§ Dr. Haden Guest (Islington, North)
On a point of Order. Do I understand, Major Milner, that you do not intend to call the Amendment in my name and the name of my hon. Friends—
In page 39, line 7, at the end, to insert:and to provide for an inspection of the pupil's home conditions by the school medical officer if in his opinion this is necessary for the purpose of determining the cause of any illness or defect or incapacity seriously affecting the pupil's health and preventing him from profiting by education at school or young people's college.
No, I have not selected that Amendment, but perhaps the point may be raised on the Amendment which is about to be moved.
§ Mr. Linstead
I beg to move, in page 39, line 5, after "medical," to insert "dental and optical."
The purpose of this Amendment is to raise for consideration the dental and optical sections of the medical inspection and treatment which it is the duty of local authorities, under the Bill, to provide. The Committee will probably agree that dental disease is one of the most prevalent troubles among school children. The difficulty which the Board of Education will have before them is the extreme shortage of dentists. How far my right hon. Friend anticipates that he will be able to remedy that one does not know but, taking the country as a whole, we shall for long be suffering a shortage. As far as optical treatment is concerned, it appears that two or three times during a child's school life it gets an optical examination, but I am given to understand that there are only some 650 medically qualified ophthalmic practitioners available for the inspection and treatment and well over 5,000,000 school children, and one is driven to the conclusion that in a great 1130 many cases defects of vision are missed when they ought to be identified. If that is so, it raises the question whether the services of sight testing opticians should not be used to supplement the services of the few ophthalmologists available. I hope my right hon. Friend will indicate whether he is satisfied with the dental and ophthalmic services and whether he does not consider that it would be desirable to provide a full sight testing by the utilisation of opticians.
§ Dr. Haden Guest
I should like to support the hon. Member, with this proviso, that if people who are not medically qualified are to make examinations which may be necessary over a period that shall be regarded as a provisional arrangement, because examination of the eyes is a very difficult matter in which the greatest possible care should be taken and one which requires not only knowledge of the eye as a lens, or series of lenses, but knowledge of the constitution of the child, and involves a large number of other factors, so that if the matter is to be looked at sympathetically by the Minister I hope he will look at it sympathetically with a view to an interim and not necessarily a permanent arrangement. There is a shortage both in dental and eye treatment and that, of course, extends to the child population as well. In view of the fact that you, Sir, are not going to call the Amendment in my name and that of others, who are members of the Parliamentary medical group, of all parties, I hope I may make a reference to another service which we hope we may get extended.
It may appear to be a novel suggestion to provide for the inspection of pupils' home conditions by the school medical officer, if in his opinion that is necessary for determining the cause of any illness, but the point of it is to bring home conditions into relation with school conditions, because it is very frequently in the home that conditions are found which are very detrimental to the child's health. I hope the Minister will say he will accept the principle of the Amendment, because it does not involve any change of system. It does not involve any periodical visits to the home. It only gives the school medical officer the right to go to the home, if in his opinion it is necessary, in order to determine what is the matter with the child. There are quite a number of cases of that kind. The medical officer of health 1131 has the right to go into the home at present, and health visitors and school nurses also go there. There is no intrusion, because this is intended to be something to assist in the home. These matters arise from a conference in November, where members of school care committees in the London, area were appalled by the conditions of the home which produced defects, ailments, diseases and incapacities so great as to prevent the children profiting from their education. Until those defects in the home can be dealt with, it will not be possible for considerable numbers of children to profit from the education which the Bill is offering them.
The hon. Member is now discussing a later Amendment which I was not proposing to call, and I do not think this would be the appropriate place for discussing it even if it were in Order.
I understood that you said it would be appropriate to discuss it on this Amendment. I apologise if I was wrong.
I said it might be possible to discuss it on the Clause. However, the hon. Member has made his point and I hope he will be content with that.
I have not made my point. I hope to catch your eye, Major Milner, on the Question, "That the Clause stand part of the Bill."
§ Captain Cobb
This Amendment covers pretty generally the question of the effectiveness or otherwise of the medical inspection of school children, I want to make a few suggestions which, I believe, are very widely held amongst people who have interested themselves in this question. A great deal of inspection is ineffective because too little time is given to it and the doctor has far too many children to look after. It is hardly an exaggeration to say that the school medical officer hardly has the opportunity of discovering whether the patient he is examining is a boy or a girl, let alone whether there is anything the matter with him. For every child who has a disability discovered by the doctor, probably two or three escape. I hope my right hon. Friend will see to it that really effective steps are taken to ensure that, since these medical inspections are to be held, they should be really effective.
§ Mr. Vernon Bartlett (Bridgwater)
I also support the Amendment, because it seems to me that we need the utmost emphasis on preventive measures. I am sorry not to see a specific provision for optical treatment and examination in the Bill. I cannot help thinking that it has been overlooked.
§ Mr. Bartlett
I am sorry. I was hoping the right hon. Gentleman would tell me that in this vast labour he is undertaking he had overlooked it. It seems to me a great pity that he cannot give us some satisfaction on this, because it seems fairly obvious that a great number of children suffer from bad eyesight. Though my right hon. Friend assured me the other day that the examination given to children lasted somewhere about 20 minutes, none the less this seems to be a matter that should be taken up. If, as we are told, there are fewer than 1,000 ophthalmic surgeons available, there are some 7,000 fully qualified optical practitioners. I would ask, therefore, whether my right hon. Friend cannot accept the Amendment.
§ Colonel Greenwell (The Hartlepools)
I hope my right hon. Friend will accept the Amendment. We all feel that, as far as teeth are concerned, we are about 1,000 years behind America, and the effect throughout a person's life of neglect of the teeth during youth is most pronounced. It will be a great step forward if dental inspection is very much improved. On the other side of the question, defective vision, on grounds of common sense, that ought to be accepted, because a child suffering from bad eyesight cannot possibly learn. A great deal of learning is absorbed through the eye and, unless children's eyes are properly attended to, they will not only be incapable of absorbing the knowledge with which the Bill ultimately seeks to provide them but it also distracts their attention, because they suffer from headaches and other troubles and are incapable of absorbing knowledge.
§ Mr. Messer
I am surprised at the emphasis that has been placed on dental and optical inspection. I cannot conceive of a medical examination which ignores the teeth and eyes. If they are mentioned, does it mean that other parts are being left out? Does it mean that, because you specify dental and optical 1133 examination, the child will not get orthopaedic examination? Surely in urban areas the medical officer of health is the school medical officer, and he is responsible under the education committee for the examination and the recommendation and subsequent assurance of treatment of the child. If we are to be labelling every separate thing that has to be dealt with, it implies that something has gone wrong. I have suspected for some time that we have not anything like a school medical service in existence. I should prefer to see the school medical service embodied in the national or local medical service, so that we shall have the assurance of efficient professional treatment. I know that there are opticians and opticians but, if the Amendment means that you can only get people who can test sight made responsible for saying that a child does not want treatment, you are taking a heavy responsibility. It may very easily be that, whilst an optician can rectify defective sight by the application of lenses, it takes a doctor to determine that there is something wrong with an eye that requires treatment. It is because of these things that I am rather hesitant to lend support to the inspection of children by people who are not qualified for the job. I hope I am not outdoing the doctors, but I know the danger of allowing defective vision to be rectified merely by lenses when it needs treatment, because there is the possibility of permanent harm being done. I hope the Government will be very careful with regard to what they do on the Amendment.
§ Mr. Butler
The hon. Gentleman who has just spoken has really spoken for the Government. The view he has expressed is entirely sound. We sympathise with his view, because we know the interest he has taken in handicapped and other children. The position as seen by the Government is that, if we were to add these words, we would be adding nothing to the powers of the Bill. In the Definition Clause "medical inspection" covers "dental." It may be asked why "optical" is not put in the Definition Clause. I am advised that if we put in a definition of "optical" we should have to bring in definitions of the other specialised branches of medicine, in which case we should take all the longer to consider this Bill. We should have to con- 1134 sider the oral, cardiac, orthopaedic, respiratory and many other aspects of the human system, on which my hon. Friend the Member for North Islington (Dr. Guest) would be better able to advise than am. I am advised that the general terms "medical" and "medical officer" cover ophthalmologist. I have taken great trouble in briefing myself on this matter because I find that doctors are just as good politicians as we are ourselves. Therefore, one has to be very well armed in dealing with them.
The main issue raised is whether the school medical services are satisfactory. On that point I can only say that, if there were more doctors and more opportunities in war-time for staffing the services, they would obviously be better. In war-time, however, we have had to suffer from the needs of the Armed Forces and to sacrifice many of our doctors. That is not the issue which arises on this Bill. The issue is whether the Statute as we are framing it is satisfactory. There have been references from hon. Members on the subject of opticians, who have a power of organising themselves which I find almost unequalled, except perhaps on the part of some of the denominations. I should like to pay tribute to the work that the opticians do in the school medical service. In many areas it is the practice of the optician to attend with the ophthalmic surgeon when children's eyes are being examined, so that they may receive prescriptions if spectacles are needed. Opticians help in the national health services and their services are particularly vital. The point is that they are not doctors, and what the hon. Member for South Tottenham (Mr. Messer) said is true. I am advised that practically all children at birth are hypermetropic—
§ Mr. Butler
—and that between 12 and 14 the eyes gradually become emmetropic, with the result that, to put it simply from the point of view of my own children, their eyes gradually adjust themselves with their growth, and they therefore need rather more visual tests to discover what is wrong with their eyes. One has, therefore, in the general examination of children to examine not only for eyestrain, but for the physical causes that may be at the back of the eye strain. In the test for optical troubles, therefore, 1135 the children cannot be dealt with by anybody who is not a qualified medical man. Much as we pay tribute to the work of the opticians and hope that they will continue to serve the schools and the national health services as they have done, I must insist that the general examination of children for eye troubles should be done by ophthalmologists, and not by somebody solely concerned with the making up of the prescriptions with the very expert and excellent knowledge they have of glasses, and so forth.
§ Captain Prescott (Darwen)
I would like to support the Amendment. I appreciate what my right hon. Friend has said and the argument of my hon. Friend the Member for South Tottenham (Mr. Messer), but I would like to state what I am informed is the present procedure with regard to the inspection and testing of eyes in the school. I have no personal knowledge of the matter, but I am informed that very often the inspection is done by a nurse or even by a teacher. The test generally takes the form of reading a test type, and no proper inspection is made in many cases. I am informed, also, that very often treatment is prescribed which is the exact opposite of what should have been prescribed. I have been given details of a child being treated for myopia, when it was suffering from the exact opposite, hypermetropia. I would ask my right hon. Friend to consider whether, if this Amendment is accepted, it would not make it obligatory for opticians to examine children's eyes. I must not discuss the definition Clause, but this Amendment would be linked up with that Clause, in which we hope that optical inspection will be defined. The object of the Amendment is to ensure that a proper inspection shall take place by somebody. I am told that optical inspection should involve the preliminary determination by optical means of the existence of errors of refraction and incipient anomalies or abnormalities of the eye. I am told that that is not taking place at the moment. I would ask my right hon. Friend to give further consideration to this matter. I appreciate his observations about the organising power of opticians. There are 7,000 of them and they are recognised for their work under National Health Insurance, and I am told that they would be of very great value if they were employed, at least in part, for this purpose.
§ Mr. Butler
The answer to my hon. and gallant Friend is that we do pay full tribute to opticians and that they are used and will continue to be used, but I cannot substitute them for ophthalmologists in important cases.
§ Mr. Petherick (Penryn and Falmouth)
I am not fully satisfied with the reply of my right hon. Friend. I understand his view that it would be difficult to insert all kinds of specialists in the Bill to cover all the different aspects of the human body. Leaving out the question of the dental practitioner, which appears to be covered in the Definition Clause, I come to the optical practitioner. It would be desirable, of course, to have available for every school a qualified ophthalmic surgeon to examine the eyes of the children for disease, but there are not enough of them. The reason for refusing the Amendment may not be what appears on the surface. It may be that a branch of the medical profession is not very happy about it. As I understand it, a certain part of the medical profession, namely, the ophthalmologists, are rather alarmed lest the optical practitioner, who is accustomed only to rectify errors in sight, may fail to detect disease. That is an understandable reason, but I am informed that the best of the optical practitioners look out for disease and not only for errors of refraction, astigmatism, and so on, and that when they find disease they report it to the medical officer qualified to deal with the trouble. It seems to me that we might get into the difficulty that if we do not draw attention in the Bill to the necessity for an examination of eyesight, we may run the risk that sight will not be examined nearly as often as it ought to be. Lack of examination of children's eyesight may have an effect out of all proportion to the narrow question of vision; it may affect the general health. Therefore, I feel it would be well to examine between now and the Report stage the question whether it is advisable to put in the Bill something to draw particular attention to the necessity for the examination by an optical practitioner if a qualified ophthalmologist cannot be obtained.
§ Rear-Admiral Beamish (Lewes)
May I draw attention to the importance of discovering at the earliest possible moment defects in colour vision? They are of the utmost importance and are easily discovered. Something like 10 per cent. of 1137 males suffer from some form of colour vision defect, but the fortunate and weaker sex have only four cases per 1,000. The test for colour vision is now a very simple one, and the earlier it is possible to find out whether children are suffering from colour vision defects the better it is from the point of view of deciding upon their future professional careers. There are a number of careers which are completely closed to them if they are suffering from colour vision defects.
§ Mr. Linstead
Before asking leave to withdraw the Amendment, I would like to refer to the Minister's reply. It was unexceptionable on the basis that there are a sufficient number of ophthalmologists. The trouble is, however, that there are only some 700 of these specially qualified medical practitioners available for the 5,500,000 school children. The whole basis of the argument for the Amendment is that this is an insufficient proportion and that until the situation is remedied it is better that the examination should be undertaken by skilled opticians rather than by the teacher, or nurse or somebody who happens to notice that there is something wrong with the child. It is on that basis that the Amendment has been put forward, and it may become necessary to raise the matter on a later Clause.
§ Mr. Pethick-Lawrence (Edinburgh, East)
Before the hon. Member withdraws the Amendment, I would like to put it to the Minister that there is a great deal in what the hon. Member for Penryn and Falmouth (Mr. Petherick) said. What the Committee is afraid of is not that these various elements are excluded from the provisions of the Bill, but that they will be overlooked and not attended to. There are a great many things that need attending to, such as the teeth, the eyes, the feet, and also colour blindness. If the Minister were to give us an assurance that between now and the Report stage he will consider whether the words of the Clause are adequate, or whether it is desirable to include words which will draw special attention to these things being properly cared for in the schools, it will relieve the minds of the Committee.
§ Mr. Gallacher
I support the Amendment, and I suggest that we should make some progress with the Bill.
§ Mr. Butler
I can assure hon. Members that this matter is largely one of administration. Whether there are or are not sufficient ophthalmologists at present is not a matter which we can put right by altering the Statute, but I will certainly bear the point in mind in the course of the administration of the school medical service. I would add to the remarks made by the right hon. Member for East Edinburgh (Mr. Pethick-Lawrence) and the hon. Member for Penryn and Falmouth (Mr. Petherick) that I have already taken steps to see that, in the reports of the chief medical officers, special attention is drawn to the needs of children with visual difficulties, including colour blindness, being brought to the attention of doctors, through the nurses and the school teachers.
Before coming to this Debate, I have also had a review, for my own satisfaction, of the services in question, and it appears, notwithstanding what has been said in regard to the number of surgeons, that this service has been operating as well as any other in the school medical service. However, in view of what hon. Members have said, and subject to the remarks made earlier, I will give this matter my most earnest consideration in continuing stages of the Bill. I feel sure that that will be in accordance with the general sense of the Committee.
§ Amendment, by leave, withdrawn.
§ Mr. Butler
I beg to move, in page 39, line 7, at the end, to insert:and every local education authority shall have power to provide for such inspection of senior pupils in attendance at any other educational establishment maintained by them.In order to understand this Amendment, the Committee should turn to the definition of "school" in Clause 103. They will see that it would mean that there would be medical inspection and treatment only for pupils in primary or secondary schools. This Amendment accordingly has been put down to provide for medical treatment for senior pupils in technical schools.
§ Amendment agreed to.
§ Sir Ernest Graham-Little (London University)
I beg to more, in page 39, line 8, to leave out Sub-section (2), and to insert: 1139(2) Nothing in this Act shall be construed as imposing any obligation on a parent to submit his child to medical inspection or treatment nor as imposing a similar obligation on any person attending a young person's college.The Minister has an Amendment on this subject further down the Order Paper. I would ask him whether, if he cannot accept the Amendment I am now moving, he would include in his Amendment the words "inspection and treatment." The discussion which has taken place has indicated the importance of inspection. If the Minister could see his way to include inspection in his Amendment, we should be satisfied. I should also like to give notice that I will, on the Motion "That the Clause stand part of the Bill," make some further observations on this subject.
§ Mr. Butler
As has been rightly said, the Amendment which I have on page 764 of the Paper goes all the way that the Committee should wish to meet the Amendment now moved. I think the Committee will be very wrong if they omit compulsory inspection from the schools. I agree that it is a distinct novelty in this country, but one to which I attach particular importance, and which will make all the difference to the health of the child. It is quite another matter to force people to accept treatment. When the Bill was drafted the matter was left in a way which was unsatisfactory to some sections of opinion in the country. I accordingly put down the Amendment, which meets the hon. Gentleman in regard to treatment. Therefore, I hope that he will not press his Amendment, because I certainly could not accept it in regard to inspection.
§ Amendment, by leave, withdrawn.
§ Amendments made:
§ In page 39, line 9, leave out "or college," and insert "college or other educational establishment."
In line 15, after "college," insert:
or other educational establishment maintained by the authority.
In line 25, after the first "and," insert:
every local education authority shall have power to make such arrangements as aforesaid with respect to senior pupils in attendance at any other educational establishment maintained by them.
(4) It shall be the duty of every local education authority."—[Mr. Butler.]
§ Mr. Butler
I beg to move, in page 39, line 26, at the end, to insert:as aforesaid:Provided that if the parent of any pupil gives to the authority notice that he objects to the pupil availing himself of any medical treatment provided under this section the pupil shall not be encouraged or assisted so to do.The Amendment was designed not only to meet the point of view of the hon. Member for the London University (Sir E. Graham-Little) but other interests in the House. The words in the Amendment speak for themselves. It is a legitimate point, and one which I think the Committee will be wise to accept. There are certain conscientious people in this country who feel that they could not accept the Clause.
§ Mr. Woodburn (Stirling and Clackmannan, Eastern)
What happens in the case of skin troubles, which may be infectious to every child in the school, when the school might not have authority to have a particular child examined to make sure whether some skin affection endangers other children?
§ Mr. Gallacher
In the event of a parent being a crank or having some of those peculiar ideas about treatment, and of the pupil being recognised as subject to a particular trouble which is curable by a particular treatment, are we to understand that, if the crazy parent objects, the Minister is not going to give the child all the necessary assistance to get cured?
§ Mr. Butler
The Clause is so drafted that the words "encouraged or assisted" apply to treatment. The inspection is compulsory. That is a considerable advance on the present practice. The Committee should realise that that particular advance is about as far as we should go. In the case of an infectious disease, the child responsible would be excluded from school, and the other children would therefore be protected.
§ Amendment agreed to.
§ Motion made, and Question proposed, "That the Clause, as amended, stand part of the Bill."
§ Mr. Woodburn
My hon. and learned Friend the Member for Carmarthen (Mr. M. Hughes) had an Amendment down suggesting that inspection should take 1141 place at least once a year. At the moment the Clause provides for inspection at appropriate intervals. That is a very loose provision, and the question is, How often is an appropriate interval? There seems a decided argument in favour of the Amendment of my hon. and learned Friend and I should be glad if the Minister, when he replies, would state what objection there is to specifying a definite time when the inspection must take place.
§ Mr. Moelwyn Hughes
I am very grateful for that intervention on the part of my hon. Friend. It is right that there should be provision for the inspection of school children at decent intervals. Perhaps I might inject a little personal note into this matter of school inspection. My children are inspected in their school by the local education authority, and I can endorse what the Minister has said about the effectiveness of the eye inspection. The deficiency is in the provision of the necessary treatment after the inspection, and, still more, the frequency of the inspection, to make sure that the treatment recommended is being applied and that the child is improving.
As the Clause stands, the inclusion of the word "appropriate" means nothing at all. What does "appropriate" mean? Somebody has to decide what is appropriate. If you added to the word "appropriate" some authority to define what appropriate was, we should be getting somewhere, but merely to have that word alone is mere windowdressing. We might as well leave it out and say "at intervals." To say "appropriate intervals" adds nothing whatever to the legal meaning of the Clause. The Amendment of mine which was not called proposed that there should be an annual inspection. I do not particularly press for that. It might well be that the inspection should be even more frequent. I am sure that members of the medical profession here agree with me that, in orthopaedic cases, when advice has been given, it is not once a year but once in two months or three months that inspection has to take place. What is required is not necessarily a fixed term but that the Ministry should declare that it is the policy of the Department that instructions will be given to local education authorities to see that the inspections take place at intervals sufficiently close to ensure that they are effective, and that the advice which has 1142 been given for treatment is being carried out. At present there is a shortage of school medical staff. It is shorter than it was before the war, and it certainly is deficient now in many parts of the country. I would like to see some flexibility in it, as regards the number of doctors and others who are available to carry out the medical inspection.
But what matters, I think, is that the Minister should assure the Committee that it is his intention, and the intention of the Department, as its declared policy, which in due course can be checked in this House, that medical inspection shall take place at sufficiently close intervals to ensure that it is effective and that treatment has been carried out.
§ Dr. Haden Guest
I support what has just been said about medical inspection. I suggest that the Minister might insert, possibly at some later stage, a provision that inspection shall take place not less than three times during the school career—entrance, midway in the school career, and before leaving. That was the practice in London for a long time—I was a school medical inspector myself—and it worked very well. If a child is reported for treatment, that is followed up by the people at the clinics, so that part of the matter is covered to a certain extent. [Interruption.] It depends on the area of the education authority. It would, undoubtedly, be better if inspection were carried out at regular intervals, whether annually or otherwise, because it is not only the inspection that is of value to the child, but regularity, and watching a child's development and growth over a period, and having it recorded on the school card.
I wish to ask the Minister a question with regard to the point I attempted to raise by way of Amendment. It is with regard to the school medical officer being given the opportunity to inspect the home conditions if the condition of the child was such that he thought it must arise from something within the home. Will the Minister consider whether that could properly be the subject of a new Clause? In a case, for instance, where there is concealed tuberculosis in the home, one could not tell that just by asking questions. One must go to the home. There is the case where there is, for instance, an incompatibility between the parents leading to frequent quarrels, possibly due, on one side, to drunkenness or something else, 1143 which causes a tearing of the nervous fabric of the child's mind and spirit. It is most important that the medical officer should be able to see what is going on there. To take a more concrete case, in these days when there is great overcrowding, it is very important to the medical officer to be able to see whether there is adequate sleeping accommodation for a child. In a recent survey in my own constituency and an adjoining area, a very large number of cases were found in which all the members of a family up to the age of seven were sleeping in one room in very overcrowded conditions. In such conditions it is quite impossible for proper rest to be obtained, and sleep is almost as important for a child as food.
In those conditions, the medical officer is not likely to get that information in the course of medical inspection. He might get it from a school nurse who has visited the home, or from a parent who was present at the inspection, though in my experience only a minority of parents attended. It would be very desirable if the school medical officer had the duty of going to see for himself what the conditions were as regards sleep, possible tuberculosis infection, nervous disturbance, and so on. I am sorry that my Amendment was not called as I could then have gone into the matter more fully. But I would ask: Does not the Minister think there is a good case for giving the school medical officer, not only the right but the duty of visiting the home in order to report on the conditions affecting the child's relation to its school?
One further question, not one of disease at all, is that of the play activities of the child. Many homes have no room where a child can play. They have no room where a child can do homework. These conditions have a vital effect on the progress of a child in school. I hope that the President will reply affirmatively and make this the subject of a new Clause to ensure that one of the duties of the school medical officer will be to give attention, not only to the child, but to the conditions in the home surrounding the child which do so much to mould a child's life, mind and body.
§ Sir Geoffrey Shakespeare (Norwich)
I should like very strongly to support the principle of the Amendment which my hon. Friend would have moved if he had 1144 had the opportunity. I believe that the school medical service, where it is properly run, is the finest part of our health service. Its power for good is beyond calculation. Therefore, if there is, as near as may be, an annual inspection, I am sure that the amount of ill-health and disease that could be prevented would be beyond all calculations. The life of the child at school is to go up by one year, and then two years, and I hope that the President will, as soon as may be, issue instructions to local education authorities to see that this inspection is carried out.
§ Mr. Messer
I support what has been said in regard to having a definite time for inspection. It appears to me that the local education committee may avoid its obligations unless these are specified. One can see the possibility that when a child is examined, it will display a condition which does not call for immediate treatment. Its condition is entered in the report, and it is quite possible that there may be something, which does not show any symptoms. For instance, early curvature may be tuberculosis of the spine. Sometimes the symptoms of such a condition are not such as to cause a parent to go to a doctor, but because a child has had that examination its condition will be compared with the condition shown at a subsequent examination, and the school medical officer will be able to say, "Here is a condition which requires some attention." There is a possibility that by so doing you will prevent a cripple from being added to the community. That is one instance. I do not want to delay the Committee but I could give many other instances.
Perhaps it is not known that tuberculosis itself is a young person's complaint. If you look at the figures you will find that when you have arrived at the age of 45 you are safe, through having built up a measure of resistance. In the sanatoria of the country, there are large numbers of children of school age being educated, who might never have needed attention in a sanatorium had their condition been discovered earlier. That again is a condition that does not disclose itself sometimes. Often the only symptom is lassitude and tiredness, lack of desire for activity. I think it most important, therefore, that the school medical examination should be at regular periods, so that the medical officer can see what change is taking place 1145 in the child, and can look for an accountability of that change. I cannot follow my hon. Friend the Member for North Islington (Dr. Guest) on the question of the right of the school medical officer to go into the homes of people. In this matter you have to get the co-operation of the parents. You have to be very careful about that, because it is the very type of parent who has a home which he would prefer not to show, who will be concerned in this matter, and probably you will find yourself in difficulties.
May I say that often in the course of my duties I have unofficially entered homes? I have never been refused by parents, because I came to help them.
§ Mr. Messer
My hon. Friend qualified what he said by saying "unofficial". That is the whole point. There are many parents who are willing to be helped by those whom they regard as friends, but when you have a certain atmosphere created as a result of an examination, and the doctor is to have the right to walk into a home, it will put up the backs of the parents. It is not that I object to the homes being inspected by a doctor. But it is possible, for instance, for a home to be inspected by the sanitary inspector, by the medical officer of health, and now, if this suggestion were adopted, by the school medical officer. Whilst I want to do the best I can for the health of the people, I do want to respect the right of an Englishman to regard his own home as his castle.
§ Mr. Messer
I have never regarded myself as being less freedom-loving for being a Socialist. If my hon. Friend would fight for healthy homes there would be no need for the school medical officer to go into them. I urge the necessity for regular routine examination of the child at periods, not left to be determined by the local education authority itself, but laid down in the Bill.
§ Mr. Butler
I hope we may draw towards our concluding discussions on this Clause as we have a lot of work still to do. I can answer the main points raised, subject to any further questions that may be asked. The first point is whether the inspection shall be at appropriate intervals. The Government prefer 1146 to leave the Bill as drawn, for various very good reasons, one of which may rather surprise the Committee. I would like to tell the Committee that the number of children proceeding through routine inspections was 1,500,000 in the year immediately before the war. With the number of re-inspections that figure came to 2,000,000 and the number of special examinations, which is an examination on the recommendation of the teacher or nurse,. was 1,500,000. Thus a large majority of the whole of the children were in some way covered in the routine of a normal year before the war. We prefer to leave the matter like that, because we do not want to lay down a statutory minimum number of inspections. It very often has this result, that a doctor spends a great deal of his time looking at healthy children and is not able to devote all the time he would wish to cases that need attention. We suggest that there shall be these appropriate and regular routine inspections generally. We also suggest that the nurses shall refer to the doctors the cases that need attention.
In answer to the point put by the hon. and learned Member for Carmarthen (Mr. Moelwyn Hughes) who wanted to know how the Minister could watch this matter, I would refer the Committee to Clause 74, the first part of which requires every local education authority to furnish to the Minister of Health such particulars that he may from time to time require of the arrangements made by the authority in the exercise of their functions relating to medical inspections and treatment. That means that the Minister, through his colleague the Minister of Health, with whom he works in this matter, will be brought into the picture, and the Bill is not silent on this particular point.
The hon. Member for North Islington (Dr. Guest) raised the question of going into the home. I have made inquiries as to the people who already go into the homes. The medical officer of health, the sanitary inspector, and the health visitor have certain rights of entry for public health purposes, in connection with the spread of infection, and so forth; and we do not think it would be right to include an extra duty on the school medical officer to go into people's homes. It is quite different for the hon. Gentleman, with his friendly characteristics, to go into a home unofficially from the school medical officer 1147 being expected to do so, in addition to all those others. Moreover, treatment does not include treatment in the pupil's home, except in accordance with arrangements made under Clause 73. Under that Clause a school doctor could go in in the case of a child having a disease of a character so serious that it is impossible to educate the child at school. We do not think that this extra power should be added, but we think that the school medical service should obtain its information from the child's own doctor, or from the public health authorities, which would make it perfectly possible for the school medical service to be fully informed of what was going on. Those are the main points which have been raised on the Clause, which, as has been pointed out by several speakers, is an important one. In view of the fact that we have a great deal more work to do to-day, I hope that we shall now make progress.
§ Sir E. Graham-Little
This is a medical question, simply and solely. I would ask the Committee to pay some attention to expert medical reaction to this Clause. Those who are interested—and everyone ought to be interested—should read the "British Medical Journal" for 15th January. A very excellent article appeared on that date, giving the reason why there ought to be very material alteration in this Clause. One of the difficulties is the sidetracking of the family practitioner that is taking place. Everybody in this Committee pays lip-service to the importance of the family practitioner, but what is going to be his position if these arrangements are carried out?
§ The Deputy-Chairman (Mr. Charles Williams)
The answer to that is that we are not discussing the position of the family practitioner on this Clause.
§ Sir E. Graham-Little
May I make some observations on what is to be and what is not to be desired? The inspection and treatment of school children between the ages of two and 18 are to be carried out by the school medical officer. In paragraph 73 of the White Paper on Educational Reconstruction, the proviso is made that, for the school medical service to carry out its functions, the co-operation of the "State Medical Service" will be required. I would ask the Committee to consider what is the probability of a State 1148 Medical Service being instituted by 1st April, 1945. Surely, the position with regard to the health service is not such at this moment as to give any promise of that being possible. But the matter is much more important than that. If the inspection and treatment of school children from two to 18 is to be a function of the school medical officer, without any reference at all to the family practitioner—and that is what would happen—a very unfortunate position will arise. Some of the consequences have been mentioned to-day. It is ridiculous to suppose that a school medical officer, with that enormous influx of work, can make anything like an adequate inspection. Where is the help to come from to make that inspection really valuable? Surely, from the family practitioner. There is going to be antagonism between the family practitioner and the school medical officer, in those circumstances. The school medical officer is usually a young man—quite often it is the first appointment he gets. He is not in a position to ignore the family practitioner, and it is very unfortunate that he should be encouraged to do so.
What is the present practice? I have some knowledge of that, because for 26 years I have been an honorary physician to one of the largest children's hospitals in the East End of London. A family practitioner, if he finds a case that he cannot deal with, has no difficulty in sending that case to a hospital for further advice. The specialist at the hospital is a much more valuable assistant in those conditions than the school medical officer, and I do not think we are going to change things for the better if we are going to rely chiefly upon the school medical officer for diagnosis and treatment. How far is a parent to have any real say in the matter of treatment? Is he to be ignored, as he is being ignored in so many other matters by Clauses in this Bill? The parent, under this Bill, seems to be regarded as entirely irresponsible. The time, certainly, has not arrived for taking so great a step in the medical treatment of school children, before we have some further knowledge of what is going to happen to the general health service. The chaos at the present moment is unbelievable. The school medical officer will treat the school child only at the school. He has no right to make any visits to the home. If any treatment at the home is required, that is the function of quite another person. I 1149 think there is a very strong case for reconsideration of this Clause. There can be no question that no Clause in any Bill could excite more opposition from the medical profession than this Clause does.
Mr. Rain (Peckham)
Sub-section (3) provides for the provision of free medical treatment. Free medical treatment is defined in Clause 103. It appears to include hospital treatment. My right hon. Friend will know that a charge has to be made for hospital treatment, and that the parents are assessed. That appears to conflict with this idea of free medical treatment. If the child is sent to a voluntary hospital, the hospital is entitled to make a charge. What arrangements will my right hon. Friend make to ensure that the voluntary hospital does not make a charge? I do not suppose that he is prepared to answer that question now, but the point ought to be looked into, because there appears to be a contradiction between the concept of free medical treatment and the concept of charging, which is required in a local authority hospital, and which is the practice in a voluntary hospital.
§ Question, "That the Clause, as amended, stand part of the Bill," put, and agreed to.