HEALTH OF THE NATION.

HC Deb 17 October 1940 vol 365 cc831-915

Mr. Rhys Davies (Westhoughton)

I beg to move, That this House takes note of the general health of the nation, and would welcome an extension of National Health Insurance, particularly to meet the conditions created by the war. The House will note that this is a very large and important question, but I want to assure the Minister of Health that I am not sounding an alarm in what I am about to say. I shall, to use a modern term, call the alert, and the right hon. Gentleman will realise that there is a vast difference between an alert and an alarm. During the last few weeks the nation has been warned to take heed of what might happen unless we are very careful with the health of the community. I notice that Lord Horder, who may be regarded as an authority on health problems, stated the other day that "unless effective measures were promptly taken we could foresee with the approach of winter a state of affairs in respect of infectious and contagious diseases which might prove more devastating than the blitzkrieg." That is a serious statement to make, and I think it can be prophesied that unless the nations at war are very careful with the health of the community they may be faced with much more serious issues than bombs, battleships and bayonets. Another well-known medical man, speaking at Bath the other day, stated that unless every law of medicine was broken this winter a terrible pestilence would break out on the Continent of Europe. Fortunately, we have the Channel between us, but whether that would be sufficient to prevent it spreading to England is another matter. I feel a little nervous when I take on myself a duty of this kind, especially when there are eminent medical gentlemen sitting all round me. They will forgive me if I just do what I can with this large issue. The experience gained in the present conflict compels the view that we neglect the health of our people at our peril. We are, therefore, calling the attention of the House of Commons and the nation to the obvious deficiencies that have arisen already in connection with our health services. The first thing that emerges is this. I do not think it is borne on the minds of all of us yet that the troops in this country, several millions of them, living in safety are as well equipped with medical attention and services as any troops in the world, but I am not so sure that the civilians, who are light in the front line of the battle and in peril, are as well placed as the troops. I do not think I am exaggerating when I put it in that way.

Vital statistics may be quoted to show the great improvement we have made in the health services, and Members of all parties are pleased with the progress that has been made in the past. It has been stated in the House on more than one occasion that a child born in this country to-day may reasonably expect to live on an average about 13 or 14 years longer than his grandfather could. That is a gloat achievement. One of the best authorities on the health of the community, Dr. Newman of the Ministry of Health, said that the greatest achievement man has ever acomplished is the postponement of the date of his own death. The rate of infantile mortality has decreased in the last decade or so, and the general rate of mortality has improved, and it is true to say that in no industrial country in the world has greater progress been made with the health of the people than in this country. Let me point out, however, some of the problems that arise out of the war. I have been trying to follow Press reports on this point during the last few months, and, as far as I understand it, as soon as the Germans invaded Holland there was an outbreak of typhoid. I understand that the Pètain Government have almost given carte blanche to the Pasteur Institute to do what it likes to inoculate the people of France and to take almost any step to prevent the spread of disease within the territory governed by them. In Switzerland, which borders on France, special precautions have also been taken to prevent the disease spreading. Pestilence knows no creed, no frontier and no nationality.

In this country we have been immune from serious disease since the last war. Some of us in Lancashire were a little frightened a short while ago, however, when there were about 30 cases of paratyphoid in the Bolton area, but the local authorities had the situation well in hand, and I have been assured that the outbreak was not unusual and that it might have taken place had there been no war. Another thing we have to be careful about is that we now have in this country, probably for the first time for centuries, large contingents of foreign troops—Poles, French, Czechs, Norwegians and others. That is something new. I suppose that the military authorities will look after their health; and although I do not wish to be critical, I should say that it does create a new problem when we have foreign troops mingling with our own civilian population. I leave that point by just putting it in that way.

Two months ago I ventured, on my own account, to send a request for information to about 20 medical officers of health serving all types and sizes of local authorities, and I was pleased to learn that on the whole the health of the community had not deteriorated; that, in fact, there had been an improvement in some cases, although in one industrial county there was a slight tendency to an increase in tuberculosis. I do not know whether that comes about because of the blackout. When people black out their windows they close them at the same time, and I should imagine that that might give rise to an increase in respiratory diseases in due course. I would ask the right hon. Gentleman to give us to-day some indication of how the health of the people in the devastated areas has been affected. Take districts like London and Liverpool, where probably some sewers have been destroyed, the water supply has been interrupted, and people have been for a time without gas or electricity or both. It would be interesting to have a statement about the health of the people in those parts. Without being an alarmist, or critical, I feel that we should be a wonderful people indeed if we could struggle through all that has happened recently, especially in the East End of London, without any sign of epidemic. I want to find out one thing in particular. I hesitate to put the point—hon. Members know my views on war, how I detest war with all my soul—but if this war deteriorates further into a conflict with poison gas, I should like to know what the Ministry of Health are doing to meet that situation. There are no rules in war, and in the end, I suppose, we may have to face what I should regard as almost the climax of horror, the use of poison gas.

What of our health services as a whole? Let me pass to the background of the situation as I find it. I do not think any public service is so haphazard as our health services. We have the local authorities dealing with maternity and child welfare matters, the National Health Insurance scheme covers about 20,000,000 insured persons, we have our hospitals, the general medical practitioner, the oculist, the dentist and the specialist. We have, therefore, a series of services, and as far as I can see they are not very well co-ordinated. Later I shall have one or two suggestions to make for improving the situation. One of the main points I desire to press on the Government is that the time has arrived when we ought to extend medical provision for the wage-earning classes in particular. How is it to be done? I do not know that there can be any extension of the medical service for the mass of the people except through the machinery of National Health Insurance. The right hon. Gentleman the Lord President of the Council knows as much about National Health Insurance as most of us, and I think he will agree that that should be the method of approach. We have about 20,000,000 insured persons and, strangely enough, about the same number of dependants. That accounts for 40,000,000 of the population.

Can the Government, in order to provide medical attention for these dependants, see their way to extend the National Health Insurance scheme, making use of the panel practice for the purpose? There is plenty of criticism of the panel doctor, some of it very ill-deserved. The strange thing about the people of this country is that they are always more prone to criticise an institution if the State has anything to do with it. When the same institution is under private control they make no grumble at all—perhaps because they think it is no use grumbling. On the whole, I should say that the panel service is the only possible method of extending the National Health Insurance scheme to cover dependants of insured persons. The right hon. Gentleman the Minister of Health will remember that some time ago I came to him with a deputation who were asking for an extension of the National Health Insurance scheme to cover the dependants of those who are in the Forces. A considerable number of those in the Forces, however, are single men who are without dependants and consequently we should not cover a very large number in that way.

There is one thing in favour of the proposal to extend National Health Insurance to cover the dependants of insured persons. I have been agreeably surprised to find growing up all over the country voluntary associations of workmen—sometimes covering factories, sometimes whole industries, and occasionally towns —to provide all that I am asking for, with, in addition, specialist and hospital services. The members of those associations are willing to have a deduction, on the poundage system, from their wages in order to provide these things. That is one of the best arguments that can be put forward in favour of the proposal that something should be done. There is another point to be considered in this connection. Deductions are now made all over the country also on a poundage system, sometimes on the penny-a-week principle, for hospital purposes. It is well-known that one of the costliest things in this country to-day is to undergo an operation. People are as afraid of the cost as of the operation. It is not that the charges themselves are too heavy but that they are too heavy for the pockets of the people who have to undergo treatment. I have had some experience of this, and I speak feelingly about it. I ask the right hon. Gentleman again to tell us to-day whether the Ministry has any proposals to bring before us for the extension of this service so as to cover the dependants of insured persons. I know that the money problem will arise at once. There is nobody here to-day representing the Treasury, but I may point out that the money problem in relation to this matter has already been worked out, in essence, and probably the Minister of Health already has the estimated cost by him. I think he British Medical Association went into this question and estimated exactly what the cost would be.

Let me come now to a comparatively small though important point. The Minister of Labour recently raised the income limit for non-manual workers in connection with the Unemployment Insurance Scheme, from £250 per annum to £420 per annum. That has created a first-class anomaly, because £250 per annum still remains the income limit in connection with National Health Insurance. This makes the whole thing look simply ridiculous. I ask the Minister of Health, therefore, whether the time has not arrived for raising the income limit in the case of non-manual workers under National Health Insurance, to the same figure as that which now applies to the Unemployment Insurance Scheme. I know that one of the reasons for retaining the present income limit in relation to National Health Insurance is the attitude of the medical profession. I am sure the representatives of the profession will not mind if I am a little critical of their attitude on this point. They have probably told the Minister of Health that anybody in receipt of more than £250 per annum should be able to pay for his own medical attention, instead of going to the panel doctor. That is their argument. I think the British Medical Association has a little too much influence with the Ministry of Health and I should like the Ministry, on this occasion, to ward off that influence. I ask them to take the plunge and raise this income limit figure to £420 as has been done by the Ministry of Labour. I would not like to think that the right hon. Gentleman the Minister of Health has not as much courage as the Minister of Labour and I leave it at that. It is all a question of courage and willpower. There is another matter to which I wish to direct the Minister's attention. He knows that the approved societies—and in this connection also I can speak feelingly—get 4s. 6d. per insured person per annum for administration. Can he not give them a little more? This change would not require any courage on his part, because this money does not come from the Treasury but from other sources.

Further, on what is a most important point, though it may appear relatively small, may I make a suggestion? It is a very remarkable thing in our community, that when people are organised and can publish a paper or journal, or can put up a spokesman to state their case with greater eloquence than I have, the Government will always listen to them. Let me bring to the Minister's notice, however, the case of a body of about 300,000 people in this country which is almost voiceless, except for an occasional letter to the Press. There are about 300,000 people on disablement benefit under the National Health Insurance Scheme. Not one of them will get more than 10s. a week to live on, and the vast majority will get only 7s. 6d. When wages have increased, when the prices of commodities have risen, when almost everything one has to buy is dearer than it was before, it is not fair that the sick person should be the one member of the community who is left without any increase in the amount available to buy what he requires. After all, it is much more costly in this country to be sick than to be well. That is taken for granted, and I have never understood why a person is assumed to be able to live on about one-half of his ordinary income, simply because he is ill. I know the difficulties in connection with this matter and I almost apprehend the answer which I shall receive from the right hon. Gentleman. He will probably ask "What about increased contributions?" I will leave the right hon. Gentleman himself to answer that question. He is the person who is paid to answer. But I will take him back a few years to the period when the present Prime Minister was Chancellor of the Exchequer. The present Prime Minister is a good War Minister but I do not like him in peacetime. He stood at that Box in 1926 and reduced the State contributions to this scheme. Ever since, although the scheme is still sound financially and actuarially, it has suffered a loss of £2,250,000 per annum. Had the present Prime Minister not been Chancellor of the Exchequer at that time, I suppose there would be no need for my request, to-day. I wonder whether the Minister of Health is big enough to do what I ask him to do—to increase benefits all round under the National Health Insurance Scheme, and, particularly, the benefits on disablement, in respect of the 300,000 people, who, are at present living on the scale I have indicated.

There is one other point which I wish to put on National Health Insurance. I have been in this House a long time and I have noticed that when Ministers are pugnacious and determined enough they can get away with a lot and leave their colleagues standing. The Minister of Pensions pays compensation to persons who are injured physically by enemy action. If a person breaks his arm as a result of an air raid he receives compensation but a person who suffers from nervous collapse as the result of an air raid has to go to his approved society for benefit and gets nothing from the State. I am not sure, but I should not be surprised to find that, as the war proceeds, there will be more people suffering from nervous collapse than from physical injury as a result of enemy action in this country. I know of one society which had 13 claims in nervous breakdown cases, in one day, from one district alone. I leave that point also to the right hon. Gentleman. I do not want the State Insurance Scheme to bear a financial burden which ought to belong to the Ministry of Pensions. This is a matter between the right hon. Gentleman and the Minister of Pensions and if the right hon. Gentleman cannot defeat the Minister of Pensions in argument on this issue, then it will be a bad day for us all.

I have dealt with National Health Insurance and I have tried to indicate to the right hon. Gentleman how he can find the means to extend the benefits. I wonder sometimes whether we can coordinate these health services. Apart from the medical services I have mentioned there is the certifying factory surgeon service, which comes under the Ministry of Labour, and there is now another scheme, the factory medical service. Some of the best employers employ doctors in their own factories who attend to the physical welfare of the workers in those factories. Can we do something to co-ordinate all these schemes, which sometimes straddle across the countryside. The right hon. Gentleman ought to take this matter in hand at once.

My very last word is upon a new point which has arisen during the war, and which I really must bring to the attention of the Minister. He will know better than I do that there are mental welfare societies in this country, operating under local authorities. A case came to my notice the other day in which a mentally deficient person had actually set fire to some buildings and had caused damage to the extent of £30,000. He seemed, like Nero, to enjoy the sight of flames. When he was brought before the police court it was discovered that the local education authority ought long ago to have taken steps to ascertain his mental condition and to put him under supervision. Can we do something in that connection? I am pleased to know that I have helped to induce the Ministry of Labour to take one step. Some of the mentally deficient boys were put into the Army, but I am happy to say that now a mental welfare association gives a note to them, which they take to the medical board of the Army. As soon as the medical board see the note they know what to do. Local authorities should be made to carry out their duties in these things. Some local authorities do their work well, but others do not take the slightest notice of what is happening in this regard.

We are at war. As I go up and down the country I see the great ravages that are taking place as a result of bombing from the air, and I often wonder what will happen to us all in due course. Of one thing I am certain; our forefathers conquered plague and cholera with means at their disposal of a very much more slender kind than we have to-day. I hope that the few remarks which I have made will put the Govt. on the alert to prevent anything like epidemic or pestilence happening to our people in these dark days.

The Minister of Health (Mr. Malcolm MacDonald)

I am sure that hon. Members who are present will be extremely grateful to the hon. Member for Westhoughton (Mr. Rhys Davies) for introducing so effectively this important discussion. He has asked a number of questions, of which my hon. Friend the Parliamentary Secretary has made a note and to which she will endeavour to give an answer when she winds up the Debate. The hon. Member has raised questions relating to National Health Insurance, and suggested changes in the scheme to meet the situation brought about by the war. As he pointed out, important questions are raised in that connection. He suggested that the income limit for those who are insured should be raised to £420, which is the level for Unemployment Insurance, and that the statutory rates of sickness and disablement benefits be increased on account of the war situation. Another question was whether there should be a system of dependants' allowances introduced into the scheme.

Those are all very wide questions, which involve a considerable number of different points affecting many different categories of people. They affect employers and employed, doctors and friendly societies. I could discourse at great length upon the different points which have been raised and have been set before the House, and give the pros and cons of them, but I am not prepared to do so. I want to tell the House that the Government Departments concerned have been conducting a very close examination of this problem to see what action might be proper for them to take, and we had advanced a good way in the study of the matter before the "Blitzkrieg" started. We had made certain contacts, with a view to seeing what action, if any, we might be able to take by agreement, but then the intensive air bombardment began, and some of my officers had to be turned to more urgent tasks. We have been bound to put first things first and to deal with the really urgent problems which have arisen. Our attention to this matter has been interrupted for a little while, but we shall get back to it as soon as we possibly can. I can assure the hon. Member that we are considering the problem sympathetically, and that we shall make a statement at the earliest possible date as to whether we think something should be done at the present time. In the meantime, it is exceedingly valuable to have this discussion so that we may have the views of hon. Members upon it.

The hon. Member also raised much wider issues, those touching the general health of the population under war conditions. I propose to take this opportunity to survey this matter broadly, as it is second to none in importance, when we contemplate the capacity of the British people to fight the war through to a final victory. Superficial observers might be tempted to suppose that the health services, while properly a prime concern of Government during peace-time, should, in the midst of the fierce preoccupations of battle, be relegated to a position of secondary importance, while all the energies of Whitehall are turned to the production of ships, guns, aeroplanes and every conceivable kind of armament with which our men can defeat the enemy. But these munitions are not produced by unattended machines. At the machines stand hosts of men and women, and the health of those people is a matter of crucial importance. If they are unwell, the production of armaments will flag and halt, but if they are physically and mentally in trim, then the flow of that production will increase steadily until it becomes a flood which overwhelms the Nazi forces. For that and other reasons, I repeat that the people's health is a factor second to none in importance in this supreme hour of the nation's destiny.

May I say a few words in order to make the survey one which is in proper perspective with what has gone before? In the 20 years between one war and the next we made great forward strides. Although there was still a long way to go before anyone could feel complacent, the good health of the nation was on the march. We had established solidly and widely health services which ministered to those in need and which produced a cumulative process of improvement which nothing could thwart. Not even the calamity of the outbreak of war, when it came with its inevitable disturbance and interruption of many good works, could stay the steady upward surge. We have now got the health statistics for 1939, which I think give striking proof of that fact. They tell a story of a year in which there were eight months of uneasy peace and four months of war. Yet despite that disturbing situation, the figures were almost uniformly better than those for the preceding 12 months, which in their turn were in advance of what had gone before. I should like to give to the House in a few sentences a small collection of facts which are the best pointers to the state of the nation's health, just those figures which are watched for every year by the public as well as by experts, because they are the tests of retreat or advance.

First, taking the infantile mortality rate, the number of children in England and Wales who died before their first birthday in 1939 was 50 per thousand children born. That is the lowest figure ever recorded. It is three per thousand less than the figure for 1938. It is interesting also to reflect that it is less than half the corresponding figure for 1914, the first year of the first world war. The second significant index figure is the maternal mortality rate, recounting the number of women who died in childbirth for each thousand total births. In 1939 it fell to 2.82. Again, that also was the lowest figure ever recorded in this country. It was 0.15 lower than in the previous year, and little more than two-thirds of the corresponding figure for 1914. Thirdly, I take the death rate from tuberculosis. Compared with that of the year before, the figure does not show any actual decline. Otherwise, I could have presented to the House a most impressive hat trick of low records in these three vital statistics. Nevertheless, the figure is encouraging. The crude death rate from all forms of tuberculosis last year was 636 per 1,000,000 living souls. That is one per million higher than in 1938, but it is much less than half the figure for 1914.

Those three eloquent figures are the great trinity of bright facts which illumine the national advance to good health. I might mention a number of the lesser lights of 1939. Only one case of smallpox was notified last year. Reports of scarlet fever and diphtheria were fewer than in the year before, and the anticipated biennial measles epidemic failed to put in an appearance. But I will not mar the fair face of this statement on the nation's health by an irritating rash of statistics. Moreover, the nation's chart was not uniformly good. There was an ominions increase in the incidence of cerebro-spinal fever, and that is a matter which should make us pause in our contemplation of the winter that lies ahead. Yet the disease is not so formidable as it was, even two or three years back. Its terrors have abated since the discovery of that drug which hides its pleasant life-giving qualities under the forbidding name of M and B 693. By the spring of this year that drug had already reduced the proportion of deaths among sufferers from cerebro-spinal fever to almost one-third of what they were accustomed to be. Nor is that the sum of benefit of this new discovery. There are brother and sister drugs being born in this family of the sulphonamides, which are not only healing the wounds of our soldiers more swiftly but which have proved to be an effective cure for other diseases, notably pneumonia and puerperal fever. Nevertheless, the worst visitation in 1939 was the outbreak of war itself.

Sir Francis Fremantle (St. Albans)

The right hon. Gentleman has given us the death rate for infantile mortality, tuberculosis, and maternal mortality. Can he give us the total death rate for the year?

Mr. MacDonald

I cannot do so at the moment, but perhaps my hon. Friend will be able to do so at the end of the Debate. As I was saying, the outbreak of the worst disease, which was the outbreak of war in 1939, did disturb, interrupt and threaten a great deal that was precious. At its very beginning it threw a new kind of strain on our health services, which they successfully withstood, and which shows how they can adapt themselves to circumstances. The evacuation of 730,000 school children and 420,000 mothers from the industrial cities to the country was a large migration of people from the thickly populated areas where the necessary special medical services, such as maternity and child welfare services, the school medical services, as well as the provision for infectious diseases and the like, are widely established. With the removal of large numbers of people from those well-equipped areas to the less populated areas where this provision was sparser, the problem presented to the health authorities was exceedingly difficult. It had to be met by a great deal of swift improvisation, a process which, of course, was smoothed by the announcement that the Exchequer would be ready to bear the total cost of all those works which were involved over and above what would be normally expected from local authorities in times of peace. Skilled staff was recruited, equipment in large quantities was bought centrally and distributed, private houses and other buildings throughout the countryside were transformed into sick bays, maternity homes, residential nurseries, homes for cripples and all sorts of other purposes. May I give one example of the scale of this addition to the services in the country? For London expectant mothers alone there are emergency homes in the country which can cope with 2,800 births every month. This provision can be added to whenever it becomes necessary. The number of expectant mothers leaving London at the present time is something over 500 every week.

With regard to the evacuation which has taken place, there is one reflection that I would like to make. With all our experiences during the war, we must be watching for the lessons which they teach about our conduct after the war. Our present trials in this much-bombed city, as in the rest of the country, are not the prelude to defeat; they are not the death agony of Britain, but rather the unpleasant, the terrible, but the hopeful birth pangs of a new Britain. One of the things we should remember in that new Britain is this. The sojourn of children from London and other evacuation areas into the country has had a most stimulating effect upon their physical well being. Fresh air has made them taller, healthier and more resistant to disease, and contact with nature has done something to broaden their minds and to enrich their spirits. They are healthier and more educated beings. We must see that after the war our town and city children have ample opportunity every year to go and draw these fresh draughts of health and life from the lovely countryside of England. Children certainly cannot have too much fresh air.

Dr. Edith Summerskill (Fulham, West)

And food.

Mr. MacDonald

I am coming to that. There are a few simple things which are fundamental to health, things which have tended to be too long neglected and which would build up a foundation of sound health that it would be exceedingly difficult to shake. One of those fundamental needs is the consumption of adequate quantities of the right kinds of food. The importance of body-building and protective foods is becoming better recognised every day. I would rank it as second to none amongst the elements contributing to good national physique and health. The scientists who urge this have often been misunderstood. They do not propose that we should eat each day just so many ounces of a limited and rather unexciting diet. What they urge is that if we make such fare the basis of our diet our health would be well founded, and we should then be free to add whatever foodstuffs are to our own individual tastes. I am not going to enter here upon a discussion of the virtues of potatoes and fresh vegetables and the rest of the scientific menu; these matters are in the capable hands of my right hon. Friend the Minister of Food. But I would like, as Minister of Health, to record my special pleasure at one of his actions. Of all the nutritive foods, milk is far and away the most important. It contains all the life-giving ingredients classified under the names of proteins, carbohydrates and the rest. The inauguration this year of the nation-wide scheme for free milk for nursing mothers and infants is a most important milestone to have passed on the road to national good health.

In war-time there are other more customary and orthodox tasks thrust upon the health authorities. We have to make plentiful provision, and an army of doctors and nurses has to be recruited for the care of the wounded. In this war no strict professional exclusiveness, no chivalrous cramping sense of military etiquette, was to confine casualties to those who had donned uniform and contracted to fight. We had to be prepared for a multitude of civilian casualties which might be as numerous as those among the fighting men themselves. The Ministry of Health had the twin task of providing in England and Wales for the hospital care of the great majority of the men who would return wounded from the actual battlefronts and also of all the private citizens who might be severely injured by enemy action. The Emergency Hospital Service, which was built up to meet this double need, is a very remarkable creation, which also has its lessons for us after the war. Under one supreme operational direction has been joined the fine equipment and the great resources both of the voluntary and of municipal hospitals. To them have been added other public institutions which, by the addition of equipment and supplies, have been converted into first-class hospitals. In many cases these hospitals have been surrounded by little hamlets of brand new, up-to-date huts which can hold tens of thousands of extra patients. The cottage hospitals have been expanded, some of the stately homes of England have been equipped as auxiliary hospitals, and supplies are also stored in other mansions and in a number of our schools, so that in a few hours their halls and classrooms also may be transformed into wards if the need should arise.

The first severe test fell upon these preparations at the time of the withdrawal of the British Expeditionary Force from the beaches at Dunkirk. The Service then had to perform a function which it had hardly expected. Some of the hospitals on the South-East Coast became veritable casualty clearing stations, to which the wounded were borne over the narrow sea, straight from their encounters on the field of battle. Further inland, the base hospitals opened their doors. In a week many thousands of casualties were admitted. The surgery, the doctoring, the nursing, proved themselves of a high standard—so high, indeed, that a return from the London hospitals sector, which bore the brunt of the work, shows that even in that sector only 1.7 per cent. of the men died from their wounds.

Some good comes out of evil, and it cannot be denied that the science of medicine thrives in war. The battlefield is a laboratory in which in a few weeks are created opportunities and experiences for doctors and surgeons which in other times would not come to them in years. The practice of healing is perfected, and new discoveries are made. In this first twelve months of this war there have already been great advances in that respect. Hon. Members are already aware of the great strides made in the work of blood transfusion and in the storage of plasma for that purpose. We have already learned extremely valuable facts about the healing of serious burns, and improved treatment is now being applied throughout the hospital service. There has been much progress in the mending of broken jaws, and in plastic surgery generally. Many other lessons are being patiently and eagerly learned, and the results will bring wide benefits to the human race. There is one other aspect of the healing of the wounded—whether of military or civilian wounded, or, indeed, ordinary cases of industrial accidents—which I should like to mention, because it is being given full play in the Emergency Hospital Service. It is a matter of particular importance; indeed, it is the secret of the maximum cure possible for the patient. It is the process known as rehabilitation. It is not sufficient that the wound should be healed; the wounded part of the patient must be enabled to function again so that he may once more play his part in society as a worker. If it is not possible for him to work exactly as he did before, then he is to be examined in order to see what kind of work he would be able to do, and the wounded limb would then be trained to perform it. All this requires in the hospital system remedial exercises, both outdoor and indoor games and occupations, and finally workshops where training in the movements needed for productive work may be provided. All that we are supplying on a very considerable scale. I have appointed an adviser on rehabilitation, and I am also forming a strong committee of medical experts to encourage the development of this treatment, and to guide its growth so that it may be efficient now for the purposes of war, and also, hereafter, form the nucleus of an organisation which shall be progressively valuable in the re-establishment of the victims of industrial and other accidents when we return to peace.

With the reception in our hospitals of the last military convoy from the battlefields of France, that episode has closed, and it has been succeeded by a somewhat different chapter of intense, heroic activity. For many weeks now our nurses and doctors have been tending civilian victims of the Heinkel that seeks to be "the terror by night," and the Messerschmitt that "flyeth by day." The stretcher parties, the first-aid units, the ambulance teams, and the hospital orderlies, nurses and doctors have performed their tasks—often under fire—with inexpressible coolness and skill. We know now, what we suspected before, that they will perform whatever work falls upon them, however difficult or however dangerous it may be.

As is well known, the numbers of casualties are slight in comparison to the strenuous and wanton efforts which the German airmen are making. At this moment only some 5,500 beds in our hospital wards throughout England and Wales are filled by air-raid casualties. It would be a mistake for us to feel too much assurance from that fact. It would be foolish to assume that we shall not suffer worse before the enemy is finally beaten back from London to Kent, and from Kent across the Channel, and from the Channel over Europe to final destruction on the soil of Germany itself. We must keep large numbers of beds empty in all hospitals so that they are ready to receive sudden casualties or sick in force, lest a sudden emergency arises, but we ought not to keep too many beds empty. There are other needs of the nation at war, and I am glad to say that the authorities of the Emergency Hospital Service have been quick to recognise that they can play a great part in relieving those needs. Our emergency hospitals are to be used for nursing our military sick. But also the other day my right hon. Friend the Minister of Labour approached me about the care of munition workers who fall ill away from their homes and who cannot get their customary domestic nursing.

Dr. Haden Guest (Islington, North)

Is my right hon. Friend going to say anything about the financial arrangements with regard to the military, and the civilians injured by air raids in hospitals? What are the financial arrangements in connection with these cases?

Mr. MacDonald

I did not propose to deal with that matter, but perhaps if my hon. and gallant Friend wishes to raise it, he will do so if he catches Mr. Speaker's eye, and my hon. Friend the Parliamentary Secretary will deal with the matter. As I was saying, we are exceedingly anxious that the emergency hospitals should not only serve military and civilian casualties, and the military sick. My right hon. Friend the Minister of Labour approached me the other day about munition workers who fall sick away from their homes and who cannot, therefore, get their customary domestic nursing, and he suggested that I should create new sick bays. I told him that I would do more than that; his men and women could come and be nursed in our emergency hospitals. There are other civilian-soldiers in this war who are being succoured in the emergency hospitals. At the present time there are large numbers of mothers and their children who are being evacuated from London to the country. In many cases they are tired after their grim experiences, they may not have had any opportunity to refresh themselves with a thorough wash or to acquire clean clothes before they have had to leave London, and they wish to do these things before presenting themselves to the hosts and hostesses who are waiting to welcome them in their households. We have made an arrangement in those cases by which these evacuees are taken first for two days into one of our emergency hospitals, where they have the best of care, and an opportunity for rest, refreshment and recovery before they go on to their billets. Moreover, our country hospitals are now making room to receive many hundreds of chronic invalids and aged people, who, under war conditions, cannot be cared for in their own homes.

These are some of the features on the health front that I would marshal in review. But there are still two or three others which I must pick out for mention, problems which have been aggrevated or even created by the war—the risk, for instance, of venereal disease. The prowling advance of this notorious camp-follower of war moved the authorities in 1916 to institute a wide-flung service for its treatment, and it has been active ever since and has achieved remarkable success. The incidence of venereal diseases is among those which have shown a large and steady decline over the last 20 years. But there have been indications during the last few months that it is once more on the increase. This also is partly the result of the shifting of population which has followed the outbreak of war. New large congregations of population have been created round military camps and in the neighbourhood of expanding war industries, and this expansion of population has often occurred in places where the population before was comparatively sparse, and where there was no established service for the treatment of venereal diseases, because there was no great volume of cases to be dealt with. The Service must now be extended. But the burden of financial responsibility should not fall mainly upon the rates of local authorities which have to face the problem as a result of war conditions. Therefore, while I am asking local authorities to take effective steps to maintain the treatment service where it exists, to increase it wherever necessary and to create new units of treatment where the need has arisen, I am also informing them that there will be an Exchequer grant of 75 per cent. of the cost of treatment facilities required to meet the new war circumstances. My officers are putting themselves in touch with local health authorities and will assist them in getting an effective organisation. For example, in many rural areas a mobile unit will be the best means of achieving results. A van equipped with the necessary appliances and drugs and carrying the medical, nursing and clerical staff required will visit periodically a number of fixed treatment centres.

I trust we need not speak of venereal diseases in whispers. I am not, thank goodness, Minister of Morals, but I am Minister of Health, and I speak of this as a medical problem. I urge all those who suspect they may have venereal disease to overcome their foolish and dangerous qualms, to be sensible and visit a treatment centre. Their personal confidence will, as heretofore, be respected. The eradication of venereal disease needs no new medical discovery; the means are there, and treatment can be quickly given, so that there is no danger of infecting others. If individuals reject the oppor- tunity of disinfection and cure then they are only storing up trouble for themselves in the future which, most unhappily, they may hand on to their children.

Sir F. Fremantle

Will that grant also apply to the central services of the Social Hygiene Council?

Mr. MacDonald

That is another matter which we shall certainly be ready to consider with the Council if they wish to make an application about it. The decision which I have just announced applies only to local authorities.

Dr. Guest

Are the services for the military as well as civilians?

Mr. MacDonald

We have an agreement with the Service Departments that their cases can be treated. This national service will cover every category of the population.

Mr. David Adams (Consett)

Does the 75 per cent. grant cover civilian as well as military cases?

Mr. MacDonald

Certainly, the 75 per cent. is towards facilities which are required for civil or military cases arising out of the new circumstances of the war.

Finally, there is a problem which looms out of the winter darkness ahead of us. If you search for the people of London at nights now you do not find the great majority of them in their houses. Their living rooms with fires in the hearths and their bedrooms are empty. They are in the shelters. The sudden collapse of France and the Nazi occupation of North-west Europe has indeed made a difference to our ways of living. These shelters which were built for or adapted to be refuges for a comparatively short period of time during air raids have now become dormitories in which the populace stay throughout the night. How are these people going to fare during what the doctors call the "catarrhal season" throughout the winter? The responsibility for the construction of public shelters rests upon my right hon. Friend the Minister for Home Security, but the health aspect of the problem naturally concerns my Department. My right hon. Friend and I are co-operating closely in this task and we have the advantage, as the House knows, of the advice of a Committee of experts under the distinguished, wise and energetic chairmanship of Lord Horder.

Dr. Morgan (Rochdale)

Is he a public health expert or merely a physician?

Mr. MacDonald

He is an expert on health matters and the committee is representative of different types of experience in this question. He and his colleagues have spent much time in studying conditions in London shelters and have made a number of valuable recommendations. Every recommendation has been accepted and is being acted upon. The Committee continues in being; its members will watch the situation continuously, and their field of work covers the whole country.

It is of high importance that a proper standard of provision for health should be preserved in all the large shelters. We are co-operating in this matter with the local authorities and their medical officers of health and I am also appointing, in the Ministry of Health, a body of medical experts who will devote much of their time to inspections and to seeing that the standards laid down are maintained. I do not propose now to weary the House with many details of the provisions that we have in mind, but I will mention briefly a catalogue of ten propositions. First, the burden of the problem is overcrowding. If the population in each of these refuges can be reduced to reasonable proportions the problem of protecting them, not only from bombs, but also from germs and parasites, becomes much simpler. Therefore, the policy of evacuating people who can be spared from London gains added importance as winter approaches. By a steady process of persuasion that policy is bearing abundant fruit. Already, some 489,000 schoolchildren—about 56 per cent. of the whole school child population in the London evacuation areas—have left.

Mr. Kenneth Lindsay (Kilmarnock)

That is in the whole region, not just the L.C.C. area?

Mr. MacDonald

In the L.C.C. area some 300,000 out of 500,000 have left. This is for the larger area, not the whole region, but from the evacuation areas in the London Region. At the present time, mothers and children are leaving London at the rate of several thousands each day and every few days we are taking some hundreds of the aged and in- firm—who are among the most difficult problems in the shelters—to be cared for in hospitals and homes that we have found for them in the country.

Dr. Summerskill

Would the Minister define "infirm" because I have tried to get many people, whom I consider infirm, to go away and they will not go?

Mr. MacDonald

I do not know that a definition by me, even as Minister of Health after getting proper advice, would be valuable, but we have done something which is more useful and it is this: we have asked local medical officers, with such assistance as they require, to go to rest centres and shelters to look at the aged and infirm and ask them whether they are ready to be evacuated. We have left it to their discretion to decide what is an infirm person. They are bound by no rigid or narrow instruction on the point. We have asked them to be, on the whole, generous in their interpretation and I do not know that any definition from headquarters would work more satisfactorily than that local discretion, left to the medical people.

I have dealt with the first proposition, of evacuation. The second is that, in order to reduce overcrowding, it would be prudent for the total shelter population to be dispersed over the various kinds of shelter which, on the highest advice as to their safety, the Government have provided. The Minister of Home Security is taking steps to accomplish this. Third, it is of supreme importance that the night dwellers in shelters should be able to lie down in comfort and sleep the sleep of the just. That state of affairs will be achieved when bunks have been set up, which will be as early as possible and in the very near future. Fourth, a healthy standard of sanitary equipment is being provided. It includes the provision of one latrine for every 20 persons inhabiting the shelter.

Mr. Lindsay

Who is really carrying that out? Who is responsible? Is it Admiral Evans' staff?

Mr. MacDonald

The local authorities are acting as the agents of the central organisation and it is the London regional organisation under the Minister of Home Security, which is responsible. They issue their instructions to the local authoties, who are supposed to carry them out. There is a certain amount of inspection already. This is one of the things which will be regularly inspected, not only by the local authorities but by our staff of inspectors from the centre as well. There is a double check and I hope we shall find that the standard laid down is adhered to in the very near future in all shelters.

Dr. Summerskill

When the right hon. Gentleman says one latrine for 20 people, does he refer to underground stations as well as other shelters?

Mr. MacDonald

Certainly. The London Passenger Transport authorities are being as helpful as they could be about all these shelter matters, and they have said they will be guided by the Ministry of Home Security, the responsible Department on these matters of sanitary provisions as well as other matters, and the standard which is laid down for other places used as large public shelters is already laid down with regard to the tube stations which are being used. I do not think the standard has been attained yet but we shall work up to it. This is a fairly new standard. That is one reason why we have not yet attained it in some of the best shelters.

Sir Robert Tasker (Holborn)

There is one shelter providing for 138 families where, notwithstanding protestations, not one single latrine has been provided.

Mr. MacDonald

We are very familiar with a great many cases but I should certainly welcome information about cases like that. This involves, of course, the manufacture of a very large number of latrines. They are being turned out as rapidly as possible. Hon. Members who are accustomed to go round to these places must recognise that in some of the big shelters the increase of supply has been very steady for some short time past. I have indicated the standard which we have laid down, and to which we shall work up as rapidly as we can, and maintain after that. In addition, the local authorities have been given full powers to engage whatever staff is required for the regular cleansing of the shelters every day and, where necessary, during the night. The fifth proposition is that the Medical Officer of Health in each borough is being made responsible for seeing that a frequent inspection of each public shelter is made. Sixth. in each shelter holding more than 500 people there will be a first-aid post, the equipment of which will run beyond normal first-aid supplies. It will contain appropriate supplies for dealing with headaches, earaches and all those minor ailments which are among the worst of the afflictions of mankind. Seventh, there will be a sick bay in every one of these shelters lest partial isolation of individuals sleeping in a shelter becomes desirable. Eighth, there will be a nurse in attendance throughout each night. Ninth, we are making arrangements that there shall be a medical practitioner, either in residence through the night or available on call, for each large shelter. Tenth, inhabitants of the shelters who contract infectious diseases or other serious illnesses will be taken out of the shelter and accommodated in hospital.

In addition to these ten propositions we are examining other aspects of the problem. There is the question of ventilation in the shelters and the problem of heating and the possibility of using some spray for effective disinfection and so on. We must make the shelters safe for the sturdy defenders of democracy. We are in close consultation with the Medical Research Council on some of these points, and we are deeply indebted to them for invaluable help on many problems touching the health of both warriors and civilians.

That is the general story that I have to tell. Its importance is manifest. In these testing days and nights the people of Britain are demonstrating once more their fine quality. They are showing again that they deserve the best out of life that organised society can give them and we must certainly do all in our power to see that the care of their health is such that they possess the physical strength not only to outlast and defeat the Nazi enemy, but to overcome successfully the stern problems which they will have to face when peace returns.

Dr. Morgan (Rochdale)

We have just heard from the Minister of Health a very able review of his Department, especially with reference to war and health. I wish, conscientiously, that I could congratulate him on the work of the Department, as much as I can on the eloquent effort that he has made to-day, but for some years now I have been gravely perturbed, as one interested in social and economic affairs, at what I consider to be the rather complacent attitude of the Ministry of Health with regard to social problems and public health matters in general. I have heard since I have returned to the House that the Minister has had the misfortune to accept responsibility for certain things which have not been done in the past. I do not say it is his individual fault—far from it—but his Department cannot always be too late and behind-hand. It is part of the work of the officers of his Department to plan ahead and so adjust their policy and readjust it that they can constantly look not only to routine administration, such as has gone on in the past, but to the future. When the workers, who are now being called upon to make sacrifices in almost every direction, whose morale is being kept up without any stimulus from and sometimes in spite of Government Departments, are doing their part, the higher bureaucracy and the Government Departments must also attempt to do theirs.

The right hon. Gentleman has made some reference to shelters and health. The right hon. Gentleman promised that his programme with regard to shelters would be carried out, but up to the present that has not been the case. Some of the tube shelters are a thorough disgrace, and I challenge the right hon. Gentleman, to-night, if necessary, to go to the sanitary section of Piccadilly Circus Tube and, if he can, remain there for 10 minutes without being sick. If he is not, he is able to stand more as a layman than I have been able to stand in nearly 35 years of qualified medicine. The tubes were never intended to be dormitories, and they should be properly equipped and regulated by methods of modern ventilation. There should be daily cleansing, as the right hon. Gentleman has promised, and there should be a medical officer and staff in attendance. The right hon. Gentleman should use the Post Office tubes as centres for a medical staff to be constantly on duty; perhaps many people do not know of the existence of the Post Office tubes.

I do not wish to stress too much the question of shelters—it is too topical and every one is taking an interest in it. However, I should like to make some reference to three subjects—firstly, hospitals, secondly, tuberculosis as a social index of the effect of the war on health, and, thirdly, the question of rehabilitation. I heard the right hon. Gentleman's remarks on rehabilitation and wish I could remove the gossamer web, the phantasm he has that all is well in the Department with regard to this subject. From whatever aspect he looks at the problem, whether it is in regard to aerial bombing, road accidents, industrial accidents or injuries that men receive in the Services, he will find that his Department has not grasped the question, and that there is not the necessary co-ordination. The Department has an Emergency Medical Service with plenty of time to organise; but what is going to grow out of it? What about the voluntary hospital system? Has not the Department neglected the municipal hospitals in making the appointments of the medical officers? I have the figures with me if I am challenged on that.

Take the case of the sector officers. Who appointed them, who recommended them, who selected them, and where have they come from? I tell the right hon. Gentleman that the sector officers were selected, on class patronage, from the voluntary hospitals. There was no proper investigation of their qualifications by a Committee; they were taken from the voluntary hospitals purely on their surgical and medical knowledge which has nothing to do with administration. I notice that the right hon. Gentleman shakes his head, but can he tell me in private of any case whether this is not so? I am not saying anything about their medical qualifications, because their work is of the highest standard. Surgical work in our voluntary hospitals is the best in the world, and I have seen most, but it is the system of administration which is entirely wrong. I want to see the Ministry of Health build up a really efficient hospital system, whether it be by co-ordinating the work of the voluntary and municipal hospitals, or adjusting the present peculiar financial system of the voluntary hospitals by State finance. Again I ask, What is the right hon. Gentleman's policy? No sector officer has been selected from outside the voluntary hospitals. I know this to be the case in London, and I have made meticulous inquiry in regard to the provinces also.

Take the case of the Horder Committee. I will say nothing against Lord Horder, who is a first-rate physician and a man with vast knowledge of his particular medical art. But he is not a public health authority; he has not written a book on infectious diseases, knowledgeable though he is on working-class conditions. Able as he is in all directions, his public health experience is not of the standard to enable people to rush to him every time as if he were the only person in the world to approach on the subject. Then there is Dr. E. H. R. Harries, Medical Superintendent of the North-Eastern Hospital, who writes most of the classic articles in the textbooks on infectious diseases. He is an authority on public health and epidemiology. But the infectious disease hospital is converted into an ordinary hospital and he is an ordinary superintendent, while someone also without his knowledge or practical experience is being appointed on the Committee. The right hon. Gentleman might say that this is a trivial matter. It is not. I am only using it as an illustration of what I want the Ministry to change.

The voluntary system is a bad system. It has lost its voluntary character, and its precarious finance is a strong force to battle against. We should do everything we can to have a democratic and decent hospital system in this country. The hon. Member for Westhoughton (Mr. Rhys Davies) made some remarks on National Health Insurance. I ask the Minister whether by any chance he can make a pronouncement here, or in one of the many platitudinous reports which are issued from his Department, on what is the policy of his Department with regard to National Health Insurance. Does he propose to reform, review or extend it? He knows the report of the Royal Commission, and he knows the majority and the minority reports. He knows the evidence which was put before the Commission by representative bodies. Does he propose to allow approved societies to be in existence with their many anomalies? Does he know that according to the Act the business of approved societies should be under the control of members whereas by nature of the Statute it is not? Does he realise the vested interests which are attached to approved societies and how they hide their mistakes by constantly attacking the doctors, who have been given a razor to axe down a tree, who are working under difficult conditions, conditions of overcrowding and bad ventilation, and who are doing the best they can to give a square deal to the people? These general practitioners are the front line pioneers in the medical profession to whom I would give first place in the order of priority of praise as against the consultants and medical bureaucrats, yet they are constantly being attacked because a few mistakes are made. The Ministry of Health is there to look after the health of the nation and not to look after vested interests by which the voluntary hospitals and the approved societies are bolstered up.

There should be a House of Commons Committee reviewing the work of the Department, or, as I will propose later, a constant inter-departmental committee aiding the Minister of Health in his work. There are health difficulties in connection with transport which we can see every day, although even in peace-time those difficulties existed. We should have a departmental committee bringing in the Ministry of Transport, the Ministry of Food, the Home Office and the Ministry of Labour. The latter would help with the question of industrial workers because as workers they are still citizens and their health still counts. I ask the right hon. Gentleman to give us some indication of his policy with regard to the medical system of the future from the point of view of the hospitals, and to say whether he will bolster up the voluntary hospital system, whether he will have co-operation in an advanced regional organisation, and whether he will give the hospitals State grants. He will have to proceed gradually; I am not asking for drastic changes. The voluntary hospitals are out-of-date and are existing on precarious finance; they are in bad sites, they are ill-placed, and they are poorly equipped. On the other hand, the municipal hospitals are up-to-date in equipment and far in advance of the voluntary hospitals, in which, I agree, some excellent work has been done in the past and is being done now. I am not saying a word about the medical side but about the administrative side.

What is the Minister's policy with regard to national health? Is he considering changes with a view to extending it? Does he think the system should deal only with the insured and not with the uninsured? Will he not consider a real national health system by which every citizen is entitled in disease to the best medical attention available, irrespective of class, colour, economic status or any- thing else? I ask the right hon. Gentleman to have the vision to frame a policy which will make his name famous in the annals of his Department.

With regard to the question of tuberculosis, this disease is a good index for knowing how the scoial conditions of a country affect the population. The right hon. Gentleman knows that 50 per cent. of the deaths among young women now are due to tuberculosis., especially at certain ages. He also knows that within certain ages 33 per cent. of deaths are due to it. During the last war and in the years following Germany suffered tremendously from tuberculosis. How many sanatoria beds have the Ministry cleared out to make vacant for the casualties which it was thought might arise? Is it a fact that every active case of tubercular disease sent to a sanatorium goes back to the old surroundings merely to infect others? Should not the sanatoria beds be kept up to the full number to meet requirements, only releasing them if and when in a crisis something happens? I know several cases even in Wales, where the disease is so rampant, where beds and sanatoria have been cleared out.

The right hon. Gentleman may say that recently there has been an improvement and that sanatoria are being filled again, but it was a wrong policy even to ask them to empty their beds in the way they have done. I still maintain that a circular should be issued by the Ministry to the local authorities asking them to keep their sanatoria beds fully occupied with their tubercular cases, especially the active ones, and that the work in connection with examination of contacts should be continued and everything done to prevent a rise in the rate of the disease which would be seen in full vigour immediately after the war. In the last war Germany lost 250,000 of the population through the disease. In this war things are entirely different and the civilian population is affected much more than in the last war. Unless there is a very active and keen staff at the Ministry of Health watching the question, especially with regard to the vulnerability of males between 14 and 27 and of females between 15 and 25—that is, those who will be the citizens of the future—we shall suffer very badly from tuberculosis. I wish the Minister would say that he regarded the mortality rate of tuberculosis—not the incidence rate—as a great index of the value of the work done in his Department and as an illustration of how social conditions affect the bulk of the population.

To return again to the question of rehabilitation. I wish to speak only on my own personal authority. I do not speak authoritatively for any representative association by which I am employed or in any way officially. The problem is a big one. By rehabilitation I mean the disability of the injured person from the time immediately after his accident to the period of his full restoration for his work in the industral market. I make that point because several of my medical friends seem to think that after the surgical treatment, the massage and electrical treatment, and the exercise period are ended, their work is finished. It is not. The rehabilitation stage has still to go on. The Minister knows the report of the committee of the British Medical Association and what that committee showed up of the work of the voluntary hospitals where the best surgical skill was available. They were passing the patient from one person more skilled to a person less skilled, without knowing his history, without anything which would show that the fracture had been badly treated, resulting sometimes in mal-union and sometimes in permanent disability, with marked loss of industrial efficiency and a loss of many days work.

The right hon. Gentleman knows the work of the L.M.S. Clinic in Crewe. He knows the work of Mr. Griffiths at the Seamen's Hospital in the East End. I want to ask the Minister how many hospitals and big centres are still without their fracture clinics. On the evidence given before the Inter-Departmental Committee on Rehabilitation, on the evidence before the British Medical Association and the evidence given before the Royal Commission on Workmen's Compensation, there is conclusive and definite proof that fracture clinics are necessary, but still there are big centres in Great Britain where there is no fracture clinic. Take the position in Wales. Is it true that there are still only two fracture clinics in Wales; one in Cardiff and one in Swansea, or is it two in Swansea and none in Cardiff? The provision of fracture clinics will not end the problem because there is the question of rehabilitation. There are no rehabilitation centres anywhere in this country—unless we except that connected with the hospital in the East End to which Mr. Griffiths is attached.

Then with regard to physio-therapy centres in emergency medical service hospitals. Is it true that in some hospitals where the Department have agreed to the setting up of a physio-therapy department for massage and electricity treatment it has not yet been provided? In one hospital, owing to the attitude of the Treasury, the centre has not yet been set up although it was asked for more than a year ago. I want to be careful here, because I met the physio-therapy expert to that hospital, and he gave me an evasive answer. He said he could not reply, because the matter is still the subject of negotiation. I know that if the centre had been set up he would have told me, but the provision of the centre, although agreed to by the Ministry of Health, is blocked by the Treasury.

Mr. M. MacDonald

I hope the hon. Member will let me have, at any rate in confidence, the name of the hospital concerned, because it is our policy that these centres should be set up in all hospitals.

Dr. Morgan

I will give the facts, and I think the right hon. Gentleman will find out that what I have said is right, because my information comes from a very reliable person, a very safe person, so cautious that he declined to give me all the information because he thought he might get into trouble with the Ministry of Health. I could see by his very evasiveness that something was wrong, and I knew that if he had got the centre that he would have told me. The centre was promised some time ago. It is a hospital of the requisite size and he is a man with the necessary qualifications, but as far as I know the Treasury have not given the requisite permission. There is a constant passage of letters between local medical officers of health and the department. In the hospital to which I am attached we have been asking for a year for oil-skin gloves for gas cases, and we have not got them, although they were promised in September, 1939. I happen to be the gas specialist at the hospital, the one who will be in charge of any gas cases that come in, and I know the trouble we had to get the gas equipment. With regard to the gloves, I saw the correspondence only yesterday morning. There has been a constant passage of letters between the medical officer of health or his deputy and the Department, and up to now those oil skin gloves have not arrived. If a gas case is brought in I, as the specialist, have to take the risk of my hands being contaminated. I shall be able to put on all the other equipment but the gloves.

I feel sometimes that the right hon. Gentleman has no idea of how the higher bureaucracy are letting him down. His intentions may be good, but his higher bureaucracy have not been well selected in the past, and he ought to be watching them constantly. Indeed, some medical organisations say that his medical officers are only those who have been recommended by a certain organisation and not by any other. I think that if this is found to be true on investigation it should be modified. Appointments to the Ministry of Health ought to be made free of any partisanship or patronage or discrimination. In the past that has not been so, and I ask the right hon. Gentleman, in all fairness, to watch his Department very carefully.

I come back to the question of rehabilitation. Apart from the voluntary, semi-rehabilitation centre in the East End under Mr. Griffiths, which was closed unfortunately for a long time during the first months of the war, can the right hon. Gentleman tell me of any rehalibitation centre which has been set up? They were advocated by the British Medical Association Fracture Committee and the Inter-Departmental Committee on Rehabilitation, and have been urged upon his Department for the past five years. After a fracture has been treated, after the bones have been united and the muscles brought up to tone, sufferers are given a period of light work without any treatment and without any supervision and then put on to heavy work in their own industry. The thing is an impossibility. I ask the right hon. Gentleman either to summon a conference of people interested in rehabilitation or do what he says he is doing, select some committee of those whom he thinks are experts on this particular job. On that committee we do not want only experts, but people with the knowledge of working-class psychology and with push and energy. We want to do as Lord Beaverbrook has done with aircraft production. He has appointed as an adviser an excellent trade union secretary, Mr. J. Stevenson, and has given him full powers and the work there is going ahead. I urge that the Minister shall appoint somebody to advise him and to break through the red tape of his Department.

In my speech I have selected three points. I have not dealt with the question of maternity and child welfare, but I would just like to say that when bodies like the Trades Union Congress and the British Medical Association have advised a scheme of maternity and child welfare I should have thought his Department would have rushed to see whether they could not get the best out of that scheme. Instead, the Department have stood by and done absolutely nothing. I ask the Minister to tell us something of his policy and whether that policy now is to try to merge these two hospital systems together into one or, at any rate, to bring all the hospital systems of the country under the control of a single Department. It is ridiculous that medical education should be in its present state, in which one series of hospitals is under the right hon. Gentleman's Department and another is under no Department at all.

The whole thing should be brought together, co-ordinated and co-operated under the Ministry of Health. The right hon. Gentleman has his emergency powers now, and a standard should he worked out to settle how these hospitals should be administered. The same thing is true of the tuberculosis scheme. I appeal to the right hon. Gentleman to say, in view of the difficulties in regard to health, milk, sanitation and things like that, that the country be not allowed to deteriorate in regard to tuberculosis. As to rehabilitation, I again appeal to the right hon. Gentleman, because the worker is interested in that matter both as worker and citizen. I can tell him that, because I am in touch with a good many workers who are vitally concerned about rehabilitation. They feel strongly about the matter, both as it concerns themselves and as it concerns relatives injured by heavy bombardment.

On the subject of patronage, I noticed recently in the "Economist" an article on the subject of patronage and Government Departments. It related how Government Departments make their appointments from certain directions and certain classes only. I asked the Minister to look at the article and to consider it in all its aspects, and then to see whether a new system can be followed in future in his Department, when introducing fresh blood and making a review, as ought to be constantly done by Departments, by this House of Commons and by an inter-Departmental Committee. The right hon. Gentleman should see that he does not make such appointments according to the old method, but that if he puts unorthodox people into his Department, who may not have the right accent, the right school tie or the right Masonic lodge, he does so not because of their associations but some times because of their merits, push and personality. The right hon. Gentleman is an able Minister, with youth, the war, emergency legislation and a responding public, all on his side. I would point out to him that the good work done by the voluntary hospitals is an example showing that surgical skill is still there, to be used if properly administered by Government Departments or local authorities.

The right hon. Gentleman now has a chance to devise some scheme by which to reorganise local government in this country from the health aspect, and to introduce a system by which Government Departments would not only advise and guide, but would supervise and, where necessary, command in the public interest. Public opinion is ripe, and so are the local authorities with the changing conditions brought about by the war, and I ask the right hon. Gentleman to take advantage of the opportunity. Many local authorities have not the finance; it is impossible to ask a district with poor finances and a low rateable value to set up a modern hospital with all its equipment. Such districts cannot do it with the efficiency, and knowledge of the whole country, which are at the disposal of the Department, and the Minister has an excellent opportunity of really doing something to raise the country still further, as compared with countries on the Continent. I ask him to give this matter a real advance, so that we may be able to look back upon this war period as one in which the destruction did not in any way paralyse our efforts to make a decent medical service in the future.

Sir Francis Fremantle (St. Albans)

I do not want to speak long, because this House does not seem particularly interested in criticisms of the Minister of Health, after his extremely useful and reassuring statement. I would like particularly to thank him for one phrase, that the present trouble which is upon us and the poor unfortunate victims of raiding are the birth pangs of a new Britain. We have to recognise that fact all the way through. Those birth pangs have to be met and eased, but they are leading to a new world. In a way, I welcome the speech made by the hon. Member for Rochdale (Dr. Morgan), because of the definite points which he brought before the House, with great enthusiasm and very considerable and long experience from a particular point of view—that of the trade union with which he is connected. We learn more and more on this side of the House to appreciate the value of trade unions—although I am bound to say, on behalf of the Parliamentry Medical Committee, that that Committee is as much opposed to trade unionism in the profession as ever it has been. Anyhow, that is a point which we need not discuss further here.

To many of the points of the hon. Member, put forward so emphatically, there is an answer, which is not overwhelming, or cancelling them. There is an answer which many of us could make, but, at the same time, the hon. Member illustrated how necessary it is in this House to come forward and state directly particular points which the public, especially the informed public, have in mind in criticism of the administration. The hon. Member's speech brings before us again what we do not often realise—that we have a double function to perform in this House. One function is to help the Government by sizing up all the different views and taking more or less a judicial position between them on behalf of the electorate which we represent. On the other hand, the House of Commons includes experts on almost every subject in the world. When you have a definite experience to bring before this House, it must be brought forward from that one aspect, and should not be confused with the other side. I hope the hon. Member will agree that there is a good deal to be said for the voluntary hospitals and for their administration, as well as a good deal to be said for the present selection of officials in the Government. I can leave this matter for the Minister and his Department to deal with in due course.

As to rehabilitation, I am sure my right hon. Friend would be the first to recognise that there is some truth in what the hon. Gentleman said. I agree that there is a tremendous demand for rehabilitation. Many of us have voiced it again and again. To put it upon a pecuniary basis only, rehabilitation helps to reduce the enormous bill of the Ministry of Pensions and of the hospital services. We need to go ahead with the rehabilitation as much as possible, and we could go ahead with a great deal more of this work. I happen to know enough of the Ministry of Health and of its personnel during the past 40 years to be able to recognise that sometimes there may be a certain amount of difficulty in keeping the Civil Service up to the mark. At the same time I would like to state that the two recent chief medical officers of the Ministry of Health, whose names are household words throughout the world, are Sir Arthur Newsholme and Sir George Newman; Sir Arthur Newsholme was medical officer of health at Brighton, and Sir George Newman was medical officer of health for the Borough of Finsbury. I can give other examples if necessary. With regard to trade unions, of which the hon. Member for Rochdale knows so much, I would point out that they do not agree with bringing people in from outside merely on merit. They believe in acting according to seniority.

With regard to the wider hospital and medical services, I am glad that my right hon. Friend said that he had already got a committee considering the question. I daresay that the hon. Member for Rochdale knows that the British Medical Association are setting up a commission at the present time, upon which two of us have been appointed to serve as representing the Parliamentary Medical Committee, to inquire into these services. I doubt how far that is valuable at the present time, and I am not at all sure that it is not premature. However, it has been thought desirable to lay down the outlines, which can be filled in at a later stage. A great deal of latitude must be left, because heaven only knows what we are coming to at the end of the war or even when the end of the war is coming. We only know that the medical services have been turned upside down, both in regard to individual practices and hospital practices. As regards the statement which my right hon. Friend made to-day about the enormous extension of the hospital services, that is a monument of prevision on the part of the last Government as well as the present, in having made great preparations for a demand which seemed to be useless and against which there was much criticism because of the enormous staff of medical men, nurses and others who were doing nothing for the first year of the war. Now we see how necessary it is. I do not think there is anything superfluous, although there is a number of hospitals lying idle and waiting for work.

There is another side to the question of voluntary hospitals, and although I do not want to deal fully with the question, let us remember when we are making reforms or re-organisations that one of the reasons for this lack of coordination on which people dwell is that we deal with services that have grown up under one system or another. They have grown up where there has been enthusiasm. Throughout the country we have voluntary services which are a definite symbol of the democracy, the liberty, the enterprise and initiative for which we are fighting. You cannot wipe it all off and start with a clean slate, such as one might like to do when one is in the privacy of one's own chamber, with diagrams and drawing straight lines—

Dr. Morgan

If you were a surgeon would you not consider it desirable to try to straighten a very rickety limb?

Sir. F. Fremantle

We do not want to make it absolutely linearly straight, but it has got to be straight enough in order to serve its purpose, and we want to straighten out the hospital services according to the purposes which they have to serve. We all know the difficulties and the inefficiency which have been caused by these complications, but a great deal can and will be done to improve matters.

The story that was told by my right hon. Friend is familiar to us in the public health services, but is not sufficiently recognised by the public in general. With regard to infant mortality, which is the most delicate thermometer of public health, by bringing it down to 50 per 1,000 for the whole of England and Wales we appear to be getting down to the irreducible minimum, if it is irreducible, and that is one matter on which we can congratulate ourselves. When one is considering this increase in the length of life to which the right hon. Gentleman referred, let us remember that there is no increase in length of life for those over about 45. A greater recruiting strength has been given to the people for whatever services recruitment is required; above all, the higher services for which this nation stands.

It you are to congratulate yourselves on that, you must equally deplore the present tendency of the constant decline in the birth rate. I will do nothing but just mention the subject now, but successive Ministers of Health have shut their eyes to this problem. It is brought home to us, now that we are lighting this war, when we recognise the appalling dangers which are facing this country and this civilisation. You cannot diminish the death rate much lower than it is at present. The birth rate is going down, and even if it does not go down any more, the population will dwindle within a century from 45,000,000 to 4,000,000. That must be considered as a serious proposition. It is in the midst of a war that these lessons should be made to strike home to the people. They should be told that one of the greatest acts of patriotism that the female sex can be asked to do is to become mothers of more children than they have been inclined to be in recent years. It should be recognised that this constant decline in the birth rate is one of the greatest dangers of this Empire and this democracy in the long run.

Nobody will tackle the subject unless the Minister of Health does. Whatever may be the objection among his fellow Ministers, it must be tackled. Somebody must alter this deplorable danger which besets us. That is the long-term danger. The short-term danger my right hon. Friend has dealt with. He has not told us the total death rate for the population. He has given us the plums in the cake, but I think the cake itself is good. The total death rate, I believe, is about 12 per thousand, and has not gone up much, although in the last year or two there have been minor fluctuations. But any calculation based on the death rate going down further is unscientific. If we are to get down to a rate of 10 per thousand continuously over a period of time, that would mean that the average baby born will have to live to the age of 100. That is impossible. We are trading on the increasing birth rates of the past. That tendency has come to an end. We have to consider that the general death rate will go up, not because of any deterioration in health, but simply because of the higher average age of the population.

I believe that the Minister has thrown himself into the problems of the day as thoroughly, as sympathetically, as ably, as any Minister could. I believe that he is doing so with the very best advice. I hope that these committees which he is appointing to deal with these subjects will be given all support. Also, I hope that we shall be able to get over the appalling dangers which we see facing us, of infectious diseases on a large-scale during the winter; and that the Government will, as far as they can, press such measures as inoculation and vaccination upon the people, in order to guard against those dangers.

Dr. Haden Guest (Islington, North)

I do not want to follow the hon. Member for St. Albans (Sir F. Fremantle) into the very interesting perspective of speculation with regard to the future age constitution of our race and the numbers of people in this country, because I want to deal more particularly with the immediate dangers to health of the present situation, and to suggest, if I may, some simple means by which they might be avoided. I agree entirely with my hon. Friend the Member for Westhoughton (Mr. Rhys Davies) that for the dependants of insured persons there should be an immediate extension of National Health Insurance. It can be done at once. It involves, of course, financial commitments, which, in view of the present scale of national expenditure, would not bulk very largely in the national Budget. It would provide that at the present time, when the population are disturbed as to their domicile and when they move about the country and go to unfamiliar places, the whole of those dependants, estimated—and, I believe, correctly—by my hon. Friend at 20,000,000, would receive adequate medical attention, by the well-recognised means of the National Health Insurance services, wherever they might be. That would be one of the greatest safeguards to the health of the population at the present time.

When people go from the town to the country—or, indeed, from the country to the town—they do not always know where to get medical attention. It was the experience of all of us during the first period of evacuation that in a number of cases—not, perhaps, very numerous—children, simply through lack of knowledge, did not get the medical attention which they could have got had they known the way to set about it. If there were an extension of National Health Insurance to the dependants of all insured persons, that would be avoided. The dangers threatening the health of the civilian population are among the greatest dangers to our war effort. As hon. Members have said, those people who are in the Services are very well looked after from the medical point of view. Also a very large proportion of the civilian population is very well looked after from that point of view. But the dependants of insured persons are not looked after. It is most desirable to establish for looking after them a system which is simple, and which could be immediately applied. Such a system could be established by the extension of National Health Insurance to those people. I do not think that at present it would be opportune to go in for any large-scale and fundamental reconstruction of our medical administrative machinery, because we have other preoccupations. But I think that we could, by simplifying administrative procedure, without legislation make very great improvements in the working of our medical machinery at present.

The Minister of Health, in his very interesting survey, talked of the Emergency Medical Service. He spoke of the experiences of Dunkirk, that episode which will live in our history as long as our history itself is read or understood of man. He spoke of the great second chapter of the Emergency Medical Service's work in dealing recently with the large number of air-raid casualties, and dealing with them efficiently and thoroughly. He spoke of another possible extension of the service to munition workers. I was particularly interested to hear that. Here we have the story of the Emergency Medical Service. It deals with the whole of the Armed Forces and the whole of the civilian casualties; and now it is proposed to extend the service to munition workers. By extending the National Health Insurance Scheme to the dependants of insured persons, you would be, for all practical purposes, covering the whole nation; and doing so in a simple way. When the Minister was speaking, I interrupted to ask whether he was going to say anything about the finances of the Emergency Medical Scheme. The finances of that scheme, as I have no doubt the hon. Lady the Parliamentary Secretary knows, are very simple. When a soldier goes into hospital his name, number and all other particulars are taken, but he is not asked to make any payment; neither is an airman or a sailor.

When a civilian air-raid casualty goes into hospital, he is not asked to make any payment. The hospitals do not do without money, but all the financial arrangements are a very big book-keeping transaction between the departments. I understand that members of the Services are paid for from the funds of the Services, and that the Ministry of Health pay for the civilians. There is no reason why that simple scheme of book-keeping should not be extended and all kinds of medical treatment made available to any person who cannot pay on the spot, without any question of any immediate payment at all, and why we should not let everybody know that that was the case. If we did that we would get a very great extension of the possibilities of immediate medical treatment at the present time.

What is the danger to the health of the nation and of the civilian population at the present time? It is, as has been indicated, the danger of epidemics, and not necessarily those epidemics which are called pestilences. Under the conditions under which many people are living and taking refuge in shelters and so on, we might very easily get a very considerable increase in ordinary diseases of the respiratory system, a large number of cases of pneumonia and so on. That would not be a pestilence in the ordinary sense, but it would add very materially to the casualties. You would encounter other troubles. You would certainly get infestation presumably with lice and scabies because of over-close proximity, and various troubles of that kind, which in the aggregate might cause a great deal of suffering and inconvenience. We might, because of the conditions always set up by war, have a natural increase in virulence of such diseases as influenza, so that eventually they assumed the characteristics of an epidemic, as they did at the end of the last war. That is really the danger against which we have to fight. In order, therefore, to fight against that, there should be the extension and the opening up of all means of medical treatment as easily and as freely as possible to all people, and that would do a great deal to prevent the trouble.

There is also one class of the population to whom particular attention must be paid. I refer to those persons who, for whatever reason, are paid small amounts of money out of which they have to live; the poorly paid pensioners, workers, retired persons, and their families. Even at the present time, when a considerable number of people are earning more than is customary, between five and ten per cent. of the population are receiving an amount of money upon which it is difficult to get really adequate nutrition. Those badly nourished people, among whom are many children, are the most likely to be attacked by infectious illnesses. If you have infectious illness, incubating and becoming more violent among them, you will have the infection spreading to the rest of the population. Therefore, from the point of view of protection we should be most careful not only to provide medical treatment, but to see that they get adequate nutrition. That is a more complicated matter to which I shall not refer further.

The Minister at the present moment might consider the pooling of the whole of the hospitals of the country, and, as far as possible, the whole of the medical services on lines which are already working with efficiency in the Emergency Medical Service. I did not have the pleasure of hearing the whole of my hon. Friend's remarks on this matter, but I had a note taken of what he was saying, and I am, at any rate, in agreement to some extent with regard to what he said about the methods of medical treatment. I believe that there would be a very great advantage to the public health by a greater degree of pooling of medical resources. I have always thought that the controversy relating to the voluntary hospitals and the municipal hospitals would solve itself before many years were over by the natural development of the institutions concerned. The problem of the co-ordination of the voluntary hospitals and the public institutions is to a very large extent being settled at the present time in the Emergency Medical Service, and especially in the sectional organisations round about London, where there is a system of co-operation which, as far as I know anything about it, is working very well indeed, and with satisfaction to practically everybody concerned.

I was glad to hear the Minister extend support to the activities of the medical officers of health. He spoke of the extension of the activities of medical officers of health to inspect shelters and so on. That is all to the good. I do not think that he could go too far in extending the activities of the health organisation of the different local authorities, because that would be preventative medicine, and the more prevention we have at the present time the better. I also took note of the fact that the Minister, when talking of the Emergency Medical Service, stated that its benefits were being extended to mothers and children, to chronic invalids and aged persons. This means a very considerable addition to the people who come within its scope. At the present time we have a very extensive apparatus both for the prevention of illness in the health organisation of the various local authorities, and for the care of illness in the ordinary medical services—the panel medical service, in the hospitals and especially in the Emergency Medical Service. We have this immense apparatus, and we can do everything with that that is required at the present time. We do not need, as far as I know, any fresh apparatus. I am not speaking of all the detailed applications of medical knowledge at the present time and of such matters as blood transfusion systems, pathological work, and so on, but, broadly speaking, I think you may say that we have the whole of the medical apparatus that we can use and which we need at the present time both for the Service and civilian populations.

I would urge the hon. Lady to take into serious consideration the question whether the Ministry could not, by administrative procedure, very largely simplify the machinery of administration so as to avoid an immense amount of time being wasted in presenting bills for this kind of ailment and that kind of ailment. An immense amount of time is actually occupied not in the medical work, but in dealing with the financial adjustments between one Department and another. It should be possible at the present time greatly to simplify that administration and to draw more widely than ever before upon the means of medical treatment and disease prevention for the benefit of the general population. I would emphasise that one of the weakest spots in our National Defence machinery is that section of the poorer-paid members of the community who find it difficult to get adequate nutrition through sheer lack of the necessary amount of money. These people constitute a danger and require special attention, and I ask the Minister very earnestly to consider whether he cannot perhaps appoint a special committee to see how health conditions, and especially the nutrition of the poorest classes of the community, can be safeguarded at the present time.

Dr. Summerskill (Fulham, West)

I do not apologise to the House for dealing once more with the question of shelters, because I believe that if we are to discuss health here to-day, it is quite absurd to approach the question in an abstract manner. The hon. Member for Rochdale (Dr. Morgan), in his description of the sanitary conditions of the shelter at Piccadilly Circus, used words that were mild compared with some of those I have heard some people use. I am extremely fortunate in finding the Joint Parliamentary Secretary to the Ministry of Home Security and the Parliamentary Secretary to the Ministry of Health here to-day, because I believe that they together are more capable of dealing with the problem than the rest of the Government put together. I do ask them seriously to treat this matter immediately, because I think in these underground shelters we find people herded together, poor ventilation, primitive sanitation and all the predisposing causes of an epidemic, beside which the 1918 influenza epidemic would be considered mild.

If you go down to the Piccadilly Tube or the Charing Cross or Tottenham Court Road Underground stations, which are within a quarter of a mile of the Ministry of Health, you will find conditions existing which would make members of a primitive tribe in South Africa blush. The Minister of Health says, "Well, you see it takes time to manufacture latrines." What a silly thing to say. Did the gypsies who used to go to the Derby races have to manufacture latrines for a vast crowd? These gypsies would be amazed to see the conditions existing in the centre of London to-night in our Underground shelters. Queues of men and women are merged together. I am not mincing matters. I am sick of hearing the telephone go and people asking me, as a doctor, whether I will do something about it. One knows that one has no power to do these things, but if a few energetic officials of the Ministry used the telephone now, they could find shops and improvise certain accommodation which would solve half of these problems to-night. It is no use saying it cannot be done, because I know it can be done. If I had a free hand, I would not wait for a manufacturer to bring along latrines.

I am a little suspicious about this business. I see many intelligent men and women who are apparently not facing up to this question, and I am beginning to wonder whether the real difficulty is that certain people are anxious to discourage the use of Underground station shelters. The reason I am beginning to think this is so is that the committee which was set up, with Lord Horder as Chairman, came to a certain conclusion, and I was very surprised to see that one of the most important conclusions they arrived at was that people went to these underground shelters because of the herd instinct. Well, I really believe that that approach to this problem was too academic. It is no good saying that we will clear these underground shelters if we give people ear plugs and bunks in surface shelters. It is unfortunate that on that committee there was not one person who had spent a great deal of their living with working people. Lord Horder, I agree, is an eminent physician and a first-class man, respected by every doctor in the country, but who, let us confess, has spent most of his time percussing royal chests or examining the livers of wealthy business men. For a problem like this, you want people who have a knowledge of the workers and of public health. I am certain that the herd instinct may be strong in all of us, and I feel that Lord Horder should have remembered that the strongest instinct in all of us is the instinct of self-preservation.

The next instinct, I would like to remind the hon. Member for St. Albans (Sir F. Fremantle), is that of procreation. It is no good his getting depressed about the birth rate; if I had a minute or two with him privately, I could tell him exactly how it would be remedied in good time. However, this disgusting sanitation is a scandal to the whole of the country, a reflection on the Ministry and a disgrace to every local authority in London. Ignore it if you wish, but these appalling conditions will not chase people from the Underground stations. The instinct of self-preservation is so great that they will suffer that and still go down to the tubes. As bombing becomes more intense, you will find more crowds going to the Underground stations. Give out your ear plugs and bunks and your propaganda, but you will still find your crowds in those stations.

If you are to preserve the health of the country, do not leave it until next week or the week after, because I can assure you that epidemics are now beginning. It is no good having more consultations with the Advisory Committee; something should be done immediately. What else has been done to drive people from the tubes? You have told them that nobody is to take a place on the platform until 4 o'clock. This may have facilitated transport, but I want to tell the Minister of Health that so far as his Department is concerned it is the greatest mistake ever made. Go and look at the Underground stations at 11 o'clock in the morning. There are queues of little children from London. If it pours with rain this afternoon, as it has done for many days past, their clothes and sleeping material are soaked, and they spend days and nights lying in wet clothes. The result is that many doctors will find these poor children lying down with influenza and pneumonia. The measles epidemic has now started and is gaining ground rapidly, and pneumonia, which is one of the commonest complications of measles, will follow. So it is no good saying, "Let us provide ample accommodation." What you have to say to yourselves is that the people are there and they ought to have improved conditions. The children are going there after having waited from 11 o'clock. They are now becoming disease carriers for the workers who come along at 6 or 7, waiting there coughing and sneezing. The healthy worker comes along and sleeps in that atmosphere. Something should be improvised, not next week but within the next 48 hours, and it could be done by energetic action.

These are things that I am up against every day. Think of the mother who has a child with measles, living perhaps in a third-storey flat. She says to the doctor, "Am I to stay here with the child to-night and not go into a shelter?" She has to stay with her sick child through the bombardment night after night. Is it conceivable that she will stay there for a fortnight or three weeks until the child is well? Almost before the rash has disappeared and the temperature is normal the child is in the shelter, very often underground. You ought to have some kind of room where convalescent children may go. If you put convalescent children in one room, that would be infinitely better than allowing them to go among healthy people in the shelters. The other solution which has been suggested is that these people should be given season tickets. Does that solve the problem? Does anyone suggest that the working man, who needs rest, does not deserve a place on the platform as much as the housewife who can rest all day? I have always tried to improve the. conditions of women, but if there is a place on the platform where restful sleep can be obtained, the working man should have priority rather than the housewife who can sleep all day. If you go down the streets and say, "Women and children first, here are the tickets," the woman with a tired-out husband will say, "Surely my man deserves a rest." You cannot solve it in that simple way.

I was interested in what the Minister said about the lectures that his doctor was to give on venereal disease. Might I suggest that he should use the principle of lectures, with mobile vans, where they know people suffering from disease are congregated? After the first three weeks of the war I was astonished to find among my patients that I not only had people suffering from shelter throat, but a vast number had shelter legs. We should all know now what that complaint is—swollen legs due to the fact that they have not been resting. I find all these small complaints becoming aggravated by something else. It has occurred to me that, just as we have E.N.S.A. going to underground shelters and providing people with entertainment, why not let your travelling doctors go to underground shelters and give simple lectures on all these simple complaints? The people will enjoy it just as much as the comic songs of E.N.S.A., because there is nothing that people like to hear so much as their own bodies talked about in simple language. There is nothing which would be more appreciated by these women, many of whom believe they have heart or kidney disease because of their swollen legs, than simple instruction to the masses sitting there.

The right hon. Gentleman might perhaps solve another problem which I know is giving him a good deal of food for thought, and that is whether he will introduce compulsory evacuation or not. Does he realise that in many families in heavily bombed areas there is still an appalling conflict between husband and wife as to whether the children shall go? Sometimes the wife is a bit suspicious of the woman down the street. Sometimes the husband is utterly selfish and says, "I am going to have my family with me." What an excellent opportunity to give lectures on the subject, for the woman perhaps to go back feeling herself fortified because an official has said, "The right place for you is in the shelter"—not quietly going round to each other, but a public lecturer to talk to them all. That does much more good, because they would find the older women turning to others and saying, "He is quite right. You ought to be getting down." That is the kind of thing that encourages public opinion, and I am sure, if that method was adopted, the Minister would not even have to consider compulsory evacuation, which, good as it may appear, would be very difficult to enforce. It is very difficult to tell a woman that she has got to be separated from her husband whether she likes it or not. I should like to know how the right hon. Gentleman would enforce it, and perhaps penalise the woman who refuses to be separated from her husband. The difficulties are immense. The people in the shelters have no cinemas, and they would be forced to listen to lectures. It would be a fruitful source of propaganda.

I rather echo what the hon. Member for Rochdale (Dr. Morgan) said in his brilliant and informative speech. I want to know whether the Minister is considering completely reorganising the medical service as a result of this war. In these distressing times everyone who has a London constituency knows the details so well. Here we have people suddenly deprived of a home, needing certain things, and the Government have said they must have meals, shelter and clothes. What has not been said is that they should have free medical attention. What could be more necessary? Medical officers of health, I agree, in certain rest centres keep an eye on the people, but there is the soldier's wife whose child is developing measles. She will put the child to bed, but she dare not call in a doctor because the allowance she receives for the infant will scarcely cover two visits. In these very distressing times the right hon. Gentleman has failed to provide one of the most important things the people need—that is, free medical treatment. People go wandering about the streets, sick and ill, and anaemic, underfed, worried, and anxious women, who are submitting to the appalling bombardment every night, are unable to have iron, or any of those little tonics which many lay people smile at, which nevertheless are of very real physiological value. Even in these distressing times we do not find the Ministry of Health rising to the occasion. The time has come to eliminate profit from the practice of medicine.

In listening to the first part of the speech of the hon. Member for St. Albans (Sir F. Fremantle), I was much depressed. He said that he really did not consider it necessary to go on a committee to discuss reorganisation of the medical service. Those of us who know the medical service realise that after the war there must be reorganisation; but this is the time to start. Do not think that the doctors are not ready for it, because suddenly during the last seven weeks a revolution has taken place in the medical service. We find doctors in the East End who had vast panel practices suddenly, overnight, finding that all their security has disappeared. Going over to the other end of London, to Harley Street, where one sees cars outside the doors, we find that the wealthy patients are now in the provinces and obtaining advice from provincial consultants. The East End doctors have lost their security, and the West End doctors have had to go to the Emergency Medical Service where they obtain State support.

It may be said that there are other doctors in the reception areas and the country districts. I agree, but they do not forget, and have not forgotten, the long lean years of peace, when so often in order to make both ends meet they have had to prostitute science and magnify symptoms of a patient in order that the illness may last a little longer. One of the topics of conversation among the doctors in the mess of the R.A.M.C. is how they are to face up to their financial commitments. Therefore, in a few weeks a tremendous change has been taking place in the medical service. Here we have a demand, on the one hand coming from sick people who not only need free medical advice but deserve it, and, on the other, doctors with nothing to do, with their practices gone, longing to provide that service. The right hon. Gentleman's predecessor admitted, when I said that the time had come for a State medical service, that the next step in our social services was to introduce some form of State medical service, but he thought public opinion and the medical profession were not ready for it. I believe that the times have changed. During the last seven weeks, not only have doctors' houses been bombed, but with this material destruction the prejudices of generations have been destroyed. The time has arrived for action, and I ask the Minister to make his name as well known as that of Chadwick, and to take this opportunity to introduce this service so that after the war we may at least say that out of all this destruction and misery there has come some good.

Mr. Collindridge (Barnsley)

I do not wish to detain the House for more than a few minutes. In the first place I should like to offer my congratulations to my hon. Friend the Member for West Fulham (Dr. Summerskill) for her excellent speech. Although I come from a constituency in the North which, as yet, has been free from bombing, we fully realise that we are all together in this totalitarian war, and that if there is any weakening in the heroic stand of those who are facing the enemy, all of us will be affected. I have not had the same experience as that of my hon. Friend, but I have visited shelters at night, and have seen conditions about which she has spoken. The rectification of these troubles will not only be conducive to the comfort of the people, but will help us all in the struggle we are now waging. In the London shelters, in the tubes, and in various places, I have heard not one word from any of the citizens of this great Metropolis, even though they have been experiencing these bad conditions, against the fight we are waging. I think that speaks volumes. There was no indication at all that, because of these conditions, the people were wishful of being out of this struggle before victory has been achieved. However, I suggest to the Minister that he will help tremendously if he can remove some of these bad conditions.

I should like next to refer to what the right hon. Gentleman said with regard to some body which is now considering the improvement of National Health Insurance, etc. I think it says much for this House that, even during war, we can spend a few hours on this subject, I contrast this with the position in Germany—if we can believe, as I do believe, the book "Heil Hunger," written by Dr. Gumpertz upon their health conditions. There has been an improvement in this country, even during the war, in dealing with infantile mortality and maternal mortality, whereas before Germany got into a state of war her health conditions were being worsened. That should show to the world that our cause is a right one.

I would ask the right hon. Gentleman to press the committee which is considering this matter to consider the idea of giving medical treatment and benefit not only to males, but to females as well. Speaking from experience of this matter in the industrial north, I can say that many of our womenfolk allow illness and disease to take a firmer hold because of delay in seeking treatment owing to the fact that there is no State insurance and medical treatment for them. I can see how adversely this affects the women. Where people sometimes go outside ordinary National Health Insurance and become voluntary contributors, the fact that they are deprived of medical benefit is a great hardship and often puts them in serious difficulty. The fact that we did so well in health matters prior to the war and that we are doing so much, even in war time, to try to improve the conditions for our people, should be a stimulus to carry on this good work. We do not hold the view in this country that we should spend all our time with the war machine. We hold the view that the war machine can be improved if we devote ourselves to human questions as well. This debate in war time has been well worth while, and I hope that as a result of the work of the committee which is considering the improvement of health conditions we shall reach an improvement at an early date.

Mr. David Adams (Consett)

I should like to offer my congratulations to the Minister of Health for his comprehensive and wide survey of the unique situation in which the nation is with regard to health. I am certain that the position he is taking up is an advanced one and that, in spite of war's alarms and the effects of war, the general state of health of the nation may during the war years be not only preserved but actually improved. It is pleasing to hear the latest figures relating to infant mortality, tuberculosis and kindred subjects, but, coming from a district to which those figures do not apply, I cannot neglect the opportunity, which comes so seldom in the House, of presenting a picture of our health services in my area of Tyneside. Infant mortality on Tyneside is not just slightly higher than that of London, but is more than half as bad again. For every 100 babies, per thousand births, who die in London, 161 die on Tyneside. This is not a slight, but an enormous difference. The Minister of Health quoted the figures for the nation at large, but it might be for the good of the community to quote the figures for some of the distressed and poverty-stricken areas. The figures for tuberculosis show a progressive rise on Tyneside. In 1912 it was 30 per cent. worse, in death rate, than the country as a whole; in 1921 it was 48 per cent. worse; and in 1937 it was 53 per cent. worse. This appears to be a very startling proof of the neglect of certain areas in the country, and there is no question that our reiteration, from this side of the House, of the urgency for establishing some national minimum standard of existence, is clearly justified.

We are talking about free medical service for all, a most admirable and excellent, though probably remote, proposition, but it ought not to be remote. It ought to be part and parcel of the war effort that this House should determine that there should be a standard of existence below which no family will be permitted to fall in any circumstances. To my knowledge it is 40 years ago since this demand was first put forward. It is a reasonable demand, but apart from the striking illustrations we can give of the conditions under which some of our people exist, it does seem that the problem is as insoluble as ever. But I am not one of those—and I speak as an industrialist—who believe that industry cannot bear the added strain; and it must not be forgotten that industry would derive compensating advantages, in the same way as the expansion of trade unionism has proved to be a blessing to the industrial world. There is no question that there is a residue of poverty in different parts of the country which frustrates the efforts of local administrators and of the Ministry of Health itself.

I should like to take this opportunity of mentioning a subject upon which I and others who call ourselves sanitarians feel much concern, and that is the milk supply. At the mention of it the Parliamentary Secretary smiles and probably it is natural that she should do so. The milk supply is a fundamental problem in the preservation in the health of the community. I will prophesy—though that is a very unwise thing to do—that the present system, under which we have increased the quantity of milk which is not fit, in the main, for human consumption, will have a most pernicious effect upon the incidence of infant mortality and tuberculosis. Prior to the introduction of the so-called national milk scheme, medical officers of health were permitted to declare that milk which was thought to be unfit for consumption should be debarred from their districts. Under the scheme that power has been taken away from them, and the people are bound to suffer and are without redress. I know of cases in Northumberland—I could give names, privately, to the Minister—in which the medical officer of health for Newcastle has stated that repeated tests have shown the milk to be unfit for consumption, and that it must be improved before being allowed to come into Newcastle; but the agricultural people concerned summoned a meeting of their council, and the council have unanimously decided not to improve the milk. In the milk-in-schools scheme we have good milk, fit for consumption, yet we cannot make sure of the same thing in the great industrial centres. A large percentage of the milk that comes to our cities is this undesignated milk.

Can we not circumvent the position by the largest possible use of dried milk, which, as everyone knows, is tree from pathogenic organisms and is suitable for consumption? We did more than that in Newcastle. For years we had a scheme by which Vitamin D and iron was added to the milk for certain sections of the community, and modified milk was produced for children up to the first year of age. Along came the Ministry of Food and, without any protest from the Ministry of Health; said to us, "We shall supply you with cows' milk to displace your modified and special milk for infants." I hope the Minister will take note of this point. The Ministry of Food can do just what Newcastle was doing—obtain prepared milk, which is safe, and so save the country a large falling-off in breast-feeding among nursing mothers. We have been providing these mothers with milk which they could not pass on to the children, but once you give nursing mothers cows' milk, they are tempted to pass it on and, in fact, that is what they do. They stop the customary method and take to national milk instead. If ordinary cows' milk is given to these infants, under the conditions on which it is supplied by the Ministry of Food, as undesignated milk, there is no question that there will be increases of ill-health among children and mothers.

Under the national milk scheme, mothers may obtain milk by authority from various persons in the community; for instance, policemen may give authority for the purchase of this cheap milk, or may give details regarding free milk. I have no objection to policemen. I had a desire to be one myself in my younger days, but the very fact that authority can be given in that way instead of the women and children being compelled to go to health centres for their milk supply, has meant a falling-off in attendance at the health centres. The number of women attending them has seriously fallen off. I have certain figures, and although they may be a little due to evacuation problems, they are largely due to the fact that this milk can be obtained from all and sundry and it is not necessary now to frequent our health centres. That is a very dan- gerous change in the habits of that section of the population. For the four weeks ended 14th September—I have not obtained the later figures—the ante-natal cases fell by 25 per cent., the post-natal fell by 40 per cent., and there was a diminution in the attendance of children up to the age of five of no less than 32 per cent. at the centres in Newcastle. I am inclined to imagine that that state of affairs will prevail in other parts of the country. My complaint about non-designated milk is very well founded. I have the very last figures obtainable from Newcastle showing the unsatisfactory nature of things. Taking 100 samples, no less than 38 per cent. of the undesignated milk- was unsatisfactory from the point of view of the medical officers of health—unsatisfactory either as regards pollution, tubercle bacilli or other matters.

I do not wish to detain the House on other aspects of this problem, but the Minister of Health, with the ability that he displayed in another branch of Government and for which he properly received his promotion, has sufficient courage, ability and strength of will to master in this respect the other Departments which at the moment are mastering him; I refer to the Ministries of Food and of Agriculture. As a nation we have spent millions of pounds in offering bribes to the agricultural community to produce wholesome milk. We have now passed the stage at which we can afford merely to content ourselves with offering bribes. There must be compulsion. I know of thousands of farms in this country, and I have visited large numbers of them, which are insanitary and which would not be tolerated under proper social conditions. I ask the Minister to cease being dominated by these Departments and, as the grand custodian of the health of the nation, to insist that those Departments shall in this particular, immediately put their houses in order.

The Parliamentary Secretary to the Ministry of Health (Miss Horsbrugh)

In the Debate to-day it seems that the main topics which have interested hon. Members and which they desired to put before my right hon. Friend are those of health in shelters—in other words, the subject which is most pressing at the moment—and the scheme for the development of greater health services after the war. Then, there is the subject which the hon. Member for Westhoughton (Mr. Rhys Davies) spoke about particularly at the beginning, National Health Insurance. The hon. Gentleman, in urging a wider basis of National Health Insurance, put forward some of the difficulties that the approved societies are meeting under war conditions. The difficulty about the 4s. 6d. has been got over. The maximum appropriation for ordinary expenses in administration has been raised from 4s. 6d. to 4s. 10d. for the whole of 1940. Also, societies are to be allowed to appropriate, in addition to the normal amount, a sum necessary to cover expenditure imposed upon them by the need for protection of their staff, premises and records.

Mr. Ammon (Camberwell, North)

Above the 4s. 10d., what is the normal amount?

Miss Horsbrugh

If they want more protection than they have in normal times, the cost of the extra protection will be met from an extra appropriation. When we discuss National Health Insurance and Unemployment Insurance we very often do not consider the difference between the two. The hon. Member said that, in connection with Unemployment Insurance, the income limit had been set at £420. Surely it is ludicrous, he said, that we should have a different limit for National Health Insurance. Perhaps we do not always realise that on the National Health Insurance Fund there is a continued liability. From the Unemployment Fund the unemployed person draws unemployment benefit for 26 weeks, and then passes on to another Fund.

Another difference is that a great many people in this country have, for years past, insured themselves against sickness. We all know the amount of insurance that is going on in the friendly societies. There was no other way, except through the trade unions, by which the unemployed man was able to insure. A great deal of voluntary insurance is being carried out to-day through National Health Insurance. The National Health Insurance Fund has other schemes as well, for those whose income limit is above £250. There is the voluntary scheme and a special voluntary scheme for black-coated workers. All those things must be taken into account when discussions are continued on the subect of enlarging the scope of the Fund. People above the income limit are insuring for pensions. They can insure in the voluntary fund for health insurance as well. Those are a few of the differences between the two insurance schemes. The National Health scheme is wider, and it gives some chance to those whose incomes are above the limit.

Mr. Rhys Davies

Does the hon. Lady mean to contend that ever since the two schemes started the State has always been wrong for allowing the income limit to be the same? Why must the two amounts now be different?

Miss Horsbrugh

I do not think that I said that the two amounts must be different. As the hon. Gentleman knows, perhaps better than anyone, because he is an expert on the subject, the National Health Insurance Fund has grown up on its own, and the Unemployment Insurance Fund was a later development, and a particular limit was fixed. There are many people to-day who are in National Health Insurance and not Unemployment Insurance. A person who has £420 a year will be in Unemployment Insurance but not in National Health Insurance. I could go on to point out more anomalies. There are not simply one or two. I think we are all agreed that, when there is time and there are the people available, there should be a conference in order to make a real study of the social services of this country and of the whole scheme of social insurance, and that at a later time it might be possible to announce that an overhaul would take place of the different schemes and types of insurance which have grown up. Most systems in this country have grown up one by one, higgledy-piggledy, as the hon. Member said. If it is found possible to have a thorough overhaul of the social and insurance services of this country, there is not the slightest doubt that many of the anomalies that exist to-day will be overcome. We hope that under better conditions the social services of this country will be the finest in the world, and bring to each individual person help in time of need. It would mean the bringing together of provision for old age, unemployment, sickness, into a general scheme of social insurance, but it is not possible to do that at the present moment. My right hon. Friend has said that the matter is being looked into to see what other alterations could be made in the present circumstances. The hon. Gentleman said that most schemes that were State schemes met with a great deal of criticism and that when people ran things on a voluntary basis there was not the same amount of criticism. He said that various voluntary schemes were growing up, and that people were willing to have a certain proportion of their wages deducted. I would suggest to him, and to other hon. Members, that we may find very many valuable experiments of which we can make use when we come to consider the voluntary organisations. But the people in this country are not to-day living, either geographically or in regard to their occupations, in the normal kind of way in which we hope they will be able to do in times of peace. We have to consider the population as it is constituted at present. There are large numbers of men in the Army, and their health services are looked after separately. Munition workers are taken away from their homes, and my right hon. Friend has pointed out how they are to be taken under the Emergency Hospital Service. Expectant mothers are taken into the country to emergency maternity homes, and I would have reminded the hon. Gentleman the Member for North Islington (Dr. Guest) if he had been here, that the evacuee children come under a scheme to provide them with medical service and hospital treatment if they are ill. The very fact of evacuation has has brought them under a medical health scheme as never before. More and more of these people will be taken into the hospitals of our country and the sick bays which we are setting up. More people are coming under these schemes than ever before and are coming under them in a way they would not do in a normal life at home.

The hon. Member for Rochdale (Dr. Morgan), speaking of the Emergency Hospital Service, asked several questions. He told us he thought that in working out the personnel for the scheme too many of the appointments had been given to those who had been working in voluntary hospitals and not sufficient to those who had been connected with municipal hospitals. I heard most of his speech, and I do not think he criticised the work now being done by the emergency hospitals. Nor did he say that people were not being well looked after or that hitches had occurred in dealing with casualties during air raids, and I think it is well that we should remember that against this Emergency Hospital Service there has not been one word of criticism of the actual working of the scheme or the attention which we have been able to give to the injured.

Dr. Morgan

I went out of my way to make a special point that it was not the surgical or the medical skill that I was criticising but that the staff were doing their work in spite of, and not because of, the bad administration and appointments.

Miss Horsbrugh

I did not mean to say that the hon. Gentleman was criticising that particular point, but he said we had not got the right staff and administration. I will answer him with this: The fact that the scheme has worked well and has not met with criticism anywhere means that it needs more than that to show there is bad administration, or that too many of those administering it belong to voluntary hospitals. I would remind him that the Deputy Director-General, to whom the sector officers are responsible, came from a municipal hospital and not a voluntary hospital. If we are to discuss the hospital system in future, and whether voluntary hospitals can go on, it is well that we should remember how, during this time, these hospitals have worked together for the first time in this Emergency Hospital Service. Perhaps from both we shall get, when this emergency is over, not an emergency hospital scheme but a normal hospital scheme in which each can play its part and play it well.

The hon. Gentleman also asked about rehabilitation centres. We had in England 73 centres for the rehabilitation of persons injured by accident, and in Wales three. Under the Emergency Hospital Scheme we have in addition 17 orthopaedic centres in England and two in Wales.

Dr. Morgan

I should like to know where the hon. Lady gets the figures, because, according to the report of the Inter-Departmental Committee on Rehabilitation, there were actually in existence at the time of the report 59 hospitals with organised departments while 116 had partially organised departments. Therefore, out of 1,000 voluntary hospitals 59 had fracture clinics.

Miss Horsbrugh

I am informed that the fracture clinics set up on the lines of the inter-departmental committee for the rehabilitation of persons injured by accidents numbered in England 73 and in Wales three, while, in addition, there have been set up 17 in England and two in Wales. I will go into the figures afterwards with the hon. Gentleman and tell him where the addition have taken place.

The hon. Member for St. Albans (Sir F. Fremantle) asked whether we could add the death rate to the figures given by my right hon. Friend. The death rate for the last year was 12.1, which included civilian casualties.

Sir F. Fremantle

Are not civilian casualties always included?

Miss Horsbrugh

I ought to have said that Army casualties were not included. I now come to the question of health in shelters.

Dr. Morgan

I asked the Minister to tell me how many rehabilitation centres are now in existence.

Miss Horsbrugh

I am afraid I cannot give the hon. Gentleman any further figures at present.

Dr. Morgan

The figures my hon. Friend has given are of fracture clinics, but I am referring to rehabilitation centres.

Miss Horsbrugh

If the hon. Gentleman will allow me, I will get the figures for him. It is difficult in the wide debate we have had to-day to be able to provide all the figures in a short time.

On the subject of shelters, we all realise that the original scheme did not visualise the difference in the war situation after the collapse of France, and that the shelters would have to be the dormitories of the citizens of London. That was not anticipated, and therefore shelters were not fitted up as dormitories. That has got to be changed, but the greatest help we can make to the shelter problem is by encouraging more and more evacuation. I am sure that every hon. Member will agree that whatever we do in providing sanitary accommodation and other things, and in giving lectures and E.N.S.A. concerts and providing tea, hot or cold refreshments, the greatest thing is to get the children out of the shelters into the country. The figures my right hon. Friend gave to-day were very encouraging. I have just had a note to say that the registration of mothers and children has gone up and that it has now reached 10,000. We were running at 7,000 a day, but the figure has always gone down during the week-end. Evacuation is going on rapidly, and I ask every hon. Member in this House to help us in every possible way to induce individual people to send their children to the country. We cannot promise them that they will never hear a bomb drop or an aeroplane. We cannot promise them complete safety anywhere in this country so long as we are at war, but we can promise them that if they take their children out of the shelters into the country, their health will be better.

Mr. Lindsay

Has it been made clear that there is room in the country for the 200,000 children in the L.C.C. areas?

Miss Horsbrugh

Yes, there is room in the country areas. The hon. Member will be pleased to hear that we have not remained absolutely fixed in our ideas as perhaps he thought and that we have not made geographical limits in our scheme. The children can go all over the country, and if we had not adopted this method, we should have had to give the whole thing up long ago. We have had to change and rechange our plans because areas which have been regarded as reception areas have now become vulnerable areas. As the war advances day by day we have to find suitable places to which to send the children. Because the situation has changed, we must have a bigger scheme of evacuation. The hon. Member for West Fulham (Dr. Summerskill) asked whether lectures could be given in the shelters dealing with various health points and with evacuation. We have tried that, but it has been a failure; but, even if you have failed, it does not mean that you must not go on.

Dr. Summerskill

Can the hon. Lady tell us in which shelters this scheme has been tried?

Miss Horsbrugh

We have tried it in big shelters in London.

Dr. Summerskill

Has the scheme been universally tried?

Miss Horsbrugh

No, only in certain shelters.

Dr. Summerskill

I am very interested in this point, because I think it is of importance. How do you determine what the response is? Do you determine the response as a failure if women do not hold up their hands and say "I will go"?

Miss Horsbrugh

I think the hon. Lady might credit me with a little more intelligence in dealing with the problem.

Dr. Summerskill

The hon. Lady has just said the numbers are increasing. Does that not mean that the lectures and the propaganda which has appeared in the papers are having some effect?

Miss Horsbrugh

The numbers are increasing, but the hon. Lady may be partly correct in what she says. The fact remains that we have found people in shelters extremely bored and unwilling to listen to, or take advantage of, the suggestions and advice which are given.

Dr. Summerskill

How did you choose the lecturers?

Miss Horsbrugh

If the hon. Lady wants more details, perhaps we could have a discussion later. I agree that it is very important. If you could get a perfect lecturer who could interest the people, it would be a very good thing. What we want the shelters most for is sleeping. Apart from that, in the earlier part of the evening I quite agree that if we could get the attention of the people we might yet get a better response. I was only pointing out that the idea had come to us. We had made one attempt and I could not say that it had succeeded yet, but we have not succeeded in a lot of other things and we are still going on. The subject of lecturers has not been lost sight of.

The hon. Member for Consett (Mr. David Adams) came back to a subject on which we have had many Debates. I think we must go into it more fully on another occasion. My right hon. Friend has put quite clearly the importance of milk. There is no difference of opinion upon that, but dried milk can be had under the Ministry of Food scheme. It is being distributed now. If the hon. Member knows any district where the mothers are not able to get it, I ask him to make it known that it is possible to get it and that it is being distributed in large quantities.

Mr. David Adams

Will the hon. Lady take into consideration the desirability of producing a modified dried milk?

Miss Horsbrugh

I think the Ministry of Food has arranged for a standard dried milk. In all the circumstances it is better to keep to one standard and see that there is sufficient of it. The National Dried Milk is the one and only standard.

The hon. Member for Rochdale thought that at the Ministry of Health we were complacent, and that perhaps there was not sufficient vision, and that we should not go on waiting until various circumstances had landed us into difficulties before taking action. As I listened to the Debate, I wondered whether he really thought that was a true criticism of the work of the Ministry as a whole.

Dr. Morgan

I do, sincerely.

Miss Horsbrugh

If it is, it seems to me he must think there has been an extraordinary amount of luck and coincidence. Plans have been made and experts have been consulted on such subjects as the danger of epidemic and of the spread of minor illnesses, and the provision of nurses and doctors at their posts. Provision has also been made for the maintenance in war-time of the services for which the Ministry is responsible, such as water supply and drainage. The schemes are there. The testing may come at any time. The strain upon the health of the British people may be very great this Winter, but I think my right hon. Friend can claim for his Department that we have laid the foundations of a real health scheme for the people in time of war, and I believe that on those foundations we, or others, may be able in the future to build a better health scheme after the war. Some of the experiments we are trying out to-day may fail, others will succeed, but I believe this march towards better health in Britain will not be less speedy during war time, and that we new even see the improvement which, as shown by statistics, has been going on steadily during the last years, continue in an even greater degree; and I am sure that no one will be better pleased than the hon. Member for Rochdale when he can come again and find that we have more plans and better plans than he gave us credit for to-day.

Question put, and agreed to.

Resolved, That this House takes note of the general health of the nation, and would welcome an extension of National Health Insurance, particularly to meet the conditions created by the war.