HC Deb 01 April 1919 vol 114 cc1135-61

Order for Second Reading read.


I beg to move, That the Bill be now read a second time. I think it is probably unnecessary to rehearse the considerations which render the establishment of a Ministry of Health desirable. They are quite familiar to the House, and they do not admit of serious challenge or controversy. I shall accordingly confine myself to explaining as shortly and as clearly as I can the main features of the Bill. If I have to refer, as I shall have to do more than once, to the Secretary for Scotland, the House will understand that I am referring to the official who is so designed, and not to the present holder of the office. One of the first and most important questions which arise in connection with this Bill is this: Should the Secretary for Scotland be the head of the new organisation or should there be a separate Minister of Health? While I quite recognise what I think are the superficial attractions of the latter proposal, I have no hesitation whatever in adopting the first, and in embodying it in the Bill. Health, no doubt, is an important subject. But so is education, so is agriculture, so is fisheries. If you set up a separate Ministry of Health, each of the Departments which I have just named would have an equally good claim to a separate Ministry, and to give effect to such claims is obviously not practical politics to-day. Moreover, I think it is of the first importance that the head of the new Health Department should be a Cabinet Minister, who will have the right to speak in the inner councils of the nation, and who will also be in close and intimate touch with the Treasury. The Secretary for Scotland in normal times answers these requirements. A separate Minister of Health certainly would not, because I think it is not conceivable under existing conditions that you should have two Ministers from Scotland, both of whom would be in the Cabinet.


They are nearly all from Scotland.


I mean those representing Scottish interests—the interests represented by the Secretary for Scotland and the interests represented by a separate Minister for Health. If you had two Ministers under these conditions I do not think we could reasonably hope that both would be included in the Cabinet. It may be quite reasonably said that the Secretary for Scotland has already a large number of duties to perform, and is it really proposed to add to these duties by imposing on him yet another? My reply would be that it is, if at the same time you supply the Secretary for Scotland with a Parliamentary Under-Secretary. This the Bill proposes to do. I think that this should have been done long ago, but it is better late than never. The Bill provides that the Parliamentary Under-Secretary shall be responsible, under the Secretary for Scotland, for the administration of the new Health Board. What will be the relation of the Secretary for Scotland and the Parliamentary Under-Secretary to the Health Board? Under the provisions of the Bill, the Secretary for Scotland is to be the President of the Board, and the Parliamentary Under-Secretary the Vice-President. The Board to-day, as my Scottish colleagues will know, consists of three appointed mem- bers, one of whom must be a medical man with a public health qualification, and another an advocate of seven years' standing, together with three members who are ex-officio members—namely, the Secretary for Scotland, the Solicitor-General for Scotland, and the Permanent Under-Secretary for Scotland. We propose that the latter two ex-officio members shall no longer be members of the Board. Their presence has been valuable, but under the new arrangement I do not think that it would be necessary.

The three appointed members will remain members of the new Board. As regards qualifications, it is not proposed that the medical member shall necessarily possess a diploma of public health. Another member must be a lawyer, and the range of choice has been extended by including both branches of the legal profession. Formerly the legal member of the Board had to be an advocate, but under this Bill he may be either an advocate or a member of the solicitors' branch of the profession. It is further provided that ten years' experience of professional life should be a necessary qualification for this important post. Looking at the responsible character of the duties to be discharged, that is not too long. Further, it is proposed to include two of the four Insurance Commissioners, selected by the Secretary for Scotland, and, at any rate, one woman, while the chairman will be appointed by His Majesty on the recommendation of the Secretary for Scotland. I hope that the House will approve of the principle upon which it is proposed to select members of the new Board.

The next important question is, with what powers should the new Board of Health be clothed? I have endeavoured to make the transferred powers, which are to be transferred immediately, as ample and as comprehensive as possible, and in that I think that I am giving effect to the views of my Scottish colleagues as expressed to me when I had the privilege of meeting them in the Committee Room upstairs. In the first place, the powers of the Local Government Board and the Insurance Commissioners are transferred under Section 4, Sub-section (1) of the Bill. There are also transferred the powers and duties of the Privy Council under the Midwives Act, and the powers and duties of the Secretary for Scotland under the Alkali Works Regulation Act, the Burial Grounds Act, the Rivers Pollution Prevention Act, the Births, Deaths, and Marriages Acts, the Vaccination. Acts, and of the Highland and Islands-Medical Service Board. These powers-will not be transferred by Order in Council, but in virtue of statutory enactment, if the House thinks fit to agree with the proposals made. I do not go into various details with regard to each Statute. It may be thought desirable to investigate and explain these matters more carefully upstairs.


I should be glad to-know what is in the mind of the Government with regard to the words in Subsection (2), paragraph (c), "any other powers and, duties in Scotland of any Government Department." Does he contemplate taking over—I hope he does—the power of the Home Office with regard to factories, and matters of that kind?


I would not like to commit myself to the precise duties which it is proposed to take over under that very general Clause. It is, I think, common form, and leaves it open at any time in the future by Order in Council, which will require the sanction of this House, to take over any powers which bear closely upon health functions. I cannot at the moment inform my right hon. Friend more definitely with regard to the particular matters which may be transferred under this general section. It would be a matter for consideration undoubtedly whether the administration of the Factory Acts comes within health jurisdiction, and whether it would be desirable to transfer these powers. If any of my hon. Friends desire further information on the points in the Clause I would suggest that this part of the Bill might be thrashed out in detail upstairs.

I want to say a word about the two specified powers which under Clause 4, Sub-section (2), it is proposed to transfer by Order in Council. The first is the powers and duties of the Scottish Education Department with respect to medical inspection and treatment of children. The other is the powers and duties of the Ministry of Pensions with respect to the health of disabled officers and men after they have left the Service. On the first point very careful consideration has been given to the suggestion that these powers should be transferred now. There are difficulties, both financial and administrative, which stand in the way of doing it. As regards finance the transfer of these powers now would involve the splitting up of the Education (Scotland) Department which was unified so recently as last year. And for what? The sole result, so far as I can see, would be that you would have two masters to serve instead of one—the Board of Health and the Scottish Education Department. There would be no change locally effected by the transfer. The Board of Health Department would have to work through the Education Authority, as the Scottish Education Department works through the School Board to-day. In other words, the Scottish Education Department would provide the money and would have no responsibility for the spending of it. That would be done by the Board of Health. I suggest for the grave consideration of the House that the disadvantage of the duality of control which would result from the arrangement suggested would more than neutralise any conceivable benefit which would be effected by immediate transfer. On the other hand, I do not for a moment rule out of account the possibility when wider areas are established in Scotland of having such transfer effected by Order in Council, but I do suggest that in the circumstances which I have mentioned it would be desirable that the matter should be left over for further and future consideration.

As regards (b) in Sub-section (2) of Section 4, namely, the transfer of the duties of the Pensions Ministry, I am assured that the schemes are not sufficiently developed at the present moment to admit of a transfer, though it may quite appropriately be done by Order in Council at no very distant date. There are one or two other matters to which it is necessary to refer at this stage. One is the provision for setting up consultative councils. That, of course, resembles the provision in the English Bill with which hon. Members are familiar. I have a very strong and firm belief in councils of this kind. I have found such councils of immense service in a very different region of administration, namely agriculture. I have set up advisory councils also under the Education Act last year. One entertains very high hopes of the beneficial advice to be received from these councils, which will keep the central body in touch with responsible and enlightened public opinion throughout the country. The Bill provides that on the consultative councils to be set up there shall be women as well as men.

A word finally with regard to the Poor Law Sub-section—Sub section (3) of Clause 4. It deals with this matter in precisely the same way as the English Bill deals with the matter. It is, I quite admit, a somewhat unusual type of Clause in an Act of Parliament. Still the House will probably think it right that it should be included. The Poor Law manifestly requires revision. But I think that it would be overloading the Bill and would impede its passage—as the Bill does not really admit of delay—to attempt to revise the Poor Law and include that within the four corners of this measure. The intention, however, is at the earliest possible moment to eradicate from health administration what has come to be known as the taint of the Poor Law. I wish it had been possible to deal under this Bill with local as well as central administration. Large areas in my humble judgment are as essential to effective health administration as they are to successful educational administration, and one hopes that the time is not far distant when that problem will be tackled again. In the meantime it would be a profound mistake to delay this measure by the insertion of provisions which might turn out to be highly contentious in their character. It is better, I think, to do one thing at a time and to take the more urgent things first. This is an important and an urgent reform, and I feel sure that recognising this the House will facilitate the passage of this Bill into law. I venture, therefore, to suggest that the House should give the Bill a Second Reading on the footing that it can be thrashed out upstairs in all details, when any suggestions—and I know how varied they are—and opinions by my hon. Friends as regards many of the provisions of this Bill can be put forward and argued out. They will certainly be very carefully and very fully considered.


It is a matter of regret to, I think, all Scottish Members here present that we should not have had a better opportunity of considering the Bill before having had to take part in the Second Reading. I do not blame my right hon. Friend for that. The Bill has come on quite unexpectedly, but I think that on the whole it would have been unwise for Scottish Members not to seize the opportunity of taking the Second Reading of the Bill and getting it up to a Grand Committee if possible before Easter, because those of you who know Parliament and its uncertainty know that the missed opportunity is the one which has gone and not the one which you may have. Therefore, despite the drawbacks which I certainly suffer from, because I frankly confess I had only seen the draft of the Bill, I think it is just as well to have the Second Reading this evening. My right hon. Friend, perhaps all unconsciously, has been adding another instance to the tremendous case which is piling up for Home Rule for Scotland. He read out a list of offices which he at present holds, and he asks us quite fairly, and with a good deal of force, whether under the existing state of things there is anything to be gained by adding another. Frankly I do not think there is. If you add another in the existing state of things you set up a separate Ministry in Scotland and derange the whole of the existing machinery, working as it is with great difficulty but, in a measure, which after all I am bound to say reflects great credit on the right hon. Gentleman the Secretary for Scotland, the Lord Advocate, and the Solicitor-General. I do not know how they do it but somehow the thing is done, not well done I think they will admit, or not as well as it ought to be done. But, of course, the only thing to do is to pile these offices up until the time comes when Scottish affairs can be dealt with by Scotsmen in Scotland, and until that we must make the best of things and take, as Scotsmen always do, what they can get always in the hope of getting more. As to the transfer which the right hon. Gentleman said he proposed to take the various powers under Clause 4 which follow the English model, I have not much to say, except to press this point upon the right hon Gentlemen. In the English Bill, at any rate as it left the House, it was not proposed to take within the scope of the measure the powers of the Home Office. I have not followed what occurred upstairs, and I do not know whether that was altered. [HON. MEMBERS: "It was not!"] There is not the slightest doubt that there is the power in Clause 4, Sub-section (2, c), to transfer to this new Board in Scotland the powers of the Home Office in relation to factories and mines in so far as they affect health and well-being from the purely health point of view of the workers there. I do not know what the case is against it. In this matter, which vitally affects hundreds of thousands of men and women and young persons in Scotland, it is vitally important that in setting up this power, with all its multifarious responsibilities, that you should not cut out from it and leave under the dominance of a purely English office the question of the factories and workshops of Scotland and all those teeming industrial centres which we know so well. I hope, when we come to deal with this matter in Grand Committee, that my right lion. Friend will see that that power is translated into an effective undertaking to take from the Home Office, as far as Scotland is concerned, those purely health functions and place them under this Board.

There is another point as to which I think my right hon. Friend has been too modest, and that is the question of the relief of the poor and the machinery therefor in Scotland. The question is not nearly so complicated as in England. I was chairman of a Committee which considered this matter, and no one who sat on that Committee could come to any other conclusion than that in the English Bill it was too great a matter to deal with there. I really do not think the problem is anything like so complicated in Scotland. There may be points of contention, but there is a real opportunity now, instead of deferring it, of dealing with the whole matter, and there is no reason why you should not make a clean sweep of the whole thing. The system in Scotland is not nearly so interlaced with the whole of the Government Departments as in England. I notice that in the constitution of the Board it is provided that we are to have one or more women. I venture to think the time has come when we should start by saying two women. That is necessary, because after all women are becoming qualified in medicine in numbers which nobody ten years ago thought probable or indeed possible. Women have a dominant interest in the health of the home, and therefore I think the minimum number should be two. I think it is right that the legal member of this Board should be drawn from either branch of the legal profession, and not limited to the advocate side. The solicitor is in much closer touch with the problem and you can get a really good man drawn from either branch of the profession and quite competent to undertake the duties set out here. I say no more now about the constitution of the Board, which is a matter which can be more easily dealt with in Committee. The other point, that of finance, is one which should receive very careful attention. There will be a Money Resolution, and as to that I would remind the Lord Advocate of what I take is now the established practice of the House, namely, to hold on to Money Resolutions until the House has an adequate and proper statement from the Government of what the cost is to be in connection with the particular undertaking. I can promise him a much longer Debate than he would like on such a matter as this, unless the most careful consideration is given to the Money Resolution.


Unlike the Leader of the Opposition, I did read this Bill yesterday, and therefore before the right hon. Gentleman made his speech, and I had the opportunity of consulting with some colleagues. I fully agree with the right hon. Gentleman and also with the Leader of the Opposition that in existing circumstances the demand for a separate Minister of Health for Scotland could not in those words, or by that name at any rate, be granted. I think the reason given by the right hon. Gentleman is conclusive, namely, that it is essential that there should be a Cabinet Minister in charge of this very important Department of Scottish administration, and that under existing circumstances it would not be hopeful if we were to ask to have two representatives holding Scottish offices. I recognise that the right hon. Gentleman has gone some considerable distance in the direction of meeting the demands made to him by providing in this Bill for an Under-Secretary responsible under the Secretary for Scotland for the administration of this Board. In other words, I take it that we are to have a certain amount of specialisation as between the Secretary for Scotland and the Under-Secretary—that is to say, that the Under-Secretary will be the man to whom people will go who wish to get into real touch with the administration of the Board of Health. The right hon. Gentleman accepts that interpretation, and then I am rather troubled, if that be so, by the insertion at the end of Clause 3 of the office of chairman. Though it is quite true that we cannot have a separate Minister for Health, yet there is a very great deal in the demand that was made for a change in the spirit of administration. On all hands you hear in Scotland that people are tired of this administration by Board. Unfortunately, this Department is to be called a Board. That is the name in the Bill, and I suppose you can hardly alter it. We would have preferred that it should have been known as a Department, and put on all fours with the Scottish Education Department, and that it should have had a Secretary as permanent head in charge of it, and then we should have some beginning of symmetry in the administration of Scotland in the institution of a Scottish Home Office and the first step away from this, administration by Board. There are a great many of us, in fact, I may tell the Secretary for Scotland the majority at any rate of the non-official members, and I am not quite sure that there are not a majority of all the Members from Scotland, who feel that it is essential that we should have even further specialisation in the extraordinarily heterogeneous duties of the Scottish Office, and that we should have a second Under-Secretary to divide with the Secretary for Scotland the duties of the Scottish Office. As it is at present, the Secretary for Scotland, though he is dealing with a small country, is dealing with the equivalent of no fewer than four Departments, at least, of the English Administration. Though he is dealing only with the affairs of a small country, that does not prevent those affairs from being extraordinarily different in their character and making a great demand on the brain of one man.

Our feeling is that if we can have something like a little administrative Cabinet in Scotland, presided over by the Secretary for Scotland, with his two Law Officers and his two Under-Secretaries, we may have something different from that merely bureaucratic administration which we have at present in Scotland. It should be possible under such circumstances normally to have one Minister present in Edinburgh, and that important local authorities wishing to get into touch with the Government of Scotland when they go to Edinburgh should not merely have to deal with permanent officials, but should be able to see one of the men whose names figure in the reports of Parliamentary proceedings when Scottish affairs come before the country, and that they should feel that they are getting in touch with the men elected by the people and chosen from among the representatives from Scotland. I know there are some of my colleagues who fear that by taking such a step we shall be deferring Scottish Home Rule, but my feeling is that you cannot and that you will not get Scottish Home Rule until you can have a scheme for devolution all round, and I am not in the least afraid that by making the administration of Scotland efficient in the meantime we shall be deferring that very great change in the administration of this country which is implied in the scheme which we ordinarily describe as Home Rule all round. Therefore, I venture to express the belief that we may safely take steps now to obtain a really efficient administration of Scotland. We are only going to get that by accepting the two principles—on the one hand a division of labour among the Ministers responsible, and, on the other hand, the abolition of that spirit of bureaucratic and board administration which has grown up in Scotland, because we had not an adequately manned Ministry for Scotland. Therefore, while we accept the proposal of the Bill that there should be an Under-Secretary responsible especially for the Board of Health under the Secretary for Scotland, I am bound to tell the right hon. Gentleman that there will be Amendments moved in Committee with the object of bringing this Board more into harmony with the Department of Education. Names in these matters count for something. People-in Scotland are looking for a departure from your system of boards, and we shall ask that we shall not have a Chairman but a Secretary as the permanent official at the head of this Department, because we want openly and definitely to depart from the spirit which has prevailed up to now, and we want to have this Under-Secretary for Scotland not merely nominally responsible for this Board, but actually and directly and personally responsible and interested in the working of the administration. We want a real Minister. We may have presently a Housing Bill which might be correlated with this, and your Under-Secretary for Health might deal with health and housing. You might have an Under-Secretary dealing also, on the other side, with such matters as agriculture and fisheries; and in order to impress upon the Scottish administration the general desire that there should be such a change I think, after careful consideration, it is possible that a large number, at any rate of the Committee upstairs, will desire to mark that by instituting if possible some other title than that of "Chairman." I notice especially also the salary which is to be separately assigned to this Chairman, thereby marking the importance of his office. We fear that that does signify that you are merely camouflaging the continuance of the present system by yielding to the pressure that has been put on you, and putting a double screen, not only that of the Secretary for Scotland, but that of the Under-Secretary, between you and the criticism which has been levelled at you. Therefore, while I would do nothing to impede the Second Reading of this Bill this evening, at the same time we do give notice that we shall have definite criticism upstairs with a view to action in the directions I have indicated.


I am bound to say that in Scotland there is great dissatisfaction that, instead of the Secretary for Scotland with his many duties being made the head of a new Health Board, we should not have had a separate Minister of Health. I do not share with my hon. Friend the Member for Camlachie (Mr. Mackinder) the view that the Scottish people detest a Board. That is not the feeling in Scotland. They do not care what the Department is, whether it is a Department or a Board, or whether you call the head of it a chairman or a president. What they do distrust in Scotland is the influence of the Scottish Office in London, and they want to work this Department apart from the paralysing influence of the Scottish Office here If in the provision that is made in the Bill for an Under-Secretary it is made clear that he will devote his whole time to health matters alone, that will reconcile us in Scotland to the fact that the Secretary for Scotland is to be the head of the new Department. But if the Under-Secretary is going to be maid-of-all-work, and to potter around in the Scottish Office here, it will not be at all to our liking and will create a most unsatisfactory feeling. If you are going to reconcile the Scottish people to not having a separate Minister of Health, you will do so by making the Under-Secretary under this Act a Secretary who will devote his whole time to the duties of public health. I am sorry to learn that the Secretary for Scotland is not disposed at the outset to transfer to the new Health Department in Scotland the medical inspection of school children. At the present moment a new educational authority is being formed in Scotland. The elections are in progress, large areas have been created, the whole of the Scottish educational system is in the melting pot, and this appears to many of us to be the very opportunity for the medical inspection and treatment of school children to be transferred from the medical authorities and handed over to the new Board of Health. I have had the privilege of being chairman of a committee. The old authorities have been tinkering, with medical inspection in Scotland for a few years past, but they have only touched the fringe of the question, and we should greatly appreciate it if at the very outset it had been decided to transfer from the Education Department to the new Board of Health the inspection and treatment of school children. While this was not provided in the English Bill, the Committee on that Bill have resolved that the medical inspection of school children will be handed over to the new Health Board for England, and what is good enough for England should be good enough for Scotland. I hope the Secretary for Scotland will carefully consider whether, instead of relying on that vicious system of Orders in Council upon some future occasion, he will not forthwith arrange for the Committee to give the same privilege in regard to the medical treatment of school children as has been granted under the English Bill. I hope that the setting up of this central authority in Scotland will lead to larger local areas being established in Scotland. We suffer just now in Scotland from having far too many small local health bodies. These should be grouped or merged into larger areas, with a population of not less than 40,000 or 50,000, instead of tinkering away with the small local health bodies that we have just now, who are not discharging their duties at all adequately. In regard to the appointment, of women on the Board, I prefer the terms of the Bill itself, "one or more." Representatives from Scotland waited on the Secretary for Scotland, and a lady member impressed upon the right hon. Gentleman that he should not put any limits on the number, but that he should put it in "one or more," so that sex should be no disqualification, and so that in time to come it might be possible to have all women, if necessary. In regard to the ex-officio members, and the Solicitor-General and the Permanent Under-Secretary being out of the new Board, I think that will work very well. The Solicitor-General attends so infrequently, and I am glad that this Health Board will be limited to one ex-officio member, and that two of them will disappear. The Secretary for Scotland has had many representations made to him in regard to this new Health Board, and I am bound to acknowledge that he has met us remarkably well. He has not gone the whole way, but he has shown an earnest desire to meet Scottish opinion and to do the best he could to gratify a strong desire in Scotland for a thorough-going Health Department that will do good work for the country and will improve the conditions of health there. If in Committee he will meet us a little further in order to improve the Bill and make it really workable we shall be very glad.

7.0 P.M.

Mr. J. TAYLOR (Dumbarton)

I claim the indulgence of the House in making my first speech here. I do not know if I would have intervened in this Debate but for one remark made by the hon. Member who said that Scottish opinion was against the Secretary for Scotland being the Minister for Health. I entirely disagree with him. One section of Scottish opinion, the Insurance Committees, undoubtedly are, but the great local authorities, at a conference in Glasgow, and various congresses throughout the country passed resolutions in favour of the Secretary for Scotland and the Minister for Health being the Minister of State. It has been my privilege to attend most of the congresses that have taken place during the last 25 years, and as one who has been dealing with public health in a very large and growing borough, it has been my duty to face these problems and try and overcome the difficulties that lie in our way. All through we have felt that there ought to have been not only a co-ordination of the Public Health Acts, but that they ought to be under one head, and I agree that there ought also to be co-ordination of administration. I congratulate the Secretary for Scotland in having given way to the opinion of Scotland on many of the points that were originally in this Bill. The right hon. Gentleman has done the best he could to meet Scottish opinion, and I think he has done so very successfully. The constitution of the Board may not be all that we could desire, but I think it is about the best you could have in Scotland at the present time. We shall have the best of the Local Government Board, the best of the Insurance Commissioners, we shall have the Secretary for Scotland, with an Under-Secretary, and we are going to have at least one woman. I agree with the hon. Member for Lanarkshire, that we should not limit it to two, or even three women, but should leave it as it is now, "one or more women." The Scottish Members are of opinion that they know some women in Scotland who would adequately fill these positions. I am pleased that the Secretary for Scotland agreed to the alteration in connection with the constitution of the Board, and as well as an advocate, put in a lawyer, of ten years' qualification, because, after all, public health in Scotland has been administered by our own clerks and our county clerks, and they know far more about public health matters than does the Solicitor-General for Scotland, or some other advocate. I am pleased that in the Bill research work is included. That was excluded from the English Bill, I do not know-whether the Committee has reinstated it or not. In research work I think we have what is going to be the future of the medical service. Our medical service will be mostly engaged in preventing disease rather than curing it afterwards. I am pleased to see that under this Bill research work is to be carried on under the Ministry of Health.

While I say all that in favour of the Bill, I am disappointed that the Secretary for Scotland has not included the medical service of the Scottish Education Department. I think that as this is the time when you are going to make a change, that you ought to make it, and include every one of the Departments, because the local authorities have thought for a long time that the dual responsibility in treating children is not for the good of the children or for the nation. A child from one to five years is under the jurisdiction of the town council, in boroughs; from five upwards it is under the jurisdiction of the educational authority. That should be altered as soon as possible. And I hope that the Secretary for Scotland will see that that is included in the Bill when it goes upstairs to Committee.


I rise to support, in a very few words, the Second Reading of this Bill. Taking a Second Reading at such short notice has certain disadvantages, but at the same time the question of the establishment of a Board of Health is of such an important character that I think everyone of us will welcome its introduction, even in the exceptional circumstances in which it has been brought in this afternoon. I hope, however, that the Secretary for Scotland will keep in mind the circumstances under which we are taking the Second Reading, and will give very careful and sympathetic consideration to Amendments that may be moved by the various Scottish Members when the Bill gets into Committee upstairs. My chief objection to the Bill is that it is of far too limited a character, if we are to deal more effectively with the health of our people in the coming days than we have been able to up to the present. I think the Secretary for Scotland would have been well advised to have taken a much bolder line than he has taken and to have sought to have set up a real Health Ministry. No social programme has loomed so largely and persistently before the public during the past two years or thereabouts than that relating to the health services and to the setting up of a Ministry of Health. The Bill that we are considering on the Second Reading to-night falls short, to my mind, of dealing with this question in the comprehensive fashion that the people of Scotland desire. I am also very strongly of the opinion, as has already been expressed by the hon. Member for one of the divisions of Renfrewshire, that there will be considerable disappointment on the part of a large section of the Scottish people if an Amendment is not accepted providing for the appointment of a Minister who will give his full time to health and housing. The Secretary for Scotland, in his opening remarks, dealt briefly with the provisions made in the Bill. There are just one or two points of criticism which I want to make. The first is that in setting up this Board he has made no provision for Labour being represented. As he is very well aware, for a considerable time past it has been the custom, when new legislation has been introduced, to give effect—sometimes in a limited way, I have to confess—to the idea of Labour representation, and I hope I may have the privilege upstairs of seeing accepted an Amendment enabling Labour to be represented on the Board of Health. I regret, also, that no attempt has been made in this Bill to co-ordinate the local authorities. Unless we have some scheme of co-ordination of the local authorities, I fear we shall lose a considerable amount of the benefit which we should otherwise obtain from such a measure as has been introduced this evening. When one realises that we have in Scotland no less than 310 local authorities administering public health, and that under some of these local authorities the population drops down to as low as 500, one can see that there is not much chance of improving the public health service. So far as I am personally concerned, I would gladly welcome a scheme of co-ordination of the local authorities in connection with this measure. I do not think it will be possible to carry out the ideas of the people of Scotland unless we have very much larger areas than we have at present, and I would be quite prepared to support the establishment of these larger areas if the Secretary for Scotland were willing to give the same provision to those who represent the people on these larger local health boards as was given in the Scottish Education Act which was recently passed. But these are points which can be raised in Committee, and it will be for those of us who have ideas concerning them to put them in form of Amendments and discuss them with the Secretary for Scotland when the Bill comes before us upstairs. I therefore content myself with supporting the Second Reading of the Bill, and I hope that we shall have all these matters fully discussed upstairs by the Grand Committee.


The fact that this Bill has come on unexpectedly puts some of us at a disadvantage, especially an unsophisticated rustic like myself, fresh from the heather, who is not accustomed to speaking when suddenly called upon. But I can quite understand why my right hon. Friend the Secretary for Scotland, with the Scottish instinct for taking advantage of an opportunity, seized the occasion to get the Second Reading of the Bill. This is a Bill in which I take a very special interest. We should always remember that the health of the people depends, not upon Bills or Ministries of Health, but almost entirely upon improving the social conditions of the people at large. Neither this nor any other Bill will necessarily affect for the better the health of the people of this country at all. The health of the bulk of the population depends to a very large extent—more, perhaps, than is realised—upon the social conditions of the people. By this I mean sufficiency of food, sufficient and efficient housing, clothing, and all those other necessary things that are connoted by the term "social conditions." A Bill, a Ministry of this sort—I am adding a more dignified name than the right hon. Gentleman has given in the baptism of his child—is of very great importance as an auxiliary to these other efforts towards the improvement of social conditions. All the same, I gladly, if I may say so, welcome this Bill, and congratulate the right hon. Gentleman upon the lucid way in which he has explained to us its general principles.

I am happy to agree with the speech of my hon. Friend the Member for Renfrewshire in believing that to do justice to the health requirements of Scotland we ought to have gone upon the same lines as England, and have instituted a Ministry of Health instead of a Board of Health. It is not that I have any objection to the term "board." We must admit that in Scotland we have no reason to object to that word "board" as applied to an institution of this sort. A testimonial from me may not be of very much use, but I happen to have been a medical officer of health and a medical inspector of schools, and I think I can say honestly, that not in any country can you find a more efficient, and a more progressive Board than the Local Government Board of Scotland. That, from my connection with it, is, at any rate, my firm conviction. The same applies to the other body with which the Secretary for Scotland will have to do, the Scottish Insurance Commission. It is not because I have any particular dislike for Scottish bureaucracy that I object to the term "Board of Health." But the health of the community should be considered one of the most important matters which the Government undertakes in these times. I know, and it is necessary to say so, that I believe the right hon. Gentleman the Secretary for Scotland does not argue for these various bodies to be retained in his own Ministry simply because he is Minister for Scotland, or because he wants to add to the authority and dignity of his office. But the matter is one for practical consideration to apply. I am not convinced by the argument he has brought forward. The right hon. Gentleman's strongest argument seemed to me to be the logical conclusion. When people want to defeat a suggestion of this sort they always try to frighten us with the logical conclusion to our argument. It is argued that if you institute a separate Ministry of Health, then the fishery people will want a Ministry of Fisheries, the lunacy people will want a Ministry for Lunatics, and the education people will be wanting a Ministry of Education. Not at all! I am all for the improvement of the status of the Secretary for Scotland. I believe we can make the office much more efficient if we allow the right hon. Gentleman time to do the work which he has on hand. The Secretary for Scotland must be what is colloquially known as a "Jack of all Trades"—and I think I ought fairly to add to that a "Master of None." I must, however, make amends for that last observation by saying that I think—and sincerely—that if any man could be a Master of all Trades in connection with the Scottish Office it would be my right hon. and learned Friend. But no man, no matter what his abilities, can with efficiency perform all the duties which are required at the present time from the Secretary for Scotland. Therefore I think the House would be adding to the status, dignity, and efficiency of the Secretaryship for Scotland if they separated this great question of health from his control.

We live in an age of reconstruction. If we are going to look at these things in a new attitude at all, in a new orientation, I think this is a splendid opportunity for putting this health of the people question upon a satisfactory basis, and giving it in charge ad hoc of a separate Minister. What is proposed by the right hon. Gentleman is, I think, adding to his own difficulties. An Under-Secretary is proposed by the right hon. Gentleman for this particular work—although he did not say whether he was to be entirely confined to this work. However that may be, the Secretary for Scotland would still be responsible to this House for the work of the Under-Secretary, and the Under-Secretary would be responsible for the work of the Board of Health generally; so that it is rather a circulocutory arrangement. I should like to have something more direct than a Board of Health, and that you can only have by having a Minister of Health responsible to this House. I am not at all influenced by the argument that such a Minister would not and could not be a Cabinet Minister. If he were a suffi- ciently wise, progressive, and aggressive Minister much could be done. In past times some of those who have been outside the Cabinet have done better work in progressive legislation in this country than some inside the Cabinet, for when those who were outside got inside they appeared to some of us to be overwhelmed by the inside people, and we subsequently found that they could not do their work so well. It is on account of the very great and growing importance of this subject that I have pleaded for a separate Ministry of Health instead of a Board of Health under the Secretary for Scotland. I hope when we get into Committee the right hon. Gentleman will not turn a deaf ear to the proposals made in that direction in order to improve the efficiency of the work. I should have liked this Bill to be something in advance of the English Bill. In all these matters of progressive legislation we expect in Scotland to be pioneers and to show the people of England how the thing is, or should be, done. I should like the right hon. Gentleman, certainly in dealing with the machinery of a Bill for the public health, not only to have given us a skeleton, but also to have given us some flesh and blood, and perhaps to have infused a little spirit and soul into it. However, I am glad he has put a little flesh and blood into the Bill.

He has taken up the question of research and made it a distinct section of the work of the Ministry of Health. I am very glad that he has put that in the forefront of the Bill. I have no doubt, from what I know of the two bodies which the right hon. Gentleman proposes to bring into the Bill, the Local Government Board and the Scottish Insurance Commissioners, that the Research Department of the new Ministry of Health will be a progressive body, and will take advantage of the splendid facilities and opportunities of our Scottish universities, of our Scottish hospitals, and other auxiliary bodies, in order to promote medical research in the interests of the health of the people.

If I may give a bit of autobiography to make my point a little clearer, may I say that I was a Parliamentary candidate some twenty-four years ago, and that the first plank in my platform, as the Americans say, was that the Government of this country should have more to do with the health of the people, and especially with matters of medical research. I shared the fate of all pioneers. I am glad, how- ever, to say that research has come into its own, and that we see it in the Public Health Bill for Scotland. I am very glad, also, that the right hon. Gentleman is taking into his Bill the Highlands and Islands (Medical Service) Board. That is a board which has done very good work in the Highlands and Islands of Scotland. It is a real, live, human board. There is not anything of the bureaucracy about it. It has gone about its work in an unconventional manner, without red tape, and had done splendid work. Not only so, but it seems to me that this Highlands and Islands (Medical Service) Board forms a sort of model for part of the public health service of the future in the country. It provides a medical service in the remote parts of the country where the poorest people live who are not able to afford to have a doctor for themselves. Where the high rates prevent the provision of nursing services in remote quarters far away from doctors the nursing schemes have been of immense service. We cannot speak too highly of the work done by the nurses in the Highlands and Islands. There are also schemes which have not yet been sufficiently developed for providing special surgery and dentistry in places where they cannot afford these for themselves. I hope in this way it will be a sort of model, a leaven for the Ministry of Health which will leaven the whole lump, so that every quarter of Scotland, however remote, may have skilled medical and surgical services.

Therefore I am pleased for many reasons that the Highlands and Islands medical service is to be taken into this Bill. I believe that the big cities and towns can generally look after themselves. I trust the new Ministry of Health will look well after the remote rural districts, where the rating is so high, that they cannot provide the health or sanitary services which the circumstances require. I sometimes see hon. Members of this House up in the West of Scotland either fishing or deer-stalking or, it may be, taking an interest in the grouse. They are apt to think that in my Constituency, for instance, in the Western Isles that there should be no need for medical services. The people there, they are apt to think, do not die. But hon. Members are mistaken. In my Constituency, and especially in the Isle of Lewis, I we have the highest death, rate from tuberculosis of any part of the country. Although I have been a public health officer it has been a most heartbreaking business to be there. Why? Because it must be remembered that you cannot assess a rate for more than 1s. in the £ under the Public Health Act, and in that constituency that 1s. in the £ was exhausted years and years ago, so that when you wanted a well to be sunk, even a surface well, you said to rob Peter to pay Paul—the payment had to come out of something else. In these parts the local authorities could not provide the necessary sanitary necessities for civilised life. I hope that any scheme devised under this new Ministry of Health will not be dependent for its success upon the rating capacity of the locality to which it applies; otherwise these rural parts, and especially the islands of Scotland, will not get any benefit from them. No one admires more the work of the Prime Minister than I do in connection with tuberculosis. He tried to do a good deal, and earmarked a large sum of money for this purpose, but all that passed over the Western Islands, and when the 1910 Budget came out such a big amount of money was required from the local authorities be fore they could get any benefit, and the rates were so high that they could not possibly add to them. Therefore, all these blessings which the Prime Minister intended for the whole of the country passed over the Highlands and Islands of Scotland. I hope, in connection with any schemes which are to be developed in the future, that the success of them will not depend upon the rating capacity of the locality to which they apply.

With regard to some of the things that are put in and left out, we have become familiar with that kind of thing in the English Act—that is, taking over a lot of duties that do not apply to the purpose of the Bill and then resolving to discard them and later on taking on some others, and so on, with this in-and-out method of legislation. I do not know what is to happen if many more Bills of this sort are brought forward, and I am afraid we shall have to set up a separate Ministry to utilise the waste products of reconstruction. I am sorry the right hon. Gentleman did not bring in the medical inspection of schools. I would not be surprised if the Education Department were a little jealous of giving up the medical inspection of schools, because it is a system upon which that Department have reason to plume themselves. I can quite see why the Education Department should be sorry to part with this very promising child on which they devoted so much attention and care, and if Civil servants are allowed to be mentioned I think Sir John Struthers deserves to be mentioned for what he has done in connection with this work in Scotland. I am convinced, however, the medical inspection of school children should come under the Public Health system. I wish for this Bill a great success, and I trust it will be to the good of the whole community in Scotland.

Lieutenant-Colonel Sir JOHN HOPE

I welcome this Bill, and I hope it will receive a Second Reading. We all recognise that the Secretary for Scotland has improved this Bill by giving us a separate Bill for Scotland and by making a certain alteration in the principle of the measure. There are three different schools of thought as regards this Ministry: one advocates that the Minister of Health should be the Secretary for Scotland; another believes that it is impossible at present to have an independent Minister of Health for Scotland, and that we should have a special Minister allocated for health purposes and health matters under the supervision of the Secretary for Scotland; the third school requires an independent Minister of Health for Scotland absolutely independent of the Minister for Scotland. I believe that to be impossible, and I think the Secretary for Scotland has gone a long way to fall in with the views of the second school of thought, that is, setting up a separate Under-Secretary for Scotland who will be practically a Minister of Health.

I cordially support the speech of the hon. Member for Camlachie on this subject. What we really want is that this ad hoc Under-Secretary should be the real head of the Board of Health, not only under the supervision of the Secretary for Scotland, but that he should be the genuine working head responsible to Parliament. We desire that he should spend a good deal of his time up in Scotland, in Edinburgh, where the offices of the Ministry of Health will be situated. What Scottish people desire is that they shall be able to get into contact easily with the responsible Minister for matters of health, and that can only be achieved by the Under-Secretary being not only the head of the Department, but by being in actual close working touch with those in Edinburgh, perhaps three or four days a week, and only coming up to London to consult with the Secretary for Scotland to answer questions and speak in the House of Commons.

I am doubtful whether what we desire will not be prevented by the last two paragraphs of Clause 3 which appoint a member of the Board, other than the Under-Secretary, chairman of the Board in the absence of the president and the vice-president. In all other Boards the permanent official, who is the chief Parliamentary official, is called the secretary, and that is so in the case of the English Board of Education and the Board of Agriculture. Why should that practice not be followed in the Scottish Ministry of Health and why should not the chief permanent official be called the secretary? If he is called the chairman, I am suspicious that he will take the chair too often. I want to see the Under-Secretary or the Minister for Health in the chair, and I hope that the Secretary for Scotland in Committee will agree to some Amendment on these lines.

I regret that the Secretary for Scotland has not found himself able to make some effort to provide for the co-ordination of local authorities, because we shall really never get a satisfactory measure of health until not only the central authority, but the local authorities are co-ordinated. I quite appreciate the difficulties, but I do not think there are so many complications in Scotland as in England. I regret that the Secretary for Scotland has not made the attempt to slightly amend the present local health authorities and district boards by altering their constitution and co-ordinating them for general health purposes under this Bill. I hope before long we shall introduce a measure co-ordinating these local authorities. I cordially support what other people have said on this all-important question as to the powers and duties of the Scottish Education Department with respect to the medical inspection and treatment of young persons, and I believe these should be at once placed under the new Ministry of Health. This alteration was made in the English Bill in response to a practically unanimous expression of opinion, and we have now got the same principle in the Scottish Bill.

I would point out that if this Bill is carried into law the medical officers will be under two masters—the Board of Education and the Ministry of Health—and we want the medical officers put under one authority. In the English Bill power is taken to transfer to the Ministry eventually all or any of the powers and duties of the Secretary of State under the enactment relating to lunacy and mental deficiency. I do not understand why that has been left out of the Scottish Bill. We do include the omnibus Clause giving the Government power to hand over to the Ministry of Health eventually any powers that appear to His Majesty to affect incidentally the health of the people. I think arrangements should be made for handling these duties over to the Ministry of Health and they should be sufficiently organised to take over this Department. I cordially welcome this Bill, and I hope the Secretary for Scotland will consider these various Amendments which have been suggested from all quarters of the House and that he will be able to accept them in Committee upstairs.


I have not the least intention of detaining the House or interfering with the business which has been arranged. I should like to say how grateful we are for the promptitude with which the Secretary for Scotland has introduced this special measure for Scotland. It was said, when the Bill for Great Britain was introduced, that a special measure was due for Scotland, and the right hon. Gentleman has promptly introduced it. There were divergent views as to whether there should be a separate Ministry of Health for Scotland, and as to whether he should have an Under-Secretary to do this work for him. Personally, I am inclined to think that the right hon. Gentleman has chosen the right course in having an Under-Secretary for this purpose, if only for the fact that it appears to afford a sort of nucleus perhaps for a Scottish Cabinet for the future. There is a feeling in Scotland that with these increased duties, and controlling an Under-Secretary, the status of the Secretary for Scotland is not sufficient. This would be quite out of order in Committee upstairs, but I wonder whether in this Second Reading Debate the right hon. Gentleman could give us any information at all as to whether there is any likelihood of that happening which we so much desire, namely, the raising of the status of his own office from that of a Secretary to that of a Secretary of State?

Captain ELLIOT

I do not wish to detain the House. I simply wish to repeat that in my opinion the Scottish people will be disappointed at the fact that there is only a single Under-Secretary to be appointed. They will consider that it will not be an Under-Secretary for Health, but an Under-Secretary for Scotland, and that the enormously important duties that he has to discharge will not be efficiently discharged if in addition he has to act as an Under-Secretary to the Secretary for Scotland in all the multifarious duties which the Secretary for Scotland has to carry out. I also think that education should be taken over straight away. These, however, are matters for the Committee. I wish to compliment the Secretary for Scotland on his prompt introduction of the Bill, and to say that we are very gratified that he has seen his way to include the duties of the Registrar-General. It is a strange thing that whereas the English vital statistics are among the best in Europe, the Scottish vital statistics are among the worst. We hope that he will do his best to remove from Scotland the reproach which is levelled at us by no less an authority than Karl Pearson, namely that the vital statistics of Scotland are the worst in Europe. The Clause providing for the initiation and direction of research is extremely important, and we hope that the research to be carried on in Scotland will be efficiently decentralised, that it will be a real live measure, and that research will be pushed to the utmost as one of the most important duties which the Minister of Health can possibly carry out.

I do not know whether I am in order on this occasion in referring to the fact that one of the most important branches of research, namely, research into the disease of rickets, which all Scottish Members, and particularly Members for Glasgow, will agree is one of the most tragic diseases, afflicting as it does the young, destroying their chance for future life and health, is even now threatened by a Bill before this House, a Bill which is calculated to put an end to this extremely salutary and necessary work. I only wish to say that when hon. Members appeal to us to protect our pockets and leave our babies to undergo the ravages of disease they are making a false appeal which should not carry any weight with this ancient, authoritative body. I simply wish to say how grateful we are to the Secretary for Scotland for his prompt redemption of his promise to bring in a Scottish Health Bill, and we wish him God-speed, and hope that it will have a speedy passage into law.


Perhaps by leave of the House I may answer the direct question put to me by my hon. and gallant Friend opposite (Captain Benn). The only answer that I can give him is the answer given by the Leader of the House to two similar questions put at Question Time recently, namely, that the whole subject is under the consideration of the Government. I cannot go further than that.

Question put, and agreed to.

Bill accordingly read a second time, and committed to a Standing Committee.