THE WELFARE SERVICES

§ THE EARL OF LONGFORD

Delinquent.

§ LORD AMULREE

I thank the noble Earl. We have a comparatively new service which has started, called the Prison Welfare Officers' Service, which seems to be doing extremely good work in the prisons where they are. But once again, there are far too few members, and one would like to see their work—although I do not know whether it is humanly possible—much more tied up with that of the probation officers, and to see possibly the probation officers doing a spell inside the prisons with the prison welfare officers, and a good deal more change and co-ordination made in that service. That ties up again with what is going to become of the delinquents when they come out of prison. Quite a large number go back to their homes, but there are those who have nowhere to go, and who want some kind of hostel care and attention for quite a long time. Some may be able to cope with life again when they have been there for a month or two, but again some may need much longer than that. I think that is one of the Welfare Services that could be studied and expanded at the present time, because that seems to me one of the great ways of coping with delinquents at the present time.

I am afraid that I have been talking to your Lordships far too long, but I want to come to the voluntary services. I think that if you are not going to mention the voluntary services when you are dealing with welfare you are really not talking about the kind of work that is being done, because I think the Welfare Services would not be possible if there were not a great deal of voluntary effort working with them. I am sure that all would gain a great deal from what these voluntary workers do, and I think often one can obtain the best work from voluntary workers when they work in connection with some of the trained staff, which is possibly paid. What one would like to see is far more voluntary workers coming along to work with the trained staff, because then we should go a long way to improving our services and getting a far more satisfactory state of affairs.

There are many old prejudices to be overcome in the welfare world. I think what I have said about the way they started shows why some of these pre- 759 judices have arisen. People were going along doing one particular job, and they could not really see further than the job they were doing. That is entirely changed now, but in the course of the change a good deal of frustration and irritation among the various services has taken place, and that is why I suggested that it might be possible to study the services again to see whether some kind of change should not be carried out.

There is one other point I should like to mention, and that is whether it would not be possible to bring as many of the services as we can under one Government Department. Some are run by the Ministry of Health; some, I think, by the Ministry of Education, and some by the Home Office. I should like to see things taken away from the Home Office and given to the Ministry of Health, because although we may have the kindest people at the Home Office—and I am sure they are as good as they can be—the Home Office is associated in people's minds with something penal. It may be wrong, but that is the fact. This is one thing which we want to avoid if we are to have a satisfactory Welfare Service.

The number of people needing welfare will grow: it is going to grow enormously. The services will need a great deal of expansion. We have not a large number of trained staff, or people who can be trained, available; and we can get a successful service only by running it economically and intelligently. I referred at the beginning of my speech to the Seven Works of Mercy being a common feature of mediaeval churches. I do not want to see them transferred or altered into what was another picture in mediaæval churches, the Four Last Things. I beg to move for Papers.

§ LORD ILFORD

My Lords, your Lordships are indebted to the noble Lord, Lord Amulree, for the opportunity he has given us this afternoon of discussing the development of these important services. We are indebted to him also for the interesting survey which he gave us of the birth and growth of these Welfare Services. I do not think there was much in what the noble Lord said with which most of us would disagree.

760 I am not sure that I should follow the noble Lord in the solution which he proposes for what has been one of the most persistent problems of the Hospital Service—the elderly person living in residential accommodation of the local authority, who at one time is in need of medical care, and at another time is not. Of course, in the old days the solution was a simple one. There was no difficulty whatever in transferring the elderly person from the chronic ward in the institution to the sick ward. It presents much greater difficulties to-day. I am not at all sure that the solution proposed by the noble Lord, that the residential accommodation in which these elderly people are found should he transferred to the Hospital Service, is the right one. I do not think that is the right solution at all or, indeed, a very practical one. The difficulty arises from the fact that an old person at one time may be in need of medical care, and at another time may not.

The noble Lord in terms of his Motion this afternoon has laid emphasis on the need for study. A good deal of study is being devoted to the working of the social services. Research projects are being actively pursued by many different bodies in many different places. The new universities have thrown themselves enthusiastically into the work of teaching what has come to be called "sociology" and into the work of research. If their enthusiasm sometimes gets a little ahead of their capacity or their resources, many of these research projects have nevertheless added much to our knowledge of the working of these services and the results which have been attained by them.

I think what is certain is that Government Departments which are engaged in administering the Welfare Services, or in supervising the administration of Welfare Services by other authorities, will have to undertake research on a much broader scale than the scale which has hitherto been regarded as sufficient. Work on research, after all, cannot be left entirely in the hands of private individuals and private bodies. At present the organisation of research work within the Government Departments who have responsibility for these services tends to be of a rather casual character.

To-day one has a situation in the administration of the social services which 761 did not exist before the war. There are to-day great administrative Departments in the Government directly responsible for administering a Welfare Service. That was something which hardly happened before the war. It was brought about by the changes which took place at the end of the war. As the services which these Departments administer grow in scale and become more complex, it is, I think, increasingly essential that these Departments should undertake research investigations into the services for which they are responsible. It may be that the first step should be the appointment of a director of research within the Departments.

One of the difficulties that I have always experienced in the administration of the social services is that it is very difficult to bring to people's notice what social services are available to assist them. Most people are completely ignorant of the social services and do not find out much about them until the need for a service has arisen. I think that in this connection posters are not of much value and I doubt whether leaflets and pamphlets are of any great value either. People tend to throw leaflets straight into the wastepaper basket—and that, no doubt, is the right place for many of the leaflets which reach us—but it makes it difficult for many people who need to know of these services to be made aware of the fact that a service does exist for them.

Far and away the best form of publicity that you can get is the publicity that the B.B.C. can give. There is no doubt that a very short broadcast passage is worth all the posters, pamphlets and leaflets that any Department can possibly produce. The B.B.C. has been very helpful in this matter. There are the Sunday lunch-time talks under the title "Can I help You?" which have been a means of bringing to the notice of people the social services intended to help them and of which they were otherwise completely ignorant; and there have been subjects dealt with in "Panorama" which have been very valuable to those who are responsible for administering these services. But I am bound to say that the B.B.C. must recognise that they are in danger of losing the confidence of important sections of the community, who are beginning to wonder whether 762 the objectivity of the service is quite as complete and comprehensive as it once was. Apart from that criticism, I am sure that the B.B.C. has certainly afforded very great assistance to those responsible for administering the social services.

My Lords, there are only one or two of the services to which I propose to make any reference in detail. The noble Lord has dealt very fully with most of the health services allied to the National Health Service and I should like to make one or two observations about what always seems to me to be the most difficult welfare service which local authorities have to administer: that is, the service of providing accommodation. I am not speaking of housing accommodation; I am speaking of the obligation which the welfare authorities have to provide accommodation for elderly folk, about which the noble Lord has spoken and no doubt other noble Lords will speak in the course of this debate and about which I do not therefore propose to say very much.

The other form of accommodation which they have an obligation to provide is temporary accommodation, which is required mainly by the families who have conic to be called "problem" families. These families have usually been evicted from their homes for one reason or another. Many of them have been evicted from local authority houses for non-payment of rent, and many, of course, have been evicted from privately-owned houses which are mostly furnished and to which control has never applied. They present the local authority with a very special and extremely difficult problem. I am quite sure that the first essential step in preventing a family from sinking down into the "problem" family class is to prevent their being evicted. Local authorities, I know, go quite a long way when rent is in arrears to try to avoid eviction. I am never entirely satisfied that they could not go a little further.

This subject is so complex and so varied in its application as between one district and another that I think that some body like the Central Housing Advisory Committee, who some years ago published a very valuable pamphlet on unsatisfactory tenants, might be 763 invited to look at this question again and see whether any means can be found of ensuring that the rent was paid without the family having to be evicted first. I am quite confident that eviction is the first step on the downward ladder to "problem" family status.

This problem, of course, is a problem of varying intensity. In some parts of the country it is acute. In some parts of the country it seems almost not to exist. I was looking at the statistics of accommodation provided for this purpose by local authorities in different parts of the country. The difference between towns in the South and the South-East of England and the larger towns in the industrial North is quite surprising. In the London regional hospital area—that is the area for which I have figures—the London County Council is providing now 22 units with accommodation for 989 families, and they evidently anticipate that this is a problem which will be capable only of long-term solution, because they provide that in six years' time there will be 38 units providing accommodation for 3,472 families.

I turn to two large county boroughs in the North of England. I find that one has provided only one unit with accommodation for seven families. They anticipate that for the next five years their requirements will be met by two units accommodating 12 families. And in a big town in the Midlands six units are provided with accommodation for 59 families; and it is anticipated that in five years' time the numbers will be increased to eight units accommodating 97 families. So this problem, although it is an acute and a very distressing problem in its manifestations, is one which appears to be very largely a localised problem. Whether that is so, as these figures suggest, or not I do not know. But it presents the Welfare Services with one of the most difficult tasks they have to perform, and I should have thought it would be possible for some better guidance to be given to diem along the lines which I have suggested: that means might be found for paying the rent, getting the arrears reduced at least a little, without having to make an eviction order.

764 I turn for a moment to another class of accommodation. It is rather astonishing that in the very valuable collection of statistics of these services which was published a short time ago by the Ministry of Health, no information appears to have been collected about common lodging houses. The supervision of common lodging houses is one of the oldest public health functions of local authorities. I believe it dates back to the first Public Health Act in 1875. Many of these common lodging houses of course, belong to private owners. I think that your Lordships could hardly conceive the degree of squalor and degradation which exists in some of these places. There is, I believe, a very much greater need for lodging houses than the local authorities at present are prepared to concede.

Most of the larger cities do provide lodging houses, although the power to provide lodging houses is relatively recent. But many of the authorities obtained special powers to do that, and they have done it. The municipal lodging houses are, as one would expect, well managed, very simple, in many ways austere, but they meet their purpose. Outside the municipal lodging houses there are the very large lodging houses provided by voluntary organisations. The Salvation Army has for many years been the leading voluntary organisation in the provision of accommodation of this sort, and the Church Army provides excellent accommodation in many places for a rather different type of man. Both these bodies, if I may say so without presumption, seem to me to be doing a most excellent job. But they do not meet, and they cannot be expected to meet, the complete need for lodging houses, and I should like to see among the local authorities keener recognition of the need for these places.

Before I conclude I should like to make one or two observations about the costs of these services. I wonder whether it is wise to allow so great a proportion of the costs of these services to be met from the rates, as is the case at present. The expenditure on the Welfare Services is at present overwhelmingly rate-borne. It is quite true that probably some modification may be required in the figures that are available to take account of the general Exchequer grant; but generally 765 speaking the position remains that these services are overwhelmingly paid for from the rates. With the best will in the world, a local authority may find it difficult to raise some of the services to the standard which is desired to-day without imposing an undue burden on their rates. In those circumstances I think it might well be considered whether some proportion of the costs of these services, which are, after all, adjuncts to the National Health Service, ought not to be undertaken by the central Government.

§ BARONESS SUMMERSKILL

My Lords, I am sure that the whole House would wish to thank the noble Lord, Lord Amulree, for giving us the opportunity of debating welfare, I think in its broadest aspects. We all know of the noble Lord's brilliant work in the field of geriatrics, and I quite understand that this afternoon he should have concentrated specifically on welfare services as seen by medical people. But we should, I think, recognise this afternoon (and the noble Lord who has just spoken has led the way) that welfare, in its broadest sense, concerns four Government Departments. I propose to limit my remarks to some aspects of the social services where I consider there are serious gaps, despite the fact that the Government have had their attention directed to these gaps by various Committees of Inquiry. Indeed, during the last few years, when we have had debates similar to this, initiated by noble Lords on both sides of the House, we have stressed the importance of increasing the welfare services to those people who are in the most desperate need.

I would in the first place say (I must repeat this) that some of the discontent felt by the general practitioners, and some of the pressure on the hospitals, stems from the failure to provide the ancillary workers in the domiciliary services such as the noble Lord mentioned. He agrees that there is a great shortage of these people who can help the medical men and women in the country. Let me take one important example. It is significant that this morning we were told that the Ministry of Health have issued a report giving the cost of the various items of the Health Service, and that this report men- 766 tioned the heavy cost of the Mental Health Service and the services dealing with the neurotic. I hope that your Lordships will not think that I am being disparaging, but it is said that every one of us has some element of neurosis in our makeup.

In the Mental Health Service there is a national shortage of psychiatric social workers, and it is now proposed that grants which had previously been available to them as students, irrespective of age, are to be brought into line with the grants paid to first degree students. This will mean that the workers whom the Ministry of Health have sought to encourage will be dependent upon their parents, although a large number are accepted at 24 years of age, after they have completed two years' social work experience. I should like to ask the noble Marquess, when he comes to reply (I have a few questions to which I should like to have the answers), how the Minister can reconcile this new attitude of the Ministry with the pressing need for more psychiatric social workers. We all know that if we are to empty our institutions of these tragic people who have some mental disability, we must in the first place have the psychiatric social workers who can do this priceless fieldwork.

Now I should like to turn to the maternity services. I have raised this matter again and again in the last two years, and I ask your Lordships to forgive me if I am guilty of tedious repetition. But although the Minister of Health accepted the recommendations of the Cranbrook Committee in 1959, they have still not been implemented. In order to meet the need for maternity accommodation, the Minister has recommended—I think he met representatives from the L.C.C. a few months ago—the introduction of early-discharge schemes, and I understand that an increasing number are taking place every year. This means the early discharge of the mother from the hospital, sometimes within 24 hours of the birth of the baby. I say that this is a retrograde step, opposed to the interests both of the mother and of the child. The baby needs training, particularly with regard to feeding, and the mother needs an adequate rest. We are becoming a bottle-fed nation. I am beginning to think that while a 767 woman is adapted to feed a baby certain parts of her anatomy will soon become vestigial structures if this goes on.

When a woman is discharged in this manner she is immediately beset, on returning home, with all the worries of the household. In fact, mother is expected to conduct the housekeeping from the bed: she is given her purse, which she keeps under the pillow. I have seen this so many times. Her life then starts all over again, with all the day-to-day worries, and she is subjected to a strain which is detrimental to her health and that of her child. I would emphasise here that there is another part to childbirth. Not only must we ensure that the mother is delivered safely, but we much also ensure that she is protected afterwards from the impact of the household.

Further serious comment on perinatal mortality has come from the Committee sponsored by the National Birthday Trust Fund. They presented a most serious Report, and I have not noticed that the present Minister of Health, or his predecessor, has rejected their findings. When I mention these findings now they may sound rather horrific; but I can only say that this survey was made by some of the most eminent specialists in the country and, so far as I have read, the Minister of Health has not rejected their findings. The perinatal survey expresses the opinion that there are 100 unnecessary infant deaths a week. Its recommendations include sufficient beds in fully staffed hospitals, maternity units, and immediate steps to increase the number of midwives.

The Report states—this has been said over and over again—that the staff shortage results from overwork and underpayment. If we are to be guided by the perinatal survey, which, as I say, was conducted by many eminent people, then in the two years in which the midwives have been negotiating for better pay 10,000 babies have died unnecessarily. The midwives negotiated. they got a little increase, but still they have not been given what they asked for. It has been estimated that to pay the midwives adequately might cost the country an extra £1½ million. Is that too big a price to pay? We have seen lately in the Press the profit made by Ferranti—£3 million of profits, which was ignored.

768 These women have been asking for better pay year after year, and now we find a kind of passive resistance: they refuse to go out and do this physically hard and exhausting work unless society recognises their work.

Driving to-day in the traffic of London and other big towns, we have sometimes to avoid a little woman in blue on a bicycle with a black bag fixed to the back of it. This is one of the finest workers in the Welfare Services, going to deliver a child. For the sake of the mother and the child, when this woman arrives, having negotiated the traffic, she must be cool, calm and collected; and this is the shabby way society treats her. She is pot vocal; she has not got a big pressure group; she does her duty, and society seems to say "So long as you do that and do not make a fuss, we are not going to do anything more about it".

The perinatal survey recommended that each midwife should have a small van—I suppose we should call it a "mini-van". That is an excellent idea. It also recommended that she should have proper equipment, and be instructed in emergency resuscitation. It is a short-sighted policy to try to get the maternity services on the cheap. Apart from the waste to the nation of these potentially healthy babies, there is the huge cost of maintaining in institutions the maimed and often mentally deficient patients who survived a difficult birth but whose brain may have lacked oxygen at a vital moment because of lack of medical skill. These are the findings of the perinatal survey. Of course we cannot assess the toll in human unhappiness involved in this.

Now I turn to another aspect of maternity. It is still a cause for concern that unmarried mothers tend to seek antenatal care later than married women do, and that the illegitimate child has a greater chance of being born prematurely than the legitimate child. I am glad to learn that that fine organisation the National Council for the Unmarried Mother and Child are now considering the changes necessary in the legal and social policy we adopt towards our unmarried mothers. On an average 37,000 illegitimate babies have been born annually since 1955. In London, where I admit the circumstances are rather different, because these girls can come to London and remain anonymous, the 769 ratio of illegitimate to all live births has risen from 7.7 per cent. in 1955 to 14.1 per cent. in 1962, and in 1961, 5 per cent. of the babies were born to girls under sixteen years of age.

Again, this is a social problem which we are inclined to ignore, but it cannot be entirely divorced from the increase in venereal disease. Your Lordships will recall that last month the newspapers gave great prominence to the report of the British Medical Association which was concerned with measures to combat venereal disease, particularly among young people. It was given prominence for a day or two, but then, so far as one knows, was forgotten. At any rate, little more has been heard about it. It seems that the community does not like facing reality about its sexual behaviour. Perhaps when the noble Marquess conies to reply he can tell us what action the Ministry of Health is taking following this most serious report. The report revealed that from 1951 to 1962 the population increased by 6.5 per cent., but the incidence of sexually transmitted diseases increased by 73 per cent. But, of course, these figures reveal but a part of the problem, because they relate only to patients seen at venereal disease clinics, and exclude those treated by general practitioners, those treated privately, and those in the Armed Forces. Young people below 25 present a particular problem, for they contribute about 40 per cent. of the total increase of infections in women.

The report quite rightly does not blame the young man or young woman. It blames society as a whole for blurring the essential values. The fact is, as I think, that promiscuity is glamorised by adults; it is glamorised every day on television, and there is all this pornography—and we are told the country is swamped with it—coming from America. The adolescent amateur seeks to ape the adult, and ends up in a squalid little adventure with disastrous results. The point is that when a boy or girl has got into this very serious trouble all the expensive apparatus of the various Welfare Services is set in action. Doctors, health visitors, clinics, moral welfare societies all come in immediately and try to help. But it is not enough to provide an ambulance service. We must provide an antidote to the insidious influence inside or out- 770 side families before it begins to affect the child's behaviour.

What happens now? Society tries to shift the blame. It says, "Let the teachers teach these boys and girls (boys and girls in their last two years at school, looking like young men and women) about the dangers of sexual intercourse; the dangers of venereal disease; the risk of becoming pregnant at an early age." The overworked teachers quite understandably say, "This is not our job. This is the parents' job." Well, the parents are either indifferent or find the topic embarrassing. It is quite remarkable that it is not only the parents of a child in a working-class area who appear to find this topic embarrassing. The most extraordinary thing is that one finds fathers unable to talk to their sons about these things. We must not expect cocksure youth before they are hurt to seek advice. It is no good setting up some kind of organisation to which we think the adolescent can go, and then sit back comforted in the thought that we have done something. We have just set up one more committee. We have taken a room somewhere in a crowded neighbourhood and said, "Let's name it the Advice Centre", or some euphemism of that kind, and have told them to go there.

Somebody must take this knowledge to the adolescent. I was very impressed when yesterday I heard my noble friend Lord Willis say that the greatest success in the field of crime had been achieved by sending a police officer to the schools, during the last year or two of school life, to tell the boys and girls just what they may expect if they engage in petty crime. He said that the result had been remarkable. I think that, in the same way, if we are to help these children effectively we must take the information to them—somebody who can look them in the eye, not hedge on any aspect of the subject, and somebody whom they trust. We have already heard that ordinary welfare workers are in short supply, and they are not equipped to do this.

I would suggest that the part-time services of a large number of married women doctors, who have dependent children and therefore cannot now take a full-time job, should be used. These boys and girls have been treated by women doctors in the clinics as children 771 and therefore they trust them; they are not shy with them and are prepared to accept advice. I would attach a new kind of school visitor. This particular doctor would not be there for the purpose of making a physical examination. She would be chosen because she could tackle this difficult problem. I suggest that she could go there and could talk to them without feeling any embarrassment, and she could do that because it is her life and she has been trained in these things.

Moreover, she would not be prejudiced against any boy or girl because of his or her unruly behaviour in the school. We must have someone who would see these young men and women, not knowing their background or how they behaved, but knowing that they should be equipped with some very important information before they faced contemporary adult life—a life charged with so much temptation of a kind which we did not envisage some years ago. Therefore, a piece of constructive advice I should like to contribute to this debate is that this new kind of school visitor for this particular purpose could be introduced without delay, because there is an available supply and, in my opinion, this matter brooks no delay.

§ THE LORD BISHOP OF CHESTER

My Lords, I should like to join with the noble Baroness in thanking the noble Lord who has introduced this important matter. I should like also to express to the noble Baroness what I am sure is the feeling of the House—a note of gratitude for the fine, authoritative and moving speech which she has just made and for which I know many of us are extremely grateful. Like her, I should like to take the opportunity of mentioning another gap in the general services which the nation provides in dealing with a particular social problem. The matter receives a passing reference in the document Health and Welfare in paragraph 133. The fact that it is only a passing reference is, I feel, symptomatic of the way in which the nation approaches this problem.

The matter I wish to put before your Lordships is the plight of the alcoholic, the research into the nature and treatment of his disease. We must be clear 772 what we are talking about, for the alcoholic is not necessarily, or in essence, the heavy drinker, the "boozer", or the drunkard. The alcoholic is the compulsive drinker. The World Health Organisation has defined him as: the excessive drinker whose dependence upon alcohol has attained such a degree that it shows a noticeable mental disturbance or interference with his bodily and mental health, his inter-personal relations and his smooth social and economic functioning: or he shows the prodromal signs of such developments. He therefore requires treatment. In other words, the alcoholic is a drug addict.

His situation is a pathetic one. The people most likely to fall victim are those who are sensitive, idealists, ambitious, imaginative. All too often they follow a rake's progress from relief or social drinking to heavy drinking, with warning signs of brain damage; then to drinking into insensibility and, finally, to the chronic stage. It represents a breakdown of the whole personality. Those who have held honoured and responsible positions become dishonest, furtive, dirty, unreliable. They are prepared to jeopardise everything in order to get the alcohol for which they crave. They will sacrifice the happiness of their homes and the welfare of their children. They become victims to nameless fears, they lose their self respect, they are indifferent to the humiliation which they bring on their relatives and their friends. Their state is most pitiable.

What is the extent of the problem which they present? It is not easy to make an exact calculation, since by the very nature of the condition those who are victims are ashamed of themselves and do not readily reveal their degradation. The World Health Organisation has adopted what is known as the Jellinek formula, and in those countries where it is possible to assess statistics accurately the figures have proved to be on the conservative side. Applied to this country, the Jellinek formula produces the figure for England and Wales that one in every 100 is an alcoholic; in other words, that there are 400,000 alcoholics in Great Britain, of whom a quarter—100,000—are in the last stages of the disease, showing marked physical and mental deterioration. Some hold that these figures are exaggerated, 773 others that they understate the case, but many experts consider them to be about correct.

These, my Lords, are terrible figures—400,000 alcoholics, of whom one-quarter are in ay advanced stage of deterioration. Measured in terms of their social consequences they represent a vast waste of people whom we can little afford to abandon, for, as I have said, alcoholics are often those who start out with high ideals; they are the perfectionists. The figures represent a serious wastage in manpower. In the United States of America they reckon that 3 per cent. of the labour force is rendered useless through alcoholism. Alcoholism is the main cause of the break-up of marriages, and where it is tolerated the children grow up in an atmosphere of insecurity and humiliation. The cost to the State is considerable, both in hospital treatment and in support of the family. Many alcoholics spend long periods in mental hospitals and in prisons. The loss to society, to the professions, to industry, through alcoholism must be great. It is a very real social problem.

What can be done to stem this tragic tide? The first thing is to establish the clear recognition that alcoholism is a disease treatable by the medical profession. The situation has been bedevilled by the moralistic attitude and the lack of understanding which society has so often adopted. I yield to no one in my admiration of what has been achieved by the temperance movement in this country. My own grandfather founded the Church of England Temperance Society, which was the parent of the National Police Court Mission, itself the parent to the probation service. But too often that movement has suggested that this is essentially or wholly a moral problem and that it can be solved by an effort of the will. That is not so. Alcoholism often finds its origin in human frailty, but when it has obtained a grip upon a person then neither moral exhortation nor punishment can be the right treatment it needs.

Of course, there must be a continuing effort of the will, but it needs the medical man as well. It is also the case that the alcoholic can seldom, if ever, be 774 cured, in the sense that he can be the same man as he was before he became an alcoholic. He may have done himself some irreparable physical or mental damage. He may never touch alcohol again without the danger of triggering off the whole process once more. But he can be, in many cases, rehabilitated and become a respectable and useful citizen once more, but only so long as he is recognised to be a sick person who must be treated as such.

In the battle to persuade public opinion to acknowledge this truth, a major advance was achieved in the publication in 1962 by the Ministry of Health of Memorandum H M.(62)43 on the hospital treatment of alcoholism, which commended to hospital authorities the need for providing facilities for the treatment of alcoholics, as recommended by the Standing Medical and Standing Mental Health Advisory Committees and endorsed by the Central Health Services Council. That document represented an important breakthrough, for, for too long this aspect of medicine has been a Cinderella. Is there not some significance in the fact that, in the recently published Report on the medical services from a Committee under the chairmanship of Sir Arthur Porritt, although a number of ancillary medical services were represented I could find no mention of treatment for alcoholics?

My first question, therefore, is to ask to what extent the recommendations of that Memorandum have been implemented. If my figures are correct, there are fewer than 40 hospitals in the National Health Service offering facilities for treatment. These facilities vary a good deal in the expert and specialised nature of their treatment. Many of them are situated in mental hospitals, which are not necessarily the best places for such treatment. I hope that the Ministry of Health will look at the situation carefully, and encourage the establishment of specialised units in general hospitals in much greater numbers.

But clearly in this debate we should be more concerned with the wider aspects of treatment and rehabilitation. For alcoholism represents so complete a breakdown of the personality that its redemption needs the co-operation of all who are concerned with the well-being of society and of the individuals within 775 it. Doctors, clergy, welfare workers, probation officers, must all make their contribution and work together to a common end. Much is already being done. Alcoholics Anonymous has blazed a trail in bringing the techniques of group therapy to bear upon the problem. The country has reason to be grateful to its members for their unselfish service. The Church Army and the Salvation Army, and such expert institutions as the Reginald Carter Foundation here in London, are doing much in the realm of treatment and personal counselling to help the victims of this disease. The recently-created National Council on Alcoholism is making a start in coordinating information and in doing constructive thinking on a comprehensive scale. It aims, among other efforts, to set up regional information centres from which information may go out and where general advice may be given.

These activities are all to the good, but they are only a beginning towards the understanding of a very big and complex problem. We cannot be content in this respect, as the noble Lady has said in other respects, merely to pick up the bits and pieces. We need a comprehensive national programme of education in which agencies of government, welfare services and voluntary effort are co-ordinated. There is need for education on the dangers and treatment of alcoholism, so I understand, in the medical schools. Children at school should be warned of the dangers. Medical officers of health should be encouraged to support the establishment of clinics and information centres. The voluntary services should be alerted to the importance of a recognition of the symptoms and the appropriate means of treatment. Financial aid should be available from national sources for the National Council on Alcoholism, and on a wider scale from local authorities for local effort.

My Lords, all the evidence suggests that this problem of alcoholism is a growing one, and the dangers are especially acute among young people. Unless we enlist in a planned policy the service of all agencies concerned to halt its progress, we shall be laying up for ourselves a legacy of wasted life and wasted energy. One way or another the Government receive a lot of revenue 776 from alcoholic liquor. I hope that they will plough back a great deal more than they do now in order to encourage voluntary and professional action in the solution of a great social evil.

§ LORD STONHAM

My Lords, I join with all noble Lords who have spoken in expressing grateful thanks to the noble Lord, Lord Amulree, for introducing this debate, and for giving us this opportunity of discussing an extremely important subject. As so often happens in your Lordships' House, all those taking part so far have, I am quite sure without pre-arrangement, devoted their attention to particular aspects of the Welfare Services; and already, even if no other useful word were spoken in this debate (although I am sure noble Lords who follow me will have a lot to say which will be of great use), we could now say that, if the Government had any real determination to tackle this problem, the suggestions already made would be of very great value indeed.

Although, according to the Motion moved by the noble Lord, we are asked to devote our attention to suggesting ways for the better use, or the best use, of the limited resources available for the Welfare Services, I feel one must begin by protesting at the pitiful inadequacy of the forces available, particularly the manpower forces, for these services. My noble friend Lady Summerskill made brief reference to the Mental Health Services. I feel that the 1959 Act, of which we hoped so much, will prove a delusion and, indeed, a swindle on the mentally afflicted until we have in the community the means of providing the domiciliary care and attention which were promised when that Act was passed.

The last issue of the Ministry of Labour Gazette shows that there are 27,596 vacanies for professional and scientific workers which cannot be filled. Of these, 19,539 are vacancies for women—and this, of course, would include nurses and midwives, to whom my noble friend referred. I would say to my noble friend that those who have responsibility for the administration of hospitals, including maternity units, are resolutely determined to ignore or resist the pressure which is put on us to discharge mothers and babies within 24 hours; and I would also say to my noble friend 777 that her own profession can do a very great deal in resisting this pressure if consultants in charge of maternity units resolutely refuse to discharge mothers before it is safe to do so.

My Lords, a total of nearly 30,000 unfilled vacancies is a frightening total, and in my experience the position is getting worse. When we debated this question nearly two years ago, reference was made to the acute shortage of medical auxiliaries, radiographers, physiotherapists, occupational therapists, almoners, psychiatric social workers and the like. The shortage then varied from a minimum of 20 per cent. to a maximum of 42 per cent., and it is even worse now. Like my noble friend, I have become really tired of saying that the salaries paid to these medical auxiliaries, who are vital to the Welfare Services, are far too low—extremely low compared with the earnings of unskilled people in other callings. Unless the Government make radical changes quite soon, I think we shall have an insoluble problem on our hands.

It is imperative to realise that the Health and Welfare Services will not recruit the large numbers of people needed to build up for the future until it is recognised that some kind of career structure must be created and a great many more training schemes introduced. For example, only ten days ago, at the Annual Conference of Child-care Officers, it was estimated that the services would require at least 600 new entrants a year. But the training provisions will provide only 300—half the number needed.

There must also be an adequate provision for proper training allowances, because it is not enough to promise a good job at the end of training. A girl of 17 or 18 can find herself earning £400 or £500 a year in industry, and with the training allowances that are at present available we just cannot attract sufficient recruits into the Welfare Services. We have got to the stage where, struggle as we may, we count ourselves very fortunate if, at the end of the day, we are no worse off. Indeed, in London we are confronted with a new situation of a declining population in central London and an increased population on the perimeter; and, with the considerable difficulties that there are, people just will 778 not travel long distances when they have to face so much traffic chaos and delays in travelling into London. They will get jobs near to their homes.

I think the only answer is to reorganise existing services, so as to enable a concentration of skilled personnel, wherever possible, to operate a particular department efficiently. It is therefore a matter of crucial importance to the efficiency, economy and well-being of the Welfare State that the available resources should be used to the maximum benefit of those in need of them. I think, therefore, that this makes imperative a careful study of the operation of our existing services, and it is especially necessary for the adequate servicing of chronic as distinct from acute conditions, and to facilitate the rehabilitation of those suffering from different degrees of disability.

I would add a word or two to what the noble Lord, Lord Amulree, said about old people, and then devote my remarks to the special needs of the mentally-handicapped people of all ages. I would emphasise at once that I am not speaking about the mentally-ill but the mentally-handicapped whose problems and needs are not so much psychiatric as educational. I think that, even with the resources we have, a good deal can be done for old people if hospitals will do more; and, in doing so, they may have to disregard some of the instructions given to them.

In my London group of five hospitals we have a geriatric hospital of some 300 beds. Four or five years ago we established a modern group laundry which enables us to do something like the fantastic number of 30,000 or 40,000 pieces of laundry a week; and we are even taking in other groups' washing. But it has enabled us, I am glad to say, through the social welfare departments of the two or three boroughs which form our catchment area, to undertake the laundering of washing for old people who are incontinent. This includes not merely those in hospital, but those who live round about.

I know that this subject may sound rather sordid, but it is one of the great difficulties and one of the things which imposes such a burden on the home. If help of this kind can be provided it makes it possible to keep these people 779 longer as only potential patients—because eventually, if they live, they will become patients in that hospital. It is an economic use of resources both of manpower and of money. In old age the distinction between being well and being ill is often blurred, and the decline into illness is frequently gradual. It is quickened sometimes by the stresses that arise: through living alone, or living without sympathy, help and care; or by having to bother with catering for oneself and by other domestic matters. All these contribute to the gradual onset of incapacity, and frequently to its accompanying illnesses.

The noble Lord, Lord Amulree, spoke about the need for far more domiciliary visits to aged people. I am sure that matter is extremely important, because loneliness among old people is such a tragic thing and is a very important factor in furthering their rapid deterioration. If we can provide some services in the home, and from the hospitals, to postpone hospital entry, it is cheaper and reduces the pressure on the waiting lists.

Many of the great social changes in house and living standards, and in the pattern of neighbourhood life, intensify the loneliness of the aged, in spite of many improvements to living through better social conditions. Often their neighbours and also their own families—certainly the part of London that I am thinking of—live in new, self-contained units, instead of in the tenement rooms of shared houses; and many of the younger people are too busy with full-time employment to have time to be neighbourly. In many cases, old people suffer real neglect and are badly in need of help and care. In this particular area the shortage of home help workers is quite acute, so the plight of some of the old people in their homes is deteriorating very greatly.

In this same hospital that I have spoken of we have tried to meet this need by starting a day club, both for people living outside it and also for in-patients. This is an excellent thing for the patients in the hospital who are less ambulant—though not much—than those who live outside; and it is very good for both kinds of old people, especially those who still live at home, 780 to get a communal daily meal, an interesting occupation and entertainment, as well as medical supervision, at quite a small cost to us. Generally speaking, they help each other very much indeed.

This is a simple enough scheme, and not very costly; but the financial help provided for geriatric needs is very difficult to come by. We have had—I was going to say the devil's own job, but I will say an awful job, to get £1,500 for essential lavatories and a few ramps to the lavatories for old people; and we have had to go to the King's Fund for £2,000 to make the hall decent. This is such a comparatively small amount of money to do such a great deal of good. I think that all this is terribly short-sighted. I would draw the Minister's attention to the fact that in these hospitals we make sure that we have on our house committees full-time social workers employed in the borough or boroughs. This means that we have immediate contact all the time, so that it all becomes virtually the same service, although under two different authorities and two different Government Departments. I commend that suggestion to the Minister as one that might be found generally useful.

I will now ask your Lordships to consider the question of mental subnormality, which presents a clear example of the extent to which the integration and co-ordination of the various services is of such paramount importance, if the individual is to receive the help and support which he needs and which it is within our competence to give. Unfortunately, in my view, the tripartite form of the Health Service has become a major impediment to efficiency, and it is high time that we considered how to overcome it. This is an operational problem, and the first step towards its solution is operational research. There must be, first, a full assessment of all resources available: of the hospital service; of the local authority services in health, welfare and education; from the general practitioner and from the voluntary societies. Secondly, there must be joint planning, so that more effective co-operation can be established between these various agencies. Thirdly, there must be a study of the requirements: of the real needs 781 of the individual needing help, and, indeed, of the help that his family needs.

The problem is to harness the resources we have in order to achieve the maximum benefit, and in order to use the skilled personnel available to the best advantage. I believe that these multi-disciplinary techniques involve a team approach, and it is in these terms that we must plan our services and distribute the experienced staff at present available. The training programme for new recruits and auxiliaries to our social services must be adapted to the idea of working together as a team. I think the team structure is replacing the old hierarchical structure which was characteristic of the hospitals of the past. We need specialists who can work with social workers and teachers, and social workers and teachers who can work with consultants. Above all, we need teams of differently-skilled people equipped to work not only with the disabled individual but also with his family and relatives, and even with his employer. I am speaking particularly of the mentally handicapped. Available resources vary too much in different areas for a single plan to be imposed everywhere, but the resources which exist in every area can be coordinated through joint planning and they must be related to the real requirements of those in need of them.

I think the official policy of domiciliary care will succeed only if the Welfare Services in the community are developed in the greatest co-operation with the special knowledge of the consultant and the special need of the "consumer". Lack of co-ordination would be grossly uneconomic. The unhappy failure to provide adequate services in the community increases the demand on the hospital services for residential care, which is much more expensive, both in money and skilled labour, than if we looked after these people in the community. The length of stay in hospital is intimately related to the services in the community which are available to a patient on his discharge and to those looking after him. We should not send a patient out into the world unless we are satisfied he can be looked after. We can make better use of our hospital beds if we provide better services in the community and if 782 those services are planned jointly with the hospital specialists by the authorities concerned. This not only applies to the mentally handicapped; it is also relevant to the old people.

The health and welfare services can only use parents and relatives as auxiliaries and colleagues in caring for the mentally subnormal if they are prepared to treat them as co-operators in the service and as members of the therapeutic or rehabilitation team. We must make available to them the advice, practical help and knowledge necessary to enable them to care for the disordered in the community at home. The parents are often unpaid nurses and they should be given the same access to specialist help and guidance as nurses in hospital. If we are going to use unpaid people, willing as they may be, let us see that they are trained.

Subnormality is one of the largest problems confronting the Welfare Services and one of the most neglected. We have made some progress, but further improvement is impeded by lack of coordination. Let me give one or two examples. Day nursery provision for the pre-school handicapped child is essential to relieve the strain on the mother and to provide an opportunity for gradual diagnosis and assessment of the child's educational needs. The nursery group could be invaluable as an observation centre, if it was linked with a common centre in each area, through which all the agencies concerned with expert advice and guidance, ascertainment, assessment and supervision were co-ordinated, for it is in these first years that the basis of further treatment has to be planned. Then, short-stay care is often hard to find. Better provision for temporary care is needed, if the mother is to have an occasional break or if she herself is ill or if the rest of the family are to have a holiday.

Further vocational and social training should be available for the older handicapped child. He will be doubly handicapped if it is not available. Above all, there is urgent need for hostel accommodation for subnormal adults who are viable in the community and can pay their way, provided there is somewhere they can live. It is shameful to think that we still allow the sub- 783 normal person who has lived perfectly well at home to go into an institution when his parents can no longer look after him, merely because society fails to provide an alternative home for him. Institutions are not intended to be living units. Partially disabled people, the handicapped and the aged are social beings like ourselves. Hospitals do not meet their social needs and were never designed to do so. It is deplorable that we do not yet have hostels for the handicapped adult who cannot live on his own.

There should be far greater flexibility in residential care. It should be available on a daily, weekly, monthly or term basis, according to the needs of the individual child. The parents of a child in care or in hospital should not be treated as though they had abdicated their role as parents. They should have the same mutually co-operative and helpful relationship with the hospital staff that good parents expect to have with the teaching staff responsible for their children at school. Another suggestion I would make to the noble Marquess, Lord Lothian, is that parents of mentally handicapped children should be considered for membership of house committees of institutions for the mentally handicapped and, indeed, for membership of hospital group management committees. I am sure that they could have a valuable contribution to make.

Resources vary in different areas, and local circumstances make an all-over blueprint impossible, but in each area some common centre or focal point should be established through which all necessary services can be co-ordinated. The voluntary services, of course, have a great contribution to make to the Welfare Service and the National Society for Mentally Handicapped Children, of which I am Chairman—an office bequeathed to me by my noble friend Lord Longford some time ago—has a wide experience of the needs and problems of the subnormal person. But we find that much of our time and resources is devoted to the providing of services which are at present lacking entirely and which we think should he provided by central or local government.

784 For example, the Society has an industrial training centre at Slough for young adults and it is pioneering methods of training designed to further the social development of the trainee. But now that the scheme is working well and coming to fruition, one of our problems is that local authorities are not ready to assure us that when these young people we have trained go hack to their homes, there are the necessary services in their area to look after them to the limited extent for which they will still need care.

We have plans in hand for a rural training unit, run on similar lines, designed to give the subnormal specific rural skills. Another unit is planned for horticultural training, for an industry in which open employment is both feasible and available for the mentally subnormal. These are only three of something like 15 projects which we have in hand, and every single one of these is to supply a need which is very real and very great but for which there is as yet apparently no glimmer of a determination by the central Government to provide the badly needed resources. It seems extraordinary that it has to be left to a voluntary society, not only to take the lead but also to do almost all the work, in an essential matter of this kind.

Those of us who do not ourselves have a mentally handicapped child can have little idea of the stress this problem creates for the family, who love him and strive to help the child to learn how to live with this disability. The relatives of the mentally disordered are in the position of having a highly skilled job to do, without the advantage of the special training and of the supporting team that the hospital staff has to support and guide it. Subnormality is not a problem which the neighbours know much about, because it is hidden away from them. It is not even a problem which the general practitioner knows much about. It is a specialised problem, and the parents get little specialised help or advice.

Professor Illingworth, of the Chair of Child Health at the University of Sheffield, wrote the other day: It is difficult and almost impossible in the busy out-patient department to give parents all the help they need with regard to the problems 785 of their mentally sub-normal child. It is difficult, not only because of the considerable amount of time necessary to help each parent, but also because the problems are so deep and complex, and often so individual in each family, that it is easy for the doctor to think he has dealt with the matter in full, when in fact he has only touched the fringe of the problem, and he has totally failed to understand the real feelings of the parents. There is not a chair of retardology in any university in this country; there is scarcely any teaching hospital which has a clinic where a consultant pædiatrician can meet the parents of retarded children and help them. My Society has a responsibility to provide specialised counsel and advice to parents. It is directly available to them, and it is also used by the other agencies dealing with the case. The specialist dealing with the child, who has not time to help the parents with their own great stress and anxiety, can call on this service. It is amongst the resources available that can be called on to help. It is provided through the devoted efforts of some 25,000 afflicted parents.

We have some resources—considerable resources, if you like—but still all too few. Our greatest lack is co-ordination, integration and joint planning. We cannot use the resources we have to the maximum benefit unless hospital, local authority and voluntary services cease to be regarded as separate empires and operate as a single, integrated service. In practice, of course, sometimes they do; but, generally speaking, the problem is to establish the means to begin to plan jointly. The financial obstacles are great, but not insuperable. We could do so much more with what we have if we were not obliged to pursue separate, uneconomic planning in a vacuum.

My Society represents a large group of "consumers"—250,000 of them. I ask the noble Marquess to tell us when the Government will begin to cater for them. When will they give a dynamic lead and get all concerned to act in the realisation that the Health and Welfare Services exist to benefit people and are not run for the sake of the authorities whose responsibility it is to organise them? We cannot afford to parcel out our resources and dissipate them in separate packages. The need for decisive action is, I submit, urgent, and I hope the Minister can assure 786 us that the necessary action will be taken soon.

§ THE LORD BISHOP OF LEICESTER

My Lords, the noble Lord, Lord Amulree, has initiated what has proved to be already a wide-ranging debate, far from being limited, as might have been thought from the actual wording of his Motion, to the detailed problems of manpower. We shall all remember the plain words of the noble Baroness, Lady Summerskill. It is certainly a fact that the Churches, so far as they are concerned, are fully alerted to the gravity of the problem upon which she touched, although we are under no illusions about the range of our direct influence, and we understand fully that there are large numbers who can be reached only in other ways. Her suggestion about visitors to the schools is one that I personally feel is well worth following up. The only immediate modification that I would make about the proposal is that these visits and lectures should not be too much in the nature of a cautionary tale, in the sense of being purely negative and building up fear, but, as I am sure she would be the first to agree, should be positive in their content and open up for the young people the positive advantages to health and happiness of a properly ordered sex life.

We are also glad that this debate gave an opportunity to my brother the Lord Bishop of Chester to make his important speech on alcoholism. We have seen that subject on the Order Paper under "No Day Named" for a very long time, getting nearer and nearer to the top, but never quite getting there; and the noble Lord, Lord Amulree, has certainly done a service to that particular branch of social concern by giving my brother a convenient opportunity to speak. I hope—and I am sure others agree—that the fact that his speech took place in the context of a long, wide-ranging debate will in no way reduce from the importance that will be attached to it by those who have to follow these matters.

If I may say just one word, following the noble Lord, Lord Stonham, about the laundry service, I am sure that the town in which I live, Leicester, is by no 787 means the only one which has this service, but I can certainly testify to its extreme usefulness. The service is run by a co-operative effort between the local authorities, the W.V.S. and the old people's welfare associations. It is now well established and is deeply appreciated over a wide area of the population.

I questioned one word when reading the Motion of the noble Lord, Lord Amulree, and that was where it refers to "the need for a further study". I wondered about the word "a", and whether it was likely to lead to a demand for another early full-scale Report, on the lines of the many Reports that we have already had. I felt that, if that were so, we might be taken along a wrong path just at this moment, in that I am not sure whether we have reached the time when we are ready for a completely new step: in other words, whether we have consolidated the land that we have already claimed, or tried to claim, through recent Reports and studies.

I believe that there are certain moments of vision in the life of a country, each one of which can, and often does, result in some direct step forward in the matters of social welfare. One of the obvious historical cases that at once comes to mind is the Elizabethan period, which found itself confronted with the problem of the beggars, sturdy or otherwise, and in order to deal with them had to produce its first Poor Law laws. It has only recently struck my mind that the old nursery rhyme raises the whole dilemma of social action in these matters: The beggars are coming to town, Some gave them white bread, some gave them brown, Some gave them the horsewhip And drove them out of town.

§ LORD TAYLOR

Plum cake, they gave them.

§ THE LORD BISHOP OF LEICESTER

That is another version.

There was in my version of the rhyme the dilemma of the social welfare approach and, so to speak, the criminal responsibility approach. We are still confronted with this dilemma, as I shall hope to show in a few moments. In the nineteenth century, it was the plain, 788 obvious needs of physical ailments that struck people; and that, of course, is still going on. I find myself repeatedly attending centenary meetings or seventy-fifth anniversary meetings of various societies for the blind or the crippled. These were the things that struck the imagination of the nineteenth century.

Since the last war, we have the new vision of a Welfare Service covering, so far as we can see it, every aspect of human need, although, as we have heard this afternoon, there are still very large gaps. As we try to measure up to those needs we have had our Younghusband Report, the Ingleby Report, and all the others. My impression is that we are still in a fluid state in these social services, and that we have a great deal to master as we try to work out the schemes that have been put before us. These are enormous documents, and it takes a long time for them to be translated into action. However, in the meanwhile, we have to go on making continuous study of these services and of our use of the limited manpower available.

I wonder whether we have made sufficient progress along the lines that were indicated in both the Younghusband Report and the Ingleby Report—what one might call a general practice approach to social service. The Ingleby Report asked for these family bureaux where general problems of any kind could be opened up. The Younghusband Report had a place for the general-purpose social worker. I believe that if we could do more about that kind of thing, we should be attacking this problem at a vital spot, because we should then be making sure that people get to the right place and the right people at the right time. That, surely, would be a help in the economy of effort.

Meanwhile, of course, we want co-ordination. That is a word which is easy to say, but difficult to translate into action. One of the things we need, as a first step to it, I think, is better communication and more easy contact. There are many barriers to this kind of contact between professional workers of different kinds. One of the chief barriers is that they all have their special language—it can be called jargon by those who do not happen to use it. This different language is a real barrier, as, 789 for instance, between the psychiatric social worker and the health visitor, to mention just two obvious examples. I believe that manpower would be saved if we were able to take a non-judgmental attitude over a wider area of these social problems.

I have talked a good deal to our own social workers in my own area, people working with the Family Service Unit and bodies of that kind. Their impression is that society is still a little too insistent on what I might term the educational aspect of its treatment of welfare cases, to the detriment of the human compassionate need that is obviously there. The kind of examples they give are the application of what is called the wage-stop, the rule whereby people can get from the National Assistance Board only what they would have been able to earn had they been physically and mentally fit to earn it. I am told that in cases of large families, this works out to the detriment of the family concerned, although one can easily see what is intended by the regulation. There are also strict rules about the maintenance of the double family—the man who, through the irregularity of his life, finds himself supporting two families at the same time. There are, I understand, distinct limits as to how far the children can receive the fullest help and support. One can see that obviously the nation does not want to encourage people to have several families at the same time; and that view has to be balanced against the human need of the children who already exist.

The home-help system is one that would bring about considerable economy in the use of more technically trained manpower if more generous help could be given; if cases could be brought more easily into the group which qualifies for home-help. And that, of course, would in turn require more home-helps. Altogether, under this heading we have to see that failings of personality and character are just as real handicaps as obvious physical limitations. In my view, society will have to accept that and plan its services accordingly.

I should like to say just a word about the relations between the Churches and welfare work. I am sure I speak for all Churches when I say that we welcome the obvious awareness in the Home Office 790 and elsewhere of the service that can be rendered, and could be rendered more effectively, by religious communities, and by a better and more organised policy of good-neighbourliness. We welcome the Home Office circular, on Section 1 on the Children and Young Persons Act, 1963, in which there is a definite invitation to Churches to nominate people who will work with the local authority in family welfare of a general friendly character, and I am sure the Churches want to do what they can to follow that up.

The clergy have a part to play in all this work, which I believe is to be touched upon later by the right reverend Prelate, the Lord Bishop of Wakefield. I will just say this. We sometimes notice a reticence on the part of Government Departments and other authoritative bodies to mention clergy and ministers among those who may help in difficult situations. We get used to the list of doctors, psychiatric social workers, probation workers and so on, but we do not even see the clergy put in that list. That is no doubt our own fault. Evidently, there is in the minds of a good many the feeling that parsons, in the very nature of their work, are bound to be what is called judgmental. I do not believe that this is necessarily true. I think that in the course of years, indeed, centuries, the clergy must have picked up a considerable amount of wisdom and experience, and we should hope that they will be regarded as among those who have some contribution to make in these matters.

Finally, I would stress the fact that we had better accept the need for an overall expansion of workers in the social services. Parkinson's Law must be seen to be not only a joke but also a fact of life, and I think we might get ourselves into a better frame of mind about all this if all of us could see that, once we have embarked upon this great project of providing a social welfare service, we have at that time committed ourselves to a continuously growing army of workers. It is not easy to get them, to train them or pay for them, but if we can all see together that this is something we have to do, it will, I think, help the atmosphere.

I think it was the noble Lord, Lord Stonham, who mentioned that probably 600 new child care officers are needed 791 every year, so far as we can calculate the need. That is only one branch of this tremendous work that we have to cover. If we can see this as something that is bound to grow and bound to make a continually increasing demand upon society as society takes a stricter view of its duties in relation to every branch of needy person in the community, I think that perhaps we shall be better placed to deal with it.

Finally, my Lords, I would mention that there is always a balance to be struck between providing an adequate casualty service and that bracing atmosphere of reward and even punishment, without which character and good standards of life cannot easily develop. We are told in our history books that the monasteries not only relieved beggars but also created them. We do not want to fall into that trap, although it is very difficult not to, but even if we have to create a few in relieving a lot, we are going to choose to relieve a lot. But these two sides of our needs will always have to be held in tension. The needs for both sides will be voiced by different persons and by different Parties, or perhaps by the same Parties sitting in different parts of the Houses of Parliament at different times. But, whatever may be said on either side about this double problem, in the end it has to be dealt with by an act of statesmanship which does justice to both sides of the argument, and it is in that spirit that I would ask Her Majesty's Government to approach this matter.

§ LORD TAYLOR

My Lords, the right reverend Prelate the Lord Bishop of Leicester said that the clergy tend to get left out of the list. I must say that when I am making my little list of social institutions I always put churches and public houses together, and I am never quite sure which to put first. Now I am not very sure whether the right reverend Prelate the Lord Bishop of Chester will approve of me at all. It so happens that I have been waiting for his speech on alcohol for a long time and, like an ass, I was having tea when he was talking about alcohol. I must apologise to him. I was hoping he was still going to make his speech. I am sorry that I missed it.

792 It used to be said that you needed a bench of six Bishops before you could open Joanna Southcott's Box. There were six Bishops on their Benches a minute ago—but, alas!, three of them have gone, because I want to open Joanna Southcott's Box for a minute in reference to the Motion of the noble Lord, Lord Amulree, as I do not like welfare services—I suppose I am the only person here who does not—and I do not like them because they represent failure. I admire intensely the people who work in the welfare services; I think they are some of the most wonderful people in the world; but we ought to look forward to the day when the number of clients of the welfare services will not grow.

We are all going to be using the welfare services some time, said the noble Lord, Lord Amulree. I think this is awful. I really think this is a shocking attitude, and I would entirely disagree with him. I think we want to try to teach and help people not to need the welfare services. I loathe illness, but we have to have health services. I loathe poverty and I loathe the things we have to deal with in the welfare services, and I look forward to the days when we are going to get rid of those things. I think that is perhaps what we ought to be thinking about a little more. I disagreed with a great many of the remarks of the noble Lord, Lord Amulree, but I am sorry he is not here for me to disagree with him. I will talk about something else just in case he comes back in about five minutes' time.

I was out this morning with a friend of mine, a first-class general practitioner in South London, and I said to him, "Tell me straight off which are the welfare services which you use, and list them roughly in the order of value to you and your patients as you see them." Here is what he said, and I thought it was rather an interesting and good judgment. First, he said, come the health visitors and the district nurses. He valued both those extremely highly. Secondly came the Meals-on-Wheels service. He said that this was "one of the most valuable things for my old people"—and he regarded them as his old people. He linked that, he said, with the Invalid Meals service, which delivers special meals to people in their homes. Then, he said, came the mental welfare 793 officers and children's welfare officers, and incidentally, of course, he mentioned the home helps earlier on when he was speaking about district nurses and health visitors.

Then he mentioned the National Society for the Prevention of Cruelty to Children. I was surprised because I had a prejudice against the National Society for the Prevention of Cruelty to Children because I thought that they prosecuted people for neglecting their children, but he told me that I was wrong and that their aim always is to keep the family together. He then said that he could not remember the name of the next organisation but he referred to them as, "Those wonderful people who supply the bedding and furniture after the family have smashed theirs up". He was referring to the Family Service Units. I would agree with him: he was absolutely right.

Then he mentioned the local Old People's Welfare Association and all that they did; the chiropody service as being enormously valuable for old people; and, finally, the women police officers. Actually, he mentioned one more group of people whom he admired very much, the National Assistance Board, whom he said did splendid work and were always ready to send someone out to somebody's home when a person was in real difficulty. There I would disagree with the noble Lord, Lord Amulree. Although it is obviously desirable to keep old people mobile, to keep them going to centres and to a place where they can get a meal for as long as you possibly can, rather than to take it to them, there comes a point at which people need help in their homes; and, thank goodness! there are people who take meals to their homes and are not unwilling to go. Many of those old people are most deserving and valuable folk.

The noble Lord, Lord Amulree, in his Motion calls for a further study of the welfare services. I would ask for a further study of the people who use the welfare services, and I would ask particularly for a regular, annual statistical survey to be carried out by the Government Social Survey (they have the machinery) of the extent of the need for welfare services, so that we have a picture of how much is needed in terms 794 of the nation as a whole—it can be done perfectly well on a sampling basis—to set against what is available in the way of welfare workers. I should have thought that that was a simple social study which the Government could carry out for an expenditure of under £10,000 a year, which would give us a most valuable indication of where we were going and whether we were going on in the right direction.

Now I see my noble friend Lord Amulree has returned, so I can have a "go" at him with a good conscience. He had some remarks to make about health visitors, and may I say I agree in principle with what he was saying? But his point of criticism, as I gather, was that the health visitors spend an enormous amount of time visiting mothers and children and far too little time visiting old people. I think he got hold of some rather old-fashioned county councils or county boroughs to quote from, because I believe progressive and sensible county boroughs and counties, in my experience, practise or enable their health visitors to practise selective health visiting of children and do not try to make the enormous number of statutory visits that they are supposed to make to every mother and child; because if they try to make the statutory visits they waste an immense amount of time visiting people who do not need visiting, whereas they should be visiting, as he said, the old and sick and the people who are in need of social help.

He asked, why not let the health visitors nurse? In the rural areas the health visitors do usually nurse; that is to say, they are combined district nurse, health visitor, midwives. They are excellent people. But it is only fair to say that they do less health visiting work, less of the social side of their work, because they have to do so much curative work and midwifery. So, on balance, I have reached the conclusion that it is not a good idea to encourage a health visitor to be a nurse as well. I think she is the most valuable kind of social worker, and I would keep her as that. I am absolutely certain that the proper thing to do is to leave her in her work with the general practitioner and let her work from his surgery.

The standard objection is that the general practitioner does not look after 795 a clear-cut area; he looks after a scattered population, and the next general practitioner has another scattered population. If you link the health visitor with them, she does not get a nice, clear-cut administrative area. But in fact it works perfectly well in all the places I know where it has been tried, and where the health visitor has been given a room in a group practice centre the system has worked like a charm. We have done it for eight years in Harlow in all the group practices, and more and more local authorities are doing it with general practitioners all over the country. I have not heard of a single case where it has not been a tremendous success. It is no good having a tea party where they get together. This is day-to-day work. The general practitioner must use the health visitor as his social worker.

I disagree with what the noble Lord said about district nurses. He said that if district nurses were attached to general practitioners there would be about a quarter of a district nurse per general practitioner, and this would not be very good. As a matter of fact, this is what does happen. I would say there is a quarter of a district nurse per general