§ 10.7 p.m.
§ Mr. Julian Ridsdale (Harwich)
I welcome the opportunity which this debate gives me to press the Government to ensure that the help which is given especially for the elderly is channelled into the areas of greatest need. What will be said in this short debate will underline, I am sure, a lot of what has just been said by my hon. Friend the Under-Secretary of State in winding up the first day of the Second Reading debate on the National Health Service Reorganisation Bill.
In his speech in the Budget debate on 8th March, my right hon. Friend the 1056 Secretary of State for Social Services pointed out that 16 per cent. of our population are over the ages of 65 for men and 60 for women. He pointed out also that there are about 7 million people over the age of 65 and that that number is rising by 100,000 a year. He said that there are 2½ million people over 75 years of age, and that that number will reach 3 million by 1981.
Although all those over 75 are not in the Harwich constituency, we have an extremely large number over 75—perhaps because of the excellent air which we enjoy there. I say at once that the over-80s are most grateful for the pension which the Conservative Government have given them, as well as the other new benefits, one of the most helpful being the special invalidity benefit.
The percentage of elderly people in my constituency is much higher than the figure of 16 per cent. which the Secretary of State gave for the country as a whole. We have 24,385 people over 65 out of a total of 102,075 residents. Allowing for women over 60 as well, in simple terms my constituency has nearly double the percentage of elderly people for the country as a whole. Moreover, to put personal resources into proper perspective, I should point out that the coastal towns of North-East Essex have the highest percentage in the country of people receiving rent rebate. In addition a high proportion are drawing supplementary benefit. For example, in Clacton alone the number is 3,976 out of a population of 38,500— that is, just over 10 per cent. of the population.
My right hon. Friend the Secretary of State said, quite rightly, that weface a huge task in creating, expanding and improving the services and cash benefits for a rapidly growing and ageing population.Fortunately, we are some way from the cuts in some of these services brought about by the deflationary policy in 1968 under the Labour Government. Our economy is now expanding at over three times the rate of expansion under the Labour Government, and consequently, my right hon. Friend said, we have been able to expand the home help service in terms of whole-time equivalents bythree times the annual pace of increase achieved by the Labour Government, and in the current three years we have trebled the amount in real terms being spent on geriatric 1057 buildings in the National Health Service".— [OFFICIAL REPORT, 8th March 1973; Vol. 852, c. 611.]All that is very laudable but, alas, these resources over the last 10 years have not been channelled into areas where the need is greatest, such as in my constituency, though I have continually pressed for something to be done, and where the situation is becoming much more serious because of the increasing number of elderly people. The population increase of people over the age of 65 will be 38 per cent. compared with the present 25 per cent. for the general population.
Further, do the Government take into consideration the policy of the Greater London Council in buying bungalows for the elderly in various parts of the country? I know that in my constituency the number is only 200 houses, but this means approximately 400 elderly people to be looked after in addition to already overstrained resources. I am most anxious to ensure that the local authorities are not overloaded any further. I hope that the Government will warn the GLC of the danger of continuing with such a policy in North-East Essex.
We in North-East Essex are behind as regards both the national goals for the geriatric services as set by the Department of Health and Social Security and the average level of service now provided in England. This means some heartbreaking individual case such as the recent case which I raised with the Department of Mr. Tennant of Point Clear, St. Osyth. If it had not been for the work of the Royal British Legion and the voluntary work of some very kind people, this case, which is only an example of many similar cases, could have ended most tragically. I thank the Department for its help and the voluntary organisations for what they have done, but the Minister must know that because of inflation and because of the great overstrain on the resources of North-East Essex, both official and voluntary, we need extra help urgently.
Is it possible to shorten the period before the attendance allowance is paid, especially for a single person going back to his own home with no family in the house? What can be done to increase the supply of nursing auxiliaries and to provide home visitors, especially in view of the shortage of volunteers and the in- 1058 creasing elderly population? Can something be done to have more health visitors and district nurses attached to general practitioners? Has the Minister considered a psycho-geriatric unit to screen patients for the correct medical and residential facilities? Is it not time that we reconsidered the question of getting a larger hospital in Clacton, particularly in view of the huge influx of population in the summer which already overstrains our medical resources?
At present there are 371 geriatric beds available for the district, approximately eight per 1,000 people over the age of 65, in contrast to the national goal of 10 beds per 1,000. The national average provision in 1971 was 9.53 beds per 1,000. I am informed that, according to population figures estimated by the Department, the amount of geriatric beds in Colchester hospital district will decline to 5.9 beds per 1,000 in 1981 unless something urgent is done. This is serious by any standards and it calls for urgent action.
I know that the regional hospital board plans to transfer the use of the 68-bed geriatric facility at Notley Hospital from the Colchester hospital district. In its stead the new district general hospital at Colchester will have 60 geriatric beds—a net loss of eight beds. In future a 120-place medical care facility is to be built to help alleviate the situation.
Can the Minister say when the 60 beds in Colchester will be ready and when the places in the geriatric day centre at Clacton will be available? I understand that they were to be ready in February 1974. It is apparent to me that the inadequacy of geriatric hospital facilities in North-East Essex is forcing the elderly into the non-medical facilities of the county where they cannot get adequate care and are a heavy burden on facilities not designed for such use, not to mention the personal problems of many families who look after elderly sick parents. I know that this is not a matter for the Department of Health, but could not the Government look at the suggestion of giving some form of tax rebate to families who pay out for the medical help for their sick parents?
I know that special housing for the elderly is a major goal of the social services department of Essex County Council. We certainly have some excellent 1059 units. It is good to visit such housing units and to see how there is a warden for 20 people—to give aid. Special housing for the old is provided along with other types of housing by local authorities. I am informed that county council-wise special housing is provided to 3.3 per cent. of the elderly, with a goal of 5 per cent. for 1976. Could my hon. Friend the Under-Secretary confirm these figures? However, because of the large increase in our population over the last 10 years, our figures in North-East Essex have fallen well behind even those of the rest of Essex. Indeed, like geriatric places in the hospitals, these are coming to a critical stage as well. I am informed that the waiting list for special housing accommodation for the elderly now totals 1,000 persons.
Clearly, in the next few years we want to see a concentration of resources in North-East Essex. This is a matter of great urgency both for the geriatric cases and for housing. As certain areas for industry are made development areas and categorised as special areas cannot the same policy be adopted by the Government to see that their funds for the elderly are channelled into the areas of greatest need? This underlines part of the case my hon. Friend was making for the reorganisation of the National Health Service.
This overstraining of resources such as exists in North-East Essex is becoming a national problem and is not something which can be tackled by the county council alone. Yet all this costs money and needs the proper allocation of resources. I believe that it is up to the Government to face this problem and not leave it to the councils alone to deal with, because they have not the resources and cannot impose such burdens on the already overburdened ratepayers. I welcome the fact that the national cake is now growing at a much faster rate again, but even if it were growing more slowly I must once again underline that because of the change of population and the quickly growing numbers of elderly who have come to North-East Essex urgent help is needed to tackle this problem, which in a few years' time will be at crisis level unless something is done urgently.
I hope the Minister will assure us that such aid will be forthcoming shortly and that the problem is being tackled urgently.
§ The Under-Secretary of State for Health and Social Security (Mr. Michael Alison)
I congratulate my hon. Friend the Member for Harwich (Mr. Ridsdale) both on securing this Adjournment debate and on the comprehensive way in which he has stated his case. If I may sum up what he has said, I think his message is that the Government are to be congratulated on what they have done nationally but that not all areas—for example, that represented by my hon. Friend—have so far benefited to the extent that might have been expected. I propose first to say a few words about the national situation, then to focus on North-East Essex and finally to try to answer the specific questions my hon. Friend has put to me.
As my hon. Friend has said, the Government attach a high priority to the development of the health services to meet the needs of the elderly. Hospital boards are asked, in drawing up programmes for future developments, to pay very particular attention to geriatric patients and accommodation for elderly patients with severe dementia. Hospital authorities have also been given detailed advice on the targets they should adopt in planning the development of these services.
The first target is the total number of beds, and this has been set at 10 for every 1,000 elderly people—that is, over the age of 65. Because the number of beds is related to the numbers of the elderly among the population, it automatically takes account of those areas like North-East Essex where there is an above-average population of elderly people.
The second target relates to the location of these beds. An active, modern geriatric service is based on full assessment and intensive rehabilitation. For this to be possible many of the beds need to be in the district general hospital and our advice to hospital authorities is that they should aim to place at least half of the total geriatric beds indicated by applying the first target in the district general hospital.
The third target relates to day hospital services. Over the last 10 years or so the rate of development of these facilities has been quite phenomenal and there is now wide acceptance of the vital rôle which day hospitals have to play in an active geriatric service. This aspect of 1061 the service has now passed through its experimental stage and the Department has therefore set a target of two day places for every 1,000 elderly people in a given area. As with beds, this can be seen to reflect the proportion which the elderly population bear to the total locally.
Side by side with the development of geriatric services, where the elderly with mainly physical symptoms will be treated, we are anxious to see the development of small units in local hospitals to deal with elderly patients with severe dementia. At present they are mostly housed in the large mental illness hospitals and, as part of the programme for the rundown of these hospitals, alternative accommodation of the kind I have described will be needed for these patients. We have recently asked hospital authorities to plan to provide such accommodation at the rate of 2.5 to three beds and two to three places per 1,000 elderly in a given population.
These targets are not intended as inflexible levels of achievement, and hospital authorities are well aware that they need to be moulded to meet local circumstances which may demand a greater or a lesser quantity of one form of facility or another. If they are to have the power to vary according to local circumstances, they will take a hard, long look at the demographic features of the areas or sub-areas for which they are responsible.
As regards local authority provision, we have asked local authorities to draw up plans for the development of their social services. They too have been given guidelines to help them, and it is suggested that 25 residential places might be provided for every 1,000 elderly. But if a local authority decided to devote more resources to domiciliary services the requirement might not be so high.
I have talked so far of targets and guidance, and of course these are very important. But I should now like to turn to resources, and it is here that I think the present Government can claim to have been outstandingly successful. I am sure that my hon. Friend will agree with me there.
To help towards the achievement of the targets that have been set, the Government have made substantial extra resources available. On 11th November 1062 1970, after we came to office, my right hon. Friend the Secretary of State announced details of an extra £110 million which it was planned to spend in England and Wales over the next four years on the development of health and personal social services for those sectors of the population, such as the elderly, who are particularly vulnerable and neglected.
In the following year, on 22nd November 1971, he announced that a further £100 million was being allocated for the health and personal social services in England over the following four years, in the main for expanding and improving services for the elderly. About £30 million was earmarked for the health and personal social services provided by local authorities, in particular to get rid of the old workhouses and to increase the total provision of homes. About £45 million was for improving hospital accommodation, staffing, furnishing and food, and for increasing the number of places for the elderly.
I now switch from the national scene to the North-East Essex scene, which my hon. Friend has put before the House. The development of hospital services in North-East Essex is the responsibility in the first instance of the North East Metropolitan Regional Hospital Board. This board has had its share of the extra resources which I have just mentioned. In the present financial year, 1972–73, the extra share amounts to almost £900,000 for capital development, and last year it was just under £500,000. Not all of this is being spent on the elderly. Some of it is being spent on other vulnerable sectors like the mentally handicapped. But this expenditure is, of course, over and above what the board is spending on these groups out of its regular capital allocation, which is increasing at a higher rate than ever before.
The board is very conscious of the needs of North-East Essex with its high proportion of elderly people. It has recently built a day hospital at St. Mary's, Colchester, for £17,000 which has proved a great boon, and it is about to build another at Clacton. This should be in use by early 1974. The board fully realises that present provision is not adequate and it is making every effort within the resources available to it to achieve the targets which I have outlined.
1063 The main problems are that there is a deficiency in the number of hospital geriatric beds available, and those that are available are not all in the most appropriate places. At present there are unfortunately, as my hon. Friend said, 8.3 geriatric beds in hospitals per 1,000 population over 65 against the target of 10 per 1,000. There is also need for the provision of beds in the coastal towns of Harwich and Clacton where the population of elderly is particularly high.
The Hospital Advisory Service has recently visited the Colchester Hospital Management Committee and made a number of recommendations on the development of geriatric services. The board and the hospital management committee are at the moment considering these recommendations and I expect to have their views on these recommendations shortly.
The regional hospital board is planning a new district general hospital for Colchester. It hopes to begin building the first phase of this in 1975 or 1976. The first phase will include 60 geriatic assessment and rehabilitation beds so that the district general hospital will become the centre of a comprehensive geriatric service for the aged according to the best medical practice. In reply to my hon. Friend's specific inquiry, I regret to have to say that it is too early to give a firm date when these beds will be in use. I would here like to pick up a point made by my hon. Friend. It is, as he said, correct that the board is planning to transfer services provided at Notley Hospital to Mid-Essex. But the board hopes to offset the overall loss of geriatric beds that would otherwise result by reallocating existing beds in the North-East Essex area.
There is a need for more locally-based supporting beds which can provide less intensive care. In the short term the board is considering how to do this in the light of the advice of the Hospital Advisory Service; most particularly it is looking at ways and means of providing geriatric beds for the coastal towns. In the longer term the construction of the new district general hospital in Colchester will leave room for reallocation of beds, which will be a help towards meeting the needs of a 1064 rising population. It is the board's general policy ultimately to provide 50 per cent. of the hospital beds needed for the elderly in the district general hospital with the remainder in smaller, locally-based units. My hon. Friend will also be interested to know that the board is actively considering the provision of a community hospital at Clacton when resources permit.
My Department has recently issued hospital boards with guidance on the development of hospital services for elderly patients suffering from severe dementia. I have already given some detail on these policies and boards are now considering the implementation of this advice.
I now turn to residential services. When considering the level of provision of residential services one must first start with the provision in the county as a whole. The Government are firmly of the opinion that residential services should be planned and administered over a large catchment area, and it is for this reason that the personal social services have been made the responsibility of the new county authorities under the recent Local Government Act. The level of local authority residential provision in the county of Essex as a whole is about the same as the national average—nearly 20 places per 1,000 elderly population.
This does not mean, of course, that the needs of particular districts within the county area do not have to be taken into account. But it does mean that it may not be possible or desirable to provide a separate residential home in each locality. In the guidance which my Department has sent recently to local authorities on the provision of residential accommodation for elderly people it is suggested that a home of 40 places might serve an average population of about 16,000 people.
In the county council's social work area—which is designated as North-East Essex, embraces Clacton-on-Sea and Colchester borough, and I think covers more than my hon. Friend's constituency—the county council has 13 old people's homes providing more than 700 places. This is about one-third of the total local authority provision in the county and on this basis the north-east has a not unreasonable share of the existing provision. A further 50-place home 1065 at Brightlingsea is likely to be approved for loan shortly and another 50-place home at Frinton is programmed for 1975–76.
I am aware, however, that only three of these 13 homes are new purpose-built homes and relatively more new homes have been built in other parts of the county. As I said earlier, however, the county must look at the needs of the county as a whole and I would not question its decision to build most of its new homes in other parts of the county while continuing to use its adapted homes in the north-east, all of which—apart from the one former public assistance institution— were provided in the early post-war period. The council envisages a substantial expansion in the provision of houses. A further eight residential homes are programmed for the three years 1973–4 to 1975–6 involving a capital expenditure of about £1 million. My Department will shortly be notifying the council of the homes that have been selected for loan approval in this period.
The Essex County Council has recently reviewed the position in the county as a whole in the course of preparing its 10-year plans for the development of the personal social services. The extent to which homes are required depends of course on a number of factors including the development of other services. The council has decided to give a very high priority to the development of domiciliary services with the aim of assisting elderly people to continue leading independent lives. My hon. Friend will, I am sure, be impressed to know that, for example, there has been a 29 per cent. increase in home nurses and a 55 per cent. increase in health visitors employed by the Essex County Council between 1965 and 1972 —key health agents for sustaining an independent life for elderly people in their own homes.
The provision of warden-assisted housing makes a very valuable contribution to meeting the accommodation needs of the elderly. Local authorities have a statutory obligation to consider all the needs of their areas with regard to the provision of further housing. Successive Governments have encouraged them to provide housing specially designed to meet the needs of old people. Although there is no national programme for this 1066 type of accommodation, the Government place no restriction on the number of dwellings which may be built. Almost one-third of all local authority house building is at present being devoted to one-bedroom and bed-sitting room accommodation and the total of such dwellings now exceeds 500,000. Housing associations are also active in providing housing specially for old people. I am glad to say that with the encouragement of the county council a substantial amount of this special housing has been provided by the housing authorities in the county.
All this holds out a great deal of promise for the future—and I am sure my hon. Friend will accept the sincerity of the efforts being made by all of us to provide decent services for the elderly —which are of course no more than they deserve.
To conclude, I should now like to try to answer the specific questions my hon. Friend set me which I have not already answered. First, he rightly drew attention to the uneven distribution of the elderly population. This is brought home to me every day, because in my office I have a map showing the concentration of elderly people across the country. The coastal areas of southern England stand out because they are in particularly vivid shades of deep purple, indicating a well above average concentration of elderly. As I have already indicated, our targets for geriatric beds are directly related to the number of elderly people over 65 in the population. But, in addition, I am sure that my hon. Friend will be pleased to learn that a weighting for the number of elderly people is included in the allocation formulas for rate support grant and for hospital capital and revenue.
My hon. Friend asked what could be done to increase the supply of nursing auxiliaries and home helps. He noted that since the present Government had been in office the number of home helps had been dramatically increased. We can fairly claim to recognise the value of these groups, and I have already referred to the fact that the Essex County Council's plans include giving a very high priority to domiciliary services. I should point out, though, that we are not concerned here merely with a finance restraint. Possibly the more intractable 1067 problem is to get a sufficient supply of willing helpers—actual bodies, be they paid or voluntary.
My hon. Friend also asked about the Government's attitude to the attachment of health visitors and district nurses to general practitioners. Local authorities have been encouraged in this respect, and in recent years there has been a marked increase in attachments. For example, between 1971 and 1972 the number of health visitors in England attached to general practitioners increased by 10 per cent. and the number of home nurses so attached by 15 per cent. That is in just two years. The Government can therefore claim a good record on this.
My hon. Friend asked whether it is possible to shorten the period in which constant attendance allowance is paid. I take it that he is referring to the period of six months during which the medical requirements for attendance allowance must be met before the allowance becomes payable. This waiting period is 1068 related to what is seen to be the essential purpose of the allowance. The public concern which influences the decision to introduce the allowance is about people whose illness or disablement is long-term.
It is the long-term need for intensive care which lays a heavy burden on both the sufferer and his family, and justifies special cash provision, as the means of providing at least a little relief. Six months seems to us a reasonable measure of what is long-term. It is the measurement used in connection with the transition from earnings-related sickness benefit to invalidity benefit, for example. Although this may not entirely satisfy my hon. Friend, I hope he will concede that it is a genuine attempt to marry compassion with a determination that resources should be concentrated on those whose need is clearly and demonstrably the greatest.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-five minutes to Eleven o'clock.