HL Deb 17 July 1918 vol 30 cc926-57

LORD WILLOUGHBY DE BROKE rose to call attention to the desirability of establishing a Ministry of Health without undue delay; and to move to resolve—

That this House urges His Majesty's Government to introduce at an early date a Bill to constitute a Ministry of Health.

The noble Lord said: My Lords, in moving the Resolution that stands in my name I make no apology for bringing before your Lordships' House such an extremely important subject. It is particularly appropriate that it should be debated in the House of Lords, because it has been barked and blocked and put into the background in the House of Commons. We have heard something to-day in a debate which took place just now with regard to free speech in this House, and I believe that the general public outside is proud of the privileges of this House and would be very sorry indeed to see any diminution of those privileges. I do not wish to go into the controversy which we have just had, except to re-affirm, as far as a private member may do, that the only ultimate constitutional authority with regard to free speech in this House is a majority of the members of your Lordships' House present on a particular occasion.

With regard to the Ministry of Health, there is no doubt that this is the most important subject to which we could possibly address ourselves. I could cite many historical authorities in favour of the principle of health as affecting the life of the nation. If your Lordships will allow me, I will only take one. It is that of Disraeli, who, you will remember, reminded an audience I think at Manchester in 1872 that the Vulgate version of Solomon's words, "Vanitas vanitatum omnia vanitas" was really intended by that wise and witty king to be "sanitas sanitatum omnia sanitas."


Mr. Gladstone said it.


I do not advise the noble Lord to say too much about Mr. Gladstone in this respect. The contemporary Whigs of the day called all this sort of thing "the policy of sewage." I should be very sorry to enter into a controversy about it, but I believe that it is common knowledge that Disraeli said that. Am I not right?


Yes, you are right.


He went on to say— After all, you cannot possibly over-estimate the importance of this subject. Your land may be covered by historic trophies, you may have museums of art and of science, and you may have galleries, and your people may be covered by historic trophies, you may have museums of art and of science, and you may have galleries, and your people may be even famous in the annals and action of the time, but if the stature of the people every ten years decreases and the population every ten years diminishes, the history of your nation will very soon be a history of the past. I would only add to this one more saying of contemporary historical importance, and that is one which I have quoted to your Lordships before of the illustrious Sovereign who rules over these Islands, and who has reminded us, in his own immortal phrase, that "the foundations of glory are set in the homes of the people."

With regard to the particular principle of the Ministry of Health, we have on our side all the principal pioneers of racial reconstruction. We have among others Dr. Saleeby, who is one of the greatest prophets of eugenics in this country, and who has spared neither time nor trouble to address meetings on this great subject throughout the land where innumerable resolutions have been proposed and passed; and he himself proposed the first resolution on a public platform with regard to the Ministry of Health as an urgent war measure at a meeting at the Duchess of Marlborough's house as far back as three years ago. We have also Major Waldorf Astor, who has taken a great interest in this matter, and who calls it "a sound business proposition." Lord Milner said the other day that he was in full agreement as to the urgency of a Ministry of Health. That is my position too. Lord Milner said— We could not expect to have it in its final and complete form now, but a substantial benefit will be obtained by unifying control at the centre under one head. We have also Major-General Sir Bertrand Dawson, who said— The foundation of the Ministry of Health is the most pressing of all reconstruction problems. And last, but not least, we have the late Lord Rhondda, who said— The Prime Minister was heart and soul with the movement, and the Ministry of Health was a most urgent war measure, for 1,000 babies were lost every week through maladministration of the Health Services. I suggest to your Lordships that the foundation of a Ministry of Health would be a more fitting and a more enduring memorial to the memory of that great man than all the perorations that have ever been uttered inside the doors of Westminster Palace.

Then we have the Bishop of Birmingham, the President of the Birth-rate Commission which is now sitting. Resolutions have been passed by all enlightened voluntary bodies who are entitled to have a say in this matter; and a large and influential memorial is about to be presented—or, I think, has just been presented—to the Prime Minister on this extremely important subject. It is important because we have to face among other things the loss of the actual fathers of the race in the war; many of our best men who should be the healthy fathers of the next generation have sacrificed their lives. Owing to the war we have an actual loss of babies. Sir Bernard Mallet, the Registrar-General, said at the Royal Institute of Public Health that, but for the war, there would probably have been 650,000 more babies born in England and Wales since 1914 than have been born. We have to face the lowest birth rate on record. We have to face the fact that venereal disease and tuberculosis are greatly on the increase. And in this regard I should very much like to know what has happened to the Joint Committee that was promised not long ago to sit on those two Bills with regard to venereal disease. Has that Committee gone the same way as other things? But that is not really in the Ministry of Health, though it is germane to what I was saying, and if I can get an answer about that presently it might be well.

We have also to face the fact that 1,000,000 children in our elementary schools are either physically or mentally defective, so that we need not be surprised that the lists of Grade III men fill up remarkably well. Not only that, but the present and the future fathers of the race, owing to our having lost so many of the best of our manhood, will not be recruited as heretofore from the strongest. That is why their children will want additional care. Further, we have to face diseases that are brought home, and will be brought home, from the war—such as malaria, trench fever, and dysentery. We have the admitted neglect of maternity; and I submit to your Lordships that we have, in fact, an overwhelming case for constituting a Ministry to deal with the public health.

Now, how is this being dealt with at the present time? What I am going to say is illustrative of some of the methods we employ in this country. We have now, dealing with the public health, the Local Government Board (including the Registrar-General's department), the National Health Insurance Commission, the Board of Education, two Departments of the Home Office, a Department of the Privy Council dealing with midwives—though I should be glad if the noble Earl the Lord President of the Council could tell us what the relationship between these two classes of the community is; at present it is one of the anomalies of the Constitution which has not been explained—the Board of Trade, the Ministry of Pensions, the Ministry of Munitions, the Ministry of Food, the Ministry of Reconstruction, the Railway Traffic Control Board, the Admiralty, the War Office, the Air Council, the Colonial Office, the Indian Office, the Foreign Office, and the Board of Agriculture, which is responsible for pure milk, and therefore is acutely connected with the spread of tuberculosis. In addition to all those Departments, we have 1,800 sanitary authorities, 630 boards of guardians, 238 local insurance committees, 318 education authorities, and 320 new pensions committees. All these bodies deal either directly or indirectly—and for the most part independently of each other, therefore having no common or concerted action and no clearly defined object—with the health of the country.

There is no safeguard in this extraordinary system against overlapping, and, what is still worse, there is no safeguard against overlooking which is much more important. Yon may have what you consider to be a perfectly water-tight system, but if you have a great many of these bodies operating in the same area the very thing you want to check may easily slip between the crevices. All these bodies are conducting their own investigations on their own account. It is, of course, no very wide exaggeration to say that a representative from each of these bodies might conceivably be in the same house looking at different members of the same family at the same moment. In the old days Lord Chatham used to say—and this quotation has been given to the House, I believe, by Lord Rosebery— that "however the storm, or the rain, or the wind, may enter the cottage of a poor man; the King of England could not enter; all the forces of the Crown dare not cross the threshold of that ruined tenement." But we heard the other day in evidence before the Birthrate Commission that at least eleven forces of the Crown had entered the tenement of one man in order to inspect him and his family from various points of view.

These are not highly coloured exaggerations which I have brought in for the purpose of giving point to what I have to say. I will corroborate my statements by reading one or two sentences from the Report of the Local Government Committee of the Ministry of Reconstruction, a very powerful Government Committee—which reported not very long ago— There are at this moment a large number of different bodies giving various forms of public assistance out of rates and taxes, with very inexact delimitation of the persons eligible. Many of these bodies deal on different lines, and for different reasons, with members of the same family. There are, for instance, seven different public authorities giving money in the home, leaving out of account the exceptional cases of money payments by the education and health authorities. All these are found contributing towards maintenance in various forms, institutional or other. At least six are providing various forms of medical treatment. Three are giving educational training of one sort or another. The able-bodied unemployed may be subsidised by five of them. These public bodies, many of them extending over different areas, have, with a few exceptions, no common system of registration of cases; so that even the names of persons receiving assistance from one or more of the bodies may be unknown to some other body which may be considering their case. This absence of common knowledge results in much overlapping, and also in occasional failure to detect cases of need. Not only are there many public authorities dispensing assistance out of the rates and taxes, but new ones are frequently being improvised to meet emergencies. The extent, variety, and overlapping of the activities of these various bodies cannot adequately be set out, but there may be, often with little co-ordination between them, dealing with:—infants and maternity, five different bodies; with children of school age, three different bodies; with persons of unsound mind or mentally defective, six different bodies; with sick persons, four different bodies; with the aged, three different bodies; and with the able-bodied, not fewer than five different bodies. In the face of all this, my Lords, he would be a very brave man who tried to disentangle it, but a still braver one who would agree in Parliament to let things remain where they are at the present moment.

Now we have brought to bear upon this question two different frames of mind. We have that frame of mind which says, "Oh! we don't want to have anything to do with this at all. We have too many Ministries already"; and then you have the frame of mind which will agree that the matter is urgent but wishes the treatment of it to be postponed till after the war. I would say to that noble Lord, or to that member of the public, who thinks the argument that there are too many Ministries already is sufficient to dispose of this great subject, that he is bringing forward a consideration which is not worthy of the issues that are at stake. The second answer to him is that it is not proposed to create a new Ministry at all, and I shall show your Lordships in a moment that we do not propose to create a new Ministry but are actually trying to save an existing Ministry. Even it we had to create a new Ministry I see no reason why it should not be done; the case is sufficiently urgent to warrant it. Because since the war we have created a great many new Ministries and left out the most important one of all is no excuse for not appointing it at the present moment; and those people in the country who are anxious to see a Ministry of Health established, and who intend to see it established, are not going to be put off by arguments of this kind, and will not be put off by the plea of expense, because they believe, and they believe with great truth, that the expenditure of lives is the greatest extravagance of which a nation can possibly be capable, and that to create a Ministry of Health, so far from being an extravagance, will be national salvage all round. It will be national salvage of officials, national salvage of money, and national salvage of lives, and it will be the most important part of construction and reconstruction that we can possibly imagine. Nor, my Lords, are we going to be put off by allowing children to be thrown to the wolves in the shape of the Maternity Bill. Your Lordships will shortly, I believe, be asked to discuss a Maternity Bill which has been passed at the other end of the passage.




If anybody tells your Lordships that it is a substitute for all this, do not believe it; it is nothing of the kind.


Nobody said so.


It is the frame of mind which those responsible for the Bill are trying to create.


Nobody said so.


I am very glad to hear it. May I produce, my Lords, one or two reasons why I am saying this? This Maternity Bill is all very well in its own way, and I shall do everything I can to assist in passing it into law and to make it a success. I am not going to be guilty of the same thing which I understand is going on downstairs, in the shape of Departmental jealousy. But the Maternity Bill does not deal with the three great killing agencies of the human race. It does not deal with tuberculosis, venereal disease, and alcoholism, and although it is a useful measure it touches only a small part of the great problem of health.

Now, we can do all that is necessary without creating a new Ministry. We shall save a Ministry, as I ventured to say just now, and if it is a matter of saving a Ministry, there are a certain number of old-fashioned and archaiac Ministries which are approaching a period of senile decay or even obsolescence; and in the very able book written by Mr. Henry Higgs, who was appointed by the Government to unravel the working of the Civil Service in South Africa and Egypt, it is stated that a Minister without a Portfolio is a greater expense than a Portfolio without a Minister. Those who have studied the subject advise that what should be done is to bring together the Insurance Commission and the Local Government Board. I should like to say that, I, for one, sincerely hope that the new Ministry of Health will not confine itself to the orbit which now controls both these Ministries. The idea of merging the Local Government Board and the Insurance Commission is already agreed in principle, but it is being delayed, as I understand, either because the Local Government Board and the Insurance Commission are fighting with one another or jealous of one another or are not on sufficient terms to live in the same house. I understand that a good deal of difficulty arises over the Poor Law, and that the position of the Poor Law is being exploited, either honestly or dishonestly, by Departmental interests as an excuse for holding up the Ministry of Health.

All insurance interests, whether industrial, friendly, or approved, naturally object to being mixed up with the Poor Law. That is intelligible. But the attitude of the Local Government Board towards it is a little more difficult to fathom. I wonder if the Local Government Board hope that the Poor Law will survive, and will cling to the Poor Law; or is it suggested that they are afraid to let any one into their house until the poor relation has been despatched and got rid of? Is that the reason? Whatever the reasons may be, the public have a right to know what it is that is hanging up this very vital reform. I say that the first step is to merge the Local Government Board and the Insurance Commission, because practically all the functions of the Local Government Board are already health functions. I know there are other functions—non-health functions—which could be properly allocated to other Departments, but the bulk of the Poor Law, concerned as it is with infirmity, sickness and infancy, performs in elect a health function. If it is necessary to get rid of the non-health functions of the Poor Law, the Poor Law schools, for instance, could be handed over to the local education authorities and the Board of Education, while unemployment could be transferred to the Ministry of Labour. But it does seem that the break-up of the Poor Law is a condition precedent to a Ministry of Health.

Those who are interested in the matter hope most earnestly, and we urge upon the Government, that they will introduce a Bill at an early date, and either follow it or accompany it, if they like, by the announcement that their policy will be that which has long been arrived at by those who are qualified to judge in this matter—that their policy will be to follow it by the break-up of the Poor Law. I do not know whether this occasions noble Lords opposite any great surprise, but I should have thought that they were sufficiently hardened not to mind announcing any number of policies, in view of the fact that they have already announced that they can pass Home Rule for Ireland and enforce Conscription at the same time, and have abandoned the intention. At any rate, there will be no difficulty in announcing that you are going to do away with the Poor Law. You cannot object to that. Let us make a beginning at any rate, and let the Ministry of Health, at its inception, be a central authority to disentangle, co-ordinate, superintend, and make collective and coherent all investigation that is now being carried on by a hundred and one different Departments. Let it stand to the other Departments of the country with regard to health in the same relation as, say, the Board of Works stands to other Departments in relation to architecture, or the Stationery Department stands to other Departments in the matter of buying their paper and, I believe, their furniture at a cheap and uniform rate.

In establishing this Ministry (it is rather early, perhaps, to talk about what it should do until we have seen the Bill) it is not too much to hope that we shall be able to keep in view the following principles—that we shall place science in its proper position, and that, as Sir Bertrand Dawson said in his extremely able letter in the British Medical Journal, the skilled shall no longer be under the control of the unskilled; and that the proper people to decide about doctoring are the doctors. It is not necessary in this regard—we are not asking—that the new Minister of Health should be a doctor, but it does seem essential that the permanent Under-Secretary should be a medical man, and that there should be somebody responsible of technical training who has direct access to his chief. It is to be hoped also that the new Ministry, as soon as it is formed, will call to its counsels representatives of all medicines, and will link up both the preventive and curative sides. People talk a great deal now about preventive medicine on the one hand and curative medicine on the other. It is not out of place to remark here that, with regard to all infectious and contagious diseases, the curative side of medicine becomes preventive, inasmuch as you prevent other people catching the disease by curing the sufferers, and the two branches of medicine become practically indistinguishable.

There are other questions which it will be appropriate for the new Minister to examine as soon as he is appointed. They are rather important questions, about which the nation would like to know, and Parliament ought to know, the answer. How much do we spend on public health? I do not suppose anybody knows. By what Departments is it spent? How much is spent by each Department? What does each Department regard as its proper functions in the matter of health? How far do we get value for the money that we spend? How far do various bodies—this is a very important question—concerned in health compete with one another in administering health functions? Surely all this is of first-class importance, and it is worth doing and it is worth doing now. The noble Earl the Leader of the House, Lord Curzon, I suppose admits the urgency of it. At any rate, he says that the postponement is due to nothing else except acute and deep-seated difference between the various Departments concerned. This is not a very satisfactory state of things. It means either that the Government is not master in its own house—that the Government cannot manage its own servants—or else that it is taking advantage of a squabble that is going on downstairs in order to postpone the introduction of the Ministry of Health. I believe that the general public will not stand this sort of thing very much longer, but will want to know what this quarrel is about, and how soon the Government is going to take steps to put it right. I am sanguine enough to believe that many of your Lordships will agree with me as to the urgency of dealing with the health of the nation by at least forming a Ministry of Health and doing it at the earliest possible date.


Hear, hear.


I have spoken to some noble Lords and to friends outside the House, and I find a disposition to admit the force of all this, but, at the same time, to say "You had better do it after the war." I am getting a little tired of the phrase "after the war." I believe that to say you will do a thing after the war—the noble Viscount who is going to follow will, perhaps, tell me whether my law is right—means, in the opinion of lawyers, to "void for perpetuity," or something near it. Nobody can tell how long the war is likely to last. The war may last for a very great number of years. And there is this point. Unless you set up a Ministry of Health and do every single thing in your power to arrest the consequences of the war on the public health, you are doing the very best thing you can to prolong the war.

This is a war measure. It is an urgent war measure, and every day that it is postponed we take the responsibility of postponing the conclusion of hostilities. No one knows when the war will be over. Then people say that you are not to have any fresh legislation during the war. That is really not bad, considering that just before your Lordships allowed me to get up to speak a gentleman came from the end of the passage and said that the Education Bill had just passed the House of Commons, and that we have been told by the noble Earl, Lord Curzon, that we are going to sit up all night for some weeks to come in order to give consideration to the Education Bill. Let me say this about the Education Bill. If you have time to pass an Education Bill you can equally make time to pass a Health Bill, and it is no good whatever passing an Education Bill and deciding how you are going to educate your children until you have taken measures to ensure that there will be a proper supply of children to educate. To pass an Education Bill before a Health Bill is to put the cart before the horse.

I believe, with all my heart, that this matter is urgent. Anybody who does not think it is urgent had better read the Casualty Lists which appear every morning in the Press, and he will see that it is becoming very urgent. We may wait in this matter, but nature is not going to wait, and we should not be doing our duty to the nation if we did not take this matter in hand at the earliest possible moment. I am extremely anxious, and I entreat your Lordships to pass this Resolution, or at any rate a Resolution something like it. I will make an offer to the noble Lord who is going to answer for the Government. I will modify the Resolution if necessary, and make it as wide as possible, short of admitting that this reform can be held up until after the war is over.

We may be told by the Government that they are going to produce their Bill. If they are going to produce their Bill they cannot possibly have any objection to the Resolution. If they do not intend to produce a Bill, then we must take the only means we can to bring pressure on them by passing a Resolution urging them to produce a Bill at the earliest possible moment. I do not want to embarrass the Government, but they are like all other Governments. They have acquired a knack of yielding at the proper moment to pressure. They are like a certain type of horse that I know very well, and have ridden a good many times. They are a very good type, whose principal characteristics are that they are not overburdened with courage; they have an excellent notion how to take care of themselves, have unlimited staying power, and every now and then surprise themselves and their friends by winning a race, provided you kick and cuff them every yard of the way. That does not apply particularly to this Government, and I hope noble Lords opposite will understand that I say this in no offensive sense, but it is a characteristic that long tenure of the Front Bench is bound to develop. I hope your Lordships will affirm the principle of a Ministry of Health, which has been to long neglected.

I should like it to be clearly understood that those who wish to promote a Ministry of Health have no idea, as some people seem to fear, of nationalising either the medical service of the country or the hospitals. Our hospitals are one of the finest monuments of this country. What we would like to do is not to nationalise our hospitals, but, if possible, to make them superfluous. We wish also to place the medical profession on a higher level than it occupies at the present moment; to place it on the same sort of level which it occupies in the United States. In short, my Lords, I hope I shall not be out of place if I implore you to pass this Resolution. Lord Beaconsfield really did say this, and not Mr. Gladstone—" I beg your Lordships, on this occasion, to be on the side of the angels." We are not threatening any interest; we are not attacking anything at all except disease. I honestly believe, from many communications I have received from outside, that the general public look to this House to stimulate the formation of a Ministry of Health, and to announce that the welfare and health of the race is the primary function of Government.

Moved to resolve, That this House urges His Majesty's Government to introduce at an early date a Bill to constitute a Ministry of Health.—(Lord Willoughby de Broke.)


My Lords, I rise to second the Motion, and I shall be able to do so very briefly because I do not wish to go over the ground which the noble Lord has covered. One thing, however, I wish to emphasise. I think this is a war measure, and a very urgent war measure. The noble Lord quoted statistics given by Sir Bernard Mallet, the Registrar-General, as to the loss of births since the commencement of the war, but these statistics do not merely represent the peril to which we are exposed—a peril which arises not out of the war but which existed before it, and which constitutes a serious danger. After the war we shall have to do our utmost to build up our population, and we require, as early as possible, to take the steps requisite for that purpose.

I do not think it is generally realised that by far the greatest loss in population is not post-natal, but ante-natal. Statistics show that the number of children who ought to be born into the world and who are not, by reason of various diseases, is enormous, and it is due to the three causes which the noble Lord mentioned—alcoholism, venereal disease, and phthisis. These are subjects which require the most careful scientific investigation. To pass a Maternity Bill is to scratch on the surface, and to try and solve questions which the Motion raises by means of a Maternity Bill is, I assure the Government, to bring down presently ridicule on their own heads. They do not realise the depth of feeling which has been awakened on this question, and the immense importance it presents to the nation, and to try to deal with it by any method other than one which will go to the root of the whole matter and provide a system which will afford us some redress from what we are suffering as a people, is only to bring down very hostile criticism indeed upon their heads.

This brings me to what I want to say as to what is necessary in a measure of this kind. There are three things which have to be seen to—population; the prevention of disease generally (which is a very wide thing); and also what the noble Lord alluded to, the training of health officers. I think this is a very wide subject indeed, and one beyond the scope of any Department. They must come to some extent, and to a very important extent, within the scope of a Public Health Ministry, and to suppose that the Local Government Board, as at present constituted, could even approach such a problem is simply to show that you do not know what you are talking about.

The question of medical education in this country is in urgent need of consideration. We have not only fallen behind the United States in many particulars, but we peculiarly require the systematic training of a body of health officers who can discharge the necessary work we have to do. It is not merely the question of the medical men; it is also the question of the training of nurses, of inspectors, and of a variety of people, who will have to deal with the carrying out of a practical measure of this kind. It will require the best thought of the Universities, and the best thought of the medical profession to be brought to bear on it, and it will require the sympathy and stimulation of a great Government Department which really is furnished with the knowledge that this great problem requires. This means that before you can make progress you must know what it is that you have to do. You must have your principles clear; and fortunately as regards this Bill, I think that the principle has become very fairly clear.

The noble Lord referred to the very valuable Report with which I also have provided myself—the Report of the Local Government Committee on the Transfer of the Functions of Poor Law Authorities in England and Wales, a Report which goes far beyond that mere subject, for it dealt with the general question of the co-ordination of public assistance which is germane to the Poor Law. That was a very striking Committee. It included Lord George Hamilton and Mrs. Sydney Webb, the rival antagonists of the two Reports, Majority and Minority, of the Poor Law Commission, and it had the happy result of a complete agreement being reached between those representing the two views upon Poor Law reconstruction. It was reached in this way, and it has the most direct bearing on the subject of which the noble Lord opposite is going to speak. It is quite clear, and if proof were wanted of it this Report makes it clear, that the only way of dealing with the public health of this country is by devolution—devolution under the direction of a highly competent Minister with a Department from which he can supervise it.

To talk of local government is to use an expression which was admirable in the old days when we had no local government properly so-called, in the times when the Poor Law was first the subject of attention by statesmen, and when, very slowly, laws relating to sanitation and other subjects were being evolved. To-day we have got far beyond the stage of treating these things by the Local Government Board. They are too many and too varied to be handled by any one Minister except in a Lilliputian fashion. What is recommended on all hands, and what is recommended by this Report—and I think that nobody has dissented from that view, and that countenance has been given to it by some members of the Government—is that you should take the method of devolution, and in time that you should distinguish between the forms of public assistance and the functions which you wish to evolve.

Take, for example, what we have to-day. The noble Lord truly said, quoting the Report, that there are no less than six authorities who administer the public health of the nation. I will not go over them again, because we know them. The boards of guardians do a good deal. It is very simple to split up the public assistance which you give into its various forms, and to take public health and treat that as one of the forms. Then you will have the thing mapped out for you. You have an Education Department which does not administer education at Whitehall. It is a common delusion that it does. Education is administered, is carried out and worked, by the 390 local education authorities which Whitehall superintends. And so it ought to be with the Public Health Ministry, which ought to be exactly in the position of the Board of Education, and which ought to work through the borough and county councils.

If this analogy were followed, what would be the result? Every borough council, every county council, would have its health committee as it has its education committee; that is a statutory committee on which experts should be co-opted—as has been done with such good results in the case of education—and you would then devolve the whole of public health assistance to that committee, working of course under the responsibility of the council to which it belonged. In the same way, you would take the provision of employment for able-bodied and all questions connected with out-relief and so on, and you would hand those over to a statutory committee of the county council, and so you would break up the bundle of special forms of public assistance which are to-day all included under the general name of "local government" without rhyme and without reason.

What would be the effect of this? You would get devolution, and you would look to your local parliaments, your county and borough councils, to do the work that you would like them to do through the medium of these statutory committees. You would gain, I think, a great advantage, because these local bodies have become enormously important, and you would relieve Parliament of an immense deal of work which it has at the present time to do. What is the use of our considering quite minor measures connected with public health? Everybody approaches them from a different point of view. There is no unity, no conception, no scientific view of the nature of the services, and the result is that a great deal of our time is consumed uselessly, and a great deal of legislation is undertaken which never ought to come before Parliament at all. I believe that if we were in earnest about this notion of devolving the responsibility to local authorities with the assistance of expert statutory committees, such as the education system provides, we should have gone a long way towards solving one of the most pressing features of the problem of Home Rule.

This question of devolution is, therefore, a big one. If that be so, however far it goes and however much further you can extend the problem of devolution, what is the effect upon the existing state of things? The effect is this. The Local Government Board will become what it ought to be primarily—the Ministry of Public Health. It would be only secondarily a Ministry of Local Government, because there would be little local government to look after. Certain questions in connection with the able-bodied and other forms of public assistance would remain, but they are trifles compared to those referred to by my noble and gallant friend, and they are subjects which would take up only secondarily the attention of the Local Government Board.

There are other services performed by the Local Government Board which I think would be better performed by other Departments to which they are more germane. The result would be that you would have a Ministry of Public Health, and such residue of local government as remained after you had broken up the fasciculus of special service and devolved the administration of that to the local bodies concerned. I can honestly say that I cannot think of any measure which, if passed speedily and put vigorously into operation under a really sympathetic man, would do more completely to change for the better the state of things in this country and bring people to realise not only that the remedy for their condition was in their own hands, but that the nature of that remedy had been pointed out to them, and that they had the wise and benign supervision of a Ministry of Public Health, comprising within itself the best expert knowledge that the country could command for the purpose of guiding the local authorities in the very important duties which they would have to discharge. I beg to second the Motion.


My Lords, I have no wish to take up any of your Lordships' time; indeed, it would be difficult, on what is a comparatively restricted field, to add to what has been said by the noble Lord who moved this Resolution and by the noble Viscount who has just seconded it, but I should be very sorry if before the noble Lord replies on behalf of the Government—I hope in a favourable sense—no voice were raised from the Episcopal members on this subject to support the Motion. Naturally the subject is one which continually, day by day, concerns those with whom I and other Bishops have to work in every part of the country.

The war has brought indeed many calamities, but it has brought this great blessing—that it has, in a manner which we have not known in the life of this country before, aroused and directed public opinion in regard to the vitally important question of public health. I do not think there ever has been a time when a larger number of able and thoughtful people have been deeply concerned with this problem and when there has been aroused in every part of the country a more convinced, united, and determined public opinion. But this quickened public opinion has discovered two things. One is the unity of health problems. There is scarcely one which can be really considered apart from the other. The noble Lord has given many instances. For example, you cannot make any real distinction between the medical treatment which should be given to a mother in the vitally important days, not only of birth, but before and after birth, and the provision of satisfactory nourishment both for the mother and the child. You cannot isolate the efforts made to promote the health of the children in our elementary schools and the sanitary conditions of their homes and the facilities which are open to the mothers for obtaining proper nourishment for their children. You cannot separate—that is a vast and most interesting matter to which the noble Viscount has only just referred—you can less and less separate all that is meant by the prevention and all that is meant by the cure of disease. You cannot possibly separate the schemes, which I hope will be more abundant and more intelligent after the war than they were before, for the housing of the people from the most complicated questions of sanitation and public health generally. And, above all, you cannot possibly separate research in these matters from administration.

Wherever you turn you find the same conclusions, that health problems are fundamental ones and must be thought out and administered in unison. That is what public opinion has everywhere come to see with increasing clearness and force. At the same time the second thing it has come to realise, with this unity of the problem, is the extraordinary diversity of administration on a question which, more and more, as people come to see it, depends on unity of treatment. There is what, to the outsider, seems a most inextricable confusion and overlapping of administrative bodies. What those who realise the necessary unity of the problem want to know is, What is it that stands in the way of bringing all these operations which closely concern public health under the one Ministry? Is it a difficulty of principle? I cannot see where such a difficulty of principle can arise. Is it a difficulty of administration? Then surely it is one which ought to be at once set right. I agree with every word that the noble Lord said about the urgency of the problem. In the conduct of the war it has been found necessary to create new Ministries. It seems to me that even during the war it ought to be possible, not, as the noble Lord has pointed out, to create a new Ministry, but to correlate existing Ministries and put this matter under unity of control, which is the only way of meeting the unity of the problem itself.

I feel sure the noble Lord will not think that this is a problem which can be safely entrusted to the vague days after the war. There is not one of us who knows what the problems will be when that occurs. We may be faced with difficulties which will tax to the uttermost the thoughts and energies of the whole people. Moreover, as I think the noble Lord has himself pointed out, this is a matter that directly concerns war conditions. It is not a matter that one wishes to speak of in any detail or at any length, but it must be obvious that questions gravely affecting public health will immediately arise in proportion as the Army begins to be demobilised, and we ought to be ready. Moreover the question of raising up a population to meet the terrible depletion which has occurred in the ranks of the citizens of the country is not one that can be postponed for a single day. It has an urgency which arises out of the very conditions of the war.

It is no good attempting to bring in piecemeal legislation on these questions until a united Ministry has been created, because there is always the difficulty—either you postpone that legislation until questions of administration are more satisfactory, or you bring in a measure and entrust it to some branch of administration which admittedly is not satisfactory and which may in a very short time be removed. Just, therefore, at a time when measures affecting the public health are so necessary those who are concerned in them are perplexed and paralysed by this apparently unintelligible and inextricable variety of administration. I am sure that there is a larger force of public opinion than is, perhaps, realised pressing at this moment to know precisely why it is that this Ministry, so long promised, has been delayed. I am sure, with the noble Lord, that people will not be satisfied with the answer that the reason really is departmental difficulty. These are things that a strong Government exists to overcome.

I associate myself with the appeal that has been made to-day by the noble Lords who have just spoken that at any rate a beginning shall be made in the direction of making the administration of public health as united as the problem with which it has to deal. I think that we must look to the Government to show that it is not merely in word but in fact the case that we are not less concerned with measures which will assist in winning the war than we are with measures which may bring about that better order of our national life without which in many ways the war will have been waged in vain.


My Lords, since I came into contact with the very numerous bodies which are dealing with public health in one way or another I could only come to the conclusion that the confusion was perfectly appalling, and I most cordially agree with the noble Lord that we must have a Ministry of Health as soon as it is possible to set one up. But I think that some of the advocates of a Ministry of Health have not quite clearly thought out all the difficulties, and those of us who have listened to the speech of the noble and learned Viscount, which was full of constructive proposals, will, understand how very much has to be done before a Ministry of Health can be made as effective as it should be. The Local Government Board was only established in 1871, and though it has still imperfect powers I think it has accomplished a considerable amount of excellent work, which is too little realised. But all the most important developments in the direction on public health, however they are initiated, must depend for their administration and for their executive power upon the local authorities, as the noble and learned Viscount has said. That is neces- sary, and it should always be necessary; therefore the efficiency of the local government system will really be a test of the efficiency of the health arrangements which we all hope to see set up.

Among many developments in late years I should like to mention the setting up of venereal disease clinics, fever and small-pox hospitals, clinics for expectant mothers, asylums for insane and feeble-minded, and tuberculosis hospitals and sanatoria. To give some little idea of how one part of the work is done, I may say that the public health authorities provide 170,000 beds, the Poor Law guardians 96,000 beds, and the voluntary hospitals somewhere about 45,000 beds. I think it may be fairly said that under the œgis of the Local Government Board the average of life has been prolonged, that there has been a diminution of nearly one-third in the death rate, and that there has been a considerable reduction in the mortality among infants, though that is not nearly so great as would be possible with better arrangements. Meanwhile the National Insurance system was set up. That was a bad copy of the German system, and was never properly thought out. It seems to me to be a most striking instance and warning of the evils of too hurried legislation. I believe that the principle of that Act is really wrong. It picked out about one-third of the population for medical assistance but left out their families, and it also neglected other people equally deserving, and, in some cases, equally poor. That scheme, I believe, is now practically bankrupt for women, and it would be bankrupt for men if full medical assistance could be given, as it is not given now. That whole system must be transferred bodily to the Ministry of Health. This, the noble Lord said, was one of the first steps, and I entirely agree with him. But probably the best course would be to abandon medical benefit altogether and to provide medical assistance on general lines for the insured persons, for their families, and for all other classes who are equally poor and in equal need of it. That is a great principle, which will have to be decided by somebody, and which will have to be approved by Parliament.

Bu there is another great difficulty which arises from the fact, as the noble and learned Viscount has stated, that the important proposals of the Poor Law Commission have not been carried out. It would have made an immense difference and facilitated the measures for which we wish, if those proposals had been carried out. Then there is the whole question of the work of the Poor Law guardians. Is this to be transferred to the public health authorities or not? That is a question of principle, and a question which must be decided before we know where we are with regard to the Ministry of Health.

So far as I can see a Ministry of Health can only be really effective on certain conditions. It must, as I have said, absorb the whole work of the National Insurance Commission; and all the chief medical state services must, I believe, be brought under one control. A new Ministry of Health must exercise power over the local authorities, to watch over them, to guide them, and to keep them up to the mark; but they must always be administrating agencies. There must be central authority, and each area must also be under one central authority. All this means great changes and reforms in our whole system of local government, as the noble and learned Viscount has pointed out. That system has been described not quite unjustly as "a crazy patchwork," and one of the first things to do is to reorganise that system in order that it may perform these duties and the much larger duties in relation to national health which are so urgently needed. But even then I am doubtful whether all health work can be brought under the Ministry. The health of school children must be to a great extent under the administration of the education authorities; the health of seamen and the sanitary conditions on board ship, and so on, can hardly be taken away altogether from the Board of Trade; while factory and mining laws may to some extent still have to be administered under the Home Office. But, of course, in an ideal system all these other bodies dealing with those aspects of the question would have to be brought into the closest touch with the Ministry of Health, which should be the real inspiring source of knowledge, and science in its best form.

I hope I have said enough to show that this question is a most complicated one. I do not think that we have enough guidance at present to enable us to reach a sound conclusion. We have made many mistakes in the past, and it is most important that we should not repeat them. In ordinary times, of course, a Royal Commission would be set up at once to say exactly what should be done, what duties the new Ministry should perform, and how it should be organised. But we cannot do that now. Yet I believe that a well-selected body of only three thoroughly competent people, with all the mass of information they have at their disposal, could in three mouths lay down the lines of a really constructive policy for administering national health under a single Ministry, and that a Bill might then be drafted and passed during the next session. We have had, especially lately, far too much hurried legislation, and I am certain that out of that legislation much trouble will arise in the future. While I strongly support the Resolution of the noble Lord, I feel that we must not leave this matter to be fought out and wrangled out between Departments behind the scene. That is not the way to get at the best solution. Therefore I would beg of the Government to consider the suggestion I have made, and to make sure of their ground before they are committed to what must be an exceedingly complicated and at the same time a most important Bill.


My Lords, I will do my best to try and answer, or to deal in some form with the very complicated matters that have been fully discussed this afternoon. The whole object of this movement, I understand, is to urge the Government to bring in legislation on the subject at an early date. The point is rather what should be the precise nature of that particular legislation; and I could not help thinking, while I was listening to the very important and informed speeches which have been made this afternoon, how difficult it would be to construct any Bill on those speeches, because on important points they differed so profoundly among themselves. I was rather grateful to the noble Lord, Lord Sydenham, because he to some extent lightened my task by dwelling briefly on the very profound differences and on the difficulties in the way; and I think he realised that to deal with this matter immediately by a three-clause Bill—as one of its enthusiastic advocates suggested in the other House—would really be doing great injustice to the complexity of the matters which we have to solve.

My noble friend Lord Willoughby de Broke introduced this subject in an eloquent and figurative speech, supported by quotations from Solomon and from Lord Beaconsfield. I should like if I may, before I deal with the large matters that have been raised, to say a few words on some specific points on which the noble Lord challenged me for an answer. The first point I noted was with reference to the Joint Committee. I have to inform the noble Lord that this Joint Committee has now been set up. That, I think, will satisfy my noble friend so far. The next point was the question of the Maternity Bill, the Second Reading of which I hope to have the honour of proposing to-morrow to your Lordships. I understand that my noble friend is a supporter of that measure. I was rather sorry, if I may say so, that my noble friend, and, I think, the noble and learned Viscount opposite, re-introduced what I may call the old story, that anyone in authority had suggested that this particular Bill was regarded as a substitute for this great question of co-ordinating all the health powers in a central authority. I cannot conceive how that idea can seriously have arisen, because the two subjects are quite apart. The matter with which we are dealing this afternoon is the question of a central authority and the co-ordination of powers, many of which are now exercised by different authorities. I do not want to anticipate the Bill of to-morrow, but that Bill is for extending powers, very valuable and far-reaching powers as they are, to the local authorities; and I rather regret that my two noble friends should have alluded in that way to this Bill, because the President of the Local Government Board, who is responsible for the Bill, has emphatically stated in another place, and stated more than once, that he certainly did not regard the Maternity Bill as any substitute for, or as related to, the other very much larger question we are discussing this afternoon. Let me, therefore, dismiss that matter.

There is one more observation which I would like to make to my noble friend. He was, I think, a little ready to deal with Departmental differences, and with what he called Departmental jealousies. I was much refreshed, if I may say so, by the speech of the most rev. Prelate, who dealt not at all with these matters but with the larger question of the co-ordination of powers, because I think it must have been obvious to your Lordships, not only those well informed on these matters but also those who have listened to the discussion this afternoon, that an amount of legitimate difference of opinion is quite possible upon these difficult matters of co-ordination of powers, and the question as to what powers should be centred in one authority and what powers should be left to other authorities. There is clearly room on this matter for much consideration and much thought.

There was one omission, if I may allude to it, in the well informed speech of my noble friend. He was no doubt, in making his speech, convinced that he was addressing an assembly very well informed on all these matters of local administration, because I think that if any stranger had come into this House who was not acquainted with our local administration he would have gained a very false idea of the existing situation from the speech of my noble friend. My noble friend, no doubt for considerations of space, did not dwell upon the vast work of public health which has been carried on by the Local Government Board for the last thirty or forty years. He did not tell your Lordships that the Local Government Board is and has been for years a great health authority. In fact, it is rather difficult in running over the different duties discharged by the Local Government Board to say what duties it does discharge which are not closely connected with health. For instance, the whole of the work done by the Local Government Board under the Public Health Acts, the whole matter of sanitation, the whole matter of the disposal of sewerage, and of administration under the Housing Act, are all matters directly connected with the question of public health. Moreover, take such matters, less sonorous perhaps but most important to the health of the people, as the administration of the Food and Drugs Act, the notification of births, the Contagious Diseases (Animals) Act, and other matters of that kind.

Even then one comes to the whole question of the Poor Law. I think possibly I misunderstood the first observation which fell from the noble Viscount opposite, because I thought at first he was criticising the administration by the local authorities; but then I understood that he really wanted to hand over the whole public assistance to the local authorities. Dealing with the Poor Law as it is, there is a vast amount of public health connected with the Poor Law, and the question which I should rather like to have put to my noble friend opposite is, What division is he going to make between the health administration of the Poor Law and the rest of the administration of the Poor Law? He waves his hand. I do not know whether it is a very significant gesture or not, but is he going to divide these two functions? Is he going to put on one side perhaps the work in the infirmary and the medical relief, and hand over to the Local Government Board the work in the poorhouse and the administration of Poor Law relief? I do not gather what his proposals are from his speech, but I only suggest that in the administration of the Poor Law itself you have an immense problem even as it is at present, and the division or diversion of some of its functions to a Health Ministry ought to be a matter of careful and very close consideration.

Moreover, I should like to allude to one distinction which I think has been referred to by some of the speakers, as to the growth of opinion on some of these great subjects. The bulk of the work for the last thirty or forty years carried out by the Local Government Board has been on what one may call public health generally—that is to say, it has attacked the question of health in the mass rather than in the individual; rather on the preventive than on the curative side. That situation has been changing, because during the last few years there is no question that great new powers have been exercised of a distinctly curative nature by the Local Government Board in connection with tuberculosis, venereal disease, and matters of that kind; and incidentally I was rather surprised to hear my noble friend allude to the vast increase in these diseases. I have seen no figures, and I do not know whether he has seen any, which establish the truth of his statement. Anyhow, what I want to point out is this, that before the war, and before public opinion had been stimulated as regards the curative treatment of disease by the war and the great losses we have sustained in the war, there was growing up a feeling, which was reflected also in the administration of the Local Government Board and in our legislation, of the necessity not only for dealing with health and disease in the mass but also in the individual as well.

What I should like to try to get clear is this point as regards the setting up of a Ministry of Health. My noble friend dealt rather scornfully with any one who thought that the creation of a new Ministry was a matter to be considered, and therefore I was led, wrongly, I believe, to think that he proposed to set up a definite Ministry of Health under a definite Minister. Undoubtedly one view of this proposal is that there should be a totally new Ministry set up under a separate Minister, to whom all the health duties of the Local Government Board are to be transferred and other duties now discharged by other public authorities. That would leave the Local Government Board as a sort of shell with certain local government duties to discharge, and I suppose certain financial duties as well in connection with loans and matters of that kind. I was rather glad to see from the later portions of the speech of my noble friend that he did not support any view of that kind; and I do not think that view has succeeded in obtaining much support from noble Lords who have spoken to-night. Indeed, I think that would be a deplorable result, because to try and separate local government and the administration of local government from the health question would be, as I think the noble Viscount would say, most deplorable, because his own suggestion for dealing with the matter, so far from diminishing the work of the local government authorities, was that their work should be increased and that more burdens and duties should be put upon them in connection with health and other matters.

If I may be allowed, as an old member of the greatest municipality in this country, and as one, I suppose, who has attended either as a member or as spokesman more deputations to more Ministers than most people, I should say that one would very much regret looking at it from the local authority end, to have a new set of masters or a double set of masters set up to whom one should be responsible and whose criticism one would have to meet. I should like to quote in this connection two resolutions passed by the London County Council in November last on this very subject. These Resolutions were to the effect, firstly, that the functions of a Ministry of Health should not be separated from those of the Department entrusted with the central supervision of local powers, such as those relating to housing, drainage, water supply, and the like, which are closely and essentially connected with the health of the community; and, secondly, that any further powers which may be granted by Parliament with regard to public health should form part of the existing system of local government. I gather that most of those who have spoken are in general agreement that there should be no dissociation, as there really cannot be, between the existing and new health powers and local government; that still the local authority should be used as the great instrument for carrying out these complicated powers and duties.

It then becomes, perhaps, rather a question of whether you keep the Local Government Board anyhow—under another name if you like, as the local governing health authority—as a centre of the powers, and add new powers to it, whether drawn from existing authorities or powers, or newly conferred by Parliament. There, I think, we come into what I may call rather difficult and complicated questions. First of all there is the question of the transfer of the powers, or perhaps the transfer of the whole of the Insurance Commission to, I will not call it the Local Government Board, because there has been a criticism of that name, but we will say the Local Government and Health Board, if my noble friend prefers that. The most rev. Prelate told us that it would really be inexplicable to a New Zealander if he were to examine into the way powers are distributed; he would wonder at there not being greater concentration. The most rev. Prelate knows extremely well how things are done in this country and how these different powers arise, in response to public opinion expressed in particular ways at particular times, and find utterance a legislation passed by Parliament. No doubt times do occur when it may be wise to revise all these powers and their distribution, and to consider whether some greater concentration may not be possible or necessary.

May I say just one word on the question of the Insurance Commission? The noble Lord, Lord Sydenham, referred to it, and he suggested that these powers may be at once handed over. Your Lordships are very well aware that these Insurance Commissioners do much more than merely administer medical relief. They have two sides. They administer a series of benefits—the maternity benefits, the sick benefits, and the breakdown benefit—and they also, through a system of panel doctors, local committees, and approved societies, administer the medical benefits. No doubt these powers may easily be transferred to a new central authority, but then my noble friend Lord Sydenham raised a very interesting point. There is a considerable school of thought in this country which thinks that, up to a certain point at least, medical attendance for the great mass of the population should be free. If this were decided upon, it is quite clear that the insurance side of medical benefits would drop away, and that either the contributions to insurance would be reduced or the other benefits would be enlarged, as no one would then find it necessary to insure for medical benefits when he could get the benefit free under the other arrangement. I only want to cite this for the purpose of pointing out how closely policy is connected with administration, and how, while you may desire to set up your central authority, you must at the same time consider your policy, and not, as I think was suggested, leave your policy entirely to the new body, because on the constitution of that new body your policy must largely depend.

I do not wish to delay your Lordships too long with details, but I am doing this for a special purpose, because I want to give some idea of the complexity of these matters and of the difficulty of dealing with them in a moment by legislation. I have already alluded to the question of the Poor Law—I will say nothing further about that—and to the great difficulty there would be, first of all, in separating the health functions and the administration of the Poor Law from the other functions connected with what is now to be called, I believe, public assistance. Then there are, of course, a great many other powers of a health character which are administered by other authorities. My noble friend, Lord Sydenham, in dealing with the subject, rather indicated that he thought that perhaps some of these powers should be left with the existing authorities. I should like to allude to one of them, which I think may possibly be considered of the nature of a borderline case, which ought certainly to be closely considered. That is the medical side administered by the Board of Education. I do not know, of course, what are the views of my right hon. friend the Minister of Education on this subject, but this is a very specific form of administration which deals with children in the schools, with certain particular illnesses and diseases incident to children of school age. The Board has, through its medical inspection, an enormous advantage in dealing with these children, because it deals with them as special communities in the schools. Moreover, as regards treatment in clinics and so on, and as regards health in schools, light, ventilation, and often such matters as the size of the printing of books—all those matters are really so special to children in schools that it is quite possible that even though you did concentrate in one body all the powers that have been mentioned you might still, I think, require specialists to deal particularly with these problems affecting children in schools. I cite that as an instance of the complexity of the problem and of the necessity of thinking before you say, "Oh! let us give all these particular powers at once to some new authority."

May I allude also to another Department? Possibly your Lordships may forgive me for alluding to it, because as I represent the Department of National Service in this House I feel rather hurt that my noble friend, in enumerating all the authorities that deal with health, should have left out the most important of all, and that is the great system of medical control and organisation which has been set up under National Service. There are now all these great Boards which cover the whole country—there are ten Commissioners and 133 sub-Commissioners—dealing with everyman from eighteen to fifty-one years of age and these Boards have gathered together an amount of knowledge about the health of the community which must be of immense value to whoever deals in the future with questions of public health. These Boards deal with much more, because they not only deal with their proper work of recruiting, for which they were set up, but they examine and keep records of all the men who are sent away from the Army at the discharge centres, and recently they have taken up the work of examining men as regards pensions. So in these three ways, through a network of medical men all over the country, you have set up a system of which, I regret to say, my noble friend seems unacquainted, or I am sure he would have mentioned it as one of the authorities dealing with medical matters. I think, at least, that all the information so gathered will not be valueless when the time comes.

One word, if I may say it, on two other matters which are germane and practical matters, and closely related to this subject. What are you going to do with the Home Office? You might, I suppose, without any great difficulty, take away the administration of the lunatics, and so on, from the Home Office and hand the duty over to the new health authority. I do not know whether the Home Secretary would be ready to do so immediately on his return from Holland or not. Take the other question of the administration of factories and the Factory Acts, a matter far more complicated because, no doubt, a great deal of that administration is connected with health and the prevention of disease. But there are innumerable other matters which are administered under the Home Office. Are you going to hand over all these duties to the new authority' or are you going to separate them? If you separate them, are you going to have double sets of inspectors in the same place—a matter which, in another connection, I have heard criticised in this House. Take the Board of Trade and their action and duties with regard to the health of seamen, and also the arrangements made during last year by the Ministry of Munitions for dealing with the health and food mainly of the women who are working so well in the factories. I think we are bound to come, to some extent, to this result, that health administration is indeed all pervading, and it is so all pervading that it is very difficult to concentrate all these duties under one authority, because that one authority would almost be too vast for the administrative power of any single Minister. Once you have arrived at this conclusion you have to agree that the matter is more difficult and complex than it has been treated in another place, and outside. It is a matter which requires close thought and consideration. I do not say it should be relegated to that vague and dismal period "after the war." That may be too late to deal with these things. No doubt the matter should be dealt with at once.

On the general question I must confess to your Lordships—and it is a confession I ought to have made at the beginning—that I am in somewhat of a difficulty in giving you a precise reply to the Motion. This matter is really now under the very close consideration of a Government Committee. They have been sitting already on several occasions, and sit again to-morrow, and if they had been able to come to a decision before it was my duty to address your Lordships on the Motion to-day my task would have been much easier. I come to the precise nature of the Motion which my noble friend has introduced to the House. A committee of the Cabinet are now considering this question very closely, and they are no doubt considering it with a view to action. The question is what should be our attitude here towards the particular Motion which the noble Lord has introduced. The words of his Motion are— That this House urges His Majesty's Government to introduce at an early date a Bill to constitute a Ministry of Health. I am not quite sure whether it would be constitutionally right for His Majesty's Government to resist "urging" on the part of either House of Parliament. I think it is hardly possible for it to do so, and I do not think it would be right to offer any opposition to any insistance of that kind. I hope my noble friend will realise—he uses the words, "at an early date"—that in view of the considerations with which I have dealt, and the difficulties and complexities of the whole matter dealing with so many Departments, the words "early date" (though I do not wish to push it over to the period I have alluded to) will be given a very large and liberal interpretation. In these circumstances, if my noble friend will accept those assurances, I think I should be justified is not offering any opposition to his Motion.

On Question, Motion agreed to.