(Class 7.) (Hansard, 9 March 1920)

§ Mr. G. THORNE
My object in rising is to ask for further information and not to make criticisms. Speaking for myself, always provided that the money has been judiciously expended, money could not be spent in a more productive way than in providing for the health of the nation. There is one item of an increase in regard to child welfare, a direction in which money can well be spent. But I should like to know what were the circumstances under which the increase in the amount has taken place. I hope this is going to be a progressive extension, for the more we judiciously spend in promoting the health of the children, the less we will have to spend in promoting the health of the adults. I feel sure the Minister of Health will be able to justify the expenditure and to explain what has been done. I should also like him to give some more information with regard to medical bene- 1218 fits There is a sum of £050,000 which I assume is largely due to increased money to be paid to the. panel doctors for the health service. Can he tell us anything about whether provision is made for securing greater benefits for the panel patients. While we want the doctors to be well paid, we want to be absolutely certain that the patients are duly looked after. I trust that he will be able to give satisfactory assurance on that head. I am glad to sec that the savings are somewhat large. I notice a sub-head with regard to disablement and other medical benefits The amount saved is £700,000, and for the medical benefit special grant there is a saving of £115,090. These are so large as to suggest that a mistake was made in the Estimate. But I repeat that any money judiciously expended would receive the support of this Committee.

§ Lieut. - Commander KENWORTHY
We are asked to vote here a sum of £130,000 for child welfare, and I am certain that there is no member of the Committee who will not vote that with great alacrity. But, while voting this money, I think the right hon. Gentleman should put his own house in order. I refer to the boards of guardians about the country. I should like to refer briefly to a ease in my own county of Yorkshire which I think he will remember, that of the employés of the board of guardians of a certain parish in Yorkshire, who were dismissed because they had children. They were told that the children were an "encumbrance." I think there were two cases, and that the board of guardians said they were not able to keep them on in their quarters if they had children, and that either they or the children must leave. That is a scandalous state of affairs, and I am certain that there is no hon. Member who will approve of that for a moment. The right hon. Gentleman, the Minister of Health, declared, in reply to questions which were put to him in this House, that the matter was really outside his jurisdiction, that he could not bring pressure to bear on boards of guardians, but that, of course, he would represent the views of hon. Members. I submit that we want something a little better than that. If the right hon. Gentleman has not power to deal with a case of that sort, it is his duty to come to this House for such power. Is it the idea that we should expend £130,000 on child welfare, 1219 while the very board of guardians themselves can discourage the bringing up of healthy children by persecuting people in this way?

§ The DEPUTY-CHAIRMAN
This may be Child Welfare in one sense, but it is not Child Welfare as set out in this Supplementary Vote. I do not think that Child Welfare has anything to do with boards of guardians, or at all events, with the administrative work of boards of guardians. That would not be a proper subject for discussion now.

§ Lieut. - Commander KENWORTHY
With great respect I would submit that the guardians have responsibilities with regard to the administration of Child Welfare. We are asked here to vote £130,000 which these people will have the spending of, and I think that this matter embraces the question of the fitness of those guardians to expend the money.

§ The DEPUTY-CHAIRMAN
The Minister will correct me if I am wrong, but I did not understand that the boards of guardians had the spending of this money. The other point to which I drew the attention of the hon. and gallant Member was that the administration generally of boards of guardians certainly does not come under this Vote.

§ Lieut.-Commander KENWORTHY
I only wish finally to ask whether this £100 on L. 8 is a total sum, or if we can have some idea, before we vote, what is to be the extent of the medical examination of aliens under the Aliens Order of 1919. I imagine that that is one of the Clauses by which we are empowered to keep out diseased foreigners from this country, and, therefore, this Act that we have passed seems to have put an extra charge on the Exchequer. I think we might have an assurance that this £100 is not the beginning of a very large expenditure on medical examination.

§ The MINISTER of HEALTH (Dr. Addison)
With regard to the case which the hon. and gallant Member mentions in Yorkshire, it is a case to which I have given some personal attention, and, with the best will in the world to use any powers that I have, the statement I made was that I had no legal authority in the matter. That statement is correct, and the board of guardians in question are, I am sorry to say, within their legal right in acting as they did. If 1220 I had any authority in the matter, I am sure I should have acted upon the view which I share with the hon. and gallant Member in regard to cases of that kind. This is not the time nor the occasion to enter into the question of the future of the Poor Law, but I sincerely hope we shall be able to realise our projects so that this kind of discussion at all events will not arise in the near future.
With regard to the question of the £100 for the Port Sanitary Authorities, that is an item which appears on the Vote for the first time. It will be larger, and not smaller, another year. I found, when I took up the question of what I may call our sanitary protective system, that many of our Port Sanitary Authorities were sadly handicapped by lack of funds, and were not able to provide the necessary apparatus for cleansing garments and for employing the necessary staff with a view to preventing the introduction into this country of various diseases. During demobilisation, and after, as the hon. and gallant Member will know very well, every country has been running additional risks lest various diseases, which are rampant in some districts of Europe and elsewhere, should be introduced, and it has been urgently necessary that we should keep ourselves as clear as we can of those diseases. I could, if the House wished it, give some striking illustrations of the promptitude and efficiency with which this kind of thing is handled. There are in Europe and various other parts of the world whole territories which are being ravaged by typhus and other highly infectious diseases, and it is urgently necessary for me to watch the returns as they come in weekly, and to see how we are keeping ourselves guarded against such diseases, including various tropical diseases, and also what precautions shall be taken against such diseases as influenza. I think the additional expenditure which I have urged should be incurred in this matter is most necessary expenditure, and I am already quite sure that, in keeping this screen around this country against highly infectious diseases which are prevalent in many parts of the world, we have only done what was necessary. I found that the Port Sanitary Authorities had been very much crippled for lack of funds, and I suggested a scheme by which we could contribute 50 per cent. of their expenditure. This is only a beginning. This small sum will come into this year's 1221 Vote, but it may be several thousands next year. It is not that we want to examine aliens in any way other than we are entitled to at present. It is solely to improve our protective machinery.
The other item, relating to child welfare, is, as my hon. and gallant Friend opposite (Lieut.-Commander Kenworthy) said, one which I feel no one will criticise, and I am anxious to loll the House what we have done. Just as in the case of the "sanitary cordon" which I have deliberately obtained money for, this measure, is really a protective service. I suggest that this is a proper way in which to spend public money, and we are already reaping some of its benefits. It is clear that the employment of health visitors, and so on, is, so far as many useful services are concerned, only in its infancy. The lack of trained personnel for maternity nurses, health visitors, and so on, is our great drawback at the present time. We have been urging the employment of nurses and health visitors in child welfare centres with a view to preventing infant mortality. We have opened this year 400 additional centres, and I hope to open a great many more next year. Then there is the midwifery service, which is also a factor in the avoidance of infant mortality, and which requires great development. There are still many districts in the country where women have to bear their children with very inadequate assistance, and therefore we have developed an extension of the midwifery service for that purpose. We have not gone anything like far enough yet, and in this respect I look forward to a greater increase in another year. We have provided maternity services for a population of 200,000 people during the past year.
Another direction in which I have developed our services has been the provision of what are called maternity homes, places where women can go in child-birth and be properly attended to on payment of quite a moderate fee, or, if necessary, no fee at all. I obtained Treasury sanction to the making of grants for the provision of these homes, which are very badly needed all over the country. Women have to bear their children in rooms where the other children are, often amid very insanitary and other Unpleasant surroundings, and the wonder is that under the circumstances so many children grow up to be as well as they are. We are only making a start in this 1222 matter, but for all that we have established 50 homes within the past year. I propose to go on establishing more. This is a service which, as a matter of fact, it will be seen, has nearly doubled in the last eighteen months. It is, I am quite sure, a thoroughly justifiable way of spending public money. We are making grants towards approved expenditure, and the House may be assured that we do not approve if the work is not well done. In order to make sure that the money shall be properly spent I have had a special inspection of welfare centres during the year, and I was very much dissatisfied with the working of a good many of them. It was in consequence of this inspection that we obtained the grant for the provision of training, and so on, because we found a good deal of the work quite unsatisfactory. I am glad to say certain good results have been obtained. At all events the infantile mortality registered last year is considerably the lowest on record, being 89 per cent., which is eight points lower than the previous two years. It ought to have been down to 50. What that means everyone interested in these questions will realise, and the £130,000 has not been ill-spent in bringing about that result.
The other big item at the bottom of the page, about which my hon. Friend asked for information, relates to the proposals which will come before the House, at any time now in the National Health Insurance (Amendment) Bill. It was a promise to the medical profession during the War that as soon as possible after the War revised terms would be offered to them in regard to the medical service. It was also felt that we must take the opportunity to revise the conditions of service. During the autumn of last year, over a long period, this matter received our close attention. I entirely agree with my right hon. Friend opposite when he says that it is very important that we should get good value for our money. I met a deputation from the medical profession. I told them quite plainly, with no pretence, that, in my opinion, in a large number of cases we were not getting a good enough service. I do not think we are. They recognised that, and the deputation promised to use their endeavours to bring about hearty co-operation in the way of trying to improve it. They entirely agreed with me that we ought to get, for every insured 1223 person, as good treatment as the medical man gives to his ordinary private patient. That is the standard. The new medical Medical Benefit Regulations aim at improving the conditions of service. The House may rely upon it I will do my best to see that we obtain this better service. As part of this scheme we are appointing a number of referees and consultants to whom may be sent, by the societies, cases of those who have been too long on the books, or where a second opinion is desirable, and I have no doubt at all that that will also greatly improve the standard of service.
The increased cost of living, the increase in the cost of practical working of a medical service, and other cognate considerations were closely examined by my officers. Having in view the high prices, the increased cost of drugs, the increased cost of locomotion in country districts—it is better to deal with these latter two things quite separately, so we have taken them out of the ordinary medical fund and they are dealt with in separate arrangements and in accordance with pledges given during the War, the figure which I finally sanctioned for medical attendance per head was 11s., which I think is a fair figure. It represents roughly about 50 per cent. increase. According with the arrangements made with the medical service, we take the 15th of January in any year as our starting date, so that in this case the first quarter is to be borne on the Supplementary Vote and before the new Act can come into operation. The medical profession found themselves unable to accept my offer of 11s., and it was agreed to refer the matter to arbitration. I am glad to say that for once the offer which I made was the figure the arbitrators have arrived at as a fair and adequate offer, and as a proper sum to be offered. Part of the understanding on both sides was that each mould do their best to work the revised arrangement with goodwill and as successfully as possible. I have no doubt but that that will be done. It is on account of the fact that the amending Act is not yet on the Statute Book that this special figure has to be shown in the Exchequer Vote here, although later on, of course, its quota will be derived from the Common Fund provided under the Act. I hope that will be considered a satisfactory answer to the 1224 question which my hon. Friend addressed to me. With regard to the savings, I had better say that that is a very encouraging item. It is due to the fact that on the whole there has been better health. I attribute it largely to better housing, and also to the fact that a number of the men have been specially dealt with by the Ministry of Pensions, which may have removed to some extent a. certain number from these figures. But in the main it reflects an improvement of national health, and if we can improve the service, as I am sure we shall be able with the aid of the Referees, I sincerely hope we shall have still better figures for next year, especially a reduction in the amount paid out for sickness. In the meantime I may tell the House, with regard to the state of the finances of the different societies in this matter, that it is much more encouraging than I had even dared to anticipate.

Dr. MURRAY
It would be a pity if this Vote were passed without a word from some member of the medical profession. I do not rise to offer any criticisms, but I want to tender my congratulations to the right hon. Gentleman on the splendid administration of his Office.
We, of the medical profession know what has been going on. We have sometimes had to criticise the right hon. Gentleman in regard to housing, but that is a new development in regard to which we know he is doing his best, many of the defects in respect of housing being due to causes hardly under his control. But with respect to the items mentioned this evening, we have every reason to congratulate ourselves and the Ministry upon the efficient manner in which the officials of the. right hon. Gentleman have performed their work. Of this system of protecting the health of the country against the ravages of disease, the public see and hear very little. They do not realise the work done by medical officers of health, sanitary inspectors, health visitors and other officials of the right hon. Gentleman's Department, who are working day and night in order to keep the health of the country in as satisfactory a condition as possible, and especially to prevent the incursion on to our shores of some of those diseases that ravage other countries in a much more serious fashion than they do this country. Not only the officials of the right hon. Gentle- 1225 man but those of the various health authorities all over the country deserve the thanks of the House for what they have been able to do in guarding our shores from the plagues which have attacked other parts of the world.
I am very glad to see that infantile mortality is reduced. After all, that is perhaps the acid test of health administration. No doubt better social conditions, better housing, and possibly better looking after by mothers have contributed to this improvement. But it is a proof that this new aspect of health administration which has developed so much under the administration of the right hon. Gentleman is beginning already to have its effect, and that is certainly a matter for congratulation. Infantile mortality has gone down. In this respect the contrast between country and town is very marked. One great item in connection with the prevention of infantile mortality may be found in the fact that in rural districts breast-feeding is general while in the towns it is exceptional. Unless mothers feed their own children, unless they take the responsibility of breast-feeding with all that it entails, you cannot expect to have a healthy population in this country. In those areas where breast-feeding is the rule we have a very low infantile mortality, and that fact should not be forgotten, but should be pressed in every possible way on the women of this country. In the constituency which I represent housing conditions are not at all good, and yet infantile mortality is comparatively low because the mothers nurse their own children, and do not leave it to other people. I congratulate the right hon. Gentleman on his own efforts in various Departments to promote the health of the people. After all, this is the most human and most humane Ministry we have. It is something worth paying for, and I trust that whatever money the right hon. Gentleman asks for will not be grudged by this House in promoting the health of the population. Question put, and agreed to.