HL Deb 14 December 1915 vol 20 cc600-8

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

Moved, That the House do now resolve itself into Committee.—(The Marquess of Crewe.)

On Question, Motion agreed to.

House in Committee accordingly.

(The EARL OF DONOUGHMORE i11 the Chair.]

Clause 1:

Certification.

1.—(1) From and after the first day of January one thousand nine hundred and seventeen any woman who, not being certified under this Act, I shall take or use the name or title of midwife (either alone or in combination with any other word or words), or any name, title, addition, or description implying that she is certified under this Act, or is a person specially qualified to practise midwifery, or is recognised by law as a midwife, shall be liable on summary conviction to a fine not exceeding five pounds.

(2) From and after the first day of January one thousand nine hundred and twenty-two no woman shall habitually and for gain attend women in child-birth otherwise than under the direction of a registered medical practitioner unless she be certified under this Act; any woman so acting without being certified under this Act shall be liable on summary conviction to a fine not exceeding ten pounds, provided this section shall not apply to registered medical practitioners or to anyone rendering assistance in a case of emergency.

(3) No woman shall be certified under this Act until she has complied with the rules and regulations to be laid down in pursuance of this Act.

(4) No woman certified under this Act shall employ an uncertified person as her substitute.

(5) The certificate under this Act shall not confer upon any woman any right or title to be registered under the Medical Acts or to assume any name, title, or designation implying that she is by law recognised as a medical practitioner, or that she is authorised to grant any medical certificate, or any certificate of death or of stillbirth, or to undertake the charge of cases of abnormality or disease in connection with parturition, but nothing herein contained shall prevent a midwife granting such certificates as may be required by the rules of approved societies or insurance committees in connection with maternity benefit under the National Insurance Acts.

THE LORD PRESIDENT OF THE COUNCIL (THE MARQUESS OF CREWE)

I move to omit from the proviso at the end of subsection (2) the word "section" and to insert "subsection." This is a drafting Amendment. Subsection (2) is the one which is the subject of the provision, and it is desirable that the provision should be formally made to apply to it only and not to the whole clause.

Amendment moved— Clause 1, page 1, line 20, leave out ("section") and insert ("subsection").—(The Marquess of Crewe.)

On Question, Amendment agreed to.

Clause 1, as amended, agreed to.

Clause 2 agreed to.

Clause 3:

Constitution of the Central Midwives Board for Scotland

3.On the passing of this Act the Lord President of the Council shall take steps to secure the formation of a Central Midwives Board for Scotland (hereafter in this Act termed the Board) which shall consist of—

  1. (1) Three persons to be appointed by the Lord President of the Council, two of whom shall be certified midwives practising in Scotland; and shall be first appointed when, in the opinion of the said Lord President, midwives so qualified are available in number sufficient to warrant such appointment; and
  2. (2) Four persons to be appointed, one by the Association of County Councils for Scotland, one by the Convention of the Royal Burghs of Scotland, one by the Queen Victoria Jubilee Institute for Nurses (Scottish Branch), and one by the Society of Medical Officers of Health of Scotland; and
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  3. (3) Five registered medical practitioners to be appointed, one by the University Courts of the Universities of Edinburgh and St. Andrews, conjointly, one by the University Courts of the Universities of Glasgow and Aberdeen, conjointly, one by the Royal College of Physicians of Edinburgh, the Royal College of Surgeons of Edinburgh, and the Royal Faculty of Physicians and Surgeons of Glasgow, conjointly, and two by the Scottish Committee of the British Medical Association.

On the first day of February one thousand nine hundred and twenty-one, and on the first day of February in every fifth year thereafter, all the members of the Board shall retire from office together, but Shall be eligible for re-appointment, and their places shall be filled by the appointment, by the same person and bodies respectively, of a like number of members possessing, where any qualification is prescribed, the same qualifications as aforesaid.

Any vacancy occurring by death or resignation or any cause other than retirement in ordinary course shall be filled by a member appointed by the person or body by whom the member whose office is vacated was appointed, and possessing, where any qualification is prescribed, the same qualification.

The Board may act notwithstanding a vacancy or vacancies in their number.

The Board shall elect a chairman from their own number.

The meetings of the Board shall be held in the city of Edinburgh, and the members shall be paid in respect of their attendance thereat reasonable expenses on a scale approved by the Privy Council.

LORD STRACHIE

I venture to intervene on this clause and to put a question or two to the noble Marquess the Leader of the House. I do not for a moment object to the general principles of the Bill; quite the contrary, because in England a similar measure has worked very effectively and has proved of great advantage. The reason I intervene in regard to a Scottish measure is that old friends of mine, Liberal Members of the House of Commons who sit for Scottish constituencies, are not at all satisfied with certain of the provisions of this Bill. I asked them why they did not raise the matter in the House of Commons, and they replied that under present arrangements and with a Coalition Government it is practically impossible for independent Members to do anything there; and, to my surprise, these Radical Members said they had to look to the House of Lords for freedom of debate and for having matters threshed out.

The first question I wish to ask is, why is it thought necessary to constitute another Board for Scotland? At the present time there are, I am informed, nineteen Boards established in Scotland, at an expenditure of over £3,000,000 a year; and I am further informed that it would be quite easy for the whole of this work to be done by the Local Government Board for Scotland. That Board, I am told, has very little work at present. In making that statement I speak under correction, but that is the view of a number of Scottish Liberal Members of the House of Commons. When I asked what evidence there was that the Local Government Board for Scotland had little work to do, I was told that an old House of Commons colleague of mine who was made Permanent Secretary of the Local Government Board the other day had been given a military appointment. which necessitated his entire absence from the Scottish Local Government Board. The question was asked in the House of Commons whether it would not be necessary to appoint some one temporarily in his place, and in reply it was stated that it was entirely unnecessary to do so because there was so little work for the Local Government Board for Scotland to do. If that is the case, surely this extra work might be given to that Board. If that were done the Government would save a certain amount of expenditure, because obviously you cannot establish a new Board even in Scotland, where I understand things are done much cheaper than they are in this country, without having officials and a certain amount of expenditure. Moreover, Clause 15 empowers the Lord President of the Council to appoint a paid Secretary for the new Board which it is proposed to constitute.

The fees which will be obtained from midwives registered under the Bill will not amount to a large sum, and I notice that power is given to the new Board to make up any deficiency out of local rates; so that this Bill has a double effect—not only will it lead to an increase of general expenditure from the Imperial Exchequer, but it will also lead to an increase in local rates. My Scottish friends think that as the Government are always talking about economy they should practise what they preach, whereas here they are setting up, quite unnecessarily, a body of new officials and incurring additional expenditure. Perhaps my noble friend in charge of the Bill can give an estimate of what the extra expenditure will be on the Exchequer and on the local rates, and also state the reasons why the object desired could not be achieved by giving this work to the Local Government Board for Scotland instead of setting up a new Board.

LORD BALFOUR OF BURLEIGH

I should like to say a word before the noble Marquess replies to the noble Lord, some of whose statements have come to me with surprise. I was for eight years responsible for the government of Scotland, and this is the first time I have heard that there was very little work for the Local Government Board to do. It has an enormous amount of detail to attend to, and at the time I was acquainted with its work the staff were fully occupied. If any Civil Servant has been released for military or naval service in present exigencies I have no doubt that the other members of the staff are cheerfully working overtime to enable that purpose to be carried out. I venture to say that the noble Lord might just as well have moved the rejection of the Bill on Second Reading as attempt to alter the structure of it to such an extent as to change the method of administration by a mixed council, as proposed in Clause 3, and substitute the Local Government Board for Scotland, which has not, and cannot have, any of the technical knowledge that would be at the disposal of such a Board as is indicated in this Bill. The English Act is worked by the Privy Council. It would be absolutely impossible for the Privy Council to work this Bill in Scotland. Some Scottish body is necessary for the purpose. The meetings must be held in Scotland, because it would involve an enormous amount of expense and trouble if everybody had to come to England for this purpose. So far as my experience goes, I venture to say it would be absolutely impossible for the Local Government Board for Scotland to do this work. So far as expense is concerned, I had probably better leave that matter to be dealt with by the noble Marquess the President of the Council. I heard a rumour, however, that it was on the ground of expense that this point was to be raised, and I have endeavoured to ascertain as far as I could what the expenses under the English Act are, and what, upon a moderate estimate, the similar expense in Scotland would be were this Bill to be worked upon the same lines. I am assured that, if the same relative expenses are incurred in Scotland as in England, as soon as the Act comes into working order there should not be a total expense of more than £200 or £300 a year to be defrayed from Imperial and local resources. Even in these days of strict economy, that does not seem to me a serious prospect, and I hope the noble Marquess in charge of the Bill will resist the noble Lord's suggestion.

THE MARQUESS OF CREWE

It seemed that my noble friend on the Front Bench opposite (Lord Strachie) recognised a certain incongruity in his appearance as champion of a particular form of Scottish opinion. That, no doubt, arose from the fact that his forbears settled themselves in a part of England as remote from Scotland, apart from the Scilly Islands, as they well could have; and I imagine that this is the first time in my noble friend's political experience that he has appeared in the character of a champion of Scottish economy.

I am afraid I cannot accept my noble friend's suggestion, for the reasons very tersely given by my noble friend above the Gangway (Lord Balfour). It would entirely destroy the structure of the Bill, as anybody can see by looking at some of the later clauses, if the provision for the appointment of a representative Board were eliminated from the Bill. Lord Strachie bases his demand upon the necessity for introducing, as far as possible, economy in the conduct of all our public affairs, and the consequent disadvantage of appointing a new Board at this moment. It was accordingly suggested by those for whom he is acting that the business ought to be handed over to the Local Government Board for Scotland.I hesitate to believe that there is a large body of opinion in Scotland which would like to see work of this kind administered solely by a Government Department rather than by a representative body such as we propose to form under the Bill. Of course, if the charges involved thereby were heavy, or, indeed, substantial, my noble friend would have at any rate a plausible case; but if the analogy of the English Act can be taken as a guide to this—and I think it may—he will find that at any rate for a number of years to come no charge is likely to be made upon either Imperial or local funds.

What happened with regard to the English Act was this. The first application which was made under Section 2 of the English Act was made in the year 1902, and between that time and the end of the financial year of 1905 between 22,000 and 23,000 women were certified as midwives, and the certification fees for this number amounted to £11,154. That kept the Board going altogether until 1909, after which a small debit balance began to accrue. The debit balances for England for the last three years have ranged slightly over £2,000. If he takes Scotland on a like proportion of population, as it is reasonable to do, my noble friend will find that for some time no charge is likely to be made upon Scottish or Imperial revenues at all, because the sum received by certification fees ought to amount to somewhere about £1,300, which would go a considerable way towards meeting the necessary expenditure. After that it may be presumed that a sum of between £200 and £300 might be required annually for meeting all expenses. I think the House will agree—and I am entitled to think my noble friend himself would agree on consideration—that the prospect that this sum may have to be spent in the course of the next few years is not sufficient to warrant the destruction of this particular measure.

LORD STRACHIE

I am quite satisfied with what my noble friend has said upon this question, and can quite appreciate the fact that he should be somewhat amused at my interfering in regard to a Scottish measure. At the same time I am sure he sympathises with me in wishing to give an opportunity to my Scottish friends in another place to make use of the House with which they were not always in sympathy.

Clause 3 agreed to.

Clauses 4 and 5 agreed to.

Clause 6:

Provisions as to suspensions.

6.—(1) The power of the Board to frame rules defining the conditions under which midwives may be suspended from practice shall include a power of framing rules—

  1. (a) authorising the Board to suspend a midwife from practice for such period as the Board think fit, in lieu of removing her name from the roll, and to suspend from practice until the case has been decided, and (in the case of an appeal) until the appeal has been decided, any midwife accused before the Board of disobeying rules or regulations or of other misconduct:
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  2. (b)authorising the local supervising authority to suspend from practice until the case has been decided any midwife against whom a prosecution has been taken for a contravention of any of the provisions of this Act.

(2) Where in pursuance of any power conterred by any such rule a midwife has been suspended from practice pending the decision of her case by a court or the Board and the case is decided in her favour, or where in pursuance of the duty imposed by paragraph (3) of section sixteen of this Act a midwife has been suspended from practice in order to prevent the spread of infection, the Board or the local supervising authority by whom she was suspended may, if they think fit, pay her such reasonable compensation for loss of practice as under the circumstances may seem just.

THE MARQUESS OF CREWE

The Amendment standing in my name to Clause 6 refers to a small matter, but it is one which ought to be set right. Paragraph (a) of subsection (1) makes it possible for rules to be framed by the Board which would allow an indefinite suspension of a midwife from practice. The Board is authorised "to suspend a midwife from practice for such period as the Board think fit." That might be for the term of her natural life. On the other hand there is an appeal from a sentence of removal from practice altogether; and although one need not suppose that rules would be so made or would so act, it does not seem right that a power should be given of practically destroying a right of appeal by allowing indefinite suspension. Therefore I propose to omit the words "for such period as the Board think fit."

Amendment moved— Clause 6, page 5, line 36, leave out ("for such period as the Board think fit ").—(The Marquess of Crewe.)

On Question, Amendment agreed to.

Clause 6, as amended, agreed to.

Clauses 7 to 12 agreed to.

Clause 13:

Fees and Expenses.

13. There shall be payable by every woman presenting herself for examination or certificate such fee as the Board may, with the approval of the Privy Council from time to time determine, such fee not to exceed the sum of one guinea. All such fees paid by midwives in practice at the passing of this Act and by candidates for examination shall be paid to the Board. The Board shall devote such fees to the payment of expenses connected with the examination and certificate and to the general expenses of the Board. The Board shall, as soon as practicable after the thirty-first day of December in each year, publish a financial statement made up to that date, and showing the receipts and expenditure, including liabilities, of the Board, during the year, which statement shall be certified as correct by an accountant who shall be a member of one of the Societies of Chartered Accountants in Scotland or a member practising in Scotland of the Society of Incorporated Accountants and Auditors. The Board shall submit a copy of such statement to the Privy Council, and, if the statement shows any balance against the Board and such balance is approved by the Privy Council, whose approval shall be binding and conclusive as to the amount of the balance to be apportioned, the Board may apportion such balance between the local supervising authorities in proportion to the populations of their districts as ascertained at the last preceding census. The Board may issue precepts to the local supervising authorities for the amounts so respectively apportioned to them. The local supervising authorities shall within six months after the receipt of such precepts, or such longer period as may be agreed with the Board, pay to the Board the amounts so payable by them respectively.

THE MARQUESS OF CREWE

moved to omit the words "who shall be a member of one of the Societies of Chartered Accountants in Scotland or a member practising in Scotland of the Society of Incorporated Accountants and Auditors," and to insert "practising in Scotland to be appointed annually by the Secretary for Scotland." The noble Marquess said: This is one of those points covered by the observation which I made on the Second Reading that certain variations have to be made from the English Act on account of the difference of Scottish procedure. I understand that the appointment of the auditor by the Secretary for Scotland follows the uniform practice in similar cases; and the change has this advantage, that it removes from the Board the power of appointing their own auditor, and, as we know, in most cases it is considered desirable that where possible the auditor should be appointed from outside rather than by those whose accounts have to be audited.

Amendment moved— Clause 13, page 7, line 37, leave out from ("accountant") to ("The") in line 40, and insert ("practising in Scotland to be appointed annually by the Secretary for Scotland").—(The Marquess of Crewe.)

On Question, Amendment agreed to.

Clause 13, as amended, agreed to.

Remaining clauses agreed to.

The Report of Amendments to be received To-morrow, and Bill to be printed as amended. (No. 186.)