§ 3.52 p.m.
§ THE MINISTER OF STATE, DEPARTMENT OF HEALTH AND SOCIAL SECURITY (LORD ABERDARE)My Lords, I apologise for interrupting this Second Reading debate, but this may be a convenient moment, if I may have your Lordships' permission, to repeat a Statement which my right honourable friend the Secretary of State for Social Services is making in another place on Development in the Health and Personal Social Services. The Statement is as follows:
§ "The Government have decided to allocate a further £118 million to speed progress in improving conditions in sonic of the most vulnerable sectors of the health and personal social services over the next four years. Taking into account the extra £110 million which the Chancellor enabled me to announce in the House of Commons in November last year, this means that since the Government came to office 17 months ago they have made resources totalling some £250 million at present prices available for special improvements in the services over and above, and completely additional to, the cumulative increase of the order of £80 million each year which is included in the expenditure programme for normal development.
§ "My right honourable friends the Secretaries of State for Scotland and Wales will be informing the House of 835 their proposals for development of services in those countries. The English share of the latest addition, amounting to £100 mill ion, will in the main be spent on expanding and improving services for the elderly and the mentally ill.
§ "I envisage that about £45 million of the money will go to the hospital service. The Government intend to improve hospital accommodation for both the elderly and the mentally ill. Some of the money will also be spent on improving the standards of such things as staffing, furnishing and food, and on increasing the number of places for the elderly.
§ "The extra provision will certainly not enable us to overcome all the problems of these hospitals but it will be enough to secure substantial improvements. In the five years ending in 1975–76 hospital authorities are expected to spend about £150 million over and above the level of expenditure last year on improved services in long-stay hospitals. Of this about two-thirds will come from the special additional allocations.
§ "About one-third of the latest £100 million has been earmarked for the health and personal social services provided by local authorities. In particular, I am sure that local authorities will wish to join with me in a determined effort to sweep away all the former Poor Law institutions still being used as old people's homes and to replace them with modern buildings. I hope this programme will be completed within the next five years. In this way we should at last dispose of the old workhouse and its Dickensian associations. I also hope that local authorities will be able to go a long way towards replacing the many old and not always satisfactory houses which have been' adapted to accommodate old people, and that they will, in general, make special efforts to provide more and better accommodation for both the elderly and the mentally ill. Additional loan authorisations of £30 million will be available to enable the local authorities to undertake these programmes.
§ "I am also making provision from the extra money to meet the costs of 836 re-organising the National Health Service. The balance of the money is to be spent on a number of improvements: I intend, for example, to provide for increases in key staff for accident and emergency departments, and I shall have particularly in mind the need to provide more facilities for people with epilepsy, and the need both to develop and to evaluate and spread information about aids and equipment of all kinds for the disabled. Where appropriate, I shall be seeking the co-operation of the voluntary organisations as well as that of public authorities. The response of the hospital authorities in improving arrangements for the younger chronic sick has been such as to exceed the money I set aside from last year's £110 million and I am therefore providing the further sum required from the extra money now available. I shall be making announcements about these, and other developments later.
§ "Mr. Speaker, the whole House will, I am sure, welcome the Government's allocation of these substantial extra resources and will recognise the importance of the contribution they will make. to improving the health and personal social services."
§ 3.56 p.m.
§ BARONESS SEROTAMy Lords, may I first thank the noble Lord, Lord Aberdare, for his usual courtesy in repeating the Statement made by his right honourable friend in another place. I am sure that I shall be expressing the view of the whole House in saying that we all warmly welcome the allocation of additional money to improve existing services both in the hospital and in the local authority field, particularly in the areas of greatest deprivation. I must first ask the noble Lord to confirm that this is new money and is not, and will not need to be, met either in whole or in part from increased charges now that the iniquitous and totally impracticable proposal to introduce cost-related prescription charges has had to be dropped.
With regard to the allocation of hospital monies which, as I read in the Statement, are to be spent primarily on improving hospital accommodation for the elderly and the mentally ill, I would enter a special plea and urge the noble Lord and his right honourable friend to see 837 that some of this money is spent on improving facilities for children in our long-stay hospitals for the mentally handicapped as well. For these children the hospital is their home, and, in some cases, school as well. I very much hope that I have the support of the whole House in urging that, in addition to improving hospital living conditions for the elderly, we shall also spend some of this additional money on our long-stay children who are in hospital for long periods during their most formative years.
With regard to the section of the Statement dealing with additional money for local authorities, which will be warmly welcomed by all concerned, to develop the personal social services they provide, I should like the noble Lord to clarify one point. The Statement refers to one-third of this latest allocation of £100 million in England. The end of the paragraph concludes with a reference to additional loan authorisations of £30 million to enable local authorities to undertake these programmes. Am I right in thinking that the £30 million that is referred to at the end of that paragraph is in fact the one-third of the £100 million? Am I also right in thinking that the £30 million for loan sanction means that in the field of the local authority personal social services the additional monies will be capital monies only, channelled into new buildings and improving existing ones? If this is so, I would ask the noble Lord to consider whether some of this money can be used for the maintenance of the services. It is not enough for local authorities to build, provide and adapt; these are high labour-intensive services, and unless local authorities are given additional money specially earmarked for staffing the services they cannot run the homes the capital allocation provides. We need people to care for people, and I would urge the Government to allow some of the local authority allocation to be used to improve staffing levels in the services for the elderly, for the mentally ill and the mentally-handicapped, and for children in their care.
Finally, may I thank the noble Lord and his right honourable friend for a most welcome Statement, and particularly for the references towards the end of it indicating their interest in and concern for the special groups who need additional help—the epileptics and the 838 younger chronic sick and the disabled, in particular. VISCOUNT NORWICH: My Lords, five minutes ago my noble friend Lord Amulree was called away to render his own personal health service to someone (I am not quite sure who) in this House who has been taken ill. It therefore falls upon me to welcome most warmly, on behalf of my noble friends on these Benches, the Statement which the noble Lord, Lord Aberdare, has just made.
§ LORD ABERDAREMy Lords, I am most grateful to both the noble Baroness, Lady Serota, and the noble Viscount, Lord Norwich, for their kind welcome of this Statement. I am particularly grateful to the noble Baroness, who I know has a very deep interest in these matters. I would straightaway confirm that this is indeed new money and is in no way dependent on increased charges. I naturally take very much to heart what she had to say about children in hospitals for the long-stay mentally handicapped. Indeed, this is very much a sector of the Health Services where we certainly ought to do our best to provide improved facilities. As the noble Baroness is aware, in the recent White Paper on the mentally handicapped it is stated that we hope that more and more of these children will not have to be provided for in hospitals and that provision will be made for them to be cared for in the community. The £30 million mentioned, which is about one-third of £100 million, is indeed the loan sanction for the local authorities. I take the point the noble Baroness made about the need for additional revenue resources, but this particular effort is directed towards the plan for clearing away once and for all the old workhouses and some of the unsuitable buildings, and in this instance is capital money only. But I am very grateful for the noble Baroness's kind reception of this Statement.
§ BARONESS SUMMERSKILLMy Lords, I am sure we all welcome the Statement of the Minister, but I listened in vain for those very important words "domiciliary services ". I am one of those people who believe that old people should be kept in their own homes as long as possible, and if we had adequate domiciliary services then so many more could have a happy end to their lives 839 among their own bits and pieces and not in an institution. But the noble Lord did not mention these. Am I to understand that this money is all earmarked for institutions, or are the local authorities to have a free hand to use it for domiciliary services if they so wish'?
§ LORD ABERDAREMy Lords, this money that we are allocating to local authorities is indeed capital only, and is intended to sweep away the old workhouses. But, like the noble Baroness, we are all fully convinced of the need for keeping old people in their homes as long as possible; and, indeed, our policies in other directions are directed to this end. We have already made money available in the last rate-support grant negotiations for local authority extra revenue expenditure.
§ BARONESS SUMMERSKILLIt is very disappointing.
§ VISCOUNT AMORYMy Lords, may I ask my noble friend whether he is aware how pleased noble Lords in every part of the House will be at the announcement which he has made this afternoon, and how pleased I think we shall all be in general with the allocation of the grants to the objects he has mentioned, with the additional object, I hope, of the one which the noble Baroness, Lady Summerskill, has just brought to his notice. May I ask my noble friend whether he knows to what extent plans are in hand to cover improvements of this sort? I say that because it seems so very desirable, in view of the distressing level of unemployment in the country, that these efforts should be turned into actual expenditure at the earliest possible moment.
§ LORD ABERDAREMy Lords, I am very grateful to my noble friend for his kind remarks. As a former Chancellor of the Exchequer, he will realise how hard we fought for this extra allocation of money. I think I can say that it has been the policy of successive Governments to remove these ex-workhouses, and one therefore hopes that there are plans for extra expenditure to clear them away. There are at the moment about 120 in use for old people, with some 13.000 places in them, and we are hoping that with this 840 concerted effort and with this extra money, we shall be able to clear them away in about five years.
§ LORD DELACOURT-SMITHMy Lords, may I follow up the question which has been put to the noble Lord by the noble Viscount, Lord Amory? Can the noble Lord say a word about the likely employment consequences of the announcement which he has made, and can he give any estimate of when the expenditure indicated in his announcement may start to have an effect in employment terms?
§ LORD ABERDAREMy Lords, I should like to make it clear straight away that this Statement has nothing whatever to do with the employment difficulties at the present moment, for which, as the noble Lord knows, there is a special programme of infrastructure works in which, again, the hospital service will be playing a part. This particular allocation is specifically for the development of the health and welfare services and, particularly, to improve them where we feel they are weakest. It may well take a year for the programme to get fully under way.
§ LORD DAVIES OF LEEKMy Lords, may I thank the noble Lord for that Statement which, in any case, is in keep ing with his gracious self? Without sounding churlish, may I draw his attention to the fact that there was a Royal Statement the other day which drew attention to the lack of general practitioners? If it is not out of order on this Statement, may I ask whether the noble Lord will draw the attention of the Department to this fact and to the fact that the time has now come to look again at the Willink Report, which did not give a broad enough base for the general practitioner? Finally, may I say that the base of this magnificent service is the general practitioner and, if he can be given the time, he can have a psychosematic effect upon a patient through giving him some serenity and confidence in himself. Quite often, this can save the time of the hospitals and other people, and the useless sale of unnecessary drugs.
§ LORD ABERDAREMy Lords, I am very grateful to the noble Lord. Certainly we attach the very greatest importance to 841 the development of the general practitioner services. There is some allocation within this money for the development of more health centres, and this in turn will assist the operations of the general practitioner.
§ LORD DAVIES OF LEEKMy Lords, we want more in the universities now.
§ LORD SEGALMy Lords, may I add an additional word of welcome to the Statement which we have just heard? May I also ask the noble Lord whether he can give some indication of when the later announcement will be made and whether it will include rather more specific allocations to the various heads which he mentioned in his Statement? In particular, may I ask whether some announcement can be made of the building expenditure intended for mentally handicapped children as an alternative to their institutionalisation in hospital, and also whether the additional maintenance requirements will be fully met, in addition to this intended building allocation?
§ LORD ABERDAREMy Lords, I think these are rather detailed matters for me to go into at the moment. May I write to the noble Lord and give him some answers on the questions he has asked?
§ LORD AUCKLANDMy Lords, the Statement made by my noble friend will be welcomed not only by this House but by the country as a whole. My noble friend knows of my interest in the house committee of a mental hospital, and many of my noble friends and other noble Lords have the same interest. May I press my noble friend on this question of mentally handicapped children? Is he aware that there are still many cases of subnormal children, particularly boys, being kept in adult wards of mental hospitals, and can he give an assurance that these much-needed and very welcome funds will be allocated very carefully, with special priority being given to cases where this occurs, particularly in areas where there is already a desperate need for new hospital building and for an increase in staff?
§ LORD ABERDAREMy Lords, this particular allocation of money is especially concerned with provision for the old and the mentally ill, but I sympathise 842 with the points which have been made by my noble friend. It is our policy that mentally handicapped children should not be in the same wards as mentally handicapped adults, and if my noble friend has any particular case in mind, and he will let me know the details, I will certainly go into it.
§ LORD LEATHERLANDMy Lords, may I ask the noble Lord what may be a minor question off the major stream of his Statement? It relates to these purpose-built new homes for old people. Will they be homes to accommodate 50 or 60 people, which seems to have bean the fashion at the Ministry during the last twenty years or so, and, if they are not, will he pay some attention to the advantages which that size of home carries with it? It enables people to be fed on a fine scale, to he accommodated on a decent scale and also—which is most important—to be able, out of 50 or 60 people, to find friends while they are in that home, because in a small home they often cannot find friends and as a result are very lonely.
§ LORD ABERDAREMy Lords, I have great sympathy with what the noble Lord has said. These homes, of course, are built by the local authorities, and I am sure that they will take into account the sort of considerations the noble Lord has put forward.
§ LORD SLATERMy Lords, is the noble Lord aware that it so happens that one of these homes to take in some of these aged people has been opened within my own village only this week, and that it will give accommodation to about 36 people? But I have been looking at the figures of the cost per inmate so far as these homes are concerned, and I find that the maximum is £14 per week, coming down to a minimum of about £4 a week. I take it that this allocation is made in accordance with the financial circumstances of the individual. I wonder if the Minister is in a position to say whether this operates on a national basis. Does it differ from one area to another, or is it a basis that has been laid down nationally by his Ministry?
§ LORD ABERDAREMy Lords, I think this is rather outside the scope of the Statement. Perhaps I could let the noble Lord know privately the answer to his question.