CARE OF THE ELDERLY

HL Deb 12 March 1980 vol 406 cc1172-98

8.7 p.m.

Lord HYLTON rose to ask Her Majesty's Government whether they are giving favourable consideration to certain modest but significant proposals for improving the financial arrangements affecting residential homes and care generally for the elderly who arc frail or handicapped. The noble Lord said: My Lords, I beg leave to ask the Question standing in my name on the Order Paper. After those formal words I should like to thank in advance all those who are going to speak on this question this evening. I am doubly grateful to them for doing this after an all-night sitting and after a long debate on a question of world importance. I am delighted to have attracted a maiden speaker tonight in the person of my noble friend Lady Trumping-ton.

I should perhaps briefly declare my interest in this subject. I have been for many years closely connected with three charitable trusts which make both grants and loans for the housing of elderly people. Therefore I am perhaps in a position to know, as regards the voluntary sector, just where the shoe pinches. It may be helpful if I try briefly to define some of the terms of art which 1, and no doubt other speakers, will use.

First, there is sheltered housing. By this I mean grouped, self-contained housing for the elderly, usually with a resident warden and with some communal facilities designed normally in accordance with the DOE circular 82/69. There is also under this heading shared accommodation of, for instance, the type of Abbeyfield Houses with which many of your Lordships may well be familiar. The second important term is voluntary homes for the elderly. By this I mean residential accommodation registered with local social services departments and designed to standards set by the Department of Health and Social Security.

The neatness of these definitions is slightly blurred by some other newer forms. We have, for instance, caring hostels in accordance with the Housing Corporation Circular 1/77, and certain extra care units which are built on to traditional sheltered housing. Voluntary housing associations manage all of these forms of accommodation;in some cases one association manages more than one form. Housing associations provide some 10 per cent. of all sheltered housing, and this involves some 50,000 people living in it. The voluntary homes supply about one third of the places in residential care for the elderly. This Question is wide enough to include local authority homes and domiciliary services, which I know my noble friend Lady Faithfull will be touching on later.

I will confine myself to the voluntary sector only. One of the problems faced there, first at the national level, is the division of responsibility between, on the one hand, the Department of the Environment and, on the other, the Department of Health and Social Security. At the local level, housing is normally the responsibility of the district and social services that of the county, while health comes under a third body, the area health authority.

There has been much documentation about the numbers of people aged 75 and over, and we know as a fact that a big bulge is coming in the next few years. It is thought there will be some 500,000 extra people over 75. Many of these, of course, will be perfectly healthy and fit, as we know from experience in many parts of your Lordships' House, but there is certain to be a considerable increase in the number of those who are frail and handicapped, and that poses serious difficulties both for sheltered housing and voluntary homes. With this progressive ageing, help is needed for such things as dressing, washing, lavatories and feeding. This can produce acute problems for the wardens of sheltered housing who may be expected to give extra care when domiciliary services are unfortunately not fully available. The same sort of thing happens in the voluntary homes when they begin to find themselves in a nursing situation.

There are, therefore, human and financial problems. The financial problems are possibly most acute for the voluntary homes. It is possible now, and has been for some years, for an approved sheltered housing scheme to qualify for 100 per cent. loans and other help above that, but new voluntary homes seldom or never qualify for Government grants and loans. These homes have urgent cash needs for such things as lifts and fire precautions, and the money for these has at present to be raised nearly entirely from voluntary sources. One sometimes finds one Government department saying, "Do this;put in your fire precautions ", and another saying, "No, you cannot have any money for it". It is all very difficult. There are also revenue problems, but I will not go into those in detail.

Housing associations which are providing, the voluntary homes ask, "Why should this form of housing be the poor relation of all the other forms? Why should it be, in effect, the Cinderella of what they are able to provide? "These problems have been highlighted by a working party set up by the National Federation of Housing Associations. The conclusions which that working party came to were, first, that we need better co-operation at national level between the two Ministries, the DOE and DHSS, and the Federation would be only too willing to do anything it possibly could to help on that point. At local level we need closer liaison locally to co-ordinate in each area the provision and use of sheltered housing and residential homes, together with those all-important domiciliary services. I believe they do these things slightly better than us in Scotland and we look forward to improvements both nationally and locally in England and Wales.

We are also asking in the conclusions of this study for some increased Government funds for the voluntary homes, first for repairs, then for modernisation—lifts, fire precautions, kitchens and boilers in particular—a little extra money for extensions to existing homes to make them more manageable and workable, and a few brand new homes. I stress that this is a very limited number of homes about which we are talking, homes designed particularly to relieve the pressure that exists and is building up in the sheltered housing. For example, one home could serve a number of local housing associations or local authorities, or a mixture of both. Such homes would be much cheaper than hospital accommodation and many housing associations are already well qualified to provide them.

In this connection, I would say with respect to the Department of Health and Social Security that it is no good saying that the number of places in voluntary homes has kept pace with the increase up to now in the elderly population. Because of the bulge I mentioned earlier, we are getting into a much more difficult situation. We also need greater flexibility of design and management of sheltered housing with the aim that the tenants there should be able to stay in occupation until the point of death.

How can these things be done? This is where I come to what is referred to in the Question as: …certain modest but significant proposals for improving the financial arrangements". First, we need some capital funding for improvements and extensions and new building of voluntary homes, and I hope that could come from the Department of the Environment via the Housing Corporation to registered housing associations. Secondly, the revenue costs of existing and new voluntary homes will come, as they do now, from charges made to residents, but these need supplementing, and the possible places from which they might be supplemented are the Supplementary Benefits Commission via board and lodging allowances, from attendance allowances and from block grants from social service departments and/or area health authorities. The effect of involving the Supplementary Benefits Commission would be to relieve some of the burden that currently falls on local authorities.

As regards the sheltered housing, we feel we need an amendment or perhaps several amendments to Circular 82/69 to allow, first, lifts to all dwellings on two floors or more;secondly, accommodation designed to mobility standards;thirdly, communal kitchens capable of providing meals, not only to tenants but to other old people living nearby;and, fourthly, flexible staffing for sheltered housing, and the suggestion is that care assistants should be attached to sheltered housing schemes where domiciliary services are not so readily available, and I think these would have to be paid for by social service and health funds.

The important question is how much this will all cost, and some careful studies have been made. It is probably accurate to say that the immediate demands for repairs and some extensions to voluntary homes would be about £1 million per annum. New building of voluntary homes, especially for those people who are mentally confused or physically frail, might come to £27 million spread over three years. That would allow, say, 30 schemes of about 30 beds each. This is equal to 5 per cent. of the allocation to housing associations for sheltered housing in 1979–80. Therefore, it is, I believe, a modest re-allocation of existing funds and is not a call for additional Govern- ment funding. As regards sheltered housing, communal kitchens cost on average £4,000 extra, and lifts for two storeys cost about £12,000 each. If mobility standards are to be incorporated in sheltered housing schemes, this will cost very little extra provided they can be built in at the design stage.

The voluntary housing movement fully accepts that it must take its share of the current cuts;it is not asking for preferential treatment. However, it is asking that there should be greater flexibility both for existing and new buildings and a more pragmatic use of the available funds, both capital and revenue funds. I am sure that at the end of the debate I shall receive a sympathetic reply from my noble friend Lord Cullen of Ashbourne. and I trust that the Government are giving the favourable consideration for which we are asking. I very much hope that my noble friend and his colleague, the noble Lord, Lord Bellwin, will use their influence with Her Majesty's Government to secure the best possible results for the elderly people who are frail or handicapped.

8.20 p.m.

Earl GREY

My Lords, I look forward with great interest to the maiden speech of the noble Baroness, Lady Trumpington, who I know is well qualified and experienced in matters of health and welfare. I, too, am grateful to the noble Lord, Lord Hylton, for asking this Question, and I shall welcome any considerations that the Ministers may extend this evening. We are all aware of the Government's policy on cutbacks in public expenditure, but I am convinced that there are one or two areas in which the greatest care must be taken before implementing this policy. One such area is education, which is receiving our closest attention this week, and the other is that of the elderly and handicapped. I have read the sub- mission to the Minister from the National Federation of Housing Associations. That report is a worrying one, in that it highlights many areas in which the situation for the elderly and handicapped is not improving;in fact it is worsening. It appears that there is virtually no statutory finance available to improve existing homes or to meet the demands regarding new homes.

As the noble Lord mentioned, the indications are that over the next 20 years the population of people over 75 years of age will increase by 500,000, which will create a problem in itself. It is obvious that all elderly people do not, and will not, need special homes and care provided for them, but it is very likely that the numbers needing help will increase, and if the facilities are not now adequate, it is certain that the position can only get worse.

I am not advocating that the Government should have the sole responsibility of financing, housing, and taking charge of people who are no longer able to care for themselves. Many families have at least one person who is in that position, and I believe that a moral duty and an obligation to be concerned and involved rests with them, but it is not always easy or practical for a family to house an elderly relative who needs constant attention. It can prove very expensive, disrupt family life, and lead to bitterness.

Some councils that I know of provide excellent facilities and homes for the elderly and handicapped;for example, self-contained flats, well maintained in pleasant surroundings, with trained wardens on hand to look after them, are to be found in many districts. Mealson-wheels contributes an invaluable service and friendly contact, ensuring the health and wellbeing of an individual and, most important, making sure that he is not forgotten. It should be said that approximately one-third of the places in residential care are provided by voluntary or private homes, but with rising costs and inflation there is a likelihood of a drastic, though reluctant, cutback in these services. It is vital that extra homes are provided, that finance becomes available, and that people are trained to be well-qualified to care for the special needs of the elderly and infirm.

I should like to ask the Minister when taking into consieration the Government's policy of cutbacks in public expenditure, to bear in mind that this is an area that requires not a reduction in funds, but an injection of more funds. The old-age pensioner who is able to care for and look after himself has difficulty enough to make ends meet, but for one who is physically handicapped and incapable of coping by himself the problems are enormous.

I should like to ask the Minister, finally, what is the present position with regard to the attendance allowance payable to families who are able to look after an elderly or handicapped relative at home. This allowance has been of immense benefit, in that it eases both the financial and manpower pressure on councils and hospitals which would otherwise have to bear the responsibility.

8.24 p.m.

Baroness TRUMPINGTON

My Lords, my tiny hand may be shaking, but it is certainly not frozen, in view of the warmth and friendliness which has been extended to me in the limited time in which I have had the honour to be a Member of your Lordships' House. I would therefore crave your Lordships' indulgence over what I fear will only inadequately express my strong feelings on the subject that has been raised by my noble friend Lord Hylton this evening.

As a former member of the social services committee of the Cambridgeshire County Council, it was natural for me to consult officers from that authority concerning the very real and pressing problem of care for the elderly who are frail and handicapped, particularly in relation to residential homes. It was pointed out to me that over the decade from 1974 to 1984 Cambridgeshire will have built six homes for the elderly, which will provide 240 more places. However, at the end of this decade Cambridgeshire envisages that they will still have the same number of places per thousand as at the beginning. In other words, they will have stood still, instead of moving forward in the face of an ever growing population of old people. I assume that this situation is paralleled throughout the country.

It follows, therefore, that local authorities will depend more and more on housing associations and organisations such as the Abbeyfield Society to provide accommodation for those who can no longer live alone. Local authority sponsorship of places in voluntary homes does, of course, exist. It was however a depressing fact to be told that, due to financial cuts in the budget, Cambridgeshire will this year be reducing their sponsorship by 10 places. This cannot be right. The economic climate forces cuts in all programmes, but surely care of the elderly is such an essential service that their wellbeing is paramount.

Of course, the ideal is for all of us to live out our days in our own homes, with our own familiar possessions around us. But the fact is that for many, indeed for an increasing number, that simply is not possible. Sponsorship of places should therefore be increasing, and not standing still—if not decreasing;and surely during a time of economic difficulty it is cheaper to sponsor rather than to build. I am informed that only 3 per cent. of those living in sheltered housing move out of such places. People are now living longer, and therefore there is a greater demand for places. Also more care and attention will be needed to look after the residents.

At present, charges in voluntary homes are usually below local authority levels, partly because the homes tend to be smaller and cost control may be easier, partly because they aim to provide each individual with only the specific care that he needs, and no more, and partly, as in the case of the Abbeyfield Society, because they depend greatly on voluntary help. If the residents are to remain in these homes, being hospitalised only for acute illness, and returning to the homes after convalescence, in many cases the organisers of sheltered housing will have to replan their homes to accommodate the needs not just of the elderly, but of the very old and frail, too.

As my noble friend Lord Hylton said, corridors should he wide enough for wheelchairs, and provision should be made for communal facilities such as occupational therapy, and for day care and communal eating, as well as other facilities which he mentioned. I fully appreciate that public funding for sheltered housing through district councils or the Housing Cor- poration is becoming very limited. But the problem is so urgent that public funding levels must be maintained, and, given the growing numbers, let alone the current population of the elderly, increases will be needed. As an alternative I would suggest that encouragement should be given by the Government, and acceptance made by the housing associations now to plan joint schemes for the future whereby sheltered homes and local authority Part 3 old people's homes are situated near enough to each other to provide complementary facilities. This alternative would be more economical and flexible.

If your Lordships will bear with me for one more moment, I feel I must bring to your Lordships' notice one other problem which is not often mentioned but which is entirely relevant. I refer to the question of incontinence, which is the key to so many of the troubles experienced by the elderly;for instance, home help problems, support by relatives, the expense incurred in laundry and cleaning by a group with very limited financial resources, and, indeed, for old people's homes themselves. The national guidelines state that one lavatory should be provided for eight people in old people's homes. Although these guidelines are not directives and are not rigid—and, indeed, local authorities are planning above that level for old people's homes—they do not go far enough to encourage the provision of such basic necessities at a reasonable level. In the wider community of the elderly, the problem of incontinence is far more widespread and personally disastrous than many of us appreciate, and I see an urgent need to develop services, training and research into the needs of the elderly for the amelioration of such a basic and undignified disability.

My Lords, I wish that I was ending my maiden speech on a more elegant note. Indeed, it was suggested to me today that I should ask to be excused in midspeech in order to make my point. It is a long time since many of us were teenagers, though we remain young in heart. The physical and psychological problems of aging are major ones in the latter decades of this century. Without being over-protective we must do everything to enable the aged to live in comfort and dignity—above all, dignity. It is remarkable how the old respond to a challenge. In many ways they react better than the middle aged. In fact, I have been struck by what a happy relationship can exist between the young and the old—not second childhood, indeed, but often a meeting of kindred spirits who learn from each other.

I speak as the wife of a headmaster among whose pupils he is happy to count my noble friend Lord Hylton. Many schools, in their schemes of community service, provide not only a social service but an educational benefit in bringing the generations together. The young can till the well of loneliness and discomfort in which too many of the old live. We, too, can play our part.

8.33 p.m.

The Lord Bishop of DERBY

My Lords, I should like to offer congratulations to the noble Baroness, Lady Trumpington, on her fine maiden speech, which comes out of so much close knowledge and experience. We all have to discover by trial and error what the traditions, the Standing Orders and the customs of this House are, and I suppose it would have been only by staging the demonstration that she suggested as a possibility that she would have discovered those traditions. But I hope that we shall again have her lighthearted touch, as well as the knowledge that she has to give.

My Lords, the first point that I want to make—and at this late hour I must try to avoid ally repetition of facts which have already been given—links up closely with what the noble Baroness was last saying. The pressure of the number of old people now requiring care and homes means that many of them are ceasing to be treated with full humanity. Something is being lost in their life as human beings, as real persons;and what I think this Question is concerned about is not primarily buildings and finance but things which flow from them. We need to be concerned with this increasing number of old people, and with securing that they are helped to be as fully human to the end of their days as they have been during the course of their lives.

Another effect of the pressure of the still increasing numbers is that very often people who are being discharged from hospital are not able to go into any caring situation. Recently I heard of one 80year-old who could not be kept in hospital.

She was totally confused in mind and had to go to her own home where she would not allow anyone in to give her any help at all. There was no transitional stage which could be provided for her. But, of course, this kind of stubbornness is one of the problems which have to be dealt with by the kind of care which is given, one way or another.

There are those who enjoy the benefits of day care, but this can be a very expensive business, both in the provision of transport and in the provision of escorts, who so often have to be there to help old, frail and handicapped people in and out of cars. For example, collecting 25 patients in the morning and taking them home later in the day is both time-consuming and very expensive. Then there is the increasing burden, often by way of intolerable pressure with increasing responsibility on those who are wardens of homes.

Other pressures arise at the present time. There are homes of one kind and another which will take old people while the relatives with whom they are normally living go on holiday. This works very well if the relatives return at the end of the holiday to take the old people home again. But so often this does not happen;and there is no longer any legal obligation on the relatives to care for parents and other old people. This problem goes on increasing in extent. Similar things happen, though at a slower pace, over "Granny flats". The family may have an extension built on to their house, or set aside a part of it for Granny, but in no time reasons are found for sending her elsewhere;and elsewhere may not be a very satisfactory place. This is a further indication of the need for greater provision. Sometimes, in some places, the joint funding between area health authorities and social service departments leads to all sorts of interdepartmental fighting—and, in fact, arrangements last for only five years.

The noble Lord, Lord Hylton, mentioned that one-third of the places in residential care are provided by voluntary or private homes. A very large proportion of these are provided and run by Church bodies—Methodists, Roman Catholics, the Salvation Army and the Church Army—and this is one particular reason of mine for being interested in the subject. Reference has already been made to the fact that the report of the National Federation of Housing Associations points out that charges in voluntary homes are usually below local authority levels, and this may well be a reason for continuing to maintain them and to increase their number slightly. But they need increased financial support, and this need I would join in stressing.

Some of the homes, as we have heard, need extensive repairs, if not replacement, and some need considerable refurbishing and improvements, some demanded by authority and some known by those who work in them. But again let me say that this financial provision which is being asked for is designed to serve deep human needs which go on expressing themselves in a greater number of people, and I hope that the Government will take this into account as they consider the material that the noble Lord, Lord Hylton, and this debate bring to their attention.

8.40 p.m.

Countess of LOUDOUN

My Lords, I, too, should like to congratulate the noble Baroness, Lady Trumpington, on her fine maiden speech. I hope she will often give us the benefit of her wisdom. I shall be very brief as I am feeling rather frail and elderly myself. I realise that at the moment we are in no position to spend vast sums of money to improve our care of the elderly who are frail or handicapped. More could be done at no great financial cost to improve the facilities we already have. In 1978 there were 151,000 elderly people living in residential homes, some in voluntary or private homes and the remainder in local authority homes. The demand for these places increases as the number of very elderly people in our population is rising, but many voluntary organisations seem to be unaware that the nature of this demand for residential care is changing.

Most elderly people live in the community, some managing on their own for as long as possible, but most living with their families. Due to the fact that they are remaining in the community longer, the degree of frailty and disability of residents in the homes is intensified, which suggests that both the admission policies and the discharge practices of voluntary homes should be reviewed. Many of these voluntary homes are at a grave dis- advantage in meeting present-day needs for care with out-of-date buildings, in-adequate facilities and low staffing levels.

If the voluntary sector is to continue to play its part in supplementing statutory provision, it must be equipped to do so. Part of the problem comes from the fact that the services for the elderly have been developed piecemeal both by the National Health Service and local authorities, so that the resulting facilities conflict or overlap, or cannot meet the needs of whole sections of the eldery population.

Surely one answer would be joint planning between local authorities, the Health Service and voluntary organisations, to develop a range of residential services which complement each other and yet offer a choice to meet the needs of individuals. Add a large amount of common sense to the great deal of expertise which exists among all these people—that is, the local authorities, the Health Service and the voluntary organisations—plus the earnest desire to cut out any unnecessary waste, and I am sure we can only improve the quality of life for our senior citizens.

8.43 p.m.

Baroness FAITHFULL

My Lords, a few days ago the noble Baroness, Lady Trumpington, was sitting next to me in a debate and she said, "I itch to get up. I should like to speak, but I cannot". Now she can. We are delighted that she has made her maiden speech and that she will no longer have to sit quiet. She will be able to let us have the wisdom of her experience.

I am most grateful to the noble Lord, Lord Hylton. I feel very deeply on the question of the elderly, having been a director of social services. I wish, if I may, to take a slightly different course from that taken by the speakers up-to-date, but may I say, before I do so, that I agree with all that has been said by the noble Lord, Lord Hylton, the noble Earl, Lord Grey, the right reverend Prelate, our maiden speaker, Lady Trumpington, and the noble Countess, Lady Loudoun. I should like to take up the question of domiciliary services and not mention the question of residential care, except in one or two areas. As the noble Baroness, Lady Trumpington, said, people like to be in their own homes, with their own bits and pieces round them, to a very late age. How can we do this?

As the noble Lord, Lord Hylton, has said, residential care is very expensive. It is expensive in personnel. It is expensive in buildings. It is expensive in revenue. We must have residential care and I agree with all that has been said, but I am wondering whether we should not think much more deeply and much more positively about our domiciliary services;first of all, the home help service. The home helps are the salt of the earth. I think of the home helps we had in the area of Oxford, where I worked, and of what they used to do not only as a job but also in their spare time. A number of people are going to be without jobs and we ought to maximise on them. Home helps, given the support and help of social workers, can give an infinite service and many people can be helped to remain in their own homes.

Secondly, I want to ask the Minister about district nurses. I understand that district nurses are getting extra training which they have not had before. If there was a tremendous infusion of people and of finance into the district nursing service, many people could remain in their own homes who, at the moment, have to leave. I say this with the utmost diffidence. 1 wonder whether the medical profession, the general practitioners, are all experienced in the care of geriatrics and the elderly. I wonder how many of them have the knowledge and the wide experience of helping people at the end, helping relatives at the end of a person's life and helping a person through very difficult stages. General practitioners give a marvellous service, but I think many of them have not qualified in geriatric work, particularly in the homes.

My fourth point is the question of volunteers. We have at Berkhampstead a volunteer centre and I have read in the Hospital and Social Service Journal of various schemes in the country involving volunteers in the most extraordinarily imaginative way. In the Isle of Wight, for instance, there is a total scheme of volunteers;district nurses, health visitors, doctors and professional social workers who work together, who have plotted the island and are helping one another to help people to stay in their own homes. I think there are also such schemes in Southampton, Kent and in many other places. I am wondering whether we should not give thought to a united local team, using volunteers with a certain sense of co-operation, of gaiety and of knowledge.

I now come to the question of wardened accommodation. I have found—and I shall be grateful to hear from the noble Lord, Lord Hylton, whether he has found the same—that when you get good wardened accommodation the people in the area within which it is situated think, "Oh, there is a warden there;then there is nothing for us to do. It is her responsibility to care for the elderly in the wardened accommodation". I was privileged to go up to Northumberland to open one of the Johnny Johnstone wardened accommodations. These wardened accommodations are run by a voluntary committee of the air aces who survived the last war, Bader being one of them. As their thanksgiving for having survived the last war, they have contributed to build the Johnny Johnstone wardened accommodation.

I went up to open it and it was a magnificent place. But I felt that, with the charming and enchanting warden, there was perhaps—I have seen this not only in that place but in many others—an opting out of the community because it was felt the warden was there to do everything. The warden did do everything in many cases, but she needed support and help. I think that sometimes the wardened accommodation, by the very fact that it is a little community on its own, becomes slightly divorced from the community, and the volunteers and the people in the area have the feeling that the old are being looked after there and there is nothing for them to do—forgetting, perhaps, that the warden herself needs help.

I was responsible for seven old people's homes and I agree with the noble Lord, Lord Hylton, that to make these viable and a possible place for the very elderly to live is expensive, but I cut my costs quite considerably in our old people's homes by dividing the houses so that the old people looked after each other and themselves. We divided the houses into little flatlets of six so that six people lived together and looked after themselves and were only provided with one meal a day, themselves shopping and getting the other meals. We have a number of hostels, and here again it is a question of responsibility, of asking people to give much in the hostel to those who cannot care for themselves.

I wonder whether we ought to think of what hospital is for. Should we be sending people to hospital who are not ill, who are simply frail by virtue of age but not by virtue of illness? On the whole question of the frail elderly, I ask myself whether this is the terrible chink in the armour of our services to the elderly. If one is fairly young, one can get into an old people's home after a while, but one must be fairly healthy to get into an old people's home. The other day I was in the library in Oxford getting a book out and I heard two people talking on the other side of the library. One of them said, "I'm 70. I'm putting my name down for an old people's home". The other said, "I'm 71. I shall get into one in five years' time".

When it comes to trying to get in frail elderly persons, they are not acceptable in wardened accommodation, in hostels or in homes. So where are they to go? We must think very carefully about the domiciliary services, but we must also have regard to this chink in our armour because the frail elderly are very often those who have had the courage to live in the community until they are too frail. They do not go in at an earlier stage.

I should also like to touch on the question of knowledge. Very often we arc talking about work in the schools in home economics, for training people up for marriage, for home, for children, and for family life. But are we informing our elderly and ourselves exactly what we ought to be doing for planning for our own future? A hook entitled, Taking Care of the Elderly Relative has just been written by a doctor in the area I live in, and his colleague. It is an extraordinarily interesting book born of their experience of the kinds of things we all ought to know. Looking at this book, one realises they are very simple things but the kind of things that people very often do not know: when to put one's name down, who to go to, what one can expect and what hope there is. As the noble Lord, Lord Hylton, pointed out, and perhaps to put the whole thing in proportion, it is right to say that an enormous number of people do live in their own families, do die within the orbit of their families, but do not want to stay in the mainstream of life until the very end. I think that with all the domiciliary services we ought to try to make this possible.

8.55 p.m.

Viscount BARRINGTON

My Lords, I do not know if this is in order, but the noble Lord, Lord Wells-Pestell, has very kindly allowed me to say a few words. The subject of this debate is old age, including incontinence. I am not continent enough to refrain from saying how much 1 agree with everything the noble Lord, Lord Hylton, said, and how grateful I am to him. I should like to congratulate the noble Baroness, Lady Trumpington on what I thought was a superb maiden speech. It will read extremely well tomorrow. She said her tiny hand was not frozen. I do not know whether it is tiny but certainly it was not frozen. I think that making a speech in a House as empty as this, after everyone has sat up all night, would make most people's hands freeze. It did not do so in her case. I say this without any prejudice, because I believe she has some association with Cambridge, just as the noble Baroness, Lady Faithful! has some association with Oxford—I do not express any preference. The noble Baroness may even have had some association with Eton, although I suppose that is not very likely. I agree entirely with everything she said.

The point I should like to make is that voluntary help in these things should come in the right way. Recently I visited an elderly relative of mine in a home, after she had been taken from one that was quite appalling to a very good one. She had been really rejuvenated by the fact that there were a great many younger people around her. There is a saying that age and youth cannot live together. Youth and age cannot, but young people can help old people. Perhaps I am very lucky, being one of what has been described as "a big bulge". Having been helped by younger people, I felt I could not listen to the debate without saying how much I appreciated what has been said. I apologise to the House: perhaps it was the fact that I sat up all night that made me decide to speak in this debate.

8.59 p.m.

Lord WELLS-PESTELL

My Lords, the first thing I should like to do is to extend my personal congratulations to the noble Baroness, Lady Trumpington. I do not know when I have enjoyed a maiden speech quite so much. I say that very sincerely. I have not a reputation for saying things that I do not mean. It really was delightful and I am almost inclined to say, "To the manor born". I was warned before the noble Baroness came to this House not to be intimidated by her appearance. I was told that I would find her a most delightful and charming person;and those of us who have come to know her—perhaps not too well in so short a time—realise that we are fortunate in having her in this House. I hope that it will not be too long before she makes a further speech and plays a full part in the work of this House. We, on this side, I am sure, will spend more time disagreeing with her than agreeing with her, but that is the purpose of the whole thing.

I should like to answer a good many things that have been said. I feel that I want to congratulate the noble Lord, Lord Hylton, on being able to draw attention to the needs of the elderly in residential homes without commenting on the disastrous policy of the present Government, which is keeping a large number of people who need to be in residential homes out of residential homes because the homes are not there to meet their needs. I was surprised that he said, if I understood him correctly, that voluntary organisations accept the fact that the Government cannot do anything more financially in this matter.

Lord HYLTON

My Lords, the voluntary homes are being realistic about the position. They would like an avalanche of funds, but they probably will not get them.

Lord WELLS-PESTELL

My Lords, their realism is based on the fact that they know the Government have dug their toes in and are not doing anything more about it—No, my Lords, I am not going to give way to an intervention. Whenever I speak, the noble Baroness finds some reason to try to intervene. I would say to the noble Countess, Lady Loudoun, that if the Government, when they came in, had not given away by way of tax reduction £4,500 million, one-third of that sum going to the higher income groups of £10,000, £15,000 and £20,000 a year, they would have been able to meet this situation and to do the everything that the noble Lord, Lord Hylton, wants them to do.

With the noble Lord, Lord Hylton, I am concerned as to what is happening in this particular field. He rightly pointed out that only a very small percentage of the elderly need residential homes. I believe the figure to be something like 150,000. Some 20,000 of them find places in private homes, 30,000 in voluntary homes and 100,000 in local authority homes. We must face up to the fact that the position is serious. It is not a question of what we want for the future;it is what we need here and now. Private homes are getting more and more expensive—anything up to £500 a week. I think there must be a lot of thieving scoundrels who charge that amount of money. Voluntary homes can do it for between £55 and £60 a week. Local authority homes certainly cost more, at something like £70 a week, as I understand the situation.

The Government are in a difficult position when it comes to providing financial aid to charities, although as noble Lords will probably know there is legislation which enables the social services departments to give capital grants or loans to such voluntary organisations as Residential Care for the Elderly who are providing services. i am aware of the fact that this money is not going to be forthcoming because of the present economic situation. But what does it mean? It means that many local authorities have new buildings in the course of construction—and the latest figures I have are that there are between 55 and 60 such buildings—which, when completed will be left unused. They will include buildings of homes for the elderly. In addition, there are about 50 to 60 existing establishments which will close. They will be largely residential homes for the elderly;although I accept that some of those 50 to 60 buildings will be for children. So that not only are we not going to have the 55 to 60 buildings which are now under construction and will soon be finished, but something like 50 to 60 arc going to be closed.

The noble Baroness, Lady Faithfull, spoke about the domicilary provisions. I think she is right. I think that we ought to be debating this. This question is so important that it ought not to be left to an Unstarred Question late at night. The whole field of help for the elderly ought to be brought under the microscope. But we must bear in mind that there is a substantial number of elderly people whose problems are not going to be met by home helps, and are not going to be met by other domicilary services, for the simple reason that they need to be under the watchful eye of somebody for 24 hours a day. We all know a large number of elderly people who sometimes go days without seeing anybody. This is why it really is so important that the Government should do something without further delay to make it possible for these new buildings, which otherwise will remain empty, to be occupied, and to take some immediate step to prevent the 50 to 60 existing buildings, in the main housing the elderly, closing down.

I do not know who it was who said that we are in the middle of an age explosion. The number of elderly people is increasing rapidly each year and will continue to do so right up to the end of the century. The 74 to 85 age group will increase by 20 per cent. in the next 10 years. Think what that means, my Lords! We shall become a country concentrating mainly on manufacturing bath chairs. I do not mean that literally, but your Lordships know what I mean.

The number of those aged 85 and over will increase by no less a figure than 30 per cent. in the next 10 years, and the 85s will increase by 48 per cent. by the year 2011. This is what medical science is doing for us, keeping us alive. Whether it is desirable that it should be allowed to go on doing so is another matter. For decades there has been a steady improvement in the services provided for the elderly and weaker members of the community. I should have thought that this is the responsibility of Government, particularly if they believe in a compassionate society. I am told from time to time that there is nothing between us on this, that the party opposite is just as compassionate as we on this side of the Chamber. If this is so—and I do not deny it—then we ought to be thinking first and foremost of the weaker members of the community. We ought to be thinking of the elderly who need so much. I have a great admiration, as I am sure other noble Lords have, for the work of the National Council for the Single Woman and her Dependants. In Oxford we have a very large branch, as the noble Baroness knows. A vast army of women have sacrificed marriage and careers to look after an aged father, an aged mother or an aged couple. It is not only that they are saving the community a tremendous amount of money;it is that they are maintaining a parent or parents in the kind of environment, in the kind of atmosphere, that they would want to be in.

I am glad that, as far as I know, the Department of Health and Social Security is helping that organisation financially—at least it did when I was in that Department. I know that we engage in party politics. That is what it is all about;that is why we are here. However, I think that if we are concerned for the wellbeing of the less fortunately placed, we ought to be doing something—and noble Lords opposite are in a far better position to do it than we are—to bring pressure upon the Government to stop the closure of residential homes for the elderly and to see that these new buildings which were built for the purpose, will be used.

Let us face it, it does not involve a great number of people: 150,000 is the top number in the three groups providing facilities for the aged. It cannot possibly cost very much money. It cannot possibly cost more than a few million pounds. I would have thought that to do this for this section of the community would be making a supreme contribution to the community in the sense that we may well save in the long run far more money than we expend.

I am not asking the noble Lord the Minister any questions: I do not think this is a case for questions. This is a matter for setting out what we think and what we believe, as the noble Lord, Lord Hylton, has set out what he thought ought to be done. I think it can be done and I want to see the noble Lord, Lord Hylton, succeeding in what he wants to achieve. But before that happens I do want to see something done for the elderly immediately, and I think it can be done.

9.14 p.m.

Lord CULLEN of ASHBOURNE

My Lords, we have listened with great interest to a number of stimulating and thought-provoking speeches on the subject of housing and care for frail and elderly people. I should first like to congratulate my noble friend Lord Hylton for raising this matter and for the cogent way in which he argued for changes in the present arrangements. I should like also to congratulate him on his timing: his timing is remarkable, because after having debated the Education Bill throughout yesterday and yesternight, your Lordships should be just in the right mood to discuss matters affecting the elderly and frail.

I think it would be helpful if I were to explain something of government thinking and policy in this area and to indicate our reactions to the proposals put forward by the National Federation of Housing Associations. However, before doing so, I should like to add my sincere congratulations to my noble friend Lady Trumping-ton on a most interesting speech. It was admirably brief, clear, practical and extremely moving. I am not sure that I have heard a better. My noble friend told me that she was nervous about making her maiden speech. I well remember what an ordeal I found it when I made my own, but I would say that, even if at this moment she does not believe me, she needs have no qualms on future occasions, to which I feel sure all your Lordships will look forward, as I do.

As my noble friend Lord Hylton mentioned—and the noble Lord, Lord Wells-Pestell, expanded on it—it is a familiar fact that the numbers of very old and frail people will continue to increase. As has been mentioned, it is estimated that by 1990 there will be some 3½million people aged 75 and over—an increase of half a million. Since I very much hope to be one of them, I unhesitatingly declare my own personal interest in this estimate.

Although 90 per cent. or so of these elderly people live in ordinary housing, perhaps with such modest adaptations as some handrails, a ramped access or a relocated lavatory, a significant minority need sonic degree of support or care and attention. The increasing numbers of frail, elderly people present a challenge to our society;and it is right that, as invited by the National Federation, we should review administrative and financial arrangements to make sure that they arecapable of meeting sure that they are capable of meeting needs in the most appropriate and satisfactory ways. In this connection, I should like to pay tribute to the splendid work done by housing associations in providing accommodation for elderly people, and indeed for other groups with special housing needs. I believe that housing associations have already provided 47,000 specially designed units for old people and indeed for other groups in need of special housing. I very much hope they will continue to be active in this way.

We have heard that the National Federation of Housing Associations consider that present administrative and financial arrangements are insufficiently flexible to permit of the kinds of developments which their member associations would like to undertake, and we have heard of the suggestions they have made heard of the suggestions they have made to introduce a great degree of flexibility into the system. We have naturally looked with the greatest care at the Federation's suggestion and my honourable friend the Parliamentary Secretary at the Department of the Environment has today written to the Federation with reactions to these suggestions. If I may, I would like to direct my remarks to the remarks made by the Federation and I do not propose to answer the few questions I have been asked today because I think that the rest of my speech will answer the bulk of them.

As I have indicated, the majority of old people neither need nor indeed want sheltered accommodation, and only a minority have recourse to the statutory services. For those who do, the primary aim of Government policy is to ensure that wherever possible, and practicable, the services should be provided in the community so that elderly people can continue to remain in their own homes. This point was particularly stressed by my noble friend Lady Faithfull, who seemed to say so many things with which we in Government entirely agree.

To this end, emphasis is placed on the provision of domiciliary health and personal social services, which are available to tenants in sheltered housing and hostels in the same way as they are to elderly people living elsewhere in the community. It is, however, recognised that there will always be a minority of elderly people who cannot be maintained in their own homes even with full domiciliary support;and to meet their needs long-term care is available in hospital or residential home.

It has been said that there is a shortage of such facilities. That may be so in some parts of the country, but I do not think we should ignore the significant body of opinion which is calling in question the need for more places in residential homes as a universal answer to difficulties. Also I think that we should approach with caution measures which would serve to turn sheltered housing into some sort of residential home. I see as matters for concern the possibility of creeping institutionalisation and the erosion of the independence of the individual by a gradual, perhaps imperceptible, change from a housing scheme to a quasi-residential home. For these reasons alone, we should preserve the fundamental and established distinction between, on the one hand, essentially housing schemes;and, on the other hand, schemes which are essentially for "caring" institutions.

One of the consequences of this distinction is that housing schemes look for their sources of finance to such bodies as the Housing Corporation, while" caring" schemes are financed by local authority social services departments. It is therefore of considerable importance that schemes which include an element of both housing and caring, that is those schemes which straddle the boundary, can obtain adequate finance. Our arrangements need to be sufficiently flexible to cater for such schemes. We have therefore considered, in the light of the representations from the National Federation, whether we need to change our present arrangements;and in particular whether we should move in the specific directions which it advocates.

I should like to draw your Lordships' attention to Housing Corporation Circular 1/77 on "Caring Hostels". This circular, which was issued in December 1977, with the approval of DOE, DHSS and other interested departments, was intended to encourage developments in the kind of hostel accommodation that gives a degree of care to its tenants. It introduced a much greater degree of flexibility through the concept of supportive hostels—that is, hostels which provide a degree, but not a high degree, of care. The housing element of such hostels is eligible for housing association grant and extra running costs of providing supportive care are met by other, non-housing funds—in practice largely by social services. The provision of meals and home help services, and a measure of support under the terms of the circular, and the provision of a degree of care by way of additional facilities or extra staff, do not make these schemes ineligible for hostel deficit grant.

The essential ingredient in Circular 1/77 is co-operation between those who provide housing and those who provide care and the consequential arrangements—agreed in advance—which are needed to ensure that the hostels function well. It is open to the members of the National Federation to enter into negotiations with social services departments locally to see whether they would wish—or be able—to provide the kind of care envisaged. But I think it right to say that the assessment of need for personal social services is solely for the social services authority to determine. Such assessments are primarily made upon the needs of individuals, and authorities need to retain sufficient flexibility in the deployment of their resources in order to ensure that those most in need are assisted wherever they may he living.

On design standards of sheltered housing, and therefore grant entitlement, the National Federation have made four specific suggestions for greater flexibility. As is well known, the Department of the Environment is at present engaged in a major review of the role of Parker Morris standards and cost yardsticks in local authority housing. The aim is to relax the present system of centrally determined standards, and thus to permit local authorities a greater degree of discretion to take their own decisions in the light of local circumstances. Although I cannot of course anticipate the outcome of that review, it may well be that changes in the general direction of more flexibility for local authorities will result in similar changes for housing association schemes. Meanwhile, there is already a degree of flexibility in three of the areas to which the National Federation draw particular attention.

On the question of added facilities to ease the delivery of services to occupants of sheltered housing, policy is to the effect that neither housing nor social services should unduly subsidise each other's functions. But the additional capital costs of providing for an enlarged kitchen and a dining room to allow meals to be prepared on the premises, and consumed in a communal setting by the tenants and by other elderly non-residents, can be provided with finance from social services or other non-housing sources, including funds made available by health authorities under joint financing arrangements.

On the question of mobility standards, the Department of the Environment are always prepared to negotiate the costs of additional work, in ground floor premises or in blocks that are already provided with lifts, to allow greater freedom of movement for those with some degree of dependence on a wheel chair. The DOE are aware that there is pressure to subsidise the provision of lifts in two-storey sheltered housing, but this is something that they are actively considering at present.

On the question of standards on heated enclosed access in Category 2 housing, final decisions will need to await the completion of the review of project control. Meanwhile, housing associations which wish to build a scheme without covered access arc free to make a case on merits to the appropriate Department of the Environment regional office.

I hope that your Lordships will forgive me this complicated elucidation of a complex subject. It may he that the complexity of arrangements in the Housing Corporation circular and their relatively recent vintage mean that they are not well enough known or understood. My honourable friend the Parliamentary Secretary at the Department of the Environment has therefore suggested in his letter to the National Federation that officials from the DoE and DHSS might meet with representatives of the Federation to discuss the detailed operation of the arrangements. I am sure that such a meeting would be valuable. I trust that my noble friend Lord Hylton and other noble Lords who have taken part in this debate will feel that this is the way forward. Perhaps we should also consider, as the noble Lord, Lord Wells-Pestell, suggested, a more wide-ranging debate on the subject of the care of the elderly.

I hope that I have been able to demonstrate that, on the housing side, the financial arrangements are such as to permit an adequate degree of flexibility in funding schemes which include elements of both housing and care. Also, I hope that I have demonstrated that, on the social services side, it is not a problem of inadequate arrangements requiring review but one of limited resources. Much of what the National Federation of Housing Associations suggest is becoming standard practice. But authorities individually have to decide the priorities of the pressures competing for a share of their resources. Inevitably, in the process of making choices, they will not always reach the same conclusions as others over relative needs. My right honourable friend the Secretary of State for Social Services does not treat this lightly, and has made it clear that authorities should, as far as possible, aim to protect services for the most vulnerable, including the very old and frail and the physically handicapped. We believe that authorities themselves are very mindful of the need to do so.