and fabrics, all hospitals should be able to provide comfortable, well-fitting, attractive clothes of reasonably good quality. To what extent, I wonder, is advice given to those hospitals where little has been done, so that they may benefit from the experience of others who have been alive and imaginative and, consequently, have produced original ideas in this field.
A conference was held on this subject of clothing for long-stay patients at the Hospital Centre in 1967. Discussions took place between nurses, administrators, supplies officers, laundry managers and manufacturers. They approached the common problem from very different points of view. I wonder what notice was taken generally of the findings of this conference. I know that there may be purchasing difficulties and that buying small quantities of appropriate sizes is very expensive. But if the pattern of purchasing were changed so that, instead of an individual supplies officer being responsible for the clothing of his own hospital, or group of hospitals, a group of hospital management committees combined together and arranged area contracts; or if the directors of Marks and Spencer were invited to tackle the problem of providing inexpensive but attractive clothes for long-stay patients, they would produce a solution forthwith. A greater variety of garments at less cost might be the result, which would be of

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benefit to everyone. The ideal is for every patient to have his or her own clothing. In some hospitals the patients have been encouraged to bring their clothing with them, but in many hospitals it has been quite impossible to organise individual personal clothing because the problem of storage has been allowed to become insurmountable.
Then there is the question of staffing. Many of these hospitals are so grossly understaffed that the nurses are unable to do as much psychiatric and therapy nursing as they would like. There are nowhere near enough domestic cleaners. That work has to be done, and for lack of domestic staff it is the nurses who are too often called upon to do it. In one hospital that I know the full nursing establishment was fixed in 1907 at 480. It has never been revised. But that hospital is now 60 nurses below strength, and out of the total of 480 there are more than 100 staff nurses too few. How can the existing staff cope? In the hospital to which I am referring there are 30 large wards with only 25 domestic cleaners—fewer than one per ward. Why should something not be done to pay the fares of cleaners who cannot get to these isolated hospitals except by travelling long distances every day from the nearest town?
So far as the recruitment of nurses for these hospitals is concerned, a very high percentage come from overseas. We could not get on without them and they are making a valuable contribution. But although most of them speak English, and therefore there should be no major language difficulty, the English which some of them speak is easier to understand than that spoken by others; and when their English is not clear it is bound to slow down the speed with which tuition can be given and practical work demonstrated. British staff are not coming forward in sufficient numbers, and they will not come forward until the conditions of service, the pay and the lack of suitable living accommodation, are attended to.
My Lords, if you are going to devote the major part of your working life to employment in these hospitals you must be given the chance to enjoy your time off. Facilities for social life and entertainment for the enjoyment of leisure time are often totally neglected by those
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who administer the Service. Many of the trained staff who are in posts are often unhappy through lack of appreciation and poor job satisfaction, for the reasons that I have given, and this leads either to apathy or to aggressiveness. The isolation from a more lively and thought-provoking community makes life difficult for the many members of the staff who have to depend upon public transport or scanty hospital transport to get away. Consequently, the staff tend to live in on themselves, surrounded by others working in the same field, and unless there is some imaginative leadership they tend to become, as I have said, apathetic or aggressive—aggressive to the patients, aggressive to themselves, aggressive to the doctors and to the hospital management committee. And who can blame them? As one enthusiast in this field said:
"A difficulty which surely every big organisation must experience is the problem of personalities and passive resistance. One sometimes feels that our hospital is staffed by centipedes—each member with a hundred toes all waiting to be trodden on, and of course almost any new venture could be taken as a personal criticism of someone's work".
My Lords, all is not bad. In many hospitals first-class work is being done under similar physical disadvantages, but those are the places where appreciation for good work is given freely, and where there is closer relationship and better communication between staff and staff and staff and patients, and between the hospital and the community outside. This latter is an overwhelming need, and where it has been achieved the veil of mystery clothing psychiatric treatment in mental hospitals has been lifted. It is highly necessary for the hospital staff to get the people in the neighbourhood living around them to be on their side. Once such relationships and co-operation are created, support from without will flow in automatically.
Co-operation does not cost money; it is brought about by freedom to have informal meetings; freedom for members of the public to enter the hospital to help with voluntary jobs, and freedom for the hospital staff to make friends and to develop interests outside. I look forward very much to hearing the noble Baroness, Lady Swanborough, on the splendid work which has been done by the Women's Royal Voluntary Service. There are the Leagues of Hospital Friends and there are splendid

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schemes where young volunteers and the Red Cross are making invaluable contributions to the more human side of the life of these patients. There is much to do. If this debate to-day serves to draw attention to the needs for more voluntary work to be offered and received, it will not have been in vain.
My Lords, I should like to end what I have been trying to say on a note of warm appreciation. In the Mental Hospital Service there are many devoted and dedicated men and women, at every level, doing selfless jobs of work. May their example shine as a beacon to those others in the Service who do not yet seem to recognise the full purpose of their work; and may those hospitals which are rapidly reaching the forefront of what really good mental hospitals should be act as an encouragement to those other hospitals which up to now have been lagging behind to try to catch up to the pace of those in the lead! Encouragement, not carping criticism, should be the call that goes out from this debate.
3.18 p.m.
LORD AMULREE: My Lords, I, too, am glad that the noble Lord, Lord O'Hagan, has seen fit to put down this Motion to-day. It is a long time since we had an opportunity of talking about mental health, and many things have occurred since then. I want to confine myself to two points to-day, but there is one thing I should like to say before that. When I was talking in the debate on the gracious Speech after the Opening of Parliament, I said that in my view the report of the Central Health Services Council upon the future of the general district hospital was a very encouraging document, because it said that the time should come when the geriatric services should be closely linked with the district general hospital. To-day I should like to add that it says in the same report that the time should come soon when the psychiatric department should be part of the district general hospital. I think that is one of the most encouraging pronouncements I have seen for some time, because in the long run it must mean the end of the large mental hospital, isolated in the country, forbidding in appearance and with, I regret to say, even now some of those large wards to which the noble Lord referred and which make any form of treatment absolutely impossible.
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At the present time in the treatment of mental illness the tendency is towards having small treatment centres attached to general hospitals, from which patients speedily return home with their treatment completed. It may be said that quite a number of those patients will relapse and need to go back again. I do not think that that matters at all. The fact is that they have been able to return for a short time to their family and to the community, even though they need to go back; they can have further treatment and return home again. That is one of the things with regard to mental treatment which we should encourage very much in the medical world. Some of the big mental hospitals have a large amount of ground round them. At one time they used to farm and keep pigs, and all that sort of thing. One wonders whether some of those lands, if they are not too far out in the country, could not be used for building these new little departments where treatment can be given, during which time the bigger buildings could be pulled down, modified or destroyed.
There is one point in the Mental Health Act 1959 to which I should like to refer. One of the really first-class things that that Act did was to open the doors of the locked wards in the mental hospitals, and that has been entirely to the good. One or two difficulties have sometimes arisen, but these have been overcome and do not really cause any trouble. The whole problem, as was shown in an article which I read in the Practitioner last month, comes from a tiny number of patients. It is further complicated by the fact that some mad patients are also bad. That may be the difficulty with a tiny group of patients when they are transferred to regional mental or general hospitals. If you get one or two psychopathic criminal types coming into a general ward they can do an infinite amount of damage to the patients who are there and being successfully treated. This type need some kind of further control—I am sorry to have to say it; it is a very unpleasant thing to have to say. One wonders whether it might not be an improvement on what is being done at the present time if there were some sort of closed community for them, well run and well taken care of, not oppressive at all. I read in The Times on November 1 something

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which I checked in an article in the Practitioner: that the danger is growing of a real use of restraints. There is a nasty thing called the geriatric chair—why it is called the geriatric chair I do not know—which is rather akin to the stocks; a patient is locked up in this chair and cannot move. Another thing is called the "safety vest"—another word for a straitjacket. These are things that I thought we had got rid of from our medical circles, once and for all. If people must be restrained and it cannot be done by any other means, it would be far better to keep them in some kind of confined locked community, rather than restrain them physically in this kind of way, which is quite repulsive.
The noble Lord referred to the need for research into mental disease, and I agree with him, because so far as one can see the amount of mental disease is not going down very much; it may be increasing. Certainly the amount of neurosis is going up, and that is an illness we do not know very much about. Going on from that, I think that one of the big problems of the future will be the care of the increasing number of senile, elderly, confused patients who need some kind of care and treatment. From a curative point of view there has not been much advance in their treatment yet, and so far as one knows—I am not an authority on the research which is being done—there is not very much possibility in the future of any radical change occurring. A great deal can be done to make them more comfortable by the use of day hospitals, which take the burden off their families, and these old people can live in the community and live at home.
A good deal more can be done by ensuring proper housing. I know that it is rather a King Charles's head of mine that most of our social ills can be alleviated by proper housing. I wonder whether any particular inquiry has been made into that with regard to these senile, confused old people. One of the troubles is that it is becoming, or was becoming until recently, more and more difficult to find accommodation for them, because they are not really suitable to be in a mental hospital. They are better in an annex in the grounds of a mental hospital, where they can be by themselves, have much more freedom and be regarded as
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normal people, just a little confused in the head and not needing to be taken care of too much. There were a number of such places around London to which I sent a number of patients myself, once upon a time; but when the Mental Health Act came in the hospitals said that they had now become acute mental hospitals and did not wish to take in any more elderly people who would be there all their lives with no possibility of cure. That is a pity, because I am sure it is important that places for these elderly, confused people should have some tie-up with a mental hospital, not necessarily being part of it. Certainly it is a great advantage if some members of the staff have been trained in a mental hospital, because they will not be so upset by the rather bizarre behaviour of some elderly people when by themselves.
Coming to the question of staff, I should like to echo what the noble Baroness, Lady Brooke, has said about stalling. I would say, as she did, what extremely fine work is done by the staff of these hospitals under the most appallingly bad conditions: overcrowded, understaffed. The marvel of it is that they do their work so thoroughly and well on the whole. I admit that there is the occasional lapse, as the noble Baroness said, which immediately gets pounced on by the Press, whereas nothing is said of the good work done by the 99·9 per cent. whose work must be extremely trying, even under the best conditions. One would like to say how much one admires the very high standard kept up in these hospitals, and trust that as much as possible will be done to keep up the standards and improve the conditions in which these men and women have to do their work.
3.30 p.m.
BARONESS LLEWELYN-DAVIES OF HASTOE: My Lords, as other noble Lords have said, the noble Lord, Lord O'Hagan, has done the House a very great service in initiating this debate this afternoon. Perhaps I may say to him that we do not at all feel that he is being mean to the Government in the way he raised it. As the noble Baroness, Lady Brooke of Ystradfellte, said, there is nothing Party political about this; we are all in it together. It is a problem we all have to deal with, and if I may say so—I hope without appearing in any

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way condescending—I thought it particularly good that one of our youngest colleagues should have spoken with such deep concern and so movingly about a subject which a great many people, after all, are only too anxious to forget because of its nature. I think the young generation to-day are wonderfully concerned with the problems of the underprivileged, and this, for me, is a great hope for the future of our deeply troubled world.
As many people have said, attitudes really do condition what actually happens, and what the noble Lord said about attitudes is absolutely right. Many of the problems which the Health Service faces to-day arise from past attitudes, and it is only in new attitudes that solutions can be found for, at any rate, some of the problems. There has really been a need for a revolution in thinking about how to deal with mental health, both by the authorities and by people generally, and I think that this debate shows that that revolution has begun.
The old approach to the subject is symbolised by those grim, remote, ghastly edifices in which most of our mental hospitals still exist, but they were built by men who sincerely believed in their mission. They believed that they should be custodial, and that their duty lay in safeguarding the public and society. The very solidity of these buildings is a tribute to their industrious faith, if I may call it that. But, of course, that solidity poses one of our major problems in following the new approach to this subject. We have had a revolution in thinking about these problems, but there has also been, as the noble Baroness said, a therapeutic revolution which is, in a way, more important. But that therapeutic revolution can basically be acted upon only if the social conditions for its implications are adequate, and this includes not merely social institutions but social attitudes.
If I may just glance at what is actually happening now, noble Lords know that in our actual services we are at the moment in a position of transition. The Royal Commission on Mental Health in 1957, which was followed by the Mental Health Act of 1959, unquestionably marked a major turning point in this whole field. In the past, barriers were created between mental hospitals and the community. Possibly this was necessary,
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but since 1959 we have been actively working towards creating positive links between the hospitals and the community.
When we think of the mentally ill we have to think in terms, as the noble Lord, Lord O'Hagan, said, of preventive services, of active treatment and rehabilitation. This calls for an enormous range of facilities: outpatient services; day hospitals; acute psychiatric units; after-care hostels; workshops and day centres. Noble Lords will know as well as I do the multitude of services that are needed in this new approach; and, above all, social work support. Most important, we know that where these services exist the need for in-patient beds and the average length of stay in them can be drastically reduced, and is being drastically reduced. But we are able to think in these terms partly because the changes in attitudes which the noble Lord looks for have actually happened, and also because the therapeutic revolution has made these attitudes possible.
Of course, when we talk about the therapeutic revolution it is perhaps a rather fancy phrase; all it really means is the treatment of mental disease by drugs or other medical means. This has all happened remarkably recently. In 1950, I think, insulin coma treatment and other forms of shock treatment became available, but early in the 1950s the tranquillising drugs were discovered, and this made a tremendous difference in the treatment of the more disturbed patients. This, in itself, also made a very great difference to the general atmosphere in the wards, and was able to lead to a new approach in the unlocking of doors. Those of your Lordships who are familiar with mental hospitals will know the profound change that all this has created. It is now possible to provide a much better social atmosphere and better occupational facilities for patients, and a very dramatic improvement has resulted in the patients themselves, which is one of the hopeful things about the present situation.
Noble Lords will know that from 1954 onwards the total number of patients in mental illness hospitals has steadily declined. Later, new drugs were discovered which have a beneficial effect on the depressive illnesses. For the last ten years it has been possible to treat all the functional mental illnesses with one or other

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form of drug therapy, and where these physical treatments have been combined with changes in the social environment —and I stress that fact—patients and their families have benefited very much. This is hopeful. It has made a breakthrough, and we have been dealing with it, as the noble Lord, Lord Amulree said, by opening psychiatric departments in general hospitals. It is known that these departments can now handle not only the more hopeful acute cases, but almost any form of mental illness, apart, as the noble Lord said, from those needing conditions of special security. It was a breakthrough in treatment, and most important it has led to a reconsideration of the actual role of the hospitals.
If I may, I should like just to explain that. What we are now doing is to plan to unite the department and the staff treating mental illness with the general hospital. In this way, not only will fewer beds be needed in the future, but the patient and his family will receive greater support. It is important to remember, however, that although fewer beds will be needed, more nurses and doctors will be needed than in the past, and this, of course, is one of our great blocks. My noble friend Lady Serota will be dealing in detail with subnormality, but I should just like to mention that there has also been a therapeutic breakthrough here, too. Sadly, there is no specific treatment for mental subnormality, but immense advances have been made in dealing with the physical conditions that go along with it.
This combination of revolutions, if I may call it that, both of treatment and ideas, means that we have to make sure that the service is directed towards the patient's rehabilitation and, as the noble Lord, Lord Amulree, said, his return to the community at the earliest possible moment, even if he does not always stay there. Nothing is so bad for patients as keeping them in hospital when they should not be there; and, on the other side, nothing is more wasteful in resources. Therefore, it follows that the mental health services of the future must be centred on the community, and not on these large, isolated hospitals. District general hospitals have far closer links with all the things we know they need —hostels, day centres, and all the rest of it—and this is now our constant aim.
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There is the question whether we might possibly need separate hospitals for medium and long-stay patients, but experience in a number of areas where modern district general hospital units are in operation suggests this may not be necessary. But this is something about which we shall have to think a little further.
What I have said applies to hospitals for the mentally ill, but the same principles apply to hospitals for the subnormal. Not all severely handicapped patients can hope to leave such a hospital, and it is essential that it should be thought of by them as their home. It is their home and there must be a homelike atmosphere there.
I should like to deal for a few moments with the point raised by the noble Baroness, Lady Brooke, about clothing, because this applies to both kinds of hospital. I know that she has taken a deep interest in this subject and I must say that I agreed with every single word she said. I think we are progressing a little, and I hope she will be comforted to hear that, although no specific advice has as yet been given to hospitals, they are very much aware of the way we are thinking. In fact, a memorandum which I hope will shortly go out will say that clothing provided by the hospital should be in modern style both for men and women, and for underclothing as well as top clothing. Dry cleaning facilities should be made available to patients and consideration given to the care of modern garments by those organising laundry services. We all know what it is like to send a nylon garment to an ordinary steam laundry, and I hope that this problem will be a thing of the past. The memorandum will also suggest that a laundrette service should be available to patients in hospital, and that encouragement should be given to the purchasing and wearing of individual clothes from local stores. I noted the reference of the noble Baroness to Marks and Spencer. I think it was a very interesting suggestion, and it must apply for everyday purposes. We all know the bulk buying of hospital issues to be one of the old bugbears, and the memorandum will say that this has a devastating effect on the individual who cannot claim that he owns even the trousers he is wearing. Moreover, the sameness is humiliating to the

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individual. I hope your Lordships will agree, after what I have said, that we really are tackling this problem in exactly the same spirit as the noble Baroness looks at it. Of course, the geriatric patients usually wear their own clothes, but they often have to be issued with clothing and we will apply the same principles.
The noble Lord, Lord O'Hagan talked about the large isolated hospitals, as other noble Lords have done, and we accept that it is clearly essential for hospitals to be more accessible not only for the patients, but also for the staff. It is absolutely wrong that these dedicated people should be cut off from the main stream of medicine, nursing and other professional work, and cut off also in their social lives. I very much agree with what the noble Baroness said about this. I am sure it makes it easier for them to carry out their extremely difficult tasks if they have a relaxed atmosphere outside their work, and this is what we are aiming at all the time.
I know that there are some arguments in favour of specialist mental hospitals, but even if they were accepted they must still be in close contact with the community. In all this what we are aiming at is to stop these terrible communities of institutionalised patients. We are deeply aware of the necessity for this. But I must stress again that this calls for a revolution in thinking, not only from the organisations, but also from the public, and it is only through that that we shall be able to achieve what we want.
I have tried to explain broadly what our aims are, and I think noble Lords will understand that what we are really doing is gradually—I am afraid it is only gradually—proceeding towards admitting mentally ill patients to the new units in district general hospitals, returning them to their community, as speakers have said we should, but with this difference; that we want them to remain in the care of the same therapeutic team of doctors, nurses and social workers as in their psychiatric hospitals, and continue to have treatment in day hospitals and out-patient clinics.
I was very interested in the suggestion of the noble Lord, Lord Amulree, that we should use these vast grounds—where,
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as he said, we used to grow pigs—for some kind of unit. I should be a little afraid that they might be a little far away from the community, but it is an interesting point. Noble Lords will know that doubts were expressed at the beginning about having mentally ill patients in the district general hospitals, and the hospitals have—understandably, I think—progressed cautiously. But the advantages to the patients are now quite obvious and we shall proceed from there.
The success of all this also depends on the attitudes of the public. It is only if a caring community exists that we can make sure that the strain will not be too great, not merely on the patient but also on his family. This is a point which is so often forgotten. Many of your Lordships will know of really tragic cases where the family has had a total breakdown as an entity because of the strain of looking after a mentally disturbed patient, even if only for a short time. This is what we have to direct our efforts towards helping. The therapeutic teams will also be working in patients' homes, in day centres, and wherever they are necessary.
Noble Lords may think that I am only describing a future perfect world. It is quite true that the provision of these essential services is uneven, but this is inevitable because we are moving from one kind of pattern of care for the mentally sick to another. Local health authority services have expanded rapidly in the last few years, but I do not attempt to pretend for one moment that these services are as yet as comprehensive as they should be. Nevertheless, in the last five years local authorities have invested £24 million in building training centres, workshops and hostels. There are at present 108 local authority hostels and another 57 are being built. There are 23,000 places in training centres for adults and another 11,000 are planned. I would not say that it is a drop in the ocean, although I know that it is not adequate. The programme has a long way to go, but a great deal has been done and your Lordships will be glad to know that it is gathering momentum and is in many ways more substantial than people realise.
The noble Lord, Lord Amulree, referred to the article in the Practitioner on restrainers. The House deeply appreciates the noble Lord's experience in

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these matters and we all value his wonderful contributions to our debates. I was especially glad to hear that he favours the "open door" principle. Of course, it is true that this principle carries difficulties with it and I think there can be no possible doubt that there is a necessity for a small area, a small ward, which can be locked for the most disturbed patients. I do not think anybody will deny that that is the case.
LORD AMULREE: My Lords, that is the point I was trying to make. While entirely approving of the open door so far as one can possibly have it, there might be need for one tiny little place where you keep some of these unfortunate people.
BARONESS LLEWELYN-DAVIES OF HASTOE: My Lords, I realised that that was the noble Lord's point. However, I wanted, as it were, to dot the i's and cross the t's as well, because although we are passionately in favour of the open door there must be some other provision. The subject of restrainers is a distressing one. I asked the Department about this, and they told me that they are not aware of mechanical methods of restraint being used in the treatment of psychiatric patients. But body-bands and ankle-restrainers sometimes have to be used, particularly in general or geriatric hospitals, where the patient's physical condition makes it necessary. The trouble is that some of these patients, as noble Lords will know, can hurt themselves as well as other patients and staff. I am sure that we have got rid of the safety vest, the straitjacket. As to the geriatric chair, it was an horrific description in the Practitioner but there are special geriatric chairs which have been designed to enable bedfast patients to sit up. They very much welcome this; they like to sit up and have their meals. But it has to be a rather, if you like, mediæval contraption; though I do not think they are used—I hope they are not—in the form of the stocks, as the noble Lord said.
With regard to the noble Lord's second point, elderly patients present an ever-increasing problem in psychiatric hospitals—and, of course, we all know about the mental confusion which occurs among the elderly—and we wholly agree that we need more places for them. The rising proportion of elderly people in the
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population has led to an increasing number of psycho-geriatric patients, and it is quite true, as the noble Lord said, that many of them have been admitted to mental hospitals simply because there has been nowhere else for them to go. This is a tragic situation, and we know that geriatric homes, and so on, would be more appropriate. We are hoping to deal with this, but I would deceive the House if I did not say that it will be a long haul. It will be; but we are deeply aware of the problem. I think the noble Lord will probably agree that improved assessment will help in this way—who should be admitted where, and so on. What we are trying to do is to set up assessment centres in psycho-geriatric units and outside to try to decide where these particularly disturbed old people, or, rather, confused old people, should go. Noble Lords have expressed anxiety about the hospital side of the health services, and I hope that the developments which we have planned and the great changes of attitudes on all sides will lead to real improvement.
The noble Lord, Lord O'Hagan, talked about prevention and training. Broadly, I think that this comes down to education. Modern research is of course adding to our knowledge of the causes of some forms of mental handicap—better obstetric care; vaccines, such as for German measles; genetic counselling, and that kind of thing—but I think the National Health Education Council is doing a very important job here. My noble friend Lady Birk, who is the chairman of this body, and who we are all looking forward to hearing, will describe it in more detail than I can, but, basically, the point is that there are two things in education: first, in preventing the occurrence of mental illness; and, secondly, in developing public understanding of the nature of mental disorder and of the need for support for patients and their families.
My Lords, I have taken a little time to describe the impact of new treatments and new attitudes, and I hope your Lordships will forgive me. It is a very complicated situation, and I wanted your Lordships to know the kind of progress that we are making and, perhaps more important, what we are aiming at. All this is what we are aiming at; but, of course, there are tremendous difficulties. When the National Health Service started

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in 1948, 45 per cent. of all hospitals were built before 1891, and even after twenty years of the National Health Service hospitals with anything up to 2,000 patients are trying to adapt themselves. In the course of time they have got to be abandoned or remodelled—I hope they will be abandoned—but there they are, and inevitably this will be a gradual process. In the short-term, this deeply concerns us all, because they face a formidable task in adapting their management and structure to modern methods. I do not want to minimise that: it is a formidable task. But noble Lords will know that my right honourable friend the Secretary of State and my noble friend Lady Serota are deeply conscious of and concerned about this problem.
At this point, I should like to say what is perhaps more difficult for my noble friend herself to say: that in my view the new policy in this field has shown very great courage. It would be easy to try to sweep the whole question of mental illness under the carpet because it is distasteful, distressing and, indeed, frightening to many people, and the problems of inadequate staffing, housing and so on are immense. But my right honourable friend and my noble friend, together with the Department, have firmly grasped the nettle, and I think they have made significant and important moves towards improving the situation.
The truth is that some of the difficulties in the care of the mentally handicapped arise in a very significant degree from our success in other directions: getting them out of these long-stay hospitals and putting them on the community; the fact that in the past people born with severe handicaps often did not live very long whereas now they do. But one of the major difficulties lies in the present tripartite structure of our National Health Service. The new approach calls for very close co-ordination between the services in the community and the hospitals. Overlapping boundaries between hospital catchment areas and local authority areas cannot but be a major handicap. Unless we can solve this fundamental problem we shall not get a comprehensive and co-ordinated service for our mentally sick. My noble friend,
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with her great experience in this field, will be saying something about the Government's policy in this direction.
For myself, I should like to say again how deeply grateful we are to the noble Lord for providing this opportunity to have this debate, which has inevitably raised issues wider even than those of his original Motion. I have myself, like many noble Lords, served on the management committee of a group of mental hospitals, and the one thing which shone out among all the distressing problems we had to deal with was the dedicated devotion of the staff. I do not regret the recent publicity of bad conditions in some hospitals. I think it is important that the public should know about it. But the overwhelming majority of nurses and doctors show quite exceptional qualities in their challenging and very trying work. Their positive attitudes are fundamental if we are going to get the improvement of our mental services. No one who has ever worked with them could underestimate their magnificent contribution.
My Lords, I am afraid this has been, perhaps, a rather sombre debate so far. I say that we in the Government know what we have to do. It is a challenge—a tremendous challenge. I have tried to outline a blueprint for our mental health service, and we are trying to implement it. So far as our present knowledge of this incredibly complex subject goes, it has everything we need, but changed attitudes are essential if we are to achieve it.

CIVIL AIR TRANSPORT
3.58 p.m.
LORD BESWICK: My Lords, with permission, I would now repeat a Statement made by my right honourable friend the President of the Board of Trade in another place. May I take the opportunity to apologise to the noble Countess, Lady Loudoun, for delaying her maiden speech, to which I am sure noble Lords are looking forward?
My Lords, the Statement reads:
"I am to-day laying before the House a White Paper setting out the Government's decisions in the light of the Report of the Committee of Inquiry into Civil Air Transport—the Edwards Report.

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"Over 90 per cent. of the output of British airlines is on international services. The industry must be strong in that intensely competitive field. In this country domestic services are limited and not very remunerative. There is need for rationalisation. Everywhere in the world civil aviation is highly regulated. We need to improve our regulatory machinery with the aim of strengthening the industry.
"In the public sector the Government will establish an Airways Board charged with the task of securing that the fleets and resources of B.O.A.C. and B.E.A. are planned and marketed to the greatest overall advantage.
"The Board will have complete authority and will not, therefore, represent an additional layer of decision-making. The Airways Board will also be responsible for setting up a separate regional airline bringing together certain domestic services of B.E.A. and of the British Air Services group.
"The Government would welcome the emergence through combination of a strong independent airline undertaking scheduled services. They will favour the licensing of such a carrier on routes, notably on the North Atlantic, where the presence of a second British carrier could be expected to increase the British share of business. But they do not accept that the creation of such an airline should be made conditional on the transfer of a significant part of the Air Corporations' routes. They believe that there are continuing opportunities of growth for independent airlines and will pursue pricing policies which should assist them.
"The Government accept that, after other steps have been taken to strengthen regional air services, it may still be necessary to subsidise certain services which can be shown to contribute to the economic or social development of the regions. They will seek powers to grant subsidies where detailed economic studies show them to be justified.
"The Government propose to improve the regulatory machinery by setting up a Civil Aviation Authority which will have comprehensive responsibility for the regulation of the industry
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in all its aspects—economic, operational and technical. The Board of Trade will lay down the objectives and policies to be pursued by the Authority: these will be published and come before Parliament before being made binding upon the Authority. In addition, the Board of Trade will continue to exercise its present functions in relation to the public sector—the Airways Board and the British Airports Authority. It will also continue to bear the main responsibility for negotiating international agreements affecting civil aviation, for investigating accidents and for the control of aircraft noise.
"I am inviting the chairmen and members of the boards of the Air Corporations, of the Air Transport Licensing Board and of the Civil Aviation Advisory Committee generally to continue to serve for a further year, to allow time for the introduction of legislation.
"With these changes the industry should be able to meet, with confidence, the challenges of the future and increase its contribution to an expanding economy and to the service of the public."
THE EARL OF KINNOULL: My Lords, I am sure that the whole House will be grateful to the noble Lord for repeating that fairly lengthy Statement made in another place on the long awaited, rather protracted, birth of the Government White Paper on the future of the civil air transport industry. The noble Lord knows as well as any of us that all sections of the industry have been eagerly, in some cases anxiously, awaiting the Government views on the recommendations of the Edwards Committee, and the House will remember that this was forcibly expressed by my noble friend Lord Balfour of Inchrye during the debate in July. The conclusions that the Government have arrived at will, I am sure, be examined closely by those of us who are interested, and I hope that in time we shall have the opportunity of debating this White Paper. If there is one conclusion that I am sure will be widely welcomed from all sides, it is that the Minister will retain full responsibility for the control of aircraft noise.
Arising from the Statement, I should like to have clarified a number of small points. Could the noble Lord say

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whether the White Paper makes it crystal clear that the new Airways Board will be intending to take a financial stake in any of the independent forces, or second force, as recommended by the Edwards Committee? Secondly, when he says that the
"Government would welcome the emergence … of a strong independent airline …"
could he explain just how different in practice the new licensing system will be from the old one? Thirdly, could he say whether the Government intend to follow the Edwards Committee recommendation by publishing its future policy as a Statutory Instrument? Fourthly, if I am not going too fast, one assumes from the Statement that it is intended to keep the Civil Aviation Authority separate from the British Airports Authority. Who, in practice, will be responsible for future siting of airports? Lastly, and most important, could the noble Lord confirm that the Government definitely—I repeat "definitely"—intend to introduce legislation implementing this White Paper this Session?
EARL AMHERST: My Lords, we on these Benches should also like to thank the noble Lord for the Statement which has just been made. I should like to have one or two points clarified. First, is this new Airways Board to take the place of the Boards of B.O.A.C. and B.E.A.? The Statement says that the Board
"will have complete authority and will not, therefore, represent an additional layer of decision-making."
Are we to assume that the Boards of B.O.A.C. and B.E.A. will no longer be charged with making decisions on what is to be their own futures and their own policies? Does it not rather indicate criticism of these two Boards? Surely the noble Lord would agree that both these Boards have rendered tremendously successful service over a period of many years.
We should welcome the decision in the Statement that it is not intended to take away from the State airlines the routes that they have established across the Atlantic; but there is a rather alarming suggestion of the
"transfer of a significant part of the Air Corporations' routes".
What does the word "significant" mean? Is it going to be a small portion
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of the routes that they have developed? Will it be done in conjunction with them and with their agreement, or will it be done arbitrarily? Another question that I should like to ask concerns the subsidies of certain internal services. Does this refer to what is known as the social services—for instance, the Highlands and Islands services? Lastly, is the Civil Aviation Authority to take the place of the Board of Trade, will it be additional to the Board of Trade or will it be just an additional cog in the machinery?
4.8 p.m.
LORD BESWICK: My Lords, I shall try to answer those questions. First, may I thank both noble Lords for their welcome to the Statement. I was asked about the possibility of the new Airways Board having a financial stake in the independent companies. It is not intended that the Board should have this stake. In this respect the White Paper makes it clear that it has a different view from that recommended by the Edwards Committee. I was asked about the difference between the Licensing Board as it now exists and the proposed new Civil Aviation Authority. The directive of the new C.A.B. will be much more purposeful. There will be greater scope and there will be the possibility of having a second operator on a given scheduled route, which was denied by the directive given to the present Board. I was asked whether the policy of the new Aviation Authority would be laid down in a Statutory Instrument. The answer is, yes; in that it will be, in a formal document. Its exact form has not yet been decided.
I was asked whether I would clarify the responsibilities between the C.A.B. and the B.A.A. for aerodrome policy. The responsibility of the British Airports Authority will remain precisely as it is now laid down by Statute, but the responsibility for the licensing of aerodromes will be passed to the new Civil Aviation Authority. The siting of airports, however, with the implication of land usage, will be the responsibility of the Board of Trade. I was asked whether I could give any definite indication as to legislation. The intention of Her Majesty's Government is that the new Authority and the Board will be brought into being before the end of next year.

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In order to achieve that, there will have to be legislation.
I was asked by the noble Earl, Lord Amherst, about the definition of "complete authority". I think that if he reads the new White Paper, which is a closely reasoned and fully argued document, he will find that this is made quite clear. Within the defined area there will be a complete authority to the new Board. The noble Earl asked if this was not a criticism of the two Corporations. Again if he reads the White Paper, he will find that there is absolutely no criticism intended. It is not a criticism of the two Boards but a recognition of the development of this industry; the new aircraft and the possibilities of marketing in through-traffic which it is thought—and the argument is made clear—could be more efficiently carried out by centralising this sector of decision making. I was asked about the transfer of routes. There will be no transfer of routes, excepting in so far as the new licensing authority, on the facts before it, might come to a decision in certain cases that a given route could better be operated by one of the independent companies.
EARL AMHERST: My Lords, would that apply to new routes and not existing ones?
LORD BESWICK: My Lords, certain routes are designated to the Corporations, but there will be powers to designate a second carrier. In certain cases, on the facts before them, the new authority may well come to the conclusion. in the interests of the economy generally and of getting a bigger share for Britain of the going traffic, that the licence should be given to an independent rather than to the Corporations.
I was asked about the regional services. Of course, these do refer to the Scottish Highlands and Islands services, but, in addition, the regional services in England too; the North-East and the South-West, for example.
LORD BALFOUR OF INCHRYE: My Lords, I have only two questions to ask the Minister. He used the term "Government decisions". He also told us that there would be some period of time before legislation is introduced. Are these decisions absolutely inflexible, or are they decisions which will be debated? And will the Government be willing to
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listen to the point of view of representations within both Houses of Parliament and outside? My second question is addressed more to the Leader of the House. Would the Government consider promoting an opportunity at a not-too-distant date for debating the White Paper?
LORD BESWICK: My Lords, the White Paper is now available in the Printed Paper Office. It will be necessary for it to be discussed in the journals and outside; and, of course, a Parliamentary debate would be expected. I shall be very happy to discuss through the usual channels the possibility of a debate here. The noble Lord asked whether it would be possible to change the Government's policy. The Government's decisions, taken in the light of their considerations, are enshrined in the White Paper. Of course, it would be foolish to say that if an absolutely conclusive argument was brought forward it would not be possible to listen to that argument and to make changes; but it is not intended as at present to make any changes to the policy laid down.
THE EARL OF SWINTON: My Lords, the noble Lord would agree that it is for Parliament to have the ultimate authority. Therefore, before irrevocable decisions are taken, surely there should be a full debate on these proposals in both Houses of Parliament.
LORD BESWICK: My Lords, I do not think that there is anything inconsistent in what the noble Earl has said with what I said. The irrevocable decision will be when an Act of Parliament is passed, and of course it will be Parliament which will decide whether a Bill should become an Act of Parliament.
EARL JELLICOE: My Lords, I wonder whether the noble Lord could confirm the impression I gained from listening to the Statement. I think it was said that it was the intention that the new Civil Aviation Authority should have comprehensive responsibilities. Am I right, therefore, in taking it that all the functions at present exercised by the A.R.B. will come under the umbrella of the new Authority?
LORD BESWICK: My Lords, the authority of the Civil Aviation Authority, or the responsibiliy of the Civil

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Aviation Authority, will of course be comprehensive over those areas defined in the White Paper, and they include the A.R.B.

NORTHERN IRELAND: ULSTER DEFENCE REGIMENT
4.15 p.m.
LORD SHACKLETON: My Lords, with permission I, too, should like to repeat a Statement, and at the same time I would apologise to the noble Countess, Lady Loudoun, who is about to make her maiden speech. My Lords, the Statement, which concerns the Ulster Defence Regiment, is as follows:
"The House will recall that in the debate on Northern Ireland on October 13"—
and in a similar debate in your Lordships' House—
"the Government proposed to create within Northern Ireland a local reserve defence force. This force is the subject of a Bill which is to be presented to-day.
"The Bill has been drafted on the established pattern of Reserve Forces legislation and provides the statutory framework within which the new force can be raised. There are therefore a number of matters which do not fall within its scope but about which the House will wish to be informed. My right honourable friend the Secretary of State for Defence is therefore publishing at the same time as the Bill is laid a White Paper which will set out the broad outline of the new force's function and constitution.
"The Hunt Committee recommended that the Royal Ulster Constabulary should be relieved of all military duties and that the Ulster Special Constabulary should be replaced by two separate forces—one a police reserve, the other a military force to assist the regular Armed Forces.
"The nature of the new military force will be governed by its operational task. That task will be to meet what the Hunt Committee called armed guerrilla-type attacks'. This calls for a force to guard key points and installations, to carry out patrols
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and to establish check points and road blocks.
"This force will be an integral part of the Army. It will be controlled by the Secretary of State for Defence, and will be under the command of the General Officer Commanding, Northern Ireland. Its immediate Commanding Officer will be a Brigadier of the Regular Army. The Regular Army will also supply administrative and training staff.
"The size of the force will be determined in the light of experience as the build-up proceeds, but will not ultimately exceed 6,000 officers and men. Of necessity the new force will draw substantially on the Ulster Special Constabulary for its initial recruitment, but there will be a campaign to enrol recruits from all sections of the Northern Ireland community. Apart from the formal qualifications of age, residence and nationality the sole criterion for acceptance will be suitability for service in a military force. There will be a strict security vetting.
"The force will be called The Ulster Defence Regiment.
"The power to call it out for local emergency will be vested by the Secretary of State for Defence in an officer of the Regular Armed Forces who may in turn delegate that power to other officers of the Regular Forces not below the rank of major. Members of the new force will be liable to be called out for service only in Northern Ireland.
"Officers of the new force will be subject to military law at all times; others will be so subject when on training or on duty.
"Members of the new force will be required to do one week's consecutive training, four other full days' training and 12 drills. This is, I believe, the minimum training required to produce an efficient force. In some special cases the requirement may be varied within this total amount.
"Members of the force will receive Regular Army emoluments for full days' training or duty in the same way as the T. & A.V.R. A non-taxable annual bounty will be paid to all members who complete the training obligation.

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"Although the defence of the United Kingdom is the sole responsibility of Her Majesty's Government here at Westminster, the tasks for which this new force will be raised are of the greatest importance to the Government of Northern Ireland. We therefore envisage that the G.O.C., Northern Ireland, will have the fullest possible consultation with the Government of Northern Ireland about the use of this force. This in no way diminishes the powers and responsibilities of the G.O.C.
"The success of this force is vitally important to the people of Northern Ireland. It must he representative of the community as a whole. Recruits must come forward from all sections. We are confident that they will. The Government will do all in their power to ensure the success of the Regiment."
LORD BROOKE OF CUMNOR: My Lords, I would thank the noble Lord the Leader of the House for repeating this important Statement. In our debate a month ago I welcomed the decision to set up a force of this character, and I think that the noble Lord, Lord Hunt, must be gratified that his recommendations not only have been accepted but are being acted on so speedily. I cannot refrain from expressing the earnest hope that Catholics as well as Protestants in Northern Ireland will volunteer freely for service in this force.
I have two questions to ask. I was expecting all the time to hear in the Statement that all the details in it had been endorsed by the Government of Northern Ireland. It seems to me extremely important that that should be the case, though the responsibility here lies on the United Kingdom Government at Westminster. I hope that we may have that assurance. Secondly, I cannot help wondering whether the training schedule set out in the Statement will be sufficient, at any rate in the initial period. I should have thought that if this force is to take over its new duties, which will be to oppose I.R.A.-type raids of all kinds, should they occur, it will be necessary for recruits, at any rate in the first year or two, to experience rather more extensive and intensive training than is set out here. The terms of the Statement seem to be giving a kind of assurance that
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nobody will ever be required to do more than this. I trust that, if the assessment of the position and the progress of the force require it, these periods of training here will not be treated as an absolute maximum.
LORD BYERS: My Lords, I should like to welcome this Statement and to congratulate the Government on the speed with which they have acted in producing this decision. I have only one question. There is reference in the Statement to strict security vetting. I would ask what body will be responsible for the strict security vetting, and who is going to lay the standards required of members of the force, bearing in mind the experience which we had with the "B" Specials and in view of the fact that, as I understand it, the initial recruits are likely to be drawn from that force.
LORD SHACKLETON: My Lords, I am grateful to both noble Lords for their recognition of the part that the noble Lord, Lord Hunt, played and of the speed with which we have been able to move on this. It is clearly of great importance that we should move quickly. A Bill is being introduced in another place, and we hope to have it and deal with it speedily in this House. The position about the Government of Northern Ireland is that they have been fully consulted on detailed matters, and I understand that they are in general agreement with the proposals. Of course, the responsibility for this force and its conditions rests solely with Her Majesty's Government. But I can frankly say from my own knowledge that there has been very full discussion with the Northern Ireland Government and that, although some changes have been discussed, they are content with what is proposed. However, I would not want to bind them totally. There may well be some points on which they might have liked something different.
On the training commitment, we are in somewhat of a dilemma, and this is an aspect with which the Northern Ireland Government themselves have been concerned. A number of the members of this force will be small-time farmers, who will probably find it difficult to fulfil the training requirement. Naturally the Army want the longest possible training, and I very much take the noble Lord's point. But we are satisfied that what

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is proposed will be satisfactory. Clearly we shall want to consider this further, and maybe we shall have an opportunity to do so when we discuss the Bill. But we arc satisfied that what is proposed is right for the particular purposes we have in mind.
The noble Lord, Lord Byers, asked about security. The vetting will be done in the same sort of way as for those men who join the Armed Forces. There is of course a special problem here, and vetting will be in the hands of the military authorities, who will no doubt make sufficient use of the specialised information we may be able to obtain. There is a danger either way. Do not let us assume that it is always from Ulster Protestants; there is also the possibility of I.R.A. members trying to join the force. It is important to ensure that there is complete confidence in the members of this force, and I am sure that in fact this will be achieved.
LORD THURLOW: My Lords, could the noble Lord tell me the answer to two points? First of all, will the unit of T. & A.V.R. 2 which still exists in Northern Ireland be incorporated into this force, and are the former soldiers of T. & A.V.R. 3 units going to be eligible for the new force?—because it seems likely that the A.V.R. 3 units have been disbanded. The other point is: are there enough drill halls in existence for the training of this force?
LORD SHACKLETON: My Lords, may I give the noble Lord a quick answer, subject to further examination? I do not think that the question of incorporating T. & A.V.R. 2 arises. If my recollection is right, from our earlier debates, T. & A.V.R. 2 is organised in support of NATO and of the Regular forces. As for T. & A.V.R. 3, of course it will be open to anyone to volunteer for the new force, and clearly it is desirable in general that men from the Ulster Special Constabulary, and others with territorial or military experience should join the force. I should think that the noble Lord's question will be met in this way.

PARLIAMENTARY PAPERS: LABOUR DISPUTE
LORD SHACKLETON: My Lords, I wonder if I may add a personal statement—yet another apology on my part to the noble Lord, Lord Carrington. I know that it makes it difficult for him every time I apologise and that this is probably not the correct moment. I indicated earlier, when making a Statement on the supply of Parliamentary Papers and the situation in the Stationery Office that copies of yesterday's Commons Hansard were now freely available. I am told now (and I am going to be very careful about what I say) that it was Monday's Hansard that was available. However, I also understand that a number of copies of yesterday's Lords Hansard are now coming through. I thought it right to correct this. Noble Lords who are here will now know my apology and those who are not may, with luck, be able to read it in Hansard.

MENTAL HEALTH: ATTITUDES AND POLICY
4.29 p.m.
Debate resumed.
THE COUNTESS OF LOUDOUN: My Lords, this is my maiden speech and I crave the indulgence of the House for any faults, an indulgence which I know your Lordships always readily give. First of all, I, too, should like to thank my noble friend Lord O'Hagan for initiating this debate. Much has been done in the last few years to bring to the notice of us all the problems and stresses of mental health. The contemporary attitudes to mental health are somewhat contradictory at the present time, but could be looked at from three points of view. In the first case, there is the critical searchlight which is directed particularly to subnormality hospitals, triggered off, one must admit, by events that have taken place in the hospitals. Although the policy of the authorities is constantly to improve the service, it is possible that recent events have been inclined to overshadow the great amount of good and to emphasise the bad. I am glad to say that in the most recent programmes on the radio steps have been taken to correct

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this difficulty. We know that in many cases the buildings are old and that the work is made more difficult because of this. But the majority of hospitals are not deterred by this, and the work is going forward in a very progressive manner, with ever-increasing imaginative enthusiasm.
Of recent years, big efforts have been made to make the public more aware of the hospitals and what goes on; and the recent spate of programmes on both radio and television indicates that some success has been achieved in this respect. I should like to emphasise the need for it to be understood by the wider public that the patients are people, just as much as any other section of the community, and should not be regarded as a kind of lower order of life just because their difficulty lies in the intellectual sphere. In recent programmes and articles one has been inclined to detect a slight amount of surprise on the part of the writers when they found the patients doing "ordinary things". I feel that it would help people generally if they could think of people with subnormality as a glass half-full, rather than as one half-empty.
The second point is the attitude of the staff who are intimately concerned with the day-to-day care of the patients. They have no power to provide buildings and facilities, and yet they feel that they bear the brunt of the criticism. Although many are able to weather the storm, there are some who are discouraged by it. There has been a noticeable reduction in recruiting in the last few months, which, of course, makes the work more difficult for those who have to carry on.
In the third matter, there has been a considerable increase in the interest of voluntary workers, who seem to be motivated by the feeling that things are so bad that they feel compelled to come and lend a hand to put them right. In one hospital I know that they have over 100 volunteers on the books. The contradictions I mentioned earlier are between the critical attitude, on the one hand, and the increase in the desire to help by members of the public on the other. I have the greatest admiration for all those connected with nursing of all types, but I should like to pay my tribute especially to those of the mental health service.
4.33 p.m.
THE LORD BISHOP OF LICHFIELD: My Lords, I am very happy that it should be my privilege to be the first to congratulate the noble Countess on her maiden speech. I am sure that we all much appreciated her most thoughtful speech, and that the House will look forward to further speeches from the noble Countess in due course.
I am grateful to the mover of this Motion, the noble Lord, Lord O'Hagan, for drawing our attention to this subject this afternoon, because it is a vast problem which needs regular consideration. I am informed on good authority that it is the case that the number of hours lost in work to the nation through mental illness probably amounts to about four or five times the amount that is lost by strike action. Those figures, which, as I say, I have obtained from the most creditable source, show the vast scope of the problem with which we are dealing. The noble Lord, Lord O'Hagan, has drawn attention to contemporary attitudes to mental health, and I would say that in this respect the public attitude has greatly improved. As has already been remarked, there is no longer a stigma attached to it, and people are more open about the subject. This is wholly desirable. It is one of the reasons why the rate of admissions to mental hospitals has increased, because many who in former years would not have asked for admission are now doing so.
There is, however, one respect in which the attitude of the public falls short. It does not sufficiently realise that new money will have to be obtained if the problems are to be overcome. Recently there has been a great deal of holding up of hands in horror about the statements that have been made in regard to overcrowding in these hospitals. I shall refer to that again in a moment, but undoubtedly those statements were justified. It is no good just holding up hands in horror; the nation must realise that improvements will cost money. If I may speak as a member of a Regional Hospital Board, I should like to say how, sometimes, it is frustrating for a Board to know of these problems but to be unable to cope with them to the extent they would like. Time and again,, the anxious choice has to be made as to the way in which the money available to the Board should be spent.

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There are other ways in which contemporary attitudes to mental health can be improved. First, there is a need to convince people that psychiatry is nothing of which they need be afraid. I think it is true to say that in the past people have shrunk from admitting that they themselves might have need of psychiatric treatment. It is therefore necessary that we should overcome this very natural reluctance. So let it be understood that there are periods of particular risk in people's lives; and let it also be understood, as again has been remarked, that none of us can say that at any time in our lives we may not be subject to this kind of difficulty.
I hope, too, that further consideration will be given to the use of mass media in order to dispel fear of psychiatric treatment. This has been used to a certain extent, but in regard to one programme I was not quite sure whether, rather than being dispelled, fear was increased; but that might have been a personal opinion. This is a matter which has to be carefully approached by producers. When we come to physical illness, an operation can be portrayed on television in such programmes as "Your Life in Their Hands", and we all look at it goggle-eyed, but it is not so easy with this kind of ailment. The line between physical health and physical illness may be clearly defined, but it is not so clearly defined in mental health. The line there is much more indistinct, and in order to prevent the trouble we have to help people to understand that in their lives they may be near this line.
I therefore hope that we shall refrain from making moral judgments on such people. It is only too easy to do so, and is perhaps rather natural. On the other hand, I hope that none of us will ever regard psychiatry as being a kind of panacea for all such types of mental illness. Some people do so, and apply to a psychiatrist in order to try to dodge the realities of life, when in reality they should be taking a grip on themselves. But here a difficulty arises for those who are in a position to try to help. How, for instance, are people who desire to help to know whether others are in need of psychiatric treatment? When, for instance, ought people to go to their doctor, and when ought they, frankly, to try to
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snap out of it? Here I think the clergy, in particular, need real guidance. They often have to deal with this type of case, and efforts are now being made to give them some knowledge in order to equip them for their task. I do not want to imply for one moment that what we want to do is to try to turn the clergy into a group of amateur psychiatrists—that would be highly dangerous—but I feel that it will help them to recognise certain psychiatric cases as a rather different matter. Here we are particularly grateful to a number of consultants in this speciality of medicine who have given up their time freely to lecture to ordinands and clergy, and courses have been arranged in clinical theology. If I may say so, turning from my own profession to another, the general practitioner is probably recognising psychiatric cases to a greater extent than in the past. This is also leading to a greater caseload in mental hospitals.
The increase in the caseload leads me on to stress once again that surely overcrowding is still one of the greatest problems. Looking back over the years, how often have I heard it said that as a result of the new techniques, and so on, the number of patients was going to come down; and yet here we are, still the same in 1969 with this terrible problem pressing upon us. I suppose the consultant might say, "All right, do not admit any more patients. This is the number of beds we have, and that is that." When I was discussing this subject the other day with a medical superintendent of one of these large hospitals he said, "In all the years I have been here I have not turned away a case that a general practitioner has sent to me. If I did, what would happen to that person, and what would happen to the family?".
It is not so easy to say, "Clamp down on it". The Hospital Service cannot be expected to cope with the whole of this problem. It is a fact that there are many people in hospitals to-day who, by their presence, reflect a lack of community care, because many of them, we know, ought not to be there at all. There is this tremendous problem of the overlapping between the psychiatric and the geriatric patients. We must do all we can to keep psychiatric beds simply for psychiatric patients, and not for others. So the Hospital Service must look to the

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other authorities to play their part. Most of the local authorities are making some provision for community services for the mentally ill. This, however, is still far from enough. I hope the possibility of boarding patients out will he still further developed. I understand that one of the authorities in Northern Wales by this expedient has greatly reduced the crowding in the mental hospitals, and of course if it can be pursued it is far less costly than keeping patients in hospital.
In this matter of the mentally subnormal, to which many references have already been made in this debate, as was natural, may I come again to the need for more money if the problem is to be overcome? Given the proper facilities, many of these people could lead useful and productive lives in the community, and we need greater provision of day centres for their training in simple occupations. But a consultant psychiatrist of great experience impressed upon me the other day that if the subnormal is to be cared for at home rather than in hospital, he must not be given any precedence in care over the rest of the family, but must be treated along with the rest; otherwise great jealousies and tensions can undoubtedly arise.
Efforts are now being made to avoid segregation of psychiatric cases, and the Bonham Carter Committee recommended that these cases should be dealt with in the district general hospital. I am quite sure that that suggestion must at any rate be tried. Also, we need more hostels to adjust patients to everyday life when they come out of the hospitals. But is it not true, my Lords, that these hostels are tending rather to price themselves out of the market? Could they cost less than they cost at the present time? It would be quite hopeless if these hostels were blocked by cases who stayed there a long time, for they are not there for that purpose. They must be short-stay institutions, or the whole object of the hostel is defeated.
Then there is a need for the follow-up on the part of the psychiatric social worker and the mental welfare officer. Again, as we have heard, there are still not enough of them to cover the work. Moreover, still more day hospitals arc needed where these patients can go and receive a certain amount of supervision. I am informed by people who have great experience in this matter that very many
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readmissions of patients are due to the failure on the part of those patients to carry out the instructions of their doctor when they have left the hospital.
In recent months there has been a lot of bad publicity for a number of these hospitals. There were the allegations that were made in a book which, if I remember aright, was entitled Sans Everything; there was the story of the Ely Hospital, and others. I agree that in a sense this publicity is desirable, because if there are instances of cruelty they should be very definitely stopped. On the other hand, we must always remember, before we criticise too sharply, the kind of tasks that the staff have to undertake. I have recently been around several of these hospitals. My Lords, honestly I wonder, as I look at the work that has to be done, that we get anyone to do the job at all. As has been remarked this afternoon by the noble Baroness, Lady Brooke of Ystradfellte, one hears about the cases of bad behaviour, and so on, and they get highlighted. In a sense that is right, because they must not be allowed to go on. But when one speaks to some of these ladies and gentlemen who act as the staffs of these hospitals, one feels most moved that they should go on year in and year out in the way that they do.
I said to the matron of one hospital. "Matron, looking at the jobs that have to be done, how do you get staff at all?". She replied, "Well, you know, after you have been at it for some time, you come to love them very much". It is that kind of attitude to the work which animates so many of the men and women who are serving on the staffs of these hospitals, and we should be indeed most grateful to them. If we get continuing adverse publicity, it is going to affect recruitment very badly. What the noble Countess said just now in her maiden speech is perfectly true: that in the past few months recruitment has been flagging very badly indeed. It is getting very worrying. If we keep on having this kind of publicity, what can be expected as a result of it? So I would add my voice to those speakers who have said that we must call on all kinds of voluntary workers to help as much as possible. And it is remarkable what a number of organisations do—for instance, an organisation like the Round Table, which comes and takes the patients out for the

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day, or organises their summer holidays. That kind of thing is going on to a much greater extent than people realise. Let it always be said, as is true, that in this day of the National Health Service there are more people engaged in voluntary work in our hospitals than ever before; and let us be most grateful for what is done.
May I, in my concluding remarks, say one or two things about chaplains and the part that the Church must play? It is very gratifying for us to know that in hospital after hospital the chaplain is now being regarded much more as a member of the healing team. We are trying as best we can to fit him for this work, and the Hospital Chaplains' Council organises regular training courses for chaplains. We are pleased to know that we have passed through these courses more than a thousand chaplains. I should like to express gratitude to the Department of Health and Social Security for the way in which they support these courses. They do so not only by paying for the men to attend the courses. We have had a senior representative of the Department to give the opening lecture; and this kind of seal, set on it by the Department, is something that helps the Church very much. A really good chaplain in a hospital is undoubtedly going to be a great source of strength to the patients, just as the good parish priest will be a source of strength in his work. Let it also be said that the chaplain should be a man who does much to help the staffs in their difficult tasks.
So, as we think of the role of the Church in this matter, surely the link between the Church and the sphere of psychiatry should be a close one; and here the Churches' Council of Healing and the Institute of Religion and Medicine have been very active in trying to bring the two together so that we may work in the closest harmony. The pastoral work of the good psychiatrist and of the good parson are closely akin. But it is important to remember one outstanding fact: what we must aim at, first and foremost, is not so much the treatment of mental illness, but its prevention. Prevention is so much better than cure; it relieves so much anxiety, and from the economic point of view it is far less costly. We must strive to help people to become, and to remain, whole. I hope,
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therefore, that the public will have a fair and open approach to this problem. And if this debate this afternoon helps us in our attitudes to this great problem, then I think that the noble Lord, Lord O'Hagan, will feel that he has been rewarded.
4.52 p.m.
LORD GRENFELL: My Lords, I know that we should all like to thank my noble friend Lord O'Hagan not only for initiating this debate but also for bringing the word "contemporary" before us: for never before, perhaps, has the situation of the mentally handicapped been more urgent than it is to-day. The right reverend Prelate has spoken most movingly on the subject of staff in hospitals, and I do not apologise in any way for speaking on that subject as well We all know that there have been incidents which have been highlighted in the Press and in books, with such unattractive names as Sans Everything and Put Away. I am told that this flurry of literature is necessary to inform the public on the conditions in our mental hospitals, and it is right that the public should know. But the fact is, of course, that many of the public do not read these books; they read only the extracts printed in our daily newspapers. And these, I fear, have on the whole been very one-sided and have deeply disturbed the staffs of mental hospitals, who in many cases are working under extreme pressure in near to impossible circumstances. My Lords, they are the salt of the earth; and if in some isolated cases the salt has lost its savour can we in Parliament, the local authorities, and indeed the public, put our hands on our hearts and say that we ourselves are blameless?
I doubt whether the record of spending in the last forty years on our mental hospitals would, if carefully analysed, make us very proud. In many hospitals our mentally handicapped live in conditions which we do not allow to our worst criminals. There is public indignation if we allow our prisoners to sleep three in a cell; but the fact that many of our mentally handicapped citizens are sleeping in overcrowed wards, with beds touching, and the nurses, both male and female, battling to keep them clean and happy—and, if I may say so, to remain sane themselves—has been largely overlooked. No, my Lords; we have little

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to be proud of in the way we care for these unfortunate people and those who look after them.
I shall be speaking a little later on the contemporary thought for the future. But before we look into the crystal ball let us face the hard facts of the present. For some years I have raised my voice in this House on the requirement for hostels for the mentally handicapped, and I have in the past given a résumé of what local authorities have done under the permissive rights given to them in the Mental Health Act 1959. I do not intend to go into these details to-day, but I will firmly state to both Front Benches, and to all your Lordships, that the provision of hostels is totally inadequate for the urgent need at the present.
There are some local authorities who have a high record in their care of the mentally handicapped; and there are some who have not. And never at any time in our history should our consciences be more moved than at the present time. I would appeal to the public not to raise objections to the establishment of hostels for mentally handicapped in their neighbourhood. It is so easy to say, "Of course we must have hostels—but not next door to me". Those who can live in hostels will be harmless people, badly in need of help and friendship, and all the kindness that the public, whether they be children or adults, can give them. I can only trust that both Press and television will be of help in this cause. In some local authorities excuses may be made that, even if they had hostels, they would be unable to staff them. My answer to this is: acquire or build your hostels, and then get your staff. Experience shows that where there are hostels staff have been forthcoming; and I am certain that if they are shown the hostel there will be men and women of good will who will accept the challenge.
In disasters in war and peace we in this country immediately rally round—and in saying what I am about to say I am picking my words carefully. In many hospitals, including those in my own group, we have a great number of wonderful nurses, both male and female, from our Commonwealth. In my opinion, it is only right, should they so desire, that after we have trained them they should return to their country to take up posts in order to train their own people in the
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art and the care of healing. I have spoken to many of them, and the majority are undecided as to their future. But have we thought of the consequences should a great number of them, together with the doctors, decide to return to their native lands? Have we considered the consequences if a number of our nurses of the mentally handicapped came to the conclusion that conditions were so bad that they could not carry on? Have we considered the consequences of all this adverse publicity to recruitment of nurses, both here and overseas? My Lords, we indeed face a crisis, and I am firmly convinced that this crisis can be met only by the provision of increased accommodation in beds for the mentally handicapped in either hostels or hospitals.
Recruitment of nurses is naturally tied up with pay, about which I shall be speaking in a moment. But there is also the undoubted question of environment. There can be no doubt that it is far easier to work in bright, attractive wards rather than dark prison-like hospitals which savour of the old institutions. "Morale" is a difficult word to define. We all know that with fine leadership morale may be tremendously high in impossible situations; but this is characteristic of the British race. It is quite a different thing when nurses are working in terribly difficult circumstances, in which they can see no future improvement and at the same time are accused of cruelty and lack of care for their patients. On their behalf I would quote a line from Rudyard Kipling's famous poem:
"If you can keep your head while all about you
Are losing theirs and blaming it on you".
It is a well known fact in the world of hospitals for the subnormal that patients who are highly disturbed are prone to self-infliction of wounds, and in fact to wound each other. We do our best to help those who are prone to self-infliction of wounds by providing protective headgear, and in some cases gloves. Our nurses do all they can to prevent patients wounding one another, but it must be understood that, in the case of the severely disturbed, these things happen so suddenly that they may be impossible to avoid. In my opinion the complete answer to charges of cruelty is open visiting. We have nothing to hide. Any form of cruelty is immediately

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looked into. In return, we would ask visitors to trust us to give our all to the welfare of the patients, and not immediately to jump to a conclusion if a patient has an abrasion on his or her face.
As I am closely connected with mental hospitals, I feel a deep responsibility in speaking out for the nurses. Of course as in all professions, there are black sheep; but when I come back from a round of my hospitals I feel humble and grateful that there are so many people, both young and old, who are prepared, with loving care, to look after our fellow citizens. It infuriates me that, because of a few, as yet unproved, cases, they should be given a reputation which is wholly unjustified.
The present situation is frankly this. I say this in the full understanding that I have a group of hospitals with lovely 20-bedded wards in villas, and although for children we have a waiting list of over 100 we are better off than many. But as a Member of your Lordships' House I speak for all hospitals. There have been a number of conferences at which the future of the Hospital Service has been discussed. In one report to the Ministry it is stated that our mental hospitals are to be run down and abolished and that the mentally handicapped will be looked after in district hospitals, local authority hospitals and in the home. In my opinion it will be impossible to abolish the mental hospitals for at least twenty years. In fact, there can be only one solution to our present situation; namely, that to relieve overcrowding and the waiting list beds must be provided for adults and children. Time is not on our side. For this reason, in asking the noble Baroness to inform us of the plans of the Government for the immediate future I put forward suggestions which will go some way to deal with what is a very difficult problem.
I fully realise that it will take time to educate the public into having hostels next door to them. For this reason, as the noble Lord, Lord Amulree, has stated, where applicable hospital land should be released for prefabricated hostels to be occupied by patients released from hospital, and paid for by the local authority. This scheme would save an enormous amount of money in regard
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to the purchase of further land and would be the first stage in returning the mentally handicapped into community care.
My second suggestion is that in any New Towns or new housing developments it should be mandatory, commensurate with the proposed population, to include a number of hostels, thus making the hostel situation a fait accompli and furthering our hopes that, in the eyes of the public, more of our mentally handicapped can be brought into the community. My third suggestion, on which I have spoken before, is that if the cottage hospitals are to be closed in favour of district hospitals—a decision on which I cannot comment, except to say that it seems to be unpopular—I would hope that these hospitals would be used as hostels or, maybe even more important, as centres under the local authority for day help and for counselling the families of handicapped children and adults. If contemporary thought is that more children should be kept in the home these centres will be invaluable. It is to this subject that shortly I turn now.
I have spoken on many occasions of the strain placed on the family of the mentally handicapped child and I do not intend to weary your Lordships with repetition, but I would say this. If encouragement is to be given to such families to keep their children in the home, massive support must be given to them both in counselling and in money. Counselling centres must be set up where the family can obtain kind and understanding advice, especially on how to get assistance. Forms can be very cruel, especially in the early years when the whole family is desperately keyed up. Home help and laundry must be considered, for in the first place the parents are never able to go out together unless there is some responsible person to look after the child; and in the second place, and maybe reaching into adult years, incontinence can put an unbearable burden on the parents.
Above all, in order to encourage families to keep their children in the home an assurance must be given that the children will be happily looked after in case of their parents death. I am wonderfully blessed in the fact that my daughter can stay at St. Mary's Convent, Roehampton, for her life, but I get a number of letters from people who know

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that I am interested in this subject, begging me to find a place for their child. It matters not whether they are able to pay. There do not appear to be vacant beds, in hospitals or homes that I know of, to accommodate them. It would be of great assistance if there could be set up a central bureau of information—something on the lines of the emergency bed service —which would have knowledge of accommodation for the mentally handicapped available in hospitals, local authority and charity homes, and which would be able to advise families who have got to the end of their tether and require temporary relief, and those who have reached an age when they wish to have an assurance of their children's future in case of their death.
Let it be fully understood that parents just cannot leave the case of the mentally handicapped child to other members of the family. Other children will be growing up and will have children of their own, and it would be unfair to leave with them any care of mentally handicapped child or adult. We must take this heavy burden off the family, and ensure that anyone can die in peace and know that their child will be looked after in a way of which they would approve.
I know that I am speaking for quite a long time—more than I usually do—but I would add one final observation. In the last few months we have seen how strikes have been settled by the main demands being met. It is not necessary to go into that matter in your Lordships' House, but I cannot help feeling that those who are unable to strike through humane considerations are at a considerable disadvantage. Is it not time that, out of our consideration for fair play, we show our gratitude for the work that they do, and also, because of the urgent requirement of recruiting, decide to give a substantial increase in pay to our nurses? Those of us who work closely with them know their worth and realise fully their difficulties in making both ends meet at the end of the month. Apart from this, it is monstrous that a job which has responsibility for making decisions of life and death should be so badly paid in all ranks of the nursing service. The Daily Telegraph has announced that a great increase, amounting to £15 million, has been given to ancillary staff. I am delighted to read it. But does not this
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award make the case of the nurses even more urgent? My Lords, it is indeed urgent. It is a subject which is deeply worrying many of us. Something must be done immediately if real trouble is to be avoided.
I have spoken enough, but I trust that everyone in the House will realise how deeply we must feel with the situation as it is. We are in a crisis. As we go on we shall go deeper into that crisis, unless something is done to relieve the overcrowding of hospitals and to see that those who give such valuable service, our nurses, are properly paid.
5.12 p.m.
BARONESS BIRK: My Lords, may I first add my congratulations to the noble Countess, Lady Loudoun, on her maiden speech, and say how both informative and human I found it, as I think we all did. I am extremely grateful to the noble Lord, Lord O'Hagan, for couching his Motion in such wide terms so that it is possible for me, as Chairman of the Health Education Council, to say something about health education in this field. The Health Education Council, as your Lordships know, was set up as a result of a recommendation of the Cohen Committee. It had rather a prolonged gestation and also an uncertain post-natal progress, as I am sure my noble friend Lady Serota will agree. She was its first Chairman, and I had the privilege of following her as Chairman; but there was a year's gap in between. Though the Council itself was working during this time, there was no organisation, very little personnel, and it is really only in the last six months that we have been, so to speak, in business.
We are in an extraordinary position. We receive a main grant from the Ministry of Health—and I would point out to the noble Lord, Lord O'Hagan, who compared the sum of £223,000 that we get with the £10,000 which the Exchequer gives the National Association for Mental Health, that what we get is meant to cover the whole field of health education. I think that, measured in those terms, one can almost say that what we receive is proportionately even less! While cooperating and working out our programmes in conjunction with the Secretary of State and the Ministry of Health

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we do have a considerable degree of independence. We are the Health Education Council, Limited. This helps us to act both as a stimulus and, sometimes, as a goad to the established authorities, both central and local.
It is true that in our present and future estimates we have no special allocation for mental health. This does not mean for one moment that I, or the members of my Council, think that this is something that we should not be concerned with—far from it. This is something with which we are greatly concerned. But one of the reasons we have nothing under that head is lack of resources. In the context of mental health (I am talking of mental health, rather than mental illness or mental disease, about which so many other speakers have spoken, with great experience) the recent brochure which we pubished makes it clear that at least six of the subjects which we pick out as being among the most important of the current health problems have a mental as well as a physical content: alcoholism, drug addiction, venereal disease, sex education, health problems of new immigrants, preparation for retirement and helping old people to stay healthy and independent. I think this is a very important aspect of our work and our approach, that we should be able to try to integrate physical health with mental health, rather than have it divided, as unfortunately it is divided to such an extent because of the necessity to concentrate on mental disease and mental illness.
Where the major mental illnesses have their origins in biochemical causes and do not seem to be precipitated by behavioural or environmental causes, our rôle can be very important in helping to change the attitude of the community. My noble friend Lady Llewelyn-Davies referred to social attitudes, and there is no doubt that there has been a great deal of change. But I take issue with the right reverend Prelate when he says that the stigma of psychiatry has gone. This just is not so. It may be true so far as a great many fairly sophisticated people are concerned, but to many people to-day the word "mental" still means mad; and this is something we have to accept; it is no good pretending that it is not so. Indeed, this is to such an
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extent that the editor of the periodical, Mental Health, the publication of the National Association for Mental Health, was telling me that they were considering trying to find an alternative title simply in order to get away from the word "mental".
So far as the mentally handicapped are concerned, I think that we in the education field can perhaps be of some help. Again, my noble friend Lady Llewelyn-Davies spoke about a caring community, and I believe that a great deal of education of the community still needs to be done here. I am talking now of the cases of subnormal people. The principal way one can deal with the problem is through education of the patient, so far as that is possible, but much can be done also by education of the teachers and of the family, and also of employers. The attitude of employers is extremely important because a great many mentally handicapped people could be employed on certain jobs if only employers were prepared to take them on. But they have all sorts of fears about this, and often are not prepared to give them a chance. In addition there is, as my noble friend pointed out, the need for genetic counselling and emotional counselling, because the breakdown (to which several speakers have referred) in families can be a very serious thing. Very often a decision has to be made as to whether a child can be kept at home or should be sent to an institution; and this decision may leave the family, and particularly the mother, with a tremendous feeling of guilt. I am not suggesting that we should encourage people to put their children into institutions, but there are circumstances where it really is far worse for the child and for the family for the child to be kept at home. I feel that in these cases we should be doing what we can to mitigate the guilt, and to understand and support (my noble friend used that word) the family and the relatives, as well as the patient.
Where I think that we in the health education field can be of real assistance is in the preventable stresses, because here when we talk about prevention the main way we can bring it about is by means of education. As the right reverend Prelate pointed out—and it is perfectly true —figures show that in 1966–67 29 million working days were lost through mental

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disorders, depression and nervousness. This evidently equals £25 million in sickness benefit; but that figure gives no indication of what it means in terms of personal tragedy, unhappiness or, again, the effect on the family and workpeople and other people around.
In the prevention field one of the problems with which we are particularly concerned at the moment, and which I believe is responsible for a great deal of the bad mental health which is preventable, is the problem of the unwanted pregnancy. The effect of the unwanted pregnancy, not only on the mother but, if there is an illegitimate child, on the child itself, and on the child who is unwanted even though born in wedlock, and on the whole family can be extremely serious and traumatic and often long-term. What we want to see is a comprehensive contraception service which is part of the National Health Service. The Family Planning Association, whose slogan this year, "Every child a wanted child", is one that I warmly support, has done, as we all know, a magnificent job in this field. Nevertheless, the time has now come, in my opinion, when this work should be part of the State Health Service with, of course, the Family Planning Association and other bodies participating.
The question of education here is extremely important. One of the things that we have been pressing the Ministry to do is to try to see that whenever possible, when any woman leaves a hospital after an abortion, miscarriage or the birth of a child she is offered contraceptive facilities and is directed to them. At this point—and this is often the point where again some form of education could start—the ideal would be to have contraception clinics attached to the hospitals, all the hospitals, as well as having the contraceptive facilities provided by the local authorities. I have set up a Sex Education and Contraception Advisory Panel in order that we can work out the best way to set about so many of these problems, because there are a great many problems which come very much into the area of mental health. It is not just a question of the physical facilities and the geography. We also need to know why so many women who know about and have access to contraception do not in fact use them, and either have
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an abortion or give birth to an unwanted child.
We are also extremely concerned with sex education. Criticising parents for dereliction of duty is a very popular pastime, but I think it is both counter-productive and quite unfair, as many parents find it absolutely impossible to communicate in this way. Some of the reactions that I saw in letters to The Times, and other papers, to the announcement of the B.B.C. programmes, seem to me, with great respect to the Archbishop of Cardiff and some of the other people who wrote, a misunderstanding of the present problem. What we must hope for is that we are going to make it possible for future generations of parents to have this sexual dialogue with their children. This means that we must have a far better and more coherent form and more consistent system of sex education in schools which is part of an ongoing course in living. This seems to me to be part of the basis of a stable and good mental health structure for this country. Though there are some courageous exceptions, on the whole I am afraid that sex education in schools is inadequate, uneven, and often nonexistent.
Recently—and I am not talking about years ago but in the last few months—I was talking to a number of youngsters from different schools; secondary modern, grammar and comprehensive. They were about the age of 15, and I asked them what sex education they had had. The majority had had one lecture at the age of 11, and some had seemed to manage to miss out altogether. Many knew all about the sex life of the salmon, but, as one boy pointed out, as he was not a salmon it was really very difficult for this to be of much use. One girl said, "Yes, I know all about V.D.". I asked, "What were you told? How old were you?". She said, "I was 11, and the games mistress told us never to go out with boys with spots around their mouths." If that is the extent of our sex education., then we ought to question the basis of whether we are going to have a positive mental health policy in this country.
But if the educators are not educated, how can they be expected to educate their pupils? This again is another of the things with which we are concerned. A report prepared by the Young Teachers

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Advisory Committee of the National Union of Teachers shows that of teachers entering the profession between 1964 and 1967, over one-third received no instruction in sex education during their three year training course. Of those who did receive it, 13 per cent. pronounced it inadequate, and only 12 per cent. found it was good. Therefore, in the Health Education Council we are calling a conference on sex education next spring in order to try to hammer out a coherent and consistent policy, and face up to many of the implications frankly and without hypocrisy, and to face the problems which are swept under the carpet. There is a point at which people shy off them. People will give instruction up to a point, but when it comes to imparting knowledge on contraception and giving advice they shy off it. I think we have to accept that the morals and values must be included, one hopes, in parental teaching, teaching in school, the churches, and any other agency with which the young person comes into contact. But it really must be at some point divorced from clinical advice, otherwise the results will be shown not only in bad physical health but also in bad mental health as well.
The Health Education Council has a field division which gives in-service training to health visitors and health education officers on human relations. One of the most important of our tasks, as I see it, is communication, because although a great many people are trained in their subject and have the knowledge, I think it is a skill in itself to be able to put it over to the people concerned, and even more so to many of the groups who are most at risk in the mental field. We need very many more trained health education officers. The majority of health authorities have someone responsible for health education, but only a minority of these people are professionally trained. This is no longer a job for the amateur, and, like many of us here, I am waiting anxiously to see what the Government's legislation on the Seebohm proposals is going to be. I earnestly hope that the conflict between the various vested interests will not weaken the sort of family service that so many of us want to see.
I believe that a health education officer must be an essential part of every local structure, because he or she forms one of
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the bridges between the medical and social agencies which are so important in the field of mental health work. For instance, in Croydon, which has a very good health education set-up, there is a mental health education committee which meets in the health education office, and which brings together G.Ps. and local and voluntary organisations, as well as so many other people who are involved in that field.
Also, because it is now recognised that education and behaviour patterns, which are going to affect the mental health of our lives in the future, start right back in childhood they hold ante-natal classes explaining the emotional effects on the mother and father before the arrival of the baby. I think it is very important to bring the father into many of these activities, because this creates a much better and healthier atmosphere in the family.
There are also what they call "toddlers' clinics", where mothers have group discussions every fortnight about the whole family. This is very important, because J. W. B. Douglas, in his book All our Future, reports that the mothers of a number of delinquents on whom he was researching and to whom he was talking had not used the facilities available for child welfare in their children's early years.
The health education officer should cover the school health service; and it is interesting that even in a place like Croydon, where the health education set-up is a good one, half the schools co-operate but the other half do not. We are concentrating on two campaigns which have a very direct relationship to mental health. One of them is anti-smoking, and, although that may sound a physical matter, I think there is a very strong mental content because although people who smoke are very well aware of the dangers there is still this compulsiveness to smoke which has something very much to do both with personality and, presumably, also with the stress of the life we are living. The ether is V.D. in young people. To tackle these matters adequately, we are doing an evaluation so that we know where we can make the most impact.
We also hold a number of colloquia—I was not sure what that is, but I understand that it is "a getting together"; it

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is not my word—on different subjects. Although we cannot run specific campaigns on them ourselves, it enables us to bring together the people concerned. We have had one on cancer, and yesterday we had a very successful one on nutrition. Here, again, you cannot completely segregate the physical from the mental, and one of the distinguished doctors present told us that there was now evidence to show that in the later months of pregnancy, or in the first few weeks of infancy, malnutrition can affect the growth of the brain. Similarly, another doctor concerned with geriatrics pointed out that his research had shown that malnutrition can lead to degenerative senile psychosis. So all these matters are very much interlocked.
There is another tie-up, my Lords, between mental health and nutrition. Domestic science training is very important, and such training, including budgeting, should be part of the curriculum of girls' schools, because so many of the family breakdowns, and so many of the difficulties that people get into, result from the mother's not being able to cope and not knowing where to go for help. Our next colloquia will be on mental health. Health education cannot be done just from the centre. We can lay down the guide lines, and we can produce material as we will; but it needs the close co-operation of doctors, nurses, teachers, social workers, and all those people who are in direct contact with the person concerned. One of the most important aspects is the training of doctors and nurses, and it seems incredible that sex education and human psychology form part of the basic curriculum for medical students and student nurses in so few medical schools. Then I think that medical students and student nurses need far more education in communicating with the patient, because the G.P., who has the closest contact, is often too embarrassed to discuss many of the problems with his patients, although the spoken word is often very much better than a prescription for another pill or another drug.
I also attach a great deal of importance to counselling. I am a member of the Youth Service Development Council, and in our recent publication, Youth and Community Work in the '70s, we stress the tremendous need for counselling for young people. I understand that at
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Cambridge University a group of about 12 G.Ps. and social workers, has been set up as an experiment in counselling for students. Many people either receive no help at all or are sent to a psychiatrist, when their G.P. or a counsellor could help them if those people were only available.
Finally—and I must apologise for taking up so much of your Lordships' time—we must look ahead to the human result of the technology and automation about which we hear so much, and which we also feel, since it is all around us. The Minister of Posts and Telecommunications, Mr. John Stonehouse, referring yesterday to some of the wonderful computers that there are going to be in the '70s, when people will not even have to leave their own homes and can do all their office work at home—a situation which, it seems to me, is going to create a tremendous problem of loneliness and isolation—said that Britain in the 1970s would get a new and infinitely more refined and sensitive "nervous system" What I want to know is, what is going to happen to the nervous system of the individual? These are matters about which we must be taking a very much longer-term view than we have taken up till now. In America, these are subjects with which "think tanks" are concerned, but that takes the sort of money that we do not have to spare. But I do not think we can afford to leave the subject alone, as otherwise we are going to have a great deal of human disaster.
In conclusion, I really believe that health education needs to be taken much more seriously if it is to become a natural part of people's lives and upbringing. But this can be done only if there is a far bigger allocation of resources. The subject must be high on the order of social and medical priorities, and a bit could be pinched here and there from other places. The noble Lord. Lord Bernstein, who was introduced in your Lordships' House this afternoon, said in a speech yesterday that he thought that colour T.V. would cost the nation £600 million over the next five years, and that we could not afford it at this time. He compared this unfavourably with money spent on housing subsidies, roads and education. I should like to add to that list health education, because if there

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was ever a good investment it is spending more money on health education. This will produce high dividends in economic, social and human terms; and this, in my opinion, is one of the most important ways of enormously improving our mental health.
5.40 p.m.
BARONESS SWANBOROUGH: My Lords, like other noble Lords I should like not only to thank the noble Lord, Lord O'Hagan, for making to-day's debate possible, but also to tell him what he has been able to do for me, the impetus which he has given to my thinking and the tremendous impression and inspiration which he has been able to create. It has been said before to-day that this strength coming from youth is doubly valuable, and perhaps he will never realise what he has started by putting the Motion down to-day. If only I had his ability to sychronise my thoughts with my words, I should be a much happier woman.
But, having spoken of Lord O'Hagan, I should like my first tribute to be to the nurses in the mental and subnormal hospitals. I think it is a mistake to keep on talking about the bad things which have been said. I should like to hear people refer to the things they have realised as they have visited hospitals and seen what these women and men do. This is one case where the greater embraces the less, and that is why I put the women before the men! I have a feeling that anyone who travels the country and visits mental hospitals can only come back, as I do, humbled at seeing what these nurses are prepared to do and the way in which they do it. I think I have the right to say this because I represent a body which works in 105 out of the 190 mental hospitals and in 49 out of the 181 subnormal hospitals. Here, I am ashamed that the percentage should be so low, but I hope that we shall soon he able to make it much higher. One of the things I regret about this afternoon's debate is that more tributes have not been paid to the tremendous work that has been done up to date by mental health associations of a variety of different natures. I suppose it is because of my age that I can look back to the times when such things did not exist, and to the great efforts of the late Lord Feversham and
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others, and can look at to-day's situation, which owes a very great deal to these societies.
My contribution to-day, I fear, is only a very small one. I want to make one point, and one point only. It is to emphasise that the slightest contribution from the volunteer who makes even the lowliest gesture is of value, for it is the start of the involvement of the individual within the community and is of paramount importance. I think the realisation by that individual of his own particular responsibility within the community is the start of the effort we are anxious that individuals should make in participating in helping both with mental health patients and also with subnormal patients. I think this can be achieved only by contacts and the understanding that is bred of such contacts. To do this, a great deal of individual hard work must be undertaken.
The reasons why people are sent to mental hospitals are many, but it is mostly because of their disregard of the rules of society or because in some way or other they have become too difficult within their own environment and are either an embarrassment or a real nuisance to handle within the community. One of the really serious problems which has not been mentioned today is that life in hospital often results in an illness of isolation, and institutional neurosis. This often results in the patient's lacking confidence and being fearful of going back to live in the great world from which he has come.
It is often thought that it is difficult to find volunteers to work in mental hospitals, but this is not so. It is true that there used to be a shrinking away, and the start of work in such a hospital was something which had to be undertaken rather carefully, but once volunteers have found how easy and how tremendously worth while the work is, the catchment area can produce the volunteers required. The demand, as it should be set out, is for regular workers, both in the mental and in the subnormal hospitals; and, whether it be for a day a week, half-a-day a week or whatever it may be, the work quickly becomes interesting to the individual. The patient gets to know and trust the volunteer, and the volunteer begins to appreciate the reason for his contribution and to understand why he is needed.

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I do not have to tell your Lordships that mental illness touches all sorts and kinds of persons, but I would remind your Lorships that equally help in voluntary service can be given by all sorts and kinds of human beings. It is the person that matters, not the clothing or the cut of the hair. The very quiet, simple, unassuming housewife is a much more welcome helper, because of her understanding smile and gentle patience, than her counterpart with a rich car and a hasty manner. The help from youth which comes forward to-day is of tremendous value and welcome in every single way. It may not, perhaps, be uninteresting to report that due to a Motion in this House, set down by the noble Lord, Lord Willis, youth, together with a background of older people, undertook to build an indoor, heated swimming pool in one particular mental hospital—a hospital which has 1,200 patients. The matron tells me they have never had any shortage of nurses because recruitment is facilitated by the fact that there is a swimming bath.
There are many ways in which those who live in the area can help. Very often people do not realise how much they can do. They can help in a mental hospital with music or drama, with art or craft, with needle or paint-brush, with visiting or canteen work. The work in the mental subnormal hospitals is rather different and has its own problems. The social behaviour of the patients is unacceptable to the community, and their personal care needs constant supervision. They have not learned to live within the community, and so they are sent to an institution. Their surroundings are not what any of us would like, but we all hope that they are going to be very much better—and, here again, keeping in touch with the outside world, with the community to which they belong, is supremely necessary.
My experience is in the simple, humble things done by the volunteer—things done on a large and continuous basis. The provision of bright and gay canteens where the patients can feel that they are on their own and away from their usual hospital environment; the running of a shop; the provision of a club—these things are the beginning of a small movement towards the restoration of dignity and independence. As patients order and
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pay for a cup of tea and a cake for themselves they begin to realise that they can do the same thing for other people. They recognise that they can entertain a friend, and they immediately take the opportunity to talk to someone sitting next to them at the table— a table at which the electrician, the telephone operator or someone else has just popped in for "elevenses".
All these little things start the patient moving forward towards self-dependence. They come slowly; and these people need a tremendous amount of patience to help them, whether it be in the selection of sweets or of cigarettes. I have watched a woman take 15 minutes to decide whether she would have pink or blue suckers! One realises then what is necessary in the way of tolerance and understanding on the part of the people who are helping. The time taken when a man is trying to decide what sort of tie he should buy or a woman is deciding on the colour of the stockings she is going to get is something that is unbelievable unless one watches oneself. With all these things, volunteers can help. They can help with the reading of plays in the clubroom, and they can help with all types of things—things that are a start to the return to normal life, aided by the quiet, patient help that can be provided. I would ask your Lordships to believe me when I tell you how deeply moved I have been, again and again, watching a man sitting in a canteen with a cup of coffee and a large jug of hot water, eking out his coffee, with the aid of a great deal of sugar, to last as long as two hours, so as to be sitting at a place busy with the va et vient of the people who, to him, are the world, and being given a feeling of being among other people, a feeling of friendliness, a feeling of happiness. Shops and canteens teach the patients to make choices and to spend their money. Beauty parlours which have been started in some hospitals help the women to re-establish their own self-respect, and individual kitchens where cooking is reintroduced to the housewife are of tremendous help. Friendly visiting is of great value. This is a field in which a great deal more could be done by a great many people.
As the volunteer works in the hospital —and this is the theme I really want to impress on your Lordships—so does much understanding come to him, under-

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standing that as an individual within the community he can really do something and be responsible. As he returns to the community this understanding in turn is shared with others by talking to them and by suggesting to them that their help also is needed. So little, when it is provided by those who are thoughtful of the loneliness of the patients away from home and personal surroundings, means so much when one is in hospital. Those with whom I have talked and who have invited patients to their homes for tea (and use good china and good linen) are made humble by the appreciation shown by their guests. A garden tea party with posies of flowers by each individual's plate results in so much pleasure that the hostess is appalled to realise how much she could do if she only applied herself to it.
Voluntary service in its manifold shapes can teach individual members of the community something of the degree of tolerance which can be such a strong factor in influencing admissions to and discharges from mental hospitals. This is where the community is suffering from a lack of knowledge, lack of impetus and lack of energy. One is apt to think of the community as a whole instead of as a collection of individuals. I am sure that if those who make up the community were to realise even a small part of their capacity to help, the lot of those in mental hospitals and subnormal hospitals could be greatly helped. The reentry, such a difficult thing at any phase of life, could be made easier for the ex-patients as they return to their own background within their own community.
5.55 p.m.
LORD AUCKLAND: My Lords, first I should like to apologise to the noble Baroness, Lady Serota, and to the House because I may not be able to stay until the end of the debate. To-day is Prize Day at our local district hospital in Epsom. I had promised a long time ago to attend and I feel I ought to do so, if only out of loyalty to the staff of that hospital. I hope that I have the indulgence of the noble Baroness and of the noble Lord, Lord O'Hagan, whom I should like to congratulate on a most courageous and thought-provoking speech with which to introduce this debate. I should like to add my congratulations to the noble Countess, Lady Loudoun,
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on a particularly charming maiden speech. I am sure that we all hope to hear much more from her in the future.
My Lords, Governments of all political Parties come and go; but the mentally handicapped and the mentally sick are with us, however good or bad the Government may be. I should like to follow the noble Baroness, Lady Swanborough, in her typically wise speech when she said that we are a nation of individuals and not just a mere collection of people. Those who are mentally handicapped are, each one of them, single, individual people. I think it is a fair estimate to say that on average one person in eight or nine at some time in their lives has treatment for some form of mental illness. This happened recently to a very close member of my own family. It need not necessarily be something particularly serious; it may just be a nervous breakdown—which is a small thing compared to the illness of somebody who is severely handicapped for life. It is when we think of mental health along those lines that our attitude, whether contemporary or in the past, must really take a jolt.
The first experience I had of visiting a mental hospital, or an asylum as it was called at the time, was at a large hospital in Bedfordshire. It was still known as "the loony bin", but, thanks to a very enlightened medical superintendent, the lot of the patients and the staff—this was just after the last war and shortly before the National Health Service came into being—was a relatively happy one. I myself used to play billiards with some of the patients as well as with the medical superintendent and his son, whom I happened to know particularly well. Contemporary attitudes have changed. There are more open days in our mental hospitals. The hospitals on whose house committee I have the honour to serve has as its outstanding chairman of the hospital management commiteee a Member of your Lordships' House. We have heard his first-class speech to-day. Here we have an outstandingly good staff, a dedicated staff with whom those of us who are on the house committee work in close liaison. We visit the wards; we talk to the nurses; we talk to the patients. Some of the patients are very severely handicapped; many will never walk; many will never talk; but I repeat that

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they are all human beings and should be treated as such.
Much has been said about our nursing staffs. Perhaps we tend to think of a radius of 30 to 40 miles of London as containing the whole of our mental hospitals. Some forget that there are places like the Black Country, that there are places on Tyneside and places near Glasgow which are perhaps not as salubrious as those areas nearer London. But, my Lords, mental health in those areas is just as important, if not more so, and one should be particularly grateful for the work of the staffs of hospitals in areas where it is perhaps not so easy to gather together a "League of Friends"; or where the local Rotary Clubs or Round Tables are perhaps not quite so prolific in membership. However, I think it may fairly be said that what might be lacking in quantity would certainly be made up for in quality, because the people of those places are people with extremely warm hearts.
There is a large mental hospital in Hertfordshire—I read about it in the Sunday Times supplement the other day —which has something like 24 different nationalities represented on the nursing staff. There are a large number of hospitals, and certain other noble Lords and I attend the prize-giving ceremony of one of them. There almost all the student nurses come either from Commonwealth countries or countries other than Britain. We should be extremely grateful to these people. It hardly needs me to reinforce the view already stated that if these people who came from Spain, India, Hong Kong, Sweden and other countries went back to their own countries tomorrow, it would be no exaggeration to say that the National Health Service would break down.
I live in a town in which there are seven mental hospitals, dating back to the Victorian days when these places were situated in concentrated areas. Recently one of the evening papers carried out a picture probe among some of the local people. This probe was not very favourable to the hospitals in the area. The impression given was that the local people lived in a reign of fear. My Lords, that is just the attitude that I hope we are trying to dispel this afternoon. Of course, if you have a young family
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and if you have patients from mental hospitals in the area, there is some risk. There have been incidents on our local common in which young girls and indeed children of both sexes have been attacked, and every now and again it may well be that a patient from a mental hospital was responsible. But that is not by any means true in every case, and I think that our Press and television, who on the whole do a very good job in this connection, have a bounden duty to make this absolutely clear; because if the staffs of these hospitals are not loyally backed up by our communication media, no campaign by any Government or from any other source, to recruit nursing stalls will succeed.
My Lords, I conclude by saying this: the more people who can visit mental hospitals on open days the better. The more schoolchildren from private and State schools who are enabled to meet their less fortunate colleagues the better. We all have to realise that we in your Lordships' House to-day, who have our sanity, are no more or less human beings than those unfortunate fellow creatures who cannot walk or talk, many of whom are in our mental hospitals. As I see it, that is what this debate is all about.
6.5 p.m.
LORD PLATT: My Lords, as one of the medical Members of your Lordships' House, I should like to add my thanks to those of other noble Lords who have thanked the noble Lord, Lord O'Hagan, for his excellent opening speech and for initiating this debate. The noble Lord deliberately opened the subject very widely for us in his title. Naturally, he referred to the fact that he could not cover every aspect of it himself. Nor, of course, shall I try to do so. I shall confine myself—not I hope at too great length—to two questions, some points about community services, and something about the education, or I might almost say the non-education of doctors and medical students in psychological medicine. As I have never specialised in the field of psychological medicine myself I have consulted a number of eminent colleagues who are my friends, and I shall call on their material and quote from it when necessary.
There has been great progress in mental health in the last 25 years and developments of which I think we may

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reasonably feel proud. The opening of the locked doors in mental hospitals and the opening of the mental hospitals into the community have transformed the relationships between patients and staffs, both within the hospitals and within the community, and the attitude towards the needs of psychiatric patients. The establishment of psychiatric units in general hospitals, the more active therapeutic programmes of mental hospitals, have brought the image of the psychiatric patient closer to that of a physically ill person who requires medical care; and at the same time an increasing emphasis has come to be laid on the psychological, social and family facets of psychiatric disorders. This has had its effect on medical practice as a whole.
Yet, my Lords, the amounts of money invested in community care are quite inadequate to do anything like a satisfactory job. There are far too few social workers, and the role of these and other community workers, and the optimal form of organisation, requires more precise definition. There is urgent need for objective investigation into the quality of care of such individuals who are discharged from mental hospitals into the community. There is some evidence that areas in which the community services are exceptionally poor get more than their share of patients discharged from the local hospitals. Some of these patients tend to drift into inferior lodging houses, or into vagabondage. As one of my friends said, it has become accepted as a principle that the community should care for its disabled persons, be they physically or mentally handicapped, but nobody has really defined community care; least of all have they asked whether the community really does care. Moreover, the effects of these current trends on the family also require investigation. Families are expected to care for psychotics, dementias in old people and the mentally subnormal. What are the social consequences of this? There is some danger of a backlash of intolerance. It tends to be forgotten that there are not numbers of pairs of spare female hands available at home. The emphasis on community care has come to stay, but programmes will need to be developed and applied with realism, flexibility and humanity, if we are not to run into serious difficulties.
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Turning now to medical education, and starting at the beginning, I must say that there is still a quite inexcusable lack of any proper training in psychological medicine, and in the psychological background which should precede it, in most of our medical schools— though many of them are beginning to wake up to the facts. The Royal Commission on Medical Education called attention to this in strong terms and also to the almost equal lack— can you believe it?—of sex education, even to medical students, in universities. I was glad that the noble Baroness, Lady Birk, referred to this point in her speech. This lack of adequate attention to psychological medicine leads to a vicious circle. Because of it good men are only comparatively rarely attracted into psychiatry. Thus there is a shortage of teachers and, of course, the inadequate instruction in psychological medicine goes on. Fortunately, there are now a few very important exceptions and some very good growing departments of psychiatry, psychological medicine, mental health—call it what you like—but they are usually inadequately staffed and provided for. There is a real need here for something to be done to encourage these departments with better facilities and more money to spend, more teaching time and more opportunities created for the personnel they train, so that in time—and it will take some years —we can build up a core of good research departments in psychological medicine and good teachers to go with them. Only in this way, by a new realisation of the importance of psychological medicine in medical education, will the vicious circle to which I have referred be broken.
Even those who do become teachers are mostly concerned with adult psychiatry and not with child, or (as it is better called) family psychiatry. The emotional development of the child is neglected in teaching and research. Yet only here can the beginnings of psychological illness be studied; and only through this study can the violence and instability of certain young persons be eventually prevented or at least mitigated. The proper education of future general practitioners in psychological medicine is equally important and should also have a preventive function. At present, far too few of them are equipped to deal with the everyday neuroses and anxiety states,

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and with the early symptoms of mental breakdown which form so large a part of their practices—though here, as everywhere, I know of honourable exceptions to the general state of ignorance, an ignorance for which, I repeat, the medical schools are largely to blame.
Recruitment to the field of psychiatry suffers in another way. Quite naturally, young men and women with inquiring minds have been caught up in the technological advances of our age and are attracted to the departments in which phenomena of organic and physical disease can be accurately measured and assessed; and are little attracted to the vaguer and more difficult disorders of behaviour, which often they find frightening and bizarre. This re-erects the barrier between disorders of the body and disorders of the mind which it is important to try to remove; and, as a result, psychiatry gets less than its share of the kind of individuals it most needs. Yet there are plenty of questions to be answered in the psychological field, plenty of opportunities for rewarding research. One way to attempt to break the vicious circle would be to do what I believe has been done in Sweden, for the Government to take action to endow in various universities and medical schools research departments in psychological medicine. It is believed by friends whom I have consulted that there would now be enough good men to make a start with departments such as these.
My Lords, I have spoken mostly from the doctor's point of view, though I am very well aware that in this field the doctor is but one member of a team. But other noble Lords have spoken of other aspects of the mental health services, and I am convinced that doctors have an essential role in creating the new attitudes towards mental health which the noble Lord, Lord O'Hagan, so rightly feels are necessary. But until medical education is drastically revised, the doctors will far too often remain reluctant, unconvincing and insecure in a field in which their good influence and guidance are so much required.
6.17 p.m.
BARONESS STOCKS: My Lords, I had intended to discuss two matters which seem relevant to this debate. One was the question of priorities in connection
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with public spending, but my noble friend Lady Birk has dealt very pertinently with that and given us some exceedingly vivid examples of the relevant expenditure on various services. The only thing I would add to what she said is to suggest that the money spent on the Concorde would go a long way if spent on mental health services.
The other matter that I wish to raise was referred to by the right reverend Prelate the Lord Bishop of Lichfield, when he spoke of fear of psychological treatment. With several other speakers, he pointed out that recent publicity given to deficiencies, and even abuses, in mental hospitals might have occasioned such fear. It is possible that there have been abuses, and we shall all agree that they should not be swept under the carpet: if they are not known, they cannot be remedied. There is no doubt that those sections of the Press and others who have given them publicity were not actuated by a desire to denigrate or frustrate the mental health services as such.
The same cannot be said of a sect which seems to have taken the field under the name "Scientology". For some months—indeed, I think, for a year—I have received, unasked, a great deal of literature from that sect. Much of it appeared to me to contain what can only be described as the ravings of lunacy. My first impulse was to consign it to the wastepaper basket, and that I did for some time. Then I began to think again and I consigned it instead to my neighbour, Lady Norman, who is a devoted and hard worker for the National Association for Mental Health, of which I believe she is Vice-President, because it seemed to me that this was getting beyond a joke. Such literature, if widely disseminated and likely to fall into the hands of ignorant or disturbed people, might indeed create a general fear of psychiatry, of psychology or of the mental health services, as such: because the literature that I received contained accounts of sadistic torture in mental homes and psychiatric units, of horrifying pictures of skeletons labelled "psychiatry", and of trampling on unhappy human beings. So it went on from week to week, and is, I believe, still going on. No doubt other noble Lords have been similarly visited.

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The existence of this attempt, as I regard it, to denigrate the mental health services raises for the citizens of a free country a rather awkward problem. We pride ourselves on our freedoms: on the freedom of the Press; on the freedom that we allow individuals to express opinions, even unpopular opinions, to persuade others to share their opinions; to conduct propaganda, and to issue literature on behalf of their opinions. That is part of the freedom which we, as a free country with a free Press, cherish, and, I hope, shall always cherish. But there comes a point, in face of the kind of propaganda which is being carried on by the scientologists, when one may have to compromise with that conception of freedom.
I understand from the evening papers that I saw a little while ago in the Library, which contain a report of this afternoon's annual meeting of the National Association for Mental Health, that members of that sect, who have apparently infiltrated the membership of the Association, succeeded in disrupting the meeting, which I gather from the Press has been adjourned. What the result will be, I do not know. But this raises a legal problem. What I really want to know is whether Her Majesty's Government are aware of this risk; whether they have made any inquiries into the teaching and practice of this particular sect and its possible effect on the mental health services; and, if so, whether there is anything they can do about it.
6.22 p.m.
LORD CRAWSHAW: My Lords, I should like to start by thanking the noble Lord, Lord O'Hagan, for introducing this debate to-day, because I feel that if ever a subject wanted a good airing, this is it. The problem of mental health is often swept under the carpet. In spite of progress in this field, I feel that there is still a great deal of misunderstanding, fear and mistrust. There is an element of "Don't know" and "Don't want to know". The composition of our planet has been explored, and outer space and the oceans are continually being probed. A tremendous effort has gone into the finding out about the rest of the human body and its ills, but the mind and the
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brain has been left severely alone. To my mind, mental illness still carries a social stigma. People continually express revulsion about discrimination in other spheres, and I hope that some of this might be channelled into expressing disgust at treating mental patients as something apart. The illness itself makes no distinctions: it is everyone's problem, and can strike quickly and cruelly. I believe that one in four families in this country is in some way affected.
Is the attitude which I have described reflected in the fact that although some 40 per cent. of hospital beds are filled by mental patients of some kind, mental hospitals are in comparison understaffed and under-financed? I believe that a psychiatrist may well have to look after 200 beds in a mental hospital, whereas his counterpart in other spheres may not have to look after more than 50. The situation at the Ely Hospital seems a natural result of understaffing and under-financing. But I, like other noble Lords, should hesitate greatly before trying to criticise staff, who have a very difficult job in any mental hospital, because I feel that they and the patients alike are victims of certain public attitudes. While on the subject of staff, I should mention that over 40 per cent. of junior hospital staff come from abroad, and though we are grateful to them this is not a satisfactory situation in regard to psychiatry, where we need the maximum communication between doctor and patient. Three hundred doctors a year leave this country, and, as I say, this is an unsatisfactory state of affairs.
I want to say a word about rehabilitation, re-employment and recirculation of mental patients. I feel that more should be done to bridge the gap between hospital life and the outside world. Here I support strongly my noble friend Lord Grenfell in his request for more hostels. I understand that in 1967 there were only 2,846 hostel beds available, and there is not much provision for sheltered employment and reserved jobs. This compares unfavourably with what is provided in other spheres of injury, disease, disablement and so on. In other spheres we have great work done by the Remploy Factory; and we have the 1944 Disabled Persons Act, which makes special provision for disabled people. I feel that this sort of attitude should be

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adopted with regard to the re-employment of mental patients. There is a crying need here, particularly when we consider that 32 million working days a year are lost to the country due to mental illness.
In all this, no progress can be made without research; and here I feel that as a country we are falling down badly. The Ministry of Health figures for 1967 show that the Health Service cost £1,500 million, out of which £610,000 was allocated for all research, and only £50,000 for mental research. The Americans, as I understand it, spend 4,000 times as much as we do on mental research. I realise that the National Health Service is under great strain, but I think we should appreciate that perhaps £1 spent on research could easily save £100 being spent on bricks and mortar in the form of hospitals.
To augment money available for mental research, the Menial Health Research Fund was set up in 1954, and has so far raised £400,000 to finance 230 different research projects. A sum of £50,000 has been distributed in the present year. I help to raise money in the East Midlands Division of this fund, and I have been greatly heartened by public reaction and support. A wide variety of people are involved. Those of your Lordships who read the sporting Press will have seen that the Wolverhampton Wanderers and Irish centre forward, Mr. Dougan, recently received eight weeks' suspension for saying something to a referee, or not saying something to the referee, whichever the case might be. But it is an ill wind which blows no good, and he has promised to use this time to raise more money for this fund, in addition to the several thousands of pounds that he has already been responsible for raising in the Wolverhampton area. I should like to take this opportunity of thanking him for the example he has given to all sportsmen and others by the great work he has done, and is doing. I believe that it is in no small part due to the efforts of people such as this that a revolution has taken place in recent years in the treatment of mental illness by modern techniques and drugs. I can personally vouch for the success of much of this. I hope that the Government will do all they can to encourage these spontaneous efforts, and that they might
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perhaps, for example, allow exemption from tax for money bequeathed to such funds.
I realise that much of what I have said is impersonal and unreal in terms of the suffering and hardship experienced by many people. I want to conclude my speech by mentioning just one specific case of a slightly eccentric friend of mine with whom I and several Members of your Lordships' House were at school. For the past 12 years he has been detained under Section 26 of the Mental Health Act. Apart from the odd week-end staying in my house and one or two others, he has had almost no contact with the outside world, his family or friends. In my opinion (confirmed yesterday by my noble friend Lord Elton, who is unfortunately not able to be here to-day) he remains remarkably cheerful and sane. Some six months ago a part-time occupational therapist at the hospital, with the consent of the hospital authorities, found him an outside job with an understanding employer. The day before he should have started someone at the hospital changed his mind, and he was refused permission to start work. He is now back in his old empty and frustrating routine with hopes dashed. In my view, unless something is done he will become institutionalised and without hope and liable to stay in the mental hospital for the rest of his days.
I mention this case to-day because it so happens that this man is, or is entitled to be, a Member of your Lordships' House. I thought it might illustrate that this problem is not far away from these four walls. I also mention it because it seems to me to illustrate a classic case of "don't know" and "don't want to know" attitude, a certain lack of communication between a mental hospital, the outside world and employment; and perhaps, above all, the chronic need for great research so that such cases of needlessly frustrated and wasted lives may be a thing of the past.
LORD PLATT: My Lords, may I intervene just for one second, before Lord Soper speaks, on the question of funds for research? Of course I agree with the noble Lord who has just spoken abort the need for more money. But we must not forget that the research funds in medicine, including psychological medicine, in this country largely come not

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from the National Health Service, but through the Medical Research Council, and through the University Grants Committee. I did not want that fact to be forgotten.
LORD CRAWSHAW: My Lords, I accept what the noble Lord said.
6.34 p.m.
LORD SOPER: My Lords, by this stage in this comparatively long debate I feel satisfied that the noble Lord, Lord O'Hagan, will have a quiet sense of satisfaction at the way in which the arguments have been deployed; and he has put us all in his debt for the initiation of this debate and for the quality with which he introduced it. Perhaps even more gratifying is the large amount of common ground that has been trodden by the various speakers and the large element of congruity in the kind of general results that have followed from the setting out of arguments and the describing of conditions. I should like to re-emphasise some of these common points. Let me begin by establishing unanimity with my noble friend Lady Stocks in her animadversions on Scientology. I think it is sufficient for your Lordships' House to read the "stuff", and that will have a converting influence immediately, and prevent any further contamination. The trouble is that there are so many suggestible people who are right for any kind of totalitarian offer, and I would cordially invite the Government to accede, if they can, to the general requirement that Lady Stocks was putting forward.
However, on the general theme of the debate, this is no comparative matter in the field of ethics or human behaviour. Your Lordships will have sensed the sense of almost the absolute in what has been described and called for in this debate to-day. I am reminded of the occasion when I listened to Dr. Inge comforting a number of undergraduates who were quite sure that there was no such thing as absolute morals. He said that there was, and he was challenged to give an illustration of anything that was absolutely wrong. He said that it was absolutely wrong to ill-treat a child; he said that it was absolutely wrong to mock the insane. I have never forgotten that second absolute. I was reminded of it a few days ago when I visited one of the great, large
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hospitals for mentally afflicted people, what has been cynically described as forming the "lunatic fringe" of London, stretching from Epsom, in the South, to St. Albans, in the North.
It happened to be the last day of this year's Indian summer: the countryside was resplendent, and the outward and visible signs of this large conurbation were equally attractive. It was my business to go to a closed ward. As I entered it, about 80 pairs of eyes were fixed upon me, and it was my job to try to talk to a number of people inside that closed, locked ward. I do not know whether I was more affected by the person whose eyes were fixed on me, and who said she could tell me of the room—which was very close—where they had the straitjackets, and where people were confined in chairs, or by the person with a blank look who told me that she was quite sane and was going to be released within a few days. The word "mockery" came back to my mind.
As I think of these things, I am well aware it would be foolish and churlish to fail to recognise that great changes for good have taken place; and that perhaps experiences in these large and, in my judgment, wrongly sited and wrongly formed hospitals are the residual legacies of the past, and no longer represent the intentions of Her Majesty's Government. The second unanimity to which I believe we have come is that the general direction to which Her Majesty's Government look, and the plans in the pipeline, are right. There may be modified rapture as to the pace at which they are going, but there is little contradiction as to the correct nature of this trend away from the whole area of stigma, and towards the area of community care.
I think your Lordships will also agree, however, that even if there is a marked movement towards better things there is still, if not stigma, at any rate indifference. One of the phrases colloquially to describe insanity is "round the bend". I believe that the vocabulary for those who are insane, as well as for those who are drunk, is probably more voluminous than almost any other human affair. When I think of "round the bend", I think of out of sight, for that is precisely, geographically, what "round the bend" means. As in our prison background, so with care for those who are mentally

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afflicted, there are far too many people who would prefer that the mentally afflicted are round the bend, so that they can no longer be seen; and in so many cases what the eye does not see, the heart does not grieve over. if we have been pricked in our consciences to-day and can communicate the sense of conscientious realisation to a wider community, we have done, I think, the first thing to break into this wall of indifference.
How will it be done? There has appeared in speech after speech the recognition of the block system, the large hospital catering, or pretending to cater, for a thousand mentally afflicted people, and of the intolerable strain on those who do the caring. Let me add my word of commendation and my word of humble recognition for the splendid work which is done, the self-sacrificial work which is done, and to echo what my right reverend friend said. He said he was surprised, as I think we all are, at the number of people who vocationally accept this unrewarding work and pursue it with such diligence. It nevertheless remains true that the proper care of those who are mentally afflicted must entail reducing the total numbers of those who are congregated together under conditions which militate against their own personal therapy. Therefore, how right, in my judgment, speech after speech has been in claiming that smaller units attached to local hospitals must be preferred to those vast conglomerations of 19th century huge residential premises, which were never really suitable and are now in so many respects a mockery.
I want to draw attention to one particular group: the rootless, unattached adolescents, of which there are far too many in London—and indeed it would be far too many if there were very few. I have it on the highest authority from those who, as in the Tavistock Clinic, have expert knowledge of this matter—and I have a little myself—that what is needed is far more experimentation, not only in day care but in residential care; and that residential care must be tuned to and geared to a variety of rootlessness and a varying degree of mental stress and difficulty. I am sure there is need for more approved hostels of the kind I know something about in the Catherine Price youth hostel. I am sure there is profound need for more hostels in which
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to care for boys. The tragedy is now that so often those who work in the Tavistock Clinic find in the end that the rootless adolescent ends up in borstal, where of course he cannot be refused. This is one of the experimental elements in your Lordships' debate which I am quite sure Her Majesty's Government have already intended to take seriously, and I hope they will be spurred by the unanimity with which this need has been expressed.
I will detain your Lordships to talk about only one other matter. I believe that mental health, as my noble friend Lady Birk exemplified in what she had to say, has more to do with social environment than have many other ailments from which we suffer. To put it simply, if I have a tooth that aches or if I contract gout—perhaps as a teetotal Methodist minister that is a more academic supposition, but suppose I were afflicted in either the tooth or the toe—therapy very largely would be directed towards that afflicted part; or at least such therapy would be directed to the individual who was suffering the affliction. But let me tell your Lordships a true story. Since the ingestion of the pill and the operation of the Abortion Act there has come a subtle and difficult change in the two hostels to which I have already given mention.
Once upon a time we calculated that if there were one disturbed girl among (shall we say?) 13 or 14 more or less stable girls, the effect of the stability would be reflected in an improvement in the condition of the unstable girl. But nowadays it is highly likely that those who come to a hostel—for instance, pregnant girls who are unmarried—will be those who are unstable, because of the opportunities that are now offered to more stable girls to avoid the troubles in which their less fortunate sisters find themselves. So it comes about that in these hostels today—I have checked it up within the last 24 hours—instead of having, say, 10 or 12 more or less stable girls (not ideal and not saintly, but stable) and one or two disturbed, the proportion is the other way round. This produces instability, or tends to produce instability, even among those who previously were stable.
The reflection which I would offer to your Lordships is that this question of

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mental health has far more to do with society, far more to do with the background and the environment in which people live. I reflect that, sometimes with kindness and not always with contempt, a place was found for the village idiot in the community of yesterday. It is possible that he would not find anything like that same place in the conurbations of today. As the noble Baroness, Lady Swanborough, said so eloquently, and as I should like to repeat out of an experience which for me grows almost daily, unless we are prepared to recognise that community care means care by the community, expressed by the totality of the community, alike in its corporate relationships and its family relationships, we shall be left with a residuum of mental ill-health which will become increasingly intolerable.
Therefore I would add my word of thanks to those who have initiated this debate, and invite those who would become volunteers to cheer themselves up with one reflection. It is my experience, and no doubt my right reverend friend also shares it, that ordinary decent people, if they are prepared with love and care to take into their own heart and mind and sometimes into their own house, certainly into their own environment, those who are at present mentally disabled, do not require to think that they are inadequate for the task. They require, obviously, the trained and occasional help from the psychiatrist—better still, I think, the parson, but that is another matter—but what is essentially demanded is the recognition that it is possible for decent, ordinary people to rise to heights of social and personal care, which I believe will have a greater therapeutic effect on the sum total of those who are now mentally afflicted than almost anything else I can think of.
6.47 p.m.
LORD VIVIAN: My Lords, it is always difficult to follow the noble Lord, Lord Soper, for he is a very experienced speaker. However, I shall not inflict myself upon your Lordships for more than ten minutes. Like other noble Lords who have spoken this afternoon in the important debate of the noble Lord, Lord O'Hagan, calling attention to contemporary attitudes to mental health, I wish to congratulate him most sincerely
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for initiating such a debate in your Lordships' House. The noble Lord, Lord O'Hagan, is one of the youngest Members of this Chamber a young man who has already proved himself in a thoughtful and brilliant maiden speech a few months ago. Like all noble Lords, no matter where they sit in your Lordships' House, I look forward to a great future for him in this Chamber.
Before going on to make my modest contribution to the debate, I should also like sincerely to congratulate the noble Countess, Lady Loudoun, on her maiden speech. My thoughts have been with her very much this afternoon, for every noble Lord or noble Baroness in your Lordships' House will recall the anxiety which he or she had to face up to when the day arrived on which they had decided to "take the plunge".
The stress and strain of everyday life in our present age is in a great way responsible, I feel, for much of our mental illness. In consequence, it is of vital necessity for any Government in power to keep a constant watch on the ways and means in which we may be able to improve our National Health services where mental health and the necessary treatments and hospitalisation are concerned.
In this connection I am firmly of the opinion that Her Majesty's Government are doing a good job, and, in common with other noble Lords, I greatly welcome the presence of the noble Baroness, Lady Scrota, on the Government Front Bench. I can think of no one in the Labour Party who is more fitted to undertake such high responsibility, nor can I think of anyone who would have devoted so much effort in the Ministry of Health and Social Security to the running of our mental hospitals. Your Lordships may have noticed that from time to time during the past year the noble Baroness has been absent from the Chamber. The reason was that she was visiting mental hospitals throughout England and Wales, trying to find ways and means of improving their administration, from the points of view of both the patients and the nursing staff. I felt very sincerely for the noble Baroness because of the many problems facing her. When she replies to the debate I wonder whether she can tell us how she has fared in connection with the existing problem of the understaffing of mental

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hospitals, for I feel that this is one of the major problems in the administration of our mental hospitals.
On May 15 last I spoke on the question of nurses' pay and conditions and pleaded for justice for the nurses in teaching and all other hospitals. What I said is recorded in Hansard of that day's date, and I need not go further into it this evening other than to say that I fear that justice has not as yet been done, although I feel sure that the noble Baroness and the Secretary of State for Social Services, Mr. Richard Crossman, have this firmly in mind and fully realise that justice in pay and conditions must be a priority in the National Health and Social Security Service. The speech made by the noble Lord, Lord Grenfell, this afternoon movingly underlined this.
Again in this connection, I am glad to see that the noble Lord, Lord Amulree, is to initiate a debate in your Lordships' House on a Motion for Papers asking Her Majesty's Government
"…whether they will consider the appointment of a review body to replace the present Whitley machinery dealing with the remuneration of nurses employed in the National Health Service in order to ensure that their pay is commensurate with their responsibilities."
Then, perhaps the noble Baroness, Lady Serota, when she comes to reply, will also tell us what progress is being made in the social and welfare department within the National Health Service, for I have found from past experience that where mental hospitals are concerned there is some need for improvement, purely from the lack of teacher training.
To continue, those of your Lordships who have not experienced the great work which is done within our mental hospitals may not fully appreciate the difficulties that patients face when they are discharged. A patient is never discharged until such time as a psychiatrist is convinced that the patient is competent and willing and able to resume his or her normal responsibilities in the somewhat abnormal stresses of this day and age. it can and does happen that the patient may slip back. This is where a certain danger sets in, and that is why it is so necessary to have a broad and constant social and welfare follow-up. I am happy to say that, due to modern drugs and the skill of psychiatrists, so wonderfully backed up by a hard-working staff of nurses in our
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mental hospitals, there has been no reason for 90 per cent. of the voluntary patients treated to return for further treatment. Of the 10 per cent, who do return for treatment, I believe the main cause is due to lack of understanding by the general public of illnesses of the mind.
For this reason, I recommend that we should all do our best to try to understand the problems of such illnesses. It is my firm conviction that if this were done, the greater part of the other 10 per cent. who return for treatment would not have to do so. I do not exaggerate when I say that a chance remark, such as "Oh, did you know that so-and-so has just come out of a 'bin'?" can trigger off a subsequent mental breakdown in a person who has already received treatment. Do let us try to educate the public a little more with regard to illness of the mind. No stigma should attach to one's having had treatment for mental illness. As yet, I fear, this is not quite so. That is why I urge Her Majesty's Government to seek ways of educating the public a little further with regard to these illnesses.
There is one other point that 1 wish to make. I would implore any former patients who are in need of subsequent help, following discharge, not to delay in seeking their doctor's help, and readily to accept his advice if they should be urged to undergo further treatment as voluntary patients. I mention this point because from experience I have found that even one day's delay can result in at least one week's further hospitalisation. In saying this, I do not wish to add to the problems of the noble Baroness, Lady Serota. I do so simply with the idea of trying to suggest one way in which a quicker turn-round could be made.
In his excellent opening to this debate the noble Lord, Lord O'Hagan, said that the stigma is on the way out. I agree with him; but it has not completely disappeared, and I repeat that in my opinion it could be a thing of the past, provided that we continue to educate the public where illness of the mind is concerned. My Lords, I have spoken to-day as someone who in the past has accepted voluntary psychiatric treatment under the National Health and Social Security Service—treatment for which I am most grateful. In view of this, I considered that I should have been lacking in my

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duty and responsibility to your Lordships' House if I had not spoken.
6.59 p.m.
LORD SANDFORD: My Lords, I should like to start by congratulating the noble Countess, Lady Loudoun, on her maiden speech, and also on the subject which she chose as her main theme, that is to say, an appreciation of all that is being done in our mental services with so few resources. I should also like to thank the noble Lord, Lord O'Hagan, for having introduced this debate. It has indeed been wide-ranging. The noble Baroness, Lady Birk, took us into the fields of contraception and sex education. I do not want to say anything about that, except that I shall be glad if my two youngest children get through school before she gets any further with her plans.
BARONESS BROOKE OF YSTRAD-FELLTE: Hear, hear!
LORD SANDFORD: Then, my Lords, the noble Baroness, Lady Stocks, led us off on to scientology. I think it was a good thing that she raised this difficult subject, because it is a difficult one to deal with in a society that believes in free speech. Only the other day I heard from my honourable friend the Member for St. Albans and my friend the right reverend Bishop of St. Albans, who have had a similar problem with a self-styled college near that town which has already been the cause of a nervous breakdown by one of the people rash enough to attend it. If the noble Baroness, Lady Serota, is going to deal with this and would like more information, I can give it to her.
I should like now to turn to the question to which several noble Lords have referred; namely, the inadequacy of the resources committed to the treatment of mental disorders, and to follow the noble Lord, Lord Grenfell, and to some extent perhaps answer the point raised by the noble Lord, Lord Crawshaw. I think we can see how serious this problem is if we look at one or two figures. The cost of maintaining an inmate in an acute general hospital for one week is £45 11s. 1d; the cost of maintaining a convicted criminal in prison is £15 10s.; the cost of maintaining a patient in a mental hospital is £14 7s. 5d.; the cost of maintaining a subnormal patient in a
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mental hospital is £12 5s. 7d. Those are 1968 figures in respect of the hospitals and 1967 figures in respect of the prison. Surely something is wrong here.
On the question of staff, in the case of the care of the physically ill one nurse looks after one patient; in the care of the mentally ill one nurse looks after four patients; in the case of the mentally subnormal one nurse looks after five patients. Surely there is something wrong here, too. Take the case of consultants. In the case of physical illness we have one consultant to 19 patients; in the case of mental illness we have one consultant to 128 patients; in the case of the subnormal we have one consultant to 570 patients. Surely there is something wrong here as well.
Looking at hospital buildings, Her Majesty's Government, as the noble Baroness, Lady Llewelyn-Davies, pointed out, are following the 1962 hospital plan. This envisaged the development of psychiatric wings in general hospitals, and that was good. It envisaged the running down of the large, old mental hospitals, and that was good. But by that plan we shall still need beds for 92,000 mentally ill patients, leaving out the subnormal altogether, and in 1975 we may well need more. It is really quite unrealistic to think that enough money will be available, unless there is a very radical change, for 92,000 beds in those old hospitals to be converted to 92.000 beds in nice new psychiatric wings by anything like 1975. And if it were, would it be right to spend it on buildings and none of it on staff? The noble Baroness, Lady Llewelyn-Davies, did not indicate that we were going even to attempt to do this, but I think it raises false hopes to give any impression that we shall be able in the near future to sweep away all these old hospitals.
BARONESS LLEWELYN-DAVIES: My Lords, if I may interrupt the noble Lord, I did not give the impression that we were going to sweep them away in the near future. It was very specifically explained that I did not think we could.
LORD SANDFORD: My Lords, the noble Baroness will not mind my emphasising what she said, because I think it is important in order not to raise false hopes in the staffs who are going to have to work in these old hospitals for a very

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long time ahead. Still on the question of the inadequate resources for this field, I should like to turn, as other noble Lords have, to the question of research. The noble Lord, Lord Platt, was right to remind your Lordships that this is channelled through the Medical Research Council. The amount spent by that Council on mental disorder, which reached over £1 million for the first time last year, one might think was substantial and satisfactory. But this very large figure, or so it would seem, is only just over 8 per cent. of the Medical Research Council's total expenditure, the point at which it has been stuck for the last five years. If one considers—and several noble Lords have said this—that 40 to 50 per cent. of hospital beds are occupied by mental patients, 8 per cent. of the money spent on research seems to me very inadequate.
There is another factor which prompts me as a layman to think that this central effort on fundamental research is so inadequate, and it is this. If the noble Baroness will allow me to suggest a correction, I think it was in the 1930s that Sakel in Hungary introduced the insulin treatment; later on E.C.T. was discovered in Italy, leuchotomy in Portugal, and then, as she said, the French hit on the tranquillisers in 1950. All that constitutes advance and it is certainly very recent, though perhaps not as recent as was indicated. But it is an advance which has been made, I believe, by people stumbling on things when they were really looking for something else; and at least two of those forward steps have been based on theories about mental illness which have since been falsified. So far as I can understand, though treatment now proceeds, and indeed advances, there would still be very few experts able to give a comprehensive account of the fundamental causes of the main mental illnesses without any fear of contradiction from their colleagues. I believe that is the position.
I should have thought, in these circumstances, that the need for far more than the numerical share of any research was required on the mental health side. The applied research efforts of the pharmaceutical industry, which is about 16 per cent. of the total effort, is better than the M.R.C. is doing, but I would judge that neither is a match for the work to
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be done, and that here is really a case for grasping the nettle, as one noble Lord mentioned earlier.
I turn from this question of resources and the right balance to the centrality of community care in this field, which everybody has recognised and applauded. I believe that the Mental Health Act 1959, although, as the noble Lord, Lord O'Hagan, said, it was perhaps weak on the preventive side, will rate as a great turning point and one of the more far-reaching pieces of social legislation in the last decade. Last year, eight years after its coming into force, its main central concept of community care for the mentally disordered came true for the first time, when the number of patients in care in the community, 194,000, exceeded the number in care in hospital, 184,000—that is, mentally ill and subnormal taken together; the total case load of G.Ps. numerically exceeding both together. I submit that this marks the point after which we need to regard the facilities, such as they are—they have been immensely improved but they are far from adequate—in the community, and the care, such as it is, in the community, as the focus of treatment for the mental patient, and the mental hospital as the place to which from time to time and for fairly short periods of a week or so he goes for assessment and more intensive treatment.
However, the pattern of progress from community to hospital and back again varies enormously from area to area according to innumerable local factors, making it abundantly clear that it is virtually impossible to arrive at the optimum policy, from the patient's point of view, unless the hospital catchment areas and the local authority areas are made coterminous, so that the local policy for mental treatment can be formulated and executed by an authority that can decide the priority of expenditure and staffing for hospital and community and general practice within the same geographical area. It is abundantly clear, from what has been said in this debate, that this applies particularly to the psycho-geriatric problem. If something like this is not brought about, I see these poor, feeble minded elderly patients becoming a shuttlecock between these three services.

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Whatever balance of pros and cons there may be for the integration of the three parts of the National Health Service in other fields, in the mental health field the case for integration in coterminous areas is quite imperative and conclusive. Just as imperative and conclusive is the case for the integration of the social services for the mentally disordered, again within the same geographical area. Not only does it seem to me that the case for inclusion of the mental social services in area terms is well made in the Seebohm Committee Report, but so also is the case made for the psychiatric social workers to be concentrated in the local authority social service departments, once the integration of the three parts is achieved within the Health Service. I hope I make myself clear to the noble Baroness. Once that is done, it surely would be best for the psychiatric social workers to be employed in the social service department and seconded from there to the psychiatric hospital rather than vice versa, and rather than having their valuable and scarce manpower divided between two treatment agencies. It will be interesting to see how the Scots work this out because they will have to face it first. From the social service department and the local social service teams it should, I think, be possible in an increasing degree to second social workers on a part-time basis to general practice.
I should like to turn, and here follow the noble Baroness, Lady Swanborough, to the development of voluntary service in the mental health field. It is fashionable—though of course the noble Baroness knows too much about it to say so—to say that the main role of the voluntary organisations in social service is to plug gaps in the Welfare State; and, as the noble Lord, Lord Platt, said, there are certainly plenty of them, and big ones, in this field. That is not at all the main aim of the voluntary service. The main role of all voluntary service and voluntary organisations is to give the lay citizen larger and larger opportunities for bringing into being, and keeping in being, the kind of compassionate society which we all want to live in. The main role of voluntary organisations is to prevent our society from being shaped and moulded by the professionals and the bureaucrats
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because we are too indifferent or lazy to fashion it ourselves.
I do not mean any disrespect in this to the professional servants of the Welfare State. The British Welfare State, and particularly the mental health and welfare services, are as good as any in the world, and I join my tribute to those that have already been paid to the professionals working in them. But the professionals in the mental health and welfare services, as elsewhere, are paid not to do our work of caring for us, but to help us, as lay folk, to look after our families, friends, and fellow citizens more effectively, and to bring into the community more enlightened attitudes and higher caring skills. It is not the case that citizens are there to be gathered in to make good staff shortages in the statutory services. If my view on this is accepted, and I hope it is, it follows that the aim of any institutions, any part of the Welfare State, is to maximise voluntary service and to spread professional expertise as far and as wide as it can be got to go, not only to doctors, patients and social workers' clients bat to the families, friends and neighbours with whom the patients and tile clients live and work. That this is capable of being realised is shown by the report that the King's Fund have produced on the organisation of voluntary work in hospitals.
This movement, building on what had already been done by the Red Cross, W.R.V.S., the Leagues of Friends, and so on, and starting originally at St. Thomas's among the general hospitals, and Fulbourn at Cambridge among the mental hospitals, with the appointment of a full-time organiser in 1963, has led by now to the involvement of up to 400 volunteers in a single hospital. This produces 25,000 to 40,000 hours of voluntary help per annum, so in fact it does plug a manpower gap in a big way. However, that, I think, is not the main point. A voluntary organiser who can do this brings among patients and nursing staff a great mix of antique dealers, actresses, train drivers, computer programmers and all sorts of people, in their spare time; it brings into an otherwise detached and isolated community all this varied contact with the outside world. This is good for the hospital community and good for the community outside, and

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it is this great two-way process of knitting together which it is the main aim of the voluntary movement to promote. I very much hope that the publication of a document setting all this forward will encourage it to develop beyond the thirty or forty hospitals in which it now exists.
Finally—and I apologise for going on so long, but I think this is an extremely important subject—I should like to turn to the suggestion, which the Conservatives have had in their manifesto since the last election, of an inspectorate for the whole National Health and Social Security Service. It is very strange that the Government are taking so long to see the virtue of this proposition. They have accepted the idea that health and social security should be combined in one Ministry, and this is part of the same packet. One would have thought that when the Ombudsman was established—but, to the dismay of all, without powers to look into the Hospital Service—the alternative of an inspectorate for the Hospital Service would have been adopted. One would have thought that when Sans Everything and the Ely Report were causing so much concern, the advantages of having an inspectorate would have been even plainer. Exactly how it would be constituted, to whom it would report, to whom it would be responsible, are things that could have been discussed. There are plenty of models to refer to: the Police have their inspectors; the children have their inspectors; the Probation Service have also; but most apt of all is the greatly respected H.M. inspectors of Schools, to whom the whole education service, both statutory and independent, owes so much.
Speaking for myself, I am sure that the inspectorate, in contrast to the Hospital Advisory Service, which is not at all the right thing, should be independent of Whitehall, independent of local authorities. Its report should be published and available to the Press, and its aims should be to enlighten and form public attitudes by getting the firm facts to help the public to judge for themselves how the whole thing is going on and whether they are getting value for money, to appreciate what is being done in the service, to judge its efficiency and to judge the efficiency of the statutory and voluntary services and their partnership. Such an inspectorate would not be
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in any way responsible for policy, or for dealing with complaints, or for conducting research; but its activities over a span of time would be of immense assistance, I believe, for those who were responsible for policy, who had to deal with complaints and who had to put research in hand.
It is a constant surprise to me that there is so much defensiveness about this proposal, because, after all, people who are doing their best—as the great majority are—have nothing to fear from being inspected. Those who are doing their best will have their service publicly recognised. The people who want to do better and to get ideas from other areas, will have everything to gain from the reports published by the inspectorate. The people who are not doing their best ought not to be allowed to continue without being spurred on. No one to-day questions the appropriateness of exposing the activities of management and company directors to the scrutiny of the shareholders; in fact, the idea is now to have them open to the scrutiny of their work force as well. So I should have thought, as shareholders of the National Health Service—which is what we all are—that we had every bit as much right to help keep an eye on the whole show and see how it is going, and no more so than in this field of mental health where so much is changing, where so much experiment and evolution is in hand, and where through community care there are so many opportunities for personal services to some patients, and so much danger of neglect and isolation to others.
I make no apology for labouring this point, and I do not press any particular detail. But, like Professor Townsend, who is well-known to Members on the Benches opposite and to others who have seen their hopes for the British Health Service eroded, if not dissolving, I see no hope for any further advance in the services, no hope for due recognition of what is being done, and no hope of more enlightened attitudes to mental health, without a very radical change in the style of leadership that we are getting now; a much more ruthless facing of the hard and very serious facts of financial stringency and staff shortage which confront us; and an end of the unnecessarily defensive attitude in Ministries and statutory authorities. To set up a strong, experienced, independent,

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wide-ranging inspectorate is the first step to put this position right. I readily acknowledge that it will be a bold step to take, but I am sure it is overdue. This is a nettle still waiting to be grasped, but it is an agency which could do a tremendous lot to help us and to give this service the honour which is its due.
7.23 p.m.
THE MINISTER OF STATE, DEPARTMENT OF HEALTH AND SOCIAL SECURITY (BARONESS SEROTA): My Lords, I think that all of us who have been in the Chamber through the long hours of this debate will recognise that our discussions here today are welcome, certainly to Her Majesty's Government; and I would say that in some senses the debate is even overdue. All our thanks, and mine in particular, are due to the noble Lord, Lord O'Hagan, for the most thoughtful and moving way in which he introduced his Motion. It has also given us an opportunity to hear from the noble Countess, Lady Loudoun, for the first time, and I join with other noble Lords in congratulating her on what I think we all agree was a most effective, informed and compassionate speech. This House, as I have learned in the last three years prides itself on the specialist knowledge of its Members and on the contribution they can make to particular topics in debate. In Lady Loudoun we clearly have a most valuable new addition to our counsels and I hope that, having overcome what to all of us is a considerable hurdle, she will now feel able to contribute freely and easily to our deliberations.
It is right that the services for the mentally ill and the mentally handicapped should be the subject of public interest and concern, and it would be surprising if this were not so. It would also be surprising if these services were not at times the subject of public criticism. I am sure that all those people who are responsible for these services, in whatever way and at whatever level, and who are anxious to develop them, welcome informed and constructive criticism, for it is in this way that we can measure our achievements, that we can make improvements and can extend further as the frontiers of knowledge, in this relatively new field of the care, the treatment and the rehabilitation of the mentally ill, advance.
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I agree with the noble Lord, Lord Soper, who is always so wise in his thought that it would be fair to conclude from the debate that public attitudes have changed much more in the last ten years towards the acceptance and treatment of mental illness than they have to the needs of the mentally handicapped, who require support, help and care, of various kinds and in different degrees, from their earliest years right up to and into adult life. The noble Baroness, Lady Brooke, in what I think we all recognised as a typically practical, forthright and constructive speech setting the whole tone of our debate today, confirmed the view that I think all of us now hold, that the worst of the stigma of mental ill health is disappearing from our society, although clearly we still have some way to go until we see throughout the country the kind of constructive and positive attitudes which all of us would wish to see, including social acceptance of mentally ill members within the community itself.
As I have listened to the debate three main themes seem to have emerged from the many speeches that have been made. First, there has been the general discussion flowing from the terms of the Motion of the noble Lord, Lord O'Hagan, on changes in attitudes and the need for further change. Then several of your Lordships have dealt with the effect and consequences of those changes, including certain criticisms of services for long-stay patients and especially for the mentally handicapped. both children and adults. Finally, many of those who have taken part in the debate have spoken from knowledge, and very frequently from their own personal experience of the services, of the kind of action they think we should provide in order to develop more effective services in the future.
My Lords, in a debate of this kind it is clearly impossible for me to deal in detail with every topic that has been raised. My noble friend Lady Llewelyn-Davies of Hastoe dealt generally at the outset of our debate with the therapeutic revolution that we have seen beginning in this field of mental illness, and with general aspects of the development of services within the community for the mentally handicapped. I will of course study with very great care the Record of the debate and will consider the suggestions which noble Lords have put to me. But in replying to-night I shall in

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the main confine my remarks to those aspects of the services for the mentally handicapped which are causing us such concern and I shall try to indicate to your Lordships how the Government are trying to tackle them. I do this on the basis that most of us seem to have agreed during our discussion that the greatest changes, both in attitudes and in services, are now required in this field of our national and community health and social services. I think we should consider the developments that are needed for the future in the context of past achievements, which to my mind are more significant than the black spots which have claimed so much interest in the last six months. The noble Lord, Lord Sandford, talked about resources. I do not want to labour the point with figures, especially at this late hour, but in financial terms the rate of progress is this. In the last five years the Government have raised the annual rate of spending on local health authority and hospital provision for the mentally ill and the mentally subnormal by, on average, about 8 per cent.
My Lords, in trying to form a balanced view of the achievements in these services I shall do as I always do and try to begin at the beginning, and start with the children. In this field we are coil cerned with children whose care, treatment and training must surely be at the heart of our pattern of services for mentally handicapped persons of all ages. Several noble Lords have spoken about the changes that have already taken place, and my noble friend Lady Llewelyn-Davies gave the House at the outset of the debate certain facts and figures. But I am not sure, my Lords, when we think of the changes that have taken place, particularly in the last ten years since the passing of the Mental Health Act, and when we talk about the inadequacy of our services for community care, that everyone realises that it is the local authorities who to-day already care for the majority of mentally subnormal people—just under 100,000, compared with some 64,500 in hospital. In the child population, local authorities are, now making day and residential provision for about 28,000 children, compared with the 7,000 in our hospitals; and there are 20,000 children in junior training centres, including 3,000 of some of the most severely handicapped children
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for whom our society needs to provide in special care units.
Great advances have been made, too, since the setting up of the training council for the Teachers of the Mentally Handicapped, in training staff to work in the training centres; and it is these junior training centres, with which many noble Lords will I am sure be familiar, that have shown that these children are not ineducable. It is on this basis of achievement that the Government have decided that the training and education of these children should become the responsibility of the education service. This decision is one which I believe will be welcomed, and has been welcomed everywhere, especially by parents. Those noble Lords who have had the unenviable task from time to time, as I myself have had, of telling parents that their child must be excluded from school, will know what it will mean to parents of handicapped children to feel that their children will in future be able to benefit from the whole range of educational services and not be cut off from them under this ugly term "ineducable". I entirely agree with the moving speech of the noble Lord, Lord Grenfell, when he told us what a tragedy it would be if this new generation of youngsters, many of whom are better trained and socially much more competent than their predecessors, were to end up in large, long-stay hospitals because there was nowhere for them to live when their parents grew old—and this is a point I should like to develop a little later when I come to talk about changes needed in services in the future.
There have, of course, been vast improvements, too, in our hospital services, although I am only too conscious of the amount of public interest and concern that has recently been focused on our long-stay hospitals for the mentally handicapped. Over the past ten years, six virtually new sub-normality hospitals have been built, and there have been improvements and additions, as several of your Lordships know, to a great number of the existing ones. Unfortunately, the new provision has not always been reflected in an increase in the number of available beds, because some of these new buildings have admittedly had to be used to replace unsatisfactory accommodation and to relieve overcrowding. But all noble Lords have pointed out in their speeches that the day-to-day care

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of patients in our hospitals depends almost entirely on nurses. Nurse staffing and nurse training are clearly the critical factors in providing better services and conditions of work. Between 1949 and 1967 there was a large increase—some 47 per cent.—in the nursing staff of sub-normality hospitals; but their numbers are still quite insufficient in view of the heavier work-load imposed on them by the increasing severity of handicap with which they now have to deal. I hear this story from nursing staff wherever I go, and it is clearly a factor that we shall have to take into consideration as we plan our services for the future.
The expansion of the local authority services has enabled many more of the less seriously handicapped to remain in the community, while previously they would have required community care. As a result, the proportion of those in hospitals who are severely disabled has risen. I do not think there is a single Member of the House who is familiar with cur hospitals who would not confirm this particular trend in terms of level of disability, particularly in the field of the multiple handicapped in some of our long-stay hospitals. Furthermore, this is a problem which several noble Lords have mentioned as one that will be with us in the future, in that higher survival rates among those born with serious handicaps have increased the number of patients who will continue to live into old age. It is also quite true to recall at this point that whereas the number of staff in some hospitals in some parts of the country is sufficient to enable nurses to provide no more than the basic care for patients, it is absolutely essential that this scarcity should not be allowed to inhibit new ideas in training which nurses are now receiving for this difficult and taxing work.
To-day, nurse training in this field is oriented towards the development of the patient's full potential—his self-confidence, his self-help and his self-reliance—and the aim of nurses, in association with all the other professions concerned, must surely be to develop in each patient the maximum social independence of which he is capable, to prepare him to return to the community wherever possible, or to enable him to live as full a life as he can within the supported community of the hospital. But it is quite
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clear, from the changes we have already seen in the services, that further changes in nurse training will be required if we are to develop, and indeed to reflect, the concept that the care of the mentally handicapped in the future will extend beyond the conventional hospital. In a few moments I shall be saying something about the immediate steps we hope to take to improve conditions in our hospitals—a point on which I have been questioned by several noble Lords—and I have made this reference to nurse training at this stage because I am quite convinced that this is one of the areas where we need to see that there is rapid development in the immediate future.
Turning now to the question which has been the subject of so much discussion during the debate—namely, what are we doing now?—I think I can best answer in the context of what action my right honourable friend the Secretary of State and I intend to take. I would also say that we see these measures as an earnest of the Government's intent to improve the existing services and to develop new ones. My Lords, immediately following the publication of the Ely Report, which has been spoken of at some length to-day, my right honourable friend the Secretary of State set up a small, expert working party to advise and assist us in tackling problems which had been revealed in the existing services and to help us plan for the future. I am very conscious that the noble Baroness, Lady Brooke of Ystradfellte, asked me what had happened since the Report, and I am equally conscious of the time at which I am speaking. I would therefore, if she is agreeable, only tell her at this stage that some 38 of the 45 recommendations have been carried out. I am more than happy to give details of what is happening on the remaining seven.
Ely was, whether we like it or not, a watershed both in policy and in thinking in this field. In addition to setting up the working party we have reviewed and are reviewing the whole question of dealing with complaints, with the object of ensuring that anyone—patients, relatives or staff—who wishes to make a suggestion or a complaint should know how to make it and feel free to do so in the confidence that it will be properly and fairly considered on its merits and without fear of victimisation. If you were to ask me

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what I found the most disturbing feature of the Ely Report, it was that the nursing staff who complained about conditions had to go. The noble Lord, Lord Sandford, in a speech which I felt was somewhat at odds with the general tenor of this debate, was very critical of the Government's decision to establish the new hospital advisory service for the regular visiting and scrutiny of all hospitals, starting with our long-stay hospitals.
LORD SANDFORD: My Lords, may I interrupt at this point? I was not critical. I said that it did not, in my view, constitute any sort of substitute for a full-blown inspectorate.
BARONESS SEROTA: Well, my Lords, I am not quite sure what the noble Lord, Lord Sandford, means by a "full-blown inspectorate", but I hope we can come to that in a moment. We decided to establish this new service, which clearly is not the kind which the noble Lord, Lord Sandford, would like to see. I must confess that I found some of his remarks difficult to follow. if there was an urgent need for an inspectorate in the National Health Service I am surprised that this is the first occasion that he has brought the matter to our notice. But, in addition to appointing the Advisory Service—and I will say a word about that in a moment—at the same time, because of the urgent nature of the situation which the Report on Ely revealed, we immediately called all Regional Hospital Boards into consultation and asked them to undertake an urgent, comprehensive review of the conditions in our long-stay hospitals. The Director of the Advisory Service was appointed on November 1. Although I know that all Governments are slow. I would submit to the House that, in view of the major policy implications of the setting up of such a new service in relation to the National Health Service, this was very quick work.
The Director will arrange for teams to visit the hospitals not only to disseminate information on new, improved methods of care and treatment and training and provide advice to those working there, but also to convey from the staff concerned—and we regard this as equally important—particularly from those working at ward level, their views direct to
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the Secretary of State. The teams will be concerned not only with physical conditions in hospitals but also with their organisation and management. The Department of Health, the Regional Hospital Boards and individual hospital management committees will also be concerned with organisation in the hospital itself, and we hope that this promotional service, if I may put it that way, will enable those working in the Service to make the best possible use of the resources available.
I disagree with the noble Lord, Lord Sandford, in his belief that what he called a "full-blown inspectorate" should be the organisation that we should set up at this moment of time and in this situation. I, too, am very familiar indeed with the working of the children's inspectorate at the Home Office and the educational inspectorate at the Department of Education and Science. I think that if you were to ask either of those two bodies to-day what kind of role they see themselves as playing, they would say, "Promotional, advisory, consultative". And not the noble Lord's "full-blown inspectorate", which I regard as a rather "old hat" way of raising professional standards.
Initially this new service, as I have already indicated, will concentrate on the long-stay hospitals and will be concerned both with work inside the hospitals and with its relationship to the general practitioners, the local authorities, the general public and the community it serves—in fact, with all aspects of the health and social needs of the patient. We have at the same time given a great deal of thought to the development of a proper and clearly understood complaints procedure. The House will be aware from my recent Written Answers to the noble Lord, Lord O'Hagan, that my right honourable friend the Secretary of State is now preparing new guidance to hospitals on the handling of complaints and will also be consulting the professional staff and others interested in this matter as well as in the idea of a Health Commissioner, on which we feel it is essential to have the views of the staff before final decisions are taken about the kind of structure that we should set up. I can assure the noble Lord, Lord O'Hagan, that these questions of complaints procedures and all that is involved, be it

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through complaints procedures at hospital level or the introduction of a system of health commissioners, are matters very much in the forefront of our minds.
Clearly, a debate such as this is not complete without reference to nurses' pay and conditions. Several noble Lords have raised this question; and quite rightly. Since 1965 there have been two salary increases to nurses: one in 1965, up to 11 per cent.; and one last April, a salary increase of between 9 per cent. and 14 per cent. The last pay improvements cost the country £37 millions, and this comprehensive settlement should run until April of next year. I think I should remind your Lordships that in this last comprehensive review of the salaries of nurses, the "mental lead" of £50 was increased to £100 and extended to all grades of nursing staff in psychiatric hospitals, whereas previously it had gone only as far as ward sister level. The review body also recommended that paid overtime, which had previously applied only to students, pupils and nursing assistants in psychiatric hospitals, should be extended to all other grades in these hospitals up to and including ward sister and charge nurse. Both of those recommendations were implemented.
But in saying that, I am equally conscious that a new settlement is due to be negotiated by the Nurses' and Midwives' Whitley Council for application as from next April. We are expecting the staff side claim very shortly and then negotiations will begin. In this context, those of your Lordships who are regular readers of the Morning Star will recently have seen a long article by the general secretary of the Royal College of Nursing stating that they do not intend to by-pass the official machinery and to go round the Whitley Council in their activities. I say this because one is only too conscious of the level of public interest in this question of nurses' pay. We know the great affection in which the public hold nurses. I put the timing of the pay negotiations on record in this debate because I think it is a matter constantly in people's minds.
I should like to thank the right reverend Prelate the Bishop of Lichfield, as a member of his Regional Board, and also those noble Lords who serve as members of hospital management committees, for the efforts they have made since April 1
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this year to re-allocate expenditure to give greater weight to the needs of our long-stay hospitals. It is not easy, my Lords, as those of us who have served on these bodies know, to change your allocations in the middle of a financial year, and this is what we had to ask Regional Boards to do in view of the very urgent and pressing problems which the report on the conditions at Ely Hospital revealed. As a result of their efforts—and I am only too conscious of some of the agonising decisions in which this must have involved them—the Regional Boards this year managed to devote some £2 million, which otherwise they would have used in other ways to improve conditions in our long-stay hospitals of all kinds. They have used it to recruit extra staff to develop schemes of staff training; to provide patients with personal clothing—a matter about which we are all concerned—and to provide lockers and better standards of decoration. As I have gone round the hospitals it has been possible to get some little idea of what this has meant to staff in some of our long-stay hospitals.
My Lords, this of course is only the beginning, and my right honourable friend has decided that a further £3 million, which represents an increase of 7·3 per cent. of the revenue estimates of the subnormality hospitals, will be made available to Regional Boards in the coming year to be used solely for improvements in subnormality hospitals. We are at present considering targets, immediate for the coming year, and continuous in terms of a five-year plan, so that we may guide and help hospitals where they need our help and show them the most effective ways in which these additional funds may be spent. I know that the noble Baroness, Lady Brooke of Ystradfellte, is concerned about the whole range of immediate short-term measures. The noble Lord, Lord Sandford accused us of raising false hopes. I think I can do no more than give some kind of indication of the way our minds are going.
The Secretary of State and I have on many occasions spoken publicly and said that one of the things we can no longer tolerate is that less should be provided for food for the mentally handicapped than for other long-stay patients; and we are determined to close the gap that

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exists between the standards of cost of provisions. This, my Lords, must be one of our top priorities. It will cost £1 million, but we shall be having discussions with Boards about making this money available. I see that the noble Lord, Lord Grenfell, is shaking his head, but those of us who talk to the staffs in our long-stay hospitals must be only too conscious of the fact that eating is one of the few pleasures in the lives of the mentally handicapped patients. I simply cannot understand why it is possible to make adequate provision for a mentally handicapped person for 26s. 5d. a week whereas it costs 33s. 10d. to provide an adequate standard of diet for a psychiatric patient. Mentally handicapped people are not ill, and we find this difference quite indefensible.
The other matters which we shall be discussing with Regional Boards who work out allocations of this additional money relate to staff and the use of volunteers. We must devise ways of lightening the burden on nursing staff. The noble Baroness, Lady Brooke, mentioned that they had inadequate domestic help. I think it also fair to say, as the noble Lord, Lord Platt, pointed out to us, that they have inadequate medical help; the noble Lord, Lord Sandford, gave us the figures. We need more medical help in our long-stay hospitals; we need the help of a whole range of professional skills; occupational therapy; chiropody for the elderly; more help with the education and training and play facilities for our children in long-stay hospitals. We also need to initiate the new training schemes that I mentioned earlier, if necessary by the appointment of training officers, and we also need to do something about staff accommodation.
I have mentioned food as the first priority. The problems of personal clothing, which so many people have mentioned to-day, will present certain difficulties, as we all know; and we think that this kind of situation may perhaps be tackled over a slightly longer period—shall we say a two-year programme? I will mention our suggestions in relation to volunteers in a few moments when I turn to the need to encourage community involvement and participation in the work of our services in the field of mental health.
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The other short-term measures include the building of two experimental demountable ward units, one in the North-East metropolitan region area and one in the Midlands, to see whether these buildings, which are comparatively cheap and quick to erect, can assist us in easing the overcrowding situation. So often, my Lords, it is not possible to relieve overcrowding because, let us face it, there is nowhere to care for the patients while improving and upgrading, and providing what all of us would regard as absolutely basic minimum standards of care. We have also commissioned a team of outside experts to undertake as speedy an evaluation as possible of various types of hospital buildings which have been used for the mentally handicapped and which have been completed in the last few years. We expect their first interim report in January.
I was delighted when the noble Baroness, Lady Brooke, pointed out to us that we should not make the mistake of thinking that all improvements we wish to see simply require extra money. As she said, a great deal may be done without money. A great deal can be done to improve the quality of life of our patients. There is the whole question of the better day-to-day organisation of services within hospitals, and also the point which several noble Lords have stressed; namely, better communications between staff of different grades and disciplines. All noble Lords have agreed that there is a need to encourage even further development of closer links between the community and the hospitals. We need to encourage more help from voluntary bodies and relatives so that the patients may have outings and feel less isolated, and so that arrangements may be made for patients to go shopping and to go to their local stores. I must not give Lord Sieff's firm another "plug", but I think we all know where they want to go. There is another matter to which I attach very great importance; namely, that hospital management committees should look at the times of their meetings to see whether they cannot bring active younger members of the community into the work of hospital management and hospital visiting. These are some of the immediate steps that we have taken, and are taking, to remedy what we accept as defects in our present situation.

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We are also very much involved in planning the services for the future. This clearly is a very complex operation and, as several noble Lords have said, it involves the reorganisation of our National Health Service and our personal social services—and indeed the restructuring of local government. The position of Her Majesty's Government on this question was, I think, made very clear in the Gracious Speech. After Christmas we shall be introducing legislation, following the report of the Seebohm Committee, and we shall also be producing a Green Paper on the reorganisation of the National Health Service and proposals on Maud. We accept—and I must confess that this was the only point in the speech of the noble Lord, Lord Sandford, with which I wholeheartedly agreed—that the personal health services, the personal social services and the reorganisation of local government are inextricably interlinked. It is in this context that the Government are looking at the future structure of these services. But whatever form the structure takes, it is clear from all that has been said today that effective services for the mentally handicapped will continue to require close co-operation among a whole range of services, however they are organised. I think that our aim and our thinking is to build on the fairly solid structure we have achieved in helping people to live outside hospitals, and especially to emphasise the need to develop preventive services for children.
My noble friend Lord Soper, from his great knowledge and experience in this field, reminded us that there will be a need for a considerable expansion in the provision of homes and hostels for children and adults. Local authorities have in prospect in their future planning some 2,300 residential places, but we think that this will need to be at least doubled. For adults they have over 4,000 residential places and plans to build by 1972 another 86 hostels, with an additional 1,860 places, but again a great many more places than this are going to be needed if we are to do what so many noble Lords have asked us to do—that is, to prevent unnecessary hospital admissions and enable more patients to be discharged.
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My noble friend Lord Soper made a plea for experimentation in this field, particularly with some younger groups, but I agree with him that hostels could well become a gimmick, if I may put it in that way. We need to provide a whole range of services and the more varied the range the more likely it is to meet the needs of individual patients. There are so many kinds of hostels, and if my noble friend and other noble Lords interested in this field can persuade people to try all kinds of experiments, I know that my right honourable friend and I will be deeply grateful.
I have mentioned the advisory group that we set up at the beginning of April to help us with planning both the short-term and the long-term strategies which we need to tackle the problem. One aspect of our consideration which has broken new ground is that we have had a two-day residential consultation (if I may call it that), with a whole range of people working in the services. It was very good, and I found the noble Lord, Lord Grenfell, there, whether in his capacity of chairman of a hospital management committee or of treasurer of the National Association for Mentally Handicapped Children, I do not mind. A whole range of people gave freely of their experience and knowledge, generally participating with Ministers in planning new services for the future. In a few weeks' time we are going to have a day with the nurses to do just the same thing. And when I say "nurses" I do not mean only matrons and chief nursing officers; I mean nurses from the ward level. Only in this way will we develop a realistic and practical policy. We cannot think out policy in the isolation of Alexander Fleming House. We are trying hard to get the views of as many people as possible on the kind of ways in which we should develop.
At the same time, we can develop on the solid findings of a number of feasibility studies which the Department has been undertaking. One is on the development of psychiatric services in a joint co-operative scheme with the Regional Hospital Boards, general practitioners and others concerned. A second is concerned with model services for the mentally handicapped and a third, perhaps even more ambitious, has just been started in the North Eastern Metropolitan area, where the object is to bring

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together the services for the mentally handicapped and those for the mentally ill.
All these discussions covering the points I have mentioned, and many more, form part of the Government's major reappraisal of all aspects of the services for the mentally handicapped. We hope to complete this wide-ranging study by early next year, and we shall be publishing a policy statement for public discussion soon after the publication of the Green Paper. I can assure the House that we are determined to tackle these problems and not to neglect them or, as I believe the noble Lord, Lord Vivian, said, sweep them under the carpet. I hope that the account that I have given to the House of the measures we have taken and intend to take and the special injection of funds which we are making available in the coming year, will testify to our determination in this field.
Many tributes have been paid to-night to the work of the staffs of our services to the mentally ill and mentally handicapped. I am most grateful for all that has been said by noble Lords, and I am particularly grateful to the noble Lord, Lord Vivian, for his kind comments about the work my right honourable friend the Secretary of State and I are trying to do. We have been visiting hospitals and local authority services extensively up and down the country during the last few months, and wherever we have gone we have been deeply impressed by the concern for the patients, by the personal kindness and by the stamina, which seems to us to be the special characteristic of the staff of mental hospitals. As our knowledge of the difficulties has increased by seeing them actually on the spot, although admittedly from what I call the "V.I.P. catwalk", so has our regard for their work increased and so, too, has our determination increased to create a situation which will enable them to do their jobs better. If this debate has done nothing else, we see it as yet another step forward in arousing the public conscience to the stresses to which those who work in our mental hospitals have been subjected.
I should also like to take this opportunity to thank the workers in all the voluntary organisations, such as that of the noble Baroness, Lady Swan-borough. the Women's Royal Voluntary
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Service, the National Association of Mental Health, the National Association for Mentally Handicapped Children and the Spastics Society, to mention just a few. These organisations have laboured in this field for a very long time and as the noble Baroness reminded us, in the past the voluntary organisations have pioneered many of our social services. We believe that they will need to continue to play an active role not only, as the noble Lord, Lord Sandford, said, to fill the gaps in the statutory services and to mobilise enough resources to provide this additional and, I think, necessary impetus for continued development, including experimentation in the forms of care, but also, above all, I would say, to enrich the quality of the services offered. I think all of us believe that there is in the public a vast amount of good will, which can be of immense practical assistance in the struggle with these problems.
I was in a large long-stay hospital on Monday morning, a hospital which has great difficulties and a considerable degree of overcrowding and concentration of patients with multiple handicaps. It was perhaps the most cheering thing that morning for me to hear that a group of boys was coming from a local school to help in the wards. The staff told me that at the beginning, when they heard that the boys were going to come, they wondered what on earth they were going to do; but they found that when they came they were prepared to do anything, and to do it with pleasure. That, I think, is a fair illustration of the kind of reservoirs of help that exist, and, I would say, particularly among the young. That is why, again, we feel that one of the first short-term measures, one of the ways in which this new injection of money can be used, is to extend the scheme to which the noble Lord, Lord Sandford, referred, and have paid voluntary organisers.
My Lords, various other questions have been raised, including scientology and a whole host of others. I hope that, in view of the time, noble Lords will allow me to answer them individually. In the last resort, and in conclusion, one conies back to the point of Lord O'Hagan's Motion namely, "public attitudes". I see this debate as part of a much needed wider campaign to help the handicapped,

739
a campaign in which Government, both central and local, hospitals, voluntary associations, individual volunteers, staffs, relatives and parents must work together to improve the service. The community as a whole, as so many noble Lords have said, must accept its responsibilities for the mentally ill and mentally handicapped, and neither deny them nor hide them away in isolated institutions.
I am beginning to feel that, when the day comes when there is not a single local protest about the setting up of a hostel in a residential area, and when there is not a single child or adult in our long-stay hospitals who never receives a visitor, then we really will have changed public attitudes. I thank the noble Lord, Lord O'Hagan, and all who have taken part in this debate. I hope that it will serve a useful purpose.
LORD GRENFELL: My Lords, before the noble Baroness sits down, could she kindly inform me whether the Government have considered, or will consider, what I asked for; namely, a certain amount of monetary help to those who have their children at home?
BARONESS SEROTA: My Lords, I think the noble Lord, Lord Grenfell, is aware that this is a matter that we have under consideration, and one to which I may say without giving away any secrets, the Government are very sympathetic. I must ask him to await the publication of the Government's new Social Insurance Bill, and to look there at some of the provisions suggested in it.
LORD O'HAGAN: My Lords, I do not really know what to say. I, at least, after all these hours cannot take in any more. So may I just thank all speakers most sincerely, and beg leave to withdraw my Motion?
Motion for Papers, by leave, withdrawn.

EXPIRING LAWS BILL
Brought from the Commons; read la, and to be printed.

EGYPT AND COMPENSATION FOR BRITISH ASSETS
8.15 p.m.
LORD COLYTON LORD COLYTON rose to ask Her Majesty's Government whether they can make a Statement on the failure of the Egyptian Government to honour the terms of the Financial Agreement of 1959 concerning British subjects in Egypt.
The noble Lord said: My Lords, I do not know whether it is necessary or proper that, in raising this issue afresh, I should disclose an interest as a former Chairman of the Anglo-Egyptian Resettlement Board. Nevertheless, I do so, and most wholeheartedly, as this is a cause which is very close to my heart. It is one which I fear, unlike the great and important issues which your Lordships have been debating this afternoon, has been swept under the carpet. Whatever view one may take of the events of the Suez Canal Zone in 1956, one thing is perfectly clear; namely, that among the principal sufferers were the members of the British community in Egypt, many of whom were deported at 24 hours' notice, and most of whom had their property nationalised or sequestrated.
The Anglo-Egyptian Resettlement Board, as my noble friend Lord Trevelyan, who was my colleague on the Board, will know, was set up in 1957 to rehabilitate those British nationals expelled from Egypt. It was, however, subsequently entrusted with the additional work of making ex gratia loans to British subjects who had suffered expropriation or sequestration on the basis of the value of their assets up to a maximum of £10,000 each. These actions were no doubt undertaken in the light of the Government's Statement at the time that the Suez operation had been taken in order, among other things,
"to protect the lives and property of British Nationals in Egypt."
In this context, I would say that, as a result of the untiring and devoted pressure by the late Lord Killearn, repeated assurances were given by Her Majesty's Government at the time that the Egyptian sterling balances of £128 million frozen in London would not be released before British nationals had had their assets restored to them or had received compensation in full.
Here one must differentiate between British property in Egypt which was actually nationalised—or, as it was termed, "Egyptianised"—on the one hand, and property which was merely sequestrated; that is to say, was turned over to the Sequestrator General, as Custodian of Enemy Property, pending a settlement on the other. The former, nationalised property, was largely property belonging to large companies and to commercial firms. The latter was the property of private individuals, rich and poor.
On February 28, 1959, a Financial Agreement was signed with what had then become the United Arab Republic, designed to restore friendly relations between Britain and the U.A.R. In consequence of this, the U.A.R. paid £27½ million in full and final compensation for Egyptianised property and for certain losses arising as a result of sequestration measures. It was also clearly stipulated that British assets which had not been acquired outright by the U.A.R. but had merely been sequestrated would be restored within a period of three months to their owners or agents. In return, Her Majesty's Government undertook to release the frozen sterling balances, which, after deduction of £28 million belonging to the Sudan, and certain commercial debts, amounted to £75 million. This was carried out within a few days of the signature of the Agreement, and the money was used by the U.A.R. to settle debts which it had incurred in other countries.
Her Majesty's Government used the sum of £27½ million paid by Egypt to compensate the owners of Egyptianised property, albeit at a considerable loss to many of the claimants. But so far as the owners of sequestrated property were concerned, a long, heartbreaking and largely fruitless battle then began to regain what was left of their possessions in Egypt. The administrative difficulties created by the U.A.R., and the ingenuity of their officials, were apparent right from the start. It soon became clear that, even where token releases were made, the U.A.R., by pleading inter alia lack of funds for effecting transfers across the exchange, would not be meeting its obligations. This distinction immediately created inequalities between those categories of British subjects who had been fortunate enough to have all
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their assets Egyptianised, and whose claim could therefore be promptly established and met, and those whose assets the Egyptian Government merely claimed to have temporarily sequestrated. The latter—and these are the people whose cause I am pleading to-night—were placed in circumstances of particular difficulty, because even at that juncture discriminatory measures were being enforced against British nationals who had held permanent Egyptian residence visas, and who were not granted re-entry permits, even of a temporary nature, to enable them to go there to wind up their businesses. There is no doubt whatever that there was definite discrimination against members of the Jewish community.
As a result of failure to secure implementation of the 1959 Agreement, further discussions were held in 1962. In the main, these confirmed the clauses of the 1959 Agreement, with the object of properly carrying out the Agreement. Her Majesty's Government at the time agreed to lend the United Arab Republic the funds necessary to effect cash transfers of up to £E.5,000 per person. At the same time, Her Majesty's Government set up a Grants Committee with the object of assisting those British nationals who were destitute, or who had fared particularly badly at the hands of the U.A.R. When we consider these arrangements, my Lords, and the problems created by the transfer across the exchange, it is ironic that when the Tiepolo ceiling, which was discovered in the Egyptian Embassy in South Audley Street, was sold at Southeby's for half a million pounds, that was immediately placed on the external account and at once made transferable to Egypt. As a result of these events, many who had qualified for an ex gratia loan from our Board at the time of the Suez operation and were still in difficulties were assisted. On the other hand, pressure was brought to bear concurrently for substantial repayments out of the ex gratia Treasury loans. My own impression at the time a may be wrong about this) was that these repayments would be required only when full repayment of the losses by these persons had been made. What actually happened was that in many cases the amount of the loan was automatically withheld from any compensation received. It is known that in many cases little or no

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benefit accrued to the claimant beyond the cancelling of his debt to the Treasury.
We now come to a further stage, when a number of nationals whose assets were purported to be released in 1959 found that they had subsequently been either disposed of by the sequestrator, and the proceeds of the sale set aside, or re-sequestrated. In the case of some 150 to 200 British nationals, these further measures of sequestration and discrimination took place. They were imposed under municipal legislation, and I should have thought (although I am no lawyer) that that entirely contravened international law, since the Financial Agreement of 1959, as an international treaty, would automatically override any municipal legislation. Repeated protests and requests for information by Her Majesty's Government between 1960 and 1967 were ignored, but meanwhile the process of spoliation, confiscation, and maladministration went on unchecked. The value of the property thus affected is estimated to have been between £20 million and £35 million in 1956. According to an Answer which was given in another place by Mr. Rogers on February 9 of this year to Mr. Wall, these losses have brought down the estimated value of such property to £11 million, In many cases losses have accounted for more than 50 per cent. of the value of the property. I will not detain your Lordships unnecessarily, but I could quote from statements by the Prime Minister in 1959, and indeed from other statements in this House, where it has been said that Her Majesty's Government would if necessary provide further contribution from public funds to meet the cases of those who were in particular distress.
As a result of the failure of the Egyptian Government to implement in full either the 1959 Agreement or the 1962 Agreement, further conversations took place in 1967. It is apparent from a further exchange of Notes between the Governments of the United Kingdom and the United Arab Republic dated April 24, 1967, which were published, that this matter of the applicability of municipal law was something on which both Her Majesty's Government and the Egyptian Government appeared to be unwilling to accept responsibility for any further losses. It is believed that at the time the only reason why the Government
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of the United Arab Republic agreed to this exchange of Notes was in order to claim before the International Monetary Fund that the U.A.R. intended to respect its financial obligations. The forebodings of the claimants were made known to the Foreign Office at the time, but once again its seems to be the case that the rights—I will call them rights, and not just interests—of a minority have been sacrificed either in the interests of expediency, or in the so-called wider public political interest. If it is right to sacrifice someone's rights in the national interest, then surely the Exchequer should adequately compensate those who suffer losses as a result. As things stand to-day, some property which Her Majesty's Government know to be British property has not even been included in the schedules to the various annexes of the Agreement. I could give your Lordships numerous examples of further injustices and hardships arising out of these events. The hour is late, and I do not wish to detain you unduly, but I would remind you that the Foreign Compensation Bill of October 31, 1962, provided for the payment out of monies provided by Parliament of additional compensation in respect of claims arising in connection with certain events in Egypt. Under this Bill, Parliament can—as it sees fit so to do—make available further amounts, and replies given in the other place by Ministers at various times show this to have been done, so there is no problem on this score. Thus the machinery and the enabling Acts exist.
Meanwhile, I should draw your attention to one further development. The Government of the United Arab Republic has signed an Agreement with the Swiss Government concerning the liquidation of Swiss assets in the U.A.R. worth £E5 million. This Agreement, containing a most-favoured-nation clause, was followed by similar Agreements, on the same basis, with other Governments—those of the French, the Greek, the Lebanese and the Italians. All these Agreements were far less favourable to the claimants than were the original 1959 and subsequent Agreements with the British Government. I understand that the Government of the United Arab Republic is now maintaining that in the light of these fresh Agreements it cannot improve on the terms so far as British claimants are concerned, and it appears to be seeking to present

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Her Majesty's Government with a fait accompli so far as British assets are concerned. I must insist that British claims cannot in any circumstances be regarded in the same light as these other claims. British assets were sequestrated and have been under U.A.R. custody since 1956, while nationals of other countries were free to dispose of their assets at will.
I do not intend to detain your Lordships any longer. There are so many other issues which could be mentioned: the highly vexatious and, indeed, intolerable conditions under which British nationals are given access to the blocked balances in their banks in Egypt; the limitations on what they can draw; the refusal of visas to enable them to enter the country; the fact that if one does not draw during one year one loses £1,000, or whatever it is, for that year and cannot accumulate, and so on. It is a tragic situation and there are people—not merely rich people but many poor people—who are suffering from the results of these events at the present time.
A practical suggestion which has been made is that the Treasury might purchase these blocked accounts from their owners and make use of the funds for official British purposes in Egypt, or, if thought preferable, might dispose of them to the Egyptian Government on a Government to Government basis. The total value I believe now does not exceed much more than £10 million, and at least the owners would secure some sort of tangible immediate benefit. The same applies to the securities held by these unfortunate people in Egyptian banks. Would it not be possible for Her Majesty's Government to press for immediate permission to be given as of right to these individuals to dispose of their securities, so that the proceeds of the sale cart be added to the liquid funds in the blocked accounts and perhaps again used, taken over, by Her Majesty's Government as I suggested just now?
It really appears that, unless Her Majesty's Government recognise that the United Arab Republic has no intention of making genuine restitution, they must themselves accept moral responsibility for doing so and take active steps to put an end to this protracted interlude. I notice in a Press report of September 4 from Cairo, regarding the interview which the present Chancellor of the Duchy of
746
Lancaster had with President Nasser on that date, that there was a reference to the fact that it was possible that the question of compensation to British nationals had been raised. There is a gleam of hope, and I hope that the Minister who is going to reply will be able to give us some encouragement to think that action will now be taken. But I believe that, come what may, justice must be secured for these unfortunate people who have suffered for 13 years through no conceivable fault of their own.
8.33 p.m.
LORD KILLEARN: My Lords, the noble Lord, Lord Colyton, has already dealt with some of the points I intended to tackle. My final position, however, is slightly different from his. I trust, therefore, that both he and other noble Lords will forgive me if I cover some of the same ground. I speak as a private citizen. I have never been directly involved in formulating official policy, nor, except for eight years as a war-time soldier, in carrying it out. I am involved to-day simply and solely for one reason, and that is that my father was so deeply interested, and indeed personally committed, in this cause. I have turned up most of the relevant passages in the OFFICIAL REPORTS—at any rate those in print—covering the years 1956 to 1964, which were the years in which he was vocal, and it is remarkable how steadfast, and indeed persistent, he was in his efforts to right not only what he regarded as but what was a glaring injustice.
Apart from his work and influence behind the scenes dealing with the leaders of the dispossessed British subjects and with various Government Departments, he took a very active part in this House in debates and Questions on a great number of occasions. OFFICIAL REPORTS which I have superficially looked at show well over thirty substantial interventions between 1956 and 1959, and as many again after 1959. He would be very gratified to know that I still receive appreciative letters arising from this crusade on his part. Mr. Mosseri, who first brought this unsatisfactory situation to the attention of the noble Lord, Lord Colyton, and myself, has now, I understand, taken over the mantle of Colonel Moore. The name of Colonel Moore was bandied about, sometimes rather unkindly I am sorry to say. I think his

747
work was absolutely fantastic and he deserves a very honourable mention for his efforts during those years. As I say, to some extent I think that Mr. Mosseri has taken over his mantle, and he speaks not only for himself but for all other dispossessed British subjects. At this point it would be only right and proper for me to pay a tribute to the noble Lord, Lord Colyton, who was a colleague of my father before the war at the British Embassy in Cairo, and who not only has raised the subject this evening but in those earlier years—especially in those earlier years—between 1956 and 1959, played a valiant part, and I should think a very uphill and sometimes a rather frustrating part, too, as Chairman of the Anglo-Egyptian Resettlement Board.
When we are complaining about the 1959 Agreement, I think it is very hard for us now—or it is for me, at any rate, because I was not here—to recollect how grim a situation existed before 1959. As a Back-Bencher, I speak to-day not against any particular Government, but I speak for the rights of the citizen against all Governments. As I see it, a British subject resident in a foreign jurisdiction is, or should be, entitled to expect two things from Her Majesty's Government: first, that they should give him their full support and protection against arbitrary and/or illegal action by foreign Powers; secondly, that if through their actions and through no fault of his own his person or his property is put in jeopardy, they should themselves assume full responsibility for what they cannot recover on his behalf—I assume (I do not know what the legal basis was) that this was roughly the background and the justification of war damage payments during the war.
Of course, we all know that this is not so. In this age the individual counts for little in his own country, and even less abroad. This is an age not only of large battalions but also of large corporations. We have therefore, willy-nilly, to accept a situation wherein Governments, or at any rate the British Government, act under prerogative and not as agents for their subjects. This may sometimes seem unfair to individual subjects, but in the main it has worked, and continues to work, to their advantage.
748
The situation arising from the Suez action was intended to be regulated once and for all by the Agreement of February, 1959, but, unfortunately, it is rather more complicated than that. As I see it, the problem—it is still a problem—may, like Gaul, be divided into three parts. The first and second parts follow directly from that Agreement and the subsequent Exchange of Notes relating to it; that is to say, the Exchange of Notes published in 1962. The third part concerns events which have all occurred since 1959. some of which were covered by the 1967 Exchange of Notes, also now published. The first part of the problem concerns the compensation in this country in sterling of those who, between 1956 and 1959, had either lost their property completely through "Egyptianisation", which one might more reasonably call "nationalisation", or whose sequestrated property on return under the 1959 Agreement had suffered physical damage or monetary loss.
My earlier remarks about what British subjects might reasonably expect of Her Majesty's Government could well apply here. Indeed several speakers in another place during the key debate of March 16, 1959, obviously considered that in the special circumstances—and I think the phrase which was bandied about was "sui generis" which I believe means "in special circumstances" — Her Majesty's Government should take over full responsibility for any part of such losses which it was not able itself to recover from the Egyptian Government on behalf of the hapless British subjects. During that debate of March 16, 1959, at col. 150 in Hansard, the Prime Minister did not commit himself fully to that view, but in an earlier debate on April 11, 1957, at col. 1296 of Hansard, he had indicated that he was indeed thinking of full compensation. On the other hand, Her Majesty's Government can argue that it obtained an exceptionally good bargain, better than had ever been obtained before in such cases; that it has been generous, first by supplementing the Sterling Compensation Fund, and secondly, by introducing an open-ended procedure for dealing with claims. So although one may well feel that it is not enough, it is still a great deal better than what might have been; and for that one must be grateful.

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Speaking now about the Sterling Compensation Fund, I would inform your Lordships that to-day only 500 files out of some 6,500 are still outstanding, while out of a total of 9,000 claims, 8,500 have been settled. A validated claim for £5,000 has received £5,000; one for £50,000 received £40,000 and one for £500,000 received £265,000. The total claims so far are £107 million sterling; claims validated are £70 million sterling, and claims paid are £34 million sterling. Over and above the original £27½ million sterling paid by the Egyptian Government in 1959, Her Majesty's Government have contributed £6½, million so far. They have also provided interest-free loans totalling some £7 million to £7½ million sterling in anticipation of payment of claims. Moreover, they have provided some £2½ million sterling in outright grants in cases of hardship, and of course they have paid the servicing of the Compensation Fund and the servicing of the agents acting in Egypt on behalf of British citizens—better treatment than ever before, for which we must all be grateful.
But one could still say, and I do still say, that it is not enough. I am strengthened in this view by the statement of the Attorney General yesterday in another place concerning the agreement with the owners of the "Torrey Canyon". You will see that at col. 199 he said—or at least your Lordships will see when copies of Hansard are available—and I quote:
"The owners have agreed to make available a sum up to a total of £25,000"—
sterling—
"for the purpose of compensating these claimants"—
that is to say, private claimants—
"in both countries"—
that is, France and England.
"This sum, on the basis of the information available to the two Governments, should be sufficient for that purpose, but if the cost of settling these claims exceeds this sum the two Governments have agreed to indemnify the owners against any excess"—
I repeat "any excess"—
"in their respective countries'.
I do not know what "sui generis" means; I do not know what is a special case. I do not know whether the "Torrey Canyon" is a special case. But if ever there was a special case where the plight
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of the British subject resulted, rightly or wrongly, from the actions of his Government, I should have thought the case of the British subjects in Egypt in 1956 was such a case.
The second part of the problem concerns the restoration of sequestrated property to its rightful owners. This is what the noble Lord, Lord Colyton, has dealt with, and indeed is the main subject of his Question. Here the situation is less satisfactory and, to me at least, less clear. The total involved was estimated by Mr. Macmillan in 1959 as 130 million pounds, which I believe to have been 130 million Egyptian pounds, of which some 50 million (which I take also to be Egyptian pounds) was the property of one corporation and was negotiated independently with the Egyptian Government by them. Of the balance, which is now, translated into sterling, the equivalent of some £60 million, it was estimated that roughly some £10 million related to land, £10 million to buildings, £30 million to various forms of personalty, £5 million to goods and £5 million to plant. Those are very rough figures. On the face of it the latter categories, or at least the last two categories, would seem to be the most likely to suffer physical damage. But in the hands of any bureaucracy a lot of depreciation can occur in such circumstances. I do not go as far as the noble Lord, Lord Colyton, because I do not know, but I can guess: one cannot assume that all concerned have always been meticulously careful to maintain the value of the assets entrusted to them during sequestration. That, I think, is an understatement.
An actual loss (direct or indirect) can, as explained earlier, justify payment from the Compensation Fund in London. However, it is perfectly clear that there have been endless delays and prevarications in making restitution of sequestrated property. In my eyes the "simplified procedure" which was introduced in 1962 still looks to be one of the most complicated I have ever seen. One may be quite sure that the sequestration itself in 1956 did not take very long and was not subject to any formalities. A short time ago many claims were still in suspense or had been turned down, very often without good reason. This applied not only to goods and property in Egypt; it applied to balances in banks

751
and documents in banks, in Egypt or abroad, and there was no limit to the number of obstacles placed in the way of the rightful owners.
There was also the problem of charges made. In the 1959 Agreement there was an allowance of a very large sum of money, your Lordships might think—£2½ million—for the charges of the sequestrator, if you please. It seems that the sequestrator was now saying that he had overspent and wanted some more. Anyway, it is clear that any number of technical and legalistic reasons and obstacles have been introduced, simply and solely to make life difficult for the claimants, which is what the noble Lord, Lord Colyton, said. And, of course, when restored these assets are frozen. The quota of sterling exchange allowed for repatriation of capital is pitifully small. Starting from now and trying to work backwards down the records, I am not quite clear at what stage who was allowed £E5,000, equivalent to £3,750, and at what stage that was reduced to £1,000; it is all very complicated; but in any case it was pitifully small, bearing in mind that in 1957 Egyptian sterling balances in London totalled some £93 million sterling. I cannot quite relate this to Lord Colyton's figure of £128 million, which I am sure is correct. In 1956 I believe it was £111 million; in 1957, £93·3 million; in 1959 at the time of the agreement just under £70 million; and after we had reached this Agreement we finally handed £41 million back. Earlier we had given them £400 million for fighting the war on their behalf, but that is a long time ago. Certainly Egypt has a balance of payments problem; we know that. But the Treasury have been extremely helpful in accepting promissory notes and in other ways. Nevertheless, in 1964 Egypt defaulted on her contractual obligation under the Agreement to provide £750,000 sterling in exchange for the repatriation of British-owned assets.
Turning now to the third part of the story, I must say that this is to me the least satisfactory and the least clear of all. It seems that in 1961 a new round of sequestration was initiated and in 1962 a new round of nationalisation. The Egyptian Government has now agreed, as I understand, once again to restore sequestrated property, or, where it has
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been sold, the proceeds thereof. There is, however, this time no provision for damage or monetary loss arising during the period of sequestration. And of course we all know that property can be neglected, and even more so that forced sales can be extremely damaging.
Concerning the property nationalised in 1962, so far as I know no facts or figures are available, at least not to me. I hope, therefore, that the House, and the Minister who will be replying, will forgive me if I stray slightly outside the terms of the Question of the noble Lord, Lord Colyton, and ask for information about all that has been happening, or not happening, in Egypt to British-owned property since the signing of the 1959 Agreement.
8.53 p.m.
LORD TREVELYAN: My Lords, having been Ambassador to Egypt in 1956, I am naturally concerned that everything possible should be done for those British citizens who suffered as a result of Egyptian action after the Suez affair and who are still in need. I have a great admiration for all that the late Lord Killearn and the noble Lord, Lord Colyton, did on behalf of the British citizens concerned in helping to get them considerable relief, after I myself had been able to achieve very little for them on my return from Cairo.
I know also that since those days succeeding Governments and my successors in Cairo have made great efforts on their behalf and have helped them to a considerable extent, but not, as the noble Lord, Lord Colyton, has shown, with complete success. I also realise the limitations of action possible on behalf of British citizens who suffered, with Egyptians and nationals of other countries equally, from the subsequent round of sequestration and nationalisation. But I hope that every further effort possible will be made to help those who are still in need as a result of the first sequestrations. In particular, I hope that further efforts can be made to induce the Government of the United Arab Republic to honour Article V.I(b) of the 1959 Agreement, the undertaking that they would give favourable consideration to applications for further transfers into sterling in excess of the transfers up to £E5,000. I believe that they have not yet

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done so, presumably in view of their shortage of foreign exchange. I also trust that if there are still people who have not been able to get even their £E5,000 over the exchanges, they will be helped to get their rights under the Agreement at last. I trust that everything possible will be done to ensure that the inter-Governmental Agreements are carried out in full in every particular
8.55 p.m.
LORD BESWICK: My Lords, I appreciate the quite special interest which the noble Lord, Lord Colyton, and the noble Lord, Lord Killearn, have in this absolutely wretched matter, and I admire the continued interest and concern which has been shown by the noble Lord, Lord Trevelyan. I only wish that it had been possible for the noble Lord, Lord Colyton, to delay a little, just a day or two, before raising this Question, so that either my noble friend Lord Shepherd or my noble friend Lord Chalfont would have been able to answer. They of course have a more detailed knowledge of the business and a more immediate responsibility for these affairs. However, I shall endeavour to set out as clearly and as fully as possible what is the present position.
Ten years have passed since the Financial Agreement of 1959 referred to in this Question, and it will be unnecessary for me, after what has been said, to take up further time with a discussion of the merits or demerits of that Agreement or of the series of supplementary Agreements which followed it. The difficulties which have arisen in recent years appear to fall into three main categories: first, the difficulties and delays over the release of the property; second, the restrictions on transferability to this country; and, third, the fresh problems that have arisen out of the measures of sequestration which have been taken by the U.A.R. Government, quite separately from and subsequent to the events of 1956 to 1959.
The 1959 Agreement provided for the speedy release of sequestrated property to the owners. Unfortunately, as the noble Lord, Lord Killearn, and the noble Lord, Lord Colyton, have said, on the U.A.R. side the process was hampered by administrative confusion and red tape which resulted, in many cases, in long delays. Nevertheless, this task is now
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almost if not quite completed so far as the 1956 measures of sequestration are concerned. The few cases which remain to be dealt with have been held up because of difficulties and complications peculiar to each case. The U.A.R. undertook in Article V of the Agreement of 1959 to permit transfers of up to £E5,000 on account of assets which had been released from measures of sequestration, to those British subjects who had ceased to be resident in the U.A.R. The U.A.R. promised also to give "favourable consideration" to applications for further transfers in excess of that sum.
The provision for transfers of up to £E5,000 has been largely fulfilled, but some transfers have still to be made. A joint account for this purpose was set up in a London bank and put in funds by the U.A.R. This account now has a balance of nearly half a million pounds (I am not sure whether there is any connection with the amount the noble Lord, Lord Colyton, quoted for that ceiling), and this will probably be sufficient to meet all the sterling transfers still due. It has of course been a disappointment to everyone that the U.A.R. authorities have not seen their way to approve transfers over and above these limits. Those with funds which remain blocked in the U.A.R. naturally resent being denied access to their remaining assets. But I understand that even before 1956 a similar restriction of transfers of over £E5,000 existed in the U.A.R. I am glad to see the noble Lord, Lord Trevelyan, nods his head in agreement.
The grants made through the Egyptian Grants Committee have gone some way to mitigate any hardship. Opportunities do occur from time to time for these blocked balances to be sold for convertible currency to persons who are specially authorised by the U.A.R. authorities to buy them. It is also possible to use up to £E1,000 a year from blocked balances for personal expenditure on visits to Egypt. The Government have deplored, and still deplore, this continued denial of access to these assets. I can assure the House that the Government will not overlook any opportunity of securing an improvement in the transfer facilities.
The third kind of difficulty arises from the delays in releasing property of certain British subjects which was resequestrated in 1961. Some British subjects who had

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had their property taken in 1956 saw it taken once again under the measures of sequestration imposed under Proclamation 138 of 1961. I should add, however, that this proclamation was not restricted to United Kingdom nationals; it applied to many persons of other nationality, including some U.A.R. nationals. Annex B to the 1967 Exchange of Notes was designed to secure the release and return of this property, or the sale proceeds if the property had been sold while under sequestration. The first problem in this connection is the confusion which has existed in the U.A.R. sequestration departments concerned with this Proclamation 138 sequestration. This confusion still appears to exist, but it is gradually being sorted out and there has been better progress during the course of this year. During the last few weeks a Working Party of United Kingdom and U.A.R. officials has met in Cairo to discuss ways and means of speeding the release of these assets. There is no simple solution. The Embassy work very closely with agents and the sequestration department and are ready to examine every individual case. They are concentrating on getting a speedy release of the assets readily available in any particular case, so that any transfer of sterling which may be due can take place without waiting for a settlement of problems attaching to other assets of the person concerned.
Other delays have been caused by legal formalities connected with some of the property which had been sold, under Government decree, while under sequestration. The buildings which were sold need to be registered in the names of the buyers, usually State-owned insurance companies, and the formalities have been protracted. But this Working Party which I mentioned has been seeking ways and means of simplifying these formalities. It should now be possible to ease them in cases where property was owned by a single owner; the formalities cannot easily be waived in cases where a building was owned by several persons, particularly—as was sometimes the case—by joint owners who were of different nationalities. The Embassy are
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continuing to pursue these questions with the U.A.R. authorities.
My Lords, some dissatisfaction has been expressed at the prices at which some of these properties were sold. For the purposes of these sales the properties were valued according to a set formula, and it is not possible to dismiss out of hand the formula that was used. It is in fact used by the Egyptian Government for valuation of properties for the purpose of assessing estate duty. In some cases the valuations produced have not seemed unreasonable to the owners themselves. In other cases, and particularly with private villas, the valuation has been low. The U.A.R. authorities maintain that their valuations must stand, and they point out that they have been accepted by other Governments who have reached agreements relating to similar properties.
We have made repeated representations at all levels in Cairo with a view to settling these problems of the property re-sequestrated in 1961, and we shall continue to do so. We believe from the discussions in the last few weeks in Cairo that the Egyptian Government are anxious to settle these questions as quickly as possible.
The noble Lord spoke about the repayment of loans. I must say that I could not quite understand the point he made there, because Her Majesty's Government have always made it clear that in demanding repayment of the loans made they would always take into account not only the amounts recovered but also any evidence of continuing hardship. We shall continue, I assure noble Lords, to make every effort in Cairo to maintain and improve on the progress which has been made in recent months.

CONSOLIDATION BILLS
Message from the Commons: That they concur in the Resolution communicated to them on Tuesday, November 4.
House adjourned at five minutes past nine o'clock.