§ Order for Second Reading read.
§ The PRESIDENT of the LOCAL GOVERNMENT BOARD (Mr. Hayes Fisher)
I beg to move, "That the Bill be now read a second time."
Attention, called to the fact that forty Members were not present; House counted, and, forty Members being found present—
§ Mr. HAYES FISHER
This is a Bill which has been much expected and long delayed. It is a Bill which, if passed, will do something at any rate to repair the ravages done by this War to the manpower of our country, because it will enable local authorities to afford further facilities for motherhood and for the care and welfare of the infant population of our country. The Bill seeks to extend the powers of local authorities in England and Wales for saving the lives of mothers and of children. It does that by developing in certain directions the powers which local authorities now have in the domain of maternity and child welfare. It ask for the local authorities of England and Wales the same powers as are now enjoyed by the local authorities of Scotland and Ireland, and which undoubtedly I Scotland have been used with very considerable benefit. It is no new policy. We have long had with us the machinery for maternity and child welfare. Originally it was more set up by voluntary bodies than by local authorities, but every year this policy of maternity and child welfare has grown more and more popular 804 with local authorities. There has been a very considerable growth of expenditure by the State on this effort to preserve our mothers and the infant population. In the year 1914–15 the expenditure was £10,439 by the local authorities and £1,049 by voluntary bodies—a total of £11,488 only. In the year 1917–18 the expenditure by the local authorities had jumped up to £92,985, while that of voluntary bodies had jumped up to £29,301, making a total of £122,286 spent on maternity and infant welfare. The sum voted by this House for the present financial year is nearly double that, being £230,000. What is the scheme of the Bill? It is that any local authority to which the Act applies may make such arrangements as may be approved by the Local Government Board for attending to the health of prospective mothers and nursing mothers and children who have not attained the age of five years and are not being educated in schools provided by the Board of Education.
That is the general scheme of the Bill. To what authorities does it apply? It does not apply to all authorities, large and small. That is a question on which there may be some difference of opinion, but it is more a point for the Committee stage. After all, power is left to the Local Government Board, after consultation with the council of any county, before it approves a scheme, and therefore before it is possible for any Grant to be made, to say to that local authority that it is better that certain particular powers shall be exercised, not by the county council but by the district council. Speaking generally, my experience at the Local Government Board certainly leads me to believe that, on the whole, in health matters and in that portion of health matters relating to maternity and infant welfare, it is better to have schemes operating over a large area than schemes operating over a small area. That is true not only of health activities, but I think of many other activities, and when this War is over we shall have very seriously to consider whether our local areas are the best areas in which to operate schemes for higher education, for public health, for electricity, and for matters of that kind. In our administration we are always brought up against the area question. That is not a question in which one, however, ought to go at any length in discussing this Bill. How are these powers to be exercised? We propose in Clause 2: 805 of the Bill that "every council in England and Wales which exercises these powers shall set up a committee, that all matters relating to the exercise of these powers shall be referred to such committee, and that the council before exercising any such powers shall, unless in their opinion the matter is urgent, receive and consider the report of the maternity and child welfare committee with respect to the matter in question. The council may also delegate to that committee any of its own powers under the Bill." The idea underlying the setting up of a committee of this kind is the idea which underlies the setting up by all county councils and by all councils of education committees with a view of attracting upon the committees persons who are not likely to obtain a place upon them by seeking election.
§ Mr. FISHER
The hon. Gentleman asks why not, and it is a very proper interrogation. There are, after all, a great many people, especially women, who are not going to face the unfortunate amount of mud slinging which often is associated with election to local bodies. That is one reason, but there is another. Those who seek election on committees of this kind for the sake of promoting questions of education or of public health are very often specialists in that one branch of public health only. They care for nothing else but education or public health, and they have devoted the whole of their lives to the subject. It has been undoubtedly the experience that on these committees you do obtain a great accession of really valuable material by allowing the councils to co-opt those who are peculiarly well adapted by their experience and their knowledge and their love of the subject. They do good service in the field of education or in the field of public health. Therefore, in considering the composition of this body with several of my colleagues who take as great an interest in this question as I do, we came to the conclusion that in administering these new powers of public health—and they are very important powers—it would be advisable for the council to appoint something like one-third of the committee from those who have not been elected, but who have special knowledge and experience of this subject, and are therefore peculiarly well qualified to promote the interests which under this Bill we 806 desire to promote and who would be a valuable addition to any committee upon which they were placed. Let the House notice that we reserve considerable power to the council itself, because two-thirds of the committee must consist of elected members of the council, so that the financial power is preserved to the council. As to the powers themselves, what will these local authorities be able to do if this Bill is passed which they cannot do now, or which, at any rate, they cannot legally do now, or cannot do without serious risk of being held up? Some of them are already carrying out some of these powers. I am afraid that some of them do occasionally go a little beyond the actual law in the matter, and take risks in order that they may do some of these things which they and we equally think that it is most desirable that they should be able to do.
Here are some of the things which local authorities will be able to do if this Bill is passed. They will be able to provide crèches and day nurseries. These are more and more needed in these days, when so many women are going out to work to help their country, and are doing most valuable work in connection with munitions and factories of all kinds. They will be able to establish convalescent homes for nursing mothers and children under five years of age. They will be able to establish homes and make other arrangements for attending to the health of children, under five years of age, of widowed, deserted, and unmarried mothers. Another power is to provide home helps or other assistance for securing proper conditions for the confinement of necessitous women. They can provide food for expectant and nursing mothers and for children under five years of age. As an emergency measure that can be done now, but only under certain Regulations under the Defence of the Realm Act. It would be far better to give this power generally in a Bill of this kind. The Bill will also provide direct authority for services which are performed now, but which perhaps are not altogether within the law now. It would give direct authority for midwives and maternity nurses for necessitous women, and for areas at present in need of this service. Last, but not least, the Bill provides direct authority for perhaps the most valuable of all the powers which are being more extensively used now—that is, the power to provide 807 maternity and welfare centres. May I break off here for a minute to point out what extreme value the Local Government Board attach to local authorities getting up within their areas complete schemes for maternity and child welfare centres? I may say that I am doing everything I can to encourage them to use the powers they have. Some of them are a little timid for fear they do not now legally possess these powers. I hope that when this Bill becomes an Act of Parliament they will no longer stay their hands, but will look to those local authorities which have met with the greatest possible success in setting up maternity and child welfare schemes, and that every single local authority will vie with one another and set up the most complete and perfect maternity and child welfare scheme it can possibly find.
May I say a word about expenses? A short time ago I visted a centre which has a perfect maternity and welfare system. It consisted of four health visitors, a whole-time doctor, a dental clinic, a hospital for the more difficult cases of confinement, a centre to which women expecting to have babies could go for advice during the whole period of their ante-natal treatment, and also a centre from which food and milk could be distributed under the certificate of the medical officer of health to all women who were in a necessitous condition or, at all events, whose condition was such that they could not obtain proper food and milk which it was necessary for them to obtain, if they were to go safely and healthily through the peril of their confinement and if they were to bring forth sound and healthy children. That centre also consisted of a maternity home, very well arranged, in which there were sixteen beds. If we take it that those sixteen beds were used throughout the year for a fortnight by each person who was delivered there of a child it would work out on the average to something like 240 women who would be able to go to that home and be confined. When you come to work out the expense to the borough of the whole of this most valuable system it amounts only to ¼d. rate. I ask anybody living in a house rated at £48 a year whether he would not be only too glad to give forty-eight farthings, or a shilling in the whole year, in order that the borough in which he resided might afford this splendid opportunity to the poorer people of having these 808 comforts which his wife would probably have for herself when she was in a similar time of need? Those are the powers we seek to give to these local authorities.
Who are asking for this Bill? I believe that the Government—this is a Government Bill—have the whole of public opinion behind them in this matter. Certainly, I have never had deputations approach me which have been so unanimous as the deputations who have come with a request for this Bill. I have had deputations from the leading local authorities, from the leading county councils, from the municipal corporations, from urban district councils, and from rural district councils. I put this question to them, "If you have these powers, will you make use of them?" One and all of them told me that there was no doubt about their making use of them. There is a possibility of applying a little stimulus on the part of the Local Government Board to recalcitrant local authorities, and possibly to timid local authorities by means of Grants, to use their powers in this direction. I propose to use every form of stimulus, if the Bill passes, to get the laggards among local authorities to come into line with the best local authorities and carry out this scheme. I have received many requests from organisations to do my best and to use my influence with the Government and the House of Commons to get this Bill passed. Here is a resolution, the latest, which I received this morning from the Women's Co-operative Guild:That this Congress strongly protests against the continued delay of the Maternity and Child Welfare Bill and calls upon the Government to place the needs of mothers and children before the wishes of interested parties and to give immediate facilities for passing the Bill into law.I maintain that public opinion is behind this Bill. Local authorities are all eager for it. They are all eager to use the powers which the Bill will give them directly it is passed. Who are opposing the Bill? It is opposed by my hon. and gallant Friend the senior Member for Plymouth (Major Astor) and a group of his friends and my friends. I am a little bit surprised that my hon. and gallant Friend should oppose this Bill, because for years past he has taken a very great interest in all public health matters and has used a great deal of energy and influence, most properly, to get these health matters attended to in this House, and 809 his general policy is to try and make it more popular with the public. I am therefore a little surprised that he should oppose this Bill, because he must agree with me that this is a measure which is designed to and will effect an enormous saving in infant life. Indeed I have a letter from him signed in his own hand as the Vice-Chairman of the National Baby Week Council in which he informs me thatA Minister of the Crown has stated that 50,000 babies could be saved each year by Government action.What Government action?
§ Mr. FISHER
My hon. and gallant Friend says "No," but he quotes a Minister of the Crown as stating that 50,000 babies could be saved every year by Government action. I know what he means. He means Lord Rhondda, the Minister for whose illness we are all extremely sorry and of whose return to health we would all be glad to hear. We all hope that he will speedily return to good health and carry on his great task. Lord Rhondda did say that the lives of 1,000 babies a week could be saved by Government action. What was the Government action? Here is a quotation from the reported speech made by Lord Rhondda at the meeting of the National Baby Week Council held at Bedford College on 30th July last:I proposed introducing a very short Bill relating to maternity and child welfare, simply empowering the local authorities in England and Wales to exercise the powers which are now given to Scotland and Ireland. Well, you would think it inconceivable, wouldn't you, that such a Bill would be opposed for a single moment.… It was only a Bill of a single clause—the effective part of it.… I believe, from information supplied to me by responsible men—I am not making this statement on my own responsibility—that it is possible to save the lives of one thousand babies a week by such a Bill as this. A thousand baby lives a week!That is the very Bill for which I am now asking the Second Reading. Lord Rhondda went on to say:Isn't it a criminal thing that a baby Bill such as I proposed should be introduced should have been delayed for a single day. It out-Herod's Herod!It is this very Bill, therefore I am a little surprised that my hon. and gallant Friend 810 should oppose this Bill, because in his letter to me he added:Until the Government take action, voluntary action must do the work which they ought to be doing.8.0 P.M.
Here we are taking action in order that the local authorities may be able to do the work which the voluntary organisations can now do, because the Treasury has been really very generous in the matter. I urged them, and after a very short time the Treasury gave their decision and informed the Local Government Board that they would gladly make new Grants and would make new Regulations for all these things, comprising all these powers of which I have just informed the House, and if these new Grants and new Regulations are made, then for the first time local authorities will be legally empowered to do all these things which voluntary associations can now do, and for which voluntary associations can obtain Grants. That is really carrying out what my hon. and gallant Friend wants to see carried out—the Government taking action in order to enable local authorities to do the very things which voluntary effort up to the present has done. I am perfectly aware that the reason for my hon. Friend's opposition, and for that of several other Gentlemen, is that they think they can use this Bill as a lever for a larger measure, and that if this is not passed it will enable them to agitate the country a little more for the Ministry of Health Bill. This Bill is not a substitute for the Ministry of Health Bill. I believe every member of the Government approves of it. It is a Government Bill. The Ministry of Health Bill also in its main outlines has been approved by the Government. I know some people think an agreed Bill could be introduced and would pass through the House in a very few days. I am not one of them. It is a great measure, which I hope to see passed in an agreed form, covering the whole subject, but I do not believe for a moment that it is possible to carry a Ministry of Health Bill through the House, unless the Government can find time for it. I believe this little Bill really ought to go through, and we ought to get the advantages of it at once. We ought not to delay, because if we can keep a thousand babies' lives a week saved by a Bill like this, the lives of a thousand babies a week are being lost while we delay. You cannot shut your 811 eyes and ears to the observations that you hear if you will only listen. Yes, we are all in favour of the Ministry of Public Health Bill, but when you come to frame it it must be a large measure, and you must give the House of Commons ample time to discuss it.
§ Mr. ANDERSON
May I ask a question on one point which seems to give some perturbation, whether this Bill will be used in any way as an excuse for postponing the larger measure?
§ Mr. FISHER
I will answer frankly and fully for myself. I will not accept this in any way as a substitute for the Ministry of Health Bill, and directly the Government can give time—it must be really adequate time—
§ Mr. FISHER
I think my right hon. Friend means this Session. After all, there may be an Autumn Session. Let the Government give time for the discussion of the Ministry of Health Bill, and I will give any assistance in my power and any influence I have with the Government to enable it to bring that Bill before the House. You may not agree with all the details of the Bill, but the sooner we can co-ordinate the Departments dealing with public health the better. There is no doubt you want to fuse the Local Government Board and the National Insurance Commission, and to carry out many things of that kind. It is impossible really for anybody to go into this question at all deeply without seeing that directly you try to set up a Ministry of Health and deal with the public health policy of this country you are confronted with the whole of the Poor Law system. I am not saying this is insoluble, by any means, but the Poor Law not only must play a very large part in the future public health policy of the country, but when you come to the discussion of public health you cannot ask the House of Commons—it would not be any good to ask it—to discuss the Ministry of Health without to a certain extent discussing the public health policy that is going to follow on after you have created this great public health machine. My plea with my Friends is this: Use all you efforts with the Government to introduce the Ministry of Health Bill. After all, when you have it this is exactly one of the measures 812 Which you will require. Then when you have got the little Bill—after all, we can get it first—the local authorities will make use of their powers under it and the whole power under it would pass hereafter under the supervision and direction of the Ministry of Health after it was set up. That represents the difference between myself and my hon. Friend. They say, "This is a good policy, but wait till you get the Ministry of Health Bill." I say, "No; this is a good policy and do not wait till you can get your Ministry of Health Bill, but give us this, which we want." The local authorities desire to undertake the work, the Local Government Board desires to help them, the Treasury is willing to find the money and the House of Commons has voted the money. Let us get on with this splendid work of trying to save life. We often hear the phrase, "Let us get on with the War." Let us get on with the War even though it involves the death and destruction of hundreds of thousands of our citizens. We know it must be so. But let us get on with this kind of legislation which does something to repair the ravages of the war and to preserve for this country its greatest national asset, and enables children to come into the world under far easier and happier circumstances and with a far better chance of living than they have at present if only these powers are given to the local authorities to use them as I have every reason to believe they will.
§ Major ASTOR
I beg to move, to leave out from the word "That" to the end of the Question, and to add instead thereof the words,in the opinion of this House, a Bill dealing with maternity and child welfare is not satisfactory unless it is accompanied by legislation combining in a Ministry of Health the Local Government Board and the Health Insurance Commissions for England and Wales, and taking powers to transfer thereto the health functions of other Government Departments.It was not until some time after I had come to the House that I heard this measure was likely to come up for discussion, and I know that several hon. Members who do not belong to the same party that I do, but who hold the same views as I do about this Bill, would have been here to take the same line as I am doing had they known it was likely to come up for discussion. I am grateful to my right hon. Friend for saying that I am very much interested in health matters, but the reason why I put down this Amendment 813 is because I do not want people to believe that it is going to do more than it actually will accomplish. There is a great public demand for dealing with health and health matters. I do not want to make the public believe that something big is being done. Next week is baby week, and I do not want people who come to the opening conference to be told, "Do not go on pressing for a Ministry of Health. You have had your Maternity Bill through. Give that a chance. Wait and see what happens." When listening to my right hon. Friend I felt more than ever convinced that what we need now more than almost anything else is to reorganise our machine. We want to get our administrative machinery in order. Then after we have done that let us proceed to legislate. This is only a bit of the health legislation that this country requires. There is a great deal more dealing with children, with adults, with men and women, and the great preparations which ought to be made for the troops before they return, the diseases which will be brought back from men in the Army fighting in tropical and subtropical areas. We ought to be getting ready with that. We ought to be having one Department, not several, making plans for preventing the spread of malaria, dysentery, and other diseases. My right hon. Friend said, "You must not proceed with the Ministry of Health until you have thought out your policy." I claim that if we are to wait until we know exactly where we are going in health legislation, until we all agree as to what the goal is which we are going to reach, we shall never really proceed.
It seems to me that what we ought to do now is, during the brief intervals that we can snatch between war measures—I am not one who would say anything dealing with health and the saving of life was not a war measure, but I meant the intervals in the time we spend in considering the prosecution of the War. In my opinion we ought to be preparing machinery which will enable us to deal with the problems of reconstruction adequately when the War is over. It is one of the reasons why I am in favour of what is called the federal solution, the creation of other Parliaments, because I do not believe this Parliament by itself could possibly deal with the mass of legislation, Imperial and domestic, which will have to be passed when the War is over. Similarly the other day I was in 814 favour of the Trade Boards Bill because that would set up machinery for dealing with industrial questions. It is obvious to everyone interested in social questions that during the War you cannot possibly find time to deal with what we call social reform adequately. What you can do, and what I suggest this House ought to do, is to prepare the machinery or to create such machinery as will be able to deal with these problems adequately and with sufficient rapidity when the time comes, because if we have not got the necessary legislative machinery, I believe we shall be faced with a very serious situation when the War is over. It is because of that that I feel that, instead of trying to tinker with public health, with child welfare and maternity, we should be more usefully employed not in passing legislation for new powers and new functions, but merely creating under one head a Ministry of Health—not a twenty or thirty Clause Bill. A three Clause Bill will be quite adequate. Roughly, the first Clause would unite under one head the main Departments dealing with public health. In the second Clause you might take care to transfer by Order in Council existing health functions from other Departments, such as the Local Government Board and the Insurance Commission, to the Ministry of Health, not to create new powers by Order in Council but to take power by Order in Council to transfer to your new Ministry such existing functions and powers as other Departments possess.
It being a Quarter past Eight of the clock, and there being Private Business set down by direction of the Chairman of Ways and Means under Standing Order No. 8, further proceeding was postponed without Question put.