PUBLIC HEALTH (NOTIFICATION OF BIRTHS) BILL (Hansard, 5 July 1965)

§ BARONESS SUMMERSKILL
My Lords, I beg to move that this Bill be read a second time. This is a very short Bill, but nevertheless I regard it as an important measure, and hope your Lordships will agree with me that it is a Bill which should go on to the Statute Book in the shortest possible time. It is designed to ensure that the notification of a child's birth is made quickly and in the best way to the local authority responsible for the care of mothers and young children. Although the Local Government Act, 1958, provided for the delegation of most local health authority functions to the county district councils, it omitted, curiously enough, to include the notification of births. Therefore, in some county areas in England and Wales, where health and welfare functions are made the responsibility of a county district council, notifications of the birth are still being sent to the medical officer of the county. He then passes them to the district medical officer for action. But however promptly he passes on these notifications, there is inevitably some delay and over weekends, of course, there may be two or three days of lost time.
In my opinion it is of paramount importance that a mother and her newborn baby should be visited without delay, since prompt action may lead to early investigation and treatment of an ailment or defect, and certainly it will lead to the mother receiving very good advice. I think your Lordships will agree that local authority maternity and child welfare services have played a large part in the steady improvement in the health of mothers and young children, and the arrangements for notifying births enable medical officers to help to mobilise the services for the care of the mother and child. In order to avoid delay, the 1121 father of the child, or the doctor or midwife, is expected, under Section 203 of the Public Health Act, 1936, to notify a birth to the medical officer of health for the area within six hours of the birth.
Of course, notification and registration are two entirely different things, and the registration of the birth does not have to be made within six hours of the birth of the child. It is patently unsatisfactory that precious time should be lost in an unnecessary passing of papers between authorities. The delay could be eliminated entirely by a simple amendment of Section 203 of the Public Health Act, 1936; and this is precisely what Clause 1(1) of this Bill proposes to do. It provides that in the area of a county district council exercising delegated health and welfare functions the notification of births should be sent direct to the medical officer of the authority. This provision applies to England and Wales. The difficulty does not arise in Scotland.
Subsection (2) deals with an entirely different matter but one to which I am sure your Lordships in these days will attach considerable importance. Subsection (2) requires local health authorities to supply, without charge, to doctors and midwives, prepaid addressed envelopes together with copies of a form of notification. The envelope will take the place of the addressed and stamped card which is all that the 1936 Act requires. It seems to me that personal information about the birth of a child and the details of the birth should be sent under cover.
Furthermore, virtually all authorities now use birth notification forms to collect information about congenital abnormalities apparent at birth. Until fairly recently little was known about congenital abnormalities and the causation of congenital malformations, but the discovery of the effects of radiation and of drugs such as thalidomide has changed matters. The thalidomide tragedy focused attention on the lack of information concerning the incidence of the different types of congenital malformations other than that obtained through mortality statistics, which of course were always available. Had a national scheme for notification been available at the time, it is probable that the increase in limb deformities would have been noticed 1122 earlier and perhaps some of the tragedies could have been averted.
We did profit by this appalling catastrophe, for during 1963 a scheme was devised for notification of congenital deformities to the medical officer of health, and this came into operation in 1964. This is now voluntarily undertaken by doctors and midwives, but may I say, in parenthesis—and I am quite sure I shall have the support of the House in this—that I regret that this is a voluntary scheme. In view of the mass of inadequately tested drugs on the market which are often taken by expectant mothers, it should be compulsory for a doctor or a midwife to notify the presence of some congenital abnormality in a newly-born child. However, the fact that it is notified is a great step forward. The medical officer of health, in his turn, completes a special form provided by the General Registry Office, on which the details of all malformations, whether single or multiple, can be recorded.
Now the nature of the information about congenital abnormalities underlines the importance of sending the notification in an envelope and not on a postcard. Looking back, it is quite remarkable to think that over all these years we have provided only a postcard for the important information regarding the notification of a birth.
Any additional expenditure arising from the measures proposed in the Bill is likely to be minimal. Therefore a Money Resolution will not be required. Clause 2(2) postpones its operation until one month after its passing. This is to allow the authorities time to make their new arrangements, including the printing of new forms and the envelopes. I would commend these proposals to the House and ask that a Second Reading shall be given to this small, but very important, measure.

§ LORD NEWTON
My Lords, I did not put my name down on the list because I was not certain whether I should get here in time for this debate; but I should like to thank the noble Baroness, Lady Summerskill, for the careful information she has given us on her small but important Bill, as she herself described it. 1123 The Bill makes two very sensible amendments to the existing law, and I, for one, and I imagine most of your Lordships, wish the Bill well.

§ LORD TAYLOR
My Lords, I have not always entirely agreed with my noble friend on every subject in the past, but this afternoon it is a great pleasure to be able to agree wholeheartedly with her and to support this Bill entirely. Her Majesty's Government welcome it, and I am particularly glad to be supporting it because one of its supporters in another place was the noble Baroness's daughter, which just shows what a family team can do.

§ BARONESS SUMMERSKILL
She is well brought up.

§ LORD TAYLOR
I agree with the noble Lord, Lord Newton, that it is a useful and necessary little Bill. As the noble Baroness has said, there are two documents which have to be filled in after the birth of every child. The first is the notification of the birth to the local health authority, which has to be done within six hours, and the second is the registration with the Registrar, which has to be done within six weeks. Here we are concerned with the notification within six hours, which has to be done either by the father or the midwife or the doctor. It will usually be the midwife or the doctor, and this is done normally immediately after the birth.
As my noble friend has explained, up to now the notification has been to the medical officer of health of the county or county borough and not to the medical officer of health of the county district, where there were delegated powers, and clearly this could lead to delay of the kind which the noble Lady has described and which was most undesirable. All the associations of local government authorities are keen to see something done about this. The first clause of the Bill will apply to about thirty county district areas where delegation has occurred. I had wondered about the situation in the new Greater London area, but in fact that is covered by Statute, and the new boroughs in the Greater London area are health authorities in their own right, so they will receive the notifications anyway.
The second point, about the substitution of a prepaid envelope for a post 1124 card, is equally welcome, and for the very reason that the noble Lady has given. First of all, it gives a little privacy to the affair, and secondly, it obviously encourages the doctor or midwife to notify congenital defects and abnormalities. The importance of this, as the noble Lady has said, is very much greater than it used to be, now that new drugs are so frequently coming into use and we may get unexpected and quite terrible happenings, such as the thalidomide tragedy. I agree entirely with her that had the system of notification been in existence at that time we might well have been warned much more quickly than actually was the case.
It is for the local health authorities to devise the kind of form that is inserted into the envelope. It is not laid down by the Ministry of Health, and I imagine most local authorities will now provide a place for the notification of congenital abnormalities. With the postcard, it has sometimes happened that only the fact of birth has been recorded on it, and the congenital abnormalities have had to be notified by letter. Clearly, there may have been some defects in the procedure as a result of that, and, although it is voluntary, I think the new system will be much more efficient and a good thing.
The incidence of these congenital abnormalities is something like 1.7 per cent. It varies a little from area to area. Some of them, of course, are quite uncommon defects; some of them, on the other hand, such as club foot and cleft lip and spinabifida, are more common. There are a number of serious conditions which will not be discovered immediately at birth; for example, some forms of congenital heart disease. But the fact that the child is at once brought under the care of the local health authority infant welfare service through the health visitors will help to pick this up. We have no hesitation, therefore, in hoping that your Lordships will give this Bill a warm welcome and a speedy passage on to the Statute Book.

§ BARONESS SUMMERSKILL
My Lords, I should like to thank my noble friend and the noble Lords opposite for the support they have given this Bill.