I was about to say that the success of the Ministry of Health depends on whether it begins with that new spirit and that new office organisation which I have tried to indicate. The danger is, as the Local Government Board powers are being taken over, that they will again maintain the Poor Law conception of organisation and thereby ruin the Ministry which they are about to found. The only way to my mind to prevent this, as there is no real safeguard in the Bill, is to secure some promise, or, better still, a printed declaration, to be issued concurrently with the passing of the Bill, to the effect that it is the intention of the Government by the passage and adoption of this Bill to ultimately abolish the Poor Law.
I think it is a matter for congratulation that at last this country is within measurable distance of having a Ministerial Department devoted to the one sole aim and purpose of the care of the health of the people of this nation. Some twenty or twenty-five years ago it was regarded as an indication of the sanitary progress of local authorities when they appointed what was called a whole-time medical officer of health. It is pleasing to-day to find this honourable House in the process of appointing a whole-time Minister of Health. We are engaged in doing something very much akin to a process of nationalisation, and that with the very greatest asset which any nation or any individual may possess, namely, the nationalisation of the health of the people of this country. The parallel in the use of the word "nationalisation" is not perhaps entirely correct in the sense in which nationalisation is understood by some people. Nationalisation in that sense, I suppose, means, primarily, the deprivation of the ownership of the thing owned and the transfer of that ownership to the State. This is a form of nationalisation which is, with all respect, very much more ideal. This is a form of nationalisation which asks for no transfer of ownership, but which leaves the ownership of that most material and important of things—health—in the possession of the original owner and proceeds, with true communal spirit, to add to the value and quality of that original possession. Difficulties and troubles which lie ahead of the Ministry of Health have been indicated. I would suggest that many of those difficulties lie in the legislation of past Governments. That legislation is of very recent date. It was not until 1849 that the first Sanitary Act was passed; that is an Act wholly concerned with the sanitation or lives of the people. In 1875 a great effort was made to codify and simplify the public health law of this country, with the result that we had the excellent Public Health Act of 1875. The principal executive function was given to the Local Government Board, which came into existence in 1871. Since 1875 there has been a wealth of legislation, a mass of the most beneficent legislation passed, but the Government are faced with this difficulty, that not having a whole-time Minister of Health, these measures had to be allocated for their carrying out to a variety of Departments. Thus from the growth of this mass of social and public health legislation since 1875 you get an overlapping and concurrent jurisdiction at the centre. You have the Local Government Board, which was the original repository of public health matters, you have the Home Office, you have the Education Office, the Board of Agriculture, the Board of Trade, and lastly, the National Insurance Commissioners. If there was this overlapping at the centre, in still greater degree did you get on the periphery of this wonderful organisation of administration a still greater perplexing maze of administration. You had the county councils, the county boroughs, the urban councils, the rural district councils, the port sanitary authorities, the Poor Law authorities, the insurance committees, county and district, and all that, a bewildering and perplexing maze. The Government is faced with this difficulty of a mass of properly originated administration, executive and legislative, and not knowing how to deal with it. It could only deal with it in one of two ways, namely, to deal with the legislation as legislation, to conduct a huge inquiry into all the past legislation, codify and simplify it, and compress it in one great health charter which would be the authority for a Ministry of Health. That may be theoretically and constitutionally a very correct course, but it still leaves the great practical question of how all these functions were to be turned out from the existing adminis- tration. I congratulate the President of the Local Government Board on the courage he has shown in dealing with these matters. He has set aside all pedantic effort, not seeking to rival the Emperor Justinian's action in introducing the Roman Code or that of Napoleon in introducing the Napoleonic Code. I can assure the House that if a codification and simplification of the public health laws of this country had been undertaken so as to create a charter of legislative authority for a Ministry of Health, the task would have rivalled both that of Justinian and that of Napoleon; but the Government have selected the wiser course, and I congratulate the President on what he has done. He has taken out of these Departments two which I might refer to as organically complete Departments. He has taken that much despised Department, the Local Government Board, and there I think his courage is remarkable, because there is no denying the fact that there is a strong feeling of prejudice and sentiment in this country, and an attitude of mind which regards the Local Government Board as a museum of lost opportunities in which there resides nothing but the spirit of those mythical individuals who are typified as Bumbledom and, perhaps, Bumbledee. I congratulate the right hon. Gentleman in absorbing into his authority the Local Government Board. Furthermore, the organically complete Insurance Commission, combined with the former, makes a very sound basis.
I was sorry to detect in the right hon. Gentleman's speech a feeling that perhaps he ought not to take upon himself too heavy a load, and I suggest to him that Section 3, Sub-section (1), of this Bill does not put too heavy a load on him. I beg this House even now as a scientific proposition to put out of their minds altogether the rigid distinction between the words "prevention" and "cure," and I hope the union of the Local Government Board and the National Insurance Commission will intensify and confirm that. Prevention is nothing more nor less than continuous treatment, and cure is nothing more nor less than occasional or intensified treatment to suit the occasion. The same scientific principle prevails in both cases. In addition to the simple absorption of these two bodies, the right hon. Gentleman has very rightly begun at the beginning, and he has taken from the Education Department those matters which deal with child life and with pregnant mothers. I am glad of that. We had some little time ago a simple little institution called by the Local Government Board Maternity Clinics, and by the Board of Education Schools for Mothers. The same little institution had two sets of rules, one set issued by the Local Government Board and the other by the Board of Education. There was an absolute duality of control. I dislike the term "joint control," as I do not think there is any true joint control in anything that exists, but you had a complete duality of control which stifled the magnificent opportunities for work which that institution could do. I am glad this is put now under the single control of the Ministry of Health. We had an Act passed in 1908 which the whole country hailed as the Children's Charter. It has been practically a dead-letter, and now I am thankful to find that this children's charter is going to have a chance of being revivified through the Ministry of Public Health. Surely it is not a difficult matter to excise from the functions of the Privy Council the Central Midwives Board. One thing which has puzzled me in reading the allocation of executive functions which was made in past years has been to understand upon what principle or method the Government of the day allocated these things, and nothing was ever a greater puzzle than why they allocated the control of the Central Midwives Board to the Privy Council. Up to now I have had nothing in my mind, but thoughts of commendation for the principle and methods of the Bill, but I wish to make reference to Sub-section (2) of Section 3. I hope the order in which those paragraphs (a), (b), (c), and (d) appear does not indicate in the slightest degree any order of priority. [Dr. Addison nodded.] The right hon. Gentleman assures me that that is so, and I assume that that means that the first thing to be taken into account will be education and the last thing would be anything which would come under what I may call the omnibus paragraph, paragraph (d). I have no objection to the President of the Local Government Board establishing an order of priority in regard to the three previous paragraphs, but I do have an objection to not knowing what this paragraph (d) may possibly contain.
For instance, I can indicate at least two organically complete authorities which are, in my opinion, at work upon matters strictly relevant and cognate to questions of public health. My right hon. Friend the Member for Peebles has referred to the difficulties of registration, to the overlapping of peripheral administration authorities, and he gave as an example of what might happen the number of authorities which might be called into play in the course of the first few months of a child's life. He was quite right. In regard to this simple question of registration alone, I will give an example of what might happen in a child's life within a few months of its entering upon its existence. Take a child born in an English county. Within forty-eight hours, by the Notification of Births Act, the fact of its birth must be notified to the county medical officer of health—Official No. 1. Then within six weeks notification of the birth of the child must be given to the registrar of births and deaths—Official No. 2. A little while afterwards the child has to be vaccinated, and notification has to be sent to the vaccination officer—Official No. 3. A little while after that the child gets scarlet fever, and an official notification of the fact has to be sent to the local authority—Official No. 4. Thus within a few months you have four registrations to make, all on questions of vital statistics. My point is this, that the Registrar-General's Department is a Department that is an organic whole which comes naturally within the compass of the work of a Ministry of Health. I am a believer in a simple universal register. We all know how, during the War, we had to find out what was the manhood of the nation. We all know the muddle of the National Registration. Act, the muddle that takes place every ten years with regard to the Census, and the amount of muddle in connection with the register for the Parliamentary elections as well as for local elections, old age pensions, and a. whole variety of purposes concerning the life of the community. And, mark you, in all those statistics which are necessary, the vital statistical element forms part and parcel. That is why I say that, instead of giving an omnibus Sub-section, you ought clearly to specify what the possible Departments are you propose to transfer in the future. I suggest that one should be the Registrar-General's Department, and another the Department that is known as the General Medical Council. The medical profession is sincerely, I believe, beginning to recognise its collec- tive responsibility for the public health and welfare. I should like the right hon. Gentleman to take into consideration whether this body could be specified in Sub-section (4). I may be wrong, or I may be right, in my views with regard to the question of registration and the question of the General Medical Council, but my suggestion would, at all events, enable public opinion, and all those concerned in these matters, to be focussed and expressed, and that the expression reveals itself the right hon. Gentleman can be guided.
There is one other point I should like very much to be included in this Bill. I am heartily in support of the remarks of the right hon. Gentleman opposite as to the necessity of the Mental Deficiency Acts being included in the purview of the Ministry of Health. Then the right hon. Gentleman made reference to the administration, under the Home Office, of the Factories and Workshops Act. I, for one, think that the administration of that Act should be under the Ministry of Public Health, and for this reason. If the proviso in Sub-section (1) of Clause 3, referring to the Research Committee, means that research as research is to be excluded—
I am glad to have that assurance, for the reason that a great deal of work has been done with regard to industrial fatigue. I have listened with the greatest interest to the Debates on the nationalisation of mines and other things in the last few days. I have spent the greater part of my professional life in the service of the miner, and am proud of it. I have every respect, and the greatest sympathy, for the miner, and shared with him the struggle before he got his minimum wage and his eight hours. I know something of the miner. I have nothing but respect and admiration for him, but I do say this, arising out of the Debate, I have been astonished and surprised at the avidity with which hon. Members put forward the idea that the number of hours that a man shall work day by day is to be settled by something which, with all due respect, I can only describe as mass caprice—the arbitrary, capricious decision of the mass. My point is that the hours which a man ought to work are capable of being demonstrated by science. It is a right and proper thing for scientific inquiry. Science is the handmaid of master and man. It smoothes human relationship; it establishes no antagonism. It is not a very difficult matter to estimate and scientifically demonstrate that thing which we call human energy. The daily output of human energy can be established, and, if necessary, standardised. If it can be established by science that a normal man can, without detriment to his physical condition, and without encroaching on his longevity, but with perfect health and safety work up to a given standard, I think that the number of hours which a man shall work a day can be standardised. Beyond that daily output of energy it should be an obligation upon the State not to ask a man to work. It should also be a corresponding obligation on the part of the worker not to submit a scientific question like this to the economic caprice of the time, but to give, according to the physiological, scientific data, the amount of honest labour which he ought to give. I would ask the House to regard a line of inquiry, such as I have suggested, not as a mere flight of imagination. From what I have read, and the experience I have had as a Territorial Force officer of the fatigue in the field of soldiers coming from the office desk, and so on, I am convinced it is well within research initiated, conducted and controlled by the right hon. Gentleman, to determine when a degree of daily fatigue is reached which in any way endangers the physical health of the worker.
There are two other little excisions I would like to have from existing authorities. One is from the Board of Agriculture and the other from the Board of Trade. I think it is a very unfortunate thing that concurrent jurisdiction exists between the Local Government Board and the Board of Agriculture in the administration of the Food and Drugs Act. The Food and Drugs Act and the Milk Act, above all things, ought, I think, to be wholly within the purview of the Ministry of Health. I cannot understand why the Board of Trade has any powers whatever with regard to the water supply. If anything were of importance to the health of the community it would be the complete control of water supply. That is not so. All the powers the Board of Trade has with regard to the water supply should be taken right away from it and given to the Ministry of Health.
Finally, we all know the debt which this country owes to the Mercantile Marine and the Navy. The Board of Trade has the complete administration of the sanitation of ships, and there is one especially distinguished Gentleman on the benches now who will bear me out in saying that the existence of tuberculosis among seamen is sufficient to raise a very convincing presumption that there is something very, very wrong with the ships that go down to the sea. I once again congratulate the President of the Local Government Board. I feel that we are standing at the beginning of a great era for the people of this country. If the spirit of this Bill is carried out by the Ministry, we are at the beginning of one of the greatest works ever undertaken by His Majesty's Government in the history of this glorious country. This race—the glorious breed of this country—is worth working for. It is worth fostering. It is worth strengthening. It is worth improving. If one of the great results in time to come is that this glorious race of ours—it is no use mincing matters, for it is a glorious race!—goes down to history to untold ages as the one which stood in the gateway of civilisation and held it secure against the most terrible, the most venomous assault ever devised by an enemy of mankind. The race is worth perpetuating for all time. It is a glorious race. I say to the President of the Local Government Board. "God speed" in doing this work; and pray God that there may never be occasion in time to come for criticism levelled at our past failures—never, never, never in the future!
I should like, if I may, to congratulate the hon. Gentleman who has just sat down for the very interesting and helpful first speech he has made in this House. He has been secretary of a medical group, and thus one has listened to him as an expert on these questions. I am afraid I cannot claim that kind of technical knowledge. But I should also like to add my congratulations to those of others to my right hon. Friend opposite for forming a Ministry, the purposes of which, if pursued, are destined to make it probably the most important Ministry of this country in the future. I do not rise to make any carping criticism upon this Bill, but I do want to make a little criticism in the direction of trying to make the Bill a reality. I do not believe, with other speakers, that my right hon. Friend can make the Bill a reality unless he gets more powers. What powers has he really got under this Bill? He is merely taking existing powers from existing bodies so as to give these local bodies a different head. He is really doing nothing else under the Bill, so far as I can see, except to establish advisory councils. The result we may look forward to is this: that the Minister will be able to exercise more fully the existing powers that at present are exercised by the various Departments. He will probably be able to co-ordinate more fully the efforts of the various local bodies. But against that he is not going under this Bill to increase the powers of local authorities, and he is not taking powers to do anything to make the backward local authorities take more action.
So far this Bill does not necessarily mean that there is going to be a single extra life saved in the area of the backward local authority. Nor does it necessarily mean that you are going to have one day's less sickness in the area of these local bodies than in the past. You merely change the name of the Department to which they finally answer. To my mind, my right hon. Friend will find that the chief obstruction in this matter will be local apathy. The other day I read over again the speech made by my hon. Friend the Parliamentary Secretary last year. Speaking in the House, he said—I should just like to quote a very few of his words—
Those of us who have experience of local authorities know what delays there will be in many parts of the country. You will get backward local authorities holding back from making the necessary provision. The Local Government Board is not able to compel them to move: It can only tempt them with Grants-in-aid.
When he occupied the post now held by my right hon. Friend Lord Downham said exactly the same thing. Mr. Hayes Fisher, as he then was, spoke of "the recalcitrant local authorities." He said that he was unable in many instances to make them move at all. So far as I can see—and I do not want in the least to be unjust to this Bill—there is nothing in it to meet that great difficulty. That, to my mind, is a serious omission from the Bill. I hope that before the Bill passes into law that upstairs, in Committee, we shall be able to give my right hon. Friend sufficient powers to deal with the local authorities who prove recalcitrant in the matter of carrying out these various duties.
There is one other point—I promised I would not speak more than ten minutes, and I do not want to go on longer—I believe the result of this Bill will be much more cure than prevention. My right hon. Friend is taking over the work of the National Insurance Act. Nothing has been more clear during the last few years than that that Act has not done very much on the side of prevention. All it has done has been on the side of cure. The whole duty of the officers under the National Insurance Act has been paying out benefits to people already sick. That is why they are agitating for this Bill, which, they hope, will act in the way of prevention, because the continual paying out of these benefits is beginning to ruin the various approved societies. I think I can prove this by figures. Between 1875 and 1900 the health of our people was, no doubt, improving very rapidly. Since the National Insurance Act was passed there has been a lower birth-rate, in spite of maternity benefits, and a higher death rate. The birth-rate per thousand of the civil population has fallen from 24 per thousand in 1912 to 23 per thousand in 1914, and the death-rate has risen from 13per thousand to 14 per thousand. In regard to tuberculosis in 1916—that is to say five years after the passing of the National Insurance Act—there were no less than 1,529 deaths per million of the population from tuberculosis—the highest since 1909.
I say, therefore, that this Act has done very little in the way of prevention. The mere taking over of the powers of the National Insurance Act under this Bill does not really mean that we are giving more prevention unless we give my right hon. Friend greater powers in the matter. I am afraid I have not got any time to make the various other points I desire to make; but I should very much like to know whether my right hon. Friend has got a promise in regard to money? If he has not got a promise from the Treasury that they will give him sufficient Grants I do not believe that he really will be able to do very much under the Bill. I am very sorry that there is no Clause in the Bill having that object in view. The only Clause dealing with money is a Clause concerned with salaries and administrative expenses. There is no Clause like there is in the National Insurance Act for money to be given for the general purposes of prevention and cure. I am sorry there is no provision in respect of money for tuberculosis. I should very much like to know if my right hon. Friend can tell me whether he has got a definite promise from the Treasury that he will get a sufficient Grant for the purposes of this Act, because he cannot go on without money. He will want millions. The French Government are just now passing through their Chamber a Bill giving them £3,500,000 for foundation charges in connection with tuberculosis alone. They are getting an annual Grant of £4,000,000 for that purpose alone. I want to see my right hon. Friend in possession of far greater power and far greater funds. I believe if he has that he will be able to make this Bill a great success, but I am sure he will have the sympathy of every party in this House in making this Bill a real and a lasting success.
In rising for the first time to address this House, I, like many other hon. Members, have to begin by casting myself upon the mercy of this historic body. As the poor are said to be good to the poor, I can only hope that those new Members who have already spoken will be good to another new Member. I cannot even speak for the length of time occupied by my hon. Friend who has just sat down. There is only one point I wish to make in reference to this Bill, and it is that the provision for the cutting out of the functions of the Ministry of Health the Medical Research Committee is very unsound, and I wish to add my testimony against it. I am considerably interested in research, and I had hoped in the future possibly to add a brick to the temple of science in that respect. I am working just now in connection with the London Hospital under one of the coming men, a professor of physiology, who is one of our most brilliant researchers. I believe that this cutting out of the Research Committee and placing it under the Privy Council is looked on with very great suspicion. We do not see any reason for it, and, in addition, we think that it will weaken the functions of the Research Committee to an incredible extent. It is now working on a fixed sum of money from the Treasury, and it will never get any more than that. Consequently, it will have to go to the Ministry of Health. It has been my experience throughout all my life that when a child like that goes begging at the door of a respectable family, it is very apt to be turned down altogeter, whereas, if this Committee is under the Minister of Health it will be his own first-born, and he will take a much greater pride in it. The right hon. Gentleman will be able to expend very much larger sums and give this Committee a status which it will not have under the Privy Council. The sum of £60,000 a year for research in a country like ours is laughable, because you want to spend some years £250,000, and even £600,000, and the Minister of Health is the only man who is able to give us that money because he will see where he can save.
The question of deafness was referred to in the earlier part of this Debate, and I remember noticing it was stated that there are 12,000 children in London with suppuration of both ears and 800 totally deaf, and they are receiving institutional treatment. The treatment of an ordinary child costs £10 a. year, but under institutional treatment it costs £40 a year. When the Minister of Health has these figures brought under his notice, he will at once see by devoting more money to health and research a definite way of saving, because he will at once see that he is getting a return for his money; but if this money is issued out like coupon tickets to the various authorities in the Kingdom, the bodies to which I refer will find the very greatest difficulty in getting funds for the reason which the President explained when he introduced the Bill.
If we are not under the Minister of Health when the influenza wave comes on again for the tenth or fifteenth time, instead of applying to the Minister of Health we shall be referred to the Research Committee, then to the Privy Council, and then to the King, and we shall have to come back to the Minister of Health, and say, "We think it is time that you dealt with this subject." The Medical Research Committee and the Minister of Health are going to suffer very greatly by this proposal. I do not think it is purely due to the will of the Minister of Health to hand over a body in this way which so eminently belongs to him, and it should be handed over to the service of the nation; I think it is due mainly to the instinct of self-preservation that occurs in all bodies, and even in public bodies, and even in such an eminent body as the Medical Research Committee. Finally, I wish, like all other medical Members, to compliment the President upon having introduced this Bill, and assure him of our hearty support in this matter.
Yesterday and on previous days, when I have been listening to the Debates in this House, and in particular when I heard the Debates respecting the impending coal strike, it struck me that the Minister who had the greatest right to be heard was the one who has not yet so far been created. If anybody has a right to speak on the impending coal strike, surely it is the Minister responsible for the health of this country! We have the influenza wave coming back again. We have a plague that is far more deadly than any of the most historic plagues of history, which has ravaged our country twice, and now is doing so a third time. And, as if there was nothing of that nature going on, it is now calmly proposed to turn out all the gas fires, shut down the electricity works and take away the coal scuttles from every sick room in the United Kingdom, and nobody can rise and ask for a trace of God; and while the country is in the grip of the most desperate plague, which the President has assured us was killing one quarter as many people as the great European War, nobody has the right to rise in the House and appeal in the name of suffering humanity for at least a temporary truce on this tremendous matter. It seems to me that it is not sufficiently realised in the House and throughout the country that this thing is like a fire on dried grass, and it will spread. The doctors are fighting it day and night at the expense of a tremendous amount of toil and energy. They are fighting this epidemic to keep it from getting a running start. If it gets a running start, there is no saying to what lengths it will go. Start an epidemic disease, turn out the fires, allow all people who are sick of it now to die, let a great many people be crowded together because of the cold and hunger, give it a good start in these crowded centres, and I do assure the House, speaking in the name of the medical community, that it is quite impossible for us to guarantee the safety of this nation against this plague. I say that no body of men, whether coal-owners or miners, ought to be allowed to bring on a thing like this without having been warned in the gravest possible terms by an official responsible for the health of the nation. There is no such thing nowadays as a bunch of hyssop to strike the lintel and the two side posts with the blood of the lamb so as to make sure that the angel of death passes over certain houses. If we get an epidemic running, it will sweep the whole country. We have only just finished a war which has swept away the younger generation. The generation to which I belong has been very nearly wiped out, and disease threatens to wipe out those of us who have been left and the most attractive members of the community. I refer to young females of about my own age. That is a very serious situation indeed, and I say that before these old miners and coal owners and the various venerable and white-headed Gentlemen we see in power in this House and in the various public bodies outside condemn the rest of our generation to death they ought to take into account the fact that they cannot disclaim responsibility in the matter. The treatment of influenza is very largely a question of fresh air. If the patients cannot get warm air they cannot get fresh air, and if they cannot have fires they cannot get warm air. That point alone would justify the Minister of Health stepping before these contending bodies and explaining that there is an enemy in the midst of the country quits as deadly as the enemy we have fought on the Western front for four and a-half years. The Bill is a splendid thing and ought to have the hearty support of the House. Its greatest defect seems to be that it cuts out this Medical Research Committee and I should be very glad to hear some defence from the President of the Local Government Board, because as yet no adequate defence has been brought before the House.
Speaking from the elevated pedestal of one who has on a previous occasion addressed this House, may I presume to congratulate the last speaker on his pointed, interesting, and illuminating address. If I may not do this as a Member I should like to be allowed to do it as an individual. The principle involved in this Bill touches so closely upon the fundamental policy of the group of which I am a member, that I hope I may be allowed to intervene in this Debate. I should like to commence by asserting that we enthusiastically agree with the right hon. Gentleman who has introduced this Bill in his determination to co-ordinate the forces ranged against disease, the enemy of mankind which has taken such a terrible toll, and in our opinion such a terribly unnecessary toll, of human life during the enlightened period of the last fifty years, an enemy whose ravages I am convinced might have been confined within much more reasonable limits had we realised not only the deadly nature of its work, but also the forces at our own disposal. We agree that a Ministry of Health should be established without delay, but we are not so confident about some of the details in the Bill. I frankly acknowledge that I should like to see the Bill so amended before it leaves this House that the right hon. Gentleman does not recognise his beautified offspring, I think I am right in asserting that it was the medical examination of recruits for the purposes of this War which produced the figures which shocked the nation and led to the introduction of the present Bill. I want briefly to summarise some of the facts brought out by those statistics and to endeavour to draw a moral from them which can, I think, with advantage be applied to this Bill. It was discovered that only 40 per cent. of the recruits examined over a period of eight and a half months reached an A1 standard and were fit according to the life of the individual but not necessarily for front line service. Amongst the metal workers disease was bad, in the factories it was worse, and in towns like Leeds it reached its climax. In the agricultural districts of England it was discovered that the physique, surprisingly enough, was astonishingly low. On the other hand, the physique of the young miner, comparatively speaking, was excellent, although the physique of the older men was decidedly bad. The deduction is that where the general standard of life is low it can be traced to obvious causes. The young miner was healthier than the young agricultural labourer because, generally speaking, his wage was better, and therefore he was better housed and better fed. Force is added to this point by the fact that the older miners who lived in the days before better industrial conditions prevailed did not reach that standard. The moral is that disease springs from certain known evils which must be overcome.
What I think this House has to examine in reference to the present Bill is this: Is the Minister of Health going to make the attempt to directly control those agencies which are attacking these evils? It is quite true that a good house is a potent factor against disease, but disease springs from many things; it springs from ill feeling, and I assert, if the right hon. Gentleman is going to make the attack it is to be hoped, he will not think it is a far stretch to say that he will have to take a prominent part in the attack on the standard wage question. My point is that it cannot be done, and I am certain that if the Ministry is going to be a success and a great success, as I hope it will be, the right hon. Gentleman in charge of it will have eventually to control directly all those agencies that are fighting disease from the purely scientific medical point of view. He will not necessarily control, but he will educate, stimulate and encourage all those other agencies which are just as certainly lighting disease, but not necessarily from a scientific point of view. The right hon. Gentleman has a great chance and a glorious opportunity, but if we allow him to overload himself at the outset, if he takes on too great a burden, then I am convinced he will ultimately find himself so handicapped that he will fail in his own particular essential task, which he alone can perform, of fighting disease from the purely expert point of view. May I be allowed to give one further illustration? Take the Ministry of Education as an example of what is being done in regard to fighting disease directly. There you have a body of gentlemen fighting disease. It would be madness to attempt to control them in their fight through the Ministry of Health. The great public schools of this country have done wonderful work in fighting disease. I hold no brief for them. It is true that they have not concerned themselves overmuch with the training of the mind, and I have not heard of any cases of direct organic disease from that cause. But in scientific training of the body by their organised games they have done great work in fighting disease. That will be extended by the present Ministry for Education. If the same system were only undertaken in the national schools of our country, if one could only imagine that the children of this country were for one hour a day undergoing scientific physical training in the open air, then I say we should have made a wonderful start in fighting disease. Next I come to the functions of the Ministry. I suggest that the first function of the right hon. Gentleman should be the one he places third on his list—the function of collecting statistics and information in regard to the health of the people. When we have got these we shall know where we are, and the right hon. Gentleman will be able to start on his campaign. I believe that with such a table of statistics and with the moral to be extracted from them popularised, explained, and widely circulated, it would have the effect not only of stimulating medical zeal, but also of encouraging the laity to help themselves. I believe the right hon. Gentleman has hit the nail on the head in the idea, first, to educate the people in regard to the elementary principles of health conservation before directing their energy to the removal of ills brought about by the neglect of those principles.
Now for the direct attack to be made by the right hon. Gentleman. Here I am afraid I shall get into trouble. The right hon. Gentleman, as intelligence officer, has done his work, and is prepared to give battle. He sends out his line of fighters, his picked men, who, to my mind, must be medical men and scientific experts. Surely something in the nature of direct control over these experts must be insured? We have allowed professional healing to become a trade—a trade honourably conducted by an honourable body of men, but still a trade. It is lamentable it should be so, but I do not think we can escape from it by eliminating competition; indeed, I fear that that would bring greater evils in its place. But surely under the Ministry of Health the right hon. Gentleman is going to claim his right to control those who are his chief agents, because they are his chief agents, whether they be country or town practitioners, fighting disease alone or united in a body, protecting the public against contamination. Through them he will be working, and I cannot see that it is an insuperable task. The right hon. Gentleman will be able to make use of existing organisations. I hope he will insist on controlling those organisations, without exception, boldly and fearlessly, so that their energies may be co-ordinated with other energies of a similar nature. I am anxious not to give offence to a highly honourable body of men, but a section of the public of this country is not satisfied with the present method of licensing medical practitioners. This is a matter of vital importance to the public, and they have a right to claim that those responsible for the health of the nation should be competent to carry nut their task, not only at the time of qualification, but also during the whole period of practice. Something in the nature of re- fresher courses might be organised. [Interruption.] It is not nonsense; it is done in other countries, and it is perfectly possible. Be that as it may, the country will look to the Minister of Health to be responsible for the efficiency of his subordinates—because they are his subordinates—and if he shirks that responsibility I assert that many people who have confidence in him will lose that confidence. I sincerely hope that he will not shirk it.
I am going to repeat deliberately a remark made by an hon. Gentleman opposite, because it is so pointed. Why is the Ministry of Health not taking over the work of the Research Committee? Is not the right hon. Gentleman going to be responsible for an attack upon any plague that visits this country, such as the influenza scourge? He cannot be responsible unless he controls the Research Committee, because in research lies the whole key to the attack. I deliberately suggest that the vanity of some person behind the scenes is responsible for this anomaly, because it is an anomaly of the most ridiculous description. With reference to the position of women, it is of vital importance that women, who have a particular interest in the Bill, should give the right hon. Gentleman sympathic co-operation. I hope that the right hon. Gentleman will meet them, and that he will give them some kind of place in the Ministry. I shall have something to say on this subject in Committee and will not waste time on it now. Another point I wish to raise is in regard to the medical personnel of the health services. Is the right hon. Gentleman going to be responsible directly for the efficiency of the medical personnel? If he is not, then all I can say is that if there is anything in my argument in regard to his responsibility for the private practitioner, it applies with redoubled force to that personnel, and I hope he will be responsible for it. I have no doubt that, in spite of my criticisms, the right hon. Gentleman will have the imagination to see the full possibilities of his glorious task and that he will have determination to carry them out. If we have ventured to criticise him, I cannot think that there is any body of imagination in this House who does not envy him and who would not like to wish him "God speed!"
I rise with all the earnestness at my command to support this Bill, so very ably introduced by the President of the Local Government Board. This Bill is an urgent public necessity and as it is conceived in a bold, comprehensive spirit, I feel sure that when its principles are carried into effect it will have the result, not only of improving the general health of the community, but of adding very considerably to the comfort of the people themselves. The House will be glad to know that the medical Members of Parliament are unanimous in their desire to support the principles of this Bill. The mental condition of the people of this country is improving, but I am sorry to say that their physical condition is steadily deteriorating. Owing to a very liberal and wise Education Act the people are now anxious and able to take an interest in all the problems of life. But it is even more important that the physical condition of the people of this land should be improved, because one knows that the last determining factor in any great war is an efficient manpower and sheer force to decide the issue. What are the chief root causes of this physical degeneracy of which I have spoken? First of all, among others, one has to mention hereditary, over which we have very little or no control. Then we have to mention low rate of wages. Then we have to mention insufficient care and attention to babies and children, and, lastly, the unhealthy surroundings in which the people live. Those are the root causes of this degeneration, which I feel certain this Bill is going to put right.
It is universally recognised that up to the present time the amount of money paid to the industrial classes for the labour they perform has been totally inadequate, in a good many instances, to allow those people to live in ordinary comfort—in fact, even to exist. The result has been that a very large number of the industrial classes, especially those who had the responsibility of a family, were compelled to seek recourse to, and obtain relief from, the Poor Law. How was it possible for a woman with a family of six children to give the necessary support and the necessary nourishment to those children on 25s. or 30s. a week? What was the result? It was that the children did not get the necessary nutrition. Their bodies were not able to be developed, they grew up stunted, badly formed, and susceptible to disease. We had rickets, stunted growth, imperfect development, and all the conditions which follow imperfect nutrition. Those are the things we want to obviate by getting at the root cause of all these illnesses. I am firmly convinced that an increase in wages amongst the industrial classes of the community would do more than anything else to provide a really sound stock of people by providing them with the necessary nourishment and the necessary endeavours to grow up into a healthy manhood. It is no use encouraging a high birth rate if the children are not permitted to grow up to maturity. Special care must be taken of the care and provision of babies and young children, and we must all pay a very high tribute to the magnificent voluntary work which has been done throughout the country in the devotion and care given to babies and young children, and I am very glad to see that this will form a very essential part of the work of the new Ministry of Health. A staple and necessary food for infants and young children is milk, and if milk is pure and wholesome nothing else can take its place in the nourishment of a young baby or child. But I regret to say that the present condition of the milk supply of this country is nothing short of disgraceful, and I sincerely hope that this new Ministry of Health will have full power to take complete charge of the milk supply, so that in addition to the contamination which the milk receives from the cow to the consumer it will obviate the very dangerous condition which is in milk to-day, namely, tuberculosis. Twenty per cent. of all the samples of cows' milk which are delivered to the consumer to-day contain living germs of tuberclulosis. Surely any great Ministry of Health would look upon that as a most essential and important part of its work in trying to improve the health of the people. I am certain if the people of this country had more confidence in the milk supply they would drink a very much larger amount of it than they do to-day. And the result of that would be increased nutrition of the children and a very large stimulus to the whole dairy industry and the formation of a big enterprise in milk.
Housing is one of the most important parts of this great campaign of the Ministry of Health. I feel certain, as all other doctors do, that when the industrial classes have a proper and a reasonable and decent place in which they can bring up their families the health of the country will be enormously increased and improved. Prevention in disease is better than cure, and I am glad to see that one of the important parts of this Bill is the provision of a research committee. Whether or not a research committee should be included in the Bill is a matter on which people may take different views. I think a Ministry of Health without a research committee is incomplete, and that a research committee certainly ought to be under the control of, and directly attached to, the Ministry of Health itself. The results of scientific research in the past has been extraordinarily beneficial to the human race. Small-pox, malaria, typhoid fever, diphtheria, have all been conquered by patient and intelligent scientific research, and I feel certain with a little more patience and continued research the great enemy we have in our midst to-day, influenza, will very soon be conquered. I would advocate that research should not only be confined to a central department in London but that this Bill should encourage a research in every town of the country. Every hospital should be encouraged to spend a, large amount of its time and money on the investigation of disease.
The key to the efficient control and treatment of disease is an adequate and completely equipped hospital system throughout the country. Under the present circumstances the industrial classes have recourse only to two classes of hospitals—the voluntary hospital or the charitable institution and the Poor Law hospital or Poor Law infirmary. Every citizen in the country ought to have a perfect right, in case of illness, to enter a hospital and receive all its benefits and pay according to the services rendered. Speaking from a long experience of hospitals, I say the present system in this country is capable of considerable improvement. The voluntary system, or the charitable hospital system, has been the pride of this country and the envy of many other countries. But it is unreasonable to think we can expect the voluntary hospitals to be responsible for the great work of the treatment of disease, especially as they are now overburdened with financial troubles. I hope, under this Ministry of Health Bill, all the voluntary hospitals, which are doing such magnificent work, will be able to receive subsidies or amounts from the Treasury or through the Ministry of Health which will enable them to continue this splendid work which they are doing at present. I also hope the present Poor Law infirmaries will be transformed into national hospitals, so that every taint or every suspicion of Poor Law administration should be removed entirely. With reception and treatment for illness or accident neither charity nor pauperism should be in any way associated. The Poor Law up to the present has done magnificent work in the treatment and the handling of very large numbers of the industrial classes when attacked with illness or destitution, but the present Poor Law treatment is out of tune with democracy, and I think the time has now arrived when the functions which have hitherto been discharged by the Poor Law might quite well be handed over to some other body. It is difficult to realise that at present nearly two-thirds of the people who are receiving hospital treatment in England are receiving it in Poor Law institutions. This shows the total inadequacy of the present voluntary or charitable hospital treatment, and under this Bill I hope this difficulty and difference will be entirely removed and that those hospitals which will be established in the future will be national hospitals, into which every citizen may have a right to enter and pay according to his means and receive the necessary treatment which he will get in a well-conducted institution. In all these hospitals there ought to be provided a certain number of beds into which those people who cannot afford to pay will be received at the expense of the State.
Another point to which I wish specially to call attention is the fact that the Lunacy Act and the treatment of all mental diseases may be associated with the Ministry of Health later. I maintain that the treatment of mental disease ought to be a primary part of this Bill itself. Mental disease is as much a part of health as any other disease we have to deal with. I would like to call attention to a matter which causes a great deal of discomfort in this country to-day, and that is the fact that there is no provision made in our laws for a temporary mental attack, such as a nervous breakdown, or, by way of illustration, the case of a woman who suffers from a temporary mental derangement following child-birth. The only place that she can possibly be received in is the workhouse infirmary or a nursing home. The reason of that is that it is impossible to treat those cases of nervous breakdown, of temporary mental derangement, unless a doctor has certified that the patient is insane. A slight alteration in the Lunacy Laws would allow all those cases of temporary mental trouble to be treated exactly as though they were hospital cases in a hospital where people might recover and return to their families without the stigma of having been certified as lunatics. The object of this great Bill is co-ordination, and I think the War has shown us that great value of co-ordination in the treatment of disease. I would like in this House to express my admiration for the splendid and magnificent work which has been done by the Army Medical Service in the field, and I speak from my four years' experience of service at the front myself. Everything that science and experience could suggest was given to our soldiers in the Army Medical Service—I speak entirely for the Western Front. The military hospitals in France were almost perfect, and the two great bugbears that we have to deal with as an army in the field, tetanus and typhoid, were almost conspicuous by their absence, thanks to the perfect system of inoculation and control by the medical staff.
The hospital in France were so perfectly managed and so perfectly controlled that the mortality from disease among our British troops was astonishingly low, whilst the health of the troops themselves was splendid. I mention this fact, and I have longed for this opportunity to pay my tribute in this House to the splendid way in which our soldiers were not only nursed but looked after, and their health considered in really perfect military hospitals. The result of that was that thousands of lives were saved and thousands of limbs saved, and I mention the fact again just to show the importance of a determined and resolute attack on disease, such as was made by the Army Medical Service from top to bottom. The great benefits of this great Health Charter, the Ministry of Health Bill, can only be received by the people, if the people who have to carry out its provisions are in loyal co-operation with the authorities which administer them. I refer chiefly and especially to the doctors and nurses who have to carry out the details and working of this Act. I feel perfectly certain that the medical profession throughout the country is as anxious as any other body of the community to do everything and to make any personal sacrifice which would be for the benefit of the community in general. I feel also equally certain that the Government will offer every possible inducement to the medical profession to loyally work and co-operate in carrying out this great charter.
I do not think that the only expression of Irish opinion on this rather belated Government proposal to extend this measure to Ireland should be confined to Belfast, and therefore I venture to make a few remarks as a representative of the South of Ireland. I desire to say at the very outset that I am in complete accord with the general intentions and objects as expressed by the three Members who spoke as representing the City of Belfast. In my opinion, as in the opinion of everyone interested in the welfare of Ireland, there is no subject perhaps more urgent or perhaps more pressing than the immediate betterment of the public health conditions in regard to the people of our country. But when it comes to a question of method, there, like my hon. Friend the Member for the Falls Division, I part company with the right hon. Gentleman the Member for Duncairn and his associates. I think that it would have been better if the Government had departed from their usual practice of shilly-shally in regard to Ireland, and had for once kept a consistent and a straight line; that having once made up their mind as they did last Session that this Bill should not apply to Ireland, they should have stuck to their original proposal and have framed a special measure to deal with the peculiar position of affairs as they exist in Ireland.
There has been one speech made in sup-fort of their recent volte face; it has come, of course, from the Government Bench. The right hon. Gentleman the Attorney-General, who made that speech in the course of his remarks by way of explanation for the sudden change of mind of the Government, declared that only recently it was discovered that the powers which existed already in Ireland were not being properly used. A very strange fact indeed that during the period when the Bill was considered last Session up to the period when the Bill was again considered this Session such a discovery was not made, and that within such a very short space of time as has elapsed since the Bill was originally introduced here that this great discovery has been made. But, indeed, it is a nice state of affairs for a British Minister, and especially for an Irish Attorney-General, to come down to this House at this stage of the twentieth century and lecture any portion of His Majesty's Dominions, the people of Ireland included, upon failure to carry out and perform their duty in regard to the people they are concerned with. Failure is written all over the history of the Irish Government for the last 117 years. Failure is written all over the attitude of the present Government in regard to Ireland at the present moment. Failure is written all over the attitude of the last Parliament in regard to legislation and administration for Ireland during the whole period of the War, and now we are told, forsooth, that because it is suddenly discovered that the authorities in Ireland have failed to carry out what they had in their power to do and that discovery was only made within the last few days, the Government are to turn once more an Irish political somersault and come down to the House and tell us "We were wrong at the beginning, but we are right now."
I am not going to say that the right hon. Gentleman did say it was sudden, I said it was sudden, because it has only taken place from the time that the Bill was first proposed in this House, a few days ago, and now. Why was that discovery not made when the Bill was originally proposed? My hon. Friend the Member for the Falls Division, of Belfast (Mr. Devlin) addressed several questions to the Government, and, among others, he asked why Ireland was not included at the commencement. No attempt at reply has been made. During my experience in the House of Commons, which is not a very long one, although I have been rather a constant attender during the last ten years, I have never heard a Government proposal put forward with such lack of enthusiasm and with such utter lack of argument or common sense than was this sudden change of policy as enunciated by the Attorney-General for Ireland. The next question asked was what inquiries had been made of representative Irishmen in regard to this proposal.
The hon. Member says that the majority were consulted. If the majority were consulted I hope the decision they have come to is known because that does not agree with what the Attorney-General said. The Attorney-General said that inquiries were now being made. I took down his words, "Inquiries are on foot." That is, they are now being made. Does the Government really mean to say that, in the first place, they make a proposal that Ireland shall not be included, then they go back upon that and say that they are going to make inquiries, or that they are making inquiries, how Ireland can be included, and while they are making these inquiries and before they know the result of the inquiries they turn round about and say that Ireland shall be included. That is the state of affairs. If they did make inquiries—and I have reason to believe that they have not made inquiries in quarters where they ought to have made them—and if they are making inquiries now, why cannot they wait for the result of their own inquiries before they determine which course they are going to take? We on these benches know full well that the Government of Ireland is not concerned with the feeling of the representative people in various capacities in Ireland, such as the great Departments represented by the various heads of those Departments and such as the medical profession in Ireland. I would like to ask the right hon. Gentleman what eminent physicians or what eminent public health specialists have been consulted during the last few days or the last few hours in Ireland upon this question. What public health authorities and what local boards of guardians or what people who are in close contact with the everyday necessities of the poor and of the sick and those whom we hope to benefit by a Bill such as this, have the Government consulted? My hon. Friend opposite says that the Government have consulted the majority, I have not heard it definitely stated who the Government have consulted. The only explanation that we have had is that they have consulted somebody but that those people have not given their decision, and in spite of that the Government intend to carry out an entirely new proposal and to include Ireland in this measure.
The Attorney-General said—and I think he let the cat out of the bag to a certain extent—that he proposed that there should be some form of central administration. What does that mean? Hon. Members from Ireland know perfectly well what is at the back of the Government's head. They want to bolster up a bureaucratic system in Ireland in Dublin Castle the like of which has never been seen, and which is almost crumbling at the present time. They want to build up and to strengthen a bureaucracy in the local board, and to appoint an autocrat the director of that board, a man who probably is not more conversant with Irish affairs than most of the Irish Government officials. They want him to rule the roost over the heads of all the local people and in spite of and without regard to local conditions in Ireland. We know what that means in Ireland. We know what boards and departments in Dublin Castle are and how they have already administered affairs in Ireland. We know in Ireland that they have no more regard for what concerns the welfare and the conditions of the people in Ireland than have the majority of the Members of the present House of Commons. We also know what this board or department as appointed in Ireland would largely consist of. Who will be nominated on that board? Will there be representatives of the Irish medical profession? Will there be representatives of the various locally elected bodies throughout Ireland? No; the gentlemen who will be placed on that board will be estimable gentlemen in their own way, but they will have no more concern or regard or knowledge of the affairs in Ireland than have the majority of the Members of this House.
The Attorney-General, towards the close of his speech, mentioned that a Bill was now in preparation conferring powers on the local board in regard to the Children's Act. What I suggest respectfully to him and to the Government is this: that if that Bill is in course of preparation why not postpone the whole question involved in, including Ireland, within the scope of this measure, and deal with it entirely under the Bill which he has announced is under consideration, and will be proposed to deal exclusively with Ireland? After all, though we have a Scottish Chief Secretary that does not make us Scotland, and we have every bit as much right in Ireland to have our special interests considered as have the Scottish Members who, because they were not pleased to have Scotland included in the Bill, were immediately allowed their own way, and Scotland was withdrawn from the scope of this measure. If the Attorney-General is going to propose a special measure with regard to Ireland, why does he not make a full, large proposal dealing exclusively with Ireland, and, if he likes, tack it on and pass it pari passu with this Bill?
Personally, I was much amused at the concluding passages of the right hon. Gentleman's speech. He proceeded to lecture people in Ireland upon their failure to use the powers already vested in them, and wound up by saying that what he would like to see in Ireland would be more health and less politics. That comes very well from the right hon. Gentleman, considering that the university which he represents—Trinity College, Dublin—has already expressed itself in that way, for at the last election it returned an eminent member of the medical profession instead of a staunch party Unionist to represent it in this Parliament, and I am glad to know that he is in accordance with the views of his constituents to that extent. I endorse fully what he said in regard to more health and less politics, and I will go even further, and say more healthy politics. But that is altogether apart from the main question in regard to Ireland. We do not believe that this hasty and sudden determination of the Government to change about in reference, to Ireland can come from any genuine motives on the part of the Government. If they had acted with sincere motives for the welfare of Ireland, why did they take all this time about it? Why did they exclude Ireland twice already from the purview of this Bill, and why does the right hon. Gentleman come down at the eleventh hour and make a proposal which he knows will be acceptable to the right hon. Gentleman the Member for Duncairn and his associates?
As a medical man, I would like to give my strong support to this Bill, but I am sorry to see that the Ministry is not to take medical research under its care. There may be very good political reasons, and possibly it may be wiser for some reasons, to leave it under the Privy Council. It strikes me that possibly the reason might be that there would be different boards for England, Ireland, Scotland, and Wales, and I suppose we would wish to have the medical research committee as a central body, and not under these different authorities. But I would very much prefer the Ministry of Health to be entirely unified. I would like, so to speak, to have an Imperial Ministry of Health over all the four boards. If that were at all possible, I believe it would be very much better for the public health. If it can be arranged, I should like to see separate boards of health for the separate Kingdoms and an Imperial Ministry of Health over all. In that way we could have the unified command of which we have heard so much. I would also like to see public service for all who cannot afford to pay for medical attendance linked up with the present insurance medical service. In that way people who cannot afford to pay for medical attendance would be guaranteed good medical attendance, and those who come under the Insurance Act would be linked up with the medical attendance carried on in that way. The President of the Local Government Board pointed out that there are far too many sanitary authorities in this Kingdom. He mentioned the number as 1,800. A great many of them have only part-time medical officers. I should like the number reduced practically to about one third, and the same amount of money devoted to giving whole-time medical officers to the whole country.
In those ways you will get a great improvement in general health and the work will be carried on in a more efficient manner. I endorse all that has been said by an hon. Member on the other side who served in the R.A.M.C. I also have served in it in the East. The hon. Member mentioned that tetanus and typhoid were almost exterminated through the splendid organisation of the R.A.M.C. I would like to add my testimony, from my experience, as to the splendid manner in which that organisation has reduced the mortality from dysentery. At the beginning of the War we lost a great many fine lives in that way, but during the last seven months, when I was connected with a general hospital, there was not a single death from that cause. Medical research, as I say, should be under the control of the Ministry of Health, and if this is possible it is advisable from every point of view. I wish to endorse the words which you, Sir, used at the opening of this Session, when you said we should build upon old foundations, and in connection with medical research grants could be given to the present universities and schools of medicine and all the laboratories which are doing good work. It should be done in that way, and if it were thought advisable to have a central laboratory to co-ordinate the work, possibly that might be the best plan to adopt. I only make that suggestion, but I would like to see the use of the present seats of learning, and the future Ministry of Health co-ordinating all that work, and not losing any good work that is being done. I thoroughly support this Bill in every kind of way, and if any of ray remarks are not in accord with it I do not wish to make any difficulty but simply throw out these suggestions.
I ask for the generous forbearance of the House on rising to address it for the first time. The right hon. Gentleman gave us some information with regard to the position and administration of the Bill so far as it concerns Wales. By Clause 5 the Minister of Health is given permission for the exercise and performance in Wales, through such officers as he may appoint for the purpose, of any of the powers or duties transferred to the Minister by the Bill from the Welsh Insurance Commissioners. That cannot be deemed to be satisfactory from the Welsh point of view, and I think it is a reactionary and retrograde step. We were led to believe that in Wales, as in all other parts of the Kingdom, all these matters were going to be unified. We should have preferred in Wales to have seen the Government taking its courage in both hands and appointing a Minister responsible to this House for Wales. Wales has asked for the separate treatment of matters relating to its government for generations past. We have been fed with hopes and have been asked to believe in good intentions. I would, however, remind Ministers that a road paved with good intentions does not necessarily lead to a healthy existence. In this particular matter I would ask the House to consider what has been the position of Wales in affairs relating to health. We have not come to Parliament to ask for Grants to initiate schemes which we consider to be in the interests of the health of the community. We have during the past thirty years set up an almost complete national system of district nursing on the basis of voluntary subscriptions. The amounts now contributed throughout the whole of Wales total £60,000 per year, which is not a small contribution from a population largely composed of poor people, and a people who have no great industry, except in the South, to draw upon for their wealth. In addition to that, largely owing to the initiative and generosity of my hon. and gallant Friend the Member for Montgomery shire (Major David Davies), we have raised a fund of a quarter of a million, also by voluntary subscription, to form the nucleus of a national system to combat the fell disease of tuberculosis. This scheme has been extended to enable the county councils to contribute towards the cost of that great undertaking, which has already done so much for the prevention, if not for the cure, of tuberculosis. Those two instances show not only grit, but also the unique capacity of the people of Wales to administer these matters under their own system of administration. It may be that I shall be told, and probably I shall be told by the right hon. Gentleman, that, unlike Scotland and Ireland, we have not got in Wales the necessary machinery to which could be transferred the powers of a Minister directly responsible to this House. That is true in part, but in part only. We have machinery which, I think, might be very easily co-ordinated and made applicable for the purpose of a Ministry of Health. I would appeal to the right hon. Gentleman to deal with Wales—which is no mere geographical expression—as he has expressed his intention to deal with Scotland. It is essential that the peculiar circumstances and conditions obtaining in relation to health matters in Wales should be fully realised and dealt with, and by those who thoroughly understand the needs of the country, and not only the needs, but the customs and traditions of the country. There is, for instance, the difficulty as to language, which is a very great one. That leads not only to difficulties, but to suspicion and distrust. There are other factors in Wales which deserve special consideration. You have industrial portions of the country in the South, and in rural Wales, which is the larger portion, you have a lack of transport which hinders and delays in every possible way. There is a provision under Clause 4 of the Bill for the establishment by Order in Council of consultative councils, but I do not think such a council would do for administrative purposes. I do not know whether the right hon. Gentleman can see his way to meet Wales in such a manner as will not make more difficult the solution of the general administrative question in a fuller measure of devolution. I can assure him that if he can devise means by giving us a Board or a Commission, the members of which should be appointed not only with reference to their capacity for dealing with matters of health but also to their capability of speaking Welsh, if he could do that, whether it was called a Board or a Commission, it would go far to reconciling Wales to the Bill. I should like to know specifically whether the right hon. Gentleman is prepared to drop the word "may" and to substitute for it the mandatory "shall," and to delete the last five words, namely, "from the Welsh Insurance Commissioners"? If he will say whether he will agree to some such Amendments as I have indicated in Committee, he will do something to meet the wishes of Wales in this matter.
I am sure the House will agree that we have had a most interesting discussion to-day, and the level of the speeches, particularly by the new Members, has been very high. I am certain that everybody will agree that the support which has been shown to-day is most gratifying to my right hon. Friend, and shows that the House appreciates the energy and the tact and diligence which he has displayed in the last two months in getting agreement on this Bill. The fact that he is able to come to-day with a big first-class measure like this and practically get unanimous support from all quarters of the House is a tribute in itself to the successful and tactful way in which he has carried out what I know have been extremely difficult negotiations. The House has shown itself appreciative of the underlying principles of the Bill. We want by this Bill to use in the great fight against the disease the same principle which has enabled us to defeat the other enemy on the Continent. That is to say, we want unified command, one staff to look ahead plan a campaign, and then carry it out. Sir Douglas Haig, when he fought against the Germans, did not have half-a-dozen general staffs, but only had one general headquarters staff, and because he had one staff he was able to carry through his operations so successfully. That is the underlying principle of this Bill. It is a co-ordinating Bill, it is an endeavour to bring under one Minister and one Department the functions connected with health which are at the present moment scattered among at least half-a-dozen Departments in Whitehall. Almost every Minister probably at some time or other reviews the way in which his Department is carried on, the way in which the functions are being carried out by his permanent officials. He may find that one assistant secretary is over-burdened, and that another one has not enough to do, and he may find that the same function is being dealt with by different heads of sections in the same Department, and accordingly he reorganises the work of his Department, he re-shuttles the powers, he applies to the Department the same principle which the head of every big, successful business firm applies to the conduct of his business. In this Bill we want to apply the same principle to the Government Departments as a whole, we want to re-organise and reshuffle existing powers, to put the health functions under one Minister, to set up one staff, and then we can come down to the House here and ask for additional powers in order that we may carry through to a successful termination the big campaign which is ahead of us. Hon. Members have referred to legislation which will be necessary in future in connection with the Poor Law, sanitation, hygiene, welfare, the position of hospitals, and the position of the various medical services, etc. All those things will have to be dealt with at some time, but my right hon. Friend came to the conclusion, and I think quite rightly, that it was essential as a first step to set up one staff, to look ahead, and to make a comprehensive plan, and, having made a plan, then to come to the House and ask for additional powers. In the past there were various health functions scattered about. Take, for instance, the case of the powers in connection with maternity, which were scattered amongst four Departments, and because it was everybody's business it therefore was nobody's business to see that an adequate and satisfactory maternity service was provided. That has been the case in the past.
As regards the future, we propose to co-ordinate and bring the powers as far as possible under one head. For the first time we shall be able to see how far we are able really to utilise existing powers. I believe we shall be able to do a great deal more than people think possible with our existing powers, if we deal with them from one head instead of having them scattered about under different heads, and under frequently competing heads, in different Departments, and that is an additional reason for not asking the House to-night to give us additional powers. Until we know the extent to which we can use our present powers, my right hon. Friend does not feel justified in asking for fresh powers. The question of money has been raised by several speakers, and it has been quite rightly pointed out that unless my right hon. Friend has adequate supplies of money it is no good setting up a Ministry of Health. My right hon. Friend means to go ahead and to draw upon the public purse. It was mentioned in the King's Speech, and I can assure the House that the Government mean business in this respect They mean this Department to be a real Department, and have real powers, and to go ahead and develop the health services of the country, and I am perfectly certain the Chancellor of the Exchequer realises that money spent on developing the health services, on eliminating disease, on reducing disablement, is money well spent in the national interest. We ask the House to make us responsible. In the past there was no single Minister whom the House or the country could hold responsible if, say, maternity was not properly dealt with. Now there will be a Minister whom the House will hold responsible—my right hon. Friend. I am perfectly certain he realises—we both realise—that there is a rocky country ahead of us the next two or three years, many difficulties to be overcome, a great deal of work to be done, courage requiring the moral support and the support of all the Members of this House. Whether we as individuals succeed or fail, I am perfectly certain the principle contained in this Bill is the right principle, that is to say, having one Minister and one Department.
Perhaps I may tell the House some of my own experiences, when I first came into public life in this House, in connection with public health. After the passing of the Insurance Act, 1911, I was made chairman by the present Prime Minister, who was then Chancellor of the Exchequer, of a committee on tuberculosis. I think we had eight departments represented on that committee. We eventually presented a unanimous Report to the Government as to the machinery which ought to be set up for dealing with this disease, but because we had eight departments looking at the question from a different angle, thinking that they represented different interests, that they had to look after their own interests, taking the side of interests at the periphery as well as at the centre, it took us, I think, thirteen months to get that Report agreed to and presented to the Government, whereas I believe, if there had been only one department, we could have got that through in half the time. That was in 1911. For some little time after that, I lost immediate personal contact with tuberculosis. In 1919 I come back to it—seven years after. The first thing when I come to the Local Government Board is, at the request of my right hon. Friend, to attend an inter-departmental conference between the Insurance Commission and the Local Government Board to deal with the question of tuberculosis. Two days afterwards I went to another conference between the Local Government Board and the Insurance Commission and the Ministry of Pensions. Again, tuberculosis. If it had not been for the Debate to-day I should have been presiding this afternoon at even a larger departmental conference, again on tuberculosis.
I have no hesitation in saying that the organisation now existing in the country for combating this disease, which is so extensive and the ravages of which are so enormous, is inadequate, because of the conflicting and competing interests represented by these different Government departments. In the future, if we can get one head, I think we shall be able to get economy of man-power, of time, of money, of effort. Not only does it apply to this one subject. As my right hon. Friend, speaking earlier in the day, said, there are other diseases with which we have to deal. There are certain sub-tropical diseases, to provide against which we have to take measures in the near future, to see that the population is not attacked by malaria, dysentery and other diseases brought back from the various fronts. The first thing my right hon. Friend has to do is to set up an inter-departmental committee. I am sure that the House will realise that all these conferences, all this correspondence between Ministers and between officials, all these departmental minutes, mean delay. The Local Government Board, in common with other Departments, have their pigeon-holes absolutely choked with inter-departmental minutes, which all means delay. We can- not possibly get action if we have to go round consulting half-a-dozen other Departments. It is not that they are wicked, or antagonistic; but the very fact that we have to go to them to get their sanction means delay. Delay in this case means disease. In many cases it means death. We welcome this Bill and these proposals, because, I believe, it will enable us to get a "move on." Where that "move on" has already commenced it will, I believe, enable us to accelerate it.
Hon. Members during the course of the discussion have raised various points and put various questions as to certain of the proposals in the Bill. Speaking early in the Debate, the right hon. Gentleman opposite (Sir D. Maclean) asked why the health functions connected with factory inspection and with industrial disease, which are now at the Home Office, had not been brought under the Ministry of Health. When drawing up the Bill my right hon. Friend felt that it would be in the interests of all to make a start on certain big things, such as maternity. He quite realises the importance of having, at any rate, satisfactory health in industry. When he was Minister of Munitions he appointed a committee which has issued reports, illuminating and instructive, and which have altered our conception, and that of a large number of people, as to the conditions under which industry ought to be carried on. He has power under Clause 3, Sub-section (2), paragraph (d), to bring the health powers connected with industry and with factories at present under the control of the Home Office into the Department of the Ministry of Health. It can be done by arrangement whenever the time has arrived. The hon. Gentleman opposite, in an excellent maiden speech, raised the same question. He referred to the ravages of consumption amongst the miners. Exactly the same answer applies to this question. My right hon. Friend, who realises the value and importance of improving the conditions of industry from the point of view of safeguarding health, so far as possible and as soon as possible, will use his powers to try to get all these matters remedied. The hon. Member referred in his speech to this Bill having the keynote of life. It has. It is a Bill for setting up and establishing a Ministry of Health. I should almost have called it a Ministry of Welfare, because I think it would be more accurately described by that term, but whether it is the keynote of life or welfare, I am sure we all agree and realise that it is the first real step towards getting that new country which we all talked about at the last election, and towards attaining this we are all pledged. The hon. Member I have just referred to, as well as the last speaker, raised a point about the position of Wales. They wanted to know where Wales was going to come in. They said they had heard the demands of Scotland met and also the request of Ireland, and they wanted to know what was going to be done in the case of Wales. I am sure my hon. Friend will be glad to know that all Committee the President of the Local Government Board proposes to. alter Clause 5 so that the Minister shall establish an office in Wales for the exercise through such officers as the Minister may appoint of any of the powers or duties transferred to the Ministry by this Act.
The hon. Member for North Leeds wanted to know why the powers of the Registrar-General were not transferred to the Ministry of Health. The answer is that they are now being already transferred to the new Ministry and the point has been met. The other point raised by the hon. Member was in regard to the General Medical Council, which he wanted transferred to the Ministry of Health. My reply is that this new Department which is being set up will deal only with England and Wales, and the General Medical Council deals with the whole of the United Kingdom, and that is why it is not in the Bill. My right hon. Friend the Member for Wood Green wanted to know how we were going to deal with the backward authorities. We depend very largely upon the cordial support which we get from the local authorities, and I believe that the same desire as is found here at the centre to get ahead and get a move on in order to improve the present unsatisfactory conditions will be found to exist at the periphery, and I believe my right hon. Friend is going to get real support from the local authorities. He proposes to set up new services. Perhaps my hon. Friend will wait until those are developed in order to see what further steps may be required.
My right hon. and learned Friend the Member for the Exchange Division of Liverpool, who has given so much time and attention to the subject of mental deficiency and lunacy, wanted the powers of the Home Office in so far as mental deficiency and lunacy are concerned transferred to the Ministry of Health. I listened very carefully to his statement of the case, and I may say that my right hon. Friend and I both agree that the right hon. and learned Member made out a good case and that as far as possible we will try to meet him. We realise the urgency of the problem, and we fully appreciate that at some time and very soon the functions now exercised by the Home Secretary in this respect should come under the Ministry of Health. Then there were one or two points raised by the right hon. Gentleman the Member for Wolver Hampton. I honestly believe that the local authorities will find their task much easier when they have only to look to one head instead of to several competing Departments as in the past. I believe the result will be that they will get guidance, instead of being merely confused. We look earnestly to the support they will give us in carrying out and making effective the co-ordinated powers which we shall try and practice from the centre. He also raised the point and asked about the consultative councils. It was also mentioned by other hon. Members. If my right hon. Friend opposite has any particular council in mind or has any specific proposals to make, I hope that he will let us have them. My right hon. Friend is going into the whole question of the number of the councils that there ought to be, their composition, and the spheres which they ought to occupy, and if the right hon. Gentleman has any concrete proposals to put forward they will be welcomed and carefully considered. Before coining to the Local Government Board I was at the Ministry of Food. There we had two councils, the Consumers Council and the Agricultural Advisory Council. I have no hesitation in saying that the Food Controller and I found these councils of the greatest assistance. I am perfectly certain that my right hon. Friend will find exactly the same. He means to set them up as soon as possible, and they are to be a real part of the machinery. Great care, of course, will have to be exercised to see that the responsibility neither of himself as Minister nor of the House of Commons is taken away, but so long as that is safeguarded I am convinced that nothing but good, and a great deal of good, will come from the establishment of these councils. Another hon. Member raised the question of the milk supply. That question is being very carefully gone into at the present time. My right hon. Friend fully realises the importance of having a safe, a clean, an adequate, and a cheap milk supply. He has had consultations with other Departments also concerned, and we hope by administrative action and possibly by legislative action that we shall be able to remove the obvious and admitted defects which were mentioned by the right hon. Gentleman.
There was another point which was raised by almost every medical Member who has spoken, namely, the position of the Medical Research Committee. I believe that the new medical Members who have discussed this matter have not fully understood the present position or the proposed position. I think they unanimously want the Medical Research Committee to be put under the Ministry of Health and not, as it is proposed, under the Privy Council. There are two sorts of research. There is what I may call fundamental research, and there is topical research. There is the fundamental research which surveys the widest field, looking for knowledge wherever it can be found, and I am sure that the House realises that there are only a very limited number of men of sufficient standing in the research world really to materially increase and add to our knowledge in a big way. At the same time there is a great deal of what I called just now topical, day-to-day, routine research. The Local Government Board is doing that research at the present time, and the Minister of Health will continue to do it in the future as the President of the Local Government Board has done it in the past, but we propose that the research over the wider field should not be limited to a Department which only covers England and Wales. We propose to put it under the Privy Council, which means that it will not only cover the whole of the United Kingdom, but that it will be in touch with the whole of the British Empire. Surely the House will agree that you will get far more progress if you have your central medical research committee in touch with the profession and giving assistance to research workers throughout the British Empire. It would be a grave mistake if it were limited to research workers in England and Wales alone. I should like to read to the House an
extract from a speech which was made by a man of standing in scientific knowledge. He said—
The methods of research are anarchical and ought to be continuously destructive of accepted opinions; when a Government Department takes an official point of view, it is apt to insist of its being respected and not criticised by its officers on the strength. It has happened that a scientific man in Government employment has had to choose between his salary and his conscience.…The type of man most fitted for research wants his value to be measured by the quality of his scientific work rather than by his official adaptability.
Hon. Members said that they wanted the Research Committee and research work to be under the strong control of the Ministry of Health. I think it would be a pity to put this work and the body of research workers under the strong control of any Minister. I can quite see, at the present moment, hon. Members only picture the Minister of Health in the person of my right hon. Friend. They know perfectly well that he would adopt a sympathetic and helpful attitude towards research work. But let those hon. Members who are medical Members of the House picture what might happen if you got an unsympathetic Minister of Health, someone who did not understand what was meant by research work, and who tried to control it directly. I cannot imagine anything more prejudicial to real progress. You cannot always tell what a Minister is going to be until he has arrived. If the Medical Research Committee is not attached to any one Ministry or Department, it can be of assistance to all Government Departments. During the War the Medical Research Committee has done a great deal of most useful and valuable work for the War Office, the Admiralty, and the Air Force. All Government Departments are beginning to turn to it when they want real research work to be done. Hon. Members know enough of Government Departments to be aware that they would not be likely to turn to it for this work if it were definitely linked up with one particular Department. We propose to put it under the Privy Council in the same way as the Council of Scientific and Industrial Research was put. The Medical Research Committee have considered this question very fully and very carefully. I speak with some knowledge, because for the last four years I have been Chairman of the Medical Research Committee, and they have unanimously decided on this, after careful and mature consideration, not once or twice, but three times, in the interest of
the research development work which they carry out, and which I believe is unanimously acknowledged to be well done—and as I am only the lay chairman I can say that that work has been of the greatest value to the State at large and to His Majesty's fighting forces. It has done a great deal to advance knowledge. The Committee are unanimously of opinion that the course proposed in the Bill is the right course.
I think that I haves dealt with most of the points, but before sitting down I feel that on an occasion like this one I ought to refer to a public man who did so much during the last two years to help forward the movement and shake public opinion, which has now enabled us to get this Ministry of Health—I mean Lord Rhondda. Lord Rhondda is no longer with us. He knew when he went to the Ministry of Food that it might end his life. He was warned about it, and one of the legacies which he left was a request that the Government and the Prime Minister should proceed with the establishment of a Ministry of Health. Lord Rhondda told the country more than once, speaking with the knowledge and authority of a President of the Local Government Board and with all the facts as he knew them and as he had had them put before him, that, in his opinion, if such a measure as this were passed, and if such a Department were set up, it would have been possible to save every week the lives of 1,000 babies. We know what that means. Since the beginning of this War this country has lost a quarter of a million infants at least. Children have died who ought to have been alive now. They have died very largely because it was nobody's business to look after them. There were four Departments, but there was no Minister we could hold responsible. There was no Minister whose first duty it was to see that they were properly looked after. They died because of the bad, limiting conditions surrounding child-birth. They died because the country neglected its duty. They died because of bad housing and malnutrition, and because of bad pre-natal, post-natal and natal conditions. Maternity, child-birth, is a natural process. Unfortunately in the past it has been too often a form of disease. Anybody who looks into it realises the amount of preventable suffering, debility and disease which women have had to suffer because of inadequate attention and assistance at the time of child-birth. We have got to turn off the tap of child mortality. We talk about increasing the birth-rate. It is far easier to diminish the death-rate than to increase the birth-rate. We have to make up for war wastage. During the War we have lost the best lives, picked lives. There was a need for a Ministry such as this before the War. It is doubly necessary now to make up the wastage of war.
I mentioned just now the fact that it will possibly be in my right hon. Friend's power to spend a great deal of money. I am sure the House will agree that every time a child, or adolescent, or adult, male or female, in middle age, dies prematurely, there is a waste of money—money spent on educating and bringing up that child or adult. It is not only a waste of money actually spent, but there is the loss of a productive unit. The greatest capital of the country is its human capital. We cannot discuss a question such as this in terms of cash. The War has made us realise the amount of suffering and misery connected with disability, disease, and wounds. Hon. Members have referred to the splendid work which was done by the Royal Army Medical Corps and the medical officers in the various centres of war. The soldiers, when they went to the trenches, knew that if they were wounded they would have the best surgical and medical treatment which could be provided; they knew they would have the best chance of recovery. Why should not the children of this country have equal facilities? These hundreds of thousands of children who have lost their lives were not killed by shot and shell and poison gas. They lost their lives because the community had neglected to provide proper treatment and conditions to live in. We cannot afford to allow this to go on. It is because of that that we ask you to set up this new Ministry, whose first and most important function will be to improve the conditions under which people live. Give my right hon. Friend the instrument, and let us support him when he comes later on and asks for additional powers. I am certain, after listening to the Debate, that we can count upon the support of hon. and right hon. Gentlemen, in whatever part of the House they sit, to assist us in getting the Bill carried through with great rapidity.
Question put, and agreed to.
Bill accordingly read a second time, and committed to a Standing Committee.
I beg to move,
That it be an Instruction to the Committee on the Bill that they have power to extend the Bill to Ireland.
I need not put forth my arguments, as the Government has already expressed its intention of extending the powers of the Bill to Ireland.
Question put, and agreed to.