HC Deb 15 July 1915 vol 73 cc1050-60

Motion made, and Question proposed, "That a sum, not exceeding £42,015, be granted to His Majesty, to complete the sum necessary to defray the Charge which will come in course of payment during the year ending on the 31st day of March, 1916, for the Expenses of the Highlands and Islands (Medical Service) Board, and for a Grant in Aid of the Highlands and Islands Medical Service."—[NOTE.—£2,000 has been voted on account.]

Mr. MACPHERSON

I am very glad that no reduction has been made in the amount granted by the Government for the upkeep of this service for the Highlands and Islands of Scotland. I desire to ask my right hon. Friend the Secretary for Scotland as to one or two points on which I wish to be reassured. I wish to be reassured on the question whether there is an adequate supply of doctors and nurses still in the Highlands of Scotland. During the War a great many doctors, who were living in wild parishes, and nurses who were also in the same wild parishes, have left the Highlands of Scotland to proceed to the front, or to occupy positions in other parts of the Kingdom. It would be a very grievous thing for the Highlands of Scotland if these wild parishes should be without an adequate supply, both of doctors and nurses. Another point is this: In the Highlands of Scotland doctors have often great difficulty, indeed, in procuring comfortable houses. Everybody knows that no doctor can work efficiently unless he has a comfortable house, carefully chosen, and well situated in the midst of his parish. I hope that a certain amount of money will be used to see that in all parishes in the North of Scotland, in those wild districts, the doctor, who is the servant of everybody, will be comfortably housed in the centre of the parish, if possible.

There is another point to which I direct particular attention in connection with the Island of Lewis. My right hon. Friend knows that that island has sent more to the fighting forces of this Empire than any other part of the Kingdom of the same population. Unfortunately, in that island, although it does produce stalwart fighting men, there is a tendency to the grievous disease of consumption, at any moment becoming rife. I understand that the Medical Service Board visited the capital of the island, Stornoway, some time ago, and seriously considered then the advisability of taking particular steps to combat that disease. I would impress upon my right hon. Friend, who has always the interest of the Highlands of Scotland at heart, and has done much for them during his term of office, the advisability, if it is in his power, of allotting a part of the Grant of this year to some scheme which may be formulated by the Medical Board, to establish on the Island of Lewis, some means whereby this disease can be combated. I desire to impress these particular points on my right hon. Friend. I think that the Government have been wise not to exercise the economic spirit in the matter of this Grant. It would be false economy if it were so exercised.

Mr. HOGGE

They have done so—the travelling expenses.

Mr. MACPHERSON

My hon. Friend the Member for East Edinburgh says that they have done so—that the travelling expenses have been reduced. That may be so, but I am satisfied that the sum of £42,000, which I understood was the original sum granted under the Act, is given to us this year, and I hope that my right hon. Friend will devote as much sympathy and time as possible to seeing that these three points on which I have enlarged, are carefully considered, and that the money so granted by the Government will be used to effect those objects.

Sir J. D. REES

There is a saving on this Vote of £882, at which I rejoice. Will the right hon. Gentleman spread the correspondingly less benefits fairly over the islands concerned? The hon. Member referred opposite to Lewis, but I want to champion the cause of Rum, which has no crofters, and is very apt to be regarded as a sort of official Cinderella of the Hebrides. If there must be some lessening of the benefits in consequence of the reduction of the Vote by £882, I urge the right hon. Gentleman to see that Rum does not suffer, as I believe it is likely to do in regard to this as to other Votes. I do not understand what the hon. Gentleman who last spoke means about the housing of doctors. I did not think that the Government had the housing of doctors any more in Scotland than in England. However, the point in regard to which I rose is that relating to Rum.

Mr. MORTON

I am glad the Secretary for Scotland has arrived on the Front Bench. I am sorry, of course, that we had no opportunity of giving him notice that these matters were coming on to-day, but we could not give him notice because most of us did not know until this morning. What I myself think is, that the Secretary for Scotland ought to give us notice; he is the official in charge, and should take care that we have notice of everything that is coming on. I want to know something about this Vote. We have got a Report which tells us that practically nothing has been done. It is the Report of the Highlands and Islands Medical Service Board, which two years ago was proposed and sanctioned by this House, on the ground that the matters to be dealt with were urgent, and we who knew something of the highland counties knew, also, that it was urgent. But the extraordinary thing about this urgency is that nothing has been done. Two years have gone by, and nothing of any consequence has been done, except paying the salaries. I am glad to hear that there has been a little reduction in the salaries and expenses this year. In regard to this Report, I think we have been treated in a somewhat shabby manner, because it is for two years, instead of having been made annually. Why we should be treated in that way I do not know, except there was a desire to conceal what was going on in connection with this Grant. On this White Paper which has been issued there is a footnote which says that they have propounded schemes, but that they have not been finally approved by the Secretary for Scotland and the Treasury, though it is hoped that they will be published shortly. Therefore the Secretary for Scotland is to blame at the present moment for not having settled in two years some sort of scheme about something. If the right hon. Gentleman can tell me to-day, notwithstanding this White Paper, that he has done something, so much the better for his character—I mean, of course, his public character. The Treasury also is to blame in regard to not giving their approval, and I want, before the money is obtained, to know from the Treasury why they are blocking the way. We were told by the Government two years ago that it was an urgent matter, and I want to know why it has not been carried out. As to this White Paper which has been issued, it does not help us much forward as to the doings of the Board, except that so far the members of this Board have treated their work as a sort of holiday. We arc told that they proceeded to Stornoway where the special difficulties of the Lewis district were fully discussed with representatives of the local bodies. But they have done nothing. They go on to say in the Report: In April the mainland districts of Ross-shire and a considerable part of Inverness-shire were overtaken. How "overtaken," or what or who was overtaken it does not say. Proposals affecting Caithness and Sutherland were considered, but poor Sutherland was not "overtaken" at all. Sutherland is not a drinking county, and therefore I can understand why it was not "overtaken." These Gentlemen borrowed a cruiser and went to a pleasant part of Scotland, namely, Orkney and Zetland. Then the Report says: On their way to Zetland members of the Board visited Fair Isle"— —a beautiful place for a holiday— on which a fully trained nurse has been resident for some years. What this Committee wanted to borrow a cruiser and to spend money to go and visit a trained nurse for I do not know, but She has been resident some years under the auspices of the Fair Isle Nursing Association. The strained financial resources of the association have, however, rendered the help of the Board necessary in order that the nurses might be retained. It does not say that they have done anything. This Report, of course, does not help us at all. I believe that the hon. Baronet the Member for Inverness-shire, from personal observations he has made, is as dissatisfied as I am with the doings of this body. It has evidently done nothing, but we are entitled to get from the Secretary of Scotland, and from the Lord Advocate, if he likes, or from somebody else connected with Scotland, some information and explanation. We are, indeed, entitled to a very full explanation from the Secretary for Scotland and the Treasury. I am afraid the representative of the Treasury has gone away, but he had better be sent for to give some answer before he gets the money. We are entitled to a full explanation, because in the note to this Report we are told distinctly that the right hon. Gentleman and the Department are blocking the way. I do not wish unnecessarily to take up the time of the Committee, and I think it will be admitted that since the War commenced Scottish Members, at any rate, have done all they can to help the Government and have neither taken up time by discussing matters nor in putting questions during eleven months. But there are some matters affecting the crofters in the Highland counties in regard to which I am personally glad to have an opportunity of saying a few words. I am sure that my Constituents are as anxious as I am to help the Govermnnet. What we do want from the Secretary for Scotland and those many boards which are supposed to be under his control—although I venture to say it is the boards who control him and not he the boards—is as much infor- mation as possible. I hope, therefore, with all respect to those hon. and right hon. Gentlemen, that they will give the Committee every possible information in regard to these matters which they themselves, two years ago, described as urgent.

Mr. J. M. HENDERSON

I only wish to ask my right hon. Friend, in regard to this Vote of £42,000, whether the Supplementary Vote of £10,000 for those parts of Scotland which are not strictly and technically in the Highlands and Islands comes under the Insurance Vote? If that is so, I need not say anything more.

Sir F. BANBURY

I wish to ask two questions of the Financial Secretary arising out of the speech of the hon. Gentleman who has just sat down. I see that £44,000 was voted last year, and if it was not spent, why was it not surrendered? I rather gathered from the hon. Gentleman below the Gangway that nothing was spent.

Mr. MORTON

Except salaries.

Sir F. BANBURY

Salaries form a very small part of the amount in comparison with the amount voted last year and this year. I want to know whether it was surrendered last year. If it was not, what happened? Of course, if there is a fund under an Act of Parliament for which this money is provided, that would be some explanation of it, but I should like to know that we are not departing from the salutary rule, that money which has been voted and not spent should be surrendered to the Exchequer.

Mr. HOGGE

The hon. Baronet who has just taken part in this Debate I dare say has not had time to read the annual report of the Highlands and Islands Medical Service Board, or he would have discovered that out of the balance which has been unexpended the report says that some 80 per cent, has already been earmarked for expenditure which is either in contemplation or in actual progress. The hon. Baronet, if he cares to look at the report, will find the details upon page 17. In connection with this subject I want to take up the suggestion of the hon. Member for Ross and Cromarty as to the provision of medical men who come under this board. The difficulty is to find suitable candidates for vacancies as they occur, and, for one reason or another, medical men are only prepared to accept the more easily worked practices. In those Highland counties and in the Islands the people left at home, owing to the large number of men who have volunteered for service abroad, consist mainly of women and children and aged parents, and of those in receipt of old age pensions. The whole physical work of maintaining the crofts, for instance, in a great many districts is thrown on those who remain. The difficulty of providing them with the right kind of medical attention is obviously great. Those who remember the original Report of the Committee which investigated the condition of affairs in the Highlands and Islands will recollect the stories that were there printed about the difficulties that those people experience with regard to medical attendance. The Secretary for Scotland, who, we are glad to recognise, is the only Cabinet Minister who has taken the trouble to attend these Debates today, perhaps can tell us what progress is actually being made with the small type of hospital which it was proposed to set up. He will remember that a very excellent proposal was made that in these outlying districts where the population is sparse they were to erect small hospitals giving accommodation for something like half a dozen patients, where there might be a resident nurse with one other attendant to look after the people in those localities, and that those might form the centre to help the people in the surrounding districts. Has any progress been made in the matter, or have any of those small hospitals been erected, and, if so, what is the experience of the board with regard to them?

Can the right hon. Gentleman assure us that the Island of St. Hilda is all right. As he well knows, that island is cut off from the mainland, and the condition of the people is sometimes rather lamentable. I do not know what the recent reports are, but I understand that the nurse that was sent there is now back on the mainland, and that a relief nurse has not yet been sent. I may be wrong, as one sometimes mixes up dates, but can he assure us that the island is being looked after in addition to the other islands mentioned by the hon. Member for Ross and Cromarty. This particular service is a matter of great concern to all Scotsmen, because of the districts which it covers and of the hardships which we know to exist amongst the very deserving race of people. I hope the right hon. Gentleman may be able to assure us that the service continues to engage his most close attention and sympathy, and that he himself takes a very deep interest, personal interest, in seeing that what was intended by this Board is being adequately carried out.

Mr. McKINNON WOOD

The Members of the Committee will recollect that Parliament decided to deal with the question of the Highlands and Islands medical service by a new authority, with the provision that both the Treasury and the Secretary for Scotland should approve of the general scheme. My hon. Friends appreciate the urgent necessity of this provision in the Highlands and Islands of Scotland, and my hon. Friend behind me spoke in a very sympathetic way of the work of the board, as I am sure everyone who has any knowledge of or close relation with the islands must necessarily do. Many of us from our boyhood have known of the miseries and suffering and loss of valuable lives caused by the inadequate medical provision in those scattered populations. I confess I am sorry that some dealt rather flippantly with the subject, but my hon. Friend spoke sympathetically and touched on one of the difficulties—that is the question of an adequate supply of doctors. That is, of course, the great difficulty. The provisions of the Insurance Act, and now the War, have made it very difficult to obtain an adequate supply of doctors for places where the practice is not very lucrative, and where the work is often very hard and arduous. But what the condition of the Highlands and Islands would have been if the Government had not set up this board and provided it with this money, I do not know. Even as we are, we have great difficulty in finding an adequate supply of doctors, but the circumstances in many parts would be serious indeed if this board had not been created, and the money provided for it. With regard to the question of Lewes, I know that the board visited that island, and considered carefully what they could do. I am afraid I cannot now give any information in detail as to what they did either in that island or in the Island of Rhum more than is contained in the Report, and I would require to have notice for further information. With regard to St. Kilda, I believe they have replaced the nurse there, and I hope that that will be a great advantage to the islanders.

A very curious criticism was passed upon the fact that the travelling expenses were reduced, as if that were some act of mean- ness on the part of the Treasury. I found it very difficult to fathom the meaning of that criticism. What has happened is this: The board on starting its work visited the localities, and the first year they required, I think, £1,500 for travelling expenses, but this year they will not require more than about half, because the whole board will not be travelling over the island, but only inspectors and officials. I think that reduction is very natural and proper. My hon. Friend the Member for Sutherland (Mr. Morton) seemed to find fault with the board for actually travelling in a cruiser. Did he suppose they were to go to Fair Isle by any other method1? Those acquainted with the circumstances know, of course, that they went in a fishery cruiser, which was the most inexpensive thing they could have done. It has to be cruising about, but the hon. Member seems to think it was a sort of giddy holiday. I cannot imagine that to the ordinary man, who is not an exceptionally good sailor, it was a holiday of a very hilarious sort. I really expected the hon. Baronet opposite, after that speech, to rise and move that the money should not be granted, because the whole of the speech of the hon. Member for Sutherland was whittling away and deriding the utility of this board, a most unfortunate speech, I think, to come from a Highland Member.

With regard to the new task which the hon Member provided me with, namely, that of informing Members of the criticisms they ought to pass on my Department, I have had a great many tasks suggested in my time, but I think that is the most superfluous that has ever been suggested. My hon. Friends are quite capable of providing themselves in that matter, and doing it, I think, very efficiently. I think we ought all to express our gratitude to this board. It is an unpaid board consisting of well-known Scotsmen, who have given themselves to this work purely from their interest in it. There are upon it men like our colleague the hon. Member for Inverness-shire (Sir J. Dewar). I very much wish he were here to-day to have spoken in this Debate and to have done so with a degree of minute knowledge of this subject which no other Member of the House could have displayed. The other names include the Principal of Glasgow University, and other Members who have, I think, been doing disinterested service of the highest value. I am sure that the reception of that work by the Scottish Members, and especially by the Members for the Highlands and Islands of Scotland, is one entirely of gratitude.

Sir J. D. REES

asked a question which was inaudible in the Reporters' Gallery.

Mr. MCKINNON WOOD

I mentioned Rhum.

Sir F. BANBURY

What about the question of the surrender of the money?

Mr. McKINNON WOOD

This amount is granted and the balance is to be carried over. It is very fortunate we can do that, because, of course, in the first year we had to undertake expenses which will not recur and which this balance will enable us to defray.

Mr. MORTON

I cannot understand the speech of the Secretary for Scotland. He left unanswered the main points I raised, namely, as to his non-approval of the schemes that are mentioned in this Report. I supposed that he would be in a position to give us information on the point. The right hon. Gentleman is entirely wrong in suggesting that I derided anybody. I mentioned no names except the chairman, the hon. Baronet the Member for Invernesshire (Sir J. Dewar), and I am aware he is not satisfied at all. I have said nothing about this Committee at all beyond the fact that they are not getting on fast enough. I asked him to explain, and he has not attempted to do so. Further, I should like to know what are the schemes that, as printed on this Report, have been kept back through the non-approval of the Treasury and of the Secretary for Scotland. Surely we can be told that. I am not at all satisfied that this board has done all they ought to have done. The only reasonable excuse perhaps that might be put forward is the difficulty of getting doctors. It is very possible if you had a Committee which was less crammed with officials it might be more efficient for the work in the Highlands and Islands of Scotland. I do trust the right hon. Gentleman will tell us about the non-approval of schemes, and I also ask the Treasury, as it is put forward that they are blocking the way, and I submit I am entitled to get an answer.

Mr. McKINNON WOOD

The schemes are on the point of being approved, and my right hon. Friend the Financial Secretary to the Treasury assures me that we shall have them back from the Treasury immediately.

Mr. MORTON

I wish to ask whether the right hon. Gentleman has approved of these schemes mentioned here as having been delayed?

Mr. McKINNON WOOD

I explained in my speech that those schemes have to be jointly approved.

Mr. MORTON

Have they been approved by the Secretary for Scotland?

Mr. McKINNON WOOD

They cannot alone. They have got to be approved by the Secretary for Scotland and by the Treasury. That is the scheme, and I cannot criticise it as that is the wisdom of Parliament.

Mr. MORTON

I will ask the Financial Secretary to the Treasury to tell us something about the schemes and why they have not been approved. We cannot expect the Committee to get on if somebody is blocking the way with regard to schemes. Until they are settled I quite understand that they cannot get on. I can understand that these two right hon. Gentlemen have to settle these schemes. Let them do so, and not block the way. May I ask the Secretary to the Treasury if he can give us any information as to why these schemes have not been approved?

Mr. MONTAGU

Owing to Parliamentary action my right hon. Friend and I are jointly responsible for the approval of these schemes. We arc proposing now to fulfil our joint responsibility and jointly to approve these schemes. They are now in course of being approved. The details of the schemes have to be considered. Both Departments have other work to do. Nobody wants to block the schemes; we are anxious to get on with them, and I assure my hon. Friend that there will be no avoidable delay.

Mr. MORTON

I quite understand now, and I am very much obliged to my right hon. Friend for the reply he has given. I wish the Secretary for Scotland could have replied in the same spirit.

Question put, and agreed to.