HL Deb 01 May 1919 vol 34 cc413-61

Order of the Day for the Second Reading read.


My Lords, it is my duty to ask you to give a Second Reading to a Bill entitled the Ministry of Health Bill. In doing so I should like to remark that this is one of the first of four important Bills having to do with national reconstruction. The others are the Housing Bill, the Transport Bill, and the Land Settlement Bill, which in one stage or another are now before the Houses of Parliament.

I desire at the outset to say one word which I hope may enlist the sympathy and remove the apprehension of my noble and learned friend opposite (Lord Buckmaster), because I have often heard him descant on the great disadvantage of the additional Ministries that were set up from time to time during the war. I can assure my noble and learned friend that this is not a Bill to increase the number of existing Ministries; because, with the appearance of the Ministry of Health, the Local Government Board as we know it now disappears as a separate entity, and at the same time the Insurance Commission is merged in the Health Ministry. No new hordes of officials will be appointed; nor, naturally, will any more large offices be commandeered in which to house the new Ministry.

I know that there are many among your Lordships who, in introducing a Bill which, though not a very long Bill, was unquestionably one of great importance, might give the House an introduction of a picturesque and interesting nature. For an obvious reason I shall not attempt anything of the kind. Not only that, but I think that the dominant feeling in the minds of most of your Lordships is that this Bill is somewhat overdue. I may also point to the rapid, indeed the eager, passage of the measure through another place; in fact, I think there were no Divisions in the House of Commons itself, though there were some differences of opinion upstairs in what is known as Grand Committee.

Supposing there to be any doubt as to the advisability of the production of this Bill, I think one has only to point to the mass of medical examinations during the last few years for soldiers, to the national service and the recruiting returns, which revealed a state of health amongst our adult and adolescent population which was surprising—indeed I may almost say staggering—and forced home to the public mind the fact that something in the nature of a real organisation to meet the health question was absolutely necessary. Further, those who have experience of educational matters, on school boards and so on, know full well how necessary is the health guardianship of children, and also especially of the prenatal condition of mothers. The new Ministry of Health will be a preliminary or a first step essential for getting subsequently into working order various local and national measures which will, we hope, gradually mitigate the causes of disease and later prevent the overlapping and confusion now existing with a variety of authorities, which overlapping and confusion in time we trust to be able to disentangle and reorganise, so as to render this service really effective in the public interests.

I know that your Lordships are acquainted with these things, because there are many of you who take a real and active interest in county and other government; but perhaps I may name one or two of the various authorities concerned in order to show the complexity of the question. There are the sanitary authority, the Maternity Committee, the Public Health Committee, the Insurance Committee of Doctors, the School Medical Service Committees of local authorities, the Midwives Committee, and others, which list really seems to one almost if not quite bewildering; and if it bewilders us what must it do when these various authorities invade, as is sometimes their duty, the cottage or the tenement house? These bodies will have to be linked up later by another Bill to establish suitable local authorities for health purposes; but in the meantime it is essential, as a first step, to set up a central health authority.

Having said so much, I desire with your Lordships' permission to emphasise the main object of this Bill. The main, indeed the one, object of the Bill is to create a central authority under a Minister responsible to Parliament for all matters concerned with health; and without this preliminary stage, as I will call it, it would be impossible to enter upon and skillfully to devise properly-thought-out plans to deal with the various intricate problems. The new Minister will not abolish, displace, or in any way interfere with local authorities. The intention is that it is to be administrative and supervisory, and that the Ministry shall gather to itself all the main departments concerned with health. I use the word "departments" advisedly as distinct from authorities.

I turn now to the Bill. Clause 2 is explanatory and illustrative, giving generally the powers and the duties of the new Minister in relation to health. It covers all questions relating to health, and also refers to the collection, preparation, and publication of statistics, and so on. Clause 3 covers a very wide ground. You will see that subsection (1) contains a reference to the transfer of all the powers and duties of the Local Government Board, of the Insurance Commissioners, and of the Welsh Commissioners; and later in the clause reference is made to other matters. Further on in the clause there is a power given which enables the new Minister to rid himself from time to time of certain duties and powers not concerned with health which can be better carried out and exercised by some other Department. Your Lordships will also notice paragraph (d), which was inserted in the Bill in the other House and which has to do with children. There was considerable discussion with regard to children during the Committee stage, and in the House itself I think, as to the relative position and responsibilities of the Health Minister and the Minister for Education in regard to health matters— that is, the treatment and inspection in schools. A large section of opinion favoured the idea that this should be at once put under the Minister of Health—that is to say, in that first category to which I referred just now. The Government came to the conclusion that amendment was advisable, and this new paragraph (d) was added to ensure transfer at once to the Health Minister, with the other matters, of the supervision, medical inspection, and treatment of children and Young persons in schools, and to make that clear in the Bill.

I might say here, perhaps, that the intention is carried out in the first two or three lines of the clause. The proviso which follows was inserted on Report to meet difficulties which it was seen would be found in carrying out the decision of the Committee. Lower down there is a reference to the Education Acts of 1907 and 1918—a reference, in fact, which was, inserted in order to make quite clear the meaning of the words "medical, "inspection," and "treatment." I might mention incidentally that this was put in on the Motion of a private Member. The matter really is one of administration and convenience; and noble Lords reading the subsection will see that the division of functions broadly amounts to this, that the Minister will be responsible for determining principles—and this was what was desired in relation to those services—whether the service is necessary, and what standard must be attained in the service from time to time by the authorities who will provide it; while the Board of Education will continue to conduct the necessary negotiations in relation to the administrative aspect of those services, and deal with administrative matters arising from day to day in relation to them.

Now I come to a proviso on a matter which I think many people will consider of great importance. It is in regard to research, and research is not to be merged with the insurance organisation in the Health Ministry. The proposition is that the Research Committee, which (as I said just now) is in the insurance organisation, which is to be merged in the Health Ministry, shall be put under the Privy Council. There has been some discussion on this, and I will try to make my meaning clear. In regard to this most interesting question we have to consider how much medical research can be carried out by the medical staff in close connection with either the Health Department or some other, Department, or whether over a wider field, perhaps a limitless field, of research the most advantageous research can be prosecuted by a body less intimately connected with and less immediately directed I by current administration in health matters; because it must be readily recognised that the field of research is one of boundless possibilities.

At present, as your Lordships know, the various departments—the Local Government Board, Munitions, Control, and so on—do spend a limited amount of money on research, which is done by their own staffs to some extent or possibly through the Research Committee, and it has never been suggested that the fact of the existance of a Research Committee, whether under the Privy Council or any other body, should prevent those Departments from doing their own research work with their own staffs. The present position is that the Medical Research Fund Regulations enjoin on the Medical Research Committee the duty of framing schemes and submitting them, not to the Joint Committee, but to the Chairman of the Joint Committee—i.e., the Minister who is the responsible authority to Parliament. If the Minister approves those schemes the Research Committee is at liberty to go ahead and carry them out, and this freedom has been very much appreciated by the eminent scientists concerned. Possibly one of your Lordships may ask why, if this is so satisfactory, it should be interfered with, but I have, I think, an answer. There are serious difficulties arising out of the construction of the Medical Research Committee which will have to be met when the Central Administration for Insurance I is altered, as it must be, by the establishment of the Health Ministry into which insurance is to be merged.

The Bill establishes a Health Ministry for England and Wales only, with some consequential adjustments in regard to Health Insurance in Scotland and Ireland, but the Medical Research Fund is a fund deliberately set up for dealing with the whole of the United Kingdom. Further, medical research has shown that for really effective work the conditions must be as elastic as possible, and that it should be in active co-operation with all the best scientific activities wherever they may be, in this University or in that, or in any part of the United Kingdom, or Empire or indeed even in a foreign country. Not only this, but also in regard to wider and different ranges of scientific subjects; and I submit that it would cause the Research Committee to fall short of its full usefulness, by limiting its scope and horizon, if it was cramped by being confined to one Department or another, wedded to perhaps some narrow field of administration, and, human nature being what it is, possibly to a Department which might have a certain problem for solution within its own walls, to which it attached importance out of proportion to its general value and which it might pursue to the detriment and exclusion of a larger problem.

A further reason for this freedom is that no one can tell quite where scientific investigation may lead. One result may lead to another and to results quite unexpected and remote from the original field of enquiry, and this, as your Lordships know, by no means infrequently occurs, The Local Government Board has its own research staff, and the Health Ministry will continue to have its own staff, and they will do their work as necessity demands or opportunity suggests. Other Departments will work in the same way, with the Research Committee to advise and to assist them. Perhaps I may say once more that we propose to set up a Research Committee under the Privy Council, with absolute freedom, the Lord President of the Council being the Minister responsible to Parliament. The object is that research should not be cramped or confined or tied up within one Department, whichever it may be, and its usefulness thus curtailed.

One other point which I beg leave to say a word about especially is in regard to what is known as the Consultative Councils to be found in Clause 4. Here, again, there has been a certain amount of discussion. It has been urged that they are unnecessary, as the work has been done and can be done by local authorities or associations of local authorities, and further that such Consultative Councils would displace and render nugatory the best efforts and energies of local authorities. Should that idea exist in the mind of any noble Lord I will do my utmost to disabuse him of it, because, as I have said already, the local authorities will not be displaced or interfered with at all. It is proposed to set up Consultative Councils by Order in Council. Each Consultative Council shall consist of twenty members who shall be appointed by the Minister. Both sexes are to find themselves members of it, and a variety of rules as to the appointment of a chairman, and so on, will be drawn up. The matters on which they will advise the Minister are all questions of health, especially as they concern women, the administration of the Insurance Acts, health, finance and so on; and one aspect, not unimportant I think, is this—that their views will be considered before, and not after, a decision or step is taken by the Ministry or a conclusion formed upon important matters referred to the Council. New matters and old matters in new shapes will be the subject of conference between the Councils and the Minister, and the Minister will therefore be able to keep in touch with advanced opinion and method. Then I may also note this. It is not proposed that these Consultative Councils should represent particular areas or particular interests. It is desired to get the best people, men or women, with the best knowledge and experience, to serve on these Councils without regard to locality or interest, and one naturally fears that by confining selection to an interest or a locality you might make the choice limited and not be able to get exactly the kind of people that you would get with a wider choice.

It is proposed that these Councils should be as follows. First of all there will be a Medical Consultative Council of men and women, with a sub-committee for ancillary services, such as nursing, midwifery, and so on, and this sub-committee will not be limited to the personnel of the parent Consultative Council. Then there may be a Consultative Council for local administration, composed of experienced people recommended to the Minister—for example, by county councils or associations of county councils, municipal corporations, urban and rural associations, and so on. Then there will be a Council for Insurance, of people experienced in these matters, such as now form the Insurance Advisory Committee; and a General Consultative Council somewhat on the lines of what was known as the Consumers Council at the Food Ministry. The Minister will be in the closest touch with these Consultative Councils. Each Council will have its own sub-committees composed, like the Medical Council (as I said just now), of members not belonging to the personnel of the parent Council.


Not necessarily belonging to it.


Not necessarily belonging to it. It is desired by this means to get the widest experience without increasing and rendering too numerous the members of the Consultative Council. As to the effect of these new Councils, I have said that they will not interfere with local authorities. Local authorities, either individually or through local Administration Associations, have in the past been consulted by the Local Government Board. That course will be continued by the new Health Ministry, but with this advantage—that, owing to the special personnel, as we hope it will be, of the Consultative Council, better, more competent, and more affective advice on a variety of matters will be at the disposal of the Minister than was available before. The Health Minister will communicate with the individual local authorities or associations as is done already. Possibly, by the formation of these Consultative Councils, there may be a guard provided against a too rigid so-called bureaucratic leaning, because the obligation on the Minister to establish these bodies is statutory.

The Consultative Councils have a right to offer the Minister advice, and the Minister is under obligation by Order in Council to receive it and consider it. It is advisable to appoint these bodies and to set them to work at once. I know it has been advanced that the Consultative Councils may tend to relieve the Minister of responsibility to Parliament, but I do not think that this need be anticipated seriously in the slightest degree. I venture to think that we may very well leave Parliament to see to that. I may add that this proposal has an analogy or a precedent in the Education Act of 1899, whereby a similar Council was set up for aiding or influencing, if you will, the Central Department by the views of such bodies as the Universities and various types of schools. This secured to the new Board of Education the confidence of these important outside bodies, and this attitude of confidence by these bodies was essential to the successful development of the new Board. The system has proved to be a great success by working admirably. The Teachers Registration Council of the whole teaching profession is another body now similarly advising the Minister of Education. There has been no depreciation whatever of the responsibility of the Minister to Parliament, and I submit that this success is good ground for anticipating the same success in the case I have tried to explain.

As regards Wales, your Lordships know that there is no Secretary for Wales, as there is for Scotland and for Ireland, and of course you also know that there is no autonomy for Wales as separate from England. The Commission for National Insurance has a separate office in Wales, but the Welsh Insurance Commission is under the Treasury and is responsible to the chairman of the Joint Committee in the same way as is the English Insurance Commission. Whatever functions they have in Wales are retained. The functions are merely transferred to the new Minister. Till now the Welsh Insurance Commission has had no separate health organisation in Wales. These powers are not taken away, but in addition to insurance the Minister may arrange for any other part of his powers and duties to be carried out, so far as Wales is concerned, through the Welsh officers who will be known as the Board of Health. These are enlarged powers of that office, and therefore not only will there be a separate body in Wales, but, instead of limiting that body to the powers of the Welsh Insurance Commission, it is proposed to add the other functions of the Ministry of Health.

I should like to say a few words as to the Orders in Council, because I have often heard Orders in Council somewhat criticised in this House. This matter was very fully discussed in the House of Commons, and the clause was amended so as to give more opportunity for criticism. One Order in Council is to fix the dates for the coming into operation of the Act, and one would naturally expect that Parliament would wish that to be as soon as possible. The Consultative Councils are established by Order in Council, the Order being laid on the Table of both Houses of Parliament for thirty Parliamentary days. In addition to that, if the Order in Council is to provide either for an increase or a decrease in the duties or powers of the Minister, it will require resolutions of approval from both Houses of Parliament. I may also add that the Orders can be amended by either House.

Scotland, as your Lordships know, will have its own Health Bill, which will be introduced by my noble friend behind me in a day or two. The Insurance Joint Committee covers the four countries. The chairman is the Minister responsible to Parliament for them, but the situation is changed by the Ministry of Health taking over insurance so far as England and Wales are concerned. The Joint Committee will continue to regulate, for all the four countries, the actuarial and financial matters—that is to say, the medical benefit, and the amounts to be paid per head per area. Therefore this Bill provides that the Secretary for Scotland and the Chief Secretary for Ireland shall be members of the Joint Committee as well as the Minister of Health. The Irish Insurance Commission is retained, and placed under the Chief Secretary instead of under the chairman of the Joint Committee. The Bill also makes the Chief Secretary responsible for health administration in Ireland. It enables Consultative Committees to be set up in Ireland, and also provides for the establishment of a special body called the Irish Public Health Council in order to give assistance and make proposals to the Chief Secretary on health matters. It amount to this—that Clauses 2 and 4 apply to Ireland, plus the Public Health Council.

That is my case for the Bill. With your Lordships' permission I should like to say a word or two about the old Local Government Board. Some four or five years ago it was my duty to ask your Lordships to assist me to pass a Bill for universal service, and I remember thinking at that time, and I may possibly have said so, how much we owed to the voluntary system to which we were saying farewell. The same thing occurs with regard to the old Local Government Board. By the setting up of the new Health Ministry its dissolution takes place as a separate entity. It has served the country very well indeed. The origin and the gradual development of local government in this country has been the responsibility of the Local Government Board for nearly fifty years. It has its critics, of course. Who has not? But compared with to-day local government was unknown fifty years ago. Sanitary administration was also unknown. If we look back to the Public Health Act of 1875, on which sanitary administration rests, and to the Public Health Acts of 1888 and 1894, which were earmarks in the history of local government and which were the foundation of a local administration which, I venture to say, is unsurpassed anywhere, we see the great advance which has taken place in local government and public health administration. The Local Government Board has prepared and paved the way for the Health Ministry which now displaces it, and it has done so in various ways—by National Insurance, perhaps one of the most humane acts ever passed by Parliament; the treatment of children in schools; the provision for tuberculosis and venereal disease, and so on, all of which will in time be concentrated under the new Health Ministry, and the members of the staff of the old Local Government Board will see their work developed in its perfection.

With the dissolution as a separate entity of the Local Government Board comes the retirement of Sir Horace Monro, the Permanent Secretary. Sir Horace Monro has spent a lifetime in the public service. He has been a zealous and courteous public servant, and a fine and true example of the great mass of Civil Servants whose assiduity is only equalled by their loyalty to succeeding chiefs whatever their political leanings may have been, or whatever tenets they may have held. It is these qualities which I venture respectfully to think have made our Civil Service the admiration of the world. With that short, but I hope pardonable, digression I have nothing more to say in regard to this Bill, except to repeat that it is a Bill for the setting up of a central Ministry, or authority, for Health, and that it in no way is to interfere with local authorities. It may be that on some points I may have been a little obscure. If that is so, I will endeavour either later in the evening or at a future sitting to clear away those obscurities. In moving that the Bill be read a second time I have only to thank your Lordships for your kindly patience over a period which is longer than it is usually my habit to address you.

Moved, That the Bill be now read 2a.—(Viscount Sandhurst.)


I am sure your Lordships would all desire me to express the universal sentiment in congratulating the noble Viscount on the manner in which he has performed his task. We are accustomed to hear from him clear and lucid explanations of the different subjects which he is entrusted to set before us. As many of your Lordships know, there is a peculiar propriety in entrusting this particular subject to my noble friend, because he has for many years devoted a great part of his leisure to hospital work and to work connected with health generally. There is, therefore, scarcely anybody in the House to whom we should listen with greater respect than the noble Viscount on this particular matter.

The noble Viscount stated that this measure might be regarded as overdue, and it is no doubt true that the creation of a Ministry of Health has been for a long time mooted and that the proposition has met with almost universal favour. This particular Bill, as my noble friend stated, met with something approaching unanimous approval in another place. It is one of the inevitable misfortunes of the present manner of conducting business that it is impossible for us to be thoroughly apprised of the discussions which took place upstairs in the House of Commons on the details of this measure. Many of your Lordships, no doubt through one means or another, have become acquainted with what passed in Committee, but the publication of those discussions is not nearly as general as that of discussions in the full House, and consequently many of your Lordships may not have followed closely the course of the debates upstairs.

The principle feature of this Bill is the disappearance or absorption of the Local Government Board. Towards the close of his speech my noble friend paid a tribute to that Department, and gracefully laid a wreath upon its grave. He also, with the universal concurrence of your Lordships, expressed the sense of what the country owes to the eminent public servant Sir Horace Monro, who has been chief permanent official there for some time. It is, of course, the principal provision of this Bill that the Local Government Board should disappear and he replaced by a Ministry of Health. It must be nearly two years ago that I heard that it was proposed, by some deeply interested in this subject, to proceed in this way towards the creation of a Ministry of Health rather I than by starting a fresh Department and endowing it with powers, some new and some taken from other Departments. The Ministry of Health was to absorb the Local Government Board, and was then to proceed to shed as rapidly as it could the somewhat numerous functions per taining to the Local Government Board which have nothing to do with health, and that is the course which has now been pursued. But it appears to me to be absolutely imperative, if this measure is to be a real one, that action in this direction should be exceedingly prompt. It clearly will not do to allow this new Ministry to continue to exercise those functions of the Local Government Board related to various spheres of local government and quite unconnected with the duty of a Health Ministry—the holding of public enquiries, for instance, on many different subjects not related to sanitation and health.


Relief of the poor.


Also, as the noble Marquess states, the whole business of the relief of the poor. Unless very rapid action is taken in that direction, His Majesty's Government will find themselves open to the charge, which I notice some Members in another place did attempt to bring against them, that this Bill is in reality only a matter of words and names—that is to say, you call the Local Government Board the Ministry of Health, you place a different name over the shop, but the wares sold are precisely the same, and you will therefore have effected nothing except to add a number of fresh functions to the Local Government Board: That, as the noble Viscount has made clear, is by no means the intention of His Majesty's Government, but I venture to emphasise the necessity for prompt action in this matter lest it should be supposed that the creation of this Ministry is not so real and large a reform as we all hope that it will become.

The noble Viscount mentioned paragraph (d) of subsection (1) of Clause 3, relating to the Board of Education. In the consideration of this matter the question of how the functions of the Board of Education in relation to health, which have been most usefully and admirably exercised, by common consent, were to be transferred formed one of the principal difficulties ahead, and I think His Majesty's Government are to be congratulated on having solved, as I conceive that they have, with the full agreement of the Board of Education, this matter of medical inspection and treatment in schools. I well remember, during the short time that I was President of the Board, that this appeared to me one of the main difficulties in the road of the creation of an independent. Ministry of Health.

The noble Marquess behind me mentioned just now the duties of the Local Government Board in relation to the Poor Law. It has been familiar to all advocates and observers of social reform for many years past that popular mistrust of the Poor Law had to be met both by legislation and by private agencies of different kinds, and to a considerable extent it has been met. To take the early stages of life first, there has been, as your Lordships know, for sometime past a powerful movement endeavouring to remove the Poor Law taint from the children who have been brought up and educated at the expense of the State. It has been the object of that movement, with no little assistance from the Local Government Board itself, to abolish the great barrack schools in which at one time practically all these children were, I was going to say immured, and to substitute something more nearly approaching the conditions of home life for their education and bringing up. Then, to go to the other end of life, the institution of old-age pensions was designed to effect, and has succeeded in effecting, the freedom for the old age of the poor from what was considered the hardship of Poor Law relief. Then, again, throughout the whole of life the system of insurance has endeavoured to relieve those who are in no position to pay for medical assistance from having to seek medical relief through boards of guardians Therefore the removal of the whole system of relief of the poor from the Ministry of Health is a purpose which obviously ought to be carried out with the utmost possible speed.

But in bidding farewell—if we are to bid farewell before long—to boards of guardians, I have no doubt that my noble friend, or whoever is entitled to speak for the Government on that matter, will desire also to pay a tribute to the admirable work which has been done by so many individual members of boards of guardians—


Hear, hear.


—in inconspicuous but extremely valuable work, which ought not to be forgotten amid the unpopularity which the guardians as an institution have undoubtedly to some extent earned. On the matter of research mentioned in the first proviso of Clause 3, subsection (1), after some consideration I am disposed to think that His Majesty's Government have taken the right course in placing this matter under the Privy Council, and not under the Ministry of Health. It is necessary, as the noble Viscount indicated, to regard research as a whole. Medical research must be in many instances closely connected with research in chemistry and research in physics, and to remove medical research in particular from the general care of the Privy Council, which is the home of the Department of Scientific and Industrial Research, would, I feel, be something in the nature of a blunder. And although I believe that this provision has, as the noble Viscount said, been criticised in some quarters, I hope that no alteration in this respect will be made in time Bill. There is the further difficulty, which the noble Viscount mentioned, of applying this provision to the whole of the United Kingdom if the Ministry of Health were made the controlling authority for research, and that is a further argument, I venture to think, in favour of retaining the Bill as it stands.

The noble Viscount gave us a clear statement about the Consultative Councils proposed in Clause 4. We were able to gather from what he said that there would be several of these bodies, and to a certain extent what their method of operation would be, although I do not know that I was able entirely to picture to myself the manner in which they would work. The noble Viscount admitted that it had been feared in some quarters that the creation of these Councils might to some extent detract from the responsibility of the Minister. I think there is a certain danger of that if the Councils are made large and powerful bodies. I do not think that the analogy of the Advisory Council of the Department of Scientific and Industrial Research can very well be prayed in aid, because that body does, in fact, represent the Department, and in the main is the Department. The noble Viscount, however, suggested that the Consultative Committee on Education might be regarded as a useful precedent. No doubt it can to a certain extent, but on the other hand its scope was exceedingly limited. The Reports that it has published have been, it is true, of great importance and interest, but it has never been supposed or believed in itself to influence or to attempt to influence the policy of the Department. And if it is clearly understood that the Consultative Councils are as limited in their operation as that, I do not know that much objection could be raised. But it has sounded rather as though they might be more important bodies than that in some sense—much larger, and designed, so to speak, to sterilise beforehand all the opposition which might be raised to particular administrative acts of the Ministry by roping in the principal critics beforehand. I should like to know how far the members of the Councils would be at liberty afterwards to express in public, if they so desired, divergent views from those of the Ministry, or whether they would be regarded as to some extent an appanage of the Ministry, and therefore, once a conclusion has been reached, that they would be bound to hold their tongues on the subject for ever after. If the scope of these Councils is of the more limited kind, I can quite understand that they might serve a very useful purpose.

I have not intended in these remarks to go through the whole Bill, and I will merely confine myself to again congratulating His Majesty's Government upon having produced what ought to prove a most useful and practical measure when it is in operation, and to congratulate once more my noble friend on the manner in which he moved the Second Reading.


My Lords, as one who took part in the proceedings which resulted in this Bill, and as one who either as Parliamentary Secretary or as President of the Local Government Board during the last few years took a very prominent part in local administration and local government in this country, I am not unnaturally desirous of making a few comments upon this Bill. I may say that I was immensely relieved that the noble Viscount in charge of the Bill did not claim for it that, although it was to be part of the large measures of reconstruction, it was likely to lead at once to a new heaven and a new earth.

Too much has been claimed for this Bill, and too high expectations have been formed of a rapid improvement in the health of the people from the mere setting up of a Ministry of Health. This Bill will lead to the greatest possible disappointment unless it is followed by a new and improved public health policy, by a new and improved Poor Law, and to a very large increase in our hospitals, our sanatoria, our clinics, the numbers of our well-educated and re-educated doctors and surgeons, the numbers of our nurses, and all the different human agencies which contribute so very largely towards public health. I have often heard it said that proverty and misery are to be removed from the face of this earth by these measures of reconstruction. Poverty will not disappear by perorations nor misery by mere machinery. The public health of our country has been a plant of very gradual growth, and it will continue to be so notwithstanding the setting up of a Ministry of Health. I am glad, indeed, that the noble Viscount paid such a handsome tribute—though none too handsome—to the splendid work that has been done during the last fifty years by the Local Government Board, which was set up in 1871 in order that it might be the great Public Health Department of this country.

I will not apologise to your Lordships for quoting a few figures as to the marvellous improvement that has taken place in the public health of this country and in the expectation of human life since the Local Government Board supervised our public health system. Recollect that the population of England and Wales has grown from 22,000,000 to 36,000,000 since the Local Government Board was established in 1871, and that the greatly increased population of this country has been congregated in urban areas. Notwithstanding this fact, the health of the whole nation has been enormously improved. The death rate, which was 21.4 per thousand in 1871, in 1916 was 13.3. The highest figure was 21.6 in 1875, and the lowest 13, in 1912. Sir Arthur Newsholme, one of the greatest administrators of public health we have had at the Local Government Board—I am sorry to say he has now left us—in his recent Annual Report showed that the deaths in each year from 1910–12 averaged nearly 250,000 fewer than they would have averaged had the death rate of 1871–80 continued. Not only has the death rate been so markedly lower but the expectation of life has been enormously prolonged. In 1871–80 the expectation of life in the case of males was 41.4 years; in 1910–12 it was 51.5 years—that is, in that period of 40 years 10 years have been added to the expectation of life. Taking the figures for females, they are respectively 44.6 and 55.4. I believe it can be proved that these figures constitute a higher expectation of life than is to be found in any other European country.

As one who was President of the Local Government Board, I wish to say that I regret immensely that many of the advocates of the Ministry of Health—I myself am an advocate of the Ministry—have in their zeal for setting up this Ministry thought it necessary to paint the picture far too black with regard to the public health of this country, and to make out that during the last forty years practically nothing has been done by the Local Government Board or by the local authorities. That picture is not true. I regretted very much when the Prime Minister said, in his great speech at Manchester, that he doubted whether there was a first-class country in the world where less had been done to organise the forces which made for the health of the nation. He was immediately taken up in the Press by Mr. Shadwell and others, who had made a comparative study of the question in-every civilised country, and who had come to the conclusion that, while there was great room for improvement in this country, England was the best off in regard to public health and sanitation, and that it could be stated truly that in no country in the world had so much been done as in England.

During the last forty years we have been pouring out Acts of Parliament relating to public health, trying in every way to cleanse our polluted rivers, directing the expenditure of millions of money through our local authorities on water supply and health functions of all kinds, and that work has been generally supervised by the Local Government Board. From my own observation, even during the four years of the war, I can say—I will take only two matters—that the Local Government Board in every way did its duty to carry out a great public health policy in this country. I will take first venereal disease. Up to 1916 there was no public policy at all for the treatment of venereal disease. Up to that time there were only three lock hospitals, and few others, to which men and women could go to be treated for this disease. Even taking into account the difficulties of obtaining doctors, surgeons, and nurses during the war, no less than 140 centres were set up in two years, acting through the agency and under the direction of the Local Government Board, for the treatment of this disease. No less than 55,000 new patients sought this treatment in 1918.

I take in the second place maternity and child welfare. Maternity and child welfare is a policy which has done and is likely to do more for the practical health of this country than any other measure I know if it is persistently carried out. It was originated only in 1907, and in 1914 there were comparatively few centres and only 600 health visitors. There are now 1,400 centres and 3,000 health visitors. All that work was being rapidly pushed along, even during the war when the Local Government Board was largely engaged in war work. I can speak from personal knowledge when I say that no better team work was done by any body of public servants than was done by Sir Horace Monro, Sir Noel Kershaw, Mr. Willis, Sir Arthur Newsholme, Mr. Simmonds, and men of that type. No men deserve more the tribute which has been paid to them than that particular group of men. If we welcome the coming host, let us at least speed the parting host; and let us say of them and to them how much we praise them for the good work they have done in the direction of public health.

I come now to a few criticisms upon the Bill. The Bill so far as it goes is undoubtedly a good one. Its main feature is that it fuses the great preventive side of medicine—carried out through the various local authorities and the Local Government Board—with the great curative side, the National Insurance Commissioners. That is the great point of this Bill. I am very glad that the noble Viscount particularly said that this was only a preliminary measure; because I am going to point out that after all it is only a machine which is created, and a very limited machine. Take Clause 2. Any ordinary layman reading that clause would think that it gave to the new Minister of Health most comprehensive powers and duties which would enable him to take all such steps as might be desirable to secure the effective carrying out and co-ordination of measures for the health of the people, including measures for the cure and prevention of disease. But, as a matter of fact, that clause really is very little but window-dressing. It gives the new Minister of Health no new powers of any sort or kind. That was expressly stated by the Parliamentary Secretary to the Local Govern ment Board when he was discussing this measure in Standing Committee A. Many members of the Committee were under the impression that this clause gave the new Minister of Health very large powers. No, said the Parliamentary Secretary. He continued that, as there was some doubt about the clause as drafted, he desired to explain it. There was no intention whatever, he said, on the part of his right hon. friend to give or to take or to try to give or to take any new powers. All that this clause does is to impose upon the new Minister the duty of taking a personal interest in matters appertaining to health. It will not necessarily transfer to him such matters for instance as medical education. He will continue to do as he has been doing in the past—namely, keep in touch with any person responsible for medical education. Nothing is more important than that we should have a far better system than we have got at present of educating our doctors and re-educating them.

There was a very admirable speech made on Saturday last by Mr. Morris, the House Governor of the London Hospital, at the forty-fifth annual meeting of the Hospital Saturday Fund, and amongst other things he said that it was at the hospitals that the future doctors who would have to work all the Departments were trained, and that it was the tone which they caught at the hospitals that was going to influence the work done for the health of England for the next ten years. He added that the British Hospital Association had resolved that the hospitals should remain voluntary, and should focus their attention upon the education of the future doctors, the treatment of cases that were extremely difficult, and the advancement of research. He added further— All these things the future doctor must learn, and the Minister of Health must recognise that hospitals were the only places where the doctors could receive their education. He then went on to make a very wise suggestion—namely, that general practitioners ought to have the right to walk their own hospitals again for two or three months every year.

Again I ask, Does this pretentious clause give the Minister of Health any power whatever over the voluntary hospitals which must remain the training grounds of our medical profession? Doctors and surgeons should be able to renew their education mid to find out what has been done, what new methods and systems have been adopted, instead of being buried away in different villages and towns and unable to renew their education because there are no opportunities or facilities for doing so. What I say about this is that under Clause 2 the Minister of Health has no power whatever to redirect the whole system of medical education, and no power to afford doctors or surgeons the right to re-enter hospitals.


He can make a grant.


I know of no power by which he can make a grant. This matter is under the great Act of 1886, and so far as any Government Department has any powers of this kind those powers reside in the Privy Council, which has power to nominate five out of the General Council of twenty or thirty which regulates all these matters of medical education. Those powers of the Privy Council are not even taken over under this Bill by the Minister of Health. Therefore I say it is one proof to my mind that the Bill is not a sufficiently big Bill, and I hope that your Lordships will address yourselves to making it, if possible, a little bit bigger and larger.

I have desired for some time, if we were to have a Ministry of Health Bill, that it should be a bigger Bill than this, and that the period for taking over many of the powers belonging to other Departments should be accelerated. We used often to hear that the great argument for the establishment of a Ministry was that health matters were now more or less controlled by twenty different State Departments, and that it was most necessary to unify control at the centre. My complaint is that this Bill does not do that enough, or go fast enough in that direction, and I think we might very well consider in Committee some Amendment by which to accelerate the process. I observe that the present President of the Local Government Board is a little shy of taking over any new powers at all. I have always been in favour of the Ministry of Health taking over all the powers which now reside in the Board of Education as regards the medical treatment of the child, and I have never seen any reason why you should compartment the child in regard to medical matters. I have never been able to understand that up to five years of age a child should be under one set of doctors; that after five and during the school age, which may be fourteen but possibly now may be up to sixteen or later, he should be doctored by doctors who come under the direction of the Minister for Education; and that after leaving school his health should be under the control of another set of doctors acting under the central control of a Minister of Health or of the Local Government Board. I rather hope that your Lordships will look carefully at the Amendment passed by Standing Committee A and see whether that Amendment was not more effective than the Amendment introduced afterwards on the Report stage by the present President of the Local Government Board.

There are one or two other comments which I should like to make before I part from that clause. One of the other arguments used for this Bill was that there were 1,800 local authorities, and it has been said for some time that it would be far more efficient and economical if we devised new areas for these new public health functions and activities. I believe that is so—that the small areas are unsuitable for the new public health duties, and indeed for other public duties—but this Bill does not touch that question at all. Then, again, Dr. Addison, in introducing this Bill, said that one of the matters that he most desired to deal with was the prevention of malnutrition, and he stated that at least half a million children in this country were suffering from malnutrition. I hope the figures are not so large, but I would like to ask the noble Viscount in charge of the Bill what words—and in what clause—give the Minister of Health any power to deal with that matter. I know of none.

Again Dr. Addison said, in answer to an interruption from Sir Edward Carson, that under this Bill the Minister of Health would be able to deal with the blind, the deaf, and the dumb. I have always wished that some Department should undertake the general supervision of these people, and I did my best when President of the Local Government Board to bring the blind under my Department. But what words are there in this Bill which will enable the Minister of Health to deal with the blind, the deaf, and the dumb? I know of none. Then he dwelt very much on bad health due to improper conditions of work in the workshop and the home, but I see no clause or words in this Bill—certainly there is nothing in Clause 2—which will enable the Minister of Health to have cognisance of any of these things, although Dr. Addison said these things should come under the cognisance of men who have to deal with health matters. Again, there are some words used of a very attractive and alluring character in Clause 2—that it will be the duty of the Minister of Health to attend to the training of persons for health services; but I see no clause or words which would give any power or duty, other than the President of the Local Government Board now has, of attending to the training of doctors or nurses or any of those human instruments which are so necessary if we are going to improve the health of the people. That is all the criticism I have to make at present on that clause, and I say that the Bill will effect very little unless it is followed by other Bills—unless it is treated as a preliminary and speedily followed by other Bills with very much enlarged grants by which we may have a more satisfactory system of hospital sanatoria, well-educated doctors, and so on.

As to Clause 3, which deals with the transfer of certain duties from the Local Government Board to some other Departments, I hardly think it ought to be possible to transfer by Order in Council a large set of duties such as those now attached to the Local Government Board in connection with the Electoral Registers of the country, the franchise of the country, and all those matters which have been enormously developed ever since the Representation of the People Act was passed. I think that when we come to deal with the transfer of powers from the Local Government Board to other Departments because it is now turned into a Ministry of Health, we should scrutinise the matter carefully and see that some of the greater powers are only transferred if we have a full knowledge of the Department to which they are to be transferred, the circumstances under which they are to be transferred, and those who are likely to administer these very important duties.

Lastly, I come to Clause 4, dealing with Consultative Councils. The noble Viscount was very interesting on Consultative Councils, and he was the more interesting because there is nothing in the Bill which really does say all that he has told us about them. When we come to that clause I am afraid I shall be very inquisitive. I shall want to ask in more detail how many of these Consultative Councils are to be set up; how they are going to be appointed; of whom they are going to be composed; what is going to be their tenure of office—that is very important for a statutory body—what powers they are to have; what payment is to be made to them; and what is likely to be the total cost. I cannot help thinking that we may be embarking on a very expensive policy, if we are going to set up these Committees—each Committee, as we are told, to have its own sub-committees—and if we are going to pay all their expenses in going from place to place, pay them subsistence allowances and for all their so-called loss of time. That seems to me to be a system of subsidising which is likely to lead us to a large expenditure.

It we set up these Committees to deal with local government it will be very difficult to resist the claim, which I see is being made by the new Labour Party in the London County Council, that they should have their travelling expenses allowed and should be paid subsistence allowances and for loss of time. I do not see how you can have one body of men dealing with local government affairs sitting at the Local Government office and paid their out-of-pocket expenses, and another body of men a few hundred yards away who are doing still harder work with no particular inducement to do it except love of country and real patriotism but who remain unpaid. There are other matters also which will have to be raised when we come to Clause 4. I think it is a serious consideration if we are to set up these statutory bodies, which are not dependent in the least for their positions on their election or any-thing of that kind, whether you are not undermining to a great extent the responsibility of the Minister in charge of the Department.

I think we shall have to criticise that proposal from many points of view, and I hope the noble Viscount in charge of the Bill will, with that courtesy which ever distinguishes him, give us information, which I believe is to be obtained, by some White Paper showing the number of Committees to be set up, how they are to be composed, their tenure of office, and their payment; and, if necessary, give us something like an estimate of the whole cost of this new and expensive machinery. I conclude, as the noble Viscount concluded, by expressing once more my own gratitude, not only as ex-President of the Local Government Board but as a public man, for the splendid work that has been done by the Local Government Board and its officials in promoting the public health of the people, and I can only say that if this Ministry of Health in fifty years has attained anything like as distinguished a record for progress, it will have deserved its title and its name.


My Lords, when the noble Lord who has just sat down rose to address the House I gladly gave way to him, because I was very anxious to hear what he would say about this Bill. He has not exactly stood up for the old state of things, but he certainly has not shown himself in love with the new. His blessings upon the Bill, for which the noble Viscount is responsible in this House, have not been of a very emphatic character. There were one or two things which the noble Lord said which certainly did seem to be very hard. He reproached the Bill for omissions. For instance, he said that the training of doctors, the future arrangements of sanatoria, where they should work, the giving of refresher courses to general practitioners, were matters which ought to have been included in the scope of the Bill. It has been my fortune to preside over two Royal Commissions and a Committee on the subject, and I never heard any responsible witness or any doctor make the suggestion which has fallen from the lips of the noble Lord.

The training of doctors and the future enlargement of their course is a very great subject and one which requires to be dealt with, but it belongs to a totally different service from that of health. It belongs to the service which is performed by the Universities and the great medical schools, by great institutions like the London Hospital, with which my noble friend Lord Knutsford is associated; certainly not to anything in Whitehall or to an organisation ruled over in the interest of a special service which is quite different from that of education. These are matters which belong to education and not merely to health as such. Then the noble Lord spoke of areas. Is it quite clear that areas should be mentioned without touching other questions? There have been the strongest recommendations lately that they should be dealt with by a Department which would hold the scales more evenly between the various Departments connected with areas. Whatever Ministry of Justice we may have in future, it seems to me that the question of areas would belong to the supervision of that Ministry rather than to that of local government.

Now I come to what the noble Lord said about the work which the Local Government Board has done in the past. No doubt it is quite true, as he says, that there have been great improvements in the statistics in regard to health. Things are better than they used to be. There is less illness, and the prospects of life are longer. Excellent work has been done by the Local Government Board. My complaint is of the smallness of its quantity. The real improvement is due to the splendid public spirit of the local authorities to whom the duties have been confided. It is to local government that England owes the great. development in health conditions to-day, and not to a Department which I am sorry to say was not famous in the past either for its provision of associates for its own guidance or for the way in which it endeavoured to get together the materials for the discharge of its duties.

The noble Lord said one thing which was very much to the point. He said that the care of public health was very scattered and broken up among a number of Departments. That is absolutely true, and that is the reason why greater progress was not made. The very strength of the Bill, the very point that distinguishes it altogether from the spirit of the old Local Government Board, is that it does in Clause 2 (which is important for that reason) lay down a principle. The principle of the Bill is to take the service of health and treat it as a service by itself; disconnect it altogether from all the other Departments of the State, where, as the noble Lord truly said, it has been too much scattered about.

Consider the state of things to-day. The miner is working in the mine. He may be in peril of his health and life from new diseases which have only recently been come to be understood, and which can only be dealt with by persons who are skilled in their operation, and conditions of life. In the factory conditions may be very bad, the atmosphere may be wrong, the temperature may be wrong, and the moisture present may be exercising a deleterious effect. All these things can be known only by the health expert. In all the industries of the country you find work for the health expert. Who does the work to-day? It is done by the Home Office. We show our sense of what the Home Secretary has to do with such questions of health by not providing him with any proper machinery for the purpose. The inspectors under the Home Office do their work admirably, but they are not trained for this particular purpose, and it is by accident that they have developed the great skill with which they combine their functions. They look after the question of "truck," the question of production; and these things, together with the health of the people, are combined in one set of men, who do the work very well no doubt. To a large extent they must continue to do it in the future, but not as the servants and officials of an Office which has nothing to do with these things, which has not to provide for the development of the proper spirit in regard to public health, and which takes up these things only as a result of accident.

I have taken one Department and shown how public health was largely in the hands of the Home Office. No wonder the Local Government Board was rather a feeble body as regards the care of health. What could it do? It could not interfere with work which came under the Home Office; nor did it interfere. It was confined to a class of question which may be said to concern the environment of health, rather than health itself. It had, no doubt, very valuable functions as regards sewers, which were carried out by the local authorities throughout the country, but that is only a very small fragment of the health question, although a very important one.

Take another Department—the Board of Education. It has a great deal to do with health, and even in connection with Health Committees a great deal of the work has been done by grants from the Board of Education. At one stage the rivalry between the Board of Education and the Local Government Board became so acute that when I occupied the Woolsack I had to decide between the two Departments as to what was the precise line of demarcation between the functions of the Board of Education and those of the Local Government Board on questions of health. It does not stop there. The Privy Council has a fragment of health administration. The noble Earl the Leader of the House is fortunately relieved by this Bill from the supervision of midwives. I congratulate him. But that is only an illus tration of how another Department was vested with matters of health with which it had no business whatever to do. I could multiply these instances further. It comes to this, that the general words of which the noble Lord complains, and which charge the new Minister to give his attention to all questions connected with public health, really do declare a very great principle—namely, the principle that no longer are we to have scattered fragments, or weak Departments, such as the Local Government Board of the past was, but that we must have a Ministry which shall gather together health subjects and service, and administer that service without let or interference from other Departments.

The first principle of the Bill is that for the future there will be a single service of health, and not a lot of scattered services. The second principle is that the work is to be founded upon knowledge and research. The Local Government Board was deficient in this respect. Now knowledge is given a place; thought is the preliminary to action. It remains to be seen how the new Minister will develop it. That is the duty confided to him. One of the great fragments of health unaccounted for was that under the Treasury. It was in the hands of the Insurance Commissioners, but I think the Treasury was their master. The Insurance Commissioners had among other things to undertake research, and I entirely agree that medical research has been most properly kept away from the Ministry of Health and given to the Privy Council.

This Bill sets up a Ministry of Health for England apart from Ireland, and Scotland is to have a separate Bill. The question of research is a national one, and is not limited to any of the constituent parts of the United Kingdom, and it would have been very narrowing and very wrong had it been placed under a local body. Exactly the same considerations apply as led to the taking away from the Board of Education of the Department of Industrial Research and transferring it to the President of the Council. I am bound to say this I hear murmurs—I wish the noble Earl who leads the House was in his place—that it is not possible for him, with all his duties, to give adequate attention to the questions of research which come under him. Now you are transferring another Department, a very admirable Department, under Sir W. M. Fletcher, to the President of the Council, and. I hope it will be possible for the Minister (who is, in this case, the noble Earl) to give that attention which so supremely important a matter requires. It is a branch which seeks to make knowledge for the future the foundation of action, not in one but in fifty spheres. I think if the noble Earl finds that his duties here and in the War Cabinet take up so much of his time that he cannot identify himself more with the great subject which in an increasing volume is being entrusted to his charge, it will be well that the office of Vice-President of the Council should be re-created. I do not mean an incompetent Vice-President; I mean a competent Vice-President, who would deal with these questions of research in a fashion which would inspire confidence in the public.

The third great feature in the Bill is that it proceeds on the footing of devolution. I do not think that until recently people in this country have quite appreciated the real value of the local government institutions which they possessed. The real strength of our local institutions lies in our county and borough councils. The best type of these bodies were developed by the Board of Education. There is a statutory committee in each of these local authorities to which was entrusted the work of carrying out the policy of the Board of Education. There you have a single service of functions concentrated in a single Department, and its execution carried out by devolution to the proper statutory committee of these bodies. As I understand, that is exactly the course which is proposed to be taken under this Bill. The Poor Law will presently disappear—it will require some more legislation, but the policy is announced—by being broken up. One of the fortunate things which Sir Donald Maclean's Committee on local government was able to do was the reconciliation of the two Reports, the Majority and the Minority, and now a system of analysing Poor Law relief into its separate heads, a large part of which consist of health, is carried out. The Poor Law will disappear, and with the Poor Law the boards of guardians, and there will come in possibly two other committees which will be statutory committees of the local authorities by whom these duties are to be carried out. That is the third great principle which is in this Bill, and that is what commends the Bill to me and makes it what seems to me to be a very effective Bill.

But I wish to draw your Lordships' attention to what has been said already, that the great evil is left to the accident of circumstances under this Bill. No doubt the policy is there. I do not think Lord Downham quite appreciated what large powers there are here if the Houses of Parliament approve of the Orders in Council. Although there is power under this Bill to take the whole of those services of health which at present are under the Home Office, and to which I have already alluded, there is no provision for exercising that power, and some adjustment will have to be made in regard to the Home Office. When you have taken these large powers from the Home Office, and when you have also taken some of its protective control for the purpose of coal reforms, as probably will be done, you will have to have a Ministry of Mines and there will be little left for the Home Office to do unless there is a very large devolution of duties connected with the administration of the Courts of Justice. I am not, of course, alluding to the appointment of Judges, or to the custody of the Great Seal, but I am alluding to the great mass of administrative work which belongs to the service of justice and to nothing else, and which I think the Home Secretary might well make his principal concern, relieving himself of all health and production matters. The Bill provides for the transfer of the health part of his duties, but of course that will still leave to be dealt with the wider problem to which I have referred. That will still be untouched and unsolved, and you will find that it will plunge you into a very large re-arrangement of the reorganisation of Government generally. That is quite right. I am far from not wishing to see it come about; I only point out that there is a good deal in the criticism that this Bill is a Bill drawn on the future.

National Insurance is a very big business, and that is being taken over. I think before the war that there were eleven and a half million persons under National Insurance in this country, and my recollection is that there were sixteen thousand doctors and ten thousand registered chemists. That in itself is a pretty big business for the new Minister to manage with the aid of his staff, even though the research part has gone to the Privy Council. There will be added a good deal of health and maternity work from the Board of Education, and therefore I cannot myself feel much sympathy with the complaint that there are not enough duties to the Minister under this Bill, or that the draftsman was otherwise than justified in introducing a rather pompous declaration of principle. It is the very thing that was wanted to show what has got to be clone, and the only complaint is that, with the enormous volume of work that is going to be transferred, there is some uncertainty not only as to when it will be done, but as to what further consequences on other Departments it will entail.

Allusion has been made to the training of doctors, and I strongly am of the view that that belongs to another service altogether—to education. It is for the Universities and the great Medical Schools. But it does touch very closely public health, and I hope that by means of Consultative Committees and by close co-operation between Departments the Ministry of Health will keep in relation with all the bodies which do medical training. And I am not confining myself merely to the civilian doctors. I have had in my time a good deal to do with that admirable body, the Army Medical Service, which has enormously improved itself in the last ten years. My noble friend Lord Midleton, I think, gave it its first start, and it has gone on steadily since that time. Nothing could be more disastrous to the Army or Navy or Air Service than that the training of its doctors should be separated from the great and increasing stream of knowledge, and the great and increasing recognition of new duties and new spheres of work which belongs to the medical profession, and I hope to see a time when the Army, Navy, and Air Medical Service will all be looked on rather as groups which have taken place within a common atmosphere than as independent organisms with nothing to do with each other. How that is to be worked out this is not the moment to speculate, but the views which I hold on this subject are shared by most prominent men connected with those Services, and it may well be one of the interests of the new Minister to keep watch upon the wider views which are growing up about the medical profession and its tremendous sphere of activity in this country, and to see that the sporadic growths cease as far as possible to be sporadic.

There is one criticism which I wish to make in conclusion, and it is this. When this Bill left Grand Committee in the House of Commons it left it with a proviso to the effect that in the appointment of the staffs for the purpose of carrying out the work of the Ministry of Health there should be no discrimination merely on the ground of sex. Nobody wants to say that you are to appoint women merely because they are women. I am as much against that as anybody can be. I am also very much against the principle that a discrimination is to be made on the ground of sex of a general character. It may be quite right to appoint to some position a man because he is more fit, but do not merely, when a women might serve just as well as a man, discriminate against her merely on the ground of her sex. I bring that forward because at the very commencement words laying down the principle that there should be no discrimination on the ground of sex alone was in the Bill when it left Grand Committee in the other House and was struck out on Report. And on whose motion? Not on the motion of the Minister of Health, whom the noble Viscount represents here, but upon the motion of the Secretary to the Treasury.

The Treasury has always had the most conservative notions about women coming into the Civil Service. Two or three Committees have reported in favour of the principle, but the Treasury, I think, clings to the hope that the Committee over which Lord Gladstone is presiding will say something which will justify it in its attitude of obstruction to the principle which was certainly recognised at the last Election and which is now a settled part of our Constitution, that although you may say as regards a particular appointment that women are not so suitable for it as men, yet as regards other appointments men are not so suitable as women. When it is an appointment for which either sex is eligible, discrimination on the ground of sex should not be made. That is the principle which the Treasury will not accept. I shall certainly move in Committee on this Bill the same Amendment as had been carried in Grand Committee in the other House, and I trust that the Government will not allow themselves to be swayed at the dictation of the Treasury, but will treat the matter on the broader ground on which it was treated by the Minister of Health himself, and which led to the words being in the Bill until a retrograde step was taken at a later stage. I have already occupied your Lordships longer than I intended, but the matter is one of profound interest. This Bill opens up new prospects, gives us new ideas, gives us new chances; and, for my part, I warmly hope that it may have all the success which its most enthusiastic advocates have hoped for.


My Lords, I had prepared a long speech on this Bill which I will save you from, as so much has already been said. But I want to take this opportunity, which is the last one we shall have, of stating one or two things which we shall expect from the Minister of Health, and which I may not have another opportunity of saying. Many of us have had very high hopes from what this Bill would bring forth. We have felt that any money spent on the health of this nation is the very best money that the country could spend, looking at it only as a speculation. And, as by fir the most important organisation in England to-day affecting the health of the nation is the Medical Research Department, I am rather alarmed to see that that Department is taken out of the duties of the Minister of Health and handed to the Privy Council.

The Minister of Health takes over all the duties of the National Health Insurance Commission as regards the health of the nation, and the Medical Research Department was one branch of National Health insurance, and got all its money and its income from the National Health Insurance Commissioners. So you realise that, when this is handed over to the Privy Council, you are taking away from the Medical Research Department the whole of their income. That I do not mind, but I think it is an extremely good thing, as Lord Haldane has pointed out, that the Medical Research Department should not be under the Minister of Health.

I hope, however, that we shall have some assurance from the Government that this Medical Research Department is not going to be stopped. At the present moment the miserly grant that they get is only £50,000 a year, and that to-day is probably worth about £30,000 to £40,000. Why, they save the whole amount that they receive in one Command—the Eastern Command—on one disease, in one year. They save £50,000 in treating what is called D.A.H. (which is an affection of the heart) in one year, in one Command of the Army. The country was paying at one time £1,000 a week to poor girls poisoned by T.N.T. This Medical Research Department saved that by investigating and finding out the cause, and stopping it. Therefore, I do hope and pray that when this Department is turned over to the Privy Council it will be treated adequately and properly.

Perhaps when we first read this Bill we were a little disappointed. Our hopes had been raised very high, and when we came to see that, after all, it was only a Bill transferring the duties of the Local Government Board to another Department, which had the power of playing battledore and shuttlecock with any duties which it did not like and turning them over to somebody else, we were perhaps inclined to be a little disappointed. But I do not think that the noble Lord who spoke as representing the Local Government Board in the past need be so very unhappy, because he is not lost; he has only, as the tombstones say, "gone before." The work that the Local Government Board has done has set a good example to the Minister of Health, and will be followed and improved.

But, though we might have been disappointed at first, I think there is no other solution to the question. It is impossible to dig out from the Local Government Board only the health powers, and to leave the others untouched, and this solution is really the best one—to hand over all the powers to the Minister of Health, and give him power to delegate some of them, if he finds it necessary to do so. But we shall not be content unless the Minister of Health—and very soon—brings forward some better Bill than this. This is only an enabling Bill.


Hear, hear.


He is given very great powers under it, but the country will expect very soon that the Minister of Health should bring forward a Bill taking more powers upon himself. He has got these powers, and we shall not be content that he should simply carry on a glorified Local Government Board. We want something better, and he has powers to do it, and I think we have a right to expect it.

But there is one very important power which has been added to the Minister of Health, and that is when he takes over the duties of the National Health Insurance Commissioners—the health part of it. He takes over the whole of the curing of the insured part of the nation. That is the largest curative branch that has ever been put under one Department. Twenty thousand doctors are now placed under the Minister of Health, and we shall be very disappointed indeed if the Minister of Health continues the very low standard of healing that is obtained by the country from panel doctors—and I want to say that with all the emphasis at my command. The term "panel doctor" to-day is ridiculed by the country. It is not the fault of the doctors; it is because the power given to them is so very limited. All that a man gets, if he goes to a panel doctor, is just what a general practitioner can give him, and nothing more. Whenever any one needs an operation, whenever any one has a serious illness, whenever any one needs the help of a specialist, is it right that the whole of the nation should depend upon charity for that? They are dependent to-day on the voluntary hospitals alone; that is the only place they can get that. The voluntary hospitals have done their best under very difficult conditions, but naturally they have totally failed to meet the wants of the nation. That is a thing that we shall expect from the Minister of Health—to improve the medical attention that the country is getting and paying for.

What is wanted is a very careful survey of the country, area by area, setting out what facilities the people have for getting the help they want and how they can get it, and the prevalence of illness in those districts. That must be done, and must be done at once. All your Lordships who live in the country know as well as I do, and a great deal better, the enormous difficulty of getting surgical and medical help for a man who is seriously ill. It is a real difficulty; he might almost be in a foreign country, it is so difficult to get it for him. That must be remedied. I want to say so from my place here in order that the Minister of Health may know that there are a good number of people really feeling that very much.

It is very necessary, of course, that we should improve the preventive side of medicine as well as the curative side. All that the panel doctor is now concerned with is treating the number of people in his district; and the more he treats the more he gets paid. I do not complain of that. But there is not sufficient attention being paid to the normal person, to the early stages of disease. There is nothing of this sort done in the country, and that is another thing to which the Minister must turn his attention. There is no real Intelligence Department. We have heard from the noble Lord who represented the Local Government Board the extraordinary improvement in the health of the nation; but we have also heard recently from the Medical Boards in this country that, when the greatest possible pressure was put upon them to get every one they could into the Army, only three out of every nine men were fit to serve, and we know that those three have been sent to the Front and a very heavy toll taken of them. Therefore I do not feel inclined to be comforted by the statistics given as to the improvement in the health of the nation. We know that of every 10,000 children born five years ago only 8,000 are alive to-day. The amount of infant mortality in this country which is preventible is something like 1,000 per week. All those matters we cannot allow to drift any more if we care for our country, and they must at last be attended to by a man who is appointed to focus his attention upon the health of the nation. We need not be dismayed in connection with this Bill by the prophets of evil. There will always be prophets of evil in regard to every change. If their prophecies come right it is our business to remedy the evils; if they do not come right, what is the good of wasting time listening to them? I want this Bill to pass unanimously, and I want it to go out to the Minister of Health that this great House of Parliament is behind bins in every earnest endeavour to do anything to add to the happiness and the health of our people, and towards the better efficiency of our workers.


My Lords, as I had the honour of proposing a Resolution in this House not very long ago, which your Lordships were good enough to adopt unanimously, confirming the principle of a Ministry of Health, perhaps I might be allowed to speak for five minutes only in order to support the spirit of everything which has fallen from the noble Viscount who has just sat down.

I sincerely hope that the new Minister of Health will be considered by Parliament and by the nation as one of the first Ministers of the Crown, and that he will have a responsible representative in the House of Lords—such as the noble Viscount who introduced this Bill—in order that we may be able to ask Questions and to get authoritative answers to them instead of having Questions about health referred from one Department to another. I suggest to the new Ministry that, unless the whole spirit, of what they are going to do is accompanied by a desire to combat ignorance and to increase knowledge in this country, they will fail in the task which it is expected they will accomplish. We have heard this afternoon some exceedingly able speeches with regard to the machinery of the new Bill, and as a member of the general public, regard this Bill as only of a preliminary nature simply enabling the Minister to gather into his own hands certain powers which exist already But this Minister in the future will have to reckon with, and should be proud of the knowledge that he will be supported by, an increasing, instructed, energetic, patriotic, totally disinterested. public opinion in this country—such as the members of the Birth Rate Commission and kindred bodies who are largely responsible for creating this Ministry. He will have to reckon with that opinion, and with the determination that the powers of the Minister of Health will not be allowed to remain on the level of those of a glorified sanitary inspector, or something of that kind. We shall expect the Minister to Acquire and to dispense knowledge; and there are those outside Parliament who will see that he is kept up to the mark in that respect. I am not saying this by way of a threat. I only wish the now Minister (in the words of the noble Viscount who has just sat down) to know that in any progressive step he takes and in any new powers for which he asks from Parliament he will receive the support of all enlightened public opinion in this country.

There are many instances which one could easily give with regard to the desirability of acquiring more information as to the state of the nation. I speak under correction, but I believe that the Registrar-General of Births and Deaths has no official cognisance of an exceedingly important public matter—namely, the number of still births in this country. I believe I am also right in saying that Sir Bernard Mallet is working under the old Statute of 1836; and I hope that one of the first projects which the new Minister will take in hand will be to collect and to publish for the information of Parliament and the nation an anthropometric survey with regard to the physical condition of the nation, so that we may at least know what is the matter and what it is that we want to tackle. It is sincerely to be hoped that there will be a permanent policy of this kind.

I am not going to deal at any great length with the question of research as that has been thoroughly gone into this afternoon. Provided that the Government are determined upon a policy with regard to research—that is to say, placing it in those hands which will give to research the greatest possible scope, I shall be content; but, perhaps, when the Bill comes up for consideration in Committee we may further consider this matter. I think it is a truism that we do not want in the future only to acquire knowledge. We want to dispense knowledge. Dispensing knowledge does not mean giving people cream and cod-liver oil for nothing, and applying ourselves to symptoms. It means that we shall look to the Minister of Health to educate the public with regard to the prevention of disease and to place within the reach of everyone the knowledge how to live a decent and healthy life. The noble and learned Viscount, Lord Haldane, if I rightly understood him, said that he thought it should not be the function of the new Ministry to educate the doctors; that this was more appropriate to the Universities and kindred institutions of that kind.


The great medical schools.


I understand that; but it is not too much to expect that in the near future the Ministry of Health should be looked to by the nation in this matter, and it is to be hoped that it will occupy a very great position in this country and be the body to which Parliament and the country can appeal with regard to the instruction of the whole nation, whether practitioners or Members of Parliament or the general public. Therefore it is surely appropriate that the new Ministry of Health should at least be responsible for such machinery that all the latest knowledge should be open and available to all practitioners whether doctors or masseurs, or whatever they may begin this country.

Now we come to the education of a body which I suppose is still of some importance in this country, and that is the education of Parliament, with regard to matters of public health; and I say that in the absence of a Minister of Health it is positively lamentable that at this time of day a Bill like the Dogs Protection Bill, flying in the face of the whole scientific knowledge of this country, should be allowed to pass through the House of Commons and let loose the floodgate of criticism upon a subject which is res judicata. That has happened because we have no one in the position of a Minister of Health to stand up and speak the truth from the place of authority. I hope that the Bill will come to the House of Lords in order that we may have the satisfaction of throwing it out. Then I say this, with the deepest respect to those responsible for advising His Majesty as to honours in this country, that we have had honours list after honours list published in this country, and with the exception of one or two noble Lords whom I will not mention, except to bring forward the names of Lord Lister and Lord Kelvin, we have, and I stand corrected if I am saying that which is not true, no representative of medical science in this House at the present moment. We have by a fortunate accident, and as an instance of the hereditary principle, the advantage of the great knowledge and experience of Lord Knutsford, but we have not seen the medical profession ennobled and given a seat in your Lordships' House; and I say, with the deepest respect to those responsible for advising His Majesty, that I hope we shall have some members of the various branches of science given a seat in the House of Lords.

If it is important to educate doctors and Parliament it is exceedingly important, and indeed much more important, to educate the general public, and it is sincerely to be trusted that the new Minister will leave no stone unturned to educate the general public with regard to the laws of health. When I say this I do not mean by Blue Books or by carefully prepared answers by Secretaries of State to undefined questions in the other House of Parliament, but I hope that be will unhesitatingly publish the truth with regard to the prevention of disease, no matter how unpopular it may appear to be. It is far too important a subject to become the plaything of public favour and public prejudice, and if the Minister of Health fearlessly publishes the truth he will create public opinion upon which alone can rest his authority. Something appeared recently in The Times over the signatures of the greatest medical authorities of the country, with regard to the treatment of venereal disease, but you cannot at this time of day bring the British public to submit to what savours of bureaucracy unless you have the justification of having first given them the necessary knowledge. If you have published the knowledge, then you will have behind you the support of public opinion in taking steps to give that knowledge popular effect. I say without hesitation that the more progressive the Minister of Health becomes the more he will create a public opinion which will exalt knowledge and apply it, and he will occupy in this country the primary function of Government, which is to preserve the health of the people.


My Lords, I have listened to the eloquent speech addressed to your Lordships by the noble Viscount, Lord Knutsford, upon a subject about which he is eminently fitted to instruct us, and I am sure that the spirit in which he asked us to approach this Bill will inspire our consideration of it at all its stages. I hope, however, that in supporting, as I am sure we shall most heartily, the principle of the Bill, we shall not be deterred on the Committee stage from applying such criticism to its several provisions as may be helpful in making it a measure of really practical utility.

We who have to apply in the counties the provisions of various Acts dealing with health will, I am sure, welcome a measure such as this which will unify at the centre all the various authorities that have to do with health matters, but I venture to hope that if unification is to take place at the centre something in the nature of greater unification will take place among the various administrative bodies throughout the country and their several officials. I look with some alarm at subsection (4) of Clause 6 of this Bill, which seems to contemplate the retention of all the officials of all the various departments which are sought to be unified by this Bill. I should have thought that, as in the case of amalgamated businesses, a large number of officials might be dispensed with—those who would be regarded in business circles as representing overhead charges or standing expenses.

As regards Clause 4, which deals with Consultative Councils, I am bound to say that I see two possible objections to this Cause if it is passed in its present form and if discretion is left to the Minister for the time being to apply these provisions as he himself thinks fit. I cannot help feeling that these Consultative Councils will form an undesirable buffer between the Ministry of Health in London and the various local authorities which have to carry out the provisions of health measures in the country. At any rate, I think it is a matter which will require to be watched very carefully. If the administration of health is in fact to be efficient there must be no sort of friction engendered between local authorities on the one hand and the Ministry of Health on the other.

There is another objection which I see to this clause, and it is that I am afraid it may tend to divest the Minister of Health of full Ministerial responsibility. During the war we have been conversant with the existence at the various Departments of Committees or Councils of this character. I always listen with some regret to the pronouncement of a Minister who appears in any sense to shelter himself behind the advice given by bodies of this sort. I myself sit as vice-chairman of a body of this character. the Central Agricultural Advisory Council, and I am bound to say that I have often heard a policy defended on the Ministerial Bench as having been approved by the Council to which I refer, when, in fact, there has been—if only our proceedings were published—considerable hostility shown or at any rate considerable criticism directed against the proposed Government policy, although in the long run it has not been thought desirable to carry to an extreme such opposition.

I venture to hope that these Consultative Councils will in no sense deprive the Minister of such responsibility as is rightfully and properly his. I do not quite understand from this Bill as drafted whether the Minister is a person who necessarily would be in one of the two Houses of Parliament. I hope that he will be, but there is no provision which seems to render this necessary. On the other hand, there is a provision which rather suggests the multiplication of Parliamentary representatives, to the effect that no less than two Secretaries of the new Department shall have seats in another place. As I read the Bill it is at any rate open to the Government' of the day to place two Secretaries of this Department in the House of Commons, even though the Minister of Health at the time may be in the same House. If I may venture to say so, I think that is quite an undue multiplication of subordinate Ministers.

I, for my part, welcome very much the proposal to leave research out of the sphere of work of this new Department and for this, if for no other, reason—that there are many Departments which are carrying on in watertight compartments work that ought to be aggregated or ought to be judged by some independent authority in its several relations. For instance, there is a good deal of work being done by the Board of Agriculture in the sphere of veterinary science, comparative physiology and therapeutics which, in other countries, is far more closely associated with research work for the benefit of human beings than is found to be the case in this country. All that, to my mind, ought to be dealt with comprehensively in some absolutely detached Research Department, which is not necessarily confined to inquiry into questions affecting human health.

The noble Viscount who moved the Second Reading of this Bill referred to certain Consultative Councils which had already been decided upon. I hope that one of them will be an Agricultural Council, for there are many matters, notably those connected with the purity of milk, upon which the practical advice that agriculturists would be able to give might result in preventing the Ministry of Health from attempting, on the advice conceivably of, shall I say, theoretical faddists, what might prove a positive damage to the public health rather than its improvement. I have in my mind particularly a crusade now being conducted, with which the Local Government Board appears to have some sympathy, against what is called "Dirt in milk" on the one hand and "Disease in milk" on the other.

I should like to remind your Lordships that if either of these problems is tackled on the lines which the enthusiasts would advocate, they will have, somehow or other, to demolish something like 50 per cent. of the cow-sheds in this country and slaughter at least 50 per cent. of the milch cattle, no less than half of which are known to react to the tuberculin test. There is a danger of this Department being ruled by faddists unless great caution is observed in the constitution of these Consultative Councils. I do not want to take up the further time of your Lordships in comments upon this Bill, but, in giving a hearty support to the principle of the Bill, I trust that the Government will not object to our moving in Committee Amendments which some of us may feel to be of a helpful character and calculated to render the actual work of the Bill more easy than some of us think it would prove with the Bill in its present shape.


My Lords, I should like to refer to Clause 2 for one moment. The noble Viscount, Lord Sandhurst, stated that it was not intended to interfere with local authorities. I think it would be a disaster if there was any interference with the policy of administration and treatment at hospitals. As I am associated with one, I know that it would be impossible to carry on the administration if one were going to be perpetually interfered with as regards treatment, and so forth. I do not imagine for a moment that it is the intention of the Bill or of the Government that there should be such interference, but I wish to have some assurance on the matter, more particularly after what fell from the noble Lord, Lord Downham. I began to feel more nervous than I already was as to whether there would be a construction of the wide powers which would affect us in this way. If you read the clause it is very difficult to get away from the fact that at any rate the powers of the Ministry are undoubtedly very wide. Although it may be possible to move Amendments which, accepted by the House, may clear up the whole matter, I certainly think the Bill in that respect does want to be made clearer, so that we should know not only what the Ministry can do but what the Ministry is going to do. If the Ministry took such powers it may be pointed out that they did not intend to use them. I am afraid such an argument as that from the chairman of a company to the shareholders would hardly hold good. He would say, "We have taken powers to do this and to do that, but the shareholders need not be alarmed as we have no inten tion of doing this or that." The clause is so wide as to be misunderstood by a large section of the public, and they do not understand what is intended to be done. I have no doubt this may be remedied in Committee, but I would like to know from the noble Viscount in charge of the Bill whether he can give an assurance that, although the new Ministry may act as an advisory body to hospitals, they have no intention of dictating the policy, administration, or treatment which will be given at such institutions.


My Lords, I should like to make a few brief remarks on the most important and necessary Bill now before us. I was a little startled by the words of the noble Viscount in introducing this measure when he said that it was not intended in any way to interfere or supersede any local authority. I am not quite sure what is meant by that. My fear is not that of the noble Lord who has just spoken, but is of quite a different character. Surely the Minister of Health, if he is to be entrusted with these large powers, must in some cases interfere with and supersede local authorities, and unless he has power to do so, and is prepared to do so, I am afraid his efforts will in many cases prove vain. We recognise that many local authorities are cluing magnificent work and can be well trusted to discharge all their functions, but there are other local authorities who are not doing so and who need to be interfered with occasionally. I think that the Minister of Health will find it necessary in some cases to intervene and see that the local authorities do carry out the duties that now belong to them. I suppose that if the Minister of Health carries out his duties under Clause 2 he will find it necessary to enter into questions concerning the provision of sanitation in many localities. It is well known that in certain cases the sanitary provisions are not carried out owing to the inefficiency, the indifference, or hostility, of members of the local authority. Surely there must be some power to see that these provisions are carried out.

There is another case. The noble Viscount told us that a Bill dealing with housing is about to be introduced. I do not know exactly how far the Ministry of Health Bill is going to deal with housing. If there is one thing more than another which affects the health of the country it is the question of housing. I suppose that the Minister of Health will be able to intervene in cases concerning the sanitary condition of houses that new exist, and also as to the exact position and soil on which new houses are being built. There are many cases I know of where houses have been built on what are absolutely insanitary positions leading to a great deal of disease and a great deal of what is undesirable in every way.

I wish briefly to refer to one other point. It is in Clause 5, which deals with Wales. I do not want to suggest, anything that would weaken the powers of the Minister of Health or to suggest that anything should be done which would lead to the appointment of a local Secretary in Wales, but I cannot help thinking that the clause can be slightly amended in a way which would encourage and develop local interest in the subject of national health and call out the local powers and interests in a way which would be highly desirable. I have no doubt that when the House is in Committee a few slight Amendments may be made which would help to strengthen the Bill and make it more valuable than it is.


My Lords, with the object of this measure it is plain that the whole of your Lordships are in complete agreement. I think many share the view, which I hold myself, that the only real objection to the Bill is that it does not go far enough. The object of the Bill is to disseminate knowledge, to enforce obedience to the laws of health which, after many thousands of years occupation of this planet, the human race is only just beginning dimly to understand. I should like to have seen some better provision made in the Bill to enable our knowledge of these laws to be extended. If all that the Bill is to do is to administer knowledge, as we now possess it, the authorities may tend to become stereotyped, and we may find ourselves with this great Ministry doing what so often happens in other Government Departments, relying on the old principles and the old practices and resisting any attempt to introduce the new. That is what I feel about the main purpose of the Bill.

I should like, if the noble Viscount would permit me, to add one thing further about the character of the work that is going to be done. One of the most important dirties, to my mind, that the Ministry of Health can undertake in connection with this Bill will be the control of advertisements relating to patent medicines and foods. Unless it is done through this Ministry it will never be done at all; and the reason is this. The value of the advertisements of these patented articles is so vast that there is no journal, which dare expose the mischievous character of these preparations for fear of finding its profit and loss account coining out on the wrong side. The only opportunity of combating this mischief is by such a Ministry as this, and I should be glad to see powers of that kind expressly given in order that it may be known that it is the desire they should be exercised. It should be borne in mind that some of these patent medicines are deliberately deleterious.

For example, the feeding of children by patent foods for children is, in the case of many children, a positive damage to their health, and the best that can be said about most of them is that they are innocuous or doubtful, and that there are very few about which it can be unhesitatingly affirmed that their consumption by people, except under medical advice, can do anything but mischief. I do think this is a matter of very great consequence indeed; and I hope, if the noble Viscount is not satisfied that this Bill does in fact confer the necessary authority upon the Minister, he will take steps so as to secure that it does.

Finally I want to say this—it relates to a matter to which the noble Viscount referred in introducing the measure—that anxious as I am to see this measure pass into law, I still think it would have been well had the Government been able to adopt a suggestion that I made some time back and see what was the total limit of all the expenditure to which they were committed, and what were the means they should adopt to provide the revenue for the payment of these expenses. This Bill of itself might very well pass without that criticism, but the noble Viscount told us that it is nothing but the forerunner of a series of Bills which are going to place grave and heavy charges upon the Exchequer; and even after reading what took place in the other House last night I find myself utterly unable to understand how the Government propose in the future to meet the expenses that these Bills will entail. I think that before the Ministry is established there ought to be proper pro vision made for their housing, and that we ought not either to have to commandeer an hotel or put the staff into an hotel which has been first commandeered and then evacuated, or to erect for them new buildings in some suburb, as we saw from a statement in the newspapers the other day was being done with regard to some of these dispossessed Departments. The passage of this measure ought to be used as a means of accelerating the clearing out of the existing bodies. I do not know if the Local Government Board can be induced to give up its offices, or the Home Office to do so, but some place should be put at the disposal of this Ministry before this Bill is made operative in order to avoid what is to my mind a very grave public danger, the illimitable multiplication of Government Departments and Government buildings with all their staffs, and the difficulty that increases every day of enabling this country to get free from the burden of bureaucracy, to which I do not think they will ever tamely submit.


My Lords, I do not wish to detain the House for more than a moment, but I ask to be allowed to say one word upon Clause 5, which has already been referred to by the right rev. Prelate. Clause 5 is the provision relating to Wales. I believe it is a provision that will cause profound dissatisfaction to a large section of Welsh public opinion. It is to be presumed that this clause has met with the approval of those who represent Wales in another place. If so, I can only say that it is a matter of very great surprise that that should be the case. Your Lordships will notice that this clause lays it down that the Minister shall appoint such officers as he may think fit to constitute a Board of Health in Wales, through whom he may exercise, in such a manner as he may think fit, any of his powers and duties, and further that the Board and any officer who is a member thereof shall act under the direction and comply with the instructions of the Minister. It seems to me that a Board constituted in that manner will be the creature if not the slave of the Minister, and will possess no powers of initiative and no powers of control, and will have a very slight chance of voicing the opinions of the people of Wales on so grave and important a subject as this. I think it is a matter for regret that Wales has not received in this Bill more generous treatment than is the case.


My Lords, I wish to be allowed to say a few words by way of a very short comment on two or three things which have been said. In the first place, I think I may fairly say that I cannot possibly be dissatisfied with the reception that the Bill has received at the hands of your Lordships. We have listened to an exceedingly interesting and also, I think I may say, a very informing debate on a variety of subjects that are raised by the Bill.

With regard to the speech made by my noble and learned friend Lord Buckmaster, I understand that there will be no need whatever for securing large and palatial premises, because the staff will be housed where the Local Government Board is; indeed, a great many are already there. I wish to impress upon your Lordships that this is a Bill for the purpose of setting up a central authority so as to enable it to do a great many of the things by way of administration which have been referred to by various speakers. The right rev. Prelate mentioned something about local authorities being interfered with. As I endeavoured to make clear, there is a great variety of these various local authorities, and they overlap and constitute a vast network of administration, and it will be the endeavour hereafter to disentangle them in the hope of making them still more useful to the public than they may be at present.

My noble friend Lord Downham, whose criticisms I naturally listened to with great respect having regard to his experience in these matters, wished for definite information of a detailed character about the Consultative Councils. My noble friend must have overlooked the Memorandum on the Ministry of Health Bill which was a Command Paper and was circulated. I do not know whether my noble friend has had an opportunity of seeing it. I think in some respects it will give him a good deal of the information he asked for.


I did not know that applied to the four or more Consultative Councils that are now to be set up. I did not even know that had been discussed in another place.


I think the noble Lord will find in the Appendix a good deal of the information he asked me for. Lord Haldane suggested that he would move an Amendment in regard to the sex discrimination question, and I would prefer not to pronounce upon that until I see my noble friend's Amendment in print. My noble friend at the Table (Viscount Knutsford) said a good deal regarding the hospital question and the need that exists at the present time for hospitals in London and elsewhere. The noble Lord behind me was very anxious that hospitals should not be interfered with by this Bill. As a matter of fact, this Bill does not touch hospitals. This Bill sets up a central authority without which we cannot do the things that are required, and which can only be done by improved organisation. I myself know well the lamentable waiting lists that exist at the various hospitals, and if in time we find that there must be more hospital accommodation, more mast be provided; but that, again, belongs to a more advanced stage, to what I may call the second phase. It we get the central body established we can then proceed to reorganise the health of the country as we desire.

I think it was my noble friend Lord Willoughby de Broke who was rather afraid that the Minister of Health might take unnecessary time in perfecting his arrangements. I can assure the noble Lord that the present Minister, the President of the Local Government Board, needs no spurring whatever; indeed, he was extremely anxious that I should have got through this Bill hutch sooner so that he could proceed with the work. Owing to other legislative business and the holidays, however, it was impossible to proceed earlier. I do not think noble Lords need be under any apprehension in that regard. One or two noble Lords have suggested lines upon which they may move Amendments, and I can assure them in no conventional terms that any Amendments which they table will receive the full and respectful consideration of the Department. I beg to thank your Lordships for the cordial welcome you have given to this Bill.

On Question, Bill read 2a, and committed to a Committee of the Whole House.