Skip to main content

Nursing Homes (Elderly Persons)

Volume 640: debated on Wednesday 17 May 1961

The text on this page has been created from Hansard archive content, it may contain typographical errors.

Motion made, and Question proposed, That this House do now adjourn.—[ Mr. Whitelaw.]

10.3 p.m.

In an effort to raise the subject of a most disquieting aspect of our national life I have been fortunate enough to have the Adjournment debate under the title "Nursing Homes for the Elderly".

I should make it clear that the situation in respect of the care of elderly people is confused by the vagueness of official definitions of the words "home" "old" and "aged", and that there is no clear guidance on the lines of demarcation. The definitions also cover old persons' homes, hotels, boarding houses and guest houses where elderly persons in need of care and attention are handled for private profit, and I would stress "for private profit".

I raised the matter of nursing homes and the care of the aged in a Question to the Minister of Health on 5th December, 1960. I asked the Minister
"in view of the concern expressed about the deteriorating standards in many nursing homes for elderly people where charges range from 7 to 30 guineas a week, if he will set up a Committee to look into the matter, and if he will consider the need for legislation requiring these homes to register annually, and prescribing precise standards of furnishings and staffing."
I was pleased that the Minister said, in reply:
"I am at present considering suggestions for strengthening the powers of the registration authorities."—[OFFICIAL REPORT, 5th December, 1960; Vol. 631. c. 853.]
I hope that the Parliamentary Secretary will tell us tonight that some progress has been made.

I first took an interest in this matter as a consequence of visiting a nursing home. I was asked to visit an old gentleman who had some complaints to make. He was paying seven guineas a week, and he was accommodated in a large room with seven other elderly men. He had been very much upset when the so-called matron walked round and said, to the so-called nurse, "Who is this old geezer?" The old gentleman replied, "I am not an old geezer. I am paying seven guineas a week to be here, and my name is So-and-so".

While I was in that nursing home I was told some terrible things by the old gentlemen. It was pointed out that, as they were all of a great age, deaths frequently occurred, and it was said that that on most occasions the dead body lay in the bed for at least twenty-four hours and that, on one occasion, a body had been forty-eight hours. There was no dining room or communal room. The old people got up once a day when a fire was lit, and when it died out there was no more heating—there was no central heating—and so they went back to bed. I could not think of anything more terrible than such conditions for elderly people who possess all their faculties but are probably a little weak because of advancing age.

I have visited a number of nursing homes since then, and I have been appalled at the lack of comfort and miserable furnishings in them—the old-fashioned beds, the old flock mattresses, and so on. Frankly, it seems to be time for us to have in many of these homes a modern Dickens to stir up the public conscience so that something is done about it. I have had pointed out to me the consideration that is shown to children and the care which is taken about children's homes, their staff and the training of the staff. I submit that the elderly people need in many respects as much care, toleration and patience as children do.

There is plenty of evidence to indicate—I think that the situation is getting worse—that some local authorities with long waiting lists of elderly people are most reluctant to turn down applications from individuals who wish to open homes for the elderly. I believe that as a result there are some shocking places where the elderly and the weak are at the mercy of unscrupulous people.

So little emphasis seems to be put on the need for registration by some local authorities that they are not always aware of the existence of old persons' homes or, as they are sometimes called, nursing homes. Because of complaints, an investigation was carried out in one town, and it was discovered that there were twelve places about which the local authority knew nothing. Less than half of those places have been registered as a consequence of the investigation.

I understand that all private homes for old people must be registered with the appropriate local authority, which may refuse an application on the ground that the applicant, or anyone employed by him in the management of the home, is unsuitable, or because of the unsatisfactory nature of the services provided. An existing registration can be cancelled for similar reasons.

I am informed that there are between 1,100 and 1,200 private homes registered with local authorities in England and Wales for the handicapped and the aged. There are many excellently run homes, but I do not think that anyone need dwell on these, for they should be well-run, particularly where the charges are fairly high. There are many homes which provide fine amenities at reasonable charges, but I am informed that there are as many which are poor and even deplorable in terms of amenities or staffing.

There are very large waiting lists for the best homes. I am informed of one established home, with a very fine record, which had 900 applications last year for 20 vacancies. Another has a waiting list of 500. Because of this situation, many odd people, through desperation, have to take the only roof over their heads that they can get.

I have had masses of correspondence from all over the country revealing that it is fear of being turned out of that one place that prevents many old people from giving testimony. Because of that, there is great difficulty—which I appreciate—for the local authorities in gathering specific evidence. As long as there is this fearful shortage of homes for old people, many of these conditions will continue to flourish.

The powers of registration authorities are vague and so weak that one can understand their reluctance to tackle this problem. That is why I hope that the Parliamentary Secretary will be able to tell us that some progress has been made since December in strengthening these powers.

Occasionally, one sees advertisements for elderly gentlefolk, and in that connection it is rather deplorable that some of the places are offered to them. I understand that the Government have announced their intention to introduce legislation to enable local authorities to contribute to the cost of maintaining resident in private homes for the aged. I would like to know whether progress has been made in this and, if so, what is to be done to ensure that all these homes are deserving of public money in this way.

I wish that I had ten times longer in which to deal with this subject, but last year we had the preliminary result of a national survey of homes for the aged which was carried out by Mr. Peter Townsend, who is Lecturer in Social Administration at the London School of Economics. He has a small team of social workers, and his interim report shows an alarming state of affairs.

The report says that information was gathered from all parts of England and Wales and one or two important points come out. The researchers interviewed the heads of 65 local authority welfare departments, many of whom expressed considerable disquiet at the present situation. The team encountered a few cases of proprietors defrauding the residents, and chief welfare officers told them of some proprietors being "on the bottle", and admitted that some of these people who had fallen foul of them had simply packed up and had opened up again in another area.

In one-third of 42 homes visited by the team, no member of the staff showed any form of qualification. The team found that inspections are often carried out by junior officials as a minor part of their duties—and sometimes such an official is content to ask the proprietor a few questions on the doorstep. Charges range from 3½ to 25 guineas. A number of them charge extra for heating or special services, and the report states that occasionally.
"…we found that the staff expected tips and even legacies."
It has been said by the Secretary of the National Co-operation for the Care of Old People that residents are being defrauded, and are being persuaded to leave legacies to the matron or someone else in the Home. We read that in the 42 homes with just under 500 residents there had been nearly 100 deaths in a year prior to the visits.

The report states:
"We came across three independent instances of undertakers paying £5 to a proprietor for seeking his services in connection with a death."
I should like to know why such a condition was allowed to exist as I found in the place I visited, where dead residents were allowed to remain in the same room for 24 hours or more. The report also states:
"Homes were managed by people with immense patience and tact, but, nevertheless, we considered that one quarter of the people in charge of the 42 homes were indifferent to the needs of those in their care."
Thirty-six out of the 42 homes were not centrally heated. In these old people's homes it is vital that there should be heating, particularly in the winter time, because, without it, life must be a misery for them as it would be for anyone else. I have here the testimony of a former social worker and organising secretary of a charitable society who, in turn, has testimonials from the highest quarters. She writes:
"I am shocked and haunted by what I have seen in my own 11 years' search for anything that could be called satisfactory—of the neglect and exploitation of these defenceless old people."
This lady suggests that
"The Press, both national and local, should not be permitted to accept advertisements from anyone offering to take in old people unless vouched for by a competent and experienced inspector and committee, and this also should apply to old people's welfare and housing societies."
There is a vast amount of testimony that there is a very bad state of affairs and, with an ageing population, there is no doubt that unless something is done, and done quickly and efficiently, this state of affairs will go from bad to worse.

The official testimony that I would like to mention is from Dr. William Fielding, Bournemouth's Medical Officer of Health. In his latest report he mentions that there are more old people in Bournemouth than in most towns. He says:
"A lot of them spend their last years in nursing homes, where they pay anything from 7 to 30 guineas a week."
He wants the homes to be more strictly supervised. He adds:
"Far too often the standard of registered nursing homes has deteriorated. The law at present states that the homes must have qualified staff, but does not say how many. Nurses are in short supply, and one nurse to 20 patients is not enough".
Dr. Fielding also complains about the furnishings.

I have to give the Parliamentary Secretary an opportunity to reply, so I conclude by saying that any country that does not look after its children or its old people deserves the utmost criticism. I assure the hon. Lady that there is grave disquiet throughout the country about what is happening in nursing homes for the elderly. Many local authorities turn a blind eye when complaints are made to them, for the very simple reason that they do not know what to do with the old people. It is a terrible state of affairs, and I shall make it my duty, during the next few months, to visit more nursing homes and to raise this matter again because defenceless old people certainly need a champion at this time.

10.20 p.m.

Perhaps I might first thank the hon. Member for Erith and Crayford (Mr. Dodds) for his courtesy in telling me in advance of the points he wished to raise. He and I had some discussion on the first point he introduced tonight, the confusion which exists about the different kinds of accommodation which is available for old people. It is a confusion which is widely shared, and I hope that I might try to remove some of the mistaken impressions.

There are private nursing homes for the elderly, and private residential homes for the elderly. The former provide nursing and medical care; the latter, residential care for the elderly who are perhaps a little infirm but who are usually able to get about.

Both those types of accommodation come within the province of my Ministry. Both are subject to registration and inspection by local authorities. I think that the confusion between the nursing home and the residential home may account for the statements attributed to the Medical Officer of Health for Bournemouth, to which the hon. Gentleman referred. He referred to two separate kinds of care, but they appear to have become mixed in the reporting, and I will return to that point in a minute.

Both these types of care fit into the framwork of facilities as a whole for the care of the elderly. I stress that they are part of the facilities. The nursing home proper is defined in the 1936 Act as:
"any premises used or intended to be used for the reception of, and the providing of nursing for, persons suffering from any sickness, injury, or infirmity, and includes a maternity home".
The significant words are "the providing of nursing for".

Under the Public Health Act, 1936—there is a separate one for London, and I make that clear for the benefit of the hon. Gentleman—statutory control over private nursing homes is vested in local authorities. It is an offence for any person to carry on a nursing home without being registered by the local authority concerned. The authority has power to refuse registration if it is not satisfied that the person applying is a fit person by reason of age or otherwise to carry on a home; that the premises are not fit for use as a nursing home; or that the medical and nursing staff does not include a proper proportion of qualified persons.

The provision includes the power of inspection by the medical officer of health himself, or a qualified nurse, or other authorised officer of the council. They have power of entry and inspection of premises and the inspection of records. The frequency of the inspection depends, of course, on the local authorities, but I am advised that they inspect regularly, and in many cases as frequently as every three months, so I would expect that they check on any nursing home which does not live up to the required standard. Inspection is within the discretion of the registration authority, but no doubt as it affects nursing homes the point made by the hon. Gentleman will be taken into account by the local authorities.

I must make it clear that in the case of private nursing homes, other than mental nursing homes, my right hon. Friend has no power to make regulations either as to the way in which local authorities should exercise their powers of registration, or inspection, or fees, or the standards of accommodation, or care to be observed by the management of such nursing homes.

More stringent powers of registration and inspection would need legislation either for nursing homes for the elderly or for nursing homes in general, and that is not a matter which we can discuss on an Adjournment debate, but the hon. Gentleman referred to the Question he asked my right hon. Friend on 5th December when my right hon. Friend indicated that he was considering the need for strengthening the power of local authorities. The present position is that we are reviewing the powers in relation to all nursing home accommodation and that, of course, will include nursing home accommodation for the elderly. In doing so we will certainly consider the points put forward by the hon. Member tonight.

Arising out of his supplementary question, which the hon. Member repeated tonight, my right hon. Friend undertook to look at the report of the Medical Officer of Health for Bournemouth. He has done so and we also made inquiries and learned that the views expressed in that report for 1959 did not relate specifically to nursing homes for the elderly in that medical officer's area.

Fees as high as 30 guineas a week were mentioned, but some newspapers apparently linked that with old people's homes and suggested that fees of that order might be charged in Bournemouth. The medical officer said that was certainly not so in his experience and that fees at that level related to better-class general nursing homes where the standards maintained were consistently of a high level. The charges for old people's residential homes are much lower, the majority of them being found within the price range of 5 to 8 guineas a week. The hon. Member referred to a particular nursing home which he has visited and where, apparently, the expression "old geezer" was used, which I, with him, abhor. If he would like to send me details of that place, I will certainly see that it is looked at.

I now come to the question of private homes for the elderly. Here the powers of registration and inspection are conferred under the National Assistance Act, 1948, and again devolve on local authorities. The registration authority may refuse to register a home, or cancel a registration, subject to appeal, if it is not satisfied that the person carrying on the home is a fit person, or if the home is not being run in a way to provide the facilities or services reasonably required by the persons in that home. If the authority feels that there is reasonable cause to inspect a place which is not registered it may of course do so.

In March, 1961, very recently, we introduced new Regulations under which a condition was laid down requiring that the number of residents in a home should not exceed the number specified in the certificate of registration, and a covering circular reminded local authorities of the encouragement and advice which their officers could give by regular visits. It also recommended that there should be a review of these arrangements for oversight of registered homes and the use of powers to bring about improvements, where desirable, in management and staffing of such homes. Our own regional welfare officers have been asked to encourage local authority officers in this respect and to take part, so far as they can, in joint visits of inspection. That is already being done.

It is our intention to review the position when we have seen the effects of these new Regulations and after a review, which will follow the publication, expected next year, of Peter Townsend's Report, which the hon. Member mentioned, arising out of the survey, which he made with financial help from the Nuffield Foundation, of residential accommodation for old people.

The hon. Member referred to waiting lists for some of the residential homes. In part, the answer lies in the substantial improvement which local authorities have been able to make in Part III accommodation under the National Assistance Act, that is, their own residential accommodation run by the local authority. The capital investment programme has been stepped up in recent years. In the financial years 1956–57 to 1958–59 the yearly average was £2·6 million, but in 1959–60 it rose to £6·3 million. The estimated figure for 1960–61 is £8·2 million and that for 1961–62 is £10 million.

In connection with waiting lists, the hon. Member referred to the suggestion that there might be legislation to enable local authorities to use private homes. In fact, local authorities have no such power at present, and there is as yet no suggestion of any legislation to that effect.

The Government are urging local authorities to provide more special housing for old people, with the services of a resident warden where necessary. In a joint Circular issued on 17th March by my right hon. Friends the Minister of Health and the Minister of Housing and Local Government, authorities were recommended to plan together, through their housing, health and welfare services, to meet the needs of old people for special housing, for domiciliary help and welfare services and for the extension of Part III accommodation to which I have referred.

Similarly, in regard to hospital care for those who need it—this, again, would affect some of the people to whom the hon. Gentleman has referred—we have taken steps to increase or improve the use of hospital accommodation. In 1957, we issued a memorandum to hospital authorities, following a nation-wide survey of hospital and specialist services for the elderly and chronic sick in which we stated that the number of hospital beds required for this particular form of treatment was, in the Minister's view, probably adequate but that better use should be made of existing beds, supplemented by better domiciliary and welfare services rather than more beds. We suggested various improvements that hospitals might consider and, since 1957, hospitals have been able to make considerable improvements. There has been an increase in the number of specialist geriatric units and an increase in the number of beds allocated to, for instance, the chronic sick. The increase in the past two years has been 900 beds.

All hospital authorities throughout the country have been asked to submit to my Ministry by the end of the present month their long-term programmes for the future, and in those the needs of the elderly and the chronic sick will be taken fully into account.

I assure the hon. Gentleman that my right hon. Friend keeps in close touch with developments in the care of the elderly. I have no more time now to expand on the subject. I agree that it is a most important matter. Much has been done, as I hope I have been able briefly to show. I should not like to suggest that all has been done, but certainly we are making considerable progress both in checking the accommodation provided in private nursing homes and residential homes and in improving the facilities provided directly by authorities.

Does the hon. Lady think that, if local authorities took greater advantage of the powers they have to build small houses for the elderly, houses really suited to their needs, that might reduce the waiting lists to which my hon. Friend referred?

That is covered in the figures I gave in regard to the capital development programmes of local authorities.

Question put and agreed to.

Adjourned accordingly at twenty-seven minutes to Eleven o'clock.