§ Considered in Committee under Standing Order No. 71A.
§ [Mr. ROBERT YOUNG in the Chair.]
§
Motion made, and Question proposed,
That, for the purposes of any Act of the present Session to amend the Lunacy Acts, 1890 to 1922, and such of the provisions of the Mental Deficiency Acts, 1913 to 1927, as relate to the constitution and organisation of the work of the Board of Control, the exercise of the powers of the Board and the protection of persons putting those Acts into operation, it is expedient to authorise the payment, out of moneys provided by Parliament—
§ Sir K. WOODI must apologise for addressing the House again, and delaying it, in view of the considerable business which follows this Resolution, but this is an important matter, involving a considerable alteration in the constitution and organisation of the Board of Control. I am sorry the 1083 Minister of Health has not thought it desirable to give us a reasonable opportunity of discussing this important resolution. I do not think he can complain of the reception of the Bill and I hope he will give us a reasonable opportunity of discussing the alteration in the constitution of an important organisation and will move the Adjournment of the Debate. If we pass the Resolution we give authority subject to any alterations which may be made in Committee, for a reconstitution of the Board of Control. The undoubtedly considerable duties of the Board involve the scrutiny of reception documents and continuing reports, and important duties in connection with the visitation of places where people are detained. A large portion of their work consists of superintending the arrangements for the treatment and care of patients. In London they have a special duty of licensing houses and in the country of examining the records of people who are unfortunately detained. These are responsible and important duties. The criticisms levelled at the Board of Control have not been in regard to personnel or the manner in which they are carrying out their duties, but that there are not a sufficient number of commissioners, that the staff is not sufficient to carry out the duties. I do not agree with the statement of one hon. Member that the criticisms and complaints have been against the present Board of Control. Most Members recognise that their difficult and delicate work has been carried out satisfactorily, and that statement is borne out by the Report of the Royal Commission. There was ample evidence before the Commission of the nature of the work of the Board of Control, and the hon. Member only brought one piece of evidence to support his statement, and at the time I wondered whether he had brought the case to the notice of the Board of Control itself. My criticism is not directed in any way at the Board of Control, but rather to examine, before we authorise the payment of these salaries under this new constitution, whether we shall improve the Board of Control by the suggestions in the Financial Resolution and in the Bill itself.
It is suggested that the Board of Control should be divided into two parts, and that one particular body of the members 1084 of the Board should be senior Commissioners. Paragraph (a) of the Resolution says that there will be Commissioners other than senior Commissioners—assistant Commissioners "as may be so fixed." What number of Commissioners is contemplated, senior and other than senior? What justification is there for the division between senior and junior Commissioners? In the present Board of Control the members are equal in status and they are recognised as full members. Would it detract in any way from the position and influence of the Board to make this division? Will the authority and status of the Commissioners other than senior be of such a character as to weaken their influence? These Commissioners will have to visit many important institutions. It is important that Parliament should give them all possible authority in order that they may carry out their important work. It is a fact, I think, that the present Board of Control is insufficient in numbers. It is stated in the Royal Commission's report that their number has not been sufficient for them to carry out even their statutory duties.
Where it has been laid down by Act of Parliament that two Commissioners should make certain visits, owing to the depleted numbers of the Board only one Commissioner has been able to go, and I want to know whether the right hon. Gentleman contemplates a sufficient number, so appointed to the Board of Control, to enable them properly to carry out their statutory duties. I also want to know, with regard to the appointments to the Board of Control, what appointments are in fact contemplated. It is suggested that medical opinion should be represented there, and that there should be certain legal representatives. On the present Board of Control there is what is called a lay representation, and there is a good deal to be said for that particular kind of representation being continued. I want to know whether the right hon. Gentleman contemplates a lay representative, and whether a woman is to be made a member of the Board of Control. Further, what is to become of the present members of the Board of Control? Are they to be continued in office, and what arrangements are being made in that connection?
There is only one other matter that I desire to raise, and that is contained in 1085 paragraph (b) of the Resolution, which deals with superannuation allowances, and I want the right hon. Gentleman briefly to state what he contemplates there. As I understand it, if an officer who is now a servant of a local authority is appointed to be one of these assistant commissioners, the years of service which he has had with the local authority will, for the purposes of pension, count as if his service had been rendered the whole of the time with the State, and I should like to have some confirmation of that. These are important matters. The success of this Bill, when it becomes an Act of Parliament, largely depends upon its administration, and in no small degree upon the administration of the Board of Control. I therefore hope the right hon. Gentleman will recognise the importance of the questions I have put, and no doubt there are other questions which other hon. Members behind me may desire to put. We desire to do our duty, and I am sure the right hon. Gentleman the Minister of Health desires to do his. It is in that spirit, and with a desire to gain information as regards the future administration of this Measure, that I venture to put these questions to the right hon. Gentleman.
§ Sir B. PETOAfter the very able and important speech of my right hon. Friend the Member for West Woolwich (Sir K Wood), hon. Members opposite might think there were no further questions to be put or comments to be made, but the first thing worthy of notice is that this Bill to which we have just given a Second Beading is no exception to other Measures that have come before the House, in that they all make a fresh call on the public finances and establish in some new entrenchment a new branch of the bureaucracy. I find, on referring to the Bill, that the underlined portions of the Bill occupy no less than three pages and refer to a large part of three Clauses of the Bill, so that, numerically speaking, one-seventh of the Clauses of the Bill require to be covered by this Financial Resolution. Besides that, in the speech which the hon. Lady, the Parliamentary Secretary to the Ministry of Health, gave us on the Second Reading, she told us something that gave me great anxiety. She told us that the Commissioners in the past had been regarded as a somewhat elusive body, whom people could 1086 not always find, because they were very hard-worked gentlemen who had to go to all parts of the country, and consequently were not always to be found in London. She said the Government were going to remedy that by establishing this Board of Control as a department of the Ministry of Health, where, I concluded, some or all of them would always be found.
I want to know whether it is the purpose, under this Financial Resolution, to establish this Board of Control permanently at the Ministry of Health. In Clause 11, in the underlined portion of the Bill, it says:
The Board of Control shall consist of the chairman (who shall be a paid commissioner) and not more than four other commissioners, all of whom shall be paid commissioners.That appears to be the central and guiding body of the Board of Control, and they are always to be found, I gather in Whitehall. Commissioners other than senior commissioners, and the assistant commissioners, of an undefined number, are, I suppose, to be the minor lights of the Board of Control, who will do the travelling about and the elusive part of the business in future. I think this is a very formidable proposition. The hon. Lady indicated that the chairman of the Board of Control was in future going to occupy a position analogous to that of the head of any other department, and she put that to us as a government recommendation, because we were led to infer that this highly paid chairman of the Board of Control would be in close touch with the Ministry of Health and that anybody who wanted to consult him would always be able to find him there.From the point of view of the taxpayer, this seems an extraordinary proceeding. I think he is entitled to ask the question the right hon. Gentleman the Member for West Woolwich asked as to the undefined number of these commissioners other than senior commissioners and assistant commissioners who are to be appointed. I think we are also entitled to ask what is the exact range of salaries from the Chairman, who is to be permanently attached to the right hon. Gentleman on the front Bench, and the other people who are to do the real hard work of travelling about the country.
1087 We should also like to know what is the total. There is no key to that in this Resolution, and it is a somewhat singular thing. We are asked to give a blank cheque. The Minister is to appoint these people. He and nobody else, and he is to fix the amount of their salaries, and all this Committee is asked to do is to authorise what Mr. Micawber calls the "demnition tottle." [Interruption, and HON. MEMBERS: "Order!"] We are entitled to know the total; in other words, what is the exact total of all these salaries to be paid. We are entitled to know what each grade is going to be paid and what it is going to cost. We would not fulfil our duty if we did not insist on this information, and I am surprised the hon. Gentle man the Financial Secretary to the Treasury (Mr. Pethick-Lawrence), who is put down on the Order Paper to move this Resolution, has not given us some of these elementary facts. It is quite obvious what will really occur. I should have thought the Financial Secretary to the Treasury, in moving this Resolution, would have been able to tell us exactly what arrangements he had made and how much money was going to be paid, and that he would have given us some outline of what the duties of these graded officials from the top of the hierarchy downwards was going to be—.
It does not end there. There is an elaborate scheme under Clause 11, Subsection (8b), on page 13, as to what is to happen on the retirement of all these new officials in this new branch of the Civil Service which is going to roam about the country, and in the office of the Minister of Health. It is a serious problem, when we are gradually getting rid of the tremendous burden of War pensions, that there should be another body of Civil Servants of unknown numbers who will receive the appropriate pension. We do not know at the present moment how many there are who will be capable of reaching the age limit. Those who brought forward this Financial Resolution have not the slightest conception of the scope which we entitle the Minister of Health to authorise. Therefore, I make no apology whatever if I fulfil my duty. That is what hon. Members on the other side of the House and anybody who has the slightest regard to their duties should do. 1088 We ought to try to lighten the burden which is being constantly increased. We make no apology for occupying some moments more than the Minister of Health desires, because there is no other business which has been talked about for to-night. I think it is entirely the fault of the Government. If, instead of showing anxiety to rush the business through anyway, they had taken a little longer in introducing the Financial Resolution, it would have saved their time in the end. [Interruption.]
§ The CHAIRMANOrder, Order. Hon. Members on my right have had a very good share of the Debate this evening.
§ Mr. GREENWOODI think it might be as well if I were to indicate what is in the resolution. I can assure the hon. Baronet that I have no desire to shirk any explanation of it. I was indeed delighted to listen to him before I spoke myself for he has thrown a very great light on the Bill. I am not complaining about the reception of the Bill, except that I am unaccustomed to having honeyed words poured out in such profusion. Those who approved this Bill might have helped us by saving a little time and letting their hearts throb in silence. Some of the questions asked are answered in the Bill itself and in the Financial memorandum that is in the hands of hon. Members and which I must assume they have read; and, therefore, perhaps I need not go all over that. There is a great change being made in the organisation of the Board of Control. On pages 154 and 155 of the Royal Commission's report, with which of course all hon. Members are familiar, it is clear that the present organisation of the Board of Control is not such as might ensure effective administration. It is difficult to have a body—a soviet of people—all co-equal who are engaged all of them on the job of visitation in the country and central administration at headquarters.
It is clear, of course, that to get effective administration, on the lines laid down in all other Departments, you should differentiate between those who have final responsibility and those who are concerned with visitation and inspection. The distinction which is made in the Bill between senior commissioners and other commissioners, including the 1089 assistant commissioners, is so that we can get this clear demarcation—the senior commissioners will be primarily engaged on central administration, control and policy; the other commissioners will be primarily engaged in the work of visitation and inspection in the Provinces. That is according to sound methods of administration and needs no further elaboration.
The right hon. Member for West Woolwich (Sir K. Wood) asked as to the composition of the Board—whether it was the intention that one of the senior commissioners should be a layman. The Committee is aware that provision is made that at least one shall be a medical commissioner, and that at least one shall be a woman. The intention, as advised at present, is that there shall be two medical commissioners, one legal commissioner, and one woman. The chairman, in addition to the four, will not be lay in the sense of being neither legal nor medical, because, after all, they are being called upon to undertake responsible executive and administrative duties, some of which are legal and some are medical in their character. The people must be experts. They are going to be the senior officers of this branch of the public service. One does not speak of a "layman" when one is speaking of a responsible public servant who is expected to be an expert at his particular job. The right hon. Member for Woolwich, West, and the hon. Baronet the Member for Barnstaple (Sir B. Peto), with their zeal for knowledge, asked as to the number of other commissioners, their salaries, and, as I understood it, their life histories. I think that was asking a little too much.
If hon. Members will look at the Resolution, which is carefully drafted, they will see that it states "such salaries as may be fixed" and "such Commissioners as may be fixed." If I appeared at this desk with a cut-and-dried scheme before the Bill was on the Statute Book, instead of inquisitiveness on that side of the House we should have the most violent denunciations. It is perfectly obvious that we are not entitled to go ahead of the House of Commons in the way in which I am being encouraged to do by so Bolshevist a Member as the hon. Member for Barnstaple. As the Bill makes its way through its various stages, and as we get nearer to the time 1090 when it will become a statute, we will get nearer and nearer to an understanding with the Treasury on this matter as laid down in the Money Resolution which Members of the Committee, I again assume, have carefully read.
§ Lieut.-Colonel HENEAGEMay I interrupt? There is mention of the Treasury under Paragraph (a) but I do not see any mention in Paragraph (b).
§ Mr. GREENWOODThe hon. Member is a little impatient. I am on the point of the central administration of the commissioners, salaries, emoluments and pensions. That, I say, as laid down in the Money Resolution, is a matter for discussion and agreement with the Treasury, and such discussions are going on at the present time. As is laid down in the Financial Memorandum it is not anticipated that the additional cost from the development in contemplation will be more than £6,000 per year. I come now to the second part of the Resolution which deals with the question of superannuation.
§ Captain CROOKSHANKMay I ask, if the right hon. Gentleman has got no cut and dried scheme, what is the basis of his estimate?
§ Mr. GREENWOODThe subtlety of hon. Members opposite increases as the night goes on. I said that we were discussing this question now with the Treasury. I said that the House could be assured that whatever the cost would be it would not exceed £6,000 every year. The question of superannuation is a matter which will not affect a large number of people, but it is the source of a particular problem for the Board of Control. Quite clearly, people who are to have such heavy responsibilities with regard to mental disease must be people who have considerable knowledge of this question, and, as vacancies occur, it may be desirable to reinforce the staff from people who are engaged in the mental hospital service. But it is difficult to attract these people into the service, because, as the law stands now, they lose their superannuation rights, and because cases may occur where men would not serve a sufficient number of years—the necessary minimum is ten years—to qualify for the pension he would have got had he continued in the local government service. The arrangements under Clause 1091 11 (8) of the Bill are designed to get over that difficulty by spreading the burden of superannuation over the Board Control service and service for these various public authorities under which the com missioner has served in the mental hospital service, so that he should not be deprived of his right in the circumstances. The intention is, as hon. Members will see if they study Clause 11, sub-section (7), that proportionate charges shall be borne by the local authority or authorities by whom the officer had been previously employed and by the Board of Control itself. That, I think, answers the main points which have already been raised and, as the House has agreed to the Second Reading of the Bill without a Division and has indeed shown itself so fond of the Bill that it wanted to keep it on the floor of the House for the Committee stage, I should imagine the Committee would be prepared to agree now to give me the Money Resolution.
§ Captain CROOKSHANKI am sorry the right hon. Gentleman, in his very lucid speech, did not explain a little further about this estimated additional cost, because on a Money Resolution the Committee is entitled to know what the probable cost is going to be to the country as a whole. That is the point of this complicated financial procedure which we indulge in after the Second Reading of a Bill. On page 2, paragraph 5, of the Financial Memorandum it says:
So far as at present can be foreseen, however, it is not expected that the additional cost will exceed £6,000 a year.The Minister said in his speech that, if he came with a cut-and-dried scheme, we would have criticised him. I do not know on what grounds he has assumed that, but I am quite prepared to criticise him on the ground that he has given us no explanation of how he reached that additional sum of £6,000. Is that all the extra charge the taxpayer will have to meet for this reconstituted Board of Control? After his conversations with the Treasury, he must have some idea of the basis of their calculations. If he considers what the duties are that are going to be placed on the Board of Control and himself by the Bill, I think he will agree that it is perfectly fantastic to suggest that the duties which the Board of Control as the central authority are 1092 going to undertake can be carried out for an additional cost of not more than £6,000 a year.Let me refresh his memory as to what are the duties of the Board of Control. Under the first Clause, he will find that any voluntary boarder may be received in any hospital or nursing home approved by the Board of Control or with the consent of the Board into single care. Those are two functions of the Board. First of all, they have to approve the hospital or nursing home and, secondly, they have to consent to single care. My argument is that the functions of the Board are so great that it is not possible to carry them out at the figure of £6,000 a year. On the second page, we find a recommendation has to be signed if a certain person is approved by the Board of Control. That is another function. On page 3, where a person is received as a Voluntary boarder notice of his reception has to be sent to the Board of Control by the person in charge. In the next Clause, if the person dies, a notice has to be sent to them. If a person is under 16 and certain things happen, the person in charge has to send to the Board of Control a report of the circumstances. In Clause 3 any commissioner may at any time visit a person received and report to the Board of Control. If you are going to make the Board of Control responsible for all these things you are asking a good deal of them if you think you can do it with only an extra cost of £6,000 a year, especially as the right hon. Gentleman has not given us any basis on which he has made his estimate.
To continue my review of their duties, on the same page to which I was referring it is provided that the Board of Control have to decide with regard to voluntary boarders, while on the next page the Board of Control have to deal with the temporary patient and his admission into a hospital or nursing home approved by the Board. Further on, it is provided that with their consent he may be admitted into single care. On page 5 of the Bill, in the same Clause, there is a provision about the approval of the Board for a medical practitioner. Again, in another Sub-section the Bill makes it necessary to report to the Board of Control if such a temporary patient dies. The Board of Control, therefore, is evidently going to be kept very busy. In Sub- 1093 section (9) of the same Clause there is another proviso that in the area within the immediate jurisdiction of the Board of Control the duty imposed by the Section on the visitors of licensed houses shall be performed by the Board of Control. In the next Sub-section there is another kind of report to be sent to the Board of Control, while in Sub-section (13) the Board, again, have to make rules under a Sub-section of the principal Act. In Sub-section (14) there is a description of what the Board of Control may at any time order.
On the next page, in Clause 6, Subsection (2), the approval of the Board of Control is necessary for certain things which local authorities may do. An hon. Member asks me if this will be day work or piece work, but, if the right hon. Gentleman had only told us on what he based his estimates, we might have saved ourselves a good deal of night work. In Sub-section (3) of this Clause there are various things set out which a local authority again has power to do, but always subject to the approval of the Board of Control. In Clause 8, one finds a provision for the appointment of a supervising medical officer, again subject to the approval of the Board of Control, while in Sub-section (6) of Clause 11 it is provided that the Board of Control shall have power to appoint assistant commissioners. Under Clause 12 the Chairman of the Board of Control, after consultation with the members of the Board, shall be made responsible for making arrangements as to the administrative business of the Board and so forth. In Clause 13, there are further references to the discretion of the Board of Control, while their powers are also referred to in Clause 15, where they are given power to make rules.
To sum up, there are in this Bill alone 24 different duties specifically cast on the Board of Control. I put it to the right hon. Gentleman that a Board with such multifarious occupations as have been imposed upon them by this Bill must require for the performance of all these functions a good deal of administrative background in order to be able to carry out all these different duties. Events will prove that £6,000 alone is not enough. If hon. Members will be good enough to read the Financial Memorandum in connection with this Bill, they will find 1094 that borne out. I am sorry that he did not explain to us what is meant by local authority "A" and "B." I am sure the Committee will not expect me to go into detail with regard to the complicated financial scheme between the two authorities.
1.0 a.m.
That is a thing which the committee must leave to the future. But, with regard to the administrative expenses and the word "control" I think the Minister or the Financial Secretary of the Treasury might give us some information as to what they themselves think of the estimate of £6,000, and whether they really do not think that with all these twenty-four items which I have already enumerated the expenses will be more than £6,000 in the course of the year.
§ Mr. CHARLES WILLIAMSWe have had some long and fairly interesting speeches, and it is a little difficult to know which speech to begin on and which to end on. As the hour is getting somewhat late, I think, perhaps, I ought, first, to comment on the Minister's speech. He referred to the fact that this discussion had been somewhat long to-day, but there are still one or two points I would like to raise. I see that the Financial Secretary to the Treasury is here. In the first place, I want to know what is going to be the salary of the Chairman. Presumably, he will have a high salary. I also want to know, and several people want to know—quite a lot of people want to know—what salary the Chairman is getting at the present time. We have heard a good deal about the estimate of £6,000. I admit that the Minister did not know where he had got that figure. There are five people mentioned and that £6,000 to get really efficient people is not going very far. I think we might be told how the money is going to be apportioned. There are two other points about which I want to know. These Commissioners will have to deal with a great variety of people in different places and I want to know—this is most important—if one of them will have a knowledge of Welsh. That is quite a serious point. I am sorry if I may seem to have been unduly critical of the Minister. I agree with my hon. Friend the Member for Barnstaple (Sir B. Peto). This is a growing expenditure 1095 in many ways, and I protest against that. But I would like to say that not a single penny of this expenditure goes to Scotland in any shape or form.
§ Mr. J. JONESHaving listened to all the mental experts in the course of this discussion, I wish to say that there are many institutions which are going to get the money, and I do not care who gets it if the people get benefit. As regards salaries, those of us who are members of local authorities know that we often make big mistakes in paying small salaries to good men and lose them in the process of sacrificing efficiency for the sake of economy. Hon. Members opposite are always talking about economy, but they are always full of extravagance when their own interests are affected. I want to say that this £6,000 may be a small estimate—I hope this is just an estimate—but, if it cost £60,000, if it was going to do half what the Minister has in mind with regard to mental administration—I have had some experience of mental deficiency since I have been in this House—it would be money well invested. I have said it before in the House and outside: there are people in our asylums to-day who ought not to be there at all. You see children mixing with people who are hopelessly incapable and insane, all together in the same ward. Those who have had experience on local authorities know that. If any effort can be made so to arrange things that those who are not so badly placed shall be segregated from those who are badly placed and that they shall receive some training to bring them back to normal as near as we can, it will be a blessing worth £60,000, let alone £6,000.
I am not particular about the Control Board. There are too many experts, and there is not enough humanity. People who know, who have been through the mill—I myself might have been certified years ago but still I think I am as sane as anyone who has spoken to-night—realise how great is the need to do something. As far as we are concerned, let us get through the Committee stage of this Bill, and let us have a real Board of Control, not comprised of medical experts—though I owe a debt of gratitude to them myself; I just escaped—I would like a human Board of Control, not merely of 1096 medical experts but of human experts, of men and women who have gone through the mill themselves. Let the cost be whatever it is. Poverty is the principal cause of this disease. Seventy-five per cent. of the men and women we have in our asylums are the victims of poverty. They were perhaps mentally deficient, but they have been starved into insanity. Therefore, conditions have made them what they are. It is better to spend £60,000 in preventing insanity than to save £6,000 in not having a chance to live.
§ Resolution to be reported Tomorrow.