HL Deb 08 June 1926 vol 64 cc270-89

Order of the Day for the House to be put into Committee read.

Moved, That the House do now resolve itself into Committee.—(The Marquess of Salisbury.)

On Question, Motion agreed to.

House in Committee accordingly:

[The EARL OF DONOUGHMORE in the Chair.]

Clause 1:

Amendment of s. 1(2) of Midwives Act, 1902.

1. The following subsection shall be substituted for subsection (2) of section one of the Midwives Act, 1902 (which relates to certification of midwives):— (2) If any person, being either a male person, or a woman not certified under this Act, attends a woman in childbirth otherwise than under the direction and personal supervision of a duly qualified medical practitioner, that person shall, unless he or she satisfies the court that the attention was given in a case of sudden or urgent necessity, be liable on summary conviction to a fine not exceeding ten pounds.

LORD STANMORE moved to add the following proviso to the clause:— Provided that the provisions of this subsection shall not apply in the case of a person who, while undergoing training with a view to becoming a duly qualified medical practitioner or a certified midwife, attends a woman in childbirth as part of a course of practical instruction in midwifery. The noble Lord said: The object of my Amendment is to safeguard the midwifery training of medical students and of pupil midwives. Under Clause 1 of the Bill as it now stands no medical student can attend a woman in childbirth except under the personal supervision of a qualified medical practitioner. It is possible that in the future the Courts might hold that the words "personal supervision" implied the actual presence of the qualified medical officer. If that were to be the case the present system of midwifery training would become unworkable. Under resolutions of the General Medical Council it is laid down that the medical student must spend three months out of his five years' curriculum in learning obstetrics and gynecology.

The usual arrangement with regard to these three months is that they begin in the fifth year of the student's time. For the first month he is required to attend lectures on the subject and also to receive instruction in practical work. During the second month the student resides in the hospital, so that he may be able to attend cases in the maternity ward at any hour of the day or night. During this time he has to deliver at least five women in the presence of a physician of the hospital to the satisfaction of his teacher. If that condition is complied with he is then, during his third and last month, allowed to attend eases outside the hospital in the adjoining district. In any case of difficulty he at once sends to the hospital for the attendance of a qualified medical officer. It is very unusual that in a case of this kind the delay of an hour or so has any bad effect upon the patient, especially as the student, having done four years of medical training, is in a position to give general treatment while awaiting the arrival of his colleague. I do not think that any authority on obstetrics would consider it necessary that a student should be accompanied by a medical man in all the cases that he has to attend. On the contrary, the student cannot learn his work properly without having responsibility during the period of training.

The case of the pupil midwives is very similar to that of the medical students. An untrained woman has to go through a course of training for twelve months, while a trained nurse has a course of six months. The training is carried out under the superintendence of experienced midwives, who are recognised by the Central Midwives Board, and the training consists in lectures and also in deliveries in hospitals and outside. It is not only undesirable that they should be subject to the personal supervision of medical men in all these cases, but, if this supervision is insisted upon, it will have the effect of greatly reducing the number of midwives owing to lack of medical teachers. Therefore I hope the noble Marquees will see his way to accept my Amendment.

Amendment moved—

Page 1, line 19, at end insert:— ("Provided that the provisions of this subsection shall not apply in the case of a person who, while undergoing training with a view to becoming a duly qualified medical practitioner or a certified midwife, attends a woman in childbirth as part of a course of practical instruction in midwifery.")—(Lord Stanmore.)

VISCOUNT KNUTSFORD

The noble Lord has been kind enough to consult me about this Amendment. The other day all the medical schools in London met and proposed an Amendment to this Bill which is very much the same as that which the noble Lord has just foreshadowed, and I am quite sure that your Lordships may accept this Amendment with perfect certainty that the women who are being attended are given proper attention and that the students, whether men or women, will be properly taught. There is one alteration which I hope the noble Lord will accept. His Amendment reads thus:— Provided that the provisions of this subsection shall not apply in the case of a person who, while undergoing training with a view to becoming a duly qualified medical practitioner.… The word "training" should, I think, be made stronger. If the noble Marquess will accept the alteration the words should read: "training recognised by the General Medical Council or the Central Midwives Board"—because "training" might mean anything. What we want to be quite sure is that nobody is allowed to attend a woman in confinement unless he is going through a proper and recognised training. If that alteration could be made I am sure we might accept this Amendment.

THE LORD PRIVY SEAL (THE MARQUESS OF SALISBURY)

It is quite true that since this Bill was read a second time there have been very strong representations made to the Ministry of Health and to the Government about this particular matter. It has been pointed out that if the clause passed in its present form it would involve a very considerable difficulty in the training both of medical students and of pupil midwives and would really constitute a great disadvantage to the public interest. On the other hand, we on our side have to consider the safety of the women who are concerned, and we could not agree to any Amendment which did not in its terms adequately protect these women. We are, as it were, between two extremes. We must not interfere, if we can help it, with the practice of the hospitals, and, indeed, it would be against the interests of the women themselves if we did; and, on the other hand, we must protect the women from unskilful attendance. My noble friend opposite (Lord Stanmore) has put down an Amendment which is designed to steer that difficult middle course, and I think that on the whole he has succeeded. But I am struck by the words which my noble friend Viscount Knutsford has suggested, which appear to me to be adequate. Perhaps he would let me consider them between now and the Report stage and put them down, if necessary, at that stage.

I may say that the point he raised is, I think, intended to be covered by the words of the noble Lord opposite. I call his attention to the words "with a view to becoming a duly qualified medical practitioner." That means that it is subject to the conditions and limitations of the great profession in whose school he has been educated, and all the limitations of which my noble friend Lord Knutsford spoke are really involved in those words. What is true of the medical students is true of the midwives, because the words are "with a view to becoming.… a certified midwife." Well, she cannot become a certified midwife unless she goes through all the training which is necessary to earn the certificate. Therefore, those words are also, I think, calculated to involve the point of my noble friend Lord Knutsford and to safeguard the necessity of adequate training. But it is necessary to be very careful in these matters. Undoubtedly, Lord Knutsford's words make the matter abundantly clear and, if I possibly can, I shall hope to insert them at the next stage of the Bill.

As regards this Amendment I think it is required. We do not want to interfere with this great school of medical training. After all, that is a matter of national importance and even for the women themselves, the women who are attended, it is a tremendous charity which they are now receiving because they get for nothing this attendance of the medical students and of the pupil midwives and all the care which that involves. I speak in the presence of very learned noble Lords in this matter and therefore I speak with due diffidence, but I understand that no medical student would be allowed to act, according to the practice of this great profession, except towards the end of his training. He is almost a qualified doctor when he is allowed to undertake these cases. And as regards the pupil midwife, as a matter of practice she does not act at all except in the actual presence of the trained midwife. The method is that when the pupil midwife goes to attend one of these cases the trained midwife goes with her in order to show her how to do the work. I think your Lordships may be assured, therefore, that adequate care has been taken in the drafting of this Amendment and on behalf of the Government—subject to what any of your Lordships who know more about the matter than I do may say—we are prepared to accept it.

LORD DAWSON OF PENN

The noble Marquess made a point just now which will be of considerable interest to the public; that is, he raised the question as to whether the public will be adequately protected in the course of medical education. I think it is very important that the public should be reassured that they are protected. They are amply protected, for these masons. To begin with, a medical student, at the time he starts his training, has been through several years of preliminary education; he has been trained in the basic sciences on which medicine is built. That is one difference and that is one advantage which he has over the midwife. Then, before he is sent out into a district to carry on midwifery, he is put through a course of education within the hospital, where he is supervised in the actual conduct of a maternity case. Having got that far, it becomes very important to send him out where he can learn self-reliance and I may say that that illustrates one of the most delicate questions there is in the whole of medical education—that is, to determine the right moment, not only in midwifery but in other things, when a medical student can be put upon his own responsibility with the right sort of advice but not with somebody standing over him.

And when he has had that month's instruction within the hospital it is found by experience that he is able, and he does his work much better if allowed, to go out to people by himself. He does so with the full knowledge that if the case he is going to attend is not normal, or if there is any difficulty at all, he can immediately send for the highest skilled assistance. It is far better in the interests of the public that he should take that first step in self-reliance with the big machinery of a hospital behind him than to postpone that date until he gets into practice, when there is no one behind him. In actual practice it works extremely well. There is always some one in the background. It is a very popular service. The patients themselves are attached to the students, largely because they come in contact with that sort of innate friendliness which seems to be part of the make-up of the British medical student; and the student, on his part, learns how closely the scientific side and the practice of his art lie side by side. Altogether it is an excellent arrangement, not only for the training in medicine but for the training in the management of people. The patients get very fond of the students, and the students themselves generally end their week on duty with larger hearts and certainly emptier pockets.

They get varied experiences. I may say so, because I have been through all this myself. You learn to put your hand to anything that comes to you. Before now I have washed a baby; before now I have baptized a baby—how efficiently I do not know, but I rather fancy I found baptism more easy than I found washing. But, from the point of view of education the public are adequately protected. The men who go there have been suitably trained up to a certain point and there is adequate help behind them. I think the machinery of medical education and the interest of the public would both be damaged if some such Amendment is not passed as is proposed by the noble Lord.

On Question, Amendment agreed to.

Clause 1, as amended, agreed to.

Clause 2:

Amendments of Midwives Act, 1918.

2.—(1) Where a midwife has been suspended from practice in order to prevent the spread of infection she shall, if she was not herself in default, be entitled to recover from the local supervising authority such amount by way of compensation for loss of practice as is reasonable in the circumstances of the case.

In subsection (2) of Section six of the Midwives Act, 1918, the words from "or where" to "infection" shall be repealed.

LORD STRACHIE moved to leave out subsection (1). The noble Lord said: I have put down this Amendment at the request of the executive of the County Councils Association. The noble Marquess in charge of the Bill used to be a member of that executive and therefore he will be inclined to give every consideration to their views. A county council at present has the duty of deciding whether compensation shall be paid to midwives who have been suspended, for whatever reason. As the law stands it simply rests with the county council to make compensation to the midwives and the County Councils Association oppose any change in it because they are not aware that any injustice has been done by the administration of the Act of 1918 by county councils.

It is remarkable that the Parliamentary Secretary to the Ministry of Health should have said in another place that under the old Act one or two authorities, though not many, have not acted properly. I think it would have been more reasonable and fair if the Parliamentary Secretary had taken the trouble to inform the Committee of the specific cases that he had in mind. I can assure the noble Marquess in charge of the Bill that the distrust of local authorities by Whitehall is quite without justification. If we had been told what were the cases to which the Parliamentary Secretary referred we should have known whether or not it was unreasonable to go in for this very strong measure of having centralisation as against the decentralisation that has been in existence. The noble Marquess will agree that in the great majority of cases, in fact, I should say, in all cases, the county councils are to be absolutely trusted in this matter.

County councils are popularly elected bodies and their actions can be discussed and any injustice exposed by those who elect them. I submit that that is a sufficient safeguard, and that this particular subsection is quite unnecessary. Apart from that it is open to the objection that it introduces centralisation. The view of the County Councils Association is that there is a certain danger that this provision will not be so freely used under centralisation as it is under present conditions. It is thought that a medical officer would be rather chary in acting, unless he was very certain, when there is a possibility of very large compensation having to be given. The County Councils Association has suggested that justice should be done to all midwives who are suspended through no default of their own, and I do not think it can be said that county councils have not in the past acted justly in the interests of both patients and midwives. On behalf of the executive of the County Councils Association, I beg to move this Amendment.

Amendment moved— Page 1, line 20, leave out subsection (1).— (Lord Strachie.)

THE MARQUESS OF SALISBURY

This is not a matter essential to the Bill, but I think the subsection, for the reason that I shall submit to your Lordships in a moment, is a valuable subsection. My noble friend Lord Strachie speaks with unrivalled authority of the views of the County Councils Association and, generally speaking, voices the views of local governing bodies, but perhaps he has not given as much weight as he might have done to the great risks that are involved in the practice of midwifery, especially in connection with these matters of infection. He must remember that the vital thing is to keep the patients from any possible contact with infection. Upon that the whole safety of the profession turns and the safety of these unfortunate women. If there is the least temptation on behalf of those concerned to conceal the possible contact with infection then very great risks are run.

I am a great advocate of local government independence, yet I am more concerned, and the Government are more concerned, for the safety of these patients. We are very anxious to go to the full length if we can in order to protect them. My noble friend said with absolute truth that the great body of county councils would act with due regard to the interests of those patients and with proper public spirit in matters of this kind. No doubt my noble friend speaks for the great rural county councils, but there are other county councils involved besides them. But let us assume for the sake of argument that they would all, in practice, respond to this necessity. What we want to do is to reassure the midwives themselves, to make them so certain that they will get compensation that they will not run any risk of carrying infection into the homes of these patients, thereby risking, the lives of the patients. It is for that reason that we want to go the extreme length to which we can go. What is the extreme length to which we can go? It is to make it obligatory that compensation should be given with the one exception of cases in which the midwives themselves are in default. It would not be possible for us to ask your Lordships to compensate those cases and those cases are exempt under the terms of the clause. But to the full extent, within that limit, we are prepared to go. That is the reason why this clause is inserted in the Bill. I hope my noble friend will not persist in the Amendment.

LORD STRACHIE

The noble Marquess having said that be will not accept the Amendment, I must ask leave to withdraw it.

Amendment, by leave, withdrawn.

Clause 2 agreed to.

Clauses 3 to 10 agreed to.

Clause 11:

Interpretation.

11. In this Act unless the context otherwise requires:—

The expression "maternity home" means any premises used or intended to be used for the reception of pregnant women or of women immediately after childbirth, but shall not include—

  1. (a) any hospital or other premises maintained or controlled by a Government Department or local authority, or by any other body of persons constituted by special Act of Parliament or incorporated by Royal Charter; or
  2. (b) any hospital or other premises for the conduct of which a duly qualified medical practitioner resident therein is responsible; or
  3. (c) any hospital or institution not carried on for profit and not used mainly as a maternity home which may be exempted from the provisions of Part II of this Act by the local supervising authority.

The expression "offence against this Part of this Act" includes an offence against any by-laws made under Part II of this Act.

THE LORD ARCHBISHOP OF CANTERBURY moved, in paragraph (b), after "responsible." to insert: and with respect to which there shall have been lodged with the local supervising authority a certificate in a form to be approved by them, and signed by two duly qualified medical practitioners practising or residing in the county, not being in partnership with such first mentioned practitioner or with each other, and not having any financial or other interest in such hospital, to the effect that the premises used or represented as being or intended to be used for such hospital, and the equipment of such premises, are in all respects suitable for the purpose, and that the medical practitioner carrying on or proposing to carry on such hospital as a fit and proper person to carry on the same.

The most rev. Primate said: When the Bill was before your Lordships for Second Reading I called attention to the provision in Clause 11 to which I now venture to move an Amendment. The paragraph as it stands practically says that any man who has attained due qualification for medical work is to be exempted from inspection by authority if he opens a home for the purposes which are here indicated. The purposes are of an exceptionally important and delicate kind, in which it is very possible that unwise, or still more malicious or mischievous, purposes have to be guarded against and we have to be very careful as to the ground on which we stand. I yield to no one in this House in my whole-hearted admiration for the medical profession and its members. There is no profession in the world which stands higher as regards the character of its members and as regards their public spirit and their desire and qualifications in almost all cases to act in the public interest and do what is right both in regard to health and in regard to morality. But even in that great profession there may be, here and there, a man who, while possessing technical qualifications, cannot be regarded as altogether relieved from a possible suspicion of having other motives in what he may be endeavouring to do. It is for the protection of the homes, for the protection of medical men themselves and for the protection of the public, that I venture to say I think there ought to be some qualification as to the complete exemption which we offer to a man who may open a home in this exceedingly delicate and difficult matter entirely on his own responsibility, with no check or control over him, no examination and no need for any registration.

The question then arises: What safeguard would you suggest? What do you think would be the best way of prevent- ing the possible danger to which you refer? In looking for words by which that can be done I turn to the General Purposes Act of the London County Council which has the same matter to deal with and deals with the problem of what are the limitations within which registration ought to be given and what are the conditions which must be satisfied in regard to it. I have taken the actual words from the Act of Parliament which lays down the restrictions in the case of the London County Council, with a view to seeing whether they are not right to be incorporated in this measure, which will now apply to the country as a whole. The form of words is somewhat lengthy and I feel myself not very qualified on technical grounds to amend the words or to say exactly how that could be done. The noble Marquess in charge of the measure on behalf of the Government has suggested another Amendment. He may be able to show that that would be a better safeguard and that ft would answer better than the one I have suggested, but I have thought it right to move my Amendment because I believe that on consideration it will be felt to be a public advantage that there should be some safeguard as regards the character and the qualifications, other than medical, of a man who is taking the sole responsibility for a home dealing with this delicate and difficult question. I therefore move this Amendment as it stands and I shall be perfectly ready to give more than respectful attention to anything that the noble Marquess may say as to other methods by which what I have proposed may be done.

Amendment moved— Page 6, line 31, after ("responsible") insert the said words.—(The Lord Archbishop of Canterbury.)

LORD BANBURY OF SOUTHAM

I hope my noble friend the Leader of the House will accept the Amendment of the most rev. Primate. I think it is absolutely necessary that there should be some safeguard to prevent a person starting a home of this sort merely in order that he may make money out of it. Perhaps a person not properly qualified, or a person who has not been a success as a medical practitioner, may think he can make some money by starting a home of this sort. I am not absolutely certain that all these nursing homes are quite what they should be. I think it very necessary to have some safeguard of this sort and I hope the Amendment will be accepted.

THE MAKQUESS OF SALISBURY

There is no difference of opinion whatever between the Government and the most rev. Primate as to the necessity for some limitation of the clause. If your Lordships will be good enough to cast your minds back you will remember that I ventured to say so at the time of the Second Reading. It is necessary to have some qualification because undoubtedly what my noble friend Lord Banbury has just said is true, that there are a certain number of these maternity homes which are anything but admirable places, which, in fact, are very disreputable, and it is necessary to provide some protection. I do not know that there is a very large number taken altogether, but there are some and some protection there ought to be. The only real question is what form the Amendment should take. The most rev. Primate has put upon the Paper this Amendment, for which he has a good precedent and for which, therefore, there is a good deal to be said, but I venture to think that the method of trying to secure safeguards by a definition and by the certificate of other medical practitioners is not a wholly satisfactory way of meeting the difficulty. The fact is that there are a certain number of black sheep in the medical profession who would be guilty of conducting a maternity home of this kind.

I am sorry to say that it is not the case of only one black sheep. The number may be very small out of the vast number of medical men in this country, but still there are a certain number and it is certainly not impossible for the one black sheep to find two other black sheep and that is really the only protection which the most rev. Primate's Amendment affords us. The practitioner has to get a certificate from two other medical practitioners. It is true that they must not be technically in partnership with the medical practitioner himself, but these things are very easily evaded and there are all sorts of indirect methods, which will occur to your Lordships, by which these things can be carried out. Therefore the Government think that, though the object of the most rev. Primate is admirable, it would be better to achieve it by a safeguard of a totally different kind. Instead of trying to fortify one medical practitioner by two others we think it better to make it a matter of discretion on the part of the county council authority, by giving that authority absolute discretion to say that they will not certify a particular home. In that way, they, having the local knowledge which is necessary, will be able to protect the public and the women concerned. It is for that reason that I have put on the Paper the Amendment which your Lordships will see, to insert after "responsible" the words "which may for the time being be exempted from the provisions of Part II of this Act by the local supervising authority." That is to say that so far as this paragraph is concerned only those will be exempted from the provisions of Part II applying to maternity homes who get exemption from the local supervising authority, leaving it open to the local supervising authority to refuse an exemption where they think fit. That we believe to be the only really efficient safeguard.

It may be suggested by some of your Lordships that the proposed safeguard goes too far, and I shall have a word to say upon that in a moment. At any rate, it is efficient; they have the local knowledge. In a county borough, for instance, the local people will know any maternity homes which are of the character that I have described, and of course they will be refused an exemption by the authority and the protection will be absolute. As I said just now, it may be suggested that the safeguard goes too far and that to leave all such homes, good and bad, in the discretion of the supervisory authority is going too far. The Government agree to that and your Lordships will see that we provide an appeal in order to prevent any possible injustice following upon this method. If your Lordships will take the two Amendments together, the discretion of the supervisory authority, and the appeal to the Ministry of Health, your Lordships will, I hope, agree that we have struck that middle course so necessary to legislation of this kind.

VISCOUNT HALDANE

We are in the happy position of being agreed about the object to be attained and the House is indebted to the most rev. Primate for having, not for the first time, on this occasion brought the matter before it. Having listened to the discussion, I, too, feel the difficulty about proceeding by way of exclusion by a definition. It is not a good way of legislating. On the other hand, I also feel the considerable risk of leaving it to the chances of circumstances whether somebody, wishing to make a little money by opening a maternity home, can or cannot get two medical practitioners to certify. We know these things happen. We have had it before in connection with lunacy in a very prominent fashion. For my part, between the two Amendments, I prefer the one the Government proposes to introduce and on the whole I think we should do best to adopt that.

THE LORD ARCHBISHOP OF CANTERBURY

I have no kind of wish to express an opinion which would differ from the opinion of the noble Marquess who is advised by those who are most competent to judge in this matter. Do I lightly understand that the local authority must first satisfy itself that the person is satisfactory before it exempts him from the requirement of registration?

THE MARQUESS OF SALISBURY

The discretion is absolute. As the most rev. Primate will see, the words are: "which may for the time being be exempted from the provisions of Part II of this Act by the local supervising authority."

THE LORD ARCHBISHOP OF CANTERBURY

Does that not mean that the home is open and the man is not to be registered because the local authority has satisfied itself that it is undesirable that it should be registered? If that is so, you are requiring an investigation beforehand, which may be an exceedingly difficult one to bring about, in order to justify the local authority in declining to subject this very man to the ordinary system of registration. That is all I am afraid of. I am in the hands of those who are more expert than I am and in the presence of those who know much better. I do not want to press my Amendment in face of the Government proposal, but it seems to me you are asking the local authority first to satisfy themselves about the unsuitableness of the individual before they decline to register.

LORD MERRIVALE

My view on reading the clause and the proposed Amend- ment of the Government is that the proposal of the Lord Privy Seal is much more stringent in the restriction of the right to open homes of this kind than that which the most rev. Primate has suggested. The proposal of the most rev. Primate does leave it at the will of two or three medical men to decide whether a home of this kind should be opened or not, but what the Lord Privy Seal has proposed is that every home of this kind should be subject to registration unless the local authority shall see fit to exempt it, and the local authority, having regard to this duty, will not see fit to exempt any adventurer from the operation of the general law until it is satisfied that he ought to be exempt.

VISCOUNT HALDANE

I think that is plainly so. As I read the Amendment the position is, that no maternity home can be opened at all unless it has been exempted by the local authority from the provisions of Part II, which would absolutely forbid the opening of such a place unless it was under the most stringent supervision. If so, that is a simpler plan than the plan of the most rev. Primate.

THE LORD ARCHBISHOP OF CANTERBURY

After what has been said on behalf of the Government and by high legal authorities on both sides of the House I do not wish to press it, but I hope he will not think me wrong if I reopen the matter on Report if between now and the Report stage those who are advising me see some difficulty in regard to it. On that understanding I am perfectly willing to withdraw the Amendment.

THE MARQUESS OF SALISBURY

Of course, I ought to have said that, if the most rev. Primate is not satisfied, and those who advise him see some difficulty, he will most certainly be justified in raising the matter again on Report.

Amendment, by leave, withdrawn.

THE MARQUESS OF SALISBURY

I beg to move, in paragraph (b), after "responsible," to insert "which may for the time being be exempted from the provisions of Part II of this Act by the local supervising authority."

Amendment moved— Page 6, line 31, after ("responsible") insert ("which may for the time being be exempted from the provisions of Part II of this Act by the local supervising authority.")—(The Marquess of Salisbury.)

VISCOUNT KNUTSFORD

I hope your Lordships will notice that if this Bill passes there will be exempted from the Bill entirely

  1. "(a) any hospital or other premises maintained or controlled by a Government Department or local authority, or by any other body of persons constituted by special Act of Parliament or incorporated by Royal Charter; or
  2. "(b) any hospital or other promises for the conduct of which a duly qualified medical practitioner resident therein is responsible."
It would be a very great pity indeed to exempt a hospital opened under a Government Department or a voluntary hospital from the benefits of this Act. They need inspection and to be compelled to make returns rather more than anybody else. All who have studied the Poor Law know the dreadful statistics of the death rate of children born in the Poor Law infirmaries.

Some years ago I went to see the largest Poor Law infirmary in Great Britain. There were 800 ill people in it, 200 of whom were very seriously ill indeed. There was a resident medical officer, who was responsible for the management of this place, and therefore it would be exempted from this measure. What did I find? Apart from these 800 ill people, with the 200 who were very ill, there was a filthy syphilis ward and there was only one medical officer. That medical officer had to do all the post mortems and deliver all the women. She was a girl of twenty-six holding her first appointment. When I exposed this I was called a liar. That I am used to and I do not mind so long as I am speaking the truth. All the city fathers denied that such a state of things existed, but I am glad to say that they had to admit it in the end and the conditions have been altered. That is an instance where; inspection by the local authority would have done infinite good, and the more we who are responsible for voluntary hospitals are inspected the better we shall be pleased. Accordingly I very much hope that the noble Marquess will take out of this Bill the clause exempting from the operation of the Bill hospitals under Government authority and voluntary hospitals where a resident medical practitioner is responsible.

THE MARQUESS OF SALISBURY

My noble friend said something to the same effect upon the Second Heading. I am well aware that he would really desire to get rid of all the exemptions and allow all the hospitals, even the great hospital which he himself conducts or does so much towards conducting, to remain open to the restrictive provisions of this Bill. That is a view which, of course, as coming from him, one is bound to treat with great respect, but, although I hesitate to say so, my impression is that the great body of hospitals do not quite share his view and do not desire to be put under the restrictive provisions, of this Bill. What the Government had to consider, in view of that opinion, was how far they could safely carry the exemption, and the clause has been drawn so that, if your Lordships are good enough to accept these Amendments, it will cover that particular ground. If my noble friend wishes to have further limitations and will put Amendments on the Paper, I will, of course, consider them on the next stage of the Bill, but as at present advised we do not think that we have gone too far in our exemptions. They are confined to institutions under Government control or the control of local authorities, to hospitals established under Royal Charter and to other hospitals and maternity homes which obtain exemption through the county council. We believe that we have not gone too far, and I hope, that your Lordships will accept the Amendment that I have moved.

On Question, Amendment agreed to.

THE MARQUESS OF SALISBURY moved, in paragraph (c), to leave out all words after "may," and to insert "for the time being be exempted as aforesaid." The noble Marquess said: I was going to say that this is a drafting Amendment, but I ought perhaps to point out that it is a little more than that, because the words "for the time being be exempted as aforesaid" import that it will be possible for the local supervisory authority to withdraw the exemption where they see fit. That is important.

Amendment moved— Page 6, line 34, leave out from ("may") to the end of line 36, and insert ("for the time being be exempted as aforesaid").—(The Marquess of Salisbury.)

On Question, Amendment agreed to.

THE MARQUESS OF SALISBURY moved to insert at the end of the clause:— (2) Any person who is aggrieved by the refusal of a local supervising authority to grant exemption from the provisions of Part II of this Act in respect of any hospital, premises or institution, or by the withdrawal of any such exemption previously granted by the authority, may appeal against the refusal or withdrawal to the Minister of Health, and the Minister, after considering the matter, shall give such directions therein as he thinks proper, and the authority shall comply with any directions so given. The noble Marquess said: This Amendment provides the appeal to which I called your Lordships' attention just now. It proposes that any person aggrieved under these limitations shall have the power to go to the Ministry of Health and appeal against the decision of the local supervisory authority. That is provided for the reason that I have already stated, but I may add that considerable representations have been made to the Government on behalf of the hospitals and on behalf of the Salvation Army desiring an appeal in these circumstances. The matter has been considered by the Ministry of Health and we see no reason why this appeal should not be allowed. I hope that your Lordships will accept this Amendment.

Amendment moved— Page 6, line 39, at end insert the said new subsection.—(The Marquess of Salisbury.)

LORD STRACHIE moved to amend the proposed new subsection by inserting, after "matter," the words "and having consulted the authority." The noble Lord said: I hope that the Lord Privy Seal will be inclined to accept this very harmless Amendment. It simply gives to the local authority the right to be consulted. The noble Marquess was good enough to say that the County Councils Association is a body that represents local authorities very adequately. That Association are very anxious that this Amendment should be accepted, as they consider that it is only fair that this right of consultation should be given.

Amendment to the Amendment moved— Line 8, after ("matter") insert ("and having consulted the authority").—(Lord Strachie.)

THE MARQUESS OF SALISBURY

I have such great reliance upon my noble friend's impartiality of mind that I feel sure that he will see that we cannot accept this Amendment. It is not, of course, that we think with any disrespect of county councils, but the Minister, under this proposed clause, sits as a judicial person in cases where it is alleged before him that a particular person has been aggrieved by the decision of the county council. He sits in appeal to decide that point. My noble friend says that he must not come to this conclusion until he has consulted one of the parties in the case. That is as if you were to say that before a Judge decided a case he must consult the defendant. Of course he will hear what the defendant has to say, but it is not necessary to state as much explicitly unless you want to import a bias in favour of one side rather than ensure that the hearing shall be strictly judicial. If the noble Lord were logical he would say, not merely that the authority must be consulted, but that the appellant must be consulted also, and that would evidently be meaningless. I think that the noble Lord will see that to require a judicial person to consult one of the parties to the case would hardly be to legislate in accordance with the traditions of your Lordships' House.

LORD STRACHIE

Since, the noble Marquess puts it that this is a judicial inquiry, I will not press my Amendment.

Amendment to the Amendment, by leave, withdrawn.

On Question, Amendment agreed to.

Clause 11, as amended, agreed to.

Clause 12 agreed to.

Clause 13:

Short title, construction, extent and saving.

13.—(1) This Act may be cited as the Midwives and Maternity Homes Act, 1926, and Part I of this Act shall be construed as one with the Midwives Acts, 1902 and 1918, and those Acts and Part I of this Act may be cited together as the Midwives Acts, 1902 to 1926.

THE MARQUESS OF SALISBURY

I have three drafting Amendments to this clause, without which there would be no definition of the local supervisory authority, for we have to import into the Bill not only Part I of the original Act but Part II of this Bill also, and in this way we introduce in Part II the definition of the local supervisory authority which exists in the principal Act.

Amendments moved—

Page 7, line 10, leave out ("Part I of this Act")

Page 7, line 12, leave out ("Part I of")

Page 7, line 13, after ("Midwives") insert ("and Maternity Homes").—(The Marquess of Salisbury.)

On Question, Amendments agreed to.

Clause 13, as amended, agreed to.