§ 30. Lady Tweedsmuirasked the Minister of Health at what date he asked the Medical Research Council to solve, as quickly as possible, the problem of finding a safe and effective analgesic agent for midwifery, and to devise for its administration, apparatus that is light, simple and requires a minimum of maintenance.
§ Mr. BevanThere was no need for me to make that request because the Medical Research Council, as I was aware, took into consideration the recommendation made in this matter by the working party on midwives, and they have decided to set up a committee in accordance with that recommendation.
§ Lady TweedsmuirCan the Minister tell the House what stage the researches have now reached, and can he also give an assurance that he will press forward with the provision of transport and the present forms of analgesia in all districts, and not wait until new forms are known?
§ Mr. BevanThe hon. Lady knows that there is a very considerable change taking place in this field. A lot of alterations are being made in the apparatus, and I am hoping that before very long very much cheaper and more easily transportable apparatus will be produced. However, that will not be allowed to interfere with the provision of transport for midwives, which is proceeding at a much accelerated rate.
§ Mr. Peter ThorneycroftIs the right hon. Gentleman aware that some local authorities are using as an excuse for not providing any additional apparatus, or any apparatus at all, the possibility that at some unknown date new apparatus will become available, and will he make it perfectly plain that they must not delay providing apparatus on that account?
§ Mr. BevanI think it is true that some local authorities might be tempted to postpone the use of this apparatus in the hope that a lighter one will be available. I have impressed upon them that they must not allow that consideration to influence them, and we are making very considerable progress in the provision of the apparatus.
§ 34. Dr. Broughtonasked the Minister of Health how many domiciliary midwives are employed by the West Riding County Council; and how many of them have now been trained to administer analgesia in childbirth.
§ Mr. BevanTwo hundred and sixty-nine whole-time and 117 part-time domiciliary midwives are employed by the West Riding County Council. Two hundred and thirty-three are trained to administer gas and air analgesia.
§ Dr. BroughtonCould my right hon. Friend venture an opinion as to when all the domiciliary midwives serving in the West Riding will have completed their training in this important relief of suffering?
§ Mr. BevanI cannot give an estimate, but I should have thought very soon indeed. Very remarkable progress is being made over practically the whole country, and I should think that we ought lo have all the midwives trained in two years at the outside.
§ 36. Mr. Peter Thorneycroftasked the Minister of Health which are the 11 local health authorities in which no analgesia is being used in the domiciliary midwifery service.
| Name of Country or County Borough | Number of domiciliary midwives qualified to administer gas and air analgesia | Position as to gas and air apparatus |
| Merioneth County | 4 | 3 sets on order. |
| Bath County Borough | 3 | 1 set available. Ministry in touch with Council. |
| Burnley County Borough | 2 | 4 sets being ordered. |
| Chester County Borough | Nil, but first one now in training. | Ministry in touch with Council on acquisition. |
| Dudley County Borough | 10 | ditto. |
| Merthyr Tydfil County Borough | 1 | 5 sets on order. |
| Nottingham County Borough | 11 | 6 sets of apparatus now obtained: further sets to be acquired. Ministry in touch with Council. |
| St. Helens County Borough | 6 | Ministry in touch with Council on acquisition. |
§ is now eight. With permission, I will circulate the names and other particulars in the OFFICIAL REPORT.
§ Mr. ThorneycroftCould not the right hon. Gentleman read out the names of the eight counties who have done absolutely nothing about this at all?
§ Mr. BevanAs there has been a reduction in one week of three, and as very considerable progress is being made—very much more than has been made in the course of the last 10 years, and very much more in six months than was made in three years before the war by the Opposition when in office—I hardly think the hon. Gentleman ought to hold up local authorities to contumely in this matter.
§ Mr. ThorneycroftI am not holding up local authorities to contumely, but if the right hon. Gentleman claims that he has power to impose this duty on local authorities, what has he been doing?
§ Lady TweedsmuirIs the Minister aware that, as this fight for the provision of analgesia for every mother in the country has been a fight against the prejudice of the entire community, it is quite unnecessary to make party political points?
§ Mr. BevanI am indeed happy to hear that there is no desire to make party prejudice and capital out of this matter, but the fact is that if there is any prejudice against analgesia, it is on the side of the party opposite and not on this side.
§ Following are the particulars:
1431§ 37. Mr. P. Thorneycroftasked the Minister of Health how many midwives are practising in Monmouthshire; how many of them are provided with motor cars; and whether motor car allowances are paid to them.
§ Mr. BevanThere are 85 domiciliary midwives employed by the County Council; 24 have their own cars and are paid a mileage allowance.
§ Mr. ThorneycroftIf the right hon. Gentleman has power to give these instructions to local authorities, why does he not do something about the recommendation of the working party which said that every midwife ought to be provided with a motor car and the means to run it?
§ Mr. BevanIn fact, steps are being taken at the present time to organise the provision of motor cars and the Monmouth County Council is organising a special scheme for this purpose. The number of cases in which mothers have received analgesia at home was lifted in Monmouth last year from the 1947 figure of 14.3 per cent. to 21.6 per cent., and the figures are increasing at as high a rate as that at which it is possible to train midwives.
§ Mr. ThorneycroftWhile the right hon. Gentleman's answer does not seem to have much to do with the Question, would he not agree that even his answer means that three out of every four mothers get no relief whatever?
§ Mr. BevanYes, but it also means that we are providing for the mothers of Monmouthshire the possibilities of analgesia which were withheld from them by the party opposite.
§ 38. Mr. P. Thorneycroftasked the Minister of Health how many midwives are operating in Watford; how many of them possess a motor car; and what means are employed to transport the gas and air apparatus and the midwife to the mother.
§ Mr. BevanThere are five domiciliary midwives. They have one motor car and the County Council are obtaining a second one for them. Transport is by car, cycle or ambulance vehicle. In 1948 there were 321 domiciliary confinements in Watford. Gas and air analgesia was given in 219 of them.
§ Mr. ThorneycroftI cannot see from the right hon. Gentleman's answer quite what is meant about transport by one motor car or by bicycle. Surely some better arrangements could be made in the case of this local authority to enable this apparatus to be provided for the mothers?
§ Mr. BevanIndeed, it is quite correct that there is a very large increase in the number of cases of analgesia in the Watford area. For instance, I am sure hon. Members would like to know that in 1939, after three years, there were 53 cases of analgesia, while in 1948, after six months of the Health Service, it was at the rate of 1,126 in a year.
§ Mr. ThorneycroftAs the right hon. Gentleman appears to have a certain licence in his answers, so far as their relevance is concerned, may I ask him to look very seriously at the report of his own working party? I ask these questions because the midwives ask me to put them. They are working under intolerable conditions which would not be accepted in the ordinary way. Can they be provided with some mechanical transport so that they can do their job?
§ Mr. BevanI have explained that the scheme for the transport of analgesic apparatus is being continued and on the 21st of this month—I think that is the date—a circular was sent out to the local health authorities informing them how they can obtain priority for motor cars for this purpose. I hope that before very long ambulances or motor cars will be available all over the country for this purpose and when we have provided them I hope we shall not be accused by the Opposition of wanton extravagance.
§ 58. Dr. Segalasked the Minister of Health whether a reserve pool of midwives can be made available in certain areas during periods when regular midwives are overworked.
§ Mr. BevanThis is a question of organisation of the local service which must be decided by the responsible local authority having regard to local circumstances and the supply of midwives.
§ Dr. SegalIs my right hon. Friend aware that cases of bad timing may occur when a midwife may have as many as seven confinements on her hands at a given time; and would it not be desir- 1433 able to recruit an emergency pool among married midwives who may be willing to volunteer their services?
§ Mr. BevanI think that it is very difficult for me, and I am sure for the House, to know what the hon. Member means by "recruit"—whether all over the country or in particular places. It is for those who are responsible for the administration of the service to make what arrangements they can in their area; and to talk of a general pool in this matter is entirely beside the point.
§ Dr. SegalWill my right hon. Friend at least seek to encourage the formation of a pool in certain areas where these difficulties have arisen?
§ Mr. BevanIf the hon. Member will show me where the difficulties have arisen, we can then apply ourselves to the facts.
§ 59. Dr. Segalasked the Minister of Health what is the lowest cost of apparatus for the administration of trilene analgesia in obstetrics; whether he is satisfied that it is sufficiently portable; and whether any areas will now be designated as trial areas for intensive scientific investigation into the suitability of this apparatus for use by midwives in domiciliary cases.
§ Mr. BevanThere are several types of apparatus, all of which are portable. I understand that the lowest price of the types on the market is about £7. The suitability of existing apparatus for use by midwives in domiciliary cases will, no doubt, be among the matters investigated by the expert committee appointed by the Medical Research Council.
§ Dr. SegalIn view of the very low cost of this particular apparatus and the fact that it is easily portable, would it not be advisable to equip every midwife with this trilene apparatus and encourage her to use it wherever possible?
§ Mr. BevanI understand from the information at my disposal that it is not yet certain that it is safe for midwives to use the trilene apparatus without assistance, and I certainly would not advise this course.
§ Mrs. MannIs my right hon. Friend aware that trilene is usually conceded to 1434 be the most popular, the most simple and the most easily transportable analgetic and that its use by midwives has been prohibited by the Royal College of Gynaecologists and Obstetricians; and in those circumstances does he feel it advisable that he should counter a decision which has obviously been taken in the interest of the mothers themselves?
§ Mr. BevanI have already pointed out that I think it is undesirable for this analgesia to be given without assistance. I mean by that without specialised technical assistance, and I certainly would not override the technical advice given by the Royal College of Gynaecologists.