MINISTRY Or HEALTH.

HC Deb 13 June 1922 vol 155 cc287-330

Motion made, and Question proposed, That a sum, not exceeding £13,512,562, be granted to His Majesty, to complete the sum necessary to defray the Charge which will come in course of payment during the year ending on the 31st day of March, 1923, for the Salaries and Expenses of the Ministry of Health; including Grants and other Expenses in connection with Housing, Grants to Local Authorities, etc., sundry Contributions and Grants in respect of Benefits and Expenses of Administration under the National Health Insurance Acts, 1911 to 1921, certain Grants-in-Aid, and certain Special Services arising out of the War."—[NOTE: £9,000,000 has been voted on account.]

The MINISTER of HEALTH (Sir Alfred Mond)

After the prolonged and somewhat exciting Debate which the Committee has had this afternoon, on a subject of, perhaps, more general interest, though of less financial importance, than the Estimates which I have the honour to place before the Committee, I have a certain feeling of difficulty in coming down to the more prosaic, if not less important, subject of the Estimates of the Ministry of Health. In presenting these Estimates, I thought that it might, perhaps, interest the Committee, and would serve a useful purpose, if I shortly pointed out the results of the recommendations of the Geddes Committee, and the extent to which we have been able to meet them in this year's Estimates. The Estimates, of course, are made somewhat more difficult to follow by the fact that there are various items coming into and out of them which are of a more or less transient and extraordinary character, due to services arising out of the War; but the net upshot of the reduction which I have been able to effect in these total Estimates for 1922–23, as compared with those for 1921–22, is £1,732,000. In arriving at that figure, I have done some-what better than the recommendations of the Geddes Committee. The Geddes Committee recommended a net estimate of £22,100,000, and I have been able, on a comparative figure, to make an actual provision of a little over £22,062,000, or about £37,000 less than the recommendations of the Geddes Committee. In arriving at that figure the totals of the various items do not, of course, necessarily agree. The principle I have endeavoured to follow in framing the Estimates of this year has been that while understanding the necessity for perhaps calling a halt in what I might call the essential health services of the country, I at any rate, did not agree to any reduction of services which are already in existence, and which have established their utility, and which it would have been anything but a real economy in any way to diminish.

The problem that presented itself to me was to endeavour, while carrying out economies of the character I have indicated, to preserve to the best of my ability, and I think I may claim successfully, the vital services of public health, such as tuberculosis, maternity, child welfare, and venereal disease, at least at the efficiency of past years, and even to endeavour somewhat to improve upon it. In order to achieve this, I have found it necessary to make very considerable reductions in the administrative cost of the Department, and I am glad to say that I have succeeded, with the assistance and loyal co-operation of those working with me, in reducing the staff of the Ministry of Health from a maximum of 6,462 in 1920–21 to 4,134 on 1st April, 1922—a reduction of no less than 2,300. I have succeeded, secondly, in decreasing salaries, wages and allowances in my Estimate for the year by £680,000 below the year before and I am still in hopes of effecting further economies during the present year, and economies in other directions, such as travelling allowances, a total saving in administration of £780,000 below the expenditure in 1921–22 and £155,000 below the recommendations made by the Geddes Committee. That saving has enabled me to exceed on vital services, such as tuberculosis, maternity and child welfare, the Geddes Committee recommendation and yet keep below the total. I have fortunately been able also to increase the Appropriation-in-Aid on administration account, and the saving on administration expenditure compared with 1921–22 is no less than £863,000, or £265,000 compared with the figure of the Geddes Committee. Of course a considerable amount of this saving is due to two large items, a reduction in the very large and expensive staff which the big housing programme involved, which I have been able to reduce with the diminution of the ambitious and perhaps over ambitious scale on which the whole question has been equipped and organised from the beginning. Further, of course, I have benefited undoubtedly by the automatic reduction which is due to the fall in the bonuses owing to the fall in the cost of living. Quite apart from that, we have effected a considerable number of reductions, both by concentration of offices, by not filling up vacancies n a number of cases, and by generally endeavouring to reduce expenditure. The housing expenditure, of course, this year is considerably greater than it was last-year. It automatically increases. The more houses get completed the greater the expenditure falling on the Treasury naturally becomes under the schemes, where anything over a 1d. rate falls on the local authority. The White Paper, shows that there is an increase of no less than £4,600,000 over last year's deficit on the housing grant of £5,000,000—a total sum of £9,630,000. In addition to that we have provided for a subsidy to private builders of £2,500,000, so that the total Estimate on housing is no less than £12,150,000. I should like to repeat that sum because, while no doubt many who would like to see an extension of the housing programme are impatient at the slowness of the policy I have adopted, £12,150,000, when you come to look into it, is a fairly staggering figure to fall on the Government for housing in any one year.

Then, of course, in insurance, I have succeeded in achieving certain economies. The bargain I made with the doctors last year for a reduction on their payment per patient saves us about £1,000,000 per annum. The economy under the Bill I introduced, relieving the Treasury of the extra grant for medical benefit, is estimated at somewhere in the neighbourhood of £1,600,000, and there are other economies which bring the saving up to £3,000,000. On the other hand, I have to set against that an increase of £500,000 in the Government grant to Health Insurance, owing to two causes. One is the increased amount which has been taken during this year owing to an estimated increase in sick benefit, and secondly, as additional benefits are now coming into operation, the Government grant on that subject automatically increases. The net saving will be about £2,500,000. When I come to tuberculosis, I have an increase in the provision over last year of something like £250,000 over the recommendations of the Geddes Committee. Last year we found our Estimate was exceeded by over £500,000, and we had to take a Supplementary Estimate for that purpose. I think the Supplementary Estimate was £570,000, and the original Estimate was £1,200,000. This year we are lower in actual expenditure by several hundred thousand pounds. We have been able to do this owing to the general fall in cost of materials, food, and other things, which of course, enables local authorities to maintain the same number of patients at a less cost. That applies, of course, to some extent to the expenditure on tuberculosis.

In maternity and child welfare again I have an actual decrease on last year. Of all the health services I do not know any which renders more valuable results. Of all the social work done in this country it is the one which is giving us the most satisfactory results, and one would like to be in a position to spend even more money on it and extend it much further than it is being extended to-day. Still, it is being extended and it covers a large amount of the country. I have been able, by economies effected in other directions, even in these hard times, to take advantage of very generous offers which have been made by the Carnegie Trustees in several cases. I have felt it to be a great pity to lose opportunities of that kind, and I have strained every nerve, in framing the Estimates, to endeavour to meet all these cases, and I believe I can say, speaking from recollection, that all these cases have been met and we have been able not only to maintain our grants, but actually to extend our operations even on a modest scale. For venereal disease we have kept at much the same figure. In regard to grants for welfare work for the blind the estimate is down by a small amount. There is only one new service which appears in the Estimate for the first time, and that is a sum of £450,000 for unemployment grants under the St. David's Committee schemes. This is for the payment of loan charges on schemes which the local authorities have incurred under the St. David Grants scheme in connection with unemployment. I will deal with that at a later stage of my statement.

One of the policies which we have adopted in this year's Estimates in order to enable us to carry out our services as economically as possible, and to meet the criticism of the Geddes Committee, in which I felt there was a certain amount of justice, in regard to the subject of percentage versus block grants, has been, as far as possible, to work out a rationing system for this year's Estimates on services like tuberculosis and other services in which we really are in partnership with the local authorities. The difficult task of my Department is to estimate ahead when we are in partnership with other people whose expenditure we do not really control, and who frame their Estimates at a different time of the year from the time when we frame our Estimates. The Committee will be aware that the Treasury have appointed a very important Committee to inquire into the whole subject of block grants versus percentage grants, and I am not going to discuss a matter so far-reaching in its importance as the work of that Committee will be, but in the interval, pending the Report of that Committee, we have taken time by the forelock, and have worked out a rationing scheme which has been accepted, on the whole, by the local authorities with great loyalty. It has had one interesting result of bringing into line a good many local authorities whose expenditure, when contrasted with that of similar bodies doing similar work, proved in many cases to be considerably more expensive than was justified. That led to a general comparison and revision.

There is a tendency, when they know that somebody else is paying part of the money, for people to think that the other party is paying it, and one gets a sort of mutual stimulus to expenditure which does not lead to economy. The local authority may say, "Do not trouble, the Ministry of Health will pay." On the other hand, the Ministry of Health official, equally enthusiastic, may say, "Do not trouble, the local authority has to pay." That is one of the difficulties of dealing with matters of this sort. There is no doubt that by a carefully-thought-out system we are able to carry out very considerable services very efficiently, and in doing so we are enabled at the same time to point out to the local authorities where their expenditure appears to he unnecessarily high, and we have succeeded in getting a kind of fixed estimate, which we know will not be exceeded. The expenditure may, by many people, still be considered of a very high, I might even say of an extravagant, character; but there is nothing new in the fact that there are people who look at any expenditure on the improvement of the condition of the State as an unnecessary expenditure. I have been interested to find that that discussion has gone on for a very long time. A very good Conservative, the late Lord Salisbury, wrote in the "Quarterly Review" in January, 1861: People who rail at, our growing expenditure forget that it is the nature of all well-governed States to improve, and that improvement in a Government, like improvements in an estate, is almost always a costly process. It is possible to govern cheaply by the simple expedient of governing badly; but efficient government implies efficient machinery, and efficient machinery must be paid for. We cannot, therefore, share the anticipations of those who look for any material reduction in the cost of our civil Government. If it were to take place we should regard it as a morbid rather than a healthy sign. As England increases in population and activity she can no more safely forego the increased expenditure upon government than the railway can increase in traffic without a rise in its working expenses. Those were the views of the great Conservative leader, written 61 years ago, and that statement is as obviously true to-day, perhaps more so, than it was when it was written. What we have to lo, and what we endeavour to do, and what I hope the Committee will support me in doing, is to endeavour to obtain the utmost value for the money we spend, and in that direction I think we have further to go. No Department of the state has an unlimited amount of money to spend upon any service, and it is not infrequently forgotten that money spent extravagantly means that you do not, [...]over as much ground an you otherwise would. Therefore, knowing that the resources of my Department are limited, I am endeavouring to see whether we cannot with the same amount of money obtain a wider sphere of results than as obtained in the past.

I will now deal in some detail with a new of the questions which have a bearing upon the Estimates. The first question is he general housing position, so far as the Government is concerned. I have given he figures in reply to questions so often that I am afraid hon. Members must be getting rather tired of hearing them. Perhaps I may summarise the position very briefly. The number of houses authorised to be erected by local authorities and public utility societies on 26th May [...] as 173,600, leaving a margin in hand not yet allocated of 2,400. The number of houses completed on the 1st May was [...]7,661, under construction 47,100, and still to be started 21,237. Private builders: Number of certificates issued, 42,514; number of houses finished, 32,928; outstanding certificates (A), 9,586; total housing provision already made, 140,589; further houses authorised, 77,925. The question has often been asked as to what will be the position when the period of this housing provision comes to a close. The extraordinary change which has taken place with regard to the prices of houses during the last 12 months, and of which I will give some examples in a moment, modify the whole position and alter one's ideas of the whole subject so as to make me extremely chary in prophesying or committing myself at the moment to any new course of action.

In May, 1921, the average tender price for a non-parlour house with three bedrooms was £697. In November, 1921, it was £577. In May, 1922, it had come down to £384. In the case of parlour houses with three bedrooms, the figure in May, 1921, was £813. In November, 1921, it was £660, and in May, 1922, it was £400. You had a very large; fall in both cases, and in the latter case a fall of more than one-half. A year, ago the lowest, figure approved for a house with three bedrooms was £603, and the lowest tender recently obtained was £298. I am quoting now the figures for houses and not including, for the moment, land, sewers, fencing and these other charges, but if you include the land, and those other charges it would bring the £298 up to £350. The Committee will see from these figures that we are likely to reach, though we have not already reached, what I would call an economic level of houses. There is no reason to suppose that the cost has reached as yet its bottom.

One thing of which I am convinced is that, however careful you are, the State is not a cheap builder. It does not get cheap building done. Even local authorities, building on their own account, would get better and cheaper results than a Government Department. Private enterprise certainly is doing it at lower prices and can find labour ready to take lower wages for that work than is possible in our case. So you are almost in a market where private enterprise can be taken as on the way to resume its normal position. But it must be remembered that before the War the amount of building done outside of private enterprise, in spite of the large powers which local authorities had under the then existing Acts, was very small indeed. The houses which we have built fill a considerable gap in the matter of satisfying the housing problem. Therefore you have to make up your mind how far private enterprise can come in, and how rapidly in order to take up its proper function, or how far you can afford or ought, by a system of artificial subsidies, to keep up the prices and produce artificial conditions in reference to the cost of houses. That is a very difficult problem.

I know well that I am often represented as a hard-hearted individual who has no interest in the problem and no care for the people who want houses. That is an accusation which is easily made and difficult to refute. Looking to the ultimate end, and not merely perhaps to the present moment, to anyone who has any responsibility for a problem like this, nothing is more certain than that a policy of restriction has produced a condition of things which is already helping the problem to solve itself. A policy of inflation, if continued, would almost certainly have bankrupted the country, and would have practically made the provision of houses in future impossible except on the most extravagant terms, and for that reason it is a matter of regret that a check was not called earlier. We should then have been let down with a much lower figure, and should be in a position to do a great deal more to-day.

In the state of things which prevailed everybody connected with building profited, from the man who carried bricks in a hod to the man who made the bricks. All had a good time. If they had not had such a good time it might have lasted a little longer, but that is a very real problem. My information in many directions is, not exactly with reference to this class of houses, but with reference to what I might call the cheaper middle class houses, that private enterprise has begun to resume in many parts of the country, and a number of public utility societies are beginning to resume or are considering the resumption of operations without any Exchequer subsidy. I have spoken to the heads of a number of the largest of them. All are beginning to operate once more. The movement is a growing one. When I spoke on this question on the Estimates last year I ventured to express the opinion, which I hold very strongly and have endeavoured to carry out to a considerable extent when I have had the opportunity, that it is the function of large employers of labour to deal with the housing of their employés as much as with any other portion of industrial work which they were carrying out. A man has no right to go and create a demand for housing by developing an industry in a certain district and throw the burden either on the ratepayer or the taxpayer.

I am glad to say that a very interesting and important scheme is being worked out, and is now coming into operation to some extent, largely due to the ingenious efforts of my right hon. Friend the Paymaster-General (Sir Tudor Walters). There is a, combination of some of the leading colliery owners of this country to form an Industrial Housing Association with a capital of not less than £1,000,000 with the object of supplying 2,000 houses a year for five years in connection with large collieries and undertakings in North Wales, South Wales, Derbyshire and Northumberland. I mention that because in some colliery districts to my own knowledge, and the knowledge of hon. Members opposite, the housing conditions are certainly worse, perhaps, than in any other part of the country. I have never understood why an industry, in which, on the whole, there is a profit to the owners, and in which the workers obtained a wage far above the average, should suffer from had housing conditions. That association will lease these houses to the collieries at an economic rent. The collieries will then let the houses to their employés at such rents as they think reasonable, and probably at lower rents than they pay for them. It will probably pay them to do so. Any cost of that kind will be carried by the colliery companies and not by the association. The members of the association are working without a Government subsidy of any kind. They are quite satisfied to do so. They hope to borrow part of their capital from the Public Works Loans Commissioners, who of course, have funds available for the purpose of helping public utility schemes of this kind.

I am very glad that a start has beer made in this important direction. I hope that the example set by this ingeniou[...] scheme, with the help of a number of very public-spirited men—Lord Aberconway is chairman of the company, and many Members of this House are working for it without any remuneration—will be followed and extended. I am certain that in that direction a great deal can be done, and will be done, towards a solution of the problem. In the meantime there are one or two aspects of the question where our present housing scheme will allow of some elasticity. Local authorities in some cases, not perhaps in as many cases as one might expect, have sites developed, roads made, and land purchased under Government assisted schemes. I am proposing to assist local authorities in utilising the sites or in disposing of them to private builders, so as to stimulate building by private enterprise. Other ideas have been under consideration. Hon. Members have in the past drawn attention to the legislation for the relief of buildings in New York from taxation. I followed that suggestion with great are and some sympathy. The application of such methods to this country is not easy, for our legislation is very different. The question whether or not we shall exempt from local rating for a number of years houses that are built under proper conditions is not unworthy of consideration. It is very largely a question for the local authorities to consider. They must decide whether or not [...] the long run it would benefit them to sacrifice present revenue for future advantage. There are many difficulties in he execution of such a scheme, and [...]ose difficulties cannot be dismissed without very careful consideration.

[...].0 P.M.

I notice that the Building Societies association had a meeting on 8th June. I noticed that in his speech the chairman as very strong in urging the Government to refrain from making excessive panic contracts that interfered [...]iously with the building industry. His speech tended to confirm statements which have been made to me by others. Last year, in speaking on the Estimates, I [...]ed to make it clear that the more a studied the question, the more one came convinced that the problem of [...]ms and the question of housing, hough they are connected, are by no [...]ans exchangeable. You might build very large number of houses, a number far in excess of any effective demand, and yet find yourself still with slum areas occupied by a certain class of people. That view is based on many years' study of this problem. We are anxious, however, to make progress with the clearance of slum areas. Last year I asked for £200,000, maximum, per annum, which was to go towards the deficits of local authorities engaged in clearing slum areas. Such schemes are slow to mature, and progress is not, perhaps, quite as fast as one would like. The Ministry of Health has approved schemes already, or schemes are in preparation, involving commitments for £60,000. These schemes include three of the worst areas in London—Brady Street, Ware Street, and Sophia Place, Poplar. Hammersmith has a scheme, and is asking for no subsidy. The scheme will require very careful scrutiny. There is, however, the right spirit at work, and schemes are being considered. In the provinces, Sheffield, Manchester, Leeds, Liverpool and Nottingham are proceeding with schemes. Negotiations with local authorities on other schemes are pending. Here, again, the fall in the cost of housing may have a very material effect. The more economically you can build houses, the less the deficit of local authorities must of necessity be.

On these slum clearance schemes everything except the product of 1d. rate falls on the Treasury. That does not seem reasonable. As a matter of fact, there are local authorities anxious to contribute more. It is, perhaps, going outside the Estimates, but I would like to say that if legislation is introduced at a later date to deal with this subject, I hope the House will give me power that will enable me to deal with local authorities that are ready to act more generously. I believe that in co-operation between the Ministry and the local authorities the hope of the future lies on this very difficult question. The question of how far local authorities should undertake responsibility under the Housing Act is a question which should be carefully considered. I have had a few estimates made which I may mention here incidentally. I find that, on a rate of one-tenth of a penny in the pound, London could finance 2,000 houses, Liverpool 170, Birmingham 150, and Manchester 250. One-tenth of a penny in the pound is a very small increase of the rates, and local authorities who are [...] this question ought to seriously go into the question of how far, even at the present time, when we know rates are high, they ought to take this burden upon their own shoulders. That was the intention of Parliament. It was not intended that the State was going to undertake indefinitely the responsibility of housing. I do not think anybody ever advocated that or ever intended it. We always insisted that the State was to come in, more or less, as a kind of stop gap. Some think it stopped the gap too little, and others think it stopped the gap too much. Conditions have changed and changed rapidly, but we must really see that these are functions which have always belonged to local authorities, and never to the central Government.

Major BARNES

Do these figures refer to so many houses per year?

Sir A. MOND

We have worked out the figure in relation to the annual loss on the houses. We have assumed the annual loss on the houses to be £9 per house, and the figure naturally deals with the annual loss.

Major BARNES

Then it means that London could do 2,000 houses per year, and go on doing 2,000 houses per year.

Sir A. MOND

It means that a rate of one-tenth of a penny in the pound in London would meet the annual loss on 2,000 houses. That, however, as I have said, is only an estimated figure, and it is possible that we might get a figure even lower than that. Another point of importance is that of continuing Section 25 of the Housing Act, 1919, which is of great assistance in regard to local bye-laws, and has in itself proved a considerable stimulus in dealing with the housing question. There are a number of other important questions which I ought to cover, but I feel some difficulty in view of the fact that there are a number of hon. Members anxious to speak and I do not wish to monopolise the time of the Committee. On the other hand, there are certain questions of a general character with which I feel bound to deal. I wish to say a word of praise, at any rate of appreciation, regarding the work done by the boards of guardians throughout the country in the extremely difficult problem with which they have been called upon to deal, in view of the prevalence of unemployment. Taking the position as it is throughout the country, I think it provides a remarkable testimony to their public spirit, their administrative capacity and their general ability in handling the situation. Though it did seem at one time as though we were threatened with the downfall of the whole. Poor Law system, I think we may now assume that time has passed.

Mr. J. JONES

They saved you from a revolution.

Sir A. MOND

No, no. I think my hon. Friend is putting it too high, but they have done a great deal of valuable work and I am acknowledging it. I wish on this occasion to express my recognition of it, which is shared by all those who like myself, have had to live with this problem for a long time and have endeavoured to assist as far as we can in the solution of the problem. It has been extraordinarily difficult, especially in industrial districts, and we all recognise the very large amount of able and devoted work which has been done. I hope we have tided over the worst of i[...] and are getting into smoother waters, Some criticism has been made of the Ministry for not interfering more i[...] Poor Law administration up and down the country. After all, the system of the administration of relief is a matter for the local authorities concerned, and I am only called upon to intervene or [...] exercise any pressure when anything [...] done contrary to the settled principles of the Poor Law as generally understood and carried out in this countr[...] or when people ask me to help [...] find further money and when, there fore, the credit of the Governme[...] becomes involved. I do not wish [...] go into the question of what are to principles of the Poor Law, although there seems to he a tendency toward controversy on that matter in certain quarters. They are, I think, on to whole, thoroughly well understood as thoroughly well carried out, and where they are not being carried out, I do [...] think it is because they are not under stood, but because there is a desire introduce another system which, while may have merits, is not the British P[...] Law as laid down and understood in [...] laws of this country.

I wish now to refer to the question unemployment relief work, in which I sure hon. Members opposite are interested. This scheme has been in operation for a considerable period, and, on the whole, I may say it has been one of the most satisfactory experiments we have made in our endeavour to relieve unemployment. I am glad to tell the Committee that a careful inspection made by technical officers of most of the work which is being done throughout the country for relief purposes, either by direct labour or otherwise, shows that it is, taking it all round, being done more satisfactorily than might be expected in the case of work of this character so far as utility is concerned. Of course, we do not get that degree of efficiency which one would expect if one only employed people who were used to the work. We find an average of efficiency of 60 to 65 per cent. I recently ventured to say that I fixed the average of efficiency at 75 per cent., and I am glad that it has worked out so correctly. The results are extraordinarily good, having regard to the fact that 30 per cent. used to be looked upon as quite a favourable result in regard to relief work. Any deficiency which exists is not due to the people not endeavouring to do the work, but to their not having experience of the work, and, on the whole, the report is very encouraging. The local authorities under this scheme have already had loans approved for something like £18,000,000 for work, some of which is finished, while some is still going on. Employment has been provided direct for 680,000 men-months, and indirect for about an equivalent amount. That is to say, work has been provided for about 1,300,000 men-months. We have raised about £18,000,000.

The work undertaken, of course, has generally been of a public utility character, and this work is independent of the Road Fund, which is employing very large numbers of people and is apart from the public utility, local authority work with which I am more directly concerned. On the whole, I think it may be considered a success, and steps are being taken to see how far a further scheme is either necessary or possible. We have issued a circular recently to local authorities suggesting a consideration of the probable unemployment position in the autumn and winter, and the preparation and examination of draft schemes by the Unemployment Grants Committee during the summer, so that we can have concerted measures ready next winter if they are considered necessary. A certain amount of work wants to be kept going, and directions have already been given for approval, if necessary, of works not exceeding a capital value of £2,000,000 immediately, but we want to take a wider purview of the whole situation and to work out, in conjunction with the local authorities, schemes which will take some time to mature, in order to see what their ultimate cost might be and how far the necessity may arise. It is not my province, and it is not within the Estimate, to deal with the whole of the large question of unemployment. I am only dealing with that section which comes under the Vote.

Mr. LUNN

Will the right hon. Gentleman be able to state, for the information of the Committee, the position of the Government in regard to further steps to encourage relief work, seeing that the money is nearly done now?

Sir A. MOND

I have just stated that £2,000,000 further is authorised where it is immediately required, as an interim period, while the other schemes are being considered.

Mr. R. McLAREN

Does that apply to Scotland as well?

Mr. J. JONES

If there is any money, you will find a Scotsman there.

Sir A. MOND

It applies pro tanto or even more so to Scotland. I have referred, in answer to questions which have been put to me at various times, to the very interesting foundation which I am pleased it has been my good fortune to he in a position to commence towards the establishment of a School of Hygiene in London in connection with the University of London and which carries out the recommendations of Lord Athlone's Committee which was appointed in January, 1921. The need for a Central School of Hygiene and Preventive Medicine has, of course, long been felt, and the necessity for and advantage of concentration is one of which all those who have studied the subject are fully convinced. The teaching of this very important subject, important not only to the metropolis, but all through the country and the Empire and the world at large, has been carried out in 10 medical schools, which really cannot specialise without necessary accommodation for research and the necessary staff for research, which is so very vital, and which is important to my mind, for the future—the most important work perhaps that medical science has to do. The recommendation was made, and it was endorsed by the University Grants Committee and the University of London, and a scheme was drafted by a Departmental Committee appointed by myself. One difficulty we met was finance, but fortunately, in this case at any rate, we got the assistance of America. The Rock-feller Institute, which possesses very large funds and a very large heart, and takes a very big view of its obligations on the subject of health, kindly promised us a sum of two million dollars, or £400,000 if the exchange does not depreciate too rapidly, in order to found an institution for this school in London, and on condition that we found the money for staffing and maintaining the school. I got a promise, if I could do it for £25,000, that I could have the money, and a site has been bought and steps are being taken to erect buildings on the land and arrange a curriculum and work together with other associations, and I hope that in the course of a couple of years that this very important service will be started, which will really, in conjunction with the School of Tropical Medicine and the Lister Institute, do much to relieve disease both in this country and throughout the Empire and will be of international benefit.

The next subject I want to say a word about is the position of our hospitals. The Committee will remember that I introduced a Supplementary Estimate last year, as the result of Lord Cave's Committee, for £500,000 in order to relieve the urgent want of our hospitals. Lord Cave did extraordinarily great service in his work on that Committee, which laid the foundations of an organisation which, under the very able and enthusiastic administration of Lord Onslow, is really going to enable us to continue our voluntary system. We have up to the present distributed money where it is required, but I am glad to be able to say that. I think, on the whole, the position of the hospitals in London is rather better than it was estimated it would be at the time that, Lord Cave's Committee reported. Lord Cave's Committee estimated the deficit to be more than, I am glad to say, it has burned out to be. The deficit for 1921 is going to be considerably less, I understand, than in 1920. Of course the cost of materials and wages and everything coming down has affected the voluntary hospitals, and it is a very creditable thing that, despite the cost of living and the high taxation, the flow of subscriptions to our hospitals has not really substantially diminished. They have really been more heavily hit by their increased expenditure than by the decreased charity of the population. The total grants up to date from the Hospital Commission are £103,000 in London and £39,000 in the provinces, or £142,000 altogether. The rest of the money is still in hand. The most important part of the work already achieved is not merely the question of the money, but of the organisation. We have largely succeeded in establishing a network of Committees throughout the country on a county basis, working not merely in regard to the collection of money, but also undertaking the very necessary work of co-ordination.

Anybody who has studied the Report of Lord Cave's Committee must come to the conclusion that there was a great deal of overlapping and want of fitting in of our hospitals as they stood. We want to prevent that, and to produce a better system. The county committee system has been established generally for administrative counties and county boroughs with a population exceeding 250,000. There are 52 committees in England, Scotland, and Wales already formed and working, and six will be completed shortly. Representatives are nominated by the county councils, the county borough councils, there are two or more hospital representatives nominated by hospitals in the area, two or more representatives of the medical profession, and normally five nominees of the Commission. These committees really form bodies which are going to do very good work, and very good results indeed have already been obtained by them. There has been a remarkable increase in the incomes, particularly in Oxford and Devonshire. The mass contribution schemes are leading to very remarkable results. The Oxford scheme, initiated by the Ratcliffe Infirmary, has shown what can be done in rural areas, and the example is being copied elsewhere.

It is very heartening and encouraging to find examples of what can be done by local enthusiasm for our hospitals, both in our large towns and in agricultural areas. I am sure that the experience of so many men who unfortunately had to be in hospital during the War has done much to help. It is much more likely that you will get more from the small contributor. We live in an age when the rich are far too poor to support anything.

Mr. J. JONES

Go to Ascot to-morrow, and see them.

Sir A. MOND

The rich cannot support much for any length of time. In putting the hospitals on a sound financial basis you will really do much better by spreading your burden over a large number of people than by relying on an occasional successful bet at Ascot. The British Hospitals Association is doing excellent work. I should also like to say a word of thanks to the approved societies for what they have done in contributing out of their valuation surpluses. They also are coming into line, because they are the people who benefit very directly from the work of our voluntary hospitals.

Mr. R. RICHARDSON

You have taken the money and given it to the doctors.

Mr. J. JONES

The more economical they are, the more you take from them.

Sir A. MOND

I do not think so. The more economical they are the less sickness pay they have to pay out.

Mr. J. JONES

No. The better they administer, the more you take from them.

Sir A. MOND

I think there is a good deal of room for improving administration, but that is another question. I have dealt roughly with the question of the hospitals. I am glad to say that the outlook is encouraging. The work is proceeding and the voluntary system I hope we can say will, with the encouragement it is receiving, survive. This splendid institution will go on doing good work, such as it has done in the past, and perhaps it will do even better, because it will be more co-ordinated and more people will take an interest in it.

There is one subject which has moved this House a good deal, on which I must say one word, and that is the question of county borough extensions. Since 1888, 103 extensions of county boroughs have been passed, 60 by Provisional Orders and 43 by Private Bills. Twenty-two new county boroughs have been created. The policy of this House has been to favour the extension of borough councils under the provisions of the Act of 1888, and we have proceeded along the lines of well-established precedent which, on the whole, has worked well. There is no doubt, and I do not disguise the fact, it would be folly to do so, that a different spirit has come over the House at the present time with regard to this subject. The whole matter of the principle of the Act of 1888, and what Parliament meant to do by it, are very seriously questioned. I, personally, have been devoting a considerable amount of time to the very difficult and important question of local administration. We had a proposal last winter from the County Councils Association for the appointment of a Royal Commission. I had hoped that we might have avoided that rather lengthy process by endeavouring to obtain a united programme from the two rival bodies, the County Councils Association and the Municipal Corporations Association. With that aim in view, I invited them to a conference with some of my officials to see whether we could find a common platform and formulate a common policy. We had a number of conferences, and very interesting they were. Both sides put their ease with their customary ability, skill, argument and wit, but I am afraid I have reluctantly come to the conclusion that no amount of meetings will reconcile the fundamental differences between them.

That being the case, I do not propose to proceed on the lines of conferences, but by the method of a Royal Commission to which I understand both sides are now agreeable. The question of when the Royal Commission should be appointed is one which requires further consideration. There is a Royal Commission on London Government now sitting. It might perhaps be wise to let them conclude their labours before another Royal Commission on the subject is appointed. This is a point on which I am not expressing any final opinion, but it is a matter for further consideration. In the interval we should call a halt, and I should like to take advantage of this occasion to give notice, so far as the Ministry is concerned, that no contentious proposals for the extension of boroughs and the creation of new county boroughs will be entertained by the Ministry in the meantime. That is the only reasonable thing to do. It is obviously mere foolishness to encourage an enormous expenditure of the ratepayers' money until we are in a position to decide; until then all this money really goes for nothing, and all this expenditure is thrown away. I certainly am not going to be responsible for encouraging anything of that kind. Personally I am very doubtful in regard to the whole question of whether Provisional Orders are really at all adapted for cases of big centres like Leeds or Bradford, but that is a question which the Royal Commission will have to go into when it is appointed. It is time that the whole problem was very fully considered. Since 1888 the old county council areas have altered. You have county council areas which have become even more important and more industrialised than are the boroughs. It is very important that the Commission should report in order to see what ought to be altered and how much alteration in legislation is needed. In the meantime we will proclaim peace between the parties, so far as the Ministry is concerned.

I must thank the Committee for having listened to me while I have endeavoured to cover, however imperfectly, a large number of important points, which I thought were points of general interest that I ought to lay before the Committee. I have no doubt there are many more points—in fact, I know there are—which interest the Committee, and about which they may desire me to say something, as I shall, to the best of my ability, when the occasion arises. The policy of proceeding on lines of economy, while seeing that no real damage is done to our essential services, will be continued, I can assure Members of the Committee, so long as I have the honour of representing the responsible position, and, indeed, the glorious and magnificent position of Minister of Health.

Mr. TREVELYAN THOMSON

I beg to move to reduce the Vote by £100.

I am sure all Members will sympathise with the Minister that this most important Vote should come on at the fag end of a sitting. I venture to say that no Vote that can come before this House is of greater importance than the one the right hon. Gentleman has laid before us this evening. It is a matter which touches the whole of the nation at the very heart, and the range of subjects with which he has dealt shows that there is matter here not merely for an hour and a half's debate, but for more than one sitting, and that it is, of course, impossible to attempt to touch even on any one subject adequately. While I am sure the whole Committee will welcome the economies in administration foreshadowed, and the business ability which the right hon. Gentleman has for carrying them out, the Committee will regret where economies result in the curtailment of those social services to which the Minister referred so sympathetically. As an illustration, I cannot but think that the reduction in the amount allotted to maternity and child-welfare of some hundreds of thousands of pounds, is one that will seriously affect those services throughout the country. The Minister has said that he was not anxious to do more than cry "Halt!" I would submit to the Committee that many of these services—maternity, child-welfare, the treatment of tuberculosis in sanatoria, venereal treatment—are services which are as yet in their infancy. They are only beginning to grow and develop, and by crying "Halt!" the right hon. Gentleman is not merely curtailing the ordinary annual growth of an established system, but he is seriously limiting the growth of services which have only recently come into being, due to that bigger recognition of the social responsibility which appertains to the whole of us. Therefore, I do regret that at such a time, when we should cherish, more than any other, the child-life of the nation, when the best of the nation's manhood has been mown down by the ravages of war, he should in any way cut down the grants made to local authorities for services which are absolutely invaluable.

I should like to refer especially to the question of housing. The right hon. Gentleman suggested—and I am sure what he has suggested will be received with disappointment throughout the country—that to make good that enormous shortage of houses which still exists in the country, those who are wanting houses must depend upon private enterprise, and he gave, as a justification of that statement, the fact that the cost of building had fallen to £350. Does the Committee really think that £350 for the, cheapest, class of house, with land, road-making, and sewers; to-day forms a basis for rental which can be paid at the present time? The right hon. Gentleman suggested that private enterprise could do better than the State. Might I remind him that the great majority of houses that are being built for municipalities are being built by private enterprise under the keenest competition? My limited experience in my own district from builders and others is to the effect that if a man wants to build a house today, he cannot get a tender as low as the municipality can get when they want to build 300 or 400 houses. That is the practical experience of those who are trying to build houses to-day. I have a letter from the local builders suggesting it is impossible for them to build on economic lines, and that they can do nothing at the present time.

But take this house of £350 which the Minister gave. We know perfectly well that whatever may be done by private enterprise in some directions, the local builder cannot borrow his money as cheaply as the State or municipality, and he wants a bigger return on his, money, too. The small private builder is not satisfied to wait for 60 years before getting his capital redeemed and the property repaid, and I submit he cannot borrow to-day under 6 per cent. He wants to get his money back in 30 or 40 years, or possibly sooner, and, taking all these factors into consideration, the small private builder will want a return of from 9 to 10 per cent. before he is going to build a large number of houses speculatively at the present time. That is what builders in the district with which I have some acquaintance say. To get 10 per cent. on £350 there must be a rental of 13s. 3d., and if 8 per cent.—and allowing for redemption of money, collection of rents, empties and incidental expenses appertaining to cottage property, no one will do it under 8 per cent.—he will want 10s. 9d. per week. Adding local rates, which at present amount from 20s. to 30s. in the £, you have a rental of 17s. 6d. a week, at least, in every industrial area where the shortage is the greatest. Wages are down in most districts to about 40 per cent. above the pre-War level, and possibly less. The people who are getting these wages got houses in pre-War times at rentals of from 3s. 6d. to 6s. 6d. a week, according to the class of house they wanted, free of rates. To-day, according to the proposal of the right hon. Gentleman, the tenant will have to pay 17s. 6d. per week, while his wages are no more than 40 per cent. above what they were before the War, when he could get his house at a maximum rental of 6s. 6d. Does the right hon. Gentleman, with his business ability and general appreciation of the situation, really think that private enterprise is going to make good this abnormal and terrible shortage? He admitted the Government must come in as a stop-gap, but the point at issue is: why should the Government stop now?

In 1919 the Prime Minister said that 500,000 houses were necessary to make up the appalling need. The Minister himself has told us that there are only 176,000 houses going to be provided, and for the rest we must look to private enterprise; but at what price? Let the hard-hearted financiers consider it even from the narrow point of view of pounds, shillings and pence. If you allow this appalling overcrowding to go on as, for example, in my own town, where I knew that over 25 per cent. of the population are living in an overcrowded state—over 2,000 families have not a house to call their own—they are living two, three, four and five families in a house; and that is simply the ordinary condition of things in every large industrial area—if,. I say, you allow this appalling overcrowding to continue, and children to grow up, with impoverished health and unable to get the necessary freedom and fresh air, to produce a decent manhood and a decent womanhood, you are piling up for the State a legacy of certain ill-health for which you will have to pay dearly in the future. Therefore, I submit that it is a penny wise and pound foolish policy to cry out for a halt now.

On this question of cost I submit that even on the showing of the Minister he has not provided the number of houses for industrial areas which his Vote would warrant. The Vote is for £9,630,000. He has told us that £130,000 of that is for slum redemption. That leaves, say, 9½ millions to build 176,000 houses, but he has given us very little information as to how he has arrived at these figures. Perhaps the right hon. Gentleman will tell us later how it is that he is going to spend 9½ millions of money and only produce 176,000 houses. He gave us some extraordinarily interesting figures just now. He said that in May, 1921, he was getting a certain sized house, one with three bedrooms, for £697. In November of last year the price had fallen to £577, and in May of this year it had further fallen to £384, and he gave us just now a figure of under £300 as the price to which this class of house had fallen.

Mr. A. HOPKINSON

The predecessor of the right hon. Gentleman was not getting them at £1,500.

Mr. THOMSON

The hon. Member for the Mossley Division (Mr. Hopkinson) is misinformed once again, for in reply to a question which I put the other day to the present Minister, he said that the highest price ever paid for any house was £1,288, and that was due to the abnormal conditions in regard to the site. The Geddes Committee took the figure of £1,100, which is the price evidently taken to arrive at the amount of 9£ millions, because if you multiply 176,000 by the loss the Geddes Committee estimated on the £1,100 you get the 9½ millions. Surely that figure will not bear investigation.

Sir A. MOND

Let me tell the hon. Gentleman that I spent days investigating these figures, and I am sorry to say that all the economy I was able to effect has been able to reduce them but very little, because the number of houses which have been built for the State at the cheaper rates bears a very small proportion to the total number of houses.

Mr. THOMSON

I was only wishful to draw the attention of the Committee to the conflict between the figures of the Minister to-night and the figures shown in the Geddes Report. Only 68,000 had been completed on the 1st October when the Geddes Report was written. There were 68,000 in course of erection. The Minister has told us that in May, 1921, the average price was only £697, while it was £577 in November, just after the Geddes Committee Report was framed. How, in the world, can you get an average price—I ask the Committee to consider it—of £1,100 for the whole of the 176,000 houses when you have during a part of that period average prices varying from £697 to £830?

Sir A. MOND

I think my hon. Friend knows that I pointed out very carefully that the figure was not going to be lower than £300 per house for the land, etc.

Mr. THOMSON

Is my right hon. Friend serious? Is that another example of his arithmetic? He suggests that £300 per house is to be added for road making, sewerage, and so on.

Mr. HOPKINSON

And cost of administration.

Mr. J. JONES

Ridiculous!

Mr. THOMSON

The land is not at an excessive price in this particular case. The price of land works out—I speak from memory—but I think I am correct—at not more than £200 per acre. As you have 12 to 18 houses per acre you cannot add more than £10 to £15 per house for the land. Then as to the cost of the roads and sewers, the right hon. Gentleman told us himself that it was another £52. I submit it is altogether fantastic for the Minister to give us this figure of £300.

Sir A. MOND

I should like to correct that figure. The average is from £170 to £180 for the land, roads, sewers, and other charges—architects and so on.

Mr. THOMSON

I can only say that the revised figure of £170 which the Minister now gives us is considerably larger than in the district of which I have some knowledge. I went to see the Ministry the other day. We were discussing various figures and the figures then given us for roads, sewers, etc., were considerably less than the figure the Minister himself now gives. I am speaking in the presence of many practical men who know the price of things, and I think they will bear me out that £200 per acre for land working out at £10 to £15 per house plus the cost of the roads, sewers and so on, are about what I have stated. Be that as it may be, I do submit to the Committee that this figure of 9½ million pounds as the cost of 176,000 houses, some of which have not yet been begun, is altogether a fantastic figure. I submit that without exceeding these Estimates a halfpenny the Minister could give permission to the local authorities to erect a larger number of houses than he has done up to the present. I hope he will not yield to the temptation to save some hundreds of thousands of pounds or a million in view of the circumstances. That saving would be effected at a deadly cost to the well-being of the country as a whole. You have a most appalling state of things when you find decent artizans crowded together with two and three families in one house, with people sleeping, living and eating in one room and rearing little children, and this is a poor reward after the promises made to these people by Ministers and hon. Members opposite at the last election that they would provide houses.

I understood that the Minister of Health gave the Geddes Report their figures, and they show that 6.8 per cent. is the cost of interest and redemption of loans. Since then there has been a fall in the bank rate of 1½ per cent., which means that we are saving 1½ per cent. on the houses for which the money has been borrowed since that time. The 6.8 per cent, is based on the 60 years period, whilst the greater part of the money which has been borrowed is on short term loans. The housing bonds were taken out for five and ten years, the local loan stocks were issued at an average of 15 or 20 years, and to suggest that the whole of this money should be taken on a 60 years basis at 6.8 per cent. is simply playing with the question. On that alone there is a very big saving, because even 1½ per cent. reduction in f he cost of borrowing the money means a saving of several shillings per week in the rental.

I hope the Minister of Health will revise his figures with regard to the estimated cost of land, sewers and road making, and also with regard to the financial charges on money that has been borrowed, and then see whether, by the expenditure of this £9,500,000, he cannot provide another 100,000 houses for the immediate needs of congested areas. He suggested that the municipalities might do this for themselves. These municipalities have great responsibilities even in normal times, but owing to the Government stopping them building during the War, and the shortage caused by action of the Government, it is up to the nation and the Ministry of Health to make that shortage good now by providing with State assistance the houses which are so badly needed for the health of the people, and which private enterprise cannot possibly provide for some years to come.

10.0 P.M.

Mr. CAUTLEY

I wish to call the attention of the Committee to the case of a hospital at Sevenoaks which confines its work to the care of children suffering from hip disease. This hospital has been admirably administered, and is admitted to be a most excellent institution. It receives these poor crippled children who spend most of their time lying strapped down on boards, and they receive enormous benefit from the healthy surroundings of Sevenoaks by what is known as the sun treatment. A great many of the local people not only contribute money towards their support but they give their services. The patients whilst there have been provided, so far as their state of health would allow, with a system of education provided by volunteers. I have a doctor's certificate to the effect that the education given at this hospital is sufficient for the purpose, and quite as much as the patients are in a state to assimilate.

The matter I am going to raise has been a subject of controversy in the newspapers. There is a lady residing there who possesses a university degree and has been used to teaching, and she states that the education given at the hospital is quite efficient and sufficient. The patients at this hospital come from different districts, and more than half of them come from the county councils of London, Middlesex, Kent and Surrey. The Minister of Health, by some arrangement made with the Board of Education, has now declared that this hospital shall not receive the patients from these various county councils outside unless it provides for the 40 patients it receives from those bodies two certified teachers at a cost of £400 a year. So long as that requirement stands it means the closing of this hospital, and putting an end to all the good work that is being done.

No doubt the Committee would like to know how the Minister of Health is entitled to do that. It is done in this way. Before the grant from the local authorities whose children come from these outside county council areas can pay such fees as they do pay, namely, 24s. a week for the treatment they receive at the hospital, the hospital has to be approved by the Minister of Health to he a suitable place for them. Until it is approved in this way these county councils cannot pay for their children, and the effect of that will be that the hospital cannot take these children and it will have to close, because it cannot raise anything like £400 a year. These children come from London, Middlesex, Kent and Surrey, mainly from crowded areas. Before they came to this hospital they were receiving no education at all and they were not provided with hospital treatment. I cannot believe for a moment that the decision which has been come to is the act of the Minister of Health himself, and I believe it has been foisted upon him by some arrangement with the Minister of Education.

The result of all this will be that a great many of these poor children will be deprived of this most beneficial treatment, and will be left in their homes without any medical treatment or educational training. To my mind this is bureaucracy run mad. Hospitals take no part in education, and they are not there to provide education. If anybody agrees with me that with regard to children in this terrible state of health and stricken with this awful disease the first duty of the community is to see that they have efficient medical treatment, if they think that in addition the State should see that they have educational training, then I say that it is not for the hospital to provide that training, but it is the duty of the Board of Education or the local authorities themselves.

I ask the Minister of Health on what ground he justifies his conduct? What is handed over to his care is the health of the children—not their education. If he does consult the Minister of Education, who thinks the children should have a better education than they now get—and I am able to prove it is a good and efficient education—why does not the Minister of Education himself provide the desired education, or why does not the Minister of Health call on the local education authority to see that the children are properly educated? I am making this appeal on behalf of this hospital. It is to my mind an outrage that the Minister of Health, who is charged with the duty of looking after the health of the children, should be responsible for a plan which will inevitably close this hospital and will deprive these children of the great benefits they are now getting, and that for a mere fad. It is, I repeat, a case of bureaucracy run mad, and unless we get some concession in this matter I shall feel it my duty to move a reduction of the Vote. May I add one further word? There has been correspondence in the "Times," and a suggestion has been made that only one certificated teacher should be insisted upon instead of two. I say that that suggestion is equally impossible, because the hospital is not in a position to raise even £200 for that purpose.

Sir A. MOND

As the hon. Gentleman has raised quite a special point, perhaps it would be as well for me to clear it out of the way so as leave the ground free for general discussion. I should like to put the real facts with regard to this hospital before the Committee, especially as it has been so difficult to make the hospital authorities understand the actual position. There has never been any demand for any certificated teacher to be appointed for the hospital. What was demanded was that some teacher should be engaged in order to deal with the children in the hospital who are of school age.

Mr. CAUTLEY

I have a letter from the lady in charge of this hospital in which she says she was told very curtly that two certificated teachers were required for the occupants of the 40 beds, and when she retorted that it was not her duty to find certificated teachers she was informed that she could easily get them by advertising for them. That is the lady's own statement.

Sir A. MOND

There is a conflict evidently as to the facts. There is no foundation for the statement that either the Minister of Health or the Ministry of Education has ever required the appointment of two certificated teachers.

Sir H. NIELD

I am speaking for the Middlesex County Council, which has sent patients to this hospital, but which has been prevented from sending certain children because there is no certificated teacher attached to it.

Sir A. MOND

These statements, coming from two hon. Members, of course require further investigation, but, after all, they really deal with past history. I have made it quite clear in my correspondence with the hon. Member on the matter that a demand has never been made for the appointment of certificated teachers. If one has ever been made, it has, at any rate, been withdrawn. It should be remembered that in institutions of this kind, children of 10 remain for as long as two years, and it is therefore necessary that they should be provided with such education as is possible in their condition. If the hospital takes in children which are not of school age, we are not concerned about their education but if it takes in children of school age, then surely it is not unreasonable to demand that a child who may be there detained for two years should receive some education. It is obviously not the function of the Board of Education to do this, but it is the function of the local authorities who are charged a certain amount per child, I believe the amount is 24s. per week. If that charge were increased by 3s. it would be possible out of the increase to pay the salary of a teacher and thus to meet the requirements of the local authority. That seems to be a practical business suggestion and I cannot understand what difficulty there is in adopting it. I am not in the least anxious to do anything to disturb this very excellent institution. Far from it. But on the other hand we must realise that as a child of school age may be detained there for two years, it would not be right that it should not be provided with any education whatever. I think the suggestion I have made is one that could easily be adopted, and an uncertificated teacher would suffice to meet all requirements. I should be glad to assist those responsible for the administration of the hospital in this matter, but I suggest they should be willing to slightly increase their charges in the way I have suggested.

Sir H. NIELD

I want briefly to reply to some of the observations of the right hon. Gentleman. The cost of each child in the hospital is 29s. per week. The local authority pays 24s., so that the additional 5s. per week has to be met by voluntary contributions or by support from friends. I hope the Committee will understand that these children are, for the most part, too ill to receive education. They are being treated under the sun cure system. The hospital has been specially constructed with verandahs for that purpose, and children lie out on these verandahs. Class teaching in their case is an absolute impossibility. At present there is a rota of educated ladies in the neighbourhood who come in and give such instruction as these poor, suffering little children are able to take. It is quite true that they do stop there as long as 20 months, or even two years, but the average, I am told, is 218 days, and for the most part during that time they are utterly unable, by reason of their physical suffering, to take advantage of anything like education. An educationally interesting talk by the ladies who go there is all that they are able to take, and I venture to think it is unfortunate that the Ministry, acting probably in conjunction with the Board of Education, have prohibited the county councils from sending any child that is not of school age. I have here a list of the patients who have come in from 1917 to 1922. There are 19 patients, one of the age of four, and the others of ages ranging from five to 17. It is impossible to say, "If you do not take children of school age we are not able to deal with you at all." It is a case of exercising reasonable discretion and acting sympathetically and reasonably. If that were done the hospital would have no complaint, but would continue its beneficent work, to the great advantage of these children, and I hope that the Ministry will not insist upon a requirement which, after all, is only a matter of pedantry.

Mr. G. BARKER

It is a pity to spoil the beautiful picture which the Minister of Health drew with reference to the boards of guardians. I certainly heard with very great pleasure of the amiable and amicable, relations which exist between the right hon. Gentleman and the boards of guardians of the country, but it does not tally with my experience. I was present at a conference of hoards of guardians last Friday in South Wales, and I should not like to tell the right hon. Gentleman the opinion that the guardians have in regard to his administration. He reminded me of the celebrated Frenchman, M. Coué, who was over here a short time ago, and who said that the crisis had passed and things were now becoming all right. It would seem that these necessitous areas have only to keep on repeating, "Things are coming all right; the crisis has passed," and then they will have no more trouble, no more poverty, and no more wretchedness. It is a pity to spoil the picture that the right hon. Gentleman has drawn with reference to these areas, but I have some figures here which do not tally with the description that he has given. These figures refer to the South Wales area, with which the right hon. Gentleman should be very familial. In Merthyr Tydvil the rates in 1913–14 were 10s. 4½d. in the £, and in 1921–22 they are 30s. 5½d.; in Abercarn they were 10s. 2d., and are now 20s. 10d.; in Abertillery they were 11s. 2d., and are now 37s. 3d.; in Ebbw Vale they were 12s. 8d., and now are 36s. 1d.; in Nantyglo Blaina they were 10s. 7d., and are now 31s.; while in the Rhondda Valley they were as low as 7s. 9d., and are now up to 26s. 6d.; in Tredegar they were 10s., and are now 30s. 5d. And so I could go on, practically over the whole area of South Wales. There is not the slightest doubt that in these areas the local authorities are almost bankrupt, and yet the right hon. Baronet has drawn such a glowing and loving picture of the amicable relations that exist between him and these local governing bodies. The condition of these bodies is due to the policy adopted by the right hon. Baronet. For the last 18 months, when we have had from one to two millions unemployed, the Minister, one would have thought would have come to the aid of these great necessitous areas, but he has taken every opportunity that has presented itself of evading his obligations. During the whole of this period these areas have been refused help from the Ministry. The unemployment problem has its origin in the War. The War arose out of a national emergency, and this unemployment problem has arisen out of this national emergency. Yet the right hon. Baronet, ever since he has been in office, has been putting the burden of unemployment upon these necessitous areas, until to-day we have practically 100 local governing areas on the verge of ruin and bankruptcy.

The right hon. Baronet very sensibly, from his own point of view, refused to refer to these areas in his very long speech, and it is my duty to give him some figures with reference to them. I take as a commencement the Bedwelty area, where there are from 7,000 to 8,000 who have been unemployed since February, 1921. This union is over £70,000 in debt. The amount of relief estimated for is £3,800 per week, but the expenditure is £6,500 per week. The right hon. Baronet congratulates himself on the way in which the guardians have assisted him, but he cannot be ignorant of the fact that there is such a revolt against his administration that these local governing bodies that he has flattered himself have such love for him are going over the top of his head to the Prime Minister because or the maladministration of his Department. In Nantyglo and Blaina there are six collieries. Four of them have been idle for the last 16 months. Three thousand of the population have been unemployed during that period, and only 1,500 have been employed. Out of a population of 16,000 81 per cent. are in receipt of outdoor relief, and this is because the right hon. Baronet has insisted upon pursuing a policy of putting this unemployment problem upon the local authorities. In these areas the rates have gone up from 100 to 200 per cent. and the rents, of course, have gone up in proportion. This affects not only the working class in these areas, but the industries in the areas. At a meeting in Bedwelty last Saturday we had the secretary of the Ebbw Vale Company present, and he stated that in 1914 the rates on a ton of steel amounted to 7d. while to-day the rates are 7s. 6d. per ton. Therefore, the policy which the right hon. Gentleman is pursuing is driving these areas into financial ruin, chaos and bankruptcy. I protest against the policy of the Government in shirking their responsibility arising out of unemployment caused by the War, and shelving the responsibility upon bankrupt areas where they are unable to face their difficulties.

In the Nantyglo and Blaina area the following sums were outstanding when the Finance Committee met on 22nd May, 1922, and since that date the amounts have steadily increased—general district rate, £6,446; water rate, £1,158; house rents, £1,934. The rateable value of the area has decreased from £53,000 in 1913 to £36,000 in 1922. A sum of £5,000 is owing to the bank, which refuses to loan any more money, and the Council have had to give notice to all their workmen, because they are unable to meet the weekly wage bill of about £150. In Abertillery the amount outstanding on the poor rate alone is £42,000, on the supplementary rate levied last September, £4,000, and on the district rate, £17,000. The total sum outstanding was £134,612, and there have been 1,500 unemployed there since 1921.

When I put a question to the right hon. Gentleman with regard to the condition of the Bedwelty area, he said that the scale of relief in that area was extravagant. I have here a copy of the scale of relief, and I will leave it to the Committee to judge whether or not the scale is extravagant. An unemployed man is paid 10s. per week. His wife receives 10s. per week, and 8s. 6d. is paid in respect of the first child, 6s. 6d. for the second child, and for the third or more children, 6s. When we consider that the cost of living is 80 per cent. higher than in 1914, it is nothing less than an insult to these people to say that this is an excessive amount of relief. Owing to the policy that is being pursued between the Minister of Health and the Minister of Labour in simply paying unemployment benefit for five weeks and then stopping it for five weeks, people are being driven to the parish to ask for parish relief. To say that 8s. 6d. a week is an excessive amount for a child to live upon, even up to the age of 14 or 15, is a monstrous statement for the Minister of Health to make. He ought not to bring accusations of this character against a body like the Bedwelty Board of Guardians, when there is no shadow of foundation for the statement. This condition of things is the result of the policy which has been pursued persistently by the Government.

The whole of the country is filled with indignation against the Ministry of Health. I believe that we shall have a deputation here in London on the 20th of this month to see the Prime Minister, of the largest and most representative character that has even been seen in this city. The right hon. Gentleman has told the Committee that everything is going on well with the local governing bodies, and he has gone so far as to thank them for the support which they have given him. He ought to make himself acquainted with the condition of the country before making such a statement. It is not pleasant for me to say the things which I am saying about his Department. I would much rather praise it. But it is impossible to praise a Minister who has such a policy as he has. I hope that the Committee will force the right hon. Gentleman to recognise that this unemployment is a national obligation, and not a local burden. The amount of misery in these areas is indescribable, and the position taken up by the Ministry is indefensible. What, will be said if the House of Commons levied a taxation 50 or 80 per cent. higher in poverty-stricken areas than in wealthy areas? That is what is done in reference to local taxation in this country. Who can take pride in statesmanship like this which bankrupts 50, 60 or 100 local governing bodies, which insists on them raising loans when their credit is long since exhausted, and which refuses to take upon itself the obligation that it ought to face, and which are the result of the national policy that has arisen out of the War?

Mr. LORDEN

I should not have intervened in the Debate but for the statements made by the hon. Member for Middlesbrough (Mr. T. Thomson) on the housing question. The statements are so absurd that any practical man must wonder where he gets his information from. He has worked out that houses built by private enterprise bring in 17s. 6d. per week. Suppose they do, then under municipal and Government enterprise they are as high as £2 2s. per week.

Mr. J. JONES

Some of them are nothing a week.

Mr. LORDEN

That may be. Then again he stated that before the War, many houses were let at from 3s. 6d. to 5s. 6d., but these were not economic rents. Houses all over the country were being let at much under economic rents. Prior to the War nearly all agricultural houses were let at from 1s. to 2s. a week. Is not that giving something away? The fact is that when you come to the question of giving something away, the Government have been doing a lot in that line with regard to houses. Whose fault is it that more houses have not been built? The working-man's fault. What is he doing to-day? He is working for less money than he earned in 1918 and 1919, and he is producing double the work. If he had only put his shoulder to the wheel in 1918 and 1919 he could have maintained his high wages, houses would not have cost nearly as much, and there would have been more houses to go round. I cannot understand the British workingman. I always had the idea that he liked high wages. But when he gets them he does not put production into his work. It does not hurt any working-man to do a fair and reasonable day's work. The Minister has stated that we were coming near the time when houses could be produced economically. I do not agree with him. When I see that he is to subsidise houses this year to the extent of £12,427,000 I hold that it is utterly impossible for economic conditions to rule. I see that there is an increase of over £4,000,000 in the cost of house grants towards the deficiencies on housing schemes for the current year. So it will go on.

We are now approaching the time for repairing the extraordinary houses that have been built. We have adopted every wild cat scheme for building houses, and in the case of many of them the expense of upkeep will be a great deal more than the rent received. That will be the burden. The country is saddled with an enormous expense which will increase. What did we see when the Minister of Health decided that he would not produce the large number of houses originally proposed? Prices began to fall directly, because he had cornered the market for material and for labour. The profiteers got to work, not only the builders and the material merchants, but the British working man. The working man was the biggest profiteer of the lot, for when he was paid the money he did not deliver the goods. He wanted medical examination, for there was certainly something wrong with his head. When he got a big wage he should have held on to it, for he could have maintained his high wages if he had only worked hard and put his best leg forward. I would urge the Minister to adopt the suggestion of the Geddes Committee and get rid of these houses, even if he gives them away. That would be a saving to the nation. The country is saddled with this expenditure for years and years, and it is extremely important to get rid of the houses. The Geddes Committee was wise in suggesting that they he sold for less than their cost.

We have heard to-day that houses are now being built for about £300 each, whereas many houses of the same class, some of them in the London area, cost something like £1,700. Probably there has to be added to the figures given to us, something for roads and sewers. What the country has to consider, is the serious question of what is going to be done with these houses. When the Minister of Health was appointed to that office, I suggested to him he should get rid of these houses, even if he let them go at half or one-third of their cost. Now I have come to the conclusion that he would be in pocket if he gave them away. Anybody who has practical knowledge can see what is going to happen in the near future with the huge amounts which will become necessary for repairs. Going through the country, I see repairs already being executed on houses built under these fantastic schemes. Had the houses been built of good, plain, solid brick, they would have lasted many years, but these houses have been put up with all kinds of material, and many of them will last but a few years. If, in 20 years' time, it is not necessary to re-build a large number of them, I know nothing about building.

Mr. JONES

Slum property.

Mr. LORDEN

Yes, they will become slum property; they will fall to pieces. That is why I am pressing on the Minister to get rid of them at all costs. The increase this year is not all for houses. It is also for what the local authorities are spending. You have promised to give them everything with the exception of a penny rate, and at a certain period you will have to stereo-type that. When that portion of the Act comes to he put into force, it will be a very serious matter for the Treasury. I hope before that time we shall have got rid of these houses and arrived at some practical scheme of dividing them out among the people and of not being responsible for their upkeep.

Sir D. MACLEAN

I wish to ask the Minister, or whoever replies on his behalf, a question with regard to the water supply of the country. Some years ago I urged upon the then President of the Local Government Board the necessity of making a general survey of the water supply of the country, so that when authorities come to Parliament for powers, they would be confronted, as it were, with very general and accurate information in the hands of the Government as to the facilities available not only as to the particular Measure then proposed, but as to the needs of the country as a whole. The necessity for some such survey has been accentuated by the drought of last year and the shortage of water this year. I should like to know, in the first place, if that survey has been undertaken, and if, as I hope, it has been undertaken, what progress has been made? In the second place, I am sure the Committee and the country will be glad to know what steps the Ministry of Health is taking with regard to the shortage of water; whether they are assisting local authorities, and whether, with the special knowledge which they must have, they can state if there is any ground for real apprehension as to shortage of water in the immediate future.

Mr. J. JONES

The speech of the hon. Member for North St. Pancras (Mr. Lorden) convinces us that our presence in this House has done some good, because we have converted him to the principle of sharing out, and in so far as his proposition of sharing houses out amongst the people is concerned, we will enthusiastically support him whenever he brings forward such a proposal. I want to associate myself with the speech of my hon. Friend the Member for Abertillery (Mr. G. Barker) in connection with the position in which a large number of the necessitous areas find themselves. It is all very well for the Minister of Health to throw bouquets to members of local authorities, but I wish he had been living in the same districts that we have been living in during this period of unexampled unemployment. I wish he had had men coming round to his door clay after day and night after night telling the most terrible stories of their poverty and their misery and asking what he could do to assist them in their trouble. We have done our best in the East End of London, but we have not got many bouquets for it, although to-night it is very nice to hear from the Minister that things are very nice in the country, but after all in what position do we find ourselves in our own districts? Our rates have nearly doubled in the period, and this is a most extraordinary thing. One local authority has been able to economise and reduce the rates, but the other local authority that has this problem of unemployment to face has been compelled to put the rates up by leaps and bounds, so that what we have saved on the swings we have lost on the roundabouts, and I suggest that you have no right to place upon authorities of our character and industries such as ours the terrible responsibilities which come as a consequence of circumstances over which they have no control.

We in West Ham are not responsible for the fact that we have a huge riverside population. We are not responsible for the fact that out of eight parishes comprising our area, seven of them are purely working-class, and every man and woman in the place have to earn their breakfast before they can eat it, and most of them see more dinner-times than dinners. These people are called upon to bear a burden out of all proportion to their relative situation, whilst other parts of the country more favourably placed are able to escape such responsibilities. Now we have reached this position, that our rates have reached their possible ultimate limit, and we are £600,000 in debt. When we go to the right hon. Gentleman he is very sympathetic. I know his heart bleeds, but it, does not bleed much. We are told we can borrow money. Fancy a bankrupt going to borrow money. There have been gentlemen who have gone to gaol for trying to raise money when they had nothing to raise it with.

We are in this position now, and we are not the only authority. There used to be a time when we and Poplar were the only places in this position, but now there are over 100 local authorities face to face with the possibility of bankruptcy—great cities that have been well administered in the past, but they have had to face the music. Nobody will say that the city of Newcastle-on-Tyne is administered by wasters or wastrels or Bolshevists. It is administered by some of the greatest business men in the country, and to-day they are face to face with exactly the same position as we are in in the so-called wastrel districts of the East End of London, and yet all we get from the right hon. Gentleman is "Live horse, and you will get grass. It will be better after Christmas."

We are not living on hopes, but we are not prepared to die in despair. We are face to face with a position which the Government will be compelled to face eventually, and whilst they are conferring at Genoa or anywhere else they may go to, they ought to get down to brass tacks in this country. If we are compelled to stop giving relief, as we shall be sooner or later, to the people who want it, you will have a different kind of conference to face from any you have had up till now, and different issues will be raised. The unemployed of to-day are not the unemployed of 20 years ago, with whom I used to March through London, and upon whom everybody used to look as people who would not work.

To-day the unemployed contain in their ranks some of the finest mechanics and workmen this country has ever produced. There are men in my own constituency who never knew what it was to be unemployed in their lives before who have been out of work for two years now. They cannot get even the hope of a job. They are outside every factory and every engineering shop and every dock. Thousands of the best workers in the East End are being turned back every morning without any possible hope. Yet we are told we have to shoulder this responsibility because we live in a poor district. The time has arrived when we may tell the Minister of Health that, although we may share our houses and other things, we have to get down to the actual problem of how to re-organise the life of this nation so that the men who can produce the wealth shall have an opportunity of doing so. We have reached a stage when we have produced too much. We were able during the War to provide for everything. Think of all the materials required to defeat the enemy. We have a bigger enemy now to fight, the enemy of misery and poverty among our people. The same organising genius which enabled our powers in the course of a few years to conquer the greatest military nation the world has ever produced should now be set to work to give our people the same opportunity to obtain work.

We are not here to apologise or to ask for favours. We want the best organisation of the people. I do not ask the Government to give something for nothing. If they cannot deal with this problem, what are we paying them for? There are 19 of them drawing £5,000 a year each, when there are other men more useful than they are starving for want of work. We are not asking for doles, but we are not going on for ever starving. They tell us that because they give 15s. a week to keep the men alive they are generous, when it costs 25s. a week for a single man to get a lodging. They tell us it is too much to give £3 a week to a man with six children, when he has to pay 17s. weekly for his rent. Yet the Government are putting all this burden on us. They think they are generous, but the first chance the people have got at an election, they will find that some of those who talk so glibly in this House will not be so ready to face the people whom they profess to represent. In 1918 you said you were going to do something for the people, and in 1922 the people will remember it when they get an opportunity of recording their opinion.

Mr. G. LOCKER-LAMPSON

It is a most unprecedented course for the Government to put down the Ministry of Health Vote as the second Order of the Day. It is one of the most important Votes which we have to consider. It amounts to over £22,000,000. The first Order of the Day, the Cabinet Secretariat Vote, ran on until 8.30 o'clock. The Minister of Health then made a most important statement, not in the least too long, but his speech lasted about an hour and a quarter. Do the Government really expect to get this Ministry of Health Vote to-night?

Sir A. MOND

No.

Mr. LOCKER-LAMPSON

I am glad to know that, because, if they did expect it, they would have to move the Closure to get it. I want to raise a point in support of my hon. Friend's Amendment to reduce the Vote by £100. I wish he had made it rather more than that. I want to ask a question about the way in which the accounts of the Ministry are presented to Parliament, printed and published. I have here the accounts of the National Health Insurance Department, which are a document of 72 pages. They were published about six weeks ago, and when published they were practically two years out of date. They are the accounts for the year ending 31st December, 1919. They are, there- fore, over two years out of date, and practically useless from the point of view of public information. A day or two ago I saw a copy of the "National Insurance Gazette," the editor of which made these remarks about the accounts which had been sent to him: Quite recently we received the National Health Insurance Fund accounts for the year ending 31st December, 1919. We do not allege delay by the authorities, for we know quite well that the Department is most efficient, but really we cannot give space to review complicated accounts over two years old. So far as we are concerned, these accounts are waste of money. I believe that the editor, in writing that, is absolutely correct. I cannot imagine what use these accounts can be to the public, two years old as they are; and I would like to point out to my right hon. Friend that it is not in the least necessary to publish them. He is not obliged to do it by Act of Parliament. Section 54 of the National Health Insurance Act, 1911, says: The accounts of the National Health Insurance Fund shall be audited by the Comptroller and Auditor-General in such manner as the Treasury may direct. All that is necessary is that these accounts should form part of the general accounts of the Ministry of Health, that a short summary should be made, and that it should be available for Members if they want it. The present document is not in the least necessary, and it is an absolute waste of money. What has this very large document of 75 pages cost the taxpaper? These tabular statements are extremely expensive. I understand that they are about the most costly process in the whole printing trade. I am not at liberty to give away any private information, but perhaps my right hon. Friend will inquire from his own officials under the Gallery what they think about this publication, and I guarantee, if he takes the advice of the officials in his own Department, they will agree with what I am saying, that these statements are absolutely unnecessary so far as public information is concerned. They are not only unnecessary, but they are not in accordance with the Act. Therefore, I hope that my right hon. Friend, when he comes to reply, will deal with that point, and try, so far as possible, to make this small economy. My hon. Friend has proposed to reduce the Vote by £100. I think that this unnecessary document must have cost at least £100. Therefore, if my hon. Friend goes to a Division, I shall be perfectly justified in going into the Lobby in supporting him.

Mr. RHYS DAVIES

I desire to join with those in supporting the reduction of the Vote—

It being Eleven of the Clock, the Chairman left the Chair to make his Report to the House.

Resolution to be reported To-morrow.

Committee report Progress; to sit again To-morrow.

The remaining Orders mere read, and postponed.