MEDICAL INSPECTION OF SCHOOL CHILDREN.

HL Deb 02 December 1908 vol 197 cc1394-407

VISCOUNT GALWAY

rose to call attention to the fact that no grant had yet been received by county councils towards the expenses incurred for the medical inspection of children. The noble Viscount said: My Lords, it may be thought that in alluding to the education question at the present moment I am raising a somewhat delicate matter, but I can assure the House and His Majesty's Government that it is not my intention to interfere in the slightest degree with a satisfactory settlement of this much discussed question if such a settlement can be arrived at. The point I wish to bring before your Lordships' notice is of a different character, and has reference to the cost thrown upon county councils for the medical inspection of children. The Act of l907 enacted that it was the duty of county councils to provide for the medical inspection of children immediately before, or at the time of, or as soon as possible after, admission to the public elementary school. Regulation No. 576 followed in November of that year, and in Paragraph 4 the respective duties of the Board of Education and the local education authority were clearly set out. That paragraph stated— The duties thrown upon the Board consist in advising the local education authorities as to the manner in which they should carry out the provisions of the Act, and in supervising the work they are called upon to do. The next paragraph stated that— The duty of carrying out the actual inspection has necessarily been entrusted by Parliament to local education authorities and not to the Board. Therefore it will be seen that the whole question of managing the medical inspection devolves upon the local education authorities. Further on, the Regulation stated that three inspections were advisable—one when the child entered the school, another about the middle of its school life, and again before it left school.

I should like to say that I have no wish to disparage the great value which the medical inspection of children may be to the nation, or to thwart its being properly carried out. My point is that these demands on the local education authorities seem to go on increasing. The form as to diseases, which has to be filled up in duplicate in regard to every scholar, throws enormous labour on the medical officers appointed to carry out this work and on the chief medical officer, and consequently adds to the cost to the ratepayers. The medical officer has to report on a variety of things, and it is also laid down that he shall report to the Board of Education if the] Schedules of the Board are not carried out faithfully. I may be wrong in my interpretation of the clause, but it reads as if the medical officer of the county council is to report to the Board of Education if their Schedules are not carried out. Surely the proper course would be for the Board of Education to make these inquiries through the proper channel—the clerk to the county council.

When the Act of 1907 was under discussion we were given to understand that county councils would get a substantial grant towards the extra charge which would be thrown on the rates, and a great many local education authorities hesitated to appoint officers under the Act until they knew what financial assistance they were likely to get from His Majesty's Government. As I have said, I do not wish to disparage the great value of this medical inspection, but it is of national, and not merely of local, importance, and it is, therefore, not unreasonable to hope that there will be a substantial contribution from the national Exchequer. I would ask His Majesty's Government to remember that every additional burden thrown on the ratepayers of the country is an additional burden also on the industries of the country, and thereby tends to the unemployment which we all so much regret at the present time.

There is one other point to which I should like to call attention. Section 10 of Regulation No. 576 says— The directions given in this circular as to the degree and frequency of inspection refer only to minimum medical inspection, the effectiveness of which will in future be one of the elements to be considered in determining the efficiency of each school as a grant-aided school. I venture to think that if, when these medical inspection clauses were before Parliament, it had been clearly stated that medical inspection of children was going to be made one of the points on which the efficiency grant would depend, the medical inspection clauses would not have passed as they did. In this case we have another illustration of the Board making regulations beyond what Parliament ever contemplated or intended. It is not the first time we have had to complain of this, and I hope the tendency will diminish in the future. The question of medical inspection should be kept entirely separate from the education demands of the Board of Education, and it should not be allowed in any way to affect the efficiency grant. I hope His Majesty's Government will be able to give the House a distinct assurance on both of the points I have raised.

LORD BELPER

My Lords, before the noble Earl replies, I should like to say a few words, not only to support what my noble friend has said, but also to point out what the exact position is with regard to the financial promises made on the subject of medical inspection. This matter, which is of the utmost importance to county councils, has been taken up by the County Councils Association, and there has been more than one deputation to the Minister in charge of the Board of Education. A very strong deputation from the County Councils Association waited upon Mr. McKenna in February last, and put before him the claims of county councils that medical inspection should be recognised as a national matter and that a grant should be made towards it. They pointed out how unfortunate it would be if, through the constant increase of the rates, the ratepayers got to dislike education, and as far as they could, refused to allow their representatives to spend extra money, especially on higher education. Mr. McKenna informed the deputation that he entirely sympathised with the view put before him. He said that medical inspection should be looked upon as part of the general charge for education, but he agreed that there was considerable ground for the View that the local education authorities should receive some grant from the Exchequer. He went on to say that he did not propose that that grant should be earmarked, but that a new grant should be given that would do far more than meet the cost of the additional requirements of the. Bill. He added that it would be possible for the deputation to meet their ratepayers with a substantial reduction in the rates. That was a promise of a substantial grant, not only to cover present charges for education, but to allow also a reasonable sum in addition for medical inspection.

That sounded very satisfactory, but, when they looked into the figures the County Councils Association came to the conclusion, not only that there would be no grant for medical inspection at all, but that the grants that were going to be given would not be sufficient to cover the services of the Bill, and that, so far from being better off, the majority of the county councils would be worse off than at present. A deputation from the Association waited upon Mr. Runciman, who was then Minister for Education, and laid the figures before him. Mr. Runciman made certain criticisms regarding the figures. No doubt the figures were open to criticism, because they had been prepared by different counties, and were not, of course, on precisely the same lines. When those criticisms were made we at once offered to have new figures drawn up on the one basis, and to submit them to the Board of Education, whose officials could go thoroughly into them with the officials of the County Councils Association to see whether they might be taken as fairly representing the charges that would be thrown by the Bill on the county councils. Those figures were got out and submitted to the Board of Education, who were more than once asked to allow their officials to go into them. I regret to say that they did not see their way to examine the figures or to discuss them in any way; but the effect of those figures, which I contend are now unchallenged, is that upon every county council appearing in the list. I have in my hand a considerable extra charge will be thrown. That varies in a very marked degree. The extra charge placed upon my own county if these figures are correct, and they have not been disputed, would be something over £12,000 a year, or an extra rate beyond that now being paid of something like 3d. in the £, that is a 40 per cent. increase on the rates raised for education. It is natural, therefore, that we should feel very great anxiety as to whether we are to receive assistance towards the expenses incurred for medical inspection.

I do not wish to discuss matters which are before the other House and which will be contained in the Bill now under discussion there; but as Mr. McKenna said that the grant for medical inspection must be included in the general grant given by the Government, it is absolutely necessary to see whether that grant is sufficient, not only for the purposes for which it is intended, but also to meet the charge for medical inspection. That is the position in which we now stand, and I think we have a right to press for an assurance in some form or another that a reasonable grant will be given towards the cost of medical inspection, which admittedly should be largely a national charge. My noble friend has referred to the fact that we are threatened with the loss of the education grants if we do not carry out medical inspection efficiently. We have every wish to carry out this work, but while the Government holds its hand it is difficult to persuade the ratepayers to put their hands into their pockets and find money for the purpose.

There is another Circular—No. 596— to which my noble friend did not allude. It covers nine pages, and contains not only regulations with regard to medical inspection, but an immense clause—no other word can be used—setting out what the annual report upon medical inspection is to contain. It goes in the greatest detail into every possible consideration that a medical officer ought to have in view. I need only quote one short subsection. An account is asked for of the methods of inspection adopted, including— General review of the relation of home circumstances and social and industrial conditions to the health and physical condition of the children inspected, so far as facts bearing on this point have come under notice. If you take that literally, it is a report on the home life and the health of every child in every school in the county. I do not desire in the least to criticise the Report asked for. I understand from those who have the technical knowledge that it is an admirable Memorandum for the purpose with a view to what may perhaps eventually be carried out, but that it is quite impossible at the present time that the Report can go into the vast number of matters mentioned. I am informed that it is not expected that county councils should make the reports in this detail in the earlier days. Indeed, the Board of Education seem to have been satisfied of the impossibility themselves, because they say— As regards the scope of the Report, however, the Board consider that it is desirable that it should deal with the whole subject of school hygiene, and should cover as much as possible of the ground indicated under the following heads. It is recognised that these heads suggest a degree of comprehensiveness which in many, and indeed in most, cases will not be immediately attainable. That qualification points out that in a great number of these matters we are not to act at once. I hope an assurance will be given that no undue severity will be used against county councils in their endeavour to carry out the requirement as to these Reports. I am sure that the work will be better done if efficiency is reached by slow degrees rather than by attempting all that may be obtainable in the future at the first moment. If there is any dissatisfaction with the heavy cost of education, the higher and scientific education, which is of the utmost importance to the country, will be certain to suffer. I have ventured to make these remarks not in any spirit of hostility. This is not a political matter in any sense, and I cordially agree with my noble friend Viscount Galway in hoping that we shall see the Bill now being discussed in the other House brought to a satisfactory issue. But, in the meanwhile, the question of finance is a most urging and pressing one, and I therefore think that this is not an inopportune moment to bring this matter to the notice of His Majesty's Government.

THE LORD PRIVY SEAL AND SECRETARY OF STATE FOR THE COLONIES (The EARL OF CREWE)

My Lords, I have been asked to reply to the question of the noble Viscount opposite and I make no complaint whatever either of his speech or of that of the noble Lord who has just sat down. At the same time, as I shall be able to show, and as I think the noble Lord himself is aware, there are circumstances connected with the discussion in another place which make it difficult to deal quite fully with the matter this afternoon.

As the noble Viscount said, the duty of medical inspection is thrown upon the local education authority by Section 13 of the Administrative Provisions Act, which we passed with great unanimity of feeling last year. The noble Viscount seemed to me rather to belong to the school which regarded this not so much as a matter of education as of public health, and I believe there have been all through people who thought that this burden never ought to have been placed on the education rate at all, and that the duty ought, in some form or another, to have been placed on the public health authority. However that may be, and I confess I do not agree with that view, in any case it would have caused great administrative inconvenience in the counties, because there, as we all know, the health authority is not the same as the education authority, and you would have started dual control of a very inconvenient kind. I might point out in addition that even before the Act of 1902 a good deal of very effective medical inspection had been carried out by school boards, and it was generally considered that it was rather a matter for the education authority than for the public health authority; that being so, it is clear that in the first instance, whatever may be done afterwards, the cost must fall on the education rate.

During the current year, as I understand, there has been a considerable outcry on the part of local authorities at the prospect of this expenditure falling upon the rates, and the whole matter has to be considered in connection with what has been said as to increased grants on behalf of the Board of Education by the former President. Your lordships will remember that early in this year—I think it was in March— Mr. McKenna issued a White Paper explaining the financial proposals of the Education Bill of 1908. The general effect was that the seven, I think they are, different kinds of grants now given to schools should be amalgamated, and only a single grant given. Mr. McKenna, made it quite clear, when he was approached by deputations on the question of this medical inspection, that if help was to be given from central funds for that purpose it must be given in the general grant, and that it was not the intention of the Government to start a special grant for that purpose. Indeed, I think it stands to reason that the moment at which you are doing away with the multiplied grants would be an unfortunate moment at which to start a new and separate grant distinct from the general grant.

Then, as your Lordships are aware, the Education Bill came to a pause, and in those circumstances the outcry of the local authorities naturally increased. The financial proposals were part of Mr. McKenna's Bill, and it seemed as though, if that Bill did not go through, the financial proposals would not go through either. Since then, however, as your Lordships all know, the situation has changed, and the financial proposals equally form part of the present Bill; and it is this fact which makes it difficult for me to enter into any financial details on the present occasion. I understand that the clause which embodies them will be considered, according to the allotment of business in another place, on Monday next, when the whole of this matter will be argued out. Therefore, I think noble Lords will see that it would be impossible for me to enter to-day into any detail with regard to the proposed grant. When Mr. Runciman's statement has been made it will be clearly open to the noble Viscount or the noble Lord to reopen the matter at any time on the question of the inadequacy of the grant to meet this particular charge. It is generally admitted—I think the Board of Education fully admit it—that this medical inspection, if properly carried out, must involve a new burden on the local authorities; but many of the figures quoted on the subject have been undoubtedly greatly exaggerated. The noble Lord mentioned, I think, the figure of £12,000 for Nottinghamshire—or was it £18,000?

LORD BELPER

The figure was £12,000. But that is not for medical inspection. Medical inspection was mixed up by Mr. McKenna with the whole of the grants. He said that the total grant would be more than enough to meet the expenditure and leave a great deal to spare. We say that we shall get £12,000 less in Nottinghamshire.

THE EARL OF CREWE

I am glad to hear the noble Lord's explanation. I understood him to say that the amount chargeable in respect of medical inspection in Nottinghamshire would be £12,000 a year, which seemed to me a rather fanciful estimate. Although I can quite understand the anxiety of the county councils upon it, the matter is not actually an urgent one, because the amount expended anywhere in respect of the present financial year can only be very small. Very few, I think, of the local authorities got to work much before the middle of this year, and therefore the whole matter will be settled, we assume, by the new grant, whether noble Lords think it adequate or not, in the next financial proposals. The matter consequently is not, in point of cash, so immediately urgent as might have been supposed from the speeches of the noble Lords. On the question of exaggeration, a deputation from a great county borough which waited upon the Board of Education said medical inspection there would cost 2s. 9d. per child; but when they undertook it on a larger scale than was supposed to be covered by that sum the cost was somewhere between 6d. and 1s. Therefore I think we may venture to hope that some of the fears of local authorities as to the charges which are likely to be made under this head are somewhat groundless.

LORD BELPER

The cost of medical inspection, taken in the whole of the counties, is 1s. per child. That is for next year.

THE EARL OF CREWE

It is worked out for next year at 1s. per child?

LORD BELPER

Yes.

THE EARL OF CREWE

Exactly. The estimate that is made for the whole country is a farthing rate. It is perfectly true that in some districts the charge may be relatively higher than in other places. I am afraid that is all I can say, because it is quite clear that we cannot, in the present position of the Bill in another place, discuss anything in the nature of actual figures. But I can assure the noble Viscount that the Board of Education are fully aware of the importance of this subject, and they do recognise the fact that a very substantial charge must be placed upon local authorities by the Act of last year. I do not entirely follow the complaint of the noble Viscount as to the effect of this being regarded as a test of the efficiency of the school. If the noble Viscount looks at the Act he will see that, under subsection (1) of Section 3, it is the duty of the local authority to provide for the medical inspection of children under the conditions which the noble Viscount read. Well, if it is a duty and that duty is neglected, the Board of Education, I should have thought, could only show its sense of the fact that the duty had been neglected in the manner of which the noble Viscount complains. We cannot regard the whole business as being distinct from education for the reasons I have stated; and, that being so, it seems to me that the Board of Education is entirely justified in taking the view which the noble Viscount thinks an unreasonable one. I have nothing to add, beyond assuring noble Lords once more that the Board of Education is fully aware of the position, and that in considering the amount of the grant this question of medical inspection will be borne in mind.

VISCOUNT MIDLETON

My Lords, nobody will doubt the sympathetic tone with which the noble Earl has just spoken, but the fact that he has to defer to a future day anything beyond an academic expression of sympathy is not at all encouraging, and my noble friend Viscount Galway can hardly be expected to let the matter drop with any feeling of complacency and satisfaction. I do not know whether it is of any use; but I have, on one or two occasions, ventured to invite the attention of the House to the extraordinary anomaly of placing additional charges on local authorities without any previous consideration having been given as to how they are to be met. I speak with some feeling on this subject, because within the last few weeks the London County Council have had to pass a very large vote for an increase of staff, I think even for this year, amounting to something like £10,000, in order to begin to carry out this very heavy, though probably very desirable, duty. I ask your Lordships to consider the very different manner in which the public exchequer is protected as compared with the local exchequer. A Bill which even takes a ten-pound note out of the public exchequer has to be brought in in Committee of Supply; those provisions which involve a charge on the exchequer have to be specially underlined, and the House of Commons considers that point before it proceeds to the general consideration of the Bill. But when a measure is proposed which lays a considerable charge on local authorities it very often slips through Parliament without consideration, or, at all events, without the smallest estimate being asked for as to whether the charge is to amount to a 1d. rate, a 2d. rate, or a much higher rate. The House should bear in mind the enormous indebtedness of the local authorities, and the great pressure already existing on the rates. Some policy should be adopted of bringing these measures forward in a special manner before the notice of Parliament, and they should not be allowed to pass without being referred to a special Committee with orders to report as to the likely incidence of the charge. The medical inspection of school children, especially in view of the statistics which have been laid before us, is a matter of national moment and probably a national necessity; obviously, therefore, it should be a national and not a local charge. I did not rise to do more than throw out the suggestion I have made.

LORD CLIFFORD OF CHUDLEIGH

My Lords, I shall not detain the House for more than a minute, but I rise to reply to the statement of the noble Earl the Leader of the House that he could not understand our particular grievance in objecting to the Board of Education taking neglect on the part of the local education authority to have a proper system of medical inspection as a test of the efficiency of the school. The noble Earl said the duty is cast on the local education authority to do this, and therefore it is quite proper that the grant given to them should be stopped if they fail in their duty. But our grievance is this, that this duty was cast upon us because it was the most convenient way of having medical in- spection carried out. It was admitted on all hands that the object of the inspection was not purely educational, but partly national; therefore, it was something quite distinct from anything which the local education authorities ever thought to be part of their duty in providing educational instruction in the schools. The grants which have up to this point been given have been awarded invariably for educational work done in the schools or for the educational efficiency of the buildings themselves, and it is very hard that neglect of this new duty cast upon local education authorities should be met by taking off a grant which was given for a totally different purpose. We entirely deny that medical inspection is a form of education; it is a duty cast upon us for the national good, and we maintain that the National Exchequer should assist us, and that the Department should not adopt the expedient of cutting off grants for which services have been already rendered.

VISCOUNT GALWAY

My Lords, although we have not obtained quite as satisfactory an answer from the noble Earl as we should have wished, we at any rate have the admission that this work of medical inspection does demand some contribution from the National Exchequer. As to stopping the grant in respect of the efficiency of the school, I should like to have had some assurance that in the present transition stage there will be no question of withdrawing the grant from county councils, at any rate for another year, while they are appointing inspectors to carry out this work.

THE CHANCELLOR OF THE DUCHY (Lord FITZMAURICE)

My Lords, the question which the noble Viscount opposite has brought before the House, and in regard to which he has received the support of my noble friend who is chairman of the County Councils Association, is undoubtedly one worthy of the attention of Parliament; but the Government feel that owing to the course of business, especially in regard to education, they are not in a position to make a statement in every way as satisfactory as could be wished. Naturally, it was our hope that the financial proposals which were an integral part of the educational proposals of the Government might, with others, have received the sanction of Parliament, and in that case the matter, even if it had been urgent, still would not have been as urgent as undoubtedly it is at the present moment in the eyes of local education authorities. I certainly can say that, in regard to the policy of the immediate future, the Board of Education will bear in mind the financial complications of this matter. At the same time, we feel that physical training, of which medical inspection is really at the root, is a matter of great urgency and importance, in some ways as important almost as education itself. Indeed, the two things are so closely connected from a scientific point of view that it is not necessary for me to labour that point. I think this particular question has also been unfortunate in that it has arrived in the world of local finance at the same time as other questions which have not been the result of the policy of the Government or of any desire on the part of the local authorities themselves to spend more money upon what may be called ancient services, but which have been entirely due to causes beyond the control of Parliament and the local authorities. I refer to such matters as the greatly increased cost of the upkeep of roads and highways. This additional expenditure, coming simultaneously with the increase in educational charges, has exasperated the local authorities, and I could only wish that the whole situation was more under the control of the Government than it is. But, clearly, the great increase in the cost of the upkeep of our roads through motor and similar traffic is not a matter for which the Government has any responsibility. I am afraid that what I am saving is rather cold comfort; but noble Lords opposite know that, as a former chairman of a county council, I am entirely in sympathy with them, and I can assure them that in regard to the immediate future the Board of Education will do its best to recognise the difficulties of local education authorities in the matter.