HL Deb 28 July 1919 vol 35 cc1073-83

Debate resumed (according to Order) upon the Motion of Viscount SANDHURST, in accordance with the provisions of Section 8, subsection (3), of the Ministry of Health Act, 1919, to resolve, "That this House approves the said Draft Orders."


My Lords, I moved my Resolution on a former occasion, and I do not propose to say anything at present except to remind your Lordships, as the House was then very empty, that one factor has disappeared. I was rather led to understand in the course of the former debate on the various changes in the Bill, that your Lordships were somewhat influenced by that factor—namely, the opposition of a powerful body known as the Association of Municipal Corporations. That opposition has been withdrawn after a conference between the Minister and the officers of the Association, and they have consented to nominate persons to serve on the Consultative Council.

LORD DOWNHAM moved to insert, at the end of Viscount SANDHURST'S Motion, the words: "but omitting in 1 (3) Local Health Administration and (4) General Health questions."

The noble Lord said: My Lords, my Amendment is intended to confine this very novel and unprecedented experiment in administration to setting up two instead of four, of these Consultative Councils. On the Second Reading, and again in the Committee stage, I expressed certain views for which undoubtedly a good deal of support was found in your Lordships' House. After all, what is it that the Ministry of Health are seeking to do? They are seeking to set up within the Ministry of Health no less than four of these Consultative Councils. They are to be statutory bodies, to be appointed for three years. They are to consist of, say, twenty members each—at all events not more than twenty, and they probably will consist of twenty members. Thus, under a single Department of State there will be four of these Consultative Councils.

These Councils may appoint committees and sub-committees, they will each have secretaries and staffs, they will each have to have offices in which to carry on their business. What they will be allowed in the way of clerks and typists and machinery of that kind, I cannot say. But undoubtedly this is going to be a very expensive process of government. They are to be paid their travelling expenses, they are to be given subsistence allowances when away from home, they are to be paid for time which is lost in any profession, trade, or calling which they may carry on. There are to be four of these bodies drawing upon the Treasury in this way in one Department.

But this is only an experiment made by one Department. if this is permitted for one Department of the State—the Ministry of Health—why should it not be permitted for other Departments that have large businesses consisting of many branches—the Board of Trade, the Ministry of Labour, the Ministry of Commerce, the Board of Education; there are about ten or twelve Departments which might equally ask to be allowed to set up four of these Consultative Councils with a large amount of machinery, and expensive machinery at that. It is a very great experiment, in government. I doubt whether my noble friend in charge of this Order can tell us that there is any precedent whatever for an experiment of this nature. I should like him to tell us if he would. I asked him or, the Second Reading whether, before we came to the Committee stage, he would tell us if the Government had formed some estimate of the cost of setting up the four Councils, so that we might know something of the expense to which as a nation we were going to be put. Really, for whose benefit is it that we are going to set up these four Councils? I agree with the first Council—the Medical and Allied Services—consisting of experts in medicine, surgery, midwifery, and matters of that kind. A Council like that may really give some value to the Minister of Health. I agree also with regard to No. 2, that where we are absorbing into the Ministry of Health what is now a separate Department—the National Health Insurance Department—it might well be that the Minister of Health may desire to have a special Council to assist him in matters connected with national health insurance.

But what good are we going to get out of Councils 3 and 4? No. 3 is a Council to advise and assist the Minister of Health on local health administration. The Minister can now get any advice or assistance he likes from the various local health organisations all through the country; he can summon them whenever he likes, and have a conference with them; he can appoint any committee within their body whenever he chooses, for as long as he chooses, with what reference he likes as regards the subject-matter with which they are going to deal. There is no difficulty whatever in the Ministry of Health getting into touch with all those who are engaged in local health administration. No. 4 is a Council to advise on general health questions. Why do you want a Consultative Council set up as a statutory body to advise on general health questions?

May I ask the noble Viscount how the Minister of Health proposes to differentiate between the duties and the sphere of activities to be assigned to the Local Health Administration Council and the duties and sphere of activities to be assigned to the General Health Council? If your Lordships turn to the Order, you will see that every one of these Councils has three powers— A council may propose to the Minister from time to time that any question in connection with such of his powers and duties as relate to matters affecting or incidental to the health of the people … that all those questions shall be considered [...]of these Councils. Then if you will [...]subsection (3) of Section 11 you [...]these words— [...]council may also present to the Minister [...]to time a Report on any matter affect[...]dental to the health of the people. All these Councils will be vieing with one another to present their Reports on the same question.

I will take the whole question of housing in connection with insanitary areas. Is that a matter for Council No. 3 or Council No. 4? I will take one of the most interesting questions that we have at the present time in connection with health—namely, the great shortage of hospitals, of sanatoria, of skilled doctors, of skilled midwives, and of skilled surgeons. Is that a subject for advice and assistance and Reports by the Council that has to do with the medical and allied services, or the national health insurance, or the local health administration, or the Council for dealing with general health questions? All these questions relating to health—the question of tuberculosis in connection with residential institutions and sanatoria, for instance—will be matters on which each one of these Councils would think it its duty to report.

I am very sorry for the permanent officials who are to be placed at the disposal of all these Councils in turn. I say of this system of government that it is really a system of "government by talking and serviettes"—there is no end to the talk; there will be much more talk than there will be action, resulting from these bodies. It is a costly and cumbrous method of government; it strikes at the very root of Ministerial responsibility; and I hope that if we are going to set it up we shall try it in homeopathic doses, and limit this experiment in the first place to two Councils—one for medical and allied services, and the other for national health insurance. I am perfectly certain that if the Minister of Health wants advice on general health questions he will be able to obtain that advice now from the numerous bodies up and down the country who are engaged day by day in the work of administering our sanitary laws. This is one of the specimens of really prodigal expenditure on the part of the Government of which we ought to take notice in this House; and it is because I want to curb this ever-growing extravagance that I move to omit subsections (3) and (4) from this Order.

Amendment moved— To insert at the end of the Viscount Sandhurst's Motion ("but omitting in 1 (3) Local Health Administration and (4) General Health questions").—(Lord Downham.)


My Lords, am obliged to my noble friend below the gangway for his courtesy last night in giving me private information that it was his intention to move this Amendment. I abstained from saying anything at the outset, because I had done my best on former occasions during the passage of the Bill to make as clear to your Lordships as I could why, at any rate in the opinion of the Government, these Consultative Councils formed a most important part of the measure which I was then advocating. I remember very well the various reasons that my noble friend gave against these Consultative Councils, and I did my best to rebut his arguments.

Really, without offence, I may say that he told us what he had to say on the former occasions, and I do not think it is necessary for me to go again into the various reasons that I then gave. I am not prepared with any such estimate as my noble friend asks for; but when he says that there will be many secretaries, many offices, expensive staffs, and so on, I may point out that there will be one secretary and one staff, which will be as small as possible, and that they will use the offices of the present Health Department. With regard to the other Departments which he mentioned—the Board of Trade, the Ministry of Labour, the Board of Education, and so on—they have Advisory Committees already, some statutory and some not.

On a former occasion I think it was the noble Marquess opposite who drew attention to the opposition of what I called just now—I think rightly—the powerful body known as the Association of Municipal Corporations. As I intimated a couple of minutes ago, that opposition has been withdraw. They were unwilling, as the measure had passed, that they should not be in a position to give the benefit of the knowledge and experience of their members in aid of this scheme, and they have put forward some names to the Minister of Health. In passing, I may say that the representative of the county councils in the House of Lords warmly supported the idea of these Consultative Councils, and I may also add that in regard to the London County Council, over which my noble friend (Lord Downham) presides with such distinction, we have received a reply from them putting forward the name of a well-known gentlemen, who no doubt will be of the very greatest service. Here again, however, I wish to allay an apprehension, if it really exists in the mind of my noble friend, that whatever that gentleman's views may be, or whatever advice he may tender, as I tried to make clear to your Lordships on a former occasion, that will in no way prejudice the view of the London County Council as regards the Minister nor will it in any way preclude the Minister from taking the advice of that Council as a whole.

I am glad to note that my noble friend—and I think also the noble Marquess opposite—said that there were good reasons for the calling together of the two first Councils. But in regard to these medical and allied services, each question is so mixed. up with administration—for example, panel services under the Insurance Act, midwives, the county and county borough councils, and so on—and further medical assistance being needed, this Council will advise as to the authority by which the additional services should be administered. These Consultative Councils were in the first instance put into the Bill so that everything should not be done from Whitehall should the Minister wish to run the administration entirely from Whitehall, which to my mind would be, if I may say so, a most unwise proceeding. I may point out that all local authorities are now agreed and have sent in most suitable names, and their advice will be essential to efficient administration.


How numerous will the Councils be?


They will have twenty members each, half to form a quorum. I think your Lordships will hardly wish to oppose this united expression of opinion on behalf of these local authorities. As to the Council upon general health questions, which my noble friend somewhat scorned, I submit that this Council is hardly less important than the other three, and I believe the other three to be most important. I will take it on as broad a ground as I can. I venture to say to your Lordships that this particular Health Bill is in the truest sense of the word a People's Bill. It touches, or should touch if it is properly administered, the heart of the whole nation in their homes and in their domestic concerns, which are very delicate matters indeed to deal with. To make this thing a success, not only for those who are around us to-day but for these who are to come, we must endeavour to get the confidence of the whole people, and to get that confidence we want to enlist for our immediate coadjutators the most sympathetic help and knowledge, and indeed the co-operation of all. I venture to suggest to your Lordships that that is what this Council will supply.

I may say—and a comment was made in this direction the other day—that we all recognise the value of expert and scientific opinion. Here again, however, it is necessary to see that it should not go too far or too fast at first and frighten people. I anticipate very great helpfulness from this fourth Council in mitigating or assuaging fear that may very easily be aroused in certain quarters. Perhaps I may remind your Lordships that very full representation is to be given to women on this fourth Council. My noble friend called attention once more to the expense, and said it was an innovation. I venture respectfully to say that the intention of the Bill as it is now drawn and passed is an innovation, and as regards expense there is a great difficulty that many of us have found, especially those that have to do with charitable undertakings on a large scale, which is that we have not always been able to get amongst our voluntary workers—and they are many—an intimate knowledge of the poorest classes with whom we have to deal. In my own experience I know of difficulties that have arisen and blunders that certainly I have made because I have not been able to get hold of the advice of those who really understood the problems of the people with whom we were trying to deal and perhaps to relieve. Mistakes are very easily made, and in this case mistakes may be made which will be difficult to retrieve, and if confidence is early lost in our measure or in our administration I am afraid we shall find it difficult to restore.

Another fear I have is that without these two Consultative Councils this may possibly occur which I think we should all regret—namely, that it may have the effect of driving the administration back into a central and local bureaucracy. Although I do not agree with a great deal that has been said lately about officialdom, I can perceive that there is a real danger. With these few words I ask your Lordships to support the Order as it lies upon your Lordships' Table. I urge it upon your Lordships with the most true sincerity, and I hope you will not consent to abridge it as suggested by my noble friend below the gangway.


My Lords, I am sure we have all listened to my noble friend with the greatest respect, and we none of us for an instant doubt his most transparent sincerity. But when my noble friend tells us that this is a People's Bill I am bound to say that in my opinion, as an old Parliamentarian, it seems, in this particular application of it, to be a Bill for taking the administration of the people's health entirely out of the hands of the people's representatives, and I view it with the greatest possible alarm and suspicion. It is a continuation and an extension of a mistake which I consider the Government has made ever since the beginning of the war, which is to trust to outsiders and not to Committees of the House of Commons, private information concerning war matters and reconstruction matters and consequently the expert knowledge which proceeds alone from the possession of that confidential information. The whole tendency of that practice has been, most disastrously as I conceive, to lower the authority of the House of Commons and of Parliament as a whole in the eyes of the nation.

We have gone to great expense to provide the heads of our Departments with Consultative Committees of experts in administration and experts also even in scientific matters. Not content with that, it is proposed to make further additions, which I must say I consider are bound to become expensive and elaborate, merely to duplicate a service which, goodness knows, was considered good enough in the past. If you have separate Committees it means that the Committees have separate minutes and separate correspondence. They must have separate registries, separate rows of pigeon holes, and besides, and worse than all these, they must have separate amour propre and competitive ambitions and aspirations. We know what disastrous effects during the course of the war have followed from the undue development of Departmental jealousies and amour propre; so much so that it is difficult to conceive, within the limits of Parliamentary language, words which adequately express the popular supicion and indignation against certain acts of certain Departments.

Why I really object to these Consultative Councils is not only that I am convinced, as an old Parliamentarian, that they will disastrously weaken the Parliamentary' responsibility of the heads of Departments and will seriously interfere with the power of Parliament over the acts of the Executive, but also that I am afraid that the manning of these Councils will become matters of intrigue and agitation, with the inevitable result that, even more than at the present time, this country will come to be governed by the secretaries of societies and not by representatives of the people. It is quite true that the noble Viscount in charge of the Bill says he has obtained support from the Municipal Corporations Association and other like bodies. Of course he has, so far as he gets responses to his invitation to them to nominate members to serve on the Councils. What is more natural than that they, seeing the Councils are about to be brought into existence, all with one accord proceed to say, "If there are going to be these Councils we will have our say upon them." It is not likely that they would refuse nominees in these circumstances. These are my objections, and. if the noble Lord is going to be allowed to have his two Councils, I am bound to say that I do not see any reason for letting him have his three or four. I am sure it will increase unduly the work of public Departments; it will increase the burdens on the Exchequer; and it will diminish the authority of Parliament.


My Lords, my noble friend has asked for all these Consultative Councils. May I say how grateful I am to him for having put off the Motion until your Lordships had an opportunity of considering it? I am sorry, however, that he has not used that opportunity of reflection in order to diminish the number of Councils for which he is asking. Of two of them there is, of course, no question. We agree, and always have agreed in the conversations which have taken place on the Health Act, that the Council which had to do with insurance and that which was representative of the medical profession ought to be accepted; but we thought that there was considerable doubt whether the other two ought also to be accepted. I do not desire in any wry to attack Advisory Committees in principle. Sometimes they are very useful bodies; sometimes they are a very necessary check upon administration and a very necessary assistance to the Minister. But the ques tion is whether you ought to have four Consultative Councils advising the Minister of Health at the very inception of his work and before he has had any experience really of how these advisory bodies are going to work.

I say that you must distinguish between Advisory Committees, because I am quite sure your Lordships do not intend, in setting up these Committees, that they should be useless. I know of Advisory Committees which are wholly useless. I know of them because I serve on them myself. But some Advisory Committees may be very useful, and no doubt my noble friend opposite expects these to be very useful bodies. My noble friend Lord Downham has pointed out that these Advisory Councils will mean eighty representatives—twenty on each Council—and they will be furnished with enormous staffs and all the concomitants of a new administration.


I think I answered that point by saying that there would be only one secretary and that the offices would be in the present Local Government Board offices.


One of the many reasons why my noble friend opposite is such a delightful person to have to deal with is to be found in his sanguine temperament. If he really thinks that the whole staff of these eighty gentlemen will be one secretary—and I suppose one typewriter—I am afraid I cannot look forward to that. Therefore, I would make this suggestion to the Government. Let them appoint two of the Councils, the two which are essential and to which we have always agreed, and let the others stand over until the Minister of Health has had an opportunity of seeing how his two Councils work. Nothing is finally concluded if the whole proposal is not carried this afternoon. If in a few months my noble friend, or whoever speaks for the Department in his place, is able to come to the House and say that, having had experience of these two Councils, the Minister of Health is quite satisfied that two more will help him greatly and will be to the public advantage, then I am sure your Lordships would be prepared to consider with an open mind any arguments which might be laid before you. That seems to me to be the simple course. I should be sorry if we appeared to be putting a spoke in the wheel of the Ministry of Health. On the contrary, we take a tremendous interest in it. We want it to succeed in every way, and we should prefer that there should not be any kind of unfriendly feeling as between the Government and ourselves. It is for that reason that I am making the suggestion that the Government should be content, in the first

Resolved in the negative, and Amendment disagreed to accordingly.