HC Deb 25 January 1929 vol 224 cc495-532

Amendment made: In page 60, line 14, leave out the word "quinquennium," and insert instead thereof the words "fixed grant period."—[Mr. Chamberlain.]

The CHAIRMAN

The next Amendment on the Paper—in page 60, line 23, at the end, to add the words: Provided always that this section shall apply also to the County of London. —is out of order. The Clause deals with districts the councils of which have established maternity and child welfare committees, and there are no such districts in London.

Motion made, and Question proposed, "That the Clause, as amended, stand part of the Bill."

Miss LAWRENCE

The object of this Clause is an excellent one, but the question which is vexing some of us is this: Where is the money to come from? The Clause proposes, in the case of any county in which there is a district the council of which shall have established a maternity and child welfare committee, that the Minister shall have power to make a scheme with the council for increasing the sum set aside out of the county apportionment in respect of the district by such amount as he thinks fit. That is to say, the Minister has a sort of partial compulsory power. I want to say at once that if this were a proposal to make this service compulsory, it would have our support provided it was aided by a Government grant, and provided also that some preliminary measure of rate relief on a very large scale had been passed, but what is proposed here is to give the Minister power, wherever in a county any authority has shown any willingness in the matter, to force the county to spend as much as may be neces- sary out of the county apportionment on this service. The county apportionment is in the main, with regard to the largest item, a compensation for rating which has been taken away, and the rest of it comes from certain grants which already exist, while there is in addition some new money.

Supposing the Minister, for any good purpose, set aside a large sum for a new service out of the county apportionment, there would be so much less in that apportionment, and this service which we are considering now is a service of the most necessary character, which, if properly carried out, would involve very large sums of money. The number of districts and counties which have taken the preliminary step of establishing maternity and child welfare centres is very large indeed, and their organisation would mean a very great deal of money. Under this head you have already such institutions as day nurseries, hospitals, and institutional treatment, but. institutional treatment for this class of service is still in a backward condition. You have, for instance, only 2,460 local authority beds at maternity hospitals, and only 122 local authorities who have got institutional treatment for puerperal fever, and only 252 that have made any arrangements for special nursing. There are only in all 98 day nurseries in England and Wales. This is not a cheap service, and, as I have said, needs development. Surgical tuberculosis is a disease which comes very commonly in children under five and which, if it is to be regulated at all, needs early treatment. We have, therefore, a great deal to do and an enormous amount of extra money can be expended.

We ought to spend something like £4,000,000 or £5,000,000 extra in order to deal with this question. There is an enormous work to be done, but it is a service which, if done, will improve the health of the nation beyond measure, and I am all in favour of very much more severe compulsion than is proposed under this Clause, provided that the State does its part and does not throw any more expenditure on the already overburdened rates.

Where is the money to come from? Whenever we approach this question, we are always told by every Minister who has, so to speak, an axe to grind for his own Department, that the additional money will be enough to develop the service he is interested in. We had the Minister of Transport saying that the new money—he rather over-reckoned it— would suffice for a highly improved system of roads, and you can see the Minister of Transport, in his mind, covering England with a network of beautiful roads and applying every penny of extra money in that way. We had the other day a Debate upon other health services, namely, mental deficiency, which is very backward, and tuberculosis, which is also very backward, and the Minister of Health pointed out how very much more money ought to be spent on those services.

The right hon. Gentleman apparently looks at the new money as something extra which he is giving to every locality, but the new money does not, in the opinion of the localities, cover even the future loss of rates that is expected. When you say you are going to put this new service, without any additional financial provision, on to the local authority out of the county apportionment, I say that you are imposing a very great burden on all those authorities which have begun to do something. Those counties where nothing at all has been done will be free to go on doing nothing; it is only the willing horse that will be whipped. Speaking on this question, an hon. Member opposite said it was perfectly well known that when the Socialist party came into office it would put up the rates, and, therefore, it was hypocrisy for us to object to an increase. That observation was, I think, 20 years behind the times. It is perfectly true that in the smooth days before the War when Mr. John Burns was standing for Battersea we said wisely that it would not hurt the rates to spend more money, and I should say if I were back to 1881 that the rates could stand a good many more pence. But since the War our one desire has been to get money off the rates. The first part of our programme would take nearly £50,000,000 off the rates, and if that were done, and the needs of the authorities for extra grants met, then, I think, these services of all others might properly be made compulsory, not merely on the local authorities who have taken the preliminary steps.

What is the situation? A district in a county may be backward. The Minister will take power to make the county give that district as much as he thinks proper out of the county apportionment. If he were doing all he ought, and all that we wish, he would make the county apportionment a very large amount, because the county will be left with so much less to bear the loss of the rates on education, police, roads, and other services. Otherwise, one of two things must happen. Either the county for its own purpose will have to make up the difference by laying another burden on the shopkeepers and so forth, or else the county will economise on the social services. It will not be able to economise on the police, but it will be able to economise on education and on roads, and on all the other services. Therefore, though this reform is a partially good thing in itself, it does mean that it is carried out in the long run at the expense of the ratepayers of the country.

I am trying to put our point as clearly as I can. We do not in the least object to a large increase in health services. We do not object to vast amounts of money being spent on the health services. The question is, who is to spend the money? Our one objection to this Clause is that it contemplates an extension of health services in certain districts which has to be paid for out of the county apportionment. If we had a great relief of the rates, we should welcome this proposal, but the financial difficulty stands in our way, that what has been spent upon the districts out of the county apportionment must, as I see it, fall on the county, either in the shape of reduction of rating. or in the shape of some economy of other services almost as worthy.

Commander WILLIAMS

I almost suspect, after the speech we have just heard, that the Minister is fast making converts to this portion of his Bill. One of the great objects of the Bill is to reduce rates, and it will be noticed that although the reduction suggested in the last speech was something in the nature of £50,000,000, at any rate under this Bill there will be a direct reduction of rates of more than £20,000,000, plus a large amount of new money, about £8,500,000, which will go directly to the relief of rates. In other words, we shall be reducing the amount to be paid by the ratepayer by something over £30,000,000, so that before the next election we shall have carried out more than half the items in the programme of the party opposite on their point of reducing rates.

The CHAIRMAN

This is not an argument that can be used on a Clause which provides for district schemes for maternity and child welfare.

Commander WILLIAMS

I apologise most sincerely for having followed rather closely on the lines of the speech to which we have just been listening, but I will not go any further into this matter at present, but return to the question of maternity welfare in this Clause. I was merely at that point endeavouring to take up the connecting link between maternity and child welfare and the new money which comes in under the Bill. As far as maternity and child welfare is concerned, probably all sections of the Committee can agree on the importance of this work. I am the last person who would wish to make out of so valuable a scheme any sort of party point. The real value of the work is that it is being done in the locality by the thinking people and many of the best people in the various localities, for the common interest of these mothers and children. No one can get away from that. I have hoard it stated here in the last few days that it is not a popular service. I dispute that statement. I believe it is about the most popular service there is at the present time, because of its value, and because people are beginning to realise the growing value of that service. But although it is a growing service, although it is a popular service, and although the value of the work is absolutely not disputed, as far as I can understand, you are, as regards this Clause, getting into a position in which it is difficult for the Committee to arrive at the exact position as to the finance of this service in the future. It is growing by something roughly over £100,000 a year, I believe. It is developing, but it is not a service which is likely to develop into enormous proportions. It is never likely to reach £10,000,000 or £15,000,000. It may develop, and many of us hope it will, into at least double what it is now in the course of the next few years.

That brings us to this position with regard to this Clause. If I understand the meaning of the Clause rightly, what will happen is that the Minister will have to see that grants to the counties make an adequate proportion of all those grants to the smaller local authorities within the area. That, I think, is really the crux of the whole position. It may very well be that a county i? not particularly interested in this thing, but in the small town or the small borough people come very directly into communication with the lives of the people, whom this maternity benefit most affects. They have just started their scheme, perhaps, and it is essential that we should be assured under this Clause that a full proportion of the new money coming; into the county does really go to these new services. The county will have to set aside, in conjunction with the Minister, a certain sum out of their new money, so as to ensure that these grants are at least on a similar basis as before. It is quite clear that the influence of the Minister, whoever he may happen to be, on the county, will be of almost paramount importance in dealing with this money. I believe that the bulk of my party would like a definite assurance from the Minister—and I think we can speak in this case for all sections—that he will do his best to see that in this particular service, if there should be the slightest danger at any point of the money not being adequate to the growing needs, that he will out of the new money give an additional sum. Even if that new money did not come up to the exact amount that was required, might it not be possible, even at this comparatively late time in the progress of this Bill, to set aside a further sum, if necessary, beyond the £8,500,000 new money that will be provided for various things?

There is a great deal of kindly feeling towards the work of the Minister, and I ask him if it is not possible to set aside a sum out of the new money, or even to make provision beyond that, so that there will be a sufficient amount to meet the full possibilities of growth in this service. There- can be little doubt of the value of this service. I am not going into the question whether the counties will gain or lose; that was discussed last night, and we came to a definite con- elusion. I believe that the county position is safe and adequate, and that the position of the smaller boroughs is better in the Bill now than it was a short time ago. I am still not certain, however, that in every case the counties will see that the fullest possible gain will be made in respect of this service. I believe that these are points which we can well spend a short time in discussing, and I feel sure that the Minister will quite easily be able to give us a guarantee in regard to a service which is so close to his heart.

Mr. PALIN

I cannot share the optimism of the hon. and gallant Member who has just spoken, although when one first read this Clause, it certainly gave one a favourable impression. It seemed to give the Minister power to go into a county area and see that fair play was done to these maternity and child welfare schemes. I am afraid, however, that the Clause, like a good many other parts of the Bill, only flatters to deceive. When the Clause is studied, it is seen that the Minister is only taking power to go into a county to advise with regard to the apportionment of money for schemes that have already been inaugurated. Although it is very desirable that the Minister should see that sufficient money is apportioned from the county fund for the schemes that are already in existence, the fear that most of us have is that the extension of this work will be arrested.

I hold the contrary opinion to that of the hon. and gallant Member for Torquay (Commander Williams). These services are not popular among those who benefit most. One can hardly expect that the person who considers himself an authority on the subject will very readily take advice from anyone, but it is in order to rescue the unfortunate offspring of that type of person, that maternity and child welfare schemes have been inaugurated. Unfortunately, the initiative has been taken away under this Bill from the small local authority which is closest to the people, and which is more likely to initiate such schemes than the county authority. I cannot imagine a county official going round stirring up local authorities to spend money. It is the last thing that they are likely to do.

Lieut.-Colonel FREMANTLE

I did it frequently.

Mr. PALIN

I am afraid that the hon. and gallant Member is an exception. They do not do it in Yorkshire or Lancashire. The county official, if our experience under the Education Act is to be any guide, is constantly going round and pulling up local authorities for inaugurating schemes which will involve the spending of money. I am borne out in that feeling by the fact that the county authority will have many pre-occupations when they come to consider how the money is to be apportioned. Under this Clause the Minister of Health is to be a stimulant, but I would point out that in other parts of the Bill he has to undertake the role of debt collector. My experience is that it is his duty to call upon local authorities to pay the debt which has been incurred for unemployment and relief. Up to the 1st of October last there was a sum outstanding of over £8,000,000, -which it will be the Minister's duty to collect from the local authorities. I cannot imagine him going to a county like Durham or Glamorgan, and urging them to apportion larger sums for maternity and child welfare, and at the same time saying, "I have remitted to you the interest on your debt, but you must pay the principal; the Treasury is pressing me on this matter, and the Government cannot be carried on like this. You must reduce your liability." So, however much hope we may have built up on the first reading of this Clause, we feel that, in view of the fact that the Minister is to collect debts on the one hand, he will not do much stirring up and much stimulating on the other.

There is undoubtedly as great need in the counties—it has, unfortunately, not been fully recognised—for this service, as there is in the large industrial centres, particularly in the mining areas, where such an unexampled amount of distress exists. It is not a case of doling out coal and blankets; there is a place undoubtedly for the curate's lady to assist with a little advice and so on, but in essence, what is required in the establishment of a maternity and child welfare centre is, in the first place, skilled medical and nursing services. That is the foundation, and however much voluntary assistance you may have, you must Have money to establish the nucleus in the form of medical and nursing services. These people cannot be expected to work for nothing; their training has been a very expensive one, and consequently they must be appointed as salaried officers.

If the Minister takes any notice of the kindly suggestion made to him just now from the benches behind, it would seem as though, quite apart from any new money which is going into the pool, a definite sum might be set aside for the inauguration and the development of these services. If such a sum were provided, either under this Bill or in some other way, so that the Minister could lay the foundation stone of these services in the districts most needing them, I think we should be able to make very real progress.

At the moment I cannot see where Clause 75 gives the Minister the power which it is said to give him. Over and over again this week both the Minister and the Parliamentary Secretary have said they have no power of compulsion. If they cannot drive, then they have got to lead. Take the counties of Durham and Glamorgan, which are two of the most distressed counties. I have no doubt the will to establish these services exists there, because there is an excellent public spirit among their local administrators, but they have not the money. We know the difficulties which have occurred in these distressed areas regarding the feeding of school children. They had the power to feed them, but they had not the money. It will be the same story when the Minister sends his inspectors to confer with the local authorities on this subject. It will be found that they are wanting roads, that they want to reduce their debt; there will be so many calls on their money that I am afraid the maternity and child welfare work, which does not loom large in the eyes of the man in the street, will get very short shrift indeed. All the skilled promptings which the Ministry's officials are so well qualified to administer will be without avail, and I fear we shall find the maternity and child welfare centres becoming the Cinderella of the public service. Instead of this work being stimulated and developed it will be neglected; this munificent work may possibly have to. mark time, for a good many years to come.

Lieut.-Colonel FREMANTLE

The remarks of the hon. Member for West Newcastle (Mr. Palin) must naturally have great weight with us owing to his considerable experience and his hearty and enthusiastic work on. behalf of the public health services in a very poor, though industrially important, area. At. the same time he strikes me as a good man struggling with adversity. He realises on which side of the House he is sitting, and the attitude his party have taken up, and is trying to twist the dangers and difficulties of effecting any reform to accord with the line which his party have taken of general opposition to the Bill. I feel certain that in his. quieter moments, when he is relieved of the necessity of declaring himself in public, and when he comes to think out how this Clause will work, he will realise that there are very great hopes for the future. I do not wish to express my feelings in any exaggerated party form, and I think the only way in which I can usefully contribute to this discussion is to take up the challenge of the hon. Member as to how this proposal will work out and to consider it in the light of the practical experience I have had as a county medical officer of health.

The hon. Member said that county officials were not given to "gingering" local authorities in their areas to undertake increased expenditure. I can assure him that the contrary is the case. I can speak chiefly from the point of view of medical officers of health. When I remonstrated with him on that point he suggested that I was an exception, but I can assure him I am no exception. In attending here to-day I am absenting myself from the annual meeting of the County Medical Officers of Health. They take a very definite line. Their attitude all the way through has been to try to do exactly what is suggested in this case. I would prefer not to use the rather ungracious and unkind expression "gingering up," but I would say instead that their object has been to try to help authorities to establish services and, where they have been able to establish them, to assist them to extend and enlarge them. The difficulty hitherto has been that under the Local Government Act, 1888, the power of county councils over district councils has been shadowy in the extreme. It consisted solely of the power, in the last resort, of reporting them to the Local Government Board, now the Ministry of Health, and leaving it to the Minister to take action. All that could be done was to argue with them and try to persuade them. As a rule, however, there was not sufficient money available; that is the real reason why they have not been able to develop these services in the past.

Despite the guarantee given yesterday by the Minister with reference to the increase of Is. per head, apparently it is not yet acknowledged by the Opposition that there will be more money available in future. I say most definitely that there is going to be more money available for every county and county (borough, and that there is a great possibility of its being expended. There is, of course, a possibility that it may be expended wrongly, that is, wrongly from the point of view which we are now discussing; the money may be applied to other services, and not sufficient devoted to these services. But from the point of view of the county medical officer of health I feel that we now have a new factor in the situation. The county medical officer of health will go round to the district medical officers of health and inquire "How do you stand with regard to these services in your urban or rural district?" He may be told "My authority have always turned down the question of introducing these services". Then the county medical officer will be able to say, in view of this extra money," Will it not be possible to bring the question forward again?"

That is the real way in which these things are worked. They are worked informally between the county medical officer on the one hand and the district medical officers on the other hand. Then it comes before the clerks of the local authorities. The clerk of the county council always works with the clerks of the district councils to see in what way they can get a move on. They will now have a new opportunity of doing so. The various committees will also be able to give more attention to this matter when considering the commitments and charges which they have to provide for. Altogether, it will be possible to make a good case for starting new centres and developing the work. I cannot see the objections of the other side. To me there appears to be a great possibility of levelling up the work. It has been assumed by hon. Members opposite that there has been no such stirring up of this work in Yorkshire by the district authorities. I happen to know a medical officer in the West Riding district who was very active in this direction. Here we have a big instrument to hand, and, although I wish to make criticisms in regard to some of the proposals of this Bill, as far as this particular Clause is concerned, I think it will be a great help to the cause of maternity and child welfare.

Mr. CECIL WILSON

I should not have intervened in this Debate but for the remarks which have been made by the hon. Member for St. Albans (Lieut.-Colonel Fremantle). I notice from the return of rates levied in various towns that, so far as St. Albans is concerned, there are only two out of ninety-eight boroughs which contribute a smaller sum to public health services than St. Albans. The amount contributed by St. Albans is l¾d. in the £ for public health services, whereas in most of the other boroughs the rate devoted to public health services averages between five-pence and sixpence. It seems to me very strange, after listening to what the hon. Member for St. Albans has said, to find that the amount spent in the county he represents should be so extremely small when compared with other places.

Dr. VERNON DAV1ES

I am not quite certain from the speeches to which I have listened whether I thoroughly understand the point which has been raised. The Clause we are discussing provides: As respects any county in which there is a district the council of which have established a maternity and child welfare committee under the Maternity and Child Welfare Act, 1918. Under that Act the local authorities were empowered to establish maternity and child welfare centres, and they had nothing to do with the county councils. As I read the Clause, it means that some of these centres will be allowed to carry on irrespective of county control, and no doubt the time will come when they will require more money. Therefore, it is quite possible that these local districts may ask for more money than the County Council think they ought to have, and, after the discussion between the Council and the local authority, the matter will be referred to the Minister of Health, who will in future see that a fair amount is given to these local maternity and child welfare centres. As far as I understand this proposal, those centres will be worked independently of the County Council, and the County Council will have no direct control over either their administration or their medical service. That is where I think hon. Members have been wrong in their statements this morning.

I would also like to refer to some of the fears which have been expressed that proper provision will not be made at these centres. May I remind hon. Members that such centres are intended to work more in a consultative capacity, and only to a small extent as treatment centres. They may be able to treat minor cases, but their principal object is to collect and distribute such cases where they can receive the best treatment. No maternity or child welfare centre could undertake the treatment of cases of tuberculosis, venereal diseases, or early mental trouble, neither could they treat the various diseases of women. For every serious case they would have to make definite hospital arrangements wherever accommodation was available, and distribute these cases to these hospitals. Of course, none of these things can be done without payment, but the expense does not amount to very much after all.

Very often at these centres it is only necessary to employ a medical officer and a nurse. and by this means the centres are able to get through an enormous amount of work in the course of a year. Even if the expense of maintaining these centres is increased by 100 per cent., it only means the expense of the doctor and the nurse and a few other subsidiary expenses. By this means an enormous amount of work can be done in a new centre. Some hon. Members fear that this particular service is going to be hampered and hindered by this Clause, but I think those fears are groundless. In the light of experience, I think hon. Members will be astonished to find how these centres will grow and develop under this Bill, and there will be provided more than ample money for their development. I think in the years to come that those of us who are alive will look back upon this Bill as being one of the most stimulating and advantageous Bills for the development of the health services of this country.

Miss WILKINSON

We are getting quite accustomed to the kind of speech made by the hon. Member for Royton (Dr. Davies), and his remarks make me realise more than ever to what extent professional jealousy can go. We are hearing continually from the hon. Member appeals for clinics on the cheap, and he tells us that we are dealing with a public service which can be carried on with as small an expense as possible and as cheaply as possible. The hon. Member wants the doctor and the nurse to do as much work as possible, and receive as little pay as possible.

Dr. DAVIES

The hon. Lady is not treating me fairly. She has never heard me suggest that medical officers or the members of nursing staffs should be hampered for want of funds.

Miss WILKINSON

I humbly apologise to the hon. Member for suggesting that he desires to pay as little as possible to the medical profession. The hon. Member, however, did make the suggestion that if you doubled the cost of maternity and child welfare services, it would only mean a few hundred pounds a year in addition to the present cost, and then everything would go on smoothly and well. Under those circumstances, all that would be done would be for someone to come and look at the tongues of these patients and give advice to the mothers, and that sort of thing is what we are fighting against. On these matters, we generally find the hon. Member for Royton expressing reactionary views. We all recognise the extraordinary amount of good work done by the hon. Member for St. Albans in regard to this kind of work, but it seemed to me that a great deal of his speech would have been quite different if he had read more carefully the first sentence in Clause 75 which we are discussing, namely:— As respects any county in which there is a district the council of which have a standing maternity and child welfare committee… I do not want to put forward any captious criticism of the Clause. It would have been possible, if this Clause had been slightly differently worded, to have in the Ministry's hands a very powerful weapon for improving the maternity and child welfare of the country, but, as the Clause is drawn, it has two weak points. One is that it does not say anything at all about what is going to happen to those districts where there is not a maternity and child welfare committee. I am only asking for information, and a number of other people also want information on this matter. I am not putting forward captious criticism—[Interruption]—I am merely trying to help, and, in the course of my desire to help, I want to know what is going to happen to those districts where there is not a maternity and child-welfare committee. That is the crux of the whole question. The Ministry may have enormous powers to deal with those people who are already trying to do their best, but what we want to know is what he is going to do with those people who are doing nothing at all. I would remind the right hon. Gentleman that many of the districts which are the worst are not crowded industrial areas, which are now largely dominated by the Labour party, and in which excellent maternity welfare work is being done where there is money to do it; the difficulties are in the rural areas, which are dominated by the squires, who are all solid supporters of the right hon. Gentlemen opposite. In many of these areas nothing at all is being done. They have enough money, and they could do it very well with a few more rates to pay. The farmers are going to be relieved under the Bill as it is. These areas, however, or very many of them, do need "gingering up," if I may use the phrase, and they not only need "gingering up," but these schemes ought to be made compulsory. The Minister should have the power to say to these people that, if they are not doing this work, they will suffer in another direction, whether by not having grants or whatever the method is likely to be. This question seems to me to be extraordinarily important, and I would urge the Minister to consider, when the Report stage comes, whether it is not possible for him, under Clause 75, to take to himself power to deal with those authorities where no committee exists. The hon. and gallant Member for St. Albans, who has been a medical officer of health, gave us a delightful picture of what was going to happen when the County Medical Officer went down to one of these areas when it became a little slack. That is all right as far as those people are concerned, but what is going to happen to the people who have not anything? We have had a good many bouquets offered to the Minister in the course of the discussion, on maternity and child welfare in particular, and a number have been presented by the hon. Member for the Sutton Division of Plymouth (Viscountess Astor). I am not, however, so sure as the hon. Member seems to be that the Minister of Health can be trusted in this matter. Everybody has said, "We have a great Minister of Health with a great heart, and this service is very near to his heart, and, if you will only trust the right hon. Gentleman, everything will be well." It is not what is in the heart of the right hon. Gentleman, but what is the record of the right hon. Gentleman—what he has done already with regard to this service. I suggest that the record of the right hon. Gentleman—he thinks it convenient not to listen when I tell him what his record is—the record of the right hon. Gentleman has been to issue circulars which have definitely, as we know, cut down grants for milk for children and nursing and expectant mothers. We remember those circulars of the Ministry of Health that have gone out during the right hon. Gentleman's term of office, and we say that a man who is responsible for those circulars is not likely to be the kind of man who is going to do all this wonderful work for maternity and child welfare. I think that this has to be said, because people get reputations in this House, and, if everyone goes round saying the same thing about them, the people outside in the country say what wonderful people they must be.

12 n.

It is becoming—and I say this very seriously—it is becoming a convention to say that the Minister of Health is the type of person who can be trusted, whatever the law says, to take the very best measures. I just want to say that I do not think he is; and I do not think he is because of his record. I should think far worse if his Parliamentary Secretary were in his shoes. Therefore, we should have liked to see something very much more explicit in this Bill, because the man who is responsible for those milk circulars will be responsible for these services if the Ministry and the Minister mean to carry out this Clause. I ought to make a correction there. Thank goodness, he will not be the Minister who is actually going to carry it out; but it will need, when the Labour party comes into office next June—[Interruption]—a real effort on the part of that Ministry to put this Bill into proper form. The Minister has said a good deal about those areas where Committees are in operation, but I want to bring before him the record of the Ministry in another matter. I want to ask him what is the position under this Clause of schemes which are not now in operation, but which are contemplated, and have been proceeded with under the guarantee of the Minister that 50 per cent. of the expenses will be paid. I have received a letter from the County Borough of Walsall, which I understand has been sent to all the other women Members—

The CHAIRMAN

This Clause has nothing to do with the county boroughs at all.

Miss WILKINSON

It is an illustration of the same thing, and I am only using it as an illustration. I am asking what will be the position if, under the district councils the same sort of thing happens. Walsall, which I am taking as an example of what others may be doing, got from the Ministry of Health a guarantee in 1927 that they would pay 50 per cent. of the annual cost of the maintenance of the home, including annual loan charges. They went ahead on that basis. That was in January, 1927. It is now January, 1929. There were endless delays on the part of the Ministry of Health, and finally, in November, 1928, after a definite promise that 50 per cent. of the maintenance charges would be paid, they received this letter: With regard to the question of grant, I am to point out that the Minister's letter of the 5th September, 1927"— be it noted— must now be read in connection with the provision of the Local Government Bill which is at present before the House of Commons, and the Council will no doubt consider the effect of that Bill upon the scheme in the event of its becoming law. There may be, under the first sentence of this Clause, and one knows that there is, a number of areas where schemes are in course of preparation and where they have received from the Minister a definite understanding that 50 per cent. of the maintenance charges will be paid; and now, months after the giving of that guarantee, they are told that they are to read the Minister's guarantee in connection with the Local Government Act. What is going to be the position? The position, of course, in this particular case is that the whole thing is being held up, and a very urgently needed maternity home in a very crowded area is being held up until we have carried through this Bill, and then there is no guarantee that it will be proceeded with. These are the sort of practical things that we are up against under this and other Clauses in the maternity and child welfare part of the Bill. We want to have some guarantee that this service is going to be extended and is going to have the enthusiastic backing of the Ministry. There is nothing in the Bill that gives such a guarantee. We admit frankly that, under this Clause, where a committee is in operation and has gone slack, the Minister has powers, but those very areas where they have gone slack are very often the areas where the money is badly needed for other purposes. The women who are most concerned about this part of the Bill are learning to distrust the Ministry of Health. We feel that either they have not that interest in the service that they ought to have or they do not realise how tremendous the burdens are on the county, and how much greater they would be under the county apportionment grant, and they feel that it is a service that they have to leave over for the time being. That is the whole difficulty, as it has been the difficulty in the case I am quoting—the leaving it over. I would ask the Minister to deal with these three points, which are the points upon which we need to be satisfied, under this Clause.

Mr. JAMES HUDSON

I want to come back to the words in the Clause as respects any county in which there is a district the council of -which have established a maternity and child welfare committee. In view of all the lip service which has been given to the necessity of the development of a child welfare service on a national scale, the problems that are the most pressing at present are those districts which have not established such a welfare service. [Interruption.] The hon. Member will not find any other Clause in this Bill which will effectively deal with this matter, in view of all the lip service which has been paid, which is the main problem confronting us. What has happened is that under the system operating hitherto, the system of the percentage grant, there have come into existence a number of centres where the work is being carried on, and, if the system had been retained—I accept fully what the hon. and gallant Gentleman the Member for St. Albans (Lieut.-Colonel Fremantle) said, that in some areas county medical officers are pressing for an extension of the service— there is every likelihood that the work would have gone on.

But now what is the situation? You are making an arrangement, it seems to me, in connection with this Clause by which you will increase, from the county apportionment, the amount that is necessary in some areas for this work. That will have an influence in drawing away from other services money that is required for those other services, but it will also have an influence with those authorities which have done nothing in the matter of maternity and child welfare and which will be dependent to some extent upon general county funds for their development. It will be an incentive to them, even more than now exists. to continue to do nothing at all. It is this crystallizing of the service at the present point that we are now objecting to. We agree, of course, that you must make some arrangement by which the money can be raised to carry on the services as they now exist. We are glad that something at least is being done, but the point of our criticism is that it is being done in a bad way, that it will react upon the service itself, particularly in backward areas, and that it will draw money away from other services for which adequate arrangements have not been made.

I want, further, to draw attention to the point that has been raised, that this work probably will not need a very great extension of public expenditure. I am sure the hon. Member for Royton (Dr. Davies), from his own practical experience, must know much about it, but I do not feel that the hon. and gallant, Gentleman the Member for Torquay (Commander Williams) can have given sufficient study to the possibilities of what can come from the work when he says that all we need is about a doubling of the expenditure that we are now making. I gave an instance the other night drawn from what had happened in my own constituency, where, instead of using nurses, an appointment was made of a further medical staff. Women doctors were appointed to go round before the child was born and to continue to visit the home at least once a month, and sometimes oftener, during the first year of the child's life. It seems to me that by that sort of extension of the work, you really would be dealing with the difficulty that the Minister says is close to his heart, the casualties on the birth of children that occur to the extent of 3,000 a year, by bringing in a trained medical man instead of a well-meaning sympathetic nurse who has not all the knowledge necessary to deal with difficult cases. The visitation by the medical officer before birth in the home of the woman who is to have the child would have a very great deal to do with some solution of this problem.

You are not going to deal with it by an expenditure of merely twice as much as we are spending now. I am not going to pretend how much we shall have to spend. This service, before we have completed it, will be spending several millions and not the £1,000,000 that is now being spent in order that the difficulty may be dealt with. May I again refer to the figures the Board of Education is constantly emphasising, the 25 per cent. of children with ailments, who never need have suffered if they had been dealt with before they became of school age. How can you pretend that by the appointment of a few nurses, and perhaps one doctor, in big areas, you can deal with a situation represented by statistics of that sort? It is because we know that this system will need very much more expended upon it, and because we also know that the Minister has actually withdrawn money from one of the greatest necessities, the expenditure upon milk, that we are thoroughly distrustful of the attitude he has taken up, and we cannot join with hon. Members opposite when they give him all these bouquets about the pretended extension of this service that they say he is carrying on.

Mr. RENNIE SMITH

When my right hon. Friend the Member of Seahara (Mr. Webb) published a pamphlet in 1918 called "Democracy and the New Social Order," he imparted into it more heat than in any other piece of writing he had ever published. The right hon. Gentleman the Minister of Health has done what the right hon. Gentleman the Member for Seaham often does. He has shed light over the whole surface of this Bill and into its very remote corners and crannies. There is only one point where he has shown heat, and it is upon the subject which we are discussing this morning. I do not want to deny the existence of this heat energy. What we are concerned about is that it shall be so generated that the whole country will benefit from it. It is from that point of view that we are directing our criticism this morning. I want to support the point of view of my hon. Friend the Member for Huddersfield (Mr. J. Hudson) and say that, as we understand the financial provisions in this Clause, the Minister is not armed with effective powers for the development of the existing maternity services, and secondly, that he is taking no steps to encourage the development of services where they are non-existent. As we see this Clause, the powers which the Minister is taking are likely to retard development in the nonexistent areas.

I should like to remind the Committee of the present situation with which we have to deal. Prior to the Act of 1918 the whole of this work was the result of voluntary activity in the country. We had only 400 infant welfare centres at the outbreak of the world War. Under the influence of Government co-operation in these schemes we had, by 1925, 1,363 schemes, and, under the continued influence of the percentage grant, the number, according to the Ministry's current report, has increased to 1,561, with the addition of some 870 voluntary centres up and down the country. It is interesting to see how many local authorities which are optionally entitled to undertake this work have done so. I find, according to the latest figures which I can obtain, that of 62 county council authorities in this country, 4a have established maternity and child welfare centres. Of the 82 county boroughs, 79 have established some kind of institution. Of the 247 non-county boroughs, only 115 have taken steps since the passing of the Act of 1918. Of 791 urban district councils—I am not saying they are all optionally entitled to do this under existing legislation—only 118 have used these powers at all.

In relation to the great need that there is in this country for the development of these services, it is quite clear that there is a very big area in the country—a necessitous area from the point of view of the development of these services— which has not been touched under existing agencies. The Minister knows perfectly well that even where these services have been developed they have not proved adequate to cope with the special problems with which they have to deal. The right hon. Gentleman took special pride the other day in reminding the Committee that the latest report points out that the death-rate has fallen from 75 per thousand two years ago to 65. That is a very welcome development, and I think he will be prepared to admit that it is very largely duo to the post-natal work developed under the stimulus of the percentage grants since 1918. He knows perfectly well that the main part of this problem has hardly yet been tackled, for while it is true that the death-rate has fallen in this remarkable way, the death-rate of mothers, and the death-rate of children under four weeks old, have responded very slightly to the existing circumstances.

I would like to draw special attention to this point. As far as I can see from the latest report, including the very valuable one made by the right hon. Gentleman's Department, and particularly that made by Dr. Campbell, there has been only a very slight percentage decrease in the actual rate of mortality of young children below four weeks old. This is not because we have not the medical science which can prevent these deaths. The Minister knows, if he looks back to the early days of the War, that Sir Arthur Newsholme, in his report in 1015, stated that 800 mothers die in each year in England and Wales, as the result of childbearing, whose lives would be saved if the experience of the rest of England and Wales were as favourable as that of London. The report goes on to say that there would be a further saving of 1,100 lives of mothers secured annually in England and Wales if puerperal fever were to be eliminated as it had been substantially from the experience of many lying-in hospitals. It is very remarkable that although that position had been established in science, and in practice in one or two areas, as early as 1915, Dr. Campbell, in his valuable report in 1925 said: Avoidable maternal deaths are a matter of everyday occurrence, and puerperal infection leads to more deaths and more injury than any other complication of childbearing. I submit that, although there has been very remarkable improvement in antenatal work, due to the provision of milk and regular visitation after birth, we have to face the fact that the nation as a whole lags terribly behind in the prenatal efforts and in the co-ordination of the best scientific treatment round about the period of actual birth.

I want to ask the Minister whether in the light, not of Labour party recommendation, but of recommendations by his own Department, which are ten years old, and in view of the fact that we are dealing with one of the most important social and health questions in the country, he cannot reconsider this question. The Minister has from time to time stated that he regards this Bill as a contribution to the development of industry. I think he will be the first to admit that there is no side of the development of industry that is more important than that of the preservation of children and of bringing into the world of well born children. I want to ask him, in the light of the accumulated evidence of the last ten years of our hopelessly backward position as a nation in relation to the best established practice, whether he cannot reconsider the inadquate financial powers he is taking to himself under this Clause.

The MINISTRY of HEALTH (Mr. Chamberlain)

Does the hon. Member suggest that the powers in the Clause are inadequate?

Mr. SMITH

I do not want to traverse ground which has already been covered by hon. Members who have spoken from this side of the Committee, but there is no specific provision in this Clause for the allocation of money for these particular services. The local authorities which have established maternity and child welfare centres cannot be constrained under the Minister's present powers to allocate more money. The money is subject to competition with regard to other services for which they are responsible. I am asking that he should take more specific powers to allocate in a more definite way more money for these particular services, and that he ought to pay attention in Clause 75 to the development of these services in the areas where they are non-existent. The big need is for a very considerable allocation of money in order that we may get trained medical officers and nurses, not only in the present areas where we have not enough but in the very large number of other areas where those services are non-existent.

I should like to make one definite suggestion to the right hon. Gentleman. He knows that there is a sum of £650,000 going a-begging under the Bill. The brewers and the tobacco manufacturers have said, quite frankly, that they do not want the £650,000 which is to be made a gift to them under this Bill. Is it too much to ask that the Minister should take this £650,000 from those two services and allocate it for the purpose of extending the maternity and child welfare services. I hope that when he replies he will go into the financial side of the Clause with real care and give us some assurance that we are going to get, not only within the framework of the existing services but outside of them, some real guarantee whereby these very important services may be stimulated in the direction which everyone in this House wishes to see them develop.

Mr. ARTHUR GREENWOOD

Yesterday, the word "subtlety" was used. This is one of the subtle Clauses of the Bill. It conveys the impression that it will confer an advantage on maternity and child welfare work, without openly disclosing the fact that it is doing that at the expense of other services. So many of the supposed advantages that will follow from this Bill are given at the expense of other people. That is precisely what is happening under Clause 75. The right hon. Gentleman in order to make provision for expenditure on maternity and child welfare has prepared this Clause, which takes any increased expenditure to be devoted to that purpose out of the total county allocation. That is merely the policy of robbing Peter to pay Paul. It does not add a single penny to the expenditure on the social services of the county districts. It is really a dodge for distributing that sum in different ways, to enable the Minister to claim the credit of doing something for maternity and child welfare work. He is doing it, and he knows that he is doing it, at the expense of other services. There is a definite County apportionment to the county council and any sums taken out of that for any special purpose means, first, that there is less left for the county itself for its various purposes. It means, also, that there is less left for other county districts within the county and it means, therefore, that there will be less left for all the other services carried out by the county and the county districts, whether non-county boroughs, urban districts or rural districts. If the right. hon. Gentleman says the additional expenditure out of the county allocation which is to be transferred to maternisy and child welfare services is relatively small, and, therefore, will not affect the money available for expenditure upon all the other services in the county and by the local authorities in the county, then I fear it is not going to be the advantage to the maternity and child welfare services that he would lead us to believe. What the local authority gains on the swings it loses on the roundabouts.

As I understand the Clause, every county district is to be consulted before any additional expenditure can be provided for in those county districts which have maternity and child welfare services. If it should be that only a minority of the county districts have such services, then I can well understand the attitude of the other county districts in resisting any such additional expense for the county districts that have maternity and child welfare schemes. Although the Minister has certain powers in this regard, it is clear that it will be very difficult for him to take any very firm line against a county or against a majority of county districts within a county. My own experience is, and I think it is the experience of other hon. Members, that Departments of State— I am not complaining of this, because they must have regard to local feeling and to democratically elected local authorities—are very l0th to run against the prevailing opinion in an area. I am not blaming the State Department for doing that, but I can quite see that in many county areas where there are only a few maternity and child welfare schemes in operation the general sense of other local authorities in the areas and of the counties would be rather against the expenditure of additional money. If that were so, it is quite clear that the Minister would be unwilling to apply any very considerable pressure.

As I understand the Minister's attitude, it is that this scheme will give a certain new measure of control over the development of these services. That is true; but I would welcome an explanation of the Minister's powers to deal with these services. The truth is, that he gets what influence he does get under this Clause, in so far as it is effective at all, merely at the expense of other services, and it would be possible to make out as strong a case for other services that are conducted by the minor authorities as it is in the case of the maternity and child welfare service?, but it is not extended to them. If the right hon. Gentleman wishes to obtain increased powers of developing maternity and child welfare schemes, this plan is about the worst way of doing it, for I am convinced that in many county areas the scheme will result in next to nothing. It is undoubtedly true that in a large number of the counties the county authorities are doing very little themselves as regards the operation of the Maternity and Child Welfare Act. It is, I think, true that only the minority of counties are active in this direction but that the counties that are doing this kind of work are not exercising half the powers that they could exercise. If that be the attitude of the county councils and if, as I imagine it is the case in all the county areas, there are a large number of authorities who are doing next to nothing, what hope will there be of this Clause operating in such a way that the county councils and the county districts within the area whether they are running schemes or not, will come to a decision to restrict their own resources in order to allow the maternity and child welfare schemes to be developed, when they themselves have shown so little interest in the matter that they have not developed the service themselves. If the right hon. Gentleman is seeking for new methods of control he should look for it in other directions.

This is one of the most subtle clauses in the Bill. It is a very specious Clause, because if one opposes it he may find himself subject to misrepresentation. It may be said that he voted against more money for maternity and child welfare service. The subtlety has been a little overdone in this Bill. I am not denying that the Minister wishes to develop more schemes, but this is not a fair and just way of doing it because every new scheme, every new development, will be at the expense of all the other county districts, and at the expense of the county council itself. There is no guarantee under this Clause that in those county districts, whether they are boroughs or urban or rural districts, where nothing is being done at the moment anything more will be done, in the future. On the contrary, the effect of the Bill will be further to discourage those county districts where nothing is being done to-day. This is a misleading Clause. It is misleading to the general public, will do nothing substantial for the maternity and child welfare services of the country, and is bound to react adversely against other social services in county districts.

Mr. MORRIS

I agree with the hon. Member for Nelson and Colne (Mr. Greenwood) that this is a subtle Clause, and this is illustrated by the debate this morning. Exception has been taken to the distinction which this places on established maternity homes as against new services. Personally, I do not think there is much in the criticism. The real point in the Clause is in the middle part of it, and the words at the end. The Clause provides: The Minister shall six months at least before the beginning of each quinquennium prepare, in consultation with the county and district councils, a scheme for increasing the sum to be set aside out of the county apportionment. That is the scheme he is going to prepare. He is not giving any additional sum of money. The last part of the Clause says: The sum to be set aside out of the county apportionment in respect of the district shall be increased accordingly. That is, according to the scheme the Minister has prepared. If the Minister is not satisfied that the welfare committee is having its fair share of the amount he can interfere, but he has provided no additional sum of money from the Exchequer. It is provided from the county apportionment fund which he has allotted to the county. He has power to step in and say that he is not satisfied that the county authority is carrying out the scheme properly so far as the health services are concerned; he has power to say that he wants more money spent on the services. So far, so good; but that power in itself is a new principle in local administration. Hitherto we have allowed local authorities, whether they are exercising their power well or ill, to have complete control over their local affairs; it has been left to them to administer their local services as they think fit. Now you are giving the Minister of Health absolute power to interfere, not only with the administration of the health services but to gay to local authorities, "I am not satisfied that you are carrying out your duties; I am not pleased with your decision as to the way in which you propose to develop your health services."

Mr. CHAMBERLAIN

Is the hon. Member referring to this Clause in what he is saying now?

Mr. MORRIS

Yes, because the way in which the county apportionment fund is administered is bound to affect all the services controlled by a county council. The moment you give this power to the Minister—he may exercise it in a benevolent way—you are introducing a new principle so far as local government is concerned. It is a dangerous power. You are giving the Minister power to say that so much of the apportionment fund shall be allocated to the health services. There may be other services, and the county authority will, therefore, have so much less money to devote to them. The right hon. Gentleman shakes his head, but that is what this Clause does, and this power given now to the Minister is an entirely new principle in local government administration.

Mr. CHAMBERLAIN

I have listened, I must say, to a good part of this Debate with a great deal of weariness of spirit. We have heard over and over again the same old fallacies. The same misstatements have been made so often in the course of the discussions on the Bill that weariness of spirit comes because so much of what has been said is quite irrelevant to the particular Clause we are supposed to be discussing. I am going to take notice of one speech which seemed to show some earnestness and sincerity. That is the speech of the hon. Member for Penistone (Mr Rennie Smith), although I must class it among those which were not relevant to the Clause. The hon. Member who has just sat down, like some other hon. Members, appears to be labouring under a complete misapprehension as to the real purpose of the Clause. I was interested in the observations of the hon. Member for West Newcastle (Mr Palin), and I thought his description of the way in which he approached it very illuminating as to his process of thought. Ho said that at first sight it made a favourable impression upon him. Of course, that upset him at once. He never appears to be happy unless he can make himself miserable. Indeed, he reminds me of a song which used to be sung by a well-known comedian who I am afraid is now no more. The refrain, I think, used to go like this I've often said to myself, I've said, Cheer up, Cully, you'll soon be dead. Having examined the Clause in vain to find anything which was really unsatisfactory about it the hon. Member proceeded to recast it according to his own ideas, and then he had no difficulty in finding in it all the evils which he had desired to find when he first examined it. If we turn the Clause round and put things in which are not there, we can soon make ourselves miserable, and make ourselves happy in being miserable. The hon. Member for Nelson and Colne (Mr. A. Greenwood) made the solemn and portentous discovery that every shilling which you take out of the county apportionment fund leaves a shilling less in that fund. I wonder what the hon. Member thinks that we are doing in this particular Clause? I wonder what the hon. Member who spoke last thought? He seemed to think that this gave some new power to the Minister to regulate the health service or the amount of money spent by local authorities. That is indeed apparently the policy of the Labour party. In their attachment to bureaucracy, which is growing upon them, they are apparently prepared to lay down in an Act of Parliament, that a specific sum of money is to be spent by each local authority on this specific purpose. [HON. MEMBERS: "No !"]. That is the compulsory Clause which the hon. Member for East Ham North (Miss Lawrence) was advocating.

Miss LAWRENCE

It is very unsafe to let anything pass without contradiction at once. I advocated that these health services should be made compulsory with proportional grants, as is done at present with education.

Mr. CHAMBERLAIN

If you are to make that compulsory, you must lay down for each local authority what precisely it has to do. That I call bureaucracy. Let me now come to the real purpose of the Clause. I must try to explain it in an elementary way, because it is so obvious that only the most elementary explanation is going to be understood. The maternity and child welfare services in a county are normally the work of the county council, but there are certain county districts which have been given powers under certain Acts of Parliament to carry on these services themselves in their own areas. Where they carry on these services in their own areas, of course the county council does not receive the money. These are, as it were, islands in the county, where the local authorities carry on maternity and child welfare, and they pay for it, and the county council does not pay for it. In making out the county apportionment we had to take account of the discontinued grants in the counties, and included in those discontinued grants are the discontinued grants to any individual county district that is a maternity and child welfare authority.

Therefore, in the county apportionment we are including the grants which have hitherto been given to these separate maternity and child welfare areas. Of course, if they are still to carry on these services, you must take out the equivalent sum from the county apportionment and see that it goes to the district for which it is intended. That is precisely the purpose of this Clause. Therefore when an hon. Member opposite says that it is robbing Peter to pay Paul, he is talking nonsense. It must be obvious to the hon. Member that what the Minister has to do here is to determine the amount of money which is to be taken out of the county apportionment, and to hand it over to the authority which has to carry on this service in its own particular area. That is not settling what the health services are to be.

Mr. MORRIS

Would the right hon. Gentleman explain what is the object of putting in the word "increasing" in both parts of the Clause?

Mr. CHAMBERLAIN

Of course, under the Bill anyhow, there has to be given to every county district in the county, some money out of the county apportionment, but that amount has to be increased in the case of the maternity and child welfare service authorities by the extra amount that has to come from the county apportionment in order to enable the service to be carried on.

Mr. MORRIS

The right hon Gentleman has a special provision here to put up a special scheme in consultation with the council. In respect of that new scheme he is given power to give an increasing amount in respect of that scheme. Does the increasing sum not come out of the amount of the county apportionment fund?

Mr. CHAMBERLAIN

The hon. Member still has not got the real interpretation of the word. He thinks that the increase mentioned means an increased maternity and child welfare grant for some other grant. I have explained it once and I will do so again. It means that out of the county apportionment a sum of money has to be deducted for every county district. It is part of the scheme of distribution within the county. That is not for maternity and child welfare. It is part of the distribution under the scheme which we have already dis- cussed. That amount has to be increased in the case of maternity and child welfare authorities by the appropriate sum to enable them to carry on that service in future. The county must not therefore have the money formerly given to it; it must be taken away from the county and given to the district, because the county will not have the expense of carrying on the service.

Mr. RENNIE SMITH

Would the Minister say whether, under the proposed scheme, each of the authorities now receiving the grant will receive as much?

Mr. CHAMBERLAIN

Whether they will receive as much in future as in the past?

Mr. SMITH

Yes.

Mr. CHAMBERLAIN

Yes, certainly. The Clause says that the Minister himself is to prepare the scheme. Do not let the Committee think that this is a very big matter. There are only about 250 of these authorities. I say again that there is no case where these authorities are doing nothing. An hon. Member opposite talked about the authorities doing nothing. He does not understand the Clause. There is no case of any authority doing nothing. Therefore that case cannot arise at all. What the Clause says is that the Minister is to make a scheme for increasing the sum or setting aside the sum out of the county apportionment in respect of the district, by such amount as he thinks fit—he has every latitude there and he has to consult the county council and the district council—having regard to the expenditure which will be defrayed by the county or district upon the service in connection with maternity and child welfare. The hon. Member for Newcastle West said that in this Clause there was no provision for doing anything more than just keeping up the service as it now stands. Where did he find that in the Clause? It is not there. He put it there himself, just in order to make himself unhappy.

Mr. PALIN

I shall have to assist the right hon. Gentleman to read the Clause.

Mr. CHAMBERLAIN

I have read the Clause, and when I read it it wag more intelligible to me than to the hon. Gentleman. What it says is that in fixing the amount of the contribution that has to be made to the authority, the Minister has to have regard, not to what the county council has spent, but to what it will spend. Therefore, it does not only provide for the existing service, but the Minister has to bear in mind what the council is to spend in future, when he is fixing the amount. I have given the Committee a plain account of what the Clause means, and only those who are determined not to understand will have any difficulty in comprehending it. In response to the hon. Member for Penistone, who had something to say about the maternity and child welfare service generally, I would make this remark: Do not let us take too gloomy a view of the progress of the maternity and child welfare service. I am doing all I can to improve it. I hope I may have an opportunity of doing still more. But do not let us talk as though the service were standing still.

If we compare the position of the service to-day with what it was when the party opposite went out of office, it will be seen that there is a very considerable improvement, particularly due to the fact that we have spent a good deal more money upon it. The amount included in the Labour party's programme for the maternity and child welfare service was £814,000. We have increased that, until this year it is £1,052.000. If we take the number or ante-natal clinics in the country, we find that in 1924–25 it was 639. That figure is now increased to 847. The number of beds in maternity homes and hospitals recognised by the depart-

ment was 2,001 in 1924. That number has now risen to 2,478. We are making substantial progress, and I assure the hon. Member for Penistone that it is quite unnecessary to seek for new sources of money for the development of the maternity and child welfare service. Under this scheme of ours, (here will be ample funds for all local authorities which have the power to provide maternity and child welfare services to develop those services quite as fast as they will find possible. They will not be hampered by want of funds. They may be hampered by want of interest in the service; but, if so, it will be the duty of the Minister and of Parliament to see to it. It is not right to say, however, that at present the service is at a standstill. It is progressing very satisfactorily and if it does not progress equally fast or even faster in the future, it will not be for want of the necessary funds.

Mr. CECIL WILSON

The right hon. Gentleman referred to a figure of something over £1,000,000 as the amount spent on the maternity and child welfare service. The return in regard to public social services shows, in 1927, an amount of £2,156,000 under this head, and in the next year, an amount of £2.069,000 which would appear to be almost double the figure mentioned by the Minister.

Mr. CHAMBERLAIN

I was only speaking of the Exchequer contribution. Of course, there is the rate money as well.

Question put, "That the Clause, as amended, stand part of the Bill."

The Committee divided: Ayes, 158; Noes, 70.

Division No. 122.] AYES. [1.0 p.m.
Ainsworth, Lieut.-Col. Charles Bullock, Captain M. Erskine, Lord (Somerset, Weston-s.-M.)
Albery, Irving James Campbell, E. T. Evans, Captain A. (Cardiff, South)
Alexander, E. E. (Leyton) Cautley, Sir Henry S. Everard, W. Lindsay
Ashley, Lt.-Col. Rt. Hon. Wilfrid W. Cecil, Rt. Hon Sir Evelyn (Aston) Fairfax, Captain J. G.
Astor, Maj. Hn. John J. (Kent, Dover) Chamberlain, Rt. Hon N. (Ladywood) Falls, Sir Bertram G.
Atkinson, C. Churchman, Sir Arthur C. Fanshawe, Captain G. D.
Balniel, Lord Clarry, Reginald George Fermoy, Lord
Barnett, Major Sir Richard Clayton, G. C. Foster, Sir Harry S.
Beckett, Sir Gervase (Leeds, N.) Cobb, Sir Cyril Fremantle, Lt.-Col Francis E.
Bellairs, Commander Carlyon Cockerill, Brig.-General Sir George Galbraith, J. F. W.
Berry, Sir George Collins, Sir Godfrey (Greenock) Ganzoni, Sir John
Bethel, A. Conway, Sir W. Martin Griffith, F. Kingstey
Betterton, Henry B. Craig, Sir Ernest (Chester, Crewe) Guinness, Rt. Hon. Walter E.
Birchall, Major J. Dearman Crookshank, Col. C. de W. (Berwick) Gunston, Captain D. W.
Bowyer, Capt. G. E. W. Crookshank, Cpt.H.(Llndsey,Gainsbro) Hacking, Douglas H.
Briant, Frank Davies, Sir Thomas (Cirencester) Hamilton, Sir George
Bridgeman, Rt. Hon. William Clive Davies, Dr. Vernon Harrison, G. J. C.
Briggs, J. Haroid Dawson, Sir Philip Harvey, G. (Lambeth, Kennington)
Briscoe, Richard George Dean, Arthur Wellesley Harvey, Major S. E. (Devon, Totnes)
Brocklebank, C. E. R. Drewe, C. Headlam, Lieut.-Colonel C. M.
Brown, Brig.-Gen. H. C. (Berks, Newb'y) Edmondson, Major A. J. Henderson, Capt. R. R. (Oxf'd, Henley)
Buckingham, Sir H. Edwards, J. Hugh (Accrington) Henderson, Lieut.-Col. Sir Vivian
Heneage, Lieut.-Col. Arthur P. Milne, J. S. Wardlaw Stanley, Lieut.-Colonel Rt. Hon. G. F.
Hills, Major John Walter Monsell, Eyres, Com. Rt. Hon. B. M. Stanley, Lord (Fylde)
Hilton, Cecil Moore, Sir Newton J. Steel, Major Samuel Strang
Hoare, Lt.-Col. Rt. Hon. Sir S. J. G. Nelson, Sir Frank Stott, Lieut-Colonel W. H.
Hopa, Capt. A. O. J. (Warw'k, Nun.) Newman, Sir R. H. S. D. L. (Exeter) Streatfeild, Captain S. R.
Hope, Sir Harry (Forfar) Nicholson, Col. Rt. Hn. W. G. (Ptrsf'ld.) Stuart, Crichton, Lord C.
Hopkins, J. W. W. O'Neill, Major Rt. Hon. Hugh Stuart, Hon. J. (Moray and Nairn)
Hopkinson, Sir A. (Eng. Universities) Penny, Frederick George Styles, Captain H. Walter
Howard-Bury, Colonel C. K. Peto, G. (Somerset, Frame) Sueter, Rear-Admiral Murray Fraser
Hudson,Capt. A. U. M. (Hackney, N.) Pilcher, G. Thomson, Rt. Hon. Sir W. Mitchelt
Hume-Williams, Sir W. Ellis Pownall, Sir Assheton Titchfield, Major the Marquess of
Hutchison, Sir Robert (Montrose) Preston, sir Waiter (Cheitenham) Tomlinson, R. P.
Iveagh, Countess of Rawson, Sir Cooper Tryon, Rt. Hon. George Ciement
Jackson, Sir H. (Wandsworth, Cen'l) Reid, Capt. Cunningham (Warrington) Wallace, Captain D. E.
James, Lieut.-Colonel Hon. Cuthbert Richardson, Sir P. W. (Sur'y, Ch'ts'y) Ward, Lt.-Col. A. L. (Kingston-on-Hull)
Kennedy, A. R. (Preston) Roberts, Sir Samuel (Hereford) Warner, Brigadier-General W. W.
King, Commodore Henry Douglas Rodd, Rt. Hon. Sir James Rennell Watson, Rt. Hon. W. (Carlisle)
Kinloch-Cooke, Sir Clement Ropner, Major L. Watts, Sir Thomas
Knox, Sir Alfred Runciman, Hilda (Cornwall, St. Ives) Wayland, Sir William A.
Lamb, J. Q Salmon, Major I. Wells, S. R.
Lister, Cunliffe, Rt. Hon. Sir Philip Sandeman, N. Stewart Williams, A. M. (Cornwall, Northern)
Loder, J. de V. Sanders, Sir Robert A. Williams, Com. C. (Devon, Torquay)
Lucas-Tooth, Sir Hugh Vera Shaw, Lt.-Col.A. D. Mcl.(Renfrew, W.) Williams, Herbert G. (Reading)
Luce, Major-Gen. Sir Richard Herman Sheffield, Sir Berkeley Wolmer, Viscount
Lumley, L. R Simms, Dr. John M. (Co. Down) Womersley, W. J.
MacAndrew, Major Charles Gien Sinclair, Major Sir A. (Caithness) Wood, B. C. (Somerset, Bridnwater)
MacIntyre, Ian Sinclair, Col. T. (Queen's Univ., Belf'st.) Wood, Rt. Hon. Sir Kingsley
Macquisten, F. A. Smith-Carington, Neville W. Worthington-Evans, Rt. Hon. Sir L.
Malone, Major P. B. Smithers, Waldron
Manningham-Bulier, Sir Mervyn Somerville, A. A. (Windsor) TELLERS FOR THE AYES.—
Margesson, Captain D. Southby, Commander A. R. J. Major Sir George Hennessy and
Marriott, Sir J. A. R. Spender-Clay, Colonel H. Major Sir William Cope.
NOES.
Adamson, Rt. Hon, W. (Fife, West) Hudson, J. H. (Huddersfield) Smith, Ben (Bermondsey, Rotherhithe)
Adamson, W. M. (Staff., Cannock) Jenkins, W. (Glamorgan, Neath) Smith, Rennie (Penistone)
Alexander, A. V. (Sheffield, Hillsbro') Jones, Morgan (Caerphilly) Snowden, Rt. Hon. Philip
Batey, Joseph Kelly, W. T. Stamford, T. W.
Bellamy, A. Kennedy, T. Sutton, J. E.
Bowerman, Rt. Hon. Charles W. Kenworthy, Lt.-Com. Hon. Joseph M. Taylor, R. A.
Broad, F. A. Lansbury, George Thurtie, Ernest
Bromley, J. Lawrence, Susan Tinker, John Joseph
Cape, Thomas Longbottom, A. W. Townend, A. E.
Charleton, H. C. Malone, C. L'Estrange (N'thampton) Trevelyan, Rt. Hon. Sir Charles
Cluse, W. S. March, S. Viant, S. P.
Clynes, Rt. Hon. John R. Mosley, Sir Oswald Wallhead, Richard C.
Cove, W. G. Naylor, T. E. Watts-Morgan, Lt.-Col. D. (Rhondda)
Dennison, R. Oliver, George Harold Wellock, Wilfred
Duncan, C. Palin, John Henry Wilkinson, Ellen C.
Dunnico, H. Parkinson, John Allen (Wigan) Williams, T. (York, Don Valley)
Greenwood, A. (Nelson and Colne) Ponsonby, Arthur Wilson, C. H. (Sheffield, Attercliffe)
Grenfell, D. R. (Glamorgan) Potts, John S. Windsor, Walter
Griffiths, T. (Monmouth, Pontypool) Purcell, A. A. Wright, W.
Grundy, T. W. Scrymgeour, E. Young, Robert (Lancaster, Newton)
Hall, F. (York, W. R., Normanton) Scurr, John
Hall, G. H. (Merthyr Tydvil) Secton, James TELLERS FOR THE NOES.—
Hardie, George D. Shinwell, E. Mr. Charles Edwards and Mr.
Hayday, Arthur Short, Alfred (Wednesbury) Paling.
Hirst, G. H. Sitch, Charles H.

It being after One of the Clock, the CHAIRMAN proceeded, pursuant to the Order of the House of 12th December, to put forthwith the Questions on any Amendments moved by the Government of which notice had been given and the Question necessary to dispose of the business to be concluded at One of the Clock at this day's Sitting.

CLAUSE 76.—(Adjustment of losses and gains of areas and payment for the purpose of Supplementary Exchequer Grants.)

Amendments made:

In page 60, line 28, leave out the word "fifteen," and insert instead thereof the word "nineteen."

In page. 61, line 2, after the word "day," insert the words "and each of the four following years."

In page 61, line 4, after the word "the," insert the word"next."—[Mr. Chamberlain.]

Question put, "That the Clause, as amended, stand part of the Bill."

The Committee divided: Ayes, 157; Noes, 77.

Division No. 123.] AYES. [1.8 p.m.
Ainsworth, Lieut.-Col. Charles Galbraith, J. F. W. Pilcher, G.
Albery, Irving James Ganzoni, Sir John Pownall, Sir Assheton
Alexander. E. E. (Leyton) Guinness, Rt. Hon. Walter E. Preston, Sir Walter (Cheltenham)
Ashley, Lt.-Col. Rt. Hon. Wilfrld W. Gunston, Captain D. W. Rawson, sir Cooper
Astor, Maj. Hn. John J. (Kent, Dover) Hacking, Douglas H. Reid, Capt. Cunningham (Warrington)
Atkinson, C. Hamilton, Sir George Richardson, Sir P. W. (Sur'y, Ch'ts'y)
Balniel, Lord Harrison, G. J. C. Roberts, Sir Samuel (Hereford)
Barnett, Major Sir Richard Harvey, G. (Lambeth, Kennington) Rodd, Rt. Hon. Sir James Rennell
Beckett, Sir Gervase (Leeds, N.) Harvey, Major S. E. (Devon, Totnes) Ropner, Major L.
Bellairs, Commander Carlyon Headlam, Lieut.-Colonel C. M. Salmon, Major I
Berry, Sir George Henderson, Capt. R. R. (Oxf'd, Henley) Sandeman, N. Stewart
Bethel, A. Henderson, Lieut.-Col. Sir Vivian Sanders, Sir Robert A.
Betterton, Henry B. Heneage, Lieut.-Colonel Arthur P. Shaw, Lt.-Col. A. D. Mel. (Renfrew, W)
Birchall, Major J. Dearman Hills, Major John Waller Sheffield, Sir Berkeley
Bowyer, Captain G. E. W. Hilton, Cecil Simms, Dr. John M. (Co. Down)
Bridgeman, Rt. Hon. William Clive Hoare, Lt.-Col. Rt. Hon. Sir S. J. G. Sinclair, Col. T. (Queen's Univ., Belf'st.)
Briggs, J. Harold Hope, Capt. A O. J. (Warw'k, Nun.) Smith-Carington, Neville W.
Briscoe, Richard George Hope, Sir Harry (Forfar) Smithers, Waldron
Brocklebank, C. E. R. Hopkins, J. W. W. Somerville, A. A. (Windsor)
Brown, Brig.-Gen.H.C.(Berks, Newb'y) Howard-Bury, Colonel C. K. Southby, Commander A. R. J.
Buckingham, Sir H. Hudson, Capt. A. U. M. (Hackney, N.) Spender-Clay, Colonel H.
Bullock, Captain M. Hume-Williams, Sir W. Ellis Stanley, Lieut.-Colonel Rt. Hon. G. F.
Burton, Colonel H. W. Iveagh, Countess of Stanley, Lord (Fylde)
Campbell, E. T. Jackson, Sir H. (Wandsworth, Cen'l) Steel, Major Samuel Strang
Cautley, Sir Henry S. James, Lieut-Colonel Hon. Cuthbert Stott, Lieut.-Colonel W. H.
Cecil, Rt. Hon. Sir Evelyn (Aston) Kennedy, A. R. (Preston). Streatfeild, Captain S. R.
Chamberlain, Rt. Hon. N. ( Ladywood) King, Commodore Henry Douglas Stuart, Crichton-, Lord C.
Churchman, Sir Arthur C. Kinloch-Cooks, Sir Clement Stuart, Hon. J. (Moray and Nairn)
Clarry, Reginald George Knox, Sir Alfred Styles, Captain H. Walter
Clayton, G. C. Lamb, J. O. Sueter, Rear-Admiral Murray Fraser
Cobb, Sir Cyril Lister, Cunliffe, Rt. Hon. Sir Philip Sugden, Sir Wilfrld
Cockerill, Brig.-General Sir George Loder, J. de V Thomson, Rt. Hon. Sir W. Mitchell
Conway, Sir W Martin Lucas-Tooth, Sir Hugh Vere Tryon, Rt. Hon. George Clement
Cope, Major Sir William Luce, Major-Gen.Sir Richard Harman Vaughan-Morgan, Col. K. P.
Cowan, Sir Wm. Henry (Islingtn, N.) Lumley, L. R. Wallace, Captain D. E
Craig, Sir Ernest (Chester, Crewe) MacAndrew, Major Charles Glen Ward, Lt.-Col. A. L. (Kingston-on-Hull)
Crookshank, Col. C. de W (Berwick) MacIntyre, Ian Warner, Brigadier-General W. W.
Crookshank, Cpt. H. (Lindsey, Gainsbre) Macquisten, F. A. Watson, Rt. Hon. W. (Carlisle)
Davies, Sir Thomas (Cirencester) Maitland, Sir Arthur D. steel- Watts, Sir Thomas
Davies, Dr. Vernon Malone, Major P. B. Wayland, Sir William A.
Dawson, Sir Philip Manningham-Buller, Sir Mervyn Wells, S. R.
Dean, Arthur Weliesiey Margesson, Captain D. Williams, A. M. (Cornwall, Northern)
Drewe, C. Marriott, Sir J. A. R. Williams, Com. C. (Devon, Torquay)
Edmondson, Major A. J. Meller, R. J Williams, Herbert G. (Heading)
Edwards, J. Hugh (Accrington) Milne, J. S. Wardlaw- Wolmer, Viscount
Erskine, Lord (Somerset, Westons.M.) Monsell, Eyres. Com. Rt. Hon. B. M. Womersley, W. J
Evans, Captain A. (Cardiff, South) Moore, Sir Newton J. Wood, B. C. (Somerset, Bridqwater)
Everard, W. Lindsay Nelson, Sir Frank Wood, Rt. Hon. Sir Kingsley
Fairfax, Captain J. G. Newman, Sir R. H S. D. L. (Exeter) Worthington-Evans, Rt. Hon. Sir L.
Falle, Sir Bertram G. Nicholson, Col. Rt. Hn. W. G. (Ptrsf'ld.)
Fanshawe, Captain G. D, O'Neill, Major Rt. Hon. Hugh TELLERS FOR THE AYES.—
Fermoy, Lord Ormsby-Gore, Rt. Hon. William Major Sir George Hennessy and
Fester, Sir Harry S. Penny, Frederick George Major the Marquess of Titchfield.
Fremantle, Lieut.-Colonel Francis E. Peto, G. (Somerset, Frome)
NOES.
Adamson, Rt. Hon. W. (Fife, West) Hardie, George D. Sexton, James
Adamson, W. M. (Staff., Cannock) Hayday, Arthur Shinwell, E.
Alexander, A. V. (Sheffield, Hillsbro') Hirst, G. H. Short, Alfred (Wednesbury)
Batey, Joseph Hudson, J. H. (Huddersfleld) Sinclair, Major Sir A. (Caithness)
Bellamy, A. Hutchison, sir Robert (Montrose) Sitch, Charles H
Bowerman, Rt. Hon. Charies W. Jenkins, W. (Glamorgan, Neath) Smith, Ben (Bermondsey, Rotherhithe)
Briant, Frank Jones, Morgan (Caerphilly) Smith, Rennie (Penistone)
Broad, F. A. Kelly, W. T. Snowden, Rt Hon. Philip
Bromley, J. Kennedy, T. Stamford, T. W.
Cape, Thomas Kenworthy, Lt.-Com. Hon. Joseph M. Sutton, J. E.
Charleton, H. C. Lansbury, George Taylor, R. A.
Cluse, W. S. Lawrence, Susan Thurtle, Ernest
Civnes, Rt. Hon. John R. Lowth, T. Tinker, John Joseph
Collins, Sir Godfrey (Greenock) Malone, C. L'Estrange (N'thampton) Tomlinson, R. P.
Cove, W. G. March, S. Townend, A. E.
Dennison, R. Morris, R. H. Trevelyan, Rt. Hon. Sir Charles
Duncan, C. Mosley, Sir Oswald Waithead, Richard C.
Dunnico, H. Naylor, T. E. Watts-Morgan. Lt.-Col. D. (Rhondda)
Gillett, George M. Oliver, George Harold Wellock, Wilfred
Greenwood, A. (Nelson and Colne) Palin, John Henry Wilson, C. H. (Sheffield, Attercliffe)
Grenfell, D. R. (Glamorgan) Parkinson, John Allen (Wigan) Windsor, Walter
Griffith, F. Kingsley Ponsonby Arthur Wright, W.
Criffiths, T. (Monmouth, Pontypool) Potts, John S. Young, Robert (Lancaster, Newton)
Grundy, T. W. Purcell, A. A.
Hall, F. (York, W. R. Normanton) Runciman, Hilda (Cornwall, St.Ives) TELLERS FOR THE NOES.—
Hall, G. H. (Merthyr Tydvil) Scrymgeour, E. Mr. Charles Edwards and Mr.
Hamilton, Sir R. (Orkney & Shetland) Scurr, John Paling.