§ 11.10 a.m.
§ Mrs. Anne Kerr (Rochester and Chatham)
I beg to move,That this House recognises the many and varied problems which arise as people grow older; calls attention to the inadequacy of the provisions and services for old age; emphasises the desirability of doing more to enable elderly people to continue living in the community in comfort, independence and dignity; urges the Government to bring forward measures for improving and co-ordinating more effectively existing social services; and also asks the Government to investigate what additional benefits and services for the elderly might be made available.It seems to me that the retirement years should be looked forward to with eager anticipation. All of us in this House recognise, I think, that that is not the case for the vast majority of our people 1509 today. While welcoming the pension increases which old people are to have at the end of March, and while welcoming also the end of the prescription charges and the ending of the earnings rule for all widows, we still have in our minds the plight of the spinsters between 60 and 65 to whom the abolition of the earnings rule for widows does not apply. We also have in our minds the fact that there has been no abolition of the earnings rule for the older men between 65 and 70.
I am wondering whether, even at this late stage, the Minister might not backdate the increases in pensions as from October, 1964. I would request my right hon. Friend to consider doing this, because the feeling throughout the country on this subject is very strong indeed. I wish also to refer to the fact that there is no pension at all for the very elderly in many cases, the people who were left out of account, the people who were too old. I realise, of course, that the hon. Member for Abingdon (Mr. Neave) is to bring forward a Measure on this subject, and I hope that there will be very wide support for him in this. I would ask that the income guarantee which we have been promised should be speeded up and also that there should be a speedy provision of the National Superannuation Scheme to provide at least half-pay on retirement.
I went around yesterday in the constituency of Putney which I represent as a London county councillor and talked to various people for about an hour. It was rather cold, but I managed to persuade 12 people to talk to me. I talked to very diverse types of individuals. I did not put a loaded question. I put this question, "Do you think anything more should be done for the elderly?" There was only one person who did not think that any more needed doing. She said that in her parish she felt that everything possible was already being done. The first person to whom I spoke was a labourer, working with a couple of others on road works. He said, "The first thing they want is a holiday and then they ought to have a pension of £10 a week." When I asked how we were going to pay for it, he said, "I do not mind a few bob on my stamp every week." That is the fundamental attitude of the people of this country. They do not mind paying more 1510 to help our elderly people. They want desperately for them to have a better deal.
What can be done immediately? First of all, I think that there should be a rescue operation. To bring that about, there would have to be a really comprehensive register so that we could know who the old people are and where they are. We know that there are something like 6 million pensioners at the moment, but the vast majority of old people are never visited at all and are not in touch with any kind of club or social centre, or any place where they can go to meet friendly people and have a warm reception. So what do they do? They walk about, or stay at home. One of the people to whom I spoke yesterday was a London Transport inspector. He said, "They just wander about. They come and talk to me." What else can they do? They can go and sit in Joe Lyons' or they can sit in the pub. They can spend long hours over one cup of coffee, one cup of tea or one half-pint of beer just to keep warm. It is simply not good enough. Some time ago I referred to the fact that I bought a sausage roll at King's Cross Station and that the meat content was almost nil. I pointed out at that time that that sausage roll, although not particularly important to me, could mean a supper for an elderly person, possibly the best meal they would have that day.
What can we do? First of all, let us compile this register so that we know where we are. Until we do that we cannot develop and co-ordinate the very fine voluntary services and local authority services into a comprehensive and adequate service which can cope with the needs of our elderly people. We should have social centres and geriatric clinics in every village, town and city community. We should have clinics which aim to analyse and prevent the diseases of old age. I went to one this week in Twickenham, where I live, which is run by a genius of a man, Dr. John Madison. He has pressed on with this clinic, where he has even invented the equipment, to research into and then analyse what goes wrong with people and what causes them to age prematurely. I asked him when he thought I ought to attend the clinic. He 1511 said, "Twenty years from now", but I think that would be a little late.
To get back to what I would term a rescue operation. Until pensions are considerably higher, we shall have to try to do something along the lines of concessions. We should waive television and radio licence fees for pensioners, as suggested by my hon. Friend the Member for Merthyr Tydvil (Mr. S. O. Davies) some years ago. We must also extend concessionary fares on all public transport, both municipally owned and privately owned, and also for that run by such bodies as the London Transport Board.
I have been trying to do something in my capacity as a London county councillor. I have been asking questions over a period of 18 months or so. A survey has been carried out in Wandsworth on the question of the travel needs of pensioners. Unfortunately, I am not in a position to give the results of this yet, but I have a feeling that elderly people have to travel a great deal more than had been previously anticipated. If one is old, one does not buy from Harrods or stores such as that, which deliver to one's door. One has to walk down to the butchers', the grocers' and the greengrocers', and if one's feet are bad one has to get on a bus. Therefore, when one gets to the greengrocers' and the butchers', one buys less because a 1s. 0d. or more has gone on the fare to get there. One also, very often, has to catch a bus or a train to collect one's pension. I had the experience in Putney of helping to bring about the provision of a post office and a chemist's shop on a housing estate, partially so that the elderly people did not have to take a 6d. bus ride down to Putney High Street and back to get these things. It costs 6d. to ride there and another 6d. to ride back. We have to think seriously about what we can do to enable our older citizens to travel at off-peak hours entirely free.
I would also ask the House to consider seriously the question of fuel coupons for old people. This winter happens to have been less severe than many others but that has been lucky. We must think about concessions until we can get proper conditions for the elderly. I would like them to have a pension of at least £10 a week, but we probably all 1512 accept that this is not feasible at the moment. Let us, therefore, take steps to initiate a rescue operation.
In considering longer-term aims, should we not try to keep them in their own homes? I do not think that this aspect has been adequately considered yet. I have talked to Professor Peter Townsend within the last few days and he takes the view that it would only cost an additional £50 million a year to provide really adequate services for elderly people if there were proper co-ordination and that a tremendous amount can be saved by providing enough home helps and adequate nursing services, "meals on wheels" services and so on. All people engaged in it are doing wonderful work but it is not enough and is not co-ordinated.
We must also stress the need for providing clinics where we would aim to prevent diseases of old age. And we must have purpose-built, grouped dwellings adjacent to where old people now live and to which they can go when for whatever reason they have to leave their houses or flats or back rooms.
Dr. Madison said to me that the ideal is to establish preventive methods so that the disabilities of old age are avoided or else become our lot only at the latest possible moment. We should realise the great importance to an elderly person of having a complete examination at one time and in one place. In 1958, a report on 360 old people who attended the clinic revealed that one-third suffered from malnutrition, with protein, vitamin and mineral deficiencies and anaemia. Dr. Madison went on to say that he felt that "chat and hope" clinics are not really much good. They are coming into existence but are, I gather, struggling along without enough money to provide for adequate services.
There are two things which hon. Members on both sides will recognise. First, that there is among elderly people a desperate, pathetic and unexpressed need in the country today. Secondly, the nation wishes us to take a great leap forward in the direction of helping them. I have done quite a lot of knocking on doors during my political work and because I have had to go and visit many people in dire straits from time to time, I have found as much support for the 1513 sort of things I am suggesting today from the young people and the middle-aged as I have from the elderly themselves.
Indeed, in many cases, the younger people have been infinitely more outspoken about it than the elderly. It is for these elderly people I am attempting to speak today—people who do not want to make a fuss. But we should make a fuss and do something dramatically better than anything done before. The country is ready for a great leap forward in this field of social provision. I also think—more controversially perhaps —that neither the "gnomes of Zurich" nor our own Old Lady of Threadneedle Street and her chrome-plated sons should divert us from our national duty.
§ 11.26 a.m.
§ Mr. Bernard Braine (Essex, South-East)
I congratulate the hon. Lady the Member for Rochester and Chatham (Mrs. Anne Kerr) on her success in the Ballot, on her wise and timely choice of subject, and on the thoughtful and sensitive way in which she introduced it. The elderly as a group are always with us and one day, if we are spared, we shall he of their company. Yet the problems that they face change as the pattern of our society changes and as people's needs and aspirations change. Perhaps, therefore, we should discuss a subject of this kind more often.
When I was at the Ministry of Health, I regretted that Parliament did not provide more opportunity to discuss a subject which touches the interests of so many of our constituents and, indeed, of ourselves and our families. The number of old folk is growing, and growing fast. Over the next 20 years, the number of those aged 65 and over will be 30 per cent. greater than it is today while the number of those 75 and over will be 40 per cent. greater. This is bound to bring new problems.
It may be that the age at which people consider that they are beginning to get old will tend to rise. I think that is happening already and it is a good thing. But inevitably, as people live longer, the demand on our available health and welfare services will grow. Even now, a high proportion of our hospital beds are devoted to the elderly. They tend to see their family doctors twice as much as the average of all ages. About one in ten is house-bound.
1514 On the other hand, I do not think we do a useful service to the elderly if we exaggerate the problem. We should avoid trying to treat old age as a problem. Most elderly people I know do not lament old age. Swift said that no wise man ever wishes to be younger. Most old people enjoy reasonable health. About half of those aged 65 and over are living with their spouses, and are normally in contact with their children or friends and if they become ill there is usually someone fairly near to hand. Most of the remaining elderly are widowed, but a good many of these are living with relatives or, if they are on their own, have a relative or friend at hand. About 96 per cent. of old people live in their own homes and only about 4 per cent. live in residential accommodation, nursing homes or hospitals. One per cent. of these are in psychiatric hospitals.
These figures, however, do not tell the whole story and that is why it is so important that the hon. Lady should have raised this subject today. Old people are admitted to institutions only because there is no one to care for them in their own homes. In fact, a good many could be discharged from institutions if they had homes to go to or had someone to care for them. I have seen it estimated that about 25,000 old people could be released from mental hospitals if they had somewhere to go. And with more incapacitated people living at home, we simply do not know how many of them or their relatives could benefit if adequate residential accommodation were available.
We do know that a good many old people enter hospital not because of one specific complaint but because of a number. It has been found that old people entering hospital had on average at least six, not necessarily clinically related, complaints caused by the neglect of years. It was not unusual to find osteo and rheumatoid arthritis associated with bad feet, swollen legs, asthma, bronchitis and bad circulation; a whole host of conditions which had been neglected over a long period.
It is not surprising, therefore, to find that an elderly patients' chance of enjoying reasonable health after discharge depends not only on his total functional disability when he leaves hospital, but on his home circumstances, his general social 1515 environment. Surveys show that where old people are taken into the acute or geriatric wards of hospitals, a high proportion of them retain some disability when they are discharged. These surveys show, too, that whereas about 30 per cent. of those who return to a home of their own and to someone who cares for them subsequently come back to hospital, about 50 per cent. of those who are living entirely on their own come back. One simply cannot separate medical from social need—hospital treatment from after-care in the home.
Bearing this in mind, I will propound two principles. The first is that there is no place like an adequate home. The primary need of all old folk is a suitable —and I stress "suitable"—home of their own where they can lead an independent existence for as long as it is humanly possible. The second principle is that the primary aim of our hospital and welfare services should be to promote positive health and well-being and not merely to treat sickness and infirmity when it occurs. This means, in the context of the elderly, the creation of a fully integrated health and welfare service.
I am bound to say, from my experience —and many hon. Members will, I feel sure, agree with this—that our present administrative structure makes it very difficult to put these principles into practice. When it works it does so because, by and large, the kind of people who are operating in the health and welfare services—the family doctors, geriatricians, nurses, medical officers of health, social workers, members of local authority health and welfare committees—are people possessed of a more than usual degree of dedication and responsibility. If the system works well, as it does in a good many places, it is because of that and not because of the system itself.
I am not saying that the Welfare State has failed. Of course it has not. It has done an enormous amount to banish primary poverty from our society. However, we deceive ourselves—and this is the value of the Motion we are discussing, for it gives us an opportunity to undeceive ourselves—if we think that it caters for all the most pressing needs and that it has its priorities right.
I often wonder why we pay housing subsidies in respect of houses which are, 1516 in some cases, occupied by those who could pay an economic rent and why we do not attach subsidies to families who are in need irrespective of whether they live in converted private accommodation. We have the ridiculous situation in which subsidies are being paid to families with £30 or £40 coming in each week, perhaps with cars standing outside their council houses, while all hon. Members know of poor elderly widows struggling up rickety staircases to their ill-ventilated, damp and unsatisfactory rooms. In other words, we do not have our priorities right and it is about time that we recognised this. I often wonder why we limit family allowances to families with more than one child. Why not consider giving allowances in respect of dependants where families are providing special care for an old person? Certainly the cost of helping to keep old people at home, enabling them to live in familiar surroundings, would be far less than keeping them in institutions and would be vastly more humane.
When one considers the specific arrangements we have for the care of the elderly one sees that there is a clear need for administrative reform. Our aim should be to gear our social services to deal with people in their own environment and according to their needs, and not to try, as we do, to fit people into services which were framed in totally different circumstances many years ago.
Maybe for the elderly who possess no other resources the basic retirement pension is not enough. I am inclined to agree with this view. However, better pensions will not provide the special housing or procure the special care which so many old people need. It will not buy for them the meals they cannot cook for themselves. Yet the truth of the matter is that there is still an enormous variety in the scope and quality of the services in kind which we provide for the elderly.
It may be that this wide variation will continue until we make vastly more resources available to the health and welfare services. An attempt was made to remedy the situation, first by setting up the National Health Service, secondly by the launching of the long-term Hospital Plan in 1962 and a year later by the publication of the long-term plans of the local authorities for the development of 1517 their services. I recall that when these plans were first published in 1963 not only did the existing provisions which local authorities were making seem to us in many cases—not all, but certainly in many—to be inadequate, but the provisions which they thought appropriate to make 10 years hence clearly fell below likely needs and reasonable standards.
It is true that when the first revision of these plans was published there was evidence of second thoughts. That is why we brought together, for the first time, the plans of all the local health and welfare authorities in one document so that comparisons could be made. However, the fact is that in 1963 some local authorities had three times as many health visitors and social workers and four times as much accommodation for the elderly, per 1,000 of people over 65, than others. Although over the country as a whole there were four or five home helps for every 1,000 old people, 10 years hence it was proposed that there should be only five or six, whereas most people knowledgeable in these matters considered that the minimum should be about 15.
I recognise that in some areas, particularly the industrial areas, it is difficult to recruit staff, but there is no evidence that the needs of the old people vary according to where they live. The disparity in the newer services is even greater. If we are to have more old people living longer additional problems will have to be faced. There will be a greater volume of incontinence, and much more trouble with feet. There is a need for local authorities to provide more special laundry services. They can provide these services at the present moment, but under a wide and confusing range of statutory provisions, and in a good many cases they do not provide them at all.
§ Mrs. Anne Kerr
I think that the point here is that in many cases the elderly people are simply not known. The local authorities do not know where they are, and do not have the powers to compile this register, which is what I would ask the Government to provide.
§ Mr. Braine
I take the hon. Lady's point, but there is nothing to prevent the compilation of a register now, and this is done by a good many local authorities. I visited some county boroughs where 1518 every old person likely to be in need was known to the medical officer of health. But in a good many local authority areas no such register exists, and the hon. Lady is quite right to draw the attention of the House and the country to the fact.
Nothing is more important to people getting on in years than to remain mobile, but many of them cannot remain mobile because they have trouble with their feet. I think I am right in saying that about 20 per cent. of old people—and when I use the term "old people" I mean those over 65 years of age—need chiropody services, but that only about 3 per cent. are getting them.
It seems, therefore, that there are two major deficiencies in our arrangements for the care of the elderly. First, while it is generally agreed that the emphasis should be upon the prevention of physical and mental illness, to do this calls for vastly more health visitors and home helps to reinforce the family doctor than we have at the moment. It also calls for much greater co-ordination between the voluntary organisations and the statutory authorities, with each getting a much clearer idea of what is required from the other. This sounds very simple and elementary, but the fact is that in many parts of the country the medical officer of health does not know what the voluntary organisations can do, while the voluntary organisations do not know what the statutory authority wants them to do.
The second deficiency that emerges is that although the local authority welfare departments are providing a good deal more residential accommodation and local housing authorities are providing a great deal more special housing—and in the counties where they are different authorities they sometimes combine the two—there is still no clear aim. There are still too many fit old people—I have seen this—being admitted to welfare homes where everything is done for them because there are not enough ordinary houses and flats provided by the housing authorities. On the other hand, there are too many frail old people still in their own homes who should be admitted either to hospital or a local authority home, but for whom accommodation is not available. Thirdly, there are too many people in hospital who could be discharged if there was an adequate home for them to go to.
1519 The conclusion is that our health and welfare services today are completely fragmented, as a result of which, as the hon. Lady made clear, we have far too little information about real needs and no very clear idea about the best way of satisfying them.
Old people are often bewildered by the multiplicity of agencies to which they can turn in difficulties. If they need financial help they must apply to the National Assistance Board. If they want a home help, the person to see is the medical officer of health. If they have a housing problem they must seek the help of their local authority or their Member of Parliament at his Friday night or Saturday morning surgery. In my constituency there are three authorities to which one may have to turn—the urban district council as housing authority, the county council as welfare authority and the regional hospital board for hospital accommodation. The answer to this could be the family doctor, if he were given sufficient ancillary support. It is his job to keep an eye on his patients, and many doctors do so, but, without any reference to the present difficulties between the profession and the Ministry of Health, we all know that many general practitioners are far too overburdened with work.
The basic problem seems to be the lack of communication. There are probably half a million old people eligible for National Assistance who, for one reason or another—usually a false sense of pride—do not claim it. There are still too many deaf people who, for various reasons, will not use the National Health hearing aid and are therefore needlessly cut off from social contact. Only about 10 per cent. of old people belong to clubs. We all have clubs in our constituencies, and we know how wonderful they are for keeping old people on their feet and happy, and giving them something to look forward to every week. Why is it that only 10 per cent. of the elderly belong to clubs? We know that a proportion are housebound, but I am sure that the main difficulty is lack of facilities and lack of transport. What is needed, and this is something to which old people's welfare committees should turn their attention, is a comprehensive visiting service, 1520 run by experts, so as to identify need at an early stage, and a voluntary transport service.
If there is a problem of old age, it surely lies in this isolation. Loneliness, the feeling of not being wanted, of not belonging any more, is more corroding to the human spirit than those of us who lead active lives can ever really understand. Conrad has written:In our activity alone do we find the sustaining illusion of an independent existence as against the whole scheme of things of which we form a helpless part.Isolation is mental death, and it is something we ought not to suffer.
I suggest that what we need is a drastic reform of the National Health Service, though that may be too big a question to deal with today. But we could, if we chose, bring about a drastic reform of local health and welfare services, and bring together health and welfare, which are two sides of the same medal, so as to ensure that local authorities see the problems of the elderly as a whole and not as a number of different and often unrelated problems. Bringing together local authority health and welfare depots would do more than do anything to help staffing by providing a decent career opportunity for young people, who could start as welfare assistants and later, when they had learned from experience, could go into specialised aspects of the work.
There is a good deal that can be done. But public opinion has to be stirred, and I hope that that is just what the hon. Lady will have succeeded in doing today. We shall not get any reform until there is a great stirring of public opinion. Yet the elderly belong to us all. One of the tests of the worth of our society is whether we really care about the old, the infirm and the weak. For that reason, I am sure that all hon. Members will agree in hoping that the hon. Lady will have lit a candle here which will also illuminate every town hall in the country and cause furious debate for weeks and months to come—followed by appropriate action.
§ 11.50 a.m.
§ Mr. Frank Allaun (Salford, East)
I congratulate my hon. Friend the Member for Rochester and Chatham (Mrs. Anne Kerr) on having chosen this subject for debate and on having spoken so feelingly and constructively. I want to make four new 1521 proposals which I think would help elderly people, particularly those living alone. It must be admitted that there are hundreds of thousands of our elderly fellow citizens who today are undernourished. This is for two reasons, partly because the pension is too low, and partly because they have lost the will and the physical capacity to cook themselves one hot meal a day.
Last weekend I visited a ward in a famous Lancashire hospital—not in Salford. During the night an old lady was brought into the ward. She was dying through under-feeding and lack of attention. Attention had been drawn to her case too late. She died the next day. I suspect that this was not an exceptional case. My hon. Friend referred to Dr. Madison, the Medical Officer of Health for Twickenham. Dr. Madison runs a clinic for 300 elderly people who are ill. He has found that nearly one-half of the 300 are under-fed. When a proper diet was provided, their health, their happiness and their whole bearing improved.
Meals on wheels are an excellent service, but it is very limited. Very few old people receive the service. It is a remarkably extravagant service in the amount of labour required. For instance, it requires a van and two helpers, as a rule, to look after the meals for 30 people. My proposal is that the existing school meals centres and services should be extended and applied to help the elderly. Why should there not be such luncheon clubs for the elderly in these premises? They would be a tremendous boon. They would overcome for many the malnutrition which forces them into institutions into which they do not want to go. We could, through these centres, overcome the loneliness and isolation which many people feel.
§ Mr. A. E. Hunter (Feltham)
Is my hon. Friend aware that some meals on wheels services issue vouchers which enable old-age pensioners to go to restaurants and obtain meals at special prices?
§ Mr. Allaun
I am aware of this, and I fully support the scheme, but what I suggest is something bigger. School meals centres are usually ideally situated. They are one-storey buildings. They have first-class kitchens and staff. But they are mostly used for only two hours a day. It 1522 would require little increase in overheads if they were continued for an extra hour a day—say, after 1 o'clock—when the schools no longer had need of them. This idea, like so many other ideas concerning the elderly, emanates from the fertile brain and long experience of Mr. Jim Roberts, the Civil Welfare Director of Salford, who has thought and felt a great deal about these questions. He believes that the idea could be extended. He believes that senior pupils in these schools could, after their own meal, be enlisted to take out hot meals from the school meals centres to the home-bound living in the immediate vicinity of the school. If this were done, it would enormously relieve the meals on wheels service, which could then go further afield.
The latest information I have is that 3.7 million school dinners a day are provided, at a cost of roughly 10d. for the food and Is. 2½d for the overheads—2s. 0½d in all. If a 50 per cent. subsidy were provided to the old people, a rather similar subsidy to that for school meals, they would get one hot meal a day for about 1 s. This would do as much as anything else to improve their lives. Obviously this would be impossible in schools which have no premises for school meals. We know that there are many such schools. But there are also many schools which have school meal centres. Obviously there would also have to be co-ordination between the various Ministries—the Ministry of Education, the Ministry of Pensions, the Ministry of Health, and so on; but this co-ordination has been secured in other matters and it would not be beyond the wit of man to do it here, too. May I urge as a first step in this direction that in one city or in one big centre an experiment be started along these lines? If it proved a success it could be rapidly extended to other centres.
My second proposal is that all elderly people living on their own should be regularly visited. Few of us look forward to growing old. There are the natural burdens of old age—the loss of one's partner, the loss of one's faculties and so on. When to these natural burdens there are added the unnatural burdens of poverty and loneliness, old age becomes a tragedy.
I was visiting some elderly folk at Christmas. At one house the old lady 1523 burst into tears because no one had been inside her house for the previous three months. A case came to light recently in Liverpool of a man who was found dead in his flat. It was seven months since any neighbour had seen him. In Blackpool the police broke in the door of a flat and found the husband and wife, one aged 73, the other aged 75, lying huddled together on the floor for warmth.
There is an even more important advantage to be gained from providing home helps and domiciliary helps for such people. Most elderly folk want to retain their independence and live amongst their friends and near their clubs and associations in their own homes. They infinitely prefer this to going into an institution. I expect hon. Members know of many a daughter who has sacrificed her chances of marriage to look after a parent. In a multitude of cases this could be avoided if the elderly person could rely on a regular visit from a trained worker.
The fact is that it is in only a few cities that all elderly people receive such visits. I am proud to say that in Salford they are regularly visited. Nearly 4,000 elderly people living alone receive a visit at least once every six weeks. When they are ill or have special needs, they are visited weekly. In addition, there are 16,000 who are visited at least once every six months. For this, great thanks are due to the Civil Welfare Committee, to the Department, headed by its Director, Mr. Roberts, to the Deputy-Director, Mr. M. C. Liddle, and to a devoted staff.
The first visit to these elderly people is paid by a trained statutory officer, but subsequently, except where there are special needs, voluntary workers do the job. The city is fortunate in having set up a most remarkable organisation, the Companionship Circle for the Elderly, which combines all the voluntary organisations in the city—the trade unions, the political parties, the women's associations and religious organisations, together with 43 old people's associations, representatives of the council and regional representatives of the Government Ministries. Among them they provide 4,000 volunteers, including even the senior schoolchildren, so that the whole community is involved in caring for the elderly.
1524 These volunteers sit and read to the old people, decorate their homes, provide hand-rails on steep stairs, take them for outings in wheel chairs and provide parties and entertainments at Christmas. They run two hotels at Southport where elderly people are able to have seaside holidays, many of them never having had a holiday in their lives before. I should stress, however, that full-time workers hold the reins. There is a small staff of only eight trained full-time welfare officers, but they are assisted by the 4,000 voluntary workers.
It has been said from both sides of the House this morning that local authorities in many cases do not know where the need is, where to find the old people who need help. In Salford we are better placed. The work has been facilitated—and I think this could be done in many other places—by a total survey and the authorities know every elderly person in the city, 20,000 of them. Of course, this record has constantly to be kept up to date as more people reach retirement age. On receiving their first pension book, thanks to the co-operation of the Ministry of Pensions local office, they receive a message which asks, "Are you lonely? Are you in need?" It contains a prepaid postcard which the elderly person can send back to the Welfare Department and in return he receives free a 20-page booklet. This booklet, written in very simple terms, explains to them all the services available to help them.
I believe that Salford was the first large authority to complete a survey of every elderly person. One can imagine the amount of patient work that went into compiling this survey, but it was worth it. Not only was it fact-finding but in the process it brought great relief. Cases of need were brought to light, and it was found that there were many people who did not know that such a thing as National Assistance existed. Others did not know that they were entitled to it. Most important of all, the survey revealed the dire poverty of so many of our fellow countrymen.
Salford is in a special position because it secured a Private Act in 1960 by which it was possible to provide other domiciliary services, including visiting, outside the provisions of national legislation.
§ Mr. John Horner (Oldbury and Halesowen)
Before the hon. Gentleman proceeds to his next point, may I ask him to clarify a matter which is puzzling me concerning the initial survey and ascertaining where the need exists? The hon. Member said that on the issue of the first pension book this information is made available. The experience of some of us is that often the need is not felt by people reaching the pension entitlement age. We have discovered that it is the 65s to 70s who do a great deal of work for the 70s to 90s. Are the Salford authorities satisfied that they have a total survey if it depends upon the pensioner taking the first step?
§ Mr. Allaun
Yes, we are satisfied. Most people know that when they are 60 or 65 they are entitled to a pension. So there is usually some personal incentive. In addition, we issue these cards to doctors, dentists, clergymen or milkmen —in fact, anybody who comes into contact with elderly people. The department believes that it has a complete check on every elderly person in the city.
The point I was making is that most local authorities who have not had a Private Act passed lack such powers, and I propose that the Government should make it possible for all local authorities to be able to do what Salford has done without having to secure special local powers. The National Assistance Act, 1948, as amended in 1962, did not grant this power except in the case where the request for a visit had already come from an elderly person. Local authorities should be given extended powers to enable them to provide a general welfare service for the elderly such as they are able to provide for the blind and handicapped persons.
The Chancellor of the Duchy of Lancaster, who I believe is going to speak in the debate because he has a special interest in co-ordinating the various social services, has thought a great deal about this need for a statutory visiting service. In the debate on the Address he dealt with the reorganisation of the social insurance schemes. He said that National Assistance would be replaced by a minimum guaranteed income, which I heartily support. But, he said, a great deal of the work of the National Assistance Board will continue, though diminished in scale. He pointed out that the Board 1526has built up a staff with a spirit of service in the care for people which must not be lost.The only welfare service that applies in many cases, he said, is that provided by the National Assistance Board officer.
I should like to quote further from my right hon. Friend's speech on that occasion:Is there here the foundation of an agency to which any citizen could turn in time of trouble or difficulty, of sickness, bereavement, incapacity or personal plight, a service which could call upon and co-ordinate other services to meet the needs of the particular situation—in two words, the citizen's friend?"— [OFFICIAL REPORT, 10th November, 1964; Vol. 701, c. 872–3.]I strongly agree with the need for such a citizen's friend, but I claim that in Salford he already exists. I think, though, that he should exist in every city. I am not worried about who provides the service, whether it be a civil servant or the local welfare officer, so long as the service is provided and provided well. However, it seems to me that there are certain advantages in letting the civic welfare officer of the local authority do the work, because so many of the services are municipal and inter-linked. For instance, the civic welfare officer has to consult the local housing officer, the local health officer and the local children's officer. Therefore, the civic welfare officer seems particularly well-placed to do the job.
May I ask the Minister to consider another matter in which a slight amendment of the law would bring relief? This arises from an actual case concerning an old friend of mine, a scientist, and later, by strange irony, herself a welfare officer engaged in domiciliary help. Now she is stricken with paralysis. She cannot get out of bed without help. She has to be dressed like a doll and can creep a few yards with the aid of a stick.
She writes me as follows.When the Health Services were planned it could not be foreseen that there would be such a demand for services that there would be such a shortage of beds and nurses in hospitals that all patients possible must be nursed in their own homes. Now if a patient gets into hospital or institution the cost is £20 to £30 a week. The patient pays nothing for her own keep. But if the patient has to stay at home she has to pay for everything except the advice of a doctor.If on National Assistance she can get domestic help allowance but nothing to pay for personal care. This has to be paid for if no relative is available to do it free.1527Amending legislation is needed to enable grants to be made out of Health Service funds to keep such patients in their own homes, to pay neighbours to look after them, to pay a relative if she gives up a job to do it and, finally, grants for every such patient even if looked after by a relative. At present it is only if they have private means that they can be looked after at home".I wrote to the Minister of Health about this matter a few weeks ago. He examined it very sympathetically, but he found that there were great difficulties in asking local health authorities to provide constant care and attendance for severly disabled people as part of their domiciliary services under the National Health Service. He pointed out the severe strain on staffs, with their many other calls, and that financial assistance was outside the scope of the National Health Service. Despite this, I put it to my right hon. Friend that there is a real need to care for such people in their own homes. Grants of, say, £5 a week would probably cover the cost compared with, perhaps, six times the cost in hospital care.
I should like to advocate the setting up of day centres for elderly people. The hon. Member for Essex, South-East (Mr. Braine) referred to the excellent work being done by old people's clubs, Darby and Joan clubs, old-age pensioners' associations, and so on. But why should they be confined to one evening or one afternoon a week? Here something practical is being done. In Salford, four day centres will be set up in the next seven years for the elderly. They will be open from 10 in the morning until 9 in the evening. There will be warmth in winter so that the old people will not have to spend their sparse money on coal. Recreation and social life will also be provided. In addition, the old people will have regular substantial meals at reduced prices.
One of the greatest needs of the elderly is warmth. My hon. Friend the Member for Holborn and St. Pancras, South (Mrs. Lena Jeger) has done a national service by introducing a new and terrible word into the common vocabulary, hypothermia, which I confess I had never heard of until recently. This is the illness of extreme cold from which people with temperatures of, perhaps, 95 degrees suffer. Apparently, there are thermometers which can regis- 1528 ter such temperatures. This stems largely from poverty because the pension is too low.
Some of the reforms which I am recommending would cost little, some of them would cost a lot. I am not suggesting increased services as a substitute for a better old-age pension but in addition to it. It is admitted nearly everywhere that the present pension of £3 7s. 6d. a week is too low. The Labour Government are raising it on 29th March to £4 a week. That is only the first step. As I understand it, the guaranted minimum income will mean a substantial increase for millions of pensioners. If it raises the pension by the average rent allowance paid by the National Assistance Board, that will mean a further 21s. a wek. The third stage will come with retirement on half-pay, but that will not fully apply until contributions have been paid for seven years. It will mean rather less than half-pay for the highly paid and rather more for the low paid.
These reforms will cost a lot of money. From where will it come? It will come partly, as my hon. Friend the Member for Rochester and Chatham said, from higher contributions. I agree that there is a wish to help the old people, but we cannot go too far with this because workers on low pay are already paying fairly high contributions and have certain reservations about an increase in them.
§ Mrs. Anne Kerr
I did not advocate that the money should come only from the stamp. I quoted a labourer as having said that he was willing to pay more on his stamp for the provision of better pensions.
§ Mr. Allaun
I am sure that we all appreciate that sentiment.
The money for these improvements will have to come from two sources, apart from increased contributions. The first is higher national production, which will take time. The second large and obvious source is the amount of money which we are wasting on armaments. Some people want us to spend £750 million on the TSR2. Some want us to spend rather less on the American substitute for the TSR2. All the problems which we are discussing this morning would be solved by the expenditure of £750 million. It is common sense and common humanity 1529 that something should be done about this. If we slashed our fantastic arms expenditure of £2,100 million a year and devoted, say, £500 million of it a year to the social services—
§ Mr. Speaker
Order. I am sorry to interrupt the hon. Gentleman, but it is a little hard on other hon. Members that he should go so wide of the Motion.
§ Mr. Allaun
Certainly, Mr. Speaker. I am concluding at this very moment.
Whatever the Governor of the Bank of England may feel about cutting the social services, I believe that hon. Members on both sides have serious reservations about his view and think that the money should be spent on the kind of thing which we are now discussing. A great deal of nonsense is talked about the Welfare State. We have only to go round the back streets of our towns and cities to see that widespread poverty exists. We have to choose between the Welfare State and the warfare State, because we cannot have both.
§ 12.18 p.m.
§ Dame Joan Vickers (Plymouth, Devonport)
I am glad to be able to take part in this debate and I should like to congratulate the hon. Lady the Member for Rochester and Chatham (Mrs. Anne Kerr) on the subject which she has chosen and the manner in which she has put it forward. I agree with what she said about the Private Member's Bill to be introduced by my hon. Friend the Member for Abingdon (Mr. Neave). I hope she will ensure that many of her hon. Friends vote for it when they get the opportunity to do so in a few weeks' time. I agree with what the hon. Lady said about the question of the register, and many of us have a register in our areas. It is an invaluable asset to the welfare of old people, and I am sure that the practice should be extended.
I should like to bring one point about concessions to the Minister's attention. It concerns the tariff systems for electricity and gas. In very many cases, the old people do not burn sufficient units of gas and, therefore, they have to take money out of their own purse to pay the amount registered when their meters are opened. It has come to my attention that in one or two cases they have had to pay back as much as 9s. 3d. In some cases the electricity board is changing 1530 the meters and is getting the money back in that way, so I hope that this point will be considered.
The laundry service spoken of by my hon. Friend the Member for Essex, South-East (Mr. Braine) is an excellent scheme and it should be extended. I can tell the hon. Member for Salford, East (Mr. Frank Allaun) that I have the privilege of knowing something of the welfare services of his city, which are quite excellent, and I hope that they will be the forerunners of many more. In my area the Guild of Social Service does good work for old people, and we have a centre which is open all day and which provides meals. As the hon. Gentleman said, the day-centre system ought to be extended.
May I quote to the House part of a short prayer which I think is helpful in expressing something of what one's approach should be in middle and later years. "Lord, thou knowest better than I know myself that I am growing old and will some day be old. Keep me from the fatal habit of thinking that I must say something on every subject on every occasion. Release me from craving to straighten out everybody's affairs. With my vast store of wisdom, it seems a pity not to use it all, but Thou knowest, Lord, that I want a few friends at the end."
The problem we are debating is not a new problem. Over 2,500 years ago Plato said that old age need not necessarily be a cause of unhappiness, and the discontents of later life had their roots in character rather than in events. I hope that one of the outcomes of this debate will be a new attitude towards planning for old age, as we realise that people are tending to live longer. Cmnd. 538 said that our whole attitude towards the elderly should be reviewed. The time has now come to make this review and a very adequate and suitable organisation to make this review would be the National Old People's Welfare Council. I think that the review could be more quickly and usefully made by a voluntary organisation and I hope that, arising out of the debate, we shall have a national review.
How best to make proper provision for old age is one of the biggest social questions of our time. Every day, 1,000 men and women reach the minimum National Insurance pensionable age. Old age is now, for the first time in our 1531 history, a risk for us all Montaigne wrote "that to die of old age is a rare lot" and that was not said many years ago. In 1952, there were 5¼ million old people each supported by six of the working population. In 1978, we shall have 8½ million old people to be supported each by six members of the working population. In 1920, 6 per cent of the population were on the old-age pension. According to the last figure available, that for 1962, 12 per cent. of the population were receiving the old-age pension. Each year, for every 100,000 babies born, 56 men and 140 women reach the very old age of 100 years. It certainly looks as though our expectation of life is being steadily extended.
Maurice Chevalier said that "old age is no bad thing if one considers the alternative". All of us here will be thinking about our retirement. In the Library there is an interesting book, "Facing Retirement", written by a country doctor, and on the jacket appears the suggestion that it is an ideal gift for anyone in the fifties or sixties.
There are a great many old people living alone. According to the best figures I could get, which come from a National Assistance survey made in 1954, there were at that time 85,000 people over 80 living alone. It is not possible to ascertain all the details, but, even so, it is an enormous number. I think that most of them like to be independent and to live alone.
When I read the book, "Facing Retirement", I thought about my own retirement, which, after all, is not so far distant—not that there will be a by-election in my constituency in the near future, I hasten to add. I have provided for my old age. I have made my will and left my eyes to the eye bank. I have a small cottage in Wiltshire, I shall have a dog to make me go out for walks. I shall do gardening and fishing in the summer. I shall attend the local Women's Institute and the flower shows. I shall do some needlework, painting and study in the winter. If I am still sufficiently active, I shall foster two children of school age. I just give that as an example. All of us must encourage old people to plan their lives for when they retire.
Those who are retired can be divided into five categories. There are those 1532 who are active and fit, those who live in towns, those who live in rural districts, the ones who can be boarded out, and, last, those in homes, institutions, hospitals and mental hospitals.
There are available quite a number of books well and simply written, for instance, "Man against Ageing", by Dr. Robert de Ropp, which is one of the best on the subject. We must have a different attitude and take advice and example from the books which are available and the experiments which have been undertaken in certain areas.
As regards the first category, old people who are active and fit, I agree with my hon. Friend the Member for Essex, South-East, that the need is for more housing accommodation of a suitable kind. I favour flatlets in a block of buildings where other people live. I mean little flats with their own cooking facilities, though not necessarily with a bathroom and lavatory. Many old people cannot have a bath more than once a week, and, in most cases, they need help. In these blocks there should, I suggest, be a warden who could help them. This is much the most economical and desirable way of helping old people who are active and well.
The retired rural worker's position is rather more difficult. Quite often, they will have lived until retirement in a tied cottage or a cottage which is certainly not modern. For old people in rural districts, small bungalows should be built on the periphery of small towns or hamlets, six or 12 of them together, for preference. They should, if possible, have district heating. I agree with the hon. Member for Salford, East, that it is essential to have warmth for old people. Also, there should be proper running hot and cold water, and the bungalows should be near to the shops. In this country, where two of the major disabilities of old age are bronchitis and rheumatism, proper provision for heating must be made.
For old people living alone either in towns or in rural districts, a satisfactory system of signalling to the general public is important. In some areas already such systems are in use, for instance, cards which can be placed in the window asking someone to come in and help, or a flashing light system. The latter is in use in some towns already and is an excellent device which ought to be adopted 1533 more widely. The old person presses a button and a light flashes outside his window until someone calls to see what is needed. In housing estates, it is possible to arrange for a buzzer to sound in the flat above or in a neighbour's home so that attention can be called. Rent collectors on housing estates could take more interest, especially in recommending the need for home helps to be provided.
It is essential for people who are active to have something to do in the day time. I should like far more consideration to be given to workshops for the elderly. There are too few of these now, and I suggest that youth club premises could be used in the day time for this purpose. It is very interesting to see how mentally handicapped people are able in a workshop to earn from £3 15s. to £4 a week doing a real job. Obviously, these workshops are a very good idea and we ought to see many more of them. Also, there should be more handicrafts provision and more courses for painting. In country districts there should be more special classes on horticultural subjects, such as flowers and fruit growing, for the elderly. In Plymouth we have some special classes for the elderly at shows, which encourages them to take part in shows.
Another means of helping the elderly is the boarding-out scheme. I believe that at present only Exeter and Plymouth undertake this type of boarding. We have about 100 people who are boarded out, just like fostering children, with people in the city, and this has proved an enormous advantage. Many elderly people living alone do not need all their accommodation for themselves and do not want to move from their house and they are willing to have a companion. I hope this system will be extended because it brings friendship to the old people.
I agree entirely with what has been said about trying to keep people in their own homes and also with what has been said about cost. I gather that some homes charge as little as £7 a week, but some charge up to £400 a year for a home, not a hospital. I most sincerely support the point nut forward by the hon. Member for Salford, East about the constant care allowance. If a war-disabled person can have a constant care allowance, I cannot see why an elderly person who needs exactly the 1534 same attention should not be allowed to have this, too. This would be infinitely less expensive than sending the person to a hospital. Also, it would enable relatives to look after the elderly. In some cases the money would go towards paying for a home help for which they may not be eligible now. I hope that the right hon. Gentleman will give attention to the constant care allowance point. I gather from doctors' reports that it is often said that to take an old person out of his environment makes him senile. He becomes confused if he does not have the same faces around him, if the furniture is different and if the attitude of those looking after him, no matter how kind they are, is different. I should have thought it preferable from everybody's point of view to keep old persons in their own homes in their own surroundings as long as possible.
The National Corporation for the Care of Old People in a quarterly bulletin in 1962 stated that, failing a programme two or three times it present size, the special housing problems of the aged would be prolonged for decades. I pay tribute to my right hon. Friend the Member for Hampstead (Mr. Brooke), who did tremendous work in putting forward special flatlets schemes for old people. The hospital should be only for those who are really frail and incapable of looking after themselves. I gather that in 1960 about a quarter of the admissions to mental hospitals were people over 65. It is very sad to have to end one's life in a mental hospital just because one becomes elderly, when other provision could be made. Also, one-third of the long-stay patients in mental hospitals are elderly people. Therefore, I hope that we may take the advice of the doctors and ensure that old people, who if they can be looked after in their own home with relatives, seldom have to go to geriatric wards or to residential homes. Emphasis should be on the domiciliary services and trying to keep old people in their own homes.
I return to the question of planning for old age. Very often, chiefly with men, retirement brings bad health. Women always have something to do in the house unless they are physically incapable. Women never retire unless they are incapable of working. The man who has been used to going out to work 1535 every day may find retirement extremely difficult. One woman said that in 41 years of married life she had only really been married part-time and had not understood that her husband rather liked to stay in bed or wanted to polish the furniture after she had dusted it, and also that he resented her talking to her neighbour and did not like her going to her clubs. She was advised to encourage him to find a hobby. He chose to learn to play the violin. I do not know how the neighbours felt about this, but it made for a very much happier life for the couple.
I suggest to the right hon. Gentleman that we should encourage such schemes as the Rubery Owen one. Under this scheme men in their fifties attend six meetings, partly in the firm's time and partly in their own time, to hear lectures about what they might do in old age, and they finish up with a residential weekend to which the wives are invited. I would also mention the Glasgow Retirement Council and the City Literary Scheme. This sort of scheme not only suggests ways in which people may interest themselves but also provides them with hints about their health in old age.
My hon. Friend the Member for Essex, South-East, mentioned the question of care of old people's feet. Some of the great difficulties in old age arise from corns, callouses, and thickened toenails. Two people named Hobson and Pemberton carried out a survey and found that 78.7 per cent. of men and 83.2 per cent. of women had foot abnormalities. Also, in old age there is a great deal of rheumatism and arthritis. Foot services ought to be greatly augmented. It is very difficult for people not on National Assistance to get help with their feet unless they pay. I have one or two cases which I am taking up now. One of the major difficulties is that people are unwilling to go out because their feet are so painful.
§ Mr. Frank Allaun
Would the hon. Lady agree that chiropody services are even more valuable if they are mobile, for an obvious reason—that they can be taken to the homes of the persons who need treatment?
§ Dame Joan Vickers
Yes. One advantage is that they can go to the home. 1536 Perhaps a more practical method is for an ambulance to pick up a number of people and convey them to the clinic or hospital. That saves time for the chiropodist, who would otherwise have to go from house to house, which would take very much longer.
I would also stress the importance of the provision of deaf aids. A great many people believe that they are becoming senile when the trouble really is that they cannot hear properly. I gather that one in eight of people between 65 and 75 should have some form of hearing aid, which they do not have now. It is said that they get into a paranoid state because they think people are laughing at them and so they will not go out and join clubs. If we could do something to get old people to understand the use of hearing aids, I am sure that it would be a tremendous help.
I agree that we need paid organisers to co-ordinate the operation of the facilities for old people, particularly the visiting arrangements. We ought to try to have one visitor for every three persons who wishes to be visited. There are very admirable organisations such as Rotary, the W.V.S., the Red Cross, the Townswomen's Guild and Women's Institutes which are willing to do this if they are co-ordinated and made aware where the old people are.
If old people have to go to homes, there ought to be leagues of friends for them, just as we have for those who are in hospital. The majority of those in the homes have no relations. One of the most pathetic things about visiting such a home, no matter how nice, modern, warm and comfortable it is, and no matter how good the person in charge of the home is, is that one invariably sees the old people all sitting around in a circle, apparently having lost all initiative. If they could be visited by members of a league of friends, it would be a very great help.
My theme today is that we must try to help people to plan for their old age. Learning to grow old is an important area of research for the future, if personal relations in old age are to be harmonious, both among the old themselves and with those who live with them This is a subject which the right hon. 1537 Gentleman should take up. We should conduct research into how to help people in their late 'fifties to plan for their old age so that they may have a contented and happy old age and be at one with the world and with themselves.
§ 12.41 p.m.
§ Mr. A. E. Hunter (Feltham)
I am pleased to rise to support and to congratulate my hon. Friend the Member for Rochester and Chatham (Mrs. Anne Kerr) on selecting this subject for debate. We have had more debates on the needs of the elderly people on Fridays than on any other day of the week. This is mainly because we take Private Members' Motions on Fridays. All Governments have difficulty in finding enough Government time for a number of subjects, and Fridays have therefore been chosen very often for discussing this very important subject.
We find when discussing the elderly people that on both sides of the House there has always been feeling and humanity towards the old. I have often had the pleasure of following the hon. Lady the Member for Plymouth, Devonport (Dame Joan Vickers) both in old-age pension debates and in debates on National Assistance. Like my hon. Friend the Member for Rochester and Chatham, she has always shown a great interest in the subject.
Retirement pensions are to be increased next month, as are National Assistance rates. That will be of great help to retired people. The pension is to be raised from £3 7s. 6d. a week to £4 a week for a single pension and £6 l0s 0d. for a married couple. A number of retired people—I think that it is about 1¼ million—also receive extra National Assistance allowances; in addition, they receive rent allowances from the National Assistance Board, which plays an important part in the help given to old people. The Board has the power, subject to conditions laid down by Parliament, not only to make weekly grants but also to provide blankets, sheets, clothes, shoes and other articles which the old people need. I feel sure that my right hon. Friend the Minister of Pensions will encourage the Board in its efforts to provide these items where they are needed. This is very important.
The increase in pensions which will be made next month is the biggest increase 1538 since 1946 and it will help the old people in their weekly budgets for rent, food, heating, lighting and the other necessities of life.
A number of other subjects which are vital to the old people have been raised today, and I want briefly to deal with some of them. Housing is very important to the old people, and I hope that the Government will encourage local authorities in their housing programmes to provide special housing units for old people. In my constituency the local authorities have done very well; they have provided bungalows and flats for old people at reasonable rents. There are only, unfortunately, a certain number of these units for those old people who, like others, must wait on the housing lists. Some local authorities are doing all that they can, and I hope that the Government will give them every assistance in their work to provide old people's housing.
Reference has been made to the meals on wheels service. We have had a number of debates on this subject. These hot meals, delivered to old people's homes, are of great help to them. Some of these schemes, run in conjunction with local authorities, provide vouchers for active old age pensioners who can then go to restaurants which have been selected and approved, and obtain hot meals at a reasonable price. I feel that this scheme should be extended. In big cities it would probably be more economical and comfortable for the old folk to use these restaurants than to provide special meals centres, and the reports which I have had from people using these restaurants show that they all speak highly of the service given.
Loneliness is certainly one of the worries of old age. There is a saying about the old, "As we grow old together, the best is yet to be." But a number of old people are single. Also when either the husband or wife dies, life can be only grey for the other partner left behind. I therefore support the plea for club centres. We have Darby and Joan clubs and old age pensioners associations. In addition, the W.V.S. and the churches all play a useful part in their weekly Darby and Joan club meetings. I know the splendid enjoyment which they give to old people by organising coach trips to the coast during the summer. These are much appreciated by the old people. 1539 Some districts have arranged holidays at the seaside, and we all know the splendid parties which they give to old people at Christmas.
I should like to see permanent clubs established in purpose-built buildings in our towns, where the old people can obtain meals and refreshment at reasonable prices and where they can play draughts and dominoes, for example, read papers and books, and carry on a fellowship which, through their all meeting together, will spread into their lives.
I hope that my right hon. Friend the Chancellor of the Duchy will give consideration to this point. I know that we have pressed for youth centres. We want also to press for old people's centres which can become clubs for them, open all day.
Those are some of the suggestions which I put forward. There are other services which could help, but housing is certainly an important question, as is the provision of higher pensions. Indeed, that is one of the most important items in their lives. They need special housing, Darby and Joan clubs, and meals on wheels services. All these can go a good way to help the old people.
I am certain that there is great good will in this country towards the old people. It is a subject which always receives support from the mass of the public. The numbers of the old are growing. In a few years' time there will be 8 million. That is a large proportion of the population. We want to make sure that men and women who have given their lives in industry and commerce spend the evening of their lives with as much comfort, friendship, and companionship as this country can provide.
§ 12.49 p.m.
§ Sir Arthur Vere Harvey (Macclesfield)
I am pleased to follow the hon. Member for Feltham (Mr. A. E. Hunter), who speaks with great sincerity on these matters, and also to congratulate the hon. Lady the Member for Rochester and Chatham (Mrs. Anne Kerr) on having selected this subject. It is very satisfactory that there are two Cabinet Ministers present on a Friday to hear the debate on this very important subject.
1540 We have many boisterous debates on various matters in the House of Commons, but on a subject like this the House is at its best. There is no doubt that much has been done since the end of the war. Vast improvements have been made. But not nearly enough has been done. Emphasis must be placed on giving a higher priority to this very grave problem. I have been impressed by the willingness of the younger section of our society in Macclesfield and elsewhere to make sacrifices for the old people, and to say that they should come first, and that it is their turn to have a break. That is very encouraging. We are inclined to criticise our young people, but they have a generous feeling towards their elders.
On 26th March my hon. Friend the Member for Abingdon (Mr. Neave) will try to introduce a Measure concerning the 250,000 old people who do not receive any pensions and have to exist on National Assistance. Their plight was very well illustrated in the Sunday Telegraph supplement last week. I do not wish to anticipate what my hon. Friend will say, but it is clear that this is a desperate problem. These people are denied sickness benefit, and do not even receive a burial allowance.
The idea of the Beveridge Plan was to introduce for all citizens adequate pensions, without means tests. But the National Assistance scheme cannot be administered without such tests. When the present scheme was introduced 17 years ago it excluded men over 65 and women over 60. Today there are about 250,000 retired professional people, clergymen, shopkeepers and people from all walks of life who thought that they had made adequate provision for their old age but have found that things have not worked out that way. Inflation has proceeded at such a pace—as it has done in practically every other country—that it has made their savings of little value.
I have always been interested in Service matters and have endeavoured to help to deal with some problems concerning Service men and their families. Two years ago we had a debate on Service widows. The previous Administration gave them something. It was not a great deal, however, and it took many debates and much lobbying to get what we did.
I want to refer to one or two cases to illustrate the hardship which these 1541 widows have to face. There is, for instance, the case of the widow of a captain who served from 1897 to 1932–35 years—taking part in the South African War and the 1914–18 War. His widow receives a pension of £185 a year, plus National Assistance amounting to £2 17s. weekly. I do not want to differentiate between one person and another but it is fair to point out that the people to whom I am referring have been used to certain standards of living, and something ought to be done to help them.
Then there is the case of a lady who is aged 77 and who is the widow of a major. She receives a pension of £201 and National Assistance amounting to £2 9s. a week. I agree that Members of Parliament should receive adequate emoluments and pensions, because they live very precarious existences and cannot look far ahead in terms of tenure of office. If a man succeeds in serving for 10 years in the House he will receive a pension of £600 a year at the age of 65. His widow will receive a pension of £300 a year. That is quite right, but I think that the principle of half the pension should apply to other widows.
We all welcome the pensions increase but—although I do not want to make a party point—I wonder how much of the increase which was announced last year will have been swallowed up by inflation by the time it is received at the end of March. Continuous inflation is the real problem. It would be interesting to know by how many shillings the purchasing power of that increase will have fallen by the time it is paid out.
Something was done for these people in 1946. It was very necessary then. But any improvement that was made in their position then has long since been eaten away by inflation. These questions need far more attention from the House of Commons.
A very good report on the subject was written by the Bow Group. I know that it is associated with the Conservative Party, but it is true to say that endless trouble was taken and a great amount of research was carried out in the production of the report. I would recommend it to the attention of everyone, because it is not written in a political party sense at all. It says that in 1961 there were 6,066,000 people of pensionable age in 1542 this country—in other words, one in seven of the population. It is estimated that by 1991 that figure will have risen to 9 million, or one in six of the population.
Only a minority of these people are infirm, and most will live independent lives until they are over 70 years of age. Few housing authorities are making adequate provision for their accommodation. In my opinion, the housing problem will become far worse than it is today, in spite of the efforts that are being made—and I agree that some local authorities have made exceptional efforts.
I will quote figures relating to two large cities. In Birmingham, 40,000 independent small dwellings are required for the aged. In 1961 the city provided 5,000 one-bedroomed dwellings. It can be seen that the gap is very considerable. In Liverpool, 30,000 special dwellings are required for the aged, but the provision so far has been 2,400. These figures are startling. When slum dwellings are pulled down the position becomes worse, because the people who have to leave those dwellings must be rehoused, and somebody has to suffer.
The survey shows that of 140,000 people over 80 years of age, 70 per cent. are living alone, and that many of that 70 per cent. occupy basement or attic rooms in old four-storey houses, where they are cut off from sanitary facilities and have great difficulty in getting up and down the stairs. The accommodation is badly lit, and there are many other disadvantages.
I suggest that local authorities should make more extensive use of improvement grants in order to bring up to standard accommodation for the aged. There must be an operational plan.
Some progress has been made. The Bow Group's report shows that 10,973 dwellings for old people were being erected per annum in 1951, and that within seven years that figure had increased to just over 18,000 per annum. This provision now represents about 30 per cent. of all local authority building. That is a considerable effort. In 1962, no fewer than 28,000 units for the aged were built, but that was only half of what was required.
The hon. Member for Rochester and Chatham pointed out that it is far cheaper to house old people in small 1543 flatlets, and far more satisfactory for them to have their own homes. I ought to mention that the Church Army has contributed greatly in helping to solve the problem.
I now want to refer to the question of private nursing homes for the elderly. Some of these are good, but many are criticised in the report. It shows that 62 per cent. of the patients in these private nursing homes were not bedfast, but nevertheless they were not provided with sitting rooms or dining rooms. They were confined to their small, pokey bedrooms and had no opportunity to mix with other people. It is very difficult to realise what these people go through. They suffer from loneliness, cold and probably deafness. Two years ago I saw the housing conditions in my constituency during that very cold winter, and these people had a grim experience.
I think that reference was made to Professor Townsend and his publication "The Last Refuge" which was published in 1962. Professor Townsend went very thoroughly into the whole problem and referred to the fact that many of the old homes and institutions had very gloomy surroundings—institutions some of which had been built over a hundred years ago.
I believe that this problem must be tackled rather like the way we are tackling the building of barracks for soldiers and their wives. It ought to be tackled on that basis. There are in my constituency, both at Macclesfield and at Poynton, houses containing eight or 12 separate one-room flatlets with a person, usually qualified, in charge of them and living in, a person who is very kind and who gives all the help the old people need. These flatlets have underfloor heating, and the old people are really happy. They know that they have security and something to look forward to.
I do not want to say anything against the homes for old people. I think that, on the whole, they are extremely well run. We have two or three in my constituency which are very well run indeed, but, of course, they are very expensive. I wish to make one suggestion. I think that industry could help in this matter.
I was rather sorry that, in an excellent speech, the hon. Lady referred to the 1544 "gnomes of Switzerland". I had the privilege of working as the representative of a Swiss group of companies in Britain and I will say why I do not agree with the hon. Lady. It was a group of companies in the chemical industry. It has a convalescent home in North Wales, with a qualified matron in charge, to which employees, when they have got over an illness, can go and convalesce. But during the slack period arrangements are made for pensioners to occupy the place. They go for a week or 10 days. They have a free holiday. I know, from my visit to the home some 18 months ago, how much this facility is appreciated.
Could not industry do more in this direction? I am all for letting the Government get on with it, but could not more be done by industry for people who in some cases have helped to build up their individual firms during 30 or 40 years' service? Many firms do this already, but a great many do not. When one thinks in terms of public relations, for industry to take care of the aged would really be public relations.
I am sure that this debate today will do much to spotlight the problem. Of course, we can only scratch the surface of it in a debate of four or five hours. It is one of the most important problems facing the country. We must do all we can to repay the old people who have done the spadework in our economy and should seek to give them a proper standard of living. We owe it to them to see that something very definite is done.
§ 1.04 p.m.
§ Mr. Gregor Mackenzie (Rutherglen)
In common with my hon. Friends and hon. Members opposite I wish to take this opportunity of congratulating my hon. Friend the Member for Rochester and Chatham (Mrs. Anne Kerr) and of thanking her for initiating this debate concerning a matter which is one of the most serious challenges that we have to face.
It always disturbs me a little to realise that though there is a tremendous amount of good will on the subject and people—I do not just mean Members of the House—pay lip-service to it, there is a good deal of humbug talked about the problems of old age. I remember a few years ago being very vexed to 1545 read in a local newspaper—thank goodness it was not in a newspaper circulating in my constituency—that the town treasurer boasted that he had been able to reduce the rates by X pence in the £. Everyone congratulated him on this achievement. But on the same page there was a short story about a man who had died whilst going to collect his old-age pension from the Post Office. When the authorities went to his house they found that he had no furniture. He had used up most of it for fuel or had sold it in order to buy food.
It struck me that here we had a classic example of attitudes. The people were prepared to pay lip-service to these problems, but when it came to being asked whether or not they were prepared to spend money on these essential services it was a different story. We all know that this is a problem of money and resources. The hon. Member for Macclesfield (Sir A. V. Harvey) mentioned the pamphlet produced by the Bow Group. It is not often that I have occasion to agree with what the gentlemen of the Bow Group write, but I commend them for the interest and activity which they showed on that occasion.
At the time that this pamphlet was published, the Royal College of Physicians in Edinburgh also published a very good book entitled "The Care of the Elderly in Scotland." It took the step because, in common with everyone interested in old age, it had looked at the figures and found that in 1951 we had slightly under 10 per cent. of people over 65 years of age. We now find that the figure stands at slightly over 10 per cent., and by 1981 it will have gone up another 2½ per cent. The Royal College of Physicians produced the book as a result of its survey and made some proposals. Perhaps I might mention them very briefly. The first proposal was that we should sustain people in independence, comfort and contentment in their own homes and when independence begins to wane we should support them by all necessary means for as long as possible.
Secondly, it dealt with the problem of alternative residential accommodation for those who, by reason of age, infirmity, lack of a proper home or other circumstances, are in need of care and attention. Thirdly, it went on to talk about the provision of hospital accommodation for 1546 those who, by reason of physical or mental ill health, are in need of skilled medical or nursing attention, or both.
These aims recognise that there are two distinct groups of problems in old age. The first group we know and we know the solution to it, but we cannot do a great deal about it because we have not enough money and resources. The second group is that of those whom we do not fully understand and who have not been properly assessed, and where we require to do a great deal further research and experiment.
On the first point, that of money and resources, it would be an impertinence on my part to talk about the question of pensions, and so on. I am quite satisfied that my right hon. Friend the Minister of Pensions, whom I am delighted to see here today, is doing this job, and I know from long experience—she happens to be the Member of Parliament for the neighbouring constituency to mine and we have a very long and happy association—how deeply she feels about this matter. When we travel home together at weekends there is never any doubt left in our minds as to how people feel about this problem of pensions. We are delighted, therefore, that a comprehensive review is to take place.
The second point relates to something referred to by a number of hon. Members this morning, and it is the problem also mentioned by the Royal College of Physicians. It is the question of residential homes and the housing in flatlets of the old people. We have in many local authorities in my constituency and round about a number of very good residential homes. I do not think, of course, that we have enough of them. We also have a number of what we call in the west of Scotland old-age pensioners' houses. They contain little flats for the old people who are able to look after themselves.
Here I want to make one point. In the nature of things, these residential homes have to be very large mansion houses which have been converted for the purpose. This has two drawbacks. The first is that they are not purpose-built units and the second is that the people who are going to live in them have never seen the inside of a mansion house before and are not used to the kind of area in which the house is 1547 situated. We are taking people away from the east ends of our cities, from areas which they know and love and which they understand, to places on the other side of the cities which they do not understand at all. The same thing applies to the building of flatlets. Many of our older people live in the slums of our cities and older towns, in areas which are ripe for redevelopment. When they are rehoused, they find themselves in redeveloped areas, very often on the periphery of a city, and far from the area in which they were born and brought up.
I am at one with my colleagues on this point, but I hope that the local authorities, when examining these problems, and Ministers when giving directions and advice, will suggest that instead of always governing from the top or shouting from the sidelines, we might think about how the old people themselves feel regarding these problems and realise that they would like to live in places which they know and understand.
The next group of problems concerning old age are also concerned with money for research, development and experiment, but perhaps not so obviously. They relate to health, loneliness and compulsory retirement. I do not think we lay enough stress in our discussions and research on the worry caused to old people by the knowledge that they are growing old. This is something which is reckoned to be a very serious matter by many people concerned with the medical aspect of the problem. I hope that in the near future we shall release more money for the study of such problems. It has often been said, and I think it is perfectly true, that old people do not die because they are old but because they have some sort of disease, albeit there may be some sort of condition of their age which makes their illness more difficult to cure. But there are cures even for old people who suffer from illnesses of this sort, and their condition can in some way be ameliorated provided that there is proper care and attention available. What worries me, and I am sure it must worry many other people, is that sometimes the necessary care is not sought. The Report of the Royal College of Physicians at Edinburgh, from which I quoted earlier, makes an important point and states: 1548We know from experience, which was confirmed at an early stage of our discussions, that there is in all probability an important difference between the real need for care and the actual demand for care, and that in practice the latter underestimates the former, perhaps to a very serious degree.This is something we must all recognise. As was said by my hon. Friend the Member for Rochester and Chatham, general practitioners cannot form registers and have not the time to look after old people specifically. Unfortunately, we do not have enough people specifically trained to deal with the problem of old people—health visitors and so on.
The other problems which I mentioned are more social in character than medical —loneliness, compulsory retirement and people getting old and worrying about it. We all know of cases of loneliness and compulsory retirement. The problem of compulsory retirement has been mentioned by several hon. Members. From our earliest days we are trained to work and taught that work is a very good thing. We may get a good deal of satisfaction out of our work, but then we come to the age of 65 and we are immediately cut off from anything that seems to be important in life in this way. I appreciate the great work done in the main by voluntary organisations, retirement councils and so on, but we have to get past the stage of basket-making and stuffing little dolls and that kind of thing. An interest in these matters must start a great deal earlier than the time of actual retirement if it is to be a real and genuine interest. People must be persuaded of this when they are about 55 to 60 years of age. Such activities must become a real and purposeful type of interest if they are to continue after 65, and, as has been said this morning, we might have workshops where people could be given jobs. That idea merits our serious consideration.
On the one side, we have the problems I have mentioned of loneliness and of growing old and so on. On the other, I think we are fortunate in that there are local authorities, general practitioners and hospital staffs and the tremendous fund of good will to be found among ordinary citizens—people like members of the W.V.S., old people's welfare societies, and churches. We should ensure that the tremendous amount of energy expended by such groups is channeled in the right direction.
1549 It is something like my experience as a fairly new Member of this House. I work very hard, but I am not necessarily working very well. I rush round this place doing things all day, but at the end of the day I do not have a great deal to show for my efforts. If the people to whom I have referred who do that sort of work in societies concerned with the welfare of old people had more professional guidance and experience upon which they could call, they might find that their efforts were much better rewarded—and no doubt the same applies in my own case.
I wish to refer to an experiment which was started in my own constituency and known as a consultative health centre. The doctor who runs this centre has given these problems much thought from a medico-social point of view. Dr. Nairn Cowan is reckoned as one of the authorities on these matters in Scotland. He has told me and he states in his report that if it is true, and it is, that we need welfare clinics for the well-being of our young children who, in the main, are given care, love and affection by their parents, how important it is also that we should have clinics or health centres for our old people who are single, widowed, or neglected by their families. This is something we should consider. I think there are far too few such centres in the country.
The centre at Rutherglen—there is another at Leicester—makes an attempt to join all the forces I have mentioned and bring them into some sort of common action medium. The hon. Member for Essex, South-East (Mr. Braine) said that people are bedevilled by the number of persons whom they have to approach to get their problems solved—housing authorities, the National Assistance Board, welfare authorities, and the rest. The Rutherglen experiment channels all these interests. People are referred to the centre at the age of about 55 by their medical practitioner. He is happy to do so, because he knows that there is a special medical interest at the centre. All the voluntary organisations are able to play their part and give advice and guidance about financial problems, leisure activities, housing and so on. We reckon that a centre such as this meets the requirements of the Royal College of Physicians at Edinburgh and assists in keeping older people in good health. It 1550 ensures that they have a useful part to play in the community. In a sentence, I think its function might be said to be to take the fear out of growing old. I hope that in future we may have a great many more of these centres.
I have made continual reference to the Report of the Royal College. They make another important point when they say:We wish to emphasise that old age is not necessarily a time of ill-health, disability and misery.I think that the Report is right. It should not be a time of misery, ill-health and disability. It should be a time of well-earned retirement, rest and contentment. I am persuaded that if we are serious in our discussion today, if we can translate this good will into positive action, the purpose of my hon. Friends Motion will be achieved.
§ 1.20 p.m.
§ Mr. Alasdair Mackenzie (Ross and Cromarty)
I should like to congratulate the hon. Lady the Member for Rochester and Chatham (Mrs. Anne Kerr) on introducing this subject in today's debate, because the welfare of the aged must bear heavily on the hearts and minds of Christian people, irrespective of which age they live in. In this day and age when there is so much being done—rightly so—for the young people, we are sometimes inclined to forget what we owe to the old people of the country. The social benefits which we know today were quite unknown 40 to 50 years ago. To whom do we owe these improved social services? Surely it is to our senior citizens, many of whom worked very hard and for a low rate of remuneration.
It is a fact, as I can testify, that many of these people were able to save a little money because of their own thrift, in contemplation, as they said, of old age. But they find now that, because of the fall in the value of money, their savings are worth very little to them. That is another reason why we must have special regard to the needs of the elderly. There are over 7 million old-age pensioners in the country, I am told, and more than half live in slums or in houses without an inside water supply. This number will be up to 10 million by 1970. A great many old-age pensioners are living alone and one finds that many of them are suffering from such common complaints as loneliness and cold.
1551 In dealing with this question, I think that we must divide our elderly people into two main categories—first, those who are no longer able to look after themselves and are in old people's homes and other institutions, and, second, those who wish to continue to live in their own homes for as long as they can struggle on their own, rather than go into an institution. There are many in this category, people who prefer to struggle along in their own homes rather than go into an institution. The problem of these two categories varies a great deal from district to district. If we are to cater adequately for the needs of the sick and the infirm old people, we must provide more beds in institutions and the extra staff who are so necessary, particularly nurses and physiotherapists.
Then there is the more difficult problem of old people living in their own homes. I believe that in densely populated areas a great deal can be done for them on a communal basis. As well as operating the meals on wheels scheme which has worked very well in many places, the mobile old people may be provided with free meals in community centres. In such centres, those who are fit could be engaged on useful jobs, and this would mean a useful social income to them. I agree with the hon. Member for Rutherglen (Mr. Gregor Mackenzie) that it is difficult to introduce some of them to these jobs. They are too old. But if they were starting at 55 years of age it would be entirely different.
A great deal can be done for the welfare of old people, by arranging outings at certain times of the year. I notice that old people who live in crowded conditions are greatly refreshed by an outing to a place of great scenic beauty and historic interest. In widely scattered communities, however, the position is entirely different. Here we have to deal with the problem on an individual basis. In sparsely populated rural areas, the problem of the old people is entirely different. I should like to pay tribute to the work which is being done by social welfare officers in these outlying parts, for many of them—this is particularly true in the north of Scotland—are part-time officers, who usually do their district council work and also look after the local education committee, because there are 1552 not sufficient to make it a full-time job. It is greatly to the credit of those officers that they find time to attend to the problems of the old people in their districts. It is also very much to their credit that they know the people as they do and can keep an eye on them. When they think that the time has come for them to have attention and be removed to an institution, they make the initial approach.
I return to the cold, as it affects old people. Hypothermia is the new term. I only have a very old dictionary and I did not find the term there. I shall just have to find myself a new one. Because of the cost of fuel, we sometimes find old people sitting by their fire wearing tweed coats. I found this myself on my rounds. This matter of the cold has been given a good deal of publicity, medically and otherwise. I suggest that the time has now come when the Minister of Health should be asked to lay down a certain standard of warmth for all old people's dwellings. While it would be the responsibility of the Ministry to ensure that a minimum standard of warmth was maintained, I believe that it would promote health if a scheme for electricity tokens could be introduced. I feel sure that a great many people would give electricity tokens to the old people at Christmas and new year, in the same way as they give book tokens to the children. This may be a difficult thing to arrange, but I think that it should be looked at. I am convinced that this would help people in certain places.
There is also the question of providing telephones in remote areas. I am sure that for old people who live alone the knowledge that they could call up their friends at short notice in case of an emergency would add greatly to their peace of mind. I think that this should be looked at also.
There are a great many aspects of this problem to be considered. I think that the first point is to get things into perspective and to get our priorities right. I hope that this debate will help to do that. I would hate to give the impression that I am trying to tell the Chancellor of the Duchy of Lancaster and the Minister of Health their job, for no one knows more about it than they do, but I hope that what I have said might be regarded as constructive.
§ 1.30 p.m.
§ Mr. Robert Edwards (Bilston)
We are all grateful to my hon. Friend the Member for Rochester and Chatham (Mrs. Anne Kerr) for using her fortune in the Ballot to initiate a debate of such human interest and importance and for the eloquent and constructive speech she made. We are very pleased that two senior Ministers concerned have been present throughout and that two junior Ministers have been here for most of the time. This is symbolical, I hope, of the importance that the Government attach to this vital subject.
I was greatly interested in the speech of the hon. Member for Macclesfield (Sir A. V. Harvey), who referred to the contribution industry can make to the after-care of the older citizens. I take the opportunity to pay tribute to him and the chemical establishment over which he presides for the pioneering work they do in this regard. I know this firm, the Clayton Aniline Company of Manchester, very well indeed. Its employees are members of my union. The firm has a lovely rest home in Rhyl to which workers who are ill and tired as a consequence of the hazards of their toil go for a rest free of charge. The home is also used for retired chemical workers from the firm, who also have holidays there free of charge.
It is vitally important for modern industry to maintain, as far as is practicable, contact with its employees when they retire because, in modern industrial establishments, employees do not just go there to produce. They take part in a whole range of social activities. They have dramatic groups, sports teams, poetry readings and the like and the intelligent working man, on retirement, is these days removed from an environment not only of work but of social activities. He no longer has the opportunity for physical activity and intellectual discussion. It is then that he becomes feeble and dies sooner than he should.
Industry can make a very great contribution towards solving this problem. We must think in terms of staging retirement from industry. It should be possible for retired people to spend a day back at work at intervals. Many of our retired workers are full of knowledge and wisdom and experience which should not be completely lost to industry. There is 1554 no reason why an active man should not continue to keep contact with the establishment in which he has spent his working life passing on his knowledge to young people, keeping contact with others and thereby making a useful contribution while, at the same time, gaining from the feeling that he is not an outcast in society but still belongs to the community.
Some years ago the Co-operative Party did some pioneering work on this subject. It studied the care of the old and its report "Care of the Aged" was mainly the work of the secretary, Mr. Harold Campbell, a man of great humanity and energy. That pioneering work did not receive the serious consideration it deserved.
Reference has been made to that melancholy publication, "The Last Refuge," by Professor Peter Townsend. I read this book with interest, and I was humiliated and outraged with what I read. A group of research workers tried to ascertain what was happening to old people. They visited 39 workhouses out of 300. Half of the old people in residential care are actually in workhouses today. That is a fact that should humiliate and shame us in this so-called affluent society. Many of these workhouses are over 100 years old. Some were built in the 17th century.
One of the worst parts of the report concerns how some old people are treated in these workhouses. One of the investigators saw a little old lady sitting by a window. She was very cold and crept to the fire to put two little lumps of coal on it. An attendant came in and denounced her, saying that the temperature was high enough. The report also referred to the absence of proper lavatory accommodation.
We should really ask ourselves why we allow this sort of thing to exist in modern society. In a majestic report in 1948–49, the Ministry of Health of the Labour Government indicated what the aim of society should be in providing residential care of old people. That Government began the process of establishing the estates of bungalows for old people with trained and cultured people to look after them. They envisaged the end of the workhouse.
That was indeed a majestic aim, but unfortunately it is still a long way from 1555 achievement. The workhouse is still with us, and hundreds of thousands of old people are spending the evening of their lives in misery and loneliness. One-third of the old people now retired from industry have no children and 20 per cent. of them have lost contact with relatives —their sons and daughters have married and moved away. The spectre of their lives is loneliness. Sickness and poverty, loneliness and poverty are the problems we have to tackle in dealing with the care of old people. About 600 old people die in their homes every year from fatal accidents, the overwhelming majority of which are due entirely to them falling downstairs. Here is a clear indication of what should be done when providing housing for old folk.
I was delighted to learn that the Labour Party's women's sections have been looking into this problem. The last Report of the Labour Women's Advisory Committee, entitled "Care of the Elderly" —a document which represents a massive piece of research; 1,800 women's sections in the Labour Movement co-operated in making a close study of the problems of the elderly—stated that to cater for the housing needs of Britain's old people we need 750,000 old people's bungalows. At least 20 per cent. of future building for the elderly, both municipal and private, should be allocated to housing units for the old, the Report stated. The Government are responsible for this task of rehousing the people of this country and I am sure that they will give proper attention to this important Report.
I hope that my right hon. Friend the Chancellor of the Duchy of Lancaster, who is a man of great humanity, will soon be submitting proposals to the House which will go a long way towards solving the poverty of our old folk, to guarantee that they will have retirement pensions as of right and that they will be given an income that will give them a civilised, physical and spiritual, hold on life. They need to know that their income will rise along with the increased cost of living and that they will get their fair share of the national income to which they are entitled in view of the massive contribution which they made towards building up our society.
This has been a useful, interesting and humane debate and one is tempted to 1556 make longer speeches than are justified in view of the number of hon. Members who wish to participate. I hope that the lip-service which has been given to the needs of the old people will become a practical reality in our priorities for the care of our old folk.
§ 1.46 p.m.
§ Sir Anthony Meyer (Eton and Slough)
The whole House is deeply indebted to the hon. Lady the Member for Rochester and Chatham (Mrs. Anne Kerr) for having given us this opportunity to debate this important subject. We are glad that the right hon. Gentleman the Chancellor of the Duchy of Lancaster has been present throughout because we know the practical and humane consideration he gives to these problems and his great knowledge of them.
I have been glad to see the direction in which, according to Press accounts, his mind is moving; concentrating benefits where need is greatest. This is the direction in which my party has given a lead, but not so clear a lead as I perhaps would have wished. Old people are particularly victims of this business of categorisation which we go in for as a result of the way the structure of the Welfare State has grown up. The needs of old people depend not at all on what contributions they have made—whether they are war widows, whether their husbands died before or after a certain date or whether they have paid regular contributions to the insurance scheme. Whatever their past history, their needs are the same—somewhere decent to live —and I have been glad to note the emphasis that has been put on the need for providing them with accommodation with no stairs to climb.
Old people need warm food, and the debate has shown how conscious we are of the fact that many of them are not able to provide themselves with warm meals. And they need warmth in winter. I am inclined to believe that the National Assistance Board, which has a humane and understanding outlook towards old people, has fixed its rates for the provision of warmth in winter rather too low.
Above all—and this is my main topic today—it is not only the material needs of the elderly which must be satisfied. 1557 Possibly the best thing we can do for them is lo make them feel wanted. If I were asked to give my recipe for happiness I would probably say that it is the feeling that one is necessary, preferably to somebody; but if one is not necessary to somebody then necessary to something or some organisation or institution—but certainly necessary to society. I fear that too many old people feel that they are unnecessary.
I have been glad to see in recent years that we a re coming to realise the importance of encouraging and helping old people to put off retirement. Obviously there are many people who long for the day when they can retire, but often what happens is that they retire for about six months and then feel completely lost, with so much leisure, and want to return to work.
I have been glad to see the gradual erosion of the earnings rule, a rule which has an immense psychological effect on many old people, who feel that they are doing something wrong because they wish to go back to work. It is said that about £100 million would be the cost to the Government of abolishing the earnings rule. As well as considering the financial cost we should look at the other side of the coin and realise how short the country is of skilled labour. However, even taking the argument at its crudest—simply in economic terms—we must balance the cost against the contribution these people can make to our problem of the scarcity of labour.
I was sorry to read in the Annual Report of the National Old People's Welfare Council that inquiries made by the National Corporation for the Care of Old People into some of the schemes for the employment of the elderly showed that there was not a great deal of help generally available at employment exchanges for retired people seeking work. I hope that the Government have taken note of this and that employment exchanges will be encouraged to do more to help the elderly who are seeking to resume employment.
Voluntary bodies are able to do quite a lot to help old people to find work, but they are chronically short of cash and have other jobs to do for the elderly that make calls on their resources. There are the admirable schemes that have 1558 already been referred to for providing workshops in which elderly people can pursue occupations, perhaps not entirely covering the cost of the workshop itself but producing such a dividend in the way of happiness to the old people, who are made to feel useful, that the cost of keeping the workshops running is well worth while—
§ Mr. Charles Loughlin (Gloucestershire, West)
I am very interested in the hon. Gentleman's argument, but I think that it is largely based on a false premise. In my experience of industrial workers, I have never known a retired engineer, or retired miner, or someone who had worked in industry who, if he had a degree of security in his old age, could not find sufficient work of his own choice to keep him occupied rather than go back into industry.
§ Sir A. Meyer
If the person has a skill that he can continue to exercise after he has reached retirement age, the problem does not pose itself in particularly acute terms, but many elderly people who have no such skill are capable of working but find difficulty in finding employment after reaching retirement age.
The workshops of which I speak may not be operating on an economic basis at present, but I can foresee the time when changes in the pattern of production and of employment habits may be such that we shall have a society in which goods are mass produced on an enormous scale, but fail to meet the individual needs of people who want something not produced by the only methods which, perhaps, in 20 years' time, will be economically viable. There may then be the possibility for old people to make by hand those things that the economy as a whole will not have room for, and these old people's workshops may then be able to work on an economic basis. I hope that these schemes can be expanded and kept alive, whatever may be the present cost in subsidies.
It is all right for people who are fit enough to go to work in firms on a commercial basis, or for those who are fit enough, if not to go to work in a firm at least to work in a workshop specially designed for the needs of the elderly, but the old people in the greatest distress are those who are too old or infirm to leave home at all, and the most difficult problem of all is how to make them feel 1559 that they are wanted, and still useful members of society.
There is no easy answer to that problem. There is no magic wand that we can wave and at once make those people feel that they are wanted. I am only too conscious that the suggestions I am about to make may sound a little fatuous, and I would not for one moment suggest that they are economically viable. A feature of our society is the young husband and wife both going out to work. That inevitably means that the young housewife is not able to carry out many of the household activities that took up a great deal of the time of her mother, and still more the time of her grandmother. She just does not get around to darning her husband's socks, mending his shirts or putting on buttons.
This work could well be done by old ladies but they cannot get out to obtain it. I should like to see the voluntary bodies getting this work from the young married people, taking it round to the old people —thus giving them a contact with the outside world—and letting them do it at their leisure, and so earn a few shillings. It would not be much—they would earn only a pittance—but they would in that way be kept in contact with the society around them.
I am sure that the best thing we can do to help the old people is to help them to help themselves. Hon. Members go regularly to parties in their constituencies for old people. I have been to many, but the party that impressed me most was one that I attended the other day, organised by a very enterprising firm in the constituency, in which the entertainment for the old people was a variety show put on by the old people themselves. They had written it, produced it, designed and made the costumes for it, and they acted in it. The fact that they had made their own entertainment enormously increased their enjoyment and their sense of participation. If we can help people to help themselves by creating activity for themselves we can, perhaps more than in any other way, enable them to live a full, rich and varied life to the end of their days.
§ 1.55 p.m.
§ Mr. Charles Morris (Manchester, Openshaw)
I would join in the tributes paid 1560 to my hon. Friend the Member for Rochester and Chatham (Mrs. Anne Kerr) for her selection of this subject for our debate. Rarely has there been such unanimity in this Chamber than we find on this subject of the needs of the elderly. It might be uncharitable to question the genuineness of the speeches made by hon. Members opposite, so I will only say that I hope that their genuineness will be reflected in their support for the financial provisions that their suggestions will involve. Perhaps they will demonstrate more consistency in that regard than they have shown in other matters in the past.
This subject is important, because I believe that the advances in medical science which we all hope will lead to further arrestation in the degenerative diseases will have a consequential and significant impact on the age pattern within our society. A number of hon. Members have said that local authorities need the power to compile a register of the elderly within their communities. The Registrar-General's recent return indicates that over the next 20 years the number of people over 65 years of age will increase by 1,800,000 or 32.5 per cent. That is the measure of the growing problem we face.
A number of hon. Members have drawn attention to the tremendously valuable work done in this sphere by Professor Peter Townsend. My hon. Friend the Member for Bilston (Mr. Robert Edwards) drew attention to that classic, "The Last Refuge", and said that he was outraged by the narrative in it. At the time when these workhouses were built, they were described as bastilles. Therefore, one can well understand the comments which Professor Townsend and his associates made about them many years later.
Professor Townsend did the nation a service by his researches. I was particularly impressed by the work he did on the family life of old people, researches which he carried out in Bethnal Green, in the east end of London. No one reading his work can fail to be impressed by the pathos and truth of the following quotation:Most people visited were short in stature. Some were lined and bent and rooted like withered trees, but others were swift and spruce … Some were exhausted by life while others seemed barely to have started it. A woman in her early sixties had resigned herself 1561 to her room, her stick, her black cat, and her fire. Yet a man in his late eighties still talked alertly and moved swiftly about the house and neighbourhood. He had not seen his doctor more than three times in ten years. And a woman in her mid-sixties said she likes an evening out. 'I like dancing. There, you wouldn't believe that, would you? I bet I'm the wildest one you've met'.Suffice it to say that those words indicate the individuality of the elderly.
Reference has been made to the need to make provision for adequate pensions and to expand domiciliary services. These are all-important. During the course of my occupation prior to entering the House I had considerable contact with the elderly. During my association with them I found that, generally speaking, they had little time for affectation but demonstrated a real desire to be of use and to be part of the community.
I want to take up the arguments of the hon. Member for Eton and Slough (Sir A. Meyer), because in some respects I support the view he expressed. I am concerned about that section of the elderly who are still what I describe as the active elderly. I sometimes think that we are too arbitrary in deciding when a person should be retired from active employment. In so many of the recent public announcements about the policy on redundancy in what is generally understood to be the contracting industries one of the suggested remedies for dealing with redundancy has been that we should advance the age of retirement. I have no argument as to those elderly who wish voluntarily to retire. This is their right as individuals. But I question whether we ought to enforce retirement. I believe that it is not possible to define when a person has finished his useful working life.
The policy of bringing unemployment to that section of the community with the least prospects of gaining re-employment prompts two questions. First, how long can the nation afford the economic loss involved in what is virtually in so many cases the enforced premature retirement of the active elderly? Secondly, if a growing number of people have to retire merely because they are growing old, are we satisfied that sufficient provision has been made for their full and active contentment in their remaining years?
1562 To take my second question first, perhaps it would be worth while to examine what is being done in the city of which I have the greatest experience—Manchester. I think it will be accepted on both sides of the House that Manchester as a city was one of the first in the field with residential accommodation for the elderly. It was certainly first in the field with the provision of residential accommodation for the recovered aged mental patient.
I was very interested in the comments of my hon. Friend the Member for Salford, East (Mr. Frank Allaun) about luncheon clubs. My hon. Friend said that this idea had come from what he described as the fertile mind of the welfare officer of Salford, Jim Roberts. What is precept in Salford is practice in Manchester. Luncheon clubs are at present in existence in Manchester, arising from very harmonious co-operation between the distinguished chief welfare officer of the City, Mr. Ryan, and those splendid ladies, the ladies of the Women's Voluntary Service in the city. These luncheon clubs provide a worth while service to the community. It is a valid point, as was said at the time of the 1906 General Election, that what Manchester does today the rest of the country might usefully follow and do tomorrow.
I said that I wanted to consider what is happening in regard to provision for the elderly in Manchester. It is worth noting that the present population of Manchester—655,000—is expected to de crease by mid-1974 to 630,000. It is almost a contradiction of that expected development that that part of the population of the city who are 65 and over is expected to increase from 73,300 to 84,100 over the same period. Naturally, the welfare authorities in Manchester noted that the Development of Community Care—Command Paper 1973, presented to Parliament in 1963—suggested that local authorities should plan 18 to 22 residential places per 1,000 persons over 65 and that this would adequately provide for the elderly within their communities. Manchester Corporation, analysing the extent of its requirements, concluded that to meet its minimum needs involved the provision of 28.5 places per 1,000 persons over the age of 65. This took into account the continued use of poor law institutions, institutions which the distinguished 1563 director of welfare services and his able deputy are anxious to get rid of, as is the city council. As a nation we should be doing more to encourage those local authorities and individuals who are endeavouring to deal with this very human problem.
As for providing for the active elderly, we have as yet merely scratched the surface of the problem. This brings me back to my first question—how long can the nation afford The economic loss arising from the enforced retirement of the active elderly? I am mindful of the fact that the one field in which we do not enforce compulsory retirement is politics. Somebody once jocularly remarked that politicians go on and on and on. If Professor Townsend were to conduct an examination of the active elderly within the House, he might very well come to the conclusion, as he did in Bethnal Green, that the most lively were the most elderly. Who would not accept that the debates and proceedings in the House have been enriched by the lucidity, wit and knowledge of my distinguished right hon. Friends, that septuagenarian the right hon. Member for Derby, South (Mr. Philip Noel-Baker), and that octogenarian the right hon. Member for Easington (Mr. Shinwell)? If one wanted an indication of the feelings of elderly people who are obliged to retire, one could turn to that work done by the distinguished investigator, D. C. Marsh, in his book "Elderly People" which is a survey of the conditions of the elderly in two areas of Nottinghamshire. He said:It is interesting to find that of those who would quite like to work again over half had retired because of an age limit for retirement in their previous conditions of employment.The hon. Member for Macclesfield (Sir A. V. Harvey) said that during the course of the last Administration a great deal had been done about the problem of taking care of the elderly. I did a bit of research to find out exactly what has been done by previous Administrations in connection with the problems of the active elderly. I have found out that the only thing which was done was that in 1952 the then Minister, Sir Walter Monckton, set up a national advisory committee to advise and assist him in promoting the employment of elderly men and women. That committee made 1564 two reports. It is sufficient to say that by 1958 the committee had ceased to operate and was wound up by the Minister, the justification being advanced at the time thatIt had made as much impact on employers as was thought possible.This attitude is not acceptable. The same Ministry, which had pointed out that by 1977 we would have 9¾ million men 65 and over, and women 60 and over, felt that after two reports and six years of consideration as much impact on employers as was thought possible had been made, and that all that was required to be done had been done. It really is not good enough. I ask my right hon. Friend to take positive and continuing action and interest in this problem.
I wish to conclude by making one positive and what I hope will be a constructive suggestion. One of the most useful activities of the Ministry of Labour is the provision within employment exchanges of a youth employment service. I ask the Minister to consider setting up such a service for the active elderly within the community. It there are people—and I know of many cases—who desire to find useful and gainful employment, the provision by the Ministry of Labour of a service of this kind would be a very useful contribution to the solution of this problem.
§ 2.12 p.m.
§ Mr. Geoffrey Howe (Bebington)
I should like to take up the point on which the hon. Member for Manchester, Openshaw (Mr. Charles Morris) closed and to express my entire agreement with him and with my hon. Friend the Member for Eton and Slough (Sir A. Meyer) on the importance of increasing the opportunities for employment for the active elderly. I would not attempt to join issue with the hon. Member on the role of the active elderly in this House, except to say that from this side of the House the view which we form of the right hon. and distinguished Gentleman the Member for Easington (Mr. Shinwell) betokens more evidence sometimes of activity than lucidity. Certainly in all fields I agree with what the hon. Gentleman said about the necessity for extending opportunities for work for the active elderly.
I should like to come on to a topic mentioned in the Motion moved by the hon. 1565 Lady the Member for Rochester and Chatham (Mrs. Anne Kerr) at which, no doubt, the Minister will look, and that is the necessity for greater co-ordination within the services for the elderly. It is a topic about which my hon. Friend the Member for Essex, South-East (Mr. Baine) had a good deal to say, and I do not intend to traverse that ground again. But it is now widely agreed amongst people in all branches of the welfare services that there is need for wider co-ordination between them.
This point was made in the Report of the Phillips Committee some years ago, pointing out the difficulty of having unco-ordinated services on a very human level, which arises from the way in which one service might tend to shuffle off its responsibilities to another. The Report said in paragraph 276:There must be a natural temptation to try to place elsewhere the responsibility for cases which do not fit easily into any of the conventional or statutory definitions, and the best interests of the individual old person may therefore not always be served.Since then a great deal has been done locally by all sorts of bodies, as the hon. Member for Salford, East (Mr. Frank Allaun) pointed out, to improve co-ordination between voluntary bodies. In my own constituency the old people's welfare committee in the Borough of Bebington has played an invaluable part in conducting a survey directed to producing something in the nature of a register of all the old people in the borough, and it is shortly going to embark on a second survey of that kind. It is encouraging to know that the major part of the initial fieldwork of that survey for visiting every house in the borough was conducted by the senior boys of two of the secondary modern schools and one grammar school in the division. The second stage was carried through by an army of volunteers from churches and other organisations within the borough. At many places throughout the country—hon. Members on both sides of the House have given other examples—attempts are being made to improve co-ordination.
One would like to know if the right hon. Gentleman is in a position to disclose any information about what the Government's thoughts are on this matter. I know the problem is not easy. The Porritt Committee made some suggestions for the closer co-ordination of the medical 1566 side of the welfare services, which at first sight seem attractive—the creation of area health boards rather along the lines on which the late Aneurin Bevan talked in his book "In Place of Fear". When one looks at the Porritt Committee's proposals one sees that they intend to exclude from the co-ordinated services the Part 3 welfare services under the 1948 Act so that the co-ordination would not be as far-reaching as one would like.
Having listened to the debate today, one gets the impression that it is easier to achieve proper co-ordination within the great cities and county boroughs than it is in areas where responsibility is divided between the second-tier and first-tier authorities. I know there is still a division of authority between the hospital services, the local executive council services and the local authority services, but the appointment of a centralised co-ordinating body seems to be easier within that structure of local government, and one would like to know whether the Government have any thoughts about possible alternatives in the two-tier areas of the country.
It is of the greatest importance, in producing a co-ordinating structure drawing together these services, to make sure that we do not strengthen the hold and authority which the Government and, in some cases, the regional boards have on local initiative. The problem of how to inspire local initiative and yet maintain overall financial control is an immensely vexed one, but my impression is that nothing is more frustrating for people working in any of the welfare services than the frequency with which projects are put forward in the knowledge that a certain percentage of them will be rejected when they go to the Minister for his approval.
I should like to think that a greater degree of independence could be accorded to these authorities and that they could be given an overall sum from which they could develop their own plans with more flexibility. The Plowden Committee's recommendation, accepted by the last Government, went a long way in this direction, but there is still this rather besetting distinction between capital expenditure and income which may not often be the best way of securing the most efficient expenditure on the services that we want.
1567 What hon. Members on both sides have said tends to illustrate the tremendous value, in pioneering terms, of local intiative in the field which we are discussing. Different experiences have been recounted, and I should like to throw one more into the pool. It concerns the example of enthusiasm which has been shown in a project, again within my constituency, last year, with the somewhat curious title of W.A.S.P.S.—the Wirral Associated Schools Project—which embraces constituencies other than my own. Largely on the initiative of Mr. Groves, the secretary of the Wirral Group Hospital Management Committee, large numbers of school children from all the secondary schools in the area were accommodated for weeks at a time and given bed and part of their board in the hospital building itself. During that time they were enabled to construct a complete garden alongside the geriatric units of the Clatterbridge Hospital which the old people could enjoy and walk in during the years ahead.
This is a tremendous example of the practical enthusiasm which young people are prepared to devote to work of this kind. It is an example which may have involved—although I hope not—bending the restrictions attached to the operation of the hospital service. It is an illustration of why it is so important that we should encourage to the maximum local enterprise and initiative in matters of this kind.
My last point concerns a quite different aspect to which reference has been made by a number of hon. Members, namely, the importance of adequate provision of home housing for old people—in other words, non-institutional housing. I think that hon. Members on both sides agree entirely on this matter. The meals-onwheels service has been mentioned. One is impressed by the rate at which this has expanded over the last five or six years. In 1958, there were 348 W.V.S. teams for carrying out the meals-on-wheels service. By 1963 the number had risen to 1,155. There was an expansion in the number of meals provided per annum from 1.9 million to 4.5 million. By setting that against the figure mentioned by the hon. Member for Salford, East of 3.7 million school meals a week as opposed to the 4.5 million meals-on- 1568 wheels a year, one gets some conception of how far we have yet to go.
Another example of the way in which local initiative can help is this. One of the Unilever factories in my constituency makes available its kitchen facilities as the base for the W.V.S. meals-on-wheels service. The school meals service has been mentioned as a possible base for it, but this is a case in which industry, with its large industrial canteens, can be called upon and is often willing to play a part.
§ Mr. Frank Allaun
The case is even stronger than the one the hon. Gentleman presents, because 3.7 million school meals a day, and not a week, are provided.
§ Mr. Howe
I am obliged to the hon. Gentleman. He is absolutely right. I incorrectly recollected the figures.
I come finally to the point which I proposed to make about housing. There is no doubt about the need for an expansion of the rate of provision of single-person homes, either in flatlets or bungalows, for old people. The rate has increased considerably in the last 15 years. The number was about 11,000, I think, in 1951. It is now well over 30,000. But that still represents too small a percentage of what we should be providing from the total national provision. Even when we provide a large enough number of houses out of current production for old people, the difficulty will still remain of ensuring the proper and most efficient use of the houses that we have. There is a tendency towards immobility in the use of our housing stock, which means that for the best housing of most people many families are still living in the wrong place.
In my constituency there are several hundred old people living in privately owned homes which are far too large for them and they are anxious to find smaller units. Young families wanting large council houses are living with their in-laws and are looking enviously at the two- or three-bedroom council houses still being occupied by single old people. As time goes by, the number of council houses built in the 15 or 20 years since the war for young married couples which are under-occupied by ageing couples will be a factor of increasing importance.
Many hon. Members will know the pamphlet by Professor Donnison and his 1569 associates entitled "Housing Since the Rent Act". I have been very struck by one passage in it which is often quoted. It reads:Council houses are now occupied in the main by larger, younger households—half of them have four or more people, and three out of five have children under 16. Soon they will be full of young earners. Then, in twenty years' time, whole estates of two- and three-bedroom houses will be peopled with small, elderly households. The gardens will bloom, but the schools will be empty.We face a real problem in securing a greater speed of mobility of change of homes as the generations change. This is not a problem which is confined to council house occupants. The owner-occupier can under-occupy just as easily as the council house tenant.
I do not think that a solution will be found to this problem of mobility by transferring more houses to the ownership of single municipal landlords. Scottish experience certainly suggests that municipal ownership reduces the rate of mobility still further. Nor do I suggest that anyone would want to devise a means of compelling people to move from large units to small units because they are being under-occupied. We can do this only by devising machinery for extending people's range of choice so that they are presented with the opportunity of choosing smaller homes, which could well he cheaper if we devised our rent structures sensibly, at an age when families grow up. We cannot oblige them to face that choice when they have advanced to mature old age. We want to give them the opportunity of moving to smaller units once we have made sure that they are available.
A useful example is the practice of at least one industrial organisation. I refer to the houses which the Unilever organisation manages in Port Sunlight. There a large number of the company's retired workers are living in houses built shortly before the beginning of the century. Whereas it used to be its practice to allow these people to remain indefinitely in the house in which they brought up their family, it has now evolved a policy whereby when the people reach retirement age they are told, "You may certainly continue to have a company house, but, please, will you have a house which is smaller and more appropriate to your retirement and which we will allot to you?"
§ Mr. Merlyn Rees (Leeds, South)
The hon. Gentleman referred just now to the problem of immobility in municipally-owned dwellings, and quoted Scotland in particular. Would not he concede, however, that the experience of the London County Council, as a large municipal owner, is that because of differences in rents there is great mobility which arises from the fact that there is one owner of a large number of different types of premises?
§ Mr. Howe
I concede that there is something in what the hon. Gentleman says. The mobility arises, in the first place, from rent variations. In the second place, common ownership can help because it is difficult to effect exchanges between very small landlords. In the third place, however, there is the disadvantage that many people who do not, in fact, secure the exchanges which they want have a mounting resentment against the monopoly authority of the single landlord. One of Professor Townsend's colleagues, Professor Brian Abel Smith, makes this point in his latest Fabian pamphlet on freedom in the Welfare State. He says that we shall not arrive at an acceptable situation until the council tenant is able to say to his landlord, "I shall take my custom elsewhere".
It seems to me that it is that sort of extension of choice which will encourage mobility and make small units available for older families. I very much hope, therefore, that policy makers will bear in mind not only the necessity for securing a rising provision of single-person units for old people, not only the necessity for securing a large number of purpose-built groups of units, as has been suggested, with warden's houses, clubs and so forth incorporated in them, but also the necessity of working out increasing diversification of the ownership and management of these places so that, if a person fails to get a house of the kind he wants from the council, he can go not merely to one housing association but to two or three. In this way, within even one municipal area, the council could have different municipal management bodies looking after particular self-contained estates, which could begin to develop their own flexible rent policies and thus encourage mobility.
1571 It is the speeding up of movement, voluntarily not compulsorily, which I regard as the other important limb of the policy which will ensure adequate provision of decent housing accommodation for old people as well as young.
§ 2.32 p.m.
§ Mr. Norman Atkinson (Tottenham)
I entirely agree with the hon. Member for Bebington (Mr. Howe) when he stresses the need for more special-purpose housing for single people, particularly retired people, but I would take the point further, and I hope to return to it and add further comments a little later.
Everyone taking part in the debate has shown a great knowledge of the problems facing elderly and retired people. There seems to be a tremendous fund of information about the difficulties which retired people experience. Before this debate, I did a little research in the Library, looking up some of the statements made over the years on this subject, and I find that not only in the House itself but in a number of Reports available in the Library the same sort of points have been made over the years. It is rather odd that we should still be repeating this experience. To my mind, it demonstrates that there is something the matter with our society in the way it treats its elderly people. There must be something fundamentally wrong with the way we govern our society if we constantly ignore the problems which are raised and the recommendations which are made both in debates in this Chamber and outside.
The hon. Member for Macclesfield (Sir A. V. Harvey)—I am glad to have got it right this time because I said "Knutsford" earlier—said that the House was at its best in this quiet mood, when it was not boisterous. I hope that we shall get really boisterous about these things. It is about time we started to kick over the traces and shout aloud about problems of this kind in our society, particularly those faced by the very people who, perhaps, have the weakest voice of all. I hope that, now that we have a sympathetic Government, note will be taken of what is said in the debate and that my right hon. and hon. Friends will try to include our suggestions in the legislation which we are confident is to come within the next 12 or 15 months.
1572 I wish to take up some of the points made in the debate and offer one or two observations about them. I have particularly in mind the speeches of the hon. Lady the Member for Plymouth, Devonport (Dame Joan Vickers) and my hon. Friend the Member for Salford, East (Mr. Frank Allaun) who, I thought, made a brilliant survey of the problems facing old people and emphasised the true nature of any programme intended to solve them.
The hon. Lady referred at one point to the therapeutic value of violin playing, but I am not sure that I can agree about that. It certainly has its difficulties and problems as well. She went on to refer to the question of bath and lavatory provision in old people's houses and made some suggestions with regard to the furnishings and equipment which ought to be put into them. She suggested that it was not necessary to have each home equipped with a bath because elderly people, perhaps, had only one bath a week and they were not really able to use the bath themselves. I do not like that suggestion at all. In the class from which I come, people do not bath more than once a week anyway. The cleanest ones I know are the miners because they have a bath every day, but, as far as I know, they are the only members of the working class who bath so frequently. In fact, we all seemed to have a dread of water. Certainly, I did.
I do not know what the bathing habits of hon. Members are, but I think that a bath once a week is quite adequate justification for having a bath fitted in every house. I am quite sure that many parents would be very glad if they could get their families to have a bath regularly once a week.
§ Dame Joan Vickers
The hon. Gentleman misunderstood me. I was speaking of small one-bedroom flatlets within a block. I was not referring to houses or ordinary flats.
§ Mr. Atkinson
I thank the hon. Lady for making it clear, but that is just what I am talking about. I am referring to the single-person special-purpose accommodation which we ought to provide for elderly people. I took part in a campaign recently protesting strongly against the introduction of a scheme under the last Government under which it was proposed 1573 to build 10 such dwellings with the provision of only one bath among the 10. We protested vehemently about it because we believed it to be utterly wrong to be so cheeseparing and so parsimonious as to restrict equipment and furnishings in that way.
To develop the point further, we all know that leaders of medical opinion have suggested that, from the point of view of preventive medicine, the bath is probably of equal importance with penicillin or some of the other modern wonder drugs. In my view, when we campaign to get people's houses fitted with baths, we ought to use arguments of this kind more frequently.
I attach particular importance to this matter because of the outcome of some inquiries which I made recently. It is a national problem, and I do not wish to relate it only to constituency experience, but a constituent of mine, a young fellow who lives with his widowed mother—just the two of them together—wrote to me recently to say that, when he arrived home from work one evening, he had found his mother in the bath and she had been there for four hours. This lady, who suffers from arthritis, managed to struggle upstairs and get into the bath, but as she got in she slipped and badly bruised herself, and the result was that she could not get out. She had the sense to let the water out and cover herself with some towels, but she was in the bath for four hours until her son came home and she attracted his attention and he helped her out. This is a very serious situation. The fact that she suffered in that way was incidental to the lady. She is very lively and full of fun. When I spoke to her she said "At least, I am the cleanest woman in Tottenham". There is plenty of humour about her. She was not seriously injured by the incident, but it points to a serious problem.
What attention ought we to give to such problems? As a result of the incident being brought to my notice, I began an investigation of baths and lavatories in some of our special-purpose bungalows, including some now being built. I found that they were all equipped with standard fittings and no provision had been made for elderly people who might be infirm, suffering from arthritic joints and so on. It is a 1574 national scandal that we should still ignore the needs of old people when we are building special-purpose accommodation. We are ignoring the purpose for which we are building the dwellings by putting in standard equipment and making no special provision for the elderly.
I examined equipment now going into the houses. I found that the average bath is at least two feet from the ground, the sides being as high as the bench before me. One has to be something of an athlete to get into such a bath. The difficulty for most elderly people is that if they manage to get into the bath, they are liable to slip in it and be unable to get out. No provision is made to enable them to have a proper bath, even though it is only once a week.
We ought to look at the information which is available and also at some of the ingenious engineering designs which could overcome this problem. One problem is lavatory pedestals which are far too low for elderly people. Many tell me that they require something higher than is normally provided. This is a very important problem. In this technological age in the twentieth century we ought to use our knowledge and engineering prowess to provide equipment of the type required.
I have with me drawings prepared from suggestions sent to me by elderly people. They have given me their ideas of the kind of bath that they would like. I have put together all their suggestions and have constructed a sketch of the kind of thing that they would like to have in their houses, something which would give them confidence to take a bath, something which would make them feel as though they wanted to use it and not be frightened of it, as 90 per cent. of them are at present. If they could have something of this kind, it would be a tremendous comfort and advantage to them. I would plead that we should try to overcome some of these difficulties by pooling our knowledge of what is required. The Government should tell manufacturers of the equipment what they would like them to provide. We ought to underwrite long-term contracts or in some other way guarantee manufacturers a production line of a certain length to make it economical to produce such equipment.
1575 Most local authorities say that they cannot get such equipment as the manufacturers do not make it because there is no organised market for it. However, manufacturers tell me that there are no production obstacles to producing such equipment. It is purely a matter of economics, a matter of organising the production. The Government ought on behalf of local authorities to underwrite contracts in order to make the equipment available. If we are to build, as has been suggested, 100,000 special-purpose single-person dwellings, let us underwrite contracts to that extent. This is the sort of thing that we ought to be doing if we are a progressive, dynamic Government in the twentieth century in order to make these things available to our elderly people.
There are many problems about special-purpose dwellings which should be examined. There is the question of the width of doors. The doors in these dwellings are the same width as those in any other dwelling. Yet elderly people often require wider doors than the normal ones. Why cannot we meet this need? We are providing these dwellings for the benefit of elderly people. Why must we install standard doors? Old people may want to get about in invalid chairs, but they may not be able to get through standard doorways. Why should it not be possible to open the door out wider?
Also, why cannot we fit handrails around the house—around the bath and the lavatory—in order to do away with the primitive equipment which people have to rig up for themselves? Many hon. Members will have gone into houses specially built to accommodate elderly people and in nine out of ten of them they will have found behind the door in the lavatory some contraption to enable the elderly people to get up from the pedestal. It is a damnable reflection on our society that in these dwellings specially provided for elderly people the occupants have to have primitive arrangements consisting of hooks on the backs of doors with ropes hanging down to make things easier for them. It is not good enough. Surely we can do better in 1965? In many of these houses one finds ropes hanging down sailor-wise to be swung on by the occupants in order to use the equipment. It would be easy for us to provide handrails round the bathroom and toilet.
1576 I have asked architects why handrails are not provided in the toilets. They tell me quite openly that, although it would cost only £5 to provide a handrail in a lavatory, by the time the authority has borrowed the money the cost rises to £25. That encourages architects to cut out such extra fittings. As my hon. Friend the Member for Salford, East pointed out, not only are we spending money for deterrents for armaments purposes, but, unfortunately, we are spending money which is acting as a deterrent against the provision of the type of equipment about which I am talking.
It is a matter of getting down to basics and declaring that we are determined to do something about it. We all know what the problems are. The Government know the problems. We are able to analyse the needs of people in their later years. We know the needs of the elderly. Why on earth cannot we do something about them? We know the reason—and it lies in the problems which local authorities face. It has been said that there is a need for a register of old people, and local authorities reply, "We want to do this but we have not the money. We cannot do it without some provision being made for it". This emphasises the great shortage of money among local authorities. This is the problem. It is the responsibility of the House to provide that money and to make sure that local authorities have the means to solve the problem.
I and many of my hon. Friends believe in differential interest rates. This must come before long. Indeed, it must come within the life of this Parliament, because there is a great crisis facing local authorities. They are in the midst of a crisis, and if this financial situation is allowed to continue we shall see the opposite to that which we have been discussing today—a diminution of services.
It is a question of what the Government are prepared to do to provide money. If they are sincere in their efforts in wanting to do something to help, I am sure that all of us will support them 100 per cent. in making this money available. I ask them to consider the question of differential interest rates. By all means pay the international bankers 7, 8 or 9 per cent. But there is no reason for not having differential interest rates 1577 in this country. There is no reason, if we have a standard Bank Rate of 6 or 7 per cent., why we cannot say to local authorities, "We believe in the work which you are doing. We shall encourage you and make money available to you at 2 or 3 per cent."
This is a progressive policy. It raises the question of determining priorities. Let us put these priorities in their correct order and put our elderly people first—and back our opinion by making money available to local authorities at a low rate of interest.
§ 2.53 p.m.
§ Mr. Oscar Murton (Poole)
I am grateful to the hon. Member for Rochester and Chatham (Mrs. Anne Kerr) for giving us the opportunity to debate in such serious and earnest terms the need for the care of the elderly. We have heard many excellent speeches, with many suggestions of a constructive nature to help these people. It is undoubtedly the advance of medical science, which has led to a much greater expectation of life, which makes this not only a social problem but a medical problem, too.
There are three related problems. Not all these people are able to fend for themselves. Many are absolutely reliant upon others, and even those who are physically active often suffer from acute loneliness—some because it is a physical loneliness because they live alone, and others, surprisingly enough, because they are deaf and are unable to hear the sounds and movements of those around them. All these people need sympathetic understanding, encouragement and active help, and our aims must be, first, to enable an elderly citizen to remain as long as possible in his or her home environment. When this is no longer possible, the hospital services must accept greater responsibility for the custody and care of those who are irremediably sick.
Between these two extremes there is an intermediate stage where people are neither active nor are they permanently incapacitated. Here we need to help not only them but the families who give them their care and help in their declining years. It may be the elderly parent or grandparent who lives with her or his daughter or son or even with grandchildren. We must make some attempt very quickly to increase the number of 1578 geriatric day hospitals and to make them available in all urban areas in order to relieve those who look after the elderly. We need places to which the elderly can be taken at the beginning of the day and can be left to have their meals, to meet their friends, and to have discourse; and then, at the end of the day, can be brought back home and put to bed by those who look after them and who themselves have been out doing a hard day's work.
We also want to have set aside in hospitals a number of beds for these semi-active elderly folk so that they can be sent there for a short span, perhaps only once a year, to enable those members of their family who look after them so devotedly to have their hard-earned holiday with their families away from home. By this means it will be possible to encourage all the families who wish to look after their elderly relatives to do so. It is our duty to give them every encouragement and help to do it.
For those who are unfortunate enough to have no family, I should like to see the beginning of a system which is well advanced in the United States, where provision is made for a type of hostel where those who are semi-active have warmth and food and have beds but also have their independence and are able to come and go as they wish. I understand that these hostels are more in the nature of a camp, but I hesitate to use the word camp because a camp often makes one think of something rather spartan. But I believe that these are organised with a central community centre and around them are the small houses where these people live—and they are free to come and go as they wish.
When one looks at one's own constituency one is struck very forcibly with the measure of the problem. In Poole no less than 20 per cent. of the population is over 60 years of age, yet the Part III homes available have only 95 beds and there are only 40 single dwellings for elderly people. That is by no means unusual in an urban area. I hope that the Government will step up the building programme of single dwellings for elderly persons. As my hon. Friend the Member for Bebington (Mr. Howe) said in a very thoughtful speeech, we need to use the local authority housing to the best possible advantage. Going round 1579 my constituency I visit many private homes, and it is tragic to see how eager they are to receive a visit from someone from outside. As one hon. Member said, often they seem to be sitting around waiting for someone to call.
These people must be looked after. Speaking to them I find that although they are happy in these excellent organisations, behind them is always a nagging fear that the time will come when they are no longer able to fend for themselves, and they know full well that this may mean removal either to a geriatric unit, if one is available, or to some other form of institution.
I urge the Government to empower local authorities to help voluntary organisations which run homes for old people, either by a financial grant or by allowing paid help, in the form of domestic help or nursing help, so that when the elderly become incapacitated they may still receive nursing attention.
I have the honour to be a member of the Herrison Hospital (Dorcester) Group Management Committee. That hospital deals with cases of mental illness. We are gravely short of psycho-geriatric assessment units. This is a fearsome-sounding term, but it is a unit in which it is possible to discover the predominant picture in an elderly person's mind, and to make sure whether he is a geriatric case, pure and simple, or a psychiatric case. In that hospital between one-sixth and one-eighth of the available beds, depending on the situation, are given over to geriatric cases. It is clear that other arrangements should be made, because there is no necessity for many of these people to be in the hospitals. These geriatric units do not require such well qualified staff. They need sympathy more than absolute skill, and I hope that the Government will examine this question.
§ 3.1 p.m.
§ Mr. Neil Carmichael (Glasgow, Woodside)
After a long debate like this, in which everyone has spoken with great feeling and has expressed gratitude to my hon. Friend the Member for Rochester and Chatham (Mrs. Anne Kerr) for raising this subject, one feels that everything has been said, until one suddenly realises that the Front Bench speakers are waiting to wind up the debate fairly soon and that the amount 1580 of time left is rather limited, which means that a great many priceless words of wisdom—as one thought they were—have to be cut out.
It has become clear during the debate that we do not know the extent of the problem, although we know a great deal about it. Every hon. Member has referred to the necessity for the establishment of a register. This register cannot be compiled efficiently by voluntary people. Perhaps an initial rough assessment can be made by them, but we need a register which will record not only the number of old people in each community but will provide critical appraisals of the services that they require. The final assessment must be made by skilled people—trained social workers and people in the health visitor service. We need the help of the general practitioners in the area to supplement the information that is acquired.
I agree with my hon. Friend the Member for Tottenham (Mr. Atkinson) about getting things lopsided. The existing registers were compiled when it was necessary to do so for commercial purposes. Some years ago, because there was a tendency for old people to gas themselves rather more frequently than young people, the gas boards felt that the old people showed a certain vulnerability to their product, and they accordingly drew up a register of elderly persons.
That register was compiled by the people who read the meters. They were given a bonus for doing so, and a useful job was done in recording numbers of old people. But this was done for a commercial purpose, and because the good name of the gas boards was at stake. The gas boards followed this up by making adjustments and repairs in the appliances used by old people, frequently free of charge. I feel that what can be done for commercial reasons can be done more quickly by the Government for humanitarian reasons.
The hon. Member for Bebington (Mr. Howe) spoke about company houses. His point was not entirely commercial, but it was partly commercial, in that it concerned the public image of such firms as Unilever and I.C.I. They give the impression of being good employers, but what they have done has been done primarily not for the benefit of the 1581 employees but for the sake of the image of the employers.
There is one other point that I really cannot allow to go unchallenged and that is the question of housing in Scotland and the fact that there is under-occupation of the housing there. This is because there are not enough houses available to enable people to shift about. We in Scotland have probably the worst housing in the country because of our peculiar situation at the time of the Industrial Revolution.
§ Mr. Howe
I would not wish the hon. Member to misunderstand the point that I was making. I do not under-estimate the shortage of housing in Scotland, but the author of the pamphlet to which I referred made the point that certainly in some authorities a proper redistribution of the housing stock would solve the entire shortage of accommodation.
§ Mr. Carmichael
I accept the fact that there is under-occupation, but I still believe that the prime cause is that it is difficult to get people to move because there is no availability of houses to enable them to go from one house to another.
In my constituency I have a large number of houses which are under-occupied by old people and who find the houses far too big for them. Some get members of their families in to keep the place clean. But think what a problem the corporation is faced with. If it gives people flats built for old people it is making the landlords a present of £1,000 or £1,500. Of course, the owner does not let the house out to people with children. He puts it up for sale. In Scotland there is a great need for the municipalisation or purchase of houses by the local authorities.
Every year the people have the right to express themselves and the more they interest themselves in the work of the local council the more likely they are to express themselves. This is one matter in which they would become involved. Once we have the register and decide our priorities we shall know what to do. We will decide, first of all, who requires residential care. This is one of the first things that we must look at.
A number of hon. Members referred in this debate to the work of Peter Town- 1582 send. So much work in respect of the sub-division of people into categories for hospitalisation and for living in homes has been done that I think a study of these matters would be much more profitable. The question of the special services is something that many hon. Members have mentioned. I think that we shall have to reorganise many of the ideas we have of what the special services should be. The obvious services have been referred to. There is the lunch club, the regular visits and the home-help service, which has so many anomalies at the present time.
The home-help service does not allow home helps in many areas if members of the family are living in those areas. But the members of the family living in a city such as Glasgow may live a long distance from their old people and have difficulty in getting to them. It is quite a task, although thousands of women manage to do it every day. Unfortunately, some of them are not being as fair to their own young children as they would like to be because of the necessity to visit the old people. I think that the extension of the home help services is essential.
Social assistance and fares are things about which I am not happy. We must always be careful about giving people props instead of money. With all the references to the increases in pensions, one thing must be recognised, which is that money itself will not do. Money is important, but it is not the only factor.
Old people suffer from great loneliness and boredom even in the expensive homes at Eastbourne, Bournemouth and other places on the South Coast. There is a feeling of loneliness even among those in wealthy houses in St. John's Wood. We must ensure that people who have served the country well in the past and helped to build up in Britain the state of affluence which we have now reached should be able to retire and live out their remaining years with as much degree of comfort as human ingenuity can provide for them.
§ 3.12 p.m.
§ Lord Balniel (Hertford)
My right hon. Friend the Member for Leeds, North-East (Sir K. Joseph), who attended the early part of the debate, has asked me to apologise to the Minister and to the House 1583 for the fact that it is not possible for him to attend the concluding stages.
It falls to me to perform the pleasurable task of congratulating the hon. Lady the Member for Rochester and Chatham (Mrs. Anne Kerr), not only on her selection of such an interesting subject about which to put down a Motion, but for the very eloquent and admirably down-to-earth fashion in which she advanced her case. The House will agree that it is most timely that we should, at fairly frequent intervals, have debates about the elderly. Their welfare is a growing and serious social problem, and frequently we should reconsider how best to care for their needs. The scale of this problem may be gauged from the fact that at the turn of the century only one in every 25 persons in the country was over the age of 65. Today the proportion is one in seven. It may be anticipated that this trend will continue for several decades to come.
The House particularly welcomed the speech of the hon. Lady because of the emphasis she placed on the crucial importance of co-ordinating the various services which can be used to support and care for elderly people. This theme of co-ordination was echoed and supplemented by my hon. Friends the Members for Essex, South-East (Mr. Braine) and Bebington (Mr. Howe). Both produced most constructive suggestions on how coordination may be improved, and I hope that these will be taken into account by the Minister when framing his policy.
Two other features of the hon. Lady's speech were also echoed in subsequent speeches. First, there was the emphasis placed on the importance of local authorities compiling a register of the elderly persons in their areas. The compilation of such registers would provide an ideal opportunity for voluntary bodies to work in close co-operation with the statutory officers. The initial steps to compile such registers often can be undertaken by the statutory officers and the subsequent comprehensive visiting by voluntary workers. Secondly, the importance was stressed of providing a focal point to which elderly people could turn for advice irrespective of which authority provides the service which they need. This is something which was suggested by the Boucher Report a number of years ago. 1584 Although a number of local authorities have embarked on the provision of such centres of information and help, there is clearly a long road to travel before such services are provided throughout the country.
This debate is valuable also in that it gives us the opportunity of asking the right hon. Gentleman the Chancellor of the Duchy of Lancaster to give us some more information about the review of social security which he is undertaking. The right hon. Gentleman will know that we have put down a number of Questions on this subject. I think he would be prepared to agree that, while his answers to the Questions have always been strictly accurate, they have not been very illuminating. More particularly is it difficult for us to judge the value of this review because we understand that it has been given no terms of reference. I should like to ask the right hon. Gentleman whether this review is solely concerned with financial provision for old age, the pensions, the supplementary pensions and, of course, the various arguments for and against the provision of a minimum guaranteed income. Is his review solely concerned with cash, or is it also taking into account the importance of care for elderly people?
I accept that the provision of unattached, independent financial resources for elderly people on an adequate scale is of crucial importance. I think, though, that the right hon. Gentleman would be the first to agree that the provision of supportive services for elderly people is closely interrelated to, and interdependent with, the provision of financial resources. Speaker after speaker during this debate has pointed out that finance alone cannot, for instance, provide the companionship which elderly people need, it cannot procure the special care which elderly people need, it cannot provide better housing or specialised housing and it cannot provide the supporting services which contribute so much to the happiness of elderly people. Of course, we accept that the right hon. Gentleman will be painstaking in his review and that he will bring the full force of his considerable intellect to the problem of trying to find a solution to the problems. However, we believe that the review which he is undertaking is inadequate, partly because it appears to be inadequately staffed, partly because it appears 1585 to be a one-man personal venture by the right hon. Gentleman and, even more, because he is not positively seeking the advice and the wealth of information which could be given to him by the professional bodies and the voluntary organisations.
I hope that the right hon. Gentleman can illumine us a little on this review, because we feel that the time is now right for a really profound review into the whole structure of social security and social care for elderly people. This should be a review to which outside bodies are invited and welcomed to give advice.
It is true that we disagree about the type of review which the right hon. Gentleman is making, but, equally, there is full agreement between us that there is room for a major improvement in the co-ordination of the services which should be available for elderly people. One has only to take a panoramic look, for instance, at the National Health Service, the service to which elderly people, more than any other section of the community, turn for help. There is in the National Health Service a built-in fragmentation, the hospital service being run by the regional hospital boards and the Minister, the community care services being run by the local authorities and the general practitioner—the key figure in the care of so many elderly people—so often isolated between these two services instead of being integrated in them both. We would all like to see the general practitioner's position develop so that he becomes the co-ordinator, the mobiliser and the leader of community care.
Too often one hears in the National Health Service, while in no way denigrating the immensely valuable contribution it has made to the health of the nation, of cases where a hospital discharges an elderly person at the weekend when the domiciliary services of the local authority are at their weakest. Too often one hears of general practitioners not being informed until several weeks later that their patients have been discharged. Equally, too often one hears of geriatric beds being occupied by persons who could be well cared for by the domiciliary services and who are not really in need of hospital treatment.
There is also, perhaps, a need for a greater integration or co-ordination be- 1586 tween the work of the National Assistance Board in so far as it applies to elderly people and the Ministry of Pensions and National Insurance. There is a strong argument that not only could the Board be given a more positive task of seeking out poverty where it exists, but that, in so far as its work is concerned with the care of the elderly, it should be integrated with the Ministry of Pensions and National Insurance.
Then, of course, the greatest field in which overall planning and co-ordination is needed is in the provision of appropriate residential accommodation for the elderly—a theme emphasised by my hon. Friend the Member for Macclesfield (Sir A. V. Harvey). I believe that the right hon. Gentleman will be anxious to pay tribute to the steps taken by his predecessors in circulars 12/61 and 21/63, issued by the Ministries of Health and Housing and Local Government to ensure co-operation between the various authorities providing residential accommodation. But even today there is considerable fragmentation.
There is no real knowledge in each area as to how many elderly people could be better cared for in their own homes if the home help service and the meals on wheels service were substantially improved. We do not know how many people in each area should be housed in purpose-built housing schemes where wardens and communal facilities were available and certainly there is an argument worth considering that medical officers of health should have a say in the allocation of these sheltered houses.
We do not know the number of elderly persons who should be housed in local authority Part III accommodation, and we would like to know the views of the right hon. Gentleman about the Townsend concept that Part III accommodation should not be permanent accommodation for elderly people but short-stay, a place where they could go to convalesce or temporarily at a moment of crisis in their lives, with the intention that they should return to their own homes. At the moment, almost inevitably, entry into Part III accommodation means permanent stay. Perhaps the right hon. Gentleman, searching for a key to achieve overall co-ordination, could find it in the area health boards, which have been mentioned so often in the 1587 debate and which were the basis of the Porritt Report.
I do not wish to take up too much of the right hon. Gentleman's time and so I will make two points rather than cover the whole subject of co-ordination. My hon. Friend the Member for Poole (Mr. Murton) referred to psycho-geriatric hostels.
The mentally confused elderly people have particular problems in that they need both the ordinary care which the elderly need as well as psychiatric attention if they are to lead happy lives. The Mental Health Act, 1959, implies a greater acceptance by the community of care for the mentally handicapped in the community. This requires a reorientation of the mental health services away from the long-stay in the psychiatric hospital towards community care.
The number of elderly people involved in this reorientation is indeed considerable. My hon. Friend the Member for Essex, South-East suggested that they might number about 25,000. I can well believe that that figure is approximately correct. We must, therefore, keep a careful watch on the run-down of beds in psychiatric hospitals and ensure that there is an appropriate build-up of accommodation by the local authorities in the way of hostel accommodation. The main point I wish to put to the right hon. Gentleman is that the manning of these psycho-geriatric hostels—and, indeed, of all hostels for the mentally handicapped —is a very skilled job. It is not a job for which one can rely solely on the dedication—vital though that dedication is—of the people who enter this service.
If wardens are to have a proper relationship with the residents and are able to co-operate with the various social agencies which cater for the elderly, these hostels must be run by people who not only are dedicated but been provided with skills and knowledge. It will come as a surprise to some hon. Members to know that neither the local authorities nor the Government are running any training courses for the wardens and staffs of these mental hostels.
I have the honour of being Chairman of the National Association for Mental Health. Last year we ran the first course for the staffs and wardens of mental hostels. It was a course for 20 persons, 1588 and another course will be run in March of this year. The Association has considerable experience of running courses for training teachers for the mentally handicapped, but from our experience of the course which we ran for the wardens and staffs of mental hostels there is no doubt at all that there is an urgent need to provide many similar courses. As a voluntary organisation, we have been able to pioneer the first course, but I would urge the right hon. Gentleman to interest himself in this matter to see whether the Government cannot themselves run courses for the wardens and staffs of mental hostels.
In the Health Service there is no sphere in which a greater reform can be achieved than by securing a co-ordination of the excessively fragmented and splintered personal family services. Some of these are concerned with child care and the probation service, which do not directly affect the provision of services for elderly people. Others, such as health visitors, provide some of the major services for elderly people. The various groups of social workers are specialists in their own spheres of work and each group has its own separate recruiting, its own separate grant system for training, separate training courses, separate career structures and separate levels of pay.
I am not suggesting that we should amalgamate or fuse these various groups of social workers together, but I am suggesting that if we are to effectively mobilise the care which can be given to people in need—be they children, families where the mother is in and out of a psychiatric hospital, elderly people or the physically handicapped—and bring better help to them, we must achieve greater co-ordination.
I have not the time to develop the case in any detail, but I would specifically ask the right hon. Gentleman to look at the training of these various groups of social workers. It is here that the first steps of co-ordination should be taken. There is the Central Training Council for Child Care, which trains social workers in child care. There is the Advisory Council for Probation and After-Care, which trains probation and after-care social workers. There is the Council for Training in Social Work, which trains the health visitors who give so much help to elderly people. I believe that if the 1589 right hon. Gentleman could appoint a national inter-disciplinary council charged with the responsibility of co-ordinating the training, the recruitment and the deployment of the various groups of social workers, he would be taking a major step forward towards achieving that coordination of social workers that has been such a basic theme of speech after speech today.
In his efforts to find a way of channelling the enthusiasm of voluntary helpers to assisting elderly people, and if the right hon. Gentleman can weld together the excessively fragmented statutory organisations so as to meet the needs of elderly people, he can count on the wholehearted support of these benches.
§ 3.32 p.m.
§ The Chancellor of the Duchy of Lancaster (Mr. Douglas Houghton)
I gladly join in the many congratulations that my hon. Friend the Member for Rochester and Chatham (Mrs. Anne Kerr) has received today. She must be feeling well satisfied with her choice of subject, following her success in the Ballot. She provided the spark—and, if I may say so, the sparkle—to a most interesting debate. Indeed, it has been one of the most stimulating debates on this subject that I remember for a very long time—due, no doubt, to the fresh point of view, the fresh outlook, and the fresh voices we have heard.
One winds up such a debate as this with mixed feelings. There is a feeling of depression that there is so much to do but, mixed with it, is a feeling of excitement and challenge that we should set about it as quickly as we can. My hon. Friend the Member for Tottenham (Mr. Atkinson) asked what the Government are doing to provide the money. I think that the question that ought to go out from this House is: what does the nation intend to do to provide the work, the will, the energy, the production and the exports to provide the resources out of which this work can be done? That is at the bottom of the whole debate—our economic position, our resources, our will to see that new social targets are provided for the 'seventies that we can feel proud of in the Britain we wish to see.
1590 The Motion speaks of… the desirability of doing more to enable elderly people to continue living in the community in comfort, independence and dignity.…We must all agree with that, because there is not the slightest doubt that the main purpose of a well-balanced community is to keep people living a full life as long as possible. The hon. Member for Essex, South-East (Mr. Braine) said that we should not exaggerate the problem nor, of course, should we minimise it. We must get it into perspective. If I may say so, I thought that the hon. Gentleman's speech was a stimulating postscript to his period of office as Parliamentary Secretary to the Ministry of Health. He showed more enthusiasm, greater knowledge and greater ability in his subject than most of his right hon. and hon. Friends who left office a few weeks ago.
I ask the House to consider for a moment, before we despair, the size of the problem. Hundreds of thousands of people beyond pension age are reasonably healthy, active and able to enjoy life for some years to come. They need no welfare services at the moment, other than perhaps the occasional visit to the doctor. They are not by any modern standards old. My father used to tell me that National Insurance had created more old people than The Almighty himself, because National Insurance had put an age to it, which had not existed before. Old-age pensions began in an entirely different context in 1909. Nobody under 70 then had an old-age pension. Yet at present, on the latest figures which I have available, 2¼ million retirement pensioners are under 70—that is, one third of the total are under 70. Only ¾ million are over 70. There are 47,000 over 90. If it is of any interest to my right hon. Friend the Minister of Pensions and National Insurance, I should tell her that my family in its day has swelled the number of people over 90. My father, his mother, his brother and three sisters all went over 90. Let that be a warning to the House.
It may surprise hon. Members to know that 95 per cent. of all people over 65 still live in their own homes. The hon. Member for Essex, South-East mentioned that only 4 per cent. or 5 per cent. are at any time in hospitals, hostels or homes. 1591 The hon. Gentleman mentioned also an important figure which is of great significance in the general context of the debate—that one in 10 of those living at home are housebound by illness or frailty.
Before I go further I want to say a few words about money facts. It comes ill from the noble Lord the Member for Hertford (Lord Balniel) to underrate the value of money.
§ Lord Balniel
The right hon. Gentleman is distorting my words beyond all recognition by the House if he makes that allegation.
§ Mr. Houghton
I have no wish to disturb the calm atmosphere of a Friday afternoon debate. If I have offended the noble Lord in any way, I willingly withdraw. I had no intention of provoking any storm this afternoon. This is an unfamiliar atmosphere to me, but I am trying to work with it. Let me say, then—do not let us underrate the value of money to people in their old age.
I must say a few words about that. After all, we are only five weeks off the payment of very substantial improvements in social benefits, and in particular the retirement pension. I cannot, I am afraid, tell my hon. Friend the Member for Rochester and Chatham that there is any hope of doing anything now about the date of payment of the benefits. They are due to be paid at the end of March, and that is how it will have to be. We went over all that ground in a period of agonising reappraisal some weeks ago. I assure the House once again, if it is needed, that no one tried harder than my right hon. Friend the Minister of Pensions and National Insurance to get an earlier payment and no one was more bitterly disappointed when she failed to achieve her purpose.
We are making improvements in the next few weeks which go far beyond anything which has been done since the last Labour Government in 1946. The hon. Member for Macclesfield (Sir A. V. Harvey) asked whether the pension increases were being eroded by inflation in the meantime. To a slight extent they are. Since the Second Reading on 25th November to last month, which is the 1592 latest figure available, the retail price index rose by 1.5 per cent., which represents a loss of Is. for the single person and 1s. 7d. for the married couple to date. The retail price index has eroded the pensions since they were last increased in 1963 by 3s. 6d. for a single person and 5s. 7d. for a married couple. That is what has taken place since May, 1963. But, as the House will recall, the increases of 12s. 6d. for a single person and 21s. for a married couple go far beyond the erosion which has taken place since May, 1963. I know that to a very large extent pensioners themselves will say that this is statistician's stuff and that all one can do is believe it or not, but we cannot get behind the fact that 12s. 6d. a week extra for a single person and 21s. a week extra for a married couple is a substantial increase and will greatly improve their position in a few weeks from now.
We have also abolished prescription charges. Amidst all the criticism for having done so, let us bear in mind that a very large number of old people were paying 2s., 4s. and 6s. a week in prescription charges and that relief from that will bring, I think, great comfort to many pensioners who were feeling that they had to pay a disproportionate amount of their slender resources for medicines and other things that came within the prescription charge.
As regards cash benefits in the future, one reason for making substantial improvements next month was to gain time for stock-taking and to review the sort of social security that we want in the next decade. We need anything up to two years to prepare what my hon. Friend the Member for Rochester and Chatham called the next leap forward.
I wish to remove some misunderstandings about our intentions that I have noticed in the newspapers lately. There was some reference to it by the hon. Member for Eton and Slough (Sir A. Meyer). I must refer the House to the fact that in our manifesto we said:For those already retired and for widows, an Incomes Guarantee will be introduced. This will lay down a new national minimum benefit. Those whose incomes fall below the new minimum will receive as of right, and without recourse to National Assistance, an income supplement.That policy still stands.
1593 In my speech on the Second Reading of the National Insurance Bill on 25th November last I said:Although it was not mentioned in the Queen's Speech, I can assure the right hon. Gentleman that it is a 'must'—that is, the income guarantee—in our legislative programme and that room will be found for it. At this moment active attention is bring given to many of the complicated details. We are working hard on it."—[OFFICIAL REPORT, 25th November, 1964; Vol. 702, c. 1398.]That work is still going on. The income guarantee is by definition a scheme to supplement low incomes which fall below a specified minimum. It is designed to fill the gap between an actual income and a reasonable minimum below which none should fall. That, if one likes to call it so, is a kind of means test, but little or no different from the means test which we all go through every year for Income Tax purposes. Income Tax in reverse, I would call it. That is the principle we shall stick to as nearly as possible.
I must clear up one serious misconception. In no circumstances do we intend to make National Insurance benefits paid for by contributions subject to any kind of means test whatsoever. They are paid as of right now and they will continue that way. Far from wanting more and better means tests, we want social provision to be adequate without it and we want to get National Assistance and income guarantee supplements into the Beveridge conception of a safety net, and not as the mainstay of the National Insurance scheme as it is today. The income guarantee we shall bring forward as soon as we can to provide a more satisfactory and acceptable scheme of income increases for thousands of retirement pensioners and for other old people on National Assistance. But it will in no sense be a substitute for benefits received as of right or for periodical revision of the flat-rate pension in fulfilment of our promise to link pensions to the rise in average earnings. I hope that that leaves the situation crystal clear.
My hon. Friend the Member for Rochester and Chatham and other hon. Members raised questions about benefits in kind—concessionary fares, fuel vouchers, luncheon vouchers, and so forth Concessionary fares were dealt with in an Act of this Parliament before the end of last year which permitted local 1594 authorities, if they so wished, to give concessionary fares to old people on municipally-owned transport systems. They were relieved of the restriction placed on them by the 1955 Act, which confined the concessions to those in existence at that time and did not permit any extension of them. But the 1964 Act lifted that restriction, and local authorities are free to give concessionary fares on muncipally-owned transport systems.
With regard to privately-owned transport systems, if it is suggested that they should be assisted out of the rates to give concessions to elderly travellers, issues of importance arise. The local authorities who are giving concessionary fares on municipal transport are able to dip into the rates to provide the additional revenue. But if it were made possible for local authorities to dip into the rates in order to finance privately-owned transport, I think that the House would look at that very carefully indeed.
On other forms of benefits in kind, I think that our recollections of the tobacco concession are clear enough to lead us to the belief that it is better to provide adequate money resources for the household and to give people freedom of choice of expenditure and not leave them with grievances because they cannot use benefits in kind which are not convertible into money value. During that period, non-smokers traded their coupons. Nonsmokers who were chocolate eaters said, "Why cannot we have a coupon for chocolate?" I am sure that it is by far the best policy, on the whole, to provide old people with adequate money resources and to allow them to take their place in the community and choose the disposition of their resources like other people.
I turn to welfare and housing. I want to stress that, whether cash benefits or welfare, social security and social services are predominantly of concern to women. In fact, the world of social welfare is a women's world, because two-thirds of all retirement pensioners are women. Over 1 million single, widowed or separated elderly women are on National Assistance. Two-thirds of all residents in local authority homes or supported by welfare authorities in voluntary homes are women. In 10 years' time the position will be little changed. Sixty per cent. of all elderly people will 1595 be women. That affects the pattern of our approach to many of the services which will be required.
But, be they men or women, the aim of all our social services, as the Motion says, is to provide people with resources and facilities to enable them to live in comfort, independence and human dignity. That is the better achieved if we can make people happy and comfortable in their own homes or in convenient homes which will give them the independence which we wish them to have.
The social services are really part of the equipment for the pursuit of human happiness in a civilised society. As the hon. Member for Essex, South-East stressed, they are there to serve our preferences and needs and not to push us around. Services should be varied and flexible and should meet our requirements. They must be fitted to the requirements of the people, not the other way about.
Getting old is not a static condition; it is progressive. The end is the same, but some take longer to get there, and we do not all go by the same route. There are some special needs which may arise on the way. As regards housing for old people, we were all moved by the vivid account given by my hon. Friend the Member for Tottenham of the inconveniences of many homes for old people and of the risks of accident which people run, perhaps simply by getting into the bath and not being able to get out, or even slipping before they get in. Accidents of this kind lead to many deaths and cases of disablement.
Obviously, there is need for a variety of housing accommodation for elderly people. Some will be in small blocks of flatlets, with centrally heated "bed-sitters", each with its own kitchen or kitchen recess. Bathrooms may be shared, but they will be constructed for the use of elderly people. Otherwise, there are the bungalows and other forms of housing which local authorities in different parts of the country are experimenting with.
In 1963, the number in special housing for the elderly in England and Wales was only 36,000, but it is expected that, by the end of the next four years, the number will have risen three times. The 1596 number of one-bedroom dwellings provided by new construction is rising slowly, though as a percentage of total completions, the proportion is remaining more or less static at 27 per cent. Plainly, this is far too little to meet the needs which are virtually rushing upon us now. The effort here will have to be stepped up if provision of the kind we want to make is to be made in time for the rising elderly population.
Many hon. Members have referred to residential accommodation. At the end of 1963, there were about 83,000 people in local authority accommodation and voluntary homes supported by the authorities. This is a field in which we can be far less proud of our achievements up to now. Many of the buildings are old, unsuitable and bleak. Although I should not follow my hon. Friend the Member for Bilston (Mr. Robert Edwards) in calling them workhouses, at least some of them began as workhouses. We have dolled them up quite a lot since and they do not look quite so bad, but many are old and unsuitable. I stress again that two-thirds of those in this type of accommodation are women.
There is the question of treatment and hospitalisation. The number of geriatric beds is increasing, but here also it is a problem of resources and competition with other priorities. It is hoped that the development of out-patient clinics will relieve the strain on the geriatric bed accommodation, and some progress has been made in that way.
Obviously, after 13 years of Government by right hon. and hon. Gentlemen opposite, I cannot claim any striking achievements, but, at the same time, I have no apologies to make, although I have not heard many from the benches opposite. I suggest to the noble Lord the Member for Hertford that those who have just left office should address their successors with suitable humility and an appreciation of the difficulties with which we have to cope. We do not want to be lectured by the noble Lord about what we should do in the first 15 weeks that has not been done in the last 13 years. We are doing our best to cope.
In conclusion, I must say a word about the future of the welfare services. Clearly, there is no service that one could discuss in the House today that is adequate—none. All need improvement. All must 1597 meet the challenge of tomorrow. We all know that it is partly a matter of physical resources, partly a matter of finance—taxation, the rate burden, and the rest—and it partly depends on the people who are willing to work in this field. I say emphatically that we shall have to be prepared to give the social worker his or her place in the scale of esteem and values in the community if we are to get the numbers which are needed. Let us face it that that is what much of the trouble is about in the social field at the present time.
New social targets are needed if we are to make Britain a country that we all want it to be. Some degree of personal sacrifice must be expected from those who are in a position to give it. How much are we prepared to give it? How much is the nation prepared to deny itself so that the problem may be solved in the way we wish? A nation which spends more on alcohol and tobacco than on housing may be thought to have some adjustment to make.
Also, we need to know a great deal more about the lives and needs of elderly people. We are setting on foot some research projects. We shall continue the projects which the right hon. Member for Bridlington (Mr. Wood) started. A pilot survey has now been completed. We shall be ready shortly to embark on the main research to find out from over 14,000 retirement pensioners information about their financial resources and the disposition of their incomes. There is a survey, which we are supporting, set on foot and largely financed by the National Corporation for the Care of Old People into the needs and requirements of domiciliary services, including housing.
As part of the Government's review of the social services, we are embarking on studies of the work and needs of the many voluntary services. We shall do what the noble Lord asked me to say we should do. We shall bring these researches together. That is overdue. Especially do we want to look at the 1598 place of the voluntary services, because there is no room for competition with them, but there is every room for co-operation with them. We want to make the best use of the voluntary social services. Nevertheless, we must remember that no matter how many agencies there may be and no matter how many different services there are, it is one person, and one person only, who is calling upon them at the time needed.
I cannot conclude without stressing the enormous value of the nationwide organisation of the National Assistance Board. Hon. Members have said that people should be visited regularly. I stress that the National Assistance Board paid 7½ million personal visits to people last year—an enormous range of visitation. National Assistance Board officers keep track of people and check their needs. It is a special duty laid on National Assistance Board officers that elderly people who are living alone must make arrangements for some neighbour, friend or relative to call them in case of need or crisis.
The debate is about a great human service, and in every phase and in every variety it is an overwhelming one. We must press on with it relentlessly. This is what cries aloud for compassion for our fellow men and women and for our fathers and mothers, and this is what cries aloud in anguish to high heaven for sanity and peace to prevail over the clash of arms and the baser follies of mankind so that civilisation and humanity can break through in the world of tomorrow.
§ Question put and agreed to.
That this House recognises the many and varied problems which arise as people grow older; calls attention to the inadequacy of the provisions and services for old age; emphasises the desirability of doing more to enable elderly people to continue living in the community in comfort, independence and dignity; urges the Government to bring forward measures for improving and coordinating more effectively existing social services; and also asks the Government to investigate what additional benefits and services for the elderly might be made available.