§ Order of the Day for the House to be put into Committee, read.
§ Moved, That the House do now resolve itself into Committee —(Viscount Peel.)
§ On Question, Motion agreed to.
§ House in Committee accordingly.
§ [The EARL of DONOUGHMORE in the Chair.]
§ Clause 1 agreed to.
§ Clause 2:
§ Amendment of section fire of the principal Act with respect to finance.
§ 2. The approval by the Privy Council of any balance against the Central Midwives Board shown in any financial statement made under section five of the principal Act shall be, and shall be deemed always to have been, binding and conclusive as to the amount of the balance to be apportioned under that section, and any apportionment of any such balance between the several counties and county boroughs under that section shall be in proportion to the population of those counties and county boroughs according to the returns of the last published census for the time being, instead of in the proportion mentioned in the said section.
§ VISCOUNT PEEL moved, after "of" ["under section five of"], to insert "the Midwives Act, 1902, in this Art referred to as". The noble Viscount said: The amendment standing in my name is purely drafting.
§ On Question, Amendment agreed to.
§ Clause 2, as amended, agreed to.
§ Clauses 3 to 5 agreed to.
§ Clause 6:
§ Provisions as to suspension.
§ 6.—(1) The power of the Central Midwives Board to frame rules deciding the conditions under which midwives may be suspended from practice shall include a power of framing rules—
- (a) authorising the Board to suspend a midwife from practice for such period as the Board think fit, in lieu of striking her name off 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;
- (b) authorising the local supervising authority which takes proceedings against a midwife before a court of justice or reports a case for consideration by the Central Midwives Board to suspend her from practice until the case has been decided.
§ (2) Where in pursuance of any power conferred 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 eight of the principal Act a midwife has been suspended from practice in order to prevent the spread of infection, the Central Midwives 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 EARL OF MEATH moved to delete the words "may, if they think fit, pay her such reasonable compensations for loss of practice as under the circumstance may seem just," and to insert "shall pay her reasonable compensation for loss of practice."
§ The noble Earl said: I desire to draw your Lordships' attention to this clause because it seems to me that there is a want of elementary justice in the second subsection. By Clause 6 your Lordships are giving power to the Central Midwives Board and to the local supervising authoritise to suspend midwives for certain offences. Now, I wish to break a lance for the midwife. It appears to me that she is hardly properly treated. You give power to the Central Midwives Board and to the local supervising authority to suspend her, but if it is proved that she is innocent it would be only justice that some reasonable compensation should be given to her for loss of practice. Under subsection (2) of this clause as it stands in the Bill the Central Midwives Board or the local supervising authority by whom the midwife is suspended may, if they think fit, pay her such reasonable compensation for the loss of practice as under the circumstances may seem just. My Amendment is that the subsection shall react "shall pay her reasonable compensation for loss of practice." Once upon a time Mr. Gladstone said that we in this House lived up in a balloon, but I think we know enough of affairs terrestrial to be aware of the fact that a prosecutor is not likely to do justice to a defendant if it is proved that the defendant is innocent, and that the prosecutor is the very last 512 person to give compensation and thus be likely to stultify himself.
§ I am not going to detain your Lordships because to my mind the thing is simple, and I feel certain that you will agree with me that these ladies are engaged in a work of the very first national importance, especially in these times when we shall want to build up a strong and healthy race to fill the gaps which, unfortunately, have been made not only in our own country but throughout the world. I leave it, therefore, to your Lordships to consider whether it would be possible, with the consent of the Government, to substitute the words appearing in my name on the Paper for those printed in the Bill.
Page 3, line 18, leave out from ("suspended") to the end of the clause and insert ("shall pay her reasonable compensation for loss of practice").—(The Earl of Meath.)
§ VISCOUNT PEEL
I do not think the noble Earl need display any anxiety that there will not be plenty of noble Lords in this House who will break lances on behalf of midwives, because in my experience they have many strong friends not only here but in the other House.
As regards this particular proposal of the noble Earl, however, I am advised that, in the first place, it will make little, if any, difference in practice, because, whether the noble Earl's words are inserted in the clause or whether the words are left as they now appear in the Bill, the Central Midwives Board will in any case have to decide what is a reasonable amount of compensation; consequently they will be in effect masters of the situation. Further, I believe it would be far better to leave the whole matter to the fair discretion of the Board, considering of what. a body of experienced men and women that Board consists.
There is another consideration, moreover, which was not mentioned by the noble Earl, and which may possibly have escaped his notice—namely, that the proposal in the Bill is really the same as the provision already enacted in the Scottish and Irish Acts; therefore what the noble Earl is trying to do—or to suggest, because I do not think it will have that effect—is to put the midwives in England, in this particular respect, in an apparently stronger position than the midwives in Scotland and in Ireland. I hope that the noble Earl will not press his proposal to do any such thing, 513 because, knowing the subject as well as he does, he can imagine what an amount of difficulty will be created if the midwives in this country are placed in a better position than their sisters in Scotland and Ireland. Perhaps the noble Earl will see his way, therefore, to withdraw his Amendment.
THE EARL OF MEATH
The noble Viscount has alluded to the Central Midwives Board, but not to the local supervising authority, which is the body least likely to give the compensation needed.
§ On Question, Amendment negatived.
§ Clause 6 agreed to.
§ Clauses 7 to 11 agreed to.
§ Clause 12:
§ Delegation of powers.
§ 12.—(1) The power under section nine of the principal Act of county councils to delegate their powers and duties to district councils shall, after the commencement of this Act, be exercisable only with the consent of the Local Government Board, and where at the commencement of this Act any powers or duties have been delegated under that section the delegation shall, as from the commencement of this Act, be revoked unless the Local Government Board otherwise order.
§ (2) Where any powers or duties of a local super vising authority are delegated to any other body, references in the principal Act or this Act to the local supervising authority shall, as respects the powers or duties so delegated, be construed as references to that other body.
§ VISCOUNT PEEL moved, after subsection (1), to insert a new subsection. The noble Viscount said: This is an Amendment to Clause 12 which raises, I think, a point of some controversy. This Amendment deals with the question of delegation by a county council to a district council of its powers and duties as a local supervising authority under the Midwives Act in England and Wales. The supervising authorities under the Act of 1909 are the counties and county boroughs, but under Section 9 of the principal Act they have the power to delegate without restriction or condition any of their powers and duties to district councils, borough councils, or metropolitan borough councils in London. The Midwives Association are opposed to this power of delegation. Clause 12 proposes to limit this power, and the Amendment or fresh subsection which I am now proposing to introduce still further limits this power of delegation.
§ If your Lordships will look at the Amendment you will see that any future 514 delegation to rural district councils is entirely forbidden, and delegation to non-county boroughs and urban districts— and urban districts include, of course, boroughs—shall not take place, "except after consultation with the Central Midwives Board, and unless that council undertake to appoint as inspector of midwives a person who is a registered medical practitioner or a woman who holds the certificate by examination of the Central Midwives Board and has had not less than six months' experience as a practising midwife." This Amendment, therefore, is an alternative to the more extreme proposal, if I may say so, of the noble Marquess opposite and of the noble Lord behind me, who wished to do away with delegation altogether.
§ I should like to say one or two words on this point. It is true that delegation or much of it practised under the Act of 1902 was not of a very satisfactory kind, and it was condemned by the Departmental Committee which reported in 1909. At that time county councils had no medical officers of health at all, and were perhaps only too ready to delegate their duties to local sanitary authorities, and the smaller authorities did not always perform the duties very well. But that power is entirely taken away by the subsection which I suggest. The position of county councils with regard to delegation was a good deal altered by the Act of 1909. In that Act every county council was required to appoint a medical officer of health, and from that time the power of delegation by county councils to these local authorities —any kind of local authority, in fact—has gradually diminished, and so at the present time there is hardly any delegation at all. Delegation only remains, I understand, in the case of four local authorities. So much for the present situation.
§ The recent development of maternity and child welfare schemes has introduced a new element into the situation. Many schemes have been carried out by towns of 20,000 inhabitants and upwards, and in the remainder of the county by county councils; and, of course, there is a natural association between the administration of the Midwives Act and these schemes which are set on foot. In the circumstances it does appear to the Local Government Board that it might be better if some power of delegation should still be retained. There are, for instance, very large urban districts such as Willesden, 515 with its 150,000 inhabitants, or the Rhondda Valley, which probably would discharge these duties quite as well, with a great deal of local interest, and with as much efficiency as if they were confined only to the country councils.
§ It has often been said that the case of Scotland is analogous, and that in Scotland there is no delegation and therefore there ought to be none in this country either. In fact, that argument has been widely used. It rests entirely upon a misconception. It is not true to say that delegation is forbidden in the Scottish Act, for the very good reason that it would be entirely unnecessary so to say, for there are no authorities in Scotland to whom these powers could be delegated, because in Scotland all these local bodies are supervising authorities. I should like to give some figures to show to what extent delegation has gone in Scotland. Many of the sanitary authorities in Scotland are very small. Of the 203 burghs twenty-four only are over 20,000 inhabitants, nineteen are between 10,000 and 20,000 and 160 are under 10,000. Yet we are asked to assimilate the law in England to that in Scotland and to forbid delegation to places with 150,000 inhabitants, whereas in Scotland the duties are performed by small places with 10,000 or 20,000 inhabitants. Of course, there is no idea of delegation to such an extent in England, but I believe there is strong reason for allowing some sort of delegation in this country; and I think I have shown clearly by these figures that the cases are so different that no argument can be drawn from them in favour of trying to assimilate the law in England to that in Scotland.
§ I know that there has been some criticism even of this very limited amount of delegation, and I should like to say that, with one small change as regards the introduction of women, this proposal about delegation entirely meets the views of Sir F. Champneys, Chairman of the Central Midwives Board, and Sir Donald Mae-Alister, President of the General Medical Council, and I feel sure that the view of these distinguished medical men, so closely associated with the work of the Midwives Acts, will carry great weight with the House. After all, how can the power of delegation be exercised? First of all, movement must be by the county councils. If the county councils want to exercise the power themselves there is no question at all. If, however, in their opinion— 516 and they are very competent bodies—these smaller bodies in particular areas can exercise the powers more efficiently than themselves, then they tan move. Secondly, the Local Government Board has to approve. Thirdly, the Local Government Board will not approve until after full consultation with the Central Midwives Board indeed, I am authorised to go so far as to say, especially with regard to London, that if any strong expression of opinion is made by the Central Midwives Board that there should not be delegation the Local Government Board will follow the suggestion of the Central Midwives Board. In those circumstances I hope your Lordships will accept the Amendment, which does give some elasticity to the law, allows some very limited power of delegation, and is so hedged about with powerful restrictions that I do not think there is any possibility that the power can he misused.
§ Amendment moved—
Page 5, after subsection (1) insert as a new subsection:
(2) The Local Government Board shall not in any case consent to the delegation to a rural district council, and shall not consent to the delegation to a metropolitan borough council or to the council of a non-county borough or urban district, except after consultation with the Central Midwives Board, and unless that council undertake to appoint as inspector of midwives a person who is a registered medical practitioner or a woman who holds the certificate by examination of the Central Midwives Board and has had not less than six months' experience as a practising midwife."—(Viscount Peel.)
THE MAROUESS OF SALISBURY
I recognise that the noble Viscount is anxious to meet the views of those who are opposed to this clause, but I hope I shall be able to show him that, even as the Amendment now stands, it hardly goes far enough. From the point of view he has put forward, I am a little surprised that he cares so much about it —I mean those who instruct him—because, as he says, he has limited it in a considerable degree. I should like to place before your Lordships the case against delegation. In the first place there is the strength of authority against it. I do not dwell upon the question of similarity between the English and Scottish Acts, because I quite follow the argument that the noble Viscount has submitted. But the first strong argument from authority is a statement made in your Lordships' House a fortnight ago by the Lord Privy Seal in moving the Second Reading of the Bill, 517 when he said that delegation had been found to be, I do not think he said a complete failure, but altogether unsuccessful as a system.
§ THE MARQUESS OF SALISBURY
The noble Earl was in very good company, because he agreed with the Committee of 1909. That Committee found—and, so far as I know, there was no doubt in the mind of the Committee—that delegation was a great mistake. The then Secretary of the Central Midwives Board, who was a witness before that Committee, spoke of it as being an "unmitigated evil." That is very strong language, and from a very high authority. Therefore, we start with authority against the system of delegation.
What is the principal argument against it? The first argument is that if you delegate to a smaller authority you submit these midwives to inspectors who are of a lower status than the inspectors employed by the county authorities. That is bad in every way. It is bad because the inferior status of the inspectors deprives the public of the guarantee which proper inspection ought to give them, and it is bad also because this inferior status makes the profession of midwives unpopular. There are these two main arguments. Moreover, having this lower class of inspectors involves want of uniformity of practice in the areas, and this is a serious matter. Then, again, it involves confusion, because a great many of the smaller areas are not such as to occupy in every case the full time of the midwife. She has a clientele outside the boundaries of the particular local authority, and in that case she is subject to two different sets of inspectors—the inspectors of the local authority to which delegation has been granted, and the inspectors of the county at large when she passes the boundary.
This produces confusion, and the upshot is that the midwives themselves are very much opposed to the system, You may say that they are wrong, but the point is that the fact of their being opposed to it, as 518 I have already said, acts as a deterrent to women joining the profession. That appears to be established, and it also appears to be a pity, for the matter is of very great importance. The profession is Specially important at this moment, because of the great lack of medical men in all parts of the country (in consequence of the great demand now being made upon them) which makes the existence of midwives most essential, and nothing should be done, if I may say so, to deter suitable women from jointing the profession. These are some of the main arguments against delegation.
There is yet another argument. The noble Viscount said, "We have hedged this elastic provision which we propose with every kind of safeguard." Now what is the principal safeguard? The principal safeguard is the consent of the Local Government Board. I want to speak on this occasion with all respect due to the Local Government Board, but, for some reason or other, the Local Government Board is very much criticised in connection with work of this kind. It is not too much to say that the Local Government Board inspires no confidence whatever. I am not speaking generally. I have the greatest possible regard for it. I hope the noble Viscount does not mistake me. I was speaking with regard to this particular matter. I should be very sorry indeed to commit myself in a general way to such a blasphemy against one of the main Departments of State. The Local Government Board, for some reason, does not command confidence in this respect. The reason is that in past times the, Local Government Board has used its influence to produce delegation. This has caused a feeling of suspicion amongst all those who take an interest. in this subject, and they are very much afraid that the possibility of the Local Government Board giving or withholding consent will be used as a means of pressure on the county council to grant delegation where delegation ought not to be granted. Therefore this safeguard of which the noble Viscount speaks, so far from being regarded as a safeguard by those in whose name I am very imperfectly speaking at this moment, is regarded as precisely the contrary and as involving a risk.
It is for this reason that they do not accept this provision as a real safeguard. It is true, I think—speaking, as I say again, 519 with all respect for the Local Government Board—that there has been in many respects for some years a tendency in the Local Government Board to prefer operating through the minor local authority rather than the major local authority. One meets it very often in different relations. In the matter of housing, for example, you will find the Local Government Board has a policy of operating through the minor local authority, whereas many of us think that the history of the last twenty years has shown that the local authority which has been the most successful in English local life has been the county council. The suspicion with regard to the Local Government Board is, therefore, not altogether without foundation. For this reason it is thought that delegation ought to be entirely obliterated. By the confession of the Government it has been a failure. It was found by a Select Committee to be a mistake. It was characterised by a most important witness as an "unmitigated evil," and it is now viewed by all those interested in this question as a mistake. The noble Viscount at the end of his speech quoted two eminent legal authorities as being in favour of the Amendment.
§ THE MARQUESS OF SALISBURY
Medical authorities. Let me read a list of the authorities against it altogether. I may speak of the Midwives Association in my own county, or I may speak of the chief of the Somerset County Nursing Association; but I will take the central ones. The Standing Committee of the County Nurses Association have passed a resolution in favour of the Amendment which I shall have the honour to submit to your Lordships when we reach it. The Council and Advisory Committee of the Midwives Institute, the Association of Inspectors of Midwives, and the Association for the Promotion of Training and Supply of Midwives, all these great, important and central bodies—I believe I speak in the name of the Central Midwives Board also —these great training authorities, agree in condemning delegation and urge the acceptance of the Amendment I have ventured to put on the Paper. They drafted it themselves, no doubt under proper advice, and have submitted it. In these circumstances I suggest to the Government that the best way is to accept it. They themselves say that the system 520 of delegation is not a success, and if it he true that this feeling continues to produce confusion and unpopularity, and that the Local Government Board's intervention so far from being a safeguard is considered to be rather the reverse, the simplest way is to strike the clause out of the principal Act, and abolish delegation altogether.
THE MARQUESS OF CREWE
My Lords, I think His Majesty's Government, and my noble friend opposite, must have felt somewhat surprised at the strength of the feeling which has been displayed in many quarters against any form of delegation. It is only fair to recognise, as the noble Marquess behind me did, that His Majesty's Government have done their best and gone a considerable way in order to satisfy that feeling by the Amendment which the noble Viscount has just moved. The noble Marquess stated the general case against delegation very fully and with great force. One argument which I think has been used against it and which is akin to one he used, although not identical, is to remind the public that even in the case of the larger minor authorities, up to populations of something like 100,000, the number of midwives who would be employed is, in fact, very small. It is quite easy to calculate the average number of births in a given population. Then it is to be remembered that the services of a midwife are by no means required for all those eases, and it is almost surprising to reflect that two or three midwives can serve a very large population indeed. It is argued that, this being so, if they are under a separate authority the inspector who, as the noble Marquess said, is specially appointed to inspect them is not likely to be of as high a calibre as if a larger number have to be dealt with. That is an argument of some considerable force.
What I take it is felt by those who object to delegation—if they cannot obtain what I have no doubt they would prefer, the proposition of the noble Marquess behind me that the power should be stopped altogether—is that the restriction placed on the system by the Amendment of the noble Viscount should be somewhat further stiffened. It is, I am well aware, never satisfactory to the palate of a Public Department to be subject to the absolute consent and agreement of those who are not themselves a Public Department. On the other hand, the Central Midwives 521 Board come very near to being a Public Department. I am not authorised to speak for anybody, but I cannot help thinking that, if the noble Viscount is altogether unprepared to accept the Amendment to be moved by the noble Marquess and other noble Lords, he would to some extent mitigate opposition if he were to agree to allow the delegation in any particular case to depend on the actual concurrence of the Midwives Board, instead of its merely taking place after consultation with them. I merely throw that out as a possible solution in the event of the noble Viscount not being willing to agree to the Amendment of the noble Marquess.
§ LORD ABERCONWAY
I hope the noble Marquess, who is to propose an Amendment to leave out Clause 12, will press his opposition even to a Division unless the Government see their way to accept it. The force of the arguments he has used has been such that I have never listened to a speech of a more destructive character. In fact, there is hardly a single authority in the country, except perhaps the Local Government Board, which is in favour of this power of delegation. Since the Act of 1902 there have only, I believe, been ten cases of delegation, and in every one of those the delegation has been revoked. It shows that the particular bodies which are entrusted with these powers, and they are the most successful administrative bodies in the country—the county councils —have felt that to give small authorities the powers of examining and awarding diplomas to these women would be a very disastrous mistake. Your Lordships will remember that these diplomas are of a very important character; and no one, in the case of an ordinary academic distinction, would allow Universities or colleges to delegate examining powers to more or less unofficial persons. The public has a right to demand that the very highest class of examiner should be employed, and that there should be no question of local favouritism, which comes in too often where you have the ordinary board of guardian person to deal with.
There is a very important recommendation made by the Midwives Committee of the London County Council. They submitted the following resolution—That the Council is of opinion that the delegation to Metropolitan Borough Councils of 522 the powers at present exercised by the Council under the Midwives Act of 1902 would be prejudicial to the public health of London, and that the Local Government Board be urged to endorse this view and explain the Board's attitude to the local sanitary authorities in London.This recommendation was passed unanimously by the London County Council. If there was a case where you would think delegation would be a success it would be in the metropolitan area. Here you have in London the most eminent medical personages, large administrative areas, every advantage you would think for success; yet the London County Council, having tried it themselves, come to the conclusion that the thing is wrong. Why should the Local Government Board struggle to maintain its grasp over the administration of this Act. I look upon this simply as an attempt to wrap "red tape" again around the administration of local affairs in this country.
I think the Government ought to see that there is not a single authority in the country that has supported their view of this case. Every journal devoted to nursing or therapeutics is opposed to it. Although two eminent medical authorities have been quoted, I should very much prefer to be guided by the opinion of the county councils on a matter of this kind, and by those eminent women who have taken a great interest in this question who are not perhaps themselves medical women but who understand the needs of the country, than by the Local Government Board.
THE EARL OF MEATH
My Lords. I must confess that the Amendment of the noble Viscount has improved the position to a great extent. But personally I hope that we will have delegation deleted altogether. I think that it is far better that it should go, because almost everybody outside, and I believe a good many in your Lordships' House, are persuaded that delegation is an absolute mistake. There are so many different dangers—dangers of jobbery and ignorance and politics. We wish to get that entirely out of the way. We do not want the possibility of having inspectors who do not know their business. In Ireland we have known inspectors—I am not talking now of midwives—who have not known anything at all about their business, and we want to place the power only in the hands of the largest corporations and bodies like county councils, who are 523 likely to be above all these petty intrigues. Another point which I do not think has been mentioned is that your Lordships' House passed in 1910 a Bill against delegation. It really is, I think, a matter which would be far better dealt with drastically by getting rid of delegation. Therefore I shall support the noble Marquess and Lord Aberconway if it goes to a Division.
§ LORD ASHTON OF HYDE
My Lords, I regret very much that the noble Viscount in charge of the Bill does not accept the proposal of the noble Marquess opposite. The noble Viscount has gone a great deal further than the Bill in the concession that he has made, for he has almost given a Parliamentary undertaking that without the consent of the Midwives Board this shall not be put into operation in the form of delegation—at any rate, in the case of the metropolitan boroughs it certainly shall not be put so into force without the consent of the Midwives Board. Though it may be that the Midwives Board has not passed any resolution on the question, it is very well known that that Board is entirely opposed to delegation.
§ LORD ASHTON OF HYDE
I spoke only from information given to me, and of course I accept the denial of the noble Viscount.
§ VISCOUNT PEEL
I read out the statement of the chairman that he accepted this Amendment; therefore I do not think it is possible to say that the Midwives Board is against all delegation when I have the acceptance of this by the chairman.
§ LORD ASHTON OF HYDE
I spoke merely from information given to me, and of course I accept at once the statement made by the noble Viscount. There are, at any rate, a large number of members of the Midwives Board who accept the position I have stated. If the noble Viscount is prepared in this Bill to put matters in the hands of the Midwives Board, he might, I think, go a point further and do away altogether with delegation, which I believe the Midwives Hoard generally desire to see done. We have, moreover, the very powerful record of the Nursing Association. We have a record that the Standing Committee, 524 I think it is, of the Nursing Association has Massed a resolution condemning delegation and supporting the noble Marquess.
It seems to me that the noble Viscount in charge of the Bill might have gone a little further than he has, and might have accepted the noble Marquess's suggestion. Why is it that the Local Government Board is not willing to accept this? It has been said that in 1909 the Committee that went into the matter refused delegation. It has been stated that a Bill passed this House—it did not pass the other House — in 1910 refusing delegation. Why is it that now the Local Government Board is not prepared to accept it? My impression is that there is one great county which perhaps has not quite done its duty in this matter, and I believe this has been used as an argument for delegation, but it is hardly fair, I think, to condemn on account of one big county. I am informed, moreover, that that great county is at present putting matters into order, and that, it is not likely that it will be an offender in the future as some people think it has been in the past.
I do not wish to go over all the arguments that have been brought forward, but there is to me one very strong reason against delegating these powers to a small local authority, and it is this. The inspector will, I presume, nearly always be a local medical man, and one knows the great influence that can be brought to bear upon such a man by the local people. There are always a large number of local people who are not desirous of having changes or improvements made, and these people can very often bring serious influence to bear upon the local medical man, and make his position an extremely difficult one. I know of one case myself where a medical man who was officer of health and was always trying to do his duty in improving housing, whose life was made such a burden to him that he lost his practice and was obliged to leave the place. Everybody who has had to do with local government knows that such cases are quite frequent, and we ought to guard against them. If you put the whole thing into the hands of the county councils you will, at any rate, succeed in giving an opportunity for the appointment of a man at a good salary who will be independent. I feel that this is such a very strong point that on this ground, apart from others, I shall certainly support the noble Marquess.
THE EARL OF LICHFIELD
May I say a Word before the reply is given on behalf of the Government? I hope that the Government will see their Way to accept the Amendment of the noble Marquess, and repeal Section 9 of the principal Act. Perhaps your Lordships will be interested to hear the view that the county councils take upon this question. This matter has been referred to a committee of the County Councils Association, and they have reported upon it. It is a strong committee, but unfortunately their report has not been submitted to a meeting of the executive council, because a meeting of that council has not yet been held. I know, however, that the committee are unanimously reporting in favour of the repeal of Section 9 of the principal Act. That is not the same thing as informing your Lordship that the executive committee have passed a resolution to that effect, Still it is as near as possible in that direction; and from all I have heard—and I have spoken to several of the members there is no difference of opinion that they most earnestly desire for the efficient working of the Act that this section should be repealed.
THE EARL OF LICHFIELD
No; the wording of Lord Peel's Amendment was not before them, and they had no opportunity of seeing it. Of course, it is a great concession. But I appeal, like other speakers, to the Government to take the whole thing and sweep away all powers of delegation. There was an argument used by the noble Lord who spoke last about the efficiency of inspection, and I know in our own county we feel very strongly on this matter, and we are most anxious to have this section repealed. With smaller areas it is very difficult to get efficient inspection. If you want efficient inspection you must pay highly trained and highly salaried women to do the work and the smaller areas cannot afford to pay experienced women to the same extent that county councils can. The result is that the work of inspection is not so efficiently carried out, in the smaller areas as it is by the county councils in the larger areas. For all these reasons I hope that the Government may agree to the noble Marquess's Amendment.
THE EARL OF CRAWFORD
I am sorry that my noble friend's (Lord Peer's) Amendment only appeared on the Paper, I think, on Friday last. I am convinced that had the very large concession now moved by Lord Peel been known to the authority in Hertfordshire, the authority in Somerset and others which have been mentioned, and also to the County Councils Association, their opposition to this clause would have been very largely modified. Does the County Councils Association realise that no delegation can take place except at their own instance? If they realised that, surely they need not take such exception to the clause. That seems to me to be a final answer, and had they known it I cannot help thinking that they would not have authorised my noble friend Lord Lichfield to oppose in so uncompromising a manner.
I cannot help thinking that the opposition is based on two principal grounds of suspicion and mistrust. Lord Aberconway was very emphatic about the Local Government Board, about its interference, its being much enamoured of red-tape. I do not think this is a just criticism; in fact, I think it is a very unjust criticism indeed. This power of delegation does not add to the red-tape of the Local Government Board; it does not help its power of interference. Rather the contrary; and, where delegation does exit, it is largely the fault of Parliament, which for years past has pressed delegation in many cases to a ridiculous degree, notably in certain aspects of education. I do not think that it is just to blame this Government Department for a fault which, in my opinion, is directly attributable to Parliament itself.
The other main ground of opposition is in a fear that delegation will place power in the hands of small local authorities which are not to be trusted. Four or five of your Lordships have opposed Lord Peel, but none of them has answered the concrete case which he put. Lord Aberconway said he was afraid of power falling into the hands of what he called "the sort of board of guardian people"—I do not know exactly what he means—which would lead, he said, to favouritism; and Lord Meath mentioned "jobbery, ignorance, and intrigue" which would result from this clause. May one just analyse how this-is going to arise? At the present moment there are scores of authorities in Scotland under 10,000 inhabitants who have full and complete rights under the existing Act. Nobody objects. Is it, then, in authoritie 527 of 6,000, 8,000 or 10,000 inhabitants that jobbery, favouritism, and intrigue are to be expected? It is placed on the question of population—
§ THE MARQUESS OF SALISBURY
It is based on our knowledge of the working of local government in England.
THE EARL OF CRAWFORD
Is 25,000 what you call a "sort of board of guardian area" in England where jobbery is possible? Because there are areas in England of 25,000 inhabitants which have full and complete powers under the existing Act. Does the noble Marquess object to that? And yet, in the same breath, he objects to the Rhondda Valley with 150,000 inhabitants exercising these powers. That is really unreasonable; it cannot really be sustained. Willesden is a town of 120,000 inhabitants. You say that town shall be forbidden to exercise power under the Midwives Act. And yet there are fifty other towns in England smaller than Willesden which already do so. That is not reasonable; it is not just. And unless that case is answered I really think that the proposal of my noble friend Lord Peel holds the field.
The safeguards are not paper safeguards; they are very material. It is essential to get the assent of the county council; you have to get the assent of the Local Government Board, which, in spite of the attack upon it, is not going to delegate or assent to delegation merely for fun; you have to consult the Central Midwives Board, and, as my noble friend indicated, in certain instances you have to carry their assent with delegation. I cannot help thinking, therefore, that on grounds of propriety as well as logic it is difficult to refuse to the Rhondda Valley powers which are exercised by fifteen local authorities elsewhere in combination whose aggregate population is smaller than that of the Rhondda Valley. I should have thought myself that in view of the safeguards which are proposed, the knowledge which your Lordships have that delegation will not be allowed except where good cause is really shown, and that in any case delegation can only be offered to authorities far bigger than scores, even hundreds, of 528 local authorities which already exercise those powers, your Lordships would have done well to accept the Bill as amended by my noble friend Lord Peel.
I am quite ready to meet the Lord Privy Seal upon the ground which he has chosen. I have had personal experience of some of these smaller local authorities as well as the larger ones, and I am quite prepared to associate myself with what was said by Lord Meath. It does happen, unfortunately, that these smaller local authorities are very often to a large extent centres of intrigue, and that their affairs are run by a very small group. Indeed, I have a perfectly clear recollection of a period fifteen years ago when one of the metropolitan boroughs of London was in fact run by a close corporation which could easily meet round a table, and where the affairs of that borough were settled entirely by those people over the heads of the electors. So much for the integrity of administration which sometimes goes on in bodies of that sort, and of which, I think, you may have a reasonable fear in a case of this kind.
Then I was very much impressed by the argument of the noble Marquess below me as to the inadvisability of having a separate authority and a separate inspecting officer for a matter of from two to six midwives, instead of having an inspecting officer for the midwives of the whole county. I was also impressed, because it is a matter of practical importance, by his argument that it did not necesarily follow that the practice of a midwife was circumscribed by the demarcation of the area. I take now the point which the noble Earl has just made—namely, why should you not give a larger urban district area, like Willesden or the Rhondda Valley, these powers if you give them to smaller county boroughs? I think that is a rather false analogy unless he is prepared to carry it a little further; if that argument applies in this case why does it not apply to all the other matters of local government given them in that case, such as the powers of a borough in respect of centralisation. A borough has a certain corporate life and corporate existence which, I think, one would hardly say the Willesden urban district, for example, can claim; and if you give them all the powers which are incident to it there is no reason why they should not have this power as well. But why give them this particular power?
529 The noble Earl suggested that if the Amendment on the Paper had been known to those concerned their views would have been different. I speak without any communication with them and without any knowledge of their affairs, but from what we have heard this afternoon from those who are in touch With them it seems to me that this is hardly so, and I think that the Government will be well advised to how to what appears to be the general opinion in the House and to accept the Amendment to leave this clause out altogether. I should certainly vote with the noble Marquess below me if the matter is carried further.
§ VISCOUNT PEEL
I hope your Lordships will pardon me for saying two or three words on some of the points raised, although my noble friend behind me (Lord Crawford) has already dealt with most of them. First of all I must say a word in reply to the rather vehement attack which was made on the conduct of the Local Government Board by the noble Marquess. I think he will see, if I give one or two facts, how extremely unjust that attack was. I am not concerned to defend the Local Government Board in any sense than as regards this particular matter. The noble Marquess says the Local Government Board has used its influence to promote delegation. Now, what are the facts of the case? In the early stages there was no doubt a good deal of delegation by the county council represented by the noble Lord opposite, but it was at their own initiative, and it was done because in those cases they had not proper medical authorities who could do the work. But after the first two or three years of administration there has been a gradual movement towards reduction of delegation, and at the present time throughout the whole of the country there are only four cases of delegation. If the Local Government Board, as the noble Marquess suggests, has been using its influence in favour of delegation, all I can say is—
§ THE MARQUESS OF SALISBURY
As the noble Viscount knows, I do not speak from any personal knowledge, and if I have been wrong I shall apologise and withdraw; but the information put into my hands was to the effect that the Local Government Board had, I will not say recently, but had been at one time the one to press for delegation and then asked the Central Midwives Board to approve of 530 delegation in cases where the population reached the very small figure of 20,000. If that is not true I will at once withdraw it, but if that has been part of the conduct of the Local Government Board it would be a reason, and a good reason, for being a little suspicious of their intervention in the present ease.
§ VISCOUNT PEEL
I can say positively that the Local Government Board has not only not encouraged but has discouraged delegation in the case of these smaller local authorities, especially in the rural district councils; and I wish to point out again, if I may, that not only is it discouraged in my Amendment but it is actually forbidden; that the county council is unable to delegate its powers to the rural district council; and that as regards what the noble Earl said with reference to county councils, as the initiative must come from them and as no delegation can take place unless they ask for it, I do not understand why they should distrust their own powers. With regard to the suggestion of red tape, and so on, on the part of the Local Government Board, the Local Government Board cannot act at all unless the movement takes, place from the county councils.
This is really a matter of convenience in the cases of these very large authorities where it is desirable for administrative purposes that this delegation should take place. Here again do the noble Marquess and the noble Lord suggest that all these matters about inspectors, about the class of woman, and so on, are unknown to the county councils? As a matter of fact they are fully seized of these matters. If theythink that the powerswill be improperly exercised in these particular areas, all the authorities have to do is not to delegate them; and it is precisely because experience shows that the powers are well exercised in these areas that I think it is better to make some loophole. It is not my business to criticise the county councils. I have said things in this House strongly in support of what they have done; but it is necessary to say that there are cases where they have not done the work very well, and that where they have in some cases delegated the work it has been far better done. I do not want to mention names, but in one or two cases if the work had been delegated it would probably have been better done. With regard to what the noble Marquess (Lord Crewe) said about the Central Midwives Board, when 531 he suggested that virtually the entire power of dealing with the matter should be invested in that body—
§ VISCOUNT PEEL
Yes; I should say they probably have that under my Amendment. The noble Marquess knows, of course, that as this Central Board is not represented in Parliament it would be necessary for the final deciding authority to be with the Local Government Board. But I have already mentioned that, as regards the London boroughs, the Local Government Board has distinctly said that it would follow the advice of the Central Midwives Board; and in other cases it would, of course, be also very largely guided —I am authorised to say this—by the advice of the Central Midwives Board.
I do not know what will be the fate of this Amendment after the criticism it has
§ THE MARQUESS OF SALISBURY moved to leave out Clause 12. The noble Marquess said: I need not repeat any of the arguments. I will content myself with moving that this clause be struck out of the Bill.
Leave out Clause 12.—(The Marquess of Salisbury.)
§ received in your Lordships' House, but after the words "unless that council undertake to appoint as inspector of midwives a person" I should like to insert "preferably a woman." That would, perhaps, strengthen my Amendment; but on the whole I strongly urge the House to allow this one point of elasticity to he left in the Bill, and not absolutely to cut off all delegation which would have the effect of destroying some useful work that is being done by large local authorities in this country.
Amendment moved to the Amendment—
Line 6, after the word ("person"), insert ("preferably a woman").—(Viscount Peel.)
§ On Question whether the proposed new subsection, as amended, shall stand part of the clause?
§ Their Lordships divided:—Contents, 23, Not-Contents, 33.531
|Finlay, L. (L. Chancellor.)||Farquhar, V. (L. Steward.)||Colebrooke, L.|
|Wigan, L. (E. Crawford.) (L. Privy Seal.)||Sandhurst, V. (L. Chamberlain.)||Elphinstone, L.|
|Devonport, V.||Hylton, L. [Teller.]|
|Peel, V.||Lambourne, L.|
|Chesterfield, E.||Monckton, L. (V. Galway.)|
|Lytton, E.||Armaghdale, L.||Ranks borough, L.|
|Northbrook, E.||Ashbourne, L.||Stanmore, L. [Teller.]|
|Stanhope, E.||Cheylesmore, L.||Stuart of Wortley, L.|
|Vane, E. (M. Londonderry.)||Clinton, L.|
|Argyll, D.||Yarborough, E.||Burnham, L.|
|Lincolnshire, M.||Chaplin, V.||Chaworth, L. (E. Meath.)|
|Salisbury, M. [Teller.]||Falkland, V.||Desart, L. (E. Desart.)|
|Hutehinson, V. (E. Donoughmore.)||Fairfax of Cameron, L.|
|Brassey, E.||Kintore, L. (E. Kintore.)|
|Cottenham, E,||Knaresborough, L.|
|Grey, E.||Llandaff, L. Bp.||Muir Mackenzie, L.|
|Harrowby, E.||Rotherham, L.|
|Lichfield, E.||Aberconway, L.||Saltoun, L.|
|Mayo, E.||Ashton of Hyde, L.||Sanderson, L.|
|Russell, E. [Teller.]||Balfour, L.||Sydenham, L.|
|Selborne, E.||Brodrick, L. (V. Midleton.)||Weardale, L.|
On Question, Amendment to the Amendment agreed to.
§ Amendment moved—
§ Insert as a new clause:
§ Repeal of section nine of the principal Act.
§ . Section nine of the principal Act (which enables county councils to delegate their powers and duties to district councils) shall be repealed.—(The Marquess of Salisbury.)
§ On Question, Amendment agreed to.533
§ Clause 13 agreed to.
§ Clause 14:
§ Medical assistance in case of emergency.
§ 14.—(1) In case of any emergency, as defined in the rules framed under section three I. (e) of tile principal Act, a midwife shall call in to her assistance a registered medical practitioner, and the local supervising authority shall pay to such medical practitioner a sufficient fee, with due allowance for mileage, according to a seale to be fixed by the Local Government Board, and such fee shall cover one subsequent visit.
§ (2) It shall be a condition of the payment of such fee that the medical practitioner so called in shall state in his claim to the local supervising authority the nature of the emergency.
§ (3) The midwife shall report forthwith to the local supervising authority each case of emergency in which she has called in a registered medical practitioner to her assistance, stating the nature of the emergency and the name of the medical practitioner.
§ (4) The local supervising authority shall have power to recover the fee from the patient or from the husband or other person liable to maintain the patient either summarily or otherwise as a civil debt, unless it be shown to their satisfaction that the patient or her husband or such other person is unable by reason of poverty to pay such fee.
§ VISCOUNT PEEL moved to delete from subsection (1) the words "and such fee shall cover one subsequent visit." The noble Viscount said: These words are really unnecessary because the fees and number of visits will be defined by the rules, and they rather confuse than make clear the result.
Page 5, line 18, leave out "and such fee shall cover one subsequent visit."—(Viscount Peel.)
§ On Question, Amendment agreed to.
§ Clause 14, as amended, agreed to.
§ Remaining clauses agreed to.
§ Provisions of Principal Act Repealed.
§ In section 5 the words "in proportion to the "number of midwives who have given notice "during the year of their intention to practise "in those areas respectively. "
§ In section 10 the words "or to the body to "whom for the time being the powers and duties "of the local supervising authority shall have "been delegated under this Act, and the words "or delegated body."
§ Section 17 from "The General Medical Council" to the end of the section.
§ THE EARL OF MEATH moved to insert as a new paragraph in the Schedule "Sec- 534 tion 9, the whole section." The noble Earl said: This is simply a question of drafting. I thought it better that it should be in the Schedule than in the body of the Bill.
Amendment moved —
Page 6, after line 12, insert as a new paragraph ("Section 9, the whole section ").—(The Earl of Meath.)
§ VISCOUNT PEEL
I will not oppose the Amendment, because I certainly think that if it is to be done this is the best way of doing it.
§ On Question, Amendment agreed to.
§ Schedule, as amended, agreed to.