§ The MINISTER of RECONSTRUCTION (Dr. Addison)I beg to move, "That leave be given to bring in a Bill to establish a Ministry of Health and a Board of Health to exercise in England and Wales and in Scotland, respectively, powers with respect to health and local government; and for purposes connected therewith."
The War has revealed in a very striking manner what a good many of us have been calling attention to for many years, namely, the need for improvement in the health of our people. After the War the need will be even greater almost than during the War for making the best use of all our powers and resources; and it is very certain that in the time of reconstruction we shall not be able to afford any waste either of material or of human power. The late Lord Rhondda, when he was President of the Local Government Board, invited me to take charge of an inquiry into this matter, and during recent months I have had very many consultations with the local authorities of this country, with medical men, and with representatives of the great insurance organisations, and the measure which I ask leave to introduce represents, except in some unimportant particulars, a common measure of agreement.
§ Dr. ADDISONThe hon. Member, not having seen the measure, is not in a position to say. There is unanimity on the part of all who have examined this topic that steps are necessary, and that it is impossible in this country either to prosecute a vigorous health policy or to 2339 secure efficient administration of it until we have brought about, in the first place, the consolidation of those Government authorities which have charge of it. For example, with respect to woman and her child, the Local Government Board, the Insurance Commission, the Board of Education, the Home Office, and the Privy Council are all involved in various matters concerning the health of the mother and the child. I could, of course, furnish many further illustrations; but it is manifest to anyone who has knowledge of public administration in this country that it is impossible to expect any progressive and continuous development of improved services whilst you have this overlapping in the central Departments; and the main purpose of the Bill is to bring together under one body of men and one Minister the chief Government Departments concerned in matters affecting the health of the people. Until that is achieved I am convinced that it is hopeless to expect any real and substantial improvement. This Bill does not provide medical treatment for any individual. It does not affect the functions of any local authority of any kind. It is purely concerned with bringing together the responsibilities of the different Government Departments, both in England and in Scotland, which are concerned with health matters. The Bill brings together under one Minister the powers and duties of the Local Government Board and the Health Insurance Commissions of England and Wales. It brings in, also, the powers and duties of the President of the Board of Education with regard to the health of mothers and infants, the duties of the Privy Council with regard to midwives, and of the Secretary of State for the Home Department with regard to the protection of infant life.
§ Sir E. CARSONMay I ask my right hon. Friend does the Bill apply to Ireland?
§ 4.0 P.M.
§ Dr. ADDISONI will deal with that presently. It unites these in one Health Department, and then we take power in the Bill to bring in as and when it is possible other considerable health duties, namely, the medical inspection and treatment of school children at the present time under the charge of the Board of Education, further, all the health duties of the Ministry of Pensions as regards the 2340 treatment of sick soldiers, and, finally, the powers of the Secretary of State with regard to lunacy and mental deficiency. It is not proposed to consolidate these latter powers at this stage, because some parts of them would have to be left where they are. They are involved in various administrative arrangements which it would take some years, at least, to disentangle. A good deal of misapprehension exists with respect to this Bill, owing, perhaps, to the fact that we have not been able to bring it forward earlier in consequence of the association of these services with the present Poor Law duties discharged by boards of guardians, who are responsible to the Local Government Board. I may say that the bringing together of the different services which I have mentioned in no way fixes to these services any Poor Law taint whatever. It is separate from them hereafter as it is now, for example, from the sanitary services of the local authorities. But we have had a Royal Commission—we have had an important Committee, presided over by the Deputy-Chairman of Ways and Means, and I am authorised to say that the Report of the Local Government Committee presided over by Sir Donald Maclean on the transfer of functions of Poor Law authorities in England and Wales has been carefully considered by the Government, and that the Government accept the recommendations of the Committee, that all services relating to the care and treatment of the sick and infirm should not be administered as part of the Poor Law but should be made a part of the general health services of the country and that the Government regard it as a matter of urgency that effect should be given to these recommendations as soon as possible. The Government accept the principle that the remaining functions of the Poor Law authorities should also be transferred to other bodies, but are not in a position to formulate precise proposals at the present time. Any approach to the complete application of the scheme recommended by the Committee will involve a considerable length of time and must be preceded by further inquiries into certain questions with regard to detailed matters. The Government recognises its responsibilities for making proposals on these subjects as soon as the exigencies of the Parliamentary situation permit of their doing so. I should like to say here that those enthusiasts for a Health Ministry who say 2341 we must wait until we have reformed the Poor Law are thoroughly impracticable people. The Poor Law will require many years of steady effort both in this House and in connection with administration to wholly disentangle and to bring about the reforms which many of us desire, but we are not prepared to postpone until that is achieved the necessary consolidation of these important health services. With regard to Scotland, the Bill brings together in precisely the same way as in England these different health services under a Board—a Board of Health—which is to be responsible to my right hon. Friend the Secretary of State, who himself has had charge of this part of the Bill in the course of its formation.
§ Dr. ADDISONThe Secretary for Scotland. With regard to Ireland we have not extended our proposals there in view of the possibility, as we hope soon, that Ireland may administer her affairs herself. But it is proposed to leave the position of the Irish Insurance Commissioners as far as possible unchanged. We do provide, however, for the continuance of a Joint Committee similar to that which is now in existence representing the four countries with regard to financial matters in health insurance.
§ Sir E. CARSONIs that all there is about Ireland in it?
§ Dr. ADDISONAnother important feature of the Bill is that we provide advisory or consultative councils as part of the machinery of the Ministry. This proposal has been a good deal criticised in many quarters, and I, for one, thoroughly believe in having at my elbow expert critics. I believe it will have a very wholesome effect on administrative work in the development of the health services of this country if we have live, active bodies of this kind in existence.
§ Dr. ADDISONCertainly not; the Minister must be responsible. In order that it may be made clear what the functions of these advisory councils are, I propose to lay on the Table of the House a draft Order in Council which sets out their functions, and has been agreed to by all concerned. They are to deal with 2342 matters referred to them by the Minister. They are to be able to make suggestions to the Minister as to subjects that may be referred to them. They are, also, on their own initiative, to make recommendations to him. We bring together, therefore, under this Bill all the important Government services which are concerned with health, and we also thereby bring under one Minister the surveillance of all the local health services of the country; and if this is achieved we believe it will be possible to expect real progress with respect to the improvement of the health of the people. It is essential to take this step first, because the legislation necessary to provide for the full development of the health services of the country may be controversial, and certainly will be difficult and involved. Therefore, it is necessary to take it in these two stages. I believe if we acquire the powers sought in this Bill we may, for the first time in this country, be able to develop and ultimately to apply scientific, well thought out, and thorough health measures for the benefit of our people.
§ Mr. HOGGEIn asking the House not to agree to the introduction of this Bill, I want to make a few observations. In the first place, I should like to say, of course, that every one of us wants to see a new arrangement whereby all the functions which deal with the health of the community may be co-ordinated into a separate Ministry. But that is a very different proposal to that which is now adumbrated to the House by my right hon. Friend the Minister of Reconstruction. Briefly, the reasons why I oppose the introduction of this Bill are as follows: In the first place, this Bill attempts to take away from the Commissioners dealing with National Health Insurance in three of the separate parts of this kingdom their existing rights to deal with questions of disease and ill-health. In the fourth case, it leaves that to the Commissioners of National Health Insurance in Ireland, and I wish to say that it is surely an act of hypocrisy to suggest that that question shall be left until the Irish question is determined by the grant of Home Rule. My right hon. Friend will find that the Irish Members, both from the North and other parts of Ireland, will strongly oppose the exclusion of the National Health Commissioners for Ireland from the duties which are associated with this particular Bill. The second reason why I oppose this—and I oppose it 2343 rootedly—is that you associate by the arrangement which the Ministry of Re-construction has suggested this new arrangement with the administration of the Local Government Board which administers the Poor Law in this kingdom. If my right hon. Friend had taken the trouble, as apparently he has not done, to acquaint himself with the views held by the large bodies of approved societies in England, in Wales, and in Scotland, with regard to the inclusion of the functions of the National Health Insurance under any Government Department associated with the Poor Law, he would have known the strength of the opposition to it. I know he has not taken the trouble.
§ Dr. ADDISONThat is entirely incorrect. I have consulted scores of representatives of authorities and of approved societies.
§ Mr. HOGGEThe right hon. Gentleman is somewhat premature; he did not let me finish my sentence. I do know, as a matter of personal knowledge, that as far as the National Health Insurance Commissioners in Scotland are concerned they have never been asked their views at all on the question of the Ministry of Health Bill, and how far their functions shall be roped in under the new arrangement. My right hon. Friend, therefore, will agree with the statement I make that so far as Scotland is concerned no one from the Ministry of Reconstruction has taken the trouble to ascertain what views are held in Scotland with regard to this matter. My third reason is this: There is in the Bill a proposal which my right hon. Friend has not explained to the House, and I suggest that the House may concentrate its attention on this for a single moment that you have inside this Bill a provision to set up an entirely new arrangement for Scotland with regard to the relationship of the Secretary for Scotland to this House. There is a proposal in this Bill for the creation of a new Minister who will act as Under-Secretary to the Secretary for Scotland and who will not be responsible even to this Board which you have set up. The Secretary for Scotland will be responsible for these Boards. If my right hon. Friend had taken the trouble for one moment to ascertain public opinion in Scotland from the National Health Insurance Commis- 2344 sioners, from the large municipalities, and from the county councils he would have known that the demand in Scotland is perfectly unanimous for a separate Bill dealing with a Ministry of Health for Scotland. We are not going to let in a Bill which applies principally to England and Wales the creation of a separate Ministry and Board for Scotland, which is the proposal of this Bill. We are not going to permit that. We insist as Scottish Members, if the Government do propose to deal with this question, that, as far as Scotland is concerned, they must introduce a separate Bill for Scotland, and not mix up the affairs of health in Scotland with a Government measure of this kind. The fourth reason is that my right hon. Friend must allow the great friendly societies and the great approved societies to express their opinion upon whether or not their functions are to be rearranged under this new measure. My final reason is that these are the declining days of the present Parliament, and it is absurd to bring in what is nothing more or less than electioneering Acts of Parliament. This is window dressing by the Government. They are going to suggest to the country that they have a great scheme for dealing with the question of health, when as a matter of fact their scheme does not meet with any approval at all in quarters where approval ought to be expected and ought to be received before it is introduced. Principally as a Scottish Member I object entirely to the introduction into an English Bill of a Board of Health for Scotland and I oppose the Bill now, and will oppose it in the Division Lobbies, on account of the fact that no separate Bill for Scotland, for Wales, and for Ireland is introduced by the Minister of Reconstruction.
§ Question put, and agreed to.
§ Bill ordered to be brought in by Dr. Addison, Sir George Cave, Sir Auckland Geddes, Mr. Munro, and Sir Edwin Cornwall.
§ MINISTRIES OF HEALTH BILL,—"to establish a Ministry of Health and a Board of Health to exercise in England and Wales and in Scotland, respectively, powers with respect to health and local government; and for purposes connected therewith," presented accordingly, and read the first time; to be read a second time upon Monday next, and to be printed. [Bill 108.]