§ 3.8 p.m.
§ Lord STRATHCONA and MOUNT ROYAL rose to call attention to the needs of the elderly, and in particular to the need for provision for their welfare in winter; and to move for Papers. The noble Lord said: My Lords, in introducing a discussion of the needs of the elderly I think I should begin by saying that we are talking about 9 million people in this country over the age of 65. That is, perhaps, one in six of the population. Various Government agencies are spending some£8 million annually on this section of the population. The number of elderly is increasing absolutely year by year, and unless the birth rate changes the proportion of the population is likely to increase as well. So the problem of their welfare is, I think, a self-aggravating one, unless a way can be found to arrest the effects of ageing, as was suggested last week in a most impressive maiden speech by the noble Lord, Lord Selwyn-Lloyd, in this House.
§ Evidence of the widespread concern that is felt about the problems of senior citizens has been evidenced to me by the volume of letters which I have had since putting down this Motion. Even though I have been somewhat overwhelmed by the volume of paper, statistics and suggestions that I have received, one of the encouraging features I have found is the number of voluntary organisations which are actively working in this field.
§ In a speech of reasonable length I cannot attempt to cover the whole field, so I will try to provide a matrix into which can be fitted the numerous knowledgeable and authoritative speeches which we can confidently expect this afternoon, by pointing out the ramifications of the subject and the range which it covers. In addition to pensions and social security, we shall have to refer to the Health Service, and I shall shortly be suggesting that one of the most important angles is the question of housing, the Department 306 of the Environment. We have a self-evident local government interest in the matter, and towards the end of my remarks I will talk about the interest of the Ministry of Energy. And over all these Departments we have the Treasury which some people might describe as a baleful influence on any spending Department.
§ But the theme running through my remarks in this debate will be prevention. I want to find means of preventing the elderly from being separated from their families, of preventing the mental deterioration which is brought on and aggravated by isolation, of physical deterioration and the avoidance of undiscovered and undisclosed hardships. I want to see the prevention of waste at a time of financial stringency; we would all agree that scarce resources must be deployed to their best advantage. I was glad to see it stated in a recent publication by the Department entitled Priorities for Health Services and Personal Social Services in England that they regarded prevention as one of their priorities. I suggest however, that even in these times of truncated Government expenditure, there are ways in which the lot of elderly people could be improved by a proper understanding of their needs and their place in society.
§ As matters stand, things are getting worse. It is bound to be difficult for the elderly to adapt themselves to change; some do it better than others. The pace of change is accelerating all the time, unfortunately one of the causes, and of the effect, of inflation which has reached unprecedented proportions in recent years in this country. The effect of inflation on fixed incomes has been pointed out so often that I need not labour it, but it is particularly sad that those who have worked hard to save for their old age should live to see the independence and self-respect for which they have striven snatched from their grasp by circumstances totally beyond their control. I dare say it is naive of me still to hope that one day we might come to a tax régime for those who are working which will enable them to save with confidence and preserve the independence that they so earnestly seek.
§ I think that a little less obvious is the process of adjustment which this pace of change calls for in minds which have perhaps become a little less agile and 307 flexible. It is difficult for somebody brought up to be used to the penny loaf to get used to whatever the loaf was yesterday, let alone what it will be tomorrow. I do not think it will be a very profitable exercise for us to try to allocate blame for this sort of situation, though I do not think anyone will dispute that it is the responsibility of Government to deal with it as they find it.
§ I would therefore like to get out of the way the one partisan comment that I intend to make this afternoon when I suggest that the Government have been guilty of slightly shabby action, almost a "con" trick, on pensions. In April they claimed to be honouring their pledges to uprate pensions in line with wages. Instead, they did a bit of statistical juggling. By using earnings instead of wages as a base and allowing for the expected forward rate of inflation, they avoided basing their calculations on the six months from March to November 1975 when, according to the Economistnewspaper, prices rose by 15-8 per cent. and earnings by 14-4 per cent., and the effect of this was to make the current pension of £21.20 worth £24.50 in November rather than £25.50. I do not doubt that the Government thought that it was necessary to save the £500 million which it is suggested was achieved by that. But I believe that many of us would have had our respect for them enhanced if they had had the courage to admit what they were doing rather than performing statistical acrobatics behind a smokescreen, if I may mix my metaphors in the usual way. What I do not want to do this afternoon is to suggest that we should simply buy our way out of the problems which we face.
§ There is another point which it is worth making, and that is that family patterns and attitudes have changed, most particularly in the towns; it is perhaps less obvious in the country, where the rate of change is slower. In the cities we have seen an inevitable, and to me rather regrettable, gradual withering away of the community with its neighbourhood shop. It has been displaced by the supermarket, representing the contemporary accelerating and impersonal style. I also believe that the extension of State responsibility has inevitably eroded the sense of personal and family responsibility 308 for the less fortunate. The creation of State institutions at great expense to provide welfare services enables us to shrug off any sense of personal obligation and involvement, often no doubt with a considerable sigh of relief. Here I am not seeking to criticise, but I hope that your Lordships will agree that that is a fair observation.
§ That brings me to a point which was made by the Archbishop of Canterbury in his Motion last week about the importance of the family. However, I must first say that I bridle at the shorthand expression which was used in that debate when we were referring to the three-tier family. That sounds like horribly bureaucratic local government terminology. I am not disputing the fact, but I think that we should try to find a better expression. But whatever expression we use, it is surely right that the proper place for the majority of the elderly to be cared for is in association with the family, where there are many and great benefits.
§ Let us not underrate the effect of social intercourse with the young in arresting the sense of isolation and frustration which can so often lead to mental decay in the old. The elderly need to be made to feel that they have a contribution to make. Too many of their lives appear to have no useful purpose and I venture also to suggest that the younger generation would profit from the broader understanding which they would gain by close contact with a past generation whose experience had been different from their own.
§ First, therefore, let us encourage the keeping of the elderly in the community. Let the Department of Health and Social Security work closely with local authorities to give grants for keeping the elderly with their families. The invalid care allowances are a good start. Some kind of dependant's maintenance allowance would, I believe, be a great deal cheaper than the special arrangements which frequently have to be made for the elderly and which can cost £100 a week and more. I have no doubt that we shall hear more about this from other noble Lords before the debate finishes.
§ Also, as my noble friend Lady Young suggested last week, let us look carefully at legislation which positively militates against the arrangements which one would like to see. Grants should be 309 forthcoming for creating accommodation with some degree of independence rather than the regrettable legislation which gave rise to the shortage of rented accommodation. The result of some of the recent Rent Acts has been a consequent drying up of rooms to let. The social services would make a further gain from care in the family since there would be a reduced demand for social service visiting which I am assured now costs something of the order of £3 per visit. I think therefore that my first suggestion would take the form of a question to the Government. It is: are we satisfied that we are doing all we can to encourage old people to be cared for by their families ? Are there legal obstacles and could there be more effective financial incentives ?
§ The basic solution lies in making old people have a sense of purpose and usefulness. If they are herded together in institutions and treated as patients, we shall, however devoted the care they receive, have very sad results as an inevitable consequence. That leads me to the nub of the problem of the elderly, which is the question of housing. That embraces the problem of warmth in winter to which I shall refer in a moment. In the DHSS pamphlet, there is a rather surprising comment to the effect that one of their first priorities is, "To put people before buildings." I suggest that buildings, by and large, are for people, and I am not sure that the Department is getting its priorities right in saying that. It may also seem rather an inappropriate moment for us to be referring to the problems of the winter warmth of pensioners when we are experiencing what will probably be the hottest day of this summer, but the fact remains that action is needed now if we are not to be caught out in the winter. I suggest that we are not succeeding in the provision for old age pensioners unless we meet their primary needs. One of those primary needs is warmth.
§ That raises the question of what standard of warmth we are seeking. A certain amount of dangerous nonsense is, I believe, liable to be talked about this. Those of us who live in Scotland in unheated houses would dispute that we are necessarily less healthy than some of our more fortunately placed brethren in the South. I wonder about the standards of heating which are demanded for offices.310
§ I admit that Help the Aged have a point when they say in an otherwise rather strident pamphlet that, in a survey as far back as 1972, they found that the morning temperature of 54 per cent. of pensioners was below the standard of 61 degrees demanded for offices in 1963, though that figure of 54 per cent. improved to 27 per cent. in the evenings. In other words, we appear to think it necessary to keep people warm in their offices but are prepared to allow pensioners to get cold in their homes.
§ There is a danger here. We do not want to select one group of the community for special treatment. We do not want to turn the elderly into the disabled. This is not a new problem. I believe that the public are becoming more aware of it, however, and of course it has been much exacerbated by the rise in the cost of energy, though one could argue that we did not so much enjoy the use of cheap energy as of under-priced energy. However, I believe that it is beyond dispute that energy will become more expensive in the years to come and that the problem is not one which will go away. I suggest that one of the troubles here is that we take the wrong view of housing economics. We are making two mistakes: first, the running costs of housing are not considered with the capital costs, either for new construction or for alterations. The effect is that local authorities are constrained by yardstick considerations and, therefore, tend to choose cheap construction which gives rise to poor insulation values and high maintenance costs. In the same way, there is a temptation to go for the form of heating which is cheapest to install — that is, the electric fire—which is then the most expensive to run. I am sure that many noble Lords will know of examples, but I heard of one the other day: last year, a local authority in Oxford wanted to put in gas central heating but was told that it would take the cost of the houses above the yardstick, so they put in off-peak electric heating which will be much more expensive to operate.
§ In a sense, therefore, there is cheese-paring by a somewhat insensitive central Government which leads to the costs being passed down the line to be incurred at the local government level, to the national detriment. Of course, the old age pensioners suffer most because they tend to be in the older, cheaper and less 311 adequate housing which, almost by definition, tends to be the least thermally efficient.
§ The second mistake is a much more general one: standards of housing should be based more on thermal efficiency than simply on the temperature. What we tend to do is to seek to provide heating components rather than insulation components, whereas we should be thinking of the total energy system of a house and thinking in terms of some measurement such as the pound cost per square metre per hour. That sounds rather esoteric, but I believe that your Lordships will recognise that it is the proper standard of measurement to consider. It is worth mentioning in passing that we do not really know very much about how heating is done, and anybody who has sat in front of an open fire will be aware that there is at least a case to be said for a form of radiant heating which heats the people rather than the room and the environment (which it tends to do), but this is a technical subject which perhaps we should not enter into today.
What I believe we can show is that the capital cost of better insulation can frequently be recovered in the reduced cost of heating installations. The Building Research Establishment recently produced an admirable, complicated and very extensive pamphlet about this matter, suggesting that we could save 6 per cent. of our primary energy demand, which would have a value of £3,000 million. I will not attempt to go into the profit and loss of this kind of an argument. But what we do know is that discretionary heating allowances cost £31 million last year, and at that time not a single improvement grant had been applied for. Subsequently a letter went out to local authorities in March inviting them to undertake improvement schemes, and saying that extra money would be made available, and I believe that this may point the way forward. Possibly the noble Lord who is to reply to this debate will be able to tell us how many projects have been initiated under the improvement scheme which specifically mentions —and I quote:
the value of investment in energy saving schemes ".
§ Could we not go further and harness some of the voluntary effort which is 312 available, and the job creation schemes, to ensure that old people have houses which either have loft insulation, combined with sufficient draught sealing, or at the very least have one room made reasonably energy efficient ? Often the work is not of a very skilled or technical nature. The materials probably cost about £50, and if we could achieve a £ 10 per annum saving on a heating allowance of £40 we would be going forwards rather than backwards. The Supplementary Benefit Commission seems to have appreciated this point because I understand that it already can, and does, grant exceptional need payments for curtain linings and draught excluders; and so this is not a very great extension of that concept.
§ My Lords, I have been trying to say that the heating needs of the elderly inevitably drag us into the much wider issue of housing standards. But in view of the interest which has been expressed publicly on the question of hypothermia and fuel disconnections since we put down this Motion, I must say one or two words about these matters. I am very glad that the noble Lord, Lord Lovell-Davis, is to speak in the debate because he it was who was responsible for what is known as the Oakes Report, and I am sure that he will give us considerable authoritative information on the subject. But on the subject of hypothermia —and I say this with due temerity in the presence of more than one doctor in the House —I believe that we must be careful not to become hysterical.
§ We really do not know the facts. The reported deaths number between 100 and 200 per annum. I know that we are talking about a series of mild winters and it would be very prudent of us to expect not to continue to have mild winters. I am sure that it is likely that cold contributed to very many more deaths than 100 or 200. Figures of 50,000 a year and 200,000 a year are bandied about, and it seems to me probable that the number of deaths to which a contribution was made by cold is probably in the tens of thousands rather than in the hundreds. But the best advice that I can get is that nobody really knows.
§ Help the Aged suggests that three-quarters of a million people are at risk, but then a considerable doubt has been cast upon the statistical basis of that 313 assertion. What I think we can say without any doubt whatever is that a number of old people endured discomfort last winter and view the approaching winter with grave misgivings, and this is a situation which should be tackled in an energetic way, in every sense of that word. I have already made one or two suggestions, and I think that such a programme would have to include the important job of identifying those who are in potential need. This is not always as easy as it might seem, and there is the well-known problem of the reluctance of pensioners to apply for assistance.
§ This leads me finally to the question of disconnections. Here again I think we must be careful not to let emotion cloud our common sense. Surely most of us would agree that it will greatly complicate the work of the fuel supply industries if they are to be asked to make social judgments about the needs of their customers. After all, we do not suggest that food shops or coal suppliers should be induced to extend additional credit by continuing to supply customers who are bad payers, and the sanction of refusing to supply—which is what disconnection really amounts to —certainly reduces the costs of collection and of the bad debts which would otherwise fall on all the other consumers.
§ Furthermore, I understand that the supply industries already go to considerable trouble to avoid overhasty disconnection in the winter and that they normally refer such cases to the social security authorities. Obviously some sad cases slip through the net. So it may be that some administrative tightening up is required. I should have thought that the kind of simple system which would be appropriate might well he that of identifying the meters and the computer accounts of the vulnerable cases by some form of positive identification —the term "risk disc" has been suggested —and then any such overdue accounts would be referred by the supplying authority direct to the social security authorities who would meet the bills and then consider whether to recover the arrears from the consumer or whether the accounts should be met from social security funds.
§ There is one other point to be made. When we talk about prepayment meters, 314 saving stamp schemes and a number of other suggestions in the Oakes Report, it must he realised that it is an unfortunate fact that they usually involve an additional cost of collection, and properly speaking that cost should be reflected in the tariff to be charged. So, on the question of heating, I am saying do not let us try to turn the energy supply industries into welfare organisations. They have a difficult enough job to do on a very big scale, with all kinds of conflicts (which were mentioned yesterday) which it is their job to resolve. By all means let them show a little extra social concern as befits a monopoly industry in public ownership, but leave welfare to the Department of Health and Social Security, whose job it is. I think this is particularly appropriate because it will encourage that Department to question some of the basic attitudes which tend to concentrate on stop-gap measures rather than try to get to the heart of the problem, which I have suggested this afternoon is very largely a matter of housing.
I have also suggested that there are social and moral benefits to be derived from encouraging the elderly to remain in closer relations with their families. We must examine the impediments to this, to see whether there are not incentives to help in this process. I believe that we could probably save money in this way, or at any rate make better use of the slender resources we have available to us. I should like to question the DHSS priority when they say, as they do here:
Capital expenditure will be cut back in order to allow current expenditure to rise.
I think we should not accept that overhastily; and I wonder whether the Minister, when replying, could tell us how often the DHSS meets to discuss these matters with the other Departments which I suggest should at least be concerned. I should like to remind him of a comment made in a Reith Lecture some years ago by Doctor Schonn, who said:
Government Departments are a monument to old problems ".
§ I would suggest to the Minister that the needs of the elderly would possibly be an appropriate subject for the Central Policy Review Staff to study, and perhaps they could start by producing a policy for warmth; because, my Lords, what I hope we shall be doing by the end of this debate is advocating a policy for investing in the 315 future, and not just pouring public money down the drain in order to subsidise waste. My Lords, I beg to move for Papers.
§ 3.42 p.m.
§ Lord AMULREE
My Lords, I was very pleased to see that the noble Lord, Lord Strathcona, had put down a Motion on this very important subject, and there are just one or two brief comments I should like to make on it. The noble Lord who has moved the Motion has gone into considerable but interesting detail about heating and warmth, and I do not propose to repeat what he has said, although I agree with practically everything that he has told us. One of the things which I think one should remember about the elderly in this country is that the majority of them lead normal, comfortable, sensible lives. They live with their families or with their spouses, their children are in contact and they have friends in contact, and therefore they do not pose any particular problem now. At the same time, a very large number of people do not come into that comfortable category, and I think these are the ones that we are talking about today.
My Lords, the things that elderly persons really need can be summed up as three in number. They need a home, they need warmth and they need food. One could probably think of a great many more things they would like to have, but these I put down as the basic needs which we have to consider. Housing is a very big and important problem, and one would like to see far more building of what is now called sheltered housing and what was, I think, once upon a time, called almshouses. These were not at all well looked upon by the Government 20 years or more ago but I think are now again coming back into favour, because they allow people to live a relatively independent life with some kind of community around them, and probably with somebody there to keep a watchful eye on them in case something really goes wrong. Of course, some people need to go into large or small communal homes because they are not quite fit enough or they have no relatives near to take care of them, but I very much hope that the building of such homes will not become more common because I think there is 316 something fundamentally unattractive about communal living, no matter how comfortable it is and how well it may be planned. But, as I was saying, for a certain number of people it becomes necessary.
Then, the elderly need warmth in the winter. I quite agree that today is not the sort of day one should talk about being cold, but the elderly tend to feel the cold. One knows that oneself; that as one grows older one feels the cold a great deal more than one did 20 or 30 years ago. On that, I should like to refer briefly to something the noble Lord mentioned; namely, the medical condition known as hypothermia. This has been talked about only within the last 15 or 20 years, largely I think because people did not have clinical thermometers available which could record such low temperatures. But, even so, I think the number of patients suffering from hypothermia is relatively small, and that is a very good thing because it is an extremely lethal complaint for people who suffer from it. The Registrar General puts the number of deaths per year at anything up to 200. For quite a number of years he does not record so large a number as that, so I shall not say anything more about it except that if people get cold and they are old, they are more liable to suffer from disease than they would be if they were kept at a normal temperature. That is a situation which has existed as far back as one can possibly trace, because I once did some work on the monks of Westminster Abbey before the Reformation, and I found that the incidence of sickness among the monks was far greater in the winter quarters than it was in the summer quarters; so that shows that we have not changed much in that respect.
To come to the question of warmth, my noble friend Lord Avebury, who was to have spoken here today but unfortunately cannot be present, has done quite a lot of work on methods of heating houses, and he has come to the conclusion (and I am bound to say that from the figures I have seen elsewhere I agree with him) that electricity is an expensive way to provide heat. Gas being a good deal cheaper, one wonders why council houses are now being built which are entirely electrically-heated, although I think the Electricity Council still advises 317 electricity as being a very good way to heat your house. In 1974, I think about 700,000 council house tenants were living in electrically-heated houses, and one wonders whether some of these could not, with success, be converted to gas, particularly where gas mains have been laid.
The other point that has been talked about a good deal lately is conserving heat and warmth by insulation. On that, I entirely agree. That is a very good idea where you have a new bungalow being built or a room on the top floor of a house which you can insulate as well as the roof and so conserve heat. But as I have said to your Lordships many times, most of the old people living by themselves in towns tend to live on the ground floor because they avoid going up the stairs, which they find difficult. Or they live in the basements because it is cheaper to get a room down there even though it means going down the stairs.
Those are the people for whom I do not think any expensive form of insulation would be very helpful. Another thing one finds going round the country is that few elderly people have heat in their bedrooms as well as their sitting rooms. It seems to me to be just as important, if your sitting room is warm, that your bedroom should be warm too. That is why in some of the houses built for old people I should like to see the bed kept in a recess off the main room so that the heat from the main room goes into the place where the bed is kept. That would be quite a good way of keeping people warm and probably preserving their health.
My Lords, there is something else which I have seen with sorrow; but I do not know the answer to it. The noble Lord, Lord Strathcona, referred to the gradual falling off in the number of coin meters provided; so that the electricity authorities and the gas authorities send in a bill monthly or perhaps quarterly. It is far simpler for elderly people living on a pension to keep a penny or two, a 5p piece or a lop piece, to put in the meter when they require to do so rather than save up the money to pay a bill which comes in once a month or once a quarter. One would like to see that latter tendency reversed. I know it may be a rather costly way of dealing with the supply, but it might be more humane and might save 318 money in the long run if people were kept warm and therefore were not going to be sick. Various other things have been mentioned, such as buying tokens to put into the meters; but these are technical points that I do not want to go into now. I think the chief reason why the old live in cold houses and cold rooms when living by themselves is because they cannot afford to pay the fuel bill. A very large proportion of the people on supplementary benefit —between 40 per cent. and 45 per cent.—apply for the heating allowance which is now available.
My Lords, that is all I want to say, except that I should like to finish with a word of advice to the voluntary bodies who work so well for the elderly people. Supposing that they wanted to give them a present at Christmas or something extra at some time, it is far better to give them either a blanket or two or a really good thermos flask in which they can keep something warm to drink, rather than to give them tins of peaches or tongue.
§ 3.54 p.m.
§ Baroness HYLTON-FOSTER
My Lords, Britain has a baffling variety of welfare benefits in both cash and kind. Nevertheless, while there are some scroungers who know their way through the welfare labyrinth only too well, thousands more, and particularly the old, are too proud, scared of officialdom or bewildered by form-filling to claim their due. Therefore, those most needing help are very often those who do not get it. I should like to say a few words about those old people who live alone in their homes. I would divide them into three categories: the mobile; the semi-mobile or frail, and the home-bound.
Let us first consider the mobile. For the time being, they are not too great a worry as they can shop, play bingo, go to clubs and can be helpful in keeping an eye on their neighbours and they still —and this is most important —have a purpose in life. The frail have good and bad days. They are apt to be caught unprepared on their bad days. and therefore they need a watchful eye kept on them. Clubs can help, when they can be got to them, for they can give them something useful to do in the afternoons, some purpose in attending rather than just a social afternoon. I have had some experience of this myself. I know what a 319 difference it makes; because they often say, " I did not feel like coming out this afternoon, but I know that you wanted it finished and so I came along." This makes all the difference.
The home-bound are our main concern because they are often very independent and resent too much interference; and of course, the main worry here is the cost of heating. There is the likelihood also of inadequate nourishment, too many carbohydrates and too few proteins, despite the fact that they get meals on wheels in mid-week. They do not get anything at the weekend. Another worry is that they need supervision to make certain that they continue to take tablets or the medicine that the doctor has prescribed because they are apt, when they are feeling better, to think, "I will give it up now." Then they are not so well again.
What steps can be taken to prepare the elderly themselves for the winter? I believe that many clubs and day centre leaders feed in names to the social service departments which they can get from their club members who are observant about their neighbours. I think that this should be very much encouraged. Now is the time —or it will be shortly —to check and remind the elderly to see that they have what the noble Lord, Lord Amulree, was talking about; a good thermos flask in good order for hot drinks at night. They need that all the year round but particularly in the winter. Somebody also needs to see that they have a good hot water bottle and also that there are supplies available for them for night lights rather than candles which can be so dangerous sometimes. Also, another very good thing to advise them to have is batteries for their transistor radios, because if their television breaks down or if there are power cuts they have no other means of learning about when the power is to come on again; they have no news or anything of general interest to listen to.
Another problem with the elderly is circulation. Both tight-fitting clothes and tight bedclothes are bad for the circulation. It has been suggested to me that more Continental quilts, which are featherweight and unbelievably warm and cosy, should be available for those for whom they are suitable and who are prepared to have them. I would hope that, when he 320 replies, the Minister could say whether this is being considered.
I was not expecting to speak so early in your Lordships' debate today and I thought that a lot of people would have already spoken about heating. No doubt they will do so. From the investigations that I have made, all forms of heating are expensive today, because everything is expensive; but electricity is the most expensive. What is worse is that so often there is no alternative. Even the people in the electricity showroom admit that it is possible for a person to have to pay up to £1 a day for electricity for heating alone; that does not cover cooking, an electric blanket or anything like that.
Therefore, I strongly support the prepaid token scheme which Japan has most successfully pioneered and with which the Marconi company are experimenting in this country. What is the best type ? Is it the self-destroying plastic token, or the electro-magnetic charged token which can be recharged and used over again ? I would not know which is the best. I hope the noble Lord who is to reply will tell us what thought has been given to this. My reasons for supporting the token idea are that, first, they are much safer against theft —because theft is always a worry to old folk —even though there are various insurance schemes in which they can take part. Tokens would reduce the worry of money for heat or money for food. As you know, this problem can arise in some emergencies and is a very real worry.
Again, I was expecting that the noble Lord, Lord Lovell-Davis, would have spoken before me, and I am very interested in the quarterly payments idea because in the discussions that I have had —and I am hoping the noble Lord, Lord Kirkhill, will be able to reassure me —I am not sure that quarterly payments are really going to be the answer. The problem is that at the end of the week there is probably no more money in the house; therefore, just being told that you can pay quarterly if you do not have any money in the house to go on keeping warm is not very much help.
Most old people —probably all of them —budget weekly. If all meters took tokens, it would be easy to see that the vulnerable people were provided with the prepaid tokens. I know that the argu- 321 ment will be that the changing over of the meters is going to be much too expensive, but the cost of the meters, I suggest would eventually be offset because there would no longer need to be a collection of money from the meters. There would be no postage to pay on the hills, and no sending out bills and asking them to be paid; and there would be no meter readings. Nobody can understand the meters except those who have been trained to read them. There would only be routine checks to make certain that the meters were in good order.
Illustrating how important heating is, at a Red Cross meeting I attended this morning, it was pointed out to me that in one London borough able-bodied old people spend the day sitting in the spectator's gallery of the local swimming baths in the winter time reading papers and chatting; and they have their meals in the swimming baths café. They sit for about five hours there and save five hours' heat. Another point the noble Lord, Lord Amulree, was making was that many old people have their beds moved into their living rooms, so that only one room need be heated. This all adds to the importance of the problem of heating.
I suggest that there ought to be far greater liaison between the hospital district management teams and the social services in order that adequate information is given to the medical social worker on the admission of the patient; so that there is no excuse for discharges to be made without warning to the social services departments, and certainly not at weekends, unless competent voluntary help has been laid on, as the social services departments close on Friday evening and reopen on Monday morning. Owing to the financial state of the country, it is unlikely that the statutory authorities will be able to afford anything like as many home helps or paid social workers as are really needed. Therefore, it would be helpful if, before the winter sets in, an analysis could be made of the likely numbers and needs of the elderly in each borough or health district, so that use could be made of properly briefed volunteers.
In many schools part of the sixth form training is the Red Cross welfare course. Surely these young people could be encouraged to put their knowledge to 322 practical use under the guidance of trained social workers. What is the Government's view about using properly briefed volunteers who must be organised to prevent overlapping? Many old folk are suspicious of strangers but come to rely and trust a regular visitor who can help them with shopping. One of the problems they are worried about now is having to buy bigger packets of things owing to the metric system. Although the item may not be more expensive, it costs them more money. Indeed, in the end it may be wasted because they do not eat it quickly enough. The visitor can back up the home help —if there is one —by collecting pensions, by trying to interpret the too many, too confusing, forms and pamphlets that come through the letter box, by having a chat and, above all, being a good listener. This is why this debate is so very timely, and I should like to add my thanks to the noble Lord, Lord Strathcona and Mount Royal, for giving us this opportunity to make suggestions and to start preparations for the provision of warmth and general welfare of our old folk during the coming winter.
§ 4.8 p.m.
§ Lord LOVELL-DAVIS
My Lords, there are three reasons why I am pleased that the noble Lord, Lord Strathcona and Mount Royal, has initiated this afternoon's debate. The least important —and I may say that I neither merit nor expect congratulation —is that, having had to endure my arguments from the Front Bench, he now has to listen to what is in fact my maiden speech from the Back Benches. However, the main reason why I am taking a brief role in the debate is that I am deeply concerned — as everyone here is —about the all-too-real problems facing many elderly people today in a world that becomes increasingly complex and bewildering: and, more specifically, because I am concerned about their right to fuel; their right to keep warm, particularly during the winter time, and to keep warm without worrying about the fuel bills which, even though they may face no threat of disconnection, many will know they cannot possibly meet.
Last winter my right honourable friend the Secretary of State for Energy asked the fuel boards not to disconnect pensioner households. This was a compassionate and necessary step. However, 323 many elderly people, fearful of the size of the bills they could foresee ultimately being presented, restricted —no doubt dangerously in some cases —their use of heating appliances.
This month, as your Lordships will know, the Secretary of State for Energy published, Review of Payment and Collection Methods for Gas and Electricity Bills. I was asked in February to carry out this review and from that time until I left the Department of Energy I, together with the officials on the Review Body, took most of the evidence that was submitted. It represented the views and suggestions of some 52 different organisations, many of whom I saw personally at the Department of Energy. I was not able to complete the report or to draw out the conclusions arising from the evidence.
I regret this, for the mass of evidence did not support the principal recommendation —which, of course, almost completely distracted the attention of the media from the rest of the Review —that the right to disconnect should be withdrawn from the fuel Boards. I believe that to make this the main recommendation of the Report was to give too simple an answer to a complex problem; it made the fuel industries appear to be the villains of the piece and it obscured the many other findings of the Review Body —in particular all the alternative methods of paying bills which the Boards arc offering or beginning to offer, and which, ironically, the Review itself acknowledged as needing to be more widely publicised.
If by " other means of recovering outstanding debts " the Review Body means, by and large, a court order, would not this lead inevitably to the fuel Boards having to " beef up " their legal departments, with all the attendant cost, representing a bonanza for the legal profession? —which is not, I submit, the most productive use of our resources. I do not believe that the Boards ar blameless of hasty and uncaring action; they are not. There are too many documented cases of suffering caused by disconnection. Nor do I believe that they should have the right to disconnect or threaten disconnection right across the board. It is plainly wrong that there should be absolute powers to disconnect pensioner 324 households, those where there are sick people, young children, and so on. There are people who simply cannot meet their fuel bills. And they are not feckless people. They either have not the money or they simply cannot budget to pay their bills in full.
Baroness WARD of NORTH TYNE-SIDE
My Lords, I wonder whether the noble Lord will allow me to intervene. Has he noticed that in speaking about this the Gas Board have already said that the price of gas will have to go up enormously, and this will add to the anxiety of the people concerned?
§ Lord LOVELL-DAVIS
Yes, my Lords, I have noticed that, and I accept that if that happens it will cause more worry to people, particularly those in the groups we are talking about this afternoon. As I was saying, once people get into the position where they simply cannot pay their bills and once they get into debt, the fact is that they just sink. The bill is too large for them to pay, so they are disconnected. Then, to get back to square one, they have to pay the outstanding bill, a reconnection charge and a deposit on their next bill. In that way a £50 bill can suddenly turn into a £100 one —quite suddenly. The effect is simply to put the disadvantaged person or family into an impossible situation.
It is my belief that much can be done to reduce the number of recalcitrant payers (those who can pay but will not until they are faced by a drastic choice) and to help those who want to pay but have genuine difficulty in doing so, if the methods of payment are tailored to the individual —and this is what the Boards are, and should be, trying to do. After all, they want revenue, not a lot of disconnected customers. So they are offering a wider choice of methods of payment —monthly, in some cases weekly or even irregular advance payments. There is a whole variety of schemes, many of which are set out in the Payments Review. And, of course, the prepayment meter, which has already been mentioned, can be made available where it is really needed. Meters can now be converted to take 50p pieces, which solves many, though not all, of the problems associated with this form of payment. I am thinking of theft, possible hazard to the staff collecting the money, 325 and so on. It may be —although much development work has to be done on this, of course —that the prepayment token meter is a possible answer, as the National Consumer Council have suggested. That has already been referred to by the noble Baroness, Lady Hylton-Foster, this afternoon.
I think that, like many of their own customers, the fuel Boards were perhaps slow in appreciating the impact that the increased price of fuel would have. However, I believe that they now recognise that they have a responsibility to help their customers meet their bills. And, from the Boards' own points of view, I should have thought that getting away from the tradition of quarterly billing —and I am glad to say that have never had to operate a company which was constantly running three months in arrears — would have the effect of improving their cash flow and therefore reducing the size of their interest charges. My hope was that the Payments Review would give impetus to the efforts the fuel industries are making and ensure that the best practices were applied generally by all the Area Boards and that everything would be done to make it possible for people to pay their fuel bills with the least difficulty, in the way that suits them best.
We should also ensure that the practice, which the Boards say they employ now, of taking into consideration all the circumstances before disconnection takes place —that is to say, precisely who is involved, whether there is real hardship, and so on —and referring cases to the local authority welfare service, the Supplementary Benefits Commission, and so on, is strengthened and made much more binding on all the parties concerned. This must be effectively carried out and much depends upon the Boards and their staffs —who, not being trained observers, must refer the matter wherever there is the slightest doubt.
I can understand the immediate reaction of the fuel Boards when suddenly confronted with the recommendation that their power to disconnect or to threaten disconnection be withdrawn —but they must recognise that the alternative demands that disconnection be applied discriminately. The crux of the matter, it seems to me, is that the Government gave the Boards the go-ahead to charge 326 realistic prices for fuel. This has meant that fuel has come into line, by a series of hefty increases, with all those other essentials of life, the price of which has soared. And, in order to forestall any political sniping, which I think would be out of place and I hope can be avoided in this debate, I should emphasise that this is a global problem. Having allowed prices to reflect the true cost of supplying fuel, it is surely up to Government to put out the safety net to catch those who cannot pay for the fuel they have to use —the fuel that is an absolute necessity of life. The problem cannot be sloughed off on to the fuel Boards —our own nationalised Boards, mark you. It must also fall to the Government Departments responsible, in particular, of course, the DHSS.
It may be that the right policy would be to give all pensioners the right to free fuel —though I imagine that the cost would be great and there are undoubtedly many who can afford to pay all or part of their fuel bills. I do not believe that there are only blanket solutions to problems. So, in my view, steps can and should be taken to ensure that no elderly person —and, although the elderly are the subject of our debate today I want to include those other groups affected : the chronically sick, one-parent families, poor families and particularly those with young children —should he allowed to suffer the hardship of disconnection or the fear of further action if they cannot pay their bills.
Perhaps the basic solution to the problem was best encapsulated in the evidence received from the National Council of Social Service. They said —and I quote:It may be inevitable that domestic consumers in the United Kingdom will be required to adjust to spending a higher proportion of their incomes on fuel. However, if undue hardship to vulnerable social groups is to be avoided, a strategy is required which will reduce the effects of higher fuel costs. Such a strategy would require action by the Government, crossing the boundaries of several Government Departments as well as the fuel industries.It is sometimes tempting to believe that Government, through their Departments of State, have become a matter of territorial imperatives —carving out and defending their own territory —but surely it is not beyond the bounds of possibility for the relevant Government Departments and the fuel industries to get together to make sure that neither our elderly nor 327 other groups at risk should be deprived of fuel or made to suffer because of their dependence upon it.
§ 4.20 p.m.
§ Lord O'HAGAN
My Lords, I am a little surprised to find myself speaking in this debate, especially at this point. Some of my stepchildren will no doubt take it as further proof of what they believe, that I am already extremely elderly. But perhaps I could use that as a peg for asking, from the point of view of somebody of my age: who are we talking about? I agreed with everything that my noble friend said in his very comprehensive introductory speech, but to say that to be elderly is simply something that happens at a certain age must be wrong. To be young or to be old, to be youthful or to be elderly, must be an attitude and an outlook and a way of thinking, as well as a state of body or of mind. Part of the object of what we are trying to do today in this debate —and this is something that my noble friend stressed —must be prevention which, in this context, is stopping those people who would otherwise have the confidence and the courage and the determination not to consider themselves elderly, from receiving slings and arrows which suddenly push them into that category.
I know that I am taking a rather different tack from the noble Lord, Lord Lovell-Davis, whose expert knowledge and passionate views I cannot really compete with. But the problem of the elderly, looked at as one of the problems which the social services have to cope with, must surely be a more difficult one to define than the problem of dyslectic children, the problem of people with wooden legs or whatever it might be. It is such a very wide-ranging category that covers so many types of need and such a huge number of people, that in order to deal with the problems of the elderly the Departments concerned and the Government must have a strategy for the social services of which a policy for the elderly must form a part, a policy which has implications for other policies in other spheres of social service. At the end of his speech, my noble friend mentioned this and so did the noble Lord, Lord Lovell-Davis, when he talked about the territorial attitudes of some Departments. It is essential for departmental 328 rights to be questioned in the context of a policy for the elderly.
President Giscard d'Estaing was very polite to us this morning. He flattered us and told us that we all respected Parliament so much in this country; and one of the reasons why we respected it so much was that it adapted itself to changing needs and circumstances. But I am afraid that he was not telling the truth. A year ago, the Central Policy Review Staff were allowed to publish —which they are seldom allowed to do —one of their reports, which was called A Joint Framework for Social Policies. There has been no debate in Parliament on this document, and there has been one Parliamentary Question. I hope that the President will not feel insulted if he hears my reply to his kind comment. We do not adapt ourselves to one of the few instances where there has been a major change in Government machinery. One of Mr. Heath's enduring monuments is the Central Policy Review Staff, which gives us the opportunity of taking an overall view, a long-term view, when it is allowed to issue reports looking at the facts behind the problems that happen to be fashionable at the moment. At one moment it is mental hospitals, at another moment it is dyslectic children and now it is hypothermia.
To look at these problems all the time, and deal with them with a proper sense of priority, we must have this continuing monitoring, and I wonder whether I may ask the Minister who is to reply if anything is to happen as a result of this document. In particular, following on what my noble friend suggested, the Central Policy Review Staff suggested very briefly at the end of their report that they should be given the opportunity to study a certain number of special problem areas, one of which was housing the elderly. This recommendation was made by the Central Policy Review Staff a year ago. I am not asking this in a Party spirit, but has anything been done about it; and if, as I suspect, nothing has, could something now be done about it?
Another thing that I wonder, especially after hearing what I might call the firsthand report from my old chief, if I may so describe the noble Baroness, Lady Hylton-Foster, is how much of the human facts, that people who work in voluntary organisations and local authorities know at first-hand, are turned into statistics which 329 can be used by the policy makers. Is there sufficient machinery for assessing all the varied needs of the elderly, so that the policies are made on the basis of proper statistics? The Central Policy Review Staff put it this way, that there was a need for, " a better trans-departmental information base ", which is an expression that I hope I shall never have to use again. But, obviously, there must be an enormous amount of experience and knowledge in the possession of those organisations which are working with the problems day by day. Is the Minister who is to reply satisfied that the various Departments which deal with these problems can work out a proper co-ordinated policy for the elderly, on the basis of really good statistics?
I want to say one final word about the position of the EEC. There is a danger in Britain, because of Lord Beveridge and the great achievements of the National Health Service in the early days, of thinking that our social services are wonderful —and of course they are, but so are a lot of other people's. While it might have been true a few years ago to say that ours really were a model, it is now true to say that the United Kingdom spends less per head, and a lesser proportion of its national income, on social security and social services than any other EEC country with the exception of Ireland. We are the bottom of the league except for Ireland. So far as the elderly are concerned, we are at the bottom of the league, with the exception of Ireland and Italy. So we have done great things, but I am sure we have a lot to learn from what other countries do. Perhaps we shall not congratulate ourselves on our past achievements quite as often as we do, if we compare the figures that I have just mentioned with what happens in other States in the Common Market.
I do not take the view that, just because we are in the Common Market, we have to do the same as everybody else in social services or in many other fields. I take the view that the Common Market should set certain minimum standards —and we can all agree about how they should be defined —below which any Member State should not fall in its social provision, and those who cannot afford it should perhaps be reimbursed from a central fund. We should all keep what we have evolved ourselves, but in our pride in 330 what we have evolved we should still be aware that once we led and now we lag. On that rather gloomy note, I will sit down.
§ 4.30 p.m.
§ Lord MAYBRAY-KING
My Lords, as one who speaks on behalf of voluntary bodies, may I assure the noble Lord, Lord O'Hagan, that I agree with him when he says that there should be the closest liaison between the State organisations and the voluntary bodies. From my own experience —I think that the Government will bear me out in this —that liaison at both local and national level grows closer every year.
1 am grateful to the Opposition for giving one of its precious days of Parliamentary time to what I think is a very important topic. I am also grateful to the noble Lord, Lord Strathcona and Mount Royal, for his carefully prepared and broad survey of the whole picture of the problems of old people, especially in winter. As honorary treasurer of Help the Aged, perhaps I should declare an interest, except that it is not a financial interest; it is one of those minus financial interests of every noble Lord who supports any good cause.
This debate rightly focuses our attention on one of the gravest handicaps of old folk in winter. According to a piece of research that Help the Aged commissioned, it is estimated —the noble Lord gave the figure —that some 700,000 pensioners face the risk of hypothermia this winter. These are the poorer old people who are inadequately housed and clothed and have inadequate methods of heating, or heating that they cannot afford to buy. I agree with the noble Lord, Lord Strathcona and Mount Royal, that we do not mean that 700,000 people are going to die of hypothermia—
§ Lord MAYBRAY-KING
but it would be a very bad Britain if anybody died this year, as some people did die during last winter, of hypothermia, for this is a country which is supposed to care for everybody. I would pay tribute both to the present and to previous Governments, way back to Lloyd-George, for what they have done, by steadily increasing the retirement pension and now by 331 providing those who are on supplementary benefit with special heating allowances. However, I believe that the country has to do much more.
The fundamental answer to this afternoon's debate is an increase in the basic pension. The newspapers were right to point out this morning that we do not so much want special favours for special heating for special cases as we want everybody to have a pension that will enable them to afford the heating which is necessary for them. As my noble friend Lady Ward of North Tyneside, in whose company I fought many battles in times past, has often pointed out, this problem becomes much more acute in the case of those people who are on fixed incomes and who have to meet the savage burst of inflation day by day.
I agree with the noble Lord who opened this debate that we want a national heating programme. I am glad to read that the discussions on energy have proved to be a fruitful beginning, at any rate. We have to consider the insulation of housing —the wastefulness of the ordinary house so far as heating is concerned —and seek methods of obtaining the maximum heat for the least money. With all this I am in agreement with the noble Lord who opened the debate. In the meantime, however, the special heating grants which we provide for those on supplementary benefit ought to be increased before next winter.
The other grave handicap of old age is loneliness, especially for the single, the widow, the widower, the spinster, the bachelor, with no family remaining to help to look after them. Help the Aged has suggested to noble Lords that there should he a Minister for Old People. After the cool reception which this House gave last week to the request of the most reverend Primate for a Minister for the Family, I am not sure that we want a Minister for Old People. On the other hand, we did set up a Ministry for the Disabled, and under the first Minister for the Disabled, Mr. Alfred Morris, MP, it has certainly made an impact on the special problems of the disabled. Therefore it might be useful to have a Minister who devoted himself to the special problems of old folk.
Policies are matters for the politicians and for the political Parties, but I speak 332 from the Cross-Benches as one who believes, and knows from experience, that voluntary aid can supplement Government action; that Government action —if I may point this out to the noble Lord who opened this debate —does not mean the erosion of human charity and human values, and that voluntary aid effectively adds to the benefits of Government action day by day. The Britain that I know and love would perish overnight if it were not for the hundreds and thousands of people who give voluntary service to Britain.
I was interested to hear my noble friend Lady Hylton-Foster speak of the work of the Red Cross which goes beyond caring for the sick in war time to doing great humanitarian work for unfortunate people in peace time. The body to which I have the honour to belong is one such voluntary body. Last year it raised over £4 million in cash and in kind for good causes relating to old people not only in Britain but all over the world. At our annual general meeting on 14th April, the speaker was the Right Honourable Edward Heath, MP, who, in a moving address, said:One in five people over 80 have no inside lavatory and no fixed bath. Half a million people over 65 have no hot water. Three out of four pensioners have no telephone, not even access to a telephone ".And he continued:What we have got to do, voluntary organisations and politicians together, is to generate a sense of outrage about poverty so that it is brought to the centre of public debate ".Part of the answer to the problem of hypothermia, the coldness of old folk in winter, is the provision of sheltered housing: 20 or 30 flats, each individual, under the care of a warden. Every good local authority is providing some of these sheltered housing units and voluntary bodies are doing the same. Two years ago I opened for the National Union of Teachers a splendid home for retired teachers, the average age of the inhabitants being over 80. The Workmen's Clubs of Britain —the limbless ex-Servicemen themselves —provide convalescent homes for their aged disabled or sick brethren. The noble Baroness, Lady Young, recently headed a project in Oxford which has provided such sheltered accommodation for over 40 old people who will live independently but under the supervision of a warden. The recent figures of the Anchor Housing Association with which I am associated show that it has provided 333 4,000 flats, with 4,000 under construction and 1,000 at tendering stage —all of which are sheltered housing units of accommodation. The Churches are providing sheltered housing. I have spoken to enlightened employers in big industries, and as part of the great industrial complexes to which they belong they are providing not merely pensions for their retired workers but sheltered housing accommodation for retired pensioners. Therefore I hope that this debate will not only congratulate the Government upon what they are doing in many fields and the interest that they are undoubtedly taking in the very problem that we are discussing, but that it will urge them to move faster and that it will increase the number of people in Britain engaged in voluntary work for the old. Those who help in Meals on Wheels, those who give their clothing to the shops which provide clothing for old people under the WRVS, those who work in day centres, those who know day centres to which old folk can come for the day, probably every day of the week in some cases, know as I know that in the winter the old folk are queuing outside the door before it is opened, because that is the place where they can get comfort and warmth.
In my own city of Southampton we have a number of these day centres, some of them one day only, usually in the church; and I pay tribute to the Churches. Some of them open every day; some of them provide a cheap meal at cost price. I believe the day centres are part of the answer to the problem of the lonely old man, the lonely old woman, and our own work in Help the Aged has shown the value of these centres. Democracy is not only the Government; it is all of us, and the task of all of us is to work for a rapid expansion in the programme of sheltered housing —not merely to wait for the Government to do it —and to work for a winter heating programme. I learn that the Republic of Eire provides 1500 heating units to the old folk of pensionable age as part of its contribution to their winter needs. We must have a national drive for house insulation and a register of the specially needy old folk in the same way as over the past four years we have compiled a register of the disabled.
I am delighted at the campaign which has been launched by the Lord Mayor of 334 London —described so eloquently by my noble friend Lord Selwyn-Lloyd in his maiden speech some days ago —for research into the causes of old age, into the disabilities of old age and the way in which we can tackle some of those problems. I for one have been enormously encouraged by the number of young folk who are working and giving in service to old people. In my own organisation 100,000 Christian youngsters raised money last year for old people. In my own city one group of youngsters goes round visiting old folk and offering to do jobs in the house free; youngsters go shopping for lonely old people. Every one of us can make the lonely less lonely.
We are living in an age when the steady development of geriatrics is noteworthy. Old people are not only living longer but they are not so old. Their life span is not only longer but their useful life span has increased. This is a remarkable feature of our time. I wish to end on one experience I have had. I went to the United States of America and there I met a brotherhood called The Moose, of which I am a member. Fifty years ago they decided to build a city for old folk and in Florida there is the most Utopian city of old people that exists on this planet. Community facilities, sheltered accommodation, the individual flat —the best geriatric unit in America —and all this by the free gift of American citizens wanting to help their aged brothers and sisters. I believe there is a place for similar voluntary efforts in this great Welfare State of ours, even more now than ever before. I hope this debate will do something to encourage such endeavours.
§ 4.46 p.m.
§ Baroness ROBSON of KIDDINGTON
My Lords, I should like to join all the other speakers in thanking the noble Lord. Lord Strathcona and Mount Royal, for giving us this opportunity to discuss a problem which, from what has been said so far, obviously arouses deep emotional feelings in all of us. I am grateful to him for having given the subject such a wide approach. I am particularly happy that until a slip of the tongue by the noble Lord, Lord Maybray-King, the word " geriatrics " has not been used in this House today, because I have always found it difficult to understand why, when you 335 reach the age of 65, you suddenly change in some peculiar way and become something quite different. What we are concerned about, and where I agree with every speaker who has spoken before me, is that our aim in society must be not to create people who need institutionalised care but to create the kind of conditions in the community so that people can live within the community as far as this is humanly possible.
Some reference was made by the noble Lord, Lord Strathcona and Mount Royal, to the priorities document and the prevention document recently issued by the DHSS and to the reference in that document to capital expenditure accounts and running expenses in order to free more money for day-to-day revenue expenditure. He expressed some concern and suggested that we ought to look at the priorities properly. I agree with him in his concern when it deals with capital expenditure on exactly the kind of housing for the elderly that the noble Lord, Lord Maybray-King, has been talking to us about. But in the priorities document I think we are correct in looking at our capital expenditure for certain aspects of the Health Service where in the past we may have spent too much on capital and not enough on people.
I believe that to all of us who are engaged in the Health Service itself there is the obvious gap which was mentioned by the noble Baroness, Lady Hylton-Foster, between the Health Services and the social services. The machinery exists at the moment for much closer cooperation, and I think all of us are engaged in trying to prevent exactly the kind of incidents occurring that she referred to; I personally very much welcome the new idea from the Department of Health and Social Security of joint financing between the social services of local authorities and the Health Services themselves. In so many cases the only way in which we can effect real economies is for the two arms of the service that are looking after the people in the community to the best of their ability to work much more closely together so that we do not have overlapping and therefore greater expenditure.
If our aim is —it should be, and I am sure it is —to keep as many as possible of our elderly citizens living within the community, then the kind of problem that 336 we have been discussing today, the problem of hypothermia, is one that we must consider very seriously. Reference has been made to the difficulty of assessing to what extent it is a killer among older people. In 1965 the Royal College of Physicians instituted a study. They used 10 hospitals for their survey and they surveyed the body temperature of all patients admitted between 1st February and 30th April. They came to the conclusion that hypothermia in hospital admissions is common and is associated with high mortality. They also concluded that, on the percentage of their findings in 10 hospitals over a period of three months, there could be as many as 9,000 patients admitted to hospitals throughout the country whose basic problem was hypothermia.
That is quite a different figure from the one mentioned by the Office of Population Censuses and Surveys which puts the figures at those levels which have been mentioned previously in this debate. But, of course, the discrepancy is explained by the number of people who already suffer from serious diseases before they are exposed to hypothermia, and also by the number of people who, through exposure to cold, contract pneumonic diseases or bronchial problems. I make an appeal because I think all of us would want to know a little more about how great this problem is. For instance, I understand that in the case of a person in hospital who has died of pneumonia, perhaps as a result of original hypothermia, only " pneumonia " appears on the death certificate. I wonder whether in some way we cannot find a method of recording this so that we would have a better knowledge of how many people are actually suffering from this horrible disease.
I have been told by the medical profession that there are certain medical factors which can lead to hypothermia. I am not an expert on that, but I should think most people will agree that cold living conditions is the danger in these cases. Many references have been made to the temperatures in old peoples' housing today. In 1973, a survey was made by the Medical Research Council which came out with exactly the kind of figures which have already been quoted. What I found horrifying was that out of a sample of 1,000 houses, 106 —that is, slightly over 337 10 per cent.—had living-room temperatures at or below 12 degrees, which is not a temperature in which you could expect even a young, healthy person to keep reasonably warm. When these 1,000 people in the survey were questioned, they all replied that they would like to have warmer housing, but that the problem was the cost. Comparatively few seemed aware that they were entitled to a supplementary fuel allowance, so there seems to be a lack in our being able to publicise to the people in need the kind of benefits to which they are entitled.
What worries me about the supplementary fuel allowance is that it is a fluctuating allowance, irrespective of the type of heating the old person has in the home. As we know from figures quoted in the newspapers, and as we know from figures quoted here today in this debate, the difference in the cost of heating is quite enormous as between electricity, gas, oil, coal and coke. It seems to me that something should be done about a scale of supplementary fuel allowance, depending upon the form of heating that the person has to use.
My Lords, the problem of hypothermia in old people in some ways has focussed our attention also, as has been mentioned by the noble Lord, Lord Strathcona and Mount Royal, on the problem of housing as a whole and on energy conservation as a whole. It is a tragedy in many ways that it takes suffering on behalf of some people before we begin to look at the real problem that faces us. It is a tragedy that the installation of heating systems which are very expensive to run year by year, is much cheaper, and as a result these systems are often chosen. It seems to me particularly sad that this should happen in local authority housing where, if extra money had been spent and perhaps the rent of the house had been a little greater, at least these old people in difficulties would find it perfectly easy to obtain a rent allowance, and the high running cost would not have fallen unevenly on the members of society who could not afford to pay for the heating they require. I also think that in view of the enormous increase in electric heating, particularly night storage heating, it is a tragedy that the Electricity Council should have spent something like £200,000 on advertising storage heaters, without explaining to people the higher running costs they are 338 letting themselves in for, although at the same time being allowed to explain that this system is cheaper to install. Then, at least, the person taking the decision would take it on the knowledge of what he is doing.
Many of the previous speakers have highlighted the problems of the conservation of energy, both from the point of view of the whole nation, and from the point of view of the cost to people of heating their own homes. I do not know of any nation in the world —and I was not born here —which heats so much for the birds as we do. We have gone on doing it year in year out, telling ourselves that we do not live in a cold country. We live in a very cold country, and the existing lack of insulation in British housing is a disgrace. It certainly should be the priority in all new house-building that the insulation of those houses is correct and provides the maximum energy saving that we can achieve.
My noble friend Lord Amulree mentioned the problems of insulating older houses, houses which maybe did not have lofts, and problems with houses where many elderly people live. My noble friend suggested that there was nothing much that could be done. I believe a great deal could be done. First, even before you start insulating the roof, sealing the windows so that there is no draught, putting a threshold on a front door so that the draught does not whistle round the old peoples' feet, are all things which could be done reasonably economically. This is what we should concentrate on; this is what we should keep in front of our minds when we are building houses in the future.
However, these things will not happen before next winter. We shall not be able to insulate all the houses of the 750,000 people at risk next winter —of course not. That is why I agree with the suggestions made so far, that we should do our utmost to see that these things are implemented. First of all, I should like to see supplementary fuel benefits on a sliding scale, which I think is possible to implement before next winter. I should also like the safeguards against cut-offs suggested by the noble Lord, Lord Strathcona and Mount Royal. I would go even further, I think, and make it mandatory on the energy companies to inform the Department of Health and Social Security in the 339 case of non-payment of hills by elderly people and families already living on social security. No cut-off of any premises of that type should be allowed without the information being available to the social services.
I believe, too, that magistrates' courts, for instance, should be told not to grant the right of entry to cut off electricity without reference first to the social services, because there are many poor families already living on social benefit who absent themseles in order to prevent the electricity services being cut off, so the house is shut and the electricity company has to go to court to ask for the right of entry. I believe that on those occasions —there are not many, but they do exist —the magistrates should be enforced to inform the social services before granting such a right of entry.
Then the noble Baroness, Lady Hylton-Foster, spoke at length about the various types of tokens for pre-payment meters. I believe that is one of the most important solutions for next winter. I think it would be preferable to use tokens, because this would not necessitate so many visits by the electricity company to empty the boxes. It would help safeguard the old people against the fear of having money on the premises. But it may not he possible to achieve that solution by next winter. If it is not, and if we cannot make up our minds what kind of tokens to have, let us, at least, have pre-payment meters if the old people so wish, because to many of them that is the way they have been brought up, paying as they go along. It is very difficult for them to change and to be able to meet a bill on a quarterly basis. If we did these things I think we should be helping to a great extent by next winter, and we would avoid our old people having to pay off last year's winter electricity bills on a day like today.
§ 5.2 p.m.
§ Lord AUCKLAND
My Lords, I must first apologise to the noble Lord, Lord Kirkhill, because, due to a very long-standing business engagement this evening, I may well have to leave your Lordships' Chamber before he winds up. When my noble friend Lord Strathcona asked me a few days ago whether I would speak in this debate I 340 was somewhat diffident, because I took part in the debate last week so ably moved by the most reverend Primate the Archbishop of Canterbury, when many of the points relevant to this debate were discussed. But I think that today we have a subject of increasing importance, because the elderly proportion of the population of this country is undoubtedly increasing, although by no means all of them are infirm. Far from it, many are very active. They contribute enormously to all walks of life, particularly the voluntary services. Indeed, many of our services would not operate if it were not for the tremendous work put in by what is so often termed the elderly population of this country. That is often very much a generalisation. I have just today reached the age of two score years and ten, so I suppose that in this House we have ages right across the board taking part in this debate.
When my wife and I were in New Zealand four years ago, we visited a splendid bungalow scheme for the elderly —mostly, I might add, for the ambulant elderly which was right by the sea, near Auckland harbour. The residents were beautifully looked after by a most conscientious staff, a number of whom were British, and they were immensely happy. They contributed according to their means. I thought then, that if only we could do more in this country on those lines how many of our problems could be solved. Of course one must get things into proportion. New Zealand is a country of about 3½ million people, of whom I suppose a third might be elderly. I do not know the exact figure; I am merely guessing. In this country we have a population 15 times that number, so it is not so easy here to run things quite on those lines.
Very largely through the many voluntary organisations, such as Help the Aged and Age Care and others which have been mentioned, the plight of the elderly has been made a great deal happier than would otherwise be the case. The British Legion is another organisation which has done a great deal, particularly for those in the Services. One must remember that there are still many veterans of the First World War, some of whom are badly disabled, living in homes, some of them manned by the British Legion, others in other homes 341 which are helped and visited by the members of that very splendid body.
My Lords, I wonder whether there has been any recent survey of the number of elderly patients—I will not use the word "geriatric"; I will use the word " elderly " —particularly in our mental hospitals. As many of your Lordships know, this is one of my main interests, and I have mentioned it in your Lordships' House on a number of occasions. At the risk of repeating myself, I would add that I live in an area of Surrey where there are a large number of mental hospitals, populated by quite a large number of elderly people, who are by no means senile or what one might describe medically as mentally defective, still less mentally retarded. One can speak with many of them and carry on a most interesting conversation.
But, of course, there is the problem—and this goes back to the fundamental problem of housing—that very often their families are not able to look after them. Of course, it can be argued, and rightly, that it is the duty of the family to look after those who have helped to bring them into this world and educated them and looked after them. But in these days that is sometimes physically not possible. Often, the dilemma arises as to who should get the priority, the elderly grandmother or the elderly great-aunt, or the young four- or five-year-old child, who is always getting into mischief, always putting its fingers round the electric light plugs and getting into other dangers. The finest parents in the world only have two eyes and two ears, so they cannot be everywhere looking out for these problems.
My Lords, when it is possible for more money to be devoted to mental health services—and in these difficult times the social services, including the mental health services, have to accept their share of economies—and when the time comes when improvements can be made, it is to be hoped that a really deep survey can be carried out to discover whether more can be done for these elderly men and women. They are, in the main, ably looked after in these hospitals (the staff deserve every credit) but they may well be occupying places which those who are younger, and who may need new treatment, ought perhaps to have. This is a major problem, and it is not one which any government can solve easily.
342 I come to the matter of safety. As an honorary vice-president of the Royal Society for the Prevention of Accidents, I have come into contact with the problem of elderly people, perhaps living on their own in houses where wiring for electricity is by no means safe, where cooking appliances are far from safe and where terrible accidents can occur. Organisations such as Meals-on-Wheels, the Women's Royal Voluntary Service, the Red Cross and others often do sterling work in visiting these homes. However, in the rural areas, and particularly in Scotland where houses may be many miles apart, the problem is particularly acute.
I have in your Lordships' House moved and talked on debates on this question of home safety. I wonder whether the Government have any recent figures—I have not given notice of this question, so I do not expect an answer now, but eventually—as to how many accidents have occurred to elderly people through such dangers as inadequate earthing of plugs, stoves designed so that when a saucepan is put on it can so easily fall off and scald them, and that kind of thing. These are points which are germane to this debate. Elderly people are naturally particularly vulnerable to such accidents, and I know that everybody would wish to see this toll cut down.
I turn finally to a question which has not been too highly ventilated, that of entertainment. One of the newest repertory theatres was recently built at Leather-head, very near my home, and named after that great lady of the theatre who died recently, Dame Sybil Thorndike. She was a person who may have been old in years but, as the tributes to her indicated, she was always young in heart. As one who had the pleasure of speaking to her on one or two occasions at the theatre of which I was a trustee for several years, I can certainly hear that out. Thanks very largely to, I think, Mr. Alf Morris in the other place, the Member for one of the Manchester constituencies, and to the Act concerning disabled persons, the Thorndike Theatre, and indeed all new theatres, are or should be equipped with lifts, ramps, and special washing and lavatory arrangements so that these people can enjoy a show at the theatre, whether it be a comedy or a serious show, and not only pass the time away if they are living on their own, but keep their minds young.
343 What we have most of all to bear in mind when discussing elderly people is that the minds of many of them are very young. From experience of my own children, who have come into contact with elderly people and who have read to them, and so on, and who have taught, I know what enormous inspiration has been given them and how much one learns from the other. I hope that this kind of thing will continue, and that these people, who have given so many years of service to the community, will not have to sit alone, as many do, with few people to visit them, but will not only be properly locked after, as has been stressed in this debate, but be given the facilities for keeping their minds and their bodies young so that they can enjoy many more years of their life to come.
§ 5.16 p.m.
The Countess of LOUDOUN
My Lords, I should like to mention briefly the mobility needs of elderly handicapped people. We all accept that age brings a general slowing down. It may well be generally true that the handicapped elderly person is at a lesser disadvantage in comparison to his peer group than the handicapped young person, but his special needs must not be overlooked. Most people, when they reach retirement age are still very active, and looking around this House some may even he said to be in the prime of life. We must not, however, forget those who were either handicapped from childhood or early in life, or those who are severely crippled by all too prevalent conditions, such as arthritis.
What I wish to draw to your Lordships' attention today is the fact that at present, although the Government have introduced a wide-ranging scheme to give mobility assistance to the younger handicapped person, the only assistance available to the elderly is paradoxically confined in practice to the non-handicapped. I do not think there is any need to go into details over the previous vehicle scheme and the new mobility scheme, both of which I am sure your Lordships are fully aware, as we have had many Questions and debates on them here in this House—for example, the controversial question of the invalid tricycle.
The old criteria have been scrapped, and the only criterion now for entitlement to a 344 mobility allowance of a taxable £5 per week or the option of an invalid tricycle in its place is inability, or virtual inability, to walk. The major advance is the extention of help to people too severely disabled actually to drive a vehicle themselves. This I welcome unreservedly. But the major defect is that under the legislation the scheme is limited to men under the age of 65 and women under the age of 60. But I should also mention that anybody who originally qualified under the old scheme may still retain reserved rights under that scheme.
There are many anomalies under the mobility allowance scheme, and still more teething problems during its phasing in. But the only one I wish to bring to your Lordships' attention today is the absence of any help for those over retirement age. In my view there should be a top age limit, certainly not over 70 years, possibly earlier, but I consider retirement age is not the right one to choose. If a person has been in work it will coincide with, and exacerbate, a probable loss of income. It will also be withdrawn at a time when a person has greater opportunities for its use. This opportunity, this leisure, can in fact weigh very heavily on recently retired people and if they are also handicapped or confined through lack of money to their own homes the effect can be very sad indeed. Mobility increases independence, which in turn prevents deterioration and renders people less likely to become a burden on the State. The allowance would therefore be a good investment at this critical age.
I mentioned earlier the paradox that the assistance given to pensioners is in practice confined to the non-handicapped. This is because the assistance is given through free or concessionary travel on public transport. But the essence of the mobility allowance is that its recipients are those who, in the main, are unable to use buses or tubes, even if it is possible for them to travel by train. I regret that I do not have the latest figures for the cost of such concessionary fares, but the estimate for 1975-76 given on 7th April 1975 in another place was about £35 million. The estimate of the cost of the mobility allowance scheme is about £39 million, so it appears that about the same amount of money is being spent on the younger handicapped as on the elderly non-handicapped, while nothing is being done 345 for the elderly handicapped. This is most unjust.
I would urge the Government to consider three courses of action most carefully. The first, which by its nature cannot be immediate, is to allow the mobility allowance to continue to be paid to recipients until, say, 68 or 70 years of age. Secondly, if there has to be an age limit, then it should be the same for both men and women. Perhaps the noble Lord, Lord Kirkhill, will be able to give some idea of the cost of paying the mobility allowance to all handicapped people who would qualify below the age of 70. My third suggestion does not directly concern the mobility allowance. I believe that the Government should pass enabling legislation allowing local authorities to provide for elderly handicapped people who need mobility assistance. At present, under the Transport Act 1968 assistance can be given with the cost of public transport for those able to use it. Unfortunately, under the terms of that Act assistance cannot be given with items such as taxi fares or private car hire, and under Section 29 of the National Assistance Act 1948 financial assistance cannot be given in this respect, either.
I am advised by the Central Council for the Disabled that, although such assistance by social services authorities is illegal, it is possible for non-metropolitan district councils or other non-social services authorities to use their powers under Section 137 of the Local Government Act 1972 which allows the council to spend a 2p rate for any purposes outside their statutory duties. The authority in the best position to assess need is of course the social services authority and it is anomalous that they should not be allowed to do so. To extend this power to them—and I do not suggest that it should he made a mandatory requirement—would allow them the opportunity of offsetting in part the harm which the restriction the Government have imposed on the mobility allowance scheme will undoubtedly cause.
To sum up, my Lords, I urgently beg the noble Lord, Lord Kirkhill, to reexamine the mobility needs of the handicapped elderly and to grant them assistance equivalent to that afforded to their more fortunate peers. I have offered three temporary palliatives. I hope not only that in his reply the noble Lord will be 346 able to cost them but that they will encourage him to expound the Government's solution to a problem of which I am sure they are fully aware.
§ 5.25 p.m.
§ Lord HUNT of FAWLEY
My Lords, we were told following the last Census that about 250,000 old people in Britain today live alone in single rooms, and we know that a great number of them seldom, if ever, leave these. As a practising doctor, it is the medical aspects of some of these needs that I will mention briefly this afternoon. We are now told that one in six of all people in this country are over retirement age. Many elderly people are partially blind or deaf, suffer from rheumatism or are unsteady on their legs. Some of them are hard to help because they are selfish, difficult or obstinate. One of the saddest and most pathetic things is when their memories are bad and they may scarcely appreciate, then, what is happening around them. One old lady who had brought up a family of five asked me one day to tell her whether she had ever had any children. Alcohol may make their memories even worse and doctors are sometimes asked whether alcohol is good or bad for old people. It supplies them with calories and may help the thin ones to gain a little weight. Alcohol is a good tranquilliser—one of the best the human race has ever known—and it may help the elderly to sleep. I seldom try to dissuade anybody over 70 from taking it moderately, but there is little doubt that in large amounts it does affect the memory badly. One old man of 80 who drank rather heavily once told me " Nowadays the only two things I always remember clearly are your telephone number and where I left my drink "! I said that anyway he had his priorities right.
More purpose-built blocks of flats and housing units for old people with a resident warden are wanted. About 5 per cent. of the retired population, we are told, need them now. We want more day centres and I agree with all that the noble Lord, Lord Maybray-King, said about that. We also need a few more hospitals for old folk and I agree with what the noble Baroness, Lady Robson of Kiddington, said about the term "geriatric ". We want only a few of these hospitals, 347 because the modern aim is to keep as many people as possible out of hospital.
The ordinary daily needs of old folk are innumerable, but it is our responsibility to supply them with as many as is reasonably possible, especially during the cold weather when they are liable to suffer the most. Hypothermia, the loss of body temperature, can be a killer at any age; it kills the young on mountains, as we know. But this is especially so with the elderly, whose body temperature-regulating mechanisms are often poor. Their temperatures are likely to drop too low, much more quickly than in the case of the young, in a draughty room with ill-fitting windows or doors, because they are insufficiently clothed, or through having too little artificial heating. Such heating can be provided by an open coal fire, an electric or gas fire, a night storage heater, a paraffin heater, central heating, hot water bottles or an electric blanket. Almost every one of those can be dangerous, and many old people need supervision when using them.
It is salutary to remember that in 1974, the last year for which figures are available, the statistician of the Royal Society for the Prevention of Accidents, a body which has done such good work over the years, told us that nearly as many people died in Britain from accidents in their homes as died on the roads. The provisional figures were 6,473 in homes and residential institutions (two-thirds of them from falls) and 6,876 on the roads. The old saying " Safe as houses " certainly does not apply here.
Inadequately protected open fires can cause severe burns. Other injuries, such as a fractured skull or a broken hip, can occur when accident-prone old people with poor eyesight, weak or unsteady legs, giddy fits or black-outs fall into them or over them, upset a paraffin heater or trip up over electric flexes. Slippery floors, loose rugs, staircases badly lit or with inadequate banisters, and shallow, unexpected steps are additional hazards when old people are about, especially those who have taken alcohol, tranquillisers, sleeping tablets or anti-allergy pills. Hot water bottles with caps not properly screwed up or with their rubber insufficiently covered can cause scalds or burns in old people in bed with numb 348 legs. One of my patients took her own electric blanket into a nursing home and managed to set her bed alight with it even there.
Central heating should not often do much damage, but one of the worst burned hands I have ever seen was in an old lady who had a stroke and had caught hold of her radiator to steady herself but could not let go. Some elderly people warm themselves up on a cold morning or evening in a hot bath, but even that has its dangers. One of my old patients could not turn off the tap or get out of her bath and unfortunately died of her scalds. Some with poor memories turn on gas rings and fires and forget to light them when their attention has been diverted temporarily elsewhere. I was called to one who had lost her sense of smell and who had gassed herself in this way. Loss of taste can contribute to poisoning by household cleaning fluids kept in unlabelled or wrongly-labelled bottles.
I mention these accidents because they can all occur as a result of inadequate attendance on and supervision of old people, many of whom need a great deal of attention. Patients' relatives and friends, doctors, nurses, district nurses, social and welfare workers of all kinds, health visitors, home helps, the clergy, all the young folk mentioned by the noble Lord, Lord Maybray-King, and many others do an enormous amount for the elderly which I shall not enlarge upon now.
However, I should like to mention one of the most imaginative recent developments in our social services. It is the so-called " attendance allowance " for helping the old and disabled in their homes in order to keep as many as possible out of hospital. The noble Lord, Lord Amulree, who has been chairman of the Attendance Allowance Board since it was appointed, has had much to do with the introduction of this splendid scheme through which any old, disabled or chronically ill person can, on application to a local social security office, and after filling up a rather long form which carefully assesses the situation, be given, free of tax, £370/£550 a year now (which will increase to £420/£630 next November) with which to pay a nurse or other attendant for some hours a day or night when relatives or friends are not available. 349 Over a period of 10 years or so, this tax-free allowance adds up to quite a considerable sum of money. To obtain it, there is no means test. I suspect that many families, including those of several of your Lordships here today, may have ill or old friends, relations or retainers who would benefit from such an attendance allowance, but who have not applied for it so far because they have not known that they were eligible.
Pride sometimes keeps old people from accepting help. About 20 years ago, a kind and generous American patient of mine offered me £200 a year for five years to distribute personally and in small amounts to any really deserving old people whom I knew. To my surprise, it was not so easy to give away as I had expected. I well remember one poor woman in my village who, during a very cold winter, refused point blank my offer of a few hundredweight of coal, saying that she was not accustomed to living on charity. Obstinacy, too, sometimes makes it hard to help old people in the way they really need. The other day, my wife, during her visiting work for the Royal Medical Benevolent Fund, found a doctor's widow living alone in terrible squalor. She obstinately refused all offers to rehouse her as she would not leave the wretched room which she has known for so long as her home.
The difficult question which has received much publicity recently and which several noble Lords have already mentioned, is whether or not old people who do not pay their fuel bills should have their supply cut off? Circumstances vary a great deal. So much depends on where and how they live, the reason why they have not paid, whether they really cannot afford to pay, whether they have alternative methods of heating and cooking, and whether they have taken the trouble to apply for supplementary benefit or rent rebate. As my noble friend Lord Strathcona and Mount Royal has pointed out, building standards, fuel policy, local government policy and pensions are all involved. Some old people are prudent and provident; others are not. Some buy special stamps to cover their fuel bills. If the weather is very cold, a pensioner who is living in a draughty room, who has no alternative source of heating, and who really cannot afford to pay, may soon die of cold if his fuel 350 supply is suddenly cut off. Surely, under those unusual circumstances, some help must be given along the lines of a grant to cover at least some part of the fuel bill which is owed.
A generous Welfare State, benevolent institutions and other charities such as Help the Aged, and kind friends and relations may supply old people with much that they need—a room, furniture, food (Meals on Wheels), light and heat, medical care, spectacles, deaf aids, mobile physiotherapy and walking aids, rehabilitation units, chiropody, some sort of occupation such as knitting, sewing or embroidery, books to read (perhaps with special large print for the partially blind which most public libraries supply nowadays), talking hooks, radio, and television. I offered to hire a television set for my old housekeeper who had worked for us for 35 years. She is now retired and lives alone in a small flat which she seldom leaves. At first she resolutely refused to take this present. In the end, however, she accepted and it has made all the difference to her life, as it does for many other old people whether the set be a private one or one in a communal sittingroom in an old people's home, a block of flats or an old people's hospital. She often says to us, enthusiastically " I saw the big fight (or perhaps the Trooping the Colour) today—were you there?" It does old folk good to know that they have seen something exciting or spectacular which other people may have missed.
One last point. It has been suggested that too little publicity is given to tell the elderly how they can obtain some of the benefits to which they are entitled. That is probably true but, however great the creature comforts they receive, a great number of them are desperately lonely. They miss contact with the young and love young people calling in on them. It is friendship, kindness, sympathy, companionship and good neighbourliness which so many of them need and long for most of all. Family doctors see this often and very clearly. One of my wise teachers once said to me " However ill or hopelessly incurable (either physically or mentally) your patients may be, however old they become and however little you can do for them medically, you should always be able to give them a little of your time." That is one of the most worthwhile but at the same time one of the most difficult things for 351 many of us to do in the hectic and over-busy life which we lead today.
§ 5.40 p.m.
§ Baroness FAITHFULL
My Lords, I am grateful to the noble Lord, Lord Strathcona and Mount Royal, for initiating this debate today, particularly since this time last week we were debating in the House the continuing importance of the family in the changing circumstances of Britain today. I believe, and I think it has been shown in the debate today, that the need to provide warmth for the elderly this winter is symptomatic of deeper, far-reaching and more basic problems. Looking at the heating needs in isolation is shown not to be enough, and in the long run, on its own, it is not as effective as it might be. The noble Lord, Lord Strathcona and Mount Royal, and other speakers have shown this in what they have said on housing.
In assessing the needs of any one sector of society I suggest that a balance should be struck between, on the one hand, an awareness of the needs of a specific group (in this case the elderly) and, on the other hand, not segregating the group from the mainstream of society. We should surely not offer a service to the elderly in such a way that it savours of help to the deserving poor and creates what one might almost call an apartheidgroup. This could tend to divide them from their families and their communities.
My Lords, there are the elderly and there are the elderly elderly. Of the latter there are in this country a few aged 107 years. Some of us are very elderly at 65, others are very young at 90, depending on the physical and mental condition, and circumstances of environment. I should like to concentrate on the elderly. In our effort to help the elderly we have too often forced them into the elderly elderly bracket. I remember when I first became a director of social services being offered tickets for Wembley Ice Rink, and I rang up the matron of one our old people's homes —and I think that the noble Lord, Lord Auckland, will agree with the point I am making here —and suggested that 20 of the old people should go to the ice rink. The matron said that they could not possibly go, that they would die. I replied, " How can man die better than facing 352 fearful odds?" They all put on their new hats, the men had their suits cleaned, and they went to the ice rink —and they did not die.
For the elderly to stay in that bracket as long as possible they need independence, mobility, a sense of giving —not always receiving —a sense of being positive, effective members of their families and their communities; and they must not be regarded as a burden. Furthermore, the needs and wants of each individual are different, and the elderly seek to make their own decisions.
I should like to follow what the noble Lord, Lord Maybray-King, said on the question of financial independence. The majority of elderly people greatly fear debt. Being disconnected from gas and electricity supplies is bad enough, but the fear of debt is worse. Surely no elderly person wants to be dependent financially on his family. No elderly person, having worked hard all his life, wants to be regarded as the deserving poor. Each normal elderly person wants to be responsible for his own decision-making as to expenditure. Some prefer to eat more; other prefer to have more heat; and other prefer to have clothes.
I submit that there is a long-term solution and a short-term solution. The long-term solution will not, alas! deal with next winter, as it is tied to the whole system of benefits and the poverty trap. Throughout their lives most people have worked hard but have not been able to save, due in part to low wages and the low taxation threshold. What the elderly want is a pension rate as of right which will meet their total needs. They do not want to apply for discretionary grants, except in exceptional circumstances —and I understand and appreciate that the mobility allowance is one. They do not want to spend their time applying for supplementary benefits for heating and fuel. Forty-two per cent. of old-age pensioners are drawing discretionary grants from the Supplementary Benefits Commission, and many more do not apply.
Administrative costs could be saved by a pension rate which included heating. I think I am right in saying that the amount of the first National Assistance benefit in 1948 was an arbitrary proportion of the average working wage, and the heating element was an arbitrary proportion of 353 that amount. This has been upgraded in time in relation to the average working wage. This matter needs research in depth, and I believe I am right in saying that it is being looked into by the National Consumer Council, by the Child Poverty Action Group, and by the Royal Institute of Consumer Affairs, and no doubt we look forward to this report.
With regard to the short-term solutions, everything I have listed has been covered, and therefore I shall not take up your Lordships' time. But there is one point I should like to make, and it is this. I do not think that the responsibility should rest with the gas or electricity Boards. I think that they might install a computer system through which, when the debt was still low it could be referred to the Supplementary Benefits Commission or to the social services. I underline the phrase " when the debt was still low " because that would be the red light showing in relation to future problems which would arise. Once the debt has become a high debt it is very difficult to help the family to right the situation, either through supplementary benefits or through the social services. If the debt is low the situation can be righted and dignity can be restored.
Much has been said about housing and what could be done in this field. I wish to take up just two points, concerned with planning —not housing —and wardened accommodation. I suggest that wardened accommodation for 30 people is of inestimable value, but I suggest also that there should be flexibility and smaller units because, for instance, in a population of 110,000 a wardened unit for 30 people is often sited in a place a long way from the neighbours, the communities and the families who are known to the old people. I would suggest that we should also think in terms of small units of five or six flats, with perhaps one flat rent-free to a couple who would befriend and look after the people in those flats; and that in the planning of our cities it ought to be possible to help an old person, not to be next door, though some people like to be next door, but at any rate to be within 10 minutes' walk of those they know and those they love.
May I pay a tribute to the home helps? There are 80,000 home helps in this country who visit 500,000 old people. 354 The home helps, to me, are the backbone and the salt of the earth. They give much more than is ever demanded of them, and I think it is deeply worrying to see from the estimates of local authorities for next year that the money allocated for home helps has in some instances been cut. It is very expensive to run an old peoples' home; it is very expensive, though not as expensive, to have wardened accommodation ; and it is false economy to cut the home helps, both in terms of happiness and in terms of finance.
Just one word about Meals on Wheels. This is one of the great pieces of voluntary work that is carried out quietly in this country, and many of the volunteers that carry out the Meals on Wheels service do much more for the elderly whom they visit. But I would wish to follow up the suggestion made by the noble Baroness, Lady Hylton-Foster, that we should use some of our juveniles who are willing to be used and who are out of work. Two juveniles could not carry the heavy containers, but there are not enough Meals on Wheels volunteers. The Red Cross, the WRVS and others are giving wonderful service, but there are not enough Meals on Wheels because in some cases there are not enough volunteers. So, my Lords, the tenor of my plea today is that we should regard, not the elderly elderly but the elderly, as people of independence, as people able to make a decision, and as people who are able to give to the community as well as to receive.
§ 5.53 p.m.
§ The Lord Bishop of MANCHESTER
My Lords, I trust that we have passed through that phase of recent history when it was common for elderly people to be regarded as the new poor of our country; as an essentially passive class to be pitied and done good to when they were not actually neglected. We have come through, I believe, to a better understanding, as this afternoon's debate has borne witness, that the policies of Government and the attitudes of younger age groups should be based upon respect. That implies the best use of the initiative and inner resources which men and women possess in the latter stages of their lives. Such respect, after all, is a very old feature indeed of human society, as this House could no doubt bear witness. The question now is how to maintain 355 that respect in a technological age which has given a much greater expectation of life to a very large number of people, while at the same time depriving them of an obvious role in that society. The Manifesto on the place of the retired and elderly in modern society, published by Age Concern, puts its succinctly:The elderly need to have sufficient income to meet their needs for social, physical and emotional wellbeing; accommodation which assures their right to privacy and the retention of their own material possessions; and the freedom to exercise those preferences and prejudices which express their individuality and sense of the past ".No doubt, my Lords, none of these high-sounding phrases has much meaning unless there can be adequate warmth in cold weather —and in these Islands I submit that that does not necessarily mean winter —for older people, and particularly those who live alone, for nothing paralyses thought and initiative more than being cold. Anybody who lives in an episcopal house, even in the modern era, can claim a nodding acquaintance with the problem of potential hypothermia, but at least we are kept on the move for most of the time. The hardship to those who sit still and shiver is of quite a different order.
I feel convinced, my Lords, that one line of attack on this problem is closely connected with the matter of bills. Many elderly people have a real fear of bills of any kind, sometimes as a result of previous experience of debt and sometimes from an exaggerated fear of falling into debt from which recovery may seem to them impossible. Indeed, younger people could testify to the incomprehensibility of many fuel bills today. The huge increases in them are very largely taken on trust by most of us, not willingly but because in querying them we start at such a disadvantage. How much more must this be true for an elderly person living alone! We should surely ask our public utilities to look as carefully as they can at the availability of some simple explanatory literature, and we should at least request them to consider whether a quarterly bill is always the most satisfactory method of collecting payment, as compared, for example, with prepayment meters —and here I support the remarks of the noble Baroness, Lady Robson.
Of course, we are up against the familiar problem of our time, that when administrative processes have been computerised 356 they become correspondingly lacking in humanity, which must include sensitivity to the needs of older people and flexibility in dealing with these relics of a simpler age. All the more, then, should we be looking for a satisfactory liaison between the fuel Boards and the many statutory or voluntary agencies which are there to attend to the needs of elderly people; and it seems from reports received that such liaison is extremely patchy. That may sound like a technical problem, but those of us whose regular business it has been to visit old and house-bound people in their homes are aware just how much suffering can be caused by the loneliness and the sometimes unnecessary fears of such people, who have too much time to think and too much cold and darkness in which to do it.
Neighbours and visitors can certainly do much to mitigate these ills; we ought not, in the modern style, to thrust all responsibility on to official agencies. Yet for them this is surely an area where sympathetic imagination and co-operation are constantly called for, and not least in order to help the elderly to help themselves, as is their desire in the vast majority of cases. I hope, my Lords, that the effect of this debate may indeed be to stimulate such imagination and co-operation between Government Departments, for a start, as the noble Lord, Lord Strathcona, suggested, and that the same process may be repeated down to the local level, so that we may have always as much accurate information and as much enlightened action as possible.
§ 5.59 p.m.
§ Lord SANDYS
My Lords, in opening my remarks I should like to say what a very real pleasure it is to follow the right reverend Prelate the Bishop of Manchester in his, if I may say so, commendably brief and particularly lucid address on this vitally important subject. His very telling phrase, "too much time to think and too much cold and darkness in which to do it ", is really the kernel of the subject which we are discussing. So I join your Lordships in expressing our gratitude to my noble friend Lord Strathcona and Mount Royal for introducing this subject at a very appropriate moment, when there is still time before the winter for local authorities and other bodies to consider carefully the range of priorities that they 357 would feel necessary in combating these matters, which your Lordships have so professionally discussed this afternoon. I am keenly aware, standing before your Lordships, how each one of you has a very special professional interest in some aspects of it. If I am able in my brief remarks to draw together some of the threads, it will have been a success.
My Lords, I think that the argument of my noble friend Lord Strathcona was centred on basing a policy not on vastly increased public expenditure which we know is totally impossible in the present circumstances —indeed, the Chancellor of the Exchequer has only today received warnings about this from our overseas creditors —but on the importance of making better use of such resources as are available and to set about reorientating our priorities. My noble friends all mentioned prevention, and perhaps I might set out the preventions that we wish to achieve: the prevention of illness through the family doctor, and there is no better doctor than my noble friend Lord Hunt of Fawley, who is so particularly experienced in this field; the prevention of accidents in the home, which was mentioned at considerable length by both my noble friend Lord Hunt of Fawley and my noble friend Lord Auckland; the prevention of mental deterioration, again mentioned by my noble friend Lord Auckland; the prevention of isolation, through the use of day centres and other social activities, many of them mentioned by the noble Baroness, Lady Hylton-Foster, and others; and, above all, in relevance to this particular debate, the prevention of hypothermia based on advice coming from many voluntary bodies and, perhaps, especially through the agency of Help the Aged. In this regard, we have been fortunate enough to listen to the advice of the noble Lord, Lord Maybray-King.
Perhaps, in addressing your Lordships, it would be a suitable moment now to mention those services which perhaps have not received sufficient attention. I would put high on my list the broadcasting services of the BBC and ITV and the enormous range of entertainment and interest which they provide to the old people. I should particularly like to stress the concessionary rates of television and broadcasting receiver licences allowed to old people, to commend strongly that 358 these be maintained in the future and that, if it should be possible, they be further reduced. I should like further to refer to the library services so ably carried out by the local authorities and by many charitable bodies. Some of your Lordships have mentioned the library service. This, in itself, is a source of great solace, entertainment, interest and, no doubt, home study; for I believe that one of the first graduates of the University of the Air was an old-age pensioner.
I should like, further, to refer to the very basic problem referred to by several of your Lordships, and especially by my noble friend Lady Faithful], in regard to the review, which is undoubtedly necessary, of the level of old-age pensions. My noble friend stressed that this is a longterm review, and I think she acknowledged the fact that in present circumstances it is particularly difficult to envisage an increase beyond the very substantial increase which is about to take place in November. If I may say so, I think that her argument was a solid one, based on what has been said by many of your Lordships and on the level of the social benefits obtainable in other countries in the Common Market. In that connection, the noble Lord, Lord O'Hagan, is particularly experienced and he referred to the fact that we are no longer the leaders, but perhaps the losers in the present situation.
My Lords, I should like further to stress that the situation so far as the present mobility allowance is concerned is one which is a matter of grave concern both to the elderly handicapped and to all handicapped people. That this debate should prove an opportunity for ventilating this has been particularly fortunate. The Attendance Allowance Board and its activities were mentioned at some length by my noble friend Lord Hunt of Fawley and we were glad to have the constructive speech of the noble Lord, Lord Amulree, who did not refer to his own particular speciality. There is one point in his speech which I should like to pick out at this point as I am about to go to the question of housing. I think that the noble Lord, Lord Amulree, was not, perhaps, intending to say what he did about the lack of opportunity over improving the older homes. If that was the case, what he did say was more than corrected by his noble friend Lady 359 Robson who gave us a breath of fresh air from her experience as one born outside Britain. She made a strong commendation to the Government, repeating one by my noble friend, in regard to insulation. If anything can be achieved in the next three or four months before the arrival of winter and the cold weather, this massive programme of house insulation is one which would be most strongly commended to your Lordships.
I should like to tell your Lordships about a meeting I had last winter with an old-age pensioner who had had the very unforunate experience of having his electricity supply cut off in the month of February. He told me that the temperature outside was 32 degrees and inside was 32 degrees also. He decided, in those circumstances, to go and sit in the showrooms of his local Electricity Board. After two days of considerable disquiet by the staff over this, they sent for the police. I hope —and I mean this seriously —that, should there be a recurrence of a situation like this, the Electricity Boards, rather than to send for the police, will perhaps show a little more kindness and possibly will venture to suggest other places to go to those who come to visit them for rather prolonged periods. I suggested to my friend on this occasion that perhaps his best course of action would be to ventilate this affair through his Member of Parliament. The only remedy that I myself could suggest was to offer him a drink. In that, I was carrying out what my noble friend Lord Hunt of Fawley recommended to his patients; so that I feel that I was on the right lines.
Many noble Lords mentioned medicine, and I was glad that the noble Baroness, Lady Hylton-Foster, mentioned the question of tablets and how frequently old people who have a series of tablets of different sizes and sorts become muddled. A document published by Help the Aged and entitled No one to blame? has come into my hands. This very fact is brought out when it says:It is terrifying to see dangerous substances handled by elderly confused people with poor eyesight, struggling to get tiny tablets out of small containers. As the lids are impossible for arthritic fingers to manipulate, tablets are decanted into egg cups, old tins etc., and separated from their labels. Equally alarming is the fact that 54 per cent. of elderly people were also found to be taking self-prescribed medicines: aspirin, cough linctus, 360 antacid, laxatives and vitamins which might well combine badly together or with doctors' drugs.I believe the medicines scene is a serious one. The question of packaging of medicines is a subject worthy of debate. I was particularly sad when the noble Lord, Lord O'Hagan, who had down a debate in the " No Day Named " section of the forthcoming Parliamentary Business for a prolonged period on the over-packaging of goods should see this Motion die of old age. I hope in due course he may think of bringing it forward to your Lordships' attention. Not only is it a matter of economy, it is a matter of serious consideration —in fact, possibly life and death in certain cases.
I should like to turn now to transport, which I think a few of your Lordships have mentioned in this debate. Transport is one of the needs of old people. Here I turn to the Government's orange paper which was introduced to your Lordships a few weeks ago and debated in this House. Volume 1 of the Annex to Chapter 3, on page 38 of the document, says:Concessionary fares for well-defined groups of vulnerable individuals such as the elderly, blind and disabled, are well justified.That is a very definite statement and I hope that both the Railway Board and the bus companies, and those concerned with the fixing of fares, will recognise this. The document goes on:The importance of concessions is reinforced by the rising cost of fares inherent in a policy of reducing the general subsidies which will bear hardest on such groups who are least able to look after themselves.The document says that it is the poor, the old, the infirm and the young who cannot make use of declining public transport. Of course in rural areas of Britain some bus services have gone to pieces so badly that people without cars are almost immobile. This came out in our debate on the orange paper.
I return to the question of the primary needs of housing and warmth. On the issue of housing, I can claim some experience because when I am not in your Lordships' House, I take a very great interest in restoring old buildings in the Midlands, bringing them up to a high standard of insulation in order that people can live in what previously were totally derelict buildings. I cannot claim that over the course of the past few years many 361 buildings have been restored because it is a particularly slow and difficult task. Nevertheless, it has a contribution to play towards the total problem with which we are concerned. The noble Baroness opposite, Lady Robson, highlighted the very large number of houses in this country. In our estimation, there are over 2 million such houses which deserve attention. Much of what is in the Paper which your Lordships have discussed previously, Our Older Homes—A Cause for Action, has been achieved already. Nevertheless, this is one of the focal points where further Government attention and further reorientation of resources could take place to the great benefit of old people, particularly those who are resident in those self-same houses at the present moment.
The standard of thermal efficiency is the central issue, and I thought that my noble friend Lord Strathcona made a most convincing point when he said one room in the house should be made thermally efficient. Even if in the larger, older houses all the rooms cannot have well-fitting windows, at least one could have one room with well-fitted windows and a well-fitted door. Surely here is an area where both voluntary groups and local authorities—if they are able to do so in a joint programme—could play an important part. I am perfectly certain that the do-it-yourself industry has a major part to play, as indeed the technical colleges and other bodies, which are much given to having both expertise and projects outside their own college activities and within the community.
Finally, I should like to come to the Consultative Document, Priorities for Health and Personal Social Services in England. Both my noble friend Lord Strathcona and the noble Baroness, Lady Robson, referred to the introduction on page 2 of the Document, and the very telling sentence to which I must return again. I make no apology for it, because I think it is basic to the argument:The first essential is to maintain the standard of services, to put people before buildings. Within the overall increase in the programmes, capital expenditure will be cut back in order to allow current expenditure to rise from 1976-77 by 1.8 per cent. a year for the National Health Service and 2 per cent. a year for the personal social services.We are not saying from this side of the House that we must start on a massive hospital rebuilding programme, knowing 362 full well that however desirable this would be this is totally impossible in the present circumstances; but we are saying that a building insulation programme, a housing renewal programme and a programme based on the repair and renewal of our older homes would be highly desirable in the present circumstances.
§ 6.18 p.m.
§ The MINISTER of STATE, SCOTTISH OFFICE (Lord Kirkhill)
My Lords, I am grateful that this Motion gives me the opportunity of telling the House something of what the Government arc doing to meet the needs of old people. I know that the whole House—not least noble Lords who have spoken this after-noon—share the concern of the noble Lord, Lord Strathcona and Mount Royal, for the welfare of the elderly. I am pleased to be able to say that the Government's record testifies to the fact that they too share that concern. Since they took office they have consistently regarded the elderly as a group deserving of special consideration in their overall policy programme. In pensions policies and in plans for development of health and social services we have demonstrated our conviction that a society should be judged by its attitude to those of its members who are particularly vulnerable. The elderly, all too frequently, fall into this category.
Let me hasten to add however that many old people would bitterly resent the suggestion that they need any sort of special protection. This House is evidence in itself of the fact that many people who would be regarded as elderly, are fiercely independent and very far from being vulnerable. And the Government would in no way wish to reduce the individual's independence. But the fact remains that most people when they become old no longer wish to work and therefore inevitably lose a large measure of independence. And alas! a small proportion of old people can no longer manage to live without outside help of some sort. We know that people aged 65 and over make proportionately greater demands on almost all health and social services than younger people. People aged 75 and over make even greater de-mands, and people over 85 even greater. Any growth in the numbers of these groups therefore inevitably leads to in-creased need for a whole range of care 363 services. In their plans for developing these services over the next 10 years, therefore, the Government have had to recognise that such a growth would take place. By 1985, the over-75s population will probably by 20 per cent. greater than today. The over-85s will be up by 16 per cent. By the turn of the century, well over 1 per cent. of the population will be over 85.
The contribution made by families in looking after their elderly relatives is enormous and we would all applaud this. Indeed, the underlying theme of the first question put to me by the noble Lord, Lord Strathcona and Mount Royal—quite generously, I agree—is the need to encourage the elderly to live within the community. However much it may he possible for the statutory services to provide, most elderly people will wish to look first to their family for help. Unhappily, the present pattern of our society—in particular the development of the restricted family unit at the expense of the extended family, limitations in housing, and mobility of labour—can make it difficult to give. In a recent Consultation Paper on Housing for Old People, the Government have suggested that housing authorities might consider whether it is right to set aside the need for residential qualifications in tenancy allocation policies in order to enable old people to be housed near relatives who are anxious to care for them. But whatever it may he possible to do to expand the amount of help and support provided by families, in the Government's view there are limits to this. Many old people have no families—a point well made by the noble Lord, Lord Amulree. It is estimated that a quarter of all people aged 65 and over have no children to assist them in time of need. About 34 per cent. of people aged 75 and over live alone. We must also bear in mind that many of the children of the very elderly will themselves be past retirement age. Thus we have to recognise a sizeable, and growing, need for outside help.
The form of this help is as varied as the wide spectrum of need it is aimed to meet. It covers each provision; help from doctors, nurses (either in hospital or in the community), social workers, home helps; provision of meals and many other services; also suitable housing. I 364 should like to say something about how the Government are meeting some aspects of the vast range of needs within the limited resources available—I would emphasise that at the present time.
The noble Lord suggested that in fixing the pension increase proposed for November 1976, the Government have not played strictly fairly in changing the method by which the increase was calculated. Let me therefore set the record straight and make my partisan point, as the noble Lord made his. In fixing the November rates, the Government have more than met their moral and statutory commitments. In their Manifesto at the time of the February 1974 Election, the Labour Party said that they would immediately raise pensions to £10 for a single person and £16 for a married couple and, thereafter, increase those figures annually in proportion to increases in average national earnings. The £10/£16 pension was introduced in July 1974—an increase of 29 per cent., which was the highest in both money and real terms since the present insurance scheme was introduced in 1948. The relevant statutory provisions, now in the Social Security Act 1975, were amended to provide that pensions shall be increased by an amount sufficient to restore their value in relation to the general level of earnings or prices, whichever is the more advantageous to pensioners, within 12 months of the previous uprating.
This has been done. Pensions were increased in April 1975 and November 1975 and, over the period from July 1974 to November 1975, pensions rose by 33 per cent. whereas both prices and earnings rose by 31 per cent. By November 1975, therefore, the real value of the pension was higher even than in July 1974. The Government are confident that the increase of 15 per cent. proposed for November 1976 will be more than the increase in prices or earnings since November 1975 and will raise the real value of the pension to a new high level. The Government consider, therefore, that they have more than met their commitments.
As to the change in the method of determining the increase, to which the noble Lord, Lord Strathcona, referred, the position is this: The Act says that the Secretary of State for Social Services shall 365 estimate the levels of earnings and prices as he thinks fit. When the Government came to estimate the movements in these levels for the upratings in April and November 1975, they foresaw great difficulty in forecasting future earnings and prices movements in a period of high inflation and rapidly increasing earnings, and decided to use movements over a past period.
For the April 1975 uprating, movements over the period from November 1973 to August 1974 were chosen—a period of 9 months corresponding to that between July 1974 and April 1975—and for the November 1975 uprating, movements over the period from August 1974 to March 1975. There were disadvantages in this method, in that past movements were used, including movements which began in November 1973—before the introduction of the £10/£16 pension whose value the Government were committed to maintain. But at the time it was thought the most appropriate method to use.
However, now that inflation is clearly coming under control—the annual rate has fallen from 25 per cent. last year to 15 per cent. Now—the Government did not feel justified in continuing to use past periods, particularly one in which inflation was untypically high. The proposed increase in November 1976–15 per cent.—is therefore related to the anticipated increase in earnings and prices since the last increase in November 1975 and, as I have said, will be more than sufficient to cover those increases. This forecasting method has been used at all past upratings except those of April and November 1975. Of course, I do not dispute that, if past movements had been used again, the increase in pensions in November 1976 would have been higher—some 21 per cent. instead of 15 per cent. But this would have been considerably ahead of the Government's commitment, and the additional cost would have been of the order of £500 million a year.
Would that circumstances were such that this could have been done; but the present economic situation and the need for restraint in expenditure meant that the overriding constraints put it out of the question. Let me reiterate that the November 1976 rates will more than maintain the value of the July 1974 pension 366 rates and that pensioners will not suffer a drop in their standard of living as a result of the change in the basis of the uprating.
For those pensioners and other retired people who need additional financial help there is the supplementary pension payable under the Supplementary Benefits Scheme. A supplementary pension is intended to bring whatever other resources a person may have up to the levels which are, for supplementary pensioners, guaranteed by the Act, and which are uprated by regulations approved by both Houses of Parliament. The proportion of retirement pensioners who have recourse to the additional help provided by a supplementary pension has declined in recent years, from 29 per cent. in 1966 when supplementary pensions were introduced, to about 20 per cent. This is, I think, a cause for satisfaction and it remains the aim of this Government to reduce dependence on means-tested benefits for elderly people. But the position of those who still need additional help is being protected. So much for our provisions for existing pensioners. As for the future, the Government's new pensions scheme, which is due to commence in April 1978, will, for the first time, provide earnings-related pensions which are comparable to those available to members of good occupational pensions schemes and which will also he fully protected against inflation.
Cash benefits are, of course, only part of the overall provision for old people. The Government are mindful of the need for practical help. The noble Baroness, Lady Hylton-Foster, emphasised this point. The extent of our awareness of this is amply demonstrated by the recent expansion in those health and social services used mainly by old people. Between 1974 and 1975, for example, the number of Meals on Wheels and club meals served to old people in England went up by 13 per cent.: between 1973 and 1974 the number of old people receiving treatment from a home nurse rose by 6 per cent.; an increase of about 25 per cent. took place over the same period in numbers receiving chiropody treatment; and between 1974 and 1975 the number of old people benefiting from the home help service increased by almost 10 per cent. Thus at the latest count some 930,000 old people in England were receiving treatment from a home 367 nurse each year, 1¼million from a chiropodist, and over half a million had the services of a home help. Some 38 million meals are served by Meals on Wheels or in clubs each year, and there are no fewer than 14,000 places available to old people in day centres.
The Government propose to maintain this momentum to the extent that resources will allow. Noble Lords will be aware that they have published a series of Consultative Documents on Health and Social Services Provision in England, Scotland, Wales and Northern Ireland. Perhaps I could draw on the English publication to demonstrate the priority the Government wish to give to services used mainly by old people. In their Consultative Document, Priorities for Health and Personal Social Services in England, the Government made proposals for giving special priority to growth and improvement in these services. The main objective of such services is to help old people remain in their own homes as long as possible. There are few people who would argue with this objective, and indeed this point has been emphasised by many noble Lords this afternoon.
The Document recognises that desire for independence which most old people have, and their right to pursue it as the rest of us do. That is why our proposals in this Document are slanted towards continued growth and development in the domiciliary services. We are suggesting an expansion in home nursing services of 6 per cent. a year up to 1980, of home helps and meal services of 2 per cent. a year and chiropody services of 3 per cent. Aside from domiciliary provision, we wish to ensure that hospital services for old people are more geared w active treatment and rehabilitation than they are at present. When young people go into hospital, they expect to come out as quickly as possible. Old people should be no different. If they need hospital treatment, they should receive it and get back to the business of living within the community.
Some four years ago new guidance was issued by the Department of Health and Social Security about the pattern of hospital provision required for an effective service for the elderly. This suggested that at least 50 per cent. of beds for the elderly should be sited in general hospitals 368 for those patients needing investigation, immediate treatment and faster-stream rehabilitation. I hope the noble Lord, Lord Auckland, will recognise that the Government are aware of the problem which he himself in part high-lighted.
Unhappily, progress towards this level of provision has been slow. In the Consultative Document we have therefore suggested interim targets for the provision of beds for the elderly in general hospitals over the rest of this decade, so that better headway may be made in securing this change in the structure of provision. We see this as a major priority not only in order to secure the most effective and economic deployment of resources, but also as an important part of our basic strategy designed to enable elderly people to continue living in the community for as long as possible. The idea of automatically putting old people into institutions for the last part of their lives, once they have difficulty in managing on their own, is as obnoxious to all of us as the image of the workhouse it evokes.
But, inevitably, there will always be some elderly people for whom there is no alternative to long-term hospital care. And it is unhappily true that all too frequently the beds available for their care are sited in old and unsuitable accommodation. Much effort has been devoted to improving these conditions, but we are in no doubt that much remains to be done. The Consultative Document therefore proposes that health authorities should continue to set aside capital resources to enable substandard accommodation to be improved or replaced at the rate of about 1,000 beds per annum.
Equally, with the prospective increase in numbers of the very elderly, there is bound to be a continuing requirement for residential accommodation for those elderly people who are not in need of constant medical and nursing care, but who cannot manage on their own even with the support of the domiciliary services. At present, some 110,000 elderly are living in residential accommodation provided by local authorities, an increase of some 10 per cent. over the past five years. The Government propose that up to 1979-80 there should be an increase of some 2,000 places a year largely concentrated in those areas where needs are greatest.
369 All these services, and the effectiveness with which they are planned, organised and delivered to those who need them, depend fundamentally on co-operation between the various authorities at local level. The elderly, possibly more than any other group, require an integrated service. Collaboration is therefore the keynote, as the noble Lord, Lord Sandys, so very clearly recognised. That means collaboration between health authorities and social service departments and—possibly as important—housing departments. Without this we can never hope to make the best use of resources or provide truly effective services. That is why this Government have taken steps to improve collaboration. We have increased local authority representation on National Health Service authorities; we are creating special joint-care planning teams—a concept welcomed earlier by the noble Baroness, Lady Robson—and we have introduced a new " joint-financing " scheme under which some health money could be used to finance social service projects. But even if we—in the various levels of government—use what we have to the utmost efficiency, we shall still need the invaluable services of voluntary bodies.
It may well be that we shall need the appointment of a Minister for the Aged, as was suggested by the noble Lord, Lord Maybray-King. This suggestion has been seriously considered by the Government and has, dare I say, a certain superficial attractiveness. Furthermore, I am sure it is made with the best interests of the elderly in mind. However, the possibility of such an appointment has been rejected on the very good grounds that, in the Government's view, it would not ensure an improvement in meeting the needs of the elderly. I do not have to emphasise that the elderly are not a homogeneous small group to be treated separately from the rest of society. They comprise over 40 per cent. of the population and exhibit the same variations, individualities and eccentricities as other people. Most of them live full and active lives, and the Government feel that their needs are best dealt with as they are now.
We are indeed fortunate in this country in the quality and range of volunteer effort offered for the elderly and other vulnerable groups, and many noble Lords have paid just tribute to the various voluntary bodies 370 concerned. The Government will continue to support this effort and will encourage health and local authorities to do so, particularly the young. If the young can be encouraged to involve themselves in rehabilitative work, the Government will do all they can to encourage them.
Perhaps their most valuable and appropriate help is in activities which involve a high input of personal time of volunteers—voluntary visiting, good neighbour and street warden schemes, night sitter services, handyman type of help and a wide miscellany of assistance of a kind which requires a very personal contribution which can mean a tremendous amount to the quality of life of an old person and which would not be suitable for statutory services to provide. In such volunteer effort the younger elderly have much to offer. Voluntary bodies are in the forefront of recognising that the recently retired have the time, the wisdom and often the expertise to be ideally placed to help older people.
My Lords, at this point I would dwell a little on the question of housing for the elderly, a point aptly emphasised, I thought, by the noble Lord, Lord Amulree. This is an important issue. There will be old people who will want to stay in the home in which they have spent most of their lives and who will have the physical and mental strength to do so. Others would prefer to move, if offered the right alternatives, and so contribute to the mobility which is necessary to the full use of the country's housing stock. Of special significance is the concept, alluded to earlier this afternoon, of sheltered housing which has gathered momentum since the last war, with encouragement in the form of special subsidies and otherwise from successive Governments to local authorities and, more recently, housing associations.
The most common form is a group of easy-to-manage and adequately heated flatlets fitted with an alarm system by which a warden on the site can be summoned in an emergency, but with emphasis on as much independence for tenants as possible. The concept has been a very successful one and there has been a gradual increase in the stock, but we are taking the opportunity to review the standards the Government lay down. But 371 other forms of housing will meet the needs of more active old people. A small unit on a level site and near essential services such as shops, public transport and libraries may be adequate. The Government have stressed the need generally for local authorities to build a greater proportion of smaller homes to match the trend towards smaller households.
However, sheltered or special housing cannot by itself provide for the wide range of needs that are thrown up by the many physical, mental and social vicissitudes that affect an ageing population. Like the other forms of care, sheltered and special housing must be seen in its place as one element in the spectrum of available provision, to be used when appropriate to individual circumstances. It is therefore particularly important that authorities set up effective methods of assessing the needs of old people who come to their attention and establish ways of collaborating together so as to ensure that the range of services available, including the health and personal social services and housing, may be deployed to best effect. This point was made very effectively earlier in the debate by the noble Lord, Lord O'Hagan. The noble Lord asked about the Central Policy Review Staff report on the joint framework of social policies. I can state that when the report was published Ministers agreed that a work programme should be put in hand. This has been done, and I hope that that assurance will go some way towards meeting the point which the noble Lord raised.
§ Lord O'HAGAN
My Lords, can the noble Lord say anything about the specific recommendation regarding housing for the elderly which was included in that report? The noble Lord has spoken a great deal about housing for the elderly. Can he link the two?
§ Lord KIRKHILL
No, my Lords, I could not link those two questions without prior notice.
However, there are dangers in encouraging old people to pursue independent lives. The process of ageing often impairs physical and psychological mechanisms which enable us to live safely alone and to fend for ourselves. Thus, old people sometimes get into difficulties when they live alone. They have accidents or sudden 372 illnesses and are unable to summon help, a point that was very clearly made by the noble Lord, Lord Hunt of Fawley.
To come to the core of the debate, they sometimes find it difficult to keep warm. Before I explain to noble Lords what the Government are doing to prevent this danger, perhaps I can clear up a few misconceptions. We see a lot in the Press about hypothermia. Every winter we hear reports that large numbers of old people are dying from hypothermia, but my information is that there is no evidence to support these claims. Indeed, the noble Lord, Lord Strathcona and Mount Royal, urged us to be cautious in our assessment of this situation. I understand that according to information from death certificates, the number of deaths attributed solely or mainly to hypothermia in a year is rarely more than a score. So why are there these exaggerated claims? I suspect, my Lords, that there is considerable confusion about what hypothermia is. There are few who would pretend that it is pneumonia or bronchitis, but it is almost certain that many of the deaths said to have been caused by hypothermia are in fact attributable to diseases such as these.
So what is hypothermia ? I am advised that, contrary to popular belief, it is not a subjective feeling of cold. What little we know of hypothermia suggests that this feeling may be dangerously absent from those suffering from it. Briefly, I am advised by medical people that hypothermia is defined as a condition in which the deep body temperature (as distinct from mouth temperature) is less than 35°C. Apparently, there is no firm evidence on how common the condition is, among either young or old, what causes it, or precisely how dangerous it is. This being so, I make a plea to the Press and other media to use the term " hypothermia " sparingly. It is essentially a technical term which is, I understand, little understood by the experts, let alone laymen. Evidence to suggest that it is a significant danger to our old people is lacking.
This is not to say that old people do not sometimes get into difficulties through failing to keep warm in winter, a point made by the noble Baroness, Lady Robson, and also by the noble Lord, Lord Strathcona and Mount Royal. For a variety of reasons, some old people are 373 particularly vulnerable to suffering in this way. They may be forgetful, or find it physically difficult to operate certain heating appliances. As in previous years, the Government will therefore take steps this winter to ensure that health and social services personnel who come into contact with the elderly are vigilant to the dangers of some of them suffering from the effects of cold and do what they can to help within the resources available to them. Old people themselves need to be reminded of the need to avoid getting too cold. In addition to any advice given them by the professionals, therefore, the Government plan to publish a leaflet later this year, and in good time, giving simple hints on how to avoid the dangers of cold. This will be widely circulated so that it reaches those old people who might not come into contact with health and social services personnel.
Old people may get into financial difficulties and feel they cannot afford fuel. As your Lordships will know, the supplementary benefit scheme provides a degree of flexibility through the discretionary powers of the Supplementary Benefits Commission to increase the amount of supplementary pension where there are exceptional circumstances. This power is used most notably where elderly people require extra heating because, for example, they suffer ill health or a lack of mobility. Information about discretionary additions, particularly extra heating additions, is made known in a number of ways. The need for such additions is considered automatically in each new claim for supplementary benefit and on the review of every existing case which takes place at least annually. The number of supplementary pensioners receiving extra heating additions has increased considerably in recent years. In November 1973 the number was 445,000 and by February this year this had nearly doubled to 849,000. There are currently some 51 per cent. of supplementary pensioners in receipt of these additions.
There are perhaps two ways of looking at these figures. There are those who will say that the incidence of discretionary additions reflects on the adequacy of the basic supplementary pension rates. I would prefer to see the rise in the number as a reflection of the concern felt for elderly 374 people in a scheme which allows for account to be taken of individual variations in circumstances.
As I said before, the proportion of retirement pensioners who have recourse to the additional help provided by a supplementary pension has declined in recent years. This is, I think, cause for satisfaction and it remains the aim of this Government to reduce dependence on means-tested benefits for elderly people. But the position of those who still need additional help is being protected. Both supplementary pension rates and the levels of extra heating additions are to be increased in November when retirement pensions are raised, extra heating additions being increased by some 27 per cent. This will give them, since October 1973, an overall increase of 133 per cent.; the increase in fuel prices generally from that date until May this year, which is the most recent date available, was 87.3 per cent., but there will clearly be a margin to meet further price rises.
The Government are of course concerned about the impact of high fuel bills on poor consumers, many of whom are old. That is why my right honourable friend the Energy Secretary secured the suspension of disconnection procedures for old people during the winter and set up a review body to look at payment and collection methods for gas and electricity bills. This body initially chaired by my noble friend Lord Lovell-Davis and latterly by my honourable friend Mr. Gordon Oakes, has now reported. Most attention has inevitably been drawn to its recommendations about disconnections, as my noble friend Lord Lovell-Davis earlier emphasised. However, I should emphasise to your Lordships that the Government will consider this recommendation with great care in the light of the views of interested organisations and individuals with whom they will consult—naturally including the nationalised industries which are worried about the impact on their financial obligations. In addition to this somewhat headline catching recommendation, the Oakes report has also made much less controversial recommendations about improved payment systems et cetera, and many of these have been mentioned in this debate. These recommendations, too, will be considered, together with comparable recommend 375 ations from the Commons Select Committee on the Nationalised Industries and the National Consumer Council.
Apart from improvements in payment procedures, other proposals have been made from time to time, such as free fuel allowances, fuel tokens, rebate schemes and tariff changes all of which I thought were fully explained by the noble Baroness, Lady Hylton-Foster. The Press recently gave much prominence to Mr. Arthur Scargill's idea for giving away the National Coal Board's coal stocks in order to generate cheap electricity. The Government are prepared to look at any proposals, but all these schemes—at least the latter—have their limitations and could expensively duplicate existing social security provisions. A Department of Energy booklet entitled Energy Tariffs and the Poor was published in February which inter alia analysed the effects of various general adjustments to electricity and gas tariffs. This analysis goes into great detail, but the fundamental point to emerge is that if arrangements are made to benefit small consumers at the expense of large, there is inevitably an adverse impact on the considerable number of poor people who are large fuel consumers because they have large families or inconvenient accommodation or are disabled or are simply elderly people who feel the cold. These large poorer consumers are in many ways the ones who most need help. So leaving aside any economic considerations—such as the desirability in general of allocating appropriate costs to consumers in order to encourage energy conservation—it is clear that no simple and satisfactory answer to the social problems can be found by making general tariff adjustments.
The noble Countess, Lady Loudoun, posed to me—and I intervene to reply to her on this point—two major specific questions. She asked me to state the provisional estimate for spending as it relates to concessionary fares for the elderly, blind and disabled in 1975/76 for England and Wales at November 1975 prices, and the figure is £75 million. In the light of her quite understandable criticism, which in part I reject because of the limitation of resources, about the concept of mobility allowance, I could say to her that unquestionably the scope of the 376 mobility allowance scheme has been restricted and we have not been able to achieve all that ideally we should have wished to do. As your Lordships may know, we are trebling the previous annual expenditure of £13 million on mobility help for the disabled, but even so, in order to provide a reasonable sum of money for each individual, a limitation on the numbers who are eligible was inevitable. In fact it comes down to a question of cash and how we should deploy our resources.
Perhaps before I leave the subject of fuel usage I could touch on the very important subject of house insulation. None of us can afford to waste fuel. But the elderly, being on fixed incomes, can often afford to do so even less than the rest of us, and this point was made earlier by the noble Lord, Lord Strathcona and Mount Royal. The Government are aware of this and are taking steps to help old people enjoy the benefits of good insulation in the context of their programme for bringing the country's housing stock up to standard. So far as council houses are concerned, roof insulation may attract Government subsidy when installed in the interests of an elderly, or a disabled, occupant. We propose to emphasise this in a forthcoming circular on subsidy for local authority house improvement in the public sector, since not all local authorities seem to be fully aware of the position.
Any expenditure of this kind is of course subject to the overall control on local authority expenditure on house improvements and conversions under Section 105 of the Housing Act 1974.
§ Lord STRATHCONA and MOUNT ROYAL
My Lords, can the noble Lord tell us when that circular is coming out, because we are getting extremely close to the time when we ought to be taking some action, are we not ?
§ Lord KIRKHILL
My Lords, I do not have before me an exact date, although my brief suggests that it will be almost immediately. But I give the noble Lord an undertaking that I will make a specific inquiry and let him know. A large number of authorities have, however, been allocated additional expenditure limits for the current financial year—and it is important to emphasise this—under the counter-unemployment programme, to which 377 spending on thermal insulation may be related, if it cannot be included in the normal improvement programme.
A further project on these lines is at present in preparation in the Department of Energy, who hope to present to local authorities nationally a financially attractive scheme for the insulation of local authority houses and public buildings—this would be particularly suitable for old people's homes. The Department of Energy hope to make an announcement on the subject fairly soon.
In the private sector—and I agree with the description given by the noble Lord, Lord Amulree, of the housing of many of our elderly, particularly in the private sector, where so many are living in very ill-fitted accommodation on ground floor and basement—improvement grant is not normally available, but may exceptionally be approved with the consent of my right honourable friend the Secretary of State for the Environment in the case of elderly or disabled applicants who cannot meet the cost of roof insulation without hardship. The task of carrying out insulation might indeed be one in which volunteers could play a major part. I therefore take this opportunity of commending it to any voluntary organisation currently seeking new ways of assisting old people. The noble Lord, Lord Strathcona and Mount Royal, mentioned the Job Creation Programme in the context of insulation. Perhaps I could remind noble Lords that this programme is designed to provide short-term jobs of social value for people who would otherwise be unemployed. The Manpower Services Commission pays the wage costs of projects which are organised and managed by sponsors who may be any organised group in the community. I am pleased to say that many projects so far approved involve help for the elderly, including some involving insulation of old people's houses. This is one further way, as I have been attempting to indicate, that the Job Creation Programme might be used.
In connection with the whole question of improvement schemes and energy conservation, the noble Lord, Lord Strathcona and Mount Royal, asked me earlier whether I could tell him how many authorities had used their additional allocation for energy saving purposes. I am sorry I cannot give the noble Lord 378 a reply to that, because authorities do not need specific approval; thus, there is no referral to a central department and therefore the information is simply not available.
But despite all our actions in this field of heating, I fear that there will still be tragic cases of old people dying in their own homes in circumstances suggesting neglect and total isolation. In the past, the circumstances of these cases have often involved an element of lack of heating. Often, of course, the proper insulation of new housing is surely important, and with this in mind, the requirements of the building regulations were roughly doubled at the beginning of 1975. I should say at this point to the noble Lord, Lord Strathcona and Mount Royal, that as far as council housing is concerned, our view is that the housing cost yardstick is flexible enough to enable local authorities to install at higher capital cost heating appliances with low running costs.
My Lords, I am sure I do not have to express the concern which Government at all levels feel about the cases of the old dying tragically in their own homes. But it is too easy merely to express indignation that such things happen and to say that something should be done to prevent them—to say, for example, that health and social services support should be marshalled to help. The sad fact is that most people who die in these appalling circumstances seem to choose to be isolated and have actually rejected help offered them. Should we force them to accept it? If they are seemingly sane, adult people, should we insist that they accept help on our terms and conform to a type of behaviour which we think is best for them? This is surely one of the dilemmas of a caring society: The extent to which we should intervene in what we see as other people's misery when they do not want us to. I do not propose to dwell on this question, but I will say that the Government in all their policies aim to ensure that when people need help and are willing to take it, they receive it. Ultimately, however, the only answer to the social isolation of old people rests with ordinary people in the community. If everybody was willing to be a good neighbour there would be no social isolation.
379 My Lords, it is not given to Governments in this country—whatever their political complexion—to take responsibility for meeting every conceivable need of the elderly or any other age group. Most people would not wish it. What Government must seek to do is accurately to reflect the wishes and attitudes of our society in how far they should go in that direction. They will end up by organising or providing help for some types of need on the one hand and leaving other needs to families, friends or volunteers on the other. This Government, like their predecessors, are attempting to strike a balance between those two options, a point taken very well earlier in the debate by the noble Baroness, Lady Faithfull. They are attempting to respect independence and freedom of action, while at the same time ensuring that help is available where it is most needed. Go too far one way and it adds up to neglect; go too far the other way, and you encroach on people's privacy. It is a difficult balance, but one which exists only because this is a basically humanitarian society.
Nobody would suggest that the balance is right at the present. The Government are only too well aware that their cash and service provision is not yet good enough. That is why Government have planned for improvements in our health and social services, and for better pensions for old people. The Government will continue to make improvements in these areas, within the resources available, and will also attempt to ensure, through our other policies, that the elderly live in a society receptive to their needs and at the same time mindful of their right to live dignified, independent lives.
§ 7.6 p.m.
§ Lord STRATHCONA and MOUNT ROYAL
My Lords, with the notable exception of the two respective Front Benches who have perhaps shown some tendency towards verbosity as they get older, the authority of the speeches this afternoon has been matched by a commendable brevity. I am very grateful to all those noble Lords and Ladies who took part in the debate. I must congratulate the noble Lord, Lord Kirkhill, for dealing so sympathetically with a very wide range of matters, a large number 380 of which were outside his own Department. I know the difficulty the noble Lord has been in, when most of his colleagues, I believe, are escorting the French President to the opera at this moment. He has acquitted himself magnificently, if I may say so.
However, I still do not detect quite the sense of urgency going through all the promises for future programmes and reports which he has dangled before us. This also permeates my congratulations to the noble Lord for what I can only describe as masterly evasiveness in not giving us any indication of the attitude of his Department towards the Oakes Report on the various problems, and in particular the disconnections. However, I am sure the noble Lord has the point, and I hope he will shortly put this right by making a more specific announcement. I beg leave to withdraw the Motion for Papers.
§ Motion for Papers, by leave, withdrawn.