§ Any local authority within the meaning of the principal Act (including in any county district both the council of the county and the council of the district) may make such arrangements as they think fit, and as may be sanctioned by the Local Government Board for attending to the health of expectant mothers and nursing mothers, and of children under five years of age who are not being educated in public elementary schools; and any expenses incurred in carrying out those arrangements shall be defrayed in the same manner as expenses of the local authority are defrayed under the principal Act.
§ Provision may be made, as part of any such arrangements, that the arrangements may be carried out in such manner as the authority direct by a committee comprising, if it is thought fit, persons who are not members of the authority.
§ Mr. KING
I beg to move to leave out the word "Any" ["Any local authority within the meaning of the principal Act"], and to insert instead thereof the word "Every."
This Amendment is moved with the object of making this Clause compulsory. I do not believe in a Bill making the notification of births compulsory for the whole country unless it is followed up and made really effective by making this Clause also compulsory. I do not know how the President of the Local Government Board is going to regard this Amendment. This Bill aims at securing that every child born in this country should from the start be well cared for and have the very best possible chance of a healthy existence, both as a child and later on as a man or woman. To secure that, the best thing is to make the Clause compulsory.
§ Mr. LONG
I think I can convince my hon. Friend that this Amendment will really defeat the object which he and I and the Government have in view. We 785 all want the notification to be universal. At present, under the adoptive Act, 80 per cent, of our people apply the Act. We want to bring in the remaining 20 per cent. If we tell the local authorities that they shall do this particular thing we are much more likely to put them up in arms against us than if we gave them the powers to make it effective. It is not enough to put the Act into operation to say to the local authorities, "You shall do this," unless the local authorities will pursue the work with vigour, intelligence, and determination when they put it into operation. The successful operation of a Bill like this depends more upon the subsequent action than it does upon the actual powers conferred by the Bill. We are all at one in agreeing that these powers shall be universally applied. We are willing to do what we can, in reason, to improve the conditions under which children are brought into the world, both by caring for their mothers before birth and seeing that the health of the children after birth is as carefully looked after as it can be. I am convinced that it is far better to leave the local authorities to carry out the powers as they think fit. By not making it applicable to the whole country in the end we shall get what the hon. Member desires.
§ Mr. DICKINSON
Clause 1 makes the notification of births compulsory all over the country, and takes away from local authorities the option as to whether or not they will apply the Act. Clause 2 gives new powers to local authorities. I agree with the Mover of the Amendment, that it would be much better if we could make them of universal application all over the country. I was rather astonished when the right hon. Gentleman said that 8 per cent. had already done this work. I am very glad indeed to hear it. If that is so, why should we not compel the remaining 20 per cent. the recalcitrant bodies, to do it? It is very much better, where the condition of the people all over the country depends upon every local authority doing this particular work, to compel them to do it. No objection could be taken by those who are already carrying it out, and those who are not carrying it out might have an excuse if it were not made compulsory.
§ 5.0 P.M.
I am very glad that the right hon. Gentleman has not made this an adoptive Bill, and I am extremely pleased he has not made this Clause compulsory. I would remind the right hon. Gentleman who has just spoken that if a 786 Clause like this were made compulsory upon every local authority, a great deal of money would have to be spent at once, and it would mostly be spent by people who have no enthusiasm for a compulsory Act, and no experience of how it ought to be spent. That is the general rule in the case of functions imposed upon local authorities who have to exercise them against their will. I am extremely glad that the right hon. Gentleman has not made it compulsory in the first instance. As time goes on, and when the benefits of the Act have become apparent and the way in which it ought to be worked is ascertained, then might be the time to make it compulsory, and then it could be made compulsory without waste of money and energy and with the full benefit that the Act is expected to attain. I therefore oppose the Amendment.
§ Amendment negatived.
§ Mr. LONG
I beg to move to leave out the words "(including in any county district both the council of the county and the council of the district) may make such arrangements as they think fit, and as may be sanctioned by the Local Government Board for attending to the health of expectant mothers and nursing mothers, and of children under five years of age who are not being educated in public elementary schools; and any expenses incurred in carrying out those arrangements," and to insert instead thereof the words, "(whether a sanitary authority or not) may, for the purpose of the care of expectant mothers, nursing mothers, and young children, exercise any powers which a sanitary authority has under the Public Health Acts, 1875 to 1907, or the Public Health (London) Act, 1891, as the case requires.
§ (2) Any expenses incurred in the exercise of these powers."
§ Sir F. BANBURY
I should like to ask my right hon. Friend one or two questions upon this Amendment.
§ Sir F. BANBURY
There is a good deal of legislation by reference to this Amendment. It incorporates the Public Health Acts from 1875 to 1907, and the Public 787 Health (London) Act, 1891. The Public Health Act, 1875, comprises 344 Sections. I have not read them because I have not had time, but I have the Act here. I have also the Public Health Act, 1891. That comprises 144 Sections. I have not read that either. I have left out any other of the Public Health Acts which deal with this question, because I have not had time to find them, and those I have found, as they comprise 488 Sections without counting the Schedules, make it very difficult for anyone to understand what the Amendment means. I should rather like a little explanation with regard to that. I should also like to know what my right hon. Friend thinks it is going to cost. I did not see that anyone asked any question about that on the Second Reading. A great many hon. Members were very pleased to do something for someone else at the expense either of the ratepayer or of the taxpayer, but I did not see that anyone asked what it would cost. The days which are past are gone, and it will be very difficult to find money for all these very excellent objects. I do not say that the object is not excellent, but I am afraid it will cost a considerable sum of money. I am not at all sure that we should be really doing very much good even if we encouraged that want of self-reliance in our people which used to be the backbone of this country. I object very much to all this sort of dry nursing. I believe people ought to look after themselves, and at present when the working classes are in receipt of higher wages, and when there is more employment than there has been for very many years before, I do not quite see why it is necessary to do this. However, I am afraid I am rather the voice of one crying in the wilderness, although I think my prophecies are coming home to roost, and that there is at last a slight turning in the direction which I have advocated for so many years. We are going to have a meeting in the City to discuss economy within two or three days. I should like to ask whether anything very dreadful is incorporated in all these different Acts and whether my right hon. Friend has made any estimate of what the cost is going to be.
Mr. PERCY HARRIS
I think my right hon. Friend may be reassured because I think this Clause as proposed to be amended really does very little. All it says is that any authority, whether a sanitary authority or not, may exercise 788 certain powers which are already possessed by the sanitary authorities. All these powers under the Public Health Acts are already possessed by the sanitary authorities. My difficulty is in really knowing what the effect of this Clause will be, and what the authorities really will be able to do, because it is very difficult, if anyone reads the Public Health (London) Act, which I did this morning, to find any powers relating to the care of mothers and of children. I should like to know exactly where the local authorities are going to stand in the matter, because I know a great many things have been done by the local authorities for which it is very difficult to find any express local authority. I suppose it has been done by straining the powers of the Act, but it is rather important when a new Clause of this kind is introduced to know exactly what it is that the local authorities will be able to do. For example, people have been appointed as sanitary inspectors under the Public Health Act who were really acting in quite a different capacity, as birth visitors. I should like to know whether this Clause will give local authorities power to carry out the scheme which was suggested in the circular issued by the Local Government Board on 30th July last year. They then contemplated the establishment of public clinics and houses of visitation for children not on any school register, "school" including not only the ordinary public elementary schools but also schools for mothers and other similar institutions. I do not know whether the words now introduced in the Amendment "for the purpose of the care of expectant mothers, nursing mothers and young children," actually have the effect of extending the powers of the Public Health Acts, but I feel that it is rather desirable to know exactly what the powers of local authorities will be because I find it difficult to ascertain. I quite understand the reason for the proposed Amendment of the Clause, but it leaves the matter a little vague.
§ Mr. KING
I want to thank the President of the Local Government Board for trying to meet objections, which were at once stated when this Bill was printed, by introducing this Amendment. I am sure we realise that he is trying to bring together all different parties and to produce a Bill which will carry the united support of the House, but there will be now, as I understand it, three different 789 authorities, all with certain powers to look after children when they are born and to bring them on to a healthy life. First of all there will be the local sanitary authorities under this new Amendment. What exactly their powers are I do not know. I spent half an hour at the Public Health Act, and got out the standard work, of 2,000 pages, and looked through several pages of the index, but at the end of it I cannot find out exactly what powers the sanitary authorities have under the Public Health Act to look after expectant mothers and children apart from the appointment of inspectors who may, though appointed sanitary inspectors, really be doing health duty, probably of a very wide and nebulous kind. The second authority you will have will be the officials under the local education authority exercising the powers which have been already largely exercised, and very advantageously in some cases, and perhaps rather more extensively than the hon. Baronet (Sir F. Banbury) would support. But I believe it is money as well spent as any public money can be. They would be carrying on the schools for mothers and advice for children of any age whatever which has already been going on under the medical work of the Board of Education. Now you have, also, a third authority which can do the same sort of work, and that is the board of guardians under the Children Act, 1908, who can appoint for any child what is called an infant protection visitor. The authority for this infant protection visitor is the board of guardians everywhere, except in the City of London, where it is the Common Council. There you have actually three authorities entrusted with looking after the health of young children from the earliest age. You say to any one of these authorities, "You may do something," and you do not prevent all three authorities getting to work, and there may actually be, therefore, some districts in which you have three authorities getting to work under three separate Acts and three different Departments. In other places, as this is a purely voluntary Clause, and does not impose duties absolutely on anyone, there may be no work done at all. That I call uncertainty, inefficiency, overlapping, and really not good organisation. I have no doubt that if the President of the Local Government Board issues proper letters and orders and instructions to local authorities he may do away with the possibility of overlapping and duplication, but really I do not think the Clause as it stands, though I welcome it, and thank 790 the right hon. Gentleman for the spirit in which it is introduced, is good legislation as it stands.
§ Mr. DICKINSON
I regret very much, in the interests of public health, and in the interests of the Local Government Board itself, that the right hon. Gentleman has been so very desirous of making friends with the President of the Board of Education. The position is this. When the Bill was brought in by the Government for the first time it was definitely stated in Clause 2:Any local authority within the meaning of the principal Act (including in any county district both the council of the county and the council of the district) may make such arrangements as they think fit, and as may be sanctioned by the Local Government Board for attending to the health of expectant mothers and nursing mothers, and of children under five years of age who are not being educated in public elementary schools.That was hailed by everyone interested in these matters as a great advance, because for the first time the sanitary authorities were going to have actual words in an Act of Parliament giving them the powers which they sought and which everybody thinks they ought to possess, namely, the powers of assisting to save the lives of hundreds of thousands of children who die from want of proper nourishment on the part of the mother or from want of proper care on their part, or from the hundred and one causes during the early months of their existence. This Bill was brought into the House of Commons and was hailed with great satisfaction by those who were anxious that something should be done; but a right hon. Gentleman on the other side of the House opposed it and the result is that the President of the Local Government Board brings in an Amendment which, as my hon. Friend opposite has shown, means absolutely nothing at all. It simply says that some authority, that is to say, the county councils in other counties not in London may do what the municipal councils have already the power to do. In London that merely means nothing at all, because the county council under this Clause does not come in. It says that the borough councils shall have the powers which they already possess under the Acts cited by the hon. Baronet (Sir F. B anbury). That, of course, means that the original idea has gone by the board.
791 The moment the President of the Local Government Board puts down the Amendment for England the two right hon. Gentlemen who sit next to him (the Chief Secretary for Ireland and the Lord Advocate for Scotland) immediately put down Amendments on behalf of Ireland and Scotland to reinsert in this Bill for Scotland and Ireland the very words which we are now asked to take out of the Bill as affecting England. They see perfectly well that this change is not going to do good in Ireland or in Scotland. It is not going to do good in England, but is going to do a great deal of harm, and it is simply put in because the Board of Education have, very properly and very energetically, taken up the question of teaching mothers and young mothers. They have given Grants for the purpose and have been very much interested in this subject. I would point out, however, that the greater part of this work is work of a health character; it has a good deal to do with the antenatal condition of the mother. Public health authorities have to do with infantile diseases; they have the power of dealing with cases of tuberculosis or the provision of children's hospitals, and all these powers are closely connected with this one power which they hoped was going to be given to them by this Bill, namely, the power of looking after and of making arrangements for attending to the health of expectant mothers and nursing mothers and of children under five years of age. I suggest that the President of the Local Government Board has made a very great mistake in accepting the views of the Board of Education.
I know that those who have been engaged in the local administration of this work are of opinion that it is much better left to the medical officer of health than to the medical officers of the school boards under the county councils and the education authorities. The work consists of visiting poor mothers in their homes. At the present time the borough councils all over the country, or at any rate most of them, have their own health visitors. These health visitors have made a practice of going into the homes of the mothers, and have then communicated with the various philanthropic institutions which have been started for the purpose of assisting mothers. The inspectors of the Board of Education do not inspect the homes; they do not go to the homes of the mothers, but are simply concerned with the 792 very laudable desire of teaching mothers. I do not know why they should teach mothers in regard to their children, because it seems to me they have quite enough to do in teaching children. I repeat that the very fact that both in Scotland and in Ireland those who represent those two countries have refused to have this new arrangement put upon them, and have insisted that the original words of the, Bill should stand part, is proof of my contention that the Amendment proposed now by the President of the Local Government Board is undesirable, and I do ask the right hon. Gentleman to consider further the wisdom of making that Amendment The Local Government Board have been extremely active in this matter recently. They have issued a very valuable circular to the local authorities, and they have issued a still more valuable volume, of advice prepared by one of their own inspectors. I think the subject has been far better dealt with in these documents and generally by the Local Government Board than it has ever been dealt with by the Board of Education, with all its good intentions. Therefore, I ask the President of the Local Government Board to stick to his own words. I do not see in the least why the old words should affect the Board of Education. The old words simply gave definite powers to the sanitary authorities. That would not, I submit, have affected the right of the Board of Education to do what it is doing now, namely, to give Grants for the purpose of education. That is all they do at the present time. They give Grants to these schools for the purpose of this kind of education. They may go on with that with very great advantage to the mothers without this Amendment of the right hon. Gentleman. It is a great disappointment to the sanitary authorities—I have been approached by my own borough council on the subject—that the powers which they would like to exercise are not to be given to them by this Amendment. I beg, therefore, to oppose the deletion of the words proposed.
§ Mr. LONG
In regard to the Bills or Acts for which I have been responsible, I have often realised how even the best of intentions fail to satisfy everybody. My hon. Friend (Mr. Dickinson) has declared this Bill to be absolutely worthless, and that it is going to do nothing, while, on the other hand, the hon. Member for the City (Sir F. Banbury) said that it offended his time-honoured prejudices because it 793 was going to do too much. It appears, on the whole, that we have hit the happy medium even better than I anticipated. The Member for the City has set me a task which I am not quite prepared to accomplish in the time at my disposal, and that is to go through all the Sections of the Public Health Act, 1875, and all the Sections of the amending Acts, and then embark with him upon an interesting investigation of the Public Health (London) Act. In the first place, there are only two Sections of the Public Health Act which really apply in this particular case, and as they are not applicable to London, because it has its own public health laws, they are really only in respect of certain limited matters: first of all, the provision of hospitals, and secondly, the provision of medical assistance under which we enable local authorities to give aid to expectant mothers and to children—powers which we think they need. The hon. Member for Paddington was almost as severe in his criticisms as my hon. Friend (Mr. Dickinson) who has been good enough to tell the Committee all the secret history of the last few weeks. He has described the terrible conflict between my right hon. Friend the President of the Board of Education and myself, in which I got much the worst of it and was heavily downed and had to submit. It does great credit to the hon. Member's powers of imagination. He has drawn a brilliant picture. I hope he thinks that I do not look very bad after my maltreatment at the hands of the President of the Board of Education.
My hon. Friend has called attention to the difference that is made as to the application of the Bill to Scotland and Ireland, compared with England. I have often had occasion to say in this House when we have been discussing local government questions that Scotland, at all events, is far more fortunate than England in her code of local government laws and her system of education. It is true that Scotland and Ireland were not satisfied with the Clause as arranged, and they desired to have it in its fullest form. It is true that the Clause as amended does go as far as it did in its original form. It is true that the Bill in its present form will not do all that many of us who are advocates of local government reform desire to see attained, but I do not admit that it will not do anything. It extends the powers now enjoyed by sanitary 794 authorities, it applies the Bill to the whole country, it gives new powers in regard to expectant mothers and young children, it enables local authorities to do what they cannot do now—to exercise powers conferred upon them by the Public Health Act for the benefit of expectant mothers and children. Therefore, if it does not go as far as many of us would wish, it goes a very long way. My hon. Friend (Mr. Dickinson) and my hon. Friend opposite have both accused me of surrendering my principles in consequence of differences between the President of the Board of Education and myself. I hope they will forgive me for saying that I am old-fashioned enough to believe that the floor of the House of Commons is not the place upon which any difference of opinion, should they exist between Departments, should be fought out. The proper place to adjust any differences that exist between Departments is before the Bills get into the House of Commons. There has been a different view taken in the two Departments, the Local Government Board and the Board of Education, about this question for a very long time. I am strongly of opinion that that difference ought to be settled finally, and can only be settled in all probability by legislation; but we thought it better to so alter the Bill as to give powers which will be useful and which will be beneficial both to mothers and infants, rather than take this opportunity of dealing at this particular moment with questions as to which there is a difference of opinion, and in regard to which the action of the sanitary authorities and of the education authorities has varied, and in regard to which their powers are to some extent conflicting and overlapping. I entirely agree, and so does the President of the Board of Education—because we are' in entire agreement and we speak with one voice in this matter—that the country should be satisfied with a modest measure of reform now, with a view later on, if he and I are responsibe in happier times for these two Departments, of producing legislation to cover the whole ground, legislation which will be the result of an agreed policy on the part of these two Departments which are so closely connected with the care of the children of the country and of the mothers upon whose health, immediately before birth, so much of the future of the children must depend. That is really the whole story, and I am sure the President of the Board of Education will confirm me in what I have said.
795 As regards the question of expense I may tell the hon. Member (Sir F. Banbury) that our estimate is that in all probability if this power is wisely exercised the total cost will not amount to more than £100,000, and so confident are we that that estimate is fairly accurate that we have provided a sum of £50,000 as our contribution, because the State is to provide one-half. I can assure the hon. Member for the City that he need have no alarm in regard to the expenditure of money in this direction, and for this reason: It is the duty of our sanitary authorities to care for and look after our women and children, and if the population of a district becomes unhealthy, if the lives of the people become precarious, it is eventually upon the local authorities that they have to fall for their maintenance. Nothing could be more costly, not only in what is a most valuable possession of this country, namely, the health of its country, but in actual cash, than the existence in any local area of a large number of people who are in such a bad state of health that they cannot maintain themselves and have to look to the Poor Law of the country to maintain them. Therefore, I believe that we are not only doing something in the best interests of the community, but by spending money in this direction we are very likely saving expenditure in the localities. I hope, under these circumstances, the Committee will be good enough to accept the Amendment.
§ Mr. DICKINSON
I beg to move, as an Amendment to the proposed Amendment, to leave out the words "for the purpose of," and to insert instead thereof the words "provide for."
I think that we are entitled to know what new powers are going to be conferred on the sanitary authorities, and I should like, instead of saying "may for the purpose of the care of expectant mothers," to say "may provide for the care of expectant mothers," etc. That says what I believe the right hon. Gentleman intends to say, namely, that the sanitary authorities shall have the powers which they imagine they have in some cases and which they have been asking for. The only effect of my words would be to give them the powers of providing for the care of expectant mothers.
§ Mr. LONG
I am afraid that I cannot add to in any way the full answer which I gave to my right hon. Friend just now. I admit that the new powers do not go as far as I should like to see them go, but at 796 the same time they are a step in the right direction. I am advised that the language in the Clause, which was very carefully considered, is appropriate, and in those circumstances I hope that the Amendment will not be pressed.
The speech which I made was for the purpose of getting a statement from the right hon. Gentleman. I think that I am satisfied, as to the powers in the possession of the local authorities, that I have learned all that I desire.
§ Amendment to proposed Amendment negatived.
§ Original Amendment agreed to.
§ Further Amendment made: Leave out the words, "Provision may be made, as part of any such arrangements, that the arrangements may be carried out," and insert instead thereof the words, "(3) Any such powers may be exercised."
§ Mr. KING
I beg to move to leave out the words "in such manner as the authority direct."
If a committee is appointed by an authority it must carry out the necessities of work which that authority gives it, and it seems to me that the words in the Bill cause difficulty and tend to hamper the work of the committee. I trust, therefore, that this Amendment will be accepted.
§ Mr. LONG
The hon. Gentleman has moved this Amendment under a misapprehension. I am not a lawyer, as he knows, but I am advised that the effect of this would be to transfer power from the local authority to the committee. That is not what we want at all. The power and the responsibility must rest with the local authority, while their exercise through a committee would be provided for.
§ Amendment, by leave, withdrawn.
§ Amendment agreed to.
§ Mr. DICKINSON
I beg to move to leave out the word "comprising," and to insert instead thereof the words "which shall include women and may comprise."
§ Amendment agreed to.
Further Amendment made: At the end of the Clause add the words,
Any such committee may be empowered by the authority by which it is appointed to incur expenses up to a limit for the time being fixed by the authority, and, if so empowered, shall report any expenditure by them to the authority in such manner and at such times as the authority may direct. A committee appointed for the purposes of this Section shall hold office for such period not exceeding three years as the authority by which it is appointed may determine.
§ Mr. KING
I beg to move at the end of the Clause to add,
"(2) Where the Local Government Board are satisfied that an authority for the purposes of this Section are refusing or neglecting to discharge their duties thereunder to the satisfaction of the Board the Board may exercise in respect of the area of that authority all or any of the powers of the authority, and may recover from the authority any sums expended by them in relation to such exercise.
For the purposes of any inquiry into any supposed refusal or neglect, as aforesaid, the Board may apply by Order any enactments relating to the holding of public inquiries, and the enactments as so applied shall extend accordingly."
Suppose that you have a case in which the local authority is absolutely neglecting its duty with the result that there is a great loss of child-life, and so on, I do think that you want the Local Government Board to be in the strongest position to exercise its powers and insist on action being taken by the local authority, and I think that this Sub-clause would add to the power of the Local Government Board in such a district where there is an obvious need of dealing with the problem under the Bill.
§ Mr. LONG
As far as the Local Government Board is concerned, my hon. Friend knows very well, better than I do, as he knows these questions so well both inside the House of Commons and out of it, that the power of compelling a local authority by mandamus is of no effect whatever in such a case. What we want is to get these 798 local authorities to approach this work with a good will and to take it up with enthusiasm. If you begin to threaten people with compulsion or do not trust them, but strive to compel them, you are much more likely to deter them and to urge them in the opposite direction. I am sure that my hon. Friend, remembering his own experience in local administration, will agree that it is better not to put these powers into the Bill.
§ Amendment, by leave, withdrawn.
§ Question proposed, "That the Clause, as amended, stand part of the Bill."
§ Sir F. BANBURY
My right hon. Friend has said that the expense would not exceed £100,000, and that he was going to provide out of the National Exchequer a sum of £50,000. How is he going to provide it? It is not in the Bill, and I think that it will require a Financial Resolution and probably an Act of Parliament.
§ Mr. LONG
I do not desire to embark on a discussion with my hon. Friend as to the Rules of this House with regard to finance. This, of course, is done under the existing system by which money is voted by Parliament for the relief of certain local expenditure, and repayment is made to the several authorities, but the money for the purpose is taken by the Chancellor of the Exchequer when we are voting the Supplies.
§ Question put, and agreed to.