Orders of the Day — Supply.

Part of the debate – in the House of Commons at on 25 June 1931.

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Duchess of ATHOLL:

As the hour is getting late, and there is another subject to be discussed, I shall not detain the Committee long. Most of the time has been spent in discussing houses, and there are two things I would say on that subject before passing on to another matter. First, there is one thing one can say about those who live in steel houses, and that is that they can sleep in their beds at night without the fear of anything coming through the roof. In the second place, I think I could bring some comfort to the mind of the Lord Privy Seal and show him some houses dating from the time of the '45 which, now that all modern conveniences have been put into them, are quite to the satisfaction of those who live in them, so that he need not despair if a "Prince Charlie" house is occupied, provided it is assisted by the Rural Housing Act.

I wish to draw attention to another matter, which is insufficiently emphasised in the report, the extension of maternity and child welfare schemes in the rural areas. The need for extending these schemes is written all over the report. We see it first in the distressing figures for maternal mortality, which have been referred to. There may be many reasons for maternal mortality, but all medical opinion is agreed that one of the chief reasons is the want of more antenatal care. For this the presence in a district of a nurse health visitor is a very important factor. There are many women who would more readily go to a nurse health visitor in matters of that kind than to a medical man. To insure that a nurse health visitor is within the reach of every woman who may be a mother is very important from the point of view of maternal mortality. As to the deaths of children within one month from birth from congenital defects, the report again emphasises the need for ante-natal care from the point of view of the newly-born child. But we are told that only one-third of the mothers of Scotland get ante-natal care, and we must feel that that is not at all a satisfactory position. When we come to the slightly older children from one year up to five years of age, we are told that only one-quarter are getting any medical care in the child welfare centres, although many of the defects found in these children when they come to school are defects which are easily remedied, but which, if left unremedied, may become serious.

The whole of the report declares the need for the extension of maternal and child welfare schemes. In the towns these schemes consist largely of child welfare centres. In the rural centres, the report tells us the work is chiefly done by district nurses acting as health visitors in return for grants from the associations which employ them. Nothing is said as to the extent to which district nurses in Scotland are acting as health visitors, and no suggestion is made as to how we can have an extension of the scheme by which district nurses will undertake these duties. If I had spoken before the hon. Gentleman, I should have liked to have asked him in how many counties in Scotland schemes are in existence by which the district nurses are undertaking those duties and advising mothers in regard to their own health and the health of their children up to five years of age. I do not think it is a very large proportion of counties, not nearly so much as in England, where this work is being done over a very considerable area.

One of the first things to be done for health in Scotland is to extend schemes of that kind so that every parish can have a district nursing association. This is a work in which co-operation is necessary, because it is common knowledge that the district nursing associations are provided by voluntary bodies. The next point to note is that it is not very easy for local authorities to arrange schemes unless all the district nursing associations, which usually have come into existence on a parish basis, are co-ordinated and federated into a county nursing association. It is very difficult for a county council or big burgh to arrange anything of the kind with disconnected parish associations. The local authority naturally wants to get them all federated into one large body. That is essential in order to extend these schemes in the counties in Scotland. In the past, if any scheme of that sort was to be made effective by the local nursing associations which had federated themselves into one body, they might have to discuss that scheme with a dozen different local authorities. I can think of one case where a scheme of that kind was discussed with five district committees and 11 burghs. The scheme as it concerned district committees was quickly carried through with the county council, but it took eight years before the last of the 11 burghs had entered into a scheme with the federation. Now, however, under the operation of the Local Government Act, the whole of the scheme would be in the hands of one body, the county council. Whatever criticism may he levelled at that Act, I cannot imagine any measures of health being levelled at it in regard to county areas. If the hon. Gentleman will utilise the advantage it gives, particularly in the rural districts, by the unification of health services, he can do a great work for the health of mothers and children in the rural districts of Scotland.

It is not always easy, however, to get district nursing associations federated into one body. There may be nobody, perhaps, who knows how to give the matter a start; one local nursing association may be afraid to step out into the open; there may be some nursing associations who want to be left alone. Therefore, it is not always an easy matter, particularly in our big scattered counties, where people are far from each other, and do not meet often to discuss things. The county councils of Scotland could give tremendous help in this way if they would approach those who are responsible for local nursing associations, and ask them to give their help in extending child welfare schemes. If the right hon. Gentleman would appeal to the county councils to put themselves in touch with local nursing associations, and invite their co-operation——