HC Deb 24 June 1918 vol 107 cc821-51

Postponed Proceeding resumed on Question, "That the Bill be now read a second time."

Question again proposed.


When we were interrupted just now I was pointing out that, in urging upon the Government the, desirability and feasibility of passing a Bill setting up a Ministry of Health, I did not contemplate a Bill of ten, twenty, or thirty Clauses, or increasing the amount of power which the Ministry would have. The first power which you want is, I think, to co-ordinate at the centre under one head the principal Government Departments that deal with public health, and I was engaged in pointing out that it was quite possible to establish a Ministry of Health by passing a three-Clause Bill. The first Clause would put under one head the Local Government Board and the Insurance Commission. The second Clause would give power to transfer, by Order in Council, to that Ministry existing health functions which now are administered by other Government Departments—such as the Home Office, the Board of Education, and the Board of Trade. The third Clause would give power to the Government to take away from that Ministry such non-health functions as would be transferred to it by the first Clause. These are such powers as audit—an entirely non-health function—or the demarcation of local authorities' boundaries, which would at the beginning be put under the Ministry of Health, but which it is not at all necessary should remain there, and much the easiest way of dealing with the matter would be to take power by Order in Council to transfer from the new Ministry of Health any non-health function, whenever that was thought desirable. Poor Law, for instance, might be divided, the health side remaining with the Local Government Board and the non-health side with the Home Office. I give that as an illustration. Audit might be handed over to the Treasury. And so it is possible, by a three-Clause Bill, to set up a Ministry of Health. Having set up a Ministry of Health, and having got your main health functions under one head in one Department and not scattered about Whitehall, you then would be able to decide far more effectively and in a far more statesmanlike manner what new powers are necessary. It would be far easier to carry a Bill asking Parliament to deal with new powers relating to health functions. The mere fact that for the last two years Government Departments have been quarrelling with each other as to whether this Bill ought to be passed is the greatest argument that could be adduced as to the advisability of having one Department and not several dealing with health functions.

Everyone who has had anything to do with administration knows perfectly well the amount of time that is wasted by negotiation between Government Departments where their functions overlap or interlock, and it is because of that that to my mind you will advance far more rapidly if you can establish the principle that there shall be one Department, not half a dozen, and one Minister, not half a dozen, dealing with health. If you do that you can not only pass a Bill such as this but many others, and these new powers are needed to develop and increase our health services throughout the country. It is fallacious, misleading, and unfair to talk of a Bill setting up a Ministry of Health as being a large Bill. It is a small Bill. It need only co-ordinate existing functions. Every Member of Parliament knows how difficult it is to get this House to increase the powers either of a central department or of local authorities, but everybody knows how easy it is to get a consolidating measure through this House. At this moment there is great agitation about the overlapping of new Departments with their large numbers of officials. A Ministry of Health would decrease the number of Departments and of officials. Such a Ministry would be dealt with by a small Bill which would put under one head existing functions. It is not necessary to settle what your health policy for the future is going to be. If you set up a Ministry of Health it is sufficient at the start. It is a big step forward to take the existing functions and put them under one head. You will have provided the machinery if you pass a Bill doing this, and then we ought to contemplate not only measures like this but others, wider measures giving numerous wider powers to local authorities to deal with health functions.

We have already wasted at least two Fridays by not sitting. We do not want to mortgage the available days which remain by passing measures which really will not accomplish a great deal, whereas we could pass another Bill in just as short a time consolidating and transferring functions under one head as I have explained. I do not think there would be more opposition, and I am convinced that you would actually do a great deal more by such a proposal. In any case, I suggest that my right hon. Friend and others connected with him in health administration should join and introduce such a Bill, and that it should pass through its First Reading and all its stages pari passu with this Bill. If my right hon. Friend will give me an assurance that he will do that, I will try and facilitate as far as I can, the passing of this Bill. I think this is essentially a matter which ought to be arranged. These two measures ought to be passed and go to the same Committee upstairs, and they ought to be incorporated in one Bill, and I believe my right hon. Friend would make far more rapid progress with this Bill, and would develop more rapidly the health powers and functions of his Department and of the local authorities, if concurrently he were to pass and assist in pushing through another Bill rearranging the health functions of the Government. Why is it that it is so necessary to do away with this overlapping, duplication, and jealousy, and to get your health powers under one Ministry?

Let us glance for a moment at the Departments which deal with health functions and see what, chaos there is and what grounds there are for rivalry, obstruction, and jealousy. There is, first of all, my right hon. Friend's Department, which deals in the main with the prevention of disease and also with the provision and supervision of institutions for institutional residential treatment. My right hon. Friend's Department deals with general sanitation—that is to say, the prevention of disease, housing, water, and so forth. It does not deal with domiciliary treatment, or so much with the cure of disease, as with the prevention of it in hospitals and other institutions. Then you have the Insurance Commission, created very largely because the Local Government Board was not filling the bill. The Insurance Commission, in the main, is curative, and deals with attacking disease in the home—domiciliary treatment through panel doctors. The prevention and the cure of disease had far better be dealt with by one Minister in one Department. You would get ahead far more rapidly if you could have the prevention and the treatment of disease dealt with by one staff under one chief. Then you have got the Board of Education, which is a sort of health department for the children. It deals with the inspection and treatment of school children, and it does so very largely because the Local Government Board in the past was not progressing as rapidly as it ought to have done in the treatment and prevention of disease. If the Local Government Board had been active and pushing in the past, it would have been dealing with the prevention and treatment of disease with children. It is the Department that ought to do it, and it is only because the Board of Education was an enterprising Department that this great and very valuable function is performed by it, and most efficiently performed too. But a new vested interest has been created, and I want to prevent that sort of thing, of new vested interests being created all round Whitehall. The longer you wait the more vested interests you set up. My right hon. Friend proposes to set up an entirely new local authority under this Bill, covering a new area.

9.0 P.M.

The Ministry of Munitions have a Welfare Department, and more has been accomplished during the course of the War in two years in those matters of industrial health that have been occupying the attention of the Home Office for the last generation. Next you have the Home Office dealing with industrial health, and also dealing with the mentally defective or lunatics; you have, as I have pointed out, the Ministry of Munitions going into the question of industrial health; you have the Board of Agriculture connected with public health through, for instance, the purity of milk; you have got the Board of Trade concerned with health on board ship. So here you have sketched out very briefly some of the main functions of the different Government Departments connected with public health. I could go into the matter much more fully, but the outline I have given shows the amount of overlapping and duplication there is in Government machinery dealing with the health of the community. We know perfectly well that overlapping means delay; we know perfectly well the way in which Government Departments hold each other up. It is not a question of two or three Government Departments, but of half a dozen, all trying to deal with different aspects of a particular problem. But, after all, we must look to fighting disease as we now look to fight the enemy in the battle-field. When this War is over we shall still have disease to encounter, and we must be in a position not only to fight it but to defeat it. Surely the methods and principles which make for success in war are methods and principles which might well be applied in counteracting and overcoming disease. Sir Douglas Haig is fighting against the enemy, but in doing so he has, not six general staffs, but one general staff at headquarters. In the same way, the French have one head, not half a dozen heads, dealing independently or by negotiation with each other, but each taking his own plan of campaign after long negotiation. If you wish to have progress, and effect rapid results, in dealing with various kinds of disease, it must be by having one Minister, and not a number of overlapping Departments, and I submit that there can be no adequate and effectual dealing with maternity and child welfare, unless it is conducted under a distinctive head and with proper co-ordination.

This Bill deals with that subject in only a very limited way. Insurance Commissions have maternity benefit, but do not provide institutional or domiciliary treatment; the Board of Education also has its finger in the pie, and deals with the question of instruction in regard to maternity; and, over and above, you have another Department responsible for the training of midwives, the Privy Council. You have the Local Government Board, the Insurance Commissions, the Board of Education, and the Privy Council all playing at trying to deal with maternity welfare, and with the question of reducing infant mortality, but none of them primarily responsible. Where a woman has been improperly treated in a maternity case she does not want to go to the Privy Council, or her husband does not want to do that for her. What the husband wishes is to go to the Minister who can be held responsible for her treatment. There is no Minister in this House to whom the husband of a pregnant woman could go, or who could be held responsible for inadequate provision of maternity treatment. There should be a single Minister whom the mothers of this country and the fathers of this country could hold responsible for seeing that adequate treatment is given, but, as it is, there are so many Ministers that they do not know whom to hold responsible. I was informed only recently that the Ministry of Munitions wanted maternity treatment for, a woman who had left home and gone into munition works, and, as the result, they set up their own Maternity Department. So that while we have so many Government Departments tinkering with this matter, we have this war Department for the making of munitions, establishing maternity treatment, which it puts into the hands of a special Department of the Ministry of Munitions. What we want is to have all these matters connected with maternity and child welfare put under one head, and in that way mothers would be benefited and infantile mortality would be successfully reduced. This Bill does not make one Minister responsible, but still leaves all the overlapping, duplication, and the jealousy between rival Ministers.

My right hon. Friend mentioned the waste of infant life. It is a matter which makes everybody reflect. Nobody wants to do anything to prevent the reduction of infantile mortality. We want to stimulate everybody, every Department, every sound measure which will deal adequately with this question of preventable infantile mortality. We are losing too many useful, valuable lives over in France. We want to save as many lives that will grow up and take their place. The Registrar-General has only recently announced that, since the beginning of the War, 500,000 potential lives have been lost to this country—children that would have been born if it had not been for the War. We want to try to deal with this measure properly. We do not want to make the public believe that something big is going to be done, when, in fact, the matter is not going to be dealt with. Those of us who are here, I always feel, have a great duty in matters like this to the fathers who are in France, who are looking to those in this country to see that their children's lives are protected and are dealt with adequately. It is because of that there has been this growing demand from the public for the establishment of a Ministry of Health, and for the setting up of it at an early date. My right hon. Friend quoted the Food Controller, Lord Rhondda. I was at a meeting in Cardiff, speaking on the question of a Ministry of Health, and Lord Rhondda was there, and he stated emphatically that when he said that 1,000 baby lives could be saved every week if a certain measure were taken, what he had in mind was the establishment of a Ministry of Health such as I have described just now. He was quite clear about it, that it was not this Maternity Bill that in his idea would reduce and prevent this loss of 1,000 baby lives. I was there and heard it, and it was reported. Referring to this measure for the establishment of a Ministry of Health such as I have described—not a thirty Clause Bill, but a three Clause Bill, putting all existing functions under one head—he said: This was a measure which could not wait until after the War, for every week that went by meant a great loss of child life. Lord Rhondda referred, not to this so-called little Bill, but to the establishment of a Ministry of Health. He was quite clear about it. I pointed that out in a letter to the Press, which I thought my right hon. Friend had seen. So that in Lord Rhondda's opinion there was a preventable loss every week of 1,000 babies, and that loss could be prevented not by this Bill, but by the co-ordination of existing functions under one Minister. The Prime Minister said to a deputation, according to the papers, that if agreement on such a proposal as this were arrived at, he would do all he could to help it through. I have read in the papers that the Minister of Reconstruction had been negotiating with the different interests or interested parties—I do not know exactly what is meant by that—but he thought he had got substantial agreement, and that he would be ready to come down to this House and to introduce that Bill for the establishment of a Ministry of Health, which, in the opinion of Lord Rhondda, would do so much to reduce this preventable loss of child life. The Minister of Reconstruction made that statement some weeks ago. Where is that Bill? Who is holding it up? What interest or what Department is preventing agreement on that measure of co-ordination which, in the opinion of Lord Rhondda, is necessary to prevent this unnecessary loss of child life?

I was attending a great conference some months ago on matters dealing with public health, and I remember a message being read out from a member of the War Cabinet, Lord Milner, saying that, in his opinion, the first step was co-ordination at the head—that the first step necessary in public health was to put existing health powers under one Minister. Why have we not got that Bill? Why have we not it here to-night? If these Ministers of the Crown—a member of the War Cabinet and my right hon. Friend's predecessor as President of the Local Government Board—in their considered judgment say that that was the measure which was going to prevent unnecessary child mortality, why have we not got it here now? It is not a twenty-Clause Bill or a thirty-Clause Bill. It is a little Bill, but it will do a great deal. It is true this is a little Bill so far as the number of Clauses are concerned, but it has some rather dangerous principles in it, and I do not think it is going to do so very much. The Leader of the House of Lords, Lord Curzon, speaking only recently, said that the Ministry of Health was being delayed at the moment because of Departmental jealousy. Is not this a case for the War Cabinet to interfere? Is this necessary measure for the saving of child life to be held up indefinitely because of Departmental jealousy? I am only speaking from what I have heard. I did not hear the speech myself, but I understand that that is what the Leader of the House of Lords said. Surely this sort of thing ought not to be allowed. It is a war measure. The men who are fighting in France want to know that this preventable infantile mortality is being tackled seriously, and why the measure which we have been assured on the highest authority will reduce that mortality is not produced. Why is Departmental jealousy making it possible for it to be delayed so many months? Can you imagine any responsible Minister saying that there was a preventable loss of 1,000 soldiers' lives every week, and the Government not at once taking action to prevent it? Why is it that the country does not demand, and the House of Commons does not demand, that the measure should be passed without delay?

There are one or two points connected with the Bill introduced to-day which I should like to raise. First of all, it is an empowering Bill. It does not compel anybody to do anything, and that is a point which the House should bear in mind when it looks on it as a measure of social reform, and likely to reduce infantile mortality. It authorises practically any local authority to provide its particular scheme if it is sanctioned by the Local Government Board. But the Local Government Board does not even lay down the scheme. It leaves the initiative to the local authority. Those of us who have experience of local authorities know what delays there will be in many parts of the country. You will get the backward local authorities, the recalcitrant local authorities, holding back from making the necessary provision. The Local Government Board is not able to compel them to move. It has no compulsory power to move. It can only tempt them with Grants-in-Aid. This Bill also enables the smaller local authorities, the rural district councils, to be the authority to deal with maternity. Anybody who has any acquaintance with rural district councils knows how much assistance you are going to get if you leave it to them. I for one am not prepared to leave the development of the maternity services entirely to the persuasive powers of the Local Government Board. I do not believe that you have got the new spirit in the Local Government Board which you require if you want a real development of the health services. It is because of the Poor Law-spirit which existed there, along with some of the traditions, that the Insurance Commission was set up as a separate Department. I believe, if you amalgamate those two Departments, and have that new spirit that experience suggests—and undoubtedly most valuable experience does exist in the Local Government Board—you will then at last get a "move" on.

As I said just now, the Bill is to set up an entirely new local authority—not the old education authority, not the county council, but a new authority for every 20,000 inhabitants. Surely we have got enough local authorities without establishing a new one? If we are going to deal with local authorities let us deal with them properly, and not by piecemeal. Those are some of the main reasons why I have put down the Motion which stands in my name on the Paper. I am very much afraid that the public opinion which has been demanding action, which has been demanding the establishment of a Ministry of Health, will be tempted to say: "Give the Maternity Bill a chance; let us see what happens, do not let us push for the establishment of a Ministry of Health; let us see what this new Bill—which, it is true, even those who introduced it admit is a little Bill—let us see what this Bill, with small and optional powers dealing with small authorities does. Let us give it a run. Let us see if anything happens." I believe we ought to deal at the present time with the reduction of infantile mortality. We ought to establish the machinery which will enable us to deal with these diseases which are going to be brought back from some of these tropical districts and countries where the men are fighting. I think we ought to do that now, so as to be ready with our machinery, with one staff, and under one head. In the last six months we have had examples of the value of co-ordination under one head. Within the last month the Allies, who tried to fight Germany separately and by negotiation, came to the conclusion that the only thing to do was to co-ordinate, which they did by the Versailles Council. More recently they have co-ordinated under one generalissimo. That is what we want to do with disease. We want to have one head, not six heads; one Department, not half a dozen Departments, dealing with this great question of fighting disease and infantile mortality. It is because I hold the views I do that I beg to move the Amendment standing in my name.


I beg to second the Amendment.

I do so on two grounds. I quite agree that the Bill will do something, but, in my judgment, the Bill is a very little one, such as a minimum public opinion demanded, no more; and it has very serious faults. I do not like the Bill. That is my first ground for seconding the Amendment. My second ground is this: I believe it will make it more difficult and less likely to establish a Ministry of Public Health. Let me deal shortly with my objections. First of all, I object to it because it is optional. Surely the right hon. Gentleman knows perfectly well what an optional Bill means! It means that when you come to deal with local authorities—and you will deal with a very large number—on the one hand you will deal with the most progressive who are already, somehow or other, doing the work, and, on the other hand, with the least progressive who do not want to do it, and whom you cannot compel. In a work, it is perfectly well known that an optional Bill at this time will not "do the trick." It really almost savours of eyewash to bring in a Bill of this sort at this time of the War. In the second place, you are making a new local authority. I want the House to realise that quite distinctly. The local sanitary authority, which is the public health authority in the counties and towns all over the land, is passed over, and a new local and a larger authority is made. That may be all right, but it simply means that instead of simplifying the confusion which exists you add to it. You have made a new health department. There is also the further point: My right hon. Friend said, and said quite distinctly, that he believed that these questions were better treated by the larger local authorities. I presume by that he meant the county council, the borough council, or the larger county urban authority. In the new Bill a limit of 20,000 population is put. I am sure that is too low. Let me give one single example.

I see nobody here on the Front Bench representing the Local Government Board, and it is really rather a farce to speak when nobody official is listening. I have a question to ask when those concerned come back, as I suppose they will do some time. My question is this: At present the administration of the Mid-wives Act is under the county councils. It is very important that there should be a large area included in the local authority which administers the Midwives Act, because unless you have a large area you cannot employ a good inspector who can keep the midwives in hand by constant inspection. She must have constant inspection or she loses her power; also the smaller authorities cannot afford to pay the same amount as a larger authority. So if you hand over the inspection of mid-wives to these smaller authorities you take a retrograde step. There are further examples that I might cite. The last objection I have to the Bill is in Sub-section (2), at the bottom of page 1, which gives the Local Government Board power to delegate the authority referred to in this Bill to the smallest local authority if it likes. First of all, I think that the Local Government Board are the wrong people to have that authority, and if it should be delegated to anybody it should be to the county council or to the borough council. My right hon. Friend said that he himself favoured the larger local authorities. When, I would like to know, did the Local Government Board arrive at this decision? Their reputation points in a very different direction; it has always been said that they favoured smaller local authorities against bigger ones. I do not think I am unduly suspicious, but the knowledge of what has occurred in the past makes me very doubtful of the advisability of giving them the power to take away from the county councils the control over these maternity and child welfare boards and give it to the smaller local authorities.

Let me summarise my points against the Bill. First, I object because it is optional; secondly, because it increases the existing chaos; thirdly, because it works through smaller local authorities; and, fourthly, because it gives the Local Government Board the power to transfer this work to still smaller authorities. Let me say a few words on the question of a Ministry of Public Health. I listened very carefully to all that my right hon. Friend said. He told us that he himself was strongly in favour of a Ministry of Public Health. Then I wish he would throw his great abilities with rather more zeal into the task of passing that Bill. I am quite certain the House would pass it because it does not want a continuance of the absurdities that now occur. Really it is absurd that, in the middle of a great war, when lives are more important than they ever were before—it is, I say, absurd that we should have six or eight different Departments, each of which does a little bit of public health work. Why should we have this work divided up in this way for no reason except departmental and historical grounds, and why should there not be one Minister in this House responsible for the health of the people? My right hon. Friend said he had a great deal of public support behind this Bill; be told us he had received many deputations, and he was good enough to read to the House what some of them had said. May I ask how many deputations he has received urging him to pass a Bill establishing a Ministry of Public Health? Of course I do not know, I am not in his confidence, but judging from the Press and the platform one knows that the demand for such a Bill must be ten times as great as it is for this present Bill. Let us see what is happening, now. I want the House to realise how many different authorities are already called in to deal with child life. Let the House try and realise what occurs to the child now. The child is born under the auspices of the Privy Council, the body which is the national authority for the supervision of midwives. As soon as it leaves the ample arms of the midwife it will, I suppose, be handed over to my right hon. Friend, who will delegate his powers to the maternity centre, if there is one; if there is none, I do not know what he will do. Let the House mark this, the maternity authority under this Bill is only one of the local health authorities which are brought into operation. When the child leaves the care of the maternity authority it reverts, as a member of the normal population, to the charge of the public health authority—the local sanitary authority. Then, as soon as it reaches five years of age—it may be earlier or at any time, for no clear line is cut as to the age, but assuming that our infant has been nurtured under the fostering care of my right hon. Friend until is has attained school age, it then passes to a wholly different authority, a wholly different medical service, but only so far as it is a school child: in its home life it is still under the local authority and its infant body is battledored and shuttlecocked from one to the other of these competing authorities. The absurdity does not end there. The father of the child may be overtaken by financial disaster and may have to go on the poor rate. The child thereupon, so long as the father is insolvent, may be sent to a Poor Law Infirmary, where no doubt he may be pretty well treated, but as soon as the father regains his solvency the child returns to the care of the local sanitary authority, not, however, for any reasons connected with health. Assuming he survives all this and reaches the age of fourteen, he goes to work. He obtains employment in a factory or workshop; then the Home Office steps in to take care of his industrial health. If he transfers his labours to a munition works, he comes under a totally different authority—not the Home Office but the Ministry of Munitions, who seeks to protest him against industrial disease. We have not reached the end of it. The boy's father may have served his country with distinction and have come home wounded; then there appears on the scene the Minister of Pensions, who provides medical treatment and nursing, not merely for the soldier but for all his dependants. At the same time the Board of Agriculture are also benignly watching his health in order to keep him free from certain diseases. Further, I am reminded that his father almost certainly will be one of the fourteen and a half millions of insured persons in this country, and the local insurance committees also come on the scene and concern themselves with this child's health.

Between his birth and the time when he leaves school he has to pass through the meshes of eight or nine different authorities, and he passes from one to the other not for any particular reason, but simply because of the chaotic system which obtains. In spite of all this, my right hon. Friend comes down here and, without saying anything about the existing authorities, just adds one more authority, and tells us he believes that by adopting his method the lives of a thousand babies will be saved. I do not think the House will credit that statement. I observe with some regret that my right hon. Friend has some rooted antipathy to the Bill which is being advocated for the establishment of a Ministry of Public Health, although it has received all the encouragement imaginable; indeed, I have never known a stronger call by the Press, on the platform, or in the pulpit than the call for this Ministry. All my right hon. Friend's colleagues are against him, they nearly all favour a Ministry of Public Health as against this Bill. It is common knowledge that before Lord Rhondda left the Local Government Board he had in hand a Bill for the establishment of this Ministry. Where is that Bill? I forget the exact date when Lord Rhondda assumed his present duties, but ever since then the Bill has been held up. When Lord Rhondda spoke of the loss of 1,000 babies a week he had in mind the passing of this Bill for the establishment of a Ministry of Public Health. That is why I feel that we ought not to pass this Bill without a strong protest. My right hon. Friend charged us with using this Bill as a lever for bringing in a Bill to establish a Ministry of Public Health. With all respect, the boot is on the other leg. We are not using this Bill as a lever; we are afraid of him using this Bill as camouflage. We are afraid that when this Bill has passed, doing the very least that will satisfy public opinion, he hopes the whole controversy will be put to rest. It is very curious and inexplicable that when the right hon. Gentleman had the biggest chance a Minister ever had he should have neglected it. He had at his feet the biggest opportunity of helping the health of this country that was ever given to any man. It so happened that there was a consensus of public opinion, and the right hon. Gentleman only had to lift his little finger and he would have got the time from the Government. He has not done so. I do not in the least know what the reasons are, but I fear that, whatever they are, they will still remain. I feel that if we pass this Bill without any assurance that a Minister of Public Health will be instituted, the right hon. Gentleman will have a chance of saying to the public that he has done that which the public requires, and this Bill may be used as a means of putting off still further a Bill for the establishment of a Ministry of Public Health. It is for that reason that I speak to-night. As far as the Bill itself is concerned, if it stands on its own merits I should not oppose it, but it is because I feel that it may be used to defeat something far more valuable that I speak against it. Even now I appeal to my right hon. Friend. He will reply soon. Cannot he give some hope to the hundreds of thousands of people who are looking for something to improve the public health. If he would only say that he would bring in the Bill this year and that the Bill had some chance, I am certain that all opposition to this Bill would be withdrawn.


Whatever differences manifest themselves as to the method by which this thing should be done, there will be a general agreement in all parts of the House that it is urgently necessary that steps should be taken in the direction of securing the objects of this Bill. That a thousand infants should die every week whose lives could be saved by proper safeguards and legislation is a most wicked and wasteful thing, and it seems to me that legislation has been long delayed on this question because of the lack of imagination to understand all that is involved in this matter. First of all, it is a great waste to the nation itself. It is not only my opinion, and perhaps the children who die get off best of all, but where you have conditions that are killing off a thousand children a week those that remain are maimed and warped and stunted and grow up in that state. Not only this, but it is a question of the pangs of child-birth being inflicted on thousands of mothers merely that the children may perish like flies. It is wrong, and it is not a creditable thing for this nation or the Government that we should have permitted a state of things of that kind to continue so long as we have done.

It would appear that some of the interests with regard to insurance and the like have made it more difficult to get on with life-saving legislation. That is a lamentable state of things, and a measure of this kind throws light upon the social conditions under which large numbers of our people live, for there can be no doubt at all that many of those children die because of bad housing conditions, filthy slums, and adulterated milk, very often sold that a little extra profit may be made out of it. What we have to fight in this matter, as in all matters, is that the public good and the public advantage shall have a right of way over private interests and private gain. I am glad that in this matter a new conscience seems to be asserting itself in the country. We are having Baby Weeks to emphasise the importance of this question, and to emphasise from the national and individual point of view the need for some forward step being taken. Therefore, the question comes down practically to one as to whether it is best that this measure should go through, or whether we should urge its delay in the hope of forcing a larger coordinating measure which will set up something in the nature of a Ministry of Health.

I have listened to the well-informed speeches delivered by my hon. and gallant Friends who have spoken, and I am bound to say that I can agree in the main with the lines they have taken on this question. In my view it would have been better if the President of the Local Government Board had taken a bolder step and brought forward a larger measure. I believe he would have had not only the backing of this House in regard to such a measure but also the backing of the country. When he says he has received deputations in order to press this or that measure forward let me assure him that those deputations are not so much concerned for this measure as against that, but they are anxious that every step shall be taken by which life can be saved and where the public health is concerned. The Member for Plymouth (Major Astor) spoke upon the whole question and examined the various phases of it. The point that appeals to me is whether the Bill we are now discussing will really be used as a means of delaying the wider question of the establishment of a Ministry of Health. If I were persuaded that that would be the case I should be against this Bill, because I think that this measure is an altogether inadequate solution of the problem. I am quite sure that it does not in the least fulfil the needs of the case and we do want a co-ordinating measure. We want a Bill that will really make our doctors ministers of health whereas now the doctors flourish most when most disease is about in the economic sense. It would be far better that the energies of all the doctors should as far as possible be directed towards preventing disease rather than curing disease. I do wish to impress upon the representatives of the Local Government Board that this smaller measure cannot be accepted as an alternative for the bigger Bill, and that we would much prefer that they should take the step of introducing the bigger Bill. When I am brought face to face with the more practical question of what would be the net result of the Amendment moved by my hon. and gallant Friend, I cannot help feeling that at any rate there would be a danger that we should wreck this Bill without any certainty that the other Bill would be introduced, and I am quite sure that they are equally anxious that no step shall be lost, even if it is an inadequate step, of immediately grappling with this very terrible problem. The matter cannot be allowed to wait, and I differ from the hon. and gallant Member for Plymouth in that I think that the Ministry of Health Bill is not going to be quite so simple a matter as he supposes. It is going to be a bigger and a more contentious and controversial Bill than he imagines, and I am afraid it is not going to be allowed to go through the House quite so easily as it is desired.


My hon. Friend will remember that some months ago I gave a definite promise on behalf of the Local Government Board that this Bill in no sense whatever would be used to prevent the bringing in of a larger measure. I give that promise on my own honour now, and I am certain that promise will be carried out.


I am very glad to have that assurance, although sometimes assurances given from that Front Bench are not so well kept as they ought to be. I am sure, however, that my hon. Friend means what he says and will take every step in that direction. It is important, because it is the crux of the question. Whatever opposition there is, is not to this Bill, except that it does not fulfil the needs, but that there is a danger that this measure, once passed, will be offered as a solution of this problem, and that it will be said that there is far less need for getting on with the bigger Bill.


The point, I submit, is that it will not be used in any sense by the Local Government Board to prevent the larger measure, but Cabinet policy is a matter on which I cannot speak at all.


I do not think it will affect public opinion at all in the direction of delaying the larger measure, and with regard to Cabinet policy my hon. and gallant Friend (Major Astor), I believe, has almost daily access to the Prime Minister, and he may be able to put some slight pressure in that direction. In my view this measure is too voluntary. It is too optional. It does not compel the local authorities to do anything. It does not set up any standard for the various municipalities. It leaves the matter optional. Therefore, I think there is a great deal in the argument that the best municipalities will do it, and that the less active and more reactionary municipalities will do little or nothing at all. Yet over and over again it will be in the areas of those less progressive municipalities that there will toe the greatest need for the work. It will be in those very municipalities that are less active and progressive that there will be the largest wastage, of child life and the largest amount of hardship inflicted upon the mothers. Therefore, when we come to the Committee stage it will be necessary to try and brace up the Bill with Amendments for the purpose of seeing whether we cannot get the Local Government Board to put more definite pressure upon the municipalities and get the worst municipalities to come into line with the best municipalities on this question. If all that is possible under the Bill is really carried out by the municipalities there will be a great step forward in regard to the wastage of child life. You will get the establishment of crèches and day nurseries, there will be care for the unmarried mother, it will be possible to provide food for expectant and nursing mothers and for the children, and larger schemes of maternity and child welfare centres can undoubtedly be established under the Bill. All that is to the good, and it is most essential that we should emphasise the importance and value of child life, but I agree entirely with those who criticise the Bill because it falls altogether short of what is really necessary, and say that nothing in this Bill must afterwards be used as an argument against pushing forward with a much bigger scheme.


The operative Clause of this Bill originally appeared in the Notification of Births Bill, 1915, but it was withdrawn from that Bill because of a conflict of jurisdiction that was going on between the two Departments, which, incidentally, is undoubtedly an argument in favour of a Ministry of Health. I objected to the withdrawal of that Clause from the Notification of Births Bill, because I considered it would be of distinct value in saving infant life. Therefore it is not open to me to object to the Clause now it is brought forward in the present Bill, but I am bound to confess that I am strongly in favour of the larger measure, and I have complete sympathy with the desire which is expressed by the Amendment in favour of the Ministry of Health. Concentration and centralised powers are badly wanted, and the sooner we have them the better, but I do not understand how my hon. Friends look upon this as a sort of rival measure to a Ministry of Health Bill. I see no reason why we should not hope to have a Ministry of Health Bill, and I do not know why it is supposed my right hon. Friend (Mr. Hayes Fisher) is not in favour of it. I also agree with the last speaker in thinking that we should find a Ministry of Health Bill a subject of considerable controversy and discussion. I know my hon. and gallant Friend the Member for Plymouth (Major Astor) hoped that he had found—and I hoped with him—a short measure which would enable the authority to be set up without raising these controversial questions, but I am afraid that there would be a considerable amount of Parliamentary time devoted to discussing any Ministry of Health Bill.

Therefore I have to face the question. Will the powers contained in the Bill be of any value in saving infant life? I think they will be. You have to face the fact that a great deal is being done now by the local authorities which, so far as I can judge, is scarcely warranted by any statutory power. I know the Local Government Board, perhaps, would not admit it, but I believe it is an absolute fact, and it is being put forward by some local authorities as a reason for not undertaking work which they are urged by the Local Government Board to undertake. My hon. and gallant Friend seemed to overlook the fact that it is not only necessary to concentrate the central health powers in the hands of a single authority, but that it is also necessary for the local authorities who have to carry out the duties to have the necessary powers. I quite agree that the optional Clause in the Bill is not as strong as one would like to see it, nevertheless it does enable things to be done which we all want done, and which are now being done by progressive local authorities. Therefore, if this Bill is passed, and vigorous action is taken by the Local Government Board, a great deal of good work will be done at once. We shall at once set about saving infant life. On that ground I, for one, cannot take the responsibility of voting against this Bill. There are one or two points I have been asked to raise by the London County Council, in the hope that they will be considered by the President of the Local Government Board. The Bill provides that Any local authority…may make such arrangements as may be sanctioned by the Local Government Board for attending to the health of expectant mothers— And so forth. The authorities in London will be the London County Council, the City Corporation, and the twenty-eight borough councils. But there is no indication in the Bill of what the powers of the London Council will be; whether they shall be concurrent powers with those of the borough councils or supervising powers. The London County Council feels, and the borough councils feel with them, that it is not desirable that there should be concurrent powers, and they ask that one authority or the other should exercise the powers. As to the proposal to set up a Statutory Committee, it is felt, rightly or wrongly, by the London County Council that the principle of exclusive reference of special subject-matters to a Statutory Committee violates the principle of administrative freedom essential to the growth of municipal life, and they deprecate that being done. They think it is a matter that requires consideration. It seems questionable whether it is desirable to put maternity and infant welfare into a sort of watertight compartment. There are many other public health questions connected with maternity and child welfare, and the whole thing is very much mixed up. Under the Notification of Births Act, 1915, it is left to the local authority to set up such committees as it pleases, and it is given power to put on the committees persons who are not members of the authority. That would enable the local authority to put on the committee persons with special experience of maternity and child welfare, at the same time not compelling them to set up a Statutory Committee. I hope that these points will be considered by the President of the Local Government Board before we come to the Committee stage. While I am in complete sympathy with my hon. and gallant Friends in their desire to see a Ministry of Health established as soon as possible, I feel there is a certain value in this Bill and that it would be a pity if we should lose it.

10.0 P.M.


The country, I am confident, will be grateful to my right hon. Friend for having introduced this Bill. They hope, as most of us in this House also hope, that it will be passed into law with as little delay as possible. I should like to say how glad I am that it has fallen to the lot of my right hon. Friend, who has had so long and so honourable an association with the cause of social reform, to introduce this Bill. The matters dealt with in this Bill are urgent to-day. They were urgent before the War, they are more urgent now. It is, perhaps, a somewhat singular, though not altogether unexpected result of the War, that it has had the effect of bringing prominently before the public mind some of those social questions which had been suffered to fall somewhat in the background before the War, but which the exigencies and the sufferings of the War have so brought to the mind of the public that they have to be dealt with without delay. The figures given by my right hon. Friend as to the enormous increase of expenditure upon maternity and the saving of child life during the last four years are in themselves a testimony to the great increase of public interest in these matters and to the urgent necessity of dealing with them. We know there has been a good deal of voluntary expenditure. In an enormous subject such as this, voluntary help is totally inadequate to deal with the matter. When you find, as has been said tonight by more than one speaker, that the large expenditure which has been made on these subjects out of public rates is somewhat open to question, that adds an argument for proceeding with this Bill without delay. It appears that most of the money that has been spent on these matters by local authorities has been spent either under the provisions of a Regulation under the Defence of the Realm Act or, apparently, without any precise legal authority at all. I am sure there is no public body in the country, the Local Government Board or any other, that would desire to question the propriety or the legality of these payments. I dare say they turn rather a blind eye towards any excess of powers in which the local authorities may have indulged. This fact however, makes it all the more necessary that we should at once regularise that expenditure and give it sanction in an Act of Parliament.

The only arguments I have heard tonight used against the Bill are two of very unequal importance. The first is that the Bill is optional and not compulsory. To that it may be fairly be answered that if, as I believe is the case, there is a strong public opinion behind this Bill, there will certainly be a strong public opinion behind local authorities for the purpose of forcing them to put the Bill into operation. If that argument does not satisfy my hon. and gallant Friends who have moved an Amendment for the purpose of postponing the Bill, it is quite open to them in Committee to introduce well-considered Amendments with a view to making the Bill compulsory in certain cases. The second argument put forward against the Bill was that if it is passed it will be used as a reason for postponing the larger but undoubtedly necessary measure establishing a Ministry of Public Health. On that point we have had the assurance of my right hon. Friend and of the Parliamentary Secretary that there is no truth whatever in that suggestion, that if this Bill is passed there will be no attempt made by the Government, or anyone else, as I understand it—certainly the Local Government Board will not use it for that purpose—to use this Bill as a reason for indefinitely postponing the Ministry of Health Bill. The argument of my hon. and gallant Friend the Member for Plymouth (Major Astor), whose interest in these matters we not only acknowledge but admire, was that it would be better to postpone the immediate dealing with this urgent subject in the hope of getting an early introduction of a bigger Bill. I fear he was far too sanguine in his estimate of the amount of Parliamentary time that would be required for the Ministry of Health Bill. If that Bill is to be of any use at all, it must be a very large Bill, and must be a very well considered Bill. It will be perfectly impossible, considering the nature of the subjects involved and its very far-reaching magnitude throughout all the social strata of this country, to get a Bill of that kind passed without very full and complete consideration by Parliament. The time for that is not forthcoming at the moment. We are all agreed that time should be found for it as soon as possible, but, in the meanwhile, having this Bill, which is admittedly a good Bill so far as it goes, it is our manifest duty, as Members of this House, and in response to the great public demand from outside, to pass this Bill into law with the lease possible delay and to the great advantage of the country.


I cannot be content merely to give a silent vote in support of this Bill. I desire to say how much we are indebted to the right hon. Gentleman for bringing it forward. There has been a feeling now for many years in all parts of the House as to the desirability of something being done to protect child life, and that feeling has been accentuated by the terrible loss of life through this War. While Hitherto, from humane feelings, we have been anxious to save infant life, now, in the interests of the preservation of the race, we are feeling that it is more than ever important that these steps should be taken. I do not for a moment think the Bill will accomplish all that can be desired, but it is a step in the right direction, and, I believe, will accomplish much. There is a strong feeling in the country in the direction in which this Bill leads, and that is a valuable consideration in entertaining the hope that the Bill, though a small one, will effect a great reform, because people are ready and waiting to use an instrument of this kind to promote the object we have in view. I have been for many years a Member of the House, and I have seen good Bills defeated by the argument, "This is a Bill insufficient for the purpose. Let us wait a bit and the Government will deal with it and bring in a far-reaching measure. That is my experience of housing Bills. I have seen good housing Bills brought before the House in the last ten or twelve years and no section of the House but what considered that they would be of great value; but they have been delayed by the argument used tonight that it is a pity to have piecemeal Bills. Let us wait a bit, and the Government will bring in a housing scheme applying to the whole country," with the result that enough has not been done in the direction of the better housing of the people. I feel some hesitation in opposing any action which the hon. and gallant Gentleman (Major Astor; advocates in the direction of social reform, but if we miss the opportunity of having this instalment of a reform in the right direction we shall experience the same disappointment that we have felt in the housing question by rejecting a simple come-at-able Bill which has done much good as far as it went and educated people to have an ambition for something still better. We have delayed the housing question now for many years. On the same principle, if we miss the opportunity of passing this Bill with the idea that we shall spur on the Government to bring in a larger measure it will be a delusive hope and we shall miss the main object we all have in view of promoting the real effective protection of health. I wish the Bill were a little stronger and it may be that in Committee I shall have to vote to make it a little stronger, but it is valuable for what it now contains. It is a step in the direction which people want and so moderate in character that it will encourage their support and lead them on to still greater things in the not distant future. We have again and again felt in the House and in different public bodies, the necessity of a step in this direction and now that we have a chance to embrace it I could not bring myself for a moment to oppose it merely because it does not do all I should like to see done.

Captain SMITH

I cordially endorse all that the hon. Member has said, but I can quite understand why the Amendment has been moved I remember a few years ago sitting on a Committee presided over by the hon. and gallant Gentleman (Major Astor) on tuberculosis and medical research, and I remember the delay which was caused by the conflicting and ambitious attitude assumed by more than one public Department. Anyone who has sat on a Committee on so important a question as that will fully realise the difficulties we are labouring under now in having our public health in so many hands. Apart from that I hope the Amendment will not be pressed to a Division. I feel honestly that although they may co-ordinate all the Departments connected with public health it will require a large measure to make it any real good, and it will occupy the time of the House a great deal more than the hon. and gallant Gentleman mentioned. In face of that I want to appeal to the past. It comes to me as a breath of fresh air to see support of the Bill in quarters where years ago the very same Members were speaking as if in the wilderness amongst their own party. If that spirit is animating that part of the House, this and larger measures will have a sure passage through the House.

It ought to be made compulsory on local authorities to set up some system of dealing with this matter. These are very important questions which have been fully realised since the loss of life in this War, but which could not be seen by a great many Members before the War. Questions of this kind were repeatedly brought before the House in argument and the full need of them could not be grasped, but now when it is realised to the full how valuable life is we want to do something to encourage it. If that is the case, we must see that every authority shall set up some system according to Regulations laid down to govern this and to improve and save child lie. For many years back urban district authorities have never had the confidence of the Department in administrative matters. I believe this is one of the matters which you must leave to urban district authorities. It is urged, I know, that county councils in all these matters may administer this more economically than separate authorities, but I claim that the 20,000 stipulated in this Bill is far too large a population to include in it. The more interest you can create and the more responsibility you put on these authorities the more interest they will take in it, and the more value you will get out of your measure. If that is done, I believe this Bill will fulfil all its promises. I quite agree that the measure is not very ambitious, but it is important and very good. Give the people confidence and some encouragement to take part in it, and I believe you will be rewarded by a very great deal of good to this country.


I think before the Bill passes from the purview of this House it is necessary to give a warning in view of some mistakes that have been made. The view the hon. Member for Plymouth (Major Astor) expressed, that a small three-Clause Bill would probably wipe out the Insurance Act is scarcely warranted. The first of these Clauses was to lump the Local Government Board and the Insurance Commissioners together. Oil and water will not mix. To begin with, the Insurance Commissioners are a joint body of four nationalities. The English Commissioners, the Scottish, the Welsh, and the Irish, all meet together and form the Insurance Commissioners under the Bill. How can that mix with the Local Government Board, that relates to England only? If you are taking the national authority in the case of the Local Government Board to mix with an international authority in the work of the Insurance Commission, I think it will take more than one Clause to accomplish it. I would like to say quite candidly that I do not know on what idea is based this mirage of an agreed Bill that has got before the minds of some speakers and the Government with regard to a Ministry of Health. I do not know on what it is founded. If hon. Members will take the trouble to go individually and convass a number of Members of this House who might well be expected to take an interest in this matter, they will find that there will be a great deal of resolute criticism if the Bill takes a certain shape. If the hon. and gallant Member who introduced this Motion was right in his interpretation, it would be a Bill only taking powers for certain Departments, to put them under a new authority. How can that save a thousand babies a week? You may save pen nibs or blotting paper, but how can you save a thousand babies' lives a week by taking clerks out of one Department and calling them by another name? It could, therefore, only be by extended, and it would seem to me very drastic, powers that you could claim such an alteration. Where are the thousand babies? Some suggest that this Bill will save a thousand. If it will save a thousand, then we are to have a Ministry of Health Bill, ten times bigger and more important that will do ten times the amount of good, then it will save 10,000 babies; this will save 1,000—that is, 11,000 a week. That is what we get by listening to figures in this House. I venture to say that no Bill that can be devised by a Government of eighty or ninety Members like this Government can be immediately passed into law and save a thousand babies a week. That has not been done in the history of the world, and cannot be done now. Matters of this kind are much more difficult to accomplish. What would be the responsibility of 670 Members of this House if, by passing a few Clauses of a Bill, you could really improve humanity at that rate? If 1,000 babies per week have died who ought not to have died, who was to blame? It is all very well to blame the Government or the policy.

There is no such a state of things in this country as that 1,000 babies are dying each week when they could be saved by passing an Act of Parliament. That this Bill may do some good I grant. I say quite candidly that I think the Bill will do some good, and I hope it will succeed; but why put forward such an extraordinary chain? I have an Amendment on the Paper. I did not put it down with the intention of moving it, but as an intimation that when Members desire to amalgamate the Local Government Board and the Health Insurance Commission they do not recognise that they would put on the new health authority a great deal of business that does not belong to it. The paying of 10s. a week for men and 7s. 6d. for women and the permanent invalidity benefit have no more to do with the health of the people directly than old age pensions. These things are exactly on the same footing as the old age pensions and payments under the workmen's Compensation Act. The Health Insurance Commission ought never to be mixed up with the Health Department, or what is called preventive medicine. Why should they be troubled with actuarial valuations every five years and questions of rules relating to friendly societies and so on which the National Health Insurance Commissioners have to deal with? If you are going to load the new health authorities with things of that kind, you will make it that it cannot work. I could believe more in the sincerity of those who prophecy so much good from the proposed Ministry of Health if they had studied this question a little more. I can promise anyone who in the middle of a war, when so many insured persons are at the front and the staffs are depleted, that if they think they can turn the whole Insurance Act topsy-turvy, especially after it was amended a few months ago by this House, and expect that they are going to be able to do it in a few hours, they are giving full vent to a lawless imagination.

I do not know how many Members of this House have seen the Bill. Perhaps the Mover of the Amendment has seen it. I do not know whether the hon. Member for Attercliffe has seen this famous Bill. I understand that the right hon. Member for Derby has seen a copy of it. I know it has been shown to a number of people, who said they would let me see it but they would have to break their word. I said I would not look at it if it was to be at the cost of someone committing a breach of confidence. The Bill is in print, and copies have been floating about the country somewhere for months. Copies have been shown to vested interests, and interested parties; but they have not been shown to Members of this House or to any Committee of this House. No Committee of this House has considered the question. I believe a copy or two has gone across to Ireland. We keep hearing about the Bill, but we do not know what its contents are. How can we say that it will pass in a day or two when we do not know what it contains? It will probably be a Bill bigger than the Education Bill now before the House. You are going to reconstitute the Local Government Board and a large number of new Departments and the whole Insurance Act, and you expect it to be an agreed Bill when it comes here. A member of the War Cabinet told us to-night that there would be no Ministry of Health this year. One reason is the existence of the War. The hon. Member for Clitheroe (Captain Smith) told us that there was a big change in the membership of this House when there was not much opposition to a Bill like this. Members would oppose it but that so many of them are resolved not to oppose any Bill introduced by the Government while the War is on. I do not think that there has been so much change in the House as my hon. Friend thinks. I do not know whether the Mover and Seconder of the Amendment will go to a Division, but, in view of what was said, I think that perhaps there will be some difficulty, particularly because I think that they are genuine friends of the measure as far as it goes—at least, the Mover is. I think that in Committee the right hon. Gentleman should keep himself free to treat the local authorities sympathetically. One hon. Member seemed to think that the rural district councils were dreadful bodies, but I think that any genuine, practical measure is just as likely to be put into operation by them as by any other body, and perhaps the right hon. Gentleman will keep that in mind and hear what the district councils have to say.


I would appeal to the Mover and Seconder of the Amendment not to press it. I am one of those who, frankly, would rather not wait. Here we have a moderate measure of reform. It may not go quite so far as the extremists would like, but so far as it goes it is good. Do not let us, for heaven's sake, be slaves to the idea that we must always go for the best, and neglect the immediate good which lies in our way. It is true that by Ministry of Health proposals, if we could get them, without any severe contention, we might go a step further than we are going by this Bill, but those of us who have worked at this question of infant mortality for a great many years, now know that you can get on—and I believe that in the end it is the only way you can get on—by patient, considerate, unwearying work in the localities, and among the local authorities. You have got to carry the local authorities with you. I hope that I can speak with the assent of the representatives of the Local Government Board when I say—and I am in fairly close touch with the local authorities of municipal areas—that you have got the good-will of the local authorities for a measure of this kind, which you have never had before. I have the honour of being a vice-president of the Association of Municipal Corporations, and I do not wish to say anything which would upset them, but, quite frankly, their attitude over this proposal surprises me. They are taking, and they realise that it is their duty to take, a position with regard to this proposal which I do not think they have ever taken before. Those of us who have worked at the Notification of Births and Deaths Act, at the whole question of inspection of nurseries, and of homes for mothers, know that it is only by patient effort continued over a long time that you can do anything. You collect the money, you erect institutions, you get voluntary workers and have deputations to the local authorities, and it all seems very heartbreaking and very useless, but gradually as it goes on the thing begins to tell, and you know that the number of deaths per 100,000 infants is going down from 200 to 100, and so on down, and down, and down. This Bill goes along the line of patient effort, and I do hope that we will get this measure, though it may not go a great way, as it stands. Local authorities have secured this result, that they have actually got down to zero in the number of deaths among infants in the first twelve months of life. I believe this Bill will help in that direction. We are told that we must wait for the Ministry of Health Bill, and that it is practically an agreed measure. We are given that assurance, though perhaps somewhat vaguely, but I suggest that you are bound, having regard to the nature of municipal government in this country, to the differences between Government Departments and to the fact that the Ministry of Health Bill will inevitably carve pieces out of the existing work of various Departments, to accept and support this measure. I hope this will not be made a contentious Bill, and that the Amendment will not be pressed. I want to get this Bill, and even if it is not the very finest, yet it is a good Bill.

Amendment negatived.

Bill accordingly read a second time; and committed to a Committee of the Whole House for To-morrow—[Mr. Hayes Fisher.]