§ Miss LAWRENCEI beg to move, in page 8, line 31, after the word "under" to insert the words "Section one of."
This is one of three purely drafting Amendments.
Dr. DAVIESI submit that this mention of Section one is quite unnecessary. It is the only part of the Bill which empowers a local authority to receive a voluntary boarder.
§ Miss LAWRENCESection one already occurs in the Clause, and this makes it more harmonious.
§ Amendment agreed to.
§ Further Amendments made: In page 8, line 36, after the word "of," insert the word "such."
§ In line 36, leave out the words "under Section one of this Act."—[Miss Lawrence.]
1792§ Mr. KINLEYI beg to move, in page 9, line 37, at the end, to insert the words:
Provided that the expenditure incurred shall not exceed the product of a penny rate in any one year.This Amendment is one that will have to be carefully considered, and I want to ask that, in giving consideration to it, the House will first assure itself of what Clause 6, as it stands, is going to impose on local authorities. Those who have made themselves familiar with the Bill will agree, first, that it is proposed to make a change in the classification of those who at present are proceeding normally to the stage of certification. It is proposed to divide them so effectively that a fair proportion of them, by receiving treatment at the proper stage, will be prevented you ever reaching the point of certification. The question arises whether the treatment that is to be provided for these people is to be provided in existing institutions, that is lunatic asylums, or whether entirely new institutions are to be provided. I hope the House will agree that, if it be at all possible—it certainly is desirable, if not necessary if the new provision is to be effective as we all hope,—the provision to be made by the local authorities should not mean provision in existing institutions, but that the new treatment should be provided entirely outside the present area of the asylums, that the people who are going to be treated should be treated in entirely different buildings and in an entirely different atmosphere. If one looks at it from that point of view, the first question that arises: is what is the cost going to be? As against the suggestion that new buildings would have to be provided, there has been made the suggestion that buildings hitherto used for Poor Law purposes, now freed under the operation of the De-rating Act, can be made available and can be used for the new services, and, where available, can be used as an entirely new hospital and take in an entirely new set of patients. Assuming that to be done, the first thing that will happen will be that the building will have to be altered and equipped. Its general surroundings will also entail on the local authority a very large expenditure of money.I suggest, if we take this matter a little further and investigate the position of the local authorities from that point of 1793 view, we shall find that in some parts of the country there is already a shortage of suitable accommodation for the Act in operation, and that, whatever additional provision be made, will have to be made in an entirely separate building. The Minister himself, in reply to questions, recently proved that, whereas there are certain local authorities whose existing accommodation is in excess of their own requirements, that excess of accommodation is taken up by the surplus patients who are being transferred to them by other local authorities under arrangements. There was a recent conference convened by the Lancashire Asylums Board, reported in the "Manchester Guardian," of 8th April, held at the County Hall, Preston, and the vital position I want to quote to the House is the statement of the chairman of the Lancashire Asylums Board, who pointed out that, from the financial point of view alone, it was extremely important that each of the local authorities should leave no stone unturned to arrange as far as possible for accommodation to be provided in their respective institutions. The result of their efforts in this direction would largely determine the question a whether or not another mental hospital should be erected in Lancashire which would involve an expenditure of at least £1,000,000, and the cost of maintenance of which would fall upon the county and the county boroughs unless some additional accommodation could be found or arranged for in existing institutions. He saw no way out of embarking on the erection of such institutions, but he was extremely anxious, as chairman of the Board, to avoid it if possible. The point I wish to make is that that additional expenditure of £1,000,000 which the Lancashire County Council is now facing is due, not to anything that they may have to provide under this Bill, but to their existing needs and immediately prospective needs under the Mental Deficiency Acts, so that whatever accommodation has been thrown free will be taken up under Acts already existing before this Bill is passed.
For these reasons, and also for reasons which are given in the report of the Lunacy Commission to the effect that, while casting no reflections whatever upon existing buildings or upon their 1794 lay-out or equipment, none the less they were firmly of opinion that the successful treatment of the patients in the existing asylums demands that there shall be a radical change in the type of building and equipment and in everything generally that means the expenditure of money, and because that of itself is going to throw a very heavy additional expenditure on the local authorities, I press this Amendment. There is the proved fact that the staff—the medical staff—of practically the whole of the public institutions is below what it ought to be. In very many cases, it is far below what it ought to be, not only in numbers, but even so far as quality is concerned. There is an overwhelming proportion of those doctors who have gone to their present positions from their ordinary general practice or with ordinary general qualifications and who have had no time during their qualifying period to make the special studies of mental diseases. Further, it has been laid down before the Commission that the medical men who were qualified during one particular period of 1921 to 1924 had no questions whatever to answer upon this very disease. While, in order to compensate for those things, many of the local authorities are encouraging the directors of their institutions to afford as many of their medical assistant officers as possible facilities for taking up those courses—
§ Mr. KINLEYWith respect, I am proving that there is need—[Interruption]. I am proving from the evidence of the Royal Commission that there is need in our existing institutions for a larger number of higher qualified, and therefore higher paid, medical men.
Mr. DEPUTY-SPEAKERThe only way that I can follow the hon Member is that there is a very large amount of expenditure needed that he does not want incurred.
§ Mr. KINLEYNo. I do not want this House to throw on the local authorities a burden which they will not be able to shoulder effectively; that is, effectively in the way in which the proper administration of this Bill when it becomes an Act will demand. I want to impress on 1795 the House that the local authorities are already in great difficulties. No one will suggest that, if it had been an easy thing for the local authorities, these things would be in existence and that the local authorities would be equipped with unsuitable buildings and not provided with the medical staffs of the size that is required. The medical staff, according to this very evidence, is in many places so small that while the superintendent, himself and the local authority are quite anxious that the assistants shall be allowed to go away for leave to study the treatment of mental diseases, they cannot, and dare not, give them the required leave. All this does prove conclusively that local authorities are doing what they can do and are greatly handicapped at the present time, and that we ought not to throw on them an additional burden that will be overwhelming. It is not merely what will be thrown on them under this Bill. Some local authorities are shouldering every day heavier burdens. In 1914 the total debt of the local authorities of Great Britain was only £362,000,000. Last year it had grown to £900,000,000.
Mr. DEPUTY-SPEAKERAgain, I think this is a very roundabout way of getting to the Amendment. The Amendment is that the local authorities shall not spend more than a 1d. rate.
§ Lieut.-Colonel ACLAND-TROYTEIs not the idea of the hon. Member that we want to try and prevent local authorities spending more than a 1d. rate, while, on the other hand, he urges that they should spend more? Is not, therefore, the whole Amendment out of Order?
§ Mr. KINLEYI want to submit that the passing of the Amendment, without any other alterations of this Bill at all, will do this—that the same duties that are herein imposed would be imposed on local authorities, but that the expenditure thereby involved would be limited to the extent of a penny rate as far as local authorities are concerned, and that therefore the additional money must come from some other source.
Mr. DEPUTY-SPEAKERThe point is not, that additional money should not come from somewhere else, but that it should only be a 1d. rate.
§ Mr. BECKETTMight I very respectfully suggest that if, in moving this Amendment, which is to restrict the amount of expenditure of the local authorities to a 1d. rate, we are prevented from explaining how the money is to be spent and what are the sources from which it will come, we shall not be able to discuss the question properly?
Mr. DEPUTY-SPEAKERI do not think that that point arises. The question here is that there shall be only a 1d. charge on the rates.
§ 1.0 a.m.
§ Mr. KINLEYI want to appeal to the House to carry two pictures in its mind. One is the work necessary by passing this Bill, and the other is the areas which that work will be rendered necessary. Take the local authorities in the industrial areas who are at the present time unable to carry the burdens already imposed on them by existing Acts. To what extent do we, through the burdens of this Measure, inflict on them an additional burden? Are we not justified in asking that whatever this Bill may inflict upon them, whatever duties may be imposed upon them, additional to their existing duties, that, so far as this House is concerned, we are not going to add to the difficulties of local authorities in industrial areas. Some of them in such areas have even got to the point that they are virtually unable to carry on their existing duties. This House and the Lord Privy Seal have tried to secure means to carry on their independent existence. In these circumstances, the House ought not to agree that an unlimited burden should be placed on local authorities. While we want every bit of good which can be got out of this Bill, we are not prepared to add to the difficulties of local authorities. I ask the House to agree that, so far as local authorities are concerned, their expenditure shall be limited to a penny rate for one year.
§ Mr. McSHANEI beg to second the Amendment. In the main section of Clause 6 it is stated that it shall be the duty of every local authority to investigate the needs of their area and to take such steps as they consider necessary for the maintenance of institutions for the reception of patients. It is obvious that, if that is to be done adequately, in the 1797 way which would meet the needs of these new voluntary and temporary patients, there must be an enormous burden upon the local authorities. I ask Members of this House to picture how far such developments could take place in distressed areas. How far could they begin to develop such treatment? I think my hon. Friend has done well to call attention to the difficulties that these areas would have.
§ Lieut.-Colonel HENEAGEI am at a loss to understand exactly what the hon. Gentleman means. So far as we can tell, he proposes by his Amendment to limit expenditure to the product of a penny rate in one year. If he takes the ordinary county council, that might mean £10,000 a year, but his proposal went into large figures—millions. He also mentioned a very large staff, and he said it would not be less than 1s. on the rates. I have had experience of the proceedings upstairs in Committee. If I remember rightly, he was clearly out of order in what he said about the Amendment. The principle of his Amendment is not a bad one and therefore I have great pleasure in supporting him, while I do not agree with the words which he has used. The Amendment is to limit the expenditure when a Socialist Government has promoted a Bill. I rather gather that it is very unusual to limit expenditure of any kind in this form of Bill, although I believe there are one or two cases in the Housing Act.
Perhaps the House would like at this moment to take thought whether this is not a good opportunity to establish a precedent, having in view the fact that we may be unfortunate enough to have a socialist Government in a future period. Here we have actually an Amendment moved by a Socialist Member to limit expenditure. I am not sure whether this idea should not be encouraged. It is very rare to limit expenditure of any kind. Their topsy-turvey way of advocating it may not commend itself to those of a logical or classical turn of mind who are sitting on the benches opposite. We should rather like to hear the opinion of the Parliamentary Secretary upon it. We know she is capable of turning it into pounds and shillings. She is an authority on the higher mathematics. For recreation she probably goes into the binomial 1798 theorem. Equations in the late Housing Bill offered no difficulty to her. Does she stand for the principle of limited expenditure? I hope very much she will support this Amendment. I would suggest that we support it. There may be more behind it than the hon. Member suggests. He sits in a corner of the House where limiting expenditure is not encouraged. They have moved Amendments even in relation to the proposals of the guardians of our public purse. I wait to announce my decision until I have heard what the Parliamentary Secretary has to say.
§ Mr. WOMERSLEYWith the principle underlying this Amendment no doubt many Members will be in agreement—that is relieving the shoulders of the local authorities of the burden of carrying out the provisions of this Bill. I take it that the Amendment has been moved in this form so that it could be described as in order. In Committee stress was laid upon the undoubted burden which would be placed on the shoulders of local authorities. The Municipal Association requested Members to bear this in mind when dealing with this in Committee and I put forward on their behalf Amendments to do something to help the authorities in this matter. It would be out of order to say that the Government ought to assume financial responsibility for this Bill. That would mean more expenditure for the Exchequer. I would ask hon. Members if it is to do any good if this Amendment is accepted. We all want to see this Bill placed upon the Statute Book. We want to see it working smoothly. We all realise that under the present system, the block grant system, there will be no increased grant given from the National Exchequer to assist local authorities. What is the position of local authorities to be in this matter? As it is a new service it should receive a grant. The Minister says he does not regard it in that light. In many local authorities the project, if tried, will be on a very small scale indeed. The cases of some of the smaller county boroughs have been quoted. What they could raise would not be sufficient to touch the fringe of this vast sum. Once we have to tackle this question we should tackle it in an efficient manner. We should provide proper institutions for these 1799 people to be treated under proper medical supervision. Take the former Act of Parliament dealing with mental treatment. Why is it that has not been universally adopted throughout the country? Simply because of the vast expenditure entailed in providing the medical supervision and so on for the patients. Even if it is accepted by the House and placed upon the Statute Book, it is not the end of it, unless you have the local authorities to administer it, it will have been in vain.
Dr. DAVIESI am actually opposed to any Amendment which seeks to limit the power of local authorities and which deals with this voluntary treatment. There is a great difference between the rateable value of county boroughs, particularly at the present time, and it will be very unfortunate if in a certain district of a local area they are handicapped in any way. This Bill will be regarded as one of the health services available for the block grant, and it simply means that, when the next grant comes up, they will become eligible for a larger grant. Any Amendment which is designed to hamper in any shape or form is to be deprecated and I hope the Minister will not be able to accept it.
§ Mr. C. WILLIAMSI see we have the Financial Secretary to the Treasury with us this evening. Does he consider that a penny rate would be likely to cover the needs of the Bill? I presume the Minister would be able to collect the facts from his Department as to whether a penny rate as far as the larger areas are concerned would in any way be an adequate amount. Many of us think that a penny rate would possibly not be an adequate amount. If I may have the attention for a minute of the right hon. Member, could he answer that question as to whether it would be likely to meet the case? Personally, I do not wish to disagree in any way with the hon. Gentleman opposite who moved the Amendment, but it is important to consider whether local authorities are in the least likely to have the necessary funds at their disposal to meet the needs under the Bill. In the very long and interesting discussion upstairs, there was a state of indecision as to the whole position as regards the Bill and its 1800 finances. I do not want to have to read the Minister's speech. At any rate, the indecision is marked there very clearly. Can he, for the sake of many of us in this House who have been well wishers of the Bill from the beginning, give us a short statement in connection with this particular matter? It is one on which there is a considerable amount of anxiety, not only in the House but outside. It is no good laying down general measures of this kind unless you have some definite knowledge of how it is going to be carried out. That definite knowledge the mover of the Amendment has tried to obtain. He is making a real effort to put the Bill on a sound financial basis. I have very great sympathy with the mover, and I hope, at any rate, that we shall have an answer from the Government which will help us.
§ Miss LAWRENCEA similar Amendment was moved by the same hon. Member in Committee. He then moved that the expenses of the local authority should be confined to a half-penny rate. After a tolerably short discussion, the Amendment was negatived. The discussion on the Amendment has provided interesting speeches, but it has found very few friends. The speech of the hon. Member for Grimsby (Mr. Womersley) dispenses me from the duty of making a reply.
§ Mr. WOMERSLEYI hope the Parliamentary Secretary will give some indication whether the Government are prepared to render some assistance to the local authorities.
§ Miss LAWRENCENo, no. Not all the kindness of the hon. Gentleman will lure me into a talk which would properly take place on a financial resolution. I think it would be utterly disorderly, and you, Mr. Speaker, would stop it if on the Report stage of the Bill we discussed proposals for Government grants. Will the House just look at what these local authorities have got to do under Section 6? Section 6 relates to their responsibilities with regard to temporary patients. The first Sub-section of Section 6 says that it shall be the duty to make accommodation for temporary patients. Where are these temporary patients at the present time? They are nearly all of them under the care of the local authorities and are actually in asylums. There are a large number of certified 1801 lunatics in asylums—people who might come under Clause 5—who are actually at the present time under the charge of the local authorities. They will be treated differently, they will not be certified, and I certainly hope that they will be put in some segregated institution. That will depend on the local authorities, so that it is exceedingly difficult to know, having regard to the new accommodation available, and regard to the fact that these classes of patients are very largely under the care of the local authorities, paid for by the rates, whether the patients under Clause 5 will cost the local authorities anything at all. It may be that it will cost them something, but not an appreciable sum.
The voluntary patients are a new class of patients. Under Clause 2 it is laid down that the local authorities shall provide this accommodation. I should not be in the least surprised from all our experts tell us that early treatment at this stage might prevent the local authorities from looking after real and hopeless lunatics. People ask how much this will cost. It is exceedingly doubtful, but, if the expectations of our experts are realised, there may, and I hope there will, be a decrease. With regard to the other matters detailed under Section 6, the local authorities are left to do as they please in the matter. These are the reasons why it is impossible to give any estimates of the cost. If we really succeed, I hope there will be a saving for the local authorities. I do not believe that anybody in the world would have moved such an Amendment if they had not desired to make some remarks with regard to the necessity of further Exchequer assistance. I have done my best to answer the question that hon. Members have put to me. I think I have shown the Amendment is not one supported by Members.
§ Mr. KINLEYI beg to ask leave to withdraw the Amendment.
§ Amendment, by leave, withdrawn.