§ Sir KINGSLEY WOOD
I want to turn to a totally different subject from that which we have been discussing, and one which is raised very largely by the next Amendment on the Paper. No doubt we shall be hearing from the hon. Member who put it down the broad position that he desires to raise in reference to the important question of maternity and child welfare. We have not had an opportunity during this Parliament of raising this very vital matter, perhaps one of the most vital matters from the point of view of the health conditions of the country. I suppose, if one had to examine into the progress that we are making in connection with health affairs, one of the aspects which we should first, investigate to see whether we were making progress is this question of maternity and child welfare, and whether it is possible within the present law and administration to take any further step 984 forward. That is a matter to which I invite hon. Members to give their consideration, because it really is a subject on which I can appeal to all sections to see whether we can advance the cause which we all have at heart.
I suppose there are two aspects of the matter which have provoked considerable public attention. One is a very gratifying one, but the other is giving considerable anxiety to social workers and health administrators. So far as the test of the infantile mortality rate is concerned, I think the country can quite rightly congratulate itself upon thy position, but when we come to the maternal mortality rate there is another and a very different aspect of the matter which is nothing like so encouraging, in fact a state of affairs which provokes a considerable amount of disquiet.
In connection with both those matters we have to realise that the work is being carried on by a sort of triple partnership. There is the work of the Ministry of Health, which I suppose may be called of a supervisory character—assisting by 985 grants and by general direction this important work—then there is the valuable work of the local authorities, and thirdly, and certainly by no means least, the work of the great voluntary agencies. The association of the three has been of the most valuable character, and I do not think anyone, on whatever side he sits, would desire to disturb that partnership but would rather,, if possible, encourage even closer relations than have existed in the past. In approaching this matter we want, if possible, looking at it from the position of the local authorities, to endeavour to bring about improvements in several important directions. Take, for instance, the work of the smaller local authorities and the many local officials, who are undoubtedly doing valuable work. I would not desire to decry for a moment the work of the smaller authorities, but there is no doubt that a considerable improvement could in many cases be obtained by transferring it to larger authorities, such as county councils.
One of the most striking advantages, one with which anyone will agree who gives a moment consideration to this aspect of the case, arises in this connection. With larger authorities you have the school medical service and, if you can co-ordinate the work in connection with maternity and child welfare, and link it up with the larger authorities, by that means you secure co-ordination of your local maternity and child welfare work with the school medical service of the local authority. That undoubtedly is a very great gain indeed. If you rely upon your smaller authority you lose that great advantage. The smaller authority may be doing good work, and its officials may be equally zealous and desirous of improving these important conditions, but you cannot get the linking up which can be obtained by transferring this work to the larger local authorities of the country. I know that a good many hon. Members who speak on behalf of the local authorities point to the individual interest which is given by the smaller local authority, and to the more exact local knowledge of the smaller local authority. We do not want to lose that very valuable benefit in our public life in this country, but, on the other hand, there will be an over-whelming advantage if, in connection with maternity and child welfare, you co- 986 ordinate the work of the larger authority and the school medical service. You will obtain a result which will do a great deal towards improving the health conditions of the children of this country, and you will practically have continuity in the supervision of the health of the children of this country from birth up to the school-leaving age. You can only obtain this by entrusting this work, very largely, to the local authorities of the country. If you reject that idea you will be thrown back upon a multiplicity of authorities up and down the country, and upon the position where one local authority does not know what the other local authority is doing. It not only means considerable waste from the point of view of money and energy, but it is not improving one of the most vital and necessary services in this country.
I hope that the Parliamentary Secretary to the Ministry of Health, when she comes to reply upon this question, will be able to say that she and the Ministry are doing everything to bring about continuity of administration and co-ordination so urgently necessary and desirable. It is not, to a very large extent, a question of money. I cannot recollect in recent years in this House when money has been grudged for maternity and child welfare services. When the Estimates of the Ministry of Health have been brought forward, I do not think that anyone has challenged seriously the careful estimates which have been made with regard to the amount of money which has been spent in this important connection. The local authorities of the country are spending £1,500,000 a year. Although times are difficult and we have before us the probability of still heavier taxation, I do not think that there are many people who would desire for a moment to cut down the expenditure in relation to the very excellent services which the local authorities are providing at the present time. The sum of £1,500,000 was spent in the year 1928–29, and, if there is any further sum necessary in the forthcoming year, I do not think it will seriosuly be challenged.
Whatever one's view may be about local administration and State supervision, do not think that there will be many Members of the House who will desire to see the work of the voluntary associations dealing with maternity and child welfare in any way cut down. The grant which 987 we vote from this House to the voluntary associations of the country for this work is something like £230,000 a year, and this is money very well spent. I do not wish to raise the particular functions in a community of the local authority versus the voluntary agencies, because I believe that, from the point of view of the future of the children and the benefit which can be afforded to them from the health point of view, we can very well rely upon, and take advantage of, the work of both the local authority and of the voluntary agencies.
While I have paid a tribute to the excellent work which the local authorities are doing in many directions, I desire also to say that there is no country in the world which is as proud of its voluntary institutions and the work which they are doing as is this country. You may look at it from the point of view of hospital treatment and hospital provisions. One of the finest features in the country to-day is the fact that all classes of the community join in assisting the voluntary agencies and the voluntary hospitals in this work. When I was at the Ministry of Health I visited several voluntary institutions which were very largely financed by the weekly contributions of the working men and working women of the country. Not only were they financed by their weekly contributions, but representatives of the large works in the particular districts concerned sat upon the boards of these voluntary hospitals, and took their part in the direction of health maternity and child welfare work as ably as did the representatives of the employers. I believe that the moment you threatened the voluntary institutions of the country by any curtailment of their activities, or endeavoured in any way to cut down their grant, the first people who would rise in protest against such action would be large numbers of working men and working women who have made such splendid contributions, not only in money but also in service, to this particular work. I hope we shall hear from the representative of the Ministry of Health to-night that the Ministry are going to assist in every way they possibly can the work both of the local authorities and of the voluntary agencies.
I want to raise also, in reference to this work and its administration, the importance of health visiting. I am glad to see 988 that this is one of the matters which arise in connection with the Estimates which we are considering, and that the work of the health visitor is becoming more and more appreciated in this country, and almost equally with the work of the medical man and of the midwife. I am glad to hear that the number of candidates who are entering what is really a profession is increasing, and that a very large number of women particularly are taking up a six months' course of training before entering the examination necessary to become a properly accredited health visitor of the local authorities of the country. Formerly it was not an occasion for astonishment when anyone thought that she could be a health visitor without any exceptional training or knowledge; the desire to do good, and the anxiety to help people suffering from bad health were considered sufficient qualifications for what is really a very difficult and important aspect of maternity and child welfare work. I am glad that that particular view of the work of health visitation very largely has disappeared, and I hope that it will soon disappear altogether.
We shall only obtain a complete and efficient service of health visitors if the local authorities of the country and the voluntary agencies which employ them realise that these people who do important and valuable work should have proper and adequate remuneration for their services. I have often thought that it has been a reproach, both to the local authorities and to the voluntary agencies, that the standard of remuneration given to people who are playing very important parts in health administration in the country has been inadequate. One of the best suggestions which I have seen, not only for improving their financial position, but for encouraging them to become better qualified, is a suggestion that advances of salary should be made to them during their period of training. It is often very difficult, indeed, for people engaged in this work to enter upon a period of six months' training without any remuneration whatever. If this were insisted upon in a large number of cases it would be practically impossible for men and women, and particularly women, to embark upon this work at all. One has only to give a moment's consideration to the domestic circumstances of large numbers of people in this country 989 who desire to enter upon this work to realise how impossible it would be unless local authorities and others realised that some advance of remuneration were made during their period of training. I am very glad also to recognise, and I hope that the Ministry of Health will encourage it as far as they can, that more and more local authorities are realising the necessity of doing something in that direction. During the last period when I had the privilege of being associated at the Ministry of Health with my right hon. Friend the Member for Edgbaston (Mr. Chamberlain) there were 12 institutions which were recognised by the Department for the training of health visitors. I hope that it will be possible for the Parliamentary Secretary to tell us that more centres of this kind are contemplated, if they have not already been established.
What is the number of health visitors upon which we have to rely for this important work? Is it sufficient? Can we do anything more to increase the number of people who are doing this most valuable service? I should like the Parliamentary Secretary to give us the number of people so employed. According to the last figures that I have, there were 2,300 people employed by the local authorities as health visitors. Although that is a substantial number, it does not seem a sufficient number for the population of this country. If we could encourage more people to take up this important work it would, in the long run, be a saving not only so far as health conditions are concerned, but a saving from the point of view of pounds, shillings and pence. One of the things that is costing this country very much at the present time in our industrial life is the bad health of very large numbers of workers. We have only to look at the figures supplied in connection with National Health administration, and to note the number of weeks lost every year on account of bad health, to realise the seriousness of the position. If those weeks could be saved, whether by improving the conditions of work or by increasing the number of health visitors, even at a very considerable cost to the local authorities, it would not be a bad investment, looked at simply from the financial aspect. I hope that we shall be able to make same advance in encouraging the local authorities to go forward with this work.
990 Anyone endeavouring to raise this question to-night, and hoping to hear a pronouncement from the Ministry of Health in regard to maternity and child welfare, could not forget the very serious position so far as maternal mortality is concerned. Apart from the consequences and sufferings of a dreadful disease like cancer, this is one of the most serious health questions of the day. It is a very painful and sad thing that the maternity mortality rate has practically remained stationary for the last 20 years. When one thinks of the advances made in the science of medicine, of the advances which civilisation has brought to us, of the increased knowledge and skill, it is a most depressing and extraordinary fact that we have not been able to make progress in overcoming this most serious condition of things. Why has the maternal mortality rate remained in this position for so long? It has not been for want of endeavour on the part of local authorities and voluntary institutions to surmount the difficulty. It does not simply arise in connection with the poorer districts as contrasted with what we may call the richer communities. It is a very puzzling state of affairs.
I should like the Parliamentary Secretary to tell us whether any progress has been made with, or whether any further light has been thrown upon, this very distressing problem, and whether, by means of administration or otherwise, the Ministry of Health has been advised that further steps can be taken to deal with this tragic condition of things. It was, I think, in the last few months of the Administration of my right hon. Friend that two Committee were appointed. The first Committee was appointed to co-ordinate and stimulate research relating to the prevention of maternal mortality. That Committee was appointed with the general support and acquiescence of all who had been brought into touch with the problem. We wanted to know whether it was a problem in relation to the medical side that was placing so many mothers in the serious position which has been revealed by the statistics with unvarying regularity for the last 20 years. It was a very wise step to try, with the best brains of the medical profession and others associated with them, to find out whether there is any medical aspect of this matter, which is causing so much 991 concern amongst social workers, which accounts for this detrimental state of affairs. It was decided that it was a vital necessity to promote local investigation into maternal deaths, and it was considered that it would be of considerable value if, in all these cases of maternal mortality, the exact facts could be brought together from the various local authorities to see whether there were certain facts which could account for this serious position.
I desire to know whether it has been possible to conduct investigations on these particular lines and what steps have been taken to collect and classify what must prove to be most valuable information. The form of inquiry sent out was approved by the members of the medical profession and the Ministry of Health so that no one could in any way question the kind of information that would be obtained. Any information given in relation to these deaths was, of course, to be of a strictly confidential character. It was made quite clear that any information which was supplied would not be made public. I should like to know the position so far as that particular matter is concerned.
I want to refer to another aspect of this subject, equally important and perhaps more closely connected with the working women of the country. I should like to know what steps have been taken during the last 10 or 12 months to improve the training of the midwives of the country. When we consider the question of maternity and child welfare we are bound to come to the conclusion that we owe our progress, or our lack of it, to the knowledge and training of the midwives of the country. Not long ago it used to be a considerable reproach to this country that the number of women who attended births were of a most uneducated and unsatisfactory character so far as their knowledge and medical attainments were concerned. Mrs. Gamp used to be a very familiar figure indeed, but I am glad to think that the days of Mrs. Gamp are rapidly going by, and it is most gratifying to know that 90 per cent. of the women on the midwives roll are now trained midwives. That is a most gratifying step forward, and it is all the more gratifying when it is realised that of the births in this country over 60 per cent. are attended and notified by midwives.
992 To a large extent the progress made in connection with maternity and child welfare work depends upon the ability and attainments of the midwives, and it is very vital indeed that the Ministry of Health should do all they can to encourage the best type of women to enter what is undoubtedly a most important profession at the present time. I do not hesitate to say that the midwives of the country are badly paid, although considerable improvement has been made in this respect. But if we want to attract the best type of women we shall undoubtedly have to do more to improve the conditions of a very difficult and in many respects a distasteful service; make it much easier for women to enter and make better provision for them in point of view of pensions and for those times, through sickness or otherwise, when they are not able to engage in, their particular profession. I hope the Ministry of Health will do, as I feel sure they will, everything they can to encourage and promote improvements in the service.
One of the most gratifying features of this subject is the great improvement in the infantile mortality rate. If we regret the maternal mortality rate at any rate we can say that there has been a great improvement in connection with the infantile mortality rate. It is one of the best signs, from the point of view of health progress of recent years, and it has been achieved by the triple partnership of a sympathetic Minister of Health, vigilant local authorities, and not least the great work of voluntary associations up and dawn the country. Let me say a word in reference to the suggestion of the hon. Member who emphasised the need of a complete service of maternity and child welfare and that it should be made "available for the inhabitants of all the appropriate areas of local government." I desire to utter one word of warning. We must not forget that with this maternity and child welfare work we must also include the work of the great approved societies of the country who administer the maternity benefit, which is much appreciated by large numbers of insured persons up and down the country. They certainly have a right to be fully consulted in any change of administration which may be desired in connection with child welfare. They have a vast stake, from the health point 993 of view, in this matter. These societies and institutions have undoubtedly, in their appropriate areas, contributed to the work that has been done in connection with maternity and child welfare.
If we were to adopt the proposal that is made here, that a complete service shall be available in all the appropriate areas of local government, approved societies of all types, friendly societies and trade unions, would resent very much any suggestion that the work that they are doing in connection with maternity benefit under the National Health Insurance Act, should be interfered with. I hope that in any future administration of the scheme or in any proposals which may be in contemplation, the approved societies will be fully consulted. I trust that any observations made in this Debate will encourage the local authorities and the voluntary institutions to go on with this excellent work. I have not indulged in any criticism of them, because my object has been rather to encourage them in their work and to invite the representative of the Ministry of Health to tell us what future plans there may be, so far as the administrative side of the work is concerned. We are not able to-night to deal with any legislative proposals. But do not let anyone despise what can be done by administration alone.
I was interested to read only a short time ago that the present Minister of Health, after some experience of the Department, said that if only the local authorities and other agencies of the country would put into operation all the existing laws, what a great benefit could be brought about in the health and other conditions of the people. That is an observation with which I can agree. A great deal can undoubtedly be done if local authorities and voluntary agencies, supported by public opinion, go forward. I want to put a question or two. What is the present position in connection with the administration of the Poor Law and in connection with test work? There have been constant questions in the House as to where the larger local authorities of to-morrow will stand.
I do not want to strike a controversial note, but we have had very varying views put forward in the past by the Minister of Health on this very important matter. 994 I remember very well, too, the First Commissioner of Works making some powerful speeches on the subject. I shall not rake up from my memory all the things of which he accused my right hon. Friend, the late Minister of Health, and myself; I shall not think of the adjectives and other epithets that he employed regarding us. I was sometimes afraid to go home in case my relatives might believe the right hon. Gentleman—that it was some terrible criminal they were fostering in their bosom. Strange to say, the particular actions of which we were accused are still going on. I have no doubt that the First Commissioner has been very fully employed. I can imagine no man who could be more employed at the present time than the First Commissioner of Works, if he fully carries out his duty. He has the whole responsibility of the London parks on his shoulders, and he is one of the three upon whom rests the problem of dealing with unemployment. No doubt with all these duties he does not know what is going on with regard to this particular work.
I am sorry to say that, as far as I can make out from questions in the House—this may surprise the Minister of Pensions also—stone-breaking is still going on under a Socialist Government. That is a very sad thing. All those things upon which we were told that we were criminals and murderers are still being performed under the jurisdiction of a Socialist Minister of Health. I think the First Commissioner will have to stir himself and find out exactly what is going on, and at any rate tell the Minister of Health, in private if not in public, some of the charges that he used to throw across the Floor of the House at us in his more excitable moments. We would like to know exactly where the local authorities stand. Is stone-breaking still going on? Is it still the policy of the Ministry of Health to permit this task to be performed? What is the administrative policy so far as tasks in connection with the unemployed are concerned? That would be useful information, not only to the House but to a number of local authorities who are perplexed by the varying attitudes of the Minister of Health and his colleagues.
Some people, I am afraid, begin to lose faith in politics and politicians because of 995 incidents of this character. The right hon. Gentlemen when in opposition fiercely denounced their opponents, and, curiously enough, when they occupy positions of responsibility they do exactly as their political opponents before them had done. That does shake faith in political institutions and in the character of politicians. I am one of those who desire to support our Parliamentary institutions. I want to see the character of our politicians, on whichever side they sit, fully sustained. I hope that in addition to giving some account of the administrative side of maternity and child welfare work, the Parliamentary Secretary will devote herself to the task of explaining exactly where we stand with regard to test work, and give a full account of the administration of her Department in this important matter.
§ Mr. LONGBOTTOM
It is not my intention to intervene for any considerable length of time in this discussion. I am very pleased that the right hon. Gentleman the Member for West Woolwich (Sir K. Wood) has raised the important question of maternity and child welfare because I know of no question which is more important in the life of the people of this country. Listening to the speech of the right hon. Gentleman, my mind went back to those days when we sat on the opposite side of the House, arid when we were pressing the right hon. Gentleman and his chief, the then Minister of Health, to remove maternity and child welfare work out of the block grant system as outlined in the Local Government Act of 1929 which was then under consideration. Despite all our efforts, and even the efforts of some Members of his own party, the right hon. Gentleman resisted that suggestion and this important work is now being dealt with by local authorities under the block grant system which, to my mind, will mean a considerable slowing up on the part of the local authorities in undertaking this work. I listened with great pleasure, however, to the right hon. Gentleman this evening as the newest convert to the policy of dealing speedily with maternity and child welfare work throughout the length and breadth of this country. I shall get the OFFICIAL REPORT to-morrow, and I shall preserve my copy in anticipation of further Debates on this important subject.
996 I join with the right hon. Gentleman in paying a tribute to the wonderful work which the voluntary organisations are doing, but it is a work which is more or less negligible as regards permanency. I have been interested in maternity and child welfare work for the last 10 years, and, to me, the awful wastage of human life that goes on throughout the country is a blot upon our boasted civilisation. It is not that the Minister of Health is wrong. It is not that the local medical officers of health are wrong. It is not that the voluntary agencies are wrong. What is wrong is the existence of the horrible conditions under which so many of our people live. Anyone interested in this work knows that the highest incidence of infant mortality is found in those areas where the people are living under conditions which are unworthy of the name or the spirit of Christianity. I know areas where people are herded together under conditions which are almost impossible to describe, and where the incidence of infant mortality is close upon 150 per 1,000 children born. For this House or the country generally to tolerate conditions which allow 150 children out of every thousand to die before reaching the age of 12 months, is a positive disgrace to all of us.
I am convinced that this awful wastage of human life is due to the conditions existing in slumdom and I welcome the speech of the right hon. Gentleman opposite because the present Minister of Health is introducing his Bill for making a wholesale attack upon the slums and no doubt, it will have the support of the right hon. Gentleman after that speech. In attempting to demolish the slum areas we, on this side of the House, are at all events making some contribution towards getting away from the awful position which now exists as regards infant mortality in this country. Because of the right hon. Gentleman's speech just now I look forward with pleasurable anticipation to his participation in the Debates on the Slum Clearance Bill and I expect to find him helping this party to pass that Bill through the House as quickly as possible. I hope, with him, that this high rate of infant mortality will soon be a thing of the past—I am sure all sections of the House share in that hope—and when that time arrives we on this side will be able 997 to take credit to ourselves for having made some contribution to that happy result.
§ Mr. SHAKESPEARE
I wish to refer to the question of test work, and, although I have no wish to sit in judgment on the respective claims of the right hon. Gentleman the Member for West Woolwich (Sir K. Wood) on the one hand, and the Minister of Health or the Parliamentary Secretary on the other, at least I share the right hon. Gentleman's disappointment that after so many months of a Labour Government nothing has been done to remedy this grave state of affairs and to do away with this very great injustice. In passing, I should like to congratulate the Government on the effect of Section 4 of the Unemployment Insurance Act which abolished the "genuinely seeking work" condition. The effect in my own constituency has been to remove from 30 per cent. to 50 per cent. off the Poor Law and put them back on the Employment Exchange, and I imagine such has been the effect all over the country. In so far as that has been the result, it is all to the good. The ratepayers have been saved that amount of money and the State has undertaken a charge which ought to have been its charge all along. As regards test work may I begin by describing what test work is because there is a certain amount of ignorance on the subject. A test worker is an able-bodied man who, owing to a law of Queen Elizabeth is not allowed to receive relief without doing test work. The theory of that law is a very excellent one. It is that you cannot pay a man, or give him relief, for doing nothing, when perhaps side by side with him, or only a short distance away, there are men who are being paid only a small wage for a hard day's work.
I have no fault to find with that theory of Poor Law relief, but, with many other Members of this House, including, I think, the right hon. Gentleman the Member for West Woolwich, and the hon. Member for Devonport (Mr. Hore-Belisha), I have been trying by means of question and answer in the House for the last nine months, to call the attention of the Minister of Health to this matter and to bring about a more satisfactory condition of affairs in reference to this test work. I have been met, however, with evasive answers. In fact, the 998 answers of the Minister have shown a complete ignorance on the subject until our persistency led him to investigate the matter further and last December he promised an inquiry. That inquiry has now been going on since the middle of December, and reports must have come in, but nothing more has been heard of it. We are now almost in April, and surely the Minister of Health could have spent some time in studying those reports. If he had, I am sure he would take action. May we know from the Parliamentary Secretary whether it is the intention of the Government to publish those reports? If it is not, the only conclusion that one can draw is that the Government do not intend to take any action in the matter, because if the reports are published, public opinion will insist on action being taken. I must apologise to the Parliamentary Secretary for not having given longer notice of this question. I gave what notice I could, as soon as I knew that this opportunity would arise, and I do not want detailed replies to all my questions, but I should like to know whether it is the intention of the Department to publish the reports of their own commissioners on the position of test work.
May I describe what happens in my own constituency? If I exaggerate in any particular, I am sure my colleague the hon. Member for the City of Norwich (Mr. W. R. Smith) will contradict me, because he feels as strongly about it as I do. Until the passage of the recent Unemployment Insurance Act, which reduced the number of test workers, there have been roughly between 600 and 1,000 test workers in Norwich, according to the season of the year. The bulk of them are men under 45, but there is a large number of men over 45, who, through no fault of their own, but owing to the change of fashion, were thrown on the Employment Exchange, and when their benefit was exhausted these able-bodied men, destitute, unable to find a jab, drifted on to test work at Hellesdon, Earlham, and Mousehold. When I asked the Minister of Health about the Hellesdon test ground, and pointed out that a man had to tramp nine miles there and back altogether to undergo test work, I was put off with the official reply that Hellesdon test ground was one mile from the city boundary. Of course, 999 it may be that, though I think it is more, but I walked the distance myself, I cross-examined a large number of test workers, and I found that the average walked by those whom I examined was about seven miles. After all, in a big city, if a test ground is a mile or a mile and a half from the city boundary, it means that a man who walks there from the middle or from the far side of the city may have to walk 10 or even 12 miles a day.
These men march out in all weathers. If it is pouring with rain, they report to the headquarters, and the test work is excused for that day. If it is not wet when they start, they march out, and they may get sopping wet on the way and have to work in the wet all day. Then they have to walk some four or five miles home at night, and I have personally known men who were fit a year or two ago, who, through undergoing this form of semi-slavery, have deteriorated in health at the end of a year and have not even been fit to walk out the seven or eight miles. The Mousehold test ground is not so far, and the average walk is perhaps four or five miles. I have paid no attention to the Earlham test ground.
As regards the work done, it is absolutely farcical. Since 1921, at the Hellesdon test ground, an average of 200 or 300 men have been making what is called a road. I have made careful inquiries and examined this road myself. It could have been made by a gang of 200 men in one month, whereas it has taken nine years for these men to make it, which shows exactly the way they work and the uselessness of the work. For nine years you have been making these men, decent, old, trade union men, believe that they are doing work of national importance on a futile task. You cannot treat grown citizens like that. You could take a child of two from a nursery and give it a spade and let it dig sand, and the child would enjoy it, but you cannot treat men of 30, 40, 50 or 60 in that way, put them on work that everybody knows is farcical and useless, and pretend that there is any use in it. The work at the Mousehold test ground is equally farcical. The men dig a hole, fill a barrow with sand, wheel the barrow 1000 30 yards, and upset it, and then someone takes the sand back, and so they go on.
When one reaches a certain time of life, one gets case-hardened. I think our generation, that went through the War, ought to be, if they are not, and one is not easily moved, but I confess that I have never visited a test ground without feeling physically sick. This test work is condemned by men of every party, by Conservatives, by Socialists, and by Liberals, but nothing is done to stop it. When I put questions to the Minister of Health, I get the reply that useful work is being performed. As a result of the questions from these benches, an inspection was made. It was a very official inquiry, and it was not done as the Minister of Health promised. Very little opportunity was taken to talk to the men and to find out their views. I do not know what happened in the rest of the country, but it was a most disappointing affair, and instead of an impartial and unofficial inquiry being made, I am afraid it was extremely official, and I very much doubt if any good will come of it.
I have here the Draft Rules and Orders in regard to the Poor Law issued on 11th February, 1930. These are the new Regulations to govern the public assistance committees, which are the successors of the present boards of guardians and which will begin functioning to-morrow. I sincerely hope that these Regulations will not govern the administration of Poor Law relief as regards test work, because although in some respects they are an improvement, in many respects they worsen the position. I believe it has been the practice of the old boards of guardians to make a certain allowance in respect of rent, but I notice that under paragraph 13 of these Regulations:The council shall not pay the rent or any part of the rent of the house or lodging of any poor person, or apply any portion of any relief granted in payment of any such rent, or retain any portion of that relief for the purpose directly or indirectly of discharging any such rent.Perhaps I have misread that, but I should like to be satisfied that the present practice is unchanged. In my own constituency the maximum relief granted is 40s., and it is not granted to any destitute, able-bodied man into whose house an income of 45s. is coming. I 1001 believe a similar rule obtains in most other Poor Law areas and that a maximum income coming into a house is fixed, but up to the present the income of children living with a destitute father has been counted as the income of the father, or at least a very large part of it has. That has been relaxed in my own constituency, and I believe the first £1 is now excused, but I imagine that in many parts of the country the income of children is counted as the income of a destitute, able-bodied test worker. That seems to me fundamentally unjust. A man is destitute and thrown out of his job; he has a boy and a girl living with him getting slender wages, perhaps of 25s. or 30s. a week, who are trying to save anything they can out of that for a nest egg—because, after all, they want to start a family some day—and their income is counted as the income of the poor father. It often happens that the father has to go to the expense of hiring two sets of rooms in order that he may qualify for Poor Law relief.
On the question of discipline and fines, I thank the Minister for the action she has taken. Fines were very common, and in my constituency a fine was imposed for some mild form of indiscipline. I took up a case with the Minister of Health, and he issued an Order, with the result that it has now been prohibited. For all gifts received, we are duly grateful. I hope that once the Minister of Health and the Parliamentary Secretary have got their minds off widows and housing, they will get down to this question, because it is a very serious question. I do not know how many men are on test work in the country, but my own constituency has suffered from it considerably. You cannot treat these men as criminals. They are a very decent lot of men. There may be a few, a very small percentage, who are taking advantage of the Poor Law relief, but the great bulk are decent trade unionists who will never get a job again. You cannot really treat them as children, and put them on useless and nonsensical work, which everyone knows has the effect of degrading and demoralising them. I hope that when the Minister of Health gets down to it, he will revise the whole system. I have not the slightest objection to work being imposed on the men, provided it is useful work, nor have the men any objection. I have never met 1002 a man on test work who objected to the work, provided it was useful work. In cases where no useful work can be found, discretion should be allowed to the new public assistance committees, and their powers in this respect should be enlarged. I should like to know from the Parliamentary Secretary when we may expect the Report from the Ministry's inspectors, and know what action the Department take on it.
§ Mr. WOMERSLEY
We are indebted to the hon. Member for Norwich (Mr. Shakespeare) for introducing this subject. I am particularly grateful to him, because his speech explains something that happened to me just before the election, when I visited Norwich to address several public meetings. I found that at one of these meetings I had a very hostile audience, and with all the eloquence that I tried to command I could not get a cheer until I announced that the Conservative Government were going to abolish boards of guardians; then the roof came off. It is evident that there is a reason for that if the test work in Norwich is of the description that the hon. Member for Norwich gave. I do not wonder at it, and I should be interested to hear the reply of the Parliamentary Secretary on this matter. I agree that if there is one thing to which a decent workman objects, it is doing the job of digging a hole and filling it up again, and doing something that is not of real value to the community. There are people who argue that if you set these men to work on a job which is useful, it will do somebody else out of a job; they therefore try to justify their action by setting men on to useless tasks that will not compete with somebody else. That is a pack of nonsense.
In my own district, which is a very enlightened part of England, evidently more enlightened than the city of Norwich, there has been carried on for a considerable time a system whereby these men can be employed on really useful work. By arrangement between the board of guardians and the corporation, a slab mill, to make slabs for paving the streets, was started. The corporation used these slabs for paving the streets, and the men realised that they were doing something of a really useful character. Afterwards they could see these slabs and walk on them, and they felt that they were doing something to make the town a better 1003 place. I believe that there was no feeling of resentment on the part of the men, because they realised that they were doing something of a useful character. We are grateful to the hon. Member far Norwich for having raised this question, because Norwich may not be the only place in England where they are doing this useless work, and there is not a Member who will not agree with him when he stated that this work should be abolished and useful work substituted.
I want to say a few words on a subject which was referred to by the right hon. Gentleman the Member for West Woolwich (Sir K. Wood). I was disappointed that the hon. Member for Lincoln (Mr. R. Taylor) was not in his place to move his Motion on maternity and child welfare because I desired to accord him my support. The hon. Member and I have a good deal in common, and we both represent a constituency in the county of Lincoln. I have been in conflict with him on several occasions. I remember once captaining a cricket team that played a team which he captained, and I believe that my side won, and I have on some occasions had to oppose him in debate in this House. I have had to object to certain Bills which he has introduced, but here we have got to a point where we can be in complete accord, and I am disappointed that he is not in his place to move his Motion. I am indebted to my right hon. Friend for raising this important question, and I am sorry that we have not a greater attendance of Members to take part in the Debate. The right hon. Gentleman divided the service into three groups. He spoke of the work of the Ministry of Health, a very important part of this work, and he spoke of the work of the local authorities—and here I am on very familiar ground. The right hon. Gentleman can speak very well of the work of the Ministry, because he had such a long and distinguished experience in that office. Then he spoke of the voluntary agencies.
I was interested in a remark of the hon. Member for Halifax (Mr. Long-bottom), when he referred to the work of the previous Government in connection with maternity and child welfare. He recalled the Debates which we had in this House during the pasage of the Local 1004 Government Bill about the question of removing these services from the block grant system, and continuing them on the percentage grant system. By not removing the services from the block grant, the late Government did a real service to those who are keenly interested in this question, because under the formula that is contained in the Act, funds were provided for the districts that were heretofore backward districts in order to enable them to put into operation a complete service of maternity and child welfare. In those Debates instance after instance was cited of poor districts which could not find the percentage necessary for this service, and which were put at a great disadvantage compared with some of the wealthier districts. We argued then, and I am prepared to argue now—and experience will prove that we were right—that putting these services on to the block grant system, and giving the local authorities the wherewithal to carry on the work, is far better than continuing on the percentage grant system, for it was well known that some of the districts could not raise the percentage which they would have to contribute towards carrying on these services. I would remind the hon. Member for Halifax that if there has been neglect on the part of the local authorities it is the fault of the local authorities and those who elect them, and not the fault of the late Government, which did provide for sufficient funds to be available to carry on this splendid work.
My right hon. Friend made a passing reference to voluntary agencies and to the volunteer workers who assist the local authorities in conection with maternity and child welfare work. I would like to pay a tribute to the many ladies who assist these local authorities without any thought of anything in the way of remuneration. If it were not for these ladies, who serve in the centres in our great towns and cities, this service would be far more expensive to the local authorities. Some of the best work is done voluntarily, and we ought to pay our tribute to these women, some of whom sacrifice to this work the time they could spend in the sporting field or in playing bridge or in other diversions of ladies who have a little leisure. They realise that this is a work of humanity, and that it ought to receive the widest possible support.
1005 I am sorry, again, that the hon. Member for Halifax is not in his place because of the references he made to the late Government. I will quote a figure or two which may be helpful to the Parliamentary Secretary when she replies, because I suggest that if she follows the example set by my right hon. Friend and the right hon. Gentleman the Member for Edgbaston (Mr. Chamberlain) in their administration at the Ministry of Health, the House will not have much to complain abóut when we study the figures of this service 12 months hence. Let us go back to the year 1924–25, when we had a Socialist Government in office. [Interruption.] My hon. Friend the Member for Rochdale (Mr. Kelly) knows quite well what I mean. The figures I am going to quote were figures budgeted for by the Socialist Government, of which I believe he was not a Member although a supporter—it may be an outside supporter.
§ Mr. WOMERSLEY
Since then the hon. Member has managed to get in and I am glad of that, because he has provided us with many happy diversions. According to the annual report of the Ministry of Health, the amount spent on maternity and child welfare services in that year was £814,519. Then my right hon. Friend and his colleague came into office, and in 1925–26 the amount went up to £897,100, in 1926–27 it mounted to £962,476, and in 1927–28 we got the figure of £1,040,786; yet during the General Election we were told that the late Government had neglected this service. These figures refute that statement. In 1928–29 the amount budgeted for was £1,061,500. For last year the amount was 30 per cent. more than for 1924, when the Socialist Government was last in office. Let us consider of what this work consists. There are four main divisions. First, there are the ante-natal and infant welfare centres.
§ Mr. WOMERSLEY
I am glad that my hon. Friend the Member for Clay Cross (Mr. C. Duncan) agrees with me. I hope that he has had as much experience of these matter as I have, and that he means what he says when he cries "Hear, hear." The second division is that of the health visitors, the third 1006 concerns midwives, and the fourth maternity homes and hospitals. Here I wish to quote a figure or two to show the development which has taken place under the administration of my right hon. Friend and his colleague the right hon. Member for Edgbaston. I will take the years 1924 and 1928, because that will show what was done under the two administrations and provide a contrast. The number of infant welfare centres increased in those four years from 2,245 to 2,684, showing steady work and steady endeavour on the part of my right hon. colleagues. The ante-natal centres increased from 571 to 871. It must be borne in mind that we were then working under the old percentage grant system, and many local authorities were in the position that they could not raise the money which had to be put down in order to secure the grants.
Next we come to the health visitors, and here I would like to say that I agree with everything that my right hon. Friend said about their usefulness. [Interruption.] The hon. Member for Clay Cross disagrees. I am sure he cannot have heard the speech, or he would not say that; because if I went into his constituency and said that he did not believe in health visitors I am afraid even his big majority would go down considerably. The number of health visitors increased from 1,848 to 2,020. That is not a big increase, and my right hon. Friend gave the reasons why it was not bigger, but if the suggestions he has thrown out are carried into effect by the Parliamentary Secretary and her colleague it will be found that the numbers will soon increase. In 1924 there were 13,620 practising midwives, and by 1928 the number had increased to 14,480, and the number of beds in maternity homes increased from 1,958 to 2,515. Taking into account the fact that the infant mortality rate has been steadily going down during this period, I say that there is some credit due to my right hon. Friend and his colleague for their administration of these services.
In 1906 the infant mortality rate stood at 132 per 1,000. In 1924 it had dropped to 75. [Interruption.] Yes, that was the year when the Socialist Government were last in office. It was a big drop as compared with 1906, but they had not been in office all that time. By 1928, under the administration of my right hon. Friend, 1007 the figure had dropped to 65, which was a record. I want to see it drop further still. I think that under the present administration we shall have a continuance of the splendid service rendered during the late administration, and if we do that administration will have the full approval of hon. Members on this side, and we shall probably see a further diminution of the figure.
The right hon. Gentleman mentioned the fact that the maternity mortality rate was pracically stationary. Although we have made a great advance in reducing the infantile mortality rate, we have not been able to make any advance in this serious matter. Is there any report which the Minister can present to the House from the Committee set up to investigate the matter? In May, 1928, the right hon. Gentleman the Member for Edgbaston (Mr. Chamberlain) announced his intention to appoint a representative Committee to inquire into the causes of maternal mortality and suggest remedies for its prevention. It was appointed in June, 1928. I do not know whether it has been able to present its report, but possibly the hon. Lady can tell us when she expects the report? Another Departmental Committee was appointed to inquire into the training of midwives and their conditions of employment. Has that Committee reported, and, if not, when can we reasonably expect the report?
In conclusion, let me say that I hope no effort will be spared by the Government to give generous assistance to the maternity and child welfare centres. During the Debates in the last Parliament, on the Local Government Act, we heard a good deal from hon. Members opposite when they were speaking from these benches about their great interest in this work. I have tried to show that we on this side have shown in a practical way in the past that we do take a deep interest in it. I trust that hon. Members opposite, now that they have the opportunity, will show by their actions while in office that their thoughts on behalf of these two services were not thoughts only when they were in opposition, but thoughts when they are in office and which they will carry out. I hope we shall hear from the hon. Lady some pronouncement of policy as to the course 1008 which the Minister intends to pursue. I hope it will be a progressive policy and, if it is, I can assure her that she can count upon the support of the majority of the Members on all sides of the House.
§ The PARLIAMENTARY SECRETARY to the MINISTRY of HEALTH (Miss Lawrence)
The Debate has ranged over a large number of subjects with regard to the whole administration of the Ministry of Health. It is somewhat unusual and not customary when a Vote like this is under discussion that there should be a Debate ranging over the whole field. I do not want to complain, but the House will understand it is almost impossible for me to answer individual cases without some previous notice being given. However, I will do my best with the aid of memory and such material as I have. I will begin with the subjects of which no notice was given, and there were a large number of these. There was the question of health visitors. The right hon. Gentleman who raised that matter knows perfectly well that the Ministry has never fixed salaries, and that the abolition of the percentage grant deprives the Ministry of Health of any control. We have just completed a survey with regard to salaries, and this will be forwarded to the local authorities and it will, I trust, have a levelling-up effect. We have agreed upon, and will shortly send out, a circular dealing with the question of training. As regards the number of health visitors, I have not the figures for a complete year and the numbers are for last year. The numbers quoted by the late Parliamentary Secretary are perfectly accurate.
As regards the question of test work, I cannot discuss individual cases without notice, but will answer to the best of my knowledge as to the law and the circumstances. As a matter of fact, a very considerable number of guardians give relief without any test work at all. We have issued a circular on the matter which states that it is desirable that some form of occupation should be given to able-bodied men. We stated that we considered every local authority ought in the first place to make arrangements for test work, and that the arrangements should include due provisions for securing that work, training or instruction should be suitable to the physical capacity and in- 1009 telligence of the individuals. Where suitable arrangements can be made, the applicants should be put to the sort of work, training or instruction which may be appropriate to their case, but if the arrangements do not cover the ground or are unsuitable in any particular locality, there is nothing whatever to prevent the authorities from granting relief according to the circumstances. One hon. Member said that a particular board of guardians had had a very bad form of test work, and its action had been disapproved of by all parties on that board. Why do they not alter it?
§ Mr. SHAKESPEARE
They have never had a chance until the public administration was taken over. The Ministry of Health has prevented them.
§ Miss LAWRENCE
The Ministry of Health has not prevented them. There is nothing whatever in the circular which prevents them from giving exactly the sort of instruction, work or training which they may consider adequate. If the work that is given is disapproved of by every member of the board, there is nothing to prevent them altering it tomorrow, and there was nothing to prevent them altering it at any moment in the past.
I turn next to the question of allowance for rent. Article 12 says the authority must not pay the rent; but the proviso goes on to say that they may take the rent into account in fixing the relief. Many local authorities do in fact take the rent into consideration and make a rent allowance, and have done so for 10 years and more. There has been a special inquiry into this matter. The reports are now completed, and my right hon. Friend will consider publication.
I think I have dealt with the chief points which have been raised this afternoon. Now I come to the question of maternal mortality and infant mortality. The right hon. Gentleman the Member for West Woolwich (Sir K. Wood) said that arrangements for children under school age might be made with the local education authority, but I would point out that under the Local Government Act this is only a permissive matter. The local education authority may apply to the Minister of Health, who has power to make an order on the subject. The 1010 local authorities at the present time are taking over new responsibilities, and they are making new arrangements under the Act. I was interested in the statement made by the right hon. Gentleman the Member for West Woolwich that additional money was required for the care of infants. I would like to ask the right hon. Gentleman, where is the opportunity offered for doing what he suggests under the Act of 1929? As a matter of fact, we should have to alter very much the whole structure of that Act. The right hon. Gentleman's suggestion means that there should be a proportional grant paid for direct services, but that would be quite unsound, and contrary to the Act of 1929. We have been told that special money is required for infant welfare. That is one of the services which have been taken away from proportional expenditure and placed under the block grant which is stereotyped for a term of years. Of course, we cannot give any more money for that purpose, unless we tear up the Act of 1929, and if we decide to do that with regard to this one service of infant life protection, I hope we shall have the right hon. Gentleman the Member for West Woolwich as a supporter.
I now come to the question of maternal mortality, which, in my opinion, is one of the most important questions to which the House can address itself. The average figure of maternal mortality has remained steady over a period of years over the whole country. Some years it fluctuates up and sometimes down. Some people might think that this was a rather mysterious thing, but if you take the figures for the whole country and compare them with some special district, you find a very striking variation, and they fluctuate over an extraordinary range. I do not want to stress the figures too much, but when you see certain counties and districts year after year heading the list, some of the figures being three or four times as large as the others, you begin to look for some special local cause, and I believe that you can account for this to a certain extent by the amount of attention that is given to the subject. There are two committees dealing with this question. One is the departmental committee on medical research, which has already received confidential reports on individual cases, and that committee is 1011 on the point of making a report. The second committee is dealing with the training and assistance of midwives, and it has already reported. That subject raises a very large number of questions of great difficulty which would involve further legislation. Our great difficulty is to obtain proper maternity services for ante-natal clinics and advisory clinics, and we want more co-operation on this subject between national health insurance work and the work of the local authorities. The matter is receiving our consideration, but I do not think the question of legislation has been fully explored up to the present by the Department of the Ministry of Health. All I can do at the present moment is simply to allude to the subject, and say that it is receiving consideration.
There is one other point I always desire to make when I have a chance of approaching the question, and that is the great importance of advice to expectant mothers. I do not think there is any form of health work where the results in proportion to the expenditure are more gratifying. In addition to that, there is the work of public education in this matter. I have here two or three figures in regard to expectant mothers. The percentage of expectant mothers who attended ante-natal clinics in Woolwich, where they have a really thorough good, healthy propaganda, is 40 per cent. The percentage is 35 in Bermondsey, 27 per cent. in Bristol, 13 per cent. in Manchester, and 15 per cent. in Gates-head. Those are very extraordinary figures, which show that not only local effort is necessary, but also that a persistent campaign of public education is necessary as well.
I do not believe that the problem is insoluble. I know that it raises very intricate questions which Parliament would do well to consider. I believe that if our local authorities would use their powers to the full and conduct a great campaign of public education in order to bring up the level of the backward authorities to that of the best, we should see, not a complete solution but a very gratifying improvement in this service. I think I have now answered all the questions which have been put to me as far as I am able. I should have given the House a fuller explanation on these 1012 points, but for the fact that the Amendment deals only with maternal mortality, and there is no Amendment on the Paper dealing with other matters. I have had no warning of any kind that the right hon. Gentleman the Member for West Woolwich was going to range over the whole administration of the Poor Law, and I think that if I had had notice of that—I am not complaining—I should have been able to give the House a very much fuller account of the situation.
§ Mr. MELLER
The hon. Lady has dealt with some aspects of this question which certainly interest me, and, I believe, interest representatives of local authorities throughout the country. The hon. Lady can congratulate herself that, although some parts of the subject have been sprung upon her, nevertheless that part in which, I think, all Members of the House and a large proportion of the population outside are very much interested, namely, the question of maternal mortality, has been dealt with very adequately by her, and, if I may say so, very kindly. I am sure that she appreciates what this problem means to the country. It is not a case of just summing up the number of deaths that occur to mothers in the act of child-bearing, but there is also the enormous amount of suffering and distress which follows. It is the morbidity of the child-bearing that is the serious matter, and, so far, the scientists do not seem very much to have touched this aspect of the question, in spite of all the work that has been done on this subject by the medical profession throughout the country.
I have had an opportunity of discussing this matter, not only here, but in Germany, and I have gathered from Germany some very remarkable statistics and experiences obtained in the maternal clinics there, which have been carried on on a much larger and more elaborate scale than in this country. The hon. Lady has referred to the great disparity in the maternal mortality figures in various parts of the country, but I think that the most remarkable feature which so far has been disclosed is that the maternal mortality, so far as London is concerned, is lower in the East End, taking Bethnal Green as an example, than in the West End. It cannot be said that that is due to lack of care or service; there must be something more than that. The view has 1013 been expressed from time to time that perhaps in the West End of London the bearing of children is postponed to a very much later date than in the East End; or it may be that the development of health and child welfare clinics has been taken on at a very much greater pace in the East End and in the poorer districts than in the West End.
I welcome very heartily the suggestion and I hope it is going to be taken up by local authorities throughout the country, that there should be more propaganda, more spreading of knowledge, on this subject. I am sure that the hon. Lady does not desire that this shall be confined to the poorer districts, but that we should have this knowledge spread in those places in which women find themselves in happier circumstances than in the poorer districts; and, therefore, if the hon. Lady can do nothing by way of the development of propaganda, I think she will have the very hearty support of Members on this side of the House. She said that she rather hoped that there would be a development of the consideration of this question and of co-operation between National Health Insurance and local authorities. May I point out what has been happening, though the hon. Lady probably knows it as well as I do? Some suggestion was made by the Ministry of Health to National Health Insurance societies that they might consider devoting a portion of the amount which is now known as maternity benefit to a payment to the doctors for services rendered—that the maternity benefit would be reduced from £2 to £1, and that £1 should be spent on providing pre-natal and post-natal services; and a large proportion of that £1 was to go into the pockets of the doctors.
For myself, I am not disposed to accept the view that a larger sum should be paid to the doctors for National Health services than is being paid at present. I should suggest, rather, that, if any amount is to be paid at all, more might be paid for the greater development of maternity and child welfare services than is the case under the local authorities at the present moment. That work has in many districts, the hearty co-operation of women who are anxious to do the greatest service to their fellow-women, 1014 and those who have had the opportunity of visiting any of these clinics will know how heartily such assistance is welcomed by women in the peculiar condition in which they find themselves, not only at the time prior to child-bearing, but afterwards, when they go and gather all the information that they can for the better upbringing and health and care of their children. Therefore, I think that the hon. Lady would do well to consider the development of the maternity and child welfare clinics, and not to ask for too much support and co-operation under the National Insurance scheme. I am sure that too much stress is laid on this point, and that there is a greater desire to get hold of some of this money for the pockets of the doctors than there is to provide those health-giving services which should be the main object.
On the question of how far the hon. Lady can go in helping the local authorities, she has said that we should probably ask for more money. I do not know that the local authorities are asking for more money at the present moment. What they are asking is that the central authority shall encourage them by looking kindly upon any applications which are made for development in their areas. I am sure that the county councils are very anxious to help as far as they can, but at the moment the county councils and local authorities art finding themselves in a little difficulty. The county councils are, or will be after to-morrow, endeavouring to carry out faithfully the powers that have been conferred upon them by the Act of 1929, but, on the other hand, you have the local authorities, who in the past have been the maternity and child welfare authorities, finding a sort of competition between the two bodies. I hope that the hon. Lady will endeavour to smooth out the difficulties which may arise from the competition of the central authority and the local authority, and that, if these difficulties come up for settlement by the Ministry of Health, she will at all events impress upon them the desirability, not of fighting among themselves as to whether they lose or gain some power, but of going forward and helping this splendid work of maternity and child welfare, which will not only benefit the district, but the country as a whole and the future population of this country. Although this discussion has ranged over 1015 a very wide field, I am sure that it has at least brought forward some views and expressions which will hearten the hon. Lady in this work, and that, if she asks the House to endorse practically what we have said to-night with regard to the development of maternity and child welfare work, although it may cost something, she will find a very hearty and sympathetic response from Members on this side of the House.
§ Major GLYN
The House has listened with very great interest to the hon. Member for Mitcham (Mr. Meller), who is so intimately associated with the work of the great friendly societies. I would like to put in a word for the friendly societies in the rural areas. There is a federation of rural approved societies, and for many years those societies have dispensed additional benefit for the assistance of women, in regard both to pre-natal information and to attendance during the time they are in confinement. I believe that this question is probably the most important and vital matter of the social health and social conditions that can be mentioned in this House, and, as we all know that prevention is better than cure, I most heartily agree with the hon. Lady that it is really a matter of educating public opinion. I am sure the House was interested in the figures the hon. Lady gave showing the extraordinary discrepancy in maternal mortality between different centres of large population. Perhaps the worst offender she mentioned was Middlesbrough, and other places were considerably better.
The most important matter is to try to see that women living in rather isolated conditions in rural areas are not forgotten under any scheme introduced by the Government. We always get statistics from great centres of population, and there are people who believe that slum conditions exist only in great cities. The fact is that there are far too many cottages in rural districts where people are asked to bring children into the world which are entirely unsuited for the purpose. I feel that we who sit for rural constituencies ought to spend the whole of our time in emphasizing to the Ministry the importance of bringing those facilities to rural areas which are, thank goodness, now available in our great cities.
1016 I believe many county councils are only too anxious to assist in this work. It is the district nursing associations which really have to carry on the business. The voluntary work done by them and by nursing committees does not obtain that recognition that it ought to obtain, nor does the devoted service of the nurses, who have to go immense distances in all weathers, receiving the most inadequate salary, proceeding on bicycles in the dark, going mile after mile to look after some woman in an isolated cottage. With that work going on day by day and night by night throughout the land. I feel that we could not spend money in this House better than by encouraging the local authorities to give that assistance to the nursing associations which will enable them to give a better salary to their nurses, and will also enable the nurses to have refresher courses where they can learn the very latest methods which will give assistance to their patients.
I do not want to say anything against the medical profession. It is known to everyone what wonderful work is done by doctors, but I often feel that, since the panel system came into force, there has been an inclination on the part of some doctors rather to lie back and not keep to the front of their profession. There is the feeling, "I am a panel doctor, and these people have to come to me. Here am I. I am going to give them so much medicine and get so much for it." I have had something to do with these rural districts. There are about 250,000 members of the affiliated societies who come under this federation, and the local secretaries all have the same tale to tell. They are opposed to the very utmost to spending any more money on the doctors while there are other things on which they believe money could be better spent.
One of the most important things in regard to educating the community is to give that public sense of the decencies of life which a man must contribute towards his wife. This is not an easy matter to talk about in the House, but there is no doubt that many cases of maternal mortality and infant death are due to the selfishness of the husband, and that is a matter which surely must be considered. It is not a matter for the 1017 medical profession. It is a matter for public opinion, and I believe there should be clinics established, and perambulating clinics, if possible, in motor lorries, to go to isolated villages and be available to explain to all married women those main principles of the ordinary rules of life which people in cities can obtain by going to these clinics but which women in isolated country districts long to know but have no opportunity of knowing. What business have we to allow ignorance to exist? The medical profession and the nursing profession slave away and do an enormous amount of good work. There were about 607,000 births in England at the last period for which figures are available, and only 61 per cent. were attended by registered midwives.
I believe the Midwives Act did an enormous amount of good, and I believe we should do all we can to encourage people to join in this profession. At the same time I have known instances, and I daresay Members in all parts of the House will know of others, where a person called a midwife is old, because there is no one to take her place, is not versed in the most modern practice nor is she kept up-to-date by the old-fashioned country practitioner. Sometimes, when you hear about the methods adopted, you realise why we are the great race we are, because it is indeed the survival of the fittest, and it means that, if people can come into the world under the conditions that obtain, they certainly should not suffer death from any of the ordinary misadventures of life. I believe the women's institutions and the rural councils of these voluntary organisations can play a tremendous part in giving that information which is so necessary, and I think our late administration deserves great credit for having allowed, under the provisions of the Act, approved societies to disburse their disposable surpluses in the direction of these additional benefits and to make a direct payment which is recognised by the Ministry towards local nursing associations. I am certain if that method can be extended in some parts of the country great encouragement will be given to nursing associations, and funds will be available for those devoted women to have the opportunity of going to the Queen Charlotte or some other hospital and learning the latest practice.
1018 There is another thing that I appeal to the hon. Lady to consider. I believe a great deal can be done, when a lorry or a van comes round to teach these ordinary practices, to have someone there who will be able to improvise those sanitary uses of modern medical skill which are available in the ordinary cottage. It is not the slightest use lecturing to these people in regard to procuring the conditions that obtain in the first-class up-to-date hospital. We have to deal with the mother who has perhaps a large family and is unable to leave them. She ought to get away to a proper maternity home or hospital, but she has to wait till the last moment. Very often the conditions under which she works do not make it easy for her to bear a child under proper conditions.
I am certain that in all parts of the House there will be assistance to any Administration that tackles this problem. I believe we lag sadly behind Germany and other Continental countries, because we have a sort of moral slide in our brains. We seem to have diffidence in talking about those facts which everyone knows and everyone should recognise, and, if we are courageous and look facts in the face, and tear away the sort of veil of false morality or false decency, whatever it may be called, none of us will remain longer in the House without doing far more than we have yet done to bring the benefits of modern medical skill to women who are about to bear children, be they those who inhabit the great cities or the most isolated rural districts.
Dr. VERNON DAVIES
The Debate has covered fairly wide ground, although the hon. Lady the Parliamentary Secretary to the Ministry of Health seemed to complain that she had not been given notice about the question of maternity and child welfare.
I beg the hon. Lady's pardon, because I was going to congratulate her on the very effective answer she made to the points which had been raised, and I thought that if that was what she had done without notice, what would she have done if notice had been given to deal with medical subjects? I regret that latterly the Debate seems to have de- 1019 veloped into a more or less underhand attack upon the medical profession. I am the only medical man who has had the privilege of addressing the House on this occasion to-night, and I would, with all humility, submit that for an effective maternity and child welfare service, you must have doctors. You cannot do without them. You cannot do without the help of the medical profession in the child welfare service, and I was surprised at my hon. Friend on my left saying, "Whatever you do, do not give the doctors more money," and another hon. Member of my party, the hon. and gallant Member for Abingdon (Major Glyn) saying, "Whatever you do, do not give doctors more money."
It has to be recognised that the maternity service of a medical man is an extremely onerous service. When a medical man who has been busy with a panel practice, working hard all day seeing his patients, and perhaps getting to bed at 12 o'clock at night, and in a quarter of an hour or 20 minutes afterwards being called out for a confinement and having to stay up all night, and then having to attend the case for 10 days afterwards, receives a guinea or 25s. for all that work, one can very easily understand why a very large number of medical men to-day are gradually going out of maternity work. They will not undertake the trouble. They say, "Why stay up all night and have to attend the case for 10 days for 25s.?" I have attended hundreds of confinements for 10 days and stayed up all night for a guinea. I would not like to start again. You will find that practitioners are not now inclined to give their time to this work—because it does require time and patience—and that there is a tendency for the maternity service to get into the hands of particular doctors. They are becoming more or less maternity specialists, while confinements are getting more and more into the hands of certified midwives. That is a move which has the hearty sympathy of all medical men, because there is no doctor who has anything like a practice who can afford to spend hours on end, perhaps, waiting for some poor woman to be delivered of child. It is better that certified midwives should attend to these cases where they have to wait so long and that they should 1020 send for a medical man if necessity arises. Unless the medical man and the midwife are adequately remunerated you are not going to get an effective maternity service.
The question of maternal mortality has been raised by several speakers. There is no more tragic affair in human life than the woman who, in giving birth to a new life, loses her own life. It is one of the greatest tragedies that a doctor has to face and one of the greatest tragedies in the life of the nation to-day. Yet the peculiar thing is, as my hon. Friend has said, that it is not of necessity that you get these puerperal cases in the slums. You will find very often that in a very bad slum district you get confinement after confinement by the score without the slightest thing going wrong and yet you may have a confinement in a mansion and get a puerperal case. Puerperal fever does not depend on slums, although one naturally does not want people to give birth to children in slums.
That brings me to one point to which I want to call the attention of the hon. Lady, namely, the provision of beds for maternal cases. There is a tremendous shortage of these beds in the country. I find that during the last Report of the Ministry of Health in the whole country the number of hospital beds recognised for grant by the Ministry is 2,480. Two thousand four hundred and eighty beds for nearly 670,000 births! It seems appalling does it not? There is a definite need for the provision of such beds. You have so very often a case which is, apparently, normal but in regard to which during the confinement something goes wrong and you desire to get the patient away. You have difficulty in getting her into hospital on account of the shortage of beds and very often the case becomes too dangerous for the patient to be removed. A method which could be much extended by the Ministry of Health, if they gave it sympathetic consideration and also made a suggestion to local authorities, is that they should take over, not what I call municipal maternity homes, which I know are coming into existence, some of which are doing extraordinarily good work but large houses which have become more or less derelict. These houses should be taken over by the local authority and made into 1021 maternity homes, simply to enable women to be taken out of slum areas or out of poor households away from their families where they can be attended by their own doctor and nurse. You would simply be providing them with fresh lodgings away from their children and away from their families. I am certain that a service like that could be established at very little cost and that it would prove a great boon to the mother and to the midwife and the doctor, and help things generally.
The need for ante-natal work has now become very well recognised, but again this is a case where the whole success depends first of all upon your doctor and secondly upon your nurse. I was the medical officer for an ante-natal welfare and child welfare centre and one great difficulty which I had with ante-natal work was to persuade the women to come. They would not come. A woman very often said, "I shall be all right. My mother tells me I am all right," or, "I have had one or two children and shall be all right." Very often they are all right, but the great difficulty is to get women who are going to have their first baby to come to the ante-natal centre to be examined to see if everything is in order. Often they do not come and when tragedy happens people turn round and say, "What an awful pity!"
What we want is education and propaganda, that the women of the country, especially the young married women, should be led to understand that it is to their advantage and to the advantage of their baby that they should be examined as early as possible in order to find if everything is perfectly in order. If things are not in order, precautions can be taken. If that happens we should not have a lot of the tragedies which we see to-day. One of the greatest nuisances and obstacles to the proper progress of maternal service is the old grandmother—the old grandmother who has had 15 or 16 children, and buried 12 or 13 of them. She never had this, that or the other; she never had any of these new fangled things when she was having her babies, and she does not see why her daughter or her granddaughter should have them. One of the greatest difficulties is to get rid of this old woman; to get her out of the way at the time of the confinement and prevent her from interfering. That is 1022 one reason why we should remove as many of these women as possible from their homes to a new home, where they Gould have rest and quiet, not merely for the sake of the confinement, but during the day. What happens in so many cases? There is the mother with her new baby in a room downstairs, where there are, perhaps, three or four other children, and where the cooking has to be done and the meals eaten in the same room. What health, rest and benefit can there be for the mother under those conditions?
I should like to bring forward another point, and that is the question of the midwife. I know that there is a committee sitting to inquire into the training of midwives. I believe that the Ministry of Health have some idea of either doing away with or relaxing some of the regulations of the Central Midwives' Board. I suggest that that would be a retrograde step. The Central Midwives' Board have done extraordinarily good work and are doing good work to-day. It should be the duty of the Ministry, instead of handicapping that institution, or interfering with it, to do all they can to encourage the board in their very good work. It is also necessary to see that there is efficient after-care, and that there are health nurses competent to look after the mother and the baby.
I am glad that the Ministry of Health insist that health visitors should possess the health certificate, to show that they have been properly trained in regard to the work that they have to do, but there is one great danger which applies to health visitors as well as other nurses. It does not necessarily mean that a person with the best certificate or with the largest number of degrees is the best person for the work. There is such a thing as professional tact, common sense, and motherliness. I have seen health nurses, with long letters after their name, wonderful and excellent nurses in every respect from the professional or technical point of view, but as human beings and nurses absolutely hopeless for the mother and children—no kindness, no tact, no motherly feeling, yet the poor women have to be cared for by these nurses. On the other hand, I have come across ignorant, untrained women among the working-classes, born nurses. I have seen them take to the children straight away. They pick up knowledge very quickly. Often in my medical career I was much more 1023 pleased when I had an untrained, motherly woman to act as nurse than a certificated nurse, very well qualified so far as degrees were concerned. Therefore, I would ask the Ministry not to pay too much attention to the certificate but to take into consideration to a certain extent the character of the women.
Another point on which the Ministry might exercise a certain amount of healthful control is in the feeding of the children. This country is perhaps not as far advanced as it should be in the question of pure milk. Every effort has been made to see that women suckle their own children, because mother's milk is best for the child. With patience and perseverance most mothers could feed their children, but very often when they do not do so it is because they do not want to do it. Their social engagements take too much out of them, and they cannot both fulfil their social engagements and feed their baby; therefore, the baby suffers, and very often it means that we have to fall back on artificial feeding. The Ministry might concentrate more than they do on the question of pure milk. They could pay more attention to the unsweetened condensed milk which is imported from the Continent in such huge quantities, which my right hon. Friend the Member for Edgbaston (Mr. Chamberlain), Minister of Health in the last Government, said was not fit for babies. What happened? People buy it just the same because it is cheaper than ordinary milk, and we know that in many districts children are being fed on milk which is bound to do them harm. The suggestion I have to make, I have made it before, but it has never done any good, is that this condensed milk from abroad should not be allowed to be sold, retail, in less than 7-lb. tins. Very few people would walk about with a 7-lb. tin of condensed milk. By doing that you would immediately stop the sale of these 4-oz. tins and then they would be compelled to provide one of the dried milk foods or, better still, pure milk from the cow. Our milk supply requires looking into. The amount of adulteration which goes on is a disgrace to our civilisation. Very often you find in the more residential towns the worst milk supply. Two years ago I brought to the attention of the House the peculiar fact 1024 that in some of the operative towns of Lancashire, where the climate is very good with plenty of rain and smoke, there was absolutely no signs of the sale of contaminated or adulterated milk. You come down to the towns on the South coast, the great watering places, and the adulteration is 20, 30 and 40 per cent. That is rather peculiar. In Lancashire they get pure milk; down in the south they cannot.
Then with regard to tuberculosis. The Parliamentary Secretary knows as well as I do that surgical tuberculosis in children, one of the most dreadful of complaints, is undoubtedly due to tubercular cows milk, yet how often is the milk examined for tuberculin? We have our tuberculin tested milk it is true, but ordinary people cannot afford to pay it. We as a wealthy nation can afford to spend millions on pensions and out of work pay yet we cannot afford to provide our children with tuberculin tested milk. The babies of this country are the future men and women; and one would have thought that the first duty of the Ministry of Health was to see that they started well, that they were properly fed with tuberculin tested milk in order to give them a chance of a good start in life; and not do so much for them when they are grown up. Hon. Members opposite seem to think that they should take care of them from the day they are born until they are dead. I believe that a man when a man is fit to work he is fit to look after himself. The Ministry of Health should do more than they are doing for the infants of the country—
§ Mr. ALPASS
Is it not the fact that the circular sent out by the late Minister of Health cut down the standard of the milk supplied to infants.
The hon. Member is quite mistaken. I thought that canard had been destroyed. All the late Minister of Health did was to point out that certain economies were necessary—[Interruption.]—and that an economy could be made on the milk supply, because towns of strictly comparable character were spending different sums of money upon the milk supply. But it was left absolutely to the local authorities to decide whether they would reduce the milk supply. The Ministry in no single case told them to reduce it, and as a matter 1025 of fact in very many towns the milk supply was increased. Those are the facts of the case, which may be verified quite easily. Of course they are common knowledge. The Conservative Government spent very much more on milk than any other Government. There is one other subject that I want to mention in connection with maternity and child welfare centres. That is the very vexed subject of birth control. I find that there is an agitation spreading to certain parts of the country, and I am very astonished to find that amongst members of the Socialist party it is becoming more and more a political question that the Government should give doctors at ante-natal centres power to inform inquiring mothers as to methods of birth control [HON. MEMBERS: "Hear, hear!"] It is apparent from those cheers that there are some hon. Members opposite so misguided and so ignorant as to imagine that the Government should have power to ensure that their medical officers give advice on the subject. The competent medical opinion of the country is definitely opposed to birth control.
I repeat my statement. Competent medical opinion in this country is overwhelmingly against birth control. It is only a few weeks ago that there was a meeting held of a medical society in London to discuss this very point, and the opinion was overwhelmingly against birth control. Therefore, when people say that they are in favour of birth control they are speaking from ignorance.
§ Mr. THURTLE
Does the hon. Member think that Lord Dawson of Penn is not a very good medical authority, and is he aware that Lord Dawson is strongly in favour of birth control?
In the first place, if I might mention the Noble Lord's name he is not an obstetrician. He is a physician generally, and I probably have attended very many more confinements even as a general practitioner than Lord Dawson ever did. Because he happens to be a swell physician it does not mean that he is really a competent authority in deciding this question. When I was speaking of competent medical opinion I was speaking only of the gynaecologists and obstetric 1026 surgeons whose work is concerned with maternity and the diseases of women. They are competent to judge, because they see the ill effects of birth control. Lord Dawson of Penn would probably never see the ill effects of a case like that, which is outside his line of practice. Let hon. Members talk to any obstetric surgeon or a medical man or woman accustomed to a large gynaecological practice, and almost without exception these people will say that birth control is detrimental to the woman and detrimental to the child. I hope that the Government will persist in the attitude that they have adopted up to now. I hope that they will refuse to instruct any of their medical officers at these centres to give information on birth control.
§ Mr. SPEAKER
It seems to me that the hon. Member is going rather far from the subject which is before the House. I understand the Ministry of Health, at the moment, has nothing to do with that matter.
Questions have been put to the Minister of Health by hon. Members asking him to give authority to medical officers in these centres to give information on birth control. These questions have asked the Minister to issue an order to that effect; and with due submission I say that that brings the matter very definitely within the scope of the Ministry of Health affairs which we are discussing.
§ Mr. SPEAKER
I understand from the hon. Member that the answer of the Minister of Health was that he would not give such instructions.
In that case I hope that hon. Members opposite will take note of your ruling, Sir. I am sure that Members of all parties are sincerely anxious that maternity and child welfare work should advance by leaps and bounds. When we think of the large number of deaths in 1027 child-birth and the large infant mortality—43,000 babies in one year—and when we know that much of this loss is preventible by efficient ante-natal work and efficient maternity and child welfare work, I am sure we shall all wish to do everything we can to encourage the Ministry. Let us therefore, not blaming them for what they have done or omitted to do in the past, encourage them to do all in their power in the future to see that the mothers and children of this land have every benefit which a highly civilised State can offer.
§ Miss RATHBONE
It had not been my intention to intervene in this Debate, but I should like to say how warmly many of us welcome what has fallen from the hon. Lady the Parliamentary Secretary to the Ministry of Health with respect to her sympathy with the proposal that maternity and child welfare work should be subject to a special grant, rather than remain under the block grant system. I hope that that sympathy will be translated into action by the Ministry. I do not wish to transgress your Ruling, Sir, by enlarging on the subject dealt with by the last speaker, but this much I hope I am in order in saying. In one respect, the action of the Ministry in that matter is actually impeding the women of the country in getting the kind of information which they most desire, to enable them to control the conditions of their own maternity. It is not, as far as I know, asked by any responsible body of opinion in this country that any physician should be asked to give information to any woman of a kind which he himself thinks undesirable or wrong. Therefore, if the last speaker is right in thinking that medical opinion of this country is against a certain practice, no one would request that any doctor should be required to give information which he himself believed to be contrary to the interests of his patient. What many of the women of this country ask is that, when their physician distinctly tells them that in the interests of their own health they cannot safely have another child, the doctor should not be prevented by the embargo of the Ministry from giving the information to the woman which she desires to have, and which he desires in the interests of her health to give her, and that owing to that refusal she may not be compelled 1028 to seek the information from the nearest quack round the corner. I shall be interested to hear how much of that unfavourable medical opinion to which the last speaker alluded refers not to practices which take place in accordance with advice given by responsible physicians, but to practices that take place when an unfortunate woman is driven to seek, from incompetent persons and from quacks, the kind of information which she believes necessary for her own health.
If we look at what is happening in the United States, where they have taken exactly the opposite course to that which is taken here, we find that they will allow nobody but the medical officer of health and those in charge of public health clinics to give a certain kind of information. I think that is a very much more logical and reasonable way of seeing that the right kind of information is given than that which we adopt in this country, where the Ministry of Health is really carrying out the policy of the ostrich with its head in the sand by refusing to take official cognisance of the subject but, instead, leaves it to be dealt with by every quack and ignorant old woman who thinks she can give information on the subject.
Lastly, the hon. Lady referred to the recent Report on the question of midwifery training. May we again hope that that will be more than a Report, and that the Ministry intend very quickly to put, at any rate, part of that Report into practice? Very much depends on the necessity for an adequate remuneration for either doctor or midwife to do their work properly. The midwifery service is an extremely ill-paid service. The midwives have much more reason than the medical practitioners to hold back from coming into a profession where, on the one hand, they are so ill remunerated and, on the other hand, they are ever increasingly more strictly watched and supervised; and when anything goes wrong it is usually the ill organised profession of midwifery, and not the strongly organised profession of medicine, that has to bear the blame. Many of us doubt the wisdom of some of the recommendations in that Report that would place the whole onus of training and of preparing the syllabus for the training of midwifery upon medical officers of health rather than upon the present General Midwives 1029 Board, because there is always the fear that the medical officers of health have too little practical experience in this kind of work and are too much, to put it quite bluntly, under the thumb of local medical opinion. But there are portions of that Report that we should greatly like to see carried into effect, and we hope there will be as little delay as possible in doing so.
Above all, we want greater encouragement given to the local authorities all over the country to spend more freely on this service. It was denied, I think, by the right hon. Gentleman on the Front Bench above the Gangway that the late Government had cut down the grants for the supply of milk. If the late Government did not actually cut down the grants compulsorily, at any rate they gave a very broad hint as to the direction in which the authorities probably might economise. That was a hint unfortunately which too many of the local authorities were very quick to take, and we hope that the hon. Lady intends to reverse that policy on the earliest possible occasion.
We have heard so much lately on the question of unemployment, that many of us have had our thoughts fixed upon those rural areas in the mining districts where there are bad conditions that lead to that excessive maternal mortality that has been the subject of such interest—bad housing conditions, very scattered cottages where there are very often no doctors or nurses within easy reach, and the highest birth-rate of any class whose birth-rate has been separately estimated. Many of these women have large families already, and are living in overcrowded cottages, with no medical help near them, and yet they are prevented from having the very knowledge which would alone enable them to prevent an increase of a family which is already pressing far too heavily on them. For all these purposes we desire a better paid midwifery service, and more action on the part of local authorities in giving that kind of information which is required for the women, and which through organised bodies, irrespective of party, they are insistently demanding the right to have when they wish it from the practitioners who are able to give it.
Duchess of ATHOLL
A good deal of ground has been covered on this extremely important subject of maternal health and infant welfare, but there are a few things which I should like to say. In regard to maternal mortality and morbidity, we were interested in what the Parliamentary Secretary said about ante-natal clinics and the great variation in taking advantage of them in different localities. She suggested the need for local authorities starting campaigns to make the advantages of these clinics better known. That is the sort of work in which valuable help can be given by voluntary effort, and for which we ought to be able to rely a great deal on assistance from voluntary societies and committees. I should like to suggest to the hon. Lady that, if she makes any recommendation to the local authorities, she should specifically invite them to enlist all the voluntary help possible. [HON. MEMBERS: "No!"] I venture to say to hon. Gentlemen that a great deal more can be done for the development and improvement of the health services of this country, which mean such a lot to national health and well-being, by a happy co-operation between local authorities and voluntary agencies, than in any other way. A public body alone cannot do it, but a public body plus voluntary assistance can do it, and that is one of the distinctive features of the public health services of this country.
I was interested in some of the remarks of the hon. Member for Royton (Dr. Davies) on the subject of maternity. He expressed his concern at the confinements that take place in slum dwellings, yet he wishes to ensure that such confinements should continue on canal boats. He went on to say what an advantage it would be for the mother to be able to get away after the confinement for a short while from her husband and her children—not an easy thing for a canal boat woman to do. In another interesting suggestion he spoke of the value of the mother, after her return home following her confinement, receiving the benefit of visits from some after-care association, but it would not be easy to ensure this for a canal boat woman. I hope he will ponder a little over this reflection, and as a result modify his attitude to the canal boat question. I would like to say a word about the subject which was brought 1031 before the House in so sympathetic a manner by my hon. and gallant Friend the Member for Abingdon (Major Glyn). It may have a bearing upon the problem of maternal mortality and morbidity, and I find it difficult to believe that the medical profession is so united in opposing consideration of this question as the hon. Member for Royton would lead us to believe. I should like to feel that the question was receiving very careful consideration in connection with this problem of maternal health. There is another factor which I cannot help feeling has a bearing on that question, and which was referred to by my hon. Friend the Member for the English Universities (Miss Rathbone). I believe that abortion is a very serious question in this country, and that it is becoming a problem of increasing dimensions. I would like to feel that the possible bearing of that question on maternal mortality and morbidity is being fully considered.
Quite obviously the health of children is of enormous importance in connection with the national health. I am sure no hon. Member needs to be reminded of what the chief medical officer of the Board of Education has said several times in regard to the health of children entering elementary schools. When that subject is brought up, some people are apt to speak as though the only way of dealing with the problem of the health of the pre-school child is by way of providing more nursery schools. I do not want to say one word against nursery schools, because I think they are doing perfectly splendid work. Another admirable method of dealing with the slum child or the child from the crowded areas is by nursery classes as they have been so well developed in Manchester. Day nurseries are yet another excellent method of dealing with children in these special areas. All these are forms of intensive effort on behalf of the young child, and one wants to see them developed in the areas where the health of these children specially calls for attention, but I want to stress to the House the point that this problem of the health of the pre-school child is an extensive as well as an intensive question; it is a question of doing something to help a large number of children as well as of doing a great deal to improve the health of a certain number. If that is admitted 1032 it is quite clear that to deal with it we must have a more widespread organisation than anyone could reasonably expect nursery schools to become. The only organisation through which, it seems to me, you can really grapple on a large scale with this problem is through the child welfare service.
I was very glad to notice that in the Circular recently issued by the Minister of Health and the President of the Board of Education, among the various means of dealing with this problem, the child welfare service is not left out. The part which the development of the child welfare service must play in this problem is so important that I feel I must draw attention to it. When I last received official information on this subject, I was informed that, while in all areas in the country child welfare services were provided for children up to the age of one year, there was little service for children above that age. That obviously means that there is a very serious gap in this service between the ages of one and five years, when the child comes within the purview of the school medical service. It is of very great importance that the country should realise how important this question is, how big the gap is, and how essential it is that local authorities should make steady progress with filling that gap, and this is a moment at which this ought to be emphasised.
The hon. Lady spoke as if the only means of dealing with this question was by giving a grant outside the black grant under the Local Government Act, but of course she will not forget that under that Act the local authorities must bring forward schemes for the approval of the Ministry—schemes for the extension of child welfare services and for grants to voluntary bodies who are co-operating with them. I should like to ask the hon. Lady to give her most serious attention, in the schemes which will come before her, to see that everything possible is done to bring before the local authorities the importance of developing these services and of giving generous assistance to the voluntary bodies who can do so much to help. I submit that, while on this side of the House, we are not anxious to emulate hon. Members opposite in the rake's progress that they seem to follow in matters of public expenditure, we feel that this is one of the most important questions dealing with 1033 the health of young children and that in the child welfare service money goes a very long way—further than in many others—and that you get the very best return for your money.
While in the towns you need the assistance of whole time health visitors in this service and you have your clinics, you must depend for this work in the rural areas largely on the help of the district nurses whose work has been so rightly praised by the Member for Abingdon. There is more than one reason for this. The first is that parents in the rural districts are often rather shy of strangers and the district nurse is not a stranger, whereas the health visitor who comes from a town some way off may not be welcome. Parents do not want several people coming into their houses, but they welcome the district nurse who they know as a friend and who with her training, is a person who can give the advice which is needed on various subjects. The local district association usually receives a grant from the local authority through a County Federation of District Nursing Associations. This has been done, I believe, in a good many English counties, but not to such a great extent in Scotland. In the county which I know best we formed a federation of our district nursing associations immediately the War came to an end, with the result that we have been able to have a regular visitation of all children from birth to five years of age, which is now showing its effect upon the health of children coming into the schools.
The position under the Local Government Act in Scotland should be better than in the past. Where there used to be many small authorities to deal with this subject, there is now only one authority with whom a Federation of District Nurses has to deal, and that gives a much better chance of carrying out schemes of this kind. This is all the more necessary in Scotland, because, unfortunately, our infant mortality, though lower than it was, is not as low as it is south of the Border. I do not press for an immediate reply to-night, but I ask the Secretary of State for Scotland to consider whether he can do anything to bring before the local authority the importance of helping forward the formation of Federated District Nursing Asso- 1034 ciations, and of inviting their co-operation in child welfare work.
§ Question, "That Mr. Speaker do now leave the Chair," put, and agreed to.
§ Supply accordingly considered in Committee.
§ [Mr. ROBERT YOUNG in the Chair.]