MIDWIVES BILL.

HC Deb 07 July 1936 vol 314 cc1047-153

Order for Consideration, as amended (in the Standing Committee), read.

3.58 p.m.

The MINISTER of HEALTH (Sir Kingsley Wood)

I beg to move: That the Bill be recommitted to a Committee of the Whole House in respect of the Amendments in Clause 1, standing on the Notice Paper in the name of Sir Kingsley Wood. During the discussions in the Committee stage everyone was in agreement that if it were possible to have a longer period than 10 days as the period of attendance of a woman as a maternity nurse, it would be advisable. This particular period was, in the first instance, decided by the Central Midwives Board subject to the approval of the Minister of Health, but the Central Midwives Board propose to extend the period, as was suggested by hon. Members, and it will shortly receive my approval. In these circumstances my hon. Friend the Parliamentary Secretary gave an undertaking that we would put down before the Report stage an Amendment to the effect that the period of attendance of a woman as a maternity nurse should correspond to the period which from time to time might be laid down by the Central Midwives Board for the attendance of midwives. That is in accordance with the pledge given and with the unanimous view of hon. Members. I am asking for the Bill to be recommitted because it will ultimately increase the minimum period of attendance on each case by a salaried midwife when acting as a maternity nurse.

4.0 p.m.

Mr. RHYS DAVIES

I beg to move, in line 3, to leave out "in the name of Sir Kingsley Wood."

The Amendment is to delete the name of Sir Kingsley Wood. I almost wish we could delete him in many other respects. But that, of course, is not the real purpose of my Amendment. The purpose of the Amendment is to deal with an important point. If the Minister does not mind my saying so, we are not quite happy about the method he is to employ to implement the promise made by his hon. Friend the Parliamentary Secretary in the Standing Committee. Very briefly the story is this: In the Bill in the first instance it was laid down that a maternity nurse should spend a minimum period of 10 days on a confinement. We proposed that the period should be a minimum of 15 days. The Parliamentary Secretary, in the absence of his chief—we got on upstairs very much better without his chief, and I am not sure whether we would not get on better to-day without him, though that is by the way—was good enough to say that our proposal to increase the 10 days to a 15 days minimum would be dealt with by the method now suggested by the right hon. Gentleman. Quite frankly I do not think that the Minister himself ought to be happy as to the method to be employed in laying down the minimum number of days that the midwife is to be in attendance at a confinement.

I have looked up Section 3 of the 1902 Act, to which the Amendment refers, and I cannot see, except in two lines, where the Midwives Board in laying down rules can deal with this problem at all. Let me read the two germane provisions. The only way in which they can deal with the problem that we are debating is in paragaph (e) of Section 3, which says that the Midwives Board shall regulate, supervise and restrict within due limits the practice of midwives. I cannot see how the 15 days minimum can come in there. In the last few lines of the last paragraph of all there are these words: and generally to do any other act or duty which may be necessary for the due and proper carrying out of the provisions of this Act. My first question is this: Where under Section 3 of that Act is the Midwives Board going to lay down any rule that the minimum period of attendance at a confinement shall be either 14 or 15 days? It seems to us that if the board is allowed to lay down 10 days the situation is not satisfactory. Then I come to the next argument—that we are not supposed to lay down all these details in an Act of Parliament. We regard this at any rate as something more than a detail. We think that the number of days' attendance of a midwife should be more than 10, and the general impression that we have got from the Government is that they too thought 10 days were enough. We had a long battle of words in Committee upon this problem. I do not think that I would be doing wrong if I repeated one or two of the arguments that we employed in Committee. The Minister tells us that we ought to leave this business to the Midwives Board, but we decline to agree that we ought to farm out this provision to any board. It is a problem for Parliament itself. The right hon. Gentleman says that it is a detail. When he was a very competent authority on National Health Insurance in the first instance every detail imaginable was laid down in the Bill. The three days waiting period is there, and the number of weeks to qualify for benefit is there, and when the Ministry want to make any change at all in details the Orders have to be laid on the Table of the House. We, therefore, say that we are not satisfied to have this very important provision farmed out to the Midwives Board in their settlement of rules for this purpose.

We shall divide on this issue for another and fundamental reason. We would like very much to extend the monetary provisions of the Bill. The Bill really is a very petty contribution to a very important problem. I shall have something to say later of the hon. Member's recent speech in Liverpool. I wish the Ministers of this Government related some of their enthusiastic speeches in the country to the laws that they propound on the Floor of the House. The hon. Gentleman tries to laugh that off with contempt, but he is not succeeding very well. We want to carry this Amendment which will give us the same opportunity of extending the provisions of Clause 1 as the Government seeks for its own purposes.

4.8 p.m.

Sir K. WOOD

It may save a little time if I explain the legal position, which I can quite understand the hon. Gentleman finds it somewhat difficult to follow, as he has not the documents before him. The matter is perfectly simple. In Section 3 of the Midwives Act of 1902 the House will find it laid down as one of the duties and powers of the Midwives Board that they shall frame rules: for regulating, supervising and restricting within due limits the practice of midwives, and pursuant to that authority the following rule was made: The midwives shall personally supervise and be responsible for the cleanliness, comfort and proper dieting of the mother and child during the lying-in period, which shall be held for the purpose of these regulations, and in a normal case, to mean the time occupied by the labour and a period of not less than ten clays thereafter. In the Motion for recommittal that I have moved the House will secure all that is desired, inasmuch as the Midwives Board in pursuance of their responsibility will increase the period to a period of 14 days. That will receive my approval and by that means the desire of the House will be effected. On the other point which the hon. Gentleman raised, namely the desire to extend the recommittal of the Bill to other matters, I cannot advise the House to accept his Amendment. There is a considerable distinction, at any rate in my mind and that of others, between the recommittal of the Bill for the purpose of fulfilling a pledge and undertaking given by the Government and its recommittal for other matters which may be mentioned in other Amendments. I will call the attention of the House to a statement made by one whom we recognise as an authority on a matter of this kind. This is the statement; it is dated 16th May, 1935: May I draw the attention of the right hon. Gentleman to one inaccuracy in what he has put to the House? He says that these two Amendments are in the same category as the matters which are to be recommitted by the Government. On his own statement they are not. The matters which the Government tells us this recommittal is required to meet are matters to carry out undertakings that were given in Committee. It is necessary, they say, because that could not be done formally at the time, to recommit in order that those undertakings may be carried out. But there was no undertaking regarding these Amendments. In fact, as I understand it, they were both definitely turned down without any undertaking, and there is all the difference in the world between the Government asking as a matter of convenience for recommittal in order that a matter may be put right, having regard to some undertakings which they have given, and their accepting an Amendment to reintroduce a discussion which normally would be completely out of order on the Report stage."—[OFFICIAL REPORT, 16th May, 1935; col. 1926, Vol. 301.] That is the statement of the hon. and learned Gentleman the Member for East Bristol (Sir S. Cripps), and upon it I found my objection to the Amendment which the hon. Gentleman has moved.

4.12 p.m.

Mr. BATEY

I do not think that anything the Minister has said will lead Members on this side to alter their opinion with regard to the Amendment. We regard the Amendment as important. With the Clause recommitted we should be able to deal with other Amendments on the Paper than that of the Minister. That is important, because Clause 1 is a most important Clause of the Bill. With some parts of it we agree, but with other parts we cannot agree. I agree whole-heartedly with the proposal, in line 15 on page 1, that provision be made for the attendance on women in their own homes. The tendency is often to have mothers removed from their homes to nursing or maternity homes. In working-class houses where a mother is to be confined, there may be two or three young children, say of two years, four years and six years of age. It is absolutely essential that such a mother should be attended to in her own home, where her young children will ask for her and she can speak to them. It is all very well, in the case of wealthy families where the children may be under the care of nurses and will not miss their mother so much, to remove the mother to a nursing home, but in the working-class families it is a good thing to make provision for attendance upon mothers in their own homes.

There are other things in this Clause which are very debatable. There is the question whether the local authority should have the appointment of these midwives or whether the appointment should be made by local organisations. What we ought to aim at is to put this midwifery reform under the power of the local authorities. In Durham the county council spends large sums of money subsidising the nursing association for midwives. The Durham County Council paid to the Durham County Nursing Association, in respect of midwives, in 1931, £3,414; in 1932, £3,397; in 1933, £3,827; in 1934, £3,828; making in four years a total of no less than £14,467. I do not say that the County Nursing Association does not do its work well; indeed, I am prepared to pay my tribute of respect to it, but, in my opinion, that association ought to be relieved of this work and ought to be able to devote its attention to nursing pure and simple. I believe that in order to ensure the effective carrying out of the nursing part of the work, it would be wise for the local authorities to give the nursing associations grants to assist them in the performance of that work, but so far as midwifery is concerned, I believe that it would be much better, seeing that the local authorities have to pay the money, for them to have charge of the midwives and supervision of them.

I emphasise this because, in spite of all the money that is being paid for midwifery services in the County of Durham, the maternal mortality rate is going up. I would mention that, in addition to the money which the Durham County Council has paid in subsidising midwives, and the amount it has had to pay to medical men who have been called in by the midwives in abnormal cases, the county council has spent not less than £10,000 a year during the years 1931, 1932, 1933 and 1934. In spite of that large expenditure, the medical officer of health for Durham County says: The maternal mortality rate in Durham is the cause of great anxiety, for, in spite of elaborate midwifery and maternity and child welfare services, the maternal mortality rate continues to rise. That is a staggering fact. In 1934 the deaths were 5.75 per 1,000 births; in 1935, they were 6.87 deaths per 1,000 births.

Mr. PETHERICK

On a point of Order. May I ask your guidance, Mr. Speaker, in this respect? Some hon. Members would perhaps like to raise various matters concerning Clause 1. Would it be in order for them to do so in this discussion?

Mr. SPEAKER

The Amendment to leave out the words "in the name of Sir Kingsley Wood" covers the discussion on the whole of Clause 1. That is the argument in moving the Amendment. It is in order to discuss Clause 1 on this Amendment.

Mr. BATEY

I repeat that the deaths in the County of Durham in 1935 were 6.87 per 1,000 births, and the rate for England and Wales was only 3.93 deaths per 1,000 births, so that the rate in the County of Durham in 1935 was almost double that for the country as a whole. Therefore, I feel bound to ask the Minister whether in this Clause he is going far enough in the attempt to prevent these deaths? We on this side have no hesitation in saying that the Minister needs to do something more than he is proposing to do here; he needs to have different and more important Amendments. We believe that the high rate in the County of Durham is due to malnutrition. Therefore, in moving to recommit this Clause and include one or two Amendments, I would have liked the Minister to face the real question and to see whether the Government could not do something to prevent the huge maternal mortality that we have in the County of Durham. I believe the Amendment which has been moved by the hon. Member for Westhoughton (Mr. Rhys Davies) is an important one. It is that we should deal with the whole of this Clause, and not merely with the question of the lying-in period. I wish to support the Amendment.

Mr. SPEAKER

I would like it to be understood that when I said the Clause could be discussed, I meant it could only be discussed with regard to those Amendments which stand on the Paper.

Mr. BATEY

I quite agree, and therefore I deliberately left out a good deal that I wanted say.

Miss WILKINSON

On a point of Order. There are on the Paper two Amendments with regard to voluntary organisations in the name of the hon. Member for Nelson and Colne (Mr. Silverman) and myself, which I understand you do not propose to call. Do I understand that they may be generally discussed during the discussion on Clause 1?

Mr. SPEAKER

Those Amendments may be discussed on Clause 1.

Mr. DENMAN

On a point of Order. Are any Amendments open to discussion even if they need not be re-committed? I submit that those Amendments which are to be discussed on the Report stage without recommittal are not capable of being discussed on the Motion to recommit the Bill.

Mr. SPEAKER

The hon. Member will see that there is no qualification in the Motion, which says, That the Bill be re-committed to a Committee of the whole House in respect to the Amendments in Clause 1, standing on the Notice Paper … and if the last words "in the name of Sir Kingsley Wood" are left out, all the Amendments standing on the Notice Paper could be discussed.

4.22 p.m.

Mr. KINGSLEY GRIFFITH

I certainly would not attempt to minimise the importance of the matters to which the hon. Member for Spennymoor (Mr. Batey) referred, but I would point out that, although in the opinion of the hon. Member the Government may not be going far enough, this Bill is in itself an attempt to deal with the problem of the maternal death rate. I think that what we are discussing here is primarily a question of procedure. The Bill has already passed through the Committee stage, and the recommittal of a Bill, although part of the normal procedure of the House, is generally undertaken to meet some special point. On this occasion it has been undertaken to meet a special case, and I was impressed by the argument of the Minister. The right hon. Gentleman promised re-committal for the purpose of dealing with a particular question with which he was asked to deal by hon. Members on all sides of the Committee upstairs, and he has fulfilled that promise. That is by way of a concession. Having opened the door, hon. Members above the Gangway want to push it open the whole way. I am not sure that is a procedure which would commend itself to me, because it seems to me that it would discourage the Minister from making concessions.

Mr. GEORGE GRIFFITHS

The Minister promised that he would do so.

Mr. GRIFFITH

Exactly, but the Minister might be very chary of making such concessions if he knew an attempt would be made to push the door entirely open. As I said on the Second Reading, I approve in general the objects of the Bill and wish to do everything in my power to facilitate its passage. Hon. Members are at least in the position that they are not being put under any handicap, because if this concession had not been made, the ordinary Rules of Order would have applied, and a good many things they want to raise could not have been raised again at this stage. Therefore, I cannot see that there is any substantial grievance, and I am inclined to resist the Amendment moved by the hon. Member for Westhoughton (Mr. Rhys Davies).

4.25 p.m.

Miss WILKINSON

I want, first of all, to deal with the statement made by the Minister with regard to the re-committal of Clause 1. This Bill has never been a party Bill in the ordinary sense of the word, except that hon. Members on this side of the House have very strongly felt, first, that it did not go far enough, and, secondly, that they very much knew the Minister of Health. It is not as the hon. and somewhat tepid Member for West Middlesbrough (Mr. K. Griffith) said in his somewhat qualified approval of both the Minister and the Bill, it is not that, having the door open, we want to push it further open, but knowing the Minister of Health we are not anxious to see him, having got this one tiny Bill made into an Act, going round the country and in his usual manner of speaking, particularly to religious audiences, calling down the grace of Heaven on himself and his Government on the assumption that he has solved the whole problem of maternal mortality. I do not intend the Minister of Health to get away with that. This is a very small contribution to the whole problem.

I want also to remind the Minister that we got a promise from him with regard to the extension of the period, and we understood that that extension was to be incorporated in the Bill. With all due respect to the Central Midwives Board and to the voluntary organisations, we here are legislators. The right hon. Gentleman is a solicitor, and he must frequently have heard judges say in court that they are not concerned with the intention that Parliament had in passing an Act, but only with what the words of the Act are. I cannot see any judge being concerned with the rules of the Central Board, which is not a statutory committee. If the Minister is serious in extending the period, why does he not put it into the Bill? That seems to me to be a complete answer to the arguments of the right hon. Gentleman.

I would like also to raise once again the question of voluntary organisations. I feel that in raising this matter I am not transgressing the limits of discussion on the Report stage, because this is a very fundamental matter between the right hon. Gentleman and ourselves. We are anxious to get this Bill on to a proper footing from the beginning and we do not think we shall do that if the voluntary organisations are maintained, with the lack of standardisation that that inevitably entails. We feel very much that the cause of having this Bill at all is the failure of the voluntary organisations. As a whole those voluntary organisations have done their job well, but this task is beyond their capacity. The whole cause of this Bill is that the task is beyond their capacity, and however much the Minister of Health may like to go round to fetes and be told how charming it was of him to have provided large sums of money for the voluntary organisations, we still maintain that the retention of the voluntary organisations breaks down the standards that ought to have been set up by this Bill.

I have always maintained that voluntary organisations have their place in our national life but their work is that of pioneers. It is their job to arouse public opinion in the beginning and to deal with a subject when it is in its experimental stage. Unfortunately, people in these voluntary organisations tend to think rather more of the financing and running of the organisations than of what the organisations were originally intended for. We think it tremendously important that this Bill should set up a high standard of nursing and training, and also a proper standard of remuneration and superannuation for the midwives. Consider the immense service that could be brought into being if the Government were prepared to tackle this problem in a proper manner, instead of tackling it, as they do everything else, as though it were a very hot poker and they were afraid of it and were looking round for somebody else to take hold of the hot end of it.

The fact is that these voluntary organisations cannot be made to conform to a standard because so much of their work is based on the general good will of people who give their leisure time, and so forth, to the work. They cannot be made to conform, and this Government is the last Government to attempt to make them conform, to a standard. It is pointed out, both by the British College of Nurses and by the Women's Public Health Officers Association, that midwives will have to do a certain amount of general nursing and that an un- standardised midwife means unstandardised nursing. A much more serious position is caused by the lack of co-ordination and the condition of divided responsibility which exists between the voluntary organisations and the local authorities, to the detriment of the mothers. During the discussions on this Bill the Minister seems to have been more concerned about the preservation of the voluntary principle than about the welfare of the mothers. Over and over again he has spoken about the necessity of maintaining the voluntary principle. We want to speak of the necessity of getting the best possible service for the mothers. We believe also that it is contrary to a canon of government that the ratepayers' money should be spent by any body other than the authority which collects it. We object to public money being given to voluntary organisations without proper control.

I know that where you have an energetic town clerk or a good borough council you will get properly audited accounts, but difficulty will arise with the "Lady Bountiful" type of organisation in the rural districts where a number of elegant idle women, with nothing else to do, occupy themselves by patronising the local nursing association. It may be necessary that ladies of the upper classes should find some way of employing their leisure time, but we think that the rising rate of maternal mortality is much more important than that, particularly in country districts where women have suffered more from voluntary associations of various kinds than women in the towns. In the towns, the women voters by coming together have the opportunity of bringing pressure to bear on those responsible. In the country, women have to put up with more voluntary organisation work of the kind which I have indicated, and it is particularly necessary, I submit, that public money should not be given to the voluntary organisations and that this work should be undertaken by public authorities such as the county councils. We have, during these discussions, raised over and over again the question of the religious difficulties which may arise where you have a voluntary association performing this kind of work. There is always the possibility of such a service being used at a critical time to influence the mother —which is hotly resented, especially by women in the rural areas. If the work is done by a properly paid public official, and if the whole supervision of the work is in the hands of properly elected and responsible people, and if the work is made to conform to a proper standard, that sort of thing cannot creep in, but it always creeps in where there are voluntary organisations.

I feel that we on this side must register our protest against so much public money being expended in this way, and also against what I can only describe as the breaking down of standards. This Measure will set the standard in the midwifery service for years to come, and we think that a great opportunity has been missed of establishing a high uniform standard, and of taking advantage of the excellent pioneer work which has been done by the voluntary organisations, in some areas though by no means in all. Instead of giving public money to voluntary organisations in the way proposed we should have taken this opportunity of establishing a real national service of which we could be proud. Seeing that one section of the right hon. Gentleman's colleagues are making provision—and large and handsome provision—to destroy as many of the present generation as possible, I think it would have been better if the right hon. Gentleman had made more adequate provision in this Bill for the generation that will have to make up for the casualties which his colleagues are arranging.

4.38 p.m.

Mrs. TATE

I listened with interest to the hon. Lady the Member for Jarrow (Miss Wilkinson), and to the hon. Member who opened the Debate, and I cannot understand the grievance which is being aired with so much eloquence as regards the period of 10 days in the Bill. We had the Minister's promise that the period would be altered in accordance with the regulations laid down by the Central Midwives Board, and we know that those regulations are to be altered to extend the period to 14 days. But if we were to insert the period of 14 days in the Bill and if, at a later period, the Central Midwives Board wished to extend it to 16 days, there would be no power to do so. It is difficult, therefore, to understand hon. Members who are so anxious to see the period extended making such an extraordinary grievance out of a provision which, in fact, gives a greater chance of having the period extended in the future than there would be if a certain number of days were specified in the Bill.

I listened with care to all that the Minister said in introducing the Bill and to all the speeches in support of it, and at no time have I heard the claim made on behalf of the Bill that it dealt with the whole question of maternal mortality. It is ludicrous for hon. Members opposite to attempt to make this a party question. I know that the hon. Lady the Member for Jarrow said that it was not a party question, but many other hon. Members on that side have sought to make it a party question and to pretend that this Bill represents the whole of the National Government's effort to reduce maternal mortality. That has never been the claim of the Government. What the Government have claimed is that after the passing of the Bill into law there will be a higher standard and a uniform standard of midwifery throughout the country and, above all, that mothers will be nursed by women who are trained and who know the work for which they have been engaged. In spite of what the hon. Lady the Member for Jarrow has said, I believe that the voluntary organisations have done wonderful work and are in the main extremely popular. I do not know where the hon. Lady gained her experience, but in any districts where I have investigated the matter, and I have investigated in a good many, I have found that the nurses and midwives employed by the voluntary organisations enjoy the trust and confidence of the people in the vast majority of cases.

Miss WILKINSON

The hon. Lady will forgive me for interrupting, but I do not wish that there should be any misunderstanding. I did not suggest for an instant that there was any feeling against the nurses and midwives. What I did say was that feeling was often aroused by the way in which the voluntary committees used their powers.

Mrs. TATE

I know that the hon. Lady and her party do not believe in the voluntary organisations except as steppingstones, and want to see this service taken over by the State. I believe that eventually this service will be run by the State. Of that I am convinced, but when that day comes we shall lose something of great value. I hope it will be long delayed. I anticipate it coming with great regret, because I believe that we shall then lose something of beauty and of value which it will be difficult to replace. I also believe that by utilising the services of the voluntary organisations we should be able to get this Measure working as the Minister wishes it to work, far more speedily than would otherwise be the case. Under the Bill we know that midwives, whether employed by local authorities or by voluntary organisations, will have standardised training and will have opportunities of refreshing their knowledge. I believe that the Measure is going to do what the Minister intends it to do, and what we all hope it will do, namely, raise both the status and the salary of the midwife.

4.43 p.m.

Mr. G. GRIFFITHS

We on these benches were very much surprised when we saw the Amendments put down by the Minister, because those of us who sat on the Committee upstairs were under the impression that there had been a definite promise that either 14 days or 15 days would be inserted in the Bill. Two Amendments were put down in Committee, one in my name for 15 days, and another in the name of the hon. and gallant Member for Blackburn (Captain Elliston) for 14 days. The Parliamentary Secretary told us that the Government would meet us and that on the Report stage they would insert the number of days in the Bill. The hon. Member for West Middlesbrough (Mr. K. Griffith) did not understand the position because he was not on the Committee upstairs and he did not know of the definite promise that was made.

Sir K. WOOD

Inasmuch as the undertaking given by my hon. Friend has been called in question, I would like to read what it was: If the hon. Member for Hemsworth and my hon. and gallant Friend withdraw their Amendments, we will put down, before Report stage an Amendment to the effect that the period of attendance … shall correspond to the period that shall from time to time be laid clown by the Central Midwives Board."—[OFFICIAL REPORT (Standing Committee C), 14th May, 1936, col. 62.]

Mr. GRIFFITHS

The hon. Member for Frome (Mrs. Tate) suggested that we could acquiesce in what the Central Midwives Board would do. My point is that this House, and not the Central Midwives Board, is the authority, and either 14 days or 15 days should be inserted definitely in the Bill. We feel rather bitter about that point. I will not go over what the hon. Member for Jarrow (Miss Wilkinson) has already said, but I would like to put another point. There is an Amendment on the Paper in the name of the hon. Member for Rother Valley (Mr. E. Dunn) and myself, which I would like to see inserted, because the Minister seems to be hedging. Upstairs he and the Parliamentary Secretary were very nice with us and said, "If you do not press this, we will see what we can do downstairs." We ask definitely that a midwife's salary shall be not less than that of a health visitor. The midwives in the past have had a very low salary, and I am sorry to say that they have been blacklegging one another. One has been doing the work cheaper than another, and then the other one has come along the next time and said, "I will do it cheaper than Mrs. Brown did it last time." We feel that a midwife is as important as a health visitor. In fact, we believe that the midwife is far more important than is the Minister for War. The Financial Secretary to the Treasury, when he was discussing the Budget on 22nd April, said: The greatest work of national importance that can exist is the taking of steps to secure the continued freedom and wellbeing of this Realm."—[OFFICIAL REPORT, 22nd April, 1936; col. 274, Vol. 311.] He was speaking about an increase in armaments, and he said—

Mr. SPEAKER

I must remind the hon. Member of the Ruling I gave a short time ago.

Mr. GRIFFITHS

I take it that if I cannot go into that, I can still talk about this increased salary that we have put down on the Paper. My only point with regard to the Financial Secretary to the Treasury is that, in our view, the greatest work in life is bringing in life, not killing, and we on this side feel that if there is to be a State maternity service, the people who are to be employed full-time in that service should have at least the same salaries as health visitors. Health visitors get about £4 2s. 6d., and in some cases slightly higher. These midwives are to be fully employed, and they will not be employed for only eight hours a day or so many morning, afternoon, or night shifts, but they will be called on at any time of the day or night, and we feel that it should be definitely laid down in this Bill, before it leaves this House, what their salary should be. It should not be less than the salary of a health visitor in the area where they are to work. We feel disappointed that the Minister is not inserting definitely either the 14 or the 15 days and is not making the Central Midwives Board people comply with us instead of making us comply with them.

4.50 p.m.

Mr. MAITLAND

Some question has been raised with regard to the integrity of those responsible for bringing forward these Amendments. May I, as a Member of the Committee upstairs, say that, in spirit, if not in form, the Minister and his colleagues have certainly carried out the promise which they made when this matter was considered by the Committee. After all, is it not a fact that the discussion has ranged not so much over the question of whether it should be 14 or 15 days as upon the machinery which is necessary to carry out that undertaking in the best possible way? I quite agree with my hon. Friend the Member for Frome (Mrs. Tate) when she said that on practical grounds it is much better that the Amendment should be put in the form in which it is proposed by the Minister than that a specific number of days should be put in which may hereafter be found to be too few. I think the machinery now proposed will be effective for the purpose in view. I thought the hon. Member for Jarrow (Miss Wilkinson), when speaking in reference to the present Member for Middlesbrough (Mr. K. Griffith), showed a certain volubility and excitability, which is perhaps responsible for her having vacated her former seat as a Member for Middlesbrough. It sounded to me as though what she was concerned about more than anything else was the impression which had been created by the Minister of Health in one of the charming speeches which he makes from time to time.

It was our aim on the Committee as far as possible to attempt so to improve the Bill that it would secure the object for which it was introduced, namely, the improvement of the service of midwives and the status of midwives, and while the hon. Member who has just resumed his seat has referred to the fact that he and one of his friends have an Amendment on the Paper asking that the salary paid to a midwife shall not be less than that paid to a health visitor, I do not want it to go unchallenged by this party that we think the midwives ought to have less. We believe that an improvement in the status of the midwife would be definitely brought about through the machinery of this Bill, and for myself I have perfect confidence in the administration of most of the local authorities of this country, I can never understand why it is that so many hon. Members of the Labour party are inclined to assume that the local authorities do not carry out their duties fairly and honestly and in the best interests of those whom they represent.

We ask the local authorities to undertake certain duties which we believe will advance the status of the midwives and result, as we all hope, in a decrease in maternal mortality. Surely it is a small thing, when we entrust them with this work, to leave them complete discretion to decide on the terms upon which they shall engage those who are to carry out the work. We are all anxious that this service shall be put on a higher status and improved, and we believe that that improvement can be obtained by the methods suggested in the Bill. The Minister, in Committee upstairs, explained the refusal to accept the Labour party's Amendment, not in a spirit of variation from it, but rather because he has confidence in the administration of the local authorities, and I do not want it to be assumed that there is any Member of the party to which I belong who has any desire to reduce the emoluments of the midwives. On the contrary, we are very anxious that they should be paid as generously as possible.

4.55 p.m.

Sir ROBERT TASKER

As one who has worked in connection with voluntary services, and as one who was chairman of one of these organisations of midwifery before the war and who occupies that unenviable position to-day, while I will not attempt to follow the method adopted by the hon. Member for Jarrow (Miss Wilkinson), I think one or two mis- conceptions might be cleared away by experience gained from actual contact with the work of voluntary organisations. The organisation of which I have the honour to be chairman has attended to more than 600,000 cases, and it is not within my recollection that there has been the death of a single mother attended by a midwife sent out by my organisation. Of course, we have taken precautions to see that no midwife is sent out unless she holds the very best qualifications and undertakes that in the event of any minor complication presenting itself she will at once call in a doctor.

The hon. Member for Spennymoor (Mr. Batey) talked about the high rate of mortality. I am happy to say that it is lower in London than in any other part of the country, but one of the great authorities, Dr. H. G. Dain, of Birmingham, chairman of the British Medical Association committee of the national maternity services scheme, and chairman of the Insurance Act committee of the British Medical Association, has declared: It is an astounding claim that a woman is safer in childbirth in a slum home than in a hospital, but it is undoubtedly true. That bears out exactly the experience of my organisation. As I said just now, I have been unable to trace the death of a single mother attended by our midwives. It is not fair to attribute death to want of care in hospitals, because we recognise that the worst cases are taken to the hospitals; the cases they deal with, therefore, are not comparable with those which take place in private homes. Let me compare the efforts of the voluntary organisations in London—I cannot be expected to extend my investigations all over the country—with those of the municipal authorities. The local authorities under the 1918 Act are the Metropolitan Borough Councils in London. In 1935 in those 28 Metropolitan boroughs and in the City they actually employed four midwives, whereas my voluntary organisation employed 40. Those midwives attended 306 cases in the whole of London, whereas my voluntary organisation midwives attended over 1,000 cases.

But what have the local authorities done? They have made arrangements with voluntary hospitals, and the number of cases they sent to those voluntary hospitals was 2,200. I have no statistics of any borough save my own. The Holborn Borough Council arranged for the treatment of 56 mothers at a cost of £41 15s. My voluntary association sent midwives to 1,000 expectant mothers at a cost of nearly £1,400. The Holborn Borough Council's work seems to have been above the average of other councils. There were 59,000 births of children in London this last year. As a matter of fact, if you take in the larger area, the figures are 65,000, but I am taking the smaller area. What do we find in those 59,000 cases? Hon. Members opposite desire that people shall be herded together. Their idea is to say to a woman bearing a child, "You shall go into a hospital." They are opposed to voluntary organisations. I think the natural and proper place for the birth of a child is in the home of the mother. It should not be in a place provided by the general body of ratepayers or a nursing home or the maternity ward of a hospital. Let a woman have her child in her own home. That is the natural place in which to have it.

Mr. GALLACHER

Would the hon. Member allow a child to be born in a home where it often happens there is a dead body on the table?

Viscountess ASTOR

How often does that happen?

Mr. GALLACHER

Very often.

Mr. SPEAKER

We are getting a long way from the Amendment, which has the object of leaving out the name of Sir Kingsley Wood. That would have the effect of making the Motion read: That the Bill be re-committed to a Committee of the whole House in respect of the Amendments in Clause 1, standing on the Notice Paper. The discussion must be confined to the Amendments to Clause 1 standing on the Order Paper, and reasons should be given why the Bill should or should not be re-committed in respect of those Amendments.

Sir R. TASKER

I apologise for having been drawn aside. The question is whether the period of 10 days should be extended, and those who have had experience of this work are in agreement about that. One knows that there are certain women who are walking about three days after delivering a child, and that is a very undesirable state of affairs. The 10 days is, as a matter of practical common knowlelge, usually regarded as the period during which a woman should be confined to her home and should not be permitted to walk about and work. The Minister has listened to the plea which was made to him in Committee and has agreed to extend the period. Unfortunately, I could not serve on the Standing Committee which considered this Bill because I was on another Committee. The Minister is trying to help the mothers, and I cannot see what opposition there can be from hon. Members on the other side. I urge the House to give the Minister the opportunity to extend this period to 14, 15 or 16 days. He is being advised by a most competent body, namely, the Central Midwives Board. Those who know the board know that if it errs at all, it errs on the side of safety because it consists of people who thoroughly understand this business. They want to do the best they can for the mother, and so does every man who is a father, and, I hope, every man who is not a father. I agree with my hon. Friend who said that it is more important to save life than to sacrifice it. I commend this Bill to the House. I believe that the mothers of this country will bless the day when this Bill was introduced.

Mr. DEPUTY-SPEAKER (Captain Bourne)

We are not discussing the Third Reading.

Sir R. TASKER

I was only appealing to hon. Gentlemen opposite to withdraw their Amendment.

5.5 p.m.

Mr. SILVERMAN

I agreed with the hon. Member for Faversham (Mr. Maitland) when he expressed the view that the Minister, in putting down these Amendments, is doing honourably what he undertook to do. My recollection of what took place in Committee coincides with his. The Minister undertook to alter the Bill so that the period should be as the Central Midwives Board would have it, on the understanding that the board amended its rules immediately so as to make the period 14 days instead of 10. On that understanding, which is common to both sides of the House, the Minister is doing in these Amendments what we urged him to do in Committee and what he promised to do. Amendments were moved many times in Committee and not accepted by the Minister, for no better reason that many hon. Members could see than that the right hon. Gentleman had not thought of them first. These Amendments are rather an exception. The right hon. Gentleman had not thought of them first, but the arguments were so overwhelmingly one way that he was compelled to give the undertaking that he gave and that he is now embodying in these Amendments.

Why should he stop there? When we have persuaded him to do something that is obviously reasonable and right, why should he limit his opportunities by rejecting other Amendments that are on the Paper and are equally reasonable and right? Take the question of voluntary organisations. I would say to the hon. Member for Holborn, (Sir R. Tasker) that there are millions of homes which would make his organisation and himself shudder to think that they were the only possible or accessible places in which the children of this nation could be born. It is for that reason as much as for any other that in places where slums have become a crime the municipal institution has been preferred to the home. We cannot talk about general principles in this matter. We may as a matter of sentiment prefer that children should be born at home, but the home must be suitable. I feel that there has been considerable misunderstanding about the line that has been taken by my colleagues on the question of voluntary organisations. We make no attack on the voluntary organisations. This Bill is, in its own way, a tribute to their work.

Sir R. TASKER

The Bill is, but the Opposition is not.

Mr. SILVERMAN

If the hon. Member will allow me to develop my argument he may find that we are less opposed to them than he is inclined to believe. It is because the voluntary organisations have already shown how much, with their limited means and with their limited appeal and organisation, can be done to stem the rising tide of maternal mortality that the public conscience has been aroused and that the Government have been compelled to go further than any voluntary organisation can go and make a State service of this matter. That is the proper function of the voluntary organisation. The business of the voluntary organisation has always been to look round the community and find what gaps the State has left unfilled, what miseries have not been cured, what preventable suffering has not been eased, what preventable disease remains uncured. Where there is human suffering and misery due to poverty, destitution and disease that the State as such has neglected, the voluntary organisations have crept in, and said, "What the State ought to do and have not done we, out of our own private charity, will do."

I think that we have aroused sufficient public anxiety to compel the State to do the work which the voluntary organisations have done on a limited scale and which they would never he able to do on an adequate scale. What does the Minister propose to do, and why do the voluntary organisations prefer that he should do it? Why do they complain when we say they should not do it? The Minister is taking advantage of the private charity of the voluntary organisations and is remedying that part of the deficiency with which the voluntary organisations have not been able to deal. The voluntary organisations are to be allowed, subject of course to the local authorities, to carry on part of the job that ought to be the job of the State.

Sir R. TASKER

Will the hon. Member allow me to give the figures? In institutions there were 37,700 births, and domiciliary cases numbered 27,200.

Mr. SILVERMAN

I am grateful to the hon. Member for giving those figures, and perhaps, if he can find an opportunity later, he will explain their relevance, but I cannot see that they are relevant or why he thought it necessary to intervene. However much the voluntary organisations are doing, this Bill would not be before the House if they were doing sufficient. They are not doing it adequately because their resources are not sufficient, and this Bill has been introduced because the service ought to be nationally performed. Why should not the voluntary organisations agree that this ought to be a State duty? After trying to do the duty of the State for so long, why should not they call upon the State to do it and release their energies and funds for new pastures, for some of the other deficiencies in the State service to which the Government is not yet alive? Would that not be wiser? Ought not these powerful bodies, with their funds and their wealth of private charity, to be devoted to those masses of suffering which the State has not yet seen, it to be its duty to relieve?

If the State is going to do this job, let it do the job properly and not rely on the resources of private individuals to do part of the job. It should be put completely on a national basis. There will unfortunately remain for many years, perhaps for generations, certainly for ever so far as this Government is concerned, large fields of ever-growing necessity for private individual charity. Let them not fritter away their activities. I think we are entitled to call upon those who have supported voluntary organisations so far, and who have done the work as well as it could be done with the resources at their disposal, to back us up and help us to get the State to take that responsibility off their hands, so that they may be free to devote their activities to other things which the Government have not so far tackled. I hope that the Minister, having by this Amendment given himself an opening to strengthen his Bill in one direction, will not stultify himself by refusing to strengthen it in those other directions where his own private intelligence, whatever the collective decision of the Government may have been, tells him it could so easily be strengthened.

5.16 p.m.

Viscountess ASTOR

I shall not detain the House long, because there has been a great deal of repetition, and that is the last thing we want. I wish to congratulate the Minister on his Bill, and particularly on this Clause, because I believe the State services will be all the better for working alongside the voluntary organisations. I have seen that arrangement in operation. I have seen people who started off by thinking the State could do everything, but who have found that the soul was missing from its work. If we have the voluntary organisations working side by side with the State they will keep the State organisations up to the standard which, I am sure, the hon. Member for Nelson and Colne (Mr. Silverman) would like them to maintain. We owe a great deal to these voluntary organisations. I do not think the country can ever be grateful enough to them, and I hate to hear them being made the subject of jeers and references to their being taken advantage of for political purposes. That is "all my eye." You can talk that "tripe" in the House of Commons and at political meetings, but the people who know the work that is being done—

Mr. SILVERMAN

Is the Noble Lady entitled to address her arguments to me personally, and to point her finger at me, especially as I was not guilty of any of the statements to which she is now referring?

Mr. DEPUTY-SPEAKER

When the Noble Lady uses the word "you" she must address the Chair.

Mr. BATEY

I wish to ask whether the word "tripe" is Parliamentary?

Mr. DEPUTY-SPEAKER

The expression appears to me to be inelegant, but I cannot see that there is anything to which I can take exception.

Mr. SILVERMAN

Is it not the name of a very humble but very valuable food in Lancashire?

Viscountess ASTOR

I was not criticising the hon. Member for Nelson and Colne, because he paid a tribute to the voluntary organisations, his speech being a great relief in that respect, but he did say one thing with which I cannot agree, when he suggested that the Government should say to the voluntary organisations, "Now you have done your work in this direction, turn on to something else." The Government cannot do that. I myself would like to see them turn their attention to open-air nursery schools—but we cannot do it that way. There are people whose whole heart is in midwifery, and you cannot get them to give it up in that fashion. I could not let the Bill go through without paying a real tribute to those marvellous workers, drawn from all sections of people and of all political parties, who have given years of voluntary, and I might also say Christ-like, service to midwifery. I hope the Opposition will let the Minister go on and give him great credit for having gone as far as he has, and for having made it possible for both the voluntary organisations and the State service to go on together. I am certain that in the end they will see that the Government have been wise in trying not to wipe out voluntary organisations.

5.20 p.m.

Mr. E. DUNN

I do not think anyone can approach this question from a party standpoint. I regard it as one of the most human questions which have come before this House. I am very glad to have the opportunity of following the Noble Lady the Member for the Sutton Division of Plymouth (Viscountess Astor) who, I understand, is a mother and has a family of her own. All I want to say, in reply to the Noble Lady, is that we on this side of the House are anxious that the same facilities should be granted to working-class mothers during the time of childbirth as the noble Lady and many of her friends have when they or their daughters have to pass through that experience.

Viscountess ASTOR

The hon. Member said he was not going to speak from a party point of view. Does he not know that the object of the Government, indeed, the object of all in this House, is to give to working mothers as good an opportunity as is possible? It is not fair to say that we do not want working women to have the same opportunity as others.

Mr. DUNN

I have not suggested that the Noble Lady or the Government do not desire to give working-class women exactly the same facilities as they would give to people in a better position, and because I believe that I cannot see why the Minister should not be prepared to insert these words in the Bill. It is my recollection that when we debated this matter in Committee every Member went away feeling there was a definite understanding that the figures would be inserted in the Bill. I think that is the reason why we have contested this point so fiercely—we are not dealing with it from a party standpoint, but we felt that a pledge had been given which caused us to withdraw our opposition upstairs.

Some of us have had very close experience of these voluntary organisations for many years. I have been actively associated with such an organisation for more than 25 years, and am still associated with it. It is an organisation which has employed fully certified midwives. That being so, I do not think anybody could accuse me of being biased against the noble work done by voluntary organisations; but my point is that child bearing is one of the most important functions which this House is called upon to consider, particularly in view of the falling birth rate. I have before called attention to the fact that during the last 10 years the birth figure has fallen from over 800,000 per annum to just over 500,000. I notice that the Parliamentary Secretary to the Ministry of Health in a speech at Liverpool last week on this all important service made rather a strong point of the number of mothers who died during child-birth last year.

I do not subscribe to the view that working-class mothers would desire that the birth of their children should take place at home, except for real economic reasons; and among those economic reasons are the fact that she has her family to attend to, that she has the cares of the home as well and has never had the opportunity of either lying in bed for a fortnight or being away from the cares of the family for a fortnight. I say definitely that the 14 days ought to be inserted in the Bill, because it is a reasonable period. If the Government are honest in what they say why should they fear to put it in the Bill? I appeal to the Government to honour the understanding which was come to in Committee upstairs, because we regarded it as a definite commitment. I should like to ask, Captain Bourne, whether you are going to allow, as Mr. Speaker did, a discussion generally upon Clause 1 as it now stands, or limit the discussion to the Amendment which is before the House.

Mr. DEPUTY-SPEAKER

I think the hon. Member was in the House when Mr. Speaker pointed out that the effect of the Amendment now before the House would be to enable a discussion to take place on the various Amendments to Clause 1 which are on the Paper, but that that discussion must be limited to the Amendments which are on the Paper.

Mr. DUNN

Therefore I understand that, apart from the question of the Motion in the name of the Minister of Health, all Amendments which are on the Paper dealing with Clause 1 are open for discussion at this stage.

Mr. DEPUTY-SPEAKER

Yes, that is so.

Mr. DUNN

I welcome the attempt of the Ministry of Health to introduce a service of skilled and certified midwives, but, like previous speakers, I am extremely anxious in this connection that the services of the useful handy women who have rendered so much help in the past should not be overlooked. The position in regard to maternal mortality is really an appalling tragedy, as I think even the Parliamentary Secretary admitted in his speech at Liverpool, when I believe he gave the figure of 2,400 deaths. I regard that as a real tragedy, and as showing the necessity for a service of certified and properly trained midwives, available for rich and poor alike, in the rural districts as well as in the big cities. Further, I think this service ought to be made as attractive as that of the health visitors. Reference has been made to the status which the health visitor enjoys in a country. I think the midwifery service is an even greater service than that of the health visitors, and the salaries to be paid to midwives should not be less than those given to health visitors. In view of the opinion which prevails in the House I take it the salaries to be fixed will be the same.

There was a time when the health visitor was not so welcome in the homes of the people as she is to-day. The health visitor is now a welcome guest. There was a time, also, when people were rather shy of the ante-natal services and postnatal care. In modern times the women of the country are being trained so that they may make the most of the protection that is available for them, and that they may be cared for and have all the facilities of ante-natal service. They do not resent that service now, as they did formerly. We have turned over from the bad old past to a better future.

Motherhood is something to be protected and cared for. That protection is not a prerogative of this side of the House, but of the whole House. My plea is that the Minister should play fair in respect of all the women and all the midwives of the country. He should withdraw his objection to inserting the period of 14 days into the Bill, and he should lay it down as a condition that whether a midwife is employed by a local authority, a welfare council or a voluntary organisation, wherever she is practising, the conditions should be uniform, whoever the supervising authority may be. If that were done, the effect of the Measure would be to allay the fears expressed by the Minister of Health when speaking at Liverpool. He said that some people in the country were frightening the women to death with regard to this question of midwifery. All we are doing is to say that, seeing that three out of four of the women who lose their lives at the period of childbirth could be, and ought to be, saved, as has been put on record by the highest authorities, we welcome the Bill, if it will save same of those lives.

5.33 p.m.

Mr. RITSON

The Noble Lady the Member for the Sutton Division of Plymouth (Viscountess Astor) has been doing her usual political stunt. She comes here, kicks up a bit of a row and runs off. I object to this modern Diana of the Ephesians getting down from her pedestal. It is in order for a goddess at least to stay upon the altar, and not fling herself about here in an irresponsible manner. I appreciate her as a mother, and honour her for that, but I want her to realise that there are many other mothers in the country who have not had an opportunity of the comforts which she has had. She condemned us for looking at this subject politically. I said upon the Second Reading that I was a member of a big family, and a father of a big family. Having gone through the tragedy of it all again and again, why should I treat it politically? I ask any Member of this House whether we can make this a political question. Our ambition is to make the best use of the practical knowledge we have of the circumstances.

I object to the references made by the Minister of Health to the "Mrs. Gamps." My objection to many of the voluntary societies is that under them, instead of one Mrs. Gamp there will be five or ten Mrs. Gamps. That is why I want the local authorities to come under the Ministry. The Ministry will have power to say to a local authority: "You are not doing your duty in this matter." An hon. Member spoke very sincerely from the Government Benches. I can understand him, but I can never understand the Noble Lady at any time. The hon. Gentleman made a statement that staggered me. He said that there had been 60,000 births in London and not one child had been lost. What different tale there is to tell in Durham, where 6.87 per 1,000 of the women have been lost. The hon. Gentleman said that the women wanted to have their babies in their own homes. There is nobody more anxious for that than I am, if it is a home. I remember some of the very serious cases that I have seen. I remember a well-known character whom we had to try to arrest, but who evaded arrest by the fact that she was going to have a baby. It was a stillborn baby, but every time the police came she kept the baby, and in spite of the local authority she could not be taken. Where that baby was born there is no stable half so dirty and mucky. It was not the woman's fault. She was living in the slums.

I have had to travel in such places, trying to get people to help these poor women through their travail, in places in which we should not dream of keeping an animal, never mind a human being. Those places are there yet. I am trying to train the mothers and to get the best possible skill for them on the part of doctors or midwives, but if they live in homes of that kind we have a duty to supply them with the best domiciliary treatment in our institutions. Why should we not do so? I hope that the Minister will give us the period of 15 or 16 days. What are 15 days? There are cases in which the women can get up and be about their work in four days, but there are other cases in which the women would not be ready for a month, although they have been compelled to rise in five or six days. Members of my own family have had to get up after three days, to get men ready for the pit.

The district nurse is now a welcome visitor. I remember when she was not. That practice is now established, and we are willing and anxious to take over the best skilled midwives. We hope it has not been forgotten that the doctors will not neglect their duty because of the midwives. The hon. Gentleman opposite must not think that my hon. Friends and I are dealing with this matter from any political standpoint. I should forgo politics altogether if I thought that the death or the life of a mother depended upon my political outlook. There is no Member of the party opposite, bitter as that party is against me politically, who, if I fell in the street, would not rush to my assistance. [HON. MEMBERS: "Hear, hear!"] I know that is so, and I pay that tribute. We feel the same way about the mothers. I hope that we are all looking at it from that point of view. I tell hon. Members sincerely that I am doing so. I see the tragedy and the trial of it.

I remember telling the Noble Lady some years ago—it is like putting two electric sparks together whenever we meet—when she sneered at one of my friends, Mr. Robert Smillie, that I could take her to places in Durham where children were born in the same houses as the dead were laid out in. Somebody objected to that. Some of us were born in one room, with eight or nine in the family. What could you expect to happen? You did not turn the body out, or turn the mother out. Again and again we have had that sort of thing happen. I ask the House and the Noble Lady to think of the magnificent courage of these women, who are living with their families in one room, and giving birth in the same room as that in which they lay out their dead. Many children have been born when there was coaldust in such places. In order that mothers who have a home may receive every care, we are asking the Minister and hon. Members on the other side to grant us 15 or 16 days.

I remember when my wife had one of the many children that she has had. When we got through, and after the work was over, the doctor said—he was a man who is well known in the medical world—"If I were you, Mrs. Eason, I should lie three weeks. It is the only opportunity a working woman has of getting a rest." Yet we are proposing to limit her, the working woman, by Act of Parliament. I do not say this with any bitterness or personality to hon. Members opposite: In your standard of life, do you allow your wife to be up before 10, 12 or 15 days, with all the care and comfort you can give her? In colliery villages, many poor women have had to lie there in circumstances such as I have described. The Bill should compel them to lie until a certificate was given that they were in a proper state of health, instead of our splitting hairs about whether a woman is to lie an hour one way or the other. I appeal to the Minister. We talk about the birthrate. I am more anxious for the birthrate than I am about anything else with which we deal in this House. The life and future of the child depend upon the happiness of the mother. Any man who has had a big family knows that when the mother with a child at the breast is worried, the child is worried also. There is a dual worry, and it is not only a physical, but a mental worry. Give us a stated period. Do not limit it to 14 or 16 days. Give us a maximum of 15 days, or even of three weeks.

Let me say why I am anxious that the local authority should do this work rather than other people. You have voluntary service in all sorts of things. I do not object, as long as they do not interfere with the liberty of the subject. My contention is that a voluntary association cannot be taken to task by the Minister. On the other hand, a local authority can be asked why its maternity homes are not up to standard, and the Ministry can send down an inspector. You cannot do that with the voluntary associations. We are, therefore, rather drawn to local authorities. We are not speaking of any Socialistic ideal of public authority, but if there is anything which should be done by public authority in the public interest, and in the interest of the nation, it is the upbringing of the children. The birth of the children should be directly under your care. I hope the Minister will not be as narrow as he appears—I am not speaking physically—and that he will give us a date or a period of at least 15 days. He ought to give us more. I hope he will feel compassion with the surroundings in the distressed areas, where there is overcrowding, due not to the neglect of good neighbours, who are called Mrs. Gamps, but to economic circumstances. We are now providing a new avenue of escape for the mother. Let it be as generous and wide as possible. She will repay you, in the hard work that she gives in the birth of a child, if you will be generous to her.

5.44 p.m.

Mr. LUNN

The most that we can expect from this Clause when it is passed is that it may reduce maternal mortality, but a point which we often raise in this House is that Bills should be drafted so that they are understandable. I suggest that the Minister's Amendment which we are discussing is not an understandable Amendment. It says: In this Sub-section the expression 'lying-in period' means the period defined as the lying-in period by any rule for the time being in force under Section three of the principal Act. I have carefully looked through Section 3 of the principal Act, and cannot find in it any rule that lays down a period of lying-in, and I am objecting to the Amendment from that point of view. In Committee we had a long discussion on the extension of the lying-in period, and Members in all quarters of the Committee were agreed that 10 days was not sufficient. I think the whole Committee favoured 14 days as a minimum. We moved to make it 15 days, which we think is little enough, and the Minister gave us to understand, however he interprets the words he used, that he accepted the spirit of our Amendment and would provide words that would fill the Bill with regard to it. I suggest that the words on the Paper are not satisfactory—that they are not clear and are not as laid down in Section 3 of the principal Act; and I feel that the Minister has not met the arguments used in. Committee by moving an Amendment in this form. I agree that there ought to be a definite minimum period in the Bill, and I cannot see that this Amendment meets the position at all. If the Minister can show us that Section 3 does provide a definite lying-in period, I suppose we shall have to accept the position, but I have carefully read it and cannot find anything in it that enables me to say that any definite lying-in period is prescribed in the Act of 1902.

I agree that there are different points of view on the two sides of the House, and that we look at this matter quite differently from hon. Members opposite. We all know the tragic fate that comes to so many young mothers, but somehow or other, whatever the reason, we have a different outlook as to how it should be dealt with. We feel that there are points, which have been raised on this side of the House, which ought to have been included in the Bill. The Bill is not going to carry out what some people hope it will carry out; it is not going to remove the dangers of maternal mortality that exist to-day; it is not going to guarantee an efficient service—that there shall be an efficient midwife at hand for every young mother; and it does not give any guarantee that there is going to be an efficient service of that kind throughout the country.

We do not object to voluntary organisations as such in any service. For generations all this work has been left in the hands of people who have done it voluntarily. We have not done our duty in this matter of provision for the care of the young mother; it has been left to those public-spirited women who have devoted their time and energy to it. But, while, we bear tribute to the work that has been done by generations of mothers who have been interested, not only in themselves, but in other mothers, we are satisfied that, when we are trying in this Bill to do something to reduce maternal mortality, we ought to take definite steps to obviate many of the deaths that now take place.

On the Second Reading of the Bill we were told by the Minister that there is no guarantee from these voluntary organisations that they are going to pay proper salaries, that they are going to see that the conditions of the midwives are efficient, or that superannuation or pension is to be provided for those employed by voluntary organisations. It is not necessarily because we are Socialists that we favour the idea of the State or the local authority taking charge, but in this service it is most important that the local authority should be the foundation of the work. We do not want to wipe out all voluntary workers. There are thousands of men and women who are devoted to helping other people. Let them do it, and let them be brought in so that they can do this work. But we desire an efficient service, and we cannot see that the proposals of the Bill will result in an efficient service. That is why we have spoken of the voluntary organisations in the way that we have, and not because we have any bitterness or enmity towards them.

I should like to mention a small Amendment, which has not been accepted, but which I think ought to be accepted, because it is vital. We had an Amendment on the Paper to require the provision by the authority of a sterilised maternity outfit in every case. It was only a small Amendment, but it was a very important one. We do not know how many young mothers die owing to the fact that instruments are used that are not sterilised and are not in proper condition, but undoubtedly many lives have been lost through the use of such instruments in the hands of inefficient people, because the facilities were not there for providing an efficient service. Personally I hope that the Minister, if he will not insert our Amendment in the Bill, will see, when he approves of the rules, that that provision is made, whether the midwives are employed by the local authority or by voluntary organisations. I hope, however, that, now that we have the opportunity of recommitting the Bill in respect of Clause 1, the Minister will consider an Amendment such as that to which I have referred. I cannot expect him, after the long arguments and discussions in Committee, to agree to the idea that midwives employed by voluntary organisations shall be paid the same salaries as those who are employed by local authorities, because he said on the Second Reading that that would not be so, and that again shows that there will not be the efficient service that we desire to see. My primary object in rising was to ask the Minister to make clear his own Amendment. I would rather that a fixed number of days were laid down, instead of leaving it in its present form.

5.55 p.m.

The PARLIAMENTARY SECRETARY to the MINISTRY of HEALTH (Mr. Shakespeare)

In the discussion of this Amendment three points emerge, with which I will deal, although two of them have been already dealt with by the Minister. The first is whether, in the framework of the Bill, we are right in utilising the experience that. voluntary effort has built up, or whether we should straight away insist on an exclusively municipal service. Hon. Members opposite are never tired of saying that they have no grudge against voluntary effort, and they frequently repeat that this is not a matter of politics. I am glad to have that assurance. If anyone told hon. Members that a scheme was possible whereby maternity mortality might be reduced by one-half, they would immediately say that that scheme must be tried. The experience of county district nursing associations working in 60 out of 62 counties is the justification for the Bill. Over a number of years in those counties, with a large number of births, running into scores of thousands a year, very low maternal mortality rates have been achieved under the guidance of these voluntary district nursing associations.

Mr. RITSON

Does that apply in Durham?

Mr. SHAKESPEARE

It applies all over the country. It applies in Durham, and is the experience in almost all counties. If this is not to be a matter of politics, let us at least try to organise a salaried service, using the experience of voluntary associations, in the hope that the maternal mortality rates will be substantially reduced.

The second point, which was raised in the Committee upstairs, is as to why we did not insert in the Bill a provision calling upon authorities to provide sterilised maternity outfits. The House may be assured that maternity and child welfare authorities have the power to provide sterilised outfits, that they use such power, and that, now that they have this duty upon them to organise a proper service instead of relying upon independent services, they will use that power more and more.

The third point is as to whether we are keeping faith with the Committee in putting down the Amendments to Clause 1 standing in the Minister's name. The hon. Member for Rothwell (Mr. Lunn) appears to be still uncertain as to the reason why we seek to achieve what we desire under Section 3 of the Midwives Act, 1902. That Section is the rule-making Section; it gives power to the Central Midwives Board to make rules governing the conduct of midwives in connection with the cases which they attend. All that we are doing here is to provide that the period of attendance of a midwife acting as maternity nurse shall correspond with whatever period may be laid down in the rules of the Central Midwives Board from time to time. We have just) been given notice that it is the intention of the Central Midwives Board to increase the period, which is now at least 10 days, to a period of at least 14 days. I hope the Amendment will be allowed to pass in its present form, be- cause, if the Amendment of the Opposition were accepted, a very great disservice would be done to the mothers.

If in two or three years' time, after this service has been properly organised, as we hope it will be by that time, the Central Midwives Board came to us and said, "Now at last we have got a proper national service throughout the whole country, and we would like to extend the 14 days to 15 or 16 days," we could not do it because hon. Members want to put a fixed number of days in the Bill. They want to stabilise a period for all time. If, in the opinion of the Central Midwives Board, a longer period proves necessary as experience is gained, the Bill will automatically give the necessary power. I honestly believe that the opposition is due to a misapprehension of the position. I do not suppose for a moment that there is anyone on the opposite side of the House who does not want the purpose which in fact will be attained by the Amendment. We are all agreed that it is of very great service to increase the period and we want to make it as elastic as possible so as not to cramp ourselves and prevent further progress being made.

Mr. E. DUNN

Would you really cramp yourself if you said at least 14 days?

Mr. SHAKESPEARE

Certainly. If we say it must be the period from time to time laid down by the Central Midwives Board, and the Midwives Board lay down a period of three weeks, we should secure a period of three weeks in the future.

6.2 p.m.

Sir STAFFORD CRIPPS

Surely the hon. Gentleman is not telling the House that if in an Act of Parliament you have the expression "not less than 14 days" you are not therefore able to say in a subsequent rule that it shall be 21 days? The two things are perfectly consistent. The only thing you cannot say in a subsequent rule is something less than 14. You cannot say 12. It is a safeguard that no rule can be made which shall be less than 14 days, but a rule can be made for any period above 14. It does not cramp anyone's style and it ensures that in no conceivable circumstances can it be less than 14 days.

Mr. SHAKESPEARE

There is something in what the hon. and learned Gentleman says, but why put a definite time in the Bill? If the Central Midwives Board has been set up to determine what is the requisite period, why not say that the period shall correspond with that laid down by the board?

Sir S. CRIPPS

Because experience has often shown that in cases of this sort too short periods are in fact adopted, sometimes from the point of view of economy. Here you are making it quite certain that Parliament considers that a minimum period should be inserted and, beyond that, there is complete elasticity for the Midwives Board to fix whatever period they like.

Mr. SHAKESPEARE

I think it is much better, having appointed a very authoritative body, to say that whatever time they fix as the requisite time for the

attendance of a midwife, the period laid down in Clause, I shall correspond. I really think that we are making rather a mountain out of a molehill, because all that the Opposition have asked for is conceded. The Amendment was pressed on us from all sides of the House, and we have put it down in a form which allows progress to be made in the future.

Question put, "That the words proposed to be left out stand part of the Question."

The House divided: Ayes, 240; Noes, 120.

Division No. 274.]	AYES.	[6.5 p.m.
Acland. Rt. Hon. Sir F. Dyke	Denman, Hon, R. D.	James, Wing-Commander A. W.
Acland,R. T,D. (Barnstaple)	Dorman-Smith, Major R. H.	Joel, D. J. B.
Acland-Troyte, Lt.-Col. G. J.	Dower, Capt. A. V. G.	Jones, Sir G. W. H. (S'k N'w'gt'n)
Agnew, Lieut.-Comdr. P. G.	Drewe, C.	Jones, H. Haydn (Merioneth)
Allen, Lt.-Col. J. Sandeman (B'kn'hd)	Duckworth, G. A. V. (Salop)	Jones, L. (Swansea, W.)
Anstruther-Gray, W. J.	Duckworth, W. R. (Moss Side)	Keeling, E. H.
Apsley, Lord	Dugdale, Major T. L.	Kerr, Colonel C. I. (Montrose)
Aske, Sir R. W.	Duggan, H. J.	Kerr, H. W. (Oldham)
Assheton, R.	Duncan, J. A. L.	Kerr, J. Graham (Scottish Univs.)
Astor, Visc'tess (Plymouth, Sutton)	Eastwood, J. F.	Kirkpatrick, W. M.
Atholl, Duchess of	Elliot, Rt. Hon. W. E.	Lamb, Sir J. Q.
Baldwin, Rt. Hon. Stanley	Ellis, Sir G.	Latham, Sir P.
Balfour, Capt. H. H. (Isle of Thanet)	Emery, J. F.	Leckie, J. A.
Barclay-Harvey, Sir C. M.	Emmott, C. E. G. C.	Lees-Jones, J.
Beamish, Rear-Admiral T. P. H.	Emrys-Evans, P. V.	Leighton, Major B. E. P.
Beaumont, M. W. (Aylesbury)	Entwistle, C. F.	Levy, T.
Beaumont, Hon. R. E. B.(Portsm'h)	Erskine Hill, A. G.	Llddall, W. S.
Bernays, R. H.	Evans, Capt. A. (Cardiff, S.)	Lloyd, G. W.
Birchall, Sir J. D.	Evans, D. O. (Cardigan)	Loftus, P. C,
Blair, Sir R.	Evans, E. (Univ. of Wales)	Lumley, Capt. L. R.
Blindell, Sir J.	Everard, W. L.	Lyons, A. M.
Bosom, A. C.	Fildes, Sir H.	Mabane, W. (Huddersfield)
Boulton, W. W.	Foot, D. M.	MacAndrew, Colonel Sir C. G.
Bower, Comdr. R. T.	Fox, Sir G. W. G.	M'Connell, Sir J.
Bowyer, Capt. Sir G. E. W.	Furness, S. N.	MacDonald, Rt. Hn. J. R. (Scot. U.)
Braithwaite, Major A. N.	Fyfe, D. P. M.	MacDonald, Rt. Hon M. (Ross)
Briscoe, Capt. R.G.	Ganzonl, Sir J.	MacDonald, Sir Murdoch (Inverness)
Brocklebank, C. E. R.	George, Megan Lloyd (Anglesey)	McEwen, Capt. J. H. F.
Brown, Rt. Hon. E. (Leith)	Gilmour, Lt.-Col. Rt. Hon. Sir J.	McKie, J. H.
Brown, Brig.-Gen. H. C, (Newbury)	Gluckstein, L. H.	Magnay, T.
Bull, B. B.	Glyn, Major Sir R. G. C.	Maitland, A.
Burghley, Lord	Goldie, N. B.	Makins, Brig.-Gen. E.
Campbell, Sir E. T.	Goodman, Cal. A.W	Mander, G. le M.
Cortland, J. R. H.	Graham Captain A. C. (Wirral)	Margesson, Capt. Rt. Hon. H. D. R.
Carver, Major W. H.	Grattan-Doyle, Sir N.	Mason, Lt.-Col. Hon, G. K. M.
Cary, R. A.	Greene, W. P. C. (Worcester)	Mayhew, Lt.-Col. J.
Cayzer, Sir C. W. (City of Chester)	Griffith, F. Kingsley (M'ddl'sbro, W.)	Mellor, Sir J. S. P. (Tamworth)
Cazalet, Thelma (Islington, E.)	Grimston, R. V.	Mills, Sir F. (Leyton, E.)
Chamberlain, Rt. Hn. N. (Edgb't'n)	Guest, Capt. Rt. Hon. F. E. (Drake)	Mills, Major J. D. (New Forest)
Channon, H.	Guest, Hon. I. (Brecon and Radnor)	Moore, Lieut.-Col. T. C. R.
Chapman, Sir S. (Edinburgh, S.)	Guinness, T. L. E. B.	Muirhead, Lt.-Col. A. J.
Choriton, A, E. L.	Gunston, Capt. D. W.	Neven-Spence, Maj. B. H. H.
Christie, J. A.	Hacking, Rt. Hon. D. H.	Nicolson, Hon. H. G.
Clarry, Sir Reginald	Hamilton, Sir G. C.	O'Neill, Major Rt. Hon. Sir Hugh
Collins, Rt. Hon. Sir G. P.	Hanbury, Sir C.	Owen, Major G.
Colville, Lt.-Cal. Rt. Hon. D. J.	Hannah, I. C.	Palmer, G. E. H.
Cook, T. R. A. M. (Norfolk N.)	Harris, Sir P. A.	Patrick, C. M.
Cooper, Rt. Hn. T. M. (E'nburgh,W.)	Haslam, H. C. (Horncastle)	Peat, C. U.
Courtauld, Major J. S.	Heilgers, Captain F. F. A.	Penny, Sir G.
Courthope, Col. Sir G. L.	Hepburn, P. G. T. Buchan-	Peters, Dr. S. J.
Craddock, sir R. H.	Holdsworth, H.	Petherick, M.
Crooke, J. S.	Holmes, J. S.	Pickthorn, K. W. M.
Croom-Johnson, R. P.	Hope, Captain Hon. A. O. J.	Ponsonby, Col. C. E.
Cross, R. H.	Hopkinson, A.	Pownall, Sir Assheton
Crowder, J. F. E.	Howitt, Dr. A. B.	Radford, E. A.
Cruddas, Col. B.	Hudson, Capt. A. U. M. (Hack., N.)	Ramsay, Captain A. H. M.
Davidson, Rt. Hon. Sir J. C. C.	Hudson, R. S. (Southport)	Ramsbotham, H.
Davies, C. (Montgomery)	Hume, Sir G. H.	Ramsden, Sir E.
Davies, Major Sir G. F. (Yeovil)	Hunter, T.	Rathbone, J. R. (Bodmin)
Dawson, Sir P.	Hurd, Sir P. A.	Reed, A. C. (Exeter)
De Chair, S. S.	Jackson, Sir H.	Reid, Sir D. D. (Down)
Remer, J. R.	Simon, Rt. Hon. Sir J. A.	Tasker, Sir R. I.
Rickards, G. W. (Skipton)	Sinclair, Rt. Hon. Sir A. (C'thn's)	Tate, Mavis C.
Robinson, J. R. (Blackpool)	Smiles, Lieut.-Colonel Sir W. D.	Touche, G. C.
Ropner, Colonel L.	Smith, L. W. (Hallam)	Turton, R. H.
Ross Taylor, W. (Woodbridge)	Smith, Sir R. W. (Aberdeen)	Wakefield, W. W.
Ruggles-Brise, Colonel Sir E. A.	Smithers, Sir W.	Ward, Lieut.-Col. Sir A. L. (Hull)
Russell, A. West (Tynemouth)	Somervell, Sir D. B. (Crewe)	Waterhouse, Captain C.
Russell, S. H. M. (Darwen)	Somerville, A. A. (Windsor)	Wayland, Sir W. A.
Salmon, Sir I.	Southby, Comdr. A. R. J.	Wedderburn, H. J. S.
Salt, E. W.	Spears, Brig.-Gen. E. L.	Wells, S. R.
Samuel, Sir A. M. (Farnham)	Spender-Clay Lt.-CI. Rt. Hn. H. H.	Williams, H. G. (Croydon, S.)
Samuel, M. R. A. (Putney)	Spens, W. P.	Willoughby de Eresby, Lord
Sandeman, Sir N. S.	Stanley, Rt. Hon. Oliver (W'm'I'd)	Windsor-Clive, Lieut.-Colonel G.
Sanderson, Sir F. B.	Stewart, J. Henderson (Fife, E.)	Wise, A. R.
Sandys, E. D.	Strauss, E. A. (Southwark, N.)	Withers, Sir J. J.
Seely, Sir H. M.	Strauss, H. G. (Norwich)	Womersley, Sir W. J.
Selley, H. R.	Strickland, Captain W. F.	Wood, Rt. Hon. Sir Kingsley
Shakespeare, G. H.	Stuart, Lord C. Crichton- (N'thw'h)
Shaw, Major P. S. (Wavertree)	Stuart, Hon. J. (Moray and Nairn)	TELLERS FOR THE AYES.-
Shepperson, Sir E. W.	Sueter, Rear-Admiral Sir M. F.	Dr. Morris-Jones and Lieut.-
		Colonel Llewellin.
NOES.
Adams, D. (Consett)	Green, W. H. (Deptford)	Pritt, D. N.
Adams, D. M. (Poplar, S.)	Grenfell, D. R.	Quibell, D. J. K.
Adamson, W. M.	Griffiths, G. A. (Hemsworth)	Richards, R. (Wrexham)
Alexander, Rt. Hon. A. V. (H'Isbr.)	Griffiths, J. (Llanelly)	Riley, B.
Ammon, C. G.	Hall, G. H. (Aberdare)	Ritson, J.
Anderson, F. (Whitehaven)	Hall, J. H. (Whitechapel)	Robinson, W. A. (St. Helens)
Attlee, Rt. Hon. C. R.	Henderson, A. (Kingswinford)	Rowson, G.
Banfield, J. W.	Henderson, T. (Tradeston)	Salter, Dr. A.
Barnes, A. J.	Hills, A. (Pontefract)	Sexton, T. M.
Barr, J.	Jagger, J.	Shinwell, E.
Batey, J.	Jenkins, A. (Pontypool)	Short, A.
Bellenger, F.	Jenkins, Sir W. (Neath)	Silverman, S. S.
Benson, G.	John, W.	Simpson, F. B.
Bevan, A.	Johnston, Rt. Hon. T.	Smith, Ben (Rotherhithe)
Bromfield, W.	Jones, A. C. (Shipley)	Smith, E. (Stoke)
Brooke, W.	Jones, Morgan (Caerphilly)	Smith, Rt. Hon. H. B. Lees- (K'ly)
Brown, Rt. Hon. J. (S. Ayrshire)	Kelly, W. T.	Smith, T. (Normanton)
Buchanan, G.	Kennedy, Rt. Hon. T.	Sorensen, R. W.
Burke, W. A.	Lansbury, Rt. Hon. G.	Stephen, C.
Charleton, H. C.	Lathan, G.	Stewart, W. J. (H'ght'n-le-Sp'ng)
Close, W. S.	Lawson, J. J.	Taylor, R. J. (Morpeth)
Cocks, F. S.	Lee, F.	Thorne, W.
Compton, J.	Leonard, W.	Thurtle, E.
Cove, W. G.	Leslie, J. R.	Tinker, J. J.
Cripps, Hon. Sir Stafford	Lunn, W.	Viant, S. P.
Daggar, G.	Macdonald, G. (Ince)	Walker, J.
Dalton, H.	McGhee, H. G.	Watkins, F. C.
Davies, D. L. (Pontypridd)	MacLaren, A.	Watson, W. McL.
Davies, R. J. (Westhoughton)	Maclean, N.	Welsh, J. C.
Davies, S. O. (Merthyr)	MacNeill, Weir, L.	Westwood, J.
Day, H.	Markiew, E.	Whiteley, W.
Dunn, E. (Rother Valley)	Marshall, F.	Wilkinson, Ellen
Ede, J. C.	Maxton, J	Williams, E. J. (Ogmore)
Edwards, A. (Middlesbrough E.)	Messer, F.	Williams, T. (Don Valley)
Edwards, Sir C. (Bedwellty)	Morrison, R. C. (Tottenham, N.)	Wilson, C. H. (Attercliffe)
Fletcher, Lt.-Comdr. R. T. H.	Muff, G.	Windsor, W. (Hull, C.)
Frankel, D.	Paling, W.	woods, G. S. (Finsbury)
Gallacher, W.	Parker, J.	Young, Sir R. (Newton)
Gardner, B. W.	Parkinson, J. A.
Garro Jones, G. M.	Pethick-Lawrence, F. W.	TELLERS FOR THE NOES.-
Graham, D. M. (Hamilton)	Potts, J.	Mr. Groves and Mr. Mathers.

Main Question put, and agreed to.

Bill accordingly considered in Committee.

[Captain BOURNE in the Chair.]

CLAUSE 1.—(Provision of domiciliary service of midwives.)

6.15 p.m.

Sir K. WOOD

I beg to move, in page 1, line 16, after "during," to insert "childbirth."

This Amendment and the two following Amendments have been put down with the object of carrying out the undertaking which I have given the House, and of which I gave a full explanation on the previous Motion before the House.

Amendment agreed to.

Sir K. WOOD

I beg to move, in page 1, line 16, to leave out from the second "time," to "is," in line 17, and to insert, "thereafter during a period not less than the lying-in period."

Mr. RHYS DAVIES

Having had such an excellent opening discussion in an attempt to delete the name of the right hon. Gentleman from the Motion just disposed of, perhaps I may ask him a very simple question. Will he be good enough to tell us whether the new rules of the Central Midwives Board will be passed and become operative in time for the implementing of the provisions of the Bill?

Sir K. WOOD

Yes, Sir, that will be so.

Amendment agreed to.

Further Amendment made: In page 1, line 17, at the end, insert: In this sub-section the expression 'lying-in period' means the period defined as the lying-in period by any rule for the time being in force under section three of the principal Act."—[Sir K. Wood.] Motion made, and Question proposed, "That the Clause, as amended, stand part of the Bill."

6.18 p.m.

Mr. BATEY

There are two questions which I want to put to the Minister on this Clause. If the local authority or the voluntary organisation fails to provide a sufficient number of midwives, what powers has he under this or any other Clause to compel them to do so? The second question is whether a woman who is confined will be compelled to have a maternity nurse and be subject to the provisions contained in Clause 3?

Mr. SHAKESPEARE

In answer to the first question, the duty is imposed on the supervising authority, and where that duty is not carried out the ordinary remedies are available.

Mr. BATEY

Tell us what the remedies are.

Mr. SHAKESPEARE

The provision of this service is clearly a vital part of the public health services, and, in the unlikely event of a local authority not making provision, the Minister will have power to withhold part of the block grant under the Local Government Act, 1929.

Mr. BATEY

That would only apply to the local authority; it would not apply to the nursing association or welfare council.

Mr. SHAKESPEARE

If the nursing association have not carried out their duty, it is the duty of the supervising authority to see that the whole area is covered by a scheme. If the nursing association will do it, well and good, but if it will not, the duty falls upon the supervising authority.

Mr. BATEY

Answer the second question.

Mr. SHAKESPEARE

Is a mother compelled to have a qualified maternity nurse? I would rather put it the other way round, and say that she is not allowed to have an untrained nurse to nurse her.

Mr. BATEY

That is another question. Is a mother, according to the Bill, compelled to have a maternity nurse such as you are providing, that is, a nurse with the midwife's certificate, and, if so, will she be subject to the penalties of Clause 3?

Sir K. WOOD

I want to be quite clear about this matter. I hope that it is not so, but I rather think that the hon. Gentleman has in mind the getting of a statement from the Minister standing at this Box that some people other than qualified nurses should be available.

Mr. BATEY

I will come to that later.

Sir K. WOOD

The answer is that no one can compel a mother to have a nurse if she does not want one, but there is a provision in the Bill which deals with unqualified people.

Mr. BATEY

There are strong powers under Clause 3. The maternity nurse can recover her fees in court, and that is an enormous power to give her over a working-class woman.

Sir K. WOOD

When this service is established it will be for the supervising authority to deal with that question?

Mr. BATEY

That still does not meet my point. I am either not making myself clear or the right hon. Gentleman does not catch the point which I am trying to make. Let me put it to him this way: A qualified maternity nurse who goes into a home will be entitled to a fee. That fee will be, say, £3 a week, and if the midwife remains in attendance upon a mother for two weeks, the fee will amount to £6, and that is an enormous sum for a working-class mother to have to find. If she does not pay, the local authority or the maternity nurse can take her to court for the recovery of the money.

The DEPUTY-CHAIRMAN

I do not see how this matter arises under Clause 1.

Mr. BATEY

No, it does not.

The DEPUTY-CHAIRMAN

It is clearly out of order.

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

Bill reported; as amended (in. the Standing Committee and on re-committal), considered.

CLAUSE 1.—(Provision of domiciliary service of midwives.)

6.23 p.m.

Mr. RHYS DAVIES

I beg to move, in page 1, line 26, to leave out "or undertake to employ."

The object of moving the Amendment is to induce the Government not to insert provisions in the Clause that will have the effect of setting up new voluntary organisations for the purposes of this work. Those of us who have followed the Bill from its initial stages will remember that there is a supervising authority which can hand this work out to welfare councils and voluntary organisations, but the Government have inserted a provision in this Clause which goes beyond that. It invites the formation of new voluntary organisations to undertake the work that has to be performed under this Bill when it has passed into law. We have been taunted on this side of the House that we are opposed to voluntary organisations. I suppose that there is no body of men in this land who have done more voluntary work than we have done. [Horn. MEMBERS: "Oh!"] I will repeat that. statement. I suppose that there is no body of people in this land who have done more voluntary work than we have done. There is no challenge to that statement. If hon. and right hon. Gentlemen opposite could come with us on occasions when we deliver speeches on behalf of our cause they would be astonished to find out how much we get for them. Not the amount that hon. Members think we get.

I want to make my position quite clear. Whatever opinions may be held about voluntary organisations, the introduction of this Bill to set up a salaried midwifery service is in itself a condemnation of voluntaryism in connection with confinements and childbirth. The right hon. Gentleman has introduced his Bill and is compelling local authorities to engage salaried midwives because he and his Department have found out that voluntary efforts have failed to make an impression upon maternal mortality. If that were not the case, why does he introduce such a Bill at all?

Mr. DEPUTY-SPEAKER (Captain Bourne)

I think that the hon. Member is now getting very much wider than the scope of his Amendment.

Mr. DAVIES

I was just saying that, Sir, in order to lead up to the next point. The point I want to make is this: Suppose that we accept, as we a-re bound to do, because the Government are able to carry the Clause, the two organisations, the welfare councils under the supervising authority and the voluntary organisations. Really it is an offence to our intelligence, when we are opposed to voluntary organisations doing this work at all, to suggest in a Clause that voluntary organisations should be induced to come into being to undertake this work. Therefore the purport of my Amendment is to remove the inducement to the establishment of new voluntary organisations to do this work. My point is strengthened because of this fact: I do not know how many voluntary organisations there are in this country who can undertake this work, but of one thing I am certain. There is a county council in every county in the land.

Sir R. TASKER

Who register midwives.

Mr. DAVIES

I think the hon. Gentleman sees my point of view. I am helped beyond measure to have the support of the hon. Gentleman, who has such a wide experience of these matters in connection with the London County Council. The provision about which I am 'speaking should not be included in the Bill at all. I will tell the right hon. Gentleman why. First of all, there is a local authority covering the whole of this land—county council, borough council, urban council or parish council. In this country we have covered every inch of the territory with elected local authorities. The right hon. Gentleman wants new voluntary organisations to compete with the local authorities. That is what he is after. While he is in office—and that will not be for so very long, I am sure—I suppose he will do what he can to encourage into existence new voluntary organisations, and we oppose the cultivating and bringing into existence of any voluntary organisations for the purposes of this work. We think that the Plymouth Town Council can do this job better than any voluntary organisation in Plymouth supported by the Noble Lady the Member for the Sutton Division (Viscountess Astor).

Viscountess ASTOR

You are wrong.

Mr. DAVIES

I very much doubt whether the Noble Lady would stand on a public platform in Plymouth and say that the Plymouth Town Council is not as competent as a voluntary organisation.

Mr. DEPUTY-SPEAKER

The discussion is becoming rather discursive, and I would ask the hon. Member to keep rather more closely to his Amendment.

Viscountess ASTOR

On a point of Order. Will you tell me what I must do? The hon. Member has spoken of the Plymouth Town Council. I want to be in order. Can I answer that statement now, or must I sit silent?

Mr. DEPUTY-SPEAKER

The Noble Lady would be out of order if she did reply.

Mr. DAVIES

It is a matter of temperament. I was rather led away by the Noble Lady. I have put my case, with certain interruptions, and I want to reach my final point. Existing voluntary organisations may be called upon to do this work, but we think that it is. too large an order to say in an Act of Parliament that new organisations should be created for the purpose of doing work that is obviously the duty of the local authorities.

6.32 p.m.

Sir K. WOOD

This matter was fully discussed in Committee, and the Amendment now moved by the hon. Member was defeated. I think the reason why the Committee accepted the proposal in the Bill was not because they wanted to set municipal authorities against voluntary organisations but because they thought that this proposal would be the most convenient in the circumstances for all concerned. There may be cases, especially in the rural areas, where voluntary organisations—I hope that I may be permitted to say—do excellent work in this connection and may want to extend, or it may be desirable that new organisations should be established. In those cases it would be for the local authority to make an arrangement with such new organisation as gave an undertaking to provide an efficient service. If there was any dispute it would have to come before me for decision. I think there can be very little objection to this proposal except on the part of those people who object to voluntary organisations as a matter of principle and think that they ought to be stamped out of existence. I cannot direct my argument to that point of view, but from the point of view of providing a fully efficient service through the local authorities and the voluntary organisations I commend the proposal in the Bill.

6.33 p.m.

Mr. DUNCAN

As I happened to be successful in getting this proposition inserted in the Bill in Committee, I was very glad to hear my right hon. Friend refusing to allow the words to be taken out of the Bill. They were inserted at the request of the Queen's institute of District Nursing, who do an enormous amount of work in, I think, 62 counties. It was not really a question of extending the number of voluntary organisations, but of allowing district nursing associations to extend their work by appointing and using more district nurses for midwifery and maternity cases. That was the basis of the argument that I used in the Committee, it was accepted by the Committee and I am very glad that my right hon. Friend does not propose to accept the Amendment now moved.

Mr. BATEY

The Minister has not answered the Amendment on the Paper.

Sir K. WOOD

I have.

Mr. BATEY

No, you have not. There are three important questions in the Amendment. The first is this: at least one month before first engaging midwives"—

Sir K. WOOD

The hon. Member is dealing with the wrong Amendment.

Mr. BATEY

I am sorry.

6.34 p.m.

Mr. G. GRIFFITHS

We desire to delete the words "or undertake to employ." The hon. Member for North Kensington (Mr. Duncan) said that the Committee inserted those words on his representation, assisted by the great influence of the Minister of Health and the Parliamentary Secretary. We do not desire that those words should be inserted, because they are an invitation to voluntary organisations who have never before undertaken this work. It ought to be the local representatives on the local authority who should do this business, together with the voluntary organisation now in the work. The words "undertake to employ" invite other voluntary organisations to make an application. They will be able to make an application and if the local authorities do not satisfy them they will be able to appeal to the Minister. The Minister will then be able to say: "Although this voluntary organisation has not undertaken this work in the past I am going to allow it to undertake it in the future." The local authority possesses the facilities for doing

this work, and they ought to undertake it. The invitation to which I have referred seems to us to be dangerous. I think it was the hon. and gallant Member for Birkenhead, West (Lieut.-Colonel Sandeman Allen) who interjected a remark when the hon. Member for Westhoughton (Mr. Rhys Davies) said that we assist in this voluntary work. We can speak as those with authority on the subject, because we have had experience. Some of us have been cradled in the work. We have been secretaries or treasurers of voluntary associations for at least a quarter of a century. We are now in the work and doing all we can. We are as much interested in voluntary associations as hon. Members in any part of the House, but we do not desire that there should be an extension to those voluntary associations who have not taken part in the past in midwifery work.

Question put, "That the word 'or' stand part of the Bill."

The House divided: Ayes, 203; Noes, 123.

Division No. 275.]	AYES.	[6.40 p.m.
Acland, Rt. Hon. Sir F. Dyke	Croom-Johnson, R. P.	Gunston, Capt. D. W.
Acland, R. T. D. (Barnstaple)	Crowder, J. F. E.	Hanbury, Sir C.
Acland-Troyte, Lt.-Col. G. J.	Cruddas, Col. B.	Harris, Sir P. A.
Agnew, Lieut.-Comdr. P. G.	Davidson, Rt. Hon. Sir J. C. C.	Haslam, H. C. (Horncastle)
Allen, Lt.-Col. J. Sandeman (B'kn'hd)	Davies, C. (Montgomery)	Hellgers, Captain F. F. A.
Anstruther-Gray, W. J.	Davies, Major Sir G. F. (Yeovil)	Hills, Major Rt. Hon. J. W. (Ripon)
Apsley, Lord	Dawson, Sir P.	Holdsworth, H.
Aske, Sir R. W.	De Chair, S. S.	Holmes, J. S.
Astor, Visc'tess (Plymouth, Sutton)	Denman, Hon. R. D.	Hope, Captain Hon. A. O. J.
Baldwin, Rt. Hon. Stanley	Dodd, J. S.	Hopkinson, A.
Barclay-Harvey, Sir C. M.	Dorman-Smith, Major R. H.	Hare-Belisha, Rt. Hon. L
Beamish, Rear-Admiral T. P. H.	Drewe, C.	Howitt, Dr. A. B.
Beaumont, M. W. (Aylesbury)	Duckworth, G. A. V. (Salop)	Hudson, Capt. A. U. M. (Hack., N.)
Beaumont, Hon. R. E. B. (Portsm'h)	Duncan, J. A. L.	Hudson, R. S.(Southport)
Fireball, Sir J. D.	Eastwood, J. F.	Hume, Sir G. H.
Blindell, Sir J.	Elliot, Rt. Hon. W. E.	Hunter, T.
Bossom, A. C.	Ellis, Sir G.	Hurd, Sir P. A.
Boulton, W. W.	Emery, J. F.	Jackson, Sir H.
Bower, Comdr. R. T.	Emmott, C. E. G. C.	James, Wing-Commander A. W.
Bowyer, Capt. Sir G. E. W.	Emrys-Evans, P. V.	Jones, H. Haydn (Merioneth)
Briscoe, Capt. R. G.	Entwistle, C. F.	Jones, L. (Swansea, W.)
Brocklebank, C. E. R.	Errington, E.	Keeling, E. H.
Brown, Rt. Hon. E. (Leith)	Erskine Hill, A. G.	Kerr, Colonel C. I. (Montrose)
Brown, Brig.-Gen. H. C. (Newbury)	Evans, D. O. (Cardigan)	Kerr, H. W. (Oldham)
Bull, B. B.	Evans, E. (Univ. of Wales)	Kerr, J. Graham (Scottish Univs.)
Burghley, Lord	Fildes, Sir H.	Kirkpatrick, W. M.
Campbell, Sir E. T.	Foot, D. M.	Lamb, Sir J. Q.
Cartland, J. R. H.	Furness, S. N.	Latham, Sir P.
Carver, Major W. H.	Fyfe, D. P. M.	Leckie, J. A.
Cayzer, Sir C. W. (City of Chester)	Ganzoni, Sir J.	Lees-Jones, J.
Cazalet, Thelma (Islington, E.)	George, Megan Lloyd (Anglesey)	Leighton, Major B. E. P.
Chamberlain, Rt. Hn. N. (Edgb't'n)	Gilmour, Lt.-Col. Rt. Hon. Sir J.	Levy, T.
Channon, H.	Gluckstein, L. H.	Llddall, W. S.
Chapman, Sir S. (Edinburgh, S.)	Glyn, Major Sir R. G. C.	Llewellin, Lieut.-Col. J. J.
Charlton, A. E. L.	Goodman, Col. A.W.	Lloyd, G. W.
Christie. J. A.	Graham, Captain A. C. (Wirral)	Locker-Lampson, Comdr. O. S.
Clydesdale, Marquess of	Grattan-Doyle, Sir N.	M'Connell, Sir J.
Collins, Rt. Hon. Sir G. P.	Greene, W. P. C. (Worcester)	MacDonald, Rt. Hn. J. R. (Scot. U.)
Colville, Lt.-Col. Rt. Hon. D. J.	Griffith, F. Kingsley (M'ddl'sbro, W.)	MacDonald, Rt. Hon. M. (Ross)
Cooper, Rt. Hn. T. M. (E'nburgh,W.)	Grimston, R. V.	McEwen, Capt. J. H. F.
Courthope, Col. Sir G. L.	Guest, Hon. I. (Brecon and Radnor)	McKie, J. H.
Crooke, J.S.	Guinness, T. L. E. B.	Magnay, T.
Maitland, A.	Robinson, J. R. (Blackpool)	Storey, S.
Mander, G. le M	Ropner, Colonel L.	Strauss, E. A. (Southwark, N.)
Margesson, Capt. Rt. Hon. H. D. R.	Ross Taylor, W. (Woodbridge)	Strauss, H. G. (Norwich)
Mason, Lt.-Col. Hon. G. K. M.	Ruggles-Brise, Colonel Sir E. A.	Strickland, Captain W. F.
Mayhew, Lt.-Col. J.	Russell, A. West (Tynemouth)	Stuart, Lord C. Crichton- (N'thw'h)
Mellor, Sir J. S. P. (Tamworth)	Salmon, Sir I.	Stuart, Hon. J. Moray and Nairn)
Mills, Sir F. (Leyton, E.)	Salt, E. W.	Sueter, Rear-Admiral Sir M. F.
Mills, Major J. D. (New Forest)	Samuel, Sir A, M. (Farnham)	Tasker, Sir R. I.
Muirhead, Lt.-Col. A. J.	Sassoon, Rt. Hon. Sir P.	Tate, Mavis C.
Neven-Spence, Maj. B. H. H.	Seely, Sir H. M.	Touche, G. C.
Nicolson, Hon. H. G.	Selley, H. R.	Wakefield, W. W.
O'Neill, Major Rt. Hon. Sir Hugh	Shakespeare, G. H.	Ward, Lieut.-Col. Sir A. L. (Hull)
Owen, Major G.	Shaw, Major P. S. (Wavertree)	Ward, Irene (Wallsend)
Palmer, G. E. H.	Shepperson, Sir E. W.	Waterhouse, Captain C.
Peake, O.	Simon, Rt. Hon. Sir J. A.	Wayland, Sir W. A.
Penny, Sir G.	Sinclair, Rt. Hon. Sir A. (C'thn's)	Wedderburn, H. J. S.
Petherick, M.	Smiles, Lieut.-Colonel Sir W. D.	Willoughby de Eresby, Lord
Pickthorn, K. W. M.	Smith, L. W. (Hallam)	Windsor-Clive, Lieut.-Colonel G.
Ponsonby, Col. C. E.	Smith, Sir R. W. (Aberdeen)	Wise, A. R.
Radford, E. A.	Smithers, Sir W.	Withers. Sir J. J.
Ramsay, Captain A. H. M.	Somervell, Sir D. B. (Crewe)	Womersley, Sir W. J.
Ramsbotham, H.	Somerville, A. A. (Windsor)	Wood, Rt. Hon. Sir Kingsley
Ramsden, Sir E.	Spears, Brig.-Gen. E. L.	Wragg, H.
Rathbone, Eleanor (English Univ's.)	Spender-Clay, Lt.-Cl. Rt. Hn. H. H.
Reed, A. C. (Exeter)	Spans, W. P.	TELLERS FOR THE AYES.-
Reid, Sir D. D. (Down)	Stanley, Rt. Hon. Oliver (W'm'I'd)	Dr. Morris-Jones and Mr. Cross.
Rickards, G. W. (Skipton)	Stewart, J. Henderson (Fife, E.)
NOES.
Adams, D. (Consett)	Griffiths, J. (Llanelly)	Price, M. P.
Adams, D. M. (Poplar, S.)	Groves, T. E.	Pritt, D. N.
Alexander, Rt. Hon. A. V. (H'Isbr.)	Hall, G. H. (Aberdare)	Quibell, D. J. K.
Ammon, C. G.	Hall, J. H. (Whitechapel)	Richards. R. (Wrexham)
Anderson, F. (Whitehaven)	Hardie, G. D.	Riley, B.
Attlee, Rt. Hon. C. R.	Henderson, T. (Tradeston)	Ritson, J.
Banfield, J. W.	Hills, A. (Pontefract)	Robinson, W. A. (St. Helens)
Barnes, A. J.	Jagger, J.	Rowson, G.
Barr, J.	Jenkins, A. (Pontypool)	Salter, Dr. A.
Batey, J.	Jenkins, Sir W. (heath)	Sexton, T. M.
Bellenger, F.	John. W.	Shinwell, E.
Benson, G.	Johnston, Rt. Hon. T.	Short, A.
Bevan, A.	Jones, A. C. (Shipley)	Silverman, S. S.
Bromfield, W.	Jones, Morgan (Caerphilly)	Simpson, F. B.
Brooke, W.	Kelly, W. T.	Smith, Ben (Rotherhithe)
Brown, Rt. Hon. J. (S. Ayrshire)	Kennedy, Rt. Hon. T.	Smith, E. (Stoke)
Buchanan, G.	Lansbury, Rt. Hon. G.	Smith. Rt. Hon. H. B. Lees- (K'ly)
Burke, W. A.	Lathan, G.	Smith, T. (Normanton)
Chafer, D.	Lawson, J. J.	Sorensen. R. W.
Cluse, W. S.	Lee, F.	Stewart, W. J. (H'ght'n-le-Sp'ng)
Cocks, F. S.	Leonard, W.	Strauss, G. R. (Lambeth, N.)
Compton, J.	Leslie, J. R.	Taylor, R. J. (Morpeth)
Cove, W. G.	Logan, D. G.	Thorne, W.
Cripps, Hon. Sir Stafford	Lunn, W.	Thurtle, E.
Daggar, G.	Macdonald, G. (Ince)	Tinker, J. J.
Dalton, H.	McGhee, H. G.	Viant, S. P.
Davies, D. L. (Pontypridd)	MacLaren, A.	Walker, J.
Davies, R. J. (Westhoughton)	Maclean, N.	Watkins, F. C.
Day, H.	MacMillan, M. (Western Isles)	Watson, W. McL.
Dunn, E. (Rother Valley)	MacNeill, Weir, L.	Welsh, J. C.
Ede, J. C.	Mainwaring, W. H.	Westwood, J.
Edwards, A. (Middlesbrough E.)	Marklew, E.	Whiteley, W.
Edwards, Sir C. (Bedwellty)	Marshall, F.	Wilkinson, Ellen
Fletcher, Lt.-Comdr. R. T. H.	Messer, F.	Williams, E. J. (Ogmore)
Frankel, D.	Milner, Major J.	Williams, T. (Don Valley)
Gallacher, W.	Morrison, R. C. (Tottenham, N.)	Wilson. C. H. (Attercliffe)
Gardner, B. W.	Muff, G.	Windsor, W. (Hull, C.)
Garro Jones, G. M.	Paling, W.	Woods, G. S. (Finsbury)
Graham, D. M. (Hamilton)	Parker, J.	Young, Sir R. (Newton)
Green, W. H. (Deptford)	Parkinson, J. A.
Grenfell, D. R.	Pethick-Lawrence, F. W.	TELLERS FOR THE NOES.
Griffiths, G. A. (Hemsworth)	Potts, J.	Mr. Mathers and Mr. Charleton.

6.47 p.m.

Mr. DUNCAN

I beg to move, in page 1, line 26, to leave out "undertake," and to insert "are willing."

In Committee I was successful in getting the words "undertake to employ" inserted in the Bill, and the hon. Member for Westhoughton (Mr. Rhys Davies) suggested that they were not very happy words. The words which I am now proposing to insert have been suggested as being happier.

Mr. MICHAEL BEAUMONT

I beg to second the Amendment.

Mr. SHAKESPEARE

This is purely a drafting Amendment. It is a happier phrase, and does not alter the meaning of the Clause at all.

Mr. RHYS DAVIES

I cannot understand the attitude of the Parliamentary Secretary. I should imagine that the words "undertake to employ" are very much better than "are willing to employ." The hon. Member seems to be playing with the House of Commons. First of all a voluntary association is to be willing to undertake, and now he wants the supervising authority to invite voluntary organisations into doing it. It is not worth dividing the House upon, but I do not think the hon. Member is a master of the English language.

6.49 p.m.

Mr. EDE

I heard with astonishment the way in which the Parliamentary Secretary accepted the Amendment. It seems to me to make the task of a local authority a great deal more difficult than the words already in the Bill. The local authority has the responsibility, but if a voluntary organisation is willing to carry out part of the responsibilities, it should be a definite undertaking to which they can be held. Now a local authority is asked to find out which of the voluntary organisations in their area are willing to do the work, and on the assumption that this willingness will not be merely temporary but will enable the scheme to be carried out, they accept the assurance of the voluntary organisation. But if they get weary in well-doing after a little experiment, or do not persevere, their willingness has vanished. If they "undertake" they will be in an entirely different position. I am sorry that the Minister has accepted less stringent words than those already in the Bill.

Mr. K. GRIFFITH

As the Minister has accepted these words, I wish he would give some explanation as to the difference they make. The explanation is that the words are happier. It sounds pleasant, but if you take the word "undertake" it is something which is capable of an objective test, there is something in writing, something which binds them, but I am not sure what test is to be applied to find out whether people are willing or not. If there is a test in one case and not in the other, I cannot see how the happiness of anybody is increased by accepting these words.

6.51.p.m.

Sir K. WOOD

This is a minor point. As a matter of fact, the hon. Member for Westhoughton (Mr. Rhys Davies) objected to the word "undertake" and criticised it in Committee, and we are now endeavouring to meet his point by putting in the words "are willing." Now, apparently, the hon. Member is objecting to these words. No doubt, however, need arise in the mind of any hon. Member. This is purely an indication by a voluntary organisation that it is willing to undertake this responsibility, but that is not the end of it. There must be a proper agreement in terms satisfactory to the local authority, and if there is any dispute between a local authority and a voluntary organisation then the matter comes before the Department.

Mr. G. GRIFFITHS

If a voluntary organisation says that it is willing to "undertake," and the local authority say that they do not want them, will you then interfere?

Sir K. WOOD

No, I shall not interfere. The local authority has the right to deal with this matter, and it will consider it from the point of view of the interests of the mothers in the district before anything else. But if there is any dispute between a voluntary organisation and a local authority the matter can be brought before me.

Amendment agreed to.

6.53 p.m.

Mr. FRANKEL

I beg to move, in page 2, line 30, after "organisations", to insert, "including conditions as to the auditing of accounts."

The Clause provides that a local authority must present a scheme, and when the Bill has passed a good many difficulties will arise, especially on the financial side. So far as local authorities are concerned most of them are carefully controlled for audit purposes; they are carefully watched in regard to their expenditure, which has to fall within certain limits, but under the Bill a local authority, having presented their scheme, and obtained approval from the Department, will have to make contributions to voluntary organisations. I am not suggesting that voluntary organisations do not carry out their work properly, but I think that if public money is to be paid over to voluntary organisations we should be told how the expenditure is to be audited. The Amendment is purely to give the Minister an opportunity of telling the House how he proposes to give effect to what is necessary and desirable, that where public money is expended by a local authority or a voluntary organisation the accounts shall be properly audited in order to see that sums which properly come within the terms of the Bill are paid, and also that local authorities shall be able to determine matters of policy in regard to expenditure. I have no desire to discuss the question of local authorities and voluntary organisations, but I would like to mention that all members of local authorities are voluntary workers. The only difference is whether this work would be more efficiently done through local authorities than through some of the organisations which hon. Members opposite prefer. I hope the Minister will welcome this opportunity of telling us how voluntary organisations are going to prove that the expenditure has been properly made and comes within the terms of the Bill.

Mr. RHYS DAVIES

I beg to second the Amendment.

6.58 p.m.

Mr. SHAKESPEARE

The hon. Member has raised a very important point. One must be satisfied where public money is spent that there are proper safeguards in regard to its expenditure. We propose to draw up agreements which will operate in cases where the supervising authority makes an agreement with the voluntary organisations, and in these agreements there will be a Clause as to audits. In a circular we shall also call attention to the importance of seeing that the money granted is appropriated to the proper purpose.

Mr. FRANKEL

In view of the explanation of the Parliamentary Secretary, I beg to ask leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

Mr. SPEAKER

The next Amendment which I propose to call is that in the name of the hon. Member for West-hough ton (Mr. Rhys Davies). I suggest that this Amendment and the next four Amendments might be discussed together if that meets with the wishes of the House.

7.0 p.m.

Mr. RHYS DAVIES

I beg to move, in page 3, line 5, to leave out Sub-section (5).

If the House will bear with me I will try to make clear the point we have in mind. Sub-section (5) reads: If an authority does not propose to make an arrangement with a welfare council or voluntary organisation which employs domiciliary midwives in the area of the authority, or if any such council or organisation is dissatisfied with the arrangements proposed to be made— (a) the council or organisation may, within two months after the proposals of the authority are submitted to the Minister, make representations to the Minister. We are dealing here with what we regard as a vital principle. The local authority in this country is made up of properly elected persons, but it would appear from the words of which I complain that if a local authority does not deem it wise to ask a voluntary organisation to undertake this task, the voluntary organisation can challenge the supervising authority. I have seen in my experience in Parliament local authorities challenging the Government; I have seen the Government taking local authorities into account. But I have never thought that I would see the day when a voluntary organisation could challenge a county council or a county borough, and here we have a provision by which that can be done. A welfare council falls it to a different category from a voluntary organisation and the point we want to make here is this. Of all the things which the right hon. Gentleman has inserted in this Bill, this one is beyond my comprehension. Although he is a Tory, a blue-blooded Tory, a reactionary of the worst type in politics, I never thought that he would descend to giving power to a voluntary organisation to challenge the constitutionally and properly elected local authorities. The Noble Lady the Member for the Sutton Division of Plymouth (Viscountess Astor) whenever I speak seems to be annoyed.

Viscountess ASTOR

Amused.

Mr. DAVIES

I do not know why. I thought that I could carry her with me, at any rate, in this proposal, because she seldom challenges anybody except the brewing trade, and on that score I am with her up to the hilt. But we are not dealing with that to-day, otherwise I would be led off the track once again. But how comes it about that the right hon. Gentleman has inserted this power in the Clause? I want to move that it be deleted because this is a principle in local government which he himself will come to regret if he allows it to pass. I do not know how long he will be Minister of Health, but just imagine him sitting in his Department in Whitehall, and there comes to him a group of ladies, six or ten, from a large county like Yorkshire or Lancashire on a deputation to him to say that they have a complaint to make about the Manchester, Liverpool, Sheffield, or Bradford corporations. That a group of people of that kind, with no responsibility to the public, should have power to challenge a corporation or county council is a serious principle to insert in an Act of Parliament, and because of that I beg to move the Amendment standing in my name.

7.6 p.m.

Sir K. WOOD

I do not think that I need detain the House long on this matter. The House will be aware of the proposal in the Bill, namely, that we hope to institute this new service by the co-operation of the local authorities and the voluntary organisations wherever it is possible to do so. All that this Clause proposes is that where there is a voluntary organisation carrying on their work in the district, and they are unable to come to an arrangement with the local authority, either that they should not be employed at all or concerning the arrangements to be made in the locality regarding the new service, the voluntary organisation should have the right to come to the Minister of Health to determine the difference between the local authority and the voluntary organisation.

Mr. RHYSDAVIES

If a local authority determines to employ a sufficient number of midwives in their own area, or employ some of the midwives now employed by a voluntary association and complete their scheme to the right hon. Gentleman's own satisfaction as Minister, will the voluntary organisation still be able to go to him and complain about that?

sir K. WOOD

It is difficult to take a case which one has directly in mind. Very few local authorities at the moment, I am sorry to say, employ midwives at all. If there were a case of a local authority and a voluntary organisation, and the local authority wanted to employ all the midwives and put on one side the voluntary association, the voluntary association has the right to come to the Minister and say in these circumstances, "It is unreasonable for the local authority to want to employ a new set of midwives when we have a sufficient number of midwives in our employment, and we come to the Minister to determine on a scheme whereby both sources of midwives could be used." That is reasonable. I do not see the constitutional danger, because under the proposal in the Bill the action taken by whoever may be Minister of Health can be challenged here, and that constitutes an additional safeguard in the matter. If the hon. Gentleman will only put on one side this unreasoning dislike of voluntary organisations and look on the matter from the point of view of getting an efficient service and of using all the agencies we have in the matter, he will see that this, is a practical provision.

7.10 p.m.

Mr. E. DUNN

I am not happy in re. gard to this Clause. The view I have formed is that it is distinctly weighted on the side of the voluntary organisation. As one who has made some contribution to voluntary organisations, this seems to be entirely one sided. I do not regard Sub-section (5) as it stands as being good local government. This Bill is intended to secure a certified salaried midwifery service, and it is intended to make the county councils of England and Wales the supervising authorities. I submit that their job will be to review the whole of their county areas with a view to establishing the necessary machinery to carry out the provisions of this Bill when it becomes law, and I cannot appreciate why the Minister of Health should seek to insert a provision of this description if he is really proposing to secure the efficient midwifery service which this House and this country think he is seeking to secure, because the voluntary organisations will have a more prominent place in the service than the local authority.

The attempt in this Bill throughout should be to place the local authority as the supreme authority throughout the country, and if these provisions are allowed to stand, the position of the local authorities, who are anxious to carry out the provisions of the Bill and to do the work properly in the interest of motherhood in this country, will be seriously handicapped. I do not know that we are entitled to take so easily the very grave manner which the Minister has employed both in Committee and in this House to secure the passage of this Bill, because this is giving to the welfare councils and the voluntary organisations a place which the country does not expect them to have. The local authority is the authority to which the country ought to look to carry out the provisions of the Bill. I beg the Minister to accept the Amendment.

7.13 p.m.

Sir R. TASKER

I beg the Minister to stand firm. An hon. Member talked about democratic assemblies, county councils and the like. Perhaps the House will permit me to read a decision by the greatest municipal authority in the world in reference to a grant for midwives: In communicating this decision they point out"— that is the county council— that fixation of the amount is necessarily a matter of which the council alone can be the judge, and it must be understood that such decision is final. In the circumstances no useful purpoe will be served by seeking an interview either with the council or individual members in the matter. That seems a very arbitrary and dictatorial attitude to take up. What the Minister is suggesting is that there should be a court of appeal. It is recognised in many matters where differences arise that the final court of appeal is the Minister of Health. I hope that the Minister will stand firm.

7.15 p.m.

Mr. G. GRIFFITHS

I was surprised to hear the Minister when he spoke on this striking a note of no confidence in local authorities. He may shake his head, but when to-morrow morning he reads in the OFFICIAL REPORT what he stated, he will see that he has not been backing up the authorities of which he is the head. It is clear from the Clause that the local authorities must approach the other people for the purpose of making arrangements and not the other people approach the local authorities. The Clause says: If an authority does not propose to make an arrangement with a welfare council or voluntary organisation which employs domiciliary midwives in the area of the authority, or if any such council or organisation is dissatisfied with the arrangements proposed to be made— The voluntary organisations are being given a double-barrelled gun. In the first place, if the local authority does not make arrangements, the welfare council or voluntary organisation can complain; and secondly, if the local authority does make arrangements and those arrangements are not satisfactory either to the welfare council or to the voluntary organisation, it may appeal to the Minister.

Let me say frankly that all the time the Minister has been throwing his weight on the side of the voluntary organisations as against his own local authorities. [HON. MEMBERS: "No."] Hon. Members may say "No," but I say "Aye." I attended the Committee upstairs, and I believe I missed only one meeting, and I know that ever since he spoke in the Second Reading Debate, the Minister has been backing these voluntary organisations, which shows a lack of faith in the people over whom he has supervision. Without throwing any stones at the voluntary organisations, we on this side contend that the local authorities, which have been elected by the people, ought to have the responsibility for carrying out this Bill when it becomes an Act of Parliament. We entirely object to Sub-section (5) of the Clause. Apparently the Minister thinks that whatever we may say on this side of the House, whether it be good, bad or indifferent, he must oppose it simply because it conies from this side. That has been the spirit in which he has approached the discussion all the time. In Committee upstairs we tried to make this Bill as good as we could and I am bitterly disappointed that the Minister again says "No" on this Subsection. There is an Amendment down in my name to delete the words "voluntary organisation," because, while we believe that a welfare council can be thoroughly supervised by a local authority, we feel that a voluntary organisation ought not to enter into this matter.

7.19 p.m.

Mr. K. GRIFFITH

I think the last words of the hon. Member for Hemsworth (Mr. G. Griffiths) rather indicated that his attitude on this Clause is part of the general attack upon voluntary organisations being in this scheme, and that to some extent takes away from the force of the hon. Member's attack on this particular Clause. I do not know why Subsection (5) should have created such great excitement. It seems to be regarded as an insult levelled by the Minister at the local authorities, but I do not think it is that. The position is that we have a particular branch of the health services which has so far been left in the hands of voluntary organisations. Now, rightly in my view, the local authorities are being brought in, and the whole matter is in the main being put on a public footing, but the voluntary organisations are being retained in existence in order that there shall be a blended service. In the initial stage, where there is a blended service, where the new element and the old element have to co-operate with one another, there will perhaps be difficulties, things will perhaps go easier in the case of some local authorities than in the case of others, and surely it is natural that in this Bill the Minister should reserve to himself some power to act as a court of appeal for the voluntary element in the early stage. I am very glad that this Clause is included, because I desire that the voluntary element should grow in along with the other. It is I believe in accordance with our traditions of progress that we should not abolish the old altogether at a stroke, and bring in a new system, but should allow the valuable elements in the old to go along with the new. To secure that it seems to me that the Minister was bound to include something in the nature of Subsection (5), and I hope he will preserve it.

7.22 p.m.

Mr. MARSHALL

I do not intend to follow the hon. Member for West Middlesbrough (Mr. K. Griffith) in his rather pathetic attempt to retain what many of us on this side of the House believe to be something which has now passed its usefulness. It seems to me that the ideal maternity service would be one under the orders of the medical officer of any great city and carried out by the servants employed by his department. The Minister seems to be running a dual system in this matter. He is giving a certain measure of local control and what may be called municipalisation of this service, and at the same time he is endeavouring to retain the voluntary system. In my opinion Sub-section (5) is based on the assumption that the Minister cannot trust local authorities to carry out this service, and he is going to compel them, even if it be against their own will, to enter into contracts and arrangements with voluntary associations. Why should the Minister coerce the local authorities? I suggest to the right hon. Gentleman that a local authority knows its own business best; it knows the local circumstances and it has the experience possibly of a long-continued administration in this connection.

I come from a city which has done a great deal in this direction. Is the Minister going to say to Sheffield, which has set up maternity hospitals and brought about a vast improvement in the service, that it must, against its better judgment, make arrangements with some voluntary association? I think the situation will be intolerable. May I refer to a comparable case? There are certain local authorities which have been beginning to operate the 1922 Act which deals with blind persons. Have the associations for the welfare of the blind the right to appeal to the Minister when the local authorities take over their functions? I have not heard that that is so. I know of local authorities which have taken over those functions and have administered the affairs of the blind better and more efficiently than the voluntary organisations, and have contributed to the happiness of these unfortunate individuals in a manner which has been beyond all praise. Nobody in this House suggests that the local authorities should be compelled to make arrangements with the voluntary associations which have been carrying out that work.

I wish to pay my tribute to the splendid pioneer work which voluntary organisations have done, but I would at the same time tell the hon. Member for West Middlesbrough that we have reached the time when, in the interests of public health and public efficiency, we have to say to the voluntary organisations, "We thank you for having done this work and we now propose that it should be taken over by the great local authorities." I can imagine what an outcry there would be if we tried to continue voluntary associations in the administration of smallpox hospitals. We believe that it is in the interests of public health that those hospitals should have been taken away from voluntary associations. I am sure that the House really believes that we have reached the position where this vital and important service with which we are now concerned should be taken completely out of the hands of voluntary associations and placed under the jurisdiction of the public health authorities of our great cities.

7.26 p.m.

Miss RATHBONE

It seems to me that on the question of voluntary organisations the House is fighting over again a battle which was fought out almost ad nauseam during the Committee stage. I suppose that is inevitable on the Report stage when there are present hon. Members who were not in the Committee. I would like to say briefly what I said more than once during the Committee stage. I think the Labour Opposition, with which I very often find myself in agreement, is on this particular question showing a curious time-lag in its thinking. Its arguments are old and musty, as though they had been kept in storage for the last 20 years. They seem to think of voluntary organisations as in the days of the Lady Clara Vere de Vere and the Lady Bountiful, as organisations of well-to-do people who cannot deal with the poor, as they would call them, except in a spirit of patronage, expecting meekness and servility from them. That is really a little unfair.

Any hon. Member who has been in touch with the great voluntary organisations knows that in general, although not always, the difference between them and the local authorities on a subject such as this is that the voluntary organisation is, after all, a voluntary organisation, and that nobody becomes a member of it unless he or she is interested in the particular problem with which it deals. I am sure that if hon. Members who have spoken against this Sub-section could be brought into touch with some of the men and women who are doing this work, they would realise the absurdity of their arguments. The people concerned are men and women—naturally very largely women—who have specialised on this problem, who know it from A to Z, who are skilled in the whole technique of midwifery and nursing services, who know every woman who works under them and are deeply interested in their well-being, and who know the latest scientific experiments being conducted abroad to improve the standards.

Against that you have a local authority. I may say that an hon. Member who objected to this work being left to voluntary organisations told me a few minutes ago that his particular local authority has only one woman on it among 50 men, and he claimed that she was an expert on this subject. There you have the case of a local authority with one woman among 50 men dealing with a problem which even the most ardent anti-feminist must admit to be a woman's problem, and it is suggested that all the expert work of the voluntary organisations should be swept away because of a stupid, old-fashioned, musty prejudice against voluntary organisations. I suppose that Mr. and Mrs. Sidney Webb are not inconsiderable experts on the subject of Labour politics and organisations, and that if ever there were people who believed in the bureaucrat, they do. Yet they have never taken the line which the Opposition is taking to-day regarding voluntary organisations; they have always made a point that the voluntary organisations should retain the delicate personal work where something rather more individual is needed than can be got from an ordinary local authority.

The time has now come for a great development and none of us wishes all the work to be left to the voluntary organisations. There are places where there are no voluntary organisations capable of doing the work and other places where they are working on old-fashioned sleepy lines; in those cases it is desirable that the local authority should be able to take over the work. But it would be nothing less than madness to sweep away all the acquired experience of the voluntary organisations and say to all those devoted men and women that their work is to be taken over by the local authorities, very likely local authorities knowing nothing whatever about the skilled side of midwifery and nursing work.

Mr. MARSHALL

On a point of Order. Does the hon. Lady suggest that a man who attends a committee meeting once a week knows more about this matter than a medical officer of health?

Mr. SPEAKER

That is not a point of Order.

Miss RATHBONE

As I did not hear what the hon. Member said, he will forgive me if I do not reply. As for this Amendment, what does it do but say that a voluntary organisation which has given years of work in dealing with this question is to be swept away without any right of appeal to the Minister? It is not always the people who want to sweep away voluntary organisations who know what is best for the good of midwifery and the good of the working mother. They are often just people who are obsessed with a rapid stupid prejudice against voluntary organisations, a prejudice which, I think, some hon. Members have been showing in these discussions. There ought to be a right of appeal to the Minister on the part of these organisations. The time may come, when municipal and other authorities have experimented a great deal and have built up their own experience and when the voluntary organisation may fade away, but that time is not yet. It is a serious thing to jeopardise the vital interests of women whose lives are at stake, for whom it may be a question of life or death whether or not they get the best sort of midwife, trained in the best way and working according to the best traditions, just for the sake of a general, theoretical, doctrinaire prejudice against voluntary organisations.

7.33 p.m.

Mr. LUNN

I think when the right hon. Gentleman the Minister spoke about Mrs. Gamp he must have had the hon. Lady in mind. [HON. MEMBERS: "Withdraw!"] I have been listening to extraordinary opinions from extraordinary quarters on this Amendment. We have the hon. Member for West Middlesbrough (Mr. K. Griffith) a Liberal, attacking the Labour party on an Amendment which seeks to apply democratic principles. [HON. MEMBERS: "No!"] Yes, the Amendment seeks to ensure that local authorities shall have the power of decision and shall not be dictated to by bodies which are not elected by the people.

Mr. K. GRIFFITH

Will the hon. Gentleman, from such knowledge as he has of Liberal tradition, inform me wherein it is alien to Liberal traditions to stand up for voluntary organisations?

Mr. LUNN

My point is that this Subsection provides that if a local authority does not make an arrangement with a voluntary organisation, that voluntary organisation is to have the right to go over the head of the local authority to the Minister. Many of us have been members of local authorities for many years before coming here and we are not inclined to take up the defence in a matter of this kind of any body which is opposed to the local authority. The hon. Lady the Member for the English Universities (Miss Rathbone) will remember, as I remember, the women's suffrage movement in this country. I fought a by-election before the War and I was very proud to have the support of the women's suffrage movement. Women got the vote and yet the hon. Lady comes here to-day to defy the vote of the people in the interests of outside bodies which are not elected.

We cannot agree to the idea that a voluntary organisation, however many people may be in it, should have this right. In many cases a voluntary organisation may consist of only two or three people in a locality, who want to interfere with everything and to be able to overcome the local authority by going to the Minister. We get a lot of that kind of thing in many of our large towns. Many prominent business men never take any part in local government, and never do anything for their fellow-citizens except complain about the local authority. Here we have the Minister playing up to that sort of thing. I say that we are justified in seeking to defend local authorities and to prevent them from being interfered with by busybodies who ought to have no power of this kind at all.

Question put, "That the words proposed to be left Out, to the word 'or,' in line 6, stand part of the Bill."

The House divided: Ayes, 205, Noes, 120.

Division No. 276.]	AYES.	[7.35 p.m.
Acland-Troyte, Lt.-Col. G. J.	Erskine Hill, A. G.	Mills, Sir F. (Layton, E.)
Adams, S. V. T. (Leeds, W.)	Evans, Capt. A. (Cardiff, S.)	Mills, Major J. D. (New Forest)
Albery, Sir I. J.	Evans, D. O. (Cardigan)	Muirhead, Lt.-Col. A. J.
Allen, Lt.-Col. J. Sandeman (B'kn'hd)	Fildes, Sir H.	Nall, Sir J.
Anstruther-Gray, W. J.	Fox, Sir G. W. G.	Neven-Spence, Maj. B. H. H.
Apsley, Lord	Furness, S. N.	Nicolson, Hon. H. G.
Asks, Sir R. W.	Fyfe, D. P. M.	O'Neill Major Rt. Hon. Sir Hugh
Astor. Visc'tess (Plymouth, Sutton)	George, Megan Lloyd (Anglesey)	Orr-Ewing, I. L.
Atholl, Duchess of	Gledhill, G.	Owen, Major G.
Baldwin, Rt. Hon. Stanley	Gluckstein, L. H.	Palmer, G. E. H.
Barclay-Harvey, Sir C. M.	Goodman, Col. A. W.	Peaks, O.
Baxter, A. Beverley	Greene, W. P. C. (Worcester)	Peat, C. U,
Beamish, Rear-Admiral T. P. H.	Gridley, Sir A. B.	Penny, Sir G.
Beauchamp, Sir B. C.	Griffith, F. Kingsley (M'ddl'sbro, W.)	Perkins, W. R. D.
Beaumont, M. W. (Aylesbury)	Grimston, R. V.	Petherick, M.
Beaumont, Hon. R. E. B. (Portsm'h)	Guinness, T. L. E. B.	Pickthorn, K. W. M.
Birchall, Sir J. D.	Gunston, Capt. D. W.	Ponsonby, Col. C. E.
Blaker, Sir R.	Hanbury, Sir C.	Radford, E. A.
Blindell, Sir J.	Hannah, I. C.	Ramsbotham, H.
Bossom, A. C.	Harris, Sir P. A.	Ramsden, Sir E.
Bower, Comdr. R. T.	Heilgers, Captain F. F. A.	Rathbone, Eleanor (English Univ's.)
Bowyer, Capt. Sir G. E. W.	Holdsworth, H.	Rathbone, J. R. (Bodmin)
Briscoe, Capt. R. G.	Holmes, J. S.	Reed, A. C. (Exeter)
Brocklebank, C. E. R.	Hope, Captain Hon. A. O. J.	Reid, Sir D. D. (Down)
Brown, Cot. D. C. (Hexham)	Hopkinson, A.	Remer, J. R.
Brown, Rt. Hon. E. (Leith)	Hudson, Capt. A. U. M. (Hack., N.)	Rickards, G. W. (Skipton)
Brown, Brig.-Gen. H. C. (Newbury)	Hudson, R. S. (Southport)	Robinson, J. R. (Blackpool)
Bull, B. B.	Hume, Sir G. H.	Ropner, Colonel L.
Burghley, Lord	Hunter, T.	Ross, Major Sir R. D (L'derry)
Campbell, Sir E. T.	Hurd, Sir P. A.	Ross Taylor. W. (Woodbridge)
Cortland, J. R. H.	Jackson, Sir H.	Ruggles-Brise, Colonel Sir E. A.
Carver, Major W. H.	James, Wing-Commander A. W.	Russell, A. West (Tynemouth)
Cary, R. A.	Joel, D. J. B.	Salmon, Sir I.
Channon, H.	Jones, Sir G. W. H. (S'k N'w'gt'n)	Salt, E. W.
Chapman, Sir S. (Edinburgh, S.)	Jones, H. Haydn (Merloneth)	Samuel, M. R. A. (Putney)
Christie, J. A.	Jones, L. (Swansea, W.)	Seely, Sir H. M.
Colville, Lt.-Col. Rt. Hon. D. J.	Keeling, E. H.	Selley, H. R.
Cook, T. R. A. M. (Norfolk, N.)	Kerr, Colonel C. I. (Montrose)	Shakespeare, G. H.
Cooper, Rt. Hn. T. M. (E'nburgh,W.)	Kerr, H. W. (Oldham)	Shepperson, Sir E. W.
Courtauld, Major J. S.	Kerr, J. Graham (Scottish Univs.)	Simon, Rt. Hon. Sir J. A.
Courthope, Col. Sir G. L.	Lamb, Sir J. Q.	Sinclair, Rt. Hon. Sir A. (C'thn's)
Craddock, Sir R. H.	Latham, Sir P.	Smith, L. W. (Hallam)
Cranborne, Viscount	Law, R. K. (Hull, S.W.)	Somervell, Sir D. B. (Crewe)
Crooke, J. S.	Leckie,J. A.	Somerville, A. A. (Windsor)
Croom-Johnson, R. P.	Lees-Jones, J.	Spears, Brig.-Gen. E. L.
Crowder, J. F. E.	Leighton, Major B. E. P.	Stewart, J. Henderson (Fife, E.)
Cruddas, Col. B.	Levy, T.	Strauss, E.A. (Southwark, N.)
Davies, C. (Montgomery)	Liddall, W. S.	Strickland, Captain W. F.
Davies, Major G. F. (Yeovil)	Llewellin, Lieut.-Col. J. J.	Stuart, Hon. J. (Moray and Nairn)
Dawson, Sir P.	Lloyd, G. W.	Sueter, Rear-Admiral Sir M. F.
Denman, Hon. R. D.	Locker-Lampoon, Comdr. O. S.	Sutcliffe, H.
Dodd, J. S.	Lovat-Fraser, J. A.	Tasker, Sir R. I.
Dorman-Smith, Major R. H.	Lyons, A. M.	Taylor, C. S. (Eastbourne)
Dower, Capt. A. V. G.	Mabane, W. (Huddersfield)	Titchfield, Marquess of
Drewe, C.	M'Connell, Sir J.	Touche, G. C.
Duckworth, G. A. V. (Salop)	MacDonald, Rt. Hn. J. R. (Scot. U.)	Wakefield, W. W.
Duckworth, W. R. (Moss Side)	MacDonald, Rt. Hon. M. (Ross)	Ward, Lieut.-Col. Sir A. L. (Hull)
Duggan, H. J.	MacDonald, Sir Murdoch (Inverness)	Ward, Irene (Wallsend)
Duncan, J. A. L.	Macdonald, Capt. P. (Isle of Wight)	Waterhouse, Captain C.
Dunne, P. R. R.	McEwen, Capt. J. H. F.	Wedderburn, H. J. S.
Eastwood, J. F.	McKie, J. H.	Williams, H. G. (Croydon, S.)
Eckersley, P. T.	Magnay, T.	Willoughby de Eresby, Lord
Edmondson, Major Sir J.	Maitland, A.	Windsor-Clive Lieut.-Colonel G.
Elliot, Rt. Hon. W. E.	Mander, G. le M.	Wise, A. R.
Ellis, Sir G.	Manningham-Buller, Sir M.	Womersley, Sir W. J.
Emery, J. F.	Margesson, Capt. Rt. Hon. H. D. R.	Wood, Rt. Hon. Sir Kingsley
Emrys-Evans, P. V.	Mason, Lt.-Col. Hon. G. K. M.	Wragg, H.
Entwistle, C. F.	Mayhew, Lt.-Col. J.
Errington, E.	Mellor, Sir J. S. P. (Tamworth)	TELLERS FOR THE AYES.—
		Dr. Morris-Jones and Mr. Cross.

NOES.
Adams, D. (Consett)	Bellenger, F.	Compton, J.
Adams, D. M. (Poplar, S.)	Benson, G.	Cove, W. G.
Adamson, W. M.	Bevan, A.	Cripps, Hon. Sir Stafford
Alexander, Rt. Hon. A. V. (H'Isbr.)	Bromfield, W.	Dagger, G.
Amman, C. G.	Brooke, W.	Dalton, H.
Anderson, F. (Whitehaven)	Brown, Rt. Hon. j. (S. Ayrshire)	Davies, D. L. (Pontypridd)
Attlee, Rt. Hon. C. R.	Burke, W. A.	Davies, R. J. (Westhoughton)
Banfield, J. W.	Charleton, H. C.	Day, H.
Barnes, A. J.	Chater, D.	Dunn, E. (Bother Valley)
Barr, J.	Close, W. S.	Ede, J. C.
Batey, J.	Cocks, F. S.	Edwards, A. (Middlesbrough E.)

Edwards, Sir C. (Bedwellty)	Leonard, W.	Shinwell, E.
Fletcher, Lt.-Comdr. R. T. H.	Leslie, J. R.	Short, A.
Frankel, D.	Logan, D. G.	Silverman, S. S.
Gallacher, W.	Lunn, W.	Simpson, F. B.
Gardner, B. W.	Macdonald, G. (Inca)	Smith, Ben (Rotherhithe)
Garro Jones, G. M.	McGhee, H. G.	Smith, E. (Stoke)
Graham, D. M. (Hamilton)	Maclean, N.	Smith, Rt. Hon. H. B. Lees- (K'ly)
Green, W. H. (Deptford)	Malnwaring, W. H.	Smith, T. (Normanton)
Grenfell, D. R.	Marklew, E.	Sorensen, R. W.
Griffiths, G. A. (Hemsworth)	Marshall, F.	Stewart, W. J. (H'ght'n-le-Sp'ng)
Griffiths, J. (Llanelly)	Mathers, G.	Strauss, G. R. (Lambeth, N.)
Hall, G. H. (Aberdare)	Messer, F.	Taylor, R. J. (Morpeth)
Hardle, G. D	Montague, F.	Thorne, W.
Henderson, A. (Kingswinford)	Morrison, Rt. Hon. H. (Ha'kn'y, S.)	Thurtle, E.
Henderson, T. (Tradeston)	Muff, G.	Tinker, J. J.
Hills, A. (Pontefract)	Paling, W.	Viant, S. P.
Hopkin, D.	Parker, J.	Walker, J.
Jagger, J.	Parkinson, J. A.	Watson, W. McL.
Jenkins, A. (Pontypool)	Pethick-Lawrence, F. W.	Welsh, J. C.
Jenkins, Sir W. (Neath)	Potts, J.	Westwood, J.
John. W.	Price, M. P.	Wilkinson, Ellen
Johnston, Rt. Hon. T.	Pritt, D. N.	Williams, E. J. (Ogmore)
Jones, A. C. (Shipley)	Quibell, D. J. K.	Williams, T. (Don Valley)
Jones, Morgan (Caerphilly)	Richards, R. (Wrexham)	Wilson, C. H. (Attercliffe)
Kelly, W. T.	Riley, B.	Windsor, W. (Hull, C.)
Kennedy, Rt. Hon. T.	Ritson, J.	Woods, G. S. (Finsbury)
Lansbury, Rt. Hon. G.	Robinson, W. A. (St. Helens)	Young, Sir R. (Newton)
Lathan, G.	Rowson, G.
Lawson, J. J.	Salter, Dr. A.	TELLERS FOR THE NOES.—
Lee, F.	Sexton, T. M.	Mr. Whiteley and Mr. Groves.

CLAUSE 5.—(Compensation to midwives ceasing or required to cease practice.)

Mr. M. BEAUMONT

I beg to move, in page 8, line 16, at the end, to insert: or by a decision of an authority under the next following Sub-section.

Mr. BATEY

On a point of Order. Are we to understand, Mr. Speaker, that you do not propose to call the Amendment in my name, in page 7, line 1, to leave out "net"?

Mr. SPEAKER

I do not select the first Amendment in the name of the hon. Member, nor do I select the second Amendment and the third Amendment standing in the name of the hon. Member.

Mr. BATEY

May I submit, Mr Speaker, that the word "net" raises a very important question on which we might be allowed to have some discussion?

Mr. SPEAKER

I am sorry, but I cannot select the Amendment.

7.45 p.m.

Mr. M. BEAUMONT

The Amendment, which I have reason to believe and hope will find acceptance on all sides of the House, is put down in pursuance of a pledge given by the Minister in Committee. In Committee some exception was taken by Members on all sides to the provision in Sub-section (5) of Clause 5 which enables a local authority, without consulting the wishes of the midwife, to change her compensation from a lump sum into the form of an annuity. While that was ostensibly for the benefit of the midwife, some of us took exception that it was really too much to give a local authority complete power to say in what form compensation which was given as a right should be given to a midwife, without consulting her or paying any attention to her wishes in the matter. Accordingly, I moved an Amendment which stated that this change could only be made to an annuity with the consent of the midwife. That did not find favour in the Committee, and it was withdrawn on the Minister saying he would consider the matter carefully.

This Amendment is the result of his consideration. It lays it down that any midwife aggrieved by the decision of a local authority to pay an annuity rather than a lump sum may have an appeal to the Minister. In theory, I very much prefer my own Amendment moved in Committee, because I believe that when compensation is given as a right, it is the recipient only who should decide what form that compensation should take. I believe it is a wrong principle that it should be allowed to be changed about without her consent, but in practice I think this Amendment will meet the case. I do not think this permission to give an annuity instead of a lump sum will in practice be very widely used; perhaps it will not be used widely enough, and I think the fact that this appeal to the Minister exists, whether it will be used or not, with all the con- sequential bother and correspondence and delay that such procedure involves, will prevent any local authority using this power unreasonably. There is something to be said for the view that when the lump sum is small it is very often frittered away by the recipient, and there is something therefore to be said for giving the power to substitute an annuity for a lump sum, provided we are quite certain that the power will not be abused; and while, as I have pointed out, I do not think in principle this way of dealing with it is the best, I think in practice it will be found adequate.

Mr. DUNCAN

I beg to second the Amendment.

Mr. SHAKESPEARE

We gladly accept the Amendment, and I think, from the experience in Committee, it is a proposal which met with favour from all sections of the Committee.

Amendment agreed to.

7.48 p.m.

Mr. SHAKESPEARE

I beg to move, in page 8, line 19, after "The," to insert "whole or any part of any."

This is to enable a local authority, if it so desires, instead of paying out the compensation in the form of an annuity, to pay it partly in a lump sum and partly by way of annuity.

Amendment agreed to.

Mr. SHAKESPEARE

I beg to move, in page 8, line 21, to leave out "so decides" and to insert: decides that it is in the interest of the midwife so to do. The Committee will remember that we promised to make it clear that the local authority's decision as to the manner in which the compensation should be dealt with should be taken by reference to the interest of the midwife, and we put in words to give effect to that promise.

7.50 p.m.

Mr. BATEY

This Amendment raises a most important question. I am sorry that my Amendment to leave out Subsection (5) was not called. However, you decided otherwise, Mr. Speaker, and one is bound to submit to your ruling. But this Amendment is, in my opinion, a most ridiculous Amendment. Here the midwife surrenders her certificate. She is entitled to compensation, but she has no power to decide whether she shall be paid a lump sum or not. If the local authority decides that she shall not be paid a lump sum, but that she shall be paid an annuity, it is entitled to do so, if it says that it is in the interest of the midwife. I cannot understand that. In my opinion, if a -midwife is entitled to compensation, she ought to be paid the compensation, and it ought not to be in the power of a local authority, or it may be an organisation, to withhold the money from her and pay it as an annuity.

Then there is a reference to attaining the age of 70. She may die before she is 70, in which case she will have lost part of the money. The money belongs to no one except the midwife, and she is entitled to it, and there should be no authority given to anybody to withhold that compensation from her. I do not know whether we intend to divide on this question or not, but I think we should divide or at any rate protest against a midwife being robbed cf her compensation. Sub-section (5) is a strange Subsection. How can anyone tell when a midwife is going to die in order to pay the money over before she dies. She may die very suddenly, and then this money is lost. I hold that that money belongs to the midwife and that there should be no power given to anybody to retain it. It should be paid in a lump sum.

7.53 p.m.

Mr. RHYS DAVIES

I have interested myself in annuities and in pensions on retirement from world for some years past, and quite frankly, if I may say so to my hon. Friend the Member for Spennymoor (Mr. Batey), I have never yet come across cases such as he would propound here. I am within an annuity scheme myself, as employed by a trade union body, and it is not possible under my own annuity scheme for the full sum to be paid out to me while I live. I have to be subject to the process of an annuity, and an annuity, of course, is something that comes to people when they leave work where a pension scheme is not applicable. It seems to me that to accept the suggestion made now, that a midwife should be in a different position from that of any other employé of a local authority where a superannuation or annuity scheme is in operation would be to do the midwife an injustice. My experience has been this—and I feel sure that every Member of Parliament will have had the same experience—that when old soldiers have compounded their pension, they have nearly always made a mistake. That is the universal experience. I have had very sad cases, and when a midwife arrives at 70 years of age—

Mr. BATEY

It may apply when she is 50.

Mr. DAVIES

I will use the age of 60. There are people around some of these old folk who are a little bit too smart for them, and may I, therefore, appeal to my hon. Friend the Member for Spennymoor not to press his opposition to this Amendment, because the experience that we have had of old people receiving lump sums of money has almost invariably been that we have all felt that it would have been better if an annuity had been bought for them and a smaller sum provided for them week by week throughout their lives.

7.56 p.m.

Mr. DUNCAN

I am glad my hon. Friend is asking the House to put in these words, for other reasons than those mentioned by the hon. Member for Westhoughton (Mr. Rhys Davies). I spoke on the Committee on this matter, and the view that I took then, and take now, is that this question of compensation for midwives is a matter which will be considered by the local authorities only in the next two or three years, until the number of practising midwives is reduced to the number required, until the surplus is got rid of. Therefore, there will be, or there might be, the temptation among certain local authorities to get rid of this liability in one lump sum, and it might be in the interests of the mid-wives themselves not to have a lump sum in certain cases, but an annuity, or part in a lump sum and part in an annuity. It was that temptation on the local authorities that I felt might exist which prompted me to speak in Committee on this point, and I am glad the Minister has agreed to this suggestion.

7.58 p.m.

Mr. EDE

I take the view on this matter that was expressed by my hon. Friend the Member for Westhoughton (Mr. Rhys Davies), but I am bound to say, as a member of a local authority, that I have no desire to see any point in what was said by the hon. Member for North Kensington (Mr. Duncan). The local authorities take this money and invest it with some insurance company or other persons who will pay the annuity, and, therefore, they have parted with the capital sum forthwith, whether they pay it in a lump sum to the annuitant or to the insurance company, and I do not think it makes any difference to them which way it is done. But I am bound to say that I see this provision in the Bill with a great deal more satisfaction in view of the acceptance of the Amendment which was recently moved by the hon. Member for Aylesbury (Mr. M. Beaumont), because it does enable the midwife, if she is in a position where she can usefully use the lump sum herself, to appeal to the Minister of Health, and I am sure the Minister of Health, in any decision which he gave, would have regard to the way in which she proposed to use the sum of money, and to the people around her who might be tempted to persuade her to get the money in the belief that they could use it a great deal better than she could. We must make quite sure that she is protected from that type of person.

Amendment agreed to.

CLAUSE 9.—(Miscellaneous amendments of Midwives Acts.)

8.0 p.m.

Mr. VIANT

I beg to move, in page 11, line 7, to leave out Sub-section (3).

We do not anticipate that this Amendment will be highly controversial, but that depends upon the reply of the Minister. Our reading of this Sub-section has led us to assume that where midwives, as a result of the Bill, are compelled to attend the refresher courses, they will be charged one guinea on each occasion, either for the examination or the certificate, or, it might be, for the certificate and the examination. We feel that the payment which midwives are likely to receive is not so enormous as to enable them to meet these charges repeatedly. We understand that the refresher courses will be arranged by the medical officer acting on behalf of the local authority, and it will be incumbent on midwives to attend them and the examinations. I am moving this Amendment in the main for information, for we hope that the Subsection does not mean that midwives will have to pay repeated charges of one guinea for examinations and certificates.

8.2 p.m.

Mr. DUNCAN

As I moved the Amendment embodied in this Sub-section in Committee, perhaps I may be allowed to explain what I then endeavoured to explain. The position is roughly that under the existing rules of the Central Midwives Board a fee of one guinea is required for each entry in the board's examinations, subject to the qualification that a pupil midwife who has entered for an examination but is prevented by illness from attending or completing her examination, is permitted to sit for a fee of half a guinea. In the new training rules which the board are shortly to pass, provision is made for a first and second examination to take the place of the present single examination, and if the expenses of the examinations are to be covered by fees, it will be necessary as the law stands at present, to charge a fee of one guinea for each examination. This Sub-section was put in the Bill to enable the Central Midwives Board to charge less than a guinea for each examination.

8.4 p.m.

Mr. G. GRIFFITHS

The hon. Member for North Kensington (Mr. Duncan) said something about half a guinea, but there is nothing about it in this Subsection. It says clearly that it has been one guinea in the past and that it shall now be one guinea for each examination or certificate in future. Many hon. Members have been trying to protect voluntary organisations, but we want to protect the midwives, and we want this Subsection deleted unless the Parliamentary Secretary can satisfy us that midwives are not going to be robbed more than they were before.

8.5 p.m.

Mr. SHAKESPEARE

I hope that I can satisfy the hon. Gentleman who moved to delete this Sub-section that the Sub-section provides a reasonable amendment to the law. It was moved in Committee by my hon. Friend the Member for North Kensington (Mr. Duncan) on behalf of the Central Midwives Board. All that it does is to regularise the position, which, in fact, exists now. It has no relation to refresher courses and it does not concern fees to be charged for those courses. In fact, no fee will be charged because a refresher course is only in respect of a woman who is already a midwife. All this Sub-section does is to authorise the fee to be charged in respect of women studying for midwifery and undergoing examination by the board. If a woman takes a number of examinations, she will pay a small fee for each examination. Hon. Members opposite can rest assured that the Minister has the last word because the scale of fees for these examinations has to be submitted to him and comes under his jurisdiction.

Mr. VIANT

I beg to ask leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

8.7 p.m.

Mr. SHAKESPEARE

I beg to move, "That the Bill be now read the Third time."

After appropriate time has been given to the consideration of this Bill in the Committee stage and again to-day on the Report stage, the House will not expect another long and detailed explanation of its provisions. We claim that it is a useful and important Bill, which adds another storey to the edifice which we are seeking to build in order to secure safer motherhood. I need not remind the House that for some years a number of strong departmental and voluntary committees have called the attention of successive Governments to the necessity of strengthening and improving the midwifery services, and it falls to our lot to supplement and to bring those recommendations into effect. This Bill substantially follows the line of attack recommended by the Joint Council of Midwifery, on which served representatives of nearly every body directly or indirectly interested in midwifery, whether doctors, nurses, midwives, obstetricians, or voluntary bodies. A number of other persons served, including the wife of the present Prime Minister, who has devoted a great deal of study and time to this problem, the daughter of an ex-Prime Minister, the hon. Member for Anglesea (Miss Lloyd George), and, last but not least, the hon. Gentleman who has now rejoined his party and has tried to go back on that agreement and findings to which he acquiesced when he was on the Committee.

I am not going into detail on the provisions of the Bill. I want to consider three aspects of it—first, how it affects the mother; second, how it affects the midwife; and, third, how it affects the nation. Under the provisions of the Bill, when the schemes are in operation, every expectant mother, whatever her circumstances, will know that she can call on the services of a well trained midwife either to act as a midwife in the absence of the doctor, or, if a doctor is in attendance, to act as maternity nurse during the lying-in period, which will be a period corresponding with that period laid down by the Central Midwives Board as the proper period for a midwife to be in attendance on a woman in childbirth. Those who know anything about this subject will rejoice that, during the passage of this Bill, we have taken an important step to increase that period of attendance. The rules of the Central Midwives Board refer only to a midwife acting as a midwife, and we take steps to secure, through the service we are organising, that there will be sufficient midwives available to act in the capacity of maternity nurses for women after childbirth for the same period of 14 days, which I understand, will be the period chosen. Therefore, a considerable advance, which has long been asked for by people in maternity work, has been conceded.

The expectant mother need no longer rely for maternity nursing on the services of an unqualified nurse. There are some parts of the country where the practice has grown up of women receiving attendance from persons utterly unqualified, and it has long been thought by people in maternity work, and it was a strong recommendation of the Joint 'Council, that this practice should be ended. We do away with it in this Bill. When the Minister has made an order in respect of an area that a midwifery service is in being, it will be illegal for any woman who is not a qualified midwife, or whose name does not appear on the general register as a State nurse, or who does not possess an obstetric certificate gained from an approved hospital, to attend on a woman as a maternity nurse for gain. That does not mean that the position of the home help is in any way affected. The position of the home help, who does the housework and looks after the children and performs manifold duties, will, of course, go on as heretofore. In the past the expectant mother in poor circumstances has sometimes found it difficult to shift for herself, as she has not always been in a position to command the best trained attendants, but in the future and under this Bill every mother, whatever her circumstances, will know that she has a claim on this highly organised and skilful service; and if her poverty is such that she cannot afford the fees laid down by the local authority or the voluntary society the fees can, under the provisions of the Bill, be remitted. As regards the mother, I think this Bill is taking a step forward of which all those interested in maternal welfare will cordially approve.

Let me put in a parenthesis which is not meant to be controversial, because I hope the era of controversy is over, but just to record the fact that in securing this benefit for mothers we are adopting what I think my hon. Friend the Member for West Middlesbrough (Mr. K. Griffith) called the English method, a partnership between the local authorities and voluntary efforts. We have taken ample safeguards to make sure that voluntary effort, which has pioneered in this field of endeavour, shall not be cut out, and, indeed, the experience of voluntary effort, of the county nursing associations all over the country, is one of the main justifications for the Bill. If throughout the whole country we can achieve the low figures of mortality which they have brought about where they have been working we shall indeed think that something has been achieved. We intend, therefore, to utilise the enthusiasm and the initiative of that public spirit which always enriches British public life, and we do not apologise for it.

Mr. G. GRIFFITHS

The hon. Gentleman stated that every poor mother would get this service free. Where is that stated in the Bill? The local authority have the power to fix the fees, and not the Ministry.

Mr. SHAKESPEARE

Power is given in the Bill for the local authority to remit the fees in case of poverty. The hon. Member is really living in a world of delusion if he thinks that we in the Ministry of Health can, from headquarters, organise this service and fix the fees. What on earth is the great service of the local authorities for?

Next we come to the position of midwives under the scheme of this Bill. Instead of belonging to an underpaid and overcrowded profession, as the midwife does at present, she will have a chance of securing a, post in a properly organised service, that is, with adequate remuneration, with provision for relief in case of sickness and for holidays, and the duty is imposed on the local authority of providing the practising midwife with an opportunity to refresh her knowledge from time to time by special courses.

Miss RATHBONE

The hon. Gentleman has referred to adequate remuneration. Will he say what guarantee there is in the Bill that the remuneration will be adequate?

Mr. SHAKESPEARE

The hon. Lady knows quite well what my answer is going to be, because this point was debated at great length upstairs. Shall we lay down in the Bill the scale of the remuneration which we at headquarters think adequate?

Miss RATHBONE

Yes.

Mr. SHAKESPEARE

Shall we do something which cuts right across the whole spirit of local government? There is no office in the local authority service for which we fix the remuneration; but if in the general administration by local authorities, who surely must be trusted, we find that for some reason or other midwives are getting inadequate remuneration, we shall take the point up, because clearly an efficient service would not be forthcoming. I can assure the hon. Lady that in the circular we shall send out to local authorities we shall point out that one of the objects of the Bill is to secure a properly remunerated service, and that in considering the salaries to be paid the work of the midwife should be regarded as comparable with that of the health visitor. I think the hon. Lady will be satisfied with that.

I therefore make the point that the midwife, at present struggling in a. rather precarious position, will, if she secures one of the posts to be created under this Bill, get a large measure of security. I need not point out that we feel justified in hoping that a service with a proper remuneration and with an increased standard of efficiency and training will attract to it women of high qualifications, and we trust that in the course of a few years we shall be able to say that we have gone a long way towards securing an efficient midwifery service. I like to think that midwives who have been struggling along for a number of years on mere pittances, sometimes working for charity, have at last received recognition and will have a chance of adequate remuneration if they join the scheme; and if they do not come into the scheme there is provision under the Bill for them to receive reasonable compensation, graded according to whether they retire voluntarily or compulsorily. Therefore, as regards midwives, I think the Bill does justice to them.

Thirdly, there is the interest of the nation in this matter. It is not necessary for me to make the point that the nation will surely gain from the strengthening of this vital public health service. When speaking the other day I tried to ensure that mothers of the future shall see this problem in its right perspective, because psychology does play a part in this matter, and we do not want to frighten mothers into thinking that the risks of motherhood are higher than, in fact, they are. If we turn the figures of maternal mortality into percentages, which is not often done, we find that out of every 100 mothers who give birth to children only 4 die. That percentage is the lowest in any country in the world in which figures are kept, with the possible exception of Holland. But while the death of 2,400 mothers a year out of a total of nearly 600,000 who give birth to children is not a percentage that need cause alarm to the new mother, it, is the peculiar poignancy and tragedy of death in childbirth which makes the Government and everybody else want to take whatever steps are possible to reduce the figures.

In any circumstances death is a tragedy. In some cases death comes suddenly, unforeseen, without warning, is swift, sudden and ruthless, but in the case of childbirth which, after all, is only a physiological and not a pathological happening, there is plenty of warning. There are months of preparation when precautions could have been taken. If, in spite of that fact, the blow falls, the tragedy is hard indeed. There is left behind a sense of bitterness, and sometimes of remorse or heart-searching as to whether every step that could have been taken was taken. It is because of the tragedy and the poignancy of death in childbirth, and the effect upon the home life and the future of the children, that any Government must do its utmost to see that nothing is left undone that can be done to strengthen the service.

This Bill will help to reduce the figures of maternal mortality, but it would be foolish to claim that merely by the provision of an adequate midwifery service there will immediately be a fall in the maternal mortality statistics. The subject is so complex, and consists of so many factors, that, in the view of those who have studied it, it will yield only to an all-round tightening of each link in the chain of obstetrics and supervision. There must be unremitting watchfulness at every stage. Nevertheless, those who are in a position to speak assure us that no more useful step could be taken at the present moment than the organisation of this service. That very strong Departmental Committee which was set up in 1928, and which reported finally in 1932, stated in these words the reason for the Bill: We are, however, convinced that the primary essential for the reduction of a high maternal mortality is sound midwifery, before, during and after childbirth. That is the considered judgment of the most able committee which has ever studied this question of maternal mortality. In seeking to organise a sound midwifery service we hope that we are doing something to reduce the risk which attends women in childbirth. With this short introduction, I hope I have shown that the Bill will bring a measure of greater safety to the mother and of security to the midwife, and that it will increase the statistics of maternal welfare. I confidently submit this Bill for its Third Reading.

8.29 p.m.

Mr. LUNN

I have heard the whole of the discussion on the Bill, in all its stages. If we do not oppose it on the Third Reading stage, I can safely say that it is not because we are satisfied with it. I was considerably affected by certain portions of the speech of the hon. Gentleman, but there were some parts of it with which I did not agree. I am certain that all hon. Members would agree that the midwifery service of this country is far from what it ought to be. I do not believe that the Bill will revolutionise it, although I should like to think so. A good deal has been said about the voluntary organisations. Although we criticise the power which is being given to them, we recognise the work that they have done in the past. We pay tribute to that work, and we do not want to eradicate it in any way. We realise, however, that there is a good deal of leeway to make up before we can get everything that we desire in the form of an efficient midwifery service. It may be that the Bill will reduce maternal mortality. How readily we accept small mercies and think they are remarkable. So much objection is taken to Bills, and so much legislation is passed which is of a reactionary character, that when we have to consider a Bill like this we hear, as we heard upon the Second Reading of this Bill, compliments paid by speaker after speaker, and much gratitude shown for the very small mercies which are to come from the Bill.

This is a big subject which has baffled all the experts and all Ministers of Health for the last 30 years. There has been no reduction in the number of deaths of young mothers in childbirth during that time. We cannot measure the large number of mothers who have been physically ruined while going through that ordeal. I heard the hon. Gentleman say that every expectant mother has a right not only to a qualified midwife but to the opportunity of having the services of one. If the Bill will have that effect, I hope that qualified midwives will be provided in that way. We want the mother also to have a qualified medical man in attendance, although I am of the opinion that the midwife is far more important on these Occasions than is the medical man. There are hundreds of doctors who curse the job and do not like it at all, but the midwife lives for it, and if she is provided for I am satisfied that that provision will be in the interests of the young mother.

The Bill does not touch poverty in the home, or malnutrition. It does not deal with matters which, we all know, are contributory causes to the death and the ruined physique of young mothers. We cannot number the sad homes which have been created as the result of our failure to provide an adequate health service in this country. The Minister of Health will have to do far more work than is provided for in the Bill, to help and to encourage local authorities in a more generous way than is the case today. The health visitor has been mentioned. She is an officer of the local authority, and is guaranteed an income which many of us think is reasonable. We should have been thankful if we had seen in the Bill a provision guaranteeing to the midwife something similar to the income which we have guaranteed to the health visitor.

We tackle the question of child welfare fairly well after the child has shed its long clothes, but the mother and the baby are still to be left largely, as a result of this Bill, to voluntary effort. We know the facts, and we ought to insist upon local authorities, backed by a Ministry that is progressive, being able to deal with the difficulties that have to be dealt with. We want more midwives than we have to-day; we want them well qualified for their work; we want them to have better pay, security of employment, and the certainty of a pension when they are past work. We are not sure that as a result of this Bill these things are guaranteed in the case of voluntary organisations, nor after reading the speech of the right hon. Gentleman on the Second Reading. That is why we take up the attitude that we do take up with regard to local authorities, for we seek efficiency in this matter. I know that the Money Resolution imposes limits on many matters which we should have liked to speak about and to see done. We should have liked, for instance, to see the question of compensation placed in the hands of the Ministry of Health, but the Bill does not do that.

The Bill will not cure the evil of maternal mortality, and, as evidence of that, I quote the speech of the Minister himself on the Second Reading. He said: I would also like to say that in bringing forward these proposals, I recognise it may well be that other steps may be necessary. Later on he said: I am also not unmindful that we must neglect no well-considered further plans for new schemes which will help to save the lives of the mothers and care for their health."—[0FricaL REPORT, 30th April, 1936; cols. 1129–1130, Vol. 311.] I agree absolutely with that, but I cannot see that these things are going to be done in the present Bill, which I think ought to have gone much further than it does. The returns of the Registrar-General for the first quarter of this year show that during that quarter there were many thousand more deaths than births in England and Wales. I am not worried so much about the decline in the birth rate, though many people are, but I believe there is nothing more beautiful than to see a young mother with a healthy baby in her arms. I would rather see her in that condition than fondling a dog or a cat. I believe that, if a child is born, it should have every opportunity to grow up into a healthy man or woman. An efficient midwifery service will give the child that chance to be well borne, and that will be a good start. But we have more to do in order to provide that efficient midwifery service than we have done. There is a great work to be done in research, and in the provision of training for midwives so that we can have more and better qualified midwives for the service.

This Bill does not deal with those matters, nor does it do anything to provide more maternity hospitals, which ought to be provided, because we know that in the homes there are not always the facilities that there ought to be, and there is not the possibility of skilled treatment which ought to be at hand for every mother. I know that it would cost money to do the things which I am suggesting and which are not included in the Bill. A co-ordinated and efficient health service is bound to cost money, but in my view it is one of the best possible ways of spending money. I do not apologise for repeating what was said on the Second Reading—that if we can find additional money for the provision of armaments, which serve no useful purpose at all in my view, it would be better to spend money in trying to secure an efficiently organised, well equipped health service under the Ministry of Health and the municipalities.

I trust that the House will pardon me if, in conclusion, I make a personal reference. I have heard all the discussions on this Bill, and have taken a great interest in it. I am very much concerned about our health services, and especially about the dangers of motherhood. I was appointed by my party to speak on the Third Reading of the Bill. This morning, when I got up, I was informed that I was wanted on the telephone by my son. thought that I was to hear of a happy event, but, instead, I learned that the young wife of my youngest son had died in childbirth this morning, tragically and suddenly. He has a good home, a good job, and good wages. They have been a very lovable couple, and I hardly knew what my duty was, because I have a family who are devoted to one another. This, I think, brings home to us the fact that, even when we have done all that I have asked for in the provision of an efficient health service from every point of view, even then they can slip through our fingers, they can pass away under conditions like that. Of course, in this case there has been not only a, doctor but a nurse continually in attendance on a very fine, healthy girl. It has, of course, been under tremendous difficulties that I have continued to take part in these proceedings to-day. It has only been because I am interested in this subject, and feel that, even if I am a loser at this moment of a delightful, lovely girl as the result of her wanting to be a mother, as I should have liked her to be, I want to see every provision that would make it possible, if it be possible, to prevent young mothers from going so easily as so many thousands of them do.

8.43 p.m.

Mr. K. GRIFFITH

I am sure that everyone who has listened to the last speech will have been filled, not only with the deepest sympathy for the hon. Gentleman, but also with a very great admiration for the courage which has caused him to come to his place to-day, subordinating his private feelings to his sense of public duty. It is not easy to say anything new on the Third Reading of a Bill which has been fully discussed, especially if one happens to agree with the Bill, and, although the hon. Gentleman who has just spoken pointed out, quite rightly, that there are matters which the Bill leaves unsolved—that it does not deal with those great problems of poverty and malnutrition which are connected with almost all our problems, and certainly with maternal mortality—still it is doubtful to my mind whether, under the title and scope of a Midwives Bill, quite all of these things could be dealt with, and it is as a Midwives Bill that we have to deal with this Measure. Dealing with it as a Midwives Bill, and remembering that, as the hon. Gentleman has said, this is a problem which has baffled all experience and all Ministers of Health, I think we should show some appreciation of the Minister and the Parliamentary Secretary for the efforts they are now putting forth, because we must all realise that it is no easy job that they have to tackle.

I am not going to pretend that everything in the Bill pleases me. I was unable to express myself as to the things I did not like because it would have been out of order. The Financial Resolution limited us. I simply say that I am not satisfied with the arrangements with regard to compensation, though I should be going beyond the Rules of Order if I indicated the way in which I would improve them. With regard to the voluntary organisations, 1 do not want to raise any controversial matters—the hon. Gentleman who spoke last was content to let that matter rest—but I hope there will be full co-operation between the new public service and the voluntary services that remain. It may be that the voluntary services are doomed to eventual destruction, but in the transitional stage their usefulness is not exhausted, and we should make use of them, as long as they last. I have risen only because I have taken an interest in the Bill from the beginning. On the Second Reading I wished it a short confinement and a happy delivery, and now I think we can all feel, those who have opposed and criticised it as much as its supporters, that we have acted as midwives to the Bill and we shall wish the child well in its future career.

8.47 p.m.

Sir R. TASKER

I join with the last speaker in expressing my admiration of the hon. Member for Rothwell (Mr. Lunn) for the courage that he has displayed in circumstances which are indeed sorrowful. I agree in very large measure with the sentiments that he expressed. All I will say of the voluntary service is that, if its sacrifice is necessary to save the lives of mothers, I am for it. I regard with horror the unnecessary loss of thousands of women's lives. I suppose all of us have had experience of one kind or another and we are a little loth to dwell on our own experience, but when my first boy was born the doctor came to me and said, "Mother or babe, which?" Such a condition ought never to exist. We have never realised the mission of mercy performed by midwives, nor have we ever paid a sufficient tribute to that noble army of doctors who give their services free. I think this Bill might be termed a Bill to save life, and saving life is a far more glorious achievement than taking it. Midwives deserve security and they richly deserve added remuneration. I can remember the time when their remuneration was miserable and paltry, but we have altered all that. We have striven to see that there is adequate remuneration. We expect skill, sympathy and devotion from midwives, and we get it. I regard the birth of a baby as a miracle, the most wonderful thing on earth. It demands fortitude and courage on the part of the mother. There is something else that the midwife brings and that is tranquillity.

The Bill ensures the attendance of a midwife who is fully qualified. That is a most essential condition. We cannot get all we want in any Bill. I should very much like to see pensions. It will not be in order to discuss it, but I am sure it will be borne in mind. I believe that local authorities will see to it, when they employ these midwives, that they become pensionable and, if they should fall by the way in the performance of their duty, some of us will be prepared to appeal to the Minister to bring in a short Bill to ensure that these devoted women in their declining years have something more than an old age pension. I should like to express my gratitude to the Minister for bringing the Bill in and to those Members who served on the Committee. I regret that I could not serve on it myself. Fewer greater or nobler works have ever been accomplished than the promotion of this Bill.

8.55 p.m.

Mr. ROWSON

Like the other hon. Members who have spoken previously, I do not rise to oppose the Bill and I do not intend to make a long speech, because I think there is general agreement in the House that at least this Bill, while it does not give us all we want, is a start for a properly organised midwifery service. Whatever may be its shortcomings, it will be something upon which future Parliaments can build and enlarge. I rise to draw attention to one or two things in the Bill, and to mention one or two items with which I am dissatisfied. I do not like the voluntary organisations having so much power to spend public money and to be left in sole control of the service in their particular area as long as the Minister is satisfied with the scheme with which they began. I should like to see the whole thing put in control of the local authorities, because I am satisfied that justice is not always done under these voluntary organisations, not even justice to the nurses and to the midwives.

One of the main reasons why I have risen to speak on this Bill is because of a case which has been brought to my notice, and I hope that the Minister, if he is to hand out public money for voluntary organisations to spend, will at least watch with a paternal eye the activities of these voluntary organisations. I hope that in the future, if any of these midwives or nurses have a grievance over wrongful treatment or wrongful dismissal, they may have the opportunity of going to the Minister and asking for an inquiry, so that they can have a measure of justice. I can state a case. I have the particulars here of a nurse who was engaged as a district nurse and midwife under a voluntary organisation, and she has done all she can through the local authority, and the county council of the area, and I and a right hon. Gentleman in this House have drawn the attention of the Minister to her case, but because it is a voluntary organisation which has control of the particular service this nurse and midwife, who is an efficient woman, has no right of appeal. She has nobody to whom she can appeal and she cannot get any inquiry at all.

The reply of the Parliamentary Secretary to me was that as this was a voluntary organisation, he had no right to interfere. If we are to hand out public money to voluntary organisations, and if some such circumstances as those arise, the Minister ought really to take such action as would enable the nurse or midwife to get some satisfaction and be treated in a proper and genuine way. In this case, there is no reason for dismissal so far as the evidence that has been submitted to me is concerned. It is in a very Conservative area, I admit, but I understand that there is no reason for dismissal only that this nurse is a supporter of our party. I submit that if the voluntary organisations are going to carry on like that, it is time that we In this House took control of such services and took the power out of their hands. I know that hon. and right hon. Gentlemen opposite will not stand behind such action as that, and that it only needs their attention to be drawn to such an injustice. In this case, I understand that if inquiry can be made, the facts that I am giving to the House can be substantiated. I have the whole case here in writing, and I have deliberately got up to mention it to-night while discussing this Bill, because there is no other means of making it public, and I know that hon. and right hon. Members on the opposite side of the House will agree that at least this nurse ought to have something done for her. It may be that by the passing of this Bill she may be able to table her case and obtain justice when it comes into operation.

There is another criticism that I want to offer in regard to the Bill. I wish that the Minister had afforded us the minimum of 14 days for the nurse to attend on the mother. It is all very well to say that it did not need to be put into the Bill. There has been much said on the sentimental side this afternoon about taking care of the mother and nursing her and so forth. I want to get away from that if I can, for this particular reason. There is no period in a woman's life when she is exposed, or has to submit, to such dangers as the period immediately following childbirth, and I submit to the Minister that 10 days after the confinement is not a sufficient time. I think that 14 days is little enough, and I hope that while that period has not been put into the Bill, he will urge the Central Midwives Board to adopt 14 days as the minimum period. It is necessary to watch the mother for more than 10 days. I claim, as one who has served on a midwives committee in Lancashire, that there is a big danger of puerperal fever supervening beyond the 10 days. If a doctor or a nurse was not in attendance beyond the 10 days, and there was an upward trend in temperature, the mother or those around her might not notice it. But if a nurse were attending the woman for three or four days longer until the mother had got out of the danger period, she would be competent to take the temperature and would note any rise in the temperature and call in the doctor at once. I submit to the Minister and to the House that anybody who has seen a, case of puerperal fever and seen what it means to the mother, will realise that there is no more agonising disease, sickness or complaint in the world. It means a thousand tortures for the mother, very often ending fatally, and for that reason alone the Minister ought to do his best to get the 14 days as a minimum.

Another important consideration is that of the welfare of the child itself. The period immediately following childbirth is one of the most important periods of the child's life concerning its eyesight. It is necessary for people to be in charge of the child immediately following birth in order to take particular care of its eyesight. There is a disease which is known to anybody who has served on public health authorities or midwifery committees and knows how it is notified to those authorities. It is the disease of opthalmia neonatorum which has resulted in the blindness of many children. It may result in the impairment of the eyesight throughout the person's life if not properly taken care of at the beginning. Very often it can be nipped in the bud and prevented from developing into a much more serious disease if it is properly treated at the beginning by people who understand it. For that reason, again, I say that the period ought to be extended beyond the days mentioned in the Bill, and that someone competent to deal with such things should be there as long as possible.

I am glad that the Bill has been brought forward, because it is a start towards a nationally organised midwifery service. I should have liked more specific terms set out for the compensation of the midwives who will be displaced, but I am glad the Committee insisted that the Minister should have the power of deciding what the compensation should be, and that we are not to have the affairs of the midwives dragged into the county courts, so that morbid-minded people might be able to say: "I saw Mrs. So-and-So's case last week. She made so much in the last three years." It is much better that the Minister should have the power to decide the question rather than, as was suggested by some hon. Members, the cases should go to the county court for trial. I hope that the Bill will be the forerunner of a much more efficient service in the days to come.

9.6 p.m.

Mr. SEXTON

I have listened with great interest to the long Debate on the Report stage and Third Reading of the Bill. I welcome the Bill, because I believe that it will be the gateway to a happier highway for the mothers of this country. What concerns me very much is the little progress that we seem to have made during the last 50 years in regard to maternal mortality. The health Measures which have been passed by this House have tended to save life in the younger years of the child's age and have also served to lengthen the lives of the older people, but in the matter of maternal mortality we have not been so successful. We have not kept the pace in that national field of health that we should have liked to have done. I will not burden the House with figures—although I was a schoolmaster I was never much good at figures—but I would point out that for the 10 years from 1924–33 the total maternal mortality was 27,645, which works out at a percentage of 56 of the total deaths in the country. A fairer comparison which ought to be made would be in respect of the number of women of child-bearing age. We find that the total number of deaths of women of child-bearing age in the 10 years 1924–33 was 434,652, and the maternal mortality 27,645, or a percentage of deaths of childbearing women of over 6 per cent.

We on this side of the House and hon. Members in all parts of the House much deplore that fact, and we deplore it more especially when we find that in the health reports and the British Medical Association Report it is pointed out that most of those deaths were preventable. The Health Department in their report say that at least one-half of those deaths could have been prevented. That report sets out certain recommendations. I will not weary the House with all the recommendations, but I will draw attention to one of them which is germane to the Bill. That recommendation is that there should be some improvement in the pre-certificate and post-certificate training of the midwife. I believe that the midwives of this country are receiving an adequate education, but I have one complaint to make, and that is that the training is rather academic. They learn their theory and their practice, but it takes three things to make a trinity, and over and above the book learning and the actual practice that they get in their work as midwives there is one great essential point, not a physiological one but a psychological one.

The psychological factor should be urged upon midwives in their training. They ought to become the real friend of the mother. They ought to take a lesson out of the books of the old midwives. I stand on the Floor of the House of Commons and pay my tribute to those old midwives. All their equipment was an apron wrapped in a newspaper, but after 50 years the maternal mortality is no lower than it was in those old days. There is something of which we have not reached the bottom, and it is up to the Members of this House, the members of the medical fraternity, and the midwives to find out the one thing that is lacking in our knowledge of maternal mortality. I said that I would pay my tribute to the old midwives of the past, honorary midwives. I stand here as one who was brought into the world by an honorary midwife, and I am one of a huge family. Although their equipment was meagre they had a large fund of neighbourly kindness. If the midwives of to-day in their training will try to get that measure of neighbourly kindness, then in their ante-natal treatment of the mothers they will give the mothers the confidence which begets fortitude, and when the mother goes into the dark shadows she will know that she has with her a friend upon whom she can rely and who will bring her emerging out of those shadows to the delectable hills arid joys of motherhood.

I welcome this step forward, and it certainly is a step forward, with all its limitations. What I look forward to, and I hope that it will come soon, is the co-ordination of all our health services—the services dealing with housing, feeding, and clothing, and the services dealing with maternity, child welfare, health insurance and old age pensions. When we have that co-ordination of all those services we shall be able to look forward to a happier and brighter time and to tackle the problem of maternal mortality among the mothers to be. In every mother to be I see a potential Madonna, and in every newborn child I see a potential deliverer, and God knows we want deliverers to-day. When we get down to the facts and try to find out what it is that we have to do, the day will be happier for this country and the world.

9.14 p.m.

Mr. LYONS

There is a good deal in what the hon. Member has just said with which most of us on this side and indeed every Member of the House will agree. For a long time I have thought that the time has come when all available machinery ought to be mobilised for the benefit of expectant mothers, in order to cope with the great problem of maternal mortality. We welcome this Bill and we congratulate the Minister of Health on having piloted through the House what I think, and what many of us think, is one of the greatest social Measures of the day. As one who served on the Standing Committee dealing with the various Clauses of the Bill I should like to pay my tribute to the manner in which the Minister of Health met the various points that were brought up in full and frank discussion, and to say how much we appreciate the spirit which prompted him in bringing forward this vast Measure of social progress, which I hope will be passed to-night by the unanimous vote of the House.

Let me say a sentence or two about voluntary organisations. The Bill takes advantage of the machinery which has been set up by voluntary organisations throughout the country, and the Minister is quite right in saying that in this first attempt to deal nationally with this great problem he will take advantage of the assistance which voluntary organisations can give towards its solution. Much as I would like to see every piece of machinery mobilised and put into one comprehensive Measure to help the expectant mother, I welcome the attempt which is being made in the Bill to get the full benefit of voluntary organisations in forwarding the scheme, which I hope will meet with every success. For too long the question of maternal mortality has been looked upon from a party standpoint. Some time ago I burdened the House with a number of figures on maternal mortality, and it is manifest from those figures that you cannot dismiss this great question by saying that it is due to malnutrition, or to the operation of any means test, or to the distressed areas.

There is no truth in any such allegation. It is a tragic fact that maternal mortality figures in the South of England, in places like Bournemouth, Brighton, Hastings and Eastbourne, where there is no unemployment, no question of malnutrition, nor any means test, are far greater than they are in the North of England where unemployment is more rife. The figures show that hon. Members in this House and those who support them outside are doing no good service to a cause which we all have at heart when they try to make party capital by saying that maternal mortality exists only where there is malnutrition, only where there is a means test, and only in distressed areas. Take Jarrow, Gateshead, Newcastle, South Shields—

Mr. DEPUTY-SPEAKER

I am puzzled as to how the hon. and learned Member connects this with the Third Reading of the Bill.

Mr. LYONS

I am sorry if T have erred, but I was dealing with the general scheme of the Bill and thought I was in order by showing figures of the north and in pointing out that this great problem was not by any means solely connected with the questions which I have indicated. This great problem demands consideration of all hon. Members, and I am glad to think that at long last we are passing a Measure which will give some safeguard and assurance to those women who are in need of this service. The Bill is to establish an adequate service for every expectant mother irrespective of her position, her means, or her place in society at a time of great anxiety, and to give her the best assistance and service which can be mobilised on her behalf. Every hon. Member will agree that there is no matter of more consequence within the comprehensive system of national health in this country than the problem of the expectant mother. Maternal mortality rates without doubt vary in accordance with the efficiency of the service. We have seen, for instance, a great institution in West Ham working with great success at this subject. For a long time attempts to deal with this problem have been localised, but now at any rate we can rejoice that we are going to give everyone the same chance, the same safeguards and the same assistance as has been given in these purely localised attempts.

The position of the midwife up to now has not been satisfactory. She has been badly remunerated, there has been no incentive to become properly efficient, to have at hand the best and most sterilised instruments to help her, and she has had an insufficient status and no prospects. The Whole of these failures have combined to make the work she has to do inefficient, and I hope we shall put an end to that inefficiency and make a midwifery service which is complete, which is efficient, which is highly trained, and which is at the disposal of every expectant mother anywhere in the country, irrespective of income or station. Many observations have been made tonight about the period of time during which a midwife should be in attendance on an expectant mother. I am not satisfied, and I say quite frankly from the inquiries I have made and the advice I have been given—I take advice on this matter from authoritative quarters—that 10 days is sufficient. The Minister himself does not accept 10 days as being the right minimum of time, and in Committee the right hon. Gentleman said that he was not wedded to that period, but would support a period of time which was most likely to be effective.

I am told by the highest medical authorities that diseases which are most likely to come to women in these circumstances are more likely to come on after 10, 11, 12 and 13 days than during the 10 days, and I express the hope that in October when the period is settled by the Central Midwives Board, it will be extended to such a period as will take in generously all the time during which disease is most likely to occur. If the Central Midwives Board assert, as I believe they will, that 14 or 15 days is the minimum period for safety, then I hope that will be the minimum period which will be prescribed. Nobody can say that 10 days is sufficient, and when the Central Midwives Board put forward an extended period, whatever it is, which will reasonably satisfy medical experience as being sufficient, I hope the Minister will accept the period proposed. I hope that science, inquiry and investigation will not hesitate to say that the period will be fixed at such a minimum as will remove, as far as it can be reasonably removed, from a mother the peril of those diseases which she is likely to encounter during the difficult period after childbirth. I am told that many diseases begin on the twelfth or thirteenth day and have to be closely watched, and I would like to see a clean certificate required from a medical attendant before the expiration of the period in this Bill.

I was one of those who, in my desire to see that the midwife was properly safeguarded, raised in Committee the question of an appeal by the midwife. I do not believe in an appeal to the Minister, and I say so without reservation. I do not believe in any circumstances in sidetracking the subject from his right to go to the courts. If the subject has a grievance the established courts of the land are the only authorities to consider that grievance. We have seen this method work badly in other attempts which have been made, and I do not desire to see any Minister put as judge in his own cause. It is no excuse to say that the midwife does not like publicity. Arrangements could be made whereby she could go to the county court judge in chambers. It would cost her nothing. She could go by herself, if she desired, without payment of any fees or costs and state her case. The Minister said in Committee that if the Bill goes through as now drawn his representative will hear the evidence, and the Minister, who does not hear the evidence or see the person, will make the decision.

That is a great drawback in the Bill. I hope that the Minister will see that the midwife who is taking that course as an aggrieved person will be given every reasonable facility to state and restate her case and amend it. It is a wholly unsatisfactory method of ventilating a grievance and getting a remedy for the Minister to rely on what one of his officers says. No remedy can compare with that given by the courts to any aggrieved person to state her case. I hope the Minister will see that any aggrieved person is not put aside on any case she makes in a letter, possibly badly phrased and insufficiently made out, but that she will be given every opportunity of ensuring that her grievance is properly stated and properly considered, so that the Minister can know the full facts before he makes a decision.

There was a general desire on all sides in Committee to make this a, better Bill. We can congratulate ourselves that, notwithstanding all our difficulties, internally and externally, we have put our hands to the wheel to try and give to the expectant mother that safeguard she gets nowhere else. All over the world this problem exists. We are trying to-night to cope with the problem, which must be present in the mind of every hon. Member in this House. It affects the whole of the country. We are determined, by better status and a more efficient and more competent service of midwives, to deal with this problem. I hope the House recognises that we can, if we have the will, extend these provisions and so make them more beneficial to the people to whom they are to apply. And I hope that the House to-night with one mind and without division will pass this Bill as a great step in social benefit.

9.31 p.m.

Mr. RHYS DAVIES

I have followed this Bill from the time it was produced. I was at its birth, and I can almost say that I was there when it was conceived, for I was on the Committee that brought forth the report on which this Bill is based. I would urge the hon. and learned Gentleman not to exaggerate the importance of this Measure. Let us remember that this Bill is a Midwives Bill, and it is not a "safety in motherhood" Bill.

Mr. SIMMONDS

Would the hon. Member agree that the mother stands a better chance of recovery if she is not suffering from malnutrition?

Mr. DAVIES

I will make my own speech in my own way.

Mr. LYONS

Would the hon. Member tell me whether it is not a fact that the only direct way of giving safeguards to the expectant mother is through machinery such as this to give her the services of a qualified midwife?

Mr. DAVIES

The hon. Gentleman is called learned, but he must learn a little more about this subject.

Viscountess ASTOR

So must you all.

Mr. DAVIES

I do not know why I always seem to anger the Noble Lady.

Viscountess ASTOR

You let me alone.

Mr. DAVIES

Under this Bill when it becomes an Act the midwife will be with the mother 14 days. Will anybody argue that a competent midwife with the mother for 14 days after confinement is going to make all that tremendous change in maternal mortality forecast by the hon. and learned Gentleman? We support this Bill because it will give the midwife a decent salary and a proper status. So far as its effect on maternal mortality is concerned, I doubt whether it will affect that problem very much. I am hoping that it will, and I am certain that if it means that a more competent midwife attends in confinement, the Bill will do something towards it. But to suppose that it is going to make a serious attack on maternal mortality is nothing but moonshine.

An hon. Member on this side said that maternal mortality is high in the distressed areas. I do not wish to be vulgar, but my view of life, after a great deal of experience, is that some people suffer from eating too much and others from eating too little. Some people are ill because they are too well fed and others because they are too badly fed. As a layman who is very closely interested in these problems, I am willing to believe the statement of the hon. and learned Gentleman the Member for East Leicester that in towns such as Bournemouth and Eastbourne they are as badly off physically as they are in Durham; but that is no reason why we should not attempt to save the mothers of Durham and Eastbourne and Bournemouth alike. If we can we should save them all, but this Bill does not save them. From the speech of the hon. and learned Gentleman one would imagine that there is to be a general clean-up of the whole midwifery service of the land, that specialists are coming in to render services to the mothers in confinement; but he knows as well as I do that all this Bill does is to improve the status and pay of the midwives, and in that connection we support the Measure. I note that the right hon. Gentleman the Minister of Health is listening attentively to what I am saying, and I am sure that when he removes all the imagination he possesses on the public platform outside, he will agree with all that I have said.

We have been criticised for our attitude on this Bill. We have been criticised because of our unwillingness to have the voluntary organisations within the provisions of the Bill. Why should we not be critical of voluntary organisations? First and foremost, the local authorities in this country have proved themselves to be one thing above all others, they are in the main efficient because their activities are open to public criticism. The voluntary organisations are not open to public criticism. As a matter of fact, cases of which I have heard from time to time show that some voluntary organisations ought never to have existed. In our criticism we have one thing in our favour: whether the local authorities are governed by Liberals, Conservatives or Socialists, it may be said in the main that they are clean, they are conducted efficiently and they are generally well managed. That cannot be said as a general thing about voluntary organisations. That is the main reason we oppose this very necessary work being handed over to voluntary organisations. The right hon. Gentleman said something about our attitude with regard to the 14 days minimum lying-in period. In criticising our attitude he said, "We have to be very careful because if we put 14 days into an Act of Parliament, the time may come when we shall want to put in 21 days." He used that argument against the 14 days minimum lying-in period. But he knows as well as I do that however Socialist we may become in this country, it is amazing how Tory we remain in all the things we do. The first Midwives Bill was in 1902, 34 years ago.

Viscountess ASTOR

Since then women have had the vote.

Mr. DAVIES

Yes, but if some women would learn to be silent, I think Parliament would make much more progress. I hope I am not being offensive to the Noble Lady. The point I was making was that the right hon. Gentleman said that we must not put 14 days in this Bill, because the Government may want to increase the 14 days to 21. Now, we have had very grave difficulty in convincing the Government that 14 days instead of 10 days should be inserted in the rules, and I am not sure that it was not a slip on the part of the Parliamentary Secretary, because his chief was in Bradford, or some other town, that day. I must say, as I have said before, that on every Bill brought before the House from the Ministry of Health we have done very much better with the Minister absent.

Mr. DUNCAN

I am sure the hon. Member does not wish to mislead the House, but I would point out that the pressure about the 14 clays lying-in period did not come only from his side of the House. I also had an Amendment down for 14 days, and if there was any pressure it was not from hon. Members opposite only.

Mr. DAVIES

I do not dispute that, but I would say that we went one day better than the hon. Member, and if he had put 15 days, we would have put 16. The point I wanted to make was that in using such an argument the Minister was only begging the question, because he knows full well that when we pass a Bill through this House the provisions of the Act very often, if not always, have to last for at least a decade. Therefore, I do not think he was justified in using that argument. As I have said before, from the midwives' point of view this is a very useful Measure, and it will undoubtedly be reflected in the better treatment of the mother during confinement, but the problem of maternal mortality is only incidental to the Bill.

The day is fast approaching in this country when the child will be very much more welcome than A is to-day. The decline in the birth rate is still going on. In some seaside resorts in this country there are more people over 60 years of age than under 14, and the trend is still proceeding in that direction. There is an extension of the average age every year and a decline in the birth rate at the same time. This Bill is well conceived, so far as the midwife is concerned, with the intention of providing a better service for the mother in confinement, but the value of the child will increase in the eyes of the public and in the estimation of the Government as the decline in the birth rate goes on. I hope to see the day come when the mother in confinement will have something even more than mere good attention at child-birth. Fourteen days' attention from a skilled midwife is hardly enough.

Before I sit down I wish to pay a tribute to the Noble Lady the Member for the Sutton Division of Plymouth (Viscountess Astor). Even though she is a Tory, she has some good points. I want to pay a tribute to her for her advocacy of nursery schools. If she can achieve her object, that will relieve and help the mother almost as much as good midwifery service in confinement. There is nothing more heartrending than the spectacle of a mother with two or three little ones round her all day long while she is nursing a newly-born infant. Although this Bill is necessary and is, indeed, a good Bill for the midwives of this country, the problem of maternal mortality remains to be tackled and nobody knows that better than the right hon. Gentleman.

9.46 p.m.

Sir K. WOOD

May I say first how much I appreciate the fact that the hon. Member for Bothwell (Mr. Lunn) was able to take part in the Debate to-day notwithstanding the tragic circumstances of which he informed the House, and also how much I appreciate the consideration and help which he has given throughout all the stages of this Bill, and particularly in Committee. I also desire to thank hon. Members of the Committee upstairs and of the House generally for the careful consideration which has been given to this Measure. Although it is but a short Bill it occupied a number of days in Committee, and I think the House will realise that I and my hon. Friend the Parliamentary Secretary gave consideration to all Amendments which were submitted for the purpose of improving the Measure and accepted a very large number of Amendments from all quarters with that end in view. It is common form for the Opposition on a Bill of this character to say that it ought to go further, that other provisions might have been made and to offer criticisms of that kind, but I confess I was rather surprised that the hon. Member for Westhoughton (Mr. Rhys Davies) took that course just now. It is within the recollection of hon. Members that he described the Bill generally as a rather trumpery affair, and expressed the opinion that it would only be of value to the midwives. I think that is a fair interpretation of what he said.

Mr. RHYS DAVIES

Not quite.

Sir K. WOOD

If the hon. Gentleman would like to amend it I am prepared to give way to him but I think it is a fair representation of what he said. But that was not what he said some time ago. I have here a report of a body called the Joint Council on Midwifery in the proceedings of which a number of distinguished gentlemen took part. I see that among those who signed the report without any dissent there is one, described as an independent member—which I think was a good title for the gentleman concerned at that particular moment—named, Mr. Rhys Davies, M.P. I am gratified to observe that so far from belittling this proposal and saying that it is only for the benefit of the midwives the report contains this statement which has the endorsement of the hon. Gentleman: A well-trained, well-informed and intelligent service of midwives, working in co-operation with the medical profession is, therefore, of premier importance in any scheme for the reduction of maternal mortality and morbidity. I am satisfied to accept that judgment on the proposals in the Bill and I think it is generally agreed that, as far as any immediate measure is possible in present circumstances, the provision of an adequate midwifery service is the step which promises best at this juncture. I agree with what has been said in all quarters of the House to the effect that no one can regard this Measure as the only solution or as indicating the only way of tackling the problem and, as regards other steps which are open at this moment to local authorities and voluntary organisations, I assure the House that I shall do my best to encourage them. Various references have been made to armaments and to expenditure on social services and comparisons of that kind. I can say that services for making better provision for maternity cases are steadily progressing. I find that, since 1921, ante-natal clinics have increased by 20 per cent. and last year the encouragement which has been given in this matter by people of all parties and all sections was shown by the fact that attendances at these clinics totalled over 1,000,000. I wish also to assure the House that postnatal facilities are steadily increasing. Maternity and child welfare authorities to-day can show considerable progress since the time when the hon. Gentleman and his colleagues had responsibilities in this matter. Some 400 maternity and child welfare authorities are supplying milk, either free or at less than cost, to necessitous expectant mothers.

On that aspect of the matter, I desire to remark only that while this Bill may be a contribution and while the services which I have mentioned may also be contributions, that is not the end of the matter as far as I am concerned. For some considerable time the Ministry have authorised expert inquiries into the various problems of maternal mortality and the causes of the high rate. For some months, expert medical men have been conducting examinations into the circumstances of those areas where the rate is high, and for purposes of comparison they have also visited areas in which there is a low rate. For months a number of officers have been devoting themselves exclusively to that work. I hope to receive by the end of the year the report of this inquiry, which I believe will be the most extensive and expert report on the subject ever obtained in this or perhaps any other country. When I receive it, I shall certainly make it available to the House and we shall then be able to consider what steps we can usefully take to deal with this very difficult problem. Many courses may be open to us. I would not dogmatise on this question. I believe that the problem will have to be tackled on many sides and in many forms. Speaking in advance of the report to which I have just referred, I do not believe it will be found that there is any single way of dealing with the problem. I believe there are many ways in which it will have to be attacked if we are to defeat it.

I do not wish to be drawn into a controversy as to how far malnutrition plays a part in this problem, because we are to debate the subject of malnutrition tomorrow. It is an extraordinary thing, but, as was pointed out by the hon. Gentleman who mentioned a tragic personal case to the House this afternoon, you cannot dispose of this question by saying that it is the poor who suffer from this high maternal mortality rate or that it is people who are under-fed who suffer from it. It is a far more difficult problem than that. I am convinced, from all the attention which I have endeavoured to give to this matter and from the extent to which we have found it in this country that certainly an expert midwifery service promises us a great deal. It is a most extraordinary thing that when you find a whole-time mid-wifely service in existence, particularly in a number of rural districts, you find the maternal mortality rate sometimes half the average rate for the country. It is on that, to a very large extent, that I am building my hopes.

Now I must say a word, very briefly, upon the major matter which has divided the hon. Members opposite and myself so far as this Bill is concerned. They have sought, both in Committee and again during the Report stage, to delete from the machinery of this Measure any scope for the voluntary organisations, and if they could have their way, as they have repeatedly said, no voluntary organisation in this country would play any part in the future in the provision of maternity services in this country. I cannot conceive for a moment that they would get much support for that policy in the country, and I do not think they would get much support for it from many of their own followers in the country. I say that because, as a matter of fact, what do I find when I examine the position of many of the local authorities which have a Socialist majority at the present time? I find that they are working, as a matter of fact, in full co-operation and on the very best of terms with the voluntary organisations in their area, and they have no desire to see the voluntary organisations wiped out. There was a very interesting letter in the "Times" only a short time ago, from the secretary of the Plaistow Maternity Hospital and District Nurses' Home, in the district of West Ham, where they have a tremendous Socialist majority, and this is what the secretary said, and it is the view of a large number of people, of all political views, up and down the country: I notice in the report on the further consideration by the Standing Committee of the House of Commons published in the 'Times' to-day that Mr. Rhys Davies, Labour Member for Westhoughton, stated: 'The Labour party were satisfied that the midwifery service of the country had ignominiously failed because of the failure of voluntaryism.' Reading such words as these, I cannot help but wonder whether such a sweeping statement is made under ignorance of the facts, or is just made in blind prejudice against voluntary institutions. Only a few days ago the record of West Ham "— Hon. Members will remember that I referred to it on the Second Reading— with its low rate of maternal mortality—2.48 per 1,000 births—in the borough, was referred to in the House. It is in West Ham that this hospital, the Plaistow Maternity Hospital and District Nurses' Home, carries on the greater part of its work. Actually our midwives attend every year to a large majority of the midwifery cases in the borough. During the past 26 years our midwives, in our hospital and at the homes of the patients, have attended to 111,406 midwifery eases, and during that time and notwithstanding that large number of cases, only 123 mothers died in childbirth, a rate of maternal mortality of only 1.10 per 1,000 cases. I would like the House to listen to the rest of the letter: West Ham is itself a Labour borough with a Labour council, but I am glad to say that our relations with the council are of the happiest, and it is largely because we are able to do our work in close co-operation with, and with financial assistance from, the council, that West Ham is able to point an example of what can be done in the way of lowering the rate of maternal mortality. I would suggest that Mr. Rhys Davies should study and think over these figures before making any such rash statements. I read that letter because it is rather on the basis of the idea in that letter that this Bill is framed. I am not attempting to set up rival claims between local authorities and voluntary organisations in connection with these proposals. I want to see them both working in co-operation here, as they are doing in West Ham, and when the hon. Gentleman opposite says that the midwifery service of the country has largely failed because of the work of the voluntary associations, nothing is further from the fact. As a matter of fact, I am not blaming the local authorities, but I have had largely to bring in this Bill because of the failure of the local authorities to appoint midwives themselves. They are allowed to do so at this moment, and yet I find that, as far as London is concerned—the right hon. Gentleman opposite knows it full well in connection with the borough councils, and I am not blaming them, because they have their reasons for not doing much—they have only appointed eight midwives over the last three or four years. On the other hand, I find that the great work in connection with the midwifery services, particularly in the rural areas of the country, has been carried out by these great voluntary organisations, and where they have carried out that work the maternal mortality rate is much lower than the rate for the rest of the country.

Therefore, I say that any Minister would take the same step as I am taking, when I say that we will set up a municipal service in which these local authorities shall be the supervising authorities, and that they shall invite and consult with the voluntary associations in their area and utilise them to the best of their ability. If there is any dispute as to the arrangements between the voluntary organisations and the local authorities, then they shall go to the Minister of Health, and whoever he may be who may succeed me, he shall decide as to the best scheme which shall be available, and then the Minister shall be responsible for it so far as the House of Commons is concerned. Surely everyone will agree that to make a blind attack upon the voluntary associations of the country and say we are going to wipe them completely out, that directly this new service is begun they have to finish, would be the height of folly and would certainly not commend itself to the people of this country. Now, if the hon. Member opposite wants to say something, let him say it.

Mr. RHYS DAVIES

If the right hon. Gentleman is so very satisfied with the work of the voluntary organisations, what purpose is there in bringing in this Bill to compel the local authorities to do the job which the voluntary organisations have failed to do?

Sir K. WOOD

The answer to that is this: I am not claiming for the voluntary organisations that they have made a complete service for the country. Their great work has been in the rural areas. When one looks round at ninny of the other districts, particularly in the towns and cities, one cannot be satisfied with the service that has been provided. Therefore, I say that I am doing a wise thing in endeavouring to avail myself of both organisations. Far from the local authorities following what I think is the unwise lead which the Labour party have endeavoured to give throughout the proceedings on this Bill, we shall find that the local authorities and the voluntary organisations will act in co-operation and agreement to carry out the provisions of the Bill, and that we shall not have that blind hatred of the voluntary organisations which has been expressed by hon. Members opposite. I have the greatest confidence that they will work happily and smoothly together, and that, as a result of this Bill, we shall get the best from both the local authorities and the voluntary organisations.

The financial provisions of the Bill were at first criticised, but it is interesting to observe that this is the first time since the passing of the Local Government Act, 1929, that a new service has been instituted in connection with our social endeavours. It was a new thing and anybody who had the responsibility for the financial proposals of this Bill had to come to some decision concerning them. We might have fallen back on the old system, which I hope has long gone, of giving a local authority a half of whatever it might like to spend. That would mean that the authorities that were the best off would get most assistance from the State and that the poor authorities, whose need was probably the most, might very well receive less. In the proposals of this Bill I am glad to think that the needs of the particular areas is the prime consideration and that the areas whose needs are greatest will receive the best financial consideration. This is of great moment in the setting up of a new service, and I will give two illustrations of how it will work. Sunderland and Merthyr Tydfil will receive something like 80 or 85 per cent. of any expenditure they may make. Gateshead and Glamorgan will receive 76 per cent.

I am grateful for the general agreement in the House that the Bill will do a great deal for midwives. It will certainly secure a considerable improvement in the conditions of midwives and a better training. Some of the most pathetic things that I have read were letters describing the present position of some of the midwives. One of them wrote: I doubt whether I have earned £90 out of 150 cases. Another sent a letter saying: There are four other midwives within a stone's-throw of my house. My yearly earnings are not more than £40. Another sent this communication: I can usually get just 25s. but I cannot get a living, and I shall be compelled in a few weeks to take anything I can get to earn a living. The last, which I think was the most pathetic, was this: In many cases I have had to take 6d. and 1s. a week, and many patients have not paid at all. We are all in agreement, 1 think, that the provisions of this Bill will do a great deal to end that disgraceful state of affairs. The midwife in future will be a member of an organised service. She will be an integral part of the public health service and no longer a somewhat lone figure in the campaign against maternal mortality. There has been a difficulty, inasmuch as certain local authorities have adopted rules which require their female officers to retire on marriage. After consulting the associations of local authorities and the London County Council, I intend to point out to local authorities that there is nothing in the Bill to prevent the employment of married midwives, and to recommend any authorities whose rules would prevent their employment to revise the rules so as to enable the authorities, in selecting the midwives first appointed to the new service, to have regard only to their efficiency as midwives. I am glad to say that I have the assent of the associations and of the London County Council, who assure me that they share my views entirely on this matter.

The Parliamentary Secretary, who has helped me so much in this matter, has already stated that we would not like anyone, because we are bringing in this Bill to deal with maternal mortality, to think that we are indulging in statements which will lead a number of mothers to think that departures from the normal occur in more than a small proportion of cases. I read a statement last week of someone who spoke at a conference in connection with maternity services, who said that it was safer to be in a car accident than to become a mother. I regret alarmist statements of that kind, which might themselves be a contribution to increased mortality, We do not want to frighten women, because motherhood is a natural event and not a serious surgical operation.

I claim for the Bill that it is a vital necessity, in which claim, I think, I shall have the support of most of the informed opinion of the country, and that it is urgent, and I claim also that it provides a workable scheme. I believe that under it the local authorities and the voluntary organisations will tackle their new task with efficiency and, I think with enthusiasm; and I believe that it will raise the whole status of the midwifery profession and give a better midwifery service for mothers. It is an honest and sincere contribution to the effort we are making to reduce the present figures of maternal mortality.

Question, "That the Bill be now read the Third time," put, and agreed to.

Bill read the Third time, and passed.