HC Deb 03 July 1924 vol 175 cc1635-46

Motion made, and Question proposed, That a sum, not exceeding £1,897,832, 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, 1925, for the Salaries and Expenses of the Scottish Board of Health, including Grants and other Expenses in connection with Housing, Grants to Local Authorities, etc.. sundry Grants in respect of Benefits and Expenses of Administration under the? National Health Insurance Acts, 1911 to 1922, certain Grants in Aid, and certain Special Services arising out of the War."—[Note: £600,000 has been voted on account.]

Mr. JAMES STEWART (Parliamentary Under-Secretary for Health, Scotland)

As regards the work of the Scottish Board of Health, it is a source of gratification that, I am able to report that the year 1923, measured by the death-rate, was the healthiest year on record. The general death rate fell to the low figure of 129 per 1,000 of the population, the lowest previous rate being 13.6 per 1,000 in the year 1921. The result is the more satisfactory when account is taken of the long continued period of unemployment and its accompanying distress on an unparalleled scale. Satisfactory as the mortality figures may be, we must not rest content with what has been done. Development, of the health services is of prime importance to the physical and industrial well-being of the nation if the people of this country are to maintain their place in competition with other countries. Realising the importance of this, one of the first actions of the Government on assuming office was to remove the embargo which had been placed on the development of these services by the late Government, and I am glad to say that the local authorities have responded to our action by submitting for the approval of the Board of Health developments and extensions of schemes with which they were anxious to proceed, but which were being hung up because of the embargo. It is our duty to prevent ill-health as well as to cure it, and to that end it must be our aim to use to the fullest extent the resources of medical and sanitary science, in diminishing the heavy burden of sickness, a large part of which is capable of being treated on preventive lines.

In the all-important matter of providing the people with decent and healthy homes, we have, unfortunately, done little more than make a beginning, but, as the question has been so fully debated on two separate occasions in the House it is, perhaps, unnecessary that I should take up time to-night by giving details of the position. There is, however, one other matter calling for reform, which I would like to mention in passing. It is the need for additional measures being taken to prevent the pollution of the atmosphere by smoke. We have made great progress in such matters as the provision of pure water, but, in my opinion, we have in the past devoted far too little attention to the question of maintaining the purity of the air that we breathe. I hope that a Bill dealing with smoke abatement in Scotland will be introduced at an early date, There is increasing evidence that the shortage of hospital accommodation in Scotland is a serious gap in the community's protective organisation against disease, and that some steps must be taken to repair it by the provision of further hospital accommodation and by securing closer co-operation between the voluntary hospitals and the Poor Law and public health hospitals. Impressed with the importance of the subject, the Board of Health have recently appointed a Departmental Committee, presided over by Lord Mackenzie to inquire into and to report upon the extent and nature of the inadequacy of the present hospital and ancillary services in Scotland, and to make recommendations for the development and maintenance of these services to meet the needs of the community. The campaign against tuberculosis goes on. It is a grim fight, but ground is being won. Slowly but steadily the mortality from the disease is lessening. Thus in 1914 the deaths from tuberculosis in its various forms numbered 7,696, whereas in 1923 that had fallen to 5,786. Within a period of 10 years, therefore there has been a decrease of 1,910, or, in round figures, nearly 2,000, in the number of persons who have succumbed to the disease. That a systematic attempt to deal with the disease is of value, is illustrated by a comparison of the death-rates over a considerable period, say, the last 30 years. Thus in 1894 the death-rate in Scotland from pulmonary tuberculosis was 172 per 100,000 of the population. In 1914 the corresponding rate had fallen to 104, and in 1923 it had been still further reduced to 81. In other words, the death-rate from this form of the disease is less than half what it was 30 years ago, and it has been reduced by 22 per cent. since 1914. In respect of pulmonary tuberculosis, Scotland has now a lower death-rate than England and Ireland. In the same period the death-rate from non pulmonary tuberculosis has fallen from 63 per 100,000 of the population in 1894 to 58 in 1914 and 36 in 1923. The fall in the death-rate from this form of the disease—a fall of 38 per cent.—since 1914, is even more marked than the fall in the case of pulmonary tuberculosis. Not-withstanding this fact, Scotland occupies the unenviable position of having the highest death-rate of any of the three countries from non-pulmonary tuber culosis. It is only within recent years that the Scottish local authorities have been turning their attention to the treatment of non-pulmonary tuberculosis and I have great hopes that these efforts will soon produce beneficial results which will be reflected in a further substantial diminution of the death-rate. There has been a substantial addition to the number of sanatorium and hospital beds reserved for the treatment of this disease In 1918, at the close of the War, the num ber of such beds was 2,590. To-day there are 3,953 beds and when we are finished the extensions which are taking place, particularly in connection with Glasgow, we will have over 4,800 beds reserved for the treatment of this disease. The local authorities who, with the aid of the State grant, bear the financial brunt of the campaign, must be encouraged to carry on and to extend their activities where necessary. The special restrictions which were imposed in 1923–24 were removed by the present Government, along with the embargo on the development of health services to which I have already referred. The local authorities will now receive in grant 50 per cent of all reasonable expenditure in connection with the treatment of this disease. With regard to maternity and child welfare, in the year 1923 the deaths of children under one year numbered 80,825, which is equivalent to a death rate of 78.9 per thousand births. This is the lowest infantile death-rate ever recorded for Scotland. The deaths for 1923 among children over one year and under five years of age numbered 4,926, which is equivalent to 12.3 per 1,000 children within those ages. Here again the death-rate is the lowest on record.

Mr. MAXTON

The lowest recorded in Scotland, but not the lowest in England—considerably higher!

Mr. STEWART

Considerably higher. These figures may be contrasted with those for 1915, in which year 14,441 infants died under one year of age, equivalent to a death-rate of 126.5 per thousand births, and 9,120 children from one year to five years died, equal to a death-rate of 22.5 per thousand of the children of these ages. Unfortunately, while the process of reducing the mortality among infants and children has been continuous, it is far from being a steady progress. In the first quarter of 1924 the infantile mortality rate in Scotland rose to 132 per 1,000 births, against 98 for the corresponding quarter in 1923. Only in June did the death-rate among children return to a less alarming level. In large measure this high mortality was due to a widespread epidemic of measles and whooping cough and to the other diseases, such as pneumonia, that follow these infections. The Scottish Board of Health have discussed with local authorities the various steps that might be taken for the further control and treatment of these epidemic diseases, and the conferences on the subject have been followed up by the issue of a circular to all local authorities. A special sum of £10,000 has also been set aside as part of the maternity and child welfare grant, which will be distributed in a manner designed to encourage local authorities to institute further measures for the preservation of child life from the ravages of these very deadly diseases.

That is not all. We have had this tremendous epidemic of measles and whooping cough, that has been wiping our children out like flies are wiped out at the end of the summer, and the necessity of something being done to prevent this tremendous death-rate will be apparent to every Member of the Committee if they will just for a brief moment pay attention to the statement, which I think is of the utmost importance, that I am about to read. I have taken Glasgow, where the epidemic of both measles and whooping cough has been of a somewhat alarming nature, and I have taken four wards—the Dalmarnock ward, with a density of 147 to the acre; the Mile End ward, with a density of 140; the Kelvinside ward, with a density of 19; and the Whiteinch ward, with a density of 23. I am not going to give the figures for 1921 or 1922, but in 1923 the deaths from measles per million of these children were 1,118 in Dalmarnock, an industrial, labour, working-class ward; in Mile End there died at the same rate, 1,173; in Kelvinside, where the children get a decent opportunity for life, there were no cases and no deaths; and in Whiteinch, partly industrial and partly well-to-do, the rate was 104. A special inquiry in 1908 revealed the following general facts regarding measles, which is, like tuberculosis itself, a poverty disease, that the death-rate in one-roomed houses from measles alone was 92; in two-roomed houses, it was half, down to 46; in three-roomed houses, it was nearly half, down to 25; in four rooms and over, it was down to 15, showing, if hon. Members of the House will take the lesson, that you can provide hospitals and medical attention, but until you have dealt with the root causes of ill-health, such as housing, combined with general poverty, but mainly housing, all the other efforts will be minimized to a considerable degree. What we propose to do by additional administrative Measures is to make the disease notifiable, appoint a special adhoc staff of visiting nurses for infectious diseases, increased hospital facilities, and an increased service of health visitors. In. 1923 a Committee was appointed to inquire into puerperal morbidity and mortality. The deaths of women in childbirth in Scotland number over 700 annually, and the amount of sickness and disablement that does not result in death is very great, if it cannot accurately be measured. The Committee have now issued their Report, in which they express with confidence the view that puerperal morbidity and mortality are largely avoidable, and can be reduced by improvement of the midwifery service, and by the provision of skilled antenatal care for the expectant mother. The Board have communicated to local authorities the recommendations of the Committee in so far as these come within the field of the public health authority, and have invited them to submit detailed proposals on the lines suggested.

On the development of maternity service and child welfare schemes otherwise, no restriction will be placed, provided the Board of Health are satisfied with proposals on the merits. The rationing scheme for calculating grant on food and milk expenditure has now been withdrawn, and grant is paid at the full rate of 10s. per £on expenditure supported by the certificate of a responsible medical officer that he considers, after examination, that additional nourishment is necessary for the maintenance of health. The Board do not ask that additional nourishment should be withheld unless there are definite signs of physical deterioration. It is in the discretion of a medical officer to authorise a supply wherever, as I have just indicated, he regards it as necessary for the maintenance of health.

With regard to venereal diseases, the opening of new centres for the treatment of the disease to meet the needs of districts not yet provided for is proceeding steadily but there are still several towns where centres are required. It is disquieting to observe that no less than 53 per cent. of patients discontinued treatment without the sanction of the medical officer. This fact makes it necessary to consider whether local authorities do not require further powers to enable them to deal more effectively with venereal disease. The obscure disease known as "sleeping sickness" is increasing. Full reports of a number of these cases have been received from Medical Officers of Health, but it has generally been found impossible to trace any source of infection, or to discover any connection between the different cases. It is hoped that investigations which are being made into the origin and nature of this disease will before long lead to the discovery of an effective method of treatment. During 1923 and the current year a number of cases of infective jaundice have occurred in East Lothian and Midlothian. The majority of those affected were miners, and all worked in the neighbourhood of two contiguous pits There have been 15 cases in all, and four deaths. The disease is associated with a disease of rats, which is due to the same organism, and though it has not been definitely settled how the disease is conveyed from rat to man, it is necessary that these animals should, as far as possible, be trapped and killed and their access to the pits prevented. Steps have been taken in this matter——

Mr. H. H. SPENCER

On a point of Order. Is it in order for a Minister to read his speech?

The DEPUTY-CHAIRMAN

The Rule of the House is that Members ought not to read their speeches, but that they may refresh their memories. I hope that the Minister will try to keep within that Rule.

Mr. JOHNSTON

Is it not in order for an hon. Member on the Front Bench to give figures from the City of Glasgow which disprove the statement made at Bradford and elsewhere by hon. Members that poverty is due to drink?

The DEPUTY-CHAIRMAN

An hon. Member may refer to his notes quite liberally for figures and for the purpose of making his speech, but he ought not to read his speech.

Mr. MAXTON

Is it in order for an hon. Member who has just refreshed his body to interfere with another hon. Member who is refreshing his memory?

Mr. KIRKWOOD

On that same point of Order. Is it in order for Members on the Front Bench of the Liberal party to wait till another Liberal Member comes in, and suggest to him that he should protest against what is taking place?

Mr. SPENCER

May I say that no such suggestion was made to me by the Front Bench?

Mr. KIRKWOOD

I will never again believe these Liberals after to-night. The truth is not in them.

Mr. STEWART

I regret very much if I have transgressed the Rules of the House, but I was giving what I thought were interesting figures with regard to health matters, as I have been mainly quoting figures in the course of my remarks that I got from———

Mr. KIRKWOOD

It is most unkind to interfere.

Mr. STEWART

The hon. Gentleman who called attention to this matter that I was refreshing my memory may not know that I was not refreshing it more frequently than he refreshes himself in other ways. Part of this statement is in regard to infective jaundice—a matter that has been causing us some concern. We do not yet know what the disease really is. The matter is being dealt with by the Medical Research Department, and has now been referred to the Mines Department. We are awaiting the result, and are not taking action until we get some definite information in regard to what this really is, and what position is occupied by the Mines Department. With regard to poor relief, during 1924 the number of poor persons who have been relieved—the ordinary poor, not the able-bodied unemployed—has increased by 4,500, a 3½ per cent. increase on the figures for 1923. On the other hand, the able-bodied unemployed figures have fallen very considerably. At the end of 1923 there were 33,520 unemployed persons with between 84,000 and 8.5,000 dependants. The abolition of the unemployment gap has tended to minimise the numbers who were applying for able-bodied relief. Since the beginning of the year there has been a decrease of 16 per cent., and the expenditure has fallen from £18,000 to slightly over £14,000. With regard to the Highlands and islands, we have had a considerable amount of distress there, and we have spent there over £100,000 which Parliament has voted in providing relief in the Highlands and the Western Isles. Besides that there was a fund raised through the instigation of the Lord Provosts of Edinburgh and Glasgow. A committee has been in charge of that fund, and it has done exceedingly good work in conjunction with local relief committees in meeting the distress in those areas, and on behalf of the Government I wish to tender to those Lord Provosts and those who have co-operated with them, and given so much of their valuable time in raising the money necessary for the valuable assistance which they have been able to give to those distressed areas.

The distress in the Highlands and Islands seems to be much more serious than the economic possibilities of those areas could cope with, and as a master of fact we are paying attention to this matter in the hope that in the near future we may be able to make recommendations dealing with the general health of the community in the direction of solving this problem. I am glad that I am able to report that the health of the people of Scotland is, on the whole, improving, although there is a large portion of the people in the industrial areas requiring considerable attention and something must be done to bring about a better state of things.

Captain ELLIOT

It would scarcely be courteous if we did not make some short reference to the long and interesting statement which the Parliamentary Under-Secretary for Health has made, although it is not possible to review at this hour the position which he has sketched out, consequently we are hopeful that at some future date we shall have a chance of discussing at some length the position of public health in Scotland. The silent fact which stands out is that in the fourth winter of unemployment the health of the people of Scotland has been better than it has ever been before. That in an extraordinary fact, and one which is worth while taking note of. In several different ways we get a cross-section showing this improved health. It has been shown that with regard to the general death rate the figures in the previous year were 13.6, and this year it is 12.4. In regard to tuberculosis it is shown that the ground which was lost last year has been recovered, and infantile mortality is the lowest on record.

Another interesting figure was given in regard to sickness benefit paid by the insurance societies, and we have been told that the figures with regard to sickness benefit will register a slight decrease. I may say that these figures relate to the year in which we on this side of the House had charge of the health of Scotland, and they relate to the period when the Conservative party were in office. Therefore, I do think that we are entitled to claim that we were not unfaithful stewards of the health of the people during the time it was entrusted to us. The Minister has also pointed out that in spite of his efforts it is not certain whether he will be able to maintain that standard, and certainly nobody would claim the merit for one party or another of being able to register these striking advantages, because they are the accumulative effect of a long and patient struggle, not by politicians, but by officials and other people in every walk of human life. There is an effort, not in one section or in another section, but a general movement of social conscience towards seeing that for all grades of society there are made available the discoveries of modern science which were at first available only to a few.

The immediate problem in front of us in Scotland is the problem of infantile mortality. There is no doubt that infantile mortality in Scotland is one of the things of which we have the most reason to feel ashamed. We shall not improve that by wild talk from any section of the people, but by solid co-operation towards improving the conditions, which all admit should be improved. I would like to ask the Minister, in particular, when he gets a chance to reply—let us hope, at some future date—what progress is being made with the scheme of dealing with measles? We were last year impressed, although it was a year in which the measles epidemic was modified, and we took steps to have a survey of the situation and to obtain from the Treasury a grant of £10,000 towards a campaign against measles. To this the Minister referred in his speech, and there was frequent reference to it in the body of the Report. We should like to know what progress is being made in the measles campaign.

We should also like to know if any steps have been taken to bring into practice the Report of the Committee on Maternal Mortality, and we should like to impress on the Minister the necessity of ensuring that the Departmental Committee in Scotland is marching hand in hand with a Committee which is making a similar inquiry, the Hospitals Committee in England. In the matter of hospitals, we in Scotland are superior to England. We have a smaller deficit, and a greater provision of beds, I think, but we should see that there are not two inquiries, one in Edinburgh and another in London, with divergent reports, and leading to a holdup of action while these reports are being brought to correspond. We should see that the Committees are marching in step, and it should be realised that the problem is not one for Scotland, or one for England, but one for Great Britain as a whole.

If there are any other hon. Members who would like to speak even for the short time at their disposal, I shall be ready to give way to them. I suffered very acutely when I found on the Housing Bill that there was a certain amount of friction, not entirely among the Members opposite, but even among Members on this side, because of the time that hon. Members had been speaking.

Mr. SPENCE

In taking part in the discussion on public health I regret that the time of my disposal is so limited, I have given some consideration to this matter and I am convinced it is associated with the question of the general death rate, the medical services and institutional demands, and when one seeks for avenues for establishing good health I find the principle requirement is the maintenance of an adequate standard of living, which implies the necessary food, clothing and shelter; and then there is the question of sanitation and improved workshop conditions necessary to be borne in mind. As the figures relating to the general death rate and infantile mortality have already been given, I shall not repeat them. But coming to the question of the work accomplished in connection with the report rendered by the Minister, I noticed that both he and the hon. and gallant Member who spoke last (Captain Elliot), in expressing appreciation of that work, implied that the improvement in the health of Scotland is due entirely to legislative procedure or administrative measures. That I deny. The improvement of health in Scotland at this moment is not due to either of those factors but is simply due to the awakened social conscience towards health in the general community. As the result of this permeating society we have discovered still further the value of voluntary organisation, and we know that large-minded administrators in Scotland have burdened themselves with the object of improving the health of the people in Scotland. If we turn to the question of infantile mortality we discover that the great or chief cause of that mortality in Scotland is due to premature births. In 1918 the infantile death rate was 19.3 per thousand, in 1921 it was 20.9 per thousand, thus showing that it is on the upward grade. Then you have congenital debility which is responsible for a very large percentage indeed of infantile mortality. Further you have diarrhœal diseases also responsible for a considerable percentage of death amongst infants. When we come to discuss this question of infantile mortality and probe it from these points relative to the figures given, one discovers that there is an accumulation of causes to be found in the antiquated standards of life of the people. The measures that were adopted in 1921 brought our people of that day into a very bad state indeed. The House of Commons adopted a line of procedure in seeking to conduct the affairs of State which reduced the standard of living of our people, and depleted——

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

Resolutions to be reported upon Monday next.

Committee report Progress; to sit again upon Monday next (7th July).