§ Order for Second Reading read.
§ 4.19 p.m.
§ The Minister of National Insurance (Mr. Osbert Peake)
I beg to move, "That the Bill be now read a Second time."
The Bill deals with maternity benefits under the National Insurance scheme. I must confess that I prefer the word motherhood, but I am advised that to make a change at this stage would be too revolutionary a departure.
The right hon. Lady the Member for Fulham, West (Dr. Summerskill), whom we are invariably pleased to see in her place, is reported to have told an audience of Labour women in Edinburgh recently that this is a subject which is of only academic or theoretical interest to men.
§ Mr. Peake
Be that as it may. Her assertion reminds me of an acrimonious dispute in this House many years ago, when we were discussing penal reform, between the late George Lansbury and the late Jimmy Maxton each claiming to have been in prison more recently than the other—on grounds, if I may add, of honourable conscience—and claiming thereby to speak with the greater authority. I hope we can agree, in principle at any rate, that there are many topics where personal experience is not an indispensable prerequisite of a useful contribution to debate. Fortified by this reflection against the shafts of the right hon. Lady. I come to the background of the Bill.
National Insurance benefits and pensions are provided, broadly, for two purposes; first, interruptions of earning power or income due to misfortunes which cannot be foreseen, such as sickness, unemployment, widowhood or industrial accident; and secondly, for loss of earning capacity due to retirement on account of old age. The death grant stands in a category of its own. Old age is a forseeable contingency, and death is inescapable; private provision against them is both right and proper, but it has also been generally accepted that some 1976 provision should be made for them by means of compulsory State insurance.
Motherhood does not fall precisely into any of these categories; on the one hand, it is not regarded as a misfortune by most of the parents whom I have come across; on the other hand, it is not, like death or old age, inevitable, and it can be foreseen only for a limited period of time. Nevertheless, in some cases it involves a loss of earnings, and it always involves the family in considerable additional expense. The happy event has therefore been accepted as a proper subject for financial provision by means of national insurance. Indeed the original Acts of 1911 and 1913 provided benefits for it which were quite substantial in relation to other social security payments introduced at that time.
Under the Act of 1911 the birth of a child attracted a grant of 30s. and from 1913 of £3 if the mother as well as the father was insured; and these figures, small as they appear today, must be considered in relation not only to the price level existing at that time, but also in relation to figures such as 7s. 6d. a week for sickness benefit, and 5s. a week for the original old age pension. In the years between 1913 and 1946 the only change made in maternity benefit was the increase in the grant to £2, or £4 if both parents were insured, in 1920.
The scheme of maternity benefits proposed by the Coalition Government in 1944 and embodied in the Act of 1946 did not differ very materially from the recommendations in the Beveridge Report. These were a lump sum of £4 for all births and a weekly allowance for mothers who had recently been in paid employment, at the rate of 36s. for a period of six weeks on either side of the confinement. The main difference between the Beveridge Report on the one hand, and the proposals of 1944 and the Act of 1946 on the other, lay in the inclusion of a new benefit, an attendance allowance of £1 a week payable for four weeks after the birth to mothers not eligible for the 36s. weekly allowance. This attendance allowance and the weekly maternity allowance of 36s. could not both be drawn; they were alternatives.
Contribution conditions, which differ for different benefits, are an essential feature of National Insurance. For the maternity grant and attendance allowance 1977 they were easy, and could be satisfied on either the husband's or the wife's insurance. For the maternity allowance—that is the 36s. a week allowance—they were on a different basis. Their effect was that maternity allowance was available to a woman who had been in actual employment for a substantial time during the 52 weeks ending at the sixth week before her confinement was expected. A minimum of 26 weeks of paid work in this year was required, and a minimum of 45 contributions or credits as an employed or self-employed person. Married women in paid employment who had exercised an option not to contribute themselves were, however, allowed to qualify for the allowance by being credited with contributions for this purpose for weeks of paid work as well as for weeks of sickness or unemployment. The effect of all this was that under these conditions a woman had to continue work until the end of the sixth month of pregnancy and often longer, unless she was sick or unemployed.
This new scheme, part of the general proposals embodied in the Act of 1946, looked on the face of it both just and generous. It had not, however, been in operation for more than 18 months before certain defects in it became apparent.
In the first place, whilst the new attendance allowance which provided £4 over and above the £4 grant had proved welcome, it was not clear that any good purpose was being served by paying it in weekly instalments.
Secondly, the scheme for giving a weekly maternity allowance to women who had been doing paid work was not working satisfactorily. Most women in employment wanted to give up work earlier than the conditions for benefit allowed, and it was feared that the contribution conditions were having the effect of encouraging them to go on working longer than they would otherwise have done, and that other regular workers were not getting the allowance at all because they had, through no fault of their own, to give up work earlier in pregnancy. Moreover the position under which the whole allowance might be lost by the lack of a single contribution or credit was not at all a happy one. Again, there was doubt whether it was fair or equitable that the weekly allowance should be paid to women who had decided not to pay contributions, seeing that the burden of 1978 finding the money is largely met by the contributions paid by other women.
Lastly, there was a growing feeling that it was unfair that the mother who had saved quite a lot on food and household expenses by having her baby in free hospital accommodation should receive the same amount of benefit as the mother who had her baby at home and had these extra expenses to meet.
My predecessor, the right hon. Lady the Member for Fulham, West therefore decided to refer the whole scheme for advice to the National Insurance Advisory Committee, the eminent body presided over by Sir Will Spens, which includes, besides other distinguished persons, representatives of both sides of industry and consisting, I may add in parenthesis, almost entirely of men.
§ Mr. Peake
This Committee has investigated many difficult and baffling problems on behalf of my Ministry. Their reports contain a body of sound and well-considered recommendations which, when adopted, have proved their worth in operation. In their review of maternity benefit the Committee have, I think, given us an extremely valuable report. I am afraid I should only confuse the House if I were to take them in detail through all the Committee's recommendations, but I will draw special attention as I go along to the few minor points where we depart from them.
The Committee were, of course, prohibited by their terms of reference, laid down by the right hon. Lady, from making recommendations which would add to the expenditure of the National Insurance Scheme. But since the Committee's report was published in January, 1952, the present Government decided at the time of last year's Budget to increase all the main benefit and pension rates embodied in the 1946 Acts, both for National Insurance and for industrial injury, by approximately 25 per cent. We could not at that time include in the Bill increases for maternity. The Committee had recommended important changes in structure and we needed time both to obtain and to consider the reactions of the public to them. Even had it been possible to include maternity 1979 provisions in last year's Bill, the changes in structure would have led to discussion, which would have delayed the passage into law of a Measure which we regarded as most urgent, and was for that reason confined to changes in rates of benefit and contribution.
In the present Bill, therefore, we have both adopted a new pattern, based on the Committee's recommendations, and provided for increased benefits of a substantial order correspnding to those made last year for other rates. The actual annual cost of the new provisions, so far as they can be estimated by the Government Actuary, will in a normal year be £2½ million; the existing figure of £8¼ million will rise to about £10¾ million. This increase is of the order of 30 per cent. We do not propose at the present time to make the appropriate increases in rates of contribution; these would be small anyway, and changes of rates are a major operation involving the withdrawal of all the current stamps and the printing and issue of new ones. This question of contribution will be deferred for consideration until the quinquennial review to be begun next year.
I will now describe briefly the main proposals of the Bill which is before the House. The new maternity grant of £9 incorporates an element in respect of the old attendance allowance which is to be abolished, and it will be payable in full for all confinements. The whole amount will be available for a woman to claim at her discretion, when she most requires it, either shortly before or after confinement. Here we depart from a recommendation of the Advisory Committee which suggested that part of the grant should be withheld till a fortnight after the birth. The Committee emphasised the desirability of providing as large a Jump sum as possible immediately preceding the birth. I feel fairly confident, therefore, that the course we suggest will commend itself to the House. But what I most want to emphasise is that the £9 grant will be payable in full with the weekly maternity allowance, whereas the present £4 attendance allowance is not. For the future all mothers, whether themselves insured or not, will get the grant in full.
Then there is the new benefit known as the home confinement grant. This is £3, 1980 making £12 in all where the baby is born at home. This also is payable with the weekly allowance. For twins, the £9 grant is doubled, but the home confinement grant is not. Twins born at home thus attract a grant of £21, triplets £30, and so on ad infinitum.
The purpose of this new benefit, the home confinement grant, is to offset the financial advantage enjoyed by a woman who has her confinement in a National Health Service hospital over the woman who is confined at home. The grant is designed entirely and only to secure that considerations of financial advantage do not influence a decision which, as the Committee said, should be taken on other grounds. The Advisory Committee received more evidence in favour of such a provision than on any other aspect of the scheme, and in their latest Report the Central Health Service Council observe:…another factor which tends to make hospital confinement more popular is that under the National Health Service it is free, whereas a home confinement entails more expense on attendance, bedding, equipment, and so on.I turn now to the important changes proposed in the Bill regarding maternity allowance. The Advisory Committee endorsed all the criticisms of the present scheme to which I have alluded earlier. They found that the majority of mothers in employment gave up work earlier than the sixth week before the baby's arrival, and that others were continuing at work too long solely in order to satisfy the contribution conditions. They stated also that they…could see no ground on which a woman who has chosen not to pay contributions should be entitled to a weekly insurance benefit, the cost of which is largely met by the contributions paid by other women.Their investigation of this problem also brings out two very interesting aspects of it. First, they stated emphatically that they could find no evidence that an especially high rate of benefit is necessary to induce women to abstain from work at the appropriate time before confinement. Secondly, they found—and this is a most striking feature of their Report—that not more than one-third of the women who receive this benefit—that is, the weekly allowance—in fact return to work after the birth. Hon. Members will remember that the weekly allowance was designed to provide for an interruption of earning 1981 capacity during a period of six weeks on either side of confinement.
The Committee's finding of fact well illustrates the fundamental difficulty about this allowance. Where a mother has been working before the birth of her child, the allowance is payable; but no one, very often not even the mother herself, can say whether or not she will resume work afterwards. In fact, what has been happening is that this allowance is tending more and more to become an allowance paid in respect of the first child of the family. Nevertheless the Committee recommended the continuance of the allowance; an extension of its period; and the payment of it at the standard rate of benefit under the National Insurance Scheme.
The proposals in the Bill, which are designed to carry out the Committee's recommendations, are therefore as follows: first, the period over which the allowance is spread will begin five weeks sooner, at the eleventh instead of the sixth week before the baby is expected. It will continue for the same period after confinement as hitherto and the weekly payments will be at the standard rate of 32s. 6d. for 18 weeks, in place of 36s. for 13 weeks as at present. The result is an increase of the amount paid by way of the allowance from £23 8s. to £29 5s. When we add to this sum of £29 5s. the lump sum grants now available for either hospital or home confinement, this type of mother—the one who has been going out to work—will in future receive £38 5s. for a hospital confinement or £41 5s. for a confinement at home. These totals compare with £27 8s. under the existing scheme. Another beneficent change made by the Bill is that by regulations made under Clause 8, the maternity allowance can carry dependants' allowances with it during the whole period for which it is payable.
Women will be able to stop work sooner in pregnancy not only because the allowance will begin five weeks earlier, but also because of important changes we are making in the contribution conditions. For the future the qualifying period will end 13 weeks before the expected birth in place of six weeks as at present. Moreover, we are accepting the Committee's recommendation that a shortage of contributions should no longer entail complete loss of benefit. It 1982 will be scaled down as it is at present for other types of benefit, but we are making one further change here which departs from the Advisory Committee's proposal that a minimum of 45 contributions for weeks of work or credits for weeks of unemployment or sickness, should be required for benefit at the full rate.
For the future we propose that as for unemployment and sickness benefit, 50 such contributions or credits shall be required for full rate benefit, but that, where a woman has at least 39, she can make up the balance by contributions in the non-employed class, that is to say, at the lowest rate. For benefit at full rate a woman need, therefore, only have been in the employment field for 39 weeks during the qualifying period, instead of for 45 weeks as at present. The main effect of these complicated changes, therefore, is that in future a woman can leave her work at the end of the third month of pregnancy and still qualify for the allowance at the full rate.
§ Mr. William Keenan (Liverpool, Kirkdale)
Does that mean that women have to pay contributions every week, whether they are working or not, in order to qualify for benefit?
§ Mr. Peake
For the full rate a woman should have 50 contributions either paid or credited in respect of weeks of unemployment or sickness. If she has a deficient record, she will be able to get benefit at a reduced rate even though she has only a minimum of, I think it is, 26 contributions.
In conclusion, I will just make a passing reference to the transitional provisions and the necessity for them. For the new lump sum grants there is no difficulty about transitional arrangements. For all births occurring on or after an appointed day, which will be as soon as practicable after the Bill becomes law, the £9 maternity grant will be paid, and where appropriate the £3 home confinement grant.
The changes in maternity allowance, which are more complex, call for more complex transitional provisions. In framing them, our object has been to ensure that no woman who has at the appointed day in any way or to any extent a record which might count towards her qualifications for it. shall fail to get a maternity 1983 allowance because of the changes made by the Bill. The new and more valuable maternity allowance under the new scheme is to depend on paid contributions. We have therefore provided that the old allowance shall continue to be available on the old conditions, as an alternative to the new, for confinements expected any time in the 65 weeks after the appointed day. For this purpose, but only for this purpose, the arrangements for contributions to be specially credited to non-contributors will be continued. For confinements expected after the end of the 65-week period women will have had time to qualify in full for the new allowance by contributions paid after the appointed day.
I believe this Bill will receive a general welcome, unlike some other Government Measures. The only criticism of it, so far, is that its introduction had been too long delayed. It is true that 14 months elapsed between the publication of the Committee's Report and the presentation of this Bill. That interval has by no means been wasted. In the course of it, we have not only improved in some respects upon the Committee's recommendations, but we have also superimposed upon its plan improvements in benefit rates which the Committee were prohibited, by their terms of reference, from considering. Moreover, we have had to deal with the highly complex question of transitional arrangements from the old scheme to the new which the Committee did not touch.
The Bill makes the most generous provision for motherhood yet made in the history of our social services. The benefits which it provides will, in combination with the National Health Service, ensure good conditions for mothers at a critical time, and a good start in life for children. I think I may also claim that this Coronation year is a happy moment in our history for a Measure so beneficial to family life.
§ 4.45 p.m.
§ Dr. Edith Summerskill (Fulham, West)
Although the Minister implied that his knowledge in this matter was equal to mine, his exposition appeared to me to be a little laboured, if I may use that expression. Perhaps he did not feel so much at home about it as he would liked to have done. After speaking for 1984 about 10 minutes, the right hon. Gentleman said that I had referred this matter to the National Insurance Advisory Committee. He was a little ungenerous, and, at the risk of appearing immodest I must point out to the House that the previous Labour Government were responsible for initiating this piece of legislation.
I would not have appeared so immodest had it not been for the Chancellor of the Exchequer, who implied in the House last week that the increases in benefit made by the present Conservative Government stemmed from their generosity, when the Minister knows, I know and the officials know that the increases which the Minister has already mentioned today were related to increases in the cost of living, and, indeed, to an anticipation of an increase in the cost of living. The Chancellor of the Exchequer said that the cost of living was static, but the Minister knows that that is purely fortuitous. The procedure at the Ministry of National Insurance has always been the same; for administrative reasons they have had to look ahead.
I want to forestall Conservative candidates at the next Election claiming credit for the Bill, and in case hon. Gentlemen opposite think that this is an overstatement I would refer them to page 5 of the Report where, in the introduction, it is made quite clear that I invited the National Insurance Advisory Committee to examine the whole position with a view to making recommendations which would be finally embodied in legislation.
The Minister has referred to 14 months of gestation on the Bill. I make it about 15 months since the report on the maternity benefit provisions. It is astonishing to me, having regard to the fact that so many of these recommendations were long overdue, that the Minister should have taken such a long time to frame a Bill of 14 Clauses only, one Clause per month, to help expectant mothers. As the provisions of the Bill could not for a moment have been calculated to provoke controversy, why the delay?
Whatever the reason, the Minister has certainly given an excellent talking point to those who object to the amalgamation of the Ministry of National Insurance with the Ministry of Pensions. They may well say that if it takes 15 months for the Ministry of National Insurance to prepare a 14-Clause Bill, they need to 1985 expand their staff and not to embrace another Ministry. Perhaps I am being a little unkind to the Minister and it is not so much the Minister's fault as that of Her Majesty's Government who, in assessing priority, put brewers and bankers before mothers.
It was remarkable to see how quickly the Government framed legislation within a few weeks to help the brewers and the bankers, but the expectant mothers, poor things, have had to wait for 14 months before they have had this very limited and broadly non-controversial Bill. I would say that the provisions of the Bill broadly are non-controversial and acceptable but certain aspects call for comment, and one particularly calls for serious criticism.
As the Minister has said, this Bill gives the expectant mother who is confined at home £3 more than her neighbour who may enter hospital for her confinement. On the face of it, this is eminently fair. No one would contend that the woman who has her confinement at home does not incur greater expense than the woman who has her confinement in hospital. But there are other things which fill me and my hon. Friends with apprehension. How far will this financial differentiation act as an inducement to stay at home?
The excellent Spens Report on Maternity Benefits dealt with this matter. Members of the Committee made it quite clear that they were anxious that an expectant mother should decide whether she should go to hospital or stay at home irrespective of the amount of the grant which she would receive. Nevertheless—and I am sure that the Parliamentary Secretary to the Ministry of Health will agree with me —many harassed hospital authorities devoutly wish that the whole confinement grant would act as an inducement to mothers to stay at home in order that beds for maternity cases should be freed for medical and surgical cases. It should be pointed out, however, that from an obstetrical and also an economic point of view it pays a modern housewife to enter hospital for her confinement.
I want to deal with this for a few moments because the Minister has pointed out today that a new principle has been introduced. There is introduced in this Bill, for the first time, a differentiation between the amount paid to a woman at home and that paid to a 1986 woman in hospital. I am not concerned with the comparison of the well-off mother who is free to make a decision in the light of circumstances, but with the over-burdened woman whom we all know, whose living conditions are poor, who has heavy family responsibilities and perhaps has a ne'er-do-well husband and who will be tempted to sacrifice herself for the sake of the extra few pounds. I am sure that my hon. Friend the Member for Liverpool, Exchange (Mrs. Braddock) has thousands of such women in her constituency
It is useless to argue that the interests of these women will be safeguarded by midwifery services, because the woman herself has the last word; and though the doctor or the health service officials may say that home conditions are unsatisfactory and that she should go to hospital, she will be free to stay at home. I hope that the Minister read the whole of the speech which I made at Edinburgh. I said then, and I say again, that if there was a trend in this direction, if this extra £3 tended to make a woman sacrifice herself in this way, then this Bill marked the end of an era of enlightened midwifery, because I do not think that anyone would contend that there is no relationship between the record low maternity mortality rate and the record low neo-natal mortality rate and the provision of maternity hospitals in the last 20 years.
§ Dr. Stross
Does my right hon. Friend contend that this relationship is an important factor, or the most important factor, or would she place the improvement in nutrition far ahead of it?
§ Dr. Summerskill
I think that my hon. Friend will agree with me that in the last 20 years there have been tremendous changes. Twenty years ago there were nearly 3 million unemployed in the country. I am sure that he will agree that a good obstetrical service is of tremendous importance when a woman is about to be delivered, whatever the nutritional standard may be.
I look forward to the day when every woman can choose between hospital and home in precisely the same way as a wealthy woman can choose between a private ward in a hospital or even a private nursing home and her home. If it is 1987 contended that the home is the right place when the conditions are satisfactory, then I say that maternity accommodation in the private wings of hospitals and, indeed, in expensive nursing homes should be used for other purposes. But I am not one of those who hold the view that there is something about even an ill-equipped home which one cannot get in a hospital.
The provision of obstetrical service in hospitals is not the only consideration. A hospital affords a mother rest after her confinement which she is so often denied in her own home and which she so richly deserves. This most striking statement is made on page 10 of the Spens Report:The cost of extra help in the home is also a most uncertain figure—both because the woman confined in hospital normally requires less attendance when she returns home, and for a shorter period, than the woman confined at home….I welcome the presence of the Parliamentary Secretary to the Ministry of Health, because I know of the pressure that is brought upon her. This statement by the Committee is most important. In fact, the Committee say that there is evidence that when the woman returns from hospital after her confinement her physical condition is so much better than that of a woman who stays at home for her confinement that she requires less attendance. That is the answer to those who are so anxious to persuade poor women to stay at home. Yet it is astonishing how many people who have no conception of the physical and psychological aspects of confinement are so dogmatic on the matter and who say that, provided there is running water and the minimum of facilities, the home is the best place for a confinement.
I have been struck by the conversations that I have had with my hon. Friends who have been members of large families and who have a very understanding approach to this problem. I say that a hospital confinement must not be regarded by the prejudiced as a waste of a bed which might well be used for other purposes, but rather that it must be regarded as offering a safe delivery for the woman and child and a period of rest for a woman who has just emerged from a trying ordeal, with its psychological reactions and who, moreover, is called upon to tax her physical resources 1988 once more to feed her child. Is it surprising that one-third of babies are bottle-fed when we know how much pressure is brought on women to remain outside hospital for their confinement?
We must watch this scheme very carefully to ensure that the apprehensions which I have expressed are not realised. It is inevitable, of course, in a complex insurance scheme for certain of the assumptions on which it was based to have been proved wrong. We know that. Those of us who have followed the working of the scheme very carefully for the last few years realise that when it was originally framed it had to be based on certain assumptions, and nobody is infallible. The maternity allowance was intended to help those women who must be tided over a difficult economic period in connection with their impending confinement, but the provision was made on the assumption that they would return to work.
As the Minister has said, the Report reveals that only a small proportion of those women return to work after their first child, and in most cases the maternity allowance therefore makes provision for the pre-natal and post-natal period in respect of the first child only. Any alleged hardship in connection with the new system of contributions made in this Bill—and I hope that my hon. Friend the Member for Kirkdale (Mr. Keenan), who asked about contributions, will bear this point in mind—must be seen in the light of this fact.
By that I mean that while a potential mother will be expected to continue after marriage the insurance contributions which she made as a single woman in order to secure a full maternity allowance or a proportion of that allowance, in the majority of cases this will continue for that period of married life which precedes the birth of the first child, when both the husband and wife are wage earners and when the heavy expenses associated with married life have not yet been incurred.
I now want to mention a point which merits strong criticism, and I ask the Minister to be receptive and sympathetic to it. I know that this is a very complex subject, and it happens that I have had contact with it in all kinds of ways. I have not only been the Minister concerned; I have been a mother and a 1989 doctor responsible for operating the old scheme for many years, so I am familiar with its variations. The Report reveals that the maternity allowance under the present scheme is not enjoyed by all those who are entitled to it, in consequence of their failure to establish a claim.
Under the scheme as at present constituted, entitlement depends upon compliance with the condition that at least 45 contributions as an employed or self-employed person must be paid or credited in the 52 weeks before the period of six weeks prior to confinement. Pages 16 and 17 of the Report make it quite clear that this condition operates harshly. It may be possible for a sedentary worker to comply with it, but a factory worker, standing at a machine all day, a conductress on a 'bus, or a domestic worker scrubbing offices, is physically unable to do so, however willing she may be, without detriment to her health.
I therefore welcome the new structure which enables an expectant mother to retire for 18 weeks, 11 of which may be before her confinement. But while it is recognised that the present conditions bear harshly on the expectant mother, will the conditions attaching to the new benefits remedy the position? The Committee recommended that 45 contributions should be paid in the contribution period ending 13 weeks before the confinement; yet the Minister has ignored that recommendation.
I do not know whether he is fully conscious of what he has done; I do not think he is. On the whole, he is a fair person, but I do not think that he has given full consideration to this point, which merits serious criticism. He has ignored this recommendation, and he makes it a condition that 50 contributions must be paid in this period to qualify for the full payment of the maternity allowance.
I do not think that an expectant mother who is doing heavy work will be able to comply with the new conditions, although she may be the one in the greatest need. I recognise that uniformity with and relation to sickness benefit is attractive, but there are other factors in a maternity scheme which make a hard and fast rule unworkable I would draw the Minister's attention to paragraph 16 of the Report, which says: 1990… the statutory authorities who decide claims to benefit do not accept a certificate of normal pregnancy as evidence of incapacity except for the six weeks before the expected confinement.I will give him an illustration of what this means. I think he will accept the fact that "scrubbies" and heavy workers are not able to draw the full allowance because they are not able to comply with the condition. Let us suppose that there are two girl typists in a typists' pool, working at the top of a three-storey building in the City. That is not an overstatement; hundreds and thousands probably do that. One of the typists is married and is about to have a baby; the other is single.
The single girl goes out, has a game of tennis and sprains her ankle, or has an attack of "tennis elbow," in consequence of which she feels a bit run down and does not feel like going up all the flights of stairs to her work. She goes to her doctor, and she is entitled to obtain from him a certificate of incapacity, and to be credited with a sickness credit for her contribution.
The girl at the next desk is, let us say, five months' pregnant. She has a sedentary job and she has stuck it out so far, but the time comes when she feels a little cramped, sitting in one chair all the time, and she feels puffed out when she climbs up the stairs to her work. She feels she would like a few days off. In terms of discomfort she is infinitely worse off than the girl with "tennis elbow" or a slightly sprained ankle, but she is denied a certificate of incapacity because her condition is normally associated with pregnancy.
It is all very well for the Minister to ignore the recommendations of the Committee who, knowing these things well as I do, say that 45 contributions are sufficient because they know that that woman, if she is uncomfortable, short of breath, and so on, is unable to obtain a certificate of sickness and thereby obtain a credit. They have, therefore, been fairly generous. I would remind the Minister that the people we are talking about are, for the most part, unorganised. He and I have to protect their interests.
§ Mr. Peake
The right hon. Lady has been very fair about the Bill, but in the various calculations she has been making she has failed to take account of the fact that in making the number of contributions for benefit 50, instead of 45 as at 1991 present, we are permitting 13 contributions—at the non-employed rate—in respect of weeks of non-employment to count towards the number required for the full benefit.
The right hon. Lady will see that we have taken out of the qualifying period the 13 weeks preceding the confinement, and we have permitted, in respect of any part of the qualifying period—say, the 13 weeks before that—13 non-employed contributions, which brings us back to the end of the third month of pregnancy. If, during the first three months of pregnancy, a woman is not well enough to go to work, she might get a certificate of sickness to cover that period and still obtain the full benefit, although she has not worked at all during the whole period of pregnancy.
§ Dr. Summerskill
The Minister's approach is rather a male one. It is what he thinks sickness and discomfort would qualify for. To obtain a certificate there must be a pathological condition. Pregnancy is a physiological condition, and that does not entitle a doctor to give a certificate. My hon. Friend the Member for Stoke-on-Trent, Central (Dr. Stross) and I have very often ignored those regulations and our consciences are quite clear. On many occasions I have given such women certificates, knowing that if I did not they would not qualify.
The excuse the Minister gives is extremely feeble. The woman is working, I presume, because she wants the money. She would not continue working, even after her first perhaps uncomfortable second or third month of pregnancy, unless she wanted the money. There is no evidence of wealthy women working daring their pregnancy. Therefore, we assume the woman who works wants the money. The Minister says, "You have overlooked that she can pay when she is unemployed, if she so wishes. She is not to get wages, but she will be given this great concession of being allowed to pay over that period." The Minister will appreciate, if he gives more consideration to it, that, although this looks very well on paper, in operation it is cruel and harsh. I ask him to get advice on this point between now and the Committee stage from some of the women workers he employs. They would give him excellent advice.
1992 I see the hand of barren male officialdom upon this Bill, which departs from the more humane recommendations of the National Insurance Advisory Committee which was specially set up to advise the Minister. The paradoxical thing is that in his opening remarks the Minister prided himself, quite rightly, on being advised by such an efficient Committee. The point is that on that Committee there is at least one doctor of medicine and two women, whereas I happen to know that in his own office the Minister is surrounded—if I may say so with due respect—by a small group of people who have had no practical experience in this matter.
If the Minister makes this concession he is not making a concession to me or my party. All he is doing is deferring to that Advisory Committee, which has been set up to advise him and is composed of excellent fully qualified people. They have recommended him to do something. All I say is: Accept their recommendation; do not reject it. If I may say so with all respect, they know much more about it than even he does. One reason this Bill has been introduced is that we recognise that we made some mistakes in the past and we want to rectify them. But if this Bill is passed in its present form, I anticipate that it will be a repetition of our previous experience, and large numbers of expectant mothers will be physically incapable of complying with the regulations.
The dependants' allowances are very welcome, but does the Minister think that they are enough in the special circumstances? An expectant mother with a family and a dependent husband is subject to all kinds of strains, mental and physical; her period of pregnancy must be fraught with worry, and unless we are generous she will be forced, whatever her conditions of work, to continue working to the 11th week before confinement for fear of losing her full allowance. I do ask the Minister to consider the dependants' allowances again.
It has been said that a civilisation can be judged by the status of its women. I think it is agreed that there is a great deal of truth in this. I therefore ask the Minister to be more generous in his approach to this Measure, and to regard it, not only as a contribution to our social 1993 services, but as a further tribute to the selfless and arduous work of the mothers of this country.
§ 5.14 p.m.
§ Mr. J. K. Vaughan-Morgan (Reigate)
We have all listened with great interest to the Minister's speech and to the speech of the right hon. Lady the Member for Fulham, West (Dr. Summerskill). I was frankly a little disappointed with the right hon. Lady's approach. She started by praising the Bill with faint damns and ended by damning it with very faint praise. She seemed to hover between one attitude and another. She started by saying that she intended to forestall any Conservative attempt to take any credit for the Bill at the next General Election, and proceeded to say that the Minister should have no credit at all for the Bill as it stood. There seems to have been some uncertainty between the two attitudes. I had hoped that she would make a quite different approach to the Bill as it stood and, if I might paraphrase a line of Lord Byron's, take as the keynote of her speech: "On with the Bill and let joy be unconfined."
The Bill will be welcomed on all sides, but there are one or two points which many of us would wish to raise. The most important points are, first, that the benefits are now limited to those who, actuarially, contribute, and that is fair and reasonable; and second, as seems to me only right, that the maternity grant is to be payable before or after confinement, which also is not in the Report of the Advisory Committee. Thirdly, the important feature of the Bill is the new home confinement grant.
Although I cannot in any way claim the expertise of the right hon. Lady, who can speak in so many capacities, I thought it was a little unfair and unreasonable of her to suggest that for the sake, as she put it, of a few pounds mothers will choose to be confined at home when, for medical reasons, they ought to be confined in hospital. After all, it is pointed out in paragraph 32 of the Report that the various assessments of the cost of a home confinement range from £2 to £10, and they therefore conclude that £3 is a reasonable minimum figure.
If there is any truth in the suggestion of a much higher figure, it seems highly unlikely that anyone will, for the sake of 1994 £3, be induced to have a confinement at home which ought to be in hospital. On the other hand, it will certainly even out what must seem to many people an inequity in the present conditions. Surely that is the real principle involved, and not the enforcing or inducing of anyone to have her confinement either at home or in hospital. We all look forward to the day when there will be as free a choice in this matter as the right hon. Lady mentioned.
Reference should also be made to other points in the last report of the Central Health Services Council. In referring to the increased proportion of confinements taking place in hospital, they say it is clear that this increase has been determined not by medical considerations alone, but partly by long-standing custom, and other reasons as well. The fact that this grant will be made to those who have their confinements at home will eliminate a quite reasonable amount of complaint.
There are one or two detailed queries I should like to put. I particularly welcome the presence on the Government Front Bench of the Parliamentary Secretary to the Ministry of Health, who I hope will intervene in this debate and give the House some assurance that she is satisfied that, if there is any increase in the home confinements, the midwifery and home-help resources are available to cope with that increase.
I should like to raise with the Minister the question of the occupant of an amenity bed in a hospital. This grant will now be payable to anyone in a paying bed. Obviously it will be withdrawn from anyone enjoying completely free service. But what about the occupant of an amenity bed, who will be making some contribution towards the cost of her confinement? I also ask the Minister to look at the question of publicity which will be given during the transitional period under this Bill. Many of us know that the cases of injustice and inequity about which we write to the Ministry and get such sympathetic replies very often arise from lack of publicity. I hope that that will be completely avoided with this Bill, and that all reasonable and possible steps will be taken to forestall misunderstanding due to ignorance.
I really think the Minister is to be congratulated on bringing the Bill forward, and the right hon. Lady as well for 1995 the part she played in referring the matter to the Committee. I think the Bill will receive a universal welcome in the country.
§ 5.20 p.m.
§ Mrs. Jean Mann (Coatbridge and Airdrie)
I am very pleased indeed that the House is devoting a few hours to discussing the needs of the mothers of the nation. I have often thought, when I have seen the pressure groups at work on behalf of spinsters, on behalf of old-age pensioners, that it is a very great pity that young mothers have not time to organise pressure groups; they have not because they are so busy organising their lives and their families. There does not seem to be a group of politicians who foresee that when the principle of equal pay is put into operation—and I do not object to it at all—the mothers will be in a very poor position indeed, having the same pay to spread over husband, furniture, carpets, curtains, clothing for all the children, and food.
I therefore welcome this Bill and the discussion, but I hope that our thoughts will turn to inducing the Chancellor not only to accept the principle of equal pay, but also to raising the status of motherhood and raising the family allowances, so that the mothers of this country may enjoy the status of the mothers of France. I hope that the House will take these other measures at the same time, otherwise we shall have a very distinct social difference between the women of our country, with the mothers well at the back of the queue in the standard of living.
So far as it goes this is a good Bill, and if I criticise I hope it will be understood that I am not making my criticism in a party spirit at all. I notice that when the National Insurance Advisory Committee was set up its terms of reference stated:To advise what changes, if any, should foe made in those provisions so as to secure that, without adding to the present liability of the National Insurance Fund in respect of maternity, the money shall be used to the best advantage.So the responsibility falls on both sides of this House for the fact that the mothers were not to get any extra money, that the Committee's terms of reference strictly limited tie Committee to operating within the present liability of the National 1996 Insurance Fund. Considering that, and considering the Report, I have no criticism with what hon. and right hon. Gentlemen have done. I do not know whether what they have given is more or less than would have been given had we been in power. I hope, therefore, that my remarks will not be misinterpreted.
While, apparently, £12 is a fairly good sum, because of the decreased value of the £ it compares with the £8 of 1946, I should think, at only about evens, so I really do not think the mothers are getting an increase. The right hon. Gentleman practically admitted that when he said he had added 25 per cent. in conjunction with the other allowances given in the last Budget. Those were given to help meet the increase in the cost of living, so I really do not think that our mothers are getting anything extra at all. unless the cost of living falls.
As to the £3, I do not know if this is an inducement to a mother to have her child at home. I had six children, all at home. I should have required an inducement to have gone into an institution, either a private nursing home or any other, because the coming of a child into our home was a great joy. Everyone looked forward to it, and when it did come poor father did not have to stand awaiting admission to see his little one. We all have great sympathy with the fathers in what they go through at such a time. Some day we may get a Fathers Bill, and I hope it will be accompanied by adequate analgesia that fathers also ought to get. In the events at home father could celebrate the occasion and bring all his friends, perhaps not upstairs but certainly downstairs. The event was celebrated night after night.
I was fortified by the regius professor of midwifery who, I could say, was the father of the Maternity Services (Scotland) Act, 1937, who said that domiciliary confinement was preferable to that at an institution provided all the conditions were there, provided it was accompanied by the necessary precautions accompanying the conduct of any surgical operation, although I have always tried to impress on my daughters and their friends that childbirth is a very natural thing indeed. Those who go into institutions separate themselves. There are those who can afford a private nursing home. There are those who can pay a little for a paying bed.
1997 Then there are those who come from our slums, who, I am sorry to say, are put out at the eighth day. There are those who tell us that the mother who has her baby in the hospital is not put to any home expenses, but if she goes home at the eighth day she certainly needs help at home. She is in no condition to bath the baby morning and night and do the washing up, and she still needs attention herself. Therefore, I think the £3 is not sufficient.
I was very interested in an address given by Dr. Dugald Baird, Regius Professor of Midwifery in the University of Aberdeen, at the annual conference in London last year on Maternity and Child Welfare. I think that Professor Baird posed some problems which we in this House ought to face. Will this Bill, as it stands, reduce the infant mortality rate, and the neo-natal mortality rate? He told the conference that in 1939 the figure was 37 per 1,000 live births and that in 1948 it had fallen to 25. I am sure that the Government Front Bench want to see that figure fall still further; I am sure that they will be distressed to know that it varies with the social groups.
In 1947, it was 18 in Greater London, 20 in the rest of South-East England and 26 in the North of England. Glasgow had the worst neo-natal mortality rate of 28 per 1,000. When we divide the population into social groups—from class 1 to class 5—we find that in social class 1 the neo-natal mortality rate is 18.9, and it rises steadily until we reach class 5, when the rate is 30.1 per 1,000 births.
Professor Baird draws attention to national statistics. A low neo-natal mortality rate is, he says, found in Holland, in South-East England, where I understand there are the wealthiest social classes living, and social class 1 throughout Britain; and he says that the characteristic which is common to all three groups is a high standard of living. He states:It would appear that under these conditions relatively few debilitated and premature babies are born. Hence the low death rate.As I said, I am sure that the right hon. Gentleman and his hon. Friends are anxious to see that mortality rate still further reduced. I know that I am not striking a stone wall. I think that the Government ought to have another look at the dependants' allowances and also at 1998 the allowance to the mother to induce her to leave work earlier. At present, she gets 36s. It is proposed to give her 32s. 6d. a week, but over a longer period —18 weeks instead of 11. If one considers the fall in the value of money, and the high cost of living, I do not think that that will help her to leave as early as she should.
Let us consider the social classes. There is in the House a mother who remained here—and I admired her for it, I thought she was a brick—and took her place on these benches almost up to within a month of her confinement, and she carried it off very well. If we look at another mother, such as my right hon. Friend mentioned, the woman who is a bus conductor, or the woman who cleans, etc., she cannot choose her job, she has to take what job she can get, and she requires more inducement to leave earlier. She needs to leave that kind of work much earlier than other women in sedentary occupations.
I appeal to the Minister about the dependants. So much sympathy goes out to widows, and I think we have still a lot more to do for widows in our National Insurance scheme. One always hears of the widow, especially the poor widow, and while I do not for a moment wish to detract from the sympathy due to her I say that there is someone who requires even more sympathy financially. I refer to the woman who has been supporting an invalid husband. I find a great many of them in my constituency. These are the women who have to stay at their work until the last month of pregnancy, and who are supporting a husband who is ill at home, and the family as well. I should like to see that 21s. 6d. raised so that she shall be in the position that her husband would be if he was in work and she were ill at home.
With these remarks, I welcome the Bill. I am sorry that it was not introduced sooner, and I should be glad if there could be second thoughts along the lines which I have indicated.
§ 5.36 p.m.
§ Brigadier O. L. Prior-Palmer (Worthing)
I should like to add my congratulations to the Minister for introducing this excellent Bill, which, I am sure, will have the support of all sides of the House. I am sorry that the right hon. 1999 Lady the Member for Fulham, West (Dr. Summerskill) had to preface her remarks by introducing an element of party politics. I wish she was present. I should have liked her to do one other thing. She said she wished to forestall Conservative candidates from taking credit for this in their election speeches and addresses. I wish she had forestalled Labour candidates in their election addresses at the last Election from claiming credit for the last Labour Government for the introduction of milk-in-schools scheme, which was introduced, I think, in 1936, and also for holidays with pay, which was introduced about the same time.
May I follow the hon. Lady the Member for Coatbridge and Airdrie (Mrs. Mann) in one or two of the things she said? With what she said about sympathy for the husband, I entirely agree. I remember a doctor once saying to a husband who was particularly worried, "My dear sir, don't worry, I haven't lost a husband yet." I agree with the hon. Lady on a serious point—
§ Dr. Stross
I used to say that also, but is the hon. and gallant Member aware that we had a case recently—about six months ago—in which a father died as a result of anxiety?
§ Brigadier Prior-Palmer
I trust that the hon. Gentleman was not in charge of the case.
I should like to follow the hon. Lady the Member for Coatbridge and Airdrie on a serious point—the question of having children in the home. I have had only one experience of a child having been born in hospital, and I swore from that day that I would not agree to it again unless there were exceptional circumstances. I believe, with the hon. Lady, that the right place for women to have their children is in the home.
During the Budget debate last year, I raised the question of allowances for the first child of the marriage. As a result of that I fully realise that the sum involved was so vast as to make it an impracticable proposition to give in respect of the first child of the marriage the same family allowances as those that are given in the case of the second and subsequent children. Therefore, on the occasion of the National Insurance Bill in May last 2000 year, I evolved what I considered to be a fairly ingenious solution of this problem. I put the idea forward to my right hon. Friend at that time, and it was this: I suggested that when the Bill which we are discussing today was introduced there should be, in the form of a maternity grant, the equivalent of a family allowance of 8s. for the first child a week for one year, to be paid in a lump sum. That works out roughly at £20.
I do not wish to recapitulate all the various arguments of which there are many in regard to this plea, except to say that, obviously, the first child is the most expensive from the point of view of buying clothes, the pram and the layout of the layette. With the second child these things are nearly always handed on; therefore, the second child is by no means such an expense in the initial stages.
There is one further point on that. A married couple, before the arrival of their first child, are probably both working, so the woman has a double burden: she has the added expense of the new infant and she has the reduction in her income to compete with as well. So I think that there is a very strong case concerning a large proportion of our population for the encouragement of the first child, and not only the encouragement but to make sure that life is a little easier when this the most happy of all happy events occurs.
I think that it would be a very good thing also to encourage the first child— because once started it is apt to become a habit and we want to see plenty of families in this country. Therefore, I am only making a very short speech on this subject today as I propose to table an Amendment in the Committee stage to give effect to this suggestion, and I am very confident that that Amendment will be accepted because I will quote the words of the Parliamentary Secretary, in winding up the debate last year on the National Insurance Bill, when, referring to my suggestion, he said:I was interested to hear the suggestion made by my hon. and gallant Friend the Member for Worthing that this should be included in some improvements in the system of maternity allowance. I can assure him that we will give consideration to that proposal in due course. … I certainly think it deserves consideration."—[OFFICIAL REPORT, 5th May, 1952; Vol. 500, c. 142.]He has had a year to consider the matter —which is very rapid, I suppose, for a 2001 Government Department—but I look forward with great confidence to his assistance, or that of his Department, in framing the Amendment which I propose to table.
§ 5.43 p.m.
§ Mr. A. Blenkinsop (Newcastle-upon-Tyne, East)
I should like to begin by apologising to the Minister for my inability to hear the speech with which he opened this debate. I want to refer to certain matters particularly in relation to the home confinement grant as it affects some of our health problems and particularly as it affects some of our vital statistics for maternal mortality and neo-natal mortality rates.
I think it very natural that the House should concentrate on this aspect of the Bill, although, of course, as my right hon. Friend the Member for Fulham, West (Dr. Summerskill) said, there are many other matters of very real importance in dealing with the more strictly insurance aspect of the Bill. I want to refer particularly to this aspect of home confinement, because it is a matter upon which many of us have had to give consideration both officially and privately, if I may put it that way.
I think that we would agree that all of us in this House are very happy indeed at the great improvements that have been made over recent years in the maternal and neo-natal mortality rates, and are all desperately anxious that these improvements should continue. Therefore, we are anxious to see what effect, if any, the proposals in this Bill will have upon those figures.
I know that there are many of my hon. Friends, and, may be, many hon. Members on both sides of the House, who are anxious lest these proposals should encourage mothers who should on medical or other grounds go to hospital to have their confinements at home. That is clearly a matter upon which none of us can be at all certain and we shall certainly have to watch the developments following the application of this Measure with great care to see what is happening, and whether there is or not an increasing number of cases of those who, on medical grounds, ought to go to hospital for confinement preferring to stay at home. I hope that will not arise but it is a danger which we have to watch and be very careful about.
2002 I should, in particular, like to know whether, in framing the Estimate for the expense of this Measure, any provision has been made for an increased number of home confinements and whether it is officially expected that there will be an increase or not. I cannot help feeling that we must expect some increase, although it is too early to say just how that will work out.
On the other hand, some of my hon. Friends seem to take the view that ideally every confinement ought to take place in hospital. That is not the view of my hon. Friend the Member for Coatbridge and Airdrie (Mrs. Mann), who adheres to the view—as, on the whole, I do-that, provided all the circumstances are satisfactory—and that is a very big proviso—home confinements could be and, indeed, should be as satisfactory as, if not more satisfactory than, confinements in hospital.
I should like to quote in aid of that point the position that has arisen in New York. There, it is stated that 99 per cent. of the confinements are in hospital and 1 per cent. in the taxi going to hospital. Those figures are probably very nearly accurate. What I found in New York was the great anxiety, particularly among medical men, that the period of time spent in hospital was so short. In many cases it is not a question of the mother leaving hospital after eight days but very often of leaving hospital after three days, and complications were arising which were giving great anxiety to many people in the medical profession in America. This is not only true of New York, but elsewhere in America.
Although that problem is not so acute in this country, it is a problem. When I was at the Ministry of Health we were finding quite a number of hospitals that —because of pressure on accommodation—were encouraging or, at any rate, were allowing mothers to leave hospital certainly under the 10 days which is usually regarded as the desirable period. Indeed, I well remember the circular which was sent out, which is quoted in the Report of the Ministry of Health for the year 1951 and which was sent out towards the end of 1950, relating to guidance to hospital authorities.
It urged that a proper balance ought to be kept between home and hospital 2003 confinements, and that it should be insisted upon that all medical needs should be properly met by hospital confinements and all social needs, too, where home conditions are clearly unsatisfactory, and a hospital should not allow, certainly in normal cases, the mother to leave hospital in under 10 days after the confinement, except in special circumstances where everyone was satisfied that the mother was fully recovered.
I think, therefore, that we may be in some danger if we press for extending the use of hospital facilities for confinements of getting the second best. We may find that, through pressure on hospital facilities, shorter stays in hospital are being accepted as reasonable, and that, in consequence, mothers may be less satisfactorily treated than they would be if they had their confinements at home. That is a matter which we must bear in mind.
There are, however, other matters that we must watch very carefully. Above all, we must see how this operates in bad housing areas, the sort of areas we know so well, where, clearly, the home conditions are not satisfactory for confinement to take place. I would remind hon. Members that the proportion of domiciliary confinements is sometimes higher in these less satisfactory areas than in other areas. Therefore, we must watch very carefully the effect of this new monetary provision in those areas above all others. It must be our anxiety to ensure that there the encouragement should, quite properly, be for hospital confinement rather than for home confinement.
I am not suggesting that in many cities where home conditions may not be satisfactory some first-class domiciliary services have not been built up. We know they have. There is a world of difference between the provisions now available in many cities from what they were some years ago. Some cities now have first-class flying squad units for dealing, for example, with premature births. In my own City of Newcastle-upon-Tyne we are very proud of our very good domiciliary service which has been built up. It is amazing what good work can be done by such a service.
2004 Normally, we must try to ensure that those who are living in difficult housing circumstances are given every opportunity for hospital treatment, or, alternatively, that our domiciliary services, which are patchy at the moment in some areas, though very good in others, are built up to a much higher general level. Unless we do that we should view this provision with caution and anxiety.
The second point concerns the position in the rural areas, where we know that at the moment the proportion of domiciliary confinements is much higher than in the rest of the country. As a general rule the proportion of hospital confinements in the cities is higher than in the rural areas. I believe there is a very great variation as between one area and another as regards hospital confinements, ranging from 30 per cent. in some areas to 70 per cent. in others. The national average at the present time is, I believe, about 63 per cent. Those are the latest figures I have.
It is in the rural areas that the domiciliary services are not all that we would like them to be, and, therefore, it is particularly important that we should devote a great deal of attention to the circumstances in those areas to ensure that the services are built up to meet the existing needs of the large number of mothers who have their children at home. One thing which has become quite clear is that the remaining problem connected with maternity is the mortality rate associated with premature births. Some very interesting surveys have been made officially about this for the Ministry of Health. Therefore, in considering this Bill we must think in terms of the premature child.
The neo-natal mortality rates in connection with premature births are much higher than in any other field of confinement. I think it is true to say that for the country as a whole about 29 per cent. of premature births take place at home and about 68 per cent. in hospital. It seems to be the consensus of opinion that wherever possible these births should take place in hospital rather than at home, but there are obvious reasons why that is difficult. In many cases the premature child is immediately transferred to hospital, but it is generally agreed that that is not nearly so satisfactory as the birth 2005 taking place in hospital, and, indeed, may not be so satisfactory as attention by a proper domiciliary service once the birth has taken place at home. That is another sphere in which we must give special care and attention.
I am a little anxious because I notice in the Estimates for the Ministry of Health—I know how unreliable those Estimates can be—that lesser provision is made for the coming year as against last year for the care of mothers and young children in the local authority health services, and rather less provision for midwifery services. I know that the simple answer to that is that the birthrate is falling. I grant that, but, at the same time, if what I have been saying is correct—and I think it is—that we urgently need to improve the standard of our domiciliary services in many parts of the country, then we must ensure that more and not less money is made available for those services.
The provision per child is the same as before; there is no expansion. Before we leave the Bill we ought to be fully satisfied that before any steps are taken which may encourage mothers to have their children at home instead of going to hospital, the domiciliary services are suitably expanded in areas where they are not satisfactory at the present time.
I appeal to the Ministry of Health, because this is a matter which concerns them very directly, to ensure that a proper balance is maintained between domiciliary and hospital confinements. I do not think we should suggest that all confinements need necessarily take place in hospital, but we should ensure a proper and fair balance between the two, and that where on medical and social grounds it is necessary for confinements to take place in hospital, we should see that the monetary incentives do not prevent their so taking place. Where confinements take place at home, we must also ensure that still higher standards are set for our domiciliary services throughout the country than exist at present.
§ 5.59 p.m.
§ Mr. J. Enoch Powell (Wolverhampton, South-West)
I welcome this Bill for a number of reasons, the first of which will take me over much of the ground that has just been so ably traversed by the hon. Member for Newcastle-upon-Tyne, East 2006 (Mr. Blenkinsop), that is, the relation between this Bill and the hospital service inside the National Health Service. Perhaps the greatest problem facing the Health Service at the present time is how to secure the most effective utilisation of the hospital beds, both maternity and general, which are available.
Any Measure which tends to take outside the hospital service cases which can be dealt with at least as effectively in the home is a contribution to the efficiency of the Health Service itself. The extra grant of £3 for home confinement which is provided in this Bill works in that direction by removing a financial obstacle to domiciliary confinements; for that, I believe, is the correct way in which to describe the effect of the £3 grant.
I agree with much that the hon. Member for Newcastle-upon-Tyne, East said, and I was more in sympathy with his approach to this problem than I was with that of the right hon. Lady the Member for Fulham, West (Dr. Summerskill) in regard to the necessity for ensuring that the type of case and the type of circumstances in which confinements take place at home are the right ones, because this is essentially a matter which the circumstances of each case and of each home must decide.
The question can be very simply put. Is the sum of £3, which is provided in this Bill, too much or too little? If it is too much, then the weighting of the scales is unduly in favour of home confinement. If it is too little, it will not have the effect which we all desire. Unless and until experience shows that the sum of £3 is excessive and thus an undue premium upon home confinement, then I think we ought to conclude that its effect will only be to remove the existing financial barrier against home confinement in cases where home confinement would be appropriate.
The House should not forget that there is a very strong body of professional opinion which believes that the present proportion of hospital confinements, is, upon the whole, too high. The Royal College of Nursing made representations on this subject about two years ago to the Ministry of Health, and I should like to quote from their letter to the Ministry, because it deals with a number of points 2007 which have been raised in this debate. It says:This country has a record of successful domiciliary midwifery, and mothers delivered at home are visited and helped by the midwife for 14 days, whereas those delivered in hospital are frequently discharged five to eight days after delivery.That is a point which has already been made in the debate, and I think it was the hon. Member for Newcastle-upon-Tyne, East who referred to the anxiety of hospitals to get rid of maternity cases as one of the possible factors in favour of domiciliary confinement in suitable circumstances. This letter also states:While there is such an acute shortage of hospital beds, persons suffering from tuberculosis, and the aged sick, should have prior claim to hospital care. Many maternity wards in general hospitals are not staffed entirely by midwives, and State registered nurses, nursing midwifery cases, should be released for general nursing.So the Royal College of Nursing recommended to the Ministry of Health that steps should be taken to promote domiciliary confinement in suitable cases.
Again, the Association of Hospital Management Committees, two years ago, wrote to the Minister of Health:This demand for hospital maternity beds is bolstered up by the fact that there is a financial incentive for mothers to have their babies in hospital. The Association therefore recommends that some financial inducement should be given to mothers who have their babies at home.It is, of course, a matter of striking a balance. There must be no financial weight in either scale. The decision must be taken on the grounds of the case and of the circumstances. I do not think that anyone in this debate has sought to argue that the sum of £3 provided by the Bill is excessive, or is likely to place undue emphasis upon domiciliary confinements.
Another feature of the Bill which I welcome is its restoration to the maternity allowance of the full insurance principle. Hon. Members, certainly on this side of the House, and I think most hon. Members generally, attach very great value to the insurance principle in our national insurance scheme. Of course, no system of national insurance can be literally and actuarially an insurance scheme in the sense that a private insurance scheme is. Nevertheless, for those participating it is 2008 important that contributions and benefits should be kept in a definite and evident relationship, and that the boundary line between insurance benefits which are earned by contributions and assistance benefits which are the ultimate succour of the community should be as plainly drawn as possible.
There was an infraction of the insurance principle in the scheme of maternity allowances as it stands at present, in that the maternity allowance could be earned by a working woman who had deliberately decided not to pay the contributions, and that in spite of the fact that the actuarial basis of the maternity allowance was the contributions paid by employed and self-employed women. That discrepancy is removed by this Bill, which makes the maternity allowances dependent upon the fulfilment of contribution conditions.
A further approximation to the full insurance principle is also contained in the new graduated scales of maternity allowances, whereby, instead of the allowances being wholly lost if the contribution conditions are not 100 per cent. fulfilled, a graduated allowance, proportionate to the contributions which have, in fact, been paid, can be obtained by the expectant mother. Both those alterations bring the maternity allowance well and truly within the scope of the insurance scheme.
It seems to me that the right hon. Lady the Member for Fulham, West was under a misapprehension when she referred, in this connection, to paragraph 16 of the Report of the National Insurance Advisory Committee. She drew attention to the statement in that Report thatthe statutory authorities who decide claims to benefit do not accept a certificate of normal pregnancy as evidence of incapacity except for the six weeks before the expected confinement.She went on to argue that my right hon. Friend's action in substituting 50 for 45 contributions as the number required to qualify for the full maternity allowance would somehow prejudice the position of expectant women in employment.
This Bill, however, in no way alters the decision made by the statutory authorities deciding claims. It will still be the case that a pregnant woman, who, merely by reason of her pregnancy, ceases to be in employment or stays away from work earlier than 11 weeks before the 2009 expected week of confinement, will not qualify for sickness benefit on that account. That is just as much the case if the figure of 45 contributions had been accepted as it now is with the figure of 50 contributions. There is no difference at all, and there is no relevance in the sixteenth paragraph of this Report in relation to the choice between 45 or 50 contributions as the qualification for maternity allowance.
Finally, I come to the amount of the various benefits provided or increased by the Bill. I welcome the implementation once again, as in the National Insurance Act of last year, of the principle of uniform benefits. If the insurance scheme is designed to be a safeguard against the loss of earnings from whatsoever cause, whether it be maternity or unemployment or sickness or retirement, it is quite illogical that different scales of benefit should be provided to meet this same contingency. It was only right, therefore, that the expectant mother, who is now to be enabled and induced to give up work for 11 weeks before the expected date of her confinement, should have her loss of earnings replaced by the same sum as that to which she would have been entitled in the event of sickness or unemployment.
Under the scales introduced last year that is 32s. 6d. a week. In what I thought was a rather ungenerous speech the right hon. Lady said that the increases—which include, I assume, that increased figure of 32s. 6d. which was fixed last year and to which the maternity allowance is being assimilated by this Bill—related to a rise in the cost of living which had taken place prior to the middle of 1952. She said that they do nothing to meet subsequent rises and the present cost of living.
§ Dr. Summerskill
If the hon. Gentleman is quoting me, he is entirely wrong. I did not mention prior to 1952. I mentioned the cost of living and said that it anticipated a future increase.
§ Mr. Powell
Then I understand the criticism to have been that these benefits are related to the present cost of living and do not anticipate a prospective increase in it?
§ Mr. Powell
I am much obliged. That illustrates the difference between the situation of the present Government and their predecessors.
Of course, the previous Government, when they brought in a new scale, had to assume that their financial policy would produce its natural effects, and that they should allow for a prospective further increase in the cost of living. The present Government are under no such obligation. If my right hon. Friend can show, as he can, that these benefits are related to the existing cost of living, then he is entitled to point to the stability of the cost-of-living index over the last nine months as evidence that they will also meet the needs of those they are designed to help in the coming months and years.
I have gone to some trouble to be quite sure that the benefits recommended in the Report of 15 months ago, and those assimilated to the benefits of the National Insurance Act, 1952, are fully in line with movements of prices. I have tested a range of prices and articles likely to be bought with the maternity grant. The result is that, on balance, in the last 18 months the cost of a confinement has certainly not increased and may have fallen slightly. Articles such as prams, which have increased in cost, have been offset by others which have fallen in cost.
For example, there has been a decrease of 5s. or 6s. a dozen in the cost of babies' nappies and a decrease of an average of £1 in the cost of a cot. Therefore, as my right hon. Friend has related these benefits to the cost of living as it stood in the middle of 1952, and as the cost-of-living index has not altered appreciably since that date, and as the articles involved have only undergone alterations which, upon the whole, are self-balancing, he can claim that these benefits fully meet the requirements of today.
I conclude, then, by welcoming the Bill and wishing it a successful passage to the Statute Book.
§ 6.15 p.m.
§ Dr. Barnett Stross (Stoke-on-Trent, Central)
I have no prejudices against this Bill because it was conceived by one side of the House and delivered by the other; nor, indeed, because the conception was, as it were, that of one Minister, who is truly feminine, and the 2011 child was shyly delivered by a man midwife today. The fact is that it has now been safely delivered after a long gestation. Again, that does not seem to matter. Even elephants have to wait 15 months before they are born and we have saved a month, because it is 14 months—
§ Dr. Stross
Then we have done better than a mother elephant and I am glad to be corrected.
The hon. Member for Wolverhampton, South-West (Mr. Powell) made, in part, a thoughtful speech until he came to the defence of his own party. I agreed with him when he said that the £3 we have been discussing is, we hope, exactly the right figure; if it is not, we hope it will be altered. We do not want it offered as a bribe to make a woman who should go to hospital stay at home. On the other hand, we do not want it to be so little that it has no influence.
When I look at the figures I find that as between £27 8s. and £38 5s. for a woman who is doing paid work, there is a real advance which must have caught up any rise we have had in the cost of living these last few years. Again, the figure of £41 5s. for the fully insured woman who is confined at home is a real help even for the first child. The fact that the Minister told us in his opening speech, and later in his interventions, that a woman who may be ill from the third month can still be considered to be entitled to full benefit if she has the necessary certificates—and I am sure in such cases she would get them—gives me a good deal of reassurance.
My past experience, naturally, was concerned with meeting many cases of that type, as was the experience of the former Minister, my right hon. Friend the Member for Fulham, West (Dr. Summerskill). She, however, made statements with which I was not entirely in agreement. Sometimes I did not agree with the emphasis probably because, being a woman midwife, she thinks she knows all about it.
§ Dr. Stross
I am sure that my right hon. Friend will not mind my putting this to her: that until men midwives came into this field of endeavour women had trundled their confinement stools round from house to house for centuries, or for thousands of years, and there had been no advance. Not until Ambrose Paré was used by Louis XV to assist in the birth of a child, either of his mistress or wife, did we make a step forward in the general technique of midwifery. It was men who invented forceps and it is men who are giving them up. The men nutritionists have shown the way in which women can be protected during pregnancy and thus be easily delivered.
§ Dr. Stross
Of course. I know that my right hon. Friend agrees with me that a suitable or good obstetric service is not the prime factor in having women safely delivered, getting healthy children, and in saving the lives of mothers and their children. It is seeing to it that they are well nourished throughout pregnancy and before it. Quoting from memory, I remember the Rhondda experiment in the early '30s. We were disturbed because the maternal mortality rate in that tragic and depressed area was so high. The Government at that time did their best by making it possible to have the best medical care for every pregnant woman, but the results were no better. Year after year it was tried and still there was no improvement. Then, someone thought that when these women were pregnant, they might be offered a substantial meal once a day, because it was discovered that they could not afford it. The results were at once remarkable.
Then, in Sheffield, Melanby and his wife did some work in the out-patient department of one of the great hospitals, dividing the expectant mothers into two groups and watching them in the last month or two of their pregnancy. They gave to one group a little extra nutrition by way of milk, calcium and the vitamins A and D that are needed, and left the other group alone. The difference was that whereas in the untreated group mothers died at the rate of 6 per 10,000 births, in those who were treated in this way, at a cost of a few shillings a head, the figure fell to 1.1 per 10,000 births, 2013 which was a spectacular improvement. That is why we give the necessary social service to all expectant women who ask for it, and we give it to them free of charge.
I fully appreciate the importance of nutrition and the rest, but why was it that Queen Anne lost all her 14 children at birth?
§ Dr. Stross
To reply to that might be extremely delicate, because I should have to go into what happened also to the Tudors and why there were so many miscarriages, premature births and early deaths. I do not, however, intend at this stage to discuss pathology or infectious blood conditions.
§ Dr. Stross
I have only stressed the nutritional aspect because I think it is in the forefront, Obviously, a well nourished people will face any simple physiological feature like pregnancy and delivery more easily and safely than people who are not well fed. I agree entirely with my right hon. Friend the Member for Fulham, West that people must also be given the very best possible obstetric service, but it takes second place. If we have to choose between the one and the other and we could not afford to have both, there should be no mistake about which we choose first if we want healthy women and children.
The question of having confinements in the home or in hospital is a vexed one and we cannot be excessively dogmatic about it with any certainty. If we were, I am sure we would be wrong. Experience, however, shows that the most anxious time is the birth of the first child. Therefore, the tendency for thoughtful people is to say that, obviously, a greater percentage of first babies ought to be born in hospital than of succeeding babies. If the mother can prove, by having her first baby, that she can normally and safely deliver herself, there is nothing to prevent subsequent normal delivery.
My view is that the woman who has never yet delivered herself and is pregnant should, as it were, have a right to 2014 say, "I am nervous and frightened, in spite of all the reassurances you have given me. I would like to ask to be delivered in hospital this first time." The second delivery is, of course, an entirely different matter. Assuming that there has been no pathological condition, such as a contracted pelvis, making delivery very difficult, or almost impossible or even dangerous to mother and child, there are only certain other minor or secondary contingencies. I should put them as "secondary" because they are not really minor.
For example, we must demand proper pre-natal care. Even if a woman has had one child or two, or even 10, easily and safely, that does not mean that the third or fourth or the eleventh may not show complications and that she does not need careful supervision during the whole time, and certainly in the last month or two. If, however, no complication is noted while she is carrying, there should be no undue difficulty provided that a suitable room is available in a reasonably suitable house. I use the adjective "reasonable" because homes differ tremendously.
A home that does not have a water supply is not suitable. If hot water is not easily available at any rate in a town, I do not consider it a suitable home. In rural areas, where there may not be hot water except that which it boiled on the kitchen stove or open fire, it is a different matter. I have managed often enough, of course, without such facilities. I certainly did not have hot water laid on when I was delivering women in barges on canals, which I did quite often.
The main requirements which are asked for are a room for the woman which she can have for herself for the 10 days or fortnight, hot water during the accouchement, proper ante-natal care, a really skilled midwife whom, the mother has got to know and who has watched her, and a medical man with real experience on call in case he is wanted but who should, if possible, be kept out of sight and never used. I am sure that my right hon. Friend, who has had so much experience, will agree that doctors are not wanted too soon.
§ Dr. Stross
That does not mean that I cannot have my right hon. Friend agreeing with me.
In the old days, of course, those of us who had experience were anxious to keep women at home because of the risk of infection in the hospitals. I do not know whether hon. Members know that, but the risk of infection in the hospitals was always greater than in the home. The reason is a simple one. My hon. Friend the Member for Coatbridge and Airdrie (Mrs. Mann) knows this, having had so many sons who are doctors.
What used to happen, of course, was that women, however dirty and impoverished their homes, were used, as it were, to the flora and fauna of the bacteria growing in their own environment, and therefore they were not infected. When they were scrubbed and taken away to hospital, where everything was clean and marvellous, if one particular germ to which they were not accustomed came their way they would be infected, with the result that there were epidemics and deaths in the days before there were anti-biotics. For these reasons, people like myself, partly through teaching and partly from experience, knew that by and large it was safer to keep people at home. Now, of course, the situation is different. With the presence of new anti-biotics, this question of infection no longer matters, because we can control it at any level and in any place. That is not to say that we want it ever to occur, but it does not have too great an importance today.
There is another reason why the woman may well feel better if she has her first baby at home—assuming that the home is suitable and that all the other things which I have been describing are available for her: that is, the psychological reason. After all, the wife who is an expectant mother is the queen of her home. It is her nest. She builds it together, with the help of her husband, for the children who are to come.
I am sure that everybody in the House knows what this entails. There are the ceremonial visits after the three days are over, the congratulations of everybody round about, and the tremendous fuss that is made, none of which can happen in hospital. Moreover, it is a good thing for a man to know what his woman has 2016 gone through in delivering herself of her child; it helps him to know. If there is a little wetting of the baby's head by way of celebration, that, too, is not a bad thing either. At any rate, in my experience, the delivery of a child in its own home was a time of rejoicing and of congratulation; the mother really took her place as the most important person imaginable in the home—and so, indeed, she is.
I am glad to see that this period is extended to 18 weeks instead of the original 11 or 12 weeks. I am not so concerned with the fact that we are now only offering 32s. 6d. a week as I am concerned with the fact that if we give 11 weeks' freedom for delivery we shall be acting absolutely correctly and properly. Even then I agree with what has been said from this side of the House by more than one hon. Member, that in certain occupations even 11 weeks is not enough. I know the Minister appreciates that point and will give it consideration. It might be possible to consider exceptions according to occupation. I do not know, but that is a Committee point and I will leave it at this stage.
My hon. Friend the Member for Coat-bridge and Airdrie spoke of civilisation being judged by infantile mortality. It may have been mentioned by another hon. Member, but my hon. Friend quoted some figures about it. There was one thing which she did not quote, but which I think is accurate; that is that at Southgate the infantile mortality rate is 15. That is very magnificent, as they have a population of 70,000 to 80,000. We should never be content until we have practically no neo-natal mortality at all. Neo-natal mortality could be reduced enormously, but we have to work on the generation before. We have to bring up a generation so fit and well that there are no bony or skeletal abnormalities. We have to make certain that they have proper care and that there is a proper obstetric midwifery service always available.
I have every hope and expectation in welcoming this Bill that it will be looked upon only as a beginning, or, if hon. Members like, the second stage of something which should reach far into the distance when we shall be horrified and surprised if ever a child is born prematurely or dead, or if any woman takes hurt when she is confined.
§ 6.32 p.m.
§ Mrs. Alice Cullen (Glasgow, Gorbals)
Like all other hon. Members, I welcome the Bill, but I have one or two comments to make about it. I am a great believer in hospital confinements, and it is my experience of the constituency which I represent that makes me feel in that way. I have a feeling and fear that this confinement grant will encourage women to stay at home when they have not the facilities, because just now, with the high cost of living and other costs, they will be encouraged to stay at home in order to get a few pounds more.
If some hon. Members knew the conditions which prevail in certain constituencies amongst ordinary working-class people they would feel just as I do. Often a woman living in a single apartment house is not having her first confinement, her second, nor her third, but it may be the fifth or the sixth. She has not the bedclothes she would like to have when she knows that the doctor and the nurse are coming in, and that worries her very much. She has three or four other children running about the house. In three days' time she is sitting up in bed having children handed into the bed for washing and getting ready for school. All these conditions prevail in slum areas. I am prepared to say that in the constituency I represent at this moment there is not one home in 100 in which there should be a confinement.
I have lived among these people, and I want to relate one or two incidents. I used to live in the ward I represent among ordinary working-class people who had all these worries about confinements because they had not got facilities. We had a prominent doctor in Glasgow who told us that sometimes when he went into a home half the family had to be removed before he could start his job in these poky little places. On many occasions in my home I have had a pair of sheets, blankets, a top bed mat, a small white basin, a white towel and a cake of soap to carry to a home where I knew those things were not available and the woman was worried because she did not have those things when the doctor was coming. They were kept in my home for years in order to help people in such districts.
I do not want to take the time of the House because I know others want to speak, but I want to tell hon. Members 2018 of the fear I have that these grants will encourage people to stay at home for confinements when they have not facilities. I am a believer in hospital confinements, but there are lots of improvements which could be made there. I do not think it right to send the mother out of the hospital eight days after confinement. She ought to have 10 or 14 days there. My mother used to keep us in bed and would not allow us out of bed until after the tenth day because she said there was a danger, if everything were not back in its place by that time. Lots of people cannot even have a taxi to take them home. I know of a hospital where the ambulance is seen bringing them to the gate. Then the man and the mother lead his wife down and take her home, but she ought to be in hospital for another couple of days until she is able to come back and look after the home.
Hon. Members have stressed the point that the woman ought to have a room to herself, and I agree. She ought to have a bathroom in the house, but how many bathrooms are there in the Gorbals? Not one of the slums is being cleared away; there are no signs of the slums being cleared away. It will be years before home confinements will be advisable in the division I represent. I hope that the Minister will say that when people want to be confined at home and they have not the facilities they must go to hospital. I very much fear that this grant will do the very thing we do not want it to do—encourage people, because of the extra few pounds which they need, to stay at home when they ought to go to hospital.
§ 6.38 p.m.
§ Mr. Richard Fort (Clitheroe)
I am pleased to follow the hon. Lady the Member for Gorbals (Mrs. Cullen) because, like here, I have noticed the tendency, with the pressure on the maternity sections of hospitals at present, to allow women to leave hospitals very much earlier than I should like to see my wife up and about after a confinement. In my constituency, where we have a leading maternity hospital in the area, the pressure is so great that mothers are having to go out after a week. I think it is not only one's experience in the matter but the feeling of doctors that that is inadvisable.
2019 I am bound to say, however, that I noticed what seems to be a strongly marked difference of opinion between those who have spoken on the other side of the House. The hon. Member for Gorbals and the right hon. Lady the Member for Fulham, West (Dr. Summerskill) seemed to be so anxious to see women confined in hospital that they left some doubt in my mind whether they even welcome the extra £3 which will be given in view of the fact that they consider there is a real danger that it might induce women to be confined at home.
§ Dr. Summerskill
I listened to my hon. Friend, and I thought that she and I were in complete agreement.
§ Mr. Fort
I am sorry if I have not made myself clear. I think that the right hon. Lady and the hon. Lady are in complete agreement. They seemed to imply that they were rather fearful about giving the extra grant in case it induced more women to have their children at home instead of having them in the maternity wards of hospitals.
They have left in my mind the uncertainty whether within themselves, whatever they may say on political platforms on this subject—and I think the right hon. Lady will say plenty on political platforms—they are very doubtful whether the grant will have the effect that they consider to be medically undesirable, namely, that of inducing women to have confinements at home instead of in hospitals. I think that before this debate finishes we might hear from other speakers on the other side of the House who will make their party's viewpoint on this matter rather clearer than it is to me at the moment.
Another Member on the other side of the House with medical qualifications seemed to me to strike the balance, which as a layman I think is desirable in this matter. There has been a great increase in hospital confinements. The numbers have risen from just over 390,000 in 1949 to more than 440,000 in 1951. I should like to know—I do not know whether the figures are available—how much of that increase has been accounted for by first babies being delivered in hospitals and how much of the increase has been due to babies after the first. In my experience—and I have quite a large family— 2020 it was the first baby which it was desirable should be born in hospital. Our second and later babies were born in hospital, but could just as well have been delivered at home.
In view of the fact that we have this pressure on the maternity wards, one would hope to see, as a result of the new arrangements, an encouragement towards home confinement for those who can reasonably have their children at home because they know that they will have an easy confinement and because their home conditions are not the horrible ones which undoubtedly exist in the Gorbals and other parts of our big cities. One would hope that those who can have their children at home will feel that they will now receive some additional compensation for the rise in costs and the undoubted expense of having a home confinement. As a result beds will be released for those women who undoubtedly ought to have their children in hospital, particularly those having first children. I hope that will be one of the effects of this new grant.
We should have a clear statement from the Opposition whether they are, as a party, in favour of the new grant or whether they consider that by and large the new grant is not particularly welcomed by them in view of the effect which it may have of keeping at home women who ought to be in hospital for the delivery of their children.
§ Mrs. Cullen
I was trying to make hon. Members understand that in the constituency that I represent, there is no possibility of women having home confinements because there is not one home in 100 fit to have home confinements in.
§ Mrs. Cullen
No, I am not against it, I am in favour of it. I was pointing out, however, that in my division there is pure slumdom and nothing has been done for years for those people living in slums. I have referred to some of the conditions. Would any Member opposite like to see his wife confined in a single-apartment house, with five or six children running around? I will give another example. If I went down a street at 2021 night, and saw a man standing in the close with two children, and with nowhere to go, I would know that the doctor had sent him out while his wife was being confined.
§ Mr. Fort
I hope that the effect of this £3 will not be to encourage home confinements under those conditions, but that it will encourage those reasonably able to have their children at home to do so—that those who can balance the considerations in their mind will be persuaded not to occupy hospital beds and so enable those who live under the conditions which the hon. Lady has described, those who are to have first babies and those who know that they will have difficult confinements, to have the beds which may be released as the result of this new grant.
Because I believe that the new grant will achieve a rather better balance than we are getting at present, with the tremendous pressure there is on the maternity hospitals throughout the country, I give the Bill a warm welcome on Second Reading. At the same time, I say that there are Committee points which may well improve the Bill further.
§ 6.47 p.m.
§ Mr. David J. Pryde (Midlothian and Peebles)
As one whose following in 1912 was an official of a very powerful and influential friendly society, it fell to my lot to operate the first Insurance Act, and, in doing so, I was compelled to go into many working-class homes. According to my reading of this Bill, we are dealing very largely with the women of the working class. I do not intend to be controversial tonight.
I welcome this Measure, and divide the honours between my right hon. Friend the Member for Fulham, West (Dr. Summerskill) and the present Minister. They have both done a very good job, and I witnessed ample appreciation of that recently at a meeting in my constituency in the good old ducal town of Dalkeith, when it was reported that the right hon. Member for Fulham, West had a certain amount of justification for saying that she had done something for our womenfolk.
I deprecate the introduction by two Members opposite of party politics. The hon. and gallant Member for Worthing 2022 (Brigadier Prior-Palmer) introduced party politics in criticism of my hon. Friend the Member for Coatbridge and Airdrie (Mrs. Mann), a lady who has ample opportunity to deal with the question of maternity. She is the last person whom the hon. and gallant Gentleman should have criticised.
The hon. and gallant Member denied the fact that in the year 1906 that small and gallant band of Labour Members got the then Liberal majority to put into operation the first school milk Bill. He is credited with having said that the Conservatives had a plan for unemployment but he did not know whether it would work or not. I can assure the hon. and gallant Member tonight that it has worked very effectively in my constituency. For over a year at least 10 mills there have been working on short time, so the hon. and gallant Member's unemployment plan is working very well.
§ Brigadier Prior-Palmer
I did not mention the word "unemployment." I was not referring to the hon. Lady the Member for Coatbridge and Airdrie, but to the right hon. Lady the Member for Fulham, West. Now that she is here I should like to repeat what I said. She said that she wished to forestall any Conservative candidate from taking credit at the next Election for this Bill. I ask her to remember that certain Labour candidates in their last election addresses had claimed that the last Labour Government had introduced meals in schools and holidays with pay, both of which were introduced before the war.
§ Mr. Pryde
I have never heard of Labour Members claiming that we introduced holidays with pay. It is true that before the war 8 million people had holidays with pay and we considerably increased the number.
I heard the hon. Member for Wolver-hampton, South-West (Mr. Powell) tell the House that he also welcomed the Measure. I was glad about that because when I heard his preceding remarks I thought, from the vitriol he introduced, that he was opposed to the Bill. The Measure is not one to go into ecstasies over. It is, however, a step in the right direction. When hon. Members opposite talk of what the Labour majority Government did towards insurance, let me remind them that that Government was 2023 bringing this country along the road to recovery from behind scratch. There was nothing in the kitty. Therefore, our opportunity to do much about social legislation was very small. But we did all we could. We laid the groundwork for this Bill.
The sum of £2½ million is not a great deal to give, especially in connection with the most hazardous of all occupations— motherhood. While mining is certainly the most hazardous of industrial occupations, procreation is of the utmost importance to the nation. The million lives we lost in the First World War have not yet been replaced. Those who study statistics know that by the year 1970 the problem of old age pensioners will be a most potent question. I trust that the Minister will not weary of well doing but will take the advice of my hon. Friend the Member for Gorbals (Mrs. Cullen) and my hon. Friend the Member for Coat-bridge and Airdrie.
When I see this inducement in the Bill for women to give birth to children in their homes, I compare Scotland with England from the point of view of housing. I say to myself that whoever framed the Measure framed it from an English outlook on housing. It is freely admitted that the English housing position is not nearly as acute as the position in Scotland in such places as the Gorbals. Not many months ago I was in Glasgow when the newspaper boys came along shouting, "Wash house collapses—boy killed." They do not collapse so easily in Edinburgh, although Edinburgh is an older town. There the housing is of a much more solid type. Nevertheless, we have our Gorbals in Edinburgh—in the Royal Mile, for instance.
One of the Edinburgh Members told me today of a case in the Royal Mile of a bus driver with a wife suffering from consumption. They have three children in various hospitals in Edinburgh all suffering from consumption, and they live at the top of five flights of stairs. Would that be a house of which the Minister would approve for use for maternity purposes? For many years I was senior baillie in Bonnyrigg, a small burgh in Midlothian. That small burgh was compelled in 1929 to absorb the neighbouring burgh of Lasswade under the 1929 Act. In the neighbouring burgh there 2024 was no purification scheme and no adequate water supply. The whole place was a slum.
I was a member of the allocation committee. That was one of the most unpopular jobs in the council. Probably that is why I, the only Labour man on the council, got the job. But one learns. Sometimes it is a painful process. The allocation committee consisted of the then provost, the retired district nurse and myself. Previously it used to be said that in that burgh the houses were allocated in the coachmaker's shop. I altered that.
I convinced the committee—the committee, not the council—that houses should be allocated on need. "Well, Mr. Pryde," they said, "explain to us and define need." I replied, "The expectant mother has a need. She should have a chance for her life, the child should have a chance for its life, the doctor should have a chance to perform his function and the nurse should have a chance to do her work." Naturally, nine times out of 10 I won. because the old nurse took sides with me. She said, "Certainly, Mr. Pryde, that is correct."
The Minister should not be afraid to compete for money. We have witnessed in this House recently what some regard as the assassination of the free Health Service. I want the Minister to tell the Chancellor of the Exchequer that in Scotland we require maternity hospitals. In the City of Edinburgh the Simpson Maternity Hospital is overworked and our womenfolk are not getting that length of time in hospital when bearing a first child that they should get.
Also, we have in the County of Midlothian a new town in course of erection, without the assistance of the Government, and there we require maternity services. Within a few miles of Dalkeith 40,000 people are being congregated, and we are totally dependent upon the City of Edinburgh for services. I want the Minister to be courageous. I say in all sincerity that he has done a good job up to now. I want him to make it clear to the Cabinet that we in Scotland will not stand for just anything: we intend to claim our birthright. We claim that a good house is not a luxury. A good modern hygienic house is the right of every Scotsman and Scotswoman.
§ Mr. Pryde
The problem is six times more difficult in Scotland.
I want now to turn to the benefits provided under the Bill. A payment of 32s. 6d. for a male dependent is not sufficient today to relieve the worry of the woman who is about to take a chance with her life. It is based upon the old parish council conception, upon the old national assistance basis and upon the idea of sickness benefit. An hon. Member opposite said that we were compensating the women in that they would lose or gain to the extent of sickness benefit. I suggest that the Minister should look at the matter from the point of view of what is required in the household.
When the man is ill it is true to say that the cost of living for the household goes up considerably, especially if the house is not of a modern type. The woman has to go without many items to which she is entitled when passing through this phase of her life and trying to bring the man back to health. I notice much elasticity in the Bill, and I am glad of it, because it will leave room for the Minister, in succeeding stages, to bring it up still further to the standard which this House will welcome and pass without the slightest criticism.
§ 7.0 p.m.
§ Mrs. Eveline Hill (Manchester, Wythenshawe)
I welcome this Bill, as I am sure the women of this country will do. I am also very glad that the Government have had the time and the courage to bring it before the House now, and I hope it will pass through all its stages as quickly as possible.
It is quite true that there is a very large number of women who just cannot get into hospital, and to these women I am sure the extra benefits which are to be paid will be a very great help indeed. I very much agree with the hon. Lady the Member for Gorbals (Mrs. Cullen) that it would be very much better if women who have to go into hospital could stay a little longer. I should like to have all the confinements in hospital, but the staff is not there for the purpose, and if some people stay there longer, others will not be able to get in at all.
2026 It is of the utmost value that women should have the opportunity of going into hospital for their first babies, but, on the other hand, there are many women who very successfully have their first babies at home. We must remember that conditions are very different in these days from those of a number of years ago, and that a very large number of welfare schemes, which have come into operation very often as a result of Conservative Governments or Governments that were predominantly Conservative, have considerably helped women to look forward to their confinements with a very much greater degree of confidence than, shall we say, 50 years ago.
However, those women who at present are unable to go into hospital, simply because there is not the space for them. are now going to appreciate the extra benefit which is offered in this Bill, and, indeed, I think they have a right to some extra benefit if they are not going into hospital. They are involved in additional costs, and it is only fair that they should have additional help in order to bear those costs.
It is a very tragic thing that a woman who ought to go into hospital should be unable to do so, and, unfortunately, there have been some of these cases, because the hospitals have been full. It may have been the case that, if some of those women who were in hospital had had the opportunity of a little extra money to help them to have their babies at home, the lives of other mothers, and occasionally of babies as well, could have been saved.
I welcome the Bill, and I have very much sympathy with the comments made by the hon. Member for Stoke-on-Trent. Central (Dr. Stross), who spoke so feelingly of mothers in their own homes. He described them as queens in their own castles at that particular time, and said how much the nation required women to have their babies in just those circumstances. I hope that the Bill will have a speedy passage, so that the people of this country may derive benefit from it.
§ 7.4 p.m.
§ Mr. Douglas Houghton (Sowerby)
The hon. Lady the Member for Wythenshawe (Mrs. Hill) has referred to a matter which has been the subject of many comments from both sides of the House. The hon. Member for Clitheroe (Mr. Fort) asked, 2027 a short time ago what was the party line on these benches about the proposal for the home confinement grants. There is a perfectly simple answer, and there need be no secret about it. The collective opinion of these benches is in favour of giving these home confinement grants a trial.
At the same time, fears have been expressed by hon. Members on both sides concerning the possible effect of the introduction of this new feature of maternity benefits, and on these benches especially because we on this side of the House are probably closer to working class conditions than hon. Gentlemen opposite. Those fears are that there may be a discouragement in the home confinement grants to having babies in hospital in those cases in which they ought to be born in hospital.
We must bear in mind what the National Insurance Advisory Committee said when proposing these home confinement grants, because here is the clue to the fears expressed on these benches. I wish to quote from Paragraph 22 of the Report of the National Insurance Advisory Committee (Cmd. 8446):It has also been represented to us that the absence of differentiation in benefits, and the consequent financial advantage, encourages women who could well remain at home to apply to be confined in hospital.In Paragraph 23, the Report says:Representations have been made to us that this financial incentive is causing an excessive demand for hospital maternity beds which ought to be devoted primarily to maternity cases likely to need hospital attention (for example, abnormal confinements and cases where housing or domestic conditions make home confinements undesirable) or be transferred to other uses.They conclude, in Paragraph 24:We have been impressed by the arguments set out in the two preceding paragraphs and the unanimity of the opinions expressed.That is where the home confinement grants started, and they started in a desire to discourage mothers from pressing to have their babies in hospital when they might well have them at home. That is the reverse side of the coin which has been the chief currency in the debate so far, and hon. Members on this side of the House—and I am sure we all agree —say that it would be undesirable if this financial inducement were to encourage mothers, for the sake of the money, to have their babies at home when they ought to have them in hospital.
2028 Here, we must be careful not to insult the intelligence and common sense of the working class people of Britain. I was born in a working class household, and my father is still living in the house in which I was born, I think it would be a mistake for any hon. Members, on either side of the House, to assume that there is any lack of responsibility on the part of working class mothers and parents in knowing what is best for their children and what is the best place for their babies to be born.
We must take care not to assume that all working-class people in Britain live in slums, or that all working-class women have ne'er-do-well husbands. There are more worthy husbands than there are ne'er-do-wells among the working classes, and, really, the ne'er-do-wells are not in the working classes at all. The Labour Government, for six years, have been trying to teach them better ways by giving them less money to spend in riotous living.
Incidentally, I am not at all averse to the introduction of party politics in a debate on babies. If there is party politics in babies, let us have it. After all, we have been having party politics for a week. Why should we not go on doing it? What is party politics, anyway? It is difference of opinion held collectively, organised collectively and expressed collectively through our electoral machinery. That is party politics, and, if that were not so, we certainly would not be here, so that I do not think we need be too mealy-mouthed about it.
I doubt, however, whether this difference of judgment about the possible effects of the home confinement grants can be resolved on the Floor of the House. Nevertheless, I think it will be very difficult to discern its operation in practice because very few women will tell anybody that they had their baby at home because of the money. It will be difficult, but as we get better houses and more of them—and, after all, that is the clue not only to having babies at home, but to a great many other things we want —and more hospital facilities, then, surely, this problem will tend to resolve itself.
The hon. Member for Wolverhampton, South-West (Mr. Powell) asked whether this £3 was too much or too little. Who can say? I doubt whether this or any other benefit under the National 2029 Insurance Service is really adequate for the purpose it sets out to cover. I am not going to argue whether the cost of living has risen in particular directions to a point which would make £3 more or less adequate. I think that for maternity neither £9 nor £12 is enough, and that on occasions of this kind the National Insurance Service should be bountiful rather than merely adequate.
We shall have to observe the home confinement grant in operation and discern, as far as we can, any undesirable tendencies which may flow from it. In the meantime, I see that the Fleet Street poets have been having a little fun out of the home confinement grant. In the "Star" I recently read a little ditty which said:In future, when with frantic joyProud fathers tell us 'It's a boy—A baby of eleven pounds'It's not the giant that it sounds;For well we know when fathers phone usThe kid weighs eight—and three's the bonus.We shall have to see how it goes.
I want specially to deal with a point raised by the hon. Member for Wolver-hampton, South-West regarding the introduction of the contributory principle into the maternity allowance. I am sorry that the hon. Member is not in his place at the moment. I am not complaining, because he has been with us for a large part of the debate, and I well understand that he is in need of relaxation as much as anyone else. He welcomed the introduction of the contributory principle into the maternity allowance available to working a woman as a compensation for loss of earnings during the period of her confinement. I also feel that the introduction of the contributory principle is justified, especially when it is accompanied by improved benefits.
To find the reason why the married woman was placed in her present position, we have to go back to the Beveridge Report, and Lord Beveridge was in this difficulty. He felt that the compulsory insurance of married women under the old scheme was unsatisfactory, and said so in his Report. He realised that he had to put the married woman either on a compulsory or a voluntary basis, or shut her out of insurance altogether. He decided—and it was followed in the subsequent White Papers—that it was best to put the married woman on the basis of voluntary insurance because of certain 2030 benefits which she could obtain by such insurance, especially in regard to retirement pensions.
I think Lord Beveridge feared— although he did not express it in so many words in paragraph 108 of his Report— that when the married woman was put on the basis of voluntary insurance in contrast to the compulsory insurance under the old scheme, she might decide not to insure, and thereby do herself and her family damage through having no maternity allowance when she had to give up work on account of confinement. He provided against that contingency by recommending a maternity allowance for a married woman worker irrespective of her own insurable status, and the White Paper of 1944 placed the charge of the maternity allowance upon the contributions of women in Classes I and II.
As the hon. Member for Wolverhampton, South-West said—and I am glad to see that he has returned to the Chamber —the charge for the maternity allowance for the married woman worker was placed fairly and squarely on the contributions of other women workers or self-employed workers. The charge for the maternity grant and attendance allowance was divided equally between the contributions of both men and women. That is how Lord Beveridge, and later the White Paper, provided this insurance cover for married women workers who chose not to be insured under the new scheme.
Under this Bill, we are saying to the married woman, "If you want these benefits, you must pay contributions on the same level as other women and you must satisfy certain reasonable contribution conditions." The Minister has said that under the transitional arrangements nobody will be injured in their rights under the existing scheme for 65 weeks, and that during that time all women will have the opportunity to qualify by their contributions for these different and improved benefits.
But we still have to face the problem which Lord Beveridge had to face, that of the woman who neglects to insure, or who declines to insure, and who after 65 weeks will, as far as I understand from what the Minister has said, have no maternity allowance whatever. Thereafter any married woman worker who 2031 has not satisfied the contribution conditions will not receive a penny in respect of maternity allowances. She will not be entitled, as will other married women, to the new consolidated maternity grant of £9, or of £12 in the event of a home confinement.
I do not think we can look at that without some anxiety, because it may mean that married women workers who are contributing substantially to the maintenance of the household and who may wish to go on working after they have been confined, will be without compensation for loss of earnings during a substantial period when they may be unable to carry on their work.
Will the proposals under this Bill put pressure on such women to curtail their period off work? If so, that will be an undesirable consequence of the Bill, and I am wondering whether the Minister ought not to continue some form of benefit under existing arrangements to women who do not undertake voluntarily the insurance necessary to qualify them for the new benefits. I am disturbed about it.
I think there is always this difficulty when we allow people the option of insuring or not, and I believe there has been no more unsatisfactory feature of the National Insurance Service than the dilemma in which many married women have found themselves in trying to make up their minds whether or not to continue their payments. I have dealt with thousands of letters on National Insurance, in many of which I have been asked to try and calculate whether it would be to the advantage of the writers to continue their contributions under the National Health Service, most of them, of course, having regard mainly to what effect it would have on their retirement pension. We had to have regard to the length of time over which they would be contributing, the date on which they would qualify for the retirement pension and the difference in ages there was between husband and wife, and so on.
Most difficult and intricate questions have to be decided in trying to satisfy a woman that it would be in her interests to continue to contribute. Now we are certainly giving married women a little more positive encouragement to become insured under the new scheme, because 2032 long before they come to the stage of being interested in their retirement pension they will be interested in their maternity benefits, especially those who propose to carry on working.
Another reason why, on the grounds of equity, one is entitled to ask married women to contribute towards these benefits is that the married woman worker is very generously treated under our Income Tax system. A man and wife who are working, and who are both receiving Income Tax allowances and concessions, are much better off than a husband who. on one lot of earnings, is maintaining his wife and family. If a man is earning £6 a week and his wife £5, the Income Tax they pay between them is little more than the tax paid by a man receiving £11 a week and maintaining a wife and two children.
In the higher income ranges they would pay considerably less than a married man with one child, and in some cases less than a married man with a wife and two children. That is the incidence of the taxation system which undoubtedly favours married women workers, because it gives the husband the full allowances of a married man and it gives the wife who is working the full allowances of a single woman.
There is no doubt that in those circumstances married women workers, especially if their husbands are earning, and mostly they are, will be in an economic position to pay a contribution for their improved benefits. But I still come back to the fear that we may be leaving some married women workers entirely uncovered by insurance benefits for the period of their absence from work while they are having a child.
There may be some points to consider on the transitional arrangements and on the contribution conditions. Even the level of benefits may justify some attention when we come to the Committee stage. I am sure that the Minister, with his usual courtesy and consideration, will be glad to consider any points we may put. Taking the Bill as a whole, we are bound to welcome it for the improvements it conveys and we are not detracting in any way from those improvements by contributing a few criticisms or expressing a few fears.
The Trades Union Congress had a representative on the National Insurance 2033 Advisory Committee and he was a signatory to the Report. The T.U.C. has since approved the general principles of the Bill, which weighs very heavily with those of us, especially on this side of the House, who are very sensitive to trade union opinion. But I hope that the points I have mentioned will receive consideration by the Minister.
§ 7.24 p.m.
§ Mrs. E. M. Braddock (Liverpool, Exchange)
While welcoming the Bill, because we welcome any increase or additional benefit which can be given to people requiring it, I do not think that that aspect can be considered completely in isolation. Maternity units and hospital services throughout the country are having the greatest difficulty in meeting the needs of those people who desire to go into hospital for their confinement. Most management committees have to find some way of deciding whether a woman can be allowed to go into a maternity unit. I am concerned that if this grant is used in the working class areas as an incentive to a woman to remain at home we may find ourselves in great difficulties.
In some of the hospitals and maternity units it is not a question of discharging a woman with her baby after eight days; some are discharged at five days in order to provide accommodation for other people, and this is having a bad effect. Generally, women desire to go into hospital because they know that if necessary they can have the attention of a doctor. If they decide to have their child at home, and they book a doctor, there is no guarantee that they will be attended by that doctor. The municipal midwife is responsible for the confinement and only if she decides it is necessary is a doctor called in. Many women are concerned about that, and insist that if possible they shall go to hospital for their confinement.
When everyone in the family is working the additional £3 would not be an incentive to a woman to remain at home. But it could be an incentive if the members of the family who are earning were on short-time, and if the income of a household is seriously depleted by unemployment, as is the case in some parts of the country. Then, very often, the expectant mother insists on remaining at home and no one could persuade her 2034 that in her own interests she should go to a maternity unit.
I have been inquiring among the obstetricians in my constituency and I find that there is a divided opinion. Some of the women in the poorer areas, and who are badly housed, regard the grant as an extra £3, and take a chance by staying at home. Others say, "No. If the doctor says that in my own interests I ought to go into hospital, or to a maternity unit for my confinement, the £3 will not worry me very much." So we cannot assess the situation.
The Minister of National Insurance must consult the local authorities to be certain that the full quota of municipal midwives is available for every area. One of the reasons we cannot attract municipal midwives is that their pay is less than that of a sister who takes responsibility in a hospital unit. Local authorities are having great difficulties in making up the establishment they feel necessary to meet the needs in their areas. If a midwife delivers a child she considers that child as her special care, and she pays special attention to it. But if a woman goes into hospital she may be discharged after a short period, because (he beds are over-booked, and I believe that the beds in every maternity unit in the country are over-booked. If the woman is discharged, the district midwife who has to take responsibility is not nearly as interested in dealing with the case as she is in the cases that she has delivered.
I am told that practically all cases are discharged too early from hospital and go back home, because of over-booking of accommodation, so that hospitals can meet the needs of the people who are waiting. When mothers come home, all question of breast feeding has gone altogether. If people can remain in hospital, or at any rate in one place during their confinement, for the full period, they get the best education and attention, especially so far as child welfare is concerned.
During the progress of the Bill the Minister ought to make recommendations to, or there should be some discussion with, the Ministry of Health to see whether the £3 is an incentive to women to remain at home. If so, local authorities should be enabled to find the necessary municipal midwives to deal with them. We are well below strength in Liverpool and we cannot get any more, 2035 but I must say, in all fairness, that for a long time we have taken the view that the woman herself ought to decide what she wants to do. We have found that women who are in a position to pay heavy fees for an obstetrician or who can go into nursing homes, have home conditions which are ideal for them to be confined there.
If it is good enough for people who are in a position to get the very best attention to be permitted to decide whether they shall go into hospital or nursing home or not, it ought to be good enough for working-class people to make the same decision, even though the woman cannot pay for it.
In 1935, when I was Chairman of the Maternity and Child Welfare Committee in Liverpool, I insisted that there should be sufficient maternity hospital accommodation to meet the needs of all women who decided to go into hospital, apart from medical necessity. It is frightful for a doctor in charge of a hospital to have to decide which is the more important, the case of a woman who desires to go into hospital and has been booked, or an acute operative case that requires immediate attention, when there is only one bed.
I am inclined to believe that the Ministry of Health will use this extra £3 to urge that there is no necessity to provide great additional maternity hospital accommodation. From the women I have spoken to I find that it is very problematical how the extra grant will be used and how it will affect the decision between staying at home or going into a hospital for confinement.
While we have to watch this experiment, the Ministry of Health ought not to hold up additional maternity accommodation in the belief that the grant may keep a sufficient number of women at home to obviate the necessity of providing the hospital accommodation that people may want. The almoners and health visitors will have a terrible time, when a woman wants to go into hospital and there is no accommodation. They will have to decide, in the light of home conditions and medical needs, which woman shall go into hospital and which shall stay at home. Watching the 2036 reductions in the estimates for hospital building. I find that many management committees and regional boards are cutting down the possibility of extending the maternity services.
The Ministry may hope that the proposed grant will have some effect in inducing women to remain at home. I hope it is not so, and if it is not, then the Ministry of Health has the responsibility of ensuring that sufficient maternity accommodation is provided for women who desire, whether for medical or psychological reasons, to go to hospital. Childbirth is a difficult time for a woman. She may not be understood, but have an idea of her own about what she wants to do. If she feels that she has been frustrated about the idea, difficult complications can arise out of that frustration. We are open to accept that the £3 may keep women at home, but I hope that the Ministry of Health will not decide not to provide the maternity beds that may be necessary.
We welcome any increase in money given to people who need it. I hope that during the Committee stage it may be possible to amend the Bill in the way suggested by the right hon. Lady the Member for Fulham, West (Dr. Summer-skill) with reference to married women and the length of time they pay contributions. I hope the discussion will be useful, and that the Bill will emerge from the Committee a little better than it is now, although it is already quite good.
§ 7.36 p.m.
§ Mr. C. J. M. Alport (Colchester)
It is not on all subjects that I agree with the hon. Lady the Member for Liverpool, Exchange (Mrs. Braddock), but I never listen to her speaking on the subject of health without appreciating the very considerable experience on which she is able to rely in giving her views.
In one respect her arguments were not quite accurate this afternoon. She, and other hon. Members, must recognise that hospital accommodation, not only for maternity cases but for all forms of hospitalisation, is not likely to be ideally adequate to the needs of the people. We have to face the problem as it exists, which is that a good many women who face confinement will have to have the confinements at home, as is at present 2037 often the case and as has been the position for some time. The Bill does something which we should support to make it easier for such women to have their confinements at home.
We hope that priority will be given to those who most need to go to maternity hospitals for their confinement. They fall into two categories, those who face a first confinement and those who face a difficult confinement. I fully agree with the hon. Lady that it is essential that women should be allowed to remain in hospital as long as possible, and I would say for the full 14 days. If we can by the Bill reduce the pressure on maternity accommodation in hospitals so that priority cases can enjoy hospital amenities for as long as possible, the Bill deserves our support.
I entirely agree with the hon. Member for Sowerby (Mr. Houghton) who said that mothers of all classes, and not only of the working class, are the people who make the decision and that they would always make a responsible decision in this matter. Husbands possibly have a somewhat different approach from that of their wives to the problem. For my own part, ideally I should like to see all confinements take place in hospital, but women, for various reasons, often prefer to have their confinements in their own home. This Bill merits our support because it enables them to do that in cases where they have not adequate means to have their confinement in the conditions of greater comfort which their husbands and the community would like them to have.
For the reasons which I have mentioned alone, I think that this Bill deserves the whole-hearted support of the House. The hon. Member for Gorbals (Mrs. Cullen) made a point which we on this side of the House fully appreciate when she referred to the problems of those women who, for various reasons, must have their confinements at home. On that point we come to the housing problem as being at the root of the matter. The facilities are not available at home because of the housing conditions and we know that conditions in the hon. Lady's constituency are in many cases shockingly bad. I think that this Bill should be welcomed and supported and given a speedy passage through the House, and I hope that that will be the case.
§ 7.41 p.m.
§ Mr. William Keenan (Liverpool, Kirkdale)
I have wondered during the course of this debate whether we were really dealing with insurance problems, because most of what has been said has been with reference to the National Health Service. The hon. Member for Colchester (Mr. Alport) referred to the housing need. I join with him in that expression of opinion. The proposed increase in the maternity allowance is actually £4, because the maximum is £1 more than the £3 offered to those who have their confinements at home. I believe it to be true to say that the £3 will be the means of inducing a very large number of women to remain at home when they ought to go to a hospital.
At least 50 per cent., if not more, of women who give birth to children have today no facilities for confinement at home. In all of our large industrial areas a newly-married couple have to wait many years before they secure a home of their own, and it is probably those couples who, in the first few years of marriage, are the parents of nearly half of the children born in this country. Nearly all those couples live in apartments, many of which are not very satisfactory.
The serious housing situation has been responsible very largely for the extension of our maternity services. I do not think that it is very commendable that the provisions of this Bill are the only things that we can do to induce women to be confined at home, and that when, very often, it is highly desirable that they should have their confinement in an institution or a hospital. It is tragic that the provisions of this Bill should be our approach to what is probably the most important problem confronting us at the present time.
Through the provisions of this Bill the Government will get out of the need to extend the maternity services of the country at a time when the National Health Service should be extended instead of being stopped or curtailed. The majority of children born today are children of parents who are not living in a home of their own or who are sharing their home with somebody else. I believe that the attention that has been given to maternity and child welfare in the past generation 2039 is probably more responsible than anything else for the decrease in infant mortality. But by this Bill we are complacently offering expectant mothers a bribe to stay at home and so to some extent evading the responsibility to extend our health services.
I am sorry to put it that way. Knowing as I do the economic conditions and the housing conditions of many people, I can foresee that they will fall for this bribe. I belong to a family of nine children of whom I was the second, though perhaps not the best. All my life I have been associated with the kind of neighbourhood where housing conditions are bad and I still live not very far away from such a neighbourhood. My conclusion from observations of the type of life that goes on in such a neighbourhood is that the mother will want to stay at home for her confinement, though not because she ought to do so.
Many women who ought to have their confinement in hospital stay at home because of family responsibilities. The tragedy is that when such a woman stays at home she is doing household work within three, four or five days after her confinement. We all know that that is the case. I have seen it happening in my own home when I was a boy, and I know that it takes place in many homes today. That is one reason I think that this Bill, advantageous as it is in many respects, is a retrogressive step from the point of view of health.
I would much prefer to see a better approach and I hope that on the Committee stage we shall be able to express our criticisms and have some adjustments made to this Bill. I believe that the Bill supplements the Government's health policy, a policy which shows no intention to extend the maternity and child welfare services for which there is so great a need. The Bill by no means provides what is necessary. It is something designed to persuade mothers not to go into hospital when they really ought to go and by such means to ensure that there will be less need to extend the hospital services. At the same time, I cannot help but welcome the improved benefit provided under the Bill, because that benefit will be actually 50 per cent. greater in the case of confinements at home than it is at present.
2040 The increase in benefit to a working mother is about £11. It has gone up from £27 8s. to £38 5s. I would remind the Minister, however, that the amount which the working mother will have to pay is approximately equal to that. The increased benefit which will be paid to her, so long as she qualifies, will be what she pays herself in contributions, apart from contributions made by her employer. I do not think this is a good thing; I think we lose on it. It may have the effect of preventing some young women remaining at work when it is very desirable that they should do so in the drive for increased production which is so necessary in certain industries.
We have been justifiably deploring the fact that some of our womenfolk have to remain at work for too long and then return to work too early. It has been recognised that even 13 weeks is not sufficient, because in the new Measure we intend to extend the period to 18 weeks. If they do not qualify for benefit they will work longer and return to work earlier than they should. This is not the way to ensure that young children will have a better chance.
The Minister should ask the Government to consider leaving the qualification as it is at present. One of our greatest needs—as it is in all countries—is to have the healthiest children we can. We should hesitate before doing anything to undermine our endeavours to achieve that objective. I fear that the necessity to pay the full contribution to qualify for maternity benefit in the future will have that effect. It will mean that mothers will probably remain at work longer and return sooner. That is something which we should avoid. There is no need for it in this generation. The present provision, which allows a woman to benefit by virtue of her husband's insurance— so long as she is working—is sufficient, and the step which is being taken by this Bill is a retrogressive one.
§ 7.54 p.m.
§ Mr. Geoffrey Wilson (Truro)
I did not have the good fortune to hear the earlier speeches in this debate, so perhaps I should not make any general comment on the Bill or the way in which it has been presented or opposed. Having listened to the last few speeches, however, I want to say a few words with reference to them.
2041 I ventured to interrupt my hon. Friend the Member for Colchester (Mr. Alport) —who has now left the Chamber—when he seemed to imply that most fathers would prefer their children to be born in a hospital rather than at home, even if the home conditions were suitable. I intervened as a father of six children—all born at home—the first four of whom were born in very limited accommodation.
The hon. Member for Liverpool, Exchange (Mrs. Braddock), to whom both sides of the House always listen with great attention when she talks on health matters, pointed out that many mothers who could well have their children at home, in suitable home conditions, nevertheless preferred to go into hospital, and that in some cases they were keeping out people who needed hospital attention very much more than they did themselves.
That is so in many cases. Many prospective mothers go into hospital because of a quite unnecessary fear of what they have to go through, and it seems to me that if general public opinion encouraged mothers who have suitable home accommodation, and are physically fit, to have their children in their own homes, it would help to relieve the congestion of the hospital services.
From a psychological and family point of view—and here I speak from experience—it is much better for a child to be born in the home. It relieves many psychological difficulties in connection with elder children and the mother if there is no break in the home life and the mother is not unnecessarily treated as a hospital case. We all appreciate the fact that such conditions do not very often exist and that in many cases housing conditions make it most undesirable that the mother should have her child at home. Several references have been made to housing conditions. I agree with my hon. Friend the Member for Colchester that in many cases this is really a housing case and not a case of health.
I believe that all hon. Members will welcome the Bill and the purpose for which it is intended, in giving assistance to those who have to have their children at home.
§ 7.58 p.m.
§ Mr. William Ross (Kilmarnock)
I should apologise to the Minister for the fact that a Committee elsewhere prevented my hearing his speech, but I 2042 approach the Bill with rather mixed feelings, which have not been allayed by the speeches of hon. Members opposite.
If this home confinement grant—which is the topic we have discussed more than anything else in this Bill—is to be considered as compensation for a woman having her confinement at home, I am in absolute agreement with it. All I would say is that when one considers the attention which a woman gets in hospital —the comfort, the attendance and all the services—£3 is a paltry sum to compensate for that, and is completely inadequate.
I am very glad to see a representative of the Scottish Office here. This is not really a National Insurance Bill in genesis. The Department of Health for Scotland Report of 1952, in page 27, says:Domiciliary Midwifery: As has been noted in previous years, the number of domiciliary births continues to fall….If it were a matter of compensation alone, compensation should have been given at the time domiciliary births were high rather than low. The Report says:As has been noted in previous years, the number of domiciliary births continues to fall, both absolutely and in relation to the total births. The Ministry of National Insurance are taking steps to give effect to the recommendations of the Minister's Advisory Committee that the rates of maternity benefit should be adjusted in favour of the mother who is confined at home.In other words, simply because of the need to keep people out of hospital—not because, even at the moment, there is no room for them but because it is more costly there, and because of the pressure on the available accommodation—they want to increase the number of domiciliary births. From this one paragraph alone the argument that this is a compensation is completely destroyed. This is an inducement; and when considering the Scottish position it is a very dangerous inducement.
Hon. Members opposite talk about the great increase in the number of working mothers. They can only be referring to working-class mothers, because the better-off women always went into nursing homes.
§ Mr. Ross
The majority did. I will come back to that later.
2043 Since that great increase in the number of hospital confinements there has also been a fall in the maternal mortality rate and in the infant mortality rate. I draw the attention of the Joint Under-Secretary of State for Scotland to what is said on page 14 of this Report, which, once again, shows a decline in infant mortality. The Report says:In both the neo-natal period (the first month of life) and at 1 to 12 months, there is room for improvement. With the general improvement in the infant mortality rate, however, the neo-natal period is assuming a greater importance. Indeed"—and this is important in the light of what we are doing, because more mothers are going into hospitals for confinement—in some of the larger industrial areas, 50 per cent. of the infant mortality occurs within the first two weeks.If more and more women are at present under specialist care in hospitals, will the position be better if we turn back and more and more women are attended to at home, remembering the housing conditions in industrial areas there referred to?
The Joint Under-Secretary is responsible for housing in Scotland, and he knows that in industrial areas there— and we do not need to go to the Gorbals; it is so in my own constituency—there are whole streets, even whole areas of houses without bathrooms. In one-apartment and two-apartment houses the percentage is as high as from 33 per cent. to almost 40 per cent. in our industrial areas, and this problem must be examined from that aspect.
§ Mr. Ross
I can quite believe that, although I do not know how it is relevant to my argument.
The position is serious. There has not been the extension of maternity hospital services that we want, and if we had an assurance that continued attention is to be given to the need for maternity hospitals in Scotland I should feel very much happier about the Bill. I do not deplore the fact that since the Health Service started there have been fewer domiciliary births in Scotland. One of the things I am very glad to have seen in Scotland is that there has been less of this snob birth 2044 complex, of women having to go into private nursing homes, which are very often inefficient.
§ Mr. Ross
That may well be, but in Kilmarnock, in Ayr, and in Ayrshire generally, there are only one or two private nursing homes left where there used to be quite a number. As I read the local Press in Kilmarnock, I see that the Burgh Maternity Hospital is the place where the births take place. People are relishing the service, the security, and the assurance that they will get the very best treatment there, and the £3 inducement will not be enough to combat the problem of the pressure on the available accommodation. The real answer is for the Minister of Health in England and Wales and the Secretary of State for Scotland to examine the whole question of the provision of maternity accommodation.
I can speak on this problem with a certain amount of authority based on my experience in the last few weeks.
§ Mr. Ross
Oh no. not for the first time. Look at the lines on my face.
In a sense, every time is the first time. All this talk about the second child being so much easier and all the rest of it, is not really true. We hear this glorification of having the right psychological setup for the mother. How often do we get the ideal conditions, not only the home conditions but the attention and the physical well-being of the mother, all of which have to be considered?
It is said there is grave danger that if the mother is at home she will, in order to attend to the needs of the rest of the family, get up far too soon. I think we are rather inclined to sentimentalise about that. I may have misheard what my hon. Friend the Member for Liverpool, Exchange (Mrs. Braddock) said, but I understood her to say that we should attend only to what the mother herself wants. I think the mother has to be guided in this respect by her medical attendants as to what is best for her.
I think that this Bill springs from the fact that there is pressure on hospital accommodation, and we should be getting 2045 from the Minister of Health and the Secretary of State for Scotland greater provision in their Health Estimates for more maternity accommodation, for the improvement of existing materity accommodation in certain maternity hospitals, quite apart from the actual conditions. Some of them were never intended as maternity haspitals, and I wonder how some matrons, sisters and nurses in charge cope. The reason is probably that there is more satisfaction in this kind of nursing than in any other.
We want an assurance from the Minister that this is not an inducement— if it is an inducement it is a dangerous one—and that attention is being given to the extension of maternity accommodation. The fact that the mothers want to have their confinements in hospital shows how popular it is and indicates that more and more attention must be given to this aspect. We must not look upon what is proposed as other than a temporary Measure. It must not be regarded as the final step; it should be complementary to the extension of the maternity service.
§ 8.11 p.m.
§ Mr. Bernard Taylor (Mansfield)
All hon. Members will agree that we have had a most interesting debate on a very important human problem. The boisterousness and excitement of the past week have been absent from our proceedings. It is difficult to reply to the speeches which have been made, because their content has been such that we should all like to read and re-read them in order fully to appreciate all that they imply.
I am sorry that the hon. and gallant Member for Worthing (Brigadier Prior-Palmer) is not in his place. If I understood him rightly, he made a statement with which I profoundly disagree, that the right place for a woman to have her children is in the home. The hon. Member for Colchester (Mr. Alport) said exactly the opposite. They are hon. Members of the same party, and apparently they have their differences of opinion like everybody else. I was glad to hear the hon. Member for Colchester say that it would be ideal if we had sufficient accommodation to permit all confinements to take place in hospital. I entirely agree with that and hope that the time will eventually come when that will be the situation.
2046 I join the Minister in the tribute which he paid to the National Insurance Advisory Committee. My right hon. Friend the Member for Fulham, West (Dr. Summerskill), not being satisfied with the application of the maternity benefits, decided in May, 1950, that it would be well for the Committee to look into the question. Having read and re-read their Report, I have come to the conclusion that the Committee spared neither time nor effort to obtain the views of knowledgeable people on the subject, and I join the Minister and my right hon. Friend in stating that the House is indebted to the Committee for a very interesting Report. The Committee wrestled with the problem for a long time, having 19 meetings and hearing evidence by influential organisations as well as individuals.
I wish also to express my appreciation to the Minister for the memorandum which he has submitted about the Bill. It explains in a very simple way some of the Bill's more complicated provisions. The Minister was following the precedent set by his two predecessors, as he did with the National Insurance Bill last year, and I hope that he will continue to employ this method if the occasion arises in future. As the Minister said this afternoon, the Bill gives effect to practically —I make the qualification—all the recommendations of the Committee. There are one or two minor changes, but, in the main, practically all the recommendations have been accepted by the Minister and are embodied in the Bill.
Many of the speeches today have referred to maternity accommodation in hospitals. I wish particularly to refer to the admirable speech which has just been made by my hon. Friend the Member for Kilmarnock (Mr. Ross). I hope that both the Ministry of Health and the Department of Health for Scotland will take note of some of the things which have been said in the debate about maternity accommodation in hospitals.
The Bill proposes one or two administrative changes relating to the contribution year and the benefit year. They are not at all serious and do not place any hardship upon anybody, but merely make for administrative tidiness, a subject which has not been mentioned so far. The changes will not be a bad thing from the administrative point of view, and they 2047 do no harm to anyone and do not cast an undue burden upon any beneficiary.
The three main benefits in the Bill are: first, the maternity grant; secondly, the home confinement grant; and lastly, and perhaps the most controversial, the maternity allowance. It is clear that the maternity grant is a combination of the existing maternity grant and the attendance allowance. The attendance allowance which is at present paid to non-gainfully occupied women for a period of six weeks is to be abolished. I imagine that the reason why the new maternity grant will be bigger than the existing one is that it combines the existing maternity grant and the existing attendance allowance.
Another very important matter, which I welcome, is that the increased maternity grant will be paid to all women who are confined, whether they are gainfully occupied or not. That has not been the case under the existing scheme. The attendance allowance was not payable to gainfully occupied women who were in receipt of the maternity allowance.
Another thing is that the new maternity grant will be paid either before or after the confinement as the mother chooses. That is not the recommendation of the Committee, but I do not regard it as a serious departure. On balance, it is my view that the proposal in the Bill is to be preferred to the recommendation of the Committee. Why do I say that? For the elementary reason that this proposal gives to the mother— and I think it is right—the opportunity of deciding when is the appropriate time for the benefit. Would anyone contest that the mother is the best judge and is sufficiently sensible to know whether before or after the confinement the benefit can be best used for the mutual advantage of mother and child. The opinion of those of us on this side of the House, based on our experience over the past four years, particularly since the National Insurance Act came into existence, is that it is a good thing.
What about the issue of home confinements? A lot has been said about that during this debate though I am not at all surprised about that. There is a greater diversity of opinion upon this than there is on any of the other proposals in the Bill. It cannot be contested 2048 that a home confinement is more expensive than a hospital confinement. The hon. Member for Clitheroe (Mr. Fort) asked us whether we wanted this part of the Bill or not. We do if for no other reason than that home confinements are more expensive than hospital confinements. All that my hon. Friends have been doing in this connection is to try to point out the possible dangers that there may be in home confinements.
I hope that this proposal will not result in reduced hospital admissions for maternity purposes. If I thought that this proposal was for the purpose of discouraging entry into hospital I should oppose it, but I do not think that that was in the mind either of the Committee or of the right hon. Gentleman. My view is that the reason for this additional money for home confinements is that such confinements are more expensive than hospital confinements.
There is not only diversity of opinion in the House today on this subject, but there is also diversity of opinion among women themselves. Some women prefer to go into hospital for their confinements. As was said by my hon. Friend the Member for Stoke-on-Trent, Central (Dr. Stross), most of them like to go to hospital for their first child. That may be for psychological reasons or they may be apprehensive for one reason or another, but I think it will be shown that there is a very great desire among women to go into hospital when they are to be confined for the first time.
There are, of course, a number of women who prefer to stay at home, and they, in the main, are mothers who have other children. It is not because they would not like to go into hospital, but they feel a greater peace of mind if they stay at home and discharge, in part at any rate, their responsibilities over their other children. Then there are those women who go into hospital on medical advice. It is all really a very complex problem, upon which there is a wide difference of opinion, even among women themselves.
On the question of the hospital versus the home, we should place on record the magnificent work done by our county councils and county borough councils through their midwifery services. There are many factors to be considered, such as the unsuitable and substandard houses. There are hundreds of 2049 houses which are not suitable for home confinements, as has been revealed clearly by many of the speeches this afternoon. Hospital confinement has all the advantages. If anything goes wrong, as it can easily in this sphere, in a hospital there is available on the spot at a moment's notice every facility, and the necessary skill and attention can be called upon to deal with the situation.
The Report of the Advisory Committee tells us that about 50 per cent. of confinements take place today in hospital. In 12 months or two years' time it will be interesting to see whether these statistics show that the additional grant for a home confinement has any effect upon hospital admissions for maternity purposes.
Clause 6 of the Bill brings to our attention the maternity allowance. The International Labour Office as far back as 1919, 34 years ago, adopted the idea of monetary provision for gainfully employed women who were to be confined. Yet it was not until the National Insurance Act of 1946 that the idea was acted upon practically in this country.
The changes in the maternity allowance, to which the Minister drew attention in his admirable opening speech, were undoubtedly one of the most difficult problems of the Advisory Committee; in fact, they spoke of being in a dilemma. They said that the maternity allowance of 1946 was designed for one type of woman but that experience had shown that others for whom it was not designed had been getting it, while those for whom it was intended had been prevented from doing so for reasons which they stated.
The existing provision is that it is either a contribution test or a weeks of work test. The proposal in the Bill is to abolish the latter test so that married women who are gainfully occupied, and exercise the option not to contribute to the scheme will no longer be eligible for the maternity allowance benefit. I hope that the Parliamentary Secretary can give us the number of gainfully employed women who have been in receipt of the maternity allowance. The Report of the Ministry of National Insurance for the year 1950 indicates that 119,000 maternity allowances were paid in that year. If possible, I am sure that the House would be interested to know the numbers out 2050 of that 119,000 who were gainfully employed women, had exercised the option not to contribute, and were having the benefit not on a contribution test but on the weeks of work test.
I have one fear about making this test one of contribution entirely. It will hit hard the married woman who, by force of economic necessity, has to go out to work and exercises the option not to contribute because she cannot afford to do so. To safeguard her right to the maternity allowance this type will, in future, have to make contributions, as was pointed out by my hon. Friend the Member for Sowerby (Mr. Houghton). I know it will be said that by doing this she will be entitled not only to maternity allowance, but also to sickness and unemployment benefit.
In view of the hard cases that may arise as a result of the abolition of the weeks of work test, the question may arise as to whether the maternity benefits ought not to be taken out of insurance altogether and instead, like family allowances, become a direct charge upon the Exchequer. That is a big question, however, which I mention merely in passing.
Now I turn to the recommendations of the Advisory Committee not included in the Bill. As has been pointed out, the present qualification for maternity allowance is either 45 contributions or credits, or the test of weeks of work. I regret that the Minister has not seen fit to accept the recommendation in this connection and I share the concern of my right hon. Friend the Member for Fulham, West (Dr. Summerskill), who made some comments about it.
I welcome the fact that the proposal in the Bill extends the benefit period before confinement from six to 13 weeks, but it increases from 45 to 50 the number of contributions that have to be paid before the beneficiary can enjoy the full benefit that is proposed in the Bill. I know that the Minister is amenable to suggestions and I hope that before the Committee stage, remembering that the Advisory Committee spoke so strongly on this point, he will think again with a view to reducing the number of contributions from 50 to 45, as the Committee recommended.
In 1950, the cost of benefits to the National Insurance Fund was £8,600,000. 2051 The proposals in the Bill will cost an additional £2,500,000. This will bring the maternity benefits into line with the other benefits which were increased last year, when, for the purpose of meeting the cost of the increased benefits, the contributions of all contributors were considerably increased. We welcome the Bill. We think that it is all right and that it will to greater advantage, which was the purpose of the Advisory Committee's recommendations, distribute more equitably the maternity benefits.
§ 8.38 p.m.
§ The Parliamentary Secretary to the Ministry of National Insurance (Mr. R. H. Turton)
First, I should like to say what a delightful debate we have had and to thank everybody who took part in it. It is rather like what can happen to anyone who lives on the coast. For a week the storms may be pounding the coastline, and suddenly at the end of the week the sun comes out and one basks in it. So far as hon. Members have contributed to that basking, I thank them.
§ Mr. Cyril Bence (Dunbartonshire, East)
There are not many hon. Members basking on the benches opposite.
§ Mr. Turton
As the hon. Member for Sowerby (Mr. Houghton) said, if there are politics in babies, let us have them. The reason why there is general agreement on this subject is that all parties have had a hand in building up the edifice of this social security. I looked at the report of the debate when the National Insurance Bill was introduced in 1911 and I found that Mr. Sydney Buxton, when he moved the Second Reading, disclaimed responsibility for the Bill and said that all the work for it had been done by his right hon. Friend the then Home Secretary. On looking further I found that the then Home Secretary was the present Prime Minister. That takes us right back to May, 1911.
We remember in the inter-war years how Mr. Neville Chamberlain worked hard to improve conditions of mothers in childbirth, in memory of his own mother, who had died in childbirth. Then in 1943 we had the Beveridge Plan, produced by a Liberal and approved by the Coalition Government under the present Prime Minister, the actual Bill being 2052 introduced by the right hon. Member for Llanelly (Mr. J. Griffiths). I also pay tribute to the right hon. Lady the Member for Fulham, West (Dr. Summerskill) for her work in remitting this matter to the National Insurance Advisory Committee. She has the distinction, I believe, of being the only mother who has ever held office in Britain, and I congratulate her on that fact.
The right hon. Lady introduced the very heated argument on the home confinement grant of £3. She adduced medical and obstetric arguments both for and against the home confinement grant and the amount at which it was fixed. Hon. Members on both sides of the House, without distinction of party, have taken very differing views as to whether it is better to have a baby at home or in hospital. In winding up for the Government I take no part in that dispute. It is the duty of my right hon. Friend to see that this home confinement grant is fixed at such a sum as will give the mother compensation for the extra cost of having the baby at home without providing an incentive in determining her choice. In my view, whether the baby is born at home or in hospital is not a matter to be decided by politicians, but by the mother on the advice of her medical adviser.
In our view, and in the view of the National Insurance Advisory Committee, the right sum for this home confinement grant is £3. The Committee, in paragraph 30, said that from their estimates £2 10s. was the extra cost involved in having a baby at home. The hon. Member for Kilmarnock (Mr. Ross) said that he thought it ought to be a great deal more. He said it was a paltry sum and used an argument which reminded me of a book I once read about the Ouroboros, the worm which eats its own tail. At one time he was saying that it would prevent women going to hospital and at another he said it was a paltry sum.
I admit that one may argue that the cost of having a baby at home is a great deal more than £3. Hospital costing returns show the average cost of maintenance in a maternity hospital is £13 16s. a week and the cost of those items which the parents would have to pay themselves if the confinement took place at home is £3 5s. 8d. If that is an indication it would show that the £3 is insufficient 2053 compensation, but I am influenced by the fact that the Advisory Committee have gone into the matter in great detail.
They are very representative—representing both sides of industry, the medical profession and also the housewife—and they have come to the conclusion that £3 is the correct sum.
From what the hon. Member for Sowerby said, I gather that the Trades Union Congress endorsed the recommendation and that in their view it was correct. Therefore, I think there is no justification for the outburst of the hon. Member for Kirkdale (Mr. Keenan), who stigmatised the home confinement grant as an attack on the health services of the country. It is not; it is extra compensation for the insured population to meet the cost of having their babies at home.
§ Dr. Stross
We notice when we read the Report that the lowest sum suggested was £2 and that other people suggested £6 and some £10. It seems very strange that they should come down to £3 as being the right sum. It does seem rather low.
§ Mr. Turton
I have to go on the Report before me. I cannot tell what happened in the National Insurance Advisory Committee. I am satisfied that the £3 is a fair sum and I believe that this debate has endorsed that fact. Some hon. Members have argued it is too much and some that it is too little, and for that reason I believe that £3 is the correct sum.
The hon. Member for Reigate (Mr. Vaughan-Morgan) asked my hon. Friend the Parliamentary Secretary to the Ministry of Health what were the figures of maternity beds in National Health Service hospitals at the present time. My hon. Friend has given me the figures. At the time the National Insurance Act came into operation there were 18,786, and the most recent return is 19,369.
The right hon. Lady the Member for Fulham, West and the hon. Member for Mansfield (Mr. B. Taylor) criticised the Bill because we have changed the contribution test for entitlement from 45 weeks, from the sixth week before confinement, to 50 weeks—
§ Mr. Turton
Wait a moment—to 50 weeks starting from the thirteenth week before confinement. I appreciate they are not criticising the earlier date. What they apparently are criticising, and I am most surprised, is that they say we have now made it harder by asking for 50 instead of 45 contributions.
§ Mr. B. Taylor
No, we did not say it was harder. We said it seems a pity to extend the period of weeks from six to 13 and then extend the qualification of stamps from 45 to 50. We did not say it was harder, but it could be made easier than what is proposed in the Bill if the recommendations of the Committee concerning contributions were accepted.
§ Mr. Turton
That seems to be very much how I was reciting the argument of the hon. Member. He was objecting to the fact that we were asking for 50 contributions instead of 45. But he has forgotten, and the right hon. Lady has forgotten, the other part of this Measure which entitles the insured person to pay 13 stamps at the non-employed rate. The effect of that is that instead of having to have 45 stamps or credits as at present she will require in the future only 39 stamps or credits at class 1 or class 2, plus 11 at class 3. We are dealing with an insured woman who has not opted out of insurance and has to pay for a stamp each week, so this provision is an improvement on the conditions recommended by the Advisory Committee.
§ Mr. Turton
No doubt. We could have a position where a person would be entitled to have class 3 contributions—
§ Mr. Turton
If we had accepted the recommendations of the Advisory Committee a working woman trying to qualify for a maternity allowance would be six weeks worse off than we are recommending in the Bill. I am surprised that the right hon. Lady, and the hon. Gentleman who was her Parliamentary Secretary when she was in office, should have forgotten the very involved contribution rules which govern sickness and maternity benefits. I recommend my right hon. 2055 Friend's alteration from 45 to 50, which has the effect that 11 stamps can be paid for at class 3 rates.
§ Mr. Taylor
May we clear up this point? The non-employed contributions cannot be paid where the gainfully occupied woman is in work. If she is out of work, either for one week or the maximum of 13 weeks, she will find it difficult to find even the non-employed contribution.
§ Mr. Turton
The hon. Gentleman forgets that we are dealing with a woman who has opted in. She is under a legal obligation to pay for a class 3 stamp while not in employment. If she is in employment for the whole period the question does not arise. We are dealing with a woman who leaves the employment field at some period after the 39th week. As recommended by the Committee, she would have to have contributions or credits for 45 weeks. As proposed by my right hon. Friend, she need only have contributions or credits for 39 weeks but she must pay for the stamp, as she is legally bound to do, for the other 11 weeks.
§ Mr. Taylor
This is rather complicated. The woman is under no obligation to contribute if her income comes below a certain figure—I believe it is £104 a year. If she works for only a certain number of weeks and then leaves the employment market and her wages have been less than £104 she is under no obligation to contribute—not even the non-employed contribution.
§ Mr. Turton
Again, that is not completely accurate. If a woman had been employed and left her employment and her income dropped to £104 she would be under obligation to pay until she had put forward an application for small income exception. The small income exception is not intended for cases like that of the working woman in industry who has a week or two off work.
I come to the question of dependants' allowances which were mentioned by the right hon. Lady the Member for Fulham, West, and the hon. Lady the Member for Coatbridge and Airdrie (Mrs. Mann). The hon. Member for Coatbridge and Airdrie said that she would like to see the woman in receipt of a dependant's 2056 allowance for an invalid husband getting as much for him as he would get for her if he was receiving an insurance benefit and claiming for his wife as a dependant. That is in fact what we are doing in the Bill. The married woman will get 32s. 6d. a week for herself and 21s. 6d. for her invalid husband, just as if it was the other way round and he was getting 32s. 6d. and 21s. 6d. for her—
§ Mr. Turton
She becomes the breadwinner and under this Bill she will get maternity allowance of 32s. 6d. a week. She will draw 21s. 6d. for her husband. If he is not drawing sickness benefit, she will also get a dependant's allowance, after the birth of the baby, of 10s. 6d. a week. I think this is a notable improvement. There can be no criticism of it.
My hon. Friend the Member for Reigate asked why the mother who had an amenity bed in hospital did not receive the grant. The answer is that the charge for an amenity bed does not cover the cost of accommodation and maintenance. It is made for the extra privacy provided. The ordinary cost of a mother's accommodation and maintenance is met by the National Health Service and, for that reason, a grant is not paid in such cases.
I was also asked by my hon. Friend the Member for Reigate to say something about the publicity that will be given to these proposals. This is probably one of the most important points. We want to see that the provisions of this Bill, and especially the transitional provisions, are known to every mother, and we mean to do that as far as we possibly can. We shall be bringing out a small leaflet explaining the maternity benefit changes, and we shall also be issuing a larger leaflet that will replace the existing National Insurance leaflet on maternity benefit. These leaflets will be available at clinics and at food offices where expectant mothers get their special ration books.
Of course, there is the additional problem of trying to get this across to women who are not expectant mothers, but who are potential mothers and who may well 2057 be women who are not even married, because the earlier part of the contributions for maternity allowance may cover such a period, and, therefore, we intend to use the fullest possible publicity, both in the Press and on the wireless, in order to secure that end. I can give that assurance to my hon. Friend and to others who have asked me questions on that score.
§ Mr. Ellis Smith
Will the Parliamentary Secretary ask his right hon. Friend to consider, when this Bill becomes an Act of Parliament, the advisability of giving a talk on the wireless about it?
I am very glad that the hon. Gentleman has made that suggestion. My right hon. Friend is here, I know he has heard it, and I hope he will be persuaded into giving a talk on the wireless, which I personally think is by far the best way.
§ Mr. Taylor
While on the point of publicity, which is important, would the Minister consider, in additon to all the other things that have been mentioned, having posters exhibited at places where women work in the textile areas of Lancashire and Yorkshire? It is worth considering, so that no stone shall be left unturned in bringing this information to the people.
§ Mr. Turton
My right hon. Friend has given an assurance that that also will be considered, among other suggestions. If hon. Gentlemen have any suggestions to make on publicity in order to get this across, I hope they will not hesitate either to write or to speak to my right hon. Friend or myself so that we can discuss them, because we have a common interest in this matter.
The hon. Member for Mansfield also asked questions regarding the maternity allowance and the proportion of women drawing maternity allowance who had opted out. The fact is that, out of 119,000 who were drawing the maternity allowance, some 30 to 40 per cent. have opted out. While I am giving figures, perhaps I may also answer the hon. Member for Newcastle-upon-Tyne, East (Mr. Blenkinsop), who asked me what was the estimated cost of the home confinement grants. The answer is £1 million a year, and the number of mothers who are expected to receive it is 330,000 a year.
2058 That brings me to the end of the major points that have been raised in this debate, and if there are other points to which I have not replied I will go through the whole debate and write to the hon. Members concerned, I hope before the Committee stage is reached. There is one important point in which I am personally involved. My hon. and gallant Friend the Member for Worthing (Brigadier Prior-Palmer) said he wanted a special maternity benefit for the first child, and he reminded me that he had made a plea during the Committee stage of the previous National Insurance Bill for a special maternity benefit during the first year of 8s. a week or £20. I can assure him that, as I then promised, we have given very careful consideration to his arguments, and, in fact, we have introduced this Bill following upon those arguments. We are giving to the working mothers for the first child a maternity benefit that will mean not the £20 which my hon. and gallant Friend suggested, but in some cases £41 5s., and in other cases, £38 5s.
I would remind the House that this maternity allowance has been proved by experience to be of particular benefit to mothers with their first child. It is for that reason that I hope my hon. and gallant Friend will realise that the argument he adduced on the Committee stage of the Bill dealing with family allowances has had very significant results.
The hon. Lady the Member for Coat-bridge and Airdrie criticised the change over from the maternity allowance for the short period at 36s. to the longer period at 32s. 6d. I think she has forgotten, however, that that is not the only change. Under the existing system, a woman drawing a maternity allowance is not entitled to the attendance allowance, as was pointed out by the hon. Member for Mansfield, and, therefore, under our proposals she is getting a lump sum addition of probably £4 10s., that is the attendance allowance element of the new maternity grant. This carries out the recommendation of the National Insurance Advisory Committee which was that, instead of having a very high maternity allowance, it would be better to make a large lump sum payment.
I would also point out to the hon. Lady that in no other European country, as far as I have been able to find out, is 2059 the maternity allowance higher than the sickness benefit, and there are only two other countries in Europe which have a maternity allowance for the period of 18 weeks which we are now recommending. I hope that on reflection hon. Members will realise that this Bill meets all the points about which they have been worried in recent weeks concerning maternity. We are proud to bring in this Bill at a time when the finances of this country have only recently recovered from a very difficult and dangerous predicament.
§ Mr. Turton
I am quite certain the right hon. Lady will not deny that fact. I would also say that we have shown courage in bringing it in in view of the fact that the insurance fund will face in future years a very great deficit. Therefore, I want the House to realise that some of the results of this Bill will have to be subjected to further consideration at the time of the quinquennial review.
We believe, however, that those risks are worth taking, because it is of vital importance to see that the mothers of this country have just treatment. In its recent policy document the Conservative Party said that the family is the rock on which we build society. I do not believe that anybody on either side of the House will disagree with that. It is because the family is the rock on which society should be built that we have introduced this Bill, which I hope will receive a unanimous Second Reading.
§ 9.4 p.m.
§ Mr. A. C. Manuel (Central Ayrshire)
I am very pleased see a representative of the Scottish Office on the Government Front Bench. I propose to limit my remarks entirely to the home confinement grant, and I hope that the Minister or the Parliamentary Secretary will inform us what assessment was made in Scotland of the position there as against the position in England before this provision was agreed to. I maintain that there is a great difference.
2060 Take the housing position in Scotland. The Parliamentary Secretary will be aware that the vast majority of our houses are very small in comparison to the average house in England, that one house in three is more than 70 years old and that, generally speaking, we are not meeting our commitments in the building of new houses. The deterioration in old property is making them unfit for human habitation more quickly than we are providing new houses. I see opposite the hon. Member for Edinburgh, South (Sir W. Darling), who graced Edinburgh and served her for many years in local government. He and all those interested in local government are aware of the great significance of the maternal and infant mortality rates in Scotland as against those of most other European countries, and not only of England.
For many years we encouraged in every way we could our young married women to go to hospital for their confinements. I am speaking of 20 or 30 years ago. We believed that the birth of children would be much safer and the maternal mortality rate much lower that way, but it took years to convince the working-class woman in Scotland that it was the right course. The natural tendency was for her to remain at home to be near her mother. The local midwife came in and made the necessary arrangements, yet there was still great danger, and we lost many mothers, and also children in the first few weeks of life or because they were stillborn. Public health authorities in Scotland were very anxious about the matter. Eventually, there was a decline in the maternal and infant mortality rates.
I am anxious, as are many people in local authority circles in Scotland, that we should not embark on a course that may weaken the structure that has been built up and that has saved life in Scotland. We are so keen about it that we think that term is not too strong. Did the Minister make any assessment of the position in Scotland? Did he contact the Secretary of State for Scotland or ask about the Scottish position? I do not think that he did. I do not think Scotland has had any special recognition, despite the fact that a massive case can be built up that our conditions are not similar to those in England in respect of housing conditions and the maternal and infant mortality rates. The education over a 2061 long period to which I have referred has been fruitful, and has saved life.
Quite apart from that, I believe that confinement in a maternity hospital is preferable to confinement in the home, and I am not certain that the Minister has not been persuaded by external circumstances in taking the line which he has followed. If that is so, it is a deplorable thing. One more baby saved is infinitely preferable to the building up of statistics to the credit of the Government, and we cannot forget that there has been a reduction in hospital building and in the extension of hospitals and the doing of necessary repairs during the past year.
I appeal to the Minister to recognise that the one-apartment or two-apartment houses, of which we have so many in Scotland, are not good places in which mothers should have their confinements and that there may be a temptation to take this proferred grant of £3 and stay at home. A mother with a "steering" family—to use a Scottish expression— would be better away from home during the period of her confinement. She would be better away from home worries and the job of looking after small children and preparing meals. Did we not build up the home help service to provide assistance at that time so that the mother should be relieved of her worries and her obligations to the family? It seems to me that this Bill is a most dangerous inroad into the social service which we were building up and which was to be applied in a way different altogether from that envisaged in this proposal to give a grant in respect of confinement at home.
A doctor friend of mine, talking the other day about hospitals long ago, said that hospitals could be no longer regarded, as they were in the old days, as a gateway leading to death. Rather they were now regarded as a window opening to life. That is true, and we are all proud of our hospital services. Now a grant is to be provided to persuade mothers from using the hospital service.
§ Mr. Turton indicated dissent—
§ Mr. Manuel
The Parliamentary Secretary shakes his head. He does not know Scotland very well and I want to know what assessment he has made of Scotland in connection with this Bill. 2062 We are introducing a bad thing in this Bill. We are introducing a temptation which, in certain economic circumstances, will tend to make an expectant mother remain at home instead of going to hospital, where, if anything did go wrong, all the skill of the hospital staff would be at the mother's disposal to save either her life or that of her baby or the lives of both.
The Government would be far better employed building more hospital maternity accommodation and making extensions where necessary, using bricks and mortar instead of the £3 grant they envisage in this Bill. I ask that consideration should be given to the points I have raised, which are sincerely held in many local authority circles throughout Scotland.
§ 9.15 p.m.
§ Major Sydney Markham (Buckingham)
No one in the House this evening could have failed to notice the difference in temper and approach compared with that of yesterday or the greater part of last week. The House was then not at its best and it more than once attained notoriety as an example of how a democracy should not be run. Tonight, when we have all been addressing ourselves to human problems of first-rate importance, the speakers have been worth listening to, and I venture to predict that the amount of Press space allotted to our proceedings today will be less than that which was allotted even to a few minutes of what was talked about yesterday.
I have been very impressed with the quality of the speeches this evening, but there is one subject upon which I am not convinced. The argument has been advanced by several hon. Members opposite that there should be a deliberate move on the part of the Ministry to see that every mother approaching a confinement should be advised to go into hospital. Some said that 100 per cent. of all confinements should take place there.
§ Mr. Manuel
While it is possible that I gave that impression, I meant that the decision should be a voluntary one by the mother. I certainly did not mean that there should be a rigorous application of State control and that mothers should be told that they must remain at home or must go to hospital, although my whole inclination is that the mother should go to hospital.
§ Major Markham
I am very glad to have that explanation.
There is a good deal of difference of opinion here. The wish of certain hon. Members opposite including, I believe, the hon. Member for Kilmarnock (Mr. Ross), was that every woman approaching a confinement should be induced, persuaded or educated to the point where she would want to have her child born in hospital. I disagree with that point of view. I speak as the father of five.
§ Major Markham
I shall come to that in a moment. The first of my children was born in a maternity home, but my wife saw to it that the remaining four were born at home. Many women would far rather have their children born at home than go to the strange and, very often, unsympathetic surroundings of a hospital.
§ Major Markham
The position of Scotland has been mentioned. For half a century Scotland has been notorious for its high infant mortality rate. It once had the lowest rate in the British Empire, but it has lost that proud position. During 1942 I remember that no less eminent a person than Lord, then Sir John, Boyd Orr was invited to carry out a special inquiry into the high mortality rates in Scotland.
The subsequent report was one of the worst ever published, and since that date infantile mortality rates have not improved vis-a-vis those in certain counties in England. I represent part of a county in England which has the lowest infant mortality rate in the whole of the British Isles—Buckinghamshire. With Dorset, Hertfordshire and Wiltshire, we have had the lowest infant mortality rates for the last 50 years. In these counties fewer women seek to go into hospitals for the birth of their children than in any other area in Britain. In the whole of North Buckinghamshire there is not one maternity hospital.
§ Major Markham
Oh, yes. We have one of the largest railway factories in the whole country, at Wolverton.
2064 Educated opinion among the women of this country is that if things can be properly arranged at home it is far better to have the child at home than in hospital. We men speak under difficulties about this, and we would be wise to listen to our womenfolk. I can only quote my own wife's opinion, that the moment a woman is taken away from her home and put into hospital for her confinement she begins to worry about what is happening at home. That is a profound psychological disturbance at a time when she should not be psychologically disturbed, and I think the Government are wise to encourage as many women as possible to have their children in the natural conditions of the home.
§ Major Markham
If all women had husbands like me they might be worrying all day and all night.
Given certain conditions, to which I will refer in a moment, women would far rather have their children in their own homes, in conditions they have chosen, than go to hospital, which, after all, is a strange and foreign place with a new atmosphere. They are bound to worry about home conditions while in hospital.
§ Mrs. Cullen
I wonder how many one-apartment and two-apartment houses there are in the hon. Gentleman's constituency.
§ Major Markham
I promised that I would deal with that, and I will.
Perhaps I might, with modesty, mention that I have written on this subject with the greatest sincerity, and gone into the question of why the Scottish infant mortality rate was so high compared with the more favoured counties of Buckinghamshire, Dorset, Wiltshire, and Hertfordshire. There were certain basic conditions, one of which was housing. Do not let anyone assume that everything is lovely in the garden in Buckinghamshire. It is not. In the village of Wing there are some of the worst slum conditions in the whole country, with people living in former Air Force and Army huts, without proper damp courses, or weatherproofing; with conditions so "lousy" that we in Buckinghamshire are absolutely ashamed 2065 of them. We are doing our best to remedy these things, but it takes time.
I have seen conditions in Scotland for myself, in the great cities of Glasgow, Edinburgh and Perth, the like of which is not to be found anywhere else in the British Empire except in the native quarters of cities like Johannesburg. It is disgraceful. One of the best things done by the Government is the way in which they have speeded up the building of houses, in the whole of the British Isles. This is one of the ways of tackling the problem of infant mortality. These people must be rehoused, and we are tackling that problem realistically. But that is only one angle to the solution. I do not believe that the whole of this terrific problem of infant mortality in Scotland would entirely disappear if in the next three years every family could be rehoused. There are other factors.
One of those factors is the lack of education among the girls of Scotland in these important subjects compared with the education of girls in England. Here I do not speak from first-hand experience, but I quote from a very eminent Socialist, Lord Boyd Orr, in his Report on Infant Mortality in Scotland, in 1942, in which he said that one of the great causes of the high infant mortality rate in Scotland was the lack of domestic education amongst the young girls in Scotland, and he recommended that special methods of teaching be introduced into the schools in Scotland. That is a very important point.
But even given improvement in housing in Scotland and improvement in the education of the young girls in Scotland, there is still a third thing lacking in Scotland compared with the favoured counties of England, and that is the midwifery service. We cannot expect to have happy, comfortable, successful home confinements without a first-class midwifery service, and Scotland has not got that in comparison with what obtains in the most favoured districts of England. It is to that that attention should be directed. If such points as these were covered we should see a great reduction in the infant mortality rates of Scotland in the not too distant future.
It is not right to suggest that the best way of decreasing infant mortality rates in Scotland is to get every woman willy-nilly into a hospital for her confinement. 2066 The ideal place is the home, but with it there must go a good midwifery or medical service. Given that, we should see a vast improvement.
§ 9.26 p.m.
The Joint Under-Secretary of State for Scotland (Commander T. D. Galbraith)
I rise to give an assurance to the hon. Member for Central Ayrshire (Mr. Manuel). Before I do so I want to tell him that I listened with very great care to everything he said, but I could not help feeling that all his arguments had been fully answered in advance either by my right hon. Friend or by the Parliamentary Secretary.
§ Mr. Manuel
I listened most carefully to the Parliamentary Secretary, but he made no reference to housing conditions in Scotland. The gravamen of my case was the conditions resulting from the small houses in Scotland. The right hon. and gallant Gentleman cannot ride off on that.
In my opinion, every argument put forward by the hon. Member was fully answered in advance. As to the assurance, my right hon. Friend the Secretary of State was fully consulted on every point in connection with this matter as it might affect Scotland. The hon. Gentleman concluded his speech by saying that we were doing a bad thing. If we are doing a bad thing, let him take the only course open to him and go into the Lobby and vote against the Bill.
§ 9.27 p.m.
§ Mr. Malcolm MacMillan (Western Isles)
I do not see any reason for the Joint Under-Secretary's carping and crab-bit notes, especially when his hon. and gallant Friend the Member for Buckingham (Major Markham) has already given away the case so far as Scotland is concerned.
If we are to have an increase in home confinements which the poor are being tempted to bring about—the rich will not be tempted under this provision—we require a much better midwifery service than the one which has been described by an hon. Member opposite tonight. The hon. and gallant Member for Buckingham, who has taken a great interest in this matter as it affects Scotland, has condemned out of hand the very means 2067 and instrument with which the Government expect to carry out the policy embodied in the Bill. We have been told by him that the Scottish midwifery system is out of date and imperfect; and yet that is the service which will deal with those who are tempted by the £3 home confinement allowance.
I do not know what hon. Members opposite find funny about this. If they want another good joke, let them go back to the bar. This is a serious problem. I would remind the hon. Member for Devizes (Mr. Hollis), who pretends to have such a passionate interest at all times in the family and its welfare, that this is a serious matter affecting the mothers of the country at the most difficult time of their lives. I fail to see any reason for levity about it. However, the Bill itself is frivolous in that it offers the temptation of only £3 for the home confinement, and the other provisions in the Bill relating to benefits, partly cancelled by contributions, over increased periods rather trifle with the problem.
My hon. Friend the Member for Kilmarnock (Mr. Ross) made it clear that the problem is infinitely more difficult for Scottish mothers than it is for those on this side of the Border. That is not a Nationalist case or anything of that sort; everybody knows that the Scottish housing position is five or six times worse than that in England and Wales. Lord Boyd-Orr in his Reports was one of those who agreed with that. The Joint Under-Secretary of State will not dispute it, nor will the hon. and gallant Member for Buckingham, who has often brought that matter in past years to the attention of the House. Therefore, the position in Scotland is going to be infinitely worse, and we should have thought that the Secretary of State for Scotland, our Cabinet watchdog, and the Joint Undersecretaries, who do most of the barking for the right hon. Gentleman in this House, would have brought a greater influence to bear on the Minister of National Insurance about the special conditions in Scotland.
It is going to be quite impossible to act on the lines suggested in this Bill in an area like, for example, the Gorbals. My hon. Friend the Member for Gorbals (Mrs. Cullen) spoke with feeling and 2068 knowledge on this subject. To offer an inducement of £3 to a woman in the Gorbals is going to tempt her to her death in many cases and, after all, temptation is at its strongest where the need is greatest and where the housing conditions are the worst. I think this is a most dangerous thing to do.
This Bill may relieve the hospitals of some pressure, but it is putting that pressure on the local doctors, on the district nurse and on the members of the family who must all share in the worry and disturbance as well as the mother. I do not for one moment believe that £3 is going to cover the additional expense of a confinement at home, no matter what the Advisory Committee said. We have most of us had experience in our family of these things, and £3 does not go a long way nowadays.
The Parliamentary Secretary to the Ministry of National Insurance said that he accepted the views of the Advisory Committee without question and that he had not gone into the evidence on the question of the grants in detail. Nor, he added, did he want to. He had heard mentioned sums of as much as £10 and others as low as £2, and the Ministry had settled on £3. That was pretty near the lowest sum mentioned. At the same time he did seem wisely to have disregarded the Committee's recommendations when it came to a matter of the additional contributions. I wish he had abandoned their recommendation for the inadequate £3 and put his own interpretation, again more generously, upon what he thought ought to be given.
If this £3 is going to be looked upon as compensation for the additional expense of a confinement at home, then I say it is no use. It is putting temptation before the poorest people, because those whom it will tempt are the people most in need, and the people most in need are as a general rule the worst housed in the country. Those in the worst housing conditions are facing the greatest risk at childbirth.
I wish this Bill had not been brought forward in this form. We on this side of the House should not be supporting it too uncritically in its present form. I hope that in the Committee stage there will be radical alterations in it, and I hope that this party of ours, the T.U.C., 2069 despite its earlier support for certain parts of the Measure, and the National Council of Labour Women will come round to my view and be consistent with the past Labour Party advocacy that 100 per cent. of these confinements take place where all the specialist and institutional skill and treatment is available and where there is proper full-time skilled nursing for all these women regardless of financial needs.
§ Question put, and agreed to.
§ Bill accordingly read a Second time, and committed to a Standing Committee.