Motion made, and Question proposed,
That a sum, not exceeding £12,943,593, be granted to His Majesty, to complete the suns necessary to defray the Charge which will come in course of payment during the year ending on the 31st day of March, 1928, for the Salaries and Expenses of the Ministry of Health; including Grants and other Expenses in connection with Housing, Grants to Local Authorities, etc., in connection with Public Health Services, Grants-in-Aid in respect of Benefits and Expenses of Administration under the National Health Insurance Acts, certain Expenses in connection with the Widows', Orphans' and Old Age Contributory Pensions Act, 1925, and certain Special Services."—[Note: £6,500,000 has been voted on account."]
§ The MINISTER of HEALTH (Mr. Chamberlain)
Last year, in presenting the Estimates for the Ministry of Health to the Committee, I had to account for an increase of £40,000 over the Estimate for the preceding 12 months. This year there is a further increase of a little more than £1,105,000, but I do not imagine that on that account I shall be accused of extravagance, because the increases are really due to causes which operate automatically and are, moreover, brought about by policies which have been approved in all quarters of the House. Some £960,000 is accounted for by an increase in the number of houses upon which subsidy is paid; there is a further increase of £171,000 in the grant-in-aid for health purposes, and there is still another £91,000 increase in the cost of administration, which is, of course, due to the additional staff required for the purposes of the Contributory Pensions Act. I do not imagine that any of those figures will be challenged, and, therefore, I do not think it is necessary for me to detain the Committee by going into any special details in connection with them, but, of 414 course, if there are questions upon which any hon. Member desires further information, I hope to be able to supply him with what he desires in the course of the Debate. I think perhaps it would be of greater interest to the Committee if I were to pick out one or two of the salient features of the activities of my Department in order to give the Committee some idea of the field over which we range and the scope of our activities.
Coming now to the question of housing, it will be seen that the amount provided, which is £9,340,000, is nearly half of the total Estimate, amounting approximately to £19,500,000, and I think the Committee will like to know what we are getting for the expenditure of so large a sum of money. In order to give a comparison, I would mention that in the five years preceding the War the average number of houses built in this country was about 61,000. Taking the last three years—in each case the 12 months ended 31st March—the number built in 1925 was 137,000; in 1926 it rose to 173,000; and in 1927 to 217,000. That is really an astonishing, a prodigious effort on the part of this country, which I do not think can be paralleled anywhere else in the world, and although one does not wish to claim more credit than is due to the Government, at any rate I think we are entitled to say that the conditions which have been provided by the Government have acted as the most efficient stimulus to the building industry that could be conceived. The number which we thus find added to the common pool, looked at from that point of view, is so great that, as it proceeds, there cannot be any doubt that its effects will be felt right through every class of the population, and I feel confident myself that we are approaching the time when we may hope to see some much more active progress made with the improvement of the conditions in the slums than has been possible during all these years, when it was found difficult to deal with them, first, because of the scarcity of labour and materials, and also because of the fact that there was nowhere for people to go who might be displaced from the houses in which they were living.
But there is another aspect of the housing question which is not so satisfactory. I am, myself, very much concerned about 415 the cost of these new houses, which appears to me to be far too high. I think the problem before us at the moment is to see how we are going to get that cost reduced, and there are two ways in which it may be reduced. One of them concerns the size of the house. There is very little doubt that the rents which have to be charged for the bulk of the new houses now being built are inflicting a very great strain upon the resources of those who are paying them, while they make it absolutely impossible for many others to obtain the accommodation which they desire in a new house, because it is altogether beyond their means. I myself, am not in favour of lowering the standard of housing, but it is no use to blink facts, and while it is very easy to be eloquent about the difference between the houses occupied by the rich or the poor, as a matter of fact you cannot divide the population by a sharp line into two categories of that kind. [An HON. MEMBER: "They are already divided."] No. they are not divided into two categories. There is every possible gradation between the rich and the poor, and each category must adapt its methods of life to its means. [Laughter.] The hon. Member opposite laughs, but I thought I was speaking what was almost a truism. What I want particularly to emphasise is that you cannot pick out of the general budget of the housekeeper one particular item, namely, the rent of the house, and consider that that is to be free of the restrictions which naturally apply to all the other expenses of the household. It applies to every item in the budget. Everything must be adapted to the question of means, or otherwise they will come to disaster. I think it is a mistake to assume that every family wants a bigger house which not only ranks higher in rent than the house which they are now occupying but which means more work in cleaning and more expense to keep warm.
§ Mr. CHAMBERLAIN
The hon. Member says, "The modern house means less." What I am saving is that a large house means more work in cleaning than a small one.
§ Mr. CHAMBERLAIN
Perhaps the hon. Member has not talked to so many working people as I have. Local authorities are finding that they are getting towards the end of that section of the community who can pay the rents of houses such as they are now erecting, and that being so, I think they are wise in remembering that what they have to compare is not a small new house with a large new house, but a small new house with the houses in which people are living now, or the room in a house in which people are living now, and that if they do, as many of them desire to, build houses which contain all the necessaries of life but with somewhat smaller accommodation than those which the people have been in the habit of living in lately, they will probably be meeting the wishes of the greater number of their inhabitants.
But there is another method by which I think people may be helped to obtain houses in which they can afford to live. Last December I asked the House to approve a Draft Order under which the subsidies payable under the Acts of 1923 and 1924 would be reduced as from October next by an amount which was equivalent to a capital sum of £25 per house. I based that proposal upon the assumption that some part, at any rate, of the present cost of houses was actually due to the subsidy itself.
§ Mr. CHAMBERLAIN
I said I thought that the figures in our possession indicated that there was a definite correlation between the prices of new houses and the amount of subsidy given. I showed that the price of houses had gone up as the subsidy had been increased, and I argued that it might well be reasoned that if the subsidy were reduced the cost of houses would be reduced also. That proposal met with the strongest disapproval from hon. Members opposite. They exhausted themselves in prophecies of disaster. The right hon. Member for Shettleston (Mr. Wheatley) said this was going to wreck the building industry. The Liberal party put up two speakers to express the view that this would mean an increase in rents. although, of course, 417 we had some of the party in the Lobby with us, and there were others who did not vote at all—pursuing the usual plan. The hon. Member for Nelson and Colne (Mr. Greenwood), whom I am sorry not to see here, said that unless the price of houses came down by at least £25 either the rents or the rates must go up. That, I am bound to say, seemed to me a self-evident proposition, but the point of his statement was that he himself believed there was no possibility of any such reduction in the price as he suggested was necessary to prevent this rise in rents or rates. I am happy to say that events have completely justified the predictions I made when I asked the House to approve that Draft Order. The prices of non-parlour houses, which before the commencement of the withdrawal of the subsidy had ranged from £440 to £450, fell immediately to the neighbourhood of £425. Since then there has been a still further drop.
§ Mr. CHAMBERLAIN
Yes, exactly the same—until the very last month, when the average size of the houses has been distinctly smaller, but, then, the price has actually gone down to something below £400. So we see that the result of reducing the subsidy has not been to wreck the industry, it has not put up rents and it has reduced the price of houses. So much for housing; but before I go to an entirely different subject I would like to say something about town planning, which is a kindred subject.
§ Mr. MONTAGUE
Before the right hon. Gentleman leaves the subject of housing, will he explain to the Committee just precisely why the reduction has come about as a result of the lowering of the subsidy? What is the cause of that reduction? Who has been doing the robbing?
§ Mr. CHAMBERLAIN
I would refer the hon. Member to the speech I made when I submitted the Draft Order to the House, in which I did explain exactly what I thought would happen. As that has happened, perhaps the hon. Member will forgive me if I do not take up the time of the Committee in repeating what I said. I am glad to be able to record that public appreciation of the value of town 418 planning seems to be generally increasing. Local authorities and the public generally are realising that careful prevision in the method of development of any given area is a real practical economy. It saves unnecessary and wasteful expenditure in the future, and, at the same time, preserves amenities and conveniences for the public. At the present time some 2,700,000 acres are covered by town planning and regional planning schemes of various kinds. The development of regional planning is of the greatest importance, because it is obvious that to plan a limited area without regard to what will happen in the surrounding areas must necessarily mean a good deal of wasted time, and may lead to the adoption of plans which subsequently will have to be altered. Therefore, I am very glad to know that the adoption of regional planning, which involves the co-operation of a great number of local authorities—the Committees include a total of 621 authorities—is proceeding so rapidly and smoothly, and I think further progress in this direction will be very valuable for the country as a whole.
In those schemes and otherwise local authorities are beginning to make much greater provision than they have done in the past for playing fields. I would like to pay my tribute of gratitude and admiration to the National Playing Fields Association, which is carrying on a great movement in the country under the leader ship of His Royal Highness the Duke of York, who in this matter has once again shown his great devotion to the service of the country and the Empire. In this connection there are two matters of special interest to London. One is that steps have at last been taken to set up a Regional Committee for Greater London. That is a problem which has engaged the attention of local authorities and of Governments for many years past. Greater London presents problems which are unique in the constitution of its local authorities, and in the extent of its area, and. while I do not expect that progress in this direction will be very rapid, yet it is satisfactory to think that there is now going to be a body set up to examine those problems as a whole, and not merely to treat them from a sectional point of view.
Another matter to which I wish to refer is the preservation of London 419 squares. There has been a good deal of anxiety expressed about the future of the London squares, not unnaturally, in view of what has happened in particular cases. A little while ago the London County Council passed a resolution asking the Government to make an inquiry into the best way of preserving London squares. The Government have accepted the view of the London County Council. We propose to set up a Royal Commission to go into the whole question, and I hope before very long to be able to announce the members of the Commission and the Terms of Reference.
§ Miss WILKINSON
Will the Terms of Reference include the opening of certain squares for the children to play in?
§ Mr. CRAWFURD
Concerning the Royal Commission to be appointed to deal with London squares, will the right hon. Gentleman be more precise about the progress made with regard to the regional authority for Greater London?
§ Mr. CHAMBERLAIN
I called a conference of the authorities concerned, and they are appointing representatives on the regional committee. I come now to another question. I had not intended to say anything about the administration of boards of guardians this afternoon, because the subject was fully debated on Monday night, but I must take some notice of a statement which was made on that occasion by the hon. Member for the Stratford Division of West Ham (Mr. Groves). The hon. Member for Stratford on that occasion said he had never been accused of making an extravagant statement, but I am afraid I must now make a beginning in that direction, because he made a statement which I can only characterise as extravagant. The hon. Member for Stratford stated that relief had been given during the general strike to a number of persons without conditions, and that since the new guardians had been in office people had been engaged in writing up in the books against the sums paid in relief to various individuals during the general strike the words "On loan." In other words, as I understand the statement, the hon. Member accused the administration 420 under the new guardians of endeavouring to falsify the books so as to enable the guardians to recover the relief given to those individuals during the general strike, although that relief was given to them without their knowledge that it was to be considered as having been granted on loan. That is a very serious charge to make against a board of guardians, and if it could be substantiated and shown that such a course was taken by the authority and with the knowledge of the guardians themselves, it would be such a condemnation of them as would certainly require the most serious attention of the Minister of Health. I do not think that a statement of such gravity ought to be made without the hon. Member making himself fully acquainted with the facts beforehand. I am glad that the hon. Member made the statement in this House, because it does give me an opportunity of telling the Committee what is the information which I have received upon this subject from the chairman of the board of guardians. He says:During the general strike relief was given in this union, and the relief so given was, according to practice entered on the relieving officer's, record cards. It was on these cards that the words 'On loan' were written at the time, and were signed by the applicants, and it is this card which is produced it Court when proceedings are taken to recover relief so given. During the general strike this special relief was not entered in the application and report book by the relieving officer, under instruction. So far as I can discover, beyond the transfer to the application and report books during two or three weeks after the close of the general strike, and in no case after the 18th July last, of the words already existing on the relieving officers' record cards, not entry such as described by the hon. Member in the House of Commons. has been made in the books referred to.The real fact is that where relief was given on loan the words "on loan" were put on the relieving officers' record cards at the time, and they were signed by the applicants, so that it is quite without foundation to say that they did not know that relief was given on loan, and the entries made in the application book have merely been the transfer of the information already on the record cards and in no sense constitute any alteration of the records.
§ Mr. CHAMBERLAIN
I said the cards were signed by the applicants. The hon. Member is asking something about the old guardians.
§ Mr. CHAMBERLAIN
The charge which I am dealing with has been made against the new guardians. The hon. Member who has interrupted me is not concerned with West Eam.
§ Mr. CHAMBERLAIN
That is entirely irrelevant to the point with which I am dealing. The point I am dealing with is the charge made that the new guardians falsified the books, or that somebody else falsified them on their behalf, and I hope the hon. Member for Stratford will, in due course, withdraw the charge which he has made.
§ 4.0 p.m.
§ Mr. CHAMBERLAIN
I now come to the question of National Health Insurance which is closely associated with the administration of the Contributory Pensions Act. The administration of the latter Act has necessitated an increase in my staff which accounts for £90,000 of the increase in the Estimates. That is very largely in connection with the claims of the people who will be able to obtain old age pensions next year after attainment of the age of 65. Already we have had some 324,000 claims which are, of course, undergoing examination at the present time. Meanwhile, I may mention that, pensions and allowances have already been awarded to widows and orphans by which no less than 714,000 persons have benefited under this Act. With regard to Health Insurance proper, I would like to say something about the additional benefits which have been provided out of the surpluses disclosed upon the second valuation of approved societies. The Committee may possibly remember that nearly £24,000,000 was shown to be available for distribution under the second 422 valuation, but, out of that £24,000,000, over £11,000,000 has already been allocated by the societies for additional cash benefits, leaving therefore some £12,000,000 available for non-cash benefits. That £12,000,000 is again increased by the State grant and interest until it has reached the astonishing sum of £18,000,000 available for distribution in treatment benefits during the five years which are covered by the surpluses under this valuation. This means that all together some £3,750,000 a year can be and is being spent on these additional treatment benefits.
The Committee would like to know that the societies have allocated to dental benefits as much as eight times the amount they were able to allocate under the first valuation, and to ophthalmic benefit as much as 12½ times the amount that they formerly allocated. In connection with dental benefit a scheme has been arranged under which, for the most part, the societies pay 100 per cent. in the case of conservative treatment of teeth and 50 per cent. of the cost of dentures, and we have set up, as recommended by the Royal Commission, a regional dental service consisting of one principal and five regional dental officers whose duty it is to advise in cases of dispute between approved societies and dentists. That has required, and will require, a large number of examinations of the persons concerned. Up to the present there have been something like 2,600 references to those regional officers. The greater part of those references has already been cleared, but a certain amount of delay has been experienced owing to the fact that nearly 40 per cent. of the insured persons concerned have failed to keep their appointments with the dentists. I can quite imagine reasons why they have not been anxious to meet their dentists, but I hope, as they get more experience, their attendance will improve, and I do feel very well satisfied that the provisions of this additional benefit, under which over 12,000,000 people many of whom have never been under the hands of a dentist before, will now have their teeth attended to, will mean greatly improved health on the part of the insured persons, and, as a consequence, of course, a decrease in the claims upon the funds of the approved societies.
§ Mr. CHAMBERLAIN
I would like to mention that the International Labour Conference, which has just concluded its labours, has been considering the organisation of compulsory sickness insurance applicable to countries partaking in the Conference, and they have, by a very large majority—I think there were about 38 countries represented in the Conference—adopted a draft Convention, which is based principally upon the same principle as our own Health Insurance scheme, and I have hopes that the majority of them, at any rate, will see their way to ratify the Convention, because it is obvious that these things have an economic application, and that the competition which naturally arises between one country and another is somewhat embittered if in one case there are contributions payable on the part of industry which are not similarly to be found in other countries.
With regard to the state of the public health, I am glad to be able to give a good report. There are two general tests which we apply, namely, the general death rate and the infantile mortality rate, and in both cases it has shown an improvement. Last year the general death rate was 11.6 per 1,000, which compared with an average of 12.2 per 1,000 in the five years preceding, and the infantile mortality rate, which had been 76 per 1,000 in the preceding five years, came down to 70. That is particularly satisfactory, not only because it means that some thousands of babies born in 1926 survived who would have perished if they had been born under the conditions of 1925, but it also means that there is a corresponding improvement in the general health and physique of the children who survive, because the same conditions which kill in the one instance also maim and injure in the generality of cases. It denotes, therefore, a general improvement in the physique of the infant population, and I think I may say also an increase in the understanding of the responsibilities and the duties of motherhood. I do not think that one can say too much in praise of the great system of maternity and child welfare centres which are now spread right throughout the country, and upon which 424 an immense amount of devoted voluntary effort is being expended. To that, I think, we must ascribe, in large measure, the continued improvement in the infantile mortality rate with which we have so much reason to be satisfied.
In other respects the health of the nation, I think, continues to improve. There is a steady decline in the mortality which is due to tuberculosis, to scarlet fever and to typhoid fever. I wish I could say as much for cancer. I am sorry to say the deaths from cancer continue to increase, and I am not able to announce any new discovery which gives us hope of being, at an early date, able to cope with that disease. But our knowledge is increasing all the time. We are always finding out more about the conditions and circumstances in which this disease arises, and I have little doubt that the day will come—and we hope it is not far distant—when we shall be able to put it amongst those diseases of which we consider ourselves the master. There is one other complaint about which I must say a word, and that is small-pox. The records of the number of cases of small-pox in this country are becoming very alarming. I go back to 1922, when there were 97[...] cases. In 1923, there were 2,500; in 1924, 3,800; in 1925, 5,300; in 1926, 10,100 and this year, up to the end of May, we have had 8,700 cases.
§ Mr. CHAMBERLAIN
This is England and Wales, including London; it does not include Scotland. [An HON. MEMBER: "Deaths?"] No, cases—not deaths. Fortunately, the type of small-pox at present is of a very mild character, but one is always afraid that we may see a recurrence of that very virulent form of which we have had experience before, and which is one of the most deadly diseases of which we know. I have said that I have set up a committee to inquire into the question of vaccination, and I do not propose, therefore, to say anything more upon the subject now, except that it is quite clear, I think, from these figures that the extent of the disease is now assuming serious proportions, and, even though mild in character, it is inflicting an amount of pain, suffering and loss which is preventible, and ought to be 425 prevented, and that presently we shall have to take some further steps to see if we cannot diminish it.
I know our time is limited this afternoon, and I do not want to make as long a statement as I made last year, but there are one or two other matters upon which I must touch, I think, before I sit down. I am credibly informed that there are 9,000,000,000 cells in the human brain. I am sure that everyone of them will be wanted by anybody who tries to make himself acquainted with all the intricacies of the Department of the Ministry of Health. I am not going to attempt to touch upon them all, but I wonder a little whether the Committee realises the part which this country is playing in measures which are taken internationally for the prevention of disease and the improvement of health. The League of Nations has a Health Committee upon which we have a representative and upon which there is also, I am glad to say, a representative of India. I hope in future, there may be representatives also of other parts of the Empire. It is engaged at the present time in two pieces of work which are certainly of direct interest to us as a country and to the British Empire. One of them is concerned with the establishment of an Epidemic intelligence centre at Singapore. The sanitary administration of the ports in the Far East is a particularly difficult problem, because each one of those ports is surrounded by great areas in which conditions are such that epidemic diseases are always present, and it is of the very first importance to prevent the spread of diseases like yellow fever, plague or smallpox by communicating information from one sanitary port officer to another. By the generosity of the Rockefeller Trustees, this epidemic intelligence centre has been established at Singapore, and, thanks to that and to the introduction and development of wireless it is now possible to convey information with great rapidity and at an extremely low cost, and I think the results are invaluable to British interests generally and to British shipping in particular.
Then I will mention the work which is being done by the League of Nations Health Committee in the investigation of the prevention of malaria. Of course, we know a great deal about malaria now, thanks largely to the researches of 426 British investigators. We know that malaria can be stamped out in particular localities, as, of course, was done in Panama, but these measures are very expensive, and what the League is doing now is an attempt to discover some new methods of prevention which may perhaps be less intensive in their scope, but which will be less expensive, and can therefore be put into operation over larger areas.
I must pass over any account of the Paris Sanitary Conference that was held last year, or of the Pacific Health Conference at Melbourne, at both of which we were represented very ably by the officers of my Department; but I would like finally to mention two projects, both of first-rate importance, which are now proceeding in London. In, I think, 1920, a Committee was set up, under the chairmanship of Lord Athlone, by the then Minister of Health, Dr. Addison, and one of its recommendations was that there should be established in London a school of hygiene and tropical medicine. That school is now being built. The Rockefeller Trustees, who take the greatest and most eclectic interest in all matters of international health, have contributed a sum of 2,000,000 dollars, and the British Government has made itself responsible for the maintenance of the school when it is completed. Its object is to provide means for the study of public health in all its forms, and of tropical medicine in particular, and it is of the greatest interest to the British Empire, because there are many portions of the Empire in the tropics whose future prosperity depends largely upon our power to control tropical diseases, which at present take such a tremendous toll of our people and of the native populations. We believe that this school will form a centre to which can come those who are proposing to embark upon a career as medical officers of health or medical practitioners in the tropics, where they will be able to see clinical material actually suffering from the tropical diseases which they will find when they get to their destinations, and where, also, they will be able to study those general principles of public health which govern all administration of the kind, whether in the tropics or in temperate climes.
The other project to which I have referred is also one of the recommendations 427 of the Athlone Committee. It was that there should be established in London a post-graduate medical school. Unfortunately, for one reason or another, this recommendation has never yet been carried out, but now, I think, we are approaching a time when we shall be able to see it accomplished. I myself, some little time ago, set up a very strong committee of physicians and surgeons, of which I took the chairmanship myself, to consider what was the best way of carrying it into effect. The committee laid it down that it was not possible to combine in one school undergraduate and post-graduate teaching, and that is a conclusion which I think is supported by all expert opinion. Therefore, they had to consider whether they should contemplate the building of a new school, or whether it would be possible to adapt some existing institution. We decided against the building of a new school, because that not only meant the building of a school, but it also meant, in order to obtain the necessary clinical material, the building of a hospital with, perhaps, 400 beds; and that would have involved, not only a very large capital expenditure, but also an annual liability for the maintenance of the hospital. The committee, therefore, devoted themselves to an examination of various existing institutions, and they have come to the conclusion that they can find what they want in the West London Hospital at Hammersmith. That is a hospital which has had a long experience of post-graduate teaching. It has space into which it can extend, so that the necessary lecture-rooms and laboratories and additional beds can be provided, and the scheme has been accepted in principle by the authorities of the West London Hospital. At the present time the buildings are being examined by technical experts with a view to seeing how they can be adapted and extended so as to make them available for this purpose.
If this scheme can be brought to a conclusion, it is going to be a great thing for the medical services of this country and of the Empire, and, I think I might almost say, of the world. One of the difficulties to-day is that medical practitioners, who may have had a magnificent training before they enter into practice, go down into some remote part of the country, and find themselves unable 428 in any way to keep themselves abreast of the most modern work. I should hope that in this school it will be possible to give short refresher courses to general insurance practitioners, so that they may come up to London and ascertain what are the latest methods of dealing with the problems with which they are faced—
§ Mr. CHAMBERLAIN
I am not contemplating that at present; obviously financial difficulties would arise. I hope, however, that practitioners will avail themselves of it as it becomes further known. More than that, it will be a meeting place where medical men will come from all parts of the Empire to exchange ideas, to exchange experience, to see what the latest experiments and the latest methods are, and how successful they have been. I find that in America also a project of this kind is welcomed most warmly. Many American doctors like from time to time to come over to Europe to see what is being done here, and to check what they are doing over there against European experience. They do not always understand foreign languages, and sometimes, indeed, we do not understand their language, but in a school of this kind they would find their British brethren and would welcome very heartily the opportunities that they would get in such an establishment for exchanging ideas. The completion of a scheme of this kind would mean the expenditure of large sums of money, but, when it is realised what a great conception this is, and what a vast influence it may have in raising the general standard of medical practice, not only in this country but in other countries, I feel confident that the funds which are necessary to bring it to completion will not be wanting.
§ Mr. CHAMBERLAIN
It is possible that a contribution might be given to 429 such a hospital from the educational point of view, and that would bring the Ministry of Health into very close contact with it. But I do not think my hon. Friend need be anxious, if that be his fear, that it would in any way be divorced from the Ministry of Health, because, if such a course as I have suggested were adopted, for instance, for general practitioners engaged in the work of National Health Insurance, the Ministry of Health would certainly be brought into intimate connection with it. I have already taken up more time than I meant to take, and I will not detain the Committee longer. I commend to them the approval of these Estimates, and the sanctioning of the funds which are necessary to enable me to carry out the work.
§ Mr. CRAWFURD
I beg to move to reduce the Vote by £100.
I move this reduction in the salary of the Minister of Health in order to draw attention to one or two matters connected with his Department. The right hon. Gentleman has travelled over a very wide field in the comparatively short time during which he has been Minister of Health, and I am sure that everyone will sympathise especially with the concluding portion of his speech, in which he opened up vistas of usefulness which show him to have imagination as well as ability. I am sure that, when he sets out to pursue the mosquito, he will be led almost to circumnavigate the globe, and in that process he will, of course, pass places where much has been done, where there are many monuments to British research and British ability, and where the names of Manson, Ross and others are held in reverence; and I am sure that every Member of this Committee will wish him and his successors success in the pursuit of those matters. I want briefly to refer to some other matters nearer home, where the right hon. Gentleman started. I think we shall all agree that the figures which he gave in regard to the housing problem do show progress, and are satisfactory to that extent, but I hope, and, indeed I am sure, the right hon. Gentleman does not believe that the problem is solved. Members of the House of Commons who, like myself, represent working-class constituencies, still receive, I am perfectly sure, vast numbers of letters and complaints and appeals for help from people who are living in one, two or three rooms, 430 and, although I personally feel that perhaps the right hon. Gentleman's truism, or dictum, with regard to the necessity of living within one's means, was received rather more critically than need have been the case, I am sure the right hon. Gentleman himself will realise that housing itself, and the expenditure of any given family upon housing, is not a self-contained problem. I think that what he said would have been welcomed with more acclamation if one were certain that in all aspects of Government policy efforts will be directed to keeping those things which are needed by the working-class population as cheap and as easily accessible as they possibly can be, and of the best possible quality.
From housing to town planning is, of course, a very short step. I am very glad that the right hon. Gentleman has introduced the subject of town planning and regional planning, because I want to put to him a question which, perhaps, his colleague can answer later in the day. He said that regional planning was so important because the planning of one centre or one area might be spoilt if the adjacent area were badly planned. That, of course, is true, but it is equally true that the good planning of a new area may be rendered difficult or almost impossible if existing built-over areas are badly planned. It would not be in order here to discuss matters which we have often discussed, and in which I have taken some part, in endeavouring to impress upon the Minister of Transport the need for looking ahead in matters of planning so far as they relate to roadways and transport from one place to another; but the question I want to put is this: Is there any means of consultation, and is there any consultation, on matters of town planning, between the two Departments of the right hon. Gentleman and of the Minister of Transport, whose work is obviously so closely related in this matter. There is another small point upon which I may be able to get an answer later, and here I come to the question of National Health Insurance, upon which the right hon. Gentleman also touched, and which, of course, is very closely associated with some of the things that he mentioned in his speech. I understand that there is a draft Bill, or that there is a Bill in contemplation, dealing with approved societies and their position. I 431 am not going to discuss any question relating to the Bill or what is in the Bill, because it would be out of order to discuss legislation. I want to ask the right hon. Gentleman whether when the Bill is ready his Department will undertake to circulate it to the approved societies before it is introduced. That might fairly be called an administrative act and not a legislative act. There are precedents in this matter in regard to the Factories Bill and the Road Traffic Bill, which were circulated.
I wish to draw the attention of the Committee to some of the matters relating to the Ministry of Health in its administration of the National Health Insurance Act. The right hon. Gentleman quoted some figures, and I would like to ask for a few more. He said that there was an increase in the Estimate of, I think, £1,250,000 over the preceding year.
§ Mr. CRAWFURD
The right hon. Gentleman gave us items in regard to the health services and the additional staff necessary on account of pensions. If I am not misinformed, we have to add to that sum a considerable amount, because there was passed through this House last Session an Act of Parliament called the Economy (Miscellaneous Provisions) Act, and in that Act it was estimated that there would be a net saving to the Ministry of £4,100,000. I am speaking from memory, but I think that the expenditure under health insurance, that is the Government contribution, unlike the payment for old age pensions and widows' pensions, is put into the Ministry of Health Vote. The estimated saving under this head was that the Government grants would be reduced by £2,800,000, and that there would be an additional saving of £1,900,000 because the expense of certain medical services would be passed on to the approved societies. That makes a total of £4,700,000. There is an item, which I cannot completely understand, of a saving amounting to £600,000, due to some financial transaction, leaving a net saving of £4,100,000. The net result is that, as compared with 1924, the Ministry saved £4,100,000 but is spending £500,000 more. Therefore, the total increase in the two years is £4,500,000. It would be interesting to have an analysis of those figures.
432 Now I turn to the question of national health insurance, and I would draw the attention of the Committee and of the right hon. Gentleman and the Parliamentary Secretary to the Circular which was issued by the Ministry in December, 1926. It is headed:Investments, A.635, National Health Insurance.Notice to Approved Societies.Owing to the falling off in receipts from contributions and the unusually heavy issues of cash to Approved Societies to meet certain current expenditure on benefits and administration, together with the extra moneys required for additional benefits during the year 1926, the Department is not in a position to make any interim issue of moneys for investment by or on behalf of societies in January, 1927.The Committee may need to be reminded of what is implied in the last three lines of that notice. As I understand it, the position is this, that the contributions to national health insurance are kept in the National Health Insurance Fund, and any surplus over and above the cash payments required to pay for the benefits is invested. Part of these investments are made by the approved societies and part by the Minister, or under his direction, through the National Debt Commissioners. I think that is the process. In pursuance of that system, from time to time the Minister hands over sums of money which are due to the approved societies for investment by them. It is these sums of money which we are told will not be available this year. There will be no money for investment by the approved societies, and, presumably, any portion which is normally invested by the Minister will not be available for investment this year. I should like to draw the attention of the Committee to the circumstances in which this state of things arises.
The right hon. Gentleman drew a very alluring picture of the benefits that arose and the extra benefits that were distributed as a result of the second valuation. I think that valuation was made at the end of December, 1923. It may be interesting to tell the Committee what progress has been made in regard to the surplus which is available for distribution under the National Health Insurance Act. The first valuation was made at the end of 1918, and for an insurable population of just under 16,000,000 of people there was a 433 gross surplus of £17,250,000. Of that £17,250,000, some £9,000,000 was disposed of in additional benefits and £8,000,000 was carried forward. There were certain increases in benefits. Compared with a surplus of £17,250,000 for 16,000,000 insured persons in 1918, we find that in 1923 the surplus had grown to £42,000,000 gross, in respect of just under 14,500,000 people. Therefore, there was an enormous increase, and in that year the disposable surplus was large. The right hon. Gentleman says it was £24,000,000, but I have a figure of £27,000,000, which is presumably for Great Britain. Perhaps the £24,000,000 surplus refers to England only. That is not the material point. The material point is that in these five years between the first valuation and the second valuation the total surplus grew from £17,250,000 to £42,500,000, and what is called the disposable surplus grew from £9,000,000 to £24,000,000 or £27,000,000, a very large increase. In spite of the £24,000,000 or the £27,000,000 of disposable surplus, there was a surplus carried forward which I understand was £16,000,000 but the right hon. Gentleman says was £12,000,000. Again, it may be a case of England against Great Britain. These surpluses are built up out of the balances which remain over after the benefits are paid and which are invested either by the approved societies or by the right hon. Gentleman on behalf of the approved societies.
The right hon. Gentleman in his speech this afternoon has told the Committee of the incalculable benefit to the health of the nation which is derived from these health services. He mentioned dental treatment, ophthalmic treatment and other treatments. I believe that since 1923 there has been an increase in maternity benefit of 9s., sickness benefit, 4s. 6d., and disablement benefit, 2s. 3d. These are the benefits which arise when the surpluses come to be distributed. It is necessary to refer to legislation at this point in order to make clear what has happened under the right hon. Gentleman's administration. It is very largely due to the results of the Economy (Miscellaneous Provisions) Act of last year that there is in the present year no surplus for investment. In other words, the balances which accumulate, the surpluses which become available at the end of every five years, 434 as far as I can see at the moment largely as a result of the action of the Government in the Economy (Miscellaneous Provisions) Act of last year, will not be available, and the suggestion which I am making to the Committee is that the circular to the approved societies, which I have quoted, is misleading because it attributes the lack of money for investment to certain causes which have operated, while one of the chief causes is the Economy (Miscellaneous Provisions) Act, for which the Government were responsible. Assuming it to be true that to the extent of nearly one-half the lack of disposable balance for investment is due to that Act, then that fact ought to have been made known. The increase in the surplus available for investment during the year 1925 was just over £9,000,000, that is to say, taking the amount invested at the end of 1924—which was roughly £96,500,000—by the end of 1925 that had increased by over £9,000,000. That sum was available for investment in 1926, half by the societies and half by the Minister on behalf of the societies. For the year 1927 there is no corresponding sum for investment. That being so, and it being largely due to the Economy (Miscellaneous Provisions) Act, passed by the Government, the circular issued by the right hon. Gentleman's Department to the approved societies acquainting them with the fact that there is no money for investment, should have included that fact in the statement.
I pass to another matter. It is two years ago since the right hon. Gentleman and the Parliamentary Secretary piloted through Committee and through the House of Commons the Rating and Valuation Act, 1925. I daresay many hon. Members of the Committee may have more or less forgotten that Committee.
§ Mr. CRAWFURD
My hon. Friend says "No," and I can sympathise with him, because I was a member of that Committee and I remember the many days and hours that we spent upstairs investigating that matter. During the passage of that Act certain differences of opinion arose. It is too long ago now for me to carry in my mind the whole of the circumstances. During the progress of the Act through the House I think certain exception was taken to a proposal made 435 by the right hon. Gentleman by Members on his own side. Certain exception was taken as to the authority which he wished to set up as the rating and valuation authority in the rural district, and I am not sure—I do not want to make a charge against the right hon. Gentleman—but there is grave reason for believing that under his administration of the Act things are now being done which were, in effect, rejected by the Committee, and that the administration of the Act by the right hon. Gentleman is in some cases in contradiction to the avowed intention of the Act. I am referring particularly to the activities of the Central Valuation Committee set up by Section 57 of the Rating and Valuation Act. Sub-section (2) says:The Central Valuation Committee shall take into consideration the operation of this Act and shall give to the Minister such information and make to him such representations in respect thereto as they may consider desirable for promoting uniformity.Sub-section (5) says:Any scheme to be made by the Minister under this Section shall be laid before each House of Parliament forthwith.So that the Section makes it perfectly clear that the function of the Central Valuation Committee is purely advisory. The right hon. Gentleman is responsible for its acts and the Central Valuation Committee is responsible to him and to no one else, and before anything it does or advises can be made effective it should be made the subject of a scheme by the right hon. Gentleman and should be laid before the House. If the Committee will bear that in mind, and will also bear in mind that the valuation authority is the borough council, the urban district council and the rural district council, and that the county authority has only certain limited powers, they will be able to follow the importance of what I am now going to quote. This Central Valuation Committee has made two series of recommendations to the right hon. Gentleman. The first contains advice to the county authorities. I propose to quote from Resolution 28B on page 24:The recommendation is that in administrative counties the wisest and most economic plan to achieve this end will probably be for the County Valuation Committee to appoint permanently or retain the services of a professional valuer, to be known as the county valuer.436 There is nothing against the Act in that because, as I recollect, the county authority has power to make certain representations if valuations within its area show a lack of uniformity. It has certain rights, if there are appeals, to make objection to the valuation, but it has no right whatever to insist upon its own valuation being carried out in the county or under the other authorities, and if there is any question whatever about that, I will quote a passage from one of the right hon. Gentleman's own speeches. During those interminable Committees, when I am sure the right hon. Gentleman kept the clearest head of the lot among all of us, he made this speech:The hon. Member for Maldon said there were no powers given to the County Valuation Committees to impose their will on the various assessment authorities. I agree, and I do not imagine he would desire that power should be given to the county council or to the committee of the county council, the County Valuation Committee, to dictate to assessment authorities how they should carry on their valuation.That being so, the right hon. Gentleman sets up this Central Valuation Committee. They make their recommendation, and the paragraph following the one I have quoted from this recommendation 28B reads:Further, that such a county valuer should not only advise the County Valuation Committee, but be at the disposal of the rating authorities and the administrative county, and that where rating authorities find it necessary themselves to employ or engage additional professional persons for the valuation of special property, the latter shall be required, as a condition of their employment, to work in close co-operation with the county valuer.I admit at once that the words "close co-operation" do not necessarily mean "under the control of." But what is the right hon. Gentleman's share? What part does he take these recommendations? Last March the right hon. And gallant Gentleman the Member for Burton (Colonel Gretton) asked the right hon. Gentleman a question relating to these recommendations. He asked:If the recommendations of the Central Valuation Committee constituted under Section 57 of the Act and circulated by the Ministry to local authorities have received his approbation and are instructions upon which it is intended that valuations are to proceed.437 The right hon. Gentleman said:The recommendation of the Central Valuation Committee, which is a committee composed almost entirely of representatives of local authorities, was circulated by me practically in the form in which I received it.Now I want to ask, do those recommendations constitute a scheme in the words of the Act? If they do, they should have been laid before Parliament. If they do not, what is the right hon. Gentleman's reason for circulating them to all local authorities? The answer went on:The committee, as they themselves point out, are an advisory body, and their recommendations, which I have brought to the notice of rating and assessment authorities, are not instructions.There can surely be only one interpretation. If you take the Section of the Act:Any recommendation made by this Central Valuation Committee, which are to be acted on.Recommendations that are to be acted upon surely constitute a scheme and should be laid before Parliament. I am informed, indeed the right hon. Gentleman himself said, that these recommendations have gone out to county authorities, who, believing them to be instructions, have proceeded to act upon them as though they were instructions, and you have all over the country county authorities appointing valuation officers, sometimes at very high salaries, and in some cases they are suggesting to the Valuation Committee that they should take the county valuer, while in others, the valuation authorities are refusing to do anything of the kind, and in those cases the officers who have been appointed have nothing to do. They are sitting about asking what their work is. I am told of one place where a county authority, erring on the side of caution, indulged in an expenditure only of £2,000 a year, while in others it is as much as £10,000. The people who have been appointed are in some cases the very type of person who, after much discussion upstairs, was kept out of the administration of the Act. That is the Inland Revenue officer. The upshot of it was this.
§ The PARLIAMENTARY SECRETARY to the MINISTRY of HEALTH (Sir Kingsley Wood)
Does the hon. Member say that Inland Revenue officers have been brought in in connection with valuation?
§ Mr. CRAWFURD
I had not quite finished. I do not suggest for a moment that the right hon. Gentleman or his Department have brought in Inland Revenue officers as against the spirit of the Act. I think the Act actually mentioned that they shall not be brought in. What I am suggesting is done is that by allowing these recommendations to go out, in fact with his imprimatur on them, not having gone through the process laid down in the Act of Parliament, he has conveyed the impression—that point may or may not be valid, but by allowing these recommendations to go out he has created the impression that they are instructions front the Ministry. Under those recommendations many county authorities have appointed valuation officers, some of whom are people whose only experience has been as Inland Revenue officers. They are ex-officers of the Inland Revenue. Valuing for the purpose of Inland Revenue and valuing for the purpose of a rating authority are two entirely different things, and if there is any doubt as to the difficulty that has been experienced through the appointment of these officers, let me quote a passage from an address recently given by a very distinguished authority on rating and valuation, Mr. Michael Farraday:Within the last week I was told by a prominent official of one of the largest towns in the Midlands that their council proposed to employ valuers and that they themselves intended to value the class of property with which this statement primarily deals.Then follows a conversation:I asked him if he found 20 houses of similar accommodation, how he proposed to deal with matters. His answer was, 'I should assess them at the rent they paid.' My next query was, 'Supposing the rents vary for the reasons illustrated above, what will happen then? His answer was, 'You cannot assess a man above his rent. That has been rating law for many years.' I then put to him this query, 'Can you assess him below his rent?' His answer was, 'No, certainly not. He must get his rent reduced if he wants his assessment reduced.'You have under this Act, which was going to produce uniformity of rating, assessment and valuation, people working who do not know the first principles, or rather the value of entirely different principles from those which have always been used for valuation purposes for rating.
§ 5.0 p.m.
§ Mr. CRAWFURD
There are others, and, if it be true that people have been appointed to these posts under the county authorities, whose sole experience has been as Inland Revenue officers, it follows, as a matter of course, that that type of person is operating on one system in one place and another type of person is operating on another system in another place, and you do not get uniformity of operation at all. These recommendations, if they are to be issued to valuation authorities throughout the country, should follow the process which is laid down in the Act, and should be submitted to this House as a scheme under Section 27 of the Rating and Valuation Act.
§ Sir K. WOOD
Does the hon. Member suggest that these are instructions issued by the Ministry of Health?
§ Mr. CRAWFURD
Not for a moment. I thank the hon. Member for perhaps helping to make this point clear. I do not suggest that for one moment. What I do say is that these recommendations, being issued and being taken by the local authorities as instructions, as the form suggests they are—
§ Mr. CRAWFURD
They are recommendations, but, being issued by the Ministry of Health, they obviously appear to the local authorities as though they were instructions. I say that the recommendation I quoted does misrepresent the intention of the Act and that local authorities have been quite honestly misled by that particular recommendation. At any rate, I should like to have the reply of the hon. Member to the point which I have raised on that matter. The hon. Member asked me if I had other examples. I do not want to quote other eases. There are cases that have been given, but I do not want to go on those lines.
There is a second point with regard to the administration of this Act to which I want to draw attention, and it is this. The hon. Member himself will remember that those provisions of the Act which deal with the rating of machinery were 440 hailed by hon. Members on this side of the House and hon. Members above the Gangway as being the first step in the conversion of the hon. Member to views which many of us hold, and although a certain amount of opposition developed from some hon. Members above the Gangway on the ground that the burden taken off machinery might be better distributed among poor property, there was, on the whole, general acceptance by the House of the principle of the unrating or de-rating of machinery. The Act laid down the method by which this was to be carried out. The method was that first of all a Committee was appointed, under a distinguished late Home Secretary of this House, to formulate rules which should lay down what was the type of machinery which was to be rated and what was the type of process machinery which was not to be rated. Subsequently, there were recommendations of that Committee which were accepted and adopted by the right hon. Gentleman. Subsequently to those recommendations being received, a panel of referees was set up who are now charged with giving decisions as to whether this or that piece of machinery shall or shall not be rated. I am told that the panel is composed entirely, or practically entirely, of professional men, professional surveyors and valuers, whose experience has been that they have appeared for local rating authorities.
I am not going to say one word which will suggest that professional men of that type are consciously biased because they happen from time to time to have been in the service of the local authority, but it is quite clear to anyone who has followed the history of arbitration awards under the Land Clauses Consolidation Acts that people whose experience lies in one direction or one channel must of necessity be unconsciously biased on the side of those people whom they habitually engaged to represent. Where you have people who all their lives have been the expert advisers of local authorities engaged in rating and valuation, and trying to maintain claims of local authorities for such and such a valuation, I think hon. Members will agree that those people are not the best people to be referees when this question between the local authority on the one hand and the person whose machinery is to be rated on the other has to be decided. I would like the hon. 441 Member to give some explanation of that, or some assurance that something which would be more satisfactory to the people who are rated should be adopted.
The only other point to which I wish to draw attention is a comparatively small one, but it is an important point and it deals with the Second Series of recommendations by the Central Valuation Committee. I am not quite sure whether it is fair to spring this without notice on the hon. Member, but I shall not in the least resent it if he does not give an answer to the point. But here again you have a series of recommendations issued to these rating and valuation authorities by the Minister without their having been first before the House. In the Second Series I come across this very odd thing, which I am sure would rejoice the heart of the right hon. and gallant. Member for Newcastle-under-Lyme (Colonel Wedgwood) if he were here. It deals with the rating of agricultural property. It is the Second Series, page 9. There I find this very queer thing. There are suggestions as to how rateable value should be arrived at. No. (iii) deals with an allotment of the gross value of £2 I2s.; net annual value £2 9s. 5d.; rate-able value £1, whereas, just below there is given another case of farm buildings of gross value, not £2 12s., but £3, whose rateable value its given as nil. That an allotment of gross value £2 12s. should have a rateable value of £1 and farm buildings with a gross value of £3 should have a rateable value of nil, is very difficult for me to accept. But whether it be capable of explanation or not is not really the point I want to drive home. What I want to bring out is that these recommendations should not have gone out to the local authorities under the Act unless they had been embodied in a scheme to which the right hon. Gentleman should have given his approval and which should have been laid upon the Table of this House.
§ Mr. RHYS DAVIES
I feel sure the Committee will have been very interested in the statement which has been made by the Minister of Health this afternoon. All those who are interested at all in health problems will be very satisfied to read the figures in relation to what are termed "vital statistics," that is, the general decline in the death 442 and infantile mortality rates. Those who take—as I endeavour co do—some interest in this aspect of life will be equally sad to learn that we are not as yet able to say very much that is favourable in relation to the treatment of cancer. But if I may say so very respectfully I think the right hon. Gentleman omitted what is to some of us a very important feature of the public health of this country and that is mortality in confinement. The right hon. Gentleman, when he has spoken before on general health matters, has, I think, given us some details on that score. Some sections of the community are very dissatisfied at the present position in that sphere. Might I just read a quotation from a Report which was issued as far back as 11 years ago on this matter? The position, as far as I understand it, is very little better now than it was then. Sir Arthur Newsholme, who was an officer in the Ministry at the time, made this very strong statement:Over 800 mothers die each year in England and Wales as the result of child-bearing, whose lives would be saved if the experience in the rest of England and Wales were as favourable as that of London.I am informed that about 3,000 women die in childbirth every year in this country, and I would like to know whether London is actually better placed by way of convenience and technical skill in dealing with maternity cases; and, if that be so, whether the Minister would consider doing something, particularly in the provinces, in order that the womenfolk there shall have those facilities which the women of London are able to secure. I know, of course, that maternity nursing in the provinces, especially in Lancashire and Yorkshire, is very different from that of the south and London, because of the large number of women who are employed in the textile industry; but I would ask the right hon. Gentleman to give some thought to what is regarded by the women of this country as a very serious problem indeed, and that is the large number of women who die in confinement.
§ Sir K. WOOD
Is the hon. Gentleman asking what is being done in London that is not done in the provinces?
§ Mr. DAVIES
I gather from the statement that I have read that if the conditions were as favourable in the whole of 443 England and Wales as they are in London 800 lives would be saved annually. What I want to know is what are the conditions that obtain in London which tend to reduce mortality in these cases, that do not prevail in the provinces? I just wanted to say that in passing.
A great deal of the work of the Ministry of Health is now regarded as being beyond party politics; and I think it is well that it should be so. But there are matters which, of course, from their very nature, must be political, and I would refer to one at once. The right hon. Gentleman dealt with housing. I do not profess to be an expert on this problem; I will come to a matter with which I am more familiar later on. But the right hon. Gentleman made a remark, unless I mistook him, which rather led me to believe that he is considering reducing the size of working class houses. I thought his argument was that, because the rent of the present houses which are built by subsidy is too high to meet the pockets of working people, he intends to do something by way of producing smaller houses, presumably in order to reduce the rent. I shall be very glad to learn that I am wrong in this case. May I put it in this way? His argument appeared to be that we have now reached the stage when we have in fact provided a sufficient number of houses, at rents to meet the needs of persons who can afford to pay such high rents. Consequently, he said local authorities are now beginning to consider as to how to meet the needs of persons who cannot afford to pay the rents required for the present sized houses.
That, of course, is logic, but let us see where it is going to lead us. What I would like to put to the right hon. Gentleman is this. It will cause a great deal of alarm if he now proposes to reduce the cost of rent by reducing the size of the house. I should have thought that the only possible way out of this difficulty was not to reduce the size of the house, which, in all conscience, is very small indeed in most cases, but to bring down the building price of the house. The Ministry of Health ought not in 1927 to concentrate its attention upon reducing the size of houses, but rather towards reducing the cost of building them. I should have thought 444 that that would have been the way a Minister of Health would have travelled in order to reach the goal he has in view. As I have said, I do not pretend to know as much about housing as I do about other subjects which have been dealt with by the right hon. Gentleman, but he used the strange argument that the cost of building houses had declined just in proportion—so I understood—to the reduction in the subsidy. I think that was his argument. It was as if to say, "If you reduce the subsidy further the cost of house-building will go down automatically in consequence." Surely, there must be another side to that case. The cost of house-building has not declined merely because of the reduction in the subsidy. If his argument holds good, the Government ought to take away at once all the subsidies they are paying now to various other industries. The subsidy ought to come off the sugar-beet industry; we might then get beet sugar much cheaper than we get it now.
The right hon. Gentleman is very conversant with the housing problem, and if there be anything I envy him, it is his capacity to hurl figures at Members of the Committee without turning to any documents for them. I wish I could do the same. If I were speaking in Welsh I might do quite as well. Let me just analyse, for the moment, the argument of the right hon. Gentleman He said, "When we reduced the subsidy on the last occasion, I prophesied that the cost of house-building would go down almost proportionately"; and, unless I am mistaken, he must have in mind the carrying his point to its logical conclusion, namely, that in order to reduce the cost of house-building further he is going to take away the subsidy altogether. That is the logic of the argument. Is that the case?
§ Mr. CHAMBERLAIN
Does the hon. Gentleman think it is logical to say that because you can argue on one egg and a rasher of bacon you can argue still better on a sitting of eggs and a sucking pig as well?
§ Mr. DAVIES
When I was a collier I used to consider that two eggs were better than one; and, if the right hon. Gentleman was a manual worker, he would also know the difference between one and two eggs. I will leave it at 445 that; but really, that argument is strange coming from the right hon. Gentleman. What I want to put against his point of view is this. Surely there are other factors besides the reduction of the subsidy that have entered into the reduction of the cost of house building? If not, what has the Minister been doing? It is his duty to bring about a reduction in the cost of house building in order to reduce the rent to the level that he wants. I agree with him entirely in regard to one thing. The houses we are now building and the wages that are received by the ordinary worker create a gulf between the wages received and the capacity to pay rent for those houses. On that score, I think, he is perfectly right; but I do not think he is going to bridge the gulf by building smaller houses.
§ Mr. DAVIES
I have made one. The right hon. Gentleman has explained this afternoon that the cost of house building is still too high; but he did not tell us what he was going to do to reduce the cost. I repeat, therefore, that the right hon. Gentleman will create alarm—and he has created alarm in my mind already—in the minds of all people interested in housing when he suggests that in order to reduce rents you must reduce the size of the houses. If that argument holds good, he will ultimately build one-roomed houses. That would settle the problem, I suppose, according to his argument. A previous Minister of Health actually made that proposition, and he lost his seat in Parliament in consequence. I am sure the right hon. Gentleman will take note of that fact. As I said, I have never claimed to have followed the housing problem to the extent that other Members of the Committee have done, and if I have made any errors I feel sure the right hon. Gentleman, out of the generosity of his heart, will forgive me at once.
I now come to something in which I am intimately interested, namely, the administration of approved societies. I am sure that I shall carry the right hon. Gentleman and his Parliamentary Secretary with me when I say that it would really be a calamity if this huge business of collecting contributions from 15,000,000 446 people and paying away millions upon millions of money annually by way of benefits were allowed to pass without a word upon its administration in this Committee. I make no apology therefore for saying one or two things upon this issue. I think the right hon. Gentleman created a little humour when he mentioned the work of the regional dental officers; but he was surely wrong in suggesting that insured persons were afraid to go to the regional dental officer because their teeth were going to be extracted. It was nothing of the kind. He knows perfectly well that the duty of the regional dental officer is to examine the work of other dentists and not to extract teeth. I can very well imagine people not going to the dentist because they are afraid to have their teeth extracted. The point at issue, however, might appear to be a very small one, but to approved societies the matter is very important. The right hon. Gentleman has appointed several officers as regional dental officers to cheek the work of the dentists. That is very necessary now that the National Health Insurance Fund has become financially responsible for dental treatment. I am convinced that a few of the dentists, even now, do not play the game with approved societies. Complaints from some quarters are so strong that some of the approved societies are already thinking of diverting some of their surplus funds for use in other directions. So far as I am concerned, I want to say, that if some of the dentists and some of the opticians, do not treat us better I shall make it my business to see whether other additional benefits cannot be established in order to divert the funds from those purposes. I must say, of course, that it is only a small section of the dental and optical profession that I complain about.
When you come to the work of the regional dental officers a very interesting point emerges. The Parliamentary Secretary to the Ministry of Health, who is conversant with the work of National Health Insurance from its commencement, did not foresee one thing in connection with the appointment of these gentlemen. I am sure I am not doing the right hon. Gentleman any injustice when I also say that he did not foresee the point which I am going to mention. The point is this: The work of the regional dental officers has been made very difficult, and there are already 447 complaints of delay. I do not see how these delays are to be avoided. The regional medical officer can call a patient to him during the daytime because he is on the sick fund and not at work. But in the case of the insured person who requires dentures, he can only attend in the evening; he is at work during the day. I do not know whether it would be a good suggestion that these regional dental officers should begin their work at six o'clock in the evening and go to bed during the day. I cannot think of any other way out of the difficulty; but the problem is there, and I trust the Department will inquire into it in the near future.
In spite of the fact that the administration of National Health Insurance is carried on with great satisfaction to all concerned, it would, indeed, be a wonderful institution if there were no complaints whatever to make. There is one that I wish to make. Some approved societies are not at all satisfied with the arrangement that has been made whereby a person suffering from anything connected with the eyes is sent automatically by the medical practitioner to the ophthalmic surgeon. I have made remarks concerning the medical profession on more than one occasion in this House, and I have been criticised very severely for doing so; but I do wish to say, in the presence of a member of that profession, that we are not satisfied that the opththalmic surgeon should receive a fee of a guinea for giving advice that ought in some cases to be given at a very much cheaper rate. I am speaking now as a trade union official, too. I think it will destroy the confidence of approved societies in the work of the medical profession if the panel doctor automatically refers an insured person suffering from any defect of the eyes to the ophthalmic surgeon and a fee of a guinea is to be paid to him for his work. I think the right hon. Gentleman in charge of this important business ought to inquire into that complaint.
With regard to additional benefits as a whole, the Minister was quite right when he said that dental benefit as an additional benefit is spreading among the approved societies, that eight times the sum of money was spent after the last valution that was spent during the 448 previous valuation period; and 12½ times the amount of money is now being spent in respect of ophthalmic benefit. It is not for me to say anything now about ophthalmic benefit in its relation to optical practitioners; but I have to make a complaint in respect of the provision of spectacles. The complaint—I do not know how far it is justified—is that some optical practitioners claim anything from 100 to 300 per cent. profit on the spectacles they sell. I cannot say whether that is true or not, but it seems to me that the right hon. Gentleman ought to give some attention to the charges that are being made. Not only should he inquire into the charges made by the ophthalmic surgeon, the dentist, and the optical practitioner, but he would do well to inquire also into the charges made for surgical appliances supplied to members of approved societies, which have increased since that benefit was added to the National Health Insurance Scheme. There is a feeling, and it is a justifiable one, I think, that because this money is available in the funds of approved societies the professions which have anything at all to do with the insured population are taking undue advantage of the position in regard to their charges. It is the duty of the Minister of Health to hold the balance evenly between approved societies and these various professions. I remember full well the dispute the Minister of Health had with regard to the fees of panel doctors, and the arrangements made with the dentists and I am conversant with those now to be made with the optical practitioners. I think he will find that he will have to go a step further and do something in connection with the subject of surgical appliances as well.
Just a word with regard to the new projects which the right hon. Gentleman mentioned in his speech. We on this side of the House welcome any new preject with regard to research into diseases with the idea of giving higher and better education, and greater facilities to medical practitioners to improve their knowledge of the health of the community. That is very good work, and I am glad to learn that the Ministry is taking an active interest in the two new institutions. What I want to know is whether the Ministry are backing up these institutions by grants? It is all very well for the right hon. Gentleman 449 to say that these two new institutions have been formed and that the Rockefeller Foundation has given 2,000,000 dollars to one. That is no credit to the Minister at all, and, while we welcome these new projects, we should like to know how far the Ministry of Health itself is interested financially in these two institutions.
The right hon. Gentleman claims, and rightly, a great deal of credit with regard to the benefits payable under the Widows' Pension Scheme, and as far as I understand the method of administration I have no complaint at all to make, except complaints against the law itself. The Department has undoubtedly, as far as it could, cleared up most of the difficulties connected with claims; but I think the time has arrived when the Committee should be informed how far the payments that have already been made on account of widows' pensions and allowances tally with the actuarial calculations given to the House in 1925. We have been given figures as to the number of claims, and the amounts too; but I think we are entitled to know from the Minister how far the amounts that have been paid square with the actuarial calculations.
I want to turn back once again to the National Health Insurance scheme. The Parliamentary Secretary gave a reply some time ago to a question which I put to him—I am sorry I have not the details with me at the moment, but no doubt he will remember the question—as to the amount of sickness benefit paid away during the mining dispute last year. The Parliamentary Secretary led me, at any rate, to believe that because of that industrial dispute sickness claims on approved societies had grown enormously. I ventured to say then that while the claims had increased during that period, I was not so sure that the claims were not less than they would be this year. It is now nearly the end of June, and I think the Parliamentary Secretary should give the figures showing the amounts paid during the first and second half of last year, and probably up to date; and unless the experience of other societies differs from my own, I shall be astonished to learn that the figures of last year are much higher than they are for this year because the claims on the funds of 450 the societies, in spite of all that is said as to the health of the community being better, do not appear to diminish. The reason is not that which is usually given—namely, that the insured population is malingering. The reason is that if you have an extension of the age the older people get the feebler they become—except members of the Labour party—and, consequently, the claims of the insured population are increasing as the years go by.
There is another question which I think we must put to the Parliamentary Secretary, who I understand is going to reply. He will remember that there has been a reduction of one penny in the contribution of the men and one half-penny in the contribution of the women. It is not competent for me to dwell now upon the very foolish action of the Government in plundering the funds of the approved societies some time ago. I understand it is not in order; but I think we are entitled to know what the result has been on the funds of the approved societies, that is, the taking away of large sums per annum by a reduction in the State grant and a reduction in the weekly contribution of insured persons, men and women. The Ministry of Health has at its command one of the best actuaries in the land, and I feel sure the Parliamentary Secretary will be able to give us this information now, because the last valuation period ended in 1923 and the next period ends in 1928 for some societies and in 1927 for others.
Can we be informed—and of all the questions I am putting to the Department this afternoon, this is the most important—whether in view of the fact that the State grant has been reduced, and the contribution of insured persons per week has been reduced, the actuary is satisfied that approved societies will be in as good a position at the end of the third valuation period, that is at the end of 1928, as they were at the end of the last valuation period. I know that this is a very difficult subject to broach, because the right hon. Gentleman and the Parliamentary Secretary are sincerely hoping that in spite of all they have done in the past approved societies will come out all right in the end, that money will flow in as was the case after the last valuation. It is right that we should know whether, in the opinion of their 451 actuarial department, approved societies are likely to be as well off at the end of the present valuation period as they were at the end of the last. Let me put it in simpler form. The total amount of surplus available at the end of the last veluation period was £42,000,000. Can we take it that the right hon. Gentleman, the Parliamentary Secretary and their actuary, are satisfied that at the end of 1927–28 there will be Another £42,000,000 available by way of surplus in the funds of the society? It will be a very interesting answer.
§ Sir K. WOOD
The hon. Member might just as well ask me who is going to win the fight to-morrow night.
§ Mr. DAVIES
When the right hon. Gentleman brought in, the Economy (Miscellaneous Provisions) Act, and the Widows', Orphans' and Old Age Contributory Pensions Act, he could tell us for 50 years in advance what would be the position of the societies. I have the documents here from the Actuarial Department, and they are able to tell us what is going to happen up to, I think, the year 1975. I am sure that if the hon. Member would do his duty and get the figures from the Actuary he would be able to tell the Committee now whether the Actuary anticipates a £30,000,000. a £40,000,000 or a £50,000,000 surplus at the end of the current valuation period. He knows full well what the result is going to be; and, because the sum is going to be less, he is not going to reply. If the surplus had been £50,000,000 or £60,000,000, in spite of the plundering of the funds of approved societies and the reduced contribution of insured persons, he would have been delighted to have said that the Actuary thinks that the probable sum is £50,000,000 or £60,000,000.
Another very important problem arises in connection with the administration of approved societies. The right hon. Gentleman is well aware that some societies have a dwindling membership. Some of us are interested to know what is going to happen to these societies whose surpluses accumulate, whose investments grow from year to year but whose membership continually declines. Does the right hon. Gentleman propose to transfer some of these funds to a central pool, or to a contingency fund; 452 what is going to happen? We are nor entitled to deal with any probable legislation on this very important issue; but I think we should know from the Minister of Health what number of the recommendations of the Royal Commission have been put into operation. I have a list of some of the recommendations which need not wait for legislation, which could be put into operation without passing a Bill through Parliament. I want to know whether anything has been done with the recommendations which do not require legislation.
I feel satisfied that the Committee ought to pay more attention to the work of approved societies than has been the ease hitherto. There are 15,000,000 people involved, and large numbers of them are without any democratic control of any kind. If it were opportune, I should put the other point as to whether these millions of insured population, who have no voice at all, and no means of expressing their opinions through some of the large approved societies, could not be called together somehow in the various localities so that they might express their views on the administration of the funds.
§ Sir K. WOOD
Does the hon. Member suggest that the trade union member of an approved society shows any more interest than any other member of an approved society?
§ Mr. DAVIES
The hon. Member knows full well that in every trade union approved society, branch meetings are held, council meetings are held, and elections are held every year; and that there are millions of members of other approved societies who never have the chance of attending any meeting or taking part in any election. The hon. Member is merely playing with words when he puts that point.
As I said, there are some things in connection with the work of the Ministry of Health which are undoubtedly above political partisanship, but with regard to the subsidy on houses, and the suggested smaller houses, I feel sure that the suggestions of the right hon. Gentleman will create considerable alarm among those interested in that problem. With regard to national health insurance, the business is proceeding smoothly, and the work is being performed, as far as I know, by the medical profession as a 453 whole very well indeed. But I should like really to see the right hon. Gentleman instituting something beyond merely paying away benefits. Something should be done to aid research work. We have surely reached a stage when a sum of money should be made available to carry on research work; and although we welcome the two institutions mentioned by the right hon. Gentleman, the day has now come when we should not be satisfied merely with clearing away slums, building new houses, and paying away benefits; but when the health of the community should be the subject of research by the highest and most skilful men in the land.
§ Lieut.-Colonel FREMANTLE
I should like to follow the hon. Member for Westhoughton (Mr. Rhys Davies) on the subject of insurance, but I shall only deal with it very briefly, and I do not propose to respond to the suggestion he made that we should take up the question of the fees paid to ophthalmic surgeons. I am in the position of being a friend to a litigant in the Courts, and all I can say is that I trust the case entirely to the Court. I am certain such matters will be rightly arranged between the Ministry of Health on the one side and those who represent the medical profession on the other. I am very glad the hon. Member said that practically the whole of the matters that come under our purview in this Debate are outside party politics. Party questions come in occasionally, but on the whole we are free of party, and we can shake hands in wishing to forward the magnificient work of the Ministry of Health and the organisations under the Ministry throughout the country.
With regard to National Health Insurance, my hon. Friend suggested that something should be done for research. The medical profession would be the first to back up any such plea. I think I am right in saving that in the original insurance scheme there was a penny of the contribution put aside definitely for research, and that was commuted into the payment which has eventuated as the Medical Research Council, now doing magnificent work under the Privy Council. I entirely endorse any proposal for giving more help to that Council or to research generally, but it would be unfair not to mention that that research work arose out of the National 454 Health Insurance scheme. It is true that we want to look beyond the relief that has been afforded by the insurance scheme. That scheme has provided a most magnificent means of relief in the form of various benefits to the population. But when we come to look at the larger and wiser object which was aimed at specifically in the Act, namely, the prevention of disease, it has to be admitted that the whole insurance scheme has been a dead failure, an absolute failure. It has not resulted in the prevention of disease in any way and it does not tend to the prevention of disease.
It is only in so far as we may be able in future administration to correlate the system of the insurance scheme with that of preventive agencies throughout the country that we can hope for any marked improvement. The pensions for widows and orphans and the aged are among the magnificent new contributions to health, inasmuch as poverty is one of the three essential elements in the causation of ill-health. In so far as one may attribute ill-health to preventable causes, one may say definitely that the three main elements are poverty, ignorance and carelessness. It may be poverty in those who are neither ignorant nor careless; it may be ignorance amongst those who are neither poor nor careless; and it may be pure carelessness among those who are neither poor nor ignorant; but it is quite certain that poverty, grinding poverty, is at the bottom of a large amount of ill-health at the present time. If you can do away with this poverty, for which the individuals are really not responsible, as has been largely done by the Widows', Orphans' and Old Age Pensions scheme, you are going a long way towards improving indirectly the health of the community.
I wish to make a few remarks on the present position of the housing problem. From our side we have urged, and to some extent have been joined by all parties inside and outside the House, that in facing the appalling problem of housing after the War, despite the fact of people being intolerably overcrowded, despite the fact that houses that were dilapidated and out of repair were still inhabited, the main and essential thing was to get the building industry back to work, to increase the supply of houses before we could tackle, or while 455 we were tackling, the other thing. I would like, on behalf of all who are keen on this subject, to offer my small share of congratulation to the Minister of Health for the wonderful way in which he has managed to attain that object with the help of all parties. What is more remarkable is that the building trade has not simply been got back to work on the original plan, but, as the right hon. Gentleman has said this afternoon, back to work with a production of something like three times the number of houses in a year that were produced before the War. It is a wonderful achievement and one with which we can be heartily satisfied.
That fact is, perhaps, one answer to the question raised by the last speaker, as to the expensive house. When you have a large demand for any product and a small supply, prices naturally go up and you cannot prevent it. The facts here are that you have an ever-increasing demand for housing, and as long as the supply is limited, however great that supply may be, prices are bound to rise. You cannot keep them down except by compulsory and punitive measures. We know there was an idea that we should introduce compulsory and punitive measures to reduce profits. There has never been an idea that we should reduce wages by such methods in the building trade, but there was that idea of reducing profits. It faded away when we were face to face with the effort of trying to arrive at that result. It was impossible to keep profits down where you had so large a demand. The supply is still inadequate. It is true that we have built nearly 900,000 houses in England and Wales alone since the War, and that on the basis of the provision made for the population of 1911 we shall probably arrive at an equal accommodation of the population within the next couple of years. By the middle of 1930, if we build at the present rate, we shall have the population housed on much the same conditions as in 1911, with some improvement.
But what were the conditions in 1911? In England and Wales then we had 3,200,000 persons living in overcrowded conditions, more than two to a room. That condition of overcrowding continues now. According to the 1921 456 census there were nearly 1,000,000 people in Greater London who were living in overcrowded conditions, more than two to a room. That figure epitomises the awful stories that we constantly read in the surveys of housing that are going on. In Chelsea and Westminster recently very active and well-informed housing associations have issued reports of their surveys. I must say, knowing housing so well in London, that I am surprised that the surveys are not worse. They reveal some appalling conditions in dilapidated houses that are still allowed to be inhabited and have to be inhabited, where two or three families are living in accommodation sufficient for only one. There are cases where two or three families have only one set of conveniences or kitchens. The conditions are appalling and they have to be tackled; they are no less difficult than the task of overcoming the mere lack in the number of houses. We have to take up that question.
If you read the reports of medical officers of health throughout the country you will find that during the last 10 years they have skimmed very lightly over the question of the dilapidated house. Why? Because when they have reported houses as dilapidated and not fit for habitation no action has been taken; the local authority did not dare to take action. So houses have continued to be let when they have been reported as insanitary, and they are still inhabited. I hope that this question of administration will be taken up with increasing energy by the Ministry of Health as the number of houses built becomes more adequate. As we get towards an adequate supply of houses, there should be increasing work in securing the reporting, the closure and the demolition of the disgraceful houses that are still allowed to be inhabited and unfortunately have had to be inhabited hitherto. That is one thing for which I should ask. I suggest also that, whereas the reports of medical officers of health have in the past been extremely voluminous or varied in their size every year, and latterly they have taken to concentrating upon a survey once in every five years, the Ministry of Health should, at least once in every five years, call for a survey by the medical officers throughout the country 457 not only of the individual areas but also areas grouped together under the county councils—a survey of the housing conditions, showing what is being done in order to meet the differing needs of the housing problem.
My right hon. Friend the Minister of Health has been criticised for speaking of his desire to stimulate especially the building of small houses. I feel sure that I am interpreting rightly the inquiries made by the last speaker, when I say that what he meant was not to diminish the size of any particular house, but that, inasmuch as the subsidy is allowed for houses of different sizes and local authorities generally have two, three or four standards of size, the Minister should concentrate more on those lower standards that are already being built for the working class. A trust with which I am connected is building, very largely owing to the generosity of a gentleman who died 25 years ago, houses for the working classes. When we are deciding on any big scheme for congested areas we have to decide what is the size of house required by the working classes. In some areas we have been told that the houses that we build are too big and that smaller houses are preferred for various reasons. In other areas we have a demand for the middle-sized house. As one surveys the whole problem one must recognise that the subsidy has been too much used for the building of houses for artisans and the better-paid worker, and that there has not been sufficient provision for those who get the pay only of casual labourers and men of that sort. I trust that the Minister will endorse that opinion in his reply. Perhaps the subsidy has gone too much to those who can pay. Anyhow, if continued on the same lines it would still be going into the pockets of those who can well afford, through building societies or other agencies, to build their houses without State help. We want the whole of the funds that are available from public sources for housing purposes to be given only to those who really are in need.
What is being done with regard to that useful little Measure, the Housing (Rural Workers) Act, which enabled grants and loans to be given for the repair of workers' houses in the rural areas? It is limited to houses which are let at low rents and which will continue to be let at low rents 458 to the working classes, and it should relieve the rural areas of an enormous difficulty. The local authorities have found it impossible to take action in this matter because of the wretched rents that by custom have been paid in the country for these houses—3s., 2s. and, in some cases, even 1s. per week. Of course there are other factors to be considered, but I believe that Act enables local authorities to take strong action. They can insist on houses being either repaired or closed and demolished. They have also power, if there are not enough houses, to build, with the help of the subsidies now available. I hope we shall hear to what extent the county councils are rising to their opportunities in this matter and to what extent they are leaving it to the rural district councils who may apply to be authorities under the Act.
I hope also we shall learn that the Ministry is going to take steps to see that those authorities which have been lax or slack in adopting the Act are brought up to the mark. I hope the county councils will be pressed to do more than they have been doing hitherto on this question. There are many points in regard to which they could do more, owing to recent Acts. There is, for instance, the question of the public utility societies, which are doing so much useful work for the housing of the workers. These societies are always in difficulties with their finance. They require help, and in many cases they are trying to work under small local authorities which have not the power to finance them properly. Indeed, in some cases, these local authorities have financed them, over and above their own rateable value, and it is the county council which should help in this respect. I trust, therefore, the county councils will be urged to take action in this matter. I look forward to hearing two announcements from the Minister. I do not know if it would be in order merely to mention the question of slum clearances. That will require vigorous action before long. We have been promised a further pronouncement on Section 46 of the Housing Act, regarding compensation for slum clearance, which at the present moment, stands in the way of action by local authorities.
§ The CHAIRMAN (Mr. James Hope)
The Minister will not be in order in 459 giving any exposition of legislation which he may be disposed to introduce. If the hon. and gallant Member asks him whether he has in contemplation dealing with this or that question, he is entitled to reply, but he cannot deal with legislation in this case.
§ Lieut.-Colonel FREMANTLE
This is a subject which is concerned both with administration and legislation, and one may ask from the administrative side, to what extent slum clearance schemes are going ahead or may be expected to go ahead in the near future under existing legislation. The other point on which I hope to hear a statement by the Minister is in regard to the Rent Restrictions Act. That question will have to be faced in the near future. The Minister has said he is going to announce his policy before the end of this year. I know the difficulties in connection with the matter, but it is a question which goes to the root of the housing problem, and if it is in the power of the administration to postpone the coming into effect of certain provisions, then it is a matter of the first importance. I will not go further into that subject, but will await another opportunity of discussing it. Any idea that we have come to the end of the housing problem, or even within sight of the end, merely because we have such a fine record as the Minister has put before us to-day, would be grossly misleading, and I hope in all parts of the Committee, we shall continue to take an active part in trying to arrive at a solution of this seemingly interminable problem.
§ Mr. BRIANT
There is no Ministry which comes so near to the homes of the people as this Ministry. Whether it is dealing with pensions or insurance, with health or with housing, it is essentially a Ministry which ought to be called, indeed, the "Ministry for Home Affairs." It is the Ministry for the home. We were all glad to hear from the Minister his references to research in all matters connected with health. I do not grudge a farthing of that expenditure; indeed, I do not think we spend enough on research, but the fact remains that, however much we spend on research and whatever may be the discoveries of medical science, we can do but little for the health of the community 460 as long as present housing conditions exist. Anyone who knows the subject at all is aware that bad housing produces disease, and no amount of preventive medicine, no medical knowledge, will prevent the spread of disease with great rapidity as long as bad housing continues. This applies particularly to such diseases as tubercular diseases, which are almost entirely—I will not say entirely—produced by bad conditions of housing. It is not my habit to go to books or reports in order to know the truth. There is hardly a day in my life on which I am not approached with some pathetic story of a man, who has the money to pay for more accommodation, seeking almost in tears for additional rooms and unable to find them. Yesterday, I had a case of six people who were living in two rooms. They included an anæmic boy, who, obviously, will continue to be amæmic as long as he lives in that crowded atmosphere. That lad will grow up with a weakened constitution, and, probably, will be a burden on the community at a later stage of his life. Certainly, he will not be an efficient citizen, and it is idle to talk of many of these subsidiary questions as long as we fail to grapple with the health question. I do not intend to dwell on that proposition, which is self-evident, though I might add that there is no great problem with which social workers have to deal, such as juvenile crime or drink, which cannot be traced back to health.
One must be discursive in dealing with this Vote, because the work of the Ministry is widespread and many questions arise on it. I wish to refer first to the accumulated balances of the approved societies. There are many directions in which I wish to see these accumulations used. Any medical man will support me in the statement that a very large number of women who die at childbirth or who live on with enfeebled constitutions, could be saved from death or ill-health if they had proper medical care and had certificated midwives to attend them. I want to see the time when these balances—and I hope the idea will be favoured by the approved societies and the Minister—can be utilised to make definite provision for proper nursing and care for women in this condition. I believe the saving to the community would he enormous, and 461 would far outweigh the expenditure of money. Turning to another matter, in my experience a large number of men and women, who have not recovered from the direct effects of illness, return to work before they are fit. Those who know the working class will bear me out when I say that it is the best of the workers who go back most promptly to work.
The good workman sees he cannot live on the money which he receives in benefit, even if his doctor retains him on the list, and he is anxious to get back to work because, during sickness, he has had to use more money than he has been receiving, which means applications for relief, and also that tragic feature of many workers lives, an added number of pawn-tickets showing how the home is being reduced. The better the man, the more anxious is he to get back to work, and thousands of men and women go back to work before they have recovered proper health. Most of us here are fortunate enough to be able to allow ourselves a certain period for recovery, after the acute period of an illness, but many of these people have to resume their occupations before complete recovery. This means enfeebled constitutions, if it does not actually reduce their years of life. I think, in time, some way might be devised by which every worker should have the opportunity of being sent away for at least a month on a doctor's certificate, and by which funds should be provided to keep the family in the condition in which they were kept While the wage-earner was fully employed. It is only in this way that we can give them a chance of that complete recovery which, I am sure, we wish for all those whose circumstances are such as I have related.
I now propose to glance rapidly at two subjects which are quite disconnected. We have heard that there is a committee inquiring into the question of vaccination. I wish at once to make it clear that I am not an opponent of vaccination. As a layman, weighing up the evidence, I have long been convinced that, on the whole, vaccination is a, preventive of smallpox, but I am bound to add that recently there have been some statements which are at least disconcerting, particularly, with regard to the possible connection—I say "possible" connection—between encephalitis and inoculation. I am not 462 satisfied that we are getting all the facts. May I add, as one who believes in vaccination, that if anything would deter people from vaccination, it is a doubt as to what effects it may produce in their children? I understand that the Andrewes Committee made a report, which is in the hands of some French people, and has been published by them, but has never been submitted to the English public. That report ought to be made public to us as well as to other people. I think we have a right, not merely to wait for the result of the inquiry which is now being held, but to ask for some preliminary report from the committee which is sitting, giving information as to the cases of encephalitis which have occurred within a period of two months after vaccination. I do not wish to disturb the public mind. I am not frightened or startled in the least, but we have a right to know the facts as far as they are presentable to us. We should not necessarily be compelled to wait for the final report of a committee which may take a long time in pursuing its inquiries, while, in the meantime, these statements are disturbing many people and are creating anxiety on this subject.
I turn to still another subject—one in which I have taken a great interest. That is the condition of the workers in the hop districts. I was disturbed when the Minister of Health the other day, in answer to a question, said he saw no reason why the report of his own medical officer should be issued. No such report was issued by the Department, and I think the House of Commons have a right to demand to see the report of the inspector who visited the hopfields. I have visited them and I state frankly that some of the conditions are disgusting and almost beyond belief by those who have not seen them. I believe there has been an improvement, and I say at once I am not including in my statement by any means all the hop growers. Many of them conduct their farms as well as possible, considering the temporary nature of the work, but it is a fact that the hop grower has to get his living through this temporary work. There are not enough workmen in his own district to do the work.
The workers, however, have a right to demand that they should be put into conditions which are tolerable and at least 463 decent, and I can assure the Committee, from personal knowledge, that that is not the case in many instances. There was drawn up a list of model rules in 1926, I think, and I would like to be told how many of the district councils have adopted those rules, how many put them into force last year, and how many will put them into force this year. I think we might be supplied with the actual reports of what the medical inspectors have seen. I have every reliance on their judgment and knowledge. I have seen reports of local medical officers, and some of them have made statements as to conditions still existing which I am sure no Member of this Committee would sanction for a moment on his own property. I have myself seen a family huddled together in a small hut, without a chair or table, with a straw mattress, and the only place where food could be put was on the dirty straw that was left on the floor and covered with litter by the children running in and out. There was no place for the children to play, and there was nothing but this tiny hut in which to sleep and eat. These matters concern me because from South London there is a migration into Kent every year of some 60,000 people during the four or six weeks of the hop-picking. I hope the Minister will be able to give us some more information on this subject. It is time that the Committee should demand to see the returns I have mentioned; they were issued in the past, and they should be placed in our hands to-day.
I am afraid I have been somewhat discursive, but I take a keen interest in these points. To return to what I said at the beginning, I hope that whatever the Ministry may do in the way of research, it will do it thoroughly. I hope that the right hon. Gentleman will not spare money in this matter, for if you can save the health of a single person, the community will win that money back in a few years' time, and if you can prevent a person having an illness, it will be repaid over and over again to the general public. The rates and taxes are enormously enhanced by the heavy charge caused by people whom we have neglected when they were curable and allowed to get into an incurable position, when they have become a burden on the State. I have every confidence in the 464 Minister, who is keen on these subjects himself, and I hope he will give some encouragement to us who feel that health is the greatest service to the community and that the opportunities of the Ministry for good are probably unequalled by those of any other Ministry in the country.
§ Dr. VERNON DAVIES
It was with very great pleasure and admiration that one listened to the speech of the Minister of Health—admiration for the facility with which he travelled from subject to subject, showing great knowledge of each, and giving the Committee very valuable information which had to be more or less contracted, but which justified the opinion which, I am sure, is held on all sides of the House that in the Minister of Health and his Parliamentary Secretary we have a Department which is functioning in the very best possible way. It is, however, surprising that a Department which should be concerned solely with the health of the nation has to spend so much time and opportunity on other subjects, which are perhaps only remotely connected with health. When I found that the Amendment from the Liberal Benches to reduce the Vote was moved in a speech that was practically confined to the very intricate and technical subject of rating, I wondered why in the world the Ministry of Health should be dealing with that question when there are so many vital subjects affecting the health of the community to be discussed. The Minister prophesied last year that the reduction of the housing subsidy was going to reduce the price of houses, and the Labour party then were sceptical on that subject, but I am sure that to-day they are as delighted as we are to find that the Minister was right in his prognostication, and I suggest to them that the next time he prophesies, they should accept his prophecy as a very good tip.
The references of the Minister to public health were very favourable, but one got the impression from his speech that everything was as well as it could be. I do not think that is quite the case. The right hon. Gentleman had to confine his remarks on each subject to such a small compass that it was easy to convey rather a false impression, and I would specifically refer to his remarks on cancer. The impression that he gave me was that the outlook for cancer was very much 465 better than it had been and that he almost ventured to prophesy that within a more or less reasonable time we should have a cure for that disease. We hope that that is so, but I think it is very much too strong a statement to go forth to the public at the present time. Very good work is being and has been done, but at present I think it must be emphasised again that the only chance for a patient with cancer is early and complete operation, and not to wait for anything that the Minister may have in mind, or for any invention or discovery that may be made in future. The only chance at present is early operation, and I would like to emphasise that to correct perhaps an impression which the Minister did not mean to convey. I would like to ask the Parliamentary Secretary a question with regard to the post-graduate hospital. Most of the London hospitals and many provincial hospitals have postgraduate students. I do not quite understand how this new hospital will function. I understand that it has been provided by the Rockefeller Foundation, but how will it be kept up? Is it really going to become a State hospital for post-graduate study, not confined to medical men in this country, but open to medical men of all nations? Will a fee be charged to these medical men? That is rather an important point, because one would like to know if it is the beginning of the State control of medicine or of a State medical service, or if it is simply the State helping medical men to provide facilities at a low cost to themselves, because they have those facilities at the present time, provided that they are willing to pay for them, at most of the London and provincial hospitals.
There is one subject to which the Minister referred very slightly, and that is the question of smallpox. I have noticed in reading in OFFICIAL REPORT during the last few months that various questions have been put from various sections of the House with regard to smallpox, and I will give three or four items of information which have appeared in the OFFICIAL REPORT. We have found that during the year ended 2nd April last there have been 12,922 cases of smallpox notified in this country; that the deaths registered during the year ended 31st March from smallpox were 33; that this year there have been so far 28 deaths, 21 of unvaccinated people and 466 seven of people vaccinated in infancy; that in the County of Durham there were 20 cases of smallpox in 1924, 1,138 cases in 1925, and 6,645 cases in 1926. We also found that they have had nine cases in Hendon, of which five were fatal. These answers show that smallpox has been definitely increasing in this country in the last few years, from 2,504 cases in 1923 to 12,922 in the year ended 2nd April, 1927, and with this steady increase of smallpox there has been a steady increase in the death-rate, because we find that in 1914 there were four deaths; in 1915, 13 deaths; in 1916, 18 deaths; then we get down to 1921, five deaths; in 1922 they went up to 27 deaths; in 1923 they went down to seven deaths; in the year ended 31st March there were 33 deaths; and this year so far there have been 28 deaths.
One also found that in 1924 there was an outbreak of smallpox in 148 separate districts in this country. That means that we are gradually but surely advancing towards an epidemic of smallpox, there being increases all over the country both in the number of cases and in the number of deaths. Fortunately, it has been of an exceedingly mild type, but that has made it much more difficult for the local authorities to deal with the earlier cases and to prevent the spread of the disease. I think the Minister of Health has a very definite responsibility in this matter, and I suggest, with great respect, that the Ministry are not adequately carrying out the powers conferred upon them in dealing with this danger. We know that the Minister of Health, by his control over boards of guardians and also over other local authorities in health matters, has a very definite power, both moral and financial. In the year 1924 there were only 47.5 per cent. of successful vaccinations, 37.1 per cent. of conscientious objectors, 5.4 per cent. died unvaccinated, and 0.2 per cent. were insusceptible; and we find that there is a balance of 10 per cent. not accounted for. This 10 per cent. probably consists of children who have escaped the meshes of the vaccination officer.
We may as well put it quite plainly, and I blame the Minister of Health for not seeing that the Vaccination Act is properly carried out. Under the Vaccination Act of 1898, a conscientious objector was given a chance of declaring that he 467 conscientiously believed that vaccination would be prejudicial to the health of his child, but it was made rather difficult, because he had to appear before two justices, or a stipendiary magistrate, or a metropolitan magistrate, and there was a certain amount of difficulty in getting an exemption certificate. The result was that the number of exemptions granted under that Act kept fairly steady, but in 1907 a new Vaccination Act was brought in, which made the conscientious objectors' Clause very much more simple, and all that they had to do was to go before a justice of the peace, a commissioner for oaths, or some officer, authorised to receive a statutory declaration, and make a declaration of conscientious objection to vaccination, and the certificate was given them. The result is that, in 1908, 63.2 per cent. of children were successfully vaccinated, but in 1914 the figure had come down to 44.6 per cent., and in 1922 it was 40.3 per cent. One point to be noted in connection with the statistics is that when small-pox occurred there was a larger number of successful vaccinations but a year or two afterwards people got less frightened and said, "This is a very slight disease; this is a very mild small-pox—some people think it is chicken-pox—and we will not bother."
I would like to say that I entirely disbelieve in these conscientious objections. In very few cases is there a real conscientious objection. I am speaking from my own personal experience. I found very often in the course of my practice that parents would not allow their children to be vaccinated because they said they had a conscientious objection. Later many of those people emigrated to America. America has more sense than we have. America will not allow people to enter that country unless they have been vaccinated, and I never met a single conscientious objector who refused to have his child vaccinated if he wanted to go to America. In a case like that I say it is not a conscientious objection. The reason parents refuse to have their children vaccinated is not because they have a conscientious objection to vaccination, but a parental feeling that they do not want the baby to suffer any pain. If a child is vaccinated the arm is sore for two or three days and the child is fretful 468 and restless, and parents say, "Why should the child suffer pain? Go and get a certificate; the magistrate is compelled to give it." Thus we have in the country a huge number of unvaccinated people who are an absolute danger to the community.
In a way I do not regret that, because I am convinced that certain people are so bigoted, shall I say, against vaccination that the only thing that will cure them is a big epidemic of small-pox, with a high fatality rate. It is a terrible thing to expect, but, as far as I can see, it is bound to come. The Minister of Health has a duty to perform. It is the law of the land, to see that children are vaccinated unless they are granted exemption; and when he finds from his own statistics that things are not being properly carried out I say it is his bounden duty to put the law into operation and to exert pressure upon boards of guardians and local authorities. I would like to draw the attention of the Parliamentary Secretary to some remarks in the report of the Chief Medical Officer of Health for 1925–26:It is regrettable to have to record that the spread of the disease in the north-east counties was due to some extent to the failure of two sanitary authorities and their medical officers of health to take adequate steps to control the disease within that district.What has the Minister done about that? Has he taken any action whatever? Have those medical officers of health been spoken to, or reprimanded, or have they been dismissed?Ono ill-administered district in the Tyne-side area caused the malady to spread into eight other districts in the vicinity.Has anything been done to that local authority?Delay in the removal to hospital of a considerable number of cases inevitably led to the spread of the disease from the patients left at home.These are extracts from the report of the Chief Medical Officer of the Ministry of Health. I would like the Parliamentary Secretary to tell the Committee whether the Minister has taken any definite action upon this very serious report? If the medical officers in certain districts are neglecting their work, because that is what it comes to, the Minister of Health, seeing that he pays half the salary of these officers, ought to take steps to regulate the situation 469 reported to the Department that a certain official has not carried out his work properly, it is the bounden duty of the Ministry to interfere, and either see that an improvement is brought about or that the man is dismissed. I am speaking against my own profession, but no medical man has a right to undertake definite responsibilities affecting the health of the community unless he discharges his duty to the best of his ability. I recognise that in certain cases medical officers have to deal with recalcitrant local authorities or boards of guardians, but a medical officer of health has a definite responsibility to the community, and the Minister of Health has a definite responsibility to Parliament to see that he performs his duties properly.
A few days ago I asked a question about Government lymph and suggested that it should be sold to all practitioners who desire to use it. My reason for doing that is that Government lymph is an exceedingly good lymph, very pure, and undoubtedly the best lymph in the country. It is a very successful lymph, because in 1924 there was a case-success of 99 per cent. with primary vaccinations, which is a very high percentage. My experience in practice was that it was impossible to get lymph from any firm which was comparable in any degree to the Government lymph. If you had vaccinated a child and the result was unsuccessful, you said the child was not susceptible to vaccination; perhaps you persuaded the mother to allow a second or third vaccination, and still the child appeared to be not susceptible, and that created a sense of false security both in the doctor and in the mother. Later I was appointed a public vaccinator, and I started to use Government lymph. I got magnificent results with all my public cases, practically speaking never having a failure. In a very short time I found my private patients coming to me and saving they would rather be vaccinated with Government lymph. I told them that if that were done, they might have to allow the child to be inspected later on by a Government Inspector. They said, "We do not mind that in the least," and before I retired from practice every one of my vaccination patients was being vaccinated with Government lymph. [HON. MEMBERS: "Nationalisation!"] It was not nationalisation. I had absolute faith 470 in that lymph. I felt perfectly certain if I vaccinated a child with that lymph and it did not "take," that the child was not susceptible, and it was the only time I was confident.
Why should not other doctors have the same opportunity of using Government lymph? Over and over again patients were sent to me by other doctors, who said, "We cannot get Government lymph; we have not any confidence in the lymph we are getting; will you be good enough to vaccinate the patient?" It was my duty to do so, and I was only too pleased to do it, and I would suggest to the Minister, now that he is back in his place, that it would be a very useful thing to allow any medical man in the country who desires to do so to purchase Government lymph. The sense of security, both to the doctors and the patients, would be well worth it. In addition to that, the Department would probably make a very great profit. When going over Mill Hill Hospital a month or two ago, I found they made absolutely all their own vaccines and sera, and they made a profit of nearly £7,000 a year by supplying the Services. In view of the danger which overshadows this country of an epidemic of small-pox, which may be virulent in character, with a very high death rate, it is the duty of the Minister of Health to do all he can to prepare for the emergency by getting people vaccinated now, and not put the question off, as I suggest he is doing by the appointment of a Committee on Vaccination.
The Government will reply that they must await the Report of this Committee. I say that is a false position to take up. Smallpox is in the country—it is spreading throughout the country, and before that Committee reports we may have a very serious epidemic. No one knows when we are going to have it. A serious type of smallpox may break out tomorrow, and I would respectfully urge the Minister of Health to reconsider the question of allowing Government lymph to be supplied to private practitioners upon payment, because I am absolutely convinced that it is the best lymph in the country, and in practically every case where it is used it is successful. [HON. MEMBERS: "Socialism!"] That is not Socialism at all; it is simply common sense, when practical experience has proved that it is a good remedy. Vaccination 471 is the only remedy for smallpox. It has the overwhelming support of the medical profession throughout the world. We show ourselves the weakest country in the world in allowing conscientious objections. It is not found in other countries, and the sooner the people of this country realise that under strict antiseptic precautions there is practically no danger in vaccination, but that, on the contrary, vaccination will prevent smallpox, we shall get back to the happy stage which we had reached some years ago, when smallpox was practically wiped out from this country, as it has been from so many other countries. I hope the Minister of Health will use all the powers the law has given him to see that the population of this country is efficiently vaccinated, Which they are not at the present time.
§ Dr. DRUMMOND SHIELS
I feel a great temptation to refer to many of the subjects which have been raised in this Debate. I should like to have spoken on housing, which was dealt with so well by the hon. and gallant Member for St. Albans (Lieut.-Colonel Fremantle), but as a Scotsman I do not like to interfere in the housing affairs of England. I would only say that from his remarks it is quite evident that, in England and Wales, as certainly in Scotland, there is no room for complacency about the housing situation. I was very glad indeed to hear him emphasise the point that the position is still very serious. I should like also to have spoken on vaccination, a topic which was interestingly treated by my colleague the hon. Member for Royton (Dr. Davies). He did not like the suggestion that he was emphasising the principles of Socialism, and said it was not Socialism but common sense. The two things are exactly the same.
§ Dr. SHIELS
I was going to take advantage of the opportunity to say that when it comes to matters of health, and other questions of vital importance in peace or war, we as a country, whatever Government may be in power, take things out of the hands of private enterprise in order to see that they are well done. However, I shall not rub in that point, 472 because I want to take advantage of the quiet and peaceful atmosphere of the Committee to bring forward another subject which has been recently engaging the attention of the Ministry. Before I leave the subject of vaccination, however, may I observe that while I think it is true to say that the medical profession as a whole still believes very strongly in the efficacy of vaccination, I also think that there is some change of opinion in regard to infant vaccination. I have come to the conclusion, seriously, that the time is ripe for another inquiry into the subject of vaccination law. In some respects there is considerable laxity, enforcement is not easy, and I think most medical men will welcome another impartial inquiry so that we may get the vaccination laws put upon a modern and proper footing.
The special subject to which I wish to draw attention is that of the rheumatic child. This matter has been an anxiety to the medical profession for many years and recently active steps have been taken to grapple with the problem. The British Medical Association set up an expert committee in 1924, and this committee has issued two reports, one last year and one this year. The Medical Research Council has also been studying this subject, and has investigated the conditions among rheumatic children in London and Glasgow, and that Council has also published an interesting report. Sir George Newman and many medical officers of health have repeatedly called attention to the ravages of this disease and to its very important social and economic effects. Broadly, the facts are that acute rheumatism or rheumatic fever in children is followed in a large number of cases by heart disease, which if it does not end fatally. may leave the child more or less incapacitated for the ordinary occupations of life. While there are no figures covering the whole country, it has been shown that in particular areas 10 to 15 per cent. of the children at 12 years of age are affected by rheumatism. Therefore, the number in the country as a whole must be considerable, and the consequent suffering to individuals and the economic loss to the country from the inability of many of these children to support themselves afterwards must be very great.
It is a tragic spectacle to see these children come to adolescence, carry on 473 at ordinary work and then break down and have to go into hospital. From hospital they go back to work again, and the same process is repeated, and unless they are fortunate enough to get a very long rest or have a very light occupation, this ends in early death. The prevention of the disease is, of course, of the first importance. Unfortunately, the specific organism has not yet been discovered. Frequently the condition is associated with sore throat, adenoids and enlarged tonsils, and ample facilities for the treatment of these conditions are very desirable. It seems to be the case that environment has the main effect in this disease. It rarely attacks the children of the well-to-do, and its incidence is almost entirely on poor children. The very poorest children, strange to say, do not suffer nearly so much as the class immediately above, probably because in the very humblest sections of the population there is a very drastic system of survival of the fittest, and those who do survive have a great capacity of resistance.
There is no single feature of the environment which one can say is really the main cause of the disease. The question of housing, especially of the dampness of houses, school conditions, and many other things have been investigated, but there has been nothing very definite discovered in regard to the particular items of environment. There is also no convincing evidence of heredity in connection with this disease, the similarity of environment and contagion probably accounting for the cases which appear to suggest heredity as a factor. I trust the Minister will encourage, as I know he has already done, the Medical Research Council to go forward with research into this disease, for until we discover the specific cause we shall not be able to have effective prevention, which is what we most seek. Until we have that prevention we must make all necessary arrangements for dealing with those who actually have the disease.
Not only are medical men and those bodies I have mentioned taking a keen interest in this matter, but I am glad to notice that London is giving a very good lead to the country. I think it is to the credit of the London County Council and the Metropolitan Asylums Board that they have given this lead 474 to the whole country by the provision of special hospital accommodation for cases of acute rheumatism. The London County Council, when deciding this matter, had 1,500 cases of children absent from school on account of these rheumatic conditions. They had conferences with the Metropolitan Asylums Board and the Ministry of Health, and the latter first sanctioned the provision of 60 beds, then 16, and I understand that 350 more are at present being arranged for at Carshalton. It is estimated that no less than 10,000 children in London are suffering from these conditions, and that implies 25 per cent. of chronic invalidity. Surely it is only humane and wise to deal with this matter as the London County Council are dealing with it. This disease can only be effectively dealt with by establishing such special rest homes as they are setting up. For the interesting thing about this condition is that when it arises, if sufficient rest is available and the child is not hurried back into activity prematurely, there is an excellent chance of its escaping the development of heart disease and the consequent permanent incapacity.
While this is the position in London, I would like to ask the Minister of Health or the Parliamentary Secretary what is the position in the provinces? Are the local authorities being urged to provide similar treatment? Because this problem exists in every town and every village throughout the country. We know that many local authorities have not the facilities or the accommodation except in connection with isolation hospitals which are not particularly suitable for this purpose. Many of them have no money to spend in providing new accommodation, and a large number of these cases have to be treated throughout the provinces in voluntary hospitals, either those for sick children or general hospitals. A few years ago the Ministry granted £500,000 to voluntary hospitals. While we await some satisfactory method of dealing with voluntary hospitals, I would like to know if the Minister of Health has considered, or would he be prepared to consider, the giving of a grant earmarked for these cases to enable the provincial hospitals to provide extra accommodation of this special kind.
I know it is a rather depressing thing for him to ask the Minister of Health to provide more money, but I do know 475 that he is interested in this matter and that he has co-operated very cordially with the London authorities in providing accommodation for these cases, and I am anxious that he should extend that encouragement and assistance to other parts of the country which are equally in need of it. It cannot be too often emphasised that the percentage of cases developing heart disease can be greatly reduced. There are good authorities who declare that at present 50 per cent. of cases of acute rheumatism in children develop heart disease, and that must be greatly brought down. Another suggestion has been made that this disease should be made notifiable. It is well known that in all matters of research, statistics are most important, and these particulars are difficult to get unless the diseases are notifiable. Hospitals also should arrange with local medical practitioners for the after care of these children when they leave hospital. The children leave the hospital and are better for a time, but they are often allowed to indulge in activities which do them great harm, and which medical after care would prevent.
I should like to see this subject linked up with that of the orthopedic treatment of children. I know that in this matter also the Minister of Health has been co-operating with county and county borough authorities. The treatment of orthopædic cases is that of those who are externally disabled while the acute rheumatic children are correspondingly internally disabled. These two questions are of great importance not only from the humane point of view, but also from the economic point of view, and it is gratifying to think that here humane and economic considerations do not clash. It has been estimated by the best orthopædic authorities—we must pay in passing a tribute to Sir Robert Jones for the work he has done on this subject—that 85 per cent. of these disabled children, many of whom are put into cripples' homes and stay there all their lives or languish at home, a burden to themselves and to the community, could be rendered capable of self-support if taken in hand soon enough, and given the wonderful surgical treatment which is now available from orthopædic surgeons. I am grateful for what has already been done, but it is still very little, and I ask the Minister of Health 476 to extend his activities and his stimulation to other parts of the country. I would like to say a word in regard to the matter of maternal mortality about which the hon. Member for Westhoughton (Mr. R. Davies) spoke this afternoon. We have recently passed, both for England and Scotland, a Maternity Homes and Midwives Bill which we hope will be of some assistance in the reduction of this mortality. It is certainly a very difficult problem, and it is not altogether easy to understand why the figures remain as they do. I think we must agree however that the pre-natal condition of the mother has a great deal to do not only with maternal mortality but with infantile mortality. The largest individual causes of infantile mortality are premature birth and congenital debility. The child is born too soon, or in such a weak condition that it cannot survive the contact with its new environment, and it follows, in that case, that the mother's condition has probably been unsatisfactory. Greater attention to the ante-natal condition of the mother and especially to seeing that she has adequate nourishment, would almost certainly help to diminish maternal mortality. We must do something to improve the figures, as they are a great reflection on us. We have managed to reduce considerably practically all other mortality figures, and it is unfortunate that on this one point we seem to have failed. We have not yet got the whole reasons, although we know of many of the contributory causes.
In regard to cancer, about which the hon. Member for Royton (Dr. Davies) as well as the Minister, spoke, I should like to ask the Minister what he thinks about the question of publicity. The hon. Member pointed out, as the Minister has done before, that cancer, in the very large majority of cases, is perfectly curable if it is surgically treated at an early stage. People, however, became frightened at the idea that they have cancer, refuse to see a doctor, and in the end are taken in hand when it is too late to do anything effective. Some local authorities in this country—and in America this has been done to a very great extent—have launched a publicity campaign. They have pointed out to their citizens the early symptoms of cancer, telling them in simple language what are the first signs and emphasising the ease with 477 which a cure can be secured if early treatment is sought. I should like to ask the Parliamentary Secretary when he replies, or the Minister, if the Ministry has ever considered this point, and if they have ever thought of urging local authorities to give this information. Some people say it would spread a fear of cancer, and do more harm than good, but that is not the belief of the surgeons or of the people who are most in contact with this disease, and it has not been the experience of the local authorities when it has been tried. I do think that when you have the facts that early treatment is so satisfactory and that any number of people are not coming for treatment because they do not know that, it is obviously a case for publicity and I would like the Minister to consider that.
I was very glad to hear the Minister's reference to the international aspect of medicine and to the League of Nations, and I was very glad to hear about the new hospital which—although gifted by some of our cousins across the sea—we gather is to be maintained by the State. The hon. Member for Royton was anxious about that. But it only shows that no Government, of whatever colour, in this country can go on without having to approximate to some extent at least to our position. It is very desirable that we should make, as we are able to make and as the right hon. Gentleman pointed out we have made, a good contribution to the international common pool of health activity at Geneva. There we have, amidst all the other rivalries of nations and the sordid competitions of the different peoples, this nobler rivalry and competition—the rivalry to contribute the most possible to the universal store of the knowledge of the laws of health.
§ Mr. HARRIS
We have just listened to a very interesting speech raising very important matters dealing with the Ministry of Health. We have to remember that the Ministry was created out of the Local Government Board in order to accentuate the importance of health. It is quite right that medical problems should be brought before the Committee, but, after all, very much of the disease in this country—and the Minister of Health would be the first to admit it—is caused by unhealthy conditions and environment. I was very glad that the Minister took the opportunity to emphasise the importance 478 of housing. I want, before the Parliamentary Secretary replies, to switch the mind of the Committee back for a few minutes to housing. Fortunately, I think I can say, without much fear of contradiction, that housing is becoming more and more a non-party question. We are all agreed as to its importance, and as to the evils of overcrowding, its demoralising effects, and the need for a forward policy on the part of every Government. Every Government and party have tried their hand in legislation. At the present time we are in the serious danger of being too satisfied. The danger is largely caused by the fact that at the moment there is considerable progress being made in building. The building that has been done by all agencies is better than for some years past, and, of course, that particularly applies to private enterprise. That might have the effect of lulling the country, the Government and the local authorities into inactivity, and nothing could be more disastrous than that.
It is just as well to recognize—and the Minister will confirm this—that certain local authorities in various parts of the country have more than fulfilled their duty. They have had a housing programme on a large scale, and have made preparations years in advance, bought land and established a staff on such a scale that we can say they are doing their duty. But the right hon. Gentleman would be the first to admit that, while some are more than doing their duty, others are still lagging behind. What I suggest to the Minister is that, while it is his duty and responsibility by all means to praise and to bless those local authorities who are carrying out their functions under the various Acts of 1923, 1924, his own Act and Dr. Addison's Act, which is now practically dead, and the Wheatley Act, he should stimulate and egg on all those who are failing in their duty.
I am not going to attempt to deal with areas outside London, because London itself is quite a problem on its own. Greater London, with a population of 7,250,000, does present a problem that is a serious one quite worthy of the attention of this Committee. Here you have in London an example which is typical of the rest of the country. Some of the local authorities are very active, and others are very much behind. I 479 want frankly to pay a tribute to my old authority, the London County Council, and I can say that with the greatest frankness and sincerity because I belong to the Opposition side. It has been my business to criticise, and the majority is that of which the right hon. Gentleman is so distinguished an ornament. There is a Conservative majority and I want to be fair. It is largely due to the energy, activity and imagination of the present chairman, whose distinguished predecessor is sitting opposite, and who did his share and who would be the first to recognise that Colonel Levita has more than consecrated his work and has done his part on the London County Council. Even its severest critics will say that the council has done more than its share in trying to solve the housing problem, both by building houses and to some extent by slum clearances, though in the latter respect we have still much leeway to make up. But while the London County Council have done their part, the other local authorities in the county, outside the London County Council, have largely gone to sleep. I hope that when the Parliamentary Secretary replies he will tell us what he is doing to stimulate the other authorities into activity. Is he just praising and blessing the London County Council for doing their job, or is he doing anything to stimulate other agencies to do their share?
In 1922 the peak load was reached in activity. That was the time when the Addison Act was in full blast before the economy machinery had been set to work, and there you had, not merely the London County Council producing some 5,000 houses in that year, but the local authorities in London and the borough councils and county councils producing 2,000 houses, and the outer authorities 4,000 houses. In 1926—and I have the figures pretty well up to date—the London County Council reached the peak load of 4,600 houses, but the other local authorities in London, the borough councils and the corporations—and I complain particularly about the City Corporation and the city of Westminster—through apathy and inertia sank down, as compared with 2,000 In 1926, to a figure of 900, while the outer authorities, the great dormitories and 480 those outer districts which are rapidly developing and which have still plenty of land, sank from 4,000 to 2,700. These figures are really worse than they actually look, because some few of the districts are showing great activity, while others are doing practically nothing at all. Here at our very door the wealthy city of Westminster, second in wealth to almost no part of London, has practically done nothing. There have been certain revelations, and there was a revelation in the "Spectator" this week, showing the terrible housing conditions in the city of Westminster. I know it will be argued, with some reason, that land is so valuable that you cannot afford to use land for housing purposes, but while land is valuable the assessable value is high, and the produce of a penny rare is great. I maintain, therefore, that the corporation can well afford to deal with their own slums and make proper provision for housing in their area, at any rate to some extent.
About my own district of Bethnal Green, I can speak with some freedom, as I do not support the majority on the council. They have done their share and built all they could, and though they have been faced with the same difficulty in finding land, wherever there happened to be a quarter of an acre or a piece of land, they have taken the opportunity to build houses. The City of Westminster ought to be doing something of that kind, and even the great City Corporation might be doing something to make its contribution. This problem will only be solved by every organisation and every agency pulling its weight. I know that the anxiety of some of these rich districts is that private enterprise—
§ Whereupon, the GENTLEMAN USHER OF THE BLACK ROD being come with a Message, the Chairman left the Chair.
§ Mr. SPEAKER resumed the Chair.