§ (1) The local education authority for the purpose of Part II. of the Education Act, 1902, shall have the same powers and duties with reference to making provision for the medical inspection and treatment of children and young persons attending—
- (i) secondary schools provided by them;
- (ii) any school to the governing body of which, in pursuance of any scheme made under the Welsh Intermediate Education Act, 1889, any payments are made out of any general fund administered by a local education authority as a governing body under that Act, and any school of which a local education authority are the governing body under that Act;
- (iii) continuation schools under their direction and control; and
- (iv) such other schools or educational institutions (not being elementary schools) provided by them as the Board direct,
§ (2) The Local Education Authorities (Medical Treatment) Act, 1909, shall apply where any medical treatment is given in pursuance of this Section as it applies to treatment given in pursuance of Section thirteen of the Education (Administrative Provisions) Act, 1907.
§ The DEPUTY-CHAIRMANThe Amendments standing in the names of the hon. Members for South Notts (Lord H. Cavendish-Bentinck), Berwick (Sir F. Blake), and York (Mr. Rowntree) ought, I think, to come as new Clauses.
§ Sir P. MAGNUSI beg to move, in Subsection (1), to leave out the words "and treatment" ["medical inspection and treatment of children"].
My Amendment to omit a couple of words will be followed later by an Amendment to insert at the end of the Sub-section words to the following effect: "And the medical officer, after inspection, shall report to the local education authority by whom he is appointed."
6.0 P.M.
This is an important Amendment, because it tends to lessen some of the onerous duties and responsibilities which this Clause throws upon the local education authority. When I was speaking on the Second Reading of this Bill I pointed out that there were two Clauses in this Bill which were of a highly contentious character, and which I thought must be amended if the Bill had ever to become an Act of Parliament. One was Clause 10 and the other was Clause 18. My right hon. Friend the President of the Board of Education was good enough to accept and to introduce Amendments to Clause 10, which, I am quite certain, have expedited, and will expedite, the passage of the Bill through the House. I very much hope, therefore, that he will show the same spirit of concession in regard to the Amendments standing in my name on Clause 18. It will be seen that the Amendment I am moving deals with the marginal title, "Medical Inspection of Schools and Edu- 1458 cational Institutions." The question of treatment does not appear in the title although it occupies an important place in the Clause itself. Important as medical inspection is—and I am strongly in favour of it being given in connection with the institutions named in this Clause—the question of medical treatment is a far more important one than that of inspection. Therefore it is a little strange that the marginal title should differ so considerably from the provisions of the Clause as to have omitted from it altogether the words "and treatment." I cannot help thinking that under any circumstances some Amendment to this Clause as drafted is absolutely necessary, because it will be seen that it extends the power of the medical officers of the board to medical treatment of large numbers of persons between the ages of sixteen and eighteen for whom medical treatment is already provided. Let me draw attention to the words of the Clause, which provide that the local education authority shall make provision
for the medical inspection and treatment of children and young persons attending—There are a large number of pupils in the secondary schools provided by local authorities above the age of sixteen. In our continuation schools compulsory attendance would be required some years after the appointed day for all persons between sixteen and eighteen, and although by the Amendment of the President compulsory attendance will not be insisted upon for some years I am hoping that our local education authorities will do what they can to encourage the attendance of young persons even after the age of sixteen. Therefore we may assume that a large number of young persons will be attending these continuation schools between the ages of sixteen and eighteen. No definition is given of educational institutions, and if in moving this Amendment I obtained some definition of what is understood by educational institutions I really should not be moving it in vain. Educational institutions must certainly include technical schools which are at present aided, and in some places provided, by the local education authority, 1459 and from the statistics I have obtained I find that a great majority of the students in those technical schools are between sixteen and eighteen years of age, and therefore it will be seen that the extension of the duties provided in this Clause would enable these medical officers of the local authorities to give medical treatment to these young persons in the secondary schools and the continuation schools and also many of our polytechnic institutions. But the Clause goes further and provides that a local education authority for the purposes of this Act shall have the same powers
- (i) secondary schools provided by them;
- (ii) continuation schools under their direction and control; and
- (iv) such other schools or other educational institutions (not being elementary schools) provided by them as the Board directs."
with reference to children attending public elementary schools as respects children and young persons attending any school or educational institution, whether aided by them or not, if so requested by or on behalf of the persons having the management thereof.We are limiting it between sixteen and eighteen years of age; otherwise it might be supposed that these powers would enable local education authorities to give medical treatment to persons of any age whatever. We know that a young person is defined as between sixteen and eighteen, and I am restricting my observations to them. This means that in any one of these institutions, if those who have the management thereof request the local education authority to provide medical treatment for those young persons, the local education authority will be enabled to do so, or may be required to do so, without even consulting the young persons themselves as to the medical practitioner they would like to be employed, or without any reference to the parents. I do not know that the protest of a parent against the employment of a medical officer appointed by the local education authority would have any effect in preventing that officer from attending these young persons. It will be remembered that at the age of sixteen all young persons employed, and a large number of other persons, come under the National Insurance Commissioners, and are required to contribute, and their employers are required to contribute, and the State contributes toward the provision of medical attendance for these young persons. The result of this Clause therefore, if carried in the form in which it stands, would be that the State would contribute twice over for the medical attendance for the same set of people, and that, notwithstanding the fact that the young persons themselves and their employers are contributing towards the cost of medical 1460 attendance, they might be required to receive medical attendance from the medical officer of the local education authority.We know that doctors often differ, and it is quite possible that the treatment which these young persons would receive would be less satisfactory than if it were in the hands of one doctor only. I think that the President would be well advised if he would take back this Clause altogether and bring it up on the Report stage, after having considered more carefully some of the difficulties to which I have referred. If the Clause were limited to the attendance on young persons between fourteen and sixteen, it would be a great advance on anything that at present exists, and would remove to a certain extent the difficulties. But even that would not be wholly satisfactory, and for that reason I think it would be advisable for the right hon. Gentleman to undertake to reconsider the Clause. There is another argument which seems to me stronger than any I have advanced on this point, and it is that this House and the whole country has been looking forward to the introduction into this House of a Bill for the establishment of a Ministry of Public Health.
§ The CHAIRMANWe cannot discuss that subject now, and I shall have to deal with it on an Amendment that comes later. Is the hon. Member speaking on the Clause as a whole or on the Amendment?
§ Sir P. MAGNUSOn the Amendment.
§ The CHAIRMANThat is the Amendment to leave out the word "treatment?"
§ Sir P. MAGNUSYes. I was appealing to the President of the Board of Education and asking him whether at the present time it was really advisable to increase considerably the powers of one Department of State, having regard to the possibility in the near future of the establishment of a Ministry of Public Health, which would deal with all these matters and which would prevent one Department from trespassing on ground which would be covered by another Deparment. I feel there are many other hon. Members who are better qualified to speak on a medical subject such as this than I am. There is my hon. and gallant Friend the Member for Edinburgh and St. Andrews Universities (Sir Watson Cheyne) and my colleague in the London University. I want to ascertain whether the medical 1461 Members of this House consider that the Amendment which has been put down in the name of the hon. Member for Edinburgh and St. Andrews Universities would meet the difficulties to which I have referred.
I shall be very unwilling to press my Amendment to a Division if the hon. Baronet will state that in his opinion his Amendment will meet the requirements of the medical profession and obviate the difficulties to which I have referred, and, of course, providing that my right hon. Friend is willing to accept it. In order to obtain an answer from my right hon. Friend on the two particular questions I have put, namely, what he means by medical treatment and what is meant by educational institutions, I think it right formally to move this Amendment. If medical treatment means nothing more than the local medical officer should give advice to the students in attendance without treating them personally himself my objection would not hold, but until I get some satisfactory information I feel it my duty to bring this Amendment before the Committee.
Mr. FISHERWhile I feel myself unable to accept the Amendment which has been moved to omit the words "and treatment," I am ready to accept the Amendment which has been put down by the hon. Baronet the Member for Edinburgh and St. Andrews Universities, which, I think, covers part of the ground which occupied the speech of my hon. Friend. My hon. Friend at the end of his speech put to me two questions. First of all, he asked me what was meant by treatment. He wished to be assured that if the local education authorities were empowered to provide treatment they would pay due consideration to the desires of the parents and to the opportunities of the private practitioner. That was really the meaning of his question, and I think I can give him a very satisfactory assurance on both points. Under our existing law, the local education authority is bound to provide inspection, and it has also power to provide treatment. Under this Clause, it is proposed that the duty of inspection and the power of treatment should be extended from the elementary school to the continuation school. What happens with regard to treatment? The medical officer who inspects finds some defects which require to be followed up by treatment. 1462 The parent has the opportunity, and indeed is encouraged, to employ a private practitioner, and perhaps it may interest the Committee to know that at the present time there are 226 authorities who employ part-time officers, and forty-seven only who employ whole-time officers for the purpose of treatment. That will show the hon. Member that as things are abundant use is made of private practitioners in the matter of treatment and that in the majority of cases part-time officers only are employed. Then my hon. Friend put to me another question. He asked me what was meant by other institutions. It is very difficult to find a phrase which will cover all the possible cases in which it may be desirable to provide inspection and treatment Let us take evening schools. Let us take art schools. [An HON. MEMBER: "School Camps!"] An hon. Member suggests school camps. There again it might be desirable to have inspection, and in any case I think, ex abundanti cautela, it is desirable to have some general word which will cover cases which might not be adequately covered by the use of the term school.
§ Sir W. CHEYNEI should like to make a few remarks on this question, although the right hon. Gentleman has very kindly acceded to the Amendment which I have put down. My opinion is that treatment should be left out, but I have put down that Amendment because, if treatment were not left out, I did not want it to be left without something being done to mend matters. Therefore, in supporting the hon. Baronet who has moved this Amendment, I am supporting a view which I hold in contradiction to the Amendment which I have put down. I have no wish whatever to decry the existing arrangements as regards inspection and treatment which operate in elementary schools up to the age of fourteen. This Clause deals with children from fourteen to eighteen. The treatment which occurs during the earlier period is of a different character from the treatment which would occur at this period. In the earlier period the treatment is quite rightly more or less limited to troubles which interfere with education. We may call them educational diseases. The treatment really does not deal with things other than those which interfere with education. For instance, the teeth of young children are attended to. That is most important and of the greatest value as affecting the nutrition of the child.
§ Lord H. CAVENDISH-BENTINCKAre there no defective teeth after fourteen years of age?
§ Sir W. CHEYNEThen there is the question of eyesight. We have eye clinics where we treat defects in eyesight which interfere with education. There are certain things which interfere with breathing and which therefore incapacitate the child, such as tonsils and adenoids, and we have treatment for them. There are sudden contagious conditions which arise and which have to be dealt with, such as ringworm. We have also physical disabilities which are treated by physical exercises. These practically are all educational diseases which are treated in ages from five to fourteen, and if one reads the report of the medical officer for 1916 he will see what immense benefit children have derived from being treated in that way. There is this point to be made with regard to the elementary treatment: These children are attending school continuously. They are both known to the teachers and to the medical officer who inspects the school, and everything is quite right. I am not making the slightest objection, except that if there is a health authority set up I think it will have to come under that authority. It is quite a different thing when we come to young persons above fourteen who do not attend every day, but only for three or four hours twice a week. The Noble Lord has suggested that a dentist is required after fourteen, but we may hope that the teeth have been attended to before the age of fourteen is reached.
§ Lord H. CAVENDISH-BENTINCK indicated dissent.
§ Sir W. CHEYNEWell, we will let that slide. We then come to the question of eyesight. My hon. Friend the Member for Derby (Sir W. Collins), who is a great authority on eyesight, may have something to say in regard to that matter, but I would suggest that by the time the age of fourteen is reached many of the defects have been corrected, and that it is only a question of going on and getting spectacles. Practically all the educational diseases have been attended to by the time the age of fourteen is reached, and the medical officer in his report—I quite admit it is a very sanguine report, but still the man does his work well—speaks very strongly of the enormous advantages that the children have derived. What 1464 diseases are you going to treat in these children who only attend school occasionally? Supposing a child is taken ill one day after he goes to school, are you going to send the school doctor to his home to treat him? What would the parents say? What would you say if your boy were taken ill on Saturday and because he did not go back on the Monday the school doctor arrived to see him? I do not think you would like it. There is very little that can be done when the child no longer attends regularly except to give him a bottle of medicine. I remember once reading what was put up in the window of a doctor's surgery, "Hours of attendance such-and-such hours in the morning and such-and-such hours in the evening. Bottle of medicine and advice, 4d. Superior ditto, 6d." I suppose the educational doctor is going to give "superior advice." I cannot see the object of continuing the treatment after the child has ceased attending school regularly. When you come to the ages from sixteen and eighteen you have a young person who has a panel doctor. Are you going to send the educational doctor to a person who has got a pane! doctor? It is quite true that you are going to do it for nothing, but so far as the person is concerned so does the panel doctor. I do not suppose that the panel doctor would very much mind if the educational doctor did attend him, but still it would be a slight upon the panel doctor, about whom the Prime Minister told us such wonderful tales when he expressed surprise that anyone should wish to continue his own doctor. There is not a word about medical treatment in the Scottish Education Bill, and I have not heard anyone grumble about the absence of it. They may be a hardier race, but I do not think that accounts for it. The Secretary for Scotland, in going into the details of his Bill, had not a word to say about medical treatment, or even medical inspection. I think what really ought to happen is that these young persons should be medically inspected, and then, if anything wrong is found, the parents or the panel doctor should be communicated with. If it were something requiring treatment at some clinic, I do not suppose that either the boy or the parents would object to his being treated there, but surely some time or other the child grows into a young person when he chooses for himself whether he shall be treated by a family doctor or a panel doctor!
§ Sir H. NIELDThe Committee is fortunate in possessing a Member who is able to give it personal advice on a subject of this sort. I, who have no particular interests to serve, rise in the interest of the public to ask whether it is desirable that an Englishman's home, which has hitherto been regarded as his castle, should be invaded, as it is now by law, by nine separate medical visitants, with two added by the legislation of this Session, making twelve in all if this Clause passes? On the 4th December the British Medical Association had an interview with the President of the Board, and certainly the conclusion to which they came when they left his room was that he was prepared to concede the omission of the words "and treatment" in so far as they meant following the child to the home and treating it in the same way as an ordinary practitioner would treat it. Apparently that was a misapprehension.
Mr. FISHERNo; I have accepted the Amendment of the hon. and gallant Member for Edinburgh University (Sir W. Cheyne) on the distinct understanding that that would meet his wishes. I may say that I am very much surprised at the attitude he has taken up.
§ Sir H. NIELDYou are referring to the last speaker?
§ Sir H. NIELDThat makes it perfectly clear that, like a cautious man, my hon. and gallant Friend was prepared to take half a loaf rather than be without bread altogether. I can assure the right hon. Gentleman that if he had been in public life, as represented by this House, for a longer period, he would have known that that is a policy which is an extremely discreet one where one is obliged to deal with the elector and to deal with matters of public concern. I understood that, although the hon. and gallant Member for Edinburgh University put down this Amendment in anticipation of the other one having been withdrawn or defeated, he was none the less of opinion that the Amendment now before the Committee was the proper one.
§ Sir W. CHEYNEThat is exactly what I was trying to say. I did not realise, when the right hon. Gentleman spoke about my Amendment, of which he approved very much, that he was asking me to withdraw my support from the 1466 Amendment now before the Committee. I understood that he was asking me if the Amendment which he had had drafted, or which was drafted for him, would meet my views. Of course it does. It gives me everything I want, and I accept it with the greatest of pleasure. I told him at the time that I considered that the proper thing to do was to leave out the words "and treatment." Therefore, I am breaking no bargain.
§ Sir H. NIELDWhen the deputation from the British Medical Association left the right hon. Gentleman's room they were under the impression that the words "and treatment" would be omitted from the Bill. I have only one other thing to say, so far as the present position of parents in relation to the children attending one or other of these schools to which this Clause is supposed to apply. I am quoting from the circular of the British Medical Association:
When we remember that it is possible already to have a poor family with at least nine medical practitioners interested in its physical welfare and provided by local authorities, the in-advisability of this new complication is evident. Taking, for example, a large family in a non-county borough and assuming, what is quite possible, that one child is mentally deficient, the following medical officers might be actively interested in the family—the county medical officer of health, with his tuberculosis officer, the county mental deficiency officer, the borough medical officer of health, with his school medical officer, the child welfare medical officer, the medical officer appointed to attend cases of measles and German measles, the insurance practitioner, and the Poor Law medical officer.Since this circular was issued two others have been appointed, the medical man in charge of maternity and infant life and the pre-natal clinic. To these you are going to add another, if the right hon. Gentleman insists upon retaining the words "and treatment," and unless the Amendment on the Paper in the name of the hon. and gallant Member for Edinburgh University is accepted. From an experience of twenty years in this House I say it will be most desirable that the Committee should insist upon having some definite promise as to what is meant by the domiciliary service of the proposed Clause. It will be most necessary to prevent the right of another doctor to come in to determine, on top of all these other medical officers who have the right of entry, the course of treatment which is to be administered to a child who is already attended to so prolifically by the State in 1467 the various Departments which care for the young. Something ought to be done, and the whole of this could be done better if it were put under a Ministry of Health.
§ Sir W. COLLINSI have not spoken on this Bill since the Second Reading because I was anxious, as far as possible, to expedite its course through the Committee stage, but having been challenged by hon. Gentlemen opposite, I venture to make one or two remarks. I have received communications from Constituents who are graduates in the universities represented by the hon. Baronet the Member for London University (Sir P. Magnus) and the hon. and gallant Member for Edinburgh University (Sir W. Cheyne). They are rather hostile to the proposals in this Clause of the Bill. I cannot recollect having received any representations from any of my Constituents in Derby on the subject. I therefore refrain from making any comment. I listened to what the President of the Board said and well remember, what he does not, the Debates in 1907 on the question of the provision of medical inspection and medical treatment As the right hon. Gentleman correctly stated, at that time it was clearly laid down that medical inspection was compulsory upon the local authority, that proper medical treatment was optional to the local authority, and that neither inspection nor treatment were compulsory on the parent or child. Since the State age of education has been raised the question has naturally also been raised as to how far these powers of medical inspection and treatment should apply to these later ages and to these other educational institutions. I can understand that there is a good deal to be said in favour of pursuing the same course in regard to these institutions and these ages as was followed regarding the earlier ages and the elementary institutions. I gather that the medical profession, or at any rate some members of it, view with some alarm this extension of medical treatment, especially in the case of secondary school children. It is quite true, as the last speaker indicated, that there is a great multiplicity of public medical treatment available to parents and children at the present time. It is rather difficult to discuss this question and the further extension of the State providing medical treatment without raising those larger questions, on the one hand, of the Insurance Act, which is a matter of history, and, on 1468 the other hand, of the Ministry of Health, which is a matter, apparently, of vaticination and some doubt. It is certainly the case that the medical profession has been largely municipalised. If some reformers could have their way it bids fair to be largely nationalised in the future. It is very difficult to discuss, as it were, piecemeal these questions of the further extension of public as against private treatment which are included in this Clause.
I understand that the President expressed some surprise that the hon. and gallant Member for Edinburgh University should not be content with the Amendment which stands in his name on the Paper, and which I gather the right hon. Gentleman is prepared to accept if the Amendment now under discussion were withdrawn or defeated. I gather from the Amendment standing in the name of the hon. Member for Edinburgh University that it would then be understood that the education authority, in making arrangements for treatment, would consider how far they could avail themselves of the services of private medical practitioners, and that that is intended to meet a criticism raised by the British Medical Association and other bodies. If the hon. and gallant Member for Edinburgh University is satisfied with that, I have no doubt it will satisfy those whom he represents. But I remember that in the Education (Administrative Provisions) Act, 1907, and also in the Provision of Meals Act of about the same date, powers were given to the local authorities to utilise the assistance of voluntary agencies. In the earlier reports of the medical officer of the Board of Education the use of voluntary hospitals was recommended rather than the employment of school clinics. In recent years, however, the reverse has rather obtained, and the school clinic is coming to the front and the voluntary agency—it is also the case with regard to feeding school children—is fading into the background. It is the old story that when the State steps in and makes a provision of this kind the tendency is for it to extend over the whole field and for private and voluntary work to disappear. That has not, however, been the case with regard to the voluntary hospitals. Many said that by the Insurance Act of 1911 the State would shoulder the burden of the voluntary hospitals. During the War, if it had not been for the voluntary hospitals shouldering the burden of the 1469 State military patients would have been in a very sad case. I hope that the day of the voluntary agency or of the private practitioner is not past. If the hon. and gallant Member for Edinburgh University is content with this attempt to meet him, which I confess I consider is a rather feeble one, I do not wish to disturb the harmony which appears to exist between him and the President of the Board of Education.
§ Lord H. CAVENDISH-BENTINCKLike some hon. Members who have spoken, I have no personal interest in this question. Unlike my hon. and learned Friend the Member for Ealing (Sir H. Nield) I do not care twopence about the domestic castle. That argument leaves me very cold indeed. I cannot understand the attitude taken up by the hon. and gallant Member for Edinburgh University (Sir W. Cheyne) who, if I understood his speech aright, laid down the proposition that the medical work was so well done during the school age that there was no need to carry it on afterwards. He quoted in his support the Report of Sir George Newman. I am afraid my hon. and gallant Friend has not really studied that Report or he would not have made such a statement. If he had read Sir George Newman's Report he would have seen that so far as defective vision is concerned the number of children who leave school with it is greater than the number with it when they enter.
§ Sir W. CHEYNEThey are treated.
§ Lord H. CAVENDISH-BENTINCKYes, but at the same time they are so imperfectly treated that, with the bad lighting of the schools and the small character of the print, on the whole, the result of the educational course is to impair their vision. In the same Report the hon. and gallant Member will read that half the children in the schools leave with defective teeth. He might also take heart of grace from the statement that the work of the education authorities does not in the least interfere with the vested interests of the doctors, for the simple reason that the defects of the children would never have been discovered if it had not been for the medical inspection. I often wonder what this House of Commons exists for. It is often supposed to be a faithful reflex of the opinions of the people of this country, but as I sit here I cannot help thinking it really 1470 and truly exists to represent vested interests of many kinds. I am tired of it all myself, and I am very sorry indeed that the President of the Board of Education has given way in a slight degree. All I care for is to see the adolescence of this country growing up as fine, active, and vigorous a people as we can get. I do not care how you get it as long as you do.
§ Sir W. PEARCEI think we ought to hear rather more what is the attitude of local education authorities on the subject. I think it puts an onerous duty upon them, and, to my mind, it becomes a question at what period of inspection the treatment should be discontinued. It has to be discontinued under present conditions at some period in the child's or a growing person's life, and I understand under this Clause it would be possible to carry inspection and treatment right up to the age of eighteen. I do not speak as an authority myself, and I think the Committee ought to know what are the views of the local education authorities on assuming such duties—whether they think they would be onerous or costly, or that it is really necessary and worth undertaking in the improvement which we all hope may be effected in national health.
§ Sir W. PEARCEI understand that inspection is compulsory. Although the treatment is not compulsory, I feel there is a possibility of a very heavy extra duty being put on the local education authorities, and I should be glad to hear from the President whether he is supported by them or whether he has received any protests.
§ Amendment negatived.
§ Sir W. CHEYNEI beg to move, at the end of Sub-section (1), to add the words,
Provided that the local education authority shall not establish a general domiciliary service of treatment by medical practitioners for children and young persons to whom this Section applies, and in making arrangements for their treatment the local education authority shall consider how far they can avail themselves of the services of private medical practitioners.
§ Mr. RAWLINSONWhat does the Amendment mean? Does it mean that you are to have inspection of all the children? I merely want to have it put into English. Inspection is compulsory upon every child.
Mr. FISHERNot compulsory on every child. The local education authority is compelled to provide inspection, but the parents of the child may refuse.
§ Mr. RAWLINSONSupposing there are fifty parents who consent to inspection. I presume that domiciliary service of treatment, whatever that may mean, is to ensue. What does this provision mean? Are the fifty children inspected by the medical inspector to be treated or are they not? If so, what is the meaning "shall not establish a general domiciliary-service of treatment"? It means that in every case where there is inspection, the medical officer is entitled to follow the person consenting and treat him at his own home. My Noble Friend, who is rather inclined to brush aside all discussion on these points, said that what he wished was the welfare of the children. There are others in the House who desire the welfare of the children. The whole object of the Committee stage is to see that what we are doing is in the best interests of the children at large. That is the reason why what knowledge we have ought to be put at the disposal of the Committee to help our discussion and see whether we are doing what we all require. I do not know whom my Noble Friend employs as his doctor, nor for the moment do I mind. I want the very best treatment for him. Does he get the best treatment by having three or four different doctors? I am very much afraid that may be the result of adopting an Amendment of this kind. There is the family doctor who looks after the person, and by this Amendment apparently you are to have power to have the child inspected and you are to have the inspector follow him and give him treatment.
Mr. FISHERI think the hon. and learned Gentleman is under a misapprehension. The effect of the Clause coupled with the Amendment will be this: First of all, the local education authority will be compelled to provide inspection. That inspection may or may not be accepted by the parent. Let us suppose that the parent of children at a particular school accepts. The inspectors discover certain ailments and notify the parent. The local education authority is empowered to provide treatment, but it is debarred from establishing a service of municipal doctors who will take the treatment out of the hands of the general practitioners. That is the object of the Amendment.
§ Mr. RAWLINSONI am obliged to the right hon. Gentleman for putting so clearly what he wants to do, but I do not think the Amendment will carry it out. The inspector comes, and finds, we will say, ten children suffering from some form of trouble, and the parents are notified. By this Clause they are entitled to provide that the inspector may follow and give treatment to the children who have consented to inspection. It is that power which I am cavilling at. What is the possible object of putting in this proviso if there is not to be a domiciliary service of treatment when we know inspection is voluntary in itself, and once the inspection has become voluntary there is nothing in the Clause to prevent the inspector following each of the ten cases and looking after them in the home, and these very big words, which I do not quite follow the meaning of—"a general domiciliary service of treatment by medical practitioners"—would have no effect, because the inspector who inspected the ten cases would have power to follow into the homes and deal with the children whom he had diagnosed in that particular form?
§ Mr. RAWLINSONOf course not. There is no question of the consent of the parents here, because the whole of the inspection can only be done with the consent of the parents, but the inspection having been begun with the consent of the parents, the local education authority provides a medical man who can follow and treat as well. That is the Clause as it stands, and I cannot see that this proviso makes the slightest difference one way or the other—in fact, it only serves to mystify anyone who has to read it. It does not add or take away from the power which exists that in each case where there has been inspection the doctor can follow. Where there is no inspection, of course he cannot. I think the Amendment is unnecessary and will only obscure the meaning of the Bill.
§ Sir R. ADKINSI do not quite see how far this goes. What some of us are exceedingly anxious to do is to facilitate in every way the health of the child, but to avoid all overlapping at a time like this, when we all look forward to a proper health authority and do not want to have any part of the ground still more cumbered than it is to-day. Therefore what we want to know is, Does this admit of the educa- 1473 tion authority arranging with the Insurance Commissioners or any other body for this private practitioner? It may be perfectly right, but one wants to know where we are. I hope the right hon. Gentleman, in some form or other, if not now on the Report stage, will see to it that there is no more overlapping. It is in the spirit of preventing that, which will be an obstruction to all kinds of local administration in matters of health, that I am now speaking in protest.
§ Sir W. CHEYNEIt is simply to prevent overlapping that the Amendment is moved. Take it yourselves. You have children at school. The doctor reports to the parent that the child has such-and-such a thing the matter with him. Having your own doctor, in whom you have complete confidence, you would not like a man from the school coming in, and you would say, "No; I am not going to allow your doctor to treat."
§ Sir W. ESSEXI feel that the President of the Board of Education desires what many Members and I myself desire, but I fear he may easily be led into a false position. I will not say anything ungenerous at the moment about the action of medical authorities under the Clause more than this, that in my years of attendance in this House I have always found it necessary to watch very closely when the medical authorities are on the warpath. I know how very strong their organisation is, and I therefore want that in this House we should, while appreciating the high services the community owes to the profession, see that they are not out more for their own interests than for those of the children with whom we are more immediately concerned. That may seem ungenerous, but I hope it will not be so interpreted. What can a school authority in a country town or a provincial borough understand to be the meaning of the phrase "domiciliary service"? It is admitted that the parent may have the right of inspection, and further, if he so wishes, to have some attendance at least from the medical officer. Is there to be no limitation to that, and, if there is, how much is to be measured out to the child, should it be a case of emergency, and at what particular point shall someone have the power to step in and say, "Now the voluntary doctor must come along"? I suggest to the hon. Gentleman (Sir W. Cheyne) and to the right hon. Gentleman that there should be a clear demarcation of 1474 the various interests here concerned, but keep the principal eye upon the interests of the child. You cannot define the lines of professional etiquette where one man's interest ceases, or one man's generous spirit will take him, and another interest begins. The right hon. Gentleman ought to consent to this being taken back and considered on Report with the assistance of the Mover of it, and they should endeavour to get some definite form of language, even by means of another Clause, which will give real guidance in precise and clear language to the small local provincial authorities who may have to interpret, sympathetically or otherwise, the provisions of the Bill.
§ 7.0 P.M.
§ Mr. HERBERT SAMUELTwo different questions seem to be involved in this matter: one is the interest of the private medical practitioner in distinction to that of the public medical officer. That has been very fully discussed on an Amendment which I understand is acceptable both to the medical profession and also to the Board of Education. The other point, which is perhaps much more important, is that of the right organisation of our public health service as between the education authority on the one hand and the public health authority on the other. There has been a good deal of friction in the past in this matter—there has been overlapping and sometimes contradiction. What I am concerned with is this, that it must not be taken that this House is determining that issue by passing this Clause. It may be said afterwards, when proposals for a Ministry of Health comes forward in the House of Commons, that this House has already decided this question, as between the local education authority on the one hand and the public health authority on the other, by passing a Clause which shows if to be the wish of the House of Commons that these matters should be under the education authority. I should be glad if my right hon. Friend can make a reassuring statement on that point and tell us that what is done to-day is really done ad interim, and that the whole subject may be open to review when we come to consider the general question of public health administration.
Mr. FISHERI am very glad to give my right hon. Friend and the Committee the assurance which has been asked for. I do regard this as an ad interim arrangement. We as a Board have had experience of the 1475 admirable results of the system of compulsory school inspection which has been the result of the establishment of a school medical service. All we are proposing to do in this Clause is to extend these admirable results which have been obtained within the sphere of elementary education to the continued education which is being provided for in this Bill. Assuming that a Ministry of Health is established hereafter, I think that that Ministry will in due course of time take over or supervise the medical functions now entrusted to the school medical service.
§ Sir P. MAGNUSMay I request my right hon. Friend the President to consider, between this and the Report stage, the possibility of introducing into this Amendment words which will prevent the overlapping of medical attendance, which it is feared may occur as between the panel doctor appointed under the Insurance Commissioners and the medical officer appointed under the local education authority? It seems possible that young persons between the ages of sixteen and eighteen may become subject to treatment by both these doctors, and that cannot be considered to be an advantage either to the patient or to the public service; therefore, I hope my right hon. Friend will see his way to introduce into the Amendment words which will prevent this undue overlapping, and the consequent additional cost.
Mr. FISHERThe Board is, of course, fully conscious of the dangers of overlapping, and they will confer with the Insurance Commissioners before sanctioning any arrangement for giving medical attendance to these young persons. But I would submit to the Committee that these are matters rather of administration than questions which can be settled by the introduction of words here.
§ Mr. WINGMay I suggest, in view of what has been said, that the Amendment be withdrawn, inasmuch as it has been pointed out that there is a possibility of conflict between the school doctor and the panel doctor.
§ Amendment agreed to.
§ Clause, as amended, ordered to stand part of the Bill.