§ Order for Second Reading, read.
§ Mr. BARCLAY-HARVEYI beg to move, "That the Bill be nine read a Second time."
The House has already been occupied with a Measure possessing a considerable medical interest, and it is perhaps unfortunate that I should have to follow it with a Bill dealing with another medical topic. The object of this Bill is to reduce maternity and infant mortality in Scotland, an object which should command universal sympathy in this House, particularly so as, unfortunately, there is very great reason to take steps to reduce it. As I have not much time I will only touch upon the principal points. The two objects of the Bill are, firstly, the registration of midwives, which is an attempt to reduce the number of midwives who are not qualified; and, secondly, the registration and inspection of maternity homes. As regards the question of midwives, the position at present is regulated by the Act of 1915. In that year two Acts were passed, one of them being the Notification of Births Act, which enabled the authorities in Scotland to make arrangements for expectant and nursing mothers, and also the Midwives Act, which requires midwives to be registered and supervised by local authorities under the supervision of the Central Midwives Board. Under those two Acts certain local authorities took steps which have had the very satisfactory result of reducing the infantile death rate. I am sorry to say that the death rate is still high in England.
Nevertheless, steps have been taken to reduce it, but, unfortunately, they have not reduced the rate of maternity mortality, and this was so unsatisfactory that a Committee was appointed to in 2394 quire into this question, and that Committee was presided over by Lord Salvesen, and some of the figures which they have given in their Report are extremely interesting. They took the decennial period from 1855. In the first period, from 1855 to 1864, the average death rate per thousand births was 4.9. In the period from 1915 to 1922 the death rate has increased to 6 2. Those figures are, possibly, not quite comparable, because the first figures were based on less accurate information than the last, but, at any rate, they show that this terrible evil is not decreasing in Scotland, but is actually increasing. It is not easy to give accurate figures in comparison, because in Scotland they are taken on a different basis than that which is adopted in other countries. I believe that some reduction in this rate of mortality is possible. Lord Salvesen's Committee makes the definite statement that the evidence they received was unanimous on the essential point of this Bill. The Committee made a variety of recommendations, and two of them definitely call for legislation on the lines of this Measure. In addition, the proposed authority was recommended by the Central Midwives Board in 1925 and 1926. Let me remind the House that the birthrate in Scotland is rather over 100,000 per annum, therefore it will be seen that the death rate is no less than 600 women a year from the cause with which we are dealing. I think that itself is sufficient to induce this House to take any steps it can to reduce such a state of affairs.
The Bill has two principal objects. The first is, to attempt to reduce the number of unqualified midwives who are practising. That is dealt with in Part I of the Bill. The second object is to ensure that maternity homes are properly conducted, and that is dealt with in Part II of the Bill, Part III is general and deals with the title and so on. Part I follows Recommendation No. 9 of Lord Salvesen's Committee, and it is intended to strengthen the Act of 1915. That Act had as its intention the same point that we have in this Bill this afternoon. The desire is to eliminate, if possible, the unqualified midwife. As a matter of fact, it has not been found easy to work it. It has in it the expression
Habitually, and for gain?'2395 and there has been considerable difficulty found in administering the Act because of those words. Therefore, the first intention is to get over that difficulty and to try and tighten up the position. Of course, everybody knows that there are cases in which it is not possible to get a properly qualified midwife. Perhaps a case occurs in some far distant district, or perhaps it is a matter of urgency which could not have been foreseen. We all know of cases of that sort and to cover those cases words are put into the Clause which I am advised will leave sufficient elasticity so as not to effect hardship from that point of view. I do not think I need attempt to go through this Bill Clause by Clause. There are perhaps one or two more important points. Clause 3 is important, because it entitles a midwife who has been suspended from work on account of the possibility of her carrying infection through no fault of her own to he paid during the time which she is actually standing off. That is perfectly reasonable and fair, and I do not think anybody would object to her receiving recompense for being unoccupied through no fault of her own.The other Clauses are more or less self-explanatory. I should like to say a word or two on them, but in view of the time and the fact that I must be short I will go straight on the Part II. Part II, in brief, simply insists that Maternity Homes shall be registered, and it lays down a penalty for anyone who fails to register and yet carries on a Maternity Home. I am not going to deal with the further Clauses of that Part, because they are practically all machinery. I do not say that the Bill as it stands is perfect, and I agree, if the House allows it to pass its Second reading this afternoon, that in Committee we may be able to improve it. Those are the two main objects, and those, briefly, are the reasons which have induced us to bring it forward today. We believe that there is in Scotland a great evil to be cured. The promoters think that the Bill will do something to cure that evil. It may not do all that hon. Members would like or tackle some of the vital reasons for this terribly high death rate from which we suffer in Scotland, but it is at least a Measure in the right direction, and, as such, I commend it to the House in the 2396 hope that it will be given a Second Reading so that we may take it to the Standing Committee on Scottish Bills where Committee points can quite properly and no doubt will be dealt with.
§ Sir GEORGE BERRYI beg to second the Motion.
The Bill which my hon. Friend has brought before the House is one on which I think it is not necessary to speak at any length, particularly as the time is short, and also because it may be regarded, probably, as, a non-contentious Bill. My hon. Friend has described its main objects very clearly and fully. The Bill itself consists of two parts, which, although they may be conveniently taken together, I do not consider to be essentially similar; in fact, in one important respect they are dissimilar. Part I of the Bill is a matter of public health. Part II is really a matter more of public propriety. I cannot claim to have any experience on either of these subjects, but, as a Member for the Scottish Universities, a great number of my constituents being medical men, I think I may be properly in a position to explain to the House what is the feeling of the medical men in Scotland on this matter.
I can assure the House, having made careful inquiry, that the medical profession in Scotland approves entirely of the Bill. As regards Part I, it has been carefully considered by the Central Midwives Board, and it also came before the Consultative Committee of the Board of Health. In the earlier draft which was considered, there were some minor and quite immaterial details to which exception was taken, but in the final draft these objections have been met, and one can now state definitely that, both in principle and as to detail, the Bill meets with the approval of the medical men of Scotland. As regards maternity homes, that matter is concerned with a social reform, and, as such, I think it must commend itself to every Member of this House. It is perhaps unnecessary for me to add that the general opinion of the Scottish medical graduates is that the reform it is proposed to enact is one which is wholly desirable and highly necessary.
§ Mr. MAXTONI rise to say a word or two on this Bill, at this very late hour in the day. I am afraid it is very difficult for myself and some of my colleagues to 2397 allow an important Measure of this description to receive a Second Reading in this House after such a very inadequate discussion. The Bill seems to bear all the marks of being a Government Measure introduced under the guise of a private Member's Bill. If the Scottish Office are concerned that there should be some amendment of the principal Act of 1915, it seems to me that the right and proper procedure would have been for the Scottish Office to get the Cabinet to accept a Measure of this description as a Government Measure, and bring it forward in the ordinary programme of Government business. I do not see anything in the Bill that is of sufficient importance to justify us in assuming that it will bring about any of the very desirable changes the hon. Member for Kincardineshire (Mr. Barclay-Harvey) would indicate that it would do. There is absolutely nothing new in principle in the Bill beyond what was already in the principal Act. I see there is a regulation about providing qualified midwives. Does the hon. Member really believe a badge on the outside of a midwife's uniform—
§ Sir G. BERRYWhat about the second part?
§ Mr. MAXTONI am going to deal with the first part first. I do not see how a badge on a midwife's uniform is going to reduce in any degree the appalling maternity and infant death rate of Scotland. I agree that Scotland's position in the matter is disgraceful and shacking, and reflects no credit on the people who have been responsible for the government of Scotland in the past. An examination of the figures of infant and maternal death rate shows quite clearly that the incidence of the death rate is in the poor quarters of our, big cities. In one ward in my constituency you have an infant death rate rising well over 100 per thousand per annum. At the other end of the same city it is reduced as low as 32 per thousand. Does a badge on a midwife's coat account for the difference, which the hon. Member and the Scottish Office know is due to the horrible housing conditions? Our city medical officers have proved the most direct association between this death rate and the size of the house the person is living in. In the single and two-apart- 2398 ment houses, it rises over the hundred, and in the houses where there are five or more apartments, it drops down into the twenties. This trivial thing will have absolutely no effect. Combined with the size of the house is the incidence of poverty among the people. I agree that a well-conceived Measure along these lines would be doing something if there were an attempt in the Bill to attract midwives to the service of the local authority and assure them of a secure income in their profession. The work of the midwife is one of the most important tasks that any woman could take on.
The Act of 1915 makes arrangements for registration and for training—inadequate arrangements I admit—and I do not see that the arrangements outlined in this Bill are improving the position in any degree. The Act imposed upon the Glasgow Maternity Hospital and similar institutions in Edinburgh, Aberdeen and Dundee the duty of giving training to these people. The Government imposed this duty on these public institutions, which are entirely voluntary, and up to now, as far as I know, have made absolutely no allowance out of public funds for the extra responsible duties that are taken on, although the corresponding function carried out by hospitals in England for the training of maternity nurses is very definitely subsidised out of public funds. The same job in England is regarded as a national responsibility whereas in Scotland the duty is put on maternity hospitals, and they are supposed to get the money for the training of the nurses anyway they please. This has imposed a grievous burden on the Glasgow Maternity Hospital. It is no good setting up systems of training and laying down all sorts of rules and regulations about the registration and certification of these women unless you are going to attract into that profession-I use the word advisedly—of maternity nursing, a good class of women—women who are going to devote themselves to this work and are prepared to have the necessary courses of study which will fit them for the work. You are not going to attract the proper type of person unless you make some arrangement whereby the remuneration will represent at least a decent living. Under the original Act, in so far as this Bill does anything to amend it, the maternity nurse can get 2399 but the scraps of a living out of the odd jobs she can get. It is private enterprise of an absolutely unregulated type.
The hopelessness of attempting to consider a Bill of this importance at this hour is apparent. It is 10 minutes to four. The Secretary of State for Scotland, or the Under-Secretary, ought to say something and give the House some guidance. Other hon. Members on this side wish to speak and hon. Members opposite also wish to speak, yet we are asked to give a Second Reading to this important Measure, although there is no opportunity for any hon. Member having reasonable time to state his views. Take the first Clause of the Bill. I will quote it for the benefit of those English Members who generally come into the House and, finding it is Scottish business, say: "Oh, this is about Scotland. We are not interested. Therefore we will vote for the party." The first Clause is to apply a penalty to certain persons. One idea of hon. and right hon. Members opposite seems to be that to find out a crime and inflict a penalty is one way of bringing about wonderful changes in this country. They say: "Find out something criminal." Last week we had the question of sedition and blasphemy before the House, and the cry was, "Find out a crime. Lay clown penalties. Get some people mulcted in a certain amount of money, and you will remove this and other evils from our midst." The first Clause says:
If any person being either a male person or a woman not certified under this Act attends a woman in childbirth otherwise than under the direction and personal supervision of a duly qualified medical practitioner," etc."Persons not certified under this Act." Hon. Members are not able to visualise life in the average working class tenement in Glasgow. When the emergency for which a midwife is required happens in the ordinary home, someone rushes out to the nearest neighbour to come in and assist. Probably that nearest neighbour has to perform all the duties which in a better-off household, would be performed by a doctor and a trained nurse. She has to put through the whole of the doctor's duty and the duty of the trained nurse before it has been found possible to get professional people on the spot. In those circumstances, this Bill says that that 2400 other person, that woman neighbour, who has run in out of decency to lend her assistance to her neighbour in need, must prove that she acted in a case of sudden necessity. The Bill says…that person shall, unless he or she satisfies the Court that the attention was given in a case of sudden or urgent necessity, be liable on summary conviction to a fine not exceeding ten pounds.It is quite wrong that the onus of proof should be put on the woman. The onus of proof should be on the police or the authorities to say that the woman is doing this habitually for gain and not merely as a case of emergency.
§ The UNDER-SECRETARY of STATE for SCOTLAND (Major Elliot)The hon. Member says quite rightly that he would like very much to have some guidance. If he affords me the opportunity, I shall be glad to give it.
§ Mr. MAXTONVery well, I have done.
§ Major ELLIOTThis Bill is backed by Members of all parties, including the hon. Member who held my position in the Labour Government. The name of the hon. Member for St. Rollox (Mr. Stewart) will be found at the hack of the Bill.
§ Mr. MAXTONI do not quarrel with names. I quarrel with the facts that are in the Bill.
§ Major ELLIOTQuite so. As the hon. Member said, the time at the disposal of the House is short, therefore we wish to give an indication as to whether the matter has been thoroughly considered. This Bill is backed by a former Member of the Labour Government who was responsible for the health of Scotland and who, certainly, is not under any misapprehension as to Government Bills or non-Government Bills. It is also backed by the hon. Member for Midlothian (Mr. Westwood), therefore I think it is possible that this Bill might have a Second Reading, so that it can go to the Scottish Standing Committee where all these points can be thrashed out. The whole of the points mentioned by the hon. Member can, I think, be best examined and considered in Committee, and I hope, therefore, he will allow us to have the Second Reading. We can discuss in the Committee the question of infantile mortality and all the other points, and I 2401 agree that the more these matters are discussed and examined the better. I do not think we shall gain anything by carrying on this Debate now. It would be far better to continue it in the proper place, which is, the Scottish Grand Committee. If we reject the Bill now we put a period to the discussion of some clamant evils, which we are all agreed should he remedied although we may be divided as to the best remedy.
§ Mr. MAXTONIf we agree to allow the Second Reading this afternoon, does the Under-Secretary's assurance mean that we shall be able to consider the payment of grants to Scottish Maternity Hospitals who are training midwives?
§ Major ELLIOTAs the hon. Member knows, the contribution from the Child Welfare Centres to the Glasgow Hospital already made amounts to £5,000 year. These additional grants may raise certain questions. Hon. Members will be able to move the rejection of the Clause, on the ground that the grants are not sufficient, and there will be an opportunity for the discussion which he desires. It will not be possible to move any charges on the subject without a Financial Resolution, but the discussion can be most usefully pursued in the proper place.
MAXTONOne further point. Can the Under-Secretary tell me what is to prevent the Scottish Office bringing forward this Bill as a Government Measure?
§ Mr. BUCHANANI agree with the Measure, but I should like to have some assurance that Clause 1, which is a very-serious proposal, will be considered, with a view to some modification in Scottish Grand Committee.
§ Major ELLIOTI am able to give the hon. Member an assurance on behalf of the Secretary of State for Scotland that he will see that all these points are carefully examined.
§ Mr. HARDIEClause 1 provides for the employment of uncertified nurses. I want to know if that is in keeping with the figures that have been given?
§ Major ELLIOTI think that is Clause 2; and it merely deals with the question of students in training.
§ Question put, and agreed to.
§ Bill read a Second time, and committed to a Standing Committee.