§ Section nine of the principal Act (which enables county councils to delegate their powers and duties to district councils) shall be repealed: Provided that where at the commencement of this Act any powers or duties have been delegated such delegation shall not be affected unless on the representation of the county council concerned the Local Government Board otherwise direct.
§ The following Amendment stood in the name of Sir J. BOYTON: After the word "repealed," to insert the words "except so far as it applies to the administrative county of London."
§ Mr. G. THORNE
The Amendment which stands in the name of the hon. Member for Marylebone (Sir J. Boyton) is only a limiting Clause. The Amendment which stands in my name proposes its extinction. What will be my position if my hon. Friend proceeds with this Amendment?
§ Sir J. BOYTON
I beg to move, after the word "repealed," to insert the words "except so far as it applies to the administrative county of London."
On the Second Reading of the Bill the hon. Member for Wolverhampton (Mr. Thorne) and the hon. Member for the 524 Everton Division of Liverpool (Sir J. Harmood-Banner) both raised this question on behalf of large provincial county councils, and I have no doubt in the course of the Debate to-day they will move the Amendment which stands in their name. We are in a different position in London. We have created large borough councils, representing very large populations, and up to now you have delegated to them powders to deal with these matters, and it does seem a hardship, seeing the local interests which have been created during late years, especially in mothercraft and infant welfare centres, to destroy the work which undoubtedly has been started and which will greatly increase in volume. I am moving this Amendment at the instance of the Metropolitan Boroughs Standing-Joint Committee, and they desire me particularly to say that they hold the opinion strongly that the Bill should be amended so as to preserve such power of delegation as regards the administrative county of London. They are supported in this view by a statement of the late Lord Rhondda. When President of the Local Government Board in connection with an application of the Lewisham Borough Council, which had adopted a satisfactory scheme of maternity and child welfare for the delegation of powers, he said that there would be an advantage in the delegation of powers of inspection to the borough council. From such an eminent authority as the late Lord Rhondda, and one who was very eminent in the direction in which this Bill tends, I think that is a very strong argument in favour of the view which I have been asked to advocate. I am hopeful that the President of the Local Government Board, whatever view he may take as to large provincial centres, will regard London and its boroughs as a particular case, and will see that the powers which are being given to the county councils for delegation to borough councils shall be adopted.
§ Sir C. HOBHOUSE
May I ask for your ruling, Mr. Whitley? Both the Amendment which is now before the Committee and the Amendment which stands in the name of the hon. Member for Wolverhampton really raise the same common point, and I am sure it would be for the convenience of the Committee if you would rule that we should have a general discussion upon the Amendment now before the Committee: otherwise we who are interested in the later Amendment 525 and, as we think, the more important Amendment, may find our arguments anticipated, and you might refuse to hear us on the second occasion. I therefore venture to suggest that we might take a common discussion now upon the whole point raised by the two Amendments.
§ The CHAIRMAN
I think the right hon. Gentleman is quite right. It would be convenient in all respects that on the first Amendment it should be possible to discuss the whole question of delegation, whether in London or in other parts of the country, only it is necessary to keep the actual resulting decision separate, because it may possibly differ in the case of London and other parts of the country.
§ Sir R. ADKINS
I thank you, Mr. Whitley, for your ruling, and I think the Committee will not consider my action premature if I say a few words on this Clause and the suggested Amendments at the earliest possible opportunity. In form it appears a somewhat unusual thing to take away from county councils, which of course include county boroughs, and include London boroughs, powers of delegation previously given to them by Parliament. No doubt there is a presumptive argument against depriving local authorities of powers they already possess, but in practice delegation of this kind has not been found to be a success in the opinion of those persons who have been most intimately associated with the administration of the Midwives Acts and analogous Statutes. Therefore I, for one, prefer Clause 12 as it now appears in the Bill and as it has come down to us. This is not a case of direct administration. In the rural counties and counties generally it is obvious that direct and detailed administration must chiefly be done in areas smaller than counties. When you are dealing with inspection and supervision within the larger area in which that is exercised the greater the experience the inspector gets the higher rate of pay would be at command, the best quality of persons would be obtainable, and there would be a greater freedom from local predisposition or local embarrassments. Therefore on the general question of the county council itself appointing the inspector I submit that it is really in the interests of public health and of the efficiency of this Act, and I hope nothing will be done in this Committee or in the House at any stage of the Bill which will really seriously affect that method of 526 administration. I could give the Committee analogy after analogy. The main idea of county government in England and Wales is that the county should be the supervising authority and the smaller area the executive authority in the majority of matters. I hope the Clause will be accepted as it stands, but at the same time I do not wish to deny that there are certain cases, some no doubt in the county of Middlesex and some elsewhere, where you have areas which in population are larger than many county boroughs, and as county boroughs are county councils it would be open to criticism if to these large areas there could not possibly be delegations. I am entirely opposed to the Amendment of the hon. Member for Pontefract (Mr. Booth) to make the carrying out of this matter to be by districts wherever a district asks for the power. You must have the supervising authority not only cognisant but consenting to any delegation Under any circumstances. How far this will apply to London I am not at all qualified to say. London has its own difficulties, but there is no reason why the London County Council should not supervise this matter throughout the whole of its area. On the other hand, the boroughs have a very considerable population. While I should be glad if the Committee adheres to the Bill as it stands, I hope that if there is to be any limit the Committee will not go beyond this, that any delegation to be permitted must be on the initiative of the county council, with the approval of the Local Government Board, and it must be to authorities which have at least a population of 50,000, which is now the limit between county boroughs and districts which are not county boroughs. Only if these limits are enforced will it be possible to carry out the administration of this Act with proper supervision. I hope the Government will strenuously oppose any attempt to modify the Clause beyond this very moderate limit, which has special circumstances attaching to it.
§ Mr. THORNE
When I raised this matter on the Second Beading I did so at the instance of the Association of Municipal Corporations, and I regret if any expression I used gave a different interpretation. Speaking generally, our work in this House as regards local authorities is to give them powers and to enlarge their powers, and when one approaches a Clause such as this which take away existing powers, I think it is 527 the duty of those who are interested in local authorities to watch very jealously their operations, and the reason for them. I submit that the onus of proving Clause 12 rests upon the promoters of the measure and upon the right hon. Gentleman opposite who, I have no doubt, will speak on the subject. My hon. and learned Friend (Sir R. Adkins) has indicated to me a line upon which I think we might have general agreement, because this is a case on which the House of Commons ought not to be divided. It is an administrative matter in which we are trying to promote the general health and well-being of the community, and surely it is a matter upon which all of us might come to some common agreement. I suggest that the line indicated by my hon. and learned Friend, in the modification of the new Clause I have put down in substitution for Clause 12, might fairly meet the case. It would mean, I think, only a slight modification of the Clause which is down in my name. I agree that it should be on the initiative of the county council, and that it should then require the approval of the Local Government Board. Then I recognise that there should be a limit as to the size of the authority to which that power of delegation should be granted. If agreement could be arrived at on those lines, it seems to me that it would be far preferable to leaving the Clause as it stands in the Bill. By putting in the Clause as it stands in the Bill, not only is there no direct authority for large district councils, but there is no indirect power. There is no direct opportunity at all. I have a case put before me of a large urban district like Rhondda and Willesden, with a population of 170,000, Tottenham with 150,000, and Walthamstow and Leyton with 140,000. It seems to me absurd that great communities like these, and those with smaller numbers, should be deprived of all powers in a matter so intimate and domestic. While I do not like limiting the powers already possessed by local authorities, I am quite willing that the power shall be limited in the direction I have indicated—first, on the initiative of the county council; secondly, to be approved by the Local Government Board; and, thirdly, a limitation as to the size of the authorities. If agreement could be come to upon that line, I should be prepared to modify my proposals if Clause 12 as it stands is left out.
§ Captain BARNETT
I hope my right hon. Friend will see his way to accept the Amendment of the hon. Member for Marylebone. The case of London is quite different from the case which has been made out by the hon. Member (Mr. Thorne). There is no doubt that the real local patriotism and real patriotism in the interests of public life is to be found in the boroughs and not in the bigger areas of London. We are asked to take away powers already possessed by the borough councils, powers which have been very well exercised in the past. The hon. Member (Sir E. Adkins) has spoken about supervision. I do not know what he means by supervision. Take my own borough of St. Pancras with a population of 220,000 with a most efficient medical officer of health. We have a large number of people who have given voluntary service on relief committees and maternity committees. To deprive the borough of the right to exercise these powers which they have got at present is almost a slap in the face to these people who have been doing most patriotic and useful work for years past. I do not deny for a moment the case made by the last speaker, but it is nothing like the case that can be made for London boroughs. I wish to reinforce every argument used by my hon. Friend the Member for East Marylebone, end strongly to urge on my right hon. Friend the desirability of accepting this Amendment.
§ Sir C. HOBHOUSE
I have been asked by friends of mine, who are interested in the conduct of midwives and the practice in the county districts, to say a word on this Clause. I may add on my own behalf that, before the Act of 1902 came into operation, I took some part in discussions which then arose in the House on the subject and which, as well as my own experience as a county councillor, made me conversant with what has being taking place in rural districts. I may remind the Committee that this power of delegation has in times past been exercised by a considerable number of county councils and has been found to be a failure in every county area in which that delegation has been made.
§ Sir C. HOBHOUSE
I know that London is technically a county, but it is not the kind of county with which my remarks are connected. It is urban, not rural, in character. In every rural county 529 where delegation, has been put in force there has been a failure of the Act, either because the action taken by the district council was slothful and wasteful or else because the supervision exercised by the district council was inadequate, and throughout the county area there are different standards of practice, methods, and efficiency, a fact which is most detrimental to the welfare of that part of the population which the Act was intended to serve. Therefore, from the point of view of experience, there is every reason why this power should be withdrawn. It is a power which is not desired by the county council, who never exercise it, and whose representatives desire that it should be withdrawn. The Bill proposes that the law in future should be uniform in Scotland, Ireland, and England. The Act which was passed in the earlier part of the Session for Ireland gives to Irish county councils no such delegated powers as the English Act contains, and the Scottish Act of 1915 gives no such delegated powers to Scottish county councils; and, if I remember aright, no such demand was made on behalf of Scottish county councils and no remonstrance was made by any representative of these councils because of the omitted power. The Irish and Scottish county councils, deriving their views from the experience of English county councils, see no reason to desire this power and the power was not granted. Therefore, primâ facie, there seems to be very good reason why the existing power might be withdrawn.
There is, however, one point of view on which I may find myself in agreement with the hon. Gentleman the Member for Wolverhampton. If I am rightly informed, every county council which delegated powers to district councils has thought it right to delegate all the powers under the Act of 1902. Those powers vary in degree and in kind. There are a power of general supervision, a power of investigating malpractices, and a power of suspending midwives from practice, and then there is the necessary power of reporting to the Board the name of any midwife convicted of any offence, etc. The Committee will see, therefore, that the duties under the powers delegated to the district councils, under the existing law, differ very greatly. I do see that there is something to be said from the point of view that, while it is very undesirable to give district councils the whole responsibility for the conduct of operations of the Midwives Act within 530 their area, with regard to supervision and inspection, there might be certain minor powers which might be delegated usefully to district councils if the county council desire to apply to the Local Government Board for permission to delegate some of the inferior powers. On the whole, looking at it as well as I can with experience as a county councillor for many years, during at least ten of which I was chairman of a committee which dealt with this subject from the point of view of administration, I think that the Bill had better stand as it was drawn and as it comes down to the Committee, but that if the President of the Local Government Board feels himself bound by the weight of argument to meet in some way the wishes of my hon. Friend the Member for Wolverhampton, he might do so by permitting county councils to delegate minor powers while reserving to themselves all power of supervision and inspection of midwives within the area, unless that power is kept in the hands of the county council I fear greatly that the class of women now becoming midwives, instead of rising, as it has risen in social and educational status for the last thirty years, will tend to go down very much to the class from which it has risen, and that local jealousies and prejudices will affect the conduct and attitude of the rural district councils towards that class. For these reasons I hope that, on the whole, the President of the Local Government Board will adhere to the Bill as it is at present before us.
§ Major COURTHOPE
I also hope that the right hon. Gentleman will not agree to any Amendment to this Clause. I may call attention to a matter to which the right hon. Gentleman has referred already, and to which I think it worth referring again. It states on the Memorandum to this Bill:Since the enactment of the Midwives Act, 1902, Acts have been passed for Scotland (1915) and Ireland (1918) wherein are incorporated certain amendments and additions which experience has suggested, most of them having been included in the recommendations of the Midwives Act Committee of 1909.It is now proposed to bring the English Act into line with those in the other parts of the United Kingdom, and the present Bill is confined to that purpose, all contentious matter being thereby avoided.That Memorandum shows quite clearly that the principle of the Bill is to secure uniformity between the three Kingdoms, and it would be the; height of folly to upset the whole scheme to amend the Bill, 531 whether in favour of London or of municipal corporations or of any other local bodies. To introduce delegation would be to upset the whole purpose for which this Bill has been brought in. I would like also to draw the attention of the Committee very briefly to one or two passages in the Report of the Midwives Act Committee of 1909 to which the memorandum refers. That Committee expressed themselves far more strongly than Departmental Committees are accustomed to express themselves against delegation. They state in Clause 17 of their Report:Delegation has not hitherto been generally exercised and in most cases county councils have wisely revoked the powers which they delegated, but in a few cases where the practice still obtains it has been found to operate detrimentally to the purposes of the Act and to introduce an element of confusion and uncertainty into its administration. The evidence given on behalf of the Central Midwives Board was conclusive on that point.It goes on to give evidence of confusion that occurred in the county of Kent where the Board were confronted with sixty-five local supervising authorities in one county. It refers to the evidence of other witnesses who express similar views. It continues,It is obvious that under conditions of extensive delegation uniformity of aim and practice is unrealiseable, while the difficulties of supply, distribution, and training are enormously augmented. It is the emphatical opinion of the Committee that this power should be withdrawn and that in cases where it is still exercised the delegation should be revoked.And again I find at the conclusion they reiterate that the power of delegation to district councils under Section 9 of the Act of 1902 should be withdrawn and that in cases where it is still exercised delegation should be revoked.
That is the very strongly expressed opinion of the Committee, whose authority I believe is undisputed, which reported in 1909. I believe that in the early days of the Act of 1902 ten county councils delegated their powers. Every single one of those original ten has found delegation a failure and revoked it, the last I believe as long as five years ago. They tried it and found it was a failure. Now there are six areas only in which more recently they have adopted delegation and I am informed by the Society for the Training and Supply of Midwives that it is not working well in these six areas. But the strong point I think is that the ten counties which tried it from the beginning found it a failure and revoked it. There 532 were various obvious reasons against delegation. One is that inspection by district inspectors must result in a varying standard of efficiency. Then there is the risk arising from the fact that mid-wives may he subject to local influence which may operate against their efficient work, and generally there is a tendency to take an inferior class of women for midwives, which is a very undesirable thing. I would point out that in addition to the opposition of the Committee in 1909 to delegation the proposal to alter the Bill, and introduce delegation has been opposed strongly by the county council association within the last few days. It is also strongly opposed by the Association for Promoting the Training and Supply of Midwives. That association, I believe, has made a very close study of the question, and is doing most useful public work. Therefore, on all these grounds, namely, that the Departmental Committee, the County Councils Association, and the Association for the Supply and Training of Midwives, are all opposed to this proposal—that the purpose of the Act is also opposed to any such change—its object being to ensure uniformity—and the delegation has been tried and signally failed, I hope the right hon. Gentleman will insist that the Bill should go forward as now drafted.
§ The CHAIRMAN
I saw that the Clause on the Paper in the hon. Member's name is on a different point entirely, and it will be taken when we come to it.
§ Mr. COTTON
The Committee has listened to two speeches from London Members, and I should like to put before it the standpoint of the London County Council on this matter of delegation. My hon. Friend the Member for St. Pancras must, I am afraid, be looked upon as a hopeless case, for he seems to think that the only form of patriotism of which London is capable is borough patriotism. But the hon. Member for East Marylebone, who was at one time an ornament of the London County Council, could have drawn sufficiently on his recollection of the way in which the work 533 has been done by the London County Council to have made rather a different speech from the one he made to-night. Anyone who listened to the speeches of these two hon. Members would have imagined that the London County Council had actually delegated those powers under Section 9 of the Act of 1902. As a matter of fact they have done nothing of the kind, but during the last fifteen years they have been exercising all the powers under Section 9 of the Act of 1902. On 20th March, 1917, the London County Council resolved unanimously, as the result of experience they had acquired during fifteen years, that it would be prejudical to the public health of London if delegation to the Metropolitan borough councils of powers at present exercised by the London County Council under the Midwives Act of 1902 were contemplated. They went further, and they urged the right hon. Gentleman the President of the Local Government Board to endorse that view, and I sincerely hope that the right hon. Gentleman will not listen to the specious arguments put forward by the hon. Member for St. Pancras and the hon. Member for East Marylebone. This question has nothing whatever to do with maternity and child welfare, as the Committee has been led to believe by the two hon. Members. Let the borough councils continue the beneficent work of maternity and child welfare, which does not come within the scope of the work done by the County Council Committee under the Midwives Act. Anyone who has watched the work of that committee, which is under the chairmanship of a very accomplished lady, would at once acknowledge that the work has been most admirably and most efficiently done. What is it proposed to substitute in its place? It is proposed to throw open the door to the setting up of twenty-eight Midwives Act committees in each of the London boroughs boroughs with all kinds of different standpoints, with all kinds of different opinions on the particular work to be done. What confusion would at once take place! I was very glad that the hon. Member who spoke last quoted from the Report of the Departmental Committee of 1909. There were two or three lines which he might have added and they are very well worth quoting. Sir Shirley Murphy, who was then medical officer for the County of London, was strongly of opinion that in London administration of the Act should 534 be in the hands of the county council. On page 20 the Report says:It is the emphatic opinion of the committee that these powers should be withdrawn, and that in cases where it is still exercised the delegation should be revokedWhat has happened between 1909 and 1918 to make that strong expression of opinion no value? Nothing whatever that I know of. We are told that Metropolitan borough councils must be encouraged. They have got plenty to do at the present moment if they only choose to do it. To suggest that there should be taken from the great central authority in London, work which it has discharged with marked success, and that it should be frittered about among over twenty different boroughs, seems to me one of the most extraordinary proposals I ever heard of. I sincerely hope that the Committee and the President of the Local Government Board will not have anything whatever to say to the proposal that has been made by the hon. Member for East Marylebone. I purposely confine my remarks on the question to London, because I do not presume to speak on any question arising in connection with the Act outside London. I am bound to say that during the nine years I have been a member of the county council I have had an opportunity of seeing how the work of this committee is being done, and I cannot imagine work more efficiently and better done. I would consider it a public calamity if the Amendment of the hon. Member for East Marylebone were adopted.
§ Mr. R. McNEILL
I listened to the speech made by the hon. Member for Bristol (Sir Charles Hobhouse) with great satisfaction. He suggests that the President of the Local Government Board should retain the Bill in its present form, and he pointed to a slight modification which the right hon. Gentleman might make if he felt pressed by the weight of argument in the course of the Debate. After the speech delivered by my right hon. Friend, I think the President of the Local Government Board will not feel himself in that predicament. I think the weight of argument is entirely in support of the view of my right hon. Friend the Member for Bristol. I am certainly entirely of the same opinion. The right hon. Member for Bristol speaks with experience as chairman of a county council in a rural district. The hon. Gentleman who has just sat down speaks for the London County Council. There we have evidence 535 from a great urban population on the one hand, and a rural district on the other, and the experience of the two speakers goes to show that delegation from a central to local authority is very much to be deprecated. I cannot understand the force of the argument which appeared to appeal to the hon. Member for Wolverhampton. He spoke as if the proposal under the Clause was to take away powers from the local authorities—to deprive them of powers which they already possessed. There is no question of taking away authority from the local body. It is only a question as to which of various efficient bodies should exercise these particular! functions. My hon. and gallant Friend opposite has shown very conclusively that in so far as delegation has been practised up to the present it has been recognised by those most competent to judge as a failure. It has been pointed out that in no less than ten counties delegation originally granted has been revoked, and we must suppose that the revocation took place at the hands of persons competent to judge by the light of experience, having found that administration by delegation was not all that could be desired. An hon. Member opposite quoted strong passages from the Report of the Departmental Committed, and we must surely assume that a Committee of that kind went very fully into the experience which had been already gained, that it took the evidence of those who came before it as being the evidence of those most competent to judge, and who expressed their views against delegation on very good ground. There was one other passage in the Report which my hon. and gallant Friend might have quoted, and it was in the evidence of the secretary of the Central Midwives Board. He said, speaking on this subjectDelegation has proved an unmitigated evil.In face of such evidence as that, surely it would be an extraordinary proceeding for this Committee now, which has not had the advantage of making a close study of the subject, to call upon the Government, or to press my right hon. Friend in anyway, to alter the drafting of the Bill, which the Government must have presented in its present form after mature consideration of the whole subject! My Tight hon. Friend shakes his head.
My hon. Friend has forgotten the history of the Bill in another place. It was not presented in the form in 536 which it appears now, because an Amendment was carried against it, and the form in which the Bill appears is the one which I thought it right to take charge of in this House. It is presented in the form in which it left the other House.
§ Mr. McNEILL
I had not in point of fact forgotten the history of the Bill, but I did not understand it in the sense in which the right hon. Gentleman presents it. I certainly take it for granted that my right hon. Friend made himself responsible for the Bill in this House, and brought it into this House in a form of which he approved. At all events, whatever view my right hon. Friend may have taken when drafting the Bill, I hope he will retain the Bill as it is, if by mistake or by accident he has hit upon the best form. Apart altogether from the authority cited, I should have thought really commonsense administration of an Act of this sort should be more or less central. The object, or one of the great objects, of the administration of an Act of this sort is uniformity of administration. My hon. and gallant Friend opposite quoted a case where there was a great multiplicity of inspectors and administering authorities in a very small area. Surely the area administered by the county council was quite the smallest to accept for the efficient administration of an Act of this sort.
§ 8.0 P.M.
§ Mr. McNEILL
Certainly. I say that where possible—it is a matter of degree—you ought to have a very considerable area under one administration. I do not wish to be dogmatic on a matter of this sort, but the fewer authorities you can reasonably have in a given area for the administration of an Act of this sort, the better it is, I think. Take for instance the question of inspection. Surely it stands to reason that if you want to get a uniform standard of work the area should be large. If you have a number of comparatively small areas each with its own inspector, you are bound to get different standards, and you are also bound, I think, to get a lower class of man for the work. There is less work to be done in the small area, less responsibility and, presumably, also less salary. Therefore, I think, you are likely to get more efficient work and better class work if you have the inspection extended over the area of the county. 537 What is still more important, in fact the chief importance, is the class of woman you are going to get to carry on the profession. The thing which is most desirable to get is high-class educated women. Those who are qualified to speak for the women in this profession will tell hon. Members that you cannot get and will not get the high-class educated woman to undertake this work if she is to be under an inspector of small experience and small authority administering a small area. You are more likely to get the class of woman desirable for the profession of midwife if the question of delegation is left in the position in which it is in the Bill, as introduced by the Government. I most earnestly hope in the interests of efficient administration and of the making of this Act what it ought to be, namely, the greatest possible blessing to the whole population on a vitally important matter, that my right hon. Friend the President will not give way to any pressure, but will maintain the Bill in its present form.
§ Sir A. WILLIAMSON
I also hope that the President will maintain the Bill as it stands. It is certainly an extraordinary position that we should have a Bill presented by a Minister, who proves to be rather lukewarm in his support of this particular Clause. Here we have got a case where the people involved are all against delegation. The county councils who are the people to whom it is proposed to give the power of delegation, are against the exercise of that right, and do not wish to have it. We come to the opinions of those who are experts in this matter. We had the Departmental Committee which investigated the working of the Midwives Act and a Committee, as has been rightly said, of very great power and prestige, and I suppose a prestige far beyond anything that we in this Chamber at the present moment possess in connection with this subject. The view of that Committee was unanimously against giving the right to delegate these powers to small authorities. The midwives themselves, as far as we know, with one voice oppose this proposal to delegate these powers. The Midwives Institute, an association for promoting the training and supply of midwives, and the Queen Victoria Jubilee Institute for Nurses, very closely associated with the execution of this work are all strongly opposed to this power of delegation.
The Queen's Institute, of which I happen to be a member, carries out a very 538 large amount of district nursing work throughout the country. Many of those district nurses are also midwives. They are all inspected under the Institute by a body of inspectors, and we have had in that Institute years of experience of how inspection can best be done, and what are the best areas for inspection. We have found that the county is the best area of inspection. In most of the counties there is a district nursing association with a local inspector belonging to the county, who inspects the work of all the nurses in the county. By that system you get uniformity of standard and interchange of information. Where an outbreak occurs in any one part of a county the inspector is able to deal with it in a way in which it could not be dealt with if there were eight or ten inspectors out of touch with one on other. It seems to me that there is really no necessity to labour this point much more, because we have got all the people whose authority is really worth considering of one opinion. There is only on the other side one voice, and that is the voice of those who want to create a further number of officials and inspectors connected with the local districts. I view that desire with a great deal of suspicion. We have had far too many appointments of officials. If in this case we believe, as I think all of us, or almost all of us, do, that we are better with one large area and one official supervising that area, then I say let us be very chary indeed of taking any course which is against the experience of those who really ought to know, and of admitting an Amendment for the purpose of creating a larger number of officials.
§ Mr. BOOTH
It is somewhat refreshing to hear a representative from the extreme Highlands giving us a lecture on the duties of representing small local authorities, and it requires a little courage for any hon. Member to take up that position. The hon. Member seemed to think that there was only one voice raised against the large area and that that voice was in favour of multiplying the number of officials. Has my hon. Friend supported me on the occasions when I denounced the appointment of officials, and I challenge him to name any hon. Member who for years past has striven harder to prevent the appointment of officials and officers than I have. I think that some of the arguments used by the hon. Member opposite (Mr. R. McNeill) tell in favour of the Amendment of the hon. Member for 539 Wolverhampton. Take the case of that hon. Member's county of Kent. All his pleading for a large authority falls to the ground when you instance the case of Canterbury, a borough with a population of 30,000, and contrast that with Willesden and other districts with populations of 160,000 and 140,000, which are to be totally neglected while the small borough is to be an authority. The argument about large and small districts does not fit this position at all. In the Clause I put down I limited it to places with a population equal to a county borough, and I considered I was quite right in so doing. I should have preferred the direct appointment of the small authority and I am not ashamed to make that statement. An hon. Member pointed out that we had speeches as to urban and rural areas from county councillors, as if they were speaking for different interests. But may I remind him that they were both speaking for the county councils? My hon. Friend (Mr. Cotton), whom we are all glad to see here, and who is an acquisition to the House, was speaking as a London County Councillor.
§ Mr. BOOTH
Quite; but do not let it be represented as two different voices. It is the voice of the county councils. We are now on the point of the apportionment of the respective duties of the county councils and the urban districts. My hon. Friend had great courage in quoting Sir Shirley Murphy with regard to the position in London. He is the medical officer for London, and was he likely to say that this work ought to be taken away from his department? Was it not more likely that he should say that it ought to remain in his department? I do not know of any case of any official coming forward and Asking that work should be taken away from his department and thus lead to a reduction in salary. I wish to ask hon. Members whether they desire to encourage local government or not? The urban district councils of this country have not the glamour of the mayoralty, and there is no chain to hang about their hecks. They have hard, solid work, very little of which is reported. It is different in the county councils, which they join in order to get into the limelight, and which are used as a stepping-stone to this House. In London that is why they join, and in many cases they are very soon 540 made welcome to this House. The urban district councils of the smaller boroughs grind away at what is an arduous and humdrum task. I would appeal to the President, while he has regard to authorities who are vocal in this House, to have also regard for those authorities who are not so vocal. It is difficult to get the best men to go on these local authorities, and what is the reason? Hon. Members must be aware that in one sphere very often prominent men refuse to act, and the reason they give is because some bodies are too much under the orders of Whitehall. On the borough councils the position is different, because members can see changes brought about in the community in which they live, as a result of their labours.
There is no more democratic body than the urban district council. A certain number retire each year, and the election takes place on a democratic suffrage. These bodies cause no trouble and have never gone on strike. I submit, if you go on taking powers from them and pass Acts of Parliament which discountenance and discourage them, you will not get the best type of men to serve on them. The Amendment does not go far enough to please me, and I would have very much preferred the Clause on the Paper, but of course I can quite see that if we cannot carry the very modest Amendment proposed, then there is no chance for my Clause. I do say that what is asked would be a very small crumb for those who represent the districts concerned. I cannot conceive that the President will refuse that crumb, if we are not to get the Clause on the Paper. Why should you say to the big urban district of Willesden, if it will convert itself into a borough then it hall have these powers? Its population may fall, and yet it may be converted into a borough—or the Rhondda Valley. They will have these powers and many others. Why should it not go by population? Why have not hon. Members in this House, why has not the hon. Member for St. Augustine's answered the point I put, whether he would take away those powers from Canterbury? If there is anything in the argument that councils should be the area and not small areas with small-minded people liable to influence, he should take it away from Canterbury with 30,000 population before he refuses it to places with 160,000. What does this Clause suggest? To enable the county council, as I understand it in its 541 altered form, to delegate its authority to an urban district which is bigger than a county borough which is about 50,000. I venture to say if you are going to disregard urban districts which are bigger than county boroughs, and at the same time keep small county boroughs, you are placing an unfair stigma on some distinguished authorities whose members are doing continuous and humdrum public service.
§ Major HILLS
I submit to the Committee that the question is not one between the county council and the district council in the way that the last speaker has put it. District councils are patriotic and democratic bodies, but the question that this Committee has to decide is how best we can get a supply of midwives for the country. No one wishes to cast a stigma on the district council, but we do think that inspection should be carried on over a larger area, and by a more highly-skilled inspectorate than the district councils usually employ. All these arguments have been given at great length, and I do not want to repeat any of them, but I do want to emphasise one or two points on the general case for a larger inspectorate, and for this reason. The question is one of very great importance. Of every ten babies that are born in this world about seven or eight are brought into the world by midwives. The enormous majority of those who are born are born under the care of midwives, and therefore it is of urgent importance that we should see that those midwives are as efficient as possible. If you have a large area, a large area can afford to pay a high salary and therefore attract a better class of inspector. Then there are these three points. First of all, the status of the inspector is raised, secondly, the nurses know that they have an efficient lady inspector over them and, therefore, their own status is thereby improved, and lastly, the public know that the babies are being born under better conditions. It has been pointed out that if you have some areas large and some small that you get a difference of standard and want of uniformity. That is quite true. An inspector knows that she must keep herself in constant practice. Unless she is inspecting constantly she will lose touch just as a musician will lose touch. It is important that she should have a wide area where she is inspecting midwives daily. The right hon. Gentleman would go back on authority, authority which origi- 542 nated from his own plan and which was reinforced by the speech of his representatives in the House of Lords only a few months ago. Lord Crawford, in introducing the Bill, said that inspection had done all that was expected of it. Surely all the argument is on one side unless my hon. Friend has some evidence which we do not know. He tells us that he does not approve of his own Bill. I am sure he has good reason for saying so, but the House ought to know it. All the evidence we have is that of a strong Committee appointed nine years ago, of the bodies engaged in the training, supply and inspection of mid-wives, and lastly I believe the quite unanimous medical opinion of this country. I hope that the Committee will pass the Bill as it stands.
§ Mr. GILBERT
I rise as a London Member in order to support what has been said by the hon. Member for East Finsbury. When the hon. Members for Marylebone and St. Pancras were asking that London should have power to delegate powers under this Act, I thought that they would have put forward some very strong complaint against the administration of this Act by the London County Council. I have not heard from either of them or any subsequent speakers that they had any complaint to make against the way this Act has been administered by the London County Council. I think anyone who has inquired or looked into the matter will find that the London County Council's administration has been very satisfactory, that everybody connected with it is very pleased and that the Midwives' Society and the Nurses' Society thoroughly approve of the way in which this Act has been administered by the central authority in London. What would delegation mean in London if it is carried out on the lines suggested by the hon. Member for Marylebone? You have in London twenty-eight borough councils. He said that he was moving this Amendment at the instance of the Standing Joint Committee of the London County Council. So far as I know, the Standing Joint Committee is not a public representative body, and there is no particularly strong feeling on the part of the borough councils to take over the powers under this particular Act. In fact, it would have been very interesting if the Members who moved this Amendment had told the Committee how many borough councils in London were keen to administer the Act. So far as I know, there is only one borough council 543 that has applied to the county council to have powers delegated to it. The views of the London councils are quite unanimous on this matter. We had the Resolution passed last yearThat the Council is of opinion that delegation to the Metropolitan borough councils of the powers at present exercised by the Council under the Midwives Act, 1902, would be prejudicial to the health of London and that the Local Government Board be asked to endorse this view and explain its view to the local sanitary authorities in London.What I want to put to the Committee is, What is going to be the effect if you give delegation in London? You will have twenty-eight authorities, each with its own standard of inspection and requirements. A midwife who has to work under these conditions, even if she lives in one locality in London, not knowing the geography of the boundaries of London, would not know which authority she was working under when she went to a particular case. I suggest to the Committee that these are powers which can best be administered by a central authority. You get better inspection, and I believe you get a better type of midwife, and, speaking as a London Member, as a member of the London County Council, and on behalf of the London County Council, I strongly urge the President of the Local Government Board, who was himself a distinguished member of the London County Council, not to agree to delegation on this point as far as London is concerned.
§ Sir H. NIELD
I am in the embarrassing position that was occupied by the celebrated Pooh Bah in the "Mikado." My interests are so diversified that I can speak with a purely impartial voice in this Debate, because I am a vice-president of the Urban Councils Association, of which the hon. Member for Pontefract is also a vice-president. I happen to represent a borough and three urban districts, and in addition to that I am an alderman of the county council, so that I can take an absolutely impartial view. I am driven to the conclusion that the proper area for an inspection is the county. The hon. Member for Pontefract referred to Willesden, which is the largest urban district in my county, and I am in close touch with it, and I have never heard on the part of Willesden, which was represented on the General Purposes Committee of my county council who considered this matter twice with great deliberation, any 544 wish to have these powers. When Tottenham asked the county to delegate powers the greatest possible care was taken by the committee to investigate whether they would be justified in extending further the powers which had already been delegated at that time to one or two districts, I believe, and after a very long discussion they came to the conclusion that it was undesirable. Subsequently, a year or two after, the matter was reopened by a letter of the Local Government Board, and again the matter was gone into with great particularity, and again the committee and the council endorsed it unanimously, and came to the conclusion that the unit should be preserved as the county unit. Willesden was powerfully represented on the county council by some of the most able men we have amongst us, and not a voice has been raised on the part of Willesden against the county continuing to exercise the power.
§ Sir H. NIELD
I say the Willesden District Council has never made itself heard. It is impossible to ignore the professional opinion on this question. As late as last Session a letter appeared in the "Daily Telegraph" over the most distinguished names identified with this work—the honorary secretary of the Queen Victoria Institute for Nurses, the president of the Incorporated Midwives' Institute, and the chairman of the Association for Promoting the Training and Supply of Midwives—and they all unanimously agreed in saying that the county unit is the one thing that must be retained. [Major HILLS: "Hear, hear!"] I never know where the hon. Member for Durham, when he says, "Hear, hear!" is going to take me, because he does hold some very advanced views on kindred matters; but I am satisfied in thinking, at any rate, that the House would be unwise to alter the terms in which the Bill is now drawn.
One or two of my hon. Friends appear to think that I ought to be able to work myself into a white heat of passion in support of this Bill; but let me say, first of all, that this is not a Bill of the Local Government Board, but of the Privy Council, and in the form in which it was introduced by the Privy Council there was a very considerable discretion left to 545 county councils on their own initiative to delegate these powers of supervision over midwives with the consent of the Local Government Board, and the member of the Government who was in charge of the Bill did not retire from that position with any grace or good will. He only retired from it because he was beaten in a Division by 33 votes, I think, to 23, and when the Bill came down to the House of Commons it very naturally came down in the form in which it left the other House. I have been asked to take charge of it on behalf of the Privy Council, and I thought it only right to reintroduce the Bill in the form in which it left the House of Lords. I cannot excite myself over this great question, and I am afraid I shall be unable to excite anyone else. The choice we have to make is this: those Members—and they have been exceedingly eloquent in their expression of opinion—who appear to represent the counties seem to think that under no circumstances whatever ought the county councils to be allowed to delegate the powers of supervision and inspection of midwives, not even with the consent of the Local Government Board, not even if they do it by an unanimous vote on their own initiative, and not even if there were all kinds of safeguards put forward by the Local Government Board under regulations under which those powers would in future have to be exercised by the district council or metropolitan borough council to which they were delegated. That is a very strong position to take up—that perfectly free bodies by a unanimous vote should not be able to part with their powers in the matter, well knowing what they were doing, to very large district councils with populations of possibly 200,000, who had large and complete maternity and infant welfare schemes and whole-time medical officers of their own, and who were quite prepared to carry out the inspection and supervision of midwives in the most approved most efficient manner. When hon. Friends of mine say that, after all, the County Councils Association is of the opinion that they should not have power to delegate under any circumstances, let me remind them that two county councils quite recently, since the passage of this Bill through the House of Lords, and well knowing what took place in the House of Lords, have delegated those powers—the county council of Glamorganshire to the district council of Rhondda and the county council of Cambridgeshire to the 546 borough of Cambridge. I think the Glamorganshire County Council was very much influenced by an argument which influences me when I have a slight predilection for the discretion being left to the county council, with the Local Government Board itself to control that discretion. Glamorganshire found itself in this position. It had 650 midwives in its employ, and it had only one inspector, and the great district of Rhondda very seldom saw this inspector, and Rhondda said, "As we have a large maternity and child welfare scheme of our own we could do it much better than it can be done with your one single inspector." That, I am bound to say, was a very solid argument, and the County Council of Glamorganshire wished to part with those powers to this great district council of Rhondda.
Let me take the case of Lewisham. Lewisham is a very large metropolitan borough, with a population of 165,000. It has a very complete maternity and child welfare scheme, and I have recently personally visited and inspected it. It has a complete scheme, and it has a whole-time medical officer. That metropolitan borough said to the London County Council, "Will you not delegate your powers under the Midwives Act? We have a whole-time officer and a complete system of our own." The London County Council, I understand, on the whole thought they had better maintain the principle that they should, as a rule, be the body that supervises and inspects the midwives of London, but it did open up this question: Was the London County Council at that time in an efficient condition to inspect all these great metropolitan boroughs? and the London County Council, in consequence of this request on the part of Lewisham that it should have these powers delegated to it, found that if it wanted efficiently to inspect these great metropolitan boroughs it must appoint at least two more members to its inspectorate. I think this question when opened up was very useful in leading the county council to survey its own resources, and to strengthen those resources if it did not desire to part with these powers to a metropolitan borough council which was in possession of a very complete system of maternity and child welfare. That question of maternity and child welfare really had a very great deal to do with this question of inspection and supervision of mid-wives.
547 Some hon. Friends of mine say that these powers of delegation existed in the county councils before and they were a failure. Yes, they were a failure long before these complete systems of maternity and child welfare were adopted by these large district councils. They were a failure when the county councils themselves had not necessarily any medical officers of health. We owe the fact that the county councils were obliged to have medical officers of health to my right hon. Friend, who occupied my place at the Local Government Board. But before those days they were in the habit of delegating these powers to almost any authority. I do not think that can be adduced anyway as an argument to show that the delegation of powers, at the discretion of the Local Government Board, to the very large areas where there were whole-time medical officers would necessarily be a failure. There was one other argument adduced. Some hon. Friends of mine dwelt very much on the necessity of setting up a complete uniformity between the English Act and the Scottish Act. I think they have spoken in considerable ignorance of what happens in Scotland, and I am extremely surprised at my hon. Friend the Member for Elgin (Sir A. Williamson).
My hon. Friend, I think, laid it down that only very large areas like the county councils were fitted to possess these powers of supervision and inspection of midwives. He must know even better than I do that those powers cannot be delegated in Scotland, because there is nobody to whom they can be delegated. Every borough in Scotland has these powers. I can point out boroughs of not more than four hundred inhabitants who have these powers. They are dotted all over Scotland with a population of only a very few thousands and some only with a very few hundreds with these powers.
§ Sir A. WILLIAMSON
Is it not the case that these small boroughs which have this right do not exercise it, and that it is done by county inspectors?
In some small cases that may be so, but in cases where the population amounts to a very few thousands it is not always so, and Scottish local authorities are not very apt to part with powers given by Act of Parliament. Therefore I 548 do not think the argument of uniformity is of any weight, nor the argument that there was a failure when these delegated powers were used. Undoubtedly, up to a certain point, the bigger the area the greater the efficiency, but I would not press that too far. I think if my hon. Friend looks at great counties like Devon and Glamorganshire, that point may be pressed too far. It is only true within certain limits. I come to what the President of the Local Government Board and my Department think. We all want to attract to this great profession—and it is a great profession—a high class of mid-wives, and we are very short of them. We want them more in quantity, and gradually we shall require them greater in quality. And we want to improve them in status. For all these things we want the most efficient supervision we can possibly get. From such learning on these matters as I have been able to possess through administering my Department, I am certainly in favour of the Amendment moved by the hon. Member for East Wolverhampton (Mr. G. Thorne). I believe that far the best tiling to do would be to make it a rule, if you like, that none of these powers should be delegated to any rural council, that these powers should only be delegated after consultation with the Central Midwives Board, that they should only be delegated at the discretion of the county council and with the sanction of the Local Government Board, and in no case delegated to a place with less than 50,000 population, and then only in cases where they are willing to appoint inspectors and supervisors who are well qualified and who will obtain the respect and sympathy of those whom they nave to inspect.
I believe that really is better than a cast-iron rule that, under no circumstances whatever, shall a county council, however much it wishes to do so, disburden itself of the great task it has to perform, and if I had to give any guidance to the House it would be to accept the Amendment which has been foreshadowed by the hon. Member for East Wolverhampton, and to agree, at all events, that there shall be some discretion in the county councils, with the sanction of the Local Government Board, in the case of populations of more than 50,000. I believe that is the best decision to which we could come. At the same time, I think the arguments are very strong undoubtedly on the other side, and, as I said on Second Reacting, after all that 549 has happened in another place, and after the Debates that have taken place here, I should certainly not ask that the Whips should be put on in support of any opinion of mine. But I do indicate my support of the Amendment of my hon. Friend, who has given great consideration to this subject, and I hope that his Amendment will be agreed to, and that you will not altogether exclude county councils, on their own initiative, under any circumstances, from delegating this power to district councils, however complete a system of maternity and child welfare they possess.
§ Mr. COTTON
Would the right hon. Gentleman wish to include the words "after consultation with the Central Midwives Board"?
I am quite prepared to incorporate those words. The Local Government Board certainly would never favour the delegation of these powers to small populations and small areas, and would only consent to delegation under special circumstances such as I have mentioned.
§ carefully—as carefully as I could—and I desire to ask whether what he has safe has led him to the conclusion that he will support the Amendment of my hon. Friend the Member for Marylebone?
The greater would include the less. It would be open to the Local Government Board, on the initiative of the London County Council, to allow the London County Council to delegate these powers to Lewisham or any other borough they might consider desirable.
§ Sir C. HOBHOUSE
That is what I thought. I only wanted to know where we were as we are likely to have two Divisions.
§ Sir J. BOYTON
I think in all the circumstances I should like to ask leave to withdraw my Amendment.
§ Amendment, by leave, withdrawn.
§ Question put, "That the Clause stand part of the Bill."
§ The Committee divided: Ayes, 60; Noes, 38.549
|Division No. 84.]||AYES.||[8.49 p.m.|
|Allan, Arthur A. (Dumbartonshire)||Gilbert, J. D.||Nugent, J. D. (College Green)|
|Archdale, Lieut. Edward M.||Gretton, John||O'Donnell, Thomas|
|Bigland, Alfred||Gulland, Rt. Hon. John William||O'Malley, William|
|Bliss, Joseph||Hackett, John||Philipps, Maj.-Gen.Sir Ivor (S'hampton)|
|Boland, John Pius||Havelock-Allan, Sir Henry||Roberts, Charles H. (Lincoln)|
|Bowerman, Rt. Hon. C. W.||Hazleton, Richard.||Roberts, Rt. Hon. George H. (Norwich)|
|Boyle, Daniel (Mayo, North)||Hinds, John||Sanders, Col. Robert Arthur|
|Bryce, J. Annan||Jones, H. Haydn (Merioneth)||Scott, A. MacCallum (Glas., Bridgeton)|
|Burns, Rt. Hon. John||Jowett, Frederick William||Smyth, Thomas F. (Leitrim, S.)|
|Byrne, Alfred||Keating, Matthew||Toulmin, Sir George|
|Collins, Sir Stephen (Lambeth)||King, Joseph||Trevelyan, Charles Philips|
|Cornwall, Sir Edwin A.||Lambert, Richard (Wilts, Cricklade)||Ward, W. Dudley (Southampton)|
|Cotton, H. E. A.||Lonsdale, James R.||Watt, Henry A.|
|Crumley, Patrick||Lundon, Thomas||White, J. Dundas (Glasgow, Tradeston)|
|Davies, Ellis William (Eifion)||McCalmont, Brig.-Gen. Robert C. A.||Williams, Sir R.|
|Denman, Hon. Richard Douglas||McNeill, Ronald (Kent, St. Augustine's)||Williamson, Rt. Hon. Sir Archibald|
|Doris, William||Meehan, Francis E. (Leitrim, N.)||Wood, Rt. Hon. T. McKinnon (Glasgow)|
|Duffy, William J.||Morgan, George A.||Young, William (Perthshire, East)|
|Farrell, James Patrick||Newman, Sir Robert (Exeter)|
|Field, William||Nicholson, Sir Charles N. (Doncaster)||TELLERS FOR THE AYES.—Major|
|Gibbs, Col. George Abraham||Nolan, Joseph||Hills and Major Courthope.|
|Alden, Percy||Jones, J. Towyn (Carmarthen, East.)||Sharman-Crawford, Col. R. G.|
|Baldwin, Stanley||Kenyon, Barnet||Shortt, Edward|
|Barrie, H. T.||Lewis, Rt. Hon. John Herbert||Stanton, Charles Butt|
|Booth, Frederick Handel||Maden, Sir John Henry||Swift, Rigby|
|Condon, Thomas Joseph||Maitland, Sir A. D. Steel-||Thomas, Sir A. G. (Monmouth, S.)|
|Dougherty, Rt. Hon. Sir J. B.||Munro, Rt. Hon. Robert||Walker, Col. William Hall|
|Fell, Sir Arthur||Parker, James (Halifax)||Walsh, Stephen (Lancs., Ince)|
|Ffrench, Peter||Pollock, Sir Ernest Murray||Wardle, George J.|
|Fisher, Rt. Hon. W. Hayes (Fulham)||Pratt, J. W.||Wheler, Major Granville C. H.|
|Flavin, Michael Joseph||Roberts, Sir J. H. (Denbighs)||Wilson, Rt. Hon. J. W. (Wore, N.)|
|Guest, Hon. Frederick E. (Dorset E.)||Rowlands, James|
|Henderson, John M. (Aberdeen, W.)||Rutherford, Sir W. (L'pool, W. Derby)||TELLERS FOR THE NOES.—Mr. G. Thorne and Sir James Boyton.|
|Higham, John Sharp||Samuel, Samuel (Wandsworth)|
|Hope, James Fitzalan (Sheffield)||Samuels, Arthur W.|
§ Clauses 13 (Notification to Local Supervising Authorities of Removal of Names from Roll); 14 (Medical Assistance in Case of Emergency); and 15 (Action by General Medical Council) ordered to stand part of the Bill.