Sitting of 17 May 1926

Preamble
The House met at a quarter past four of the clock, The Lord Chancellor on the Woolsack.
AYRSHIRE ELECTRICITY ORDER CONFIRMATION BILL.
Brought from the Commons; read 1a; to be printed; and (pursuant to the Private Legislation Procedure (Scotland) Act, 1899), deemed to have been read 2a (The Duke of Sutherland) and reported from the Committee, and Bill to be read 3a on Wednesday next.
BIRKENHEAD CORPORATION BILL. [H.L.]
Returned from the Commons, agreed to, with Amendments: The said Amendments considered, and agreed to.

MINISTRY OF HEALTH PROVISIONAL ORDER CONFIRMATION (ASHTON- UNDER-LINE EXTENSION) BILL. [H.L.]
VISCOUNT GAGE: My Lords, I beg leave to introduce a Bill to confirm a Provisional Order of the Minister of Health relating to Ashton-under-Lyne; and to move that it be read a first time.
Moved, that the Bill be now read 1a.—(Viscount Gage.)
On Question, Bill read 1a, to be printed, and referred to the Examiners.

ABERTILLERY AND DISTRICT WATER BOARD BILL. [H.L.]
Reported with Amendments.
MINISTRY OF HEALTH PROVISIONAL ORDERS CONFIRMATION (No. 1) BILL.
Read 2a (according to Order), and committed.
MINISTRY OF HEALTH PROVISIONAL ORDERS CONFIRMATION (No. 2) BILL.
Read 2a (according to Order), and committed.

MIDWIVES AND MATERNITY HOMES BILL.
Order of the Day for the Second Reading.
THE LORD PRIVY SEAL (THE MARQUESS OF SALISBURY): My Lords, the Bill which is now before your Lordships and which I am going to ask you to give a Second Reading was in the hands of a Private Member in another place. My hon. friend who represents the constituency in which I have the honour to live (Colonel Fremantle) was in charge of the Bill in the House of Commons, but the Bill has the full assent of His Majesty's Government in its present form and it has been thought better that we should undertake it in your Lordships' House as a Government Bill. This is one further step in building up that great edifice of health legislation which has been the dominant note of the best part of social reform during the latter part of the nineteenth century and the first part of the twentieth century.
The original Midwives Act was passed in 1902 and it was amended in 1918, and it is with that particular branch of the law that I am going to trouble your Lordships. The midwives legislation has worked very well indeed. It has been a great success, one of those moderate measures of social reform which are specially dear, if I may say so, to the Conservative Party and which are approved by the Parties opposite. It has not developed faults which require amendment, but there are certain matters which do require amendment and those matters I am going to describe to your Lordships in a little greater detail. There is another branch of the subject which is dealt with in this Bill, which has a great deal to do with midwives legislation but is slightly on one side of it—namely, the proper regularisation of maternity homes. As regards the amendments of the principal Act they do not deal, of course, with the broad lines of that Act. Under that Act the Central Midwives Board was established and the local supervising authorities were decreed, consisting of representatives of the county council or the county borough council, as the case may be. The amendments I am going to suggest to your Lordships do not touch the main structure of the previous Acts.

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The first matter has to do with making watertight the system with regard to midwives. It is quite clear that if you provide and make necessary the provision of midwives you mast also deal with women who are not qualified in order to prevent their practising where midwives alone ought to be allowed. That was sought to be done in the Act of 1918, but Parliament thought at that time that certain saving words were necessary in cases where a woman acted as a friend and assistant to the mother, not being a qualified person but acting, as it were, upon an emergency. Consequently words were put into the Act to the effect that the unqualified woman was to be allowed to act as a midwife so long as she did not do so "habitually and for gain." One quite understands the reason why those words were inserted, but unfortunately, like so many saving words; they have operated badly and have shown themselves open to abuse. It is almost impossible to check abuse of the words "habitually and for gain." You cannot prevent unqualified women from acting as midwives and you cannot prove that they do so habitually and for gain, and accordingly you cannot restrain them. Consequently the first amendment which is sought to be enacted by Clause 1, is the repeal of the words "habitually and for gain." The only exception that is left is that a. woman may act" in a case of sudden or urgent necessity," although she may be unqualified, hut otherwise she must not act except "under the direction and personal supervision of a duly qualified medical practitioner."
This brings me to the second amendment. The principal Act said that the unqualified woman was not to act except under the direction of a qualified medical practitioner. Those words again have been shown to be too limited. Direction is not enough. You require to provide personal supervision. Cases were found where a medical practitioner gave certain directions but really did not interest himself in the case. It is not sufficient to allow an unqualified woman to act in that way and accordingly we have inserted, in addition to the words "under the direction," the further words "and personal supervision" of a qualified medical practitioner. I quite admit that there are some difficult cases which have to be met, but those are the broad lines
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of our enactment and that is how the Bill stands now. I need hardly add that all that I have said as to unqualified women applies also to unqualified male persons. In certain parts of the country it is the habit to use male midwives and not women.
I come to the next amendment in the law. It often happens, as your Lordships are aware, that a midwife may be exposed to infection and everyone knows how dangerous that is to a woman about to become a mother. The result of this is that the midwife cannot act, but the principal Act envisaged that situation and provided a power to the local supervising authority—that is, to the county council—to compensate a midwife who was so debarred from acting. That was obviously a very valuable provision because, in the absence of compensation, there would be considerable risk that the danger of infection would be concealed, with consequent great danger to the mother. Under the law as it stands this action is optional to the local supervising authority. Under this Bill we are a little more emphatic and provide that wherever the infection is due to no fault of the midwife herself she shall be entitled to compensation and this shall no longer be a matter of option for the local supervising authority. That is the second amendment in the law.
I am not going to dwell upon smaller points, but taking the general amendments I come now to the third of them. The midwife is directed by the law when a case presents special difficulty to send for a qualified medical practitioner, and if she does so, as happens in about twenty or twenty-five per cent. of cases, the medical practitioner is, of course, entitled to a fee, which is paid by the county council. The authority then have power to recover the fee from the patient, unless the patient is too poor to provide it. Great difficulty is found in recovering these fees and, in order to meet that difficulty, one county council hit upon the notion of allowing women who were about to become mothers to insure against the possibility of having to find a fee by paying a very moderate sum—I think it was 5s. That system was found to work perfectly, but unfortunately, like so many of these devices that are hit upon by some ingenious person, it had no statutory authority. The law now follows the lead

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which has been given and this Bill makes lawful that which has been shown to be successful without any legal authority. Accordingly, under subsection (3) of Clause 2, this power to insure against the expectant mother having to pay this fee is made regular and legal.
Then we come to a provision under Clause 3 for the reduction of the enormous roll of midwives. Huge numbers are on that roll who do not practise at all and we are very anxious to bring it within a reasonable limit. Accordingly an ingenious provision is inserted under which the full roll is printed only once every five years, while the names of the actual practising midwives are printed every year, so that in that smaller roll you are able to find the names of all who are really operating. The Central Midwives Board have no means otherwise of knowing whether a midwife is still operating, and accordingly some limit has to be placed upon the roll. A final provision in this part of the Bill is that of Clause 4, which provides a badge for midwives. They are very anxious to have it, and it appears to be very reasonable that they should have a badge, just as nurses have, and that the badge should be protected by law from being used by unqualified persons.
I now come to Part II of the Bill, to which I have already referred. It has reference to the registration and inspection of maternity homes. As the law stands, generally speaking, there is no power to inspect maternity homes, but under a series of local Acts in seventeen eases the power has been granted to particular county councils and borough councils—three county councils and fourteen borough councils—and there is a desire, strongly supported by great authority, that this power of inspection should be made general. The Central Midwives Board, the County Councils Association, the Municipal Corporations Association, the Association of Inspectors of Midwives and the National League for Health, Maternity and Child Welfare all combine in asking that there should be power in the local supervising authority to inspect these maternity homes. I need not say that all the proper provisions are in the Bill. If registration is refused there is power to demand to be heard and of appeal to the Courts of Law. Similarly, if a maternity home
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is struck off the register there is a power of appeal.
These provisions are really required, especially in the case of the less reputable maternity homes. You may readily imagine that alongside the great maternity homes there are a number of places where business is carried on which is not of a very reputable character and where, especially, take place the births of illegitimate children. In those cases particularly is this inspection required, because it is in those places that you might expect to find unqualified women acting and that restraint is necessary. Indeed, in the very bad cases, they are the scenes, we believe, of all the abuses connected with baby farming, with which the Legislature has tried to deal over and over again. The supervision is to be exercised by the same authority as is employed under the Midwives Act—namely, the county council authority. A little difficulty arose in the House of Commons as to whether the supervision should be by the county council or by the maternity and child welfare authority, but I think your Lordships will agree that if you have the county council authority as the authority whose business it is to look after these matters then it is better not to duplicate the authorities. In any case they would have to inspect the midwives and it is evidently better that the administration of the whole duty of inspection should be concentrated in the hands of one authority, instead of being duplicated in the county council and in the lesser local authority in those instances where the lesser local authority is the maternity and child welfare authority. That is the provision of the Bill.
There are certain exceptions to this rule about supervision—exceptions which I think your Lordships would expect to find. The hospitals, whether provided by the State, or by local authority, or by Act of Parliament, or by Royal Charter, are all exempted, and also maternity homes where there is a duly qualified medical practitioner resident and responsible. Lastly, there is exemption for 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. by the local supervising authority. Those are the exceptions. Your Lordships will

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observe that this is a strictly businesslike Bill, dealing with certain special points of difficulty which have arisen and remedying certain mischiefs which experience has shown to exist. I confidently commend it to your Lordships' approval and hope that you will give it a Second Reading.
Moved. That the Bill be now read 2a— (The Marquess of Salisbury.)
THE LORD ARCHBISHOP OF CANTERBURY: My Lords, nothing could be more lucid than the explanation which the noble Marquess has given of the object and terms of this Bill. From some little acquaintance with the discussions on this subject I have every reason to believe that what is here proposed is exactly right, with one exception, to which I will call attention in a moment. That something in the nature of this Bill is wanted is, I think, certain, and it appears to have been exceedingly well drafted, with the happy utilisation of experience gained by the county councils and others. There is, however, one single point in the measure to which I should like to call attention, with a view to its being considered before the Committee stage. I would ask the noble Marquess if it might be considered by him and those who are advising him.
He mentioned particularly what were the institutions or persons who were exempted from the need of registration prescribed by the Bill for ordinary institutions or homes, and he called attention to the exemption under paragraph (b) of Clause 11, which runs thus:—
"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:—
"(b) any hospital or other premises for the conduct of which a duly qualified medical practitioner resident therein is responsible."
The noble Marquess reminded the House of possible mischiefs that may occur in this particular matter, in which dangers are more rife than they are in many other institutions. It is very improbable perhaps, but not inconceivable, that one who is a duly qualified medical practitioner may be in charge of such a home, and yet things may go on therein which it is exceedingly desirable to prevent, and which would not take place if the
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home were registered. Therefore it would seem that some further check may be necessary than mere superintendence of a particular home by one who is, in a technical sense, a duly qualified medical practitioner.
That it is possible to take these precautions is apparent if your Lordships care to refer to the London County Council (General Powers) Act, 1915, Section 21 of which provides as follows:—
"Subject as hereinafter provided the provisions of this Part of this Act shall not apply in the case of a lying-in home carried on by a. duly qualified medical practitioner with respect to which there shall have been lodged with the Council 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 home, to the effect that the premises used or represented as being or intended to be used for such home, 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 homo is a fit and proper person to carry on the same,"
That really affords a check against abuses of the system by registration being too easily obtainable by someone who, however unlikely, it is at least conceivable may be a person not entirely free from temptation to use the place in a way otherwise than is to be desired.
I would merely ask the noble Marquess that attention might be called to that point before, we come to the Committee stage, and I would specially emphasise the point that I am not asking for something new. It is at present the law as regards the homes under the London County Council (General Powers) Act, and all that I suggest is that the clause there enacted should be made applicable here, or that other words to the same effect which may be more appropriate should be used. It is a technical point, and one about which it is very difficult for one who is not expert in the legislative mechanism of the working of these things to be precise in his language, but I think I have made clear what I want to see done. I shall call attention to it on the Committee stage in the hope that by that time the matter may be further considered and we may be told whether or not it is possible to make the change I suggest.
VISCOUNT HALDANE: My Lords, there may well be a good deal in what the most rev. Primate has now said. The words of exemption are very general, as the Bill stands, and it may be that, for safety's sake, they may require to be made more specific. The Ministry of Health is doubtless well informed on that subject, and would be in a position to advise the noble Marquess, but I was very glad that the noble Marquess entered into the exposition of this Bill with such obvious interest in it and keenness that it should pass. It is quite true it is an extension, and I think a very beneficial extension, of the policy of the Act of 1902, which was passed when the noble Earl opposite (Lord Balfour) was at the head of the Government.
The noble Marquess put before the House four points on which he recommended the Bill. The first was the necessity of imposing further restrictions on persons who act as midwives. The second was the desirability of providing compensation to those who, through no fault of their own, but really in the public interest, for fear of infection, have been suspended from practice. The third was the insurance provision and the fourth was the point to which the most rev. Primate has just alluded, that of inspection. To those last three grounds I am on general principles entirely favourable. My only doubt is connected with the first, and not as regards the principle of that matter because it is a most desirable thing that incompetent persons should not act as midwives. But I cannot help thinking that this Bill has been drawn by those who visualise a situation in which a medical practitioner who could give personal direction and supervision was near and able to act, and in which it was possible to get a qualified midwife.
I have in my mind cases, of which I have had opportunities of becoming cognisant, of women who live in remote parts of the country, perhaps a dozen miles away from any village where even a panel doctor can be got, and who, at the distance where they live, up among the hills in a cottage, it may be, cannot get a qualified midwife to come and attend. In these cases it almost always happens that the mother or somebody else acts. If the doctor can be got he is got, and gives some general advice, and
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then goes away, and he does not come again, because he cannot come again. The thing is done and carried through by the mother, or by some near relative or intimate friend. That is not good, but it is better than nothing, and what I am a little concerned about is the rigidity of the terms of prohibition in Clause 1 of this Bill. I think it will work out all right because of the exception as to sudden emergency which is put in, and it will certainly work out all right if the supervisory judicial authority, the magistrate—or the sheriff, as it will be in Scotland—takes a very wide view of his judicial duty in the matter, and does not impose any penalty in cases of necessity arising from not being able to get anybody to help.
If the noble marquess is satisfied that that will always be the case, then I think this clause had better pass, because it is a good clause, and brings in a good principle. But if it is going to frighten people out of giving help in cases of emergency, then it may be rather serious. I shall not put down any Amendment, because I think it is a thing that must be considered by people of experience who know about these matters on the spot, but I would ask the noble Marquess to consider whether Clause 1 is too rigid, or whether it should be softened a little. Subject to that, I think the Bill is an excellent Bill, and I hope it may pass.
VISCOUNT KNUTSFORD: My Lords, I very much hope that the noble Marquess will not press for his amendment excluding hospitals and institutions under Government Departments and local authorities from inspection. The fact that a duly qualified medical practitioner is resident does not at all mean that the surroundings are fair, either to the mother or the child. Any one of us who know what the Poor Law infirmaries have been of late—they are improving now—would willingly bear testimony to the fact that an inspection and a report upon the conditions of many of those institutions would be very valuable. And I think that any inspection of hospitals is useful in itself. It gives confidence to the public that those who are responsible for the duty of looking after the sick are doing their work properly. Therefore I hope very much that the noble Marquess may not exclude hospitals from this legislation.
TEE MARQUESS OF SALISBURY: My Lords, I am very grateful indeed to your Lordships for the kind reception you have given to this Bill, and I need not say that I shall take very special care to enquire into the various points which have been put by noble Lords who have taken part in the debate. The noble and learned Viscount opposite called attention to the, difficulty which might arise in remote districts where a doctor could only come at most perhaps once, and no midwife is available. I certainly hope that that particular case is covered by the words "sudden or urgent necessity"; Your Lordships will observe that it is not "sudden and urgent necessity"; but "sudden or urgent necessity"; that is to say, that, even if it is expected, yet if it is urgent it will be covered. But undoubtedly there may still be difficulty if people are afraid to act for fear that they may get into trouble. I cannot help hoping that in a case of that kind the women who are called upon to help will not be restrained by any such scruple; but I will certainly look into the matter and see whether any better words can be provided.
Then comes the other point, the matter of exemption, to which the most rev. Primate has alluded. The most rev. Primate doubts whether a medical practitioner who must be resident and responsible is a sufficient safeguard. I confess that when I first read the clause myself I had exactly the same feeling, and I shall take great care that that shall be looked into. My noble friend behind me (Viscount Knutsford) goes further; he would throw open all institutions to inspection. No man in your Lordships' House speaks with greater authority about hospitals that, my noble friend, and I confess it has made considerable impression upon me that he should be willing that the London Hospital should be inspected by the local supervisory authority. I think the local supervisory authority might be a little timid at encountering the London Hospital with its immense volume of medical knowledge, but I certainly think that if my noble friend is willing that hospitals generally should be inspected it ought to be considered. I will take care that these three points are carefully laid before my right hon. friend the Minister of Health, so that I shall be in a position to answer
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your Lordships definitely when the Committee stage is reached.
On Question, Bill read 2a, and committed to a Committee of the Whole House.

LOCAL AUTHORITIES (EMERGENCY PROVISIONS) BILL.
Order of the Day for the Second Reading read.
VISCOUNT GAGE: My Lords, this is a Bill to continue an existing arrangement whereby the poorer unions in London are helped by the richer in respect of the relief of the poor. Your Lordships will recollect no doubt that the Metropolitan Common Poor Fund was originated in 1867, the system being that an equal rate was paid by each borough to a central Fund, and then claims were made for repayment against this Fund by each borough in accordance with its own particular requirements. If these claims were in excess of the average figure and the Minister of Health passed the accounts after having looked into them, the poorer boroughs obtained payment from the Fund at the expense of the richer up to a certain limit. Until after the War this arrangement was confined to inmates of Poor Law institutions; but the great industrial depression made it necessary to extend its operation to cover out relief as well. This involved legislation, which took the shape of the Local Authorities (Financial Provisions) Act of 1921. This Act has twice been extended—in the years 1923 and 1924—arid it is now asked that a further extension should be made until 1928.
It is fully admitted by those responsible for the Bill that the principle of one local authority administering money derived from another is wrong and could never be adopted as a permanency; but for some time past there has been an intention to revise the Poor Law and to bring in a very considerable measure of Poor Law reform which will naturally affect this temporary arrangement. This reform has been considerably delayed by successive changes in Government, but I think I may claim that this Government has a more reasonable chance of being able to redeem its promises than its immediate predecessors and that no fear need be felt on that ground with respect to the declaration made by the Minister last autumn.

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The question has been raised a number of times as to the maximum per capita sum that should be chargeable on the Common Fund in regard to this excess relief. Since 1921 the sum has been fixed at 1s. 3d. in respect of the inmates of institutions and at 9d. in respect of outdoor relief. In regard to these sums two deputations have been received by the Minister of Health, one from the receiving unions and the other from the paying unions. Perhaps not altogether unexpectedly, the paying unions protested that the figure of 9d. was too much and the receiving unions protested that it was too little, suggesting 8d. and 1s. respectively as substitutes. I will not argue that the principle of splitting the difference is correct in these circumstances; but I think I can submit, taking the arguments of one side against the other and considering the slightly increased cost of administration of this relief as against the considerable decrease in the cost of living since this proposal was first introduced, that there is no real reason to alter this figure of 9d., which was agreed upon not only by the Conservative Government but by the Labour Government as well when it was in office.
It is not, and never has been, intended that this figure of 9d. should rigidly conform to the exact per capita cost of relief, or to any exact proportion of it, as has been suggested. It is an arbitrary figure, but one which the. Minister has agreed upon, after very careful examination, and after having received various deputations on the subject. He has arrived at that figure as being the most likely to satisfy a. real necessity occasioned by the unequal distribution of the poor in the Metropolis and at the same time to ensure a reasonably economical administration of other people's money. Another part of the Bill refers to the extension to ten years of the period in which local authorities can repay loans made by the central authority. I do not think that this part of the Bill is in the least controversial, so I will not labour it. The Bill has already been through all its stages in another place, and as your Lordships passed what was practically a precisely similar Bill in this House two years ago I hope you will give this measure a Second Reading. I beg to move that the Bill be now read a second time.
Moved, That the Bill be now read 2a.—Viscount Gage.
VISCOUNT HALDANE: My Lords, if this Bill were being discussed in the abstract the Party which I represent would have a good deal to say about it. No doubt a provision of this kind is needed, but it ought to come in a general measure for the reform of the Poor Law in London. Such a measure was discussed in the time of the Labour Government, and because we could not get any further than, a temporary measure we proposed a temporary measure, and your Lordships gave it to us under restrictions. This is a Bill to remove those restrictions so far as time is concerned and to extend the period. I am willing to be thankful for these mercies, but only on the footing which I gather is the view of the noble Viscount and, indeed, is implied in the Bill, that it is only a temporary measure to tide over the time which must elapse before a general Poor Law Act for London can be passed. I think there is no need to enter upon the proof that such an Act is needed and if, as I gather, the Government really intend to bring it in, I trust that the passing of this Bill will not operate to delay their zeal in setting about the task.
On Question, Bill read 2a, and committed to a Committee of the Whole House.

ECONOMY (MISCELLANEOUS PROVISIONS) BILL.
Read 3a (according to Order) with the Amendments.
Clause 7 [Short title, construction and application of Part 1]:
THE FIRST COMMISSIONER OF WORKS (VISCOUNT PEEL)THE FIRST COMMISSIONER OF WORKS (VISCOUNT PEEL) moved, in the proviso to subsection (2) of Clause 7, to leave out "the said section" and insert "Section 3 of this Act." The noble Viscount said: My Lords, I beg to move the Amendment of which I have given Notice. It is purely drafting.
Amendment moved—
Page 7, line 9, leave out ("the said section") and insert ("section three of this Act").—(Viscount Peel.)
On Question, Amendment agreed to.
Bill passed, and returned to the Commons.
House adjourned at five o'clock.