§ Order of the Day for the House to be put into Committee read.
§ Moved, That the House do now resolve itself into Committee.—(Viscount Gage.)
§ On Question, Motion agreed to.
§ House in Committee accordingly:
§ [The EARL OF ONSLOW in the Chair.]
§ Clause 1:
§ Provision of domiciliary service of midwives.
- (a) of the arrangements (if any) proposed to be made between the authority and welfare councils and voluntary organisations; and
- (b) of the number of midwives to be employed by, and the parts of the area of the authority to be served (whether exclusively or jointly) by, the authority, welfare councils and voluntary organisations respectively, or, if no such arrangements as aforesaid are proposed to be made, of the number of midwives to be employed by the authority.
LORD ABERDARE moved, at the end of paragraph (a) of subsection (3), after "organisations" to insert:
which shall include provisions similar to those contained in Section 2 (1) of this Act for giving notice to midwives practising in the parts of the area of the authority to be served by the welfare council or voluntary organisation as the case may be stating the salary and other conditions of service of midwives to be employed by such welfare council or voluntary organisation.
The noble Lord said: I must apologise to the noble Viscount in charge of this Bill for the fact that the Amendments to be moved by myself this afternoon are only in typewritten form. I apologise to your Lordships too, and I only hope that you will believe that it is not my fault. At the very last moment I have been asked to represent the views of the Midwives' Institute and of the Joint Council of Midwifery. As your Lordships know, the Joint Council of Midwifery was set up some short time ago.
§ LORD MOUNT TEMPLE
On a point of order: I have not the slightest idea what this Amendment is. Could the noble Lord possibly read it out again?
§ LORD ABERDARE
I apologise to the noble Lord; I understood that these Amendments, although in typewritten form, had already been circulated to your Lordships. I was explaining that it was the National Birthday Trust which got the Joint Council of Midwifery together in order to investigate the important and national question of maternal mortality. Therefore I take it that they look upon this Amendment from a national point of view. As regards the Midwives' Institute, that is the trade union of midwives, for whom I am 108 also moving the Amendment from the point of view of the midwives, for their betterment and improved conditions. This first Amendment which I move has, in fact, a great bearing on the question of the future salaries to be paid. Obviously, in the interest of the nation generally and of the midwife, a fair rate of salary should be paid. In order to get this fair payment it is suggested that the Minister shall order the authority to publish, not only by way of sending notice to himself but also by publishing to the midwives, and all those connected with midwifery, the scale of salaries which they in their different localities are going to pay, together with the conditions of employment.
We all realise that something is being done to improve and increase the remuneration of the midwives. We all know that in the past, especially in the case of independent midwives, very poor salaries have been paid and poor incomes have been made. In many cases we know that it has not been the fault of the midwives. I am sure the Government will agree with the point of view put forward by the Midwives' Institution, that it is very necessary to attract the busy and experienced midwife away from her present independent practice. In the same way it is very necessary to tempt the young midwife to join as a municipal midwife, and the scale of salary must be such as to tempt her not to take up the post of health visitor. There is every reason why the midwife should be paid more than the health visitor. She has more responsible work, she has irregular hours, and very often has night work. Another point is that there should be an attraction to prevent future possible midwives from taking up other branches of nursing.
I am quite sure the Government will agree with the aim which we have, but it seems that we are not quite agreed on the means of approach. In another place there was a very long discussion on a point slightly different from the one which I am putting before your Lordships to-day. In this case there is no demand for a uniform salary, and there is no demand that the Government shall fix a minimum salary. There is no autocracy in this matter. It can hardly be said that the Government are weakening, or interfering with, local government. It seems to me it would be a thoroughly 109 democratic action to suggest to the local authorities that they should expose their hand and lay their case openly beforehand. I suggest that it is better for the Minister, for his own sake, to know now what is going to be done. Under the Bill there is left to the midwife, if she thinks she is being paid too low a salary, the invidious task of having to approach the Ministry for an improvement of her salary, and it seems to us that if this procedure can be avoided it would be for the better.
I do not know whether I might suggest that in this case the Minister has a duty to both the midwife and the nation—to the midwife to see that she does not get too low a salary, and to the nation to see that a too extravagant salary is not offered. This Amendment might prevent certain things being done of which the Minister might not approve and of which he might not be aware. I suggest that the authority should be made to show its hand and indicate what it is prepared to do. I am sure we are all agreed that it is most important to see that the salaries are increased to a reasonable limit, and I suggest that this is the best form in which to ensure that result.
Page 2, line 32, after ("organisations") insert: ("which shall include provisions similar to those contained in Section 2 (1) of this Act for giving notice to midwives practising in the parts of the area of the authority to be served by the welfare council or voluntary organisation as the ease may be stating the salary and other conditions of service of midwives to be employed by such welfare council or voluntary organisation;").—(Lord Aberdare.)
§ THE EARL OF LISTOWEL
I would like to say on behalf of those who sit on these Benches that we are in very general sympathy with the intention of this Amendment, which would, if accepted, effect an important and in our view beneficial alteration in the Bill. At the same time the very fact that it is an Amendment of some importance makes us regret that it has only appeared at the last moment as a manuscript Amendment, because we feel that it has not been possible for many of your Lordships to give it that full and detailed consideration which it certainly deserves. We agree with the noble Lord opposite that it is absolutely vital, if this Bill is to achieve what it sets out to do, and if 110 it really is to improve our existing midwifery service, that the best possible people should be attracted into the profession. We therefore share his apprehension lest, if uncongenial conditions of work and inadequate remuneration are offered to those who would take up this calling, the best possible people may find themselves seriously discouraged.
We are not assuming that the local authorities as a general rule are likely to underpay their midwives. At the same time one has got to guard against all eventualities, and in the case of voluntary associations, with which the local authorities are asked to co-operate, a situation might arise in which, finding themselves with very little money, they will be obliged, against their instincts, to offer a very low salary to the midwives they engage. There is no protection for midwives under the Bill as it stands either if employed by the local authority or if employed by a voluntary organisation. I know that this matter was thrashed out at very considerable length in another place. At the same time I think one is entitled to hope that the Government will perhaps revise its former judgment, or be prepared to make a concession. If the only objection is that it is not the custom of His Majesty's Government to interfere in relations between local authorities and those they employ, the answer seems to me to be that one cannot allow a matter of administrative routine to interfere with the provision of an efficient midwifery service that will save many lives and improve the health of working-class mothers. We therefore offer our cordial support to the noble Lord opposite. We wish his Amendment success and hope that the Government will be prepared to make some concession towards ensuring proper conditions of work and proper remuneration for midwives who accept jobs under this Bill.
I have had some difficulty in connecting the arguments brought forward by the noble Lord, Lord Aberdare, and the noble Earl opposite with what I take the Amendment to mean. We understand that its effect will be to require voluntary organisations and welfare councils like the supervisory authority to give notice through the Press and individually to each practising midwife of their intention to engage midwives under the Act 111 and to include in the notice information as to the salary and other conditions of service. I want to point out that the object of requiring the local supervising authorties to advertise and notify to midwives is to safeguard the interests of the independent midwives, from whose ranks we anticipate the local authorities will fill the gaps in the new salaried service. But when we come to the voluntary associations we anticipate that if and when voluntary associations enlarge their scope and take on more trained midwives, these trained midwives will also be, as a general rule, required to do other work besides that of the ordinary midwifery work. In the case of a nursing association the midwives will generally, for instance, act as district nurses, and in the case of a voluntary hospital the midwives will have to be their own nurses as well as trained midwives. We think the Amendment would put the voluntary organisations to considerable trouble and expense without benefit to the independent midwife.
We understand that one of the main reasons why the Midwives' Institute want this Amendment carried is that they fear that voluntary organisations will not offer adequate salaries, and therefore they wish that the Minister should be aware of the scale of salaries whilst the service is in the making. The Amendment does not ensure this, as it does not require the submission of such information to the Minister. The Bill as drafted does not require even the local supervising authorities to submit such information to the Minister in respect of their own midwives. In fact, an Amendment containing such a requirement was rejected in the Standing Committee in the House of Commons on the ground that the local authorities should be given the widest possible discretion. The Minister did agree that in the circular he sends out to the local authorities when the Bill becomes law he would recommend such fixed scales of salaries to midwives as are comparable to those paid to health visitors in their districts and to make such contributions to voluntary organisations as will enable them to pay adequate salaries; and to ask the authorities to inform him of the scale of salaries proposed to be paid by them and of the arrangements made by them regarding the salaries to be paid by voluntary organisations. My conclusion 112 is that the Amendment would not have the effect that my noble friend apparently thought it would have, and, even if it did, we should have objections to it. I am afraid therefore that I must resist it.
§ LORD ABERDARE
I thank the noble Viscount for his reply, though I am naturally not quite satisfied. One point he made was that the Amendment would put a great deal of trouble and expense upon the voluntary organisations. I have been in touch with those who run these voluntary organisations, and they are quite prepared to support this Amendment. I do not know whether I might suggest that this question be re-considered by the noble Viscount, or possibly that there might be an opportunity on the Report stage to put the Amendment into a form which might be more acceptable to the Government.
I am perfectly willing to discuss this matter further with my noble friend, but I am afraid the notice is rather short, and although he may have fresh information of which we do not know anything, I think it would be unreasonable to expect me to give any undertaking that something would be done on Report. I will discuss the matter further and see whether my right honourable friend has any reason to change his views.
§ LORD ABERDARE
I would not think of asking for an undertaking. I do not mean to press the Amendment.
§ Amendment, by leave, withdrawn.
§ Clause 1 agreed to.
§ Clause 2 agreed to.
§ Clause 3:
§ Fees for attendance of midwives employed by authorities.
§ 3.—(1) It shall be the duty of every authority employing midwives in pursuance of this Act to fix a scale of fees payable for their attendance as midwives and a scale of fees payable for their attendance as maternity nurses, and to recover from any woman on whom such a midwife has attended as a midwife or maternity nurse, or from the husband or other person liable to maintain such a woman, the fees respectively fixed as aforesaid:
§ LORD BAYFORD moved, in subsection (1), before "fix," to insert "submit to the Minister, and subject to his approval 113 to." The noble Lord said: This Amendment is not moved, as the other Amendments I put down were, on behalf of the County Councils' Association. It has nothing to do with them at all. Its object is to prevent these services being charged on a quite uneconomic basis to people who can well afford to pay for them on an economic basis. As it is at present conducted, the whole of this midwifery system is uneconomic. It is paid for partly by fees, partly by voluntary subscriptions, partly by grants from local authorities and partly by grants from the Government. That is quite right for people who cannot afford to pay an economic fee for a midwife, because there is no doubt that a proper midwifery service is one of the most vital essentials to the health of the country. But the midwifery service as conducted through the nursing associations in the counties, to which, under this Bill it is to be very largely entrusted, is run on lines by which the fee charged is not by any means equal to the expense incurred by the association, and the midwifery service applies to a great many people who can afford to pay and who are not really anxious to depend on anything which is more or less of a, charitable nature. It is to these people that I wish this Amendment to apply.
§ I do not wish the authority that fixes these fees to fix them too low. That is a natural tendency, and in some places more than others. It is on the local authority and not the nursing association that this duty will devolve under the Bill, and there are certain districts where the local authority would no doubt be only too anxious to make this service as cheap as it possibly can. There is no reason why people who can perfectly well afford to pay on an economic scale for the service should get the benefit of this very charitable desire on the part of the local authority. It is for that reason that I am moving this Amendment, and I hope it will receive the favourable consideration of the Minister.
Page 4, line 42, after ("to") insert ("submit to the Minister, and subject to his approval to").—(Lord Bayford.)
§ LORD JESSEL
I quite agree with what my noble friend has said, but I cannot see how his object is going to be achieved by this Amendment. I wish he would explain what the machinery is that will 114 prevent the present state of affairs continuing. I do not see how his Amendment is going to achieve the result which he has in view.
§ LORD BAYFORD
If I may say so, it would put the onus of fixing the fees upon the Minister instead of upon the local authority.
§ LORD MOUNT TEMPLE
May I, in support of my noble friend, say that the Amendment would have this additional advantage which he did not mention—namely, that you would get uniformity of fees all over the country instead of different fees for different local authorities? It is very desirable that this uniformity should be achieved.
§ LORD JESSEL
I cannot agree with my noble friend who has just spoken. Uniformity of fees all over the country may not be desirable; it depends entirely on the locality. At the same time I notice that the local authority can recover any fees from the husband or any other person liable to maintain a woman who is attended.
I am a little surprised that this Amendment should be moved by a former Chairman of the County Councils' Association.
I beg the noble Lord's pardon—President. I have always understood that local authorities strongly resent the idea that the scale of salaries paid to their employees should be fixed by anybody but by themselves, and certainly that principle is the one which is involved.
§ LORD BAYFORD
I was not speaking of salaries. The Amendment does not relate to salaries: it relates to fees.
Nevertheless the principle is unaltered. You have the discretion of the local authority transferred under the noble Lord's Amendment to the Minister. That runs counter to the principles of the Local Government Act, 1929, and we should certainly anticipate a good deal of opposition to any reversal of this principle from the associations of local authorities with which the noble Lord is connected. In fact I am told it is a cardinal point with 115 local authorities nowadays that there is no control over them in respect of such services as hospital treatment, and there is no reason why they should not have the same discretion to fix the fees payable in the case of midwives. I would point out that it is proposed to ask the local authorities, when they submit proposals under Clause 1, to inform the Minister of the scale of fees they propose to adopt. Doubtless if my right honourable friend felt disquieted by any of the conditions laid down, he would use his good offices to try to improve them. I am afraid I cannot accept this somewhat revolutionary proposal which my noble friend has put forward.
§ Amendment, by leave, withdrawn.
§ Clause 3 agreed to.
§ Clause 4 agreed to.
§ Clause 5:
§ Compensation to midwives ceasing or required to cease practice.
§ 5.—(1) Every midwife who, on or after the first day of January nineteen hundred and thirty-five and before the eighteenth day of March nineteen hundred and thirty-six, has given notice to an authority of intention to practise and who, before the expiration of three years from the commencement of this Act, surrenders her certificate to the authority in whose area she is practising at the time of the surrender, shall be entitled to be paid by the last-mentioned authority by way of compensation a sum equal to three times the average net annual emoluments derived from her practice as a midwife or maternity nurse during whichever of the following periods is the shorter, that is to say:—
- (a) the period of three years next before the date on which she surrendered her certificate; or
- (b) the period during which she has practised as a midwife or maternity nurse:
§ Provided that where at the date upon which she surrenders her certificate a midwife is practising in the area of more than one authority, the provisions of this subsection shall have effect subject to the modifications set out in Part I of the Second Schedule to this Act.
§ (7) An authority shall forward any certificate surrendered to it under this section to the Board, and thereupon the Board shall cancel the certificate by endorsement thereon and return it so endorsed to the midwife to whom it relates and remove the name of that midwife from the roll of midwives.116
LORD ABERDARE had a manuscript Amendment, in subsection (1), to leave out all the words from "nurse" down to "Provided," and to insert:
during a period calculated as follows, that is to say:—
The noble Lord said: May I ask the Lord Chairman if he would read out my next manuscript Amendment? Perhaps it would save time, because my arguments will be the same on both Amendments.
THE LORD CHAIRMAN
I understand the noble Lord wishes to take the discussion on the two Amendments together—that is to say, on the Amendment which he is about to move and on the further Amendment, which is as follows:Clause 5, page 8, line 1, leave out from "nurse" to the end of line 7, and insert:during a period calculated as follows, that is to say:—
- (i) if the midwife has practised for more than three years before the date on which the direction was given by the authority any consecutive period of three years to be selected by the midwife after a date five years before the commencement of this Act, or
- (ii) if the midwife has practised for three years or less the period during which she has practised as a midwife or maternity nurse".
§ LORD ABERDARE
I hope your Lordships will consider the arguments I put forward on my first Amendment to this clause as being applicable also to my second Amendment. Noble Lords will notice that the first Amendment merely deals with midwives who retire voluntarily. The second Amendment deals with midwives who are required to retire. The whole object of both Amendments is to get the best compensation possible for the midwife. In tackling these two Amendments I would like to tackle them in two parts. As to the first part, I wish to say that there is a distinct hardship because of the dates on which the compensation to be arranged shall start. It will start on some unknown date after the passing of the Act when the nurse voluntarily retires or is compulsorily retired. 117 It seems to me that the fairest way, in view of the lines on which this Bill is put forward, is that the date should be as from the passing of the Act.
There have been considerable hardships forced upon the midwife in recent years, and that pressure upon her in my humble opinion is going to continue. The value of the midwives' practices is decreasing; even the Bill has been damaging their prospects during the past several months. For some little time a slump in midwifery practice has appeared, and it seems to me that this will continue during the subsequent stages of the preparation for this scheme. I suggest, in any case, that it would be fairer to take the time at which the compensation during three years shall run from the date of the passing of the Act rather than from some later date. But I have got a very much stronger objection, and that objection is shown in the Amendment in my name. My suggestion is that it is only fair to the midwife to choose the best three consecutive years in a period of five years from the passing of the Act. In another place the honourable Member representing the Minister stated that he had chosen the three years specially as being in the interests of the midwife. I can only say that the honourable Member was grossly misinformed and is in error in two directions. The first point he made was that it was in the interest of the midwife to avoid the years 1931 and 1932. In fact, those years were good years in midwifery practice. During those years there was still the value of the maternity benefit existing, and the economic depression in the midwifery service started afterwards.
I must apologise to the noble Viscount who is carrying the burden of this Bill on his shoulders for not seeing that he had received certain figures which I asked should be put before him towards the end of last week. Although perhaps he has not yet had time to study them I would suggest that when he does he should pay them great attention. They are very striking figures. They are figures that are not chosen in any way to prove this case; they are figures which were obtained at a time when there were two meetings at each of which midwives were asked if they would be good enough to supply information of the 118 cases they had attended during the last five years. I have them in two forms. The first refers to the London area. To be as brief as possible I suggest that I should read out the name of the locality where the midwife practised, and the corresponding figures for the years which I suggest could be taken being the latter three of the five-year period, and then the three years which are the three chosen by His Majesty's Government. The figures are: Limehouse, 197 to 147; Eltham, 276 to 192; Shepherds Bush, 351 to 313; S.E. 16,310 to 262; Islington, 382 to 303; Bethnal Green, 460 to 393; S.E. 11, 503 to 381. The other table is taken from Lancashire and Cheshire and is as follows: Stockport, 293 to 252; Manchester, 331 to 347; Runcorn, 260 to 297; Liverpool, 527 to 468; St. Helens, 479 to 422; Stockport, 266 to 186. Your Lordships will notice that all these figures are in my favour except in the case of Manchester. When I say in my favour, I mean the last three year period is better than the first three, although the suggestion in my Amendment is that the nurse should have choice of any three consecutive years.
Beyond that, the birth-rate has been dropping and a further point is that mothers have been going more often into hospitals. I do not know if I need stress that point. It has been the result of publicity, and from a great desire on the part of many people to bring about a decrease in maternal mortality. The hospitals have been doing more advertising, providing special maternity wards, opening their doors for the training of students whether for midwifery service or medical service, and health visitors have been persuading mothers to go to the hospital in case the services of a doctor are urgently needed.
I suggest too that the honourable Member representing the Minister was ill-informed with regard to the argument he used that it was difficult if he went back further to find the net income which was received by the midwife. Under Statute midwives have to keep what is called a case book, a register of cases, which is carefully inspected. I think I can say in every case that the books are kept accurately and are preserved. I do not think, therefore, that there is any argument in the suggestion that there is any difficulty in getting at the midwife's 119 income during those previous years. After all, if the nurse is business-like, she has kept her figures accurately during these few years. It is possible that, as she gets older, she might keep them less accurately. If the nurse is unbusiness-like, it will be equally difficult to get fair results from the more recent figures. I suggest that, as in another place great hopes were raised among midwives and those who pay these affairs so much attention, this point should be very well considered, and the Amendment that the choice of three consecutive years of five be available to the midwives, be agreed to. I feel that in this way, and in this way only, are you going to give the midwife compensation which will adequately recompense her. I beg to move.
Page 7, line 3, leave out from (" nurse ") to the end of line 8 and insert the said new words.—(Lord Aberdare.)
§ LORD BAYFORD
I have great sympathy with what the noble Lord, Lord Aberdare, has said, but I would point out to him that the object of the Amendment is that more should be paid to the midwife. Half the amount paid to her is to come out of the local rates and the other half is to be provided by the Treasury. If he looks at subsection (6) he will see that it is to be paid in respect of every financial year out of moneys to be provided by Parliament. Therefore his Amendment amounts to what is known in another place as increasing the charge. It would not be in order for any one, except the Government of the day, to do it in another place, so I assume it would be even more out of order here. If ever there was a breach of Privilege it would be not only to put on a money charge but to increase the charge.
§ LORD ABERDARE
May I try to meet that objection? I think that the Parliamentary Under-Secretary, speaking for the Minister in another place, said that they were taking the three years most favourable to the midwife in order to give her the greatest compensation. Therefore I thought it would be legitimate to move this Amendment.
I must point out that this question was very carefully thrashed out in another place and the wording in the Bill is the outcome of that discussion. 120 As my noble friend Lord Bayford pointed out, the Government liability would be increased if this Amendment were carried. I am speaking without having before me the record of what the Parliamentary Under-Secretary said in another place, but I doubt whether the impression he intended to convey was that they were taking out of the five years the three years which would give the greatest amount of compensation. We feel, in spite of what the noble Lord said about the case books of the midwives, that there would be considerable difficulty in ascertaining what their earnings were five years ago, because I am informed that although they must, by the rules of the Board, keep a register of cases, they do not necessarily keep a record of what fees they collect. My advisers tell me that it is very doubtful whether they have satisfactory records of their incomes. This point has been gone into very thoroughly not only in another place but between the local authorities and the Ministry, and I am told that the local authorities generally consider the present provision for compensation to be on the generous side and would certainly oppose any extension of this provision.
Although I am sure everybody sympathises with the hard lot of some midwives who have been doing very important work with a very low income, I must point out that what we are doing is to provide them with compensation in regard to future loss. We are trying to provide compensation having regard to what a midwife would have had had she gone on practising. Although undoubtedly there have been a good many circumstances conspiring to make her position of recent years very difficult we cannot take the entire responsibility for that. What we are setting out to do is to provide compensation for the action of the Government.
§ VISCOUNT BERTIE OF THAME
I cannot let pass what my noble friend Lord Bayford said without protest. It is perfectly open to this House to make an Amendment increasing the charge. It is then for the Speaker of the House of Commons to draw the attention of the House of Commons to the fact that it is a Privileged Amendment and the House of Commons can either resist or give way.
§ LORD JESSEL
I am glad that the noble Viscount has made that point clear. 121 I think it is important that we should all realise what is the fact in regard to that matter. I would like a little more information in regard to this Amendment. It is based upon an alleged statement made by the Parliamentary Under-Secretary in another place, that the conditions laid down in the Bill are the most advantageous for the midwives. I am sure everyone in your Lordships' House will want to do the best they can for these deserving women, but the noble Lord, Lord Aberdare, said that the people whose cause he is advocating are dissatisfied. They think that three years chosen at any time would be more advantageous than the proposal in the Bill. One cannot reconcile in one's own mind those two statements. At the same time it should be remembered that it is not everybody who, as the result of Government action, gets compensation. I have known other eases in which Governments have taken measures by which people have been thrown out of employment and no help has been given. As the Government have to pay compensation—I know the ratepayers share it—I think we ought to have the point cleared up, and perhaps the noble Viscount will be able to do that at the Report stage if he cannot do it now.
There is an obvious disadvantage in speaking on these Amendments at short notice, and I should like to have an opportunity of seeing the report of the whole debate which was referred to by the noble Lords, Lord Aberdare and Lord Jessel. I think they must have in mind a statement made by the Parliamentary Under-Secretary, which can certainly be substantiated, that in the case of a young midwife or one who has recently started practice the last three years would be most advantageous because her practice would be increasing. I do not think it was ever claimed by the Parliamentary Under-Secretary that this was calculated to be the best in every case. However, if there is any doubt I will certainly refer to the matter again on Report.
§ LORD ABERDARE
I thank the noble Viscount for his reply especially as regards the fees which midwives earn. I understand that the midwife is going to get her income by production of proof of fees earned. It seems to me that she has a very gloomy future if she has to 122 depend on proving to the utmost an income which has not been properly set down. That argument, it seems, is not against me; but if such is the case it would be just as easy to allow the midwife to prove her income during the last three of the five years as during the first three.
As regards the other question raised, I should be only too sorry to feel that I had in any way misquoted the representative of the Minister. I have before me part of the debate, in which I realise that a good deal about the three years was discussed at the time when the suggestion was made of taking an average over five years. I will, if I may, read to your Lordships the words on which I was relying:We went very carefully into the matter with the sole object of selecting a basis which would be most fair to the midwives, and we came to the conclusion that the method included in the Bill was even more favourable than the Amendment moved by my honourable and gallant friend.It seems to me, therefore, that the suggestion was that the way in which the Bill was drafted was in the best interests of the midwife and that, if there had been a better way or a more favourable way, that way would have been adopted. I have no wish to embarrass His Majesty's Government in any way, but I feel strongly on this point, because the figures are so striking. I do not know whether I might be allowed to suggest to the noble Viscount who is representing the Government on this Bill that he should give an undertaking that this question should be looked into and a reply given at the time of the Third Reading. I have no desire to make it so difficult that this Bill will not be put into execution during the course of the Session. I quite see the difficulties which will arise if the matter is to be referred back to another place. I think, however, that this is a very important question, and if it is possible I should very much like to see it raised again.
I am not a member of the Ministry of Health and therefore I cannot give any undertaking, but I shall certainly discuss the matter with my right honourable friend and see that it is brought forward.
§ Amendment, by leave, withdrawn.123
LORD ABERDARE moved, in subsection (7), to leave out "remove" and insert "place." The noble Lord said: Might I suggest that I read the first three Amendments which stand in my name together, although I understand that I may only move the one Amendment, which is to leave out the word "remove" and insert "place." The next Amendment is to leave out "from the roll of midwives" and insert" upon a retired list of midwives"; and the third to insert a new subsection:
( ) An authority may apply to the Minister for the restoration of a midwife to the roll of midwives from the retired list, and if the application is approved by the Minister, the Board shall restore the name of the midwife to the roll on such conditions as it may think fit.
I should like to underline the words "approved by the Minister" and the word "conditions"—"such conditions as it may think fit." This is a question of the removal of a midwife's name from the roll, and I will divide the question into two parts. The aim and object I have is first to help the midwife; and later I suggest my aim and object is also in the national interest.
§ The first and main point I would make is that this is a gross slur on the midwife. The midwife is proud of her status; she is proud of being on that roll; she is proud of holding her recognised certificate. In that case the removal from the roll must be considered a stigma. It is also possible that the midwife might wish to practise again. There are certain cases which one can very well foresee in which, just at present, perhaps, a young married woman takes her compensation and retires, and then, not much later on, becomes a widow and would like to practise again. There is also the case of a midwife wishing possibly, in the circumstances, to emigrate and then return to this country. But perhaps the worst point in this clause is that you are putting the midwife who retires voluntarily or compulsorily into a very bad category—in fact, into the same category as you put a midwife who is suffering from a position imposed on her because of some penal proceeding, when she has had to be retired from the roll under the Midwives Act, 1902, Section 3. You are not only putting her in that same category but it is even worse in this case, because when she has 124 suffered removal for a penal offence she can be re-enrolled, but in this case it is impossible for her ever to get back into the profession again. I can only see as the probable result of this situation that you are going to force a large number of the midwives to remain in independent practice, which is what we and His Majesty's Government feel should be avoided.
§ May I take another special case, the case of the young midwife, which is a very difficult and hard one? She is offered to-day a very small compensation, and what is it to cover? It probably covers a training fee she has already paid, of anything from £35 to £85. She has also had to provide herself with all the necessary equipment. It is possible that she has also paid something for her practice. There is no doubt that she might be tempted to-day to accept compensation because, in the competition which exists for the posts which will be going, it will probably, and rightly, be the authority's duty to choose the mature and experienced midwife in preference to the younger and less trained one. It is probably in the interests of the mothers that this should be done. It seems to me, however, unreasonable that such midwives should be unable to return to practice if they are wanted.
§ From the point of view of the value to the nation, the first point that strikes me is that such midwives might very well be needed in the case of a national emergency. There is also the case, and it is a very possible case, of an authority in a certain district finding a scarcity of midwives and wishing to employ a midwife who had already been known in that district. There is also the possibility that the length of training of midwives may be extended and that this may go far to increase the scarcity of midwives. It seems to me in this case most unreasonable that the authority should not be able to engage such a midwife. You have a safeguard in that it is only when the authority asks for such a midwife, knowing that she is of guaranteed quality. I do suggest that something should be done to allow those who are compensated to return to practice. It is quite easy in such a case to arrange that the compensation should be returned, or at least in part. I think it has been suggested that it should be returned with interest, and I do not think that the 125 midwife would object to that, although it might be unfair that she should return all the compensation, because she will perhaps have lost the good will of a practice which she bought, and which she would never get back.
§ I do suggest that a special roll might be kept—a retired list. Of course, those on this roll would not be able to practise, and it would not lead to any complications. The roll would end in three years, when the compensation period was completed. I do not see why we should not be prepared to accept such an arrangement, especially as it can do no harm and may be very useful. I do not know whether I am overstressing the case, but the authority would not ask for a midwife unless she was needed and was of the proper quality. There is another small point which I might be allowed to take. Already in these cases by grants the Government have spent a good deal of money in training these midwives, and it seems a great pity that such money should be wasted, when by following the suggestion I have made some of that money might be saved. I suggest that a special roll should be arranged, to avoid the midwife being put in the same category as she might be put in under the Penal Offence Clauses of the Midwives Act of 1902. Otherwise I fear that many midwives, and especially the younger ones, will in consequence of this Bill remain independent.
Page 8, line 38, leave out ("remove") and insert ("place").—(Lord Aberdare.)
§ LORD JESSEL
I think we are suffering under a great deal of disability, because many of these Amendments might have been moved before. I cannot see how a woman who has received compensation can possibly be in a position to pay it back. It seems to me that you are placing everyone in a difficult position. A woman, having received compensation, wants to come back and it is suggested that she should return the compensation. The difficulties seem to me to be insuperable.
THE EARL OF ONSLOW
I am very much interested in this Bill, and have therefore taken the unusual course of leaving the Chair in order to ask a question. I would like the noble Viscount in charge of the Bill to address himself to this case. Supposing a midwife, as 126 the noble Lord, Lord Aberdare, has said, is a young woman, and marries, and for that reason takes her compensation. She may also be an ordinary trained nurse. She becomes a widow. She still remains able to practice as a nurse but, apparently, is unable to practice as a midwife. Supposing she took a place in a hospital, would she be debarred, although able to practice as an ordinary nurse, from practising as a midwife? May she, I would ask the noble Viscount, if she is a midwife and has taken her compensation, and if she is on the Nursing Register and goes into a hospital, practice as a midwife? It seems to me that the matter wants clearing up, and I cannot make it out from Clauses 5 and 6.
§ LORD MOUNT TEMPLE
I think it is rather hard on the noble Viscount in charge of the Bill that he should be required to deal with these very difficult and complex subjects without the Amendments being on the Paper. I think the Committee is also at a disadvantage. I only say this in order to show the noble Viscount, Lord Gage, that there is one member of the House who sympathises with him in his great difficulty.
I am very grateful for what Lord Mount Temple has said. My chief apprehension is that my official reply to the noble Lord may appear of a somewhat curt nature, whereas if I had been able to prepare a reply I might have been able intelligently to anticipate what he would say. As it is my information may be a trifle limited. One of the main objects of the Bill is to reduce the number of midwives. I think the figures are about 60,000 on the roll at present, of which fewer than one-third are actually in practice. Therefore, however we may deal with this Bill, there must be a number of retirements and of cases where the names are taken off the roll. I do not, however, really see why that should be considered by the midwives as implying a, kind of stigma or loss of prestige. In fact, I would point out that they are enabled to have their certificates returned to them after they have been endorsed, and would be evidence of their having been qualified to practise midwifery in the past.
In regard to the idea that an emergency might require a sudden enlargement of the available number of midwives, we do not think that that is 127 really likely to happen, but if an emergency such as war compelled the nurses of the country to employ their time in other duties surely emergency legislation could be passed to deal with the matter. Lord Onslow asked a question, and I am informed that once a midwife surrenders her certificate and gets compensation she is barred from further practice. The noble Earl instanced a rather complicated case, but I am afraid that is all the information I can give at the moment. I suggest that the noble Lord, Lord Aberdare, should not press this Amendment. I should like to look into what he has said between now and the Third Reading. Again, without giving any undertaking to him, I am quite willing to see whether there may be points raised this afternoon which have not been considered by my right honourable friend, and if there are there is always opportunity to put the matter right.
THE EARL OF ONSLOW
I am sorry to trouble your Lordships again but I am rather interested in this matter. I cannot think that the question I put was the least complicated. It says in Clause 5 that if a woman whose name has been removed from the roll of midwives under that clause receives any remuneration for attending as a nurse on a woman who is confined she shall be liable to a penalty. But in Clause 6 there are certain cases where it is not to apply, and I want to know whether the case I put is one where it would or would not apply.
I really think I must consult with my right honourable friend. After all, I have given the noble Earl the answer which applies to midwives in general. Once they have surrendered their certificates and have received compensation they are debarred from further service. I really think we could settle these other points in a very short time. If there is any difficulty felt by the public at large as to the interpretation of the Bill, I could make a statement on Third Reading.
§ LORD ABERDARE
On the question of the reduction of numbers, speaking on behalf of the Midwives' Institute, I wish to say it is also our aim and object. What we feel very much is that unless certain things are made attractive to the midwife she will remain in independent practice. My Amendment was really meant to 128 help His Majesty's Government. I thank the noble Viscount for his reply. I do not think it was my fault that so short a time was given for the publication of these Amendments, but I apologise to your Lordships. I should like to accept what the noble Viscount has suggested, that if it is possible we might get together and perhaps there might be some further development during the later stages of the Bill.
§ Amendment, by leave, withdrawn.
§ Clause 5 agreed to.
§ Clause 6 [Prohibition of unqualified persons acting as maternity nurses for gain]:
§ LORD ABERDARE
May I apologise for making a statement on this clause without actually moving an Amendment? I am in an embarrassed position, having been so irregular in giving such short notice of my Amendments, and actually while the Bill was being called I was called to the telephone to see whether I could move an Amendment on Clause 6. I do not know whether the noble Viscount would allow me to get into communication with him on a question which the Joint Council on Midwifery wish to raise. It is a question arising under Clause 6 (1) (c). It is the question of arranging for maternity nurses to get the same amount of inspection as midwives.
I am quite sure my right honourable friend will be very willing to consider between now and Third Reading any proposals put forward by the Joint Council. I am sure that body is sufficiently important to allow me to make that statement.
§ Clause 6 agreed to.
§ Remaining clauses agreed to.
§ Schedules agreed to.
§ Bill reported without amendment.