HL Deb 26 July 1910 vol 6 cc434-60

Order of the Day for the House to be put into Committee, read.

Moved, That the House do now resolve itself into Committee.—(Earl Beauchamp.)

On Question, Motion agreed to.

House in Committee accordingly.

[Lord BALFOUR of BURLEIGH in the Chair.]

Clause 1:

Central Midwives Board.

1.—(1) As from such day as the Lord President of the Council may fix, the Central Midwives Board shall consist of—

  1. (a) two persons (one of whom shall be a woman) to be appointed by the Lord President of the Council, and one person to he appointed by the Local Government Board;
  2. (b) four duly qualified medical practitioners, one to be appointed by the Royal College of Physicians of London, one by the Royal College of Surgeons of England, one by the Society of Apothecaries of London, and one by the British Medical Association;
  3. (c) two certified midwives to he appointed, one by the Incorporated Midwives Institute, and one by the Royal British Nurses Association;
  4. (d) four persons to he appointed, one by the County Councils Association, one by the Association of Municipal Corporations, one by the Society of Medical Officers of Health, and one by the Queen Victoria's Jubilee Institute of Nurses.

The term of office of a medical practitioner appointed under paragraph (b) shall be one year; in the case of other members the term of office shall be three years. A member retiring at the expiration of his term of office shall be eligible for reappointment. Any vacancy occurring by the retirement, death, or resignation of a member shall be filled by a member appointed by the person or body by whom the member so retiring, dying, or resigning was appointed. The Board may act notwithstanding a vacancy in their number.

(2) Section three of the Midwives Act, 1902 (hereinafter referred to as the principal Act), shall have effect as if the foregoing provisions were substituted for so much of that section as is repealed by this Act.

(3) Nothing in this section shall affect the tenure of office of any member of the Central Midwives Board who holds office at the day so fixed, except that the members who then hold office as representatives of the Incorporated Midwives Institute and the Royal British Nurses Association shall cease to hold office.

LORD AMPTHILL moved to amend paragraph (c) by omitting the words "certified midwives" in order to insert "persons, one a midwife." The noble Lord said: The object of this Amendment is to give two representatives to the Incorporated Midwives Institute and to preserve to them their representation by a medical practitioner which they have found very convenient and valuable in the past. I must say that it seems to me rather shabby to give the Midwives Institute only one representative when you see how little representation of midwives there is on the Board. There are very good reasons, 1 think, for giving them at any rate two representatives. The Midwives Institute is the only incorporated body representa- tive of all the practising midwives in the country, who number at least 15.000, I believe. It was that association which raised the large fund necessary for carrying the Midwives Act of 1902, a measure which is now fully recognised to be one of great public utility. It meant a considerable amount of effort. It took twelve years to get that Act passed and there was all the labour connected with six successive Bills. The Incorporated Midwives Institute have, therefore, good reason to claim that they speak for the practising midwives in the country; and, indeed, there is no other association which can claim to represent the midwives in the same way. I do not know why it is necessary to restrict them to only one representative, and the effect of doing so is to make the unlucky number thirteen the number of the Board. I hope, therefore, that the noble Earl will be willing to make this small concession, more particularly as past experience has shown that it is very convenient that midwives should have a medical practitioner to speak for them. The noble Earl has strengthened the medical representation on the Board, and I do not think it need be argued that it is easier for a man and a doctor to hold his own against the eminent physicians who will be on the Board than it would be for a midwife.

Amendment moved— Page 1, line 17, leave out ("certified midwives") and insert ("persons, one a midwife"), and leave out ("one").—(Lord Ampthill.)


Your Lordships will see that this is a Bill for amending the Midwives Act and in order to strengthen the Central Midwives Board. With that in view it was naturally thought by those who were concerned in this Bill that it was very desirable that we should have midwives upon the central body itself. We think we have now reached a stage in the development of the Act when we can count upon midwives whose services on the Board would be of great value. Your Lordships must agree that prima facie there is good reason for putting midwives upon a board which is concerned with the everyday work and duty of midwives throughout the country. That is the first reason why I hope your Lordships will allow this to stand as it is at present. I admit it is quite possible that a doctor would be able also to help the midwives in any case which might come before the Midwives Board if he was there as a representative of the Incorporated Midwives Institute. But, as I think I told your Lordships on the Second Reading, in the case of mixed bodies one can only arrive at their constitution after a good deal of balancing of the various interests, and any alteration is apt to disturb the balance. However, I am not particularly wedded to the form as it appears in the Bill at the present time, and if any considerable number of your Lordships express a. desire to see the first Amendment which the noble Lord opposite has moved adopted, I shall not enter ally strong objection to it. But at the same time I wish to make it quite clear that if this Amendment is agreed to I should only agree to it as an expression of opinion from more than one noble Lord. I should like to be certain that there are several members of your Lordships' House who think that this Amendment is desirable before we agree to it, because the present scheme is the outcome of much consideration and ought not to be disturbed without good reason. The second Amendment standing in the name of the noble Lord is that the Royal British Nurses Association should be represented by anybody other than a certificated midwife. I should oppose that. As I said before, we want midwives upon this Board, and the Royal British Nurses Association would be able to send us a. certificated midwife whose services would be of real value. Therefore, though I should like to express once more a preference for the scheme in the Bill, yet if there is a decided expression in your Lordships' House in favour of adding one member to the Board as representative of the Incorporated Midwives Institute I should be willing to agree to that Amendment.


My Lords, I think it is only fair to point out that this Amendment:, after all, is only permissive. It does not prevent the Incorporated Midwives Institute appointing two midwives if they think that they are the two best people they could appoint. On the other hand, it does give them latitude in the case of one of their appointments. If they have a member of the medical profession or anybody else whom they think specially fitted for the business, they are able to appoint him. I should think that this greater elasticity would be bound in the end to work to the advantage of the present proposal. As the noble Earl asked if anybody was prepared to support the Amendment which my noble friend has moved, I may say that I certainly came down to the House with the object of supporting it; and I notice that the form in which my noble friend moves this proposal is the form in which it recommends itself to the Royal British Nurses Association. They. after all, have had considerable experience in this matter, and I hope their opinion will weigh with Your Lordships.


My Lords, I rise to endorse what has been said by Lord Ampthill in moving this Amendment. I think it would be of material assistance that latitude should be given to enable this body to appoint to the Board a person with some special experience.


After what has been said I should be willing to agree to the extent I have mentioned with the noble Lord opposite.

On Question, Amendment agreed to.

Consequential Amendment agreed to.

LORD AMPTHILL moved another Amendment to the subsection to give to the Royal British Nurses Association the option of appointing on the Board a representative other than a certified midwife. The noble Lord said: I am sorry the noble Earl seemed to make it a condition of his acceptance of the first part of the Amendment, for which I am very much obliged to him, that the second part should not be pressed; but I had no opportunity of assenting to that arrangement, and I am afraid I must press this second Amendment. It is very much desired, and, as my noble friend Lord Donoughmore pointed out, it is permissive; and it seems to me to be very desirable that there should be a certain amount of latitude and elasticity in this arrangement. By the Amendment already accepted the noble Earl will have one midwife anyhow on the council.

Amendment moved— Page 1, line 18, after ("one") insert ("person"). —(Lord Ampthill.)


My Lords, I have received a letter from a lady doctor in which she says that the one thing they arc keen about is to substitute the word "person" for that of "midwife" as their representative on the Board. She adds— It is far better for us to have a physician and not a midwife as our representative.


My Lords, I rise to support the Amendment on behalf of the Royal British Nurses Association, the body principally concerned by this Amendment. As the Bill now stands they are given one representative on the Board who must be a midwife. The Royal British Nurses Association desire to have the option of appointing such person as they may think their best representative for the time being. There is no suggestion that they would not appoint a midwife. They might appoint a midwife if they considered that their interests would be best represented by a midwife. But upon the Council of the Royal British Nurses Association there are thirty doctors, thirty matrons, and thirty nurses, and the whole society is composed of these elements. They do not, therefore, want to be confined solely to midwives as their representatives. This body is probably the largest and most important nursing association in the kingdom. It is the only body of its kind which has a Royal Charier, and they feel that they are a body quite competent to choose their best representative, and that in many cases they may not be able to find a midwife free and able to

Amendment agreed to accordingly.

act for them on this Board. They therefore attach the greatest possible importance to this Amendment, and I shall certainly support my noble friend in pressing it.


I am afraid I can only repeat my unwillingness to agree to this Amendment. Here is a Board which you want to deal with midwives. I have agreed already to one Amendment suggested by the noble Lord opposite, adding a doctor on behalf of the Incorporated Midwives Institute. You now have a body of fourteen. It is not unreasonable, I think, to suggest that in these circumstances two out of the fourteen should be midwives. We quite realise the work which is accomplished by the Royal British Nurses Association. We know they include among their members a large number of midwives who would be admirably fitted to serve on this Board. We need midwives upon it, we think the Royal British Nurses Association able to send us a good midwife, and in these circum stances I must insist on the clause as it stands.

On Question?

Their Lordships divided: Contents, 32; Not-contents, 26.

Ailesbury, M. Churchill, V. Ellenborough, L.
Goschen, V. Hindlip, L.
Cawdor, E. Hood, V. Inverclyde, L.
Doncaster, E. (D. Buccleuch and Queensherry.) Hutcliinson,V. (B. Donoughmore.) Kenlis, L. (M. Headfort.)
Knaresborough, L.
Halsbury, E. Abinger, L. Lawrence, L.
Lytton, E. [Teller.] Ampthill, L. [Teller.] Leith of Fyvie, L.
Mar, E. Balfour, L. Ravensworth, L.
Morley, E. Belhaven and Stenton, L. Shute, L. (V. Barrington.)
Vane, E. (M. Londonderry.) Clanwilliam, L. (E. Clanwilliam.) Silchester, L. (E. Longford.)
Waldegrave, E. Colchester, L. Sinclair, L.
Westmeath, E. Desborough, L.
Loreburn, L. (L. Chancellor.) Courtney of Penwith, L. MacDonnell, L.
Beauchamp, E. (L. President.) Devonport, L. Northcote, L.
Furness, L. Oranmore and Browne, L.
Carrington, E. Hamilton of Dalzell, L. Pirrie, L.
Liverpool, E. [Teller.] Hemphill, L. Shaw, L.
Mayo, E. Herschell, L. [Teller.] Shuttleworth, L.
Ilkeston, L. Stanley of Alderley, L. (L. Sheffield.)
Airedale, L. James, L.
Blyth, L. Langford, L. Weardale, L.
Clonbrock, L. Lochee, L.

Clause 1, as amended, agreed to.

Clauses 2 and 3 agreed to.

Clause 4:

Amendment of section seven of principal Act as to evidence.

4. The following paragraph shall be added to section seven of the principal Act:— A certificate under the hand of the Secretary of the Board that the name of a woman whose name appears in the roll of midwives has been removed from the roll shall be evidence that such woman is not certified under this Act.


Your Lordships will see that these Amendments to Clause 4 are purely of a drafting character to make the meaning of the clause more clear.

Amendments moved—

Page 3, line 20, after the second ("roll ") insert ("and of the date of such removal")

Page 3, line 22, after ("Act") insert ("and of" the date as from which she ceased to be so "certified")—(Earl Beauchamp.)

On Question, Amendments agreed to.

Clause 4, as amended, agreed to.

Clauses 5 and 6 agreed to.

Clause 7:

Previsions as to Midwives.

7. Every certified midwife shall on or before the thirty-first of March in each year send to the Central Midwives Board on a form to be supplied by the Board for the purpose her name and address, together with a fee of one shilling, and if any certified midwife in any year fails to comply with this requirement her name shall be removed from the roll and thereupon her certificate shall be deemed to he cancelled; but where her name has been so removed on account of such non compliance she shall at any subsequent time be entitled to have her name restored to the roll and the cancellation of her certificate rescinded on the payment of a fee not exceeding five shillings.


I move to leave out "March" and to insert "January." January is the date selected as that upon which a certified nurse gives notice to the local supervising authority if she intends to act as a midwife, and it would seem much more convenient and less likely to lead to confusion if the same date were selected to give notice also to the Central Midwives Board. I hope, therefore, the noble Earl will be able to give us his assistance in this matter.

Amendment moved — Page 3, line 32, leave out ("March") and insert ("January").—(Viscount Goschen.)


It is very kind of the noble Viscount to appeal to me for my assistance. I do not think it makes any difference. But I have no objection to offer to this Amendment.

On Question, Amendment agreed to.

LORD LAWRENCE proposed as an Amendment to Clause 7 that applications by certified midwives to have their names kept on the roll should be sent, not to "the Central Midwives Board," but to "the local supervising authority." The noble Lord said: This Amendment, which has the support of the County Councils Association, would have been moved by Lord Belper had he been able to be present this evening. In his absence the Amendment has been placed in my hands, but. I must confess that. I know little about its merits. I hope, however, that the noble Earl will be willing to accept it.

Amendment moved— Page 3, line 32, leave out ("Central Midwives Board") and insert ("local supervising authority"). —(Lord Lawrence.)


I think your Lordships will recognise that there is a real practical inconvenience suggested in the Amendment. If you turn to Clause 7 you will see that the obligation suggested is that the certified midwife should send to the Central Midwives Board. The object is to keep the roll clean and up to date. The roll is in the charge of the Central Midwives Board, and surely it would be most inconvenient if the midwife were to write to a local authority which had not got the roll in its charge. The Central Midwives Board is the body whose duty it is to keep the roll in order, and it would be a matter of great inconvenience if nurses were to send to authorities not responsible in any way for the roll. The scheme as proposed in the Bill is far more convenient than the somewhat roundabout method suggested in the Amendment.

Amendment, by leave, withdrawn.

Clause 7, as amended, agreed to.

Clauses 8 to 10 agreed to.

Clause 11:

Notification of Practice.

11.—(1) Where a woman certified under the principal Act, who has not given to the local supervising authority such a notice as is mentioned in section ten of the principal Act attends any woman in child-birth in any capacity other than that of midwife, and a duly qualified medical practitioner is not present at the time of the birth, she shall, with in forty eight hours from the birth, give to the local supervising authority notice in writing of the fact that she so attended, and if she omits to do so shall be liable on summary conviction to a fine not exceeding five pounds, but nothing in this section shall be construed as exempting any woman practising as a midwife, or holding herself out as so practising, from the obligation to give any notice which, under section ten of the principal Act, she is required to give.

(2) Where a woman certified under the principal Act has given a notice in compliance with section ten of that Act and subsequently changes her address, she shall, within seven days after such change, give notice of the change to every local supervising authority to which she had previously given notice under that section, and if she omits to do so shall, on summary conviction, be liable to a fine not exceeding two pounds.

EARL BEAUCHAMP moved, after the word "Act" ["who has not given to the local supervising authority such a notice as is mentioned in section ten of the principal Act"] at the commencement of the clause; to insert the words "or a woman not so certified." The noble Earl said: This clause is really founded upon Section 93 in the Report of the Departmental Committee. The real fear was this, that monthly nurses and so on who are not certified midwives would act nominally under a doctor, but that the doctor might not be present at the moment, and that some danger might accrue to the mother in those circumstances. We thought it desirable to make the Central Midwives Board acquainted with the fact if it became a habit in any district. The method, I admit, is clumsy, but there is no other way of doing it. Naturally the Midwives Board would take no notice if it happened occasionally; but if there was a sign of its becoming a habit they would be able to take such steps as might seem necessary. The objection which has been stated to me privately is that as the Bill stands at the present moment it does throw a certain amount of duty upon the certificated midwife which would rather act unfairly towards her and might make her employment, perhaps not so popular. For that reason I have put down this Amendment, which I think would put all nurses upon the same footing and therefore give the certificated midwife an equal opportunity with others. I hope that will meet the view of the noble Viscount, Lord Goschen, who has given notice to move the deletion altogether of subsection (1).

Amendment moved— Page 5, line 8, after ("Act") insert ("or a woman not so certified.")—(Earl Beauchamp.)


My objections to this subsection are quite met, by the noble Earl's Amendment.

On Question, Amendment agreed to.

Clause 11, as amended, agreed to.

Clause 12:

Reciprocal Treatment of Midwives certified in other parts of His Majesty's Dominions.

12.—(l) Any woman who produces to the Central Midwives Board satisfactory evidence that she has been trained as a midwife and certified in any other part of His Majesty's dominions in which there is for the time being in force any Act or ordinance for the certification and registration of midwives under a public authority, and which admits to its register midwives certified under the principal Act on reciprocal terms, shall on payment of the like fee as is payable in ordinary cases be entitled to be certified under the principal Act; provided that the standard of training and examination required in such other part of His Majesty's dominions is equivalent to the standard adopted by the Board.

(2) If any question arises under this section as to the right of a woman to be certified under the principal Act the question shall be determined by the Privy Council,


This is an Amendment which 1 put down in order to meet the case as it was mentioned on Second Reading by noble Lords from Ireland. I think we agreed on that occasion that although it was impossible in this Bill to deal with the general scheme in Ireland, it was possible to deal with the grievance as it affects individuals; and I hope I have done that to a greater extent than in the Amendment which is suggested by the noble Lord, Lord Clonbrock.

Amendment moved—

Page 5, line 37, after ("evidence") insert ("either—" (a)")

Page 5, line 42, after ("terms") insert ("or

"(b) that she is qualified to be appointed as a "midwife by a Board of Guardians in Ireland "under any regulations of the Local Government "Board for Ireland for the time being in force").—(Earl Beauchamp.)


I wish to say that I quite concur with the noble Earl, and if the present Amendment meets with the approval of your Lordships I shall be prepared to withdraw my Amendment. As to the general question of the inclusion of Ireland in the Bill, I stated on Second Reading, that it was very much desired by people well qualified to judge in Ireland, and that. I therefore had the intention of moving Amendments to include Ireland in the provisions of the Bill as it stands. But it has since been intimated to me that there are great difficulties in the way of doing that owing to the difference of the Poor-law system in England and Ireland as regards nurses and medical officers. I have also been informed that the Government are inclined to bring in a special Bill for Ireland next year embodying the provisions of this Bill. I very much hope that is the case, and I trust that the noble Earl will definitely announce that this is the intention of His Majesty's Government. I know that people whose opinion is most valuable in Ireland are very much in favour of this Bill in the interests of the public health, and would welcome an announcement that a Bill of the same character will be introduced for Ireland.

On Question, Amendment agreed to.

Amendment moved— Page line 4, after ("dominions") insert ("or, "as the case may he, under such regulations of the "Local Government Board for Ireland as afore" said."—(Earl Beauchamp.)

On Question, Amendment agreed to.

Clause 12, as amended, agreed to.

*LORD CLONBROCK had given notice to move the insertion of the following new clause— 13. Any woman who holds a certificate in midwifery granted to her from the Royal College of Physicians of Ireland, or the Coombe Lying-in Hospital and Guinness's Dispensary, or the Rotunda Hospital for the Relief of the Poor Lying-in Women of Dublin, or from such other training authority as may be approved by the Central Midwives Board, stating that she has been trained as a midwife and certified in Ireland, and who claims to be certified under the principal Act, shall be so certified.

The noble Lord said: I do not now intend to move my Amendment. But T. hope the noble Earl will tell us whether it is the intention of His Majesty's Government to introduce a Bill for Ireland next year.


As the noble Lord knows, the introduction of a Bill for Ireland dealing with this matter is not in my province, but I am assured by my right hon. friend the Chief Secretary for Ireland that he will be glad to deal with this matter. He is unable to promise what lines the Bill will take, or whether it will follow exactly the lines of this Bill, because the conditions in Ireland are entirely different front what they are in England. I But my right hon. friend will be glad to have the support in that matter of noble Lords opposite.

Clause 13:

Provisions as to Local Supervising Authorities.

13. A local supervising authority may aid the training of midwives, whether within or without their area, and may make grants for the purpose.

LORD AMPTHILL moved an Amendment to give a discretionary power to the local supervising authorities to make grants in aid of the maintenance of midwives. The noble Lord said: It seems to me that it is a necessary corollary of the legislation which is now established that there should be this discretionary power granted to county councils of making grants in aid of maintenance. I am aware that the idea is that voluntary nursing associations should provide the midwife, but there are parts of the country in which no nursing association exists. The people, then, are in this position. They are compelled by law to employ a certified midwife, and if there is no certified midwife in the district, because it is impossible in ninny cases for these women to make a living wage, they would have to do without one at all. There is no question that in many parts of the country it is almost impossible for a midwife to make a living. I have before me the report of the medical officer of health of my own district, which gives some very interesting figures on the subject. Of forty-two independent midwives practising in the county, four attended no cases and twenty-seven attended less than twenty-five cases each. As the fee in each case varies from 4s. to 10s. 6d., it is very evident that it is not possible for these women to earn a living wage. As the law compels people to employ a certified midwife, it seems to be a necessary consequence that the Government should put it within their power to obtain the services of these trained women. Your Lordships will notice that the power is only discretionary, and it seems to me that it is one that can safely be entrusted to the county councils. I hope, therefore, the noble Earl will see his way to accept this Amendment.

Amendment moved—

Page 6, line 10, after ("training") insert ("and make grants in aid of maintenance").—(Lord Ampthill.)


I think that on reflection the noble Lord will see that his Amendment in putting a large burden on local taxation would probably be considered in another place to be a very serious breach of privilege. In addition to that, I hope your Lordships will not approve of this somewhat socialistic proposal of the noble Lord's, which becomes even stronger in the next Amendment on the Paper. The noble Lord suggests that the local supervising authority should aid the maintenance of midwives. I have no doubt the noble Lord would probably be one of the first to say that midwives stood in a different category from any other class; that doctors, for instance, were entirely different. But I think a great many noble Lords would not agree. They would say that in scattered districts, where it is difficult for doctors to live, it is just as necessary that the local authority should make grants in aid of doctors as it is that they should make grants in aid of midwives. It is difficult to make any sound distinction between the two if once you throw the cost upon the local authority. I venture to think that in any case this is a very great departure in principle from anything which has been done in this country, and in view of the large charge which it would make and the fact that it is without doubt a breach of privilege, I venture to hope the noble Lord will not press his Amendment.


I would ask my noble friend behind me not to persist in this Amendment. I quite see the argument put forward by the noble Earl opposite. In the first place, it would undoubtedly be considered a breach of privilege in another place; and, secondly, it would be adding to the rates, a thing we have always deprecated. In these circumstances I would suggest to my noble friend that it would be wiser not to persist in his Amendment.


I cannot admit the argument that this would be a breach of privilege, and I do not think that view would find much support in this House. On the other hand, I admit that the principle of this Amendment is socialistic. But you have got the legislation already, and the legislation is socialistic. You are not proposing to do away with the legislation, and all that this Amendment does is to recognise a necessary consequence of legislation which is firmly established, and which you are now seeking to make just and fair in working. I do not know whether I can count on any support for the Amendment, but I am not inclined to withdraw it if there are any noble Lords who favour it.

On Question, Amendment negatived.

Clause 13 agreed to.

Clauses 14 to 16 agreed to.

Clause 17:

Payment of Fees of Medical Practitioners called in on advice of Midwives.


  1. (1) Where a duly qualified medical practitioner has been summoned upon the advice of a certified midwife attending a woman in child-birth to render assistance in a case of emergency in pursuance of any rule framed by the Central Midwives Board, be shall, on complying with the prescribed conditions, be entitled to recover from the board of guardians of the poor law union in which the woman resided such fee in respect of his attendance as may be prescribed.
  2. (2) Where any such fees have been paid by a board of guardians, the amount thereof may, if the board of guardians think fit, be recovered summarily as a civil debt from the patient or person liable to provide the patient with medical aid.
  3. (3) Every board of guardians shall in each quarter send to every local supervising authority concerned a list of the cases within the area of the authority in respect of which fees have been paid by the board of guardians under this section.
  4. (4) The Local Government Board may make regulations with respect to any matter which under this section is to be prescribed and as to the manner in which boards of guardians are to carry out their powers and duties under this section.
  5. (5) The payment of fees by hoards of guardians under this section shall not be considered to be parochial relief, alms, or charitable allowance to any person, nor shall any person by reason thereof be deprived of any right or privilege, or be subject ed to any disability or disqualification.

LORD AMPTHILL moved to substitute the local supervising authority of the county or county borough for the Poor-law guardians. The noble Lord said: I think your Lordships will recognise that this Amendment is one of very great importance. The Bill was before the House for some time and was withdrawn by the noble Earl the Lord President, and it was generally supposed that the object of withdrawing the Bill for a while was to amend this very Clause 17 in order to meet the large number of objections which had been raised. But to the great disappointment of all those interested in the Bill it returned to this House with the objectionable clause still standing in it.

The objection to the clause, of course, is that you are bringing possibly thousands of poor thrifty people within touch of the Poor-law authority, a thing which they dread and dislike more than anything else. The noble Earl has sought to remove these objections by inserting a new subsection which declares that the payment of these fees to the doctor is not to be regarded as parochial relief. It seems to me that the very effect of this provision is to remove any possible argument that there may have been for the system of making the payments through the Poor-law guardians. Either these payments are parochial relief or they are not. If they are parochial relief, surely you have no right to say in your Act that they are not parochial relief; hut if, on the other hand, the payments are not in the nature of Poor-law relief, why make it appear that they are so by employing the whole of the machinery of Poor-law relief? It is quite futile to declare by your Act that it is not to be so regarded. You cannot regulate people's sentiments by an Act of Parliament. His Majesty's Government are trying to do a great deal by legislation at the present time, but I venture to say that to regulate people's feelings by legislation is a thing they will never be able to accomplish.

Surely the Government know what the feelings of the poor are in respect of this matter, and how utterly unlikely it is that their strong objection to being brought within touch of the Poor-law should be allayed by a declaration in an Act of Parliament that they are not to regard it as Poor-law relief. Just as well might you send a man to prison and tell him he is not to regard himself as in prison, but only for the time being as one of His Majesty's guests. I hold, therefore, that this new proviso, which is supposed to remove objections, is utterly ineffective for the purpose; but what I want to know is why the Government have gone out of their way to introduce the interference of a second local authority in this matter when there is no apparent reason for doing so. The county councils and the county borough councils are the authorities responsible for the administration of the Midwives Act, for the supervision of midwives, and the regulation of everything that pertains to them. It would, therefore, seem to the ordinary person to be the obvious thing that the county councils or the county borough councils should make the payments which are necessary. After all, it is not a matter of obtaining the money from a different source. The money in either case comes out of the same pockets. There is a very good precedent too. It is the county councils who pay the doctor when the doctor is summoned by the police. It would, therefore, not be any innovation to continue that system.

But what is still more remarkable is that there is absolutely no authority which can be quoted for the proposal which His Majesty's Government have made in Clause 17. It is not a recommendation of the Departmental Committee. The proposals were not supported by any of the witnesses who appeared before that Committee, but, on the contrary, were objected to by an immense weight of authority and by a large number of public bodies who understand the question and are deeply concerned in it. I shall be interested to hear. on what grounds the noble Earl has thought it necessary to maintain these proposals in the Bill. I am in hopes that he has only done so in order that they may be discussed in your Lordships' House before an alteration is made. But, in any circumstance, I hope very much that it is the noble Earl's intention to modify the proposals and to allay the very great anxiety which exists at the present time as to the effect of these proposals, which I wish to impress upon your Lordships have the effect of bringing thousands of poor people whose most earnest effort and hope in life is to keep out of touch of Poor-law relief within the grip of the Poor-law guardians without their consent and without any application on their part; and, what is more, you are compelling them by law to make payments for which they have made no contract, for which they are entirely unprepared, and as to the amount of which they have no say.

Amendment moved— Page 7, lines 2 and 3, leave out ("the board of "guardians of the poor law union" and insert ("the local supervising authority of the county or "county borough").—(Lord Ampthill.)


My Lords, I should have thought that the proposal of the noble Lord to vary the incidence and the area of the local charge by shifting it from the Poor-law union to the county was in itself a breach of privilege, for you cannot either increase or vary the incidence of a burden without conflicting with the rights of the House of Commons. The noble Lord told us that he was proposing what was frankly socialistic legislation, and he excused himself by saying that the idea had crept into previous legislation. I must say for myself that I should wish to withstand socialistic legislation whether the thin edge of the wedge had been got in already or not. The noble Lord said that it was impossible to change sentiment by law, but I think his speech shows that he recognises the effect of the law in that direction, because his whole argument was that the idea of getting aid from the Poor-law, even though they are not pauperised through it, is so repugnant that people would abstain from obtaining this relief. It is quite clear that the noble Lord contemplates a very large additional expenditure of public money on the rates as the result of his Amendment. Therefore he is not merely contemplating the shifting of a charge from one local body to another, but a large augmentation of that charge, because he spoke of the thousands and thousands of people who would benefit in one case, but who would refrain in the other.


I do not propose any increase in the charge. I merely propose that the fees should be paid by one authority and not by another. That would not increase the amount of the charge.


I do not think the noble Lord recognises the full bearing of his own remarks. He said that there were thousands and thousands of people who would shrink from getting relief from the Poor-law, but who would obtain this relief if they had another authority to appeal to. Therefore it is obvious that he does indicate that the effect of his Amendment would be to bring in a large amount of chargeability on public funds which under the Bill as it stands would not take place. We have too many proposals to give people the benefit of being paupers without any of the stigma. I am quite satisfied that the fact that people are ashamed of getting relief which is Poor-law relief does stimulate a great deal of self-reliance and thrift and many other important virtues. We are having experience in regard to the question of providing meals for school children. That was merely a permissive power. Nevertheless local authorities are using it, and now we find attempts made to secure that children should also be fed on Saturdays and Sundays, and, indeed, all the year round, holidays as well as school time. If a parent is unable to maintain his own family, it is a proper case of destitution and for Poor-law relief, and in substance he is a pauper. I believe in a little hardness and sternness in these matters. By the sort of proposal contained in this Amendment a great deal is done to demoralise and debauch the people, and I therefore hope the Amendment will not be agreed to.


I desire to say a few words in support of this Amendment. I am not in the least deterred because to do so lays one open to the charge of supporting socialistic legislation or brings one into conflict with the privilege of the other House of Parliament. It is surely straining words to say that this is a socialistic proposal because it proposes that the payment of the fee of the doctor who is called in on child-birth should be borne by the public health authority instead of by the Poor-law guardians.


The noble Lord who moved the Amendment himself described his proposal as socialistic.


I should protest against the description just as heartily. But I think my noble friend Lord Ampthill described the previous Amendment, which he did not press, as socialistic, not this one. I did not hear him say anything in moving this Amendment about its being a socialistic proposal. I desire to submit to your Lordships that this Amendment is of extreme importance, and that it has claims upon your Lordships' attention on its merits and quite apart from any label you may attach to it. The difficulty hitherto has been this, that in cases of child-birth a doctor has been called in and in a great many cases has been unable to obtain the fee for his attendance. As there has been no provision made hitherto for the payment of his fee, in some cases it has been provided by the Poor-law guardians and in some cases by the public health authority. The Departmental Committee recommend that an alteration to payment by the Poor-law guardians should be adopted, the Government have accepted their recommendation, and that course has been put into the Bill.

I cannot help saying that this is just an instance—a very important instance—of legislating for people and at the same time ignoring altogether their own opinion on the subject. In another important controversy going on in the country at. the present moment we are told that it is unnecessary and undesirable that women should be given a vote at Parliamentary elections because Parliament always considers their interests and legislates for them adequately and generously. This is just an example of where the interests of the class affected by your legislation have been ignored from the outset. On the Departmental Committee there was no midwife and no representative of the class of poor women who will be affected by the Bill, and since the Bill appeared emphatic protests have been made against this clause. There have been protests from the midwives themselves, from the British Medical Association, from the Society of Medical Officers of Health, from the Royal British Nurses Association, from the Women's Co-operative Guild, from the Railway Women's Guild, from the Women's Labour League, and even from a certain number of boards of guardians.

This particular clause in the Bill has met with the greatest possible opposition from the moment it appeared. It was opposed on the ground that it was imposing the stigma of pauperism on people whom you compel by Act of Parliament to summon medical aid in cases of child-birth, and it was largely in consequence of the opposition raised that this Bill was withdrawn, and in the present Bill something has been done to remove the stigma of pauperism. The noble Lord opposite, Lord Sheffield, wants to discourage people from availing themselves of this provision, and he hopes that the stigma of pauperism will act as a discouragement. The Government do not I desire anything of the kind, because they have provided in their amending Bill that the doctor's fee shall not be regarded as Poor-law relief. Although the board of guardians is still retained as the authority who will pay this fee, the Bill declares that the payment is not to be parochial relief. But it does not matter in the least what it is called if the whole subject is still to be dealt with by the Poor-law authority.

The homes of these people are to be subjected to the inquisitorial visits of relieving officers, and the people themselves may have to appear before the Poor-law guardians and answer questions as to ability to pay the necessary fee.

I hold that the whole object of this Bill will be defeated if this clause is retained. Hitherto there has been considerable reluctance on the part of midwives and patients to summon a doctor on these occasions, and that will at once spring up again if, by the machinery of this clause, as it stands in the Bill at present, it is realised that to summon a doctor in cases of child-birth involves the intervention of the relieving officer and appearing before the Poor-law guardians to answer their questions. This Amendment I feel to be absolutely necessary if the Bill is to serve the purpose the Government have in view, without inflicting at the same time fresh hardships on the class of poor women whom the Bill is intended to benefit. I therefore strongly support the Amendment of my noble friend, and sincerely hope that the noble Earl will accept it.


My Lords, the Amendment which the noble Earl supports he tells us is absolutely necessary if the Bill is to carry out the objects with which it was introduced. I congratulate the noble Earl on his knowledge of what was in the minds of those who brought this Bill forward, but I can assure him that to carry this Amendment would mean that the Bill would go no further either in this House or in another place. It is true that the Bill has met with opposition in the Press, but it has been just as warmly supported as it has been somewhat ignorantly opposed in various newspapers. I am bound to say that in a considerable number of the comments dealing with this matter there is a most unfortunate assumption, which is wholly inaccurate, that the State lays upon people the absolute necessity of sending for a medical attendant. I am not anxious to labour the point, which has been raised by the noble Lord behind me, how far this Amendment really raises the matter of privilege.

But let me point out to the noble Lord opposite how incomplete his Amendment is, at any rate in its present form. If this Amendment were accepted I suppose the noble Lord would himself suggest that some method of recovery was expedient. Let me point out to him that in the great majority of cases, at any rate outside the area of county boroughs, the local supervising authority has no means of making satisfactory inquiry into the circumstances of the patient. This would either reduce recovery to a dead letter, or else they would be forced to have recourse to the boards of guardians themselves for information and for help and advice as to whether they should proceed further in the matter or not. The noble Lord makes no provision apparently for the ultimate recovery of the fee, either from the patient herself or from her husband. If it was his intention that medical attention whenever necessary should be provided at the cost of the rates by the local supervising authority his recommendation goes a good deal further even that the Minority Report of the Poor-law Commission. The Commissioners who signed that Report definitely recommended systematic recovery from those responsible, if they are able to pay, according to their means.


If the noble Earl will allow me to interrupt him I might inform him that, although I have not put it on the Paper, I do propose an alteration of subsection (2) to provide for recovery.


It is obviously inconvenient to your Lordships as well as myself to discuss Amendments that are not on the Paper, and, if the noble Lord will pardon me for saying so, I must continue, he not having given notice, as if that Amendment was not before your Lordships. I must further point out that you are dealing with the whole question of whether or not free medical assistance should be given to these people. You are really dealing with the whole question of the Poor-law. How are you going to deal with the Poor-law in future? It is an attempt, not on the part of the noble Lord himself but of his friends not in this House, to prejudge the question, and I am bound to say, on behalf of His Majesty's Government, that is a matter which we ought not to deal with on the present occasion. I am quite sure that there will he no attempt to shirk the issues which will be dealt with when the time comes to deal with them.

On this occasion we are only dealing with an amendment of a particular Act, and I venture to think it would be far more businesslike on the part of your Lordships on the present occasion not to prejudge the larger questions which must come before Parliament in due time, but to deal with the machinery such as it is and make the best of it, and in that way you will not only be more likely to get this Bill through Parliament but you will be dealing more fairly with Parliament itself. Even in the Minority Report of the Poor-law Commission they say it is very desirable that the adjudication should not be done by a local administrative body such as that to which the noble Lord refers these cases in his Amendment. In that Report they say— The work of adjudicating upon particular cases—of assessing how much each person should pay, or whether be should be excused on the ground of poverty—appears to us no less unsuitable for a local administrative body than the general decision of whether or not the tax should-be levied at all. And they conclude that— The duty of determining what special assessments are due according to the law, and from whom, together with the decision whether the person liable is of sufficient ability to pay, and the duty of enforcing payment by proper legal process, ought to be entirely separated from the work of administering the public assistance. If your Lordships look for a moment at Clause 17 you will see that the objections which have been advanced against the board of guardians as the paying authority are to a considerable extent without any real foundation. Subsection (5) expressly declares that the payment of fees by boards of guardians is not to be considered as parochial relief, alms, or charitable allowance to any person, and no person by reason thereof is to be subjected to any disadvantage; and under subsection (4) the Local Government Board may make regulations in respect to the manner in which boards of guardians are to carry out their powers and duties under the section. I venture to think that under these regulations the Local Government Board will be able to make it perfectly clear that none of that inquisitorial investigation which the noble Lord fears will be likely to take place.

Let me point out how very unsuitable these local supervising authorities really are to carry out the duty of investigation. Here you have the local medical man summoned, and it is in our opinion obvious that the near local authority is the proper authority to investigate the circumstances of the parents. Very often probably no investigation will be necessary. But let me take the noble Lord's own county of Bedfordshire. How can the county council sitting in the capital of that county know accurately the circumstances of every cottager throughout: the whole of the county? They have no machinery for doing it, and I think it is perfectly obvious, for the present at any rate, that so long as boards of guardians exist—and it may not be for ever—they are the most convenient authorities for dealing with this question.. But, in any case, I venture to hope your Lordships will not agree with this Amendment if only on this one single, but I think very important, issue—that we do not wish in this Bill to deal with or to prejudge the questions of Poor-law reform. We have the Act of 1902, which has effected a great deal of good throughout the country, and has saved a great many lives. Here in this Bill we see opportunities of amending that Act and making it still more useful, and I should very much regret if this comparatively humble little Bill were to be used as the battle ground of the contending armies of Poor-law reformers. Our object is to use the existing material, to amend the Bill on the lines which have already done so much good, and it is upon those grounds that I venture to hope your Lordships will agree to pass it.


My Lords, I confess that if anything would encourage me to vote for this Amendment it would be the attack made upon it by Lord Sheffield on the ground of privilege. My Lords, where are we coming to on this question of privilege? We are told that if we alter the incidence of a charge in this Bill we shall be infringing upon the privilege of the House of Commons. The House of Commons has never seen this Bill. This is a Bill which has been introduced in the House of Lords, and we are absolutely ignorant of the opinion of the House of Commons on the point. If we are to be debarred from altering a charge in a Bill brought in by the Government, which the House of Commons have never seen, and to be told that we are infringing the privilege of the House of Commons simply because we are acting contrary to the wishes of the Government, then I say we are reaching a pitch with regard to this question of privilege which even noble Lords opposite have never attempted to maintain before. We are at last beginning to realise that these questions of privilege really mean opposition to the wishes of the Government, and I venture to think that is a thing which your Lordships will remember on future occasions.

In my view this Amendment in no way touches the privileges of the House of Commons. It is an Amendment which must be considered on its merits, and I confess that if I came down here this afternoon prejudiced at all it was in favour of all the Amendments of my noble friend behind me and in advance against any opposition that I thought the Government might make. But, my Lords, I confess I have been converted by the debate that has taken place and by the speeches which the noble Earl representing the Government and the noble Lord behind him have made. It does seem to me that if we accept this Amendment we are deciding offhand a very important question which will have to be decided probably in the near future, but which should be decided in connection with the whole question of the reform of the Poor-law, and I think it would be very unfortunate if we were to prejudge that discussion in any shape or form. The position, as it seems to me, is this. This is a small point, and for the moment the responsible authority, the Government, advise us that it is better to let sleeping dogs lie and to continue on the lines laid down in the Bill. They have supported that position by very powerful arguments, and at the same time have not prejudiced one side or the other in the discussion which will arise in any consideration in future of the reform of the Poor-law. I certainly therefore will have no hesitation in voting with the. Government against this Amendment if my noble friend behind me proceeds to a division.


My Lords, I do hope your Lordships will not be led away by the specious but exceedingly able argument which has been put forward by the noble Earl. I do protest against the notion that this is in any way prejudging the question of Poor-law reform. I cannot imagine anything more far-fetched than the use of that argument in this connection. This is not a question of free medical attendance for the poor. If your Lordships look at the Bill you will see exactly what it is. These poor people do not ask for the attendance of the doctor. They do not want the attendance of the doctor. The doctor is forced upon them by the local authority for the protection of the midwife.


I beg the noble Lord's pardon. Will he kindly substantiate and give us the authority for his statement that this medical relief is forced upon them.


The regulations of the Central Midwives Board, which oblige the midwife in certain circumstances to send for a doctor whether the patient or the husband desires it or not. That is the position, as I understand it. Therefore it is not a question of free medical attendance. Neither the patient nor the husband has any choice whatever in the matter. I have some personal experience of these things as I happen to be chairman of the midwives committee in my county. I am constantly, therefore, in touch with actual cases of this kind, and great though the noble Earl's experience is, I do not think he has had the same experience of the matter in detail as I have. The doctor is sent for, not in order to confer a benefit on the poor people, not to give them free medical attendance, but for the protection of the midwife, and the midwife is supervised and controlled by regulations for the general protection of the public.

Then the noble Earl went on to say that the local supervising authority had no means of making the necessary inquiries. There, again, I think he is lacking in actual experience. The county council has its midwives executive committee. They have their local medical officer of health. In every district there are the medical officers of health, and counties have an inspector of midwives, who goes round and visits every one of these cases and is in an excellent position to find out the exact circumstances. Next, the noble Earl said that this Bill was continuing on existing lines. There, again, I am afraid I must join issue with him. There are no existing lines in this respect. These fees have been paid in some cases by the local supervising authority and in other cases by the Poor-law guardians. To say that the Bill is continuing on existing lines is to show an entire misapprehension of the facts. You have to choose between the local supervising authority and the Poor-law guardians, and it seems to me to be the more obvious and commonsense method to choose the authority which has the duty of administering the Act and of supervising the midwives, and which is, therefore, in the best position to know the circumstances and to adjudicate in each case. I do not want to take up your Lordships' time, and therefore I refrain from replying further; but I must say the noble Earl set up a purely imaginary version of what I said in order to make fun of it. The noble Earl misrepresented my remarks in the most extraordinary manner.


As the noble Lord founded so much of his argument upon the supposed necessity to send for the doctor I think I ought to correct that at once. There is no such necessity, and if the noble Lord will turn to the regulations of the Central Midwives Board be will find that is so. There is no obligation on the midwife or on the patient or on the parents of the patient to do so. The midwife only advises. That being so, most of the noble Lord's argument falls to the ground.

On Question, Amendment negatived.

LORD AMPTHILL did not move his next Amendment, which was to leave out subsections (2), (3), (4), and (5).

Clause 17 agreed to.

Remaining clauses agreed to.

The Report of Amendments to be received To-morrow, and Bill to be printed as amended. (No. 137.)