Motion made, and Question proposed,
That a sum, not exceeding £16,093,846, be granted to His Majesty, to complete the sum necessary to defray the charge which will come in course of payment during the year ending on the 31st day of March, 1938, for the Salaries and Expenses of the Ministry of Health; including Grants, a Grant in Aid, and other Expenses in connection with Housing, certain Grants to Local Authorities, etc., Grants in Aid in respect of Benefits, etc., under the National Health Insurance Act, certain Expenses in connection with the widows', Orphans', and Old Age Contributory Pensions Act, and other Services."—[Note.—£6,000,000 has been voted on account.]
§ 11.6 a.m.
§ Mr. Arthur Greenwood
May I ask for your ruling, Captain Bourne, on the order of business? There are several Votes down, and it may be for the convenience of the Committee if we have a general debate on these matters.
I think that, if the Committee agrees, it very obviously would. On a service such as this hon. Members may wish to raise different points. It would be rather difficult to confine the discussion, and therefore I think it would be better to have a general discussion.
§ Mr. Greenwood
I thank you, Captain Bourne. I think that the arrangement will be for the convenience of the Committee. I propose to follow the excellent example set in the last Debate of short speeches, and, therefore, I shall not cover the whole of the ground which was covered by the right hon. Gentleman. One thing, however, to which I would ask him to make reference in the course of the debate, is the work of the Board of Control, and I would ask personally, because of my own special interest in it, for some observations on the operation of the Mental 730 Treatment Act. I must, of course, join the volume of congratulations to the right hon. Gentleman on the masterly survey of the work of his Department. We know him to be a very skilful and a very adroit speaker in the House. He knows where to enlarge and strengthen, and where to slur over difficulties, or to look them squarely in the face and then pass them by. He knows, and nobody better, how to sidestep to avoid the morass he sees in front of him. Such consummate skill is given to very few of us, and I myself would never try to emulate him.
In the earlier part of his speech he made reference to the steadily declining birthrate and the trend of population. That, obviously, is an outstanding psychological problem of first importance. I am not going to saying anything about policy, but I think it is clear that we ought to know what is happening and, as far as possible, to learn why it is happening. As I understand the right hon. Gentleman, he is not at this point concerned with the problem of policy, but with the facts and tendencies out of which future policy can be formed. It will be at that stage that there may be a severe clash of opinion. But I think that the Committee will agree that ignorance is no guide to future action, and if the right hon. Gentleman can extend our knowledge of this very complex problem, I am sure that he will receive the thanks of all sides of the Committee.
I turn to the subject to which I shall practically confine myself this morning—the question of housing—because it is quite clear to me, having gone into the speech of the right hon. Gentleman very carefully, that his conscience is a little disturbed. I would remind the Committee of the melancholy history of housing during the past few years. For nearly six years now the right hon. Gentleman and his friends have had pretty much their own way. They began this inglorious record in the matter of housing by repealing the Wheatley subsidy, and then proceeded to massacre the last Act for which I was responsible—the Housing (Rural Authorities) Act. They then at long last introduced what proved to be a perfectly abortive Housing (Financial Provisions) Act, which was so bad that its author was buried in the obscurity of the House of Lords, and then, in order to fill up the gap largely 731 of their own creation, we have the Housing Act, 1935, dealing with overcrowding. Now the right hon. Gentleman is left with only three pieces of effective legislation, not all of them equally effective. He is administering the Housing (Rural Workers) Act, 1926, an Act which I saved from death in 1931 with no special enthusiasm, and an Act which has now been continued a little longer by the Act of 1935. The right hon. Gentleman spoke some words of praise about that Act, but the net result of its 10 years' operation is to have patched up about 12,000 rural cottages, which is not, therefore, a very great contribution to the rural housing problem, to which I shall return, as he did in the course of his speech.
Secondly, we have that overcrowding Act of 1935. The right hon. Gentleman said very little about it, and I am prepared to accept his word that, after all, two years is not a long time, but all he talked about in his speech was the establishment of his appointed days. To that he devoted some little time, but, as far as I can tell, nothing has yet been done to deal with the problem of overcrowding under this Act. The reason, I suspect, is that local authorities, realising that the Act is a fraud, have concentrated their energies on the Act of 1930, under which they have scope enough to keep them busy for some considerable time. That contribution so far is negligible. The right hon. Gentleman, I believe, stated that he was thinking of issuing a White Paper. We shall welcome that White Paper, and we shall be glad to know how this problem of overcrowding has been attacked apart from the settlement of appointed days. That leaves us with the only special housing Measure of any importance, and that is the Act of 1930, where the effective work is being done now to deal with the re-housing of the people. The right hon. Gentleman made a great parade of housing figures. He can do that excellently. He lumps in all the houses for which he never was responsible, he boosts up his figures by telling us how many houses private enterprise has built, he has the houses under the 1930 Act, and then, with a magnificent gesture, he implies to the House "Alone I did it." This housing progress is not nearly as large as it appears, for although the right hon.
732 Gentleman pointed out that now the private builder is building rather more houses to let than he was a year or two ago, still that proportion of those houses which are of a working class type is still very small, and the major contribution to the solution of the housing problem is still coming from the Act of 1930.
Four things emerged from the remarks of the right hon. Gentleman about housing. First, it was perfectly clear that he was very dissatisfied with the adequacy of our rural housing position. I was glad to see this sign of grace in him. He is so worried about it that he has asked the Central Housing Advisory Committee to consider further steps in rural housing. A measure of that kind is badly needed, and if it had not been for the precipitancy and rather short-sighted action of the first National Government in 1931 in winding up the Housing (Rural Authorities) Act, we should by the end of that winter have had the addition of 40,000 rural cottages, built in areas which otherwise could not have provided them, and let at rents which would have been within the means of the agricultural worker. I am glad the right hon. Gentleman's conscience is pricking him about this matter. The more his conscience pricks him, the fonder I shall grow of him. There obviously, is one cause of the right hon. Gentleman's unhappiness. I know that he smiles all over the House when he speaks or when he does not speak, but it is clear that behind them there is a heavy heart over some of these problems.
I was glad of another admission in regard to overcrowding. We have always said that the overcrowding standards were utterly inadequate, and that we could never accept the standard which permits a living room to be regarded as a bedroom. I am glad, therefore, that the right hon. Gentleman is turning his mind to that subject. I will quote his words:I would again express my personal judgment that while we are now dealing with some of the worst housing conditions in respect of overcrowding, as we are able to carry out our present programme, we shall be able to proceed to improve the present overcrowding standard in this country."—[OFFICIAL REPORT, 8th June, 1937, Col. 1612, Vol. 324.]If that is a confession of his recognition of the unsatisfactory standard of overcrowding, we welcome the confession. 733 It also struck me that the right hon. Gentleman was a little worried about the possibility of maintaining the building programme. I think he said that he hoped to continue buildingat a rate which should ensure the maintenance of the building programme at the same level during the coming year."—[OFFICIAL REPORT, 8th June, 1937; col. 1609, vol. 324.]He did not say "will"; he is not in the least certain that it will do. Here I come to another question which is bothering the right hon. Gentleman, and that is the cost of housing. He tells us that the cost of housing during the past year has increased, taking the non-parlour type of house with three bedrooms, on an average from March, 1931, to March, 1937, from £311 to £338. He then went on to try to minimise its importance by saying that most of it was due to timber, and £3 to increased labour rates, which I believe are automatically determined by the cost of living. We all know that the cost of living has gone up. I am not blaming the right hon. Gentleman directly for that. The truth is, however, that the problem is a little more serious than it appears. An increase of 8 per cent. in one year is not negligible, and that increase has not ended so far as I can see.
All that the right hon. Gentleman says that he is going to do is to watch and pray. I do not believe in faith without works, and watching and praying is not going to deal with the problem. He is well aware of, shall we say, the operations of the National Pipe Federation, an organisation two years old, a virtual monopoly, which has forced up prices. He knows that that is not the only ring which is manipulating th price level. While he drew attention to the increase in the price of timber he forgot to tell us that the price of lead is about double what it was a year ago. The predominant reason for this is the Government's rearmament programme. When that programme was first adumbrated in a White Paper nearly two years ago, I pointed out that the effect of it would be felt on housing and on our social services. That effect is beginning now. The result of these rising prices—and it is another cause of the right hon. Gentleman's unhappiness—is that as housing costs rise the number of houses will fall. There cannot be the slightest doubt about that. If prices go on rising the right hon. Gentleman will 734 himself restrict the output of houses, because he will refuse power to the local authorities to build houses at prices which he thinks are too high. That is a very serious situation. It is not a housing problem in itself, but it is one of the reactions of the rearmament programme. I prophesy—and I hope that I shall be here next year to prove whether I am right or not—that during the coming year the housing programme will be damped down. Rising prices will mean restricted building. The shortage of supplies now means deferred building. Authority after authority, who have approval from the right hon. Gentleman, now find that they cannot get delivery of the materials because of the enormous demand for those materials for the rearmament programme. Therefore, I am afraid that the right hon. Gentleman is going to find his wings somewhat clipped.
Another point is the declaration of the right hon. Gentleman's intention to continue the 1930 subsidy for a further nine months. For that I am very grateful. I hope that he is not going to start monkeying about with that matter. If he wants to try his financial genius he might try it on the Act of 1935 dealing with overcrowding, and I should be the first to support him in that. Why does he propose only to extend the subsidy for nine months? He knows that a period of nine months is not going to finish the abolition of the slums. He knows there is no sign of building costs falling; on the contrary, they are rising. He, therefore, cannot have in his mind the possibility that at the end of nine months he is going to reduce the subsidy. I should have been more pleased if he had taken his courage in both hands and had made the extension for a longer period. For once the right hon. Gentleman has been more frank than usual, and, reading between the lines, as one is always entitled to do when he speaks, one feels that he is aware of some of these problems which are very largely of his own creation or the creation of his predecessor.
On the right hon. Gentleman's speech as a whole—and these are my last words—we are glad that he is able to report a development of the social services. Much of what the right hon. Gentleman said in his speech, more particularly with regard to infants and children under school age, was warmly welcomed on this side of the Committee. Where the problems of the 735 social services are concerned—they are now really part of the life-blood of the common people and essential to their happiness—the right hon. Gentleman will find warm friends on this side of the House. I hope he will continue to develop our social services. I shall not begrudge him any honour which may come to him as a consequence. I can assure him that if he will tread the path of generosity in this matter he will have us behind him. If, however, he begins to waver, as he appears to be about housing, then I am afraid his reception will not be as warm as it otherwise would be.
§ 11.27 a.m.
§ Mr. H. Strauss
There are so many topics with which the right hon. Gentleman is concerned that it would not be difficult to speak on several where one could praise him for his complete or partial success, but I am sure he will forgive me if I deal with a topic in which the failure of the Ministry of Health up to date has been complete. It is a failure, needless to say, not of the right hon. Gentleman, but a failure which has characterised the Department throughout its history. If I mention this failure it is because the right hon. Gentleman has given such great proof of his capacity in so many fields of policy that I hope before his tenure of his great office is ended he will have remedied this failure. The matter with which I wish to deal is, in my opinion, a public scandal and a national shame. I refer to the destruction of the beauty of urban and rural England. The fact of this destruction and the pace at which it is proceeding are not disputed in any quarter of the Committee. The House of Commons, by an unanimous Resolution on 10th February this year, recorded the fact that it deplored this destruction of the beauties of town and country, and took this further step—it declared that this destruction was a matter of national concern. When a matter becomes of national concern one expects the Government of the country to deal with it.
I particularly mention town and country because I believe, in common with all those who have devoted themselves in any way to a study of this problem, that the problems of town and country are not separate but closely related. Many hon. Members may have seen a book published a week or two ago 736 "Britain and the Beast". In a brilliant and suggestive essay by Mr. G. M. Boumphrey the close connection between these two problems is ably pointed out. If we could make our towns less repulsive and more worthy of the possibilities of to-day there would be less of this blind rush to escape from them, which is rapidly destroying the country. The notion that a town is necessarily a blot on the landscape is quite modern. There is no necessity for a town to be a blot on the landscape. Two things are obviously necessary in a civilised existence; the town which has given us the civic virtues and the arts, and the country, which has given us natural beauty, greenness and solitude, recreation, serenity, and peace. To-day we are destroying the characteristic virtues of both town and country, and creating in their place a universal, hideous, formless suburbia, without the charm of city or the charm of country, or any charm at all. The result, as has been pointed out by many hon. Members including several on the Opposition side of the House, is that we are driving millions in this country to lead a sort of life in which if they have got some sort of home in what they hoped would be the country, they see the country being destroyed around them, they have to journey in overcrowded conveyances, and spend hours getting to their work in the towns from which all charm has departed. All this can be and should be remedied.
I am not going to enlarge on the nature of England's beauty. I think every hon. Member is agreed that it has a unique beauty. I think it was the hon. Member for Gower (Mr. Grenfell) in his speech on the last occasion who recorded an experience which is common to so many of us on our return to this country after travelling abroad. We are astonished at its incredible beauty, its variety and its unique charm. I would, however, call attention to one characteristic of the beauty of England which, I think, is very important if we are to act wisely in order to preserve it; that is the vulnerability of this beauty. There are certain things in England which have no parallel in any part of the world.
§ Mr. Strauss
I quite agree, but I think I had better deal with the examples which 737 are most familiar to me. Take the English Downs, which present perhaps the noblest, the most sublime and spiritual beauty in all nature. There is nothing like them anywhere in the world. If we destroy them we destroy them altogether, and for the whole world. If you contrast that characteristically English scenery with the beauties of say the Rocky Mountains of Canada, what strikes one at once is, that in the Rocky Mountains the work of nature is on so stupendous a scale and so dwarfs the work of man, that even if the work of man is bogus, trivial or unworthy, the beauty of nature is not thereby ruined. That is far from being true of the English Downs. The Downs do not impress by their grandeur or their size; the loveliness of their lines is subtle and delicate. It is quite as possible to destroy those delicate lines and mar that incredible beauty by sham and unworthy buildings, as it is to go into the National Gallery and hack a masterpiece to pieces. The difference is that whereas the latter course would quickly land you in prison or in a lunatic asylum, if you took the former course you might even make a fortune. Therefore, if the beauty of England is uniquely beautiful, it is also uniquely vulnerable.
What is threatening this beauty? It is mainly threatened by two things—buildings where no buildings should be and unworthy buildings. To take the first point, is it not obvious that there are some coasts, hillsides, downs, some banks of rivers and lakes, which ought in the public interest to remain free from buildings altogether? If one scatters a few buildings on the downs, one renders the whole of England a poorer place. My right hon. Friend the Minister of Health said that 3,000,000 houses and more had been built since the War, but he had no statistics to show how many of those houses have been put up where no buildings ever should have been put up, to mar probably for all time the beauty of this country. Those of us who urge that buildings should be put up in the right and not in the wrong places are not saying anything antagonistic to development or to the building trade. We are merely pleading for such ordered arrangement and planning as will save our great national heritage of beauty.
But if buildings in the wrong place are had, equally great is the evil of buildings of unworthy design. Whatever else may 738 be required of great architecture, this at last is required—honesty, genuineness and functional utility. The greatest curse in this country at the present day is the almost unbelievable worship of "Ye Olde" things. The other day I saw a "Ye Olde Wireless Shoppe". That piece of lunacy is characteristic of most of the buildings that are being put up. The other day, when speaking on one of the few occasions when I was able to follow and agree with the right hon. Gentleman the Leader of the Opposition, I mentioned that in a suburb through which I had recently driven, even a town-planned suburb, I had seen three alternatives offered to the public, a "Cosy Palace," a "Bijou Baronial Hall" and a "Tudor Garage"; and I remarked that the one thing that you could not get for love or money in that suburb was a decent house. In common with the right hon. Gentleman the leader of the Opposition, I was abused for my remarks in a builders' journal, and I daresay I minded it as little as he did. But the writer who rebuked me was evidently under the impression that the description which I had given of these houses was my own. I can assure him that if I had given my own description of them, I might indeed have appeared rude. Those descriptions were applied to the buildings by the people who were putting them up.
§ Mr. Strauss
That is a short-sighted interruption. If the houses were of decent design, it would not delay production. I do not differ from the hon. Member who interrupted me in thinking that more houses are necessary. I have no quarrel with him there, and I hope he will listen to me and have no quarrel with me for pleading for decent architecture, for genuineness instead of shams. Let me suggest a simple test. Let any hon. Member in any quarter of the Committee buy almost any newspaper tomorrow for one penny and he will probably find a complete page of advertisements of houses that are being built. He will be very lucky if he discovers one decent design among them, and he w ill probably discover that at least 90 per cent. of them are houses which, in a civilised community, would not be put up at all. He will find overdecorated, vulgar, tawdry and ill designed houses with gables, 739 creosoted boards, and all the bogus additions that are characteristic of Jerrybethan England. These things do not make houses cheaper or easier to build; they only make England poorer by desecrating the places where they are put. People sometimes talk as if what was wrong with building was uniformity. Of course, it is nothing of the sort. No speculative builders in this country are worse than those who offer, say, 20 different designs.
In no period of great architecture have people been frightened of uniformity. Does anyone complain of the uniformity of the terraces at Bath, the uniformity of Nash's London or the uniformity of the Bloomsbury Squares? Of course not. [An HON. MEMBER: "What about working-class houses?"]—In those countries that have the best working-class houses, there may be many different designs, but they are never frightened of making one house the same as its neighbour so as to get an orderly street. I recommend the hon. Member who interrupted me to study the progress in working-class houses where it has been best. Let him look at the examples in some of the Scandinavian countries and elsewhere. I do not say that uniformity cannot be horrible. If it is uniformity of horror, of course it is horrible; but one does not get any better results by breaking the uniformity so as to get a variety of horror. What is wrong with such architecture is not uniformity, but the fact that it is bad, unworthy and ill-designed building.
But if buildings in the wrong place are bad, and if buildings of bad design are bad, worst of all is the brilliant method by which we have combined these twin horrors by ribbon development, a method by which we are destroying the beauty of England, not slowly or gradually, but as by a raging pestilence. It is not a blot on the landscape; it abolishes the landscape itself. Everyone knows the process and has experienced it. A new road is built at great public expense. For a few short weeks it is possible to travel joyfully through some of the most beautiful country in the world. No sooner is the road completed than the margins are offered for sale for building purposes.
Am I not right in thinking that ribbon development is a matter for the Ministry of Transport, and not for the Ministry of Health?
§ Mr. Strauss
I think it may be dealt with under town and country planning. The Minister in his speech dealt with the inquiry which he is making to ascertain how far his present powers are adequate. I do not propose to develop any argument about the failure or otherwise of the Ministry of Transport in the matter. I was saying that no sooner is the road completed than the margins are offered for sale for building purposes, and within a few weeks, if one travels along the road, one finds both sides covered with buildings in what I may describe as the "Jerrybethan" style. After a few months have passed, the road becomes inadequate to serve both the needs of the through traffic for which it was created and the needs of the unfortunate inhabitants of those houses. A short time afterwards there is a demand for a by-pass to by-pass the by-pass, and so on ad infinitum. The whole scheme might have been devised by a perverse genius who wished to destroy as much country as possible while putting up as few houses as possible, and to lay waste the loveliness of rural England without creating the possibility of a civilised life. I know that, at long last, this process has been partially checked by an Act which, as you, Captain Bourne, have pointed out, is an Act administered by the Ministry of Transport. But it has only been partially checked, as anybody can see. The right thing to do with ribbon building is to stop it, and not to put the ribbon a little further back from the road.
The right hon. Gentleman may wonder what practical suggestions I would make. Let me tell him. The Town and Country Planning Act, whatever its merits may be, is demonstrably not acting fast enough to save the beauties of rural and urban England. That fact is obvious and indisputable. If the Minister is making an inquiry as to the adequacy of his powers, let me suggest to him two or three considerations. I do not think the composition of the authorities which are responsible for the planning is ideal. Very often the planning is settled by those with most financial interest in destroying the beauty which they ought to preserve. But let us assume in their favour that they wish to act in the most public-spirited manner. Those authorities which have power are often much too small and too poor. Let me refer to certain stretches of our coast. I am not going to mention them by name 741 because, even by giving that little advertisement of their beauty, I might be unconsciously encouraging some speculator to go there and do his worst. But Members of the Committee can think of some lovely stretches of the English coast which are a national and not merely a local possession, and they know very well that the local planning authorities in whose districts they lie are much too poor to raise the money necessary to preserve them and grant compensation. It is obvious that if our coasts are to be preserved, the compensation involved in saving them for the nation must not be a merely local financial responsibility.
Let me mention another fact which is seldom realised but is of great importance. The Minister said, I think, that in some three-fifths of England the first steps had been taken in planning. Accepting those figures, it is true that in the planning of that three-fifths, so far as it has proceeded, enough land has already been zoned for housing to accommodate seven times our existing population. Yet we know that the population is shortly to decline, though the amount of the decline may be open to question. In other words, even where planning is functioning, we are planning for the development by housing of an enormous area which should not be so planned. But my main complaint against the Ministry, a complaint which I hope the Minister during his tenure of office will remedy, is this. Even if the Act were perfect and even if on the supposition that everybody concerned was working it, it was capable of saving England, the fact still remains that England is being destroyed before our eyes. The House has declared unanimously that this destruction is both deplorable and a national responsibility. If that is the case, it is the duty of the Minister and his advisers not to come to the House and to say, "You have made no practical suggestion," but to say, "This is how we are going to stop it".
Since the last Debate on this subject a deputation representing various societies interested in the preservation of England, with my hon. Friend the Member for East Wolverhampton (Mr. Mander) among them, went to the Ministry of Health and urged the necessity for immediate action if our amenities were to be preserved. I have seen the official report of that depu- 742 tation in the April report of the Council for the Preservation of Rural England. The then Parliamentary Secretary promised, of course, that he would lay the views of the deputation before the Minister. But the substance of his reply—it is the reply which we are always given, but which, I hope, the Minister will not give this afternoon—was, "Oh, yes, let these voluntary impoverished societies proceed to educate public opinion and public taste". Really that answer is not good enough. If this destruction is proceeding; if, by the declaration of the House, accepted by the Ministry in the Debate of 10th February, this is a matter of national concern, then it is the business of the Ministry to stop it, and not to find excuses for allowing it to continue. Suppose that it cannot be stopped except by education, since when has national education become the duty of impoverished amenity societies? If education is what is wanted, then education should be provided by the Government, or else the Minister, whose sympathy with this great cause I do not for one moment doubt, should carefully consider whether a grant should not be made to those societies. A former British Government did a far-sighted stroke of business by investing public money in shares in the Suez Canal Company. If the present British Government saw fit to employ a few hundred thousands in securing the beauty of England for the future, they would be making an investment that would be as much praised by posterity.
There are two examples which I would give to the Minister. We were too late to stop ribbon development on the roads in many cases, and it is still proceeding. Is the right hon. Gentleman going to be too late to stop the same process on our coasts, which are now fast being beribboned? There is one by-pass near London still not completely ruined—the Barnet by-pass—which still passes through some real country. But the margins are being offered for sale. Is the Minister going to permit destruction as usual, or is he going to take some action? Why should we not do what they have the sense to do in the United States and have park-ways leading out of our great cities? I wonder whether the Minister sometimes thinks of how much better off we should be to-day if, in 1666, when we had our greatest architect, 743 Sir Christopher Wren, London had been dealt with according to his plan. How much better modern traffic would move. How much better, even from the point of view of Defence, we should now be situated. I implore the Minister to act in time. I am pleading, of course, for a different conception of the function of Government in this matter. The Government ought not to be ashamed of money being spent on beauty and amenity. These things are as well worth spending money on as anything else. If we used our brains to-day we could build cities as worthy of the 20th century as Bath is of the 18th. It is not only what we destroy that matters; it is what we are building in its place.
Even if this destruction brought profit I should fight it, for there are values far more important than money, and there are imponderables which the nation cannot afford to sacrifice. The beauty of England is not a thing to ravish. But the peculiar idiocy of our proceedings lies in this, that by destroying the beauty of England we are not only not making money, but as a nation we are losing it. There are few industries more capable of immediate expansion for the benefit of our invisible exports than the tourist industry. From inquiries which I have made in the United States and from some of our Dominion visitors, I can assure the Committee that we are already losing thousands of potential visitors as a result of the destruction which we are permitting, both of our architectural glories and our rural beauty. May I again quote words already used in this House, words taken from our greatest historian, Professor Trevelyan, and quoted by the hon. Member for Derby (Mr. Noel-Baker) in a similar connection:Without vision the people perish; and without natural beauty the English people will perish in the spiritual sense. In old days the English people lived in the midst of nature, subject to its influence at every hour. Thus inspired, our ancestors produced their great creations in religion, in song, and in the arts and crafts—common products of a whole people spiritually alive.There is, I believe, an association to advertise the beauty and charm of England abroad, to attract foreign tourists to these shores. It receives, I believe, a grant from a Government Department. They say that truth in advertising pays. If so, let me present my 744 right hon. Friend with this slogan to use in these foreign advertisements:Visit England now. No other country is destroying its beauty so quickly. A visit postponed may be too late.To-day that simple, shameful statement is the literal truth. That it is true is a scandal, and I urge my right hon. Friend to dally with it no longer, but to end it. If he does, he will have this reward, that he will as far as in him lies, have saved the matchless beauty of the English scene. If we fail, we shall destroy in a generation the gift of the ages. We shall incur, and we shall deserve, the detestation of posterity.
§ 11.57 a.m.
§ Mr. T. Smith
The hon. Member for Norwich (Mr. H. Strauss), who has just spoken, painted a beautiful picture of rural England. With regard to his remarks concerning uniformity, the uniformity that we on this side protest against is the uniformity that one finds in any provincial industrial town, and particularly in some of the smaller towns and villages, where the only thing you have is uniformity, with houses built in rows. If you open the front door, you see the front door across the street, and if you open the back door, you see the back doors of another set of houses there. We want to get away from that kind of uniformity and to see more variety brought into building. The hon. Member painted a picture of New York, but one thing that struck me while I was in South Australia was the lack of uniformity in working-class houses, and I think that that contrasted very well when set against ours. If I paint a different picture of rural England, it is perhaps because in this matter I am a little more real than the hon. Member.
I want to draw attention to certain aspects of rural housing and to say, first of all, that they are not in my constituency, but I make no apology for raising these matters in this Committee. If hon. Members who represent rural constituencies will not bring these matters to the notice of the Minister, someone else must do it. I want to refer to what has been taking place at a place called Great Paxton, Huntingdonshire, where the local council has been building houses and letting some of them to farmers, and the farmers in turn have been making them 745 into tied cottages and letting them to their workmen. The Agricultural Workers Union took this matter up with the Ministry of Health, and I am very pleased indeed to note that the Minister by his action has stopped this practice taking place in this particular locality. I hope the right hon. Gentleman will advise rural district councils that this practice does not meet with his support. But although the agricultural workers are pleased with the Minister's action in that respect, there is another matter in which they are profoundly dissatisfied with his action, and I want to draw attention to what is going on at a place called Stoke St. Gregory, in Somerset, where the council has built some houses. I had better read a letter that started the correspondence with the Minister. This is from the local secretary of the Agricultural Workers Union:I am writing to you with regard to the sanitation of the council houses which some of our members and myself live in. We have buckets just outside the door, where we have to have our own meals, and we have to empty these buckets twice a week on our gardens. There are no cesspits provided, which, to my mind, I think is a standing disgrace.It is an absolutely rotten position to have earth closets just outside the back doors of council houses, with pantries close to the closets. The local authority's argument is that the back room is not a living room, which means in effect that the cottages become one-room cottages downstairs. The occupiers, however, like anybody else, naturally want a room for receiving friends and for leisure. This matter has been taken up with the Ministry, and I regret to say that the Minister, in his reply to the Agricultural Workers Union, states that it is quite a common practice in rural England for councils to build houses with earth closets, and that he sees no reason to interfere in the matter. If these houses were being built in the wide open spaces of some of our Dominions, one could understand their being built with earth closets, but when one knows that the very next village has built houses without earth closets, and with water closets, then I think it is about time that the Minister had an investigation into this matter and told the local authority quite plainly that in these times it is a standing disgrace to build houses with earth closets.
There is another side also to this matter. We pride ourselves in this 746 country, and rightly, that we have done a good deal to make life longer and less liable to certain epidemics than was the case 20 or 30 years ago. All of us remember that in our childhood there were smallpox epidemics, fever epidemics, and so on. We have not quite eliminated them, and there are still occasional outbreaks, but I think the Minister will agree that one of the things that did more to eliminate those epidemic diseases was attention to sanitation. Yet here in rural England we have still got councils building houses with earth closets, and I respectfully ask the Minister to give this matter his personal attention and to see whether we cannot have an improvement made.
That finishes my reference for the moment to rural housing, but I now want to call attention to another very serious aspect of this matter of public health. I notice on page 20 of his annual report that the right hon. Gentleman makes reference to fumes from burning spoil banks, and he says, at the bottom of the page:Complaints of fumes from these pits have been received in increasing volume during the last two years.Great credit is due to the hon. Member for Leigh (Mr. Tinker), who has for the last two or three years persistently brought this matter before the House of Commons, together with the hon. Member for Hemsworth (Mr. G. Griffiths) and others who live in districts where this is a very important question. This question is not confined to Lancashire, but is prevalent in the West Riding of Yorkshire. The Minister of Health has been much concerned about it during the past two or three years, because in 1934 Sir George Newman, the Chief Medical Officer of the Ministry, asked for information from the West Riding County Council. The Council not only supplied the information, but had an inquiry themselves. They found that there were 78 burning colliery-spoil banks in the West Riding administratrive area, and that that was an increase. The law regarding nuisance has been in operation since the 1875 Public Health Act, but it contains a proviso which rather limits local authorities in initiating prosecutions. I mention this because on page 21 the Ministry's Report says:The matter is one to which local authorities concerned should give careful considera- 747 tion not excluding in 'appropriate circumstances the possibility of initiating legal proceedings under the Act of 1875.This proviso states that no penalty shall be imposed if it is proved that the accumulation of the deposit is necessary for the effectual carrying on of the business or manufacture. Does the Minister regard the law on the point as adequate to deal with the nuisance? If he does, can he tell us why we still have these complaints in 1937? One of the scandals in mining communities is that the mining companies were ever allowed to have these pit heaps so close to where people have to live. Although doctors state that they are not detrimental to health, no one can deny that they cause great discomfort, even to the extent of destroying furniture. If the Minister does not regard the law as adequate, does he contemplate any change in it?
The right hon. Gentleman boasts about the greatness of his Department. I think that any Minister could boast about the greatness of the Department, much as we may differ in certain respects. He also boasts about the greatness of the National Health Insurance scheme, of which we are so proud that the Department lent one of its most able officers to advise the Commonwealth of Australia. National Health Insurance, however, is not national in one respect. In addition to the statutory benefits, there are additional benefits. I find on page 182 of the Minister's Report a summary of the present position. It appears that about 90 per cent. of insured persons are entitled to additional benefits in some form or another, leaving about 10 per cent. without additional benefits at all. This 10 per cent. belongs to approved societies which either show no surplus or have a deficit. They are to be found mainly in the heavy industrial districts where the rate of sickness is greater than it is among the clerical profession, shop assistants and people of that kind who are what are called good lives and are less prone to sickness.
I want to ask the right hon. Gentleman what has been done to make the National Health Insurance scheme national in the true sense of the word. There has been developed during the last two or three years additional assistance by way of optical and dental treatment. There is a direct connection between ill-health and 748 bad teeth. Indeed, I find from reading the Medical Research Council's journals that some authorities hold the opinion that bad teeth are largely the cause of rheumatism. What happens when members of approved societies which give no additional benefit fall ill? If they have a few pounds saved they have to pay for dental treatment themselves. If they have to resort to public assistance, which many of them have to do because the benefits are too low, the public assistance committee as a rule will give assistance for dental treatment. If people do not apply for public assistance they usually neglect to have their teeth treated. I want to ask the Minister whether he is doing anything to bring about a pooling of the resources of the different approved societies. Some approved society secretaries say that they are in favour of this principle, but when they come down to the question of giving something to somebody else, they are opposed to it. Perhaps the Minister will tell us whether he is doing anything to encourage the pooling of resources or the co-ordination of approved societies and, if not, whether he contemplates taking any action in future?
§ 12.12 p.m.
§ Mrs. Tate
The speeches of the two hon. Members who have just spoken must have brought home to us once again the multiplicity of problems which come under the Ministry of Health. Great as is our confidence in the Minister, I still believe, as I told him last year, that the Ministry of Health is a department which needs two Under-Secretaries if half the problems are to be dealt with adequately. I wish to draw attention to a problem which, I think, is one of great seriousness in the country and which is costing us over £10,000,000 annually. I noticed that a few days ago the Minister of Health opened a new mental hospital at Runwell. It cost £650,000 to build, and will house about 1,000 people. There is no doubt that as a mental hospital it is probably an extremely fine place, and that the people who go there will receive every care and attention according to our present ideas of what the mentally afflicted should receive. I am acquainted with Shenley Mental Hospital which, in the same way, is a wonderful building in wonderful grounds with a most able and remarkable man at its head. There is 749 no doubt that if once mental illness has developed and mental treatment is needed, they are fine buildings and a great deal is being done there. The whole problem is, however, whether that enormous sum of money is really necessary, and whether its expenditure is touching the problem effectively. The cost of the buildings is enormous. Taking the average of the country the cost of a mentally-treated person is about 28s. each after buildings, land, staff, etc., are paid for. That would not matter if the problem were being dealt with. In an article in the "Daily Express" the other day I found this paragraph:Thousands of people could be rescued from madness every year if there had been a fund to find out about the mind as much as is known about the body. For £75,000 this country could have the finest mental research laboratory in the world.That is almost beginning at the wrong end. It is not so much a mental research laboratory that is needed now. What is far more needed is a realisation of the enormous proportion of mental diseases of wholly physical origin, which if they had proper treatment in the early stages would never lead to mental treatment being necessary at all. In the course of the year I do a certain amount of certifying of the insane, and anyone who does that cannot avoid being struck by the fact that the people one is asked to see fall into two categories. There are what one might describe as the old turbulent lunatic, the human being, whether man or woman, who, in all sympathy I say it, must be regarded as human wreckage. Whether or no they should ever have been allowed to get to that condition is another matter, but when one sees them they are human wreckage, and nothing can be done for them beyond keeping them in comfortable conditions and seeing that for the rest of their lives they do as little harm as possible.
But there is another category; there is the human being you are called in to certify who until he had that attack or perhaps some previous attack was not human wreckage, was not even an unintelligent human being, but Was very often a highly intelligent, highly valuable member of the community, with a wonderful record of achievement in the past either in the region of art or in the region of learning or general usefulness to the community—a really valuable human being, not even old, sometimes in early life. One 750 has to certify them. They go to some lunatic asylum or some mental hospital—as, thank God we call them now. If they go to Shenley or Runwell doubtless they are examined and have proper treatment. But why were they not examined and treated long before they reached the stage of having an attack? Why are we doing practically nothing all over the country to treat these mental diseases in their early stages? Almost nothing, is done on that side. Now can we always be assured that these people who get these attacks and have to be certified are going to be submitted to a medical examination which will find out the physical cause of their mental illness? Nothing of the kind? That is not what is going to happen. If they go to Shenley, yes; if they go to Runwell or a few other places, yes. There they will have the luck to have their teeth examined or the sinuses which connect the ear and nose and brain examined, or have other treatment. But what happens in a very large majority of cases? They go to some asylum where they will be lucky if they have any medical attention worthy of the name, if any real examination into the physical side of their illness is ever made. It is that which I think is such an appalling tragedy.
I would quote a very few instances published in the Report of the Board of Control, and I would say to the Minister that I think that Part II of the Board of Control's Report is one of the most unsatisfactory documents that are published. Very few people read it. We have not time in this House to read the enormous number of Blue Books that many of us would be glad to read if we had the actual physical time in which to do it. But in this Report there is very little real difference pointed out to the ordinary fairly uninterested lay person between the good hospitals and the bad; but when we come to the bad it can only be regarded as almost too appalling to be believed. I am going to give one or two instances. You have a hospital here, and I hasten to say that this is not a bad hospital for the staff are so good, but I ask whether people living under these conditions are likely to be cured or likely to have the physical side of their illness discovered? This is the Board of Control visiting the hospital and taking complaints from the patients:Few made any complaints except on the score of detention, but on the female side of the main building a number of female patients 751 spoke of the overcrowding at night and asked if we realised that they slept on the floor. Upon inquiry we found that 67 patients on the female side are so accommodated, but the majority are furnished with one mattress only. In the dormitory where this overcrowding is worst a patient wishing to get out of bed during the night might very easily step on the face or body of another patient on the mattress on the floor, and in fact disturbances arise from this cause,If you turn to other pages of the report you find that in a great many of these mental hospitals there are between 300 and 400 patients to every doctor. In many of them there is practically no dental treatment whatever. In a great many of them the sanitary conveniences are such as would not be allowed in any other building at all. There is one page in the report in which it is said that it is to be rather deplored that for 83 patients there are only three lavatories and three wash-basins. On another page you find that it is rather a pity that the washing arrangements are such that it is only possible for patients to be washed once a fortnight. In other pages you find that the sanitary accommodation is so scanty that commodes are placed in the dormitories, and some of the patients find the fact that they are not very often emptied rather trying. On other pages you find recommendations that the scrubbing brushes used for the kitchen tables and the lavatory pans would be better if they were not identical. On other pages you find a recommendation that it would be nice for the patients if they could each have an individual toothbrush. It is really rather unhygienic to keep a few tooth-brushes used for so many patients all in the same mug.
In another ward of the hospital you find that people who are very ill are kept at one end of the ward while the other end is used as a dining room and recreation room. I say that money spent on these people is money poured down the drain. To think of anyone going into these conditions, mad admittedly, but perhaps only suffering from madness because of a defective wisdom tooth or some obstruction in the passage that leads from the nose to the brain, is something that we cannot regard as unimportant; and I say further that it is quite obvious that we must have more accommodation in many parts of the country. When the public conscience is aroused these conditions will not be allowed to remain. 752 But are we going to build these gigantic colonies, such as Shenley and Runwell at this appalling expense, or are we going to spend money on setting up clinics for the treatment of disease in its very early stages and prevention of the necessity for such enormous asylums? It is for that the money is wanted. That is where you can save people who are of real value to the community.
If we have to enlarge some of these hospitals, could it not be done with far greater effect at a very much smaller cost? In all the counties of England to-day there are country houses to let and for sale which their owners know quite well nobody is likely to take. If they were occupied it might be of real assistance to the villages in which they are situated. Surely we could take some of those houses, those of moderate size, modernise them and put a certain class of mental patients into them, and have a panel of visiting doctors. Surely that is an experiment worth trying in just one county, instead of putting up these wonderful blocks of buildings for patients, many of whom ought never to have been allowed to get into the condition in which they are.
I ask the Minister to suggest to local authorities a wider extension of the work which is being done at Park Royal, Middlesex, where there is a clinic for the treatment of nervous patients. It is a curious thing, but no one minds being told that he or she is suffering from bad nerves. Anyone will go, and go thankfully, for treatment for bad nerves, because that is regarded almost as a refined, a rather genteel complaint; but there is an appalling stigma attached to the name, "mental disease." Therefore, call them nerve clinics, do everything you possibly can to see that anyone suffering from nervous disease is able to attend a nerve clinic, and that when they do go there their whole physical condition will be properly investigated.
I have spoken sometimes in the country on the treatment of mental disease, and a fairly large number of people who have at some time in their lives been certified have, after their discharge, got in touch with me and asked me whether I would see them. It is a curious thing that no matter from which part of England they came or where they had been under mental treatment, their complaints are 753 very much the same, and, believe me, they are very terrible. The complaints are not so much of ill treatment as of the extraordinary lack of treatment and ghastly lack of understanding in the treatment. I give one very small instance. It is not very pleasant for a woman in a mental hospital to feel that she has to walk down a corridor to go to the bathroom or to the sanitary closets when one week her nightgown perhaps does not reach to her knees and the next fortnight she can hardly walk because it trails upon the floor. That is a small instance of cases in which there is no individual arrangements with regard to garments. It is not money that is needed to rectify such matters, but just human understanding, and where that happens the fault is in the staff of the mental hospital.
I know that the outlook upon the treatment of mental disease has improved almost unbelievably in the last half century, but there are these old ideas still in many hospitals, and it is not always the fault of the staff, because in many hospitals it is practically impossible today to get staff. It is not a case of choosing the men or the women who are most suitable to treat the patients, but a case of getting any living human being you can to come and attend to them, and in those circumstances, of course, you must get some very unsuitable people. Any form of nursing is far more a vocation than it is a profession, and how much more that must be so in the case of these poor, unhappy people. Therefore, the staffing question is all important, and the first improvement we ought to make in those mental hospitals where conditions are bad is an improvement in the conditions under which the staff live and work. It may sound as though to do so is beginning at the wrong end, and that a start ought to be made with the patients, but the patients will not benefit till there is a better staff, and you will not get a better staff until they live under possible and reasonable conditions, which they do not get in many places at the present time.
Where a hospital has been a bad hospital, when the head of that hospital leaves, could I beg the Minister not to let the second in command be promoted just because he has been there a very long time? His outlook is probably bad. Let him go somewhere else and bring in fresh blood, someone who may see that hospital 754 in a different light and compare it not with what it was two or three years ago but compare it with what it ought to be and with what some of the better hospitals are. I am sure the whole country welcomes the fact that at St. George's they are attempting to undertake treatment of diseases in the early stage, but that should not be an isolated instance, it should be compulsory in every State hospital and it should be urged upon every voluntary hospital.
§ 12.32 p.m.
§ Mr. James Griffiths
I apologise to the Committee and to my hon. Friend for having missed the earlier part of the Debate, but I listened to every speech in the earlier Debate on the Ministry of Health Vote, and I was struck then by the wide variety of subjects with which the Ministry deals, and how intimately it is brought into touch with the lives of our people. Let me congratulate the hon. Lady the Member for Frome (Mrs. Tate) and express the thanks of the Committee to her. She delivered a moving speech and a very true one, and I think the Committee would desire me to say that we are very grateful to her for taking this opportunity of bringing before the attention of the Ministry and the country this very grave human problem.
I crave the indulgence of the Committee to confine myself to a few words about my own poor country. I will resist the temptation to say those few words in the best of all languages, because I want to convey a message to those outside. I have been reading carefully the reports upon the health of the people in Wales, and I have found some most alarming facts which, I wish to press upon the attention of the Minister, accompanied by an appeal to him to be far more generous to Wales in assisting her to develop her social services. I find that of the 10 worst administrative counties from the point of view of maternal mortality eight are Welsh counties; out of the 10 worst counties as regards mortality from tuberculosis, six are Welsh counties; and in the list of the 30 worst administrative counties in the matter of overcrowding, II are Welsh counties. Making out black lists of administrative counties in these three important and closely related matters, maternal mortality, tuberculosis and overcrowding—and they are not separate problems, but really one problem—I find 755 that there are seven Welsh counties on all three black lists—Anglesey, Denbigh, my own county of Carmarthen, Pembroke, Glamorgan, Monmouth and Cardiff. In those seven counties are 80 per cent. of of the total population of the Principality. That is to say, 80 per cent. of the population are represented on these three terrible, horrible black lists of maternal mortality, tuberculosis and overcrowding. I want to say a word or two about them, as they apply to my country of Wales.
In the period 1924–33, maternal mortality in Wales exceeded the maternal mortality in England by no less than 35 per cent. The rate in the Special Areas has been substantially increasing. In South Wales generally, we have had 10 years of very bad poverty and unemployment, and large masses of our people have been compelled to live upon meagre unemployment benefit and allowances, or upon public assistance. We know what happens in the homes. When the husbands become unemployed, the mothers become the chancellors of the exchequer. I wish I had the voice and the language to pay my tribute to those marvellous mothers, as I know hon. Members would desire to pay tribute, who have kept their courage alive in the depressed areas. I remember visiting some of those places with the Commissioner, Lord Portal. He said it was his first visit to the real South Wales, which is not Cardiff, Swansea and the other large towns, but the valleys that lie in the background. He said that what amazed him was that, after 10 or 15 years of depression and poverty, the homes were kept so clean and the children were so well looked after. He said how marvellously the people had kept their courage and hope alive.
The mothers of Wales have paid the penalty for it. When they spend their tiny shillings, as chancellors of the exchequer, and distribute the food, they see to it that the children and the men are fed first, and get the best. They themselves are left to the last. The consequence is that the mothers in Wales are suffering more than anyone else the consequences of the terrible impoverishment of the last 10 years, which reveals itself in this problem of maternal mortality. I have here a quotation from the valuable Report of the Ministry of 756 Health upon maternal mortality in Wales. I express my gratitude to the people who are responsible for the drafting and the writing of it. It is a separate report which the Ministry have issued. They say that they examined at the infant welfare centres a sample of 665 mothers. This is what they say:Of 665 mothers of young children seen at 17 infant welfare centres in South Wales, however, 30 per cent. were regarded as in definitely poor condition. This condition was manifest in a general listlessness, in apathy, by an appearance of age beyond the actual years, occasionally by some degree of emaciation, but more especially by anaemia, which in some cases was severe.Thirty per cent. of the women were going to become mothers. They were facing life's greatest trial. In a month or two they would go through that great crisis, and 30 per cent. of them were anaemic and in an emaciated condition. They were running the greatest risk. I have often told the miners and the people among whom I have spent my life in South Wales: "There is only one occupation that is more dangerous than yours, and that is the occupation of being a mother." I urge upon the Minister the importance of tackling and solving this problem. The position in South Wales is that the local authorities are too impoverished to meet the problem. Out of 13 administrative counties in South Wales, eight have no ante-natal clinic, yet they are among the counties that show the worst maternal mortality rates, and where the mothers are left without any skilled guidance or help, or adequate maternity services. Particularly in the rural administrative counties, the cost of providing adequate maternity services is beyond the means of the local authorities unless they are specially assisted by the Minister. I hope that the right hon. Gentleman will give special consideration to this problem.
I do not want to refer to the report again, except to say that it contains a wealth of very valuable recommendations. The main complaint is that maternal mortality is so bad in Wales, and the living conditions are so terrible, and that the position is due to two great main causes. The best services in the world would be an inadequate substitute to replace those two main causes, which are, first, the general poverty and the overcrowding of the houses and, secondly, 757 the low incomes and low standard of life. The mothers come last to the table and get the least, after everybody else has been satisfied, and they are paying this very terrible price.
As to the problem of tuberculosis in Wales, I have said that we are among the worst. This week I received figures from the Ministry showing the tuberculosis rate for 1936. The average for the country is 692, but every county and every county borough, except two, in Wales, is far in excess of that figure. There are five administrative county boroughs with a rate well over 8,000. This problem is linked to the fact that our people are living poverty-stricken lives. We know that tuberculosis is a problem of bad feeding, low standards of life and overcrowded houses, and that the problem in South Wales is worse in some of our finest counties. Take Carmarthen, my own county, which has an industrial belt, but is in the anthracite area. Most of the people use anthracite coal, and the atmosphere is not polluted by smoke such as comes from steam coal. The valleys are very much wider. Its natural advantages, compared with those of Glamorgan and Monmouthshire, are very considerable, yet Carmarthen has a mortality rate from tuberculosis of over 1,000. That is due to the fact that the poverty in the rural places is beyond description.
I want to make one more quotation from the report, because it confirms all that we know about rural Wales and about the peasantry of Wales, who are so poverty-stricken. On page 94 they say:In rural Wales the standard of living is on the whole low. Comparatively little farm produce finds its way to the home table. Eggs, milk and butter are produced for sale outside the area, and the staple articles of diet are bacon, broth, tea and bread and butter. Among large sections of the population there is insufficient intake of the natural protective foods and of first-class proteins. It appears also that the dietary is deficient in calcium, iron, phosphorous and iodine.Here is Carmarthenshire producing milk, butter and eggs. Train loads of them pass my home every day, to feed this great Metropolis, and yet the people die of tuberculosis because they sell the milk which they themselves ought to be consuming. That is the problem. What is true of Carmarthenshire is true of the other rural areas, and I hope that the 758 Minister will do what is in his power. We cannot talk of legislation this morning, but a great deal can be done by administrative action, and I hope that the Minister will pay attention to this matter. I am thinking not only of the Wales which is scheduled as a Special Area; the problems of maternal mortality and tuberculosis are equally bad, even if they are not worse, in most of the rural areas which cannot be described, and are not scheduled, as distressed areas. They face this problem of tuberculosis. We have the National Memorial Association of Wales, which is doing splendid work, and I want to pay tribute to their work. Their work, however, is handicapped by lack of funds, and, at the best, all they can do is to deal with cases as they are sent to them. It is necessary to deal with tuberculosis at the root, and prevent its development. As in the case of the terrible disease about which the hon. Member for Frome has been speaking, it is necessary to get hold of these tuberculosis cases early, in the very first stages. I would appeal to the Minister to help more generously the local authorities of Wales in this respect.
Let me compare the amounts spent out of the rates in trying to meet this great problem in some counties in Wales and in some counties in England which are good parallels. In my own county of Carmarthen, the rate expenditure on tuberculosis is 6½d. in the £. Across the Channel, two hours away by boat, is the county of Cornwall, which is very much like Carmarthenshire, a small portion of it being industrial and the rest rural. In Cornwall, the rate expenditure on tuberculosis is just 2d. in the £. We spend three times as much as Cornwall spends. We ought to be spending more, but we cannot afford it; we have reached a stage at which an extra penny on the rates is something that we cannot afford to consider.
Again, take the case of Middlesex, which now has a vast Welsh population, which last year increased its population at the rate of 1,000 a week, and where people in Wales are contributing towards the building of a Welsh chapel in order that their fellow-countrymen may have the opportunity of keeping in touch with Wales on religious matters. We spend money to train and educate those men, and all the advantage of them, when 759 they become adults, goes to places outside Wales. The rate expenditure of Middlesex on tuberculosis is 2d. in the £. in Glamorgan it is 6d. Surrey, where also a large number of them are going, spends just under 1d. in the £ on these services to combat tuberculosis, while Monmouthshire spends 7d. This shows that already the Welsh authorities are bearing a very heavy burden in trying to meet this terrible disease. They cannot spend more unless they are assisted, and I hope I am not appealing in vain to the Minister when I ask him to be more generous in his assistance to Wales for the purpose of meeting these two terrible problems. I was glad to hear the right hon. Gentleman say the other day that he is not only considering, but preparing, a campaign in order to try to bring to the notice of the people the value of this great system of social services which we have built up, which I want to see continue to be built up, and which, I hope, the rearmament programme will not induce the House to stop. I agree with the right hon. Gentleman that the value of these services is not as well appreciated as it ought to be.
As regards maternal mortality in the rural areas, the women, perhaps owing partly to our Nonconformist puritan training, regard this question as being something sacred and private, into which no one ought to be allowed to pry, and the problem of trying to induce more and more people to take advantage of these services is a difficult one. May I make a suggestion, without any offence? I think that the propaganda in the past has not been so successful as it might have been becauce very often the organisations in charge of these services have been manned by well-to-do and rich people. For the moment I am speaking of Wales only, but I expect the same thing applies in some degree in other areas. I would urge upon the Minister the importance, in such a campaign, of the character of the bodies and organisations through which the propaganda is conducted. Do not let this propaganda develop into, or even have the appearance of being, the job of social busybodies. Let it be the work of local authorities; let the Minister invoke the aid of the trade unions, who are very important bodies in Wales; let him invoke the aid, particularly, of the religious organisation in these rural areas, of the minister of the local chapel and the 760 schoolmaster, who are the people to whom the women particularly like to go—the people who are associated with all the most sacred things in their lives. These are the people who ought to be, and I hope will be, used—and I am sure that every one of them would be glad to have an opportunity of assisting—as the vehicles through which this propaganda campaign is conducted. I hope that these few inadequate words that I have said for my country will induce the Minister to give it more generous aid and assistance, so that this Wales of ours may be rid of these two terrible evils that afflict it so badly to-day.
§ 12.52 p.m.
§ Mr. Lovat-Fraser
I wish to speak this morning on a class of children for whom the Ministry of Health is ultimately responsible. I refer to Poor Law children who, owing to the defect or default of their parents, have been thrown upon the State for maintenance. In the Report of the Ministry of Health for last year there is this statement, which I very strongly endorse:It may fairly be said that, from the point of view of constructive utility, the most important branch of activity under the Poor Law is the maintenance, education and after-care of destitute and homeless children.The older I grow, the more I feel that the children should be the main interest of the nation. Middle-aged and older people have their claims, but the claims of the children ought to be our main interest. The record of the Ministry of Health is one long record of real progress. Of late years the defects in the law relating to Poor Law children and their treatment have gradually been eliminated, and I think the Ministry is entitled to look back with pride on what it has done to remove the evils that attach to the condition of Poor Law children. One of the principal of those which remain is the keeping of children in the workhouses. Little children who should be looking out on the world with hope, whose prospects ought to be those of prosperity and success, are to be found still associated with the wreckage and failures of life. The Ministry of Health has a regulation that no child over the age of three shall he allowed to live in a workhouse for longer than six weeks, but there are children to-day living in the workhouses contrary to the regulations of the Ministry of Health, and one of the 761 things that I wish to ask of the Ministry this afternoon is that they should specially devote themselves to the removal of children from workhouses. There are still public assistance committees who keep children in the workhouses. I ask the Ministry to remove from the workhouses those children who are still there, and to bring to an end an evil which we very much deplore.
May I refer to one or two matters which I have brought before the House which show that the vigilance of the Ministry of Health ought still to be very keen. One case to which I called attention was that of a boy of 6½—I will not mention the place, for obvious reasons—at a children's home who died in circumstances which led the jury to return a verdict that the cause of death was:shock caused by intense cold in a case of malnutrition of body and multiple minor injuries.The Public Assistance Committee held an inquiry and were unanimously of the opinion that the matron had been guilty of a grave error of judgment in administering a tepid spray in very cold weather to the boy. The Minister informed me that the case had been fully investigated.
Here is another case. It was alleged in the Press that complaints had been made about the treatment of children, and that, if two children spoke to one another in bed, they were made to stand in the kitchen holding a chair over their heads and, if they collapsed, they were beaten. I asked a Question, and the Minister replied that he did not think that any action on his part was necessary, in view of the action taken by the Council. The resignation of the matron has been accepted. Here is another case. Complaints were made of the children in the homes being out of hand, running away, pilfering and getting into the hands of the police and being birched. A Question was asked in the House of Commons. The Minister subsequently told me that all had not been well in the management of the homes, but that a complete re-organisation had been taken in hand and he hoped that, with several changes in staff, the satisfactory management of the homes would be secured in future. It will be seen from these instances—and others could be added—that there is still need for vigilance on the part of the Ministry.
§ 12.58 p.m.
§ Mr. Maitland
I was very much interested in the appeal made by the hon. Member for Frome (Mrs. Tate) in regard to the question of the treatment of mental defectives, and particularly in her reference to the mental institution at Runwell. I was interested because a few months ago I paid a visit and spent a day there, and I can quite confidently confirm what she said, that there is a very great difference in the present outlook with regard to the treatment of that unfortunate section of the community who find themselves in these institutions. There is, for example, a greater inclination to classify the various patients according to their condition, and those who are not in an advanced stage are segregated from the others. One does not want to use offensive terms but there are, of course, obnoxious patients, and there is a recognition of the fact that they have a great mental effect on those who are not so far advanced in their complaint. The new treatment means many more buildings and much greater supervision. I am very glad to support the hon. Lady's appeal to do what is possible for these unfortunate people before the disease gets to an advanced stage, and I am sure it will be re-echoed in all parts of the House.
The Minister the other day referred to the anxiety that was being created in the minds of local authorities and others arising from the increased cost of material. He mentioned as an example the price of non-parlour houses, which showed an increase for the first three months of 1937 of about £33 over the price of the same houses in the same three months last year. Local authorities are responsible for many other matters than housing, and they are very anxious to carry on their schemes, but they are very much concerned because of the increased estimates that they receive. When the Government decided to embark upon their policy of rearmament, they laid down the general proposition that they desired to carry on with the least possible disturbance to the normal course of industry and commerce. That was right, and it would be right to-day if it were not for the fact that the disturbance that the Government sought to avoid is in fact here. I am sure it must be exercising the mind of the Minister of Health, and those who 763 are responsible to the House for our social services. We are getting to the stage when he has to decide the steps that he can enforce upon his colleagues in the Cabinet whether or not there is to be some restriction of some of our social services in order that the policy of rearmament may succeed, or whether he will make it plain that the continuance of our social services, particularly with regard to housing and the like, shall be unabated.
I wish to make an appeal to my right hon. Friend—and it is for this specific purpose that I have risen—that he will not hesitate in this matter. While it is important to realise the necessity for rearmament, it is almost as important that we should not in any circumstances diminish what has been going on for some years in the direction of improving the conditions of our people by way of social reform. I assure the Minister, that should it be necessary for him to take a strong line in the Cabinet in regard to the schemes of social reform, he can do so knowing full well that he will have the House with him.
§ 1.6 p.m.
Mr. David Adams
In spite of the fact that the standing orders of the Opposition are that, like Mark Antony, we should feel it our duty "to bury Caesar and not to praise him." I intend to break those rules and say that we express to the Minister our thanks for the catholic outlook and the generous manner in which he has administered his great Department during the past 12 months. We feel assured that in his hands the social services are safe, and that the influence which he exhibits in this House through his urbanity and humane characteristics will be used with equal effect in the Department in future.
I desire to call attention to two matters only, although, perhaps, at some little length, because I deem them both to be important, and I hope to obtain assurances from the Minister. They are housing, on the one hand, and milk, on the other. The Survey of the Ministry with regard to overcrowding revealed the fact that Northumberland and Durham are the worst overcrowded areas outside London. Actually in Durham there are 39,639 overcrowded families, and in Northumberland there are 20,846 families similarly overcrowded. The six most 764 overcrowded county boroughs in England are in our North Eastern area. In Sunderland 8,600 families are overcrowded, Gateshead, 4,700, South Shields, 3,500, Tynemouth, 2,200, West Hartlepools, 1,400, and Newcastle-upon-Tyne, 8,500. It is to me, and I hope to the Minister, quite obvious that in these areas, some of which are located in what are still Special Areas, they are not able to bear the full burden of the rehousing of this vast population, and we feel that there should be more generous treatment meted out by the Ministry than the mere grant of £5 per house for a period of 20 years. The subsidy also—and this, I see, is being reaffirmed by local authorities—should be continued not merely to the end of next year but to December, 1941.
The Minister has expressed his desire, or has hinted at all events, that overcrowding standards ought to be raised. Last year I called attention to that matter. We know that the standard upon which overcrowding is based to-day takes in living-rooms and kitchens as bedrooms, some of which are very small, particularly in the mining areas in Durham and Northumberland, and we hope that these, in some new Bill, may be eliminated. We should then have a more model standard for our working classes such as is applied to the middle classes of this country. We ask, too, that aged couples, and women workers, single men and persons without families who hitherto have not been provided for by many local authorities, should have the sympathetic consideration and the assent of the Ministry to such provision. The Minister stated in a circular which he issued on 7th May of last year that he was agreeable to the larger type of house being built for the largest families. I ask, in spite of the rise in the cost of building materials, which certainly has become very alarming as far as many authorities are concerned, particularly in the North of England, that the Minister will still give his blessing to the larger type of house in order that the disabilities under which that class of family subsists today shall be eliminated. If we can have the assurances from the Minister that sympathy will be given in the matter of housing at which he has hinted, then, I think, still further steps can be taken at an early date in the advancement of our people in that direction.
765 I turn next to the question of milk. While it is true that public attention has been more closely directed to the more adequate consumption of this prime food, still we are far below what the Ministry of Health itself desires in the matter of the consumption of liquid milk. The liquid milk consumption of the country is less than one-half of what it ought to be in the judgment of the Advisory Committee upon Nutrition, which was set up by the Minister of Health. They state that the consumption of milk for children should be one to two pints per day, for expectant mothers two pints, and for other adults one to two pints. If those quantities could be consumed by the country—and medical people throughout the country are agreed that they ought to be—the consumption of milk would be doubled. It is very interesting to notice from the figures quoted by Sir John Orr, and confirmed elsewhere, that there are no fewer than 4,500,000 of our poorest people who consume in a week only 1.8 pints each, instead of that amount being consumed every day in the week. The point I wish to make is that, if this prime food is not reaching the people in the country in the quantities that we desire, at all events the Ministry should see that the quality of the milk is maintained. We ought to have statutory authority, if such is lacking, to preserve the quality standard intact. That is not the case today, and that is the gravamen of my charge in the existing circumstances.
I call attention, in the first place, to the Milk Regulations of the Milk Marketing Board. Protection is not afforded to the general public under their scheme. I have a copy of the regulations, which show that milk to be genuine should contain not less than three per cent. of milk fat, and not less than 8.5 per cent. of non-fatty solids. When it falls below that low standard, for that is a low standard, it ceases to be genuine, and the public ought to have the right of action in such cases. What happens under the Milk Marketing Board scheme, if a distributor, farmer, or other person supplying milk which, on being tested, is shown to be deficient, no matter how great the extent, either in milk fat or in non-fatty solids, as demonstrated by the tests applied by the analyst, or if the freezing point test shows that water, perhaps in heavy quantities, has been added?
766 It is provided that the supplier must be notified that the test has been made and that the milk has been found deficient, and intimation must be given to the supplier that three other tests will be taken on three successive days to see whether the milk is up to standard or not. It is obvious that the person who has been supplying defective milk will see that at least on one of the three subsequent tests the milk is genuine. If it is found that on one occasion, according to the Board's regulations, the milk is found to be genuine, no action can lie, and watered milk may continue to be supplied. I will not take up the time of the House further on that point, but it ought to be placed on record how absurd is the system which is alleged to be a protection to the public. This procedure is instituted, or appears to be instituted, in defence of fraud for, obviously, an offender who has been tampering with his milk will see to it that the picked samples are always up to normal standard.
Now I come to the general question of the sale of fresh milk. I speak as a Member of the Newcastle City Council and as one who for some years, until I resigned recently, was chairman of the health committee of that Corporation. I am now vice-chairman of the committee, so that I am still in close touch with the health committee. I have said what ought to be the constituents of milk if it is genuine. If milk is not genuine and our analysts show that it is deficient either in milk fat or in non-fatty solids, or that water has been added, certain things may have happened. The cow may have been improperly drained, thereby leaving the non-fatty solids for later milking. It is possible in draining a cow to leave the best of the milk, the real quality milk, behind, if it is thought desirable to do so. When the milk has been drained from the cow, cream may be extracted from it, or it may be that the animal may be deficient in good milk-giving qualities, and that it is not giving the quality of milk to which the public are entitled. Alternatively water may have been added in small or generous quantities.
If any of these things can be proved in certain cases and it can be proved by the freezing point test in evidence that somehow or other water has got into the 767 milk and that the milk can be shown to be sadly deficient, in some cases the deficiency amounting to 10, 15 and higher percentages, when the cases have been brought before the magistrates, the magistrates, relying upon the judgment of the High Court, have dismissed the cases. On Monday last I attended a meeting of the health committee and cases were reported to us where milk samples were deficient in milk fats by 7.6, 14.6, 7.6, and 4.3. In the normal way the Town Clerk would have recommended prosecutions, but on this occasion his recommendation was that no action should be taken because the magistrates would dismiss the cases on sufficient evidence being produced to protect the fraudulent supplier of the milk. The position is that if in transit from the cow to the consumer, the handlers of the milk state that the milk has not been tampered with, and can produce evidence that the milk is just as it came from the cow, there is no remedy for the local authority, at any rate so far as Newcastle-upon-Tyne and other places that I know of, are concerned. That is to say, if a cow gave chalk and water and it could be shown that no one had interfered with the milk in transit, the consumer, under the law as administered by our magistrates, would be expected to accept that as genuine milk. That is what happens under the Milk Regulations. On 11th May I gave notice of the following Question to the Minister of Health:Whether he is aware that cases in recent prosecutions by the Newcastle Corporation under the Food and Drugs (Adulteration) Act, 1928, Section 16 (2), of vendors selling new milk deficient in non-fatty solids 17.2 per cent. and 15.4 per cent. respectively, where dismissed by the magistrates; and whether as deficiencies on this scale indicate the presence of added water, he will consider legislation for the more adequate protection of the public in this matter.The Minister said that he would look into the matter, and the result was that a deputation was invited from the Newcastle Corporation Health Committee, of which I happened to be one. The Town Clerk was asked to furnish his observations previously, and one of the observations that he made I will bring to the attention of the House. The Town Clerk observed that, having regard to the decision in the Hunt v. Richardson case, it was a waste of money to bring milk prosecutions before any bench of magis- 768 trates, particularly as it was only necessary for the defendant to call his servants to give evidence to the effect that at no time was it possible for the milk to be tampered with. The Town Clerk also, submitted a report by the chief sanitary inspector of the results of milk prosecutions during the period from January, 1936, to January, 1937. The Town Clerk in his observations said that he appreciated the difficult position in which magistrates were placed consequent on the case of Hunt v. Richardson which case decided that, although milk contained only 2.73 per cent. of fat, and was therefore below the minimum requirements of the milk Regulations it was held that no offence had been committed provided it was proved to the magistrates that nothing was added to or subtracted from it. There was a further ruling in the case of Williams versus Reece in 1918. It now appears that milk must be accepted by the consuming public as genuine in spite of the fact that by the tests it is proved to be not genuine I High Court Judges have made fresh law on the matter, contrary, in my judgment, to the law of the land.
§ Mr. Turton
On a point of Order. Is it in order for an hon. Member to say that High Court Judges have given judgments contrary to the law of the land?
In my opinion, the judgments of the High Court appear to be contrary to the decisions of this House. I think it is necessary to quote shortly the opinions of some of our Judges, but, before doing so, I should like to say that the deputation which went to the Ministry of Health were met by the leading officials and the case was fully explained to them. I am giving away no secrets in saying that the officials were sympathetic to the position which was outlined to them, and it was admitted that similar cases had come from other parts of the country, but that at present there was not a general demand for legislation. We went away with the feeling that if it could be shown that there was a general demand, there was an incontrovertible case for protective legislation. Let me quote from the "Times" what Lord Atkin said at the anniversary dinner of the Society of 769 Public Analysts in 1932. In proposing the health of the society Lord Atkin spoke of the value of the services of public analysts to the community and:contrasted the condition of purity of food at the present time with that which was prevalent before the passing of the first Food and Drugs Act. He expressed the view that definite standards should be fixed for foods, and in particular for milk, and that the onus should be on the vendor to prove that the articles sold conformed to that standard. The fact that vendors could defy the recognised standards for milk with an explanation about the idiosyncrasies of the cow was due, not to legislation but to a decision of three out of five judges in a certain criminal case. He had always longed for the time when an enterprising municipal authority would really fight this cause in a civil case, and take it, if necessary, through the Court of Appeal to the House of Lords, for the benefit of the community.That is the conviction of one of the great lawyers of the country. Let me give a quotation from The "Times" of 27th July, 1917. It may be rather old, but none the les it is very pertinent to the matter. In the case of Grigg v. Smith in the King's Bench Division before the Lord Chief Justice, Mr. Justice Ridley and Mr. Justice Atkin, the Lord Chief Justice, according to the report in The "Times," in giving judgment, said:This appeal raised a point of great interest as to the sale of milk. It was brought on a case stated by the Justice of Stratford-on-Avon upon an information against the respondent Smith under Section 6 of the Food and Drugs Act, 1875, for selling milk which was deficient in fat to the extent of 13 per cent. and which was not of the nature substance and quality demanded by the purchaser. The Lord Chief Justice in giving judgment said that the question for decision was whether the view of the law taken by the justices was correct as based on the facts found which bound that Court. The Court had had the advantage of an able and interesting argument from Mr. Lowenthal, but it was impossible to get over the decision in Hunt v. Richardson. The magistrates had before them one standard as to milk, namely, that it must contain not less than three per cent. of milk fat, and the authority for that was to be found in the regulations of 1901. The Justices thought that, though the milk did not contain the full percentage, yet as it was sold as it came from the cow the presumption of adulteration was rebutted by the evidence, and no offence had been committed. In his opinion this was the true effect of the decision of Hunt. v. Richardson. He thought that the majority of the Court decided that when the product was sold as it came from the cow it was milk, and being so there was no offence on its sale. In that case, as in this, there was an attempt to show that the milk must contain three per cent. of milk fat; but that was not so. What was said was that if it did not contain that percentage there should be a presumption that something had been 770 added or abstracted, but that presumption could be met by evidence; and if the court were satisfied that the presumption had been met by evidence then no offence was committed. In his opinion, Hunt v. Richardson could not be distinguished from the present case. The Justices here were right and the appeal must be dismissed.He wished to add that the arguments had convinced him that it was desirable for the authorities to reconsider the position and to determine whether it was the intention of the Legislature, or of the departments which have the means of introducing amended Acts of Parliament that milk should be sold to the public as it was in this case, with an undoubted deficiency in milk fat, as compared with milk usually sold, the result being that the farmer could retain for himself the better quality milk, leaving to the public the inferior quality. He did not think that he should express any opinion on the policy to be adopted but he wished to say that the effect of Hunt v. Richardson and the case before the Court made it desirable that the matter should be considered.Mr. Justice Ridley and Mr. Justice Atkin gave judgment to the same effect, and expressed similar opinions as to legislation. Mr. Justice Atkin added that a farmer was now invited by law to give a preference to his own calves over the babies of his customers.That is one of the most effective arguments that could be advanced from these Benches in favour of the Ministry of Health introducing forthwith legislation to protect the public against what is an admitted and growing scandal, to prevent the public from being swindled either by being supplied with milk from inferior cows or by the deliberate and criminal mixing of water with milk before it is delivered. On behalf of the great population of the North of England and many local authorities which cannot afford to make tests such as those which are made by the Newcastle Corporation, I urge that this great scandal should be removed by legislation without delay.
§ 1.36 p.m.
§ Captain Elliston
As was said by the hon. Member for Consett (Mr. David Adams), however much we may differ on details, there are very few hon. Members who do not recognise that the statement which we heard last week from the Minister of Health constituted a remarkable record of social and health administration. Our services in both respects are indeed enormously in advance of anything that has even been attempted in other parts of the world. I would like to deal with a few matters which have not been discussed by other hon. Members, but first of all, I wish to congratulate the 771 Minister upon the promised campaign to educate the people to use the health services already provided by local authorities in all parts of the country. There is no doubt that the provision made by local authorities in most areas is now very complete, and it is up to the people to do the rest. Until people are persuaded to take advantage of those services, progress in public health must be very limited. In another capacity, the Minister has shown himself to be a master of the art of publicity. To give only one example, in a very short period he increased the number of telephone subscribers in this country by as much as 200,000. All hon. Members hope that he will be equally successful in promoting public health by publicity. If so, this campaign of educating the people to use the public health services and the parallel Government campaign for physical training and recreation, should produce very remarkable results.
In the time which we have to-day, I think it would be more useful, rather than to say nice things about the Ministry, to pick out a few things which we consider call for criticism. First of all, I was grievously disappointed that the Minister missed the opportunity of giving the House some assurance as to the promised long-term legislation dealing with a national milk policy. The hon. Member for Consett dealt with only one aspect of that matter, and I think I had better concentrate on the grave delay in ensuring the safety of milk supplies. Present conditions, if allowed to continue, will not only be a menace and a discouragement to the consumer, but will rob the dairy industry of the prosperity which it would enjoy if the consumers as a whole had confidence in the safety and quality of the milk supplies offered.
Apart from tuberculosis and undulant fever, during recent years there have been outbreaks of typhoid, paratyphoid, scarlet fever and septic throats which on each occasion have been recognised by the Ministry as being directly due to milk-borne infection. There is a consensus of expert opinion that the case for the pasteurisation of milk is scientifically irrefutable, and that by that means milk could he made as safe as water is made by chlorinisation and filtration. The real opposition to the protection of the public against milk-borne diseases is dictated by 772 economic considerations. In England and Wales one-sixth of the liquid milk supplies come from producer-retailers. No doubt pasteurisation would involve them in extra costs, but if unfit houses and unsound food are prohibited, is it reasonable that we should continue to allow the marketing of unsafe milk? Surely the health of the people is more important than the financial interests of any small section of the community.
I am bound to confess that sometimes one has an uneasy feeling that the Ministry of Health is influenced by considerations other than those of health. Recently, with the Senior Member for the City of London (Sir V. Bowater) and the hon. Member for Dulwich (Mr. Bracewell Smith), I brought to the notice of the Ministry the fact that large quantities of boned beef have been brought into this country in unrecognisable cuts with lesions that might indicate disease removed. Large consignments of this boned beef are brought to the City of London markets for inspection, but in such circumstances anything like a proper inspection is impossible. We were assured that the system of inspection at the port of origin was absolutely reliable and that we might rest content. But we went away wondering whether the Minister was concerned not exclusively with the soundness and wholesomeness of the beef, but also with the observance of trade agreements and quotas. Although that happened some months ago, I have in my hand an extract from a report by Mr. Ross Grant, the Australian Veterinary Officer, in the course of which he speaks of the difficulties of the meat industry in Australia. He favours the granting of an export bonus of at least ½d. per lb., but he adds:If such a bounty is granted, it must be on meat that is the product of the legitimate beef industry, and not on low grade boneless beef, the product of worn-out dairy cows, or on boneless veal derived from immature calves.That seems to be an admission that the boned beef, which we are told is so reliably inspected, enjoys no respect in Australia, the source of supply. It is a serious matter, because nearly 2,000 tons of that beef comes to England each month, more than half of it from Australia. There we have an admission from an Australian source that that sort of stuff is not worthy of being included among the meat to receive a subsidy. Yet this boned 773 beef can enter this country under the terms of the Public Health (Imported Food) Regulations which come into force on 1st January, 1938. May we hope that it is not yet too late for the amendment of those Regulations?
It is becoming an established custom in this country to leave pioneer work in matters of public health to voluntary organisations. I was very much interested in the speech of the hon. Member for Norwich (Mr. H. Strauss), and to notice that some thoughts which occurred to me on this subject had evidently been passing through his mind. Also I wonder how far the Ministry is entitled to delegate its responsibilities to voluntary bodies. I may state briefly two examples of this practice. The first is with regard to the widespread prevalence of rheumatic disease a condition which has been well described as Public Health Enemy No. 1. We have been told all about it. We have known about it for years. We know that it accounts for one-sixth of the expenditure on national health insurance, and that with the consequential loss of earning capacity it is costing the country over £20,000,000 per annum. We know that 50 per cent. of heart disease is of rheumatic origin and we know that 12,000 deaths a year are caused by heart disease.
The Chief Medical Officer has given us chapter and verse in his annual report on the measures which are necessary in order to secure any reduction in the great industrial morbidity resulting from chronic rheumatic disease. We know all that, but what are we doing? We are told that this matter is receiving the attention of a great voluntary organisation, as indeed it is. We have an organisation, the Empire Rheumatic Council, consisting of very distinguished persons, including leading specialists and consultants, and representatives of philanthropic organisations, and others. How are they spending their time? Their first object necessarily is to raise sufficient funds to enable them to carry on their work. It seems to me that if the Minister of Health can stand aside while voluntary bodies tackle problems of this kind, then, at least, he ought to find sufficient funds for those bodies to enable them to get on with their work instead of allowing each in turn to become one more deserving 774 cause appealing to the public for subscriptions. I think this Council is an excellent body for this purpose but the Ministry ought to give it help first by finding funds, and secondly by stimulating local authorities to do their part by establishing clinics in connection with public baths and so on, which people could take advantage of at a reasonable cost, and also by providing wards and research units in the poor law hospitals which have been taken over by municipalities. In that and other ways the Ministry might support the voluntary body in the work of dealing with this problem.
The other example which I would give is the prospective decrease in our population. We know that with the present trend of mortality and fertility, a decline in our population will commence within the next five years. That is an ascertained fact. We also know that if the present trend continues the population will come down to 30,000,000 within 40 years and that before the end of the century it will be down to 15,000,000. These facts are beyond dispute, provided, of course, as I say, that there is a continuance of the present trend. Surely we have to decide at once whether that fall is desirable or not and, if it is not, how it can be stopped. To my mind that is a matter of such importance as to make all the other public health problems at the present time comparatively insignificant. It overwhelms everything else. We find great satisfaction in the fact that maternal mortality has been reduced to 3.81 and that infantile mortality is down to below 60. We take great satisfaction out of the efficiency of all our public health services, but the reduction in the death rate which is effected in these ways is small compared with the fall in the population which is likely to take place.
Surely this is a problem which calls for immediate recognition. In concerns every Government Department and every municipality. It affects all our services—health, housing, education, industry, transport, national defence, Empire settlement. What are we doing about it? We have handed this problem also to a voluntary organisation. There has been set up a very influential committee, the Population Investigation Committee, which includes statisticians, men of science and other investigators of unquestionable standing and distinction, but 775 they have no staff and no funds. It is true that they are getting a certain amount of statistical assistance from Somerset House and material is being provided for them through the Ministry of Health, but here is a matter of tremendous significance social, medical, psychological and economic, and we hand it over to a voluntary body which is left, as I say, without a staff and without funds. Here, again, I think it is for the Ministry to see that this body has not to waste its time in collecting money. They should give it some help, at any rate, in this important work. Indeed, I should have thought that a matter of this urgent significance to the future of our race would call for the immediate appointment of a Royal Commission, backed up by the resources of every Government Department concerned.
There are other matters to which I would like to refer, but my time is too limited. I hope, however, that we shall hear something from the Minister about the continued exploitation of the public by vendors of quack medicines and appliances. This was the subject of a report by a Select Committee in 1913, and it was referred to again in the report of the committee which dealt with medicine stamp duties. Practically all the facts are known, and in the circumstances one cannot but be surprised that an abuse of that kind should be allowed to continue.
§ 1.54 p.m.
§ Mr. Harold Nicolson
I wish to deal with a general matter which arises from speeches made by hon. Members opposite; namely, the question of nutrition. To keep in order while discussing some of the more general aspects of nutrition, it is necessary that I should concentrate more upon those parts of the problem which fall directly within the administrative capacity of the Minister. We are fortunate at this juncture in having at the Ministry of Health the present Minister and his Under-Secretary, whom I should like to congratulate on the auspicious manner in which he has inaugurated his new functions. They are both men who are not only humane—after all we are all humane—but who have imaginative vision coupled with practical efficiency. I hope they realise that this nutrition question, which is at the moment a fashionable topic, is likely to become in a few years the very centre of Govern- 776 mental policy. I envisage my right hon. Friend the Minister of Health, in a few years' time, as the Minister who will coordinate the defence of our standard of living. That standard is going to be threatened. I envisage something more. I envisage an allegorical picture of the Minister advancing towards the citadel of prosperity, grasping in his right hand the Minister of Education and in his left hand the Minister of Agriculture, and bearing on his chest, in diamonds, the word "nutrition."
I am careful not to exaggerate the meaning of words. I think one of the great dangers of this age is that we suffer from an undue dislocation of thought owing to the employment of either beautiful or striking phrases. It was only the day before yesterday that Signor Mussolini referred to the "Times" newspaper as "a hyena in human form," a description which I think even the hon. Member for West Fife (Mr. Gallacher) would call a trifle far-fetched. But even in this country we are liable to become victims to alibis for thought: Such lovely phrases as "Covenant," "collective security," and so on, have become—as, I fear, this word "nutrition" may become—pure incantations. When we become too enthusiastic about nutrition, when we find that we are using the word vaguely, optimistically, perhaps sentimentally, I think we should check our enthusiasm by two question which I often put to myself, the answers to which I find it very difficult to supply. The first is an awfully good question to put to the nutrition crank. It is—In the history of modern knowledge, what generation has been most exposed to extreme malnutrition? The answer to that question is, The young Germans who were born between 1914 and 1924, who were deprived of all the protective and other foodstuffs, and who were subjected to our blockade. The second question is, What sector of the population, among the European countries, are to-day the finest physical specimens? My answer to that question is, The German young men and women who were exposed to the horrors of the blockade from 1914 to 1924.
I know it is often said in explanation of this paradox (and by the Germans themselves), "Yes, because you killed off all the weak ones," but that is not true. I have been into the German official figures of infant mortality, and it is a fact 777 that the mortality figures for Dm in Germany—I am quoting the official figures—were one point per thousand less than those for 1913; I call that paradox to the attention of the Ministry of Health, because I think it shows that nutrition, although perhaps the most important part of their powers, is only one part, that you can exaggerate it, and that it is very easy to think of this business about food and food preparation as being everything. I think that the real answer to the German paradox is that the German youth, both boys and girls, of the present generation are taught to be proud of their bodies and to display their bodies, whereas in this country the youth are taught to be ashamed of their bodies and to hide them. I think it is to a great extent a question of education in this matter and of greater enlightenment on the part of the population. I do not wish to trespass on matters of legislation, but although I have tried to nullify the extreme nutrition theory, I think the nutrition front is in fact the most important.
I would say, in passing, that we know very well that there are 4,500,000 people in this country who spend but 4s. a week on food per head, when it ought to be 10s. I know that we are told that to remedy that situation is pauperisation, and to that statement I answer, and shall always answer, that I would rather have widespread pauperisation than 4,500,000 paupers. Then there is this question of food and of milk, and I know that that is exceeding the limits of the present Debate. It is none the less a fact that we could, at a cost of £6,000,000 a year, give the under-fives and expectant mothers all the milk they want: that we could, for another £6,000,000 a year, give free milk to all necessitous cases and all school children: and that we could, for another £12,000,000 a year, give free meals in every school in the country, every day. That would be a very large sum, but we ought to spend it. That, however, is beyond the scope of the present Debate, and what I want to concentrate on, in the few minutes that I shall speak, is this question, which is well within the administrative capacity of the Department—of education and propaganda that has already been touched upon by an hon. Member speaking from a bench behind me. It is absolutely vital that a consistent drive, a consistently enlightened drive, a consistently explanatory drive, 778 should be made by the Department on every nutrition front. Some hon. Members may have seen the film that has been prepared on nutrition. I should like to see that film shown in every village, city and industrial centre in this country.
I have not, as hon. Members can see by a glance, ever experienced malnutrition myself, nor have I in any sense, except by chance, gone hungry. I have never had experiences such as those which are recounted in Lord Snell's admirable biography, or those also in the beautiful book written by the hon. Member for Chester-le-Street (Mr. Lawson). I have never had those experiences, but owing to chance circumstances I have had experience, a perhaps unusual experience, of various standards of living in various countries. I have never, of course, had direct or constant experience of the lowest standard of living, either in this country or abroad, but I have had the experience, while I was learning languages, of living in the sort of £400 to £500 a year families in France, Germany, and Italy, and also in this country. Moreover I used deliberately to stay with the rather poorer type of school teachers in the smaller towns of France, Germany, and Italy, and I did get to know how they lived and how people on the same sort of income level lived here.
§ Mr. Nicolson
Yes. That particular level of income is the only one I know in four countries, and what I noticed was that the actual knowledge in the preparation of food possessed by the wives of these teachers in Germany, France, and Italy was infinitely higher, infinitely greater, than that which I have experienced in -this country in houses on a similar income level, although my experience may have been unfortunate. I am not going to accuse the English housewife of being lazy and ignorant, because that is not the point; and what I found is largely due to the fact that the English husband is so extraordinarily good natured and tolerant—much more so than the French, Italian, or German husband. My word, if the French husband were sometimes fobbed off with the suppers with which the English husband is fobbed off, there would be trouble. But my experience was that it was merely a 779 question of the greater trouble that the wives of those French, German, and Italian teachers took; it was much more a question that they were interested in pleasing their families by the quality of their food. They know little ways in which to render food more palatable and, therefore, more valuable. I think that without question the nourishment of these people, which is produced by greater knowledge arid more careful selection of food, leads to happier meals, and, therefore, more nutritive meals, and, thereby, to a higher general standard of living in that class.
The poverty question is a question of policy with which I have not been able to deal to-day, and I do not think hon. Gentlemen opposite will find that I disagree with them on that policy. I urge the Minister to examine carefully the comparably administrative question of the preparation and selection of food, and to devote to the education of the public on those lines even greater energy than he has devoted before. I raise this general question, not merely because I wish to identify myself and my own group of friends with this question of nutrition, not only because I think that it is upon that front that the real battle for the standard of life is to be fought by us in the next few years, but also because I feel very deeply that upon the activity shown by the Minister on this point will depend for many of us the test whether the Government is really a National Government devoted to the interest of every section and every class, or whether it is only a party Government defending the interests of one particular class in the community.
§ 2.7 p.m.
§ Mr. E. Dunn
No one can have listened to the debates on the Ministry of Health without being struck with the wide range of subjects which have been reviewed. I have been to the trouble of classifying the subjects that have been under discussion, and I find that there are at least 50. Therefore, if one is speaking so late in the Debate, one must necessarily pass over a little of the ground that previous speakers have trodden. I could not understand the point of view expressed by the hon. Member for West Leicester (Mr. H. Nicolson). I do not believe the people in any other country are more capable than the people of this country 780 of cooking a wholesome and substantial meal. The hon. Member was much concerned about the question of nutrition and malnutrition. The root of the problem is surely very largely the question of poverty. The hon. Member says it is not a question of poverty so much as a question of ignorance.
§ Mr. Nicolson
I did not say that and I am sorry if I gave that impression. I said that I did not think I was allowed to talk on the subject of poverty, because it would entail legislation.
§ Mr. Dunn
The impression created on this side of the Committee was that the hon. Member said it was not a question of poverty so much as a question of ignorance. I am one of the people who, until I had the good fortune to come to this House, was never in the £400 to £500 a year class. I am concerned about the class of people whose family incomes are from £75 to £120 a year. They are the majority of the people of the country, and they are the people about whom there is so much concern on the part of the Minister of Health, and I believe of every honest man in the House irrespective of party. I have not listened to a debate in the House which has more impressed me with the sincerity of hon. Members who have attempted to approach this problem. Some of the speeches were among the best to which I have had the pleasure of listening in the House.
The problem is not so abstruse as many hon. Members have tried to make out. Good health is one of the main things in life, and I often think that the only time when we value it is when we lose it. I cannot conceive how we can have good health where there is a large percentage of the people who have empty stomachs, bad houses, low wages and bad social surroundings. The problem is really one of poverty and so far as the Minister of Health can do anything with his great office, his great powers and, I believe, his great anxiety about the problem, I am sure that he will do it. I want to offer one or two points for him to consider in reviewing this important problem in order to raise the general health and happiness of the people. In the Debate last Tuesday the Minister went out of his way to make a reference, not merely to building houses, but to making those houses into homes. I 781 have not heard a word in the Debate which would indicate that this problem is not realised by the local authorities, with whom the Ministry of Health has to work very closely and by voluntary organisations. Although I do not like these voluntary organisations and the Minister is very fond of them, I do not want to say anything which will prevent them from carrying on.
I have served on local authorities for many years and I still serve on one. Can the Minister indicate a single local authority that does not want to carry out the responsibilities and obligations put upon it? Local authorities are anxious to do their work, anxious to put the architectural and aesthetic beauty into their buildings, are anxious to deal with tuberculosis and with mental sickness, to build houses and to deal with the motherhood of the nation; but has the Minister of Health considered that the time has come when some reconsideration must be given to the question of the derating Act? I was much struck by the statement of the hon. Member for Llanelly (Mr. J. Griffiths), "We in Wales are quite prepared to do everything we can in every county but we cannot move because of our poverty". Local authorities cannot move because of their poverty. In 1929, on the passing of the Derating Act, there was taken out of the local exchequers of the nation the old provisions of the rating Ads. It is referred to by the Minister on page 160 and 161 of his Report. My problem is this: I am just as anxious as the Minister to provide improved social services under the authority of which I happen to be a member. But we have outgrown the position of 1929. The growth of social services of all kinds, as a result of legislation passed by this House, has brought us to the point that the finances of local authorities are bearing a burden too great for them to carry.
We are entitled to stress that note in this debate. For example under my own authority, the combined rate is 21s. to 22s. In the West Riding the county rate is 11s. 3d., after taking advantage of the derating grant, and on top of that there are the local rates of the rural district councils and the water charges. I am anxious to help the Minister to put into operation all the new services. I would feed the children and the expectant mothers; I am anxious about the birth 782 rate and all the social services. But I do not think that due regard has been paid by the Minister to the change between 1929 and the present year. The Minister has surveyed the field. It was a magnificent survey. I read and re-read his speech so as to get a proper perspective. But the local authorities of the country are carrying a burden that is too great for them to carry in consequence of the operation of the Derating Act. The argument is heard, why should industry, which is flourishing in every part of the country, take the profits that it is taking and not make a contribution to the local rates except to the extent of 25 per cent? In my own district if a steady flow of money was finding its way to the local exchequer, we could reduce the rate by from 3s. to 4s. in the £, and with that money we could carry out the services that the Minister of Health asks us to carry out.
In connection with housing has the Minister ever considered that there is nothing to be proud about in the fact that less than a 1,000,000 houses have been built by local authorities and that 2,000,000 have been built by private enterprise? The birth rate problem is largely bound up with this problem of housing, houses for sale and houses built to be let. People from whom we expect a steady flow of healthy families are now largely engaged in paying rent to landlords or in buying their own houses. They are too concerned about the insecurity of the future and their liability to the banks or to landlords to give due thought to the development of family life. I ask the Minister whether he does not regard the 1,000,000 houses built by local authorities as a greater asset to the State and the local authorities, and whether he does not place greater reliance on them than on the 2,000,000 houses built by private enterprise?
I notice that the Minister is instituting an inquiry into the fertility of the country. Already he has a lot of information on that problem, but I would point out that the poorest people, the people whose wages are only 45s. a week, and that in the staple industries of the country, are the people to whom this country is looking to produce the future generations. My hon. Friend the Member for Llanelly did not follow up the argument that the birth rate among the people who are unemployed in South 783 Wales is greater than in any other part of the country. Why should we be so concerned about restricting the activities of local authorities? Has the Minister considered whether the time has not arrived when he should re-institute the financial provisions for local authorities which were taken away from them under the Act of 1924?
§ The Temporary-Chairman (Sir Cyril Entwistle)
The hon. Member is now discussing something which would need legislation, and on which the Minister could not give him an answer in this Debate.
§ Mr. Dunn
I want to reinforce the argument made by the last speaker but one, and to ask the Minister whether he has considered the problem of rheumatism in this country. At the same time, I should like to say that I listened with great pleasure to the eloquent speech of the hon. Lady the Member for Frome (Mrs. Tate), and feel that the people of the country will read her speech with pride, and I would also reinforce her argument. Does not the Minister think the time has come when he should take further action to deal with the problem of rheumatism? It keeps large numbers of men out of industry and imposes a terrific charge upon the Health Insurance Fund, yet I do not think there is a single reference to it in the annual report, although it is the second most important problem.
Rheumatism has a particular interest to me by reason of the fact that my own brother who up to two years ago was a vastly stronger man than I have ever been, and was a regular worker, was then struck down by rheumatism, and from August, 1935, until now has never been able to walk, but is pushed about the country by any charitable person who may come along. There is no disease which is taking such a toll of the health of the industrial classes as rheumatism, and yet the annual report makes no reference to it at all. I ask the Minister not to hand this matter over to voluntary organisations but to institute an inquiry quickly. We know that tremendous help is being given to sufferers on the Continent as well as in this country, but I would beg the Minister to do more, and to provide this country with a service for those afflicted with rheumatism of which posterity can be proud.
§ 2.30 p.m.
§ Mr. Sandys
Several hon. Members in this Debate have dealt with the question of the standard of life with particular reference to the relation between poverty and nutrition. My purpose in speaking is to urge the importance of establishing an officially defined minimum standard of life measured in terms of income. About a week ago I asked my right hon. Friend the following question:Whether his Majesty's Government accept Mr. Seebohm Rowntree's recently published estimate of the minimum income required to provide the essentials of life, and if not whether his Department have made any such estimate of its own?The reply I received from the Under-Secretary was:No, Sir, my right hon. Friend is advised that this estimate involves certain features which are very conjectural and no sufficient official material for the preparation of an estimate of this kind is at present available."—[OFFICIAL REPORT, 7th June, 5937; Col. 1410, Vol. 324.]I am not trying to press my right hon. Friend to accept Mr. Rowntree's estimate. In point of fact I myself disagree with it in several respects. What does concern me however is that the Government do not appear to admit the necessity for establishing some standard of their own which they are prepared to accept. I do not altogether understand how it is possible to conduct a progressive policy for the improvement of national health unless one has some such estimate of human needs translated into terms of family income. For example, I do not see how one can fairly fix unemployment assistance scales unless one has some such estimate. I am not clear what the attitude of the Government is on this question. I am raising this matter in no critical spirit, but merely in order to obtain information from the Minister.
I think, though I am not sure, that I have noticed an unwillingness on the part of the Government to recognise the close connection which exists between spending power and adequate feeding. I do not understand this apparent unwillingness. I am the first to admit that proper nutrition is not purely a question of income. On the other hand I cannot associate myself with the people—I am not referring to the Government or to the Minister—who in what I regard as a misguided attempt to represent that everything is rosy, go about the country talking about education in nutrition. Of course education is of the 785 utmost importance in nutrition, as in every other question. But it is no good suggesting that one has only to join a lending library in order to be properly fed. I am asking the Government boldly to recognise the fact that the level of a family's income has the most direct bearing upon its standard of health in general and in particular upon its standard of nutrition. About a week ago a publication was issued by the Conservative Central Office on the subject of "Nutrition and National Health." I have an extract here which, I think, is very interesting and very true. It says:The restoration of industrial and commercial activity which has been such a marked feature of the National Government period of office, has had an important effect on the health of the nation. Increased employment and higher wages have put more money into the pockets of the people. Greater spending power has been evidenced by an increased consumption of food. This has led to a real improvement in the health of the nation and a decline in such diseases as tuberculosis.I entirely agree with that statement. The Government have every right to take credit, not merely for the excellent work which has been done departmentally by the Ministry of Health but for the general improvement in health and in the standard of feeding which has resulted from the higher wages, which in their turn were due to the Government's skilful conduct of our financial policy. It surely follows directly from that that if the Government, as they have every right to do, take credit for the improvement in health resulting from the increased spending power of the people, it is impossible for them to belittle the importance of the income factor in determining the general standard of health.
The influence of spending power upon health has recently been stressed by a mass of statistical information. We are all familiar with the investigation of Dr. M'Gonigle and Dr. Kirkby in Stockton-on-Tees. They estimated that the death rate was 25.9 per 1,000 among those whose income was 35s. or under, per week, whereas it was only 11.5 per 1,000 among those who earned 75s. a week or more—a vast difference. Similarly, a report issued about three weeks ago by the Ulster Society for Economic Research traced clearly the very close connection between poverty and the incidence of tuberculosis. There have recently been a number of unofficial inquiries of various kinds into the relation between health and 786 income. There have been statistical inquiries into the distribution of income between different groups of the population. The most recent is that undertaken by Professor Colin Clark. Scientific estimates, such as the scales of the British Medical Association, have been made of what is an adequate diet. In addition, there have also been attempts by scientific men and prominent social workers, such as Sir John Orr and Mr. Seebohm Rowntree, to correlate these two aspects of the question. If these reports with which we are all familiar, are even approximately correct, we are, I think, justified in asking the Government to take further action in the matter.
The Opposition are constantly referring to Sir John Orr's statement that 50 per cent. of the nation does not obtain the optimum diet. On the strength of this they allege that half the nation is living in a state of semi-starvation. It is absurd to suggest that because you have not an optimum diet you are therefore half starved. Exaggerated statements of that kind do more harm than good to the cause of progress. The most serious point in Sir John Orr's report was that 10 per cent. of the population belonged to an income group whose diet was deficient in all its constituents. From the recent report of Professor Colin Clark, Sir John Orr's figure, it would appear, should have been 13.7 per cent., which makes the position slightly worse.
It further emerges from Professor Clark's investigation that this poorest group of 13.7 per cent. of the population, owing to the larger average size of the families comprised in it, includes 25 per cent. of all the children in the country. That is a very serious matter, and I hope my right hon. Friend will consider it further.
The Government may very well consider that these investigations are not sufficiently complete to serve as a basis for the formulation of policy. If they take that view, I would ask them to make the necessary inquiries of their own and upon the results of those inquiries to establish minimum standards, which they are prepared to accept. In 1934, the Government's Advisory Committee on Nutrition and Diet brought out an estimate in calories of what a man's diet should contain, but there was no attempt to translate the calories into terms either 787 of food or of income. What is more, the report is of a very general character. It says:These recommendations are intended as a rough guide to medical officers of health, so as to assist them in placing the nutrition of communities and institutions under their charge on a proper basis. These values, being statistical averages, are meant to be applied to whole communities, and not to individuals or even to single families.It is, however, individuals and single families with which we are after all concerned.
We are now told that the Government are instituting an inquiry into family budgets and are also undertaking a dietary survey. I hope the Minister will say a few words about the scope of those inquiries. The information will undoubtedly be very valuable, but I feel that by themselves these inquiries will not be enough. They may tell us what people are spending and eating, but what we really want to know is what people ought to be spending and ought to be eating, in order to maintain a proper standard of health.
From the answer that was given to a Question in the House a little while ago, it appeared that, even when the Government are in possession of the complete results of these inquiries, they may still not he in a position to formulate a thorough-going nutrition policy such as we are so eagerly awaiting. I would, therefore, ask the Government to collect without further delay all the necessary information to enable them to lay down a minimum standard of life, with particular reference to nutrition, below which no one would be allowed to fall.
Unless we contemplate State feeding on a huge scale, it is impossible to isolate nutrition policy from the question of the general standard of life, and, in particular, from the general question of family incomes and needs. You cannot earmark part of a man's income for food unless you have some idea also of the cost of the other essentials of life. Therefore I ask that the Government should lay down some estimate of the cost of a general standard, which, in addition to rent—for which special provision would have to be made owing to the fluctuations in different parts of the country—would cover food, clothing, fuel and light, household requirements, and also a certain modest 788 allowance for leisure. When that standard had been laid down, it would be the task of the Government to ascertain what percentage of the population had an income too small to maintain that defined standard, and to examine the methods to be adopted in order to make good the deficiencies.
§ Mr. Bellenger
Apparently the hon. Member has studied this subject very seriously, and I think it would interest the House if he could give us his idea of what he thinks the minimum wage should be.
§ Mr. Sandys
I do not intend to make an estimate such as the hon. Member suggests. I am asking that the Government should make a proper inquiry, and should not depend upon guesswork. What we want to do is to put this matter on a regular scientific basis. The various steps which might be necessary to remedy the income and diet deficiency would no doubt include the provision of cheap food, perhaps on the lines of the Bishop Auckland potato scheme, or possibly a reduction of distributive costs as in the Northern Ireland milk scheme. They would almost certainly include an extension of the existing facilities for free or cheap milk and meals. Perhaps also a scheme of family allowances would have to be considered. Probably a combination of all these measures with others yet untried would be required to meet the case. However, until the principle is recognised, it is no use deciding how it is to be applied. What I am asking now is that the Government should accept the principle of an officially established minimum standard of life based upon income. I do not seek to lay down the level of that standard; the important thing is that some standard should be fixed. With the establishment of a standard of this kind, it would become possible—and this is most important—to supplement the dietary of poor families without having to wait, as is too often the case nowadays, for actual medical evidence that health has already been impaired by under-nourishment. It would in fact become possible to deal with the whole problem of nutrition in a scientific and businesslike fashion which is at present impossible, and from time to time to adjust the basic standard in the light of fresh knowledge and experience.
§ 2.52 p.m.
§ Mr. Denville
I do not intend to detain the Committee for very long. It will be remembered that in 1931 Mr. Speaker drew the attention of the House to the long speeches that were being made, holding up business, and a certain number of Members at that time agreed that they would make only short speeches. I wish that that could be said of many of the speeches here to-day and on other days.
I would like to draw the attention of the Minister and of the Government to certain injustices in connection with public assistance, and also in connection with sanitation—injustices to well-deserving people. I have in my mind a little travelling theatre at Atherstone, in Leicestershire, the company of which was thrown on public assistance through the action of the local authority in insisting, in the case of a little travelling building which was to remain in the town for two or three weeks only, upon the putting in of sanitary arrangements such as would only be found in a West End theatre. Had it not been for the generosity and kindness of the Showmen's Guild of Great Britain, the head of which is Mr. Bertram Mills, those poor people would have been left starving. As their funds went, they naturally had to have recourse to public assistance in the town of Atherstone.
Another case occurred in the little village of Ynisher, in Wales. Many hon. Members on both sides of the House have a very great respect for the small theatrical companies which travel about in Wales and in other parts of Great Britain, and many of which, indeed, were the teachers of hon. Members of this House, especially on the opposite side. In this little village in Wales, the company in question were to give their performance in a small market hall, but the urban district council, or whatever the authority was, came along and insisted upon their putting up a safety curtain, although it was only a little travelling company that was going to be there just for a week or two. Another little company on the outskirts of Chesterfield had a tiny theatre with a canvas top, and a stage scarcely larger than the Table in this Chamber, but the condition was made that they must put up an iron curtain, or they 790 would not get a licence. Through this vested-interest action in these various towns, 100 or more companies have been thrown on public assistance during the last few years, and their number has now been reduced to less than a dozen. I would ask the Minister and the Government to see if they cannot make some representations to assist these people. It would be perfectly in order for the local authorities to help them, and a word in the right direction might do a great deal of good.
§ 2.55 p.m.
My right hon. Friend in opening the Debate, said that, despite the optimism of the Minister's survey a week ago, there was between the lines very great anxiety and doubt. I am sure that the right hon. Gentleman, after listening to to-day's speeches in every part of the Committee, will feel that that anxiety and doubt are increased. We have had speeches ranging over housing, tuberculosis, nutrition, sanitary conditions, the control of mental institutions and the amenities and beauties of rural and urban England and, last, the hon. Member for Norwood (Mr. Sandys) has drawn attention to one of the most important factors in our national life. With him, I would certainly appeal to the right hon. Gentleman to have a full inquiry into that important matter to see whether something drastic cannot be done to obviate the difficulties with which our people are faced in these days. We have come along through the years on the understanding that our family life was based on the idea that the family income should be used for the benefit of every member of the family circle. The National Government has cut right across that principle and in many of our homes the family income is confiscated, and many of our people do not get the opportunity of enjoying the food that they ought to enjoy.
The Minister's record of the past year, good as it may be, has created very many difficulties with regard to the Special Areas. He claims—and I do riot dispute it—that a tremendous advance has been made in regard to the demolition of slums and the abolition of overcrowding. It is true that great strides have been made, but the problem is as great as ever. I, and no doubt many others, have been receiving letters from constituents, good, decent people, who have had their names 791 on lists for houses over a long period of years, and they are still without accommodation. That is one of the things to which we have to pay some little attention in the early future. The hon. Member for Morpeth (Mr. R. J. Taylor) in the last debate portrayed quite a different picture from the wonderful picture portrayed this morning by the hon. Member for Norwich (Mr. H. Strauss), who invited us to take steps to prevent the beauties of rural England being further dismantled. If he would pay a visit to some of our colliery districts and see some of the tragic things that are to be seen, arid how our citizens are compelled to live year after year, he would be able to make just as eloquent a speech in favour of the removal of some of the hideous things that our people are forced to see every day of their lives. There are unpaved streets which have had no attention because the colliery owners have said, "If you improve your streets we shall have to close the colliery down." Local councils have been terrified into leaving the work alone for fear that the men's occupation would be brought to an end.
I think the housing problem in the Special Areas has been hindered to a certain extent by the establishment of housing associations. Local authorities have to put their plans before a housing association before they can get the assistance that ought to be got direct from the Ministry of Health. I have met some of the active spirits of these housing associations, men who are doing exceedingly good work along that line, and they all tell me they cannot understand why the associations have been set up as the work could be done just as effectively directly with the Ministry as it is through this intermediary body. The complaint in the Special Areas is that there are far too many organisations of one kind and another which are simply preventing any large measure of progress. If an attempt were made to provide the houses necessary to house people who are now occupying slum property, if the slums were then demolished and the sites cleared and planned in order to make decent habitations for other people, that would increase the number of houses in the locality. There are, however, places where slums have been cleared, but the 792 sites are still vacant and there has been no attempt to make them into playgrounds, garden cities or anything else. They ought to be used at the earliest moment for additional houses. I was very struck with one part of the right hon. Gentleman's speech in the last Debate:The indications of the future are that there will be a need for a larger proportion of two types of houses. We shall need provision for a larger number of one-bedroom houses for aged persons, and also a larger number of houses for larger families requiring four or more bedrooms. A few months ago I communicated with the local authorities on this important matter, and I again desire to emphasise it this afternoon. Another requirement, especially as our people are being moved out of unfit and overcrowded houses, is that the rents charged should, if it is possible, be within the means of the lower-paid workers in the country."—[OFFICIAL REPORT, 8th June, Col. 1613, Vol. 118.]That is a very fine sentiment and a very nice ideal, but I should like to know how the right hon. Gentleman is to get it brought into operation. It is very essential, particularly the last section of it. It is one of the problems that we are called upon to face in the Special Areas, and I hope the right hon. Gentleman will give very great consideration to that section of it.
I want to draw his attention to the public assistance section of the work. Again, in the Special Areas, we are placed in a very great difficulty compared with what are called non-special areas. Our public assistance committees are being put to a tremendously extra cost in having to supply dental treatment and dentures to those persons who have been taken over by the Unemployment Assistance Board, but who, unfortunately, have not taken over the full responsibility. That is a matter to which the right hon. Gentleman ought to give some consideration. The taking over of the able-bodied people by the Unemployment Assistance Board ought to entail that they should accept full responsibility for these people, and not leave the greater part of the responsibility still with the public assistance committees in the Special Areas.
I have before me a return which has been taken out which shows that Durham County in the year ended 31st March last spent £3,323 on this particular benefit for people who are really outside their control and are now under the new control. They are having to deal also with certain 793 able-bodied people who ought definitely to be dealt with by the Unemployment Assistance Board. If it is right in principle that these people should go to the Unemployment Assistance Board, then surely it is also right in principle that the Unemployment Assistance Board should take the full responsibility. There are able-bodied single women looking after aged or sick parents. They are quite able-bodied, but the Unemployment Assistance Board do not accept responsibility for any assistance to them, and the public assistance committee has to bear it. The same applies to able-bodied women acting as housekeepers. They say that these women are not available for any other kind of work. If they were not engaged in that kind of work, they might be available for some other kind of work. All these categories are set forth, and there is apparently something in the law or in the administration that prevents these people being dealt with as, we believe, they should be dealt with. In the case of able-bodied men, men who are quite able to do some work though suffering from some physical defect, the public assistance committee has also to bear the responsibility. One could go through all kinds of cases like that which show that, in the Special Areas particularly, they are under a very great handicap and a great burden, and the Government should see to it that that responsibility should not continue to be placed upon them.
Pensions, as the right hon. Gentleman knows, is a very important matter in these days and is becoming more important as the days go by. In regard to contributory pensions, in the County of Durham for the week ended 17th April, 1937, they had to supplement by outdoor relief the income of 1,121 men and women because of the fact that the pensions were not sufficient to keep them in the reasonable necessaries of life. Of married couples where the man only was in receipt of pension, they had to assist 1,717 cases, the cost amounting to £1,456. In the case of single persons, widows and widowers, there were 2,600 persons, and the cost was £901. In respect of noncontributory pensions where both persons were receiving a pension, 582 cases had to be relieved to the extent of £246, and where the man only was receiving pension, 337 cases had to be relieved to the extent of £270. In regard to single persons, 2,198 cases had to be relieved, 794 costing £734. If all these costs are added together it can be seen that the public assistance committees are bearing a burden which ought to be borne by the nation at large. That is a submission to which the right hon. Gentleman is bound to agree.
Because certain districts happen to be very badly hit from the point of unemployment and old age there is no reason why they should suffer in this way. The right hon. Gentleman must realise that from the Special Areas they are taking all the young people and leaving us with the old people. Therefore, we are having to bear a much greater burden. The young people are being trained in the Special Areas and are then going to the prosperous areas to give them the benefit of the assistance to the expense of whose training we have been put, and we are left with the old people. That is one of the things to which the Government are bound to give serious consideration. These facts indicate that the difficulties to be overcome and removed are still exceedingly great. There will have to be some intensive concentration on them in the future. Such perorations as the Parliamentary Secretary gave on the last occasion are always very pleasant to the ear, but the needs of life call for practical application of remedies which will enable our people to realise that they are citizens of this country, and that they are to get better opportunities of living.
§ 3.12 p.m.
§ The Minister of Health (Sir Kingsley Wood)
We have had a very useful and friendly Debate, covering now almost two sittings, and it has been, in my opinion, and I have heard many debates, one of the best that we have had for many years. I thank Members of the Committee in whatever part of the House they sit for their observations and for such encouragement as they have felt disposed to give to my Department, and I thank them not less for the many valuable suggestions which have been made. It would not be possible for me to deal with every point that has been raised at this sitting or the other, but I will endeavour to answer a few. I will communicate with those hon. Members to whom I may not be able to reply to-day, and if necessary I shall be only too pleased to see them in regard to any matter which they may wish to 795 discuss with me. I should also like to thank hon. Members for their very kind and generous personal references to myself. I am reminded of a reference in another form which was made the other day by a gentleman who is a member of the National Insurance Medical Service, when lie said, speaking of my continued presence at the Ministry of Health, that it is better to have a devil you know than a devil you do not know. Perhaps some hon. Members may think the same.
I should like to say a few words about a matter which I raised in my opening speech and to which the right hon. Member for Wakefield (Mr. Greenwood) and other hon. Members have referred, namely, that further facts are to be ascertained in connection with our declining population. I emphasise that, in view of the various statements which have been made and the correspondence which I have received, in order to dispel a misunderstanding which perhaps exists, that I suggested that an examination must be made into various causes of the fall in population. What I am desirous of obtaining are certain facts which I have enumerated. A number of correspondents have written me giving their own views as to why there has been a fall in the population. Some have attributed it to high taxation, others have put it down to the effects of unemployment and others point out that the decline has proceeded during a period when there has been a continuous improvement in the conditions of our people. Others say that they have no desire to produce children as cannon fodder, while others assert that the fall in our population was the sharpest when there was the least fear of war. An expert observer has said:The dwindling family is the result of what is worst and what is best in the potential parents. Caution and self-indulgence, responsibility and the careless love of pleasure, both cry out against the large family and even the small one.Those are conjectures, and what is first needed—I am glad to have the support in this of the right hon. Member for Wakefield—is research of a scientific kind, more facts, and a more satisfactory and informative method of getting population statistics. As I promised a week or so ago, I have given further consideration to the methods by which this vital information can be obtained. Various suggestions 796 have been made in the press as to how the facts should be ascertained. There are only two ways in which really complete information can be obtained. The first is by the census, and the second by the registration system. Quite apart from the fact that the next census will not take place until 1941, I am sure that all the experts will agree that it is better to build up annually a continuous volume of statistics rather than collect them in connection with the census, which, covering as it does a wide field in a single inquiry, would produce a mass of facts taking years to digest and publish. Therefore, it appears that the registration system is the best for this purpose.
Existing powers, however, only permit of information relating to births to be obtained for entry in the birth register, and full copies of this register can be obtained by the public. It is clear that a proposal to enter up in it information as to the date and duration of the marriage and the number of children previously born of the marriage is open to objection. The confidential aspect of this matter must be preserved, and the objections which I have mentioned would be met if it were arranged for the necessary particulars to be given to the Registrar confidentially, not for entry in the public register, but for statistical purposes only, as in the case of the ordinary census inquiry. I will, of course, give further consideration to this matter and examine any other suggestions, but it would appear that by this means we shall best secure the information which is now generally agreed to be necessary. If this method is adopted legislation will, of course, be required.
The next matter to which I want to refer is in regard to the statements made in the course of the Debate by the hon. Member for Frome (Mrs. Tate), the hon. Member for St. Albans (Sir F. Fremantle) and the hon. Member for Gower (Mr. Grenfell) in relation to venereal disease and the measures taken in certain Scandinavian countries. I will observe first of all that the scheme for the prevention and treatment of venereal disease in this country is based on the recommendations of the Royal Commission which reported in 1916. The main feature of the scheme is the provision of centres throughout the country where full facilities for diagnosis and treatment are available free of charge to anyone who suspects that he may have 797 contracted the disease. In view of the discussion that has taken place, I emphasize that the Royal Commission reported against any system of compulsory notification or treatment on the ground that the element of compulsion would inevitably deter some people from consulting a doctor or attending at a centre. We have built up on that system about 180 centres in England and Wales, and the total number of attendances by patients each year is well in excess of 3,000,000.
In 1935 the total number of cases dealt with for the first time at the centres was 98,000, and of those as many as 36,230 were found not to be suffering from venereal disease. That shows that the centres are readily used by persons who are apprehensive of having contracted the disease and who are quite prepared to go there freely in the confidential circumstances I have mentioned. It ought also to be said that the number of fresh cases of syphilis attending the centres has steadily fallen from some 23,000 in 1930 to 19,000 in 1935. That is a striking decrease, because in 1920 the number of these cases was about 42,800. That is striking evidence of the decline in the incidence of syphilis, and it is, of course, confirmed by the death rate for infants under one year of age certified as due to syphilis. The number of cases of gonorrhea attending the centres has not varied very much in recent years, and it is commonly supposed that there are many sufferers from this disease, especially women, who do not receive proper treatment either at a centre or from a private doctor.
Our policy and belief at present is that the greater use of these centres by persons suffering in this way can best be secured by judicious education and propaganda on the importance of seeking early and skilled treatment for these diseases The anti-venereal disease measures in Scandinavian countries differ from ours essentially in having notification and compulsory treatment. As hon. Members have said, a report has recently been issued by a commission sent by the New York City health authorities which attributes an important part of the success in reducing the incidence of syphilis in Sweden and Denmark to notification and compulsory treatment. I do not intend 798 to comment on that report. I saw an important article in the "Lancet" which controverted a good many of the statements made in the report, and I will leave it at that; but this report has attracted a good deal of attention and has, I think, caused a revival, at any rate in certain quarters, of the agitation for compulsion here.
The position in this country is that there has been a decline of 36 per cent. in the figures of fresh syphilitic infections since 1931. It is true that between 1924 and 1929 there was apparently little or no decline, but since then the decline has been remarkable, and the rate of fresh infection with syphilis, which is now in the region of 160 per million of the population, compares rather favourably with the rate of 220 per million in Denmark.
Captain Arthur Evans
Can the right hon. Gentleman say whether the figures that have been collected in foreign countries refer only to certifiable diseases or to all cases?
§ Sir K. Wood
As far as I can tell, the figures are comparable. I realise the difficulties of comparison of figures between countries which have different methods of collecting statistics, but I think this a fair comparison. I think, also, that it can fairly be claimed that the system in this country, without compulsion, is producing good results. I feel, however, that a further special study of one or more of the Scandinavian systems might yield useful results, and my right hon. Friend the Secretary of State for Scotland and I are, therefore, arranging for one of the medical officers of my Department who is particularly concerned with this matter, and one of the medical officers from my right hon. Friend's Department, together with an administrative officer, experienced in venereal diseases to visit Scandinavia at an early date and report to us. That report should enable us to give further consideration to this problem.
§ Mr. Turton
Would my right hon. Friend consider the extension of that inquiry to Holland where there is voluntary treatment? That would enable him to get both sides of the picture.
§ Sir K. Wood
I shall certainly consider that suggestion, and I hope, at any rate, the Committee will think it right that we should take this step.
I wish to make some reference to the question of housing. The right hon. Gentleman the Member for Wakefield—one might almost call him the Vicar of Wakefield, he preaches so many sermons—rather excelled himself this afternoon when he referred to "the melancholy history" of the last few years and our "inglorious record" in the matter of housing. I think that was a special effort on his part, especially when we remember that since the War in this country we have built 3,250,000 new houses, a figure which has been exceeded by no other country. But I thought that what would have detererd the right hon. Gentleman from making such a statement was the fact that the number of houses provided has risen steadily from 194,000 in that great arid wonderful year which ended in September, 1931, and of which the right hon. Gentleman may have some recollection—194,000 of which 129,000 were provided by private enterprise without assistance—to 345,000 in the year with which I have been dealing, of which 274,000 were built by private enterprise without assistance, and 71,000 by local authorities. If it was an inglorious record" to have built 345,000 houses last year, I am sure the right hon. Gentleman would not be able to find words to describe that period when only 194,000 were built.
I recognise that a great deal more has to be done for housing, and particularly rural housing. I have listened to all that has been said on that question. It is to be the subject of special study by the Central Housing Council, and I hope that we shall be able to do something further in rural areas. As regards the right hon. Gentleman's observations on overcrowding, it is two years since the Act was brought in, and any member of a local authority can tell the right hon. Gentleman that a great deal of work has been done, in the first place in connection with the preliminary survey, and also in connection with taking the necessary steps to put the Act in operation. I thought it would be very useful to make a number of inquiries from, I think, a dozen typical local authorities in the country as to exactly what was the 800 position in regard to overcrowding, having regard to the number of houses built in the course of a year, belonging to local authorities and also, of course, to the efforts of private enterprise, to reduce overcrowding in their area. Without putting into operation any of the penal provisions of the Act, there has been a reduction, in some of the 10 or 12 districts with which we have communicated, of some 20 per cent. That is rather interesting and points to what the position will be when the Act itself comes into full operation.
I congratulate my hon. Friend the Member for Norwich (Mr. H. Strauss) on his very fine speech in connection with town and country planning. I am sure that, if it was pitched a little high, it certainly awoke—it did in my mind—a great deal of sympathy with what he said, but I do not think he intended—I think it was more a propagandist speech than anything else—to discredit the efforts which have been made by local authorities up and down the country to preserve the countryside. He gave a rather unfortunate instance in his speech when he referred to the English downs, because in fact, by the joint efforts of East and West Sussex and the valuable co-operation of the landowners—and I emphasise that point—the whole of the ridge of the Sussex Downs will be saved from building operations. That is one example, and another is the action of Buckingham in relation to the Chilterns. While I do not desire to-day to give other instances, and while I do not want to detract in any way from the appeal which my hon. Friend made, I do say that a great deal is being accomplished in this connection. I would say also, again only to give some idea of the difficulties, of which we did not hear very much this morning, that it is largely a question of compensation in a great many cases, and it is not a case, as my hon. Friend said, of a few hundred thousand pounds. But I do hope that we shall be able, with the co-operation of the landowners, which is of great importance, and with the work of the local authorities themselves, to do far more in that connection.
Now I must say a word about the work in connection with the mental health services, which has been raised for the first time in this Debate this afternoon. I claim for the mental health services that 801 good progress is being made in the humane and progressive treatment of the mentally disordered and the mentally defective people of this country. It is perfectly true that my hon. Friend, in a very powerful speech this afternoon, read from the report of the Board of Control extracts regarding a number of cases which you might call bad cases. Anyone who cares to look at that report will also see the records of a far greater number of good cases. The only point that I desire to make in that connection is that I suppose that in no other country in the world would you see such a frank statement of the position in connection with these mental institutions and what ought to be done in the particular cases referred to. There it is, open to the world, and it is one of the best means of publicity in connection with the treatment of people afflicted in this way. Directly our officers ascertain these facts we put them on record, and write to the authorities concerned, and say, "these are the facts; we call- upon you to do your best to remedy them." We do not let it rest at that for later we see what steps have been taken.
While I have said that there has been good progress, I would emphasise three things in connection with the mental services of the country. The first is that there muct be constant vigilance in the conduct and control of these institutions. Secondly, I attach a great deal of importance to unabated efforts to secure the right type of nurse. Thirdly, it is essential to investigate vigorously any instances brought to notice of ill-usage, bad treatment and matters of that kind. I think that there is great scope for further research into the causes of mental affliction, and recently I appointed a Committee under the chairmanship of Lord Radnor to see what further can be done to advance research. I would assure my hon. Friend that the need for providing additional accommodation is fully realised. Many schemes are in hand and in contemplation which should overtake this. The total amount of loan sanctions last year for the purposes of the Lunacy and Mental Deficiency Acts was over £2,000,000, as compared with £1,700,000 in 1935–36.
I would also emphasise what, I think, is one of the best signs of the time in connection with the treatment of this 802 disease, and that is that the flow of voluntary patients has steadily increased. Last year more than 25,000 patients were admitted to public mental hospitals, and of these nearly 27 per cent. were voluntary admissions. That is a good thing in two ways. It points to the larger number of people who are seeking early treatment, and it also points to the fact that our institutions and hospitals are not so bad or people would quickly hear about it and would not go into them. I would also like to assure my hon. Friend that the number of out-patients clinics has now reached a total of 165. I am not so happy about her suggestion about taking over country houses, for I do not think it would be an economic proposition. It has been tried, and has been found rather expensive. I think that for early cases it would duplicate the admission unit, the treatment centre and the equipment which we have in the admission hospital of the mental hospital. Therefore, I am afraid it is not a very practicable proposition.
The point which the hon. Lady rightly emphasised the most is the necessity of the physical examination of mental patients. I want her to be assured that the importance of physical illness as a causal factor in mental disorder is widely recognised, and by the Mental Treatment Rules which operate in this country, in every mental institution there must be kept a clinical record of each patient. One of the entries must be a record of the complete physical examination of the patient. Moreover, within seven days of admission the medical superintendent is required to send to the Board of Control a medical statement of the mental and bodily health and condition of the patient. If my hon. Friend knows of any case where that is not being done, I hope she will let me know, and I will take the matter in hand.
I want to say a word about nutrition. We are taking steps in this country to build up a nutrition policy. My hon. Friend, probably through lack of time, did not refer to the most valuable report of all, which I hope every hon. Member will study, and that is the recent report of my advisory committee upon nutrition. The hon. Gentleman referred to reports of Sir John Orr and others, which of course, I value very much, but, as he said, they are tentative and based on a very limited 803 number of figures. What I would like the Committee to look at is the report signed by all the leading men of the country, including Sir John Orr, Professor Cathcart and Professor Mellanby. Their recommendations I am carrying out at the present time and a number of inquiries are now in operation.
On the introduction of these Estimates I said that in many directions the local authorities, owing to the increased sums of money available to them under the block grants, are now extending their services in connection with milk for children arid expectant mothers and matters of that kind. The only further thing I say now as to a standard for nutrition is that, of course, nutrition is not an alternative term for food. It means the wellbeing of the body and the normal functioning of all its parts, and certainly a sufficiency of well balanced diet is a most important factor in sound nutrition. But I think that owing to individual differences in physique, personal habits, likes and dislikes, and the variations in the degree of muscular effort involved in different occupations, it would be quite impossible to lay down any standard of food requirements to be applied to all people alike.
That consideration shows that it would not be practicable to lay down a standard dietary in terms of specified articles of food. It is for that reason that all these experts have said that the best that can be done in the circumstances that now exist is to suggest standards in relation to man value in terms of energy requirements, the unit being on a sliding scale according to muscular activity. It is because of that that the particular method of calories has always been adopted by the British Medical Association, and it is for that reason that we have adopted that particular method of approaching the problem. The other inquiries which the advisory committee recommended are now in progress.
§ Sir K. Wood
My answer applies to that equally. Of course it is a considerable satisfaction to me as Minister of Health to see trade improving, employment increasing and wages increasing. The more that goes on the better it is for me from my point of view as Minister 804 of Health, because the more money people have and the more they are in regular employment the more help there is in solving the problem of nutrition.
In the course of the Debate, complaint has been made of the position of certain local authorities in relation to the National Exchequer. The increase in the Estimates does not measure the assistance which is being given by the Exchequer to our national health services.
The additional money included in the block grant was, for the first period, an additional sum of £5,000,000 a year, and for the period which began on 31st March there was additional assistance equivalent to another £5,000,000 a year. The block grant now amounts to over £46,000,000 and an increase in the total expenditure of local authorities will be reflected in a 22½ per cent. addition to such expenditure in the block grant in the next period.
So far as Special Areas are concerned, there is, of course, the special assistance given by the North-Eastern Housing Association. I do not think many Members would complain of having a housing association in their area which assisted in the erection of houses without any cost whatever to the ratepayers in the area. It should also be said that the Special Commissioner has done something to assist in the expansion of the health services in those particular districts, and considerable sums have been promised in that respect, amounting to nearly £3,500,000. Generally, if you look at the extent to which the National Exchequer is contributing to local expenditure to-day, you find that already in a considerable number of areas the Exchequer meets between 55 per cent. and 65 per cent. of the local expenditure, and the proportion for the country as a whole has now reached a figure of 44.6 per cent. It is obvious that Exchequer subsidies cannot go beyond a certain limit without the imposition of some direct Exchequer control, and to exceed that limit would undoubtedly sap our local government system and in some areas end it altogether. One must have these facts in mind in considering the matter.
In conclusion, I think I can say that in the long and continuous fight—which has still to go on—against disease and ill-health, we are steadily gaining ground. 805 I think this Debate has shown that there is much agreement, that our cause is genuinely above ordinary party consideration and that we can all contribute to the main lines of that advance to which we have all set ourselves. We are all agreed that good health is something which is more precious than the absence of disease, it is a thing of the spirit as well as of the body, and it is not only a matter of eradicating bad conditions but of creating good conditions. Looking at the events of the year, and watching the course of this Debate, one can say that, after all, the cure and prevention of disease is a negative policy, and that unless it is accompanied by schemes to promote health and better conditions in our conception of building up an A.1 nation we shall not succeed. My Department was once described as "a Department of pains and drains." That is a useful work, but I think I can claim that this great Department—which it is—has under successive Ministers belonging to all types of political views, and continues to have a much wider range and has a vision which goes far beyond pains and drains. I can assure the Committee that we will carefully study all the suggestions which have been made in the Debate. Some are long-range suggestions, some are of immediate and practical application to-day. The best and shortest answer to the many points put forward in the Debate will be to get things done, and to that task we hope to set ourselves in the coming year.
Mr. David Adams
Before the Minister finishes his speech, would he deal with a matter which is considered to be of great importance, namely, the difficulty of getting prosecutions in cases in which milk is proved to have been adulterated?
§ Sir K. Wood
I am aware that the hon. Member has been very constant in this matter, and of the particular difficulties in the area in question. There, a number of prosecutions have been launched, and I understand that the evidence has been conflicting and verdicts have not been obtained. I am carefully studying the situation, and I will confer with the hon. Member later to see whether any further practical steps can be taken.
§ 3.52 p.m.
§ Mr. Tinker
I am grateful to my hon. Friend the Member for Blaydon (Mr. Whiteley) and to the right hon. Gentleman for giving me a few moments. I have sat here for two consecutive days awaiting my opportunity, not altogether vainly, because there have been many valuable speeches. If anybody wants to know of a test of patience, I suggest that it is sitting through two days' debate. I am aware that other hon. Members have had the same experience. It has been suggested that the best test of patience is to get a wrong number on the telephone and not to talk to the girl at the other end, but I think that the one I have suggested is greater.
I want to make one or two comments upon the question of the fall in population. The Minister desires information on the matter; I want to give him a case which I think is typical of others. I received a letter the other day, and I am now dealing with it, from. a woman who told me that her husband received 33s. a week and that she had had to work as well. A child came along and she had to give up working while she gave birth to the child. It took a long time to get over the childbirth, but eventually she recovered. She tried to resume work, but was told that there was no job for her because she was not in a fit condition to take on work. She went to the employment exchange, but they told her she was not entitled to unemployment benefit. So there is the poor woman, with neither work nor benefit.
I was struck with the effect that her situation might very well have upon other people. Hers is a typical instance of the results of giving birth to children; no work and no unemployment benefit. In any working-class locality, when they talked about those matters, they would say: "Mrs. So-and-So had a child; have you heard what has happened since? No work for her and no unemployment benefit." The Minister must know that the consequence would be that in every one of those homes attempts would be made to restrict families, because of the conditions obtaining. That is one of the factors which I think he should keep in 807 mind and, if possible, he should try to give more wages to the husband. There should be no effect of driving the woman to find work, because if that happens it is not likely that many children will be born.
I listened with interest to the speech of the hon. Member for Norwood (Mr. Sandys). It was a good speech, but academic. As I listen to speeches from the other side I often think they sound too far from the subject. They are well intentioned, well cut, well prepared and strike the ear very nicely, and yet they seem away from the facts. The hon. Member talked about nutrition. He brought back to my mind a point which I wanted to raise with the right hon. Gentleman in connection with a question which I put to him yesterday and which I will read, because I am not satisfied with the information which I received. I asked the right hon. Gentleman whether he could tell me the number of wives whose husbands were drawing what is called the contributory pension, whilst the wives were not getting it because they were less than 65 years of age. The answer was that there were 250,000 wives in that category. I also asked whether the Minister could tell me how many were applying for Poor Law relief, and the answer was that he could not. I think the right hon. Gentleman ought to make inquiries in that direction.
When we are talking of nutrition and so on, we want to find out the actual number of persons who are seeking Poor Law relief for that purpose. Before we arrive at the stage of talking about the value of food, we must give the people some money with which to buy food. It is no use talking to a man who has only 10s. a week, and has to go to the Poor Law, about the value of food; he needs something with which to buy food. When he has it, if it is felt that the money is not being spent properly, then is the time to set about finding out the best way of spending the money. It seems to me to be a fallacy to talk about food values when men and women have no money with which to buy food. I cannot help feeling that lion. Members opposite, never really get to the root of this question. For instance, the hon. Member for 808 Norwich (Mr. H. Strauss) spoke about the spoiling of the beauty of the countryside by ugly buildings and so on, but I wonder whether he really understands the conditions that prevail in industrial centres. There are many other things in industrial centres, particularly the spoils or burning pit heaps. There are in the industrial centres hundreds of these heaps that are like active volcanoes. Before we talk about the countryside being ruined by drab houses, why not get this kind of thing stopped first of all?
§ Mr. H. Strauss
I am sure the hon. Member does not think that there is any conflict between what he is saying and what I said. He asks, why should not these heaps first be got rid of? I ask, why not do both?
§ Mr. Tinker
I am not in conflict with the hon. Member, but there always seems to be a big gulf between us and hon. Members opposite. They seem to be talking from a long distance off, instead of getting at the start of things. This matter has been before the House many times, but we never get any help on these questions from the other side. I have tried to get a Bill to deal with it, and the Minister promised that the matter should be taken up by the Inspector of Alkali Works. That has been done, and, if anyone cares to read the Inspector's report, they will find it very interesting. I have spent some time over it, and should like to pay a tribute to the way in which the Inspector has tried to get things done. Last year he paid 39 visits to 21 spoil-heaps, and gave advice as to what should be done. Some of the collieries have taken notice of his advice, and one or two have tackled the matter effectively and stopped the burning spoils, but I should say that in a dozen out of the 21 cases no attention at all has been paid to the advice that has been given, and the spoils remain just as they were. When the Inspector makes his report, I should like to see the collieries that he has visited named, and credit given to those where attempts have been made to put matters right, at the same time showing up those who have made no attempt to do anything. I ask the Minister to make arrangements for that to be done.
§ It being Four of the Clock, The CHAIRMAN left the Chair to make his Report to the House.
§ Committee report Progress; to sit again upon Monday next.
§ The remaining Order was read, and postponed.810
§ Whereupon Mr. DEPUTY-SPEAKER adjourned the House, without Question put, pursuant to Standing Order No. 2.
§ Adjourned at One Minute after Four o' Clock until Monday next, 21st June.