MATERNITY AND CHILD WELFARE BILL. (Hansard, 18 July 1918)

§ VISCOUNT PEEL

My Lords, I rise to ask the House to give this Bill a Second Reading. Your Lordships will remember that we had yesterday a valuable and informing discussion on the question of concentrating in one authority the different health powers exercised by certain bodies; but on this occasion I have to ask you to increase the powers that are now exercised by the different local authorities. I think it was agreed in the discussion yesterday that, whatever might be the changes in the centre, the health powers, whether increased or otherwise, must certainly be exercised through the local authorities; and 982 I can therefore claim the sympathy of your Lordships for this measure.

This Bill is in itself apparently a small one, being contained in five clauses. But I do not wish your Lordships to judge of the importance of the measure by the small number of the clauses; and I think it will be found, with regard to the general health of this country and to the welfare of the children of this country, that it will have far more value and far more result than many more resounding measures. The object of the Bill is to extend to England and Wales an enactment which is already applied in Scotland and in Ireland. Under that Act the local authorities may make such arrangements as may be sanctioned by the respective Local Government Boards of those countries for attending to the health of expectant mothers and of their infants. This has been in operation now for some few years in Scotland, and I think it will be very useful if your Lordships will allow me to give a brief account of what is being done in Scotland under that Act bearing on the operations of this Bill if it becomes an Act in England.

It has been the policy of the authorities in Scotland to encourage the local authorities to incorporate in their schemes the various voluntary institutions and agencies for maternity and child welfare in the area, and, where necessary, to contribute funds to extend and to develop their work. Great use has been made in that country of the voluntary agencies already existing for maternity and child welfare work, and schemes of a comprehensive nature have already been set on foot, chiefly, of course, in the larger centres, but there are also many operated by the smaller authorities. Where the smaller authorities do not wish to operate these schemes by themselves, they have often united together and carried out their duties by means of a joint committee.

Under this particular scheme many different services have been instituted. I want to indicate only the nature of these services at the moment. They include the appointment of health visitors, inspectors of midwives, visiting nurses for home nursing; and then, more important even than these, the establishment of maternity and child welfare special treatment centres and clinics; the establishment of crèches and day nurseries, and children's hospitals, maternity homes and hospitals, provision of doctors, midwives, and nurses for attendance at homes; provision of milk and food 983 in necessitous cases for mothers and children; and a very important provision also is the establishment of teaching in hygiene for mothers and expectant mothers. Up to the present time in Scotland there have been fifty-five schemes covering the areas of seventy-two local authorities and embracing something like 1,500,000 of the population; and further schemes are under consideration for dealing with another 2,000,000. In fact, it may be said now that the schemes already approved in Scotland cover three-fourths of the whole population of that country.

There is one more point in connection with Scotland to which I should like to allude—namely, a scheme for travelling exhibitions of child welfare work. These are subsidised partly by the local authorities, partly by the Carnegie Trust, and partly by voluntary donations, and they afford an opportunity of bringing together the local authorities and the voluntary bodies, thus securing the immense value of the enthusiasm and social energy aroused amongst those concerned with the conservation of child life. Such, briefly, is what has been done in the last three or four years in Scotland under the Act whose powers I ask your Lordships to give to the local authorities in this country. These powers of which I have spoken are not, of course, in force in England yet. All the powers we have here at present for maternity and child welfare are obtained under the provisions of the Public Health Act, 1875, which, of course, was passed so long ago as to be before the time when the present scheme for maternity and child welfare were able to take shape.

The movement is a valuable and beneficent one. It is now realised that much of the suffering and loss of life in motherhood and in infancy can be avoided if proper measures are taken; and although in the last few years the rate of mortality of infants has been largely decreased, it can be further immensely diminished if proper attention is paid to mothers and to children at an early stage. And this should be noted, that with the reduction in the rate of infant mortality comes a reduction in the rate of invalidity, and a great deal of suffering, waste, and loss is saved in the future life of those who are thus protected.

It should also be noted that this is not at all a new movement in this country. For the last ten or more years local authorities have been developing work in this connection, frequently in combination 984 with voluntary assistance. You have had health visitors, improved midwifery service, infant welfare centres, where advice and assistance is given to mothers, the provision of pure milk, and other matters of that kind. All those things have already been done, and interest has grown so much during the last few years that we have seen baby week ceremonies annually devoted to the rousing of the public enthusiasm for the movement. Moreover, money has already been voted by the State for this purpose. Since 1914 the House of Commons has voted a grant to be dispensed by the Local Government Boards in the three countries towards approved expenditure upon maternity and child welfare services, whether by the local authorities or by voluntary agencies. The figures, which I should like to give to your Lordships, illustrate the progress which has been made in this work. In the year 1914–15 the grant amounted to £11,487; in 1915–16, to £41,465; in 1916–17, to £67,961; in 1917–18, to £122,285; and in the present year the estimate is for £230,000. I should like to add, although the sums in themselves may not seem very large, that an immense amount of valuable work can be done in this respect for comparatively small sums. Very important parts of the programme now authorised are not at present within the competence of the local authorities, and, this Bill is introduced to bring their powers up to the level of those already exercised and enjoyed by Scotland and Ireland.

I should like to give your Lordships some idea of what powers may be exercised under this Bill, and to what schemes sanction has already been given by Treasury Regulations. They include such matters as the salaries and expenses of health visitors and nurses engaged in maternity and child welfare work; the provision for necessitous women of a midwife and doctor for illness connected with pregnancy; the expenses of centres providing medical supervision and advice for expectant and nursing mothers and for children under five years of age, and medical treatment at the centre for cases needing it; hospital treatment of various kinds for diseases contracted during pregnancy and afterwards; the cost of food for expectant and nursing mothers and for children under five years of age; the establishment of creches and day nurseries, and of other arrangements for attending to the health of children under five years of age whose mothers go out to 985 work—and I need hardly remind your Lordships what an immense necessity there is for the establishment of creches and day nurseries, especially at the present time when so many women are working in factories and on munition work—the provision of accommodation in convalescent homes for nursing mothers and for children under five years; the provision of homes and other arrangements for attending to the health of children (under five years of age) of widows and deserted and unmarried mothers; and there is provision also for instruction in hygiene of mothers and expectant mothers. Also, under certain regulations, about which I need not delay your Lordships, grants will be made to voluntary agencies that fulfil certain conditions. So I think your Lordships will see that, although the Bill is apparently small, its scope is large, and that the advantages gained from it may be immense for the health of future generations.

I will now deal briefly with the machinery of the Bill to show how these matters are carried out. First of all take Clause 1. This clause gives to the county councils (except the London County Council), borough councils, urban and rural district councils, powers to make arrangements under it. They will proceed by schemes. These schemes will be approved by the Local Government Board, and it has been the policy of the Local Government Board, and will continue to be their policy, to encourage the county councils to cover the the whole of their areas with schemes. It will be seen that in some cases smaller authorities will be able to deal with these questions. As the Bill was originally introduced in another place schemes were limited to the larger authorities, but the general feeling was in favour of allowing small authorities, where they could usefully do so, to join in the work and take part in it. The London County Council was omitted from the scheme of the Bill because it is also omitted from the Notification of Births Acts, 1907 and 1915, and therefore is not an authority under the Act, the work being performed by the great London borough councils.

Clause 2 deals with the machinery by which the Bill is carried out under the local authorities. It sets up committees of the councils, and in this way modifies the existing law, but the powers are wide and a good deal of latitude is allowed to the local authorities themselves. If your 986 Lordships look at Clause 2 you will see that the local authorities who exercise their powers must do so and act through committees. These committees may be appointed for the special purpose or may be existing committees or sub-committees of existing committees. They may appoint persons who are not members of the council, but they must appoint at least two-thirds from members of the council, in order to preserve financial control. Then at least two women must be appointed on every maternity and child welfare committee. So much for the machinery. Clause 3 deals with the method of raising money for the expenses, and in certain cases where the smaller local authorities have adopted schemes similar to those in the rest of the county they are allowed to receive from the county council the money raised in their area for the purpose of their own scheme. Certain borrowing powers are also given. Clause 4 relates only to Scotland and affects the powers of borrowing of local authorities there.

Such is the simple and not complicated machinery by which the very large lowers are to be carried out, and I should like to make an appeal to the local authorities to enter into a healthy rivalry to produce the best possible scheme under the Bill. Much, as I have said, has been done already, and I should like to allude, in passing, to the very admirable schemes which have already been set on foot by such places as Lewisham amongst the London boroughs, and Huddersfield and Liverpool in the North of England. If the powers under this Bill are fully utilised—and there is every reason to believe that they will be, because in all the deputations which have come before the Local Government Board on this question there has been wonderful zeal on the part of local authorities to put these powers into force as soon as possible, and we know there is behind the local authorities a great force of public opinion which feels the necessity of providing for the waste caused by the war—if the schemes are carried fully into effect, I believe a great deal will be done in the future to diminish the death rate among children and to repair the terrible ravages which hare been made in our population by the war.