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It did a great deal. I do not know whether it did more. It was all part of the Radical policy. And no doubt you have got to keep the speculative builder, or any other kind of builder including the local authority, in check to see that the houses which he puts up are decent houses. But some of the best figures on this question are derived from the report of a colleague, a County Medical Officer of Health in the North of England, which shows that the diminution in private building enterprise started a great deal before that. It started about 1902 or 1903 up in the colliery districts of the north. The general tendency of the times was to remove the speculative builder from practice. What we must recognise is that the speculative builder is the only builder who will speculate. He is the only builder who will therefore provide houses in advance of the demand. You cannot wait in ordinary times until there is a great demand. You must have provision in advance.
The right hon. Gentleman made one point which must be explained or I will challenge it as wrong. He said that there were 450,000 empty houses before the War, as if this were a great discovery made by his Department, and that therefore you had got a huge provision for two and a half million people. That is a cheap arm-chair suggestion. Anyone who knows anything about the real needs in connection with the housing of the working classes knows that those 450,000 empty houses are an absolute essential, not only for the working classes themselves, but also for industry. Where you have got, as you have at present, every single house bound up and full you cannot possibly have any movement of people, and thus industry is clogged. You cannot start a new industry in any particular district without bringing people from other districts. You have to bring your artificers and special tradesmen probably from other towns, and that is one of the many things which has been clogging industry since the War. Apart from that, there are other conditions, as to which I can show chapter and verse from the figures of the London County Council. About a month ago, it was my duty to present to the London County Council the report of two of our officers on the pressing housing needs of London. It was part of the great housing scheme of the Government that all authorities were, within two years, to survey their needs. It was assumed that, having already built their hundred thousand houses, they were to proceed with a fresh batch. This survey has been made in London. I have not yet read that any other authority has made it, but naturally enough London is in advance. This survey shows, first, that the population of the County of London during the past decade decreased by nearly 40,000 persons. [HON. MEMBERS: "No!"] Somebody has the temerity to say "no." I hope he will have the courage to explain his facts. On the census figures, the County of London population has diminished in the last 10 years by 38,436. Therefore one wonders why there should be this greatly increased demand for houses. It is true that a certain number of houses have been demolished in order to make way for industrial development, but very few, because all that has been checked by the War and, above all, by legislation. The real facts which we discover in seeking an explanation of this is, that the number of families in London has increased by 110,000 during the decade. That means to say that the number of units requiring houses has increased and that at once explains a great deal of the increased need. It is a text upon which one could expatiate to any extent, but I will not do so at this moment.
On account of the needs of the moment, as regards housing, these 110,000 additional families have had to squeeze themselves, either into the empty houses which the Minister of Health has discovered or else into houses already occupied. It only makes one think of the number of cases in which people have not married because they could not get room to start housekeeping. The Minister of Health did not seem to recognise, their existence. Still more does it remind one of the number who have married, but who cannot increase the population, because of the congestion. One of the greatest national problems with which we are faced, and one which is hardly recognised by the general public of to-day, is that of recruiting our population in the future. Whether we are war-like, and want to go to war, or whether we have to go to war; whether we are civilised, and want to develop the industries of peace; whether we are æsthetic, and want to develop the arts; even if we seek to be athletic, and to beat some of the nations of the world who at present are beating us—whatever form our activity may take, we shall find that the backbone of all national power must be population, not merely because of the numbers but because of the wider field for selection, for talent of all kinds, for genius, leadership, inspiration and everything. The birth-rate has been going steadily down. Whereas 50 years ago 35 children were born to every thousand of the population, it went down a year or two ago, at the end of the War, to as low a figure as 17, and although it rebounded in 1920 to 25, that was shown to be a temporary rebound. The causes of diminished birth-rate continue, and will continue unless we take measures to stop them. There have been Commissions, which, although not Royal Commissions, possessed great authority, sitting on the question of the birth-rate since 1913, and they have issued two outstanding reports each of which shows the same thing. They whittle down the causes to their elements. They find, again and again, that these causes are continuing, and will increase, and that among them are the housing shortage and congestion.
So far as the Minister of Health makes any case, it is that, looking at the problem as a whole, we depended before the War on private enterprise to the extent of 95 per cent., and that we should get back to that as soon as we can. During my period on the Housing Committee of the London County Council I have been challenging those who advocate private enterprise to give us their scheme. They keep on saying that the Government is killing private enterprise in housing. I say it is not the Government which is killing private enterprise now, because private enterprise has not done any of this kind of work for 20 years, and would not do it at the present time even if the Government were not in business. The hon. Member for Forth St. Pancras is one of the best exponents of the private enterprise policy, and I suggest that the Minister of Health should ask him to state categorically what private enterprise requires in the way of help and assistance in order to undertake to fulfil the housing needs of the working classes, without forcing up the prices. It requires careful consideration from the economic as well as the other points of view, and I should like the Minister of Health to summon the private enterprise people to his aid. It is no good for either local authorities or officials of Government Departments to go into the question themselves. They will get too much in the way of arm-chair recommendations. We want the private builders themselves, who are patriotic and public-spirited—and there are several of them—to come forward and say what they will do, and what is required to help them and to give them security and confidence that they may build. I do not say that even then we shall be able to depend upon it, but at any rate a case will have been made for argument. As it is, the case is incomplete.
In the Annual Report of the Ministry of Health dealing with the year before last, one is glad to see many signs that there are different aspects of this subject in its newer phases receiving a considerable amount of attention with a view to development. In particular, I would like to refer to the question of slums, and to acknowledge most gratefully what the Minister of Health has done with regard to this question. At the same time, the attitude of the Ministry has been very tardy in the matter. The right hon. Gentleman referred to two schemes of the London County Council which were actually now in progress. Of these, the Tabard Street scheme was decided on before the War, and when we started work after the War we scheduled 22 slum areas in London that particularly wanted dealing with, and we started to deal with them and put forward five to the Ministry of Health. We have had local government inquiries on four of those, but with only one of them, namely, Brady Street, have we had sanction to go ahead. That was settled two months ago. As regards the other three, inquiries were held as far back as June, 1920, more than 18 months ago, and we have not yet had any reply in regard to those slum areas—Ellen Row, Bell Lane, and Ware Street; and that is only a beginning, because there are 17 other schemes which have been scheduled as the most urgent. We are right behindhand with this slum business, and it is waiting for a policy. The Minister of Health has done very fine work, if I may say so, in having obtained this grant, a definite grant of £200,000 a year for 60 years, that is, for the length of the loans that may be required for dealing with these areas. Our Brady Street scheme is a very large slum area and will cost us £10,000 a year deficiency, which only takes £10,000 out of the £200,000, so that the remainder will enable the local authorities of this country to go in for slumming areas 20 times as large as that Brady Street scheme; and it was shown quite clearly by the Minister, when he originally made his pronouncement, that that was only an advance guard and a beginning. I hope he may be able to go ahead in that slumming policy.
I would like to mention the wider and newer questions of what are called town planning and zoning. The questions of town planning and zoning, to all except those who have studied housing, and even to some of them to some extent, are matters of rather academic interest, but those who have really tumbled to the idea of zoning, and who have seen or heard of its action in the United States of America, realise the importance of it and the interest of it, from an economic point of view as well as from other points of view. In fact, I am inclined to think that it is more from an economic and industrial point of view than from a social and philanthropic point of view that it should be argued. The whole point is this, that you have got in the centre of any big town, and, above all, in London, a centre where the residential houses have been squeezed out by offices and factories, and that is spreading more and more, so that the offices and factories are eating out into the residential areas. In some cases that is all to the good, where the people can move residentially further afield, but in other cases it is not desirable.
The idea is that you can to a certain extent direct and guide—I would not like to say completely control, because that is rather against the British character—development in the right kind of direction one way or another for new development, by a system of town planning outside, and a system of zoning in the internal part of your city. That has got to be worked at slowly, and preached, and gradually considered. It is being considered in London unofficially by those of great official experience, in connection especially with the borough of Southwark; there is a very good instance to start with, and I am glad to see the Ministry of Health are encouraging the consideration of this principle. It has been enthusiastically adopted in New York, not so much by the philanthropists as by the industrial people, who see the enormous value of keeping good residential areas residential, and of keeping a certain amount of order in your development and guiding your lines of business development, whether in factories, or offices, or other buildings.
I should like to mention one or two other points on other subjects on the Ministry of Health Vote. They are too little talked about in this House, and yet one cannot help thinking that in politics, as in other things, silence means consent, and the fact that you have got such a magnificent record of work as you always have shown in the Annual Reports of the Ministry of Health and its officials, and the local authorities, passing by year after year without any comment—for the comment here is nearly always confined to the housing question—shows that there is general consent. That, I think, is very much endorsed by the Report of the Geddes Committee, for if the Geddes Committee with their axe could not find any real flaw in the administration, I think we may feel fairly immune from any further critics, on the subject, anyhow, of economy. I should like to quote from the summary of conclusions. Except for the suggestion of the sale of the houses in order to reduce the housing debt, the Geddes Committee say definitely that they do not recommend reductions in the expenditure generally on the Vote of the Ministry of Health. They say:
We hope that, with falling prices and the greatly increased incentive to economy, the authorities responsible for this form of activity will be able still further to increase their beneficial work.
I do not think you could have had a better unsolicited testimonial for the activities of the Ministry of Health and the local authorities than that.
There is one question that is constantly recurring at the present time, on which we do want to get some kind of policy in the next year, with a view to the actual administration of the Vote, and that is the question of venereal disease. That is a problem that has been newly taken up as a result of the War, and it is one that will repay the nation a thousandfold if it is done in the right way. The Ministry has been attacked because it has decided on one particular line of policy that is associated with one of the volunteer associations that undertakes educational activities in this direction and is, if one may say so, the more morally orthodox in its activities. As against that, another association has arisen with, to the lay mind, perhaps, no very great differences in its main objects and ends, and yet a body which says that the original association in its orthodoxy is ineffective, and urges, perhaps, a more unorthodox, more direct, and apparently more effective method for dealing with this disease and preventing its occurrence. There is a great discrepancy between the actual points at issue between these two authorities—such a discrepancy that one authority only can receive assistance from the Government. That naturally gives rise to a good deal of criticism, and at the same time there is some division of effort and some conflict of effort which ought to be removed. I may hope that the Minister of Health will see his way to get some reconciliation between these two bodies. I know he has tried it for some time and has been unable so far to get the doctors, and still less the other people associated with the doctors, to agree, but I hope that possibly he may be able to inspire some kind of agreement between the two, some kind of round table conference, in order that these two bodies, engaged in a subject of vital importance and interest, both from the point of view of efficiency of the nation and of philanthropy and humanity, may be able to get to work on common lines without inflicting greater moral injuries than those which they seek to prevent.
I want to raise one point in which I think the Ministry of Health have inherited a wrong policy from the old Local Government Board, and as to which I ask for some reconsideration, because it affects the actual expenditure of the monies for which they are responsible. It is the question as to the future appointment of medical officers of health. The report of the Ministry last year shows that a county medical officer of health may not engage in private practice, and may not hold other offices without the consent of the Ministry. It then goes on to show that on the 31st March all the county and metropolitan medical officers of health, and 250 medical officers of health acting for county boroughs and county districts, gave their whole time to the public service; 62 of the latter acted as medical officers for more than one district. In the opinion of the Department—and this is the point to which I wish to draw attention—this is the best method of filling the appointment of medical officer of health in a district which is too small to need the whole time of an officer. That is the point which, I believe, is really vital to the health of the rural community. The Ministry of Health, like the old Local Government Board, are carrying on the policy, started in 1870, of trying to carry on public health by specialists all over the country, having nothing but specialists to do this work. The result is that 318 urban and rural districts out of 1,800 districts, or one-sixth, are served in England and Wales in this manner, after 50 years' endeavour.
Opinion is divided amongst medical officers of health on the subject, but in my own county of Hertfordshire, where I had colleagues, both whole-time men serving some districts and private practitioners serving as medical officers of health and school medical officers in other districts, my own experience was that one district was as well served as another. Each system had its own advantages, but the main thing was the actual personality and will of the man himself, and to get a man keen on doing his work and interested in it. But the ideal thing of all was for a country community to be served by the general practitioner of the old-fashioned sort you read of in novels, and, I am glad to say, with whom you meet very frequently in ordinary life, who fulfils all the needs of the district. I believe that is the man who does the best work, and I am perfectly certain that that is bound to remain to a large extent in the future of public health in the country. So we come to this point: When is the Minister of Health going to be able to get the further consideration of health measures in relationship to the Poor Law and the other Departments that deal with public health measures? The Poor Law medical officers in their own domestic work should be associated with the health side of the Ministry of Health, and yet they are still as separate as if they were different Government Departments. We want them connected, and I believe the foundation of public health should be for the Poor Law medical officer, who attends the people in their own homes, who gets to know their own condition, who looks after them, and is a friend to the people, to assist the Government in its ordinary work of public health. It is not so at the present moment, because, hitherto, the ordinary education of the ordinary medical man in this country has not included any practical work in public health. The ordinary medical man has not this knowledge, and has therefore not the keenness. It is quite true he can pick up some of the outward requirements of an appointment if it comes his way, but he is not educated in this way. The curriculum of his education has not been improved to meet new conditions. That is where I want the Minister of Health to come in. The curriculum is ordained by the General Medical Council, which is a public body administering public funds to protect the public interest as regards medical practice. One of its functions is to supervise and organise really the standard of medical education in this country. The question of public health is one of essential importance. The General Medical Council could quite well supervise and re-arrange. At the present time the General Medical Council has this matter under consideration. The matter is now in the melting-pot. The General Medical Council will issue these Regulations. The draft Regulations, as I have seen them, do not do as much—