Orders of the Day — Ministry of Health Bill.

– in the House of Commons on 26th February 1919.

Alert me about debates like this

Order for Second Reading read.

Photo of Dr Christopher Addison Dr Christopher Addison , Shoreditch

I beg to move, "That the Bill be now read a second time."

This Bill is in some respects similar to the one which my right hon. Friend the Home Secretary has now introduced. His Bill relates to a very important side of industrial reconstruction. This Bill deals with a very positive national need. I think that at the present time the House needs little persuading to consider carefully any measure which is designed to safeguard and strengthen the life of the people. We recollect that during the past four years we have lost about 700,000 of the pick of our race in the battles connected with the War, and I would remind the House that during the months of October, November, and December last year there was as high a mortality in the average per month from influenza alone as the average monthly mortality during the War from causes connected with the War. The men and women who were lost during that quarter were very largely people in the prime of life, as is the case, unfortunately, at the present time.

If we wanted an illustration of how necessary it was to bring our practice into accord with our knowledge, we have it before us at the present time, because in this matter our practice is far behind our knowledge. Somehow or other we hear of these things, they sink into our minds, and we go away and forget them. For years attention has been drawn to the fact that we have in our children, in our elementary schools, armies who are physically defective or have defective vision, etc. We have them of every age and in every year, not a company or a brigade or a division, but an army. Every year they go out and lose themselves in the mass of the population. We forget them until suddenly some great national event occurs which brings it up to us in its reality. That was the case in the War. Then we saw those generations of children we had hoard of so often who were represented in the military age by hundreds of thousands of men who were physically unfit and could not pass the very moderate standard of physical fitness which the Array required. Then it was revealed as a source of national weakness, which is vary great in time of emergency, but it is just as much a source of national weakness in time of peace.

Is there any one of us who knows how much waste is revealed if we think of the millions of men who could not pass the standard for recruiting? Think what we lose in productive capacity. You cannot calculate it in terms of millions. The physical, human, industrial waste of our present state of affairs is well nigh incalculable. It behoves us, therefore, to do what we canto remedy these things. I am getting tired of talking about it. We have been talking about it for a long time, and I am glad to say that this Bill indicates the conviction of the Government that the time has arrived for action. I would appeal to the House now that, when we get to the Committee stage, they should keep the big object of the Bill in view and take care that no parochial or petty or personal considerations stand in the way of the Bill. My experience is that any negotiations which it has been my duty to conduct in connection with this Bill have been no exception. Whatever you propose there are always plenty of people ready to say, "That is all right to deal with this kind of thing, but," and when you get to the bottom of these "buts" you find that somebody's interest is involved, and that there is some axe-grinding going on. I am tired of that kind of thing, and I hope that the House of Commons will see to it that whatever organisation we propose it will be directed solely, regardless of every interest, to the one object in view—the promotion of the health of the people by the most practical and sensible means we can evolve.

My hon. Friend opposite just now, I thought, provided the best argument that could be provided for the creation of a Ministry of Ways and Communications. He said that there were 2,000 different authorities dealing with the matter. Do you wonder that there is a muddle? We are not so bad as that in the matter of health, but we are getting on towards it. We have a very large number of different Departments dealing with it, and I believe that there are about 1,800 local authorities. The first thing, if you are going to get a job well done, is to make it somebody's duty to see that it is done, and not leave it to the ill-defined and the combined responsibility of half-a-dozen different sets of people. That is the central idea, of this Bill—to try to fix responsibility and make it the duty of a body of men and a Minister to see to it that adequate steps are proposed in this Parliament, and, if sanctioned, are taken, to deal with the various aspects of this question, to unify the control, to get common direction and common policy. I suggest that we shall never make real headway in this or any other similar matter until we have fixed responsibility for getting it done upon a given body of men, because if responsibility is divided among half-a-dozen different sets of people it is quite easy for one man to suggest, and quite honestly to think, that the responsibility belongs to someone else.

Referring for a moment to our present experiences, if we were told that we were going to have a new wave of influenza, in the present state of know ledge I am informed that it would be difficult and probably impossible to take adequate measures of prevention. But still it is quite clear also that if our organisation were better, if our agencies were directed by a common mind to a common end, we could have done very much more than we have. I may give another illustration of what has been done already by the hearty co-operation of the offices concerned. This country runs the risk, on demobilisation, of the introduction of a number of diseases, some of them of a very dangerous kind. Large numbers of our men have been infected with dysentery, malaria, and various other diseases, from which hitherto we have been in a large measure free, and we are endeavouring, by the joint action of the War Office, the Admiralty, the Air Service, and ourselves through my hon. Friend and colleague the Parliamentary Secretary, to see that we take steps, as far as we can with our present agencies, to prevent the introduction and spread in this country of various tropical diseases. We devised this organisation ad hoc during the last month, but it should be part of our regular organisation. I have no doubt that considerable success will attend our efforts.

The House will recognise that there are two stages in which we must proceed to deal with this matter. In the first we bring together the Government Departments concerned with health. In the next, the one which will have to be unfolded to the House later on, which the Speech from the Throne indicated, will be any proposals we have to submit with regard to organisation of certain services and the administration and extension of them, and so on, throughout the country. You have the central organisation and the local authority. This Bill relates to the central organisation. The House will see that in this Bill there has been one governing consideration which determines the Departments which will be brought together. It is set out in the third Clause. You will see there the Local Government Board, over which I have the honour to preside at the moment, the Insurance Commission, the services connected with the children under the Board of Education with respect to mothers and nursery schools, etc., the powers of the Home Office with regard to child life, are all amalgamated at once. The reason for that is this, that that gives you a central authority which deals practically with all existing, or the chief of the local agencies, Insurance Committees, local authorities, and the rest, all answerable to the one body, to control the general services of the country, and particularly those relating to infancy and maternity.

There is another group of powers which we propose to take later on. The House may perhaps desire to know why they are in the second category. We propose to take later on the powers of the Board of Control with regard to mental deficiency, and we propose to take power to take over the duties of the Minister of Pensions with regard to disabled soldiers, and the services of the Board of Education with respect to medical inspection, etc. Our reason for having this second category is that the first amalgamation is quite enough to tackle at the beginning. It is a very big job and it would be a mistake to overload the Ministry at the very start with too much work to manage at the beginning. Then there is another reason. The powers relating to mental deficiency raise a great many judicial questions which are not medical in any sense; the rights of the subject, the custody of the person and various other legal questions which clearly would have to be disentangled from the medical side of the matter. Then with regard to the Ministry of Pensions, we have postponed taking over the services in reference to the disabled men for twelve months, because in the first place we want to know what is the magnitude of the task that is to be taken over. That will be fairly clear in twelve months. There again you have to disentangle the medical services of pensions from the payments which are made weekly to pensioners, many of which are conditional upon the receipt of hospital or other treatment. That is a matter which requires serious and careful adjustment. The same applies to the services of the Board of Education.

Another provision is in the third Clause which may perhaps arouse some surprise. It will be observed that the Ministry of Health does not take over the central Medical Research organisation, the Medical Research Committee, but will transfer that to the Privy Council. I have been asked why we are not taking that over, and a number of hon. Members seem to think that that would be the natural thing to do. I said some time ago that we were not to do this on the principle of grab, but from the point of view of what is the best way to do it. The Ministry of Health which is proposed to be set up here, with qualifications to which I will refer later on, relates to two parts only of the United Kingdom—England and Wales—but if the Medical Research organisation, the Central organisation, included England and Wales merely, you would have the Scottish Board of Health, and my right hon. Friend the Scottish Minister of Health claiming one too, and the same I suppose would be the case as to Ireland. Knowledge is not limited to any particular part of the United Kingdom.

Photo of Mr Edward Carson Mr Edward Carson , Belfast Duncairn

Is that why you leave Ireland out?

Photo of Dr Christopher Addison Dr Christopher Addison , Shoreditch

The reason is this, that this body served all Ministries. We have proved that during the War. I remember that my right hon. Friend and myself had a good deal to do with the designing and setting up of this organisation some years ago, and it is an organisation which has done magnificent work during the War. I think our wisdom has been justified by the event. It has occupied a detached position so that it could serve all, and whether it was tropical diseases or in connection with the Army or the Navy, or the Colonies, they all naturally went to this body without any jealousy. The right place to have a central research body is so that it is independent of departmental considerations. That is why now we place the Research Committee under the Privy Council, which is as wide in its sphere as the Empire, and I am sure it is the right place to put it. Another change in the Bill as compared with last year is the reference in Clause 3 to the Poor Law. The House will remember the very important declaration which I made on the authority of the Cabinet last year, that we had substantially accepted the recommendations of the Committee presided over by my right hon. Friend opposite, with respect to the Poor Law, and we propose to give effect to them as soon as we can. But in one respect I have always felt that my right hon. Friend was in a privileged position, in that he showed us the fence of difficulties, while some of us have to find our way over that fence. Certain parts of the Poor Law are extremely intricate, and as an illustration of that I may mention that we shall have to deal with Statutes going back as far as the reign of Queen Anne. [An Hon. Member: "Queen Elizabeth!"] At all events, going back a very long time. You have many complex questions, such as overlapping areas, rating powers, and other matters of that kind which are exceedingly difficult and exceedingly involved. That is why I made my friendly remark about the right hon. Gentleman. As he knows, the matter is exceedingly difficult and it will take considerable time to disentangle these things.

What is embodied in the Bill now on this subject does not very much differ from the statement I made last year. We think the time has come when it is our duty in the near future to deal with the local services and to disentangle the treatment of sickness from any relation with the Poor Law. There are under the Poor Law very well managed and excellently equipped institutions. Those who manage them know well enough that they are there to minister to the needs of the sick, and in the main I believe I can say they do it very faithfully and well. But after all, if you are going to deal with sickness as a whole from the point of view of promoting the strength and vigour of our people, we cannot consider it in its relation to destitution. We have to consider it merely as a problem of sickness and that is why this declaration is in the Bill. The House will see from the various powers which are transferred to the Minister of Health that he is to be a gentleman with very wide powers indeed. They will also see how necessary it is that he should have power to deal not only with the actual remedial services but, what is much more important, that he should have power to deal with preventive services—those that are preventive and affect the question by environment. That is why the housing question must remain with the Ministry of Health. On a future occasion, I hope before long, it will be my duty to submit to the House the provisions of a Bill which is now under consideration relating to housing. We have up and down our country, both in towns and in villages, a number of places in which our people spend half their lives and which are really no better than pig styles and quite unsuitable as human dwellings. There is nothing more intimately related to the foundations of health than the places in which the people live. That is why housing must be made part of the Ministry's affairs.

All that is very important, but the Ministry should not be saddled with things which are not really appropriate to its proper business. That is why both in the Schedule of the Bill and in the Bill itself powers are provided to enable the Minister to get rid of things which are amongst the transferred powers, but which do not relate to the health of the people. I am sure that nothing would give me greater joy, if I happened to be the Minister, than to pass over to the Minister of Ways and Communications the control of motors and various other matters of that kind which at present are dealt with by the Local Government Board. I do not know which Minister will be persuaded to take the compilation of the Parliamentary register—perhaps it would be my right hon. Friend the Home Secretary—but, at all events, it is not a matter which is properly the function of the Minister of Health. There are other matters which are indicated in the Schedules as matters to be transferred to other Departments.

Photo of Sir Philip Magnus Sir Philip Magnus , London University

May I ask if it is proposed that the Local Government Board shall cease to exist altogether?

Photo of Dr Christopher Addison Dr Christopher Addison , Shoreditch

I thought it was evident from what I said. The Local Government Board and the English Insurance Commissioners will cease altogether, and all their powers are transferred to this Ministry, which has a separate existence. Therefore I think it is one matter of commendation for the Bill that it does not create an additional Ministry. We come to a matter which, I think, must give some satisfaction to those of us who have been concerned in the working of public health for a long time, and that is that the other parts of the United Kingdom are not satisfied to be left out of the Bill, but want to get it themselves. I know what are the views of my right hon. Friend below the Gangway (Sir E. Carson) with regard to Ireland, and I say I entirely share them. The reason why, in drafting the Bill, it was not applied in many respects to Ireland was because the system in Ireland in many respects is very different from, and, I am afraid, in some respects very far behind, what it is here. So it was not easy to make the Bill applicable, but, as far as that goes, however, I am quite pre-pared to try and make it applicable to Ireland as far as we can, and to accept in that sense the spirit and intention of my right hon. Friend's Instruction.

Photo of Mr Joseph Devlin Mr Joseph Devlin , Belfast Falls

Does the right hon. Gentleman propose to apply this Bill to Ireland without considering the views of the representatives of Ireland generally?

Photo of Dr Christopher Addison Dr Christopher Addison , Shoreditch

The Irish Members can state their views fully in the House of Commons with freedom and facility. I shall be glad to consult their views in any practical way which the hon. Gentleman can suggest. Another problem which this Bill has brought to the front is that it emphasises the necessity for devolution. It was drawn within the limits of our present forms of government. That is why my right hon. Friend the Secretary for Scotland announced to-day that owing to the change of procedure it would be taken separately so far as it affects Scotland. We were asked to create a Ministry of Health for Scotland and the same for Wales, and the same for Ireland. I think that would be in accordance with the lines which would follow under devolution, but you could scarcely alter your constitution under the cloak of setting up a Ministry of Health. If we come to devolution, let us call it devolution, but do not let us call it health.. That is why the Bill was drawn within the limits of existing forms of government. But it is, at all events, some satisfaction to some of us who thought devolution was necessary for years past. With regard to my hon. Friends who re-present Wales, I hope it will be possible to meet their views in Committee, and, at any rate, we will do our best to try.

5.0 p.m.

There is another feature of the Bill which is unusual, and that is that we propose to constitute a number of advisory committees to the Ministry. This was a feature of the Bill which was much criticised by those with whom I consulted, and I dare say in Committee upstairs they will have some criticisms to make upon it. As far as I am concerned, I am a whole hearted believer in this proposal. I believe that it will mean that the Ministry itself will be kept up to the mark. It will mean that a number of people who are interested in these problems will be given an active, or sufficiently active, share in policy matters, and the Minister will be kept in touch with progress and with the opinions of people outside in a very real and intimate fashion. I believe also a body of this kind will be very useful for the officers of the Ministry as well. Departments may get into old grooves and rather apart from life and things outside, and I think that it is altogether to the good that we should have some body of this kind in our organisation. I may say it is the intention that these advisory councils should not be larger than we can help. They would be set up by Order in Council, and a draft form of Order will be found in the Vote Office. It is proposed under that Order that they will deal with matters referred to them by the Minister, and they will be able to make suggestions to him that they should advise on certain matters, or they may initiate suggestions themselves, and I hope it will be found that they are a useful innovation.


Is it the intention to set up these consultative councils on the basis of a definite council for a definite area?

Photo of Dr Christopher Addison Dr Christopher Addison , Shoreditch

No; I do not propose to set up these councils either from the point of view of area or from the point of view of representation of interests. I think you want experience and knowledge, whether on local authority questions, insurance questions, or medical questions, but you want to get the best people you can to advise you, and it is immaterial, I think, what part of the country they come from or what their nationality is; and, therefore, I think you should rigidly set your face against any geographical limitation of these bodies or any constitution of them from the point of view of the representation of interests, although it is quite clear that there will be different groups of problems with which the Ministry will have to deal. Arrangements are made for taking over the insurance work, and the financial matters dealt with by the National Health Insurance Joint Committee are retained by them under the Bill, the Secretary for Ireland, the Minister of Health, and the Secretary for Scotland being on the common body dealing with financial and other questions; and arrangements are also made to deal with judicial matters which at the present time fall outside the scope of the functions of the Minister of the Insurance Commissions. My right hon. Friend the Member for Derby (Mr. Thomas) and other Members of this House got together last year bodies of people connected with insurance matters, local government matters, and medical questions, and this Bill has been thrashed out in full detail, or at least the proposals in it have, with these bodies, and I think I can say in the main that it has received the support and concurrence of all these different and very important groups of organisations, and I may add that that end has not been achieved without some considerable diplomacy. I have always found that whenever we treated a thing on big comprehensive lines, with sole regard to the national interests and the best way of dealing with health matters, sectional interests immediately fell into the background. I cannot pay too high a tribute to the assistance these gentlemen have given me. May I take this opportunity of saying, in reply to a good many correspondents, that those who are concerned at the present time with various branches of our health services need have no misgivings as to the future. One gets inquiries as to whether they are to set up a cottage hospital or whether provision of a village nurse is a fit subject for a local war memorial scheme. Of course, they are. We have not anything like enough of these services, and none of them have anything to fear from the coming of the Ministry of Health. We shall want more of them, not less, provided they attain proper standards of efficiency.

May I point out that when in the next stage we come to explain our proposals to the House, it will be found that there is to be a wide extension of facilities in connection with nursing, midwifery, diagnosis, hospitals, and so forth, because in our poor districts, in our country districts, and amongst the middle classes there are large sections of the community which have not at their command at the present time the services that we have at command. In this respect, I think, nobody suffers more than the poorly paid middle classes. Our great voluntary hospitals cater for the poor, although many of them can get admission only by charity or good fortune, and there is always a long waiting list at our hospitals—and there ought to be no waiting list. The poor middle classes are between the upper and the nether millstone all the time. They cannot afford the fees of the great expert, and naturally they do not want to be the recipients of charity, and therefore it often happens that this class of our population suffers most from a lack of the best facilities. But beyond and above any extension of our remedial services, prevention is the thing that this Ministry must aim at, and wide as our opportunities may be in treatment, they are as wide as the world in the realm of prevention. For instance, we have half a million children in our schools suffering from malnutrition, which is a preventable complaint in the vast majority of cases, and these are the children who get measles, tuberculosis, and all the rest of it. Then I do not know how many hundreds of thousands of them are suffering from deafness, due to living in in sanitary dwellings and such causes.

Photo of Mr Edward Carson Mr Edward Carson , Belfast Duncairn

May I ask whether the Ministry of Health will deal with the cases of the blind and the deaf and dumb?

Photo of Dr Christopher Addison Dr Christopher Addison , Shoreditch

Certainly. All those classes will come under it. We could not have two better illustrations than those given by my right hon. and learned Friend. Directly you begin to probe into these things you will find that an immense proportion of these cases could have been prevented. In fact, it was only two days ago that I asked the best adviser that we have what his view was, and he said that, in his opinion, so far as the revelations of the physical defects of children in our schools were concerned, the bulk of them were preventable. If that is true, think what it means. There are hundreds and thousands of these children, and the bulk of their defects are preventable, so that there is plenty of work for all our agencies and the best of our services. As a matter of fact, it is clear to any man of common knowledge that the bulk of these things are preventable, or at least a large proportion of them are. Many of the disabilities from which the men examined for the Army were found to suffer had their origin either at birth or even before that. They came from living or being brought up in unhealthy homes, and from them or their parents not having a proper knowledge of the kind of food they ought to eat; they came from living in stuffy rooms because they had never been taught to appreciate the necessity of fresh air; and they came from a large number of other causes of that kind, such as improper conditions of work and improper hours. In this connection one's mind turns to what was found at the Ministry of Munitions by that Committee which investigated the conditions relating to the health of the munition workers. We found that we were in a large number of cases able, not only to improve the health of the workers, but to increase the output at the same time by a sensible, practical, and common-sense survey of the conditions under which they were working. All these things should come under the cognisance of men who have to deal with health matters. The vast majority of them are the natural and obvious effects of common and well-known causes, and the fact is that in these things our practice is a long way behind our knowledge, and this organisation is mainly required to enable us to get nearer into accord with our knowledge. Let me say, finally, that this Bill provides only a necessary instrument. The development of the services throughout the country will have to come later. The Bill will have to be an instrument that can stimulate and develop them. This is only the central instrument, and if you want to promote the health of our people in a rational, comprehensive, sensible, and adequate way this is a vital and essential instrument, and on that ground I commend this Bill to the House.

Photo of Mr Donald Maclean Mr Donald Maclean , Peebles and Southern

The House will congratulate my right hon. Friend on the clear and excellent way in which he laid this very important measure before the House. No one is better entitled to do so. By his professional skill, his long Parliamentary experience, and his fine public spirit, he is essentially the man to introduce such a measure. I congratulate him on dropping Scotland out of the Bill, because I can tell him and the right hon. Gentleman the Secretary for Scotland that they not only saved the House a large number of speeches of vigour and length, which may well be, made upstairs, but that they have got out of the way the Amendment in the name of my hon. Friend the Member for East Edinburgh (Mr. Hogge) and his colleagues. It is an excellent idea. It would have been a very serious brake on the progress of the Bill had they not done so, and I heartily congratulate my right hon. Friends on the wise decision at which they have arrived. I should like to say, first of all, how much everybody must agree with the general ground on which my right hon. Friend bases his Bill, with the unhappy national circumstances which we find at the present time pointing the moral of his remarks. The reaper is busy among us—among every class in the land—and, since we have not yet left the realms of war, we can remind ourselves that as worthy battles are fought with fairness glory against the enemy of disease and dirt and social degradation. As the right hon. Gentleman wisely pointed out, the only way in which that can be done is by co-ordination of forces and unity of command. It is, I suppose, the note running through the whole of his speech, and indeed throughout the Bill—that message of co-ordination of succour. I would like to corroborate what he said with regard to recruits for military service. Often it was quite easy to realise what would be the grade of the man by glancing at the papers to see the district in London from which he came. Seven times out of ten you could always guess the grade into which the man would naturally fall.

We were all delighted to hear that my right hon. Friend was so fully seised of the elementary fact that the conditions under which citizens live very largely determine the health they enjoy. As he pointed out, no mere attempts to cure will meet the case, unless we adopt wise methods of prevention. He touched on one of the gravest evils, and that is the terrible defects of housing in the country. I would say only one word with regard to Scotland. May I read three lines from the Housing Report on the conditions there: 45.1 per cent. of the population in 1911 were living more than two in a room, 21.9 per cent. more than three in a room, and 8.6 more than four in a room. The mere reading of that is sufficient indication of some of the evils which my right hon. Friend is endeavouring to combat in this Bill. He appealed for unity of support, and a union of national interests to override particular interests. No one knows better than I do, after such experience as I have had, as to that terribly difficult task. It is a really serious matter to grapple with, and if for one or two minutes I refer to the Report of the Committee over which I had the honour to preside, it may, perhaps, bring home to the House some of the difficulties of the overlapping of local administration. The Committee was composed of persons who were all—exceptmyself, of course—extraordinarily well qualified to deal with the question, and it may be interesting to remember that there were gathered there the protagonists of other days—Lord George Hamilton and Mrs. Sidney Webb—I mention only those two—who finally agreed on the Report, although the whole country knew what serious differences of opinion unhappily divided them in the long gone by. The first thing with which we had to deal was the question of the boards of guardians, and we speedily came to the conclusion that it was quite necessary that those boards should be abolished. A great complaint was made that we did not call evidence, but it was quite hopeless to endeavour to go over that ground again. In dealing with the whole question of the work of the boards of guardians it became speedily evident that the dominant factor was the question of health. Every hour that we devoted to it we came, back again to the question of health. It is very likely, therefore, owing to that fact, which we brought out very clearly in our Report, that a large amount of support was given to my right hon. Friend and his advisers to go forward with this Bill.

What are the facts with regard to this question of overlapping? There are no fewer than seven different public authorities giving money assistance in any home which requires it, leaving out of account the exceptional cases of money payments for education. On the question only of medical assistance, there no fewer than six different authorities which may be rendering assistance to a given family, and often the officials working for these authorities do not know that the other authorities are connected with it. There is no proper system of registration. In the case of a family, a board of guardians may be rendering medical assistance, and the local health authority, the insurance committee, the local war pensions committee, the local education authority, and—if the family should unhappily include some mentally deficient member—the mental deficiency authority may also be rendering some assistance. Wherever we turned, the same trouble arose—overlapping, additional expense, official friction. It is extraordinary that in any common-sense community it should have been tolerated so long. In the work of the guardians, three quarters of their expenditure of money and officials' time is in connection with services relating to children, maternity, the sick and the aged, because the able-bodied problem is very largely out of the way, and if we are at all sensible it never will achieve the proportions that it did any time, say, within five or six years of the War. There is no need for that at all. This, then, is a question which will not wait, if we are to carry in any degree a proper sense of our responsibilities for the future.

I do not know whether I might give another example of how these various authorities work. Let me just tell the House the different authorities which may have to do with a baby of live and under. There is a midwife, who is under the county council. If there be a doctor's fee, the local sanitary authority comes in, or the guardians. Suppose the child has some inflammation of the eye, then the county council comes in, but, if there be a permanent affection, the local sanitary authority comes in, and if there be some other part of the child's body affected the county council is the authority. If there be puerperal fever in the case of the mother, that is a question for the local sanitary authority. But the midwife has to be dealt with under a different authority, under the Midwives Act, the health visitor under the board of guardians, while the Infant Life Protection Act has also to be administered by the board of guardians. Then suppose a Government grant comes from the Local Government Board for nursing or medical aid, now for measles or whooping cough it is all right, but for scarlet fever or diphtheria, no. I am just giving a bald recital of the facts. It really is absurd that that can be going on to-day. After all the lessons which the nation has been taught, we are now at this time of day debating the matter, and I am sure there will be an immense amount of opposition when you really get down to it. I only hope the facts we are now trying to make public will make it rather more difficult for vested interests to operate against great public measures which are urgently needed in the interest of the nation as a whole.

Having made these somewhat general remarks, let me say a few words on the Bill itself. I quite agree with my right hon. Friend that it is sweeping. I must say I gasped—I do not know whether with astonishment or relief—but certainly he swallows the Local Government Board. [An Hon. Member: "Why not?"] That is a very big mouthful. He proposes to rejects bits of it which he does not want. I will only say that I am all for wide and sweeping, drastic changes, but this will have to be rather carefully examined, because, after all, the Local Government Board has grown up after many years under very able officials, though no doubt it has grown out of touch with many developments of our modern and social administration. That may be so, but one knows the number of times the Local Government Board comes into private Bill legislation, which shows how wide and sweeping are its powers, and in the vast majority of cases how beneficial is its work. It is a tremendous proposal, and I hope and believe that will be most carefully examined in Committee upstairs—if the Bill is going upstairs, as I suppose it will—to see whether there is a sufficient case for so wide and sweeping a proposal. Then my right hon. Friend very wisely said he had omitted, for technical reasons, to take certain powers of the Home Office. I do not see why the medical side of the factory legislation of the Home Office does not come under the new Ministry. It is a most important question, and I should have thought it very naturally falls into the scope of the proposals of my right hon. Friend.

I am particularly delighted to find that he has practically taken over charge of the children. I think that is important, and makes up for a great many defects, because, unless we look after the children, I do not know what is to become of the State. A great gap has been torn in our social life. Seven hundred thousand of the most fit of our nation are gone, and at least another 1,500,000, who would have been the fit fathers of another generation, are devitalised—broken in health and in general capacity. Every child is one of the most precious jewels this nation has at the present moment, and any effort the State devotes to the well-being and development of the child is worth any amount of money and any amount of energy you put into it. Blank negation must give way to a new and living interest in the development of the child. Therefore, I most cordially welcome the fact that my right hon. Friend has here taken wide, sweeping powers of co-ordinating all possible efforts on the health side in the cause of the children.

One word or two in regard to the proposal about the boards of guardians. I say at once that the work which has been done by boards of guardians, especially of recent years, has not received anything like its fair meet of public recognition. There has been an immense amount of splendid, unselfish, unknown work done by boards of guardians. It was immediately apparent after the War began how well their work on the infirmary side had been done. Some of the very best war hospitals in the country have been justly regarded as those in the old infirmaries which were taken over with all their staff and equipment, and these furnished at once an excellent testimonial to that side alone of the guardians' work. We must, however, face the fact that there is an immense amount, a very right and proper amount, of prejudice against what is known as pauperising. I think the time has come when boards of guardians must be mingled with other authorities. I myself hope, whatever is done, that use will be made of those splendid men and women who have been constituting boards of guardians in the past. I am certain that they will devote their splendid public experience and their unselfish efforts to the furtherance of the public good in some other form than that which has been associated hitherto with boards of guardians. I hope there will be no unnecessary change in regard to their work, but only a change of instrument. My right hon. Friend is forming his supreme war council.

You cannot, however, carry on a war with a war council. You must have your units, which are going to do the real work in the field. The sooner he sets to work in regard to the necessary measures for getting local authorities who are down at the seat of the trouble the better. I am certain the whole community will welcome the introduction of this Bill. They will realise that the motto of New York is one which can really be carried out in their experience. That motto is: Public health is purchasable, and, within limits, a community can determine its own death rate.


I was, unfortunately, unable to have the opportunity of listening to my right hon. Friend; negotiations of another kind were the real cause of my absence. Nevertheless, I desire to say that there is no Minister who has worked harder than my right hon. Friend in connection with this Bill. For eighteen months, week after week, he was engaged, against tremendous opposition, pressure, and prejudice in meeting many conflicting elements; and I am perfectly certain that he is not responsible for the delay in bringing forward this measure. It would be idle to deny that there is no piece of legislation so necessary as this Bill. It is rather a disadvantage that it required a war, with all its horrors and sacrifices, as well as the patriotism so magnificently displayed by our people, to bring home to all sections of the community what a handicap there was in the health of our people. We have read of C3 men. We have been acquainted with young men who at the call of duty responded to the call. They did not hesitate to offer their services. They repeatedly offered them on many occasions. It was a sad reflection, I repeat, on our social system that these men had to be rejected, and could not serve in the War, because the country itself had neglected to do its duty in looking after their health. I would be deceiving the House if I did not frankly admit that, so far as the Labour party is concerned, we look upon this Bill only as a first instalment. One virtue of the Bill is that it for the first time co-ordinates the many authorities dealing with health questions. The fact that so many authorities at this moment are charged with this duty means that nothing is being done. [An Hon. Member: "Question!"] At least we have this particular advantage in co-ordinating the whole health services under one administration. It wilt be impossible for right hon. Gentlemen opposite to excuse their mistakes by passing the blame on to somebody else. In other words, we will at least be in a position to hold someone responsible. If the Minister, whoever he is, in charge of this matter—I hope the Act will be in force in the very near future—is kept to his job, and Parliament recognises its duty and responsibilities, then I am perfectly certain that something will be done.

I must, however, confess that I am somewhat apprehensive if this measure is transferred to the Local Government Board. My views on the Local Government Board are well known. I believe that the Poor Law arid Poor Law administration stink in the nostrils of all progressive men today. I boldly declare that there is much responsibility for the delay in bringing forward this measure due to the "dead hand" of that particular Department. If it simply means that all these magnificent Clauses, all these great proposals, and all these wide and extensive powers are merely to be transferred to this body, and nothing more is heard of it, then, instead of the Bill being an advantage, it will be mere camouflage. What I desire to impress upon my right hon. Friend is that we want a change of spirit in the Local Government Board. We want them clearly to recognise that there has got to be some driving force, and a different atmosphere, or this measure will not be so advantageous as some of us want it to be, and as, I believe, the whole House expects it to be. That, I put to my right hon. Friend, will clearly necessitate some driving force. For instance, I want the advisory councils that are proposed in this Bill to be real live bodies. I want them to be composed of people of all sections, men and women with experience, knowledge, and interest in the particular question. Whilst, of course, the Minister must always be responsible, we, at least, expect that he will look upon these new bodies as a sort of consumers' council, acting as a driving force to see that things are done.

I want my right hon. Friend also to recognise that if this Bill is to be really effective we must have large Exchequer Grants to the local authorities in order that they may be able to do their work. Anyone in this House, or connected with local administration, knows perfectly well that the great difficulty to-day in dealing with all these questions is that the local authorities always excuse themselves on the ground of the rates, often justifiably! They are entitled to say that the question of the public health is not exclusively a local matter. They are entitled to say that often local authorities are crippled by circumstances for which they have no responsibility. This occurs mainly in the poorer of our authorities. They are entitled to urge that at least the Government shall not be behindhand in giving them substantial Exchequer Grants to enable them to do their work. I know the difficulty with the Treasury. Just as one may say that the Local Government Board retard progress in some directions, so in others my right hon. Friend will be up against the Treasury. My only comment is that, whatever might have existed in 1914, whatever might have been tolerated in 1914, is not good enough for to-day. Our people will not stand it. Our people demand something better. Our people have already shown that they are entitled to something better. By the Minister in charge recognising that I am quite sure he will be able to persuade the Treasury that they must not adopt the usual policy—they must recognise the changed times.

I should like to see some more provision made in connection with the taking over of our voluntary hospitals. No one can do other than pay a tribute to the magnificent work that they have done and are doing. No one can do other than appreciate the magnificent services that have been rendered by the medical provision of our voluntary hospitals. After all, however, so far as the working classes are concerned, it is one of two things which is open to them—charity or the Poor Law. So far as the Labour party is concerned, they are quite clear, and quite determined—and they believe the time is not inopportune—that instead of these great institutions being maintained and being dependent on the charity and good will of the public, they shall be real national institutions, provided and paid for by the public, and administered for the public as a whole. There are many other points that one might deal with, but I do welcome this Bill as a first instalment of the election promises of hon. Gentlemen opposite. Every Member of this House on either side is committed to a new England, no matter to what party he belongs. When we recognise, as we are compelled to do to-day, that the homes and conditions of our people are such that breed disease, we are all satisfied that something must be done. Just imagine for a moment the waste of public money to-day, even under the Insurance Act, which, by the way, was the very first attempt to ascertain the health of the people. In that Act we provided 30s. to at least give some chance in the most critical period of a woman's life. We provided also, in order to prevent her going to work following maternity, that she was at least to be paid four weeks' benefit. But after that, so far as the State is concerned, there is no more concern for her or the baby, with the result that you can go into many of our industrial towns and see a procession of women coming out of the factories, and they rush into some hovel to find the baby that has been left to the care of someone else. After all, the child life of this country should be an asset to the nation, and it should be our first consideration, because these children are the citizens of to-morrow.

In welcoming this Bill we of the Labour party recognise that it is the first step forward, and we will give all the assistance and help we can to the speedy passage into law of this measure. I hope that the same determination, enthusiasm, and energy which my right hon. Friend opposite has displayed with many conflicting interests during the past eighteen months will be shown by the Minister in charge of this Bill, and I hope that the same energy displayed in the administration of the Insurance Act will be the kind of energy that will be displayed in his Department. In other words, I hope that, whilst these things are transferred to the Local Government Board, it is to be a new sort of Local Government Board, and it is not to be conducted on the old methods of the past; and, above all, I hope that the pledge which is here given to put into the operation the Maclean Report, which means the abolition of the Poor Law, is one not to be embodied in this Bill, but is to be given immediate effect to as soon as circumstances warrant. As my right hon. Friend knows, there is a very strong feeling in the trade union and friendly society movement on this question. We only accept this Bill as an instalment with a distinct understanding that the Maclean Report is to be followed by immediate legislation, and I hope that this first Bill to create what I have referred to as a new England will only be the first stage in this House towards many reforms dealing with the social condition of our people as a whole.

Photo of Mr Edward Carson Mr Edward Carson , Belfast Duncairn

I only desire to say a few words on this Bill, more particularly with regard to its application to Ireland. In the first place, may I join in my congratulations to the President of the Local Government Board for having brought in a Bill which, in my opinion, at all events, has before it, if it passes, a great future. I am well aware the Bill only deals at the present moment with machinery, but the machinery is the most important foundation of the whole matter, and when you have set up your machinery, I think you will find that when it is somebody's duty to do a particular thing and there is the machinery provided for doing it, you will have a much better chance of the thing being done whole-heartedly. When this Bill, or a similar Bill, was before the House in the autumn I entered a protest against it not being applied to Ireland, and I did so for the reason that, I regret to say that for some years past there has been a growing disposition in the House in Irish politics to leave out from Bills for the amelioration of the people Ireland, with a view to avoiding political opposition, or with a view of getting the Bill through in an easier way. That policy has proved very disastrous to the people of Ireland.

Last year we passed for England and Scotland an Education Bill of a far reaching character, and in regard to those Bills, great and beneficial as they are going to be for Great Britain, we are already beginning to perceive that they are going to leave the boys and young men in Ireland at a great disadvantage. So far as I am concerned, I am determined in whatever way I can to urge upon this House the great necessity of not treating the people of Ireland as if they did not require the same measures of amelioration as the people of England and Scotland. If hon. Members who differ from me, for either political or other reasons, disapprove of this course as regards the parts of Ireland they represent, all I can say is I will then urge that at least the North-East of Ireland would gladly welcome all the measures of reconstruction and advancement for England, and they do not want to be left out because other parts of Ireland do not wish to come in.

I can foresee that a great deal is foreshadowed by this Bill. In the first place, my right hon. Friend has stated, and I think rightly, that the question of housing will be under this Ministry. That question has, in my opinion, more to say for the health of the people than almost any other question that comes before us. I am not sure that it does not also help to solve the temperance question, because if a man has a decent, comfortable, healthy house to come to I think he is not so likely to be constantly frequenting the public house. In Ireland, and especially the Constituency I now have the honour to represent, there is no more pressing question at the present moment than housing. It is a fact that in Belfast, growing rapidly as it is, having grown almost out of its clothes, I do not know how in the coming few years the people of that great community are to get on unless very drastic measures are taken to supply the deficiency of houses that exists there at the present moment.

There was another matter foreshadowed by my right hon. Friend, and it was the revision of the Poor Law, and there is no place requires a revision of the Poor Law more than Ireland, more especially on the question of the separation of medical relief from the relief of pauperism. I am not going into details, and I merely make these observations to show that there really is foreshadowed in this Bill a great, policy of amelioration of the people, and I claim that policy for Ireland just as you are claiming it for England and Scotland. I would join the Scottish Members in the course they have taken in asking for a separate Bill for Ireland, were it not that. I believe if I did so I should never get it. I think my only chance and the only chance of Ireland is to ask to be, included in this Bill, and then when the people of Ireland are included they will have a chance of getting relief in all the various ways which are foreshadowed by the policy that has been stated by my right hon. Friend. Ireland, as regards public health, is miles behind this country. Let me state one or two facts. The medical officers of health in Ireland are supposed to conduct the whole question of health, which includes preventive as well as curative methods and sanitation, and when I state that except in three out of six county boroughs there are no whole-time independent medical officers of health in Ireland hon. Members will realise what that means. There are some 812 part-time medical officers of health at an average salary of just under £20 a year, and very few, not 5 per cent., of the whole of that 812 hold a diploma of public health. You cannot wonder that the Branch Medical Council of Ireland have reported that these officers cannot discharge their duties to the best advantage of the public, and sanitation for this reason, combined with the permissive character of public health legislation in provincial and rural Ireland, has become a sad farce. It is worse, because it is practically non-existent. The course of legislation has been that the most elementary Health Acts are all permissive in Ireland, and, bearing this in mind, hon. Members will readily understand what a condition we are in. Let me take the Infectious Diseases Notification Act of 1889. That particular Act is permissive in Ireland, and there are six urban and fifty-one rural sanitary districts in which it is inoperative. There are sixteen urban and ninety rural sanitary districts in which the Infectious diseases Prevention Act of 1890 in Ireland has not been put into force at all. As regards the notification of tuberculosis, only forty-one out of 213 rural sanitary districts have adopted it. That is a scandalous condition of affairs to have to bring before the Imperial Parliament.

6.0 p.m.

May I mention one or two more facts? We have not in Ireland the power of medical inspection of the children of the schools at all. We have no such Act. That is another of the Acts that were passed for this country where Ireland was purposely left out. We have no method in Ireland for the inspection of the sanitary condition of our schools. We have hardly any legislation at all in Ireland, as you have in England, as regards the blind and the deaf. All these things are still in an antediluvian state of chaos, and I do press upon this House that they should insist that this Bill in its fullest form—I say that because my right hon. Friend said as far as it may be practicable, expedient, or something of that kind—should be made applicable to Ireland, and a strong body set up—I do not care whether it is in the Local Government Board, but a statutory body—whose duty and responsibility it will be to take care that no longer are these great subjects neglected in Ireland. I cannot myself see any difficulty in adapting this Bill to Ireland. Almost every Clause of it which is beneficial might be easily applied to Ireland. But even when that is done, I must beg the Government, and particularly the Irish Executive—and now that we have a new Chief Secretary who is a Scotsman probably there may be more hope for us—seriously and anxiously to take in hand this whole question of health in Ireland, and to do something to make up for the arrears which exist there, especially for our children, and indeed the whole of the poor population, something to bring us nearer the level, because it will take a long time to bring us up to the level, of what has been done for the people in this country and in Scotland. I hope that in this matter I may have the assistance of the hon. Member for West Belfast (Mr. Devlin). I hope, moreover, that if we do happen to agree upon a matter of this kind we shall not be told that we only agree because we want to rob the British Treasury. This matter is removed from politics. It is a matter upon which, I hope, we can easily agree, and still hold our own strong views. Perhaps we are each at the further end of the pole, but for all that, while this question of the settlement of Ireland is going on, as it has been going on for so many years, do let us recollect that generations are growing up, and that they are not having a fair chance.

Photo of Mr Joseph Devlin Mr Joseph Devlin , Belfast Falls

I cannot dissent from the rather powerful indictment which the right hon. and learned Gentleman has made against health conditions in Ireland, and he may be quite certain, however we may differ upon the best method of solving this question, that I am in perfect agreement with any Member of this House of any class or politics who is willing and anxious to improve health conditions in Ireland, and to do something to put a stop to the desperate ravages which diseases called forth by these causes bring about in that country. But where I do disagree with the right hon. Gentleman is in the method of the solution. When this Bill was proposed Scotland was included in it. To-day, at the request of the Scottish Members, Scotland has been excluded. Ireland was not included in the measure, and the right hon. Gentleman proceeds to include it. I object to that altogether. It is because I feel just as strongly and just as passionately as the right hon. and learned Gentleman the need for dealing with this great and insistent problem in Ireland that I want it free from all the intricacies of an English health system and a measure brought in for Ireland that will simplify the matter and, in my judgment, deal with the evil much more promptly and effectively. The right hon. Gentleman the Leader of the Opposition (Sir D. Maclean), paid a well deserved tribute to the patience and zeal and the effective labour of the right hon. Gentleman who introduced the measure. He stated that for weeks and months, and even for a year, the right hon. Gentleman, when planning this scheme for the betterment of the health of the people of England and Scotland, was in constant touch and communication with all the great authorities whose advice and opinion would be of valuable assistance to him in the ultimate adjustment of the questions involved. May I ask—no one knows better than the right hon. and learned Gentleman (Sir E. Carson), how different is the whole system in Ireland for dealing with health matters from that in England—what consultation has taken place between the Ministers who wants to include Ireland in this measure and the Public Health authorities, the medical profession, and popular opinion as expressed by Parliamentary representation? Has there been a single health authority, medical authority, or public health authority consulted on this matter? Not one. Has a single hour of the time of a single Minister, whether the head of the Local Government Board, the Chief Secretary, the Attorney-General, or any other Minister, been given to this matter? What have they done to consult Irish opinion and to consider the peculiar conditions in Ireland before they come to deal with this question of health? Nothing at all. Yet the right hon. Gentleman gets up and says that a measure that cannot be effectively applied to Scotland must be applied to Ireland; and without consulting anybody in Ireland, any of the services involved, or any of the influences that will be bound to be touched on the question of health in Ireland, he proceeds to incorporate Ireland in the Bill, though Ireland was not mentioned originally, and to take Scotland out of the Bill, although Scotland was originally incorporated in it. I do not think that is right.

If we are to deal with public health in Ireland, I want to deal with it on right lines, and it can only be dealt with on right lines by being left to an Irish Public Health Board. I want, as far as possible, to see the future treatment of the health of the Irish people divorced from the taint of Poor Law assistance. We have our dis- pensary system differing entirely from what you have in England or Scotland. The only successful body in Ireland up till now has been the Irish Insurance Commissioners, and they are going to be wiped out. Their powers are to be taken from them. They are to be made merely the escalier of a series of other authorities. The Board composed of the most successful officials, who have carried out the work of the Insurance Act and have given universal satisfaction, because the Board is not contaminated by association with Dublin Castle, is to be wiped out and cease to exist. The right hon. and learned Gentleman quoted the opinion of the Irish Medical Council. I think he might have gone further and stated what were the views of the Irish branch of the British Medical Association on this question. They most vigorously demand the appointment of an Irish Health Board. Surely the right hon. and learned Gentleman is aware, notwithstanding his strong Unionist views, that one of the curses in Ireland is the existence of forty English boards uncontrolled by anybody except one Minister here in this House. According to this measure, the only representative of Ireland upon this Health Board would be the Chief Secretary for Ireland. He would be responsible to this Parliament. In the terrific organisation of a great Health Department dealing with 45 millions of people, you are going to subordinate the interests of a country which, according to the right hon. and learned Gentleman, and rightly according to the, right hon. and learned Gentleman, is as pressingly in need of health reforms on the lines that he has indicated as any country in the world.

Photo of Mr Edward Carson Mr Edward Carson , Belfast Duncairn

I think the hon. Gentleman misunderstands me. Perhaps I did not make myself perfectly clear. I did not put it forward that health matters in Ireland should be under any Department except the Ministry here. I said that there ought to be a statutory body set up to deal with them, and I said that I did not mind whether it was in the Irish Local Government Board or an independent body, so long as it was a statutory body.

Photo of Mr Joseph Devlin Mr Joseph Devlin , Belfast Falls

The right hon. Gentleman is, perhaps, the most brilliant lawyer in these islands, and, indeed, in all Europe. I wish I had as much faith in him as a politician as I have in him as a lawyer. What would be thought if the right hon. and learned Gentleman was asked to go into court and plead his case from a blank piece of paper? That is precisely the case here. We are asked to deal with the health problem, and we do not know where we are. I suggest that in the first place you ought to bring in a Bill to deal with Ireland. You ought, in the meantime, to bring together the representatives of the recognised medical authorities, the Insurance Commissioners, the Local Government Board, and all who are competent by experience and desire to serve, and to have some sort of a conference, with a certain promise that the matter will be dealt with during this Parliament, and set up such a tribunal as would understand Irish conditions and be able to deal with them. As far as our intentions are concerned, there is no disagreement between the right hon. and learned Gentleman and myself. The health of the people is the greatest and most vital of all national concerns, and I have seen in Ireland, as the right hon. and learned Gentleman has seen, the evil fruits of sweated labour, of bad legislation, of neglected hygienic conditions, and of an appalling lack of moral responsibility. In no place has this been more felt than in Ireland, because so many of our vast social interests have been for gotten in the perfervid character of the political controversies in which we have been engaged. Speaking not only for a great working-class constituency—and I was taunted the other day by one of my colleagues for Belfast that I represented a slum district—

Photo of Mr Joseph Devlin Mr Joseph Devlin , Belfast Falls

Yes, I know, and there never was a grosser misrepresentation. It was for the purpose of contradicting the statement of the Provost of Trinity College that I made the observation. I know the right hon. Gentleman does not represent a slum district, but I do according to the hon. Gentleman opposite. Does he think that an attack of this character worries me? I represent it because I love the people in the slums, and I am here to serve them. I take no interest whatever in the aristocratic concerns of the constituents of the right hon. Gentleman. Not at all. My grip of the situation is this, that the rich and wealthy custodians of the right hon. Gentleman's interests in Belfast are very well able to take care of themselves. The slum dwellers cannot do that; they have sent me here to take care of their interests, and I am proud to represent them.

Photo of Sir William Whitla Sir William Whitla , Queen's University of Belfast

It is not my desire or intention at this early stage of the Session, before I have become familiarised with the Orders of the House, especially as I represent a constituency that has hitherto not been enfranchised, to speak at any length, but I will ask the House to bear with me for a moment should I transgress any of its regulations. I rise with great pleasure, after hearing the very generous concession made to Ireland by the right hon. Gentleman the President of the Local Government Board for England in this Bill. I rise to express on behalf of my Constituency, which is largely a medical one, our gratitude for the concessions of the Government, and I should like also to express my gratitude to that band of professional brethren in this House who are unanimous in their desire that this Bill should be extended to Ireland. We were somewhat disappointed yesterday morning on reading in the "Times" the reply of the Chief Secretary for Ireland to the important deputation which waited upon him regarding sanitary and health matters in Ireland. We were disappointed because he did not definitely give a promise that Ireland should be included in this Bill. But perhaps he did something equally important and equally valuable, something which I have no doubt has influenced the Government and the President of the Local Government Board,—something which was done by a distinguished and illustrious Irishman in the eighteenth century when he practically showed his sympathy with another phase of sanitary reform by proving, "with one Satiric touch, no nation needed it so much." I understand the Chief Secretary is a Scotsman. I do not think he has been sufficiently long in Ireland to become tainted with what we are accused of—the use of exaggerated language. If his remarks had been made by an Irish Member they would have been put down probably to Celtic exuberance. The Chief Secretary stated to the deputation that, after having carefully studied the reports which were placed before him he had come to the conclusion that the conditions in Ireland were appalling. I put that to the House as absolute proof that not only is sanitary reform needed in Ireland, but that it is needed most urgently. I have been practising in Ireland as a physician for nearly half a century, and I can testify to the absolute accuracy and truth of the Chief Secretary's statement.

We have in Ireland that machinery which the right hon. and learned Gentleman the Member for the Duncairn Division of Belfast (Sir E. Carson) has referred to under a variety of different heads. This Bill before the House is a great co-ordinating Bill, and that is what we require in Ireland. It asks for power to co-ordinate under the Local Government Board all the different powers that are delegated to different State Departments. One fact which I wish to put before the House as an absolutely convincing proof that this Bill should be extended immediately to Ireland, and that we should not ask for a separate Bill, is that we have all the machinery in Ireland at the present moment ready for the enforcement of this measure. I ask the Government only to "touch the button," and then, all the different Departments which the right hon. Gentleman seeks power to co-ordinate, will be found centred in the Local Government Board. That is an unanswerable argument for Ireland's inclusion in this Bill. It is natural that the House should ask why this machinery is not in motion. I do not wish to criticise—I have no desire to criticise the Local Government Board for Ireland. It has done its duty. But these powers are all permissive, and they are carried out by some 400 different bodies in a most sporadic and desultory manner. Under this Bill we see untold blessings coming to Ireland, and I thank the Government and my right hon. Friend for the inclusion of Ireland in the measure. As for the Ulster Members, I think, from what my right hon. Friend has said, our action is perfectly clear. We are not going to oppose this Bill. We know, and I know as a physician, that thousands of lives are yearly lost in Ireland owing to its alarming and disgraceful sanitary condition, and we are, therefore, determined to help to pass the Bill, to get it through Committee with all the speed that we possibly can, and to remember that while we sit dallying in Debate, or hair-splitting on Amendments, lives are being lost in Ireland.

Photo of Mr Arthur Samuels Mr Arthur Samuels , Dublin University

In the first place, I wish to congratulate the hon. Member (Sir W. Whitla) and the constituency, which for the first time has power to express its views in this House on his maiden speech. I am sure that the representative of Queen's University, Belfast, in this House will have a Parliamentary career worthy of that body. I also wish, on behalf of the Irish Government, to say that we regret extremely the unavoidable absence of my right hon. Friend the Chief Secretary who, I am sure, will be glad of the facilities promised from all parts of the House for forwarding this important measure dealing with Irish health. My right hon. Friend the Member for the Duncairn Division (Sir E Carson), and my hon. Friend the representative of the Falls Division (Mr. Devlin) as well as the hon. Member for Queen's University, have all spoken of the appalling conditions prevailing in Ireland, and I am sure we are all agreed there is an overmastering demand for a measure which will improve the public health. The Irish Government has been reproached with its attitude in regard to this matter. May I point out what this Bill does and intends to do? I wish to repudiate in strong terms any suggestion that the Irish Government is thoughtless of what is going on regarding this question. As my right hon. Friend the Chief Secretary said to a very important deputation on Monday, it is the intention of the Irish Government to see that all those remedial measures for social reform and improvement in the health of the people which are to be applied to England, Scotland, and Wales, should be applied either immediately or pari passu, as the conditions best permit, to Ireland. I am sure that the House on all sides is anxious that the public health and welfare of the people of Ireland should advance along with that of the rest of the United Kingdom. The reason that the Bill which my right hon. Friend brought forward last Session was not thought quite suitable for Ireland—

Photo of Mr Joseph Devlin Mr Joseph Devlin , Belfast Falls

This was not the Bill of last Session.

Photo of Mr Arthur Samuels Mr Arthur Samuels , Dublin University

The Bill of last Session dealt with central administration, and it may surprise hon. Members to know that, as far as central administration and central machinery is concerned, the Irish position is ahead of that of the English. We have a better existing organisation. As was pointed out by the representative of Queen's College, Belfast, we have better working machinery.

Photo of Mr Arthur Samuels Mr Arthur Samuels , Dublin University

As far as central machinery is concerned it is easy to put it in operation, and in that respect we in Ireland are in advance of England. But health administration has broken down in Ireland.

Photo of Mr Joseph Devlin Mr Joseph Devlin , Belfast Falls

You are always breaking down in Ireland.

Photo of Mr Arthur Samuels Mr Arthur Samuels , Dublin University

It has broken down in Ireland and the reason for that is that the local administrative bodies which have to deal with practical matters touching the health of the people have permissive powers, and being permissive the result has been that the putting of them into operation has lamentably failed. What we have to do when we come to deal with a real practical measure for putting into operation the great preventive, the great curative, and the great administrative powers in Ireland, is to see that powers which have been neglected in the past shall not be neglected in the future. And here may I say that a tremendous responsibility is laid not on this House, not on the Local Government Board for Ireland, to which such a fine tribute has been paid by the Member for Queen's University, but on the electors of Ireland themselves and on the people who are returned to the county councils and district councils in Ireland for their failure to put the provisions which already exist, defective as they may be in certain senses, into operation. If they had put them into operation, public health would at any rate be far in advance of what it is to-day. Now let us deal with the Bill, and the reason it was not applied. The reason it was not applied is this: The Irish Government intended to have brought in a Bill to carry out, what I assume is the object of the representatives of the Government in Scotland, to deal with all these matters, having the more or less central machinery in Ireland. They hoped to deal with public health at once, and under that machinery.

Photo of Mr Joseph Devlin Mr Joseph Devlin , Belfast Falls

What does the right hon. Gentleman mean by a central machinery?

Photo of Mr Arthur Samuels Mr Arthur Samuels , Dublin University

I will deal with that in one moment. Extensive inquiries were on foot and are on foot with regard to certain powers we have to administer. My right hon. Friend intends to deal with the matter as soon as he gets the organisation necessary. If hon. Members will look at the Bill for one moment they will find that the operative Clause transfers to the new Minister all the functions of the Local Government Board, all the functions of the Insurance Commissioners, all the powers of the Board of Education in respect to mothers and young children, all the powers in the Privy Council under Midwives Acts, and certain powers of the Secretary of State under the Children Act, 1908. How are these powers, which do not exist in Ireland, to be dealt with in Ireland? The Irish Local Government Board has, speaking generally, the same functions as the English Local Government Board. They are of enormous extent. They deal with all sorts of different matters. I do not think it would be satisfactory in Ireland, when we are dealing only with the question of public health, to have to tear up all the multifarious legislation which is compact and bound together and is under the jurisdiction of the Local Government Board in Ireland. It is unnecessary for us to do that. The Local Government Board in Ireland is concerned with public health a great deal more directly than is the Local Government Board in England, for the whole of the dispensary system in Ireland, which provides for medical treatment and the provision of medicine not only to paupers but to all poor persons, is, so far as the central organisation of it is concerned, under the Local Government Board, of which the Chief Secretary is the head. As regards the Insurance Commission, you must recollect that the public health functions of the Insurance Commissioners in England do not exist in Ireland at all. There are no medical benefits under the Insurance Act in Ireland except, sanatorium benefits and they are carried into effect by an arrangement with the local governing bodies and under the Local Government Board. But the medical benefits do not exist in Ireland at all. It was at the request of the Irish medical profession and Irish Members that Ireland was excluded from those medical benefits, the reason being that it had this dispensary system.

With regard to the Board of Education, my right hon. and learned Friend has asked whether the new Ministry of Health will deal with such questions as the blind, epileptic and defective children. It is a most lamentable thing that under no Education Act, system or board in Ireland at all are there any arrangements whatsoever to deal with the blind, the deaf, the dumb and defective, although they have had that in England and Scotland for a very long time. I hope that when we have a Public Health Act for Ireland that defect will be remedied, and that we shall have at any rate something which will bring home to these poor children in Ireland the same advantages as the children have so long enjoyed in this portion of the United Kingdom. I may say that we have in preparation a Bill conferring on the Irish Local Government Board powers similar to those of the Board of Education with regard to the medical inspection and treatment of children. Up to the present we have had no such powers in Ireland at all, therefore they could not be transferred under this Bill. In the same way, the administration of that portion of the Children Act which is exercised here by the Secretary of State is exercised in Ireland by the Chief Secretary. I do not wish to detain the House by going further into all these different transferred powers. We do not want them transferred in Ireland, because we have them vested in the President of the Local Government Board, who is the Chief Secretary. Where it would be an advantage to Ireland is in the direction pointed out by my right hon. and learned Friend, namely, that we might adopt some of these measures. I hope that when we go upstairs with this Bill we shall have the combined assistance of all Members of both sides of the House to see how far we can make this Bill more effective in certain of its forms, especially with regard to consultative committees and other bodies dealing with general health, and to giving greater power, as has been suggested by the Irish branch of the British Medical Association, to the Department of the Local Government Board, reinforced by the addition of other Members, and having a statutory power and statutory abilities, such as have been suggested by my right hon. Friend.

Photo of Mr Arthur Samuels Mr Arthur Samuels , Dublin University

Yes; they will have executive powers. There are no politics in this matter. It is just as important for us all in Ireland to have healthy children, whatever our politics may be. We want more health and less politics. I wish to express the obligation of the Irish Government and my right hon. Friend for the way in which we have been met by the Minister in charge of this measure in trying to see that, so far as possible where it is applicable, it shall be applied to Ireland. I hope we may shortly have a measure which will relieve the terrible state of public health in Ireland, and shall see it enforced so that the public bodies who will be entrusted with its administration shall carry out their powers. The elections will soon be taking place for these public bodies, and a great obligation is laid on the people of Ireland as to the class of men and class of women they return to those bodies to care for the health of the men, women, and children of that part of the United Kingdom.

Photo of Sir William Cheyne Sir William Cheyne , Combined Scottish Universities

I wish, in the first instance, to congratulate the President of the Local Government Board on bringing in this Bill, which I believe, when it is suitably amended, will provide a fair basis for the erection of a great organisation. I do not propose to say much to-night, because now, fortunately, we have in the House a number of medical men who have practised in different branches of the profession, and I only wish to make a few remarks with regard to the machinery of the Bill. In the first place, I was very pleased to hear what the right hon. Gentleman said as to the principles upon which one should act. He said that this was not a political measure, and that all sorts of side issues should be put aside. I would lay down as an axiom that the health of the people is a matter of national concern rather than of sectional or vested interest. I propose in anything I say or do with regard to this Bill not to attempt to force medical interests unless they are best for the health of the people. It would be a terrible thing if measures connected with the health and life of the people were to be in any way emasculated in order to meet those interests, which may not be of vital importance. Health is a primary essential of the community and anything else must be secondary to it. When I say that, I do not mean that interests, sentiment, customs and habits, should not have full weight given to them, but if they interfere at all with health they must be given up. It is a necessity that whoever has to do with carrying out this Bill should be fully satisfied with the position he occupies and the remuneration he may receive. We do not want any sweating in connection with the Bill nor do we want any strikes.

Coming to the machinery of the Bill, we have had before us to-day another Bill, and the two Bills will illustrate the contrast I have in mind. The first Bill dealt with ways and communications. That is a known subject; the roads are there and we know how to make the roads. The mechanism of that Bill is simple, because we have done the things before and know perfectly well how to do them. But when you come to the question of health we are occupied with a very different state of matters. I speak with great diffidence in the presence of a number of doctors, but all must admit that our knowledge on the matter is not so advanced as it should be, and that we really know comparatively little about the fundamental truths of health and life. Therefore you must have a somewhat different organisation from what you have for a thing about which you know everything. My idea of the Ministry of Health would be that we should have a central brain, thinking, investigating, gathering information from every source and spreading it. That brain would have a great deal to do. Then, as quite a secondary thing, executive branches which would deal with the information and apply it according to various local conditions. When we come to consider the Bill, one looks to see where the brain is, and the only brain I can find is that of the Minister. I have nothing to say against the brain of our particular Minister, and, of course, I am not making any personal remarks at all, but the Minister must be a super-man to do all that is required for the thinking part of the organisation. He must assist it; he must form one of the thinking body. That is essential.

Then we find that consultative boards are to be instituted, and I know that he intends to make them real live boards; but I do not like the term "consultative board." A consultative body is a body that is never consulted. I have been on a consultative body myself in connection with one of the great Departments during this War. We have only been called together twice, whereas if we had been called together as I have asked, we could have done the very greatest service. The right hon. Gentleman himself used the phrase "advisory body," and that is a term I shall try to get put into the Bill. A real advisory body must meet at definite times, and should not only meet to consider problems sent to it by the Minister. It must initiate work. The third condition is that it must come directly in contact with the Minister. It must have direct access to him so that any decisions it comes to shall not be lost or pigeon-holed or delayed. He is going to have several consultative and advisory bodies. There is the thinking brain, as for as I can see it, of the Minister, plus advisory bodies, but I think most Ministers will get very tired of advisory bodies. The time will come when we shall have a medical man as the Minister, and someone who is a great executive man, and knows a good deal about the subject. He will get tired. I should like the right hon. Gentleman to think whether he-could not have, between the advisory committees and himself, a board which can thoroughly sift the information that comes from the advisory committees, and to which he can refer the information when he gets it. But even then I do not think the thing is complete. The medical profession approved of the Research Department under the Insurance Bill, and it has done excellent work. It has done the very work which was intended. It has given the sort of information a Minister of Health wants to get, but to my disappointment it was dropped and put under the Privy Council. I cannot see a Ministry of Health without a research department. With the thinking machine, the board I have suggested, the advisory committees and the research department, you would have a thing which would be of use not merely to England, but to the whole world, and which would show how to work a proper health machine. I should like the right hon. Gentleman to think over that problem. Everyone in the profession who has studied the subject wants these consultative committees. Of course the medical part of the committee would need to be selected very carefully. Physicians are in a state of great uneasiness and distrust about it now. It would go very far to relieve their mind if we can get an advisory body which is very carefully selected, which may be trusted by the profession, and which represents the best elements in the profession. The question will arise how to appoint them. I think the Clause reads as if it were an optional thing, as if it were in the power of the Minister to have advisory committees or not as he likes. It says, "It shall be lawful for His Majesty." The other paragraph says, "It shall be the duty of the Minister." I should like it to say, "It shall be the duty of a Minister to have a consultative body."

One other point as regards the duties of the Minister. His duties are most exten- sive. It seems to me he could upset everything if he chose. The right hon. Gentleman assured me the other day that so long as he kept within the four walls of the Insurance Act it would be all right. The question is how much he can do within the four walls of the Insurance Act. I am not enough of a lawyer to know, but I fancy he can do a great deal. For instance, taking the panel practices in crowded areas, I could imagine it may occur to the right hon. Gentleman that it would be well to go in for institutional treatment. He might like to set up an institution to which these cases can come instead of going to the doctor. Such an institution would have aids to diagnosis and would have consultants, so it would be an enormous benefit to the patients and to the doctors themselves. Then I can imagine the time will come when he will say, "We cannot allow people to be ill in their own crowded rooms; we must have them in hospitals. We will take over the Poor Law infirmaries"; and then the time will come when he will have to do something about voluntary hospitals. When that time comes Parliament ought to say what it is going to do. I should like an assurance that anything of far-reaching importance, like, for instance, interfering with the great hospitals and teaching schools, should, if he can possibly find a way, be brought before Parliament so that we may have an opportunity of discussing it, and, if necessary, throwing it out. As far as I am concerned, as far as the medical men in the House are concerned, and I think as far as the great part of the profession are concerned, we are sincerely anxious that the Bill should be a great success and a great example, and we will do all we can to help it.

7.0 p.m.

Photo of Mr Thomas Griffiths Mr Thomas Griffiths , Pontypool

As a new Member of this House, and I believe the only new Member who has spoken this afternoon, I want to crave the indulgence of the House and hope it will extend to me the same sympathy as it has extended to other new Members. I represent one of the most important trades in the country—the iron and steel trade and the tin-plate trade in South Wales. The right hon. Gentleman (Dr. Addison) knows what a laborious trade it is and how much ill-health arises in connection with it. For the last two years in divisional council meetings the members I represent—100,000 in number—have pased unanimous resolutions in favour of establishing a Ministry of Health. This has also been done by the miners in South Wales, the railway men, and also the women from the Industrial League of Women. The introduction of this Bill is long overdue in so far as the working classes of this country are concerned, and I want to associate myself with the other hon. Members who have congratulated the right hon. Gentleman on having had the privilege and the honour of introducing what to my mind, is one of the most important Bills which has been brought into the House during the Session. Some of the Bills that have been discussed in the House have dealt with the re-election of Ministers, others have dealt with the mode of procedure of the House, but this Bill affects every house in the land, and every individual in the land, both rich and poor. We have been told, I believe by the Prime Minister, that it is absolutely impossible to get an A1 nation out of a grade 3 population. This is true, according to the statistics which have been placed before us in reference to infant mortality in this country. I read that one eminent doctor stated that a thousand babies were dying in this country every week, and that 75 per cent. of the lives of these babies could be saved if we established a Ministry of Health. Napier Burnett, speaking at Newcastle last week, stated that 100,000 deaths had taken place from influenza during the last three months, and that the rich and tine poor were dying far more rapidly as a result of influenza than did our heroes who were killed out at the front. He stated that the reason for this was the shortage of the medical staff and the inadequate provision in the hospitals for dealing with cases as they arise from time to time. There is just one point I should like to bring before the right hon. Gentleman. I represent the Labour party, but I am also a member of the Welsh party. Why is it that the right hon. Gentleman is treating Wales so badly in introducing this Bill? During the period of the War for four and a half years the Welsh people left their homes, left the industries, and the factories, to go out and fight for their King and their country and for the freedom of small nations. Why is it now, if they were fit to fight for the freedom and liberty of small nations, that the right hon. Gentleman is not giving Wales the same freedom as he is going to give Scotland, and probably will give to Ireland? I want to appeal to him on behalf of the Welsh people, because we have in Wales miners, railway men, steel workers, and tinplate workers; and no one knew better than the right hon. Gentleman himself, when he was at the Ministry of Munitions, that not only so far as military service was concerned, but in regard to loyalty and patriotism, the industries of Wales were as patriotic as any other industries in the country in their endeavour to support the Government in the successful prosecution of the War. Therefore, I am going to appeal to the right hon. Gentleman to insert in this Bill a proviso that we shall have a separate Department for Wales, and that it shall not be optional, with the word "may," as in Clause 5. We want him to insert the word "shall." We only ask for this as a first instalment, because we are going in for Federal Home Rule in Wales. We shall only be satisfied with this as a first instalment. I think you could extend the duties of the person appointed in order to cover agriculture, education, and also housing, because, as has been pointed out by several hon. Members, this Health Bill is going to affect the Housing question as much as anything else in the land.

There are one or two points that I would like to put to the right hon. Gentleman. I want to find out what powers he has under the Bill. Take, for instance, the case of a man suffering from tuberculosis. You send that man to a sanatorium, and he is cured. What is the use of spending money, wasting energy and effort in curing that man if you are going to send him back to the very same slums in which he contracted the disease? Take the miners in South Wales. These men have to go out at six o'clock in the morning; they are down in the pits until two; they work in water; some of them work in heat. They have to wait sometimes an hour and a half or two hours in their wet clothes for trains; they contract a chill, and sometimes tuberculosis develops out of that chill. What power has the Ministry to deal with cases of that kind? Take the tinplate trade, which is one of the trades that I represent. Owing to industrial fatigue, the average life of the tin-plater is very low indeed. These people get chills, and tuberculosis is as rampant in the tinplate trade as it is in the mining industry in South Wales to-day. I want to know what power the right hon. Gentleman has, and how far he is able to go in dealing with these cases? It is useless trying to cure the men; what you want to do is to prevent the disease arising at all. Once that is done, this Ministry of Health will have accomplished some good. This is my maiden speech, and I did not think to take up so much of the time of the House. But I do want to say this: the keynote of this Bill is the finest keynote I have heard sounded in all my life. The keynote is life; that is the keynote of the whole thing. For four and a half years we have heard of nothing but death. At the first knock at the door in the morning the mother would turn pale in case the son had lost his life out on the Western or the Eastern Front. When we took up our papers in the morning we read about some hero who had fallen. When we met at our meal table we discussed some friend who made the supreme sacrifice. It was nothing but death, death from morning till night. But in this Bill we have life, and the preservation of the life of the people. I was delighted with the elevated tone of the right hon. Gentleman's remarks when he introduced the Bill. It reminded me very much of an article I read in the London "Daily News" some time ago on that great seer John Ruskin. He preached more about the life of the people of this country than anybody else. He said: Your riches are no good; your wealth is no good. There is no wealth but life; life including all the powers of joy and of love and of admiration. That is the greatest country that nourishes the greatest number of noble and happy human beings. That is the intention of your Bill, and when we have established this happiness and comfort and health among the people, then we shall have achieved the new world and the new England that has been promised us by the Prime Minister and by others during the last Election.

Photo of Mr Leslie Scott Mr Leslie Scott , Liverpool Exchange

I promise the House a short and very definite speech. I had the honour of being, with the Secretary of the Local Government Board (Major Waldorf Astor), a member of a small Committee of Unionists in 1914, who then reported in favour of a Ministry of Health. In this Bill our recommendations find their embodiment. Since that day my Friend the Secretary to the Local Government Board and my Friend the hon. and gallant Member for Durham (Major J. W. Hills) have been continuously doing all they can to get this policy adopted, and very respectfully I venture to offer them my congratulations. The point I want to make is this: Under the Bill power is given to take over generally the subject of lunacy and mental deficiency, but it is not one of the branches of health that are taken over at the commencement. I appeal to the President of the Local Government Board to alter that, and to take it over forthwith. I have the honour to be the Chairman of the Central Association for the Care of the Mentally Defective, which was founded in 1913, as soon as the Mental Deficiency Act was passed. That body is composed half of representatives of all the different statutory authorities in the country who are concerned with the administration of the Mental Deficiency Act, and half of the representatives of all kinds of voluntary associations who, in the course of their social work, come into close contact with this very grave subject of mental deficiency. My executive council, representing, as I said, county councils, education committees, Poor Law guardians, the Lancashire Asylums Board, the London County Council Asylums Board, and so on—all these statutory authorities, a body of the leading experts in the country on this subject, are unanimous, and have been unanimous ever since the possibility of a Ministry of Health Bill came near, for more than a year that is, that the subject of mental deficiency should be taken over by the new Ministry of Health, when created, from the commencement. In February of last year my executive council passed three resolutions and sent them to the President of the Local Government Board and the Minister of Reconstruction. The first one was: That lunacy and mental deficiency are health questions and ought to be so regarded equally with the physical health of the community. That precisely is recognised by the Bill.

The second resolution was: That it is essential to the efficient organisation of the health services of the country that the subject of lunacy and mental deficiency should be placed from the beginning under whatever central authority is entrusted with the general duty of supervising or administering health service. Then, thirdly: That it is of the utmost importance that the Board of Control, the Government Department responsible for this work should, from the outset, be made a sub-department of the central authority responsible for health service in whatever way that central authority be constituted. These three resolutions I ask the House to treat as the considered opinion of all those who know most about this subject in the country. The council in question, my executive council, had the honour to receive a testimonial of very high appreciation from the Board of Control in their last annual report for the work they had done in assisting in the administration of the Act. I only mention that in order to give weight to the resolutions which I have read. The next point I want to make is, that under the Mental Deficiency Act the local authority is the Statutory authority of the county council. The county council is under the supervision of the Local Government Board, and the Local Government Board is being taken over lock, stock, and barrel by the Ministry of Health. In addition to the county council the Poor Law guardians have to do with mental defectives, and of course with lunatics in their workhouses. During the War on account of the difficulty of building and therefore of providing institutional accommodation for cases which require special accommodation, it has been necessary to resort to the sections of the Medical Deficiency Act which authorise the Board of Control to treat the workhouses as certified institutions. Since November last some workhouses under Poor Law guardians have been certified as institutions under the Act by the Board of Control. In regard to this the Local Government Board is the controlling authority. In addition Poor Law guardians are under obligation to notify cases of mental deficiency or lunacy to the Local Government Board. Again, and here is a cross complication, the Board of Control have to inspect the workhouses where there are, or there are said to be, lunatics.

Take all these provisions and you observe that the Local Government Board, changed in name to the new Ministry of Health, cannot avoid having to do intimately with the whole subject of mental deficiency, because it is the Local Government Board. Under these circumstances why make two bites at a cherry? Why leave the subject of mental deficiency where it is at present under another Department of State, the Home Office? It is bound to make much more trouble and to be more difficult for the Ministry of Health if that subject is left out of the purview of the Ministry of Health at the outset than if it is taken over. It was said by the President of the Local Government Board that there would be difficulty because there were certain judicial functions that have to be exercised in regard to mental defectives and lunatics. Quite true. But who exercises them? Not the Home Office but the Lord Chancellor, and the judges and magistrates of the country. They are not under the Home Office. My suggestion is that the proposal in the Bill that the functions of the Home Office in regard to lunacy and mental deficiency should be transferred to the Ministry of Health ought to apply forthwith and not be postponed. That will not mean any more complications qua the judicial functions of the Lord Chancellor, the judges and the magistrates than will exist if it is left. If you leave the Home Office in control over part of the work of mental deficiency, and part comes over because it cannot be helped to the new Ministry of Health, because it is the Local Government Board, you will have a system of utter confusion. These are some but only a few of the practical reasons why my executive council passed these very strong resolutions. I do not want to go into all the details. There are all kinds of difficulties about certification by different medical officers, but I can assure the President that I am right in saying that he will make more trouble for himself as well as confusion for the community if he carries the Bill as it is proposed instead of taking over at once the particular duties to which I have referred.

One other matter, and it is one of the greatest importance. There was never a time in the history of this country when the perils of mental deficiency were of such direct and immediate practical importance to the community as they are now. During the War a large number of boys and girls who are feeble-minded, and therefore mentally defective, and prone particularly to sexual weaknesses, have been in remunerative employment because of the difficulty of labour. As the men come back from the Army the feeble-minded will be the first to go because they are feeble-minded, but in the meantime they have got out of the control of their parents and relations, and have been independent. They will come upon the streets in every sense of the word. Further, in the rescue homes, a very large proportion of the girls—I am not sure whether it is one-half or one-third—are mental defectives. In the lock hospitals the female patients suffering from venereal disease are more than half of them mental defectives. There are two classes of mentally defective girls who are a grave danger to the community from the point of view of venereal disease, and with all the soldiers coming back on demobilisation that evil will be ten times worse than it ever was before. These feeble-minded girls, who do not know the danger and who cannot resist temptation because they do not appreciate the consequences of their action, contract venereal disease. In connection with this problem of mental deficiency we have also the moral imbeciles who, in the case of girls, are so often erotic and who are an active danger because they seem to be perfectly normal. They are quite a trap for the returning soldier.

At a very large conference at the Guildhall in January, 1918, at which practically all the authorities in the Kingdom were represented who were concerned with mental deficiency, a resolution was passed and sent to the Government warning the Government of the very grave danger that would ensue during demobilisation unless the most active steps were taken to deal with the terrible danger arising from mental deficiency, and advocating that these steps should be taken in order to protect the boys and the girls who were mental defectives and to protect, at the same time, the community itself. The medical profession are unanimous that early cases of mental illness—this applies, of course, to lunacy and not to mental deficiency, because mental deficiency is not curable—ought to be treated at an early stage just as cases of physical illness. It is most important that they should be treated then, because then there is the best chance of cure and prevention. Half the trouble from insanity might be prevented if dealt with early enough. The proposal is that clinics for mental cases should be attached to all the great hospitals. If that is to be done it is most important that it should be done as soon as possible, and I venture strongly for that reason also to urge that the duty appertaining to lunacy as well as mental deficiency should be taken over at the earliest possible moment by the Ministry of Health, in order that we may get on as fast as we can, and deal with the great emergency that is before us.

For these reasons I urge the President to accept an Amendment in Committee which. I will put down to transfer the provision in the later part of Clause 3 to the earlier part, and thereby cause the whole administration of lunacy and mental deficiency to be taken over at once. The diffi- culty will not be great. The Board of Control is there. It is a Sub-department of the State, whose immediate duty it is to deal with all these matters. It is only that we want the driving force of a demand for real organisation of our national health behind the Board of Control, instead of the Home Office, whose functions have not to do with health. The Home Office know that their job is not health, and in the interval they would probably be tempted to do very little to promote it.


I rise to make my maiden speech, and I claim the indulgence of the House if I transgress any rules. The only transgression so far that I have made has been to come down here early in the morning and take the seat of one of my seniors. I should like to extend to the senior Members of Parliament my very grateful thanks for the courtesy and kindness which they have shown to me as a new Member. I feel highly honoured in being a Member of this House. I happen to be the first representative of the first borough to which His Gracious Majesty King George granted a charter, and I happen to have been returned by the second largest majority in a vote on this contest in the whole of England. I support this Hill very heartily, and I feel that it should also have the support of the whole House, because in the first place it favours neither politics nor creed. It has for its aim only one grand principle, and that is to improve the health of the people at large. For this reason we, as medical men, think that it should be equally applied to all parts of the British Empire, and for the same reason we think that a measure of such far-reaching importance should he presented to the people in its final form as free as possible from any doubtful Clauses. I must confess that when I came to Clause 3, to that part dealing with research, in which it is provided that research is to be handed over to the Privy Council, I was astounded. I feel that research is the very basis from which all medical science starts, and it must be closely associated with a professional body. When I read this Sub-clause I was reminded of a story of a lady who was taken suddenly ill in her confinement in a large establishment. The nurse could not obtain the services of the doctor she wanted, and she asked the servant in the house if there was no professional man there. She said she had seen a gentleman in a silk hat and frock coat walking along the corridor, and she thought he was a professional man. This was about midnight, and she went to the gentleman's bedroom and brought him in his pyjamas and dressing-gown to the bedside, but he had not been there long before the nurse discovered that instead of being a medical man he was a lawyer, and rumour says that the first thing he did when he got into the room was to ask her to make her will, and then, when the infant manifested its entry into the created world in the usual healthy manner, it was suggested that the lawyer should issue a writ against it for creating a public disturbance. It is also said that he asked what its heritage was and promised to make due provision for it in after life. But that was no good to the mother or the child. I do venture to submit that the Privy Council is not the body to look after that all important part of medical science, research work, and I ask the framers of this Bill very seriously to consider this Clause before it is presented to us in its final stages.

Photo of Mr George Thorne Mr George Thorne , Wolverhampton East

The promise of this Bill has caused very great expectation in the country which I hope earnestly will be realised. But I think that the right hon. Gentleman in his opening speech was very wise when he reminded us that this Bill itself is only an instrument, and that everything depends on how this instrument is going to be used. We all recognise that How oft the sight of means to do ill deedsMakes deeds ill done I earnestly hope that the means to do good deeds will make good deeds done. The whole country will support the Ministry in its attempts in that direction which we all hope will be fulfilled. But it seems to me that in his speech the right hon. Gentleman limited the use of the instrument in a way which I regret and which has been regretted by the two hon. Members who have spoken last. The right hon. Gentleman emphasised the point that the great object in view was to bring our practice up to our knowledge. That would be a very great advance and we should all rejoice in it, but though possibly, in view of the anecdote which we have heard just now, it may be unwise for a lawyer in the slightest degree to associate himself with a doctor, I do hope that there will be no limitation to bringing our practice up to our knowledge, but that our knowledge itself under this Bill will be extended too, and I would urge that the points advanced by the two hon. Gentlemen who have spoken from their long experience, would be taken into consideration fully by the Ministers, and that they themselves will see that methods of research and investigation are developed fully so that our present knowledge may be extended very largely and that our practice may be lifted up not only to our present knowledge, but to the level of any further knowledge that is obtained.

Manifestly the effective use of this instrument will depend on co-operation between the Minister and those in the country whose duty it is especially to work under him. Therefore his association with the local authority is of the highest importance, and I am very glad to be the means of conveying from the Association of Municipal Corporations their recognition of the spirit and way in which the right hon. Gentleman has already approached them in the preliminary negotiations prior to the introduction of this Bill, and given them cause to hope that in carrying out this measure he will exhibit the same spirit and the same desire. But they have asked me to submit this particular point. They are anxious to know what the position of local authorities is going to be when this Bill is passed into law? So far as I understand all the powers of the Local Government Board are to go to the new Ministry and consequently all the services rendered by the local authorities, under the control of the Local Government Board, will go to the new Ministry, and, therefore, there will be no divided authority in that respect and the only change that will come about will be under the Clause in the Bill which gives the Ministry power from time to time to transfer any specific services under the First Schedule to the measure. If that be so, then I think that the local authorities will always be able to understand what the position is going to be, and will not be worried by imagining that they come under various authorities when the Bill is passed. They note with interest the proposed appointment of consultative councils.

I am rather inclined to agree again with the hon. and learned Gentleman opposite that the expression "advisory council" is better than "consultative council," and I hope that his suggestion may be carried into effect. The local authorities are particularly anxious, as they will have so much to do with carrying out the work which this measure will confer upon them, that they may be availed of largely on those consultative or advisory bodies, so that their experience and knowledge may be brought together. Next to the local authorities, and, of course, the medical profession, those who can help most are the women of the country. To the women this Bill will be one of very great hope, especially in its reference to child life and motherhood, and, at the urgent request of ladies who have addressed themselves to me, I am asking that the help of women may be used so far as possible in carrying out this beneficent measure. I observe, in the Clause referring to consultative councils, that in such cases women are to be employed, but the representation that I have been asked to make is that there should be a women's consultative council, so that women may consult together and advise the Ministry as to matters specially affecting women and children. That is an appeal which I have been asked to make, and I make it on their behalf, and hope sincerely that, in the directions which I have indicated, the right hon. Gentleman may find it possible to do what I have desired.

Photo of Mr Charles Sitch Mr Charles Sitch , Kingswinford

During this week I have witnessed so many manifestations of the splendid tradition of understanding and consideration which this House always affords to a new Member who rises to address it for the first time, that I feel no hesitation in asking for its patient indulgence while I make a few observations on the Bill before the Chair. I agree with the view that has been expressed to-night that this Bill is one of the most important that could possibly come before Parliament. Some of us in our election addresses, dwelt on the need for improvement in our public health, and, while I am a Labour Member and never hesitate to criticise the composition of the Coalition party, I take this opportunity of congratulating them on making this their very first reconstructive measure. But, from what has been said in this House, I am not quite sure whether even the right hon. Gentleman who introduced the Bill is cognisant of the facts of history on the question of the unified Ministry of Health. I think that it was in the year 1848 that a Ministry of Health was established in this country, and the very same arguments were used in reference to our neglect. In 1871 the Local Government Board was established, and that was supposed to supersede the old Poor Law Board, but in effect we know quite well that health questions always have to take second place. It is true that the present Bill proposes a unified Ministry of Health, by merging the Local Government Board and the Insurance Commission and the health functions of all the other Departments, but unless the declaratory Clause is put into operation immediately, I do not think that this Bill will have the desired effect.

One infers from the Bill that the Ministry of Health will adopt or be consistent with its own principle of establishment and proceed to reorganise the public health authorities in all localities. Unless this is done, notwithstanding the existence of a unified Ministry, I am certain that the measure will be a failure. Therefore, effect should be given immediately to the declaratory Clause of the Bill, so that the work of the boards of guardians can be broken up, and care for all the sick and infirm, including maternity and infants, and mentally defective and the helpless—in fact, of all who need medical or nursing aid—may be united with the local public health services, so as to have in each area one health authority, and one only. The local authority, to my mind, should be aided by an advisory medical committee of local doctors, and should be in close contact with the local insurance committee, which must be well represented, on the public health committee. I know that there will be some objection to this suggestion, but I am convinced, notwithstanding the fact that it is proposed to have consultative councils, that unless we do have the local doctors acting in an advisory capacity, we shall not be able to appreciate the specific ills of specific districts. In addition, as the local authorities will have to do most of the work, they must be aided by Grants-in-Aid, failing which, I am convinced, there will be no success under the Ministry.