Motion made, and Question proposed,
That a sum, not exceeding £14,416,840 (including a Supplementary sum of £314,800), be granted to His Majesty, to complete the sum necessary to defray the charge which will come in course of payment during the year ending on the 31st day of March, 1936, for the Salaries and Expenses of the Ministry of Health; including Grants and other Expenses in connection with Housing, certain Grants to Local Authorities, etc., Grants in Aid in respect of Benefits and Expenses of Administration under the National Health Insurance Acts; certain Expenses in connection with the Widows', Orphans' and Old Age Contributory Pensions Acts, and other Services." [NOTE.—£6,000,000 has been voted on account.]
It is perfectly true that I have had some acquaintance with the office previously, and it certainly has been a varied and interesting one. I can claim that in my old associations with the Ministry I have not shown any partiality. I had first the honour of accepting the invitation of the right hon. Member for Swindon (Dr. Addison), who was the first Minister of Health, to be his Parliamentary Private Secretary, and when I write my book I shall be able to insert an intriguing chapter on that period, particularly if I add to it my experience when I acted in a similar capacity to his successor, the late Lord Melchett, who had a somewhat more frugal policy. Later I became Parliamentary Secretary in the spacious days when the Chancellor of the Exchequer was Minister of Health, and later still I had the privilege of regularly sitting opposite, if not of sitting under, the right hon. Member for Wakefield (Mr. Greenwood) when he was Minister of Health to my great pleasure and profit. I have one great advantage to-day, that in beginning my work I am able to build upon the sure and substantial foundations laid by my immediate predecessor, Sir Hilton Young.
Before entering on a review of the work of the Ministry of Health which is appropriate to such an occasion as this, may I say a few words about the Estimates themselves. Hon. Members will see that we are seeking approval for a total net, estimate of £20,102,000, an increase of £313,000 on last year. A great part of the increase, about £133,000, is due to the steady increase in housing grants which is accounted for chiefly by the increased activities of local authorities on slum clearance work. The only other increase, apart from a small increase in miscellaneous grants, is an increase of £58,000 in the cost of administration. That is due to the cost of the extra staff required in connection with slum clearance, town planning and rural water supplies, the normal increments in salaries, offset by savings on retirements, etc., and provision for a full year instead of nine months for the partial restoration of the cuts made in the remuneration of Ministers and civil servants in 1931. If hon. Members have any questions to raise on any points arising out of the Estimates, my hon. Friend the Parliamentary Secretary will be happy to reply to them.
The Ministry of Health Estimates are generally the occasion for a review of the health affairs of the nation, with particular reference to many of our immediate problems and the policy and methods of administration with which we are endeavouring to surmount them. It may not be inappropriate in this Jubilee year to review briefly some of the main developments of the last 25 years, especially as we can draw many lessons and considerable guidance from the experience and efforts during that period. During these years there have, of course, been setbacks, disappointments and failures, but probably never in a single generation have there been such advances and improvements relating to the preservation of life and the health of our people. It is perfectly true that there is no occasion for complacency, but what has been done during the last 25 years certainly encourages us in further active endeavour. During that quarter of a century medical science and surgery, for instance, have undoubtedly greatly advanced, there have been wise investments of large sums of money, and a considerable contribution has been made by all political parties in the State in placing on the Statute Book great measures of amelioration and reform. In fact, during the 25 years no less than 100 Acts of Parliament have been placed on the Statute Book.
But above all in my judgment the great thing to note has been the awakening of the national conscience on health and housing affairs. There has undoubtedly been a widening of human compassion and the co-operative spirit. The nation itself has learned, and is learning to-day, in many ways the supreme art of right living. We are showing greater common sense in health matters, in clothing, dietary, and in the increasing use of daylight, open air, leisure and recreation, with the result that to many people in this country life is becoming longer and better—the greatest gift that civilisation can give. In 1910, for instance, the death-rate for all ages in England and Wales was 13.5 per thousand persons and 95,000 infants died under one year of age. Last year the total death-rate had fallen to 11.8, and the loss of infant lives under one year of age was reduced to 35,000, the lowest infant mortality rate on record. It is estimated that when Queen Victoria came to the throne the English boy child at birth had an expectation of 40 years of life. In the eighties it had risen to 44, and in 1910 to 51. In 1932, a generation later, it was 59. The growth of knowledge in medicine and surgery through all that period has been continuous. Typhoid fever, for instance, has been brought under control; it was at one time the scourge of nations and armies. Another great triumph was the discovery of insulin in 1922 which revolutionised the treatment of diabetes.
Orthopaedic surgery is preventing the onset of cripping and treating cripples with new knowledge and by new methods. Indeed the cripple, to a large extent, has been eliminated from the modern world. Fresh and great discoveries have been recorded in connection with neurology and heart disease and in many other branches of medicine and I do not think it can be any exaggeration to say that never has medicine made such strides as in the last 25 years. It is true, of course, that science has yet many fields to conquer in the treatment of disease. That dread enemy of mankind, cancer, is still with us and accounted for some 60,000 deaths last year. Research, I am glad to say, is increasing and we have fresh hopes to-day that with the increasing employment of radium and X-ray therapy, something further may be done. A less malignant enemy, though regarded by many as Public Health Enemy No. 1, is the common cold. I hope that during the next decade, at any rate, medical men like the right hon. Gentleman who is sitting opposite to me, instead of warning the sufferer from the common cold to go to bed and stay there for some indefinite time, will find some sort of instant cure. The discoverer of such a cure will be well entitled to any honour that can be conferred upon him.
The creation of the scheme of National Health Insurance has been one of the most remarkable developments in public health during the last 25 years and the figures to-day show its extraordinary magnitude. The value of the benefits disbursed since 1911 is £480,000,000. In the last 10 years over £150,000,000 has been disbursed on the statutory sickness and maternity benefits and over £90,000,000 in medical benefits. The scheme has successfully survived the great strains of the European War and the prolonged depression and unemployment of recent years. It is true that it has been found necessary to underpin the scheme and to take steps to preserve its actuarial solvency. But it has stood the test of three valuations and in the result it has been found practicable to extend a total of £53,000,000 in additional benefits. Of this large sum no less than £27,000,000 has been devoted to supplementing cash benefits and over £26,000,000 to benefits of a medical character, while £20,000,000 has been devoted to dental benefit alone. It is, I think, something upon which we can pride ourselves in this country—particularly the author of the scheme and all who have amended the scheme from time to time—that our national insurance system has now been adopted by 12 other countries from Norway in the North, to Japan in the East. Many representatives from those countries have come here to learn from our experience.
Another scheme of the first order of importance to the well-being of our people has been created during the last quarter of a century. I refer to the Widows', Orphans' and Old Age Pensions scheme. The provisions of this scheme have been steadily expanding and they now include 600,000 old age pensioners between the ages of 65 and 70 and another 600,000 widows' pensions, supplemented by 270,000 additional allowances in respect of children and 15,000 orphans' pensions. In fact, the total amount expended on pensions under the Contributory Pensions Act to the end of the last complete year in our accounts has been over £232,000,000. In addition, over £103,000,000 has been paid since 1926 by way of old age pensions to persons over 70, free from restrictions as to means.
I could refer to many other Measures like the great Local Government Act, which finally divorced health provision from the Poor Law. It cannot be doubted that no other country in the world has made such provision as we have made to protect many millions of our people against some of the most serious disabilities of life such as sickness, unemployment, widowhood, orphanhood and old age. Having said that, I am bound to add that I am one of those who believe that although much has been accomplished much remains to be attained. There is, for instance, a matter to which I would like to refer because I know it is of considerable interest to everybody in this Committee and that is the unsolved problem of the unreduced maternal mortality rate. I do not believe that we need be defeatist about it, but it is a great blot on our national health record. The fact that these rates show no decline has been a matter of deep concern to my predecessors in office as it is to me. I think it is a matter of real and national concern that, while we have been successful in solving or in helping to solve so many other health problems, while we are in so many respects a healthier race, yet too often the price paid by those who give us life is death, or pain and ill-health, or lifelong disability. It is a complex problem. Its solution will require patience, constant research and active endeavour. The Departmental Committee which reported in 1932 inquired into the circumstances of nearly 6,000 maternal deaths and their report suggests that at least one-half of the deaths resulting from childbirth might be prevented.
There is another factor which I would like to bring before the Committee and that is the incidence of the maternal mortality rate as between one area in the country and another. In West Ham, a poor borough with a population of over 280,000, the maternal mortality rate over the ten-year period 1924 to 1933 was 2.48 per 1,000 births. In Nottingham, a borough which is much better off in many respects and with practically the same population, it was 3.74. In Westminster, it was 5.63; in Marylebone 3.78; in Kensington 3.51; in Hampstead 3.48 and in Poplar 2.63. Many efforts have been made by those responsible for maternity and child welfare services to deal with this problem. There has been no relaxation of their work on financial or other grounds and it is interesting to note—not in order to be complacent but in order to observe the position fairly—what has been accomplished in the last three years. The number of visits paid by health visitors to expectant mothers shows an increase of 60,000, 240 more ante-natal clinics were provided and the number of women who attended those clinics rose by 49,000. The total number of attendances rose by 242,000, and the total number of women admitted to maternity beds in institutions provided or subsidised by local authorities rose by 29,000.
My comment on all that is that we must go on vigorously with this work. It is essential that there should be continuous and concentrated effort, and particularly to improve, wherever necessary, the maternity services of local authorities. Another thing upon which I would like to comment, I hope with general acceptance, is that we should constantly encourage women to take advantage of these services, and, above all—and this is a matter to which I myself attach particular importance—that we should persevere in the investigation of the causation of maternal mortality by intensive inquiries, not only in the areas where the rate is the highest, but in other areas, with a view to obtaining data for comparative purposes. I am glad to tell the Committee this afternoon that special inquiries are now proceeding by medical officers of my Department, with the assistance of a distinguished specialist. They are being held in a number of counties and county boroughs in England and Wales, and I have great hopes that when the results of these investigations have been completed and collated, we shall have material which will enable us to understand and deal much more effectively with this difficult problem. There is also an important report of the Joint Council of Midwifery, the financial and administrative details of which are now being considered by my Department, and also by the various associations of local authorities. I attach great importance to the midwifery service, and to the work of the midwives, who attend approximately 60 per cent. of the confinements in this country. Fresh legislation would be required for any new scheme, and therefore it is not possible further to discuss this aspect of the matter to-day. I think, at any rate, this can be said, that the remuneration of midwives in this country is very low, and that the poor pay and prospects of the profession inevitably react on the quality of its entrants, and also on the efficiency of the midwives' work and the status of the profession generally.
I have only one other subject to deal with this afternoon, and that is a subject about which, I know, the Committee will desire me to say a few words. It is the position of housing, one of the most important factors in building up an A.1 nation. This country has had to pay bitterly in the past for neglect and absence of foresight in many of our building operations. Houses have been erected which hardly deserve the name of homes. Many have ruined the amenities of the neighbourhood for want of control and matters of that kind. This generation, I believe, is learning from the lessons of the past. It has certainly set its heart and mind not only on more and better houses, but on the clearance of the slums in the next few years—one of the greatest contributions which this generation could make to produce a healthier nation. The cost is, of course, the most important factor in the housing situation, but I think it is a real duty upon everybody concerned to see that we do not repeat the mistakes of the past, and particularly that we should plan our developments, especially in our rapidly growing districts.
Having said that, I may say that since the Armistice no country has made such a contribution to better housing conditions as we have done. We are overtaking the housing shortage at a rate never before approached, and, so far as the building industry itself is concerned, there is a steadily increasing volume of employment on a scale which has never yet been exceeded. I would like to give the Committee the latest figures. Since the Armistice, up to the end of March last, 2,670,000 new houses have been provided, and I would make this observation in passing that, at any rate, compared with a quarter of a century ago the housing standards have greatly improved, and the bulk of the new housing, which has been on new estates in the neighbourhood of towns, has been planned and developed on sound lines. A good many people questioned this in days gone by. They said, "If you put these people into these houses, they will soon turn them into slums again." I would say, from my own personal observations, that these new houses have been greatly appreciated by their occupants, who have shown a real pride in them. I was at Middlesbrough a few days ago, and was shown new houses where people had come from very bad conditions indeed, and one of the most gratifying things was to see the care and pride which the people had in those houses. Obviously, there are people in every section of the community who abuse what they receive, but I think, speaking of the great majority of new houses, the occupants have shown a great appreciation of their new conditions, and, from the point of view of the children, it is impossible to over-estimate the value of the work which has been done.
Of that great total of 2,670,000 new houses, 1,425,000 have been provided by non-subsidised private industry, and during the four years ended 31st March, 1935, in England and Wales approximately 1,000,000 new houses have been built. That is worthy of a poster. It is a record which is all the more remarkable when compared with the 127,000 houses which marked the peak year output before the War, when the population was increasing more rapidly than at the present time. The number of new houses built in the year ended March last was 327,000—another record in the history of this country. Local authorities have also been enabled to concentrate on special housing needs which cannot be met in the ordinary way without subsidy, and, in the result, apart from the unexampled progress in new house building, there has been a record progress in the clearance of the slums. Again, I am able to give the Committee new figures for the first six months of 1935. New houses for slum replacement have been sanctioned at the rate of over 6,000 a month in England and Wales, and at the end of June nearly 100,000 houses had been approved for this purpose, of which some 50,000, sufficient for about 240,000 persons, have already been completed. This is a great beginning of better things, especially when it is remembered that during the years 1875 to 1933 only 200,000 persons living in slum houses had been rehoused in all that long period. I need hardly say, because everyone in the Committee knows it, that there is further work still for the local authorities in the construction of new dwellings for families living in overcrowded conditions, in accordance with the proposals now before Parliament which, I hope, will shortly be on the Statute Book.
I have only one further observation to make so far as housing is concerned, on a point on which, I anticipate the right hon. Gentleman will say something this afternoon, and I always follow what he says with the greatest possible interest. It is sometimes contended that all these efforts have made only a minor contribution towards the provision of dwellings for the lower-paid workers, but, in fact, of the total of some 1,000,000 new houses provided in England and Wales by the industry from March, 1931, to March, 1935, nearly 90 per cent. were under £26 per annum rateable value in the provinces and £35 in London. Unsibsidised house-building since it has been resumed has spread downwards from the relatively more expensive house to the relatively less expensive house, and it has certainly enabled a most substantial contribution to be made to the provision of houses within the means of large classes of wage-earners, especially the black-coated workers, whose needs have too often been neglected by all parties in this country. The building industry, in fact, during the last three years, has been producing houses, of which a very great proportion are houses of a relatively small size, at an average rate of, approximately, 260,000 a year, and in the result the total housing accommodation available has been largely increased. It has made a powerful contribution to the general relief of overcrowding, and it is also plain that the removal of people to the new houses has resulted in the provision of better accommodation within the means of other large sections of the community.
It is appropriate that this year I should refer to another event of some importance. This year we have to record 100 years of local government, inasmuch as it was in 1835 that the great local government reforms were initiated. Local government touches the life of our people at every point. It is a living and moving organism, and, as the "Times" point out in their article to-day,
the foundations of our modern system of local government were well and truly laid a century ago.
It has some defects, like all human institutions, and it sometimes acts slowly; and the process of adapting it to the needs of our people must always be a continuous one. But it is a great and valuable part of our democratic system. Many parts of the world to-day have their national dictators who, in their turn, appoint as their instruments local petty dictators with whole districts without a voice, or a right, or a vote concerning their local affairs, and, in my judgment, in many respects those men are the worst tyrants of all. Instead, in this country during the last 25 years, we have seen the duties and responsibilities of our authorities greatly extended. This House often places upon them difficult and sometimes unpleasant tasks, and the men and women who administer them—and the highly qualified officers who man them—do not get much of the limelight. Honours for them are few; their work is voluntary and in many cases very heavy. The Committee will, I know, in all quarters desire on this occasion to testify to and record its appreciation of their many services to their localities and, through those localities, to the State.
In returning to the Ministry of Health and in endeavouring to refer to some of its work to-day, one cannot be unmindful of its extent or responsibilities. It has been impossible to refer to more than a small number of the many duties which are entrusted to it, affecting so intimately the lives and happiness of our people, but I am encouraged in my new task not only by the considerable contributions to national health progress that have been made by my predecessors in office, but by the belief that in this great Department there is a powerful instrument which is capable of still greater things. I believe also that, while we may differ in many ways, we are united in the desire to use the vast resources of modern civilisation in the cause of humanity and in the common weal.
I beg to move to reduce the Vote by £100.
May I at the outset welcome the right hon. Gentleman to the post which he now occupies? In the very mysterious transmogrification for which the right hon. Gentleman the Prime Minister was responsible a few weeks ago, I think no change was more welcome than that which brought the right hon. Gentleman back to the Ministry of Health. He and I have engaged in wordy warfare on many occasions, and I have no doubt we shall do so again in the immediate future. I feel that it is like a return to the good old times, for which hon. Members opposite have such an affection, but I think that in all quarters of the House we feel that the Government have not weakened themselves but, on the other hand, have perhaps strengthened themselves by the appointment of the right hon. Gentleman as Minister of Health. He has such a long association with the Ministry of Health, from its very early days, that we associate him with it rather more than with the Post Office, and I think it is good that he should now have emerged from the cloistered security of the Post Office to the fierce limelight of the Ministry of Health, because he revels in limelight of that kind and can indeed produce limelight for the National Government. I say, in all sincerity, that we are very glad to have the right hon. Gentleman's genial presence among us in a fighting Department and rescued from the relative obscurity of the Post Office, which, however, he has done a good deal to advertise.
The right hon. Gentleman has been very careful to avoid any kind of statement as to what the National Government have done in the last four years. I do not blame him. He is not going to pretend to this Committee, or anyhow to me, that he is a new Minister and has not had time to marshal the facts, because he knows all about them. The truth is that there really is not very much to say about the Ministry of Health during the past four years, and, therefore, he has been driven to a 25 years' review of the health of the people, and I suppose that will appear on a poster as having been due to the National Goverment. It is true, and I think the nation as a whole should be proud of the fact, that in the last 25 years, in the last 10 years, there has been a very substantial improvement in the standard of the health of the people. The expectation of life has increased, the death-rate has diminished, and infant mortality has been reduced in the nation as a whole very considerably, but it is worth while pointing out in this connection that that progress has been due in the main to the public services and to people who do not work primarily for private profit. I think we ought to put that on record, and had this been a profit-making industry, I am not so sure that the improvement would have been as considerable as it has been in the last 25 years. It is, however, a matter for satisfaction among us all that the health of the people has improved, though, as the right hon. Gentleman has said, we are still faced with very difficult problems and with certain diseases which, as yet, we have not been able to master.
The right hon. Gentleman dealt with various aspects of the work of his Department, and I was very interested to hear what he said about the National Health Insurance Acts. I was not in Parliament when the first of those Acts was passed, but it falls within the 25 years, and, therefore, the right hon. Gentleman referred to it. I am bound to remind the Committee that, though I personally was an opponent of the National Health Insurance Act when it was first introduced, because I felt that it would give us two rival health services, which, in fact, it has done, it was the Conservative party which put up the bitterest opposition to any scheme of national health insurance.
I am simply recording a historical fact, and I am very glad to know that the right hon. Gentleman, who has had, perhaps, more continuous experience of the National Health Insurance Acts than anybody in this House, is now able to testify as to the value of that particular legislation. Before I refer to other points, I would like to remind the right hon. Gentleman that he had nothing whatever to say about the Poor Law. In my somewhat short experience of this House something has generally been said about the Poor Law. As I say, the right, hon. Gentleman cannot complain if I say that he is not new to this business and that he must know something about the Poor Law situation. It is, I think, a little unfortunate that he did not try to explain why the National Government, of which he has been a Member now for nearly four years, has left him and the local authorities with the responsibility for so many more people on the Poor Law—more than half-a-million. I should have thought the right hon. Gentleman would have explained why it was that in this time of increasing prosperity and improving health there are more destitute people for whom he has to answer in this House than there were four years ago.
I am also surprised that he made no reference whatever to a problem which is exercising the minds, not merely of the medical profession, but of the public, the question of malnutrition. I am not going to speak on this question, because my right hon. Friend the Member for Swindon (Dr. Addison) can speak on it with a good deal greater authority than I can, but I merely wish at this stage to remark that, while this problem is a living problem at the present time, the Minister of Health did not see fit to make a single remark about it. It is undoubtedly true that there are people who feel that this problem is one which indicates the existence, or the possible existence, of physical deterioration among our people. For four years the National Government have presented the case in such a way as to attempt to convince the people that for the poor poverty is really better than prosperity, that the poorer they are the less malnutrition there is. Indeed, that is really the logic of their case, but malnutrition is one of those subtle and creeping diseases, the effects of which are not immediately seen, but from which a subsequent generation may very seriously suffer. I am sorry that the right hon. Gentleman has not dealt with that problem to-day, though no doubt after my right hon. Friend has spoken, the Parliamentary Secretary will be prepared to take up the cudgels.
On the question of maternal mortality we have had many speeches in this House. I do not remember an occasion like this when the Minister of Health for the time being has not referred to this very difficult and stubborn problem. It is not an easy problem, as the right hon. Gentleman has explained, and it is to be hoped that he will, as he said, go on vigorously with proposals which will do something to cope with it. I am bound to say that a certain conclusion emerges from what the right hon. Gentleman said. He referred to the City of Westminster, of which I happen to be a ratepayer, and said that its maternal death-rate was much higher than that of West Ham and Poplar. It may not be an accident that the lower maternal mortality in West Ham and Poplar is due to the activities of the public health service; it may be due to the fact that they have been prepared to spend money in the interests of human life which other and far richer local authorities have refused to spend. We have heard of many fruits of Poplarism, and we understand that the Lord President of the Council is going on a campaign in the country to denounce Poplarism. Well, I hope he will denounce the reduced maternal mortality in the borough of Poplar.
The right hon. Gentleman has spoken of large sums of money spent on dealing with maternal mortality reducing the death-rate. Will he explain how it is that in the borough of Willesden, where the entire maternity service has been recommended by the General Medical Council, the rate is still so very high, although more money has been spent there than perhaps anywhere else on that service?
I think the answer is that the scheme of the Willesden Urban District Council is a relatively new scheme, but what we are dealing with in the case of West Ham and Poplar is deep-seated Poplarism that has been there for a generation, and this problem is one which will take time to solve. Those authorities which have been condemned for their extravagance have at least something to their credit, and that is the saving of human life.
The right hon. Gentleman dealt with the question of housing, and it is to that question that I wish particularly to address myself. I want the right hon. Gentleman as the Government's chief billposter to compare what he has said on his posters with what he can defend as Minister of Health. I want the right hon. Gentleman, as the unofficial Minister for propaganda, who has done so much to promote the well-being of the printing industry, to square his statements with what are the actual facts about the housing situation. Most of the Government posters are extremely dishonest, not merely for what they say, but for what they do not say. They have covered up an earlier poster by the issue of a new one. The earlier poster used the word "record" about five times, and one statement said "record number of houses built." The implication of that statement is that this was directly due to the efforts of the National Government. It does not mean anything if that is not the implication.
The right hon. Gentleman has quoted figures about the number of houses built since the War. Those figures, of course, cannot be questioned. It is undoubtedly true that since the War we have built in this country something over 2,500,000 houses. Roughly about a half have been built with State assistance, either by local authorities or private builders, and half have been built without State assistance. It is also, I think, equally undeniable that the half that have been built with- out State assistance have not been built for the people who need houses most. They have not been built for working-class people and have not been houses to let. I am not going to deny that private builders have made a contribution to the solution of this problem, but they have been less concerned to deal with the problem which has faced this House since the War than they have been to build houses which they could sell. They have done that on a very large scale. The right hon. Gentleman referred to the slums. The jerry builders of to-day are building houses which will be a disgrace to this country ten years from now. This private enterprise, which is now defiling the outskirts of our great cities, has been carried on in the areas of small local authorities with no strength of character to face it but who have permitted in their own interest, from the point of view of rateable value, jerry builders to build houses which no Member of the House would dare to defend in ten years from now.
I am especially concerned this afternoon about the problem which has been stated from that Box ever since the War by every Minister of Health, except the frugal one to whom the right hon. Gentleman, referred, namely, the late Lord Melchett, who was not there to produce houses, but to liquidate the scheme left by my right hon. Friend. Every Minister has said in identical terms what the problem was, namely, that of building working-class houses to let at rents within the capacity of working-class incomes. That is the problem with which the Government were faced when they came into office. What was their contribution to that question? Their first contribution was to utilise the financial instability which has been talked about by all the newspapers to bully the local authorities into suspending their house-building programmes. They succeeded to a considerable extent. Where local authorities were insistent, the Minister of Health very reluctantly allowed them to go on with a modified programme provided that decent standards were sacrificed to cheapness. Houses that have been built during the time of the National Government will not bear comparison as regards standards with the houses that were built before. That is one of the debits which will have to be put in the ledger when we are trying to make up a balance-sheet of the efforts of this National Government. That was not all. They butchered a special Act of Parliament to deal with rural housing. The hon. Member for St. Albans (Sir F. Fremantle) may be able to speak later and put his own particular gloss upon it.
I have put the facts before, and I will put them again. Parliament agreed in 1931 to the building of an additional 40,000 rural cottages with a State subsidy of £2,000,000. The present Government never took any steps whatever to implement that Act. If they did, let the Parliamentary Secretary say so when he replies. I say that the Government took no steps. They let that Act die, and they did it on the instructions of the Chancellor of the Exchequer, because it would mean £2,000,000 with which to help to balance the Budget. Out of the 40,000 houses planned, the Government have built about 2,000. These are the facts, and they are undeniable, and, if the hon. Member for St. Albans has an explanation which is unknown to me, I should be glad to have it.
The present Government went back on what every Government since the War felt it was essential to do. It abolished the subsidy under the Act of 1924. We have had various Acts; and ever since the War it was felt by every Government that if local authorities were to be used—and it was felt that they had to be used—to deal with the problem of working-class houses, some State subsidy was necessary. The Government scrapped the Wheatley Act and did their best to put out of existence a public service which local authorities had developed in the 15 years since the War to deal with this problem in the interests of the public and not in the interests of private speculators or the jerry builders. They instituted instead a fatuous scheme of guarantees to the building societies. When that measure was before the House, I remember pointing out, and many of my hon. Friends pointed out, that the result would be purely negligible. The right hon. Gentleman's 25 years' review precluded him from dealing with what the Government have done, and he did not refer to these facts. Up to the 31st March this year the total number of houses in respect of which guarantees have been given by local authorities under that scheme was 5,537. And they destroyed the building of 60,000 houses a year by local authorities by the withdrawal of the subsidy.
This year, having withdrawn the Wheatley subsidy, and having seen the utter futility and failure of their housing legislation, the Government invent a new kind of housing problem and call it overcrowding. I do not wish to go back to that. I explained at the time that the housing problem of this country arises from a shortage of houses and the fact that certain houses are very bad. The housing problem is the problem of overcrowding. People are overcrowded, not because they like it, but because the houses are not there for them to occupy at rents which they can afford to pay. After this complete fiasco of their legislation, the Government come back this year with a new overcrowding Bill, creeping back on the old tracks which every Government has followed since the War, and providing some assistance to local authorities to build houses for people who otherwise would be unable to get decent houses. The right hon. Gentleman did not say very much about that. He did, however, say something for which I feel deeply indebted to him, that is, that the slum dweller will respond to a new environment. I have heard so often from representatives of the party opposite the statement that the slum dweller has a slum mind and that he would turn a palace into a pigsty.
I have often heard Conservatives talk of the deplorable state of things in which people are taken out of bad houses and put into good houses which later become worse. [Interruption.] I shall really have to ask the protection of the Chair against the offensiveness of the Noble Lady.
I thank the right hon. Gentleman for his statement, because it is borne out by facts. It is part of the tragedy of the system that people are made worse than they would be if they had lived under decent conditions. If they are taken out of bad conditions, people will in the vast majority of cases become good citizens, which we are entitled to expect them to become once the community does the proper thing by them. The right hon. Gentleman has referred to the progress which has been made in the building of houses during the last few years. With the skill of an old Parliamentarian the right hon. Gentleman very carefully chooses the figures which he gives to the House. I want to quote some of his own figures with which he did not think it worth while troubling the Committee. The position is that since the Government came into office there has been a very considerable reduction in the building of houses by local authorities. That is undeniable, because it is shown by the right hon. Gentleman's own figures. From 31st March, 1932, the number of houses built by local authorities with State assistance has fallen from 35,000 to 14,000—over 20,000 fewer municipal houses built in the half year ending 31st March this year than were built during the time of expanding municipal activity in the six months prior to 31st March, 1932. Those houses were built by local authorities for working-class tenants.
The right hon. Gentleman swells this total production of houses by including the number of houses built by private enterprise. In the three years which I have quoted, when municipal production went down, private enterprise production went up and was more than doubled—to fill a very rapidly narrowing gap in the need for houses but not to deal with the problem, which is still a grave problem, of the housing of the lower-paid workers. The right hon. Gentleman spoke of about 90 per cent. of the 1,000,000 houses built by private enterprise being working-class houses. In one of his earliest speeches
after his appointment as Minister of Health, speaking at a Conservative fête, I thing at Eltham, he made a similar statement. He was boosting the National Government, of course. That is what he was there for; he is Minister of Propaganda. In this speech, he said:
So far as the housing record was concerned, it was all the more gratifying because of the new houses built some 90 per cent. were houses whose rateable value was under £26 per year.
We really ought to look into these figures to see what the truth is. The important point is not the number of houses which have been built. From the point of view of Members on this side, it is the type of people living in the houses that matters. People with money can always go to a building society and get houses built for themselves. But the problem of people who cannot, or who because of economic insecurity prefer not to, have their own houses is not solved yet. These people ought to be provided with houses to let. During the half-year ended 31st March this year the total number of houses built by private enterprise with a rateable value not exceeding £13 per year and £20 in Greater London, was 53,613. That is a very respectable number of houses to be built in half a year by private enterprise. But the number occupied by persons other than their owners—that is to say, houses built to let—was only17,545. In other words, of these houses of the smallest type less than one-third of them have been built to let. If you take the houses of a rather larger type, but still working-class houses—those with a rateable value exceeding £13 but not exceeding £26 in the provinces, and exceeding £20 but not exceeding £35 in Greater London—during the half-year ended 31st March the number built by private enterprise was 75,817. It is interesting to note that more houses of the rather higher grade were built by private enterprise.
The right hon. Gentleman admits that a large number of houses have been built at a low rateable value. I take it therefore that he admits that these houses must of necessity have what is the equivalent of a low rent. During the same period to which he is referring the activities of building societies have enormously increased and building societies have been a great boon to the wage-earning classes. Does the right hon. Gentleman object to the system under which working-class people are enabled to purchase their houses through the instrumentality of building societies?
I object to the system under which, after the building societies offered to be really public-spirited and to come to the assistance of local authorities, up to 31st March of this year only 5,500 houses had been built to let under guarantees by building societies. I am not objecting to the activities of the building societies. They are established under Act of Parliament, and they can continue to do their work. I am objecting to this suggestion that the houses which have been built by private enterprise are houses which this country needs more than any other kind of houses. That is my case. I am not denying that there are people who are pressed willy-nilly, whether they like it or not, to buy houses—people who would prefer not to buy houses—and that they do so of sheer necessity.
I was saying that the number of working-class houses of a rather larger type built by private enterprise during the half year ended 31st March was 75,817. But the number of these occupied by persons other than their owners was only 12,796. In other words, only one out of six of these houses was built to let, and five out of six were built for sale to people who could afford or who were pressed to buy houses. I say that as a reminder to the right hon. Gentleman because he has himself said that the problem he has to face is not that of the building of houses for sale but of building houses to let. When the White Paper on Housing was issued by the right hon. Gentleman's predecessor, "The Economist" referred to it in these terms:
The continuance, or rather intensification, of the private enterprise building boom is demonstrated by a White Paper issued by the Ministry of Health this week.
Then it quotes some of the figures which the right hon. Gentleman used this afternoon and which I have used. I will read the whole of the passage so that hon. Members will not think that I am trying to escape statements which otherwise
they might think I did not wish to make. It continues:
In the six months ending 31st March last, in fact, building by private enterprise without State assistance reached the record figure of 149,085 houses, which was 12,120 houses in excess of the previous six months' record of 136,965 houses. The remarkable expansion of house building for middle-class occupiers, induced by low interest rates and building society facilities, was thus carried even further in the past six months. Many will doubt whether the pace can be kept up much longer, but however this may be, the enormous extent of the middle class demand made effective in the last two years suggests very strongly that there is a still more enormous potential working-class demand waiting to be tapped. And this demand, as the Ministry's own White Paper shows, has hardly been touched in the last few years. Building by local authorities with State assistance actually touched a low record in the last six months with 14,115 houses.
The word "low" is italicised.
The article goes on to say:
In rehousing under the slum clearance campaign, 14,317 houses were completed in the six months ending 31st March, making a total of 41,231 up to date. If the Government's five-year clearance plan is to be fulfilled, 280,000 houses have to be cleared between September, 1933, and September, 1938. Yet in the first year and a-half of the scheme only 41,231 new houses had been built. If this figure is compared with those given above of municipal and private building, it will be seen that the building of working-class houses has been on a very meagre scale since the Government abolished the existing subsidy in 1932.
I think that is a very fair criticism of the Government's housing policy. The Government have let loose private enterprise, and it is true that private enterprise has made very substantial profit by building very large numbers of houses. It is equally true that at the end of it we are still faced, after four years of National Government and four years of further housing deterioration, with a more serious housing problem than we had in 1931. The right hon. Gentleman side-stepped his obligations this afternoon by ignoring the difficulties of the situation.
My last word will be with regard to the closing statement in the right hon. Gentleman's speech when quite properly in this year of the centenary of local government he paid his tribute to our local government institutions. I am glad he paid such a generous tribute to their unstinted and devoted services to the people they repesent. The Minister has a good deal to thank Labour controlled local authorities for. His housing programme would not look so big as it did to-day but for the Labour local authorities, many of whom gained their majorities after the general election of 1931. I hope that in paying this tribute the Minister will not forget our local Labour administrators who are trying to help him in this work. We are naturally proud of our system of local government, which has weathered many difficulties in the last 100 years, which has had increasing responsibilities put upon it by successive Parliaments, and which has not always felt that it got a square deal from the State. If there is one thing which anchors the people of this country, more even than this House, to democratic methods of Government it is our system of local government, and I am very glad that the right hon. Gentleman paid his tribute to it. We welcome him here. Most of my speech has been critical of him, most of my speeches in future will be even more critical of him, but I want him to be assured that on this side of the House we are very glad to have a live Minister as Minister of Health.
I should like to say, in the first place, that we too would express to the Minister our felicitations in the post he is now occupying, and hope that he will bring his genial and active personality to bear sufficiently strongly upon the situation to create those improvements which have been referred to by my right hon. Friend the Member for Wakefield (Mr. Greenwood) and some to which I propose to refer. He gave us a comprehensive historical account of some of the improvements which have taken place in health conditions, and I really hoped that he would have said that a tribute was due to the great Liberal party who introduced some of the most important Measures to which he referred and were met with the opposition of his party and, in many cases, of members of the Labour party. Anyhow, I am sure that he will not deny us this reference to that work, and perhaps in the course of his researches he will delve deeply into the points put forward by us at that time, so that he may be given strength and real understanding to proceed with the work that lies before him.
I should like first to deal with the problem that was raised by the Minister in connection with maternal mortality. It was considered in the House some time ago, and I think the Minister and everybody else present will agree that it is a subject which calls for constant and anxious attention and consideration. It is, of course, essential to point out that although public attention must needs be drawn to this serious matter it is extremely important that the impression should not be created that child-bearing in itself is dangerous. The Committee will recollect the 15th annual report of the Ministry of Health, which gave some startling figures of the rate of maternal mortality. It was 4.32 per thousand for 1933–34, and an eminent authority has placed the numbers who die in consequence of difficulties which arise after child-birth owing to the manifold troubles created by the process of child-birth at 5,000 per annum. The total of the deaths involved is greater than the total of the deaths on the roads. Day by day we are devising new schemes to increase the safety of the roads. Every device that human ingenuity is capable of producing is being tested and, if found suitable, is being adopted in order to curb the catastrophic death-rate on the roads. Much money is being spent, large organisations are being created and the collective experience of every conceivable interest is being brought to bear on finding a solution to the problem. Maternal mortality is not so vividly portrayed to the public mind for very obvious reasons, and, indeed, it is doubtful whether it would be wise that it should be so clear. The Medical Officer of Health for Stepney which includes the constituency which I represent, Dr. Fergusson stated in a recent report:
Quite rightly this subject is attracting a great deal of attention at the present time. But I do want to emphasise a word of warning against pushing the propaganda too far. By all means let us consider the matter very seriously, both from an administrative and from a technical point of view, and let us do all in our power to improve our maternity services, but I do deprecate the impression that is being broadcast that child-bearing is dangerous. If the danger of child-birth continues to be exaggerated women will either take good care that they have no children or will resort to means of ridding themselves of the so-called danger at the earliest possible moment, only to place themselves for the first time in real definite danger.
This does not minimise the difficulty, but makes it even more necessary that the Minister of Health should do all in his power to press on with the work. This is an important matter and I believe it is well worth the consideration of everybody in the Committee, and certainly of the Minister of Health. It is even more necessary, because of the difficulties of propagating information, that everything should be done by the Ministry to urge local authorities to take the fullest advantage of such methods as are open to them in this regard. The important feature of the position is that the Departmental Committee on Maternal Mortality to which the Minister referred stated categorically that they considered that half the deaths could have been prevented had a reasonable degree of skill been brought to bear upon the management of the cases and adequate facilities for treatment been provided and utilised.
We were told by the Parliamentary Secretary, in a recent Debate, that the medical officers of health in certain districts had been asked to make an urgent—I would emphasise the word "urgent"—report on the measures which had been taken in their districts for the provision of a midwifery service for all confinements, the provision of adequate beds for the isolation of cases of puerperal sepsis, and the arrangements for consultant services in difficult cases. I understood that those reports would be examined and appropriate action taken. I wonder whether the Parliamentary Secretary can tell us something more than we have heard from the Minister about this investigation. Can he tell us how many reports he has received and what remedial steps are being or have already been taken? It is not sufficient to wait until the end of the year as suggested in his speech, before taking steps to deal with these points. He also referred to the circular issued in October of last year asking all maternity and child welfare authorities to make an urgent survey of their services, and said that so far the result had been satisfactory. I would refer him to this statement, which is rather an important one:
Of the 421 authorities 155 have replied that they are taking steps to improve or to extend their services, 174 have reported that they do not propose improvements,"—
In spite of the conditions that prevail and in spite of the high death rate, 174 authorities have reported that they do not propose improvements—
in only 23 of these cases are the services regarded as not reasonably complete, and 84 authorities promised attention.
Is the Minister satisfied that the authorities in question are dealing actively and thoroughly with the position, and that the 174 who reported that they did not propose improvements were justified in their attitude, seeing that the mortality rates are so high? I have again carefully read reports which have been issued recently on these matters and have discussed them with experienced professional and lay authorities, and I would ask the Parliamentary Secretary to let us know how far effect has been given to the recommendations of the General Council on Midwifery. There is a strong feeling that post-graduate courses should be generally provided for practising midwives, that the salaries of midwives should be very much higher, and that midwives in rural areas should be subsidised and their numbers increased, so that they are more readily available and do not have to travel great distances. There is also a strong feeling that a doctor should be employed in every case, even though there may not be complications in the first instance, so that the doctor may be available in the event of any complication arising; and there is a very strong feeling that the service of obstetrical specialists should be available for all pregnant women. Dr. Veitch Clark, a well-known personality in the medical world, emphasises the fact that midwives should be to all intents and purposes part of the external practice of the maternity units of hospitals. The official organ of the National Council for Maternity and Child Welfare refers to the opinion of Dr. Veitch Clark that midwives should be afforded the opportunity of living in a hostel or a home, should have an income guaranteed to reach a certain level by the local authority, and be linked up with the other services, such as the ante-natal and postnatal clinics, and the hospital. The part-time practising midwife should be firmly excluded from any fully developed maternity scheme he feels, the essential of such a scheme being that all work should be centred in the hospitals and organised so that only really expert midwives should be in practice and so that
complications should be recognised as early as possible and arrangements made for their treatment. Dr. Veitch Clark is Medical Officer of Health for Manchester, and it is said of him that he affirms that ante-natal supervision is educating the motherhood of the country to realise that the wise supervision of pregnancy improves the wellbeing of the mother, increases the vigour and healthiness of the child at birth and, in general, teaches the mother those habits of diet, personal care and recreation which make for a truly physiological confinement and a normal, healthy, puerperium and nursing period.
The Minister has referred to the increase in ante-natal clinics and in ante-natal treatment and has stated that in spite of this increase a high death-rate prevails. I would like to draw the attention of the Committee to statements which have been made by eminent authorities. I do not say they always agree with each other, I suppose it would not be conceivable that eminent authorities would agree with each other on all occasions. My hon. and gallant Friend the Member for St. Albans (Sir F. Fremantle) will know that that is particularly the case in the medical profession. Notwithstanding that fact, all the opinions which eminent authorities bring forward ought to be most carefully examined so that the highest common understanding may be attained in order to cope with these matters. Dr. Veitch Clarke, speaking of the ante-natal work in his district said that there had been a fourfold increase in ante-natal work in Manchester during the last four years. Over 50 per cent. of the pregnant women are now being seen ante-natally by the public medical service. He adds that this increase in ante-natal supervision has coincided with a fall in the death-rate from puerperal sepsis from 1.7 to 1 per 1,000. He thinks that those two factors are associated, and that ante-natal supervision has definitely contributed to that fall, and particularly to a reduction in the recognised toxaemias of pregnancy. On the other hand, it is only right to say that an eminent authority in London, Professor F. J. Brown, head of the obstetrical department of London University, is far from satisfied that the present ante-natal system is either adequate or effective. He urges that, as ante-natal work calls for experience and skill,
patients must be individualised in regard to diagnosis and treatment, and that in ante-natal work there should be no such thing as mass production. The success of a clinic should be judged, not by the numbers it passes through its books, nor even by the number of attendances registered by each patient, but by its effect in reducing maternal mortality.
I would ask the Parliamentary Secretary to consider the suggestions that are made by this man, who has had tremendous experience on the subject. In his view, well-trained obstetricians should be provided in the clinics so that ante-natal work may be carried out in a manner which will have the best results. They should not only have regard to the numbers who are treated, because dealing with large numbers of patients may in time produce an effect of unconcern at the clinic, so that those who see cases day after day do not always recognise abnormalities when they arise. It might be of considerable interest to the Ministry to examine the position, and to urge local authorities to provide obstetricians who, day by day, would deal with cases definitely from the standpoint of a specialist. Full-time clinic officers should be appointed in as many instances as possible, so that they may be able to follow the cases, and there should be adequate hospital accommodation to enable them to follow each case when the actual time of confinement comes. We cannot spend too much time discussing this very serious matter. I hope that the indication which the Minister has given will be carried into full effect, and that he will not be content to allow this matter to lag behind because its gravity and importance are universally recognised.
On the subject of housing, my right hon. Friend the Member for Wakefield pointed out that things are not quite as bright as the Minister would have us believe. Housing accommodation and the provision of houses play a tremendous part in the general health of large industrial areas, such as the constituency which I represent. Every phase of the question ought to be examined not only from the point of view of accommodation available, but also because of the consequences which may ensue from lack of accommodation or from the deficiencies in such accommodation as is available. Many of us appreiate the value of some of the measures which have been taken. I am sure that the right hon. Gentleman would not deny that attempts have been made from time to time to deal with the position, but very much more remains to be done. I hope that the Government will proceed with the work as rapidly as possible.
I would touch upon a side of the question which many of us who represent industrial areas frequently have to face, although the subject is not a pleasant one. It is in regard to the prevalence of vermin in many homes. That matter might very well claim the attention of the Ministry at the present time, and their earnest consideration should be given to the steps which have been taken by various local authorities, with a view to ascertaining the best method of removing the evil and to putting such method into effect as quickly as possible. Disease is spread by the insects, and the homes, such as they are, are frequently made unbearable because of their presence. In the report to which I have already referred, Dr. Ferguson says:
During the year it also became increasingly obvious that some form of special measures for the eradication of the bed bug was imperative. This was especially obvious in connection with council property, and on 24th October [a lady] was appointed a sanitary inspector, her chief duties being to keep all the council flats under constant supervision.
I hope that the Parliamentary Secretary realises that this is a matter which requires very serious consideration. Dr. Ferguson says further that this was only a preliminary to a comprehensive scheme for bug eradication generally, and that the council are already considering further schemes for this purpose.
This is an important matter, because the people concerned have very small homes and very small accommodation. There is plenty of overcrowding and, Heaven knows, though their lot is very hard, it is made infinitely harder by the fact that they sometimes cannot even remain in their rooms because of the verminous condition of the property. I would like to ask the Parliamentary Secretary to tell us in his reply whether steps are contemplated, or are being taken, to provide the authorities with information and assistance to enable them to deal fully with the position. Let me also ask him whether he is aware—it is well known in London—that there is great danger in the new districts of whole areas being infected with this plague because of the use of bricks which have been taken from old properties which were already infested, and by the removal to new homes of furniture from infested districts. The Minister is an expert in publicity; if anything requires publicity it is the measures which can be taken in order to cope with this particular difficulty.
With regard to the housing question in general, very much remains to be done. I have repeatedly referred in this House to an area in my constituency which was originally purchased by the postal authorities for garages, and which to-day remains empty. Last December I raised this matter, and while I hope that the original risk of this place being used for such dangerous purposes in that district is avoided, I feel that it is nearly time to decide that this place must not be left vacant in a highly congested area, but that an arrangement should be made to erect houses or flats upon it with a view to accommodating a large number of people from among those who are waiting most anxiously for that kind of accommodation. I should like to know whether the Minister proposes, when he is considering the question of overcrowding and similar cases, to do anything to remedy the position.
I have had the unhappy experience in my constituency of being informed that notices have been served upon tenants who were occupying rooms which had been decontrolled. I believe that the landlord was not very happy about taking proceedings, but I understand he said that it was reasonable that tenants should be proceeded against when there was overcrowding. It happens that the Rent Restrictions Act, 1933, which was introduced for the purpose, as I understood at the time, of alleviating the situation, has done something to make it much worse than it was before. Consider this particular situation: Tenants are occupying rooms which are decontrolled. Flats are available in the same building, some of them are controlled, some are decontrollable and others are decontrolled. That is in the same set of flats. In some cases tenants can be turned out without any difficulty and in other cases the landlord will have to wait until the tenants leave so that the rooms may become decontrolled. In probably the majority of cases the flats remain controlled. Some of the tenants have been in occupation of flats in the building for nearly 20 years. As their little families have increased, they have moved from one room to two or more rooms in the same building. By an unfortunate mischance, some of them, instead of moving in the early part of 1923, moved in the late part of 1923, with the result that their rooms became decontrolled. When the Measure was being considered we begged from these benches that provision should be made whereby control might be put back in respect of small houses, but nothing was done. We were told that the Measure would result in houses being available at a proper rental and that the whole of the working class would, in a very short time, find that the Act was benefiting tenants in a way which they could not then appreciate.
The contrary has taken place. In some districts, houses have been cut up into flats and flatlets and let at rentals higher than the rent which the houses originally commanded. Many others have become potential slums. In the main the black-coated worker has suffered heavily owing to the large rentals which have been brought upon him, and all too frequently his home is in danger of being seized and sold by bailiffs. Again, control has been maintained for all houses in London of a rateable value not exceeding £20, and in the country £13, which had not passed into the actual possession of the landlord before the passing of this Act. That was said to be a concession to the poor tenant, and that argument was utilised to the full, not merely to gain support for the Bill, but also to allay opposition to the decontrol Clauses. A proviso was added to enable the landlord to register when, for some good cause, he had not done so in time, and, in order to emphasise the intention of the Government in an unmistakeable manner, the Minister of Health issued, on the 24th July, 1933, a special circular, in which the following or similar words appear:
The proviso gives the landlord who failed to apply for registration in time the right to go to the county court for permission to make a late application for registration. If he satisfies the Court that there was a reasonable excuse for his failure to apply in time, he may be given permission to register if the house is occupied at the time. The late registration will not remove protection from the sitting tenant; the landlord will have to wait until
he again comes into possession of the premises before he can treat the house as decontrolled.
That statement was clear, and to most people it seemed reasonable enough, but the Court of Appeal thought differently about it. It gave a decision which wiped out the date of 18th October, 1933, entirely, and declared that the house became decontrolled from the date of the late registration. To make matters worse, late registrations are apparently being granted by county courts merely for the asking; any excuse made by a landlord or his agent appears to be a good excuse, even after two year's delay. In many instances the tenant has neither the funds nor the knowledge to proceed with an appeal, and consequently he cannot get justice with regard to his position; he has to let matters go on and allow the house to appear to be decontrolled, even though in some cases it may not be decontrolled. One day the sitting tenant is protected against excessive rent, ejectment and distraint, while the next day he finds himself at the uncontrolled mercy of his landlord and of the bailiff.
I have been listening to the hon. Member very carefully, and it seems to me that the matter he is now raising is one that would require legislation. In that case he must not pursue it.
Of course, I bow to your Ruling, but I am merely introducing this argument in order to show that the opinion placed before us at the time was not such as to justify us in believing that the difficulty which exists in regard to lack of housing accommodation is really being oversome. I am not asking at this stage that there should be fresh legislation, but I ask that, in those cases where uncertainty exists, the Ministry should make every effort to give the position publicity, so that the tenant may realise where he stands. That has been a very great difficulty. In all parts of the country there are many people who are unaware of their real position under the Act. Section 10 of the 1933 Act says that local authorities may provide information for people in their localities, but what actually happens? I see in his place the Noble Lord the Member for East Norfolk (Viscount Elmley), who has had bitter experience with regard to this matter, and I understand he is going to say a few words to the Committee about what he himself has seen, and the efforts he has had to make in order that people connected with local authorities may take the right action in letting the general public in their districts know what the position is in regard to this matter.
The Noble Lord will be able to give cases which I have no doubt the Committee will be interested to hear, and which will cause considerable surprise to many who have not appreciated what is actually happening in this regard. I would ask the Minister to urge the local authorities to make full use of this Section, so that the tenants may know their position, and at least may have the protection which the Acts give them, and thus may not fall victims to higher rentals and ejectments. It sometimes happens that, long before the stage of taking the matter to court is reached, landlords are able to induce those who do not know that they are protected by the Acts to leave the accommodation they occupy. I hope we may be assured to-day that, on the two important questions of which we have been speaking, a constant and careful watch will be kept, and that, instead of tenants having to rely upon information which in many cases even lawyers themselves cannot possibly have at their finger-tips, there will be publicity of the right kind, so that throughout the whole country people who are now prevented through lack of knowledge from maintaining the rights that they have may know what their remedy is, and so that at least the difficulties which at present exist for the poor person may be minimised. I hope that the Minister will accept what I have said as constructive criticism. I believe him to be a man who, if he puts his mind to remedying these matters, will succeed, and I think that the cause is one that is well worth his full consideration.
I am sure that all those Members of the Committee who are particularly interested in matters of social welfare and housing will join in the tribute and cordial welcome offered to the Minister of Health by the right hon. Gentleman the Member for Wakefield (Mr. Greenwood). We have been so long associated with the Minister in connection with both health and housing matters that we heartily welcome him back again to this sphere. That does not imply any disparagement of the late Minister of Health, who had the sympathy and friendship of all of us, and who got through a great deal of work which will abide to his lasting credit.
While we are reviewing the record of the year, I hope it will not be out of order to refer to the passing out of the Government service of the late Chief Medical Officer of the Ministry, Sir George Newman, whose work has been a cardinal factor in the improvement of the health of the nation. Everyone must recognise the extraordinary advance that has been made, largely through his special reports every year on the health of the people, as well as his reports on the health of the school child. Undoubtedly, he is a master of publicity in regard to public health, and it is essential for the advancement of the health of the nation that public opinion shall be brought into being, and that it shall be activated, strengthened and stirred. The report of the Chief Medical Officer each year has been the fountain of information which has flowed through every conceivable kind of channel—through the Press, through every local authority, and through every official concerned with public health. They have all taken it as their Bradshaw, so to speak, for the following 12 months, and I hope that that will be continued. A very great tribute must be paid to that work which Sir George Newman inaugurated, and which undoubtedly has won him the sympathy and friendship of all the medical officers in the public health service.
We welcome the new Chief Medical Officer, and here I want to ask a question of the Parliamentary Secretary on a point which has been strongly raised by my colleagues in the public health service. I have just come from Brighton, where a great Health Congress is being held, and where this matter has been discussed very seriously. I want to know what is the status of the present Chief Medical Officer, and whether it remains unimpaired. The Chief Medical Officer who has recently left the Government service ranked, I understand, definitely as a Secretary in the Ministry of Health, with direct access to the Minister, but I have heard it suggested that the new Chief Medical Officer has been deprived of that status, and is no longer a Secretary of the Ministry. That is a bit of technical jargon which may be familiar in the Service, but it is not familiar to those of us who are outside, and we do not know what its implications are. I have heard it suggested by some of my colleagues at the Health Conference that it signifies a definite differentiation—that the medical service is to be considered the adviser of the Ministry, but that the actual machinery of the Ministry is to be the pure laity of the service. If that be the case, it goes back on the original idea, which I think we owe largely to Lord Rhondda and Sir Robert Morant, that the Chief Medical Officer should rank as a Secretary, with direct access to the Minister. I hope that there will be no such reversion, and that the Parliamentary Secretary will be able to give us an assurance to that effect.
With regard to the changes in preventive medicine during the past 25 years, of which we have heard an interesting survey this afternoon, and of which I have also been hearing an interesting survey at the Health Congress, there is a practical point in administration of which I think it is well that the House of Commons should be aware. There has been a great change in regard to the understanding of infectious diseases. It may be said that 25 years ago the idea was generally prevalent that infectious disease was due to a microbe, and that all that you had to do was to find out the microbe and shoot at it, by ingestion, inoculation, disinfection, or in some way or other. In order to exterminate the microbe they isolated the patient. In 24 years there has been a very extraordinary advance. It was shown first of all that the same disease germ may exist in carriers who may be perfectly healthy. The particular microbe which is supposed to be the cause of scarlet fever, for instance, is found to exist in varying degrees in carriers who are all perfectly healthy children. It is clearly an impossible job to exterminate it. It is not merely the hunting down of the microbe that we have to aim at. Moreover, we find that there are no fewer than 28 strains of this particular streptococcus, and that introduces complications. Research has been engaged in studying the actual conditions under which the microbe sometimes does not seem to do any harm and at others is suddenly brought into activity by a cold, a chill or an injury or something of that sort. It is the soil and the variations in the soil that matter.
The actual application of this is very important. Thirty years ago we were all concerned with isolation hospitals, getting them built on a bigger scale, with marble floors and walls and all the rest of it. Different ideas now hold good and only the more extreme cases, or the cases that flare up in epidemic form, are now isolated. What you have to do is to aim constantly at improving the physique and the health of the individuals that make up the population. Therefore, we come back to what, after all, also is common sense, to the absolute importance of the pursuit of positive health, and it is that positive health that we want to see aimed at a great deal more in the Ministry of Health, in local authorities generally and in public opinion. We are getting at it, but as a separate line of thought rather than that it fits in entirely and helps to supplant the old ideas of fighting disease. Of course, there we are dealing more with the business of the Education Department, but the Ministry of Health, through the local authorities, have various means in which the promotion of physical health can be assisted, and I hope the process will be continued now through the whole of the machinery of public health throughout the country, under local authorities, under voluntary associations as well as under the guidance of the Ministry of Health, even more keenly and as an essential matter to promote the positive health of the whole population.
In that, of course, we come to the question of nutrition and of the actual means of the people. We get to a very large subject there, and I am rather surprised that the right hon. Gentleman the Member for Wakefield has not again raised the question of nutrition in the depressed areas. It is undoubtedly a very serious fact that we have to recognise that shortage of nutrition, more particularly among mothers, is bound to have some effect on the next generation But, fortunately, we have seen, with the systematic survey made under the Ministry of Health, that a great deal of our cares and anxieties in that respect have been found to be false, and that there is very little evidence of any actual increase of ill-health, either mortality or infectious sickness of one kind or another, as is shown by medical inspection in the schools in the depressed areas. What we find is that there is malnutrition in particular families and districts where there is less attention paid to the preparation of food, and where it is not a matter of the means to buy food. That is a point which, I hope, the Ministry will be pursuing in concert with the Board of Education. There is no question that the choice of proper food is a very important question. A Departmental Committee not long ago reported upon the composition and description of food, and I should like to know if anything is being done on the lines of that report. But more important than the selection of proper food is the power to cook it properly. I am afraid a generation has grown up now which is completely and entirely ignorant of the art of cooking. Those who visit villages on the Continent are struck with the wonderful way in which they can make the most nutritious and appetising meals out of practically nothing. The soup that the peasants of France make out of the common stock pot is an extraordinary result from a very small means. I have no doubt that the peasantry in France and Italy can live nutritiously on something like a tithe of what is found necessary by our people, who do not know how to cook.
I do not know enough about it, and I feel that, though milk is very useful to those who have nothing else to eat and drink, for those who can afford other things it is much better brought in as an adjunct, though a very useful adjunct.
It is an extraordinarily good food. I should next like to deal with maternal mortality. Certainly legislation will be required, and a great deal will have to be done to advance the profession of the midwife. At present there is absolutely no incentive to girls leaving school to go in for the profession of midwifery. We have to make the profession really attractive as a profession to the kind of girl that we want to have for this important service. Lots of other things have been referred to, for instance, ante-natal clinics. It is natural to want to pour out money like water, to build and to have great offices, but there is a great deal to be said for making the best of what you have got. There are two extremely interesting experiments in that way to which I wish to draw attention. I do not know how many have heard of the Rochdale experiment. Three distinguished medical men said, "We shall see what can be done in present conditions. Let us choose an area which is sufficiently limited for our purpose with one of the highest maternal mortality death rates in the Kingdom. They went to Rochdale, and with the cordial assistance, first of the medical officer of health, secondly of the local authority, thirdly of the Press and so of the whole of the people, they got a general move on to wipe out obvious things which everyone knows are conducive to maternal mortality.
For the three years 1929 to 1931 the rate of mortality had been 10 per thousand births registered, over double what it was for England and Wales generally. They set to work and, during their intensive campaign, in the years 1932 to 1934 they reduced the rate to 3.9. To show that it was not a fluke, there are the details of everyone of the eight different causes of maternal mortality, and they got a reduction in each cause. An enormous amount can be done by simply drawing attention—public attention and professional attention—to existing powers and machinery. The same thing was repeated in the Rhondda Valley and a great deal has been done. A special campaign began 18 months ago. In the first nine months there were 29 deaths—three a month—in the next three months there were only six—two a month—and in the next six months there have been only six more—that is one per month. Mortality has been reduced to a third by this intensive campaign and paying attention to what everyone ought to pay attention to in the matter of confinements. That is a lesson which, I hope, we shall all take to heart. We have to take it to heart in other matters as well as maternal mortality. Rather than pouring out money like water we can often get better results by using existing machinery, but you have to bring machinery and an elastic mind together.
There is one thing that I want to say about housing. I am not accepting the challenge of the right hon. Gentleman the Member for Wakefield with regard to the rural housing scheme of Sir Tudor Walters. That was brought up before, and the Ministerial answer, which the right hon. Gentleman apparently has not read, exploded the idea that it was due to the Government that that scheme came to an end. It came to an end owing to the conditions in which it was laid down by Sir Tudor Walters with the sanction of the House. I ask the Committee to realise that large-scale housing is being splendidly carried out under the National Government. Although I wish that houses were cheaper, the main thing is being done, namely, we are getting such a supply of houses that we are rapidly removing the scarcity. That is the reply to the hon. Member for Whitechapel (Mr. Janner) and many other hon. Members. If we build sufficient houses bad houses will not command high rents.
We have seen an enormous expansion of building along arterial roads or out in the country, and we have seen the development of industries in other directions, but there is no harnessing of these things together. There is growing up square mile upon square mile of housing which is not nice to look upon. Although the houses are provided with gardens and so on, as used to be the case, in 50 years' time they will no doubt be mostly bad streets, like some of our old residential streets. We should collate the migration of industry and the provision of houses.
There is one line of advance which has not yet been tried. I have brought it before successive Governments privately, but they have never seen their way to advocate it. The right method is to find out where industry can find its best situation outside towns, and to help it to find a situation where it will be centralised with certain units, including residential housing and all the amenities of the population, comprising shops, schools, theatres, playing fields and all the rest of it. The reply has always been that one must not put any obstacles in the way of industry, but now that industry is prospering under the National Government, I suggest that the Board of Trade, the Ministry of Transport and the Ministry of Health should tackle the question together to see if something along these lines is possible. Some kind of financial assistance by means of loan might be given to enable certain industries to migrate from the cities to properly organised centres. The principle of the garden city holds good, but industry must be the basis of the location of housing in the future. It is in the hope that that may give a new idea and a new line for the Minister of Health to follow in his distinguished career, that I beg to offer him my best congratulations and good wishes for the next year of office.
If I may offer congratulations to the Minister of Health, I would say that he smiled more in the first three minutes of his speech to-day than his very able predecessor did in the three years he held office. As long as he goes on smiling we will forgive him many things, even his poster campaign in Great Britain. But in so far as he was smiling about the achievements of the Government in building houses, I think he smiled more than the facts of the case warranted, and the statement of my right hon. Friend the Member for Wakefield (Mr. Greenwood) took much of the gilt off the gingerbread when he said that not more than one-sixth of the houses built by the National Government had been built to let at rents which working people could afford to pay. If the opposite had been true, I would have said that it should be put on the posters, and that it would have been a jolly good thing to put on the posters.
The Government have not much cause for congratulation. The Minister, himself a London Member, must know that as far as London is concerned, the housing problem has not been lightened very much. The hon. Member for St. Albans (Sir F. Fremantle) made an important point when he spoke about rents. If there is one index more than any other which indicates whether the housing situation had been bettered or not, it is the rents. Rents measure scarcity or surplus of houses better than any other single factor, and it is well known that rents in London have changed very little in the last 10 or 15 years. In West London the average rents paid by the working-classes must be something like 15s., or a quarter of the working man's income. Thousands of poor people are paying a third of their income in rent, and examples have been placed on record by a very illustrious person of families paying half their total income in rent. In my division of North Hammersmith the average rent for a two- or three-roomed tenement is from 12s. to 16s. per week, and there are thousands of people paying £1 per week in rent.
After all this building and these records of so many hundred thousands of houses being built in Great Britain, there are in Hammersmith nearly 3,000 people living more than three to a room, 13,000 living two to a room, and scores of families living six, seven and eight to a room. As long as these conditions obtain in such a borough, it is no good being complacent about the housing situation in this country, or indeed in London. In the division of the hon. Member for Whitechapel (Mr. Janner)—if he had been present in the Committee now I would still have said this—I should have great difficulty, if I were a housing dictator, in saying which street should not be pulled down. In fact, in the East End of London 90 per cent. of the streets and houses ought to be demolished from a 20th century housing standard. I think that it is true to say that from 4,000,000 to 5,000,000 houses are needed if we are to bring housing up to any reasonable 1935 housing standard. If that be true—and I have authority for saying that it is true—and if the Government built 200,000 houses a year for working-class people—I should think that they could claim to be doing more than that—it would take 25 years to bring our housing conditions up to a reasonable standard. By that time there would be millions more below standard. At the present rate of building in London, it will be near the year A.D. 2,000 before we have solved the housing situation, and by that time most people in this House will have lost all interest in housing questions on this planet. They might be interested in houses elsewhere, but not down here.
I rose really to address myself to a particular question, and not to the general question of housing. I am concerned very much with one of the blackest spots of Great Britain from the housing and health point of view. This House often discusses the distressed areas from an unemployment point of view, but there are also special or depressed areas from a health standpoint in London. I have often tried to raise this question but with very little success. I am going to have one more try, because we have a new Minister, in the hope that a new broom may sweep cleaner than some of the old brooms in the days gone by. The distressed area to which I call attention is the Royal Borough of Kensington with which I have had some connection. The infantile mortality in that borough last year was 93 per thousand, which is 50 per cent. worse than the average for London. South Kensington is composed very largely of middle class residential areas, and even North Kensington has very large blocks of well-to-do property, but the death rate in North Kensington is 102 per 1,000 compared with the rate of not more than 60 per 1,000, in Poplar of 62 per 1,000 and in Hackney of 54 per 1,000. In the last year the infantile death rate for North Kensington was 50 per cent. worse than in the average poor borough in the East End of London, and twice as high as the death rate in some of the better boroughs and working-class divisions in London. I am not choosing a particularly bad year. For the last ten years North Kensington and Kensington have been enormously above the average rate for London and the average rate for Great Britain. There are one or two wards in Kensington which had a death rate last year of 120 per 1,000. I believe that it is true to say that certain Spanish cities and one or two towns in Portugal are worse than North Kensington, but surely we are not going to compare a rich borough like Kensington with poor, poverty-stricken, Portuguese and Spanish towns. No one with common sense could do that.
If I had time I could show that not only the infantile death rate but the diseases rate in respect of tuberculosis, fever, diphtheria and pneumonia averages from three to five times that for London. Who or whatever is to blame it is shocking that a borough like Kensington, so near to this House, in which a penny rate produces £14,000 as against £3,000 in the East End of London,
should have such a death and disease rate compared with the rest of the boroughs of London. I am going to make use of statements of people whose opinions no one will venture to contradict. Lord Buckmaster, a famous Lord Chancellor, and a Member of the Liberal party, who recently died, said,
The Royal Borough of Kensington is one of the richest in the County of London, yet within its boundaries there are dens where human beings live, breed and die that are a disgrace to our Christianity and to our wealth.
That is what Lord Buckmaster said a few years ago. Lord Balfour of Burleigh, a Conservative Peer, than whom no man has done more to try to bring these conditions to the knowledge of the powers-that-be, has said:
In Kensington I have encountered appalling conditions, but have been amazed by the high standard of morality existing despite incredible discomfort and lack of privacy.
These are the views of men not supporting our party. The last statement which I have quoted from Lord Balfour was made five years ago. Let me quote what Lord Balfour said on the 24th May of this year:
The elements of the problem in Kensington were, first, overcrowding; secondly, unhealthy basement flats; thirdly, rents; and lastly vermin.
One hon. Member has spoken of bugs in Whitechapel. He ought to take a walk in the Royal Borough of Kensington. There are more bugs in Kensington than in the rest of London put together, and bigger bugs. The hon. Member talked about bugs in the East End of London, but let him walk into a few of the houses in the Royal Borough of Kensington, and he will stop talking about bugs in the East End. The Kensington Housing Association, which is composed largely of Conservatives and Liberals, all of them good people, I have no doubt, make this statement:
How many people realise that 2,400 families of two persons and over are living in one-roomed houses in Kensington?
The 1931 Census Report speaks of the notorious Golborne Ward of North Kensington, which revealed an average population of over 360 persons per residential acre, compared with Holland Ward in South Kensington, 60 per acre. One-third of the people of North Kensington live in one- or two-roomed tenements; 2,500
people live in one street of 140 houses; 2,000 live in mews dwellings. The Kensington Housing Association report:
Rows of tenement houses remain—vermin infested, and if not overcrowded are definitely not desirable dwelling-places … beds in living room, inadequacy of washing facilities, water closets shared between families, difficulties of food storage—all accentuated in a hot summer such as that of 1934.
That is the last report issued by the Kensington Housing Association.
Why this tragedy? I think I have said enough to show that things are wrong. I had a letter from the Minister of Health on 1st July in regard to the money spent by the borough council of Kensington on milk for poor expectant and nursing mothers. In 1934 they spent just over £1,000. A rich borough like Kensington spent just over £1,000 last year in milk and dinners for poor expectant and nursing mothers while the borough of Poplar, where a penny rate brings in only £3,000, spent more than five times that amount. The lowest money rate in London is always round about Kensington. The least money spent on health services in London is spent in the Royal Borough of Kensington. The richest borough of London has always spent less money on milk and dinners for poor people. They have never spent as much as boroughs like Poplar. Some people speak in a slighting way of Poplarism. Is there any hon. Member who will speak slightingly of Poplar because it spent £5,000 on milk for expectant and nursing mothers last year? Most people will agree that that is proper expenditure. How is it that we find the richest borough, which is always boasting of its lowest money rates, having the highest recorded death and disease rates? I dare not use the language that I feel inclined to use. It is a downright scandal that this thing should be.
Some people may say that things are improving. Are they? On housing in Kensington last year, apart from the penny rate that they were compelled to spend, the total expenditure on housing was less than one-third of a penny rate. Their five-year plan, of which the Minister boasts, with all their overcrowding and squalor, amounts to 80 houses. When I compare the Kensington housing plans to-day and in days gone by with those of other boroughs, they are startling. They are going to build in the next five years
80 houses or flats. A place like Hammersmith, a very much poorer borough, is going to build five times as many houses. Bermondsey, a much poorer borough, is going to build 15 times as many houses. Woolwich, the right hon. Gentleman's own borough, will be building 2,000 houses, or nearly 30 times more houses than Kensington. If the right hon. Gentleman will compare his own borough council's achievements in services with regard to the supply of food and milk for poor people and in regard to housing plans with those of Kensington, he will have a tremendous shock. Woolwich is not nearly so wealthy as Kensington. When one finds Woolwich spending ten times more than Kensington on these services there is something strangely wrong. I could give other figures, but so many hon. Members wish to speak. Lord Balfour of Burleigh said:
Kensington is a wealthy borough. Our rates, owing to high assessable value and good management, are among the lowest in London; at the same time conditions in certain parts of the borough are, to put it in a way to avoid injuring the tenderest susceptibilities, not such as we can be proud of. The burden on our rates due to housing work, over and above the compulsory one penny rate under the Housing and Town Planning Act, is a small fraction of one penny in the pound.
When things have occurred in certain areas such as West Ham, Poplar, or Durham and there has been expenditure which the Minister of Health has considered to be extravagant, he has sent commissioners to investigate and curtail the expenditure, and perhaps rightly. If it is a good and proper thing for the Minister to investigate conditions when he suspects that money is being spent too lavishly, it is common sense to urge that when you have a district where the death and disease rates are abnormally high year after year there is as much ground for inquiry there as in the other districts. The right hon. Gentleman need not accept my statements and my figures. He can obtain more up-to-date figures himself. I wish he would make some inquiry into the position of Kensington, and I hope that he will not accept the old stupid reasons that have been given for these things. It has been said that domestic servants are the cause. Domestic servants are not peculiar to Kensington. It has been
said that these high mortality and disease rates are due to the transfer of people who go to Kensington for a week or two and die there. If we are to believe the apologists for Kensington it would appear that when people are going to die they say: "Let us go to Kensington and die there." The Minister is too old a bird to be caught by rubbishy arguments of that kind. Just as we are keen in this House on doing what we can for the distressed areas, where there is shocking poverty and unemployment, let us be equally keen on dealing with the black spots in London where the terrible conditions to which I have alluded exist. Let the Government put some ginger into the councils who will not do their duty, so that the people of Kensington, Paddington and other areas may have a chance of living a decent and healthy life.
I want to make a few observations on the question of water supply. I hope that I shall not be casting any aspersions upon the late Minister of Health when I say that I am glad that he has been superseded by my right hon. Friend who now occupies that position. If I had been asked to select a Minister who is nonpareil in his ability to deal with problems of this kind, the man that I would have selected would have been my right hon. Friend. We know the great work that he has done for the Post Office. Since he has been Minister he has certainly done immense good in that direction. With regard to the water supply of the country, we know that a survey committee has been set up, that a water committee has been appointed and that two Acts of Parliament have been passed, one dealing with grants up to £1,000,000. I was not sarcastic but was telling the truth when I said that that particular Act was equivalent to trying to irrigate the Yorkshire moors with a watering can. I told the story of a man who went to buy a country cottage, and while the agent was showing him over the cottage he said: "Can you tell me what facilities there are for putting out a fire if one should occur?" The agent scratched his head, and said: "Well, sir, it sometimes rains."
In many of the rural areas they have no organised water supply. It is absurd to think that when you have a few showers of rain the water supply problem is solved. My right hon. Friend knows that in time of drought water is carted for miles and is sold and bought at so much per pail. He also knows that when there are floods, the floods pollute the shallow wells. Rain or floods are not going to be any solution of our water problem. The problem has to be tackled. My right hon. Friend when he was at the Post Office used to say: "I hope to see a telephone in every cottage in the country. Where there cannot be a telephone in every cottage I propose to put up a kiosk, where there shall he a communal telephone that can be used."
There is another Department of State which is going to supply cheap electricity to every cottage in the country. I want to know when we are to have an adequate supply of pure water for every cottage in the country. If we cannot give a tap supply to all hamlets and country villages because of the expense, there is no reason why we should not put down a bore with a purifying plant to enable these people to go to the communal pump and get pure water. It is scandalous that in this century people in the rural areas have to buy water at 2d. a pail, and it is about time that the Government took up the question. As I have said, a survey committee and a water committee have been set up. I have read the reports of Royal Commissions and Committees, reports of inquiries galore. There has been a continuance of committees, inquiries and surveys for the last 80 years, and every committee that has reported has supported the findings of the Richmond Committee which was set up 80 years ago. It is scandalous that in this country as far as water supply is concerned there are some rural areas in a worse condition than a West African village.
The Noble Lady who takes such an interest in the welfare of the women and children of this country will be the first to say that it is no use sending children to school and teaching them hygiene if when they get home there is no proper water for them to wash in. They have to use the same water for washing clothes as that in which they wash themselves. Anybody who has travelled the country, as I have, with the express purpose of finding out the difficulties of rural water supplies would be appalled. We who live in urban areas, where our water supply is automatic by turning a tap, have no conception of the hardships which exist in some rural villages. There is an institution called the Federation of Women's Institutes which has branches throughout the country. They have done me the honour of sending me extracts of the reports from various parts of the country which have been made by women on the spot, and they disclose a condition of affairs which is a disgrace in the 20th century. I am not criticising the National Government; it is not their fault. The present Government have done more for the country than any Government which has been in office for many a long day, but for years and years past practically nothing has been done in the matter of water supply. The right hon. Gentleman opposite will agree with me that he did nothing, or practically very little, to deal with this problem when the Labour Government were in office. I have been trying to urge this question of water supply during the whole time I have been a Member of the House, but up to now very little has been done.
I hope it will not be thought impertinent if I put forward what I consider to be a constructive proposal, a comprehensive scheme, which could be carried out to deal with our water supplies. A statutory authority should be appointed—not elected—to deal with the question in co-operation with the Ministry of Health. That statutory authority, in its turn, should appoint sectional authorities to deal with sectional areas, and they should be subject to the central authority. England should be divided into sections, always having regard to the physical geography and watershed areas, and the sectional body should be responsible for the water supplies in that particular area. They should prepare schemes and submit them to the central authority. Without speaking disparagingly of well-administered authorities such as Birmingham, it is absurd that a town like Birmingham should have a monopoly of 100,000,000 gallons of water per day when they use only 30,000,000 gallons of water, and that their pipe line should run through arid areas, waterless areas, which cannot take any of the water without paying an exorbitant charge which rural areas are unable to afford.
It has been said that rural authorities have had opportunities to promote schemes, and that the ratepayers themselves have turned them down. The rateable value of a rural authority is not very great, and if it desires to provide a water supply for its area it is reasonable to suppose that it will start with the thickly populated area first and leave the outlying districts to a later period. But when they are making the rate they have to make the rate over the whole of the area, and those people who are asked to pay extra rates for things which their neighbours are to receive, and in which they will not participate, object. They very properly say that if they are to have their rates increased for the purposes of a water supply, they are entitled to have a water supply, but that the authority is rating the whole of the area and giving a water supply to only a part of it. It has been held that all the 1,770 local authorities are theoretically responsible for their own water supplies. In some cases they have not even the water in their area; nor have they the money, the facilities, or the knowledge. It really means that the Government will have to take this matter in hand. It may be said that I am advocating the nationalisation of water. Well, some scheme will have to be brought into being to deal with the matter.
Within the last few years £50,000,000 has been spent on electricity, and not £6,000,000 on water. If there is one thing which is essential as a social service to the general health, well-being and standard of the individual, it is an ample supply of pure water, not water scooped out of the ditch or a bucket. I know that I shall not appeal to my right hon. Friend in vain. I shall look with great interest to the progress that is made on this question. I hope that nothing I have said will be considered as an aspersion on the National Government. I have said on more than one occasion that I support the National Government, although there have been things which I have had to criticise. But criticism is healthy if it is helpful, and, while I have criticised the Government on occasions, when it comes down to fundamentals they have delivered the goods. One of the fundamentals of good health is pure water in ample amount.
Like many other hon. Members I was cheered by seeing the right hon. Gentleman rise as Minister of Health to move the Vote of his Department. He reminded the Committee that several years ago I had the honour of introducing him to the Ministry of Health. All I can say is that if he serves his party now as assiduously in the Department as he did then, he will add another achievement to his credit, and it may be admitted in the future that he was as successful as Minister of Health as he was as Postmaster-General. It was my duty in 1919 to inaugurate the Ministry of Health, and I should like to pay a tribute to the right hon. Gentleman for the immense help he gave me in those days, especially with regard to matters associated with national health insurance, of which he was a master. Among the purposes for which the Ministry of Health, as stated at that time, was set up, the first was:
for the purpose of promoting the health of the people throughout England and Wales.
I have often thought since that that great governing purpose has been somewhat obscured sometimes, and I am afraid that it has been obscured during the last three years under the administration of the right hon. Gentleman's predecessor.
I am drawing attention to certain matters this afternoon—and I hope the right hon. Gentleman will take it in that spirit—in order to point out what I believe to be great opportunities which are open to him and which have been lamentably neglected of late. With his usual adroitness the right hon. Gentleman confined his review to the last 25 years. Perhaps wisely, he did not say much about the last four years. I agree with what my right hon. Friend the Member for Wakefield (Mr. Greenwood) said about housing standards, and I hope that the right hon. Gentleman will himself go into that matter because, with regard to housing standards, during the last three and a half years the Ministry of Health has been the spear-head of reaction. If the right hon. Gentleman will bear in mind the great purpose of the Ministry of Health I think he will find that the reasons for that charge are worthy of his personal exploration, and I hope that he will undertake such an exploration.
There is one other matter which has not yet been mentioned and which I would also ask him to examine, because I believe that it is becoming of increasing importance yearly. That is the operation of the 1925 Derating Act. Under that Act certain areas are derated with respect to certain properties, and a formula was invented for distributing Government grants. That formula is operating with great unfairness. I am not blaming anybody in particular for it, but there are certain elements in that formula which relate to density of population and certain others which relate to the percentage of unemployment and the ability to pay rates, and, as it is operating, it is working out harshly to the rural areas and to the poor or distressed areas. I believe that in the very near future either the right hon. Gentleman or somebody else as Minister of Health will have to recast the whole of this system, scrap that formula and find a method of distributing the grants which will be fairer and more helpful to the rural areas and to those areas which are least able to help themselves. At all events, I sincerely hope that he will give the matter his careful scrutiny.
May I now refer briefly to the subject of maternal mortality? It is amazing that Westminster should have a maternal mortality rate of over 5 per 1,000 births, while Poplar has only a mortality rate of about 2.5. I am not quoting the case of Poplar merely for the sake of using the name, but I remember, and the right hon. Gentleman will remember, that in 1919 and 1920 we undertook a vigorous campaign for the institution of maternity clinics, lying-in homes and the rest of it. The right hon. Gentleman's predecessor was, I suppose, a Treasury man. At all events, he had the Treasury mind and his idea was to save money. I was greatly comforted to hear the right hon. Gentleman say that he was going to act vigorously and take active steps to combat maternal mortality. It is one of those subjects on which there is a mass of information available in the right hon. Gentleman's own office. At no time, even when we were most active in promoting maternity and child welfare centres, and when I was being denounced as a super-squanderer, did any local authority spend more than a penny rate on their maternity and child welfare services. We had Supplementary Estimates presented yesterday for £11,000,000 for aircraft and other purposes. I hope that just as the right hon. Gentleman's predecessor was determined not to spend money, he will now be aggressive in his determination to see that this matter is prosecuted. I hope he will say to the Chancellor of the Exchequer, "If you can afford Supplementary Estimates to the amount of £11,000,000, you can give me some money for maternity and child welfare homes and centres." I hope he will not be content with the standard of Kensington or any other area, but that he will obtain the necessary financial support for this great work, because it is a work that can be done. We all know that the training of midwives and so forth will take time, but by a few years of active work, I believe that he or his successor will be able to bring down the maternity death rate and get rid of that 50 per cent. excess.
However, it is to a different subject that I desire principally to invite the right hon. Gentleman's attention. It is a question which is only now emerging. It is only coming to the front in, shall we say, a stealthy fashion, but it is a question of first rate national importance. The report of Sir George Newman on the school services in 1933 has often been quoted as excusing to some extent what has been happening, but I notice that a concluding sentence in that report—the report of the right hon. Gentleman's own chief medical officer—is as follows:
The physiological deterioration of the unemployed may appear at any time although it has not yet in any general degree appeared.
That was the warning which the chief medical officer gave in 1933 and I believe that since that time there has accumulated dramatic evidence that the physical deterioration which Sir George Newman foresaw in 1933 is now emerging. This deterioration of physique is, I agree, difficult to define. We all know the difficulty of an exact definition of malnutrition. At the same time, it begins to appear gradually among children at two years, three years, four years and five years of age so that by the time the child is old enough to go to school one begins to find something distinctive in their condition. We have had four years of national economy at the expense of the unemployed and
we are beginning to have some pretty dreadful evidence of the consequences to which I invite the right hon. Gentleman's attention.
I quote four examples. I find that the medical officer for Breconshire examined 2,000 children in 15 schools in July, 1934. He found that the "under weights" that is children of five classified as being under weight from depressed areas numbered half as many again as those from the areas which are not regarded as depressed. Then, in Burnley I find from the medical officer's report that the percentage of malnutrition among children has risen from 1.4 per thousand in 1929 to 8.3 in 1933, not-withstanding the provision of free meals. I am taking examples from big places where there are first-rate efficient staffs. The report of the Preston medical officer contains this statement:
Put scientifically, the industrial situation"—
I ask hon. Members to mark the words "the industrial situation"—
has deprived people of first-class proteins, fats and vitamins. In plain words, bread, jam, margarine and tea have taken the place of milk, meat, eggs and fresh fruit.
That is what you might expect—
In the districts where unemployment is most marked the results of poverty are very definitely reflected in every class of the school. Taken as a group the children are undersized, pale, listless, flabby and mentally dull.
I give one other case and that is Pontypridd. The medical officer's report states:
Long-continued unemployment in the basic trades has led to a large number of families becoming dependent upon transitional payments or public assistance. There is imminent danger of this continued low level of subsistence leading to malnutrition and physical deterioration among the children of the unemployed.
I could quote dozens of such reports, but I have given a fair sample of the reports which have emerged in the last 12 months or so, when there has been time for the malnutrition associated with unemployment to begin to make itself manifest. Some of my colleagues may remember that in February of this year I put a question to the then Prime Minister. I asked whether it was proposed to publish the report of the President of the Royal Society and other scientists that was made to the Government last year on the
nutrition of children and kindred subjects. In his reply the right hon. Gentleman said that he assumed that I was referring to a memorandum submitted last year by the Economic Advisory Council. He also said that the document was intended to be confidential. There was the usual cross-questioning afterwards and the right hon. Gentleman said at the end of it that the matter was under consideration. So I waited for a time, and then put another question to the Minister of Health. Finally on 6th June this year, he announced that he had, after considerable difficulty, etc., got together a committee which would take the place of the advisory committee which there had been before. That will not do. What some of the eminent gentlemen who advised the Economic Council have said elsewhere is common knowledge, and I am going to rely on what those gentlemen have said. Who are one or two of these eminent gentlemen, some of whom I have met and with some of whom I am good friends? One of the advisers to the Government is the president of the Royal Society, a great authority on nutrition problems. I believe that another was the secretary of the Medical Research Council. Another was the secretary of the Royal Society. There were others, all of whom at different times have made some very remarkable statements on this question of nutrition.
This report to which the Prime Minister refers is, it is true, the report about which I was asking. The Prime Minister told the House there had been this report. The report ought to be published, and I want it published. It is a year since it was put in. As the Prime Minister told the House of Commons on 14th February, it was a report submitted confidentially to the Economic Advisory Council, but he knows perfectly well that nothing is easier than to take off the trimmings, and the House of Commons on a great matter of this sort ought not to be kept in the dark for 12 months about the state of nutrition of the nation's children. Judging from their other reports, I think that I should be right if I suggested some of the things that were said. I am quite sure that they would have said that there are widespread defects of nutritional origin among the children of the people. There have been some remarkable inquiries of which the results have been published. I can refer to only one or two. One, I notice, was the subject of discussion in Sir George Newman's report.
One of the most precise inquiries was conducted at Newcastle among the children of those who had been out of work and of those who were more well-to-do. Among the well-to-do 25 per cent. of the children were above the normal height, whereas in the industrial or poorer classes only 2 per cent. were above and 47 per cent. were below it. A remarkable thing also has emerged during the last two or three years from these nutritional inquiries in the poorer areas, and that is the wide extent of anaemia among children. It arises only gradually and imperceptibly, gradually developing as a result of improper or insufficient dietary. In the Newcastle case a certain standard was taken. Twenty-three per cent. of the industrial classes and those who had been unemployed were below a very low standard. None of the other classes were below, and 75 per cent. of them were above it. In one inquiry Dr. Spencer first came across these children by accident, because he was looking out for cases of rickets to treat with the modification of a new scientific remedy. If the right hon. Gentleman will cast his mind back to 1921 and 1923 it was very difficult in our hospital out-patients' rooms to find rickets. With the better wages and food the people had at that time it was not at all easy to find cases of rickets, but in Newcastle they found 44 cases of rickets quite easily. In the first 40 cases as they came in, when their family circumstances were traced back in every case the parents were out of work.
That meant that as a result of unemployment, more or less long continued, there was this state in the children. All these cases show that among the children of these industrially poor people, particularly if they were out of work and had been subject to the family means test for a long time, anaemia, rickets, and other developments of an obviously mal-nutritional kind were becoming dreadfully prominent. It would be quite useless for the Parliamentary Secretary to quote Sir George Newman's report of 1923 about the general average of the whole country. I know that. I am talking about what is beginning to be manifest now that the children have become old enough for the effects of their nutrition to show. I want to persuade the right hon. Gentleman if I can to let us have the benefit of the advice and report which these distinguished gentlemen gave to the Government more than a year ago, and which have not yet been published.
Judging from their other speeches and writings I am confident that these gentlemen will have reported to the Government the very widespread extent of dental caries and pyorrhoea associated with poor diet. Cases throughout the country which have been investigated—and all sorts of investigations have been going on—all indicate the same kind of thing, that about 60 per cent. of the expenditure on food of the poorer people is spent on cereals, bread and so on. These particular foods do not contain certain elements which are necessary for full healthy development, and the absence of which goes to explain rickets, dental caries and so on to a large extent. They cannot afford eggs, milk, fresh fruit and vegetables. It is apparent that as a result they fill themselves up with something that is cheap; they fill themselves up too much with bread and starchy things, more than they ought to have, but because they cannot afford to buy the other things which they ought to have. I was surprised at the quaint interjection of the hon. Member for St. Albans (Sir F. Fremantle) in reply to somebody as to the value of milk. He has not been keeping abreast of the doings of his scientific brethren, because large-scale experiments as to the feeding of school children on milk have been carried out. I see that in one large group experiment children who were given a pint of milk a day grew 2.6 inches a year while children who had not been given milk grew only 1.8 inches. The children who had the milk put on 9.3 lbs. in weight whereas those who had not the milk put on only 3.8 lbs.
I am sure, judging from the mass of material available to anybody, that these scientists will certainly have told the Government that these children ought to have more than one pint of milk a day. They cannot afford it. There is no doubt that nursing and expectant mothers ought to have milk if they are to do their best by their children; and the absence of it has been shown to prejudice seriously their chances in pregnancy. Here I have the report of the Estimates, and I notice that the amount for milk, England and Wales, is £338,000. That is to enable the Milk Board to give these cheap milk supplies to children, and the right hon. Gentleman's predecessor was very anxious to secure that children did not have free milk unless they had a medical certificate. I want these scientists' report put side by side with the ruling of the last Minister of Health. These children need to have milk if you are to prevent them from needing a medical certificate. I remember catching it hot years ago because I insisted on extensive feeding of school children. I got into sad trouble about it. I was called all sorts of unkind names.
If the Chief Medical Officer of the Ministry of Health had been urged by his Minister to say a word about it, the present policy would very soon have been altered. I do not believe it will last long now. The right hon. Gentleman—I give him credit for this—will, I think, put up a fight with the Treasury on the subject if necessary. If he will publish the report for which I am asking, that was presented to the Government in June, 1934, or thereabouts, I am sure that this penurious policy which results in this very scanty provision of milk to school children in distressed areas will be brought to an end, because it is certain that the deprivation of these families, wholesale, in South Wales, the North-Eastern district, Lancashire, and elsewhere, of the ability to buy a sufficiency of milk, eggs, and food of that kind, compelling them to fill themselves up with starchy things, too much bread and so forth, is now beginning to show its immensely damaging effects.
It is the first duty of the Minister of Health, as I said at the beginning, to promote the health of the people throughout England and Wales. I may be referred by the Parliamentary Secretary—I should not blame him, because he has to make out a case—to the controversy that arose between the British Medical Association and the Government's own Advisory Committee about diet scales. Whatever may be the precise splitting of figures between the disputants, there seems to be no doubt that whichever scale you take, the amount of money available for buying the right kind of food under these scales is seriously deficient. For a father, mother, and three children I see it is put at 23 per cent., and for a father, mother, and two children 15 per cent., and so on. I am not going to get embroiled in a discussion as to whether it should be 4s. 11d. or 5s. 2d. That is not the point. The point is that it is clear now, and it is beginning to be dramatically clear, that the long-continued inability of the people in these areas to buy the right kind of food is having a seriously damaging effect upon their children.
I venture to make four or five quite confident statements based on what is now, I think, proved. We should encourage a standard whereby these children could be fed properly. I agree that you must have a considerable educative campaign as to what is the right kind of food, but the right hon. Gentleman is an absolute expert on methods of publicity—and I am sure he could get it across as well as any man in Parliament—as to the value of milk, eggs, and so on. I would not ask for a better man to take up the job. I want him to take it up, because during the past four years of this Government these services have been starved, and if the feeding of the unemployed and the allowances to be made, when they are produced by the new Board, were accompanied by a proper diet policy, I will undertake to say that in a few years' time the average stature of British children would be up by, say, a couple of inches—I make that as a confident statement—that you could wipe out rickets that you could wipe out 50 per cent. of the dental caries and pyorrhoea; and that you could practically get rid of child anaemia, which is very widespread now in all these places. If the Government knew no better, a lot of my exordium would be uncalled for, but I know they do know better. I know the people, or some of the people anyhow, who have advised them. The Prime Minister told me himself that they had made a report on these matters, and I want that report. I know that that report, when it is produced, will justify every word I say, but it will do something else: it will knock the bottom out of the family means test.
The right hon. Member for Swindon (Dr. Addison) has made a very moving appeal for a proper milk supply for the children of this country, and I deeply sympathise with everything he has said in that particular. I would like to say to him, however, that a proper milk supply is really unattainable unless there is an adequate water supply to every place in the country. Can it be imagined that in the little country districts the milk supply can be anything like what it should be if there is no water? The hon. Member for Elland (Mr. Levy) dealt with this subject, but I think he missed one essential point, and that is the sole reason for my rising this evening to address the Committee. He made a very moving appeal for an adequate water supply to the villages of this country. He pointed out the grievous results that happen because there is no adequate water supply, and he asked the Government to step in and see that an adequate supply is provided. Usually the country districts have to provide the greater part of the money necessary for such a supply themselves, and it is not unjust that they should be asked to pay an adequate sum for the provision of a water supply, but I would like to draw the Minister's attention to a letter which appeared recently in the "Times," in which it was stated that a very small district in the West of England had a water supply taken from a spring in a property some distance away. They paid £30 a year for it, and they had a lease on it. In due time the lease expired, and the proprietor said: "Oh, yes, I will renew the lease if you pay me £350"—an impossible sum for the little local authority concerned.
Here, evidently, the Minister and the Government ought to step in. Some time ago we were asked in this House to pass a Bill to make the petroleum supplies which possibly underlie the country Government property, that is, the universal property of all of us, and we did pass that Bill. But nobody has taken care to ensure that the absolutely necessary supply of water should be at the service of those who require it. Water is on an entirely different footing. If a spring is in somebody's field, you not only have to pay for a wayleave to go there, but apparently you must pay any exorbitant price that the proprietor likes to ask. I am told that any small authority may go and purchase the land in which there is a spring. In the smaller cases that is not practicable. In the larger towns, like London, Birmingham, Manchester, and so on, it is easy, with the finances at their disposal, to purchase great blocks of territory and to buy the water running through that territory and so have for themselves and their inhabitants a full and adequate water supply. But that is not at all the case with the smaller authorities. I therefore suggest very strongly that the Ministry should carefully consider the desirability of bringing in a Bill to make the water supplies of this country, whether underground or flowing on the surface, free to all those who care to use them, subject, of course, to payment for wayleaves.
At any rate, I have made a suggestion to the Government, and that was the purpose for which I rose. It is well within the competence of the Minister of Health to see that an adequate supply of water is provided for every district in this country, and the proper way for him to deal with that is, in some way or other, to obtain possession of the actual water supply itself.
The right hon. Member for Swindon (Dr. Addison) welcomed, as we all welcome, the right hon. Gentleman to his new post as Minister of Health, but I was particularly sorry to hear him say that he hoped to see an aggressive policy on the part of my right hon. Friend, and then to have him suggest that the maternal mortality figures in this country could be cured simply by the pouring out of money.
That was the suggestion of the right hon. Gentleman, as can be seen from to-morrow's OFFICIAL REPORT, and it comes particularly ill from the right hon. Gentleman, inasmuch as he himself has been a qualified medical man and knows very well that the spending of money alone will never save one mother's life in this country. The problem, unfortunately, is not as simple as that. I am afraid that there is no possible question, if we study the medical reports and medical pamphlets to which we have access, that medical knowledge in this country in the past 25 years has advanced out of proportion to the availability of that knowledge to the public as a whole. That availability to the public will come when we have a proper co-ordination of services, proper continuity of services, and, above all, proper training. We have had some interesting figures of the rates of maternal deaths in West Ham and Poplar and in Kensington and Westminster. I do not say that I can suggest the whole cause, but it will be interesting to look into it and to see if what I would suggest is not largely the cause. Is there not perhaps in Poplar and West Ham one main service to supply most of the needs of the people, whereas in Kensington and Westminster there is perhaps a large number of private doctors' practices and there are also State and voluntary hospitals? I suggest that perhaps there is less co-ordination and a lack of continuity in the services in those two areas.
In the area served by Guy's Hospital the maternity figures have been brought down to one per 1,000. That is because in that area there is a trained staff attending to the people. What is the position in the country to-day, however? We have not a greater likelihood of a trained staff; we have rather the danger of a less trained staff. In Guy's Hospital the students and midwives are getting only about half the quantity of material upon which to learn that was laid down as a minimim by the General Medical Council. I think that the right hon. Gentleman will agree that the 20 cases laid down as a minimum for training was in all conscience very small, and it is an appalling situation if in our hospitals today our midwives and doctors are not able to get even half the quantity of material upon which to train. It means that we are sending out midwives and doctors who cannot know their job properly. It is an admirable thing to have ante-natal and post-natal clinics, but it is useless having them unless they are staffed by people who are experts. There are many things which could be done to correct this. I suggest that one of the main faults to-day lies with the appointment boards of the hospitals. They insist before they give good jobs to nurses that they shall have taken a Central Midwives' Board certificate, whether or not they intend to practice midwifery. If the small supply of material is used by nurses who are never going to practice midwifery, it means that material is taken on which nurses who are going to
practise it ought to train, and the consequence is that we cannot get properly trained staffs. I feel sure that the right hon. Gentleman has read the article which appeared in the "Lancet" on the 27th April by a leading London obstetrician, who said:
Imagine the British Admiralty sending a battleship into action with an improvised crew, but that is what is being done in the battle that has been joined with maternal mortality rates. The necessary personnel has not been trained, and until this has been done there is not the slightest chance of victory.
Later, he said:
The knowledge at our disposal is ample. All we have to do is to make proper use of it, that is, to get it across to the people.
I am sure that all of us who are interested in this subject do not really want to make a party issue of it. We want to get the thing cured, and although I agree that money has to be spent, it will not be cured by the mere spending of money.
I never suggested anything of the kind. I said that I was well aware that the services will take years to develop. The hon. Member must give me credit for not thinking that the cure is in the mere spending of money.
The right hon. Gentleman certainly said the services would take years to develop, and I do not think that they need take so very many years to develop. He referred, however, to the fact that £11,000,000 had been voted for another service yesterday, and that we ought therefore to be able to spare money for the maternity services. If that does not suggest that the spending of money is the root cure of the evil, I do not know what it does suggest. I am not attempting to misrepresent the right hon. Gentleman. I am only trying to make him face the facts instead of making maternal mortality a party issue, which is what he is trying to do. I know quite well that the Socialist party has stood for the spending of money whether it was justified or not, and whether or not it meant sending up the rates of the people who had to give it. I do not believe in that policy. I believe in spending money when it is going to benefit the people. I do not believe that the mere spending of money in itself will do anyone any good.
The hon. Member for Westhoughton (Mr. Rhys Davies), when speaking yesterday of the insurance rates, said that there had been a larger number of accidents in this country lately but that the insurance money paid has been less, and that that caused him great disquiet. That is only an example of exactly the same thing. We live to-day in a mechanical age, and there is an appallingly large number of accidents in industry and on the roads. Those accidents account for a great waste of time and of money, and I believe that, owing to the system in practice, that wastage is in excess of what it should be.
I would draw the attention of the right hon. Gentleman to an interesting report which came out in February of this year. It is the report of the Committee on Fractures which was issued by the British Medical Association. It showed that in 1932 there was paid out under the Workmen's Compensation Act and the Employers Liability Act of 1880 a sum of £4,479,305 in respect of 346,243 accidents. That figure included, of course, only the accidents for which such money is payable in mines, quarries, railways, factories, docks, constructional work and shipping. It did not include building, road transport, or agricultural accidents. There is also an enormous number of accidents on the road. The report clearly shows that in this country there is a complete lack of organisation with regard to fractures in almost all our general hospitals. It shows also the serious result of this in the loss of money, not only to the workmen themselves, but to the insurance companies. It gives some interesting figures. There are two well-organised hospitals for fractures in this country; one is Ancoats Hospital in Manchester and the other is the Liverpool Infirmary. Statistics are given showing the difference in the time spent in hospital as a result of the same injury in organised hospitals and in unorganised hospitals. To quote only one example out of many, in 482 cases of Collis's fracture in organised hospitals, the disability period averaged seven weeks and the number of cases permanently incapacitated was two. In unorganised hospitals, in 38 cases of the same fracture the average period of disability was 29 weeks and the number of cases permanently incapacitated was nine. These figures give serious cause for thought. The report also states that the most efficient hospital in Europe for fractures is Baler's Clinic in Austria. It is an interesting clinic in as much as it is financed entirely by insurance companies, It has only 119 beds. In its first year 790 fracture cases in Vienna were brought to the notice of the insurance companies, but only 119 were treated in Böhler's Clinic, the others being treated outside. The insurance companies estimate that the shortness of the period of invalidity and the completeness of recovery in those 119 cases gave them a saving in the first year of £7,000.
We have been told that the finances of the approved societies are in such a bad state that it was necessary to lower the benefit paid to women in sickness, and I would therefore beg the Minister to inquire not only as to what sum of money is spent but what sum of money would be spent if we had a really co-ordinated, continuous and efficient service for accidents all over the country. I hope that the right hon. Gentleman will bring pressure to bear through the Ministry and the insurance companies to see that such a service is inaugurated, and to see that pressure is brought on the hospitals to insure that such a service shall be forthcoming.
To return to the maternal mortality rate, there are questions which none of us care altogether to face, but it is time that they were faced. One of the causes of the ill-health of mothers in the urban and industrial areas is the tremendous amount of abortion. Members may or may not approve of birth control clinics, but let them face what is going on. A well-run and well-organised birth control clinic may be of infinite value to married women. You may not believe in them, but do not imagine that the other thing does not exist. The tremendous amount of advertising of materials to produce abortion that exists all over the country must cause anyone who has the welfare of the health of our mothers at heart very serious consideration. It is time that this fact was realised and that some steps were taken to deal with it.
On the question of milk, the Government have ensured that a vastly increased number of children shall be given milk in the elementary schools. We all believe that it is for the health of the children concerned, but if we give the children milk we have to face the fact that one of the chief causes of death among young people between 15 and 20 is tuberculosis, and we must take every step to see that our milk is not tubercle and is clean. I would impress on my right hon. Friend that he should take every step to see that this is ensured. The present method of keeping milk free from tubercle bacillus is expensive for the farmer and it is not always completely effective, and I would urge upon my right hon. Friend that he should carefully watch the experiments which have been carried out in other countries, and, if they are proved to be successful, I hope he will lose no time in seeing that they are carried out in this country also.
There are three aspects of local government to which I wish to call attention, and I will be as brief as I can. The most difficult and complicated one, which I will take first, concerns the Rent Restriction Act, 1933, and what I have to say on it links with what was said earlier by the hon. Member for Whitechapel (Mr. Janner). He represents a division as different from mine as possible. His is, perhaps, the most urban and industrial division, and mine is, perhaps, the most rural, but the same trouble seems to be common to both—and I believe many other places—namely, that the Rent Restriction Act of 1933 is not working out properly. That is mainly because it is a most complicated Act, as no one will deny. I do not think the ordinary man in the street can understand it without the aid of a lawyer. That is all right for the lawyers, but it is not good for those who cannot afford to pay them, and I am sure the Minister will agree that it is not right that a Measure should go out from his Department to become as this has, a stamping ground for lawyers throughout the country.
In support of my statement that I do not believe it is working properly I will give my own experience. Section 10 provides that if complaints about rents, control or decontrol of houses, the use of improper rent books and other matters are brought to the notice of the local authorities they may investigate them. I do not need to remind the Committee that there is all the difference in the world between the words "may" and "must." A great many cases were brought to my notice, and I was informed that the local authority concerned, the North Walsham Urban District Council, would not take any action in the matter, and was asked to see whether I could do any better. I did not, as it turned out, succeed in doing very much better. I selected half-a-dozen of the worst cases and put them before the council, who made a very cursory investigation, so cursory that I could not possibly accept the explanation which they gave me. I wrote again and asked if they would be good enough to investigate more closely, because I was not satisfied with their explanation. Then they had rather an interesting meeting. One candid councillor, almost too candid, said that he was very much surprised that I had sent only six cases, because he thought there must be many hundreds. One would think that that would have encouraged the council to look into the cases I had submitted and clear them up. Not a bit of it. I do not know whether they were frightened of finding out too much, but they moved and carried a resolution that the correspondence which they had been carrying on with me should be closed. So I am afraid I was not able to do very much.
I do not think that position is satisfactory—not because they would not continue the correspondence with me, but because these were eases which really ought to be investigated to set the public mind at rest. The explanation which people put upon it is that all these councillors are the landlords concerned and, therefore, are not going to prosecute themselves, I do not think that is a satisfactory position, and I feel that one thing the Ministry could do—I am not pleading for legislation, because it would be out of order to do so now—would be to make clear throughout the country exactly what the Act provides and also show how the Act has been interpreted in cases in the law courts. The present position ought not to be allowed to continue, because it is not satisfactory for a local authority to have people saying that they will not do their duty for the reason that they are all concerned as landlords and will not prosecute themselves. It is satisfactory neither for them nor for local government as a whole that that idea should creep in. There are many people who say that the Ministry of Health ought to do something, but that opens up a very wide question, because there is a widespread opinion that Government interference has gone a great deal too far already, and to say that the Ministry of Health must always intervene might accentuate that feeling. I hope I have not done wrong in bringing the rather extraordinary conduct of this local authority to the notice of the Committee. It sometimes happens that it is a very salutary thing to bring the searchlight of publicity upon authorities which are not playing the game.
I pass from that subject to the question of relief work, which it is necessary to provide in Norfolk because, unfortunately, neither agricultural workers nor fishermen are insured against unemployment. I will not weary the Committee with the details, because I have made myself somewhat of a nuisance to the Ministry of Health on this subject in the past. After I had made representations to the predecessor of the Minister, and certain changes had been made, I was asked by those relief workers to thank the Minister for what he had done, and I take this opportunity of doing so, and assuring him that they are most grateful for the action of the Department. I must put in a plea for uniformity in the treatment of the men who are put on relief work. In the first place there is no shadow of doubt that they would rather have this relief work than nothing at all, but what does cause dissatisfaction is that men who come from a village about two miles out of Yarmouth have to walk some seven miles to their work, which is at a sandpit, and at the same time see relief workers from Yarmouth, who have only some three or four miles to go, being taken there and back in a lorry. Further, the men find when they get to this relief work, seven miles away, that no tent or other shelter is provided where they can eat their lunch, whereas the Yarmouth men have had a special shed erected for them and a man is provided to keep their food hot. They ask, and with reason, why they should be treated differently from the others. It is all very well to explain to them that the matter is under the control of the local authority, which lays down the conditions, but I hope that when this business is taken over by the Unemployment Assistance Board it will take careful note of these points and try to get uniformity as far as possible. I was glad to see a recommendation that the scale of relief should be—
I bow to your Ruling. My only object in mentioning it was to make a plea for uniformity. I will come now to my last point, which concerns rural housing. I was very glad to hear from the Minister this afternoon about the houses which are being built, and of the progress that has been made, but if he will examine the returns he will find that rural housing is a Cinderella. There is not the progress in rural housing which there ought to be. There are two main reasons for that state of affairs. The first is that in an agricultural community like Norfolk it is quite impossible for people to pay more than 5s. a week in rent. The usual wages there are 31s. 6d. a week, and some people get less than that if they are fishermen and work on another basis, and I do not think it is fair to expect them to pay more than 5s. in rent; but without a subsidy local authorities do not find it possible to build houses which will let at between 3s. and 5s. a week. Though I do not want to go into the remedy for this, because it would be out of order now, I hope the Minister will read between the lines of what I am saying. There are in my division five local authorities, and I am certain that all could do a great deal more if it were not for the present conditions. They get no grant for housing at all, except for rehousing families under the Act of 1930. I think the Minister is quite right, in the case of towns, and the districts around the towns, to look to private enterprise to build houses, but he cannot expect private enterprise to do it in the country, and I hope his Department will pay attention to that consideration. In conclusion, I would congratulate the right hon. Gentleman on his promotion to the Ministry of Health, and say that if he brings to the problems now before him the spirit of energy and enterprise which he displayed at the Post Office, the people of this country will be very grateful to him.
The variety of subjects covered by this Debate is some indication of the ramifications of the Ministry of Health, and I must confess to feeling some sympathy with my hon. Friend the Parliamentary Secretary who has to reply to all the questions which have been raised, though I have no doubt as to his ability to discharge that duty. May I join with those Members who have offered a welcome to the new Minister, and may I also strike another note which so far has not been struck, in saying that there is no disparagement whatever of the right hon. Gentleman Sir Hilton Young, who is not now a Member of this House. It is my personal opinion that his departure is a distinct loss to the House, and I should be very sorry if any observations which have been made by hon. Members during this Debate were taken too seriously. It would be a departure from a sound principle of this House to refer in disparaging terms to people who are not here to reply for themselves. I am sorry that the right hon. Member for Swindon (Dr. Addison) did not pursue a little further his statements on the block grant arising from the derating formula. He made a statement, though he did not substantiate it, that that formula was not working satisfactorily, and that the rural areas particularly, I think, were being adversely affected by the application of the block grant. I should be much obliged if the Parliamentary Secretary would tell the Committee whether the formula is, in general, working out in the way in which it was intended to work out, which was precisely the opposite of the way in which the right hon. Gentleman indicated that it was operating.
Those who were in the House when that Measure was under consideration will remember that it was rather a complicated one, but it laid down the principle of helping those districts which were most in need of help. Rural districts got help because one of the factors in the formula was the mileage of roads in a district. Industrial centres were helped by three factors—population, the number of children under five years of age, and the number of unemployed. In view of the increase of unemployment in certain districts since then I feel that that factor in the formula could not affect adversely the depressed areas but rather must have helped them. I shall be very much obliged if the Minister will give us some indication as to whether or not the formula has had that effect.
May I refer to one of the subjects raised by almost every speaker—and it is perhaps right on the Vote of the Minister of Health administration that it should be raised—the subject of housing. Everybody is agreed that housing is one of the most important things which make for the comfort and contentment of our people. When the right hon. Gentleman the Member for Wakefield (Mr. Greenwood) was speaking, I ventured to interrupt. I thank him for his courtesy in permitting my interruption, and I can understand his reluctance to pursue the question I then raised. We all know that it is not always convenient to pursue a question in the middle of a speech. I should like to pursue the argument he was advancing at the time of my interruption. The impression he conveyed to me was this. He was speaking about the decreased number of houses built by local authorities since the general subsidy was moved. He said that a large number of houses had been built by private enterprise, but he deplored the fact that the general subsidy had been removed and in its place a subsidy had been introduced which was conditional upon new houses being subject to the demolition schemes in regard to slums. I shall always have the highest admiration for Sir Hilton Young, because he was the first Minister to introduce any Measure which had as a fundamental principle the abolition of slums. That will always be to his credit, and I would like in this connection to ask the present Minister if he can give the Committee any idea as to the extent of the slum campaign.
The Committee will remember that the House as a whole has given enthusiastic support to two Measures which go to the very roots of the housing problem. I am very sceptical about people who come along and say that there are so many millions of houses needed. I realise that unless you have sufficient and reliable data on which to form an estimate that estimate is useless. Therefore, I am very sceptical of estimates that 5,000,000 or 10,000,000 more houses are needed, because I do not believe there is anybody in the country who has sufficient evidence as to the real need. There have been passed in this House recently two Measures which will help us to get the tacts, whatever else they may do. There are two facts which are vital in the consideration of the housing question. The extent of the housing shortage is decided, first of all, by the question of slums, and secondly, by overcrowding, which is not confined to slums. If we can find out, as we can by these measures, the extent of the need for the abolition of slums and the number of people to be rehoused in accordance with that abolition, we shall have established that factor, and, secondly, under the overcrowding provisions of the Housing Bill the number of houses necessary in consequence of overcrowding will be established, and we shall have reliable data on which to form an estimate as to how many new houses will be required in the future.
The right hon. Gentleman the Member for Wakefield was criticising the present Administration in this sense. He said they had abandoned the general subsidy in respect of housing and in its place had given a subsidy in respect to houses that were to be the subject of abolition schemes. I think it is a good thing that these two matters should be tied up together. I agree with the right hon. Gentleman that in the past a large number of houses have been built which unfortunately have not become occupied by the class of persons we in this House most desire to help. That is due to a variety of reasons, but nobody in this House can say that no progress has been made by the present Administration with regard to housing. I would remind members of the Opposition who like to criticise the removal of the general subsidy of this fact, which they will not dispute. The average price of houses today of the type which are suitable for and which are desired by members of the working classes, is lower than when the general subsidy was in operation. The right hon. Gentleman the Member for Wakefield said it was true that large numbers of houses had been built but that they cannot be let. From many points of view that may be a misfortune, but for myself I should be very glad to see every householder in the country the owner of his house. I should be very glad to see every person living in his own house.
I think the right hon. Gentleman overlooked the great services which have been rendered in respect to housing by the building societies. I am very surprised to hear some hon. Gentlemen below me criticising building societies. Their funds are built up largely by the savings of the working classes. They borrow money at most advantageous terms, because it is the savings of the workers, and they lend it on most advantageous terms in accordance with the market of the day. I cannot understand hon. Gentlemen criticising institutions like the building societies, which have played such an important part in helping the poorest section of our community with financial accommodation and putting them in a position sooner or later to buy their own houses. We may have doubts as to the various schemes we have put into operation being entirely successful in their main purpose, but we cannot say we have done nothing in regard to housing. The total capital expenditure on subsidised housing since 1919 has been £655,000,000. I would point out to the hon. Gentleman below me that of that sum £432,000,000 is in respect of buildings by local authorities during the last five years. The right hon. Gentleman argued that the Minister of Health had not referred to the events of the last five years. I think he said that he had taken a survey over a quarter of a century rather than confined his observations to the last four or five years. In a general survey of the Ministry of Health and its activities, it is just as well that the House should have a more comprehensive survey than we can have in only one year's activity. But taking the five years up to March, 1935, there have been no fewer than 1,079,254 houses built by local authorities and by private enterprise.
The right hon. Gentleman made some reference to the fact that houses were not built in the early days of the present Administration. That will not bear investigation. In 1931 the total number of houses built was 183,000, in 1932, 200,000, in 1033 200,000, in 1934 266,000, and in 1935 327,000. Let me deal specifically with the right hon. Gentleman's complaint that these houses have not been built for the working-classes. An analysis of the 327,000 houses built last year shows that the bulk of them have in fact been built for, and are capable of occupation by, the wage earners. I would give the ground on which I make that assertion. There have been 105,000 houses built by private enterprise without State assistance at a rateable value not exceeding £13, and 147,000 with a rateable value between £13 and £26, in addition to houses built by local authorities to be within the means of the wage earners. The Minister of Health is right when he said that of the 327,000 houses built 90 per cent. were for the wage-earning classes. I wanted to pursue the argument with the right hon. Gentleman, because when I asked him if he acknowledged that the rateable value was the great factor in determining the rent, he evaded an answer. But the fact is that Schedule A assessment is determined by the rental value. Taking the rental value, and bearing in mind the one-sixth allowance for the purposes of Schedule A, and, as a rough and ready calculation multiplying it by 20, you get the fair price of the house, which gives a rent very comparable with that which some hon. Members below me say should be paid. I am glad that we can recall with some satisfaction that progress has been made in our housing policy. It may be wrong to assume that all the work has been done, but at any rate we have some room for satisfaction in the knowledge that a great deal of work has been done and that the record of the present Administration will compare very favourably indeed with the record of the right hon. Gentleman who sits below me. I offer my right hon. Friend the Minister of Health good wishes in his new sphere and, if he will bring energy to bear in these matters of housing, maternal mortality and the other questions which have been discussed, he will have the cordial support of all Members in this House.
As the last speaker said, this Vote has opened great possibilities in the way of a speech—town planning, water supplies, rural housing, and what not—but I think most of us try to stick to the question about which we know most. I think these attacks on the late Minister of Health by some Members of the Opposition are very unfair. He has done more than any other former Minister of Health in the way of building houses, and he had very constructive views. I would admit he could not "put it over" as well as the present Minister can, but, if you look into his record, it is really very extraordinary. It is a splendid record, and all of us who are interested in this question are grateful to him for the work he has done. It is poor policy for the former Labour Minister of Health to attempt to criticise our Minister of Health. If he had half as good a record as the late Minister of Health the whole country would have been placarded with what he did. But unfortunately for the Labour party they can only have placards of what they are going to do, not what they have done. That is why they feel so bitterly towards our present Minister of Health and our late Minister, too. I am not going into the Labour position and what hon. Members have said about the health and welfare of the people. Everybody knows that the country was never better than it is to-day. It is said that there is malnutrition in some areas, but that comes from not knowing the right kind of food to give the children. [Interruption.] I am talking of what I know.
Hon. Gentlemen are talking about what they think they know. Go into any area and see what you find at the open-air nursery schools. It is not that the children of the poor have not enough to eat, but that they very often have the wrong kind of food. Every expert knows that. There are, of course, problems. What I have said does not mean that I am contented with the situation as it is because I am far from contented. [Interruption.] If hon. Members will try not to interrupt me, I will try to go on.
I hope that the Minister of Health will pay great attention to the speech made by the hon. Member for Elland (Mr. Levy), who brought up the question of the water supply in rural areas. The late Minister of Health regarded that subject as of the utmost importance and so it is to the general health, especially of the women and children in those areas. I do not believe that any man who has not tried to live in a house which has no running water can realise the discomforts and the miseries which women in such houses have to go through. I regret to state that there are many such houses in the country, and I regard the position as a national disgrace. I hope that our present Minister, who is so good and knows so much about the subject, and who has had such experience, will, for the sake of the country, make that one of his first concerns.
I am not proposing to defend the Minister of Health from the attack made upon him by the hon. Member for Gorbals (Mr. Buchanan), who made some very rude remarks about the Tory party. He said that when the Insurance Bill came in, it was opposed by the whole of the Tory party. It was not opposed by the whole of them, because the late Lord Henry Bentinck and the then Member for Plymouth were very keen about health insurance. I am sure that the Prime Minister will agree that they had the courage of their convictions, although they fought their party. There was a group in the House who believed in health insurance. The right hon. Gentleman the Member for Wakefield (Mr. Greenwood) asked why the Minister had not referred to the Poor Law, but that was going too far. The present Minister of Health helped the Chancellor of the Exchequer to bring in the greatest reform the country has had for many a day, and that was Poor Law reform. I do not think that the Government have had half the credit for what they have done. Ask the people who are now enjoying the conditions in the municipal hospitals, and they will tell you. In my own constituency, when Labour people say how wonderful is our City hospital, I remind them that it was made possible by the present Chancellor of the Exchequer, and then they do not like it so much. Of all the people in the world who have something to say about the Poor Law it should not be the right hon. Gentleman the Member for Wakefield, but the present Minister of Health.
Now just a few things about children, and then I will come to the question of maternal mortality. I do not know whether the House realises that there has been a fall in the birth-rate. That means that we have to take particular care of the children that are born. About 80,000 children are born each year, and of that number 2,500 are stillborn, 2,700 die under the age of one year, 6,700 die between the ages of one and two, and 6,600 die between one and five. Those figures are too high. Out of every 10 children born, more than one dies before reaching the age of five, and about half of those that die are under two years of age. It is in this connection that the infant welfare centres are so important. Although we are ahead of nearly every country in the world in that respect, we have not enough infant welfare centres. It surprises people to know that only about half the children under two ever go near an infant welfare centre. There are 1,750,000 children between the ages of two and five, and of that number 200,000 live in overcrowded conditions of three or more persons per room. Out of every 100 school children examined, 15.9 need medical attention, 15.4 need observation, nearly half show traces of rickets and more than two-thirds have defective feet.
The former Chief Medical Officer of Health wrote a splendid report on that matter, and said that a great many of the cases were pathetic and that he could not afford to let it go on. I know no way of really getting at the situation except through the infant welfare centres which deal with children up to two. We must increase the number of infant welfare centres, and of open air nursery schools which cater for children from two to five years of age. I cannot go into that matter on the Ministry of Health Vote. We do not want those institutions to be under the Ministry of Health; we want them under the Board of Education. I am sure the Government will do what they can in that respect. Let those who talk about malnutrition bear in mind that if we are to get the children properly fed we must teach the mothers the right food to give them.
Surely the hon. Member will accept what was said by Margaret Macmillan who was one of the greatest reformers the country has ever seen. She found also that we must teach the mothers how to feed the children, and we also find that in our infant welfare centres. Let hon. Members go into the East End, and they will see children who are eating all day long. It is the easiest thing in the world for children to pop something into their mouths, and every mother knows that. Hon. Members have referred to Kensington; I think the housing conditions there are abominable, but if I thought there was under-nutrition among the children I should be the first to say so. I am not a party hack; hon. Members must know that by now. If I were, I might be on the Front Bench. You never can tell how far you can go if you say the pleasant things, but I am not thinking about that; I am thinking of the children. It is no use hon. Members riding off on malnutrition. It is not always under-feeding; over feeding causes the trouble in a good many cases. The thing to do is to get children between the ages of one and five into infant welfare centres and out of the appalling conditions under which they live.
I am going to say something upon a subject which is not so easy or so pleasant. We have talked about maternal mortality for a long time, but there are certain facts that we do not like to face. We have to face them, although we think we cannot face them because they are controversial. A high percentage of maternal mortality is due to attempted abortion. Whether you like it or not, I am going to talk about the need for birth control centres throughout the country. I would remind hon. Members of all sections of the community or of religion that, whether they like it or not, birth control and illegal abortions are going on, and that the women of the country are suffering terribly. We, as a House of Commons and as a nation, must face up to that fact to-day. The Minister of Health wrote a very interesting article the other day and it was published, I think, in the "Daily Mirror," of all papers. He gave interesting facts showing the increase in antenatal clinics. He said that from 1930 to 1934 their number had increased by 425, and that many more women were going to them. He also said that there was a great deal more that the local authorities could do and that he would trust them. You cannot always trust local authorities to do what they ought to do. There are certain local authorities who would not move at all unless the central authority got hold of them. We have had instances of that in housing.
I know that the Minister of Health understands this problem better than anyone else in the House, but I do not want him to be too optimistic about local authorities, and I hope that the Government will give a lead to those who are not doing their job. There is only one ante-natal clinic for every 5,500 women of child-bearing age, and some of these clinics are not properly distributed—they are not in the right places. How many local authorities are prepared to make any provision for scientific measures of birth control? To be safe, such clinics should be under the local authorities; they could be run in conjunction with the maternity and child welfare clinics. We want them to be either under the local authorities or under the Government, because we do not want them to be abused. All experts recognise the importance of abortion as a factor in maternal mortality. Two or three months ago I asked a question on this subject, and received a very interesting answer. It was the first question ever asked in the House on the subject. The report of the Commission on Maternal Mortality stated that, out of 3,085 maternal deaths investigated by the Commission, 407, or nearly one in six, were due to abortion. In the same series, 514 deaths were associated with diseases of the lungs, heart or kidneys, in all of which pregnancy is practically a death sentence. Thus, 984 lives out of 3,085, or nearly one-third, could have been saved by birth control.
I am going to read presently a letter which Dr. Marie Stopes wrote to the "Times" some years ago, and which will give some idea of what is going on. Ignorance is the chief cause of the practice of abortion. Women are unable to get advice. Local authorities have been allowed to give such advice since 1934, but, of the 1,200 local authorities, only 60 have clinics, though it is true that about 150 more refer patients to voluntary agencies, and there are 54 voluntary clinics in England and Wales. I know some of the horrors that these women go through. Imagine a woman, married to a working man with a very low wage, and having two, three or four children. If there is the prospect of a fifth, naturally she is going to do her best to get rid of it, and she does. The misery that these women suffer is appalling. It is no use saying that birth control is not practised; it is practised. Hon. Members who are doctors could tell you—
I am trying to prevent that mother from having to get rid of a child. That is what I am trying to do, and the hon. Member knows it as well as I do, I am trying to give her a chance of not having to suffer a criminal
abortion, and in some cases the only way in which that can be done is by a proper method of birth control. This is the letter—a most illuminating letter—which Dr. Marie Stopes wrote to the "Times" in 1929:
A point of supreme national importance, all too generally overlooked, is the recent incredibly high proportion of deliberate and criminal interference with pregnancy among the ignorant classes. Experience at our clinic has brought staggering facts to light. Two illustrations will suffice:
Thus the fall in the birth-rate at present is clearly hot to be attributed solely to the use of birth control,' but to a much larger extent is due to criminal abortion. As this often has very serious after-effects on the mother's health, it would never be undertaken by a woman possessing knowledge of her own physiology. The only way to counteract this serious racial evil is to give sound physiological knowledge to all.
That I believe to be perfectly true, Many years ago I did not believe in these birth control clinics—I do not know whether it was due to religious views, or why it was; but, when I saw the appalling things that were going on, my attitude changed. I believe that it is the duty of the Minister of Health to give the facts. Very often they are difficult to get. We all know that the doctors are the closest trade union in the world, and they would never give one another away. Also, they will not give their patients away, and in that they are quite right; I do not blame them. But, if they could be got to speak, they would be able to tell of the appalling things that they have come up against. In my opinion a great deal of this suffering is not necessary, and could be prevented, and it is our duty to try to prevent it. The lives of some of these women are truly pathetic. They are ignorant; they do not know where to go; and, when they do go to a clinic, it takes them some time to learn. This question of maternal mortality is very largely a question of proper instruction in birth control. It has nothing to do with poverty. Birth control goes on; many women know how to practise it; but the tragedy is that it is the poorest
women who, through lack of knowledge, have to bring children into the world year after year.
I hope that the Minister of Health will take a courageous line on this matter. We know that many sections of the community, and many religious bodies, do not believe in it, but England is a Protestant country. We must have the courage of our convictions, and if we as a country really believe—and the Government do, because they have given the local authorities, since 1934, the right to give this knowledge—that it is the cause of a great deal of suffering and misery, we must have the courage to go through with it no matter what the Opposition have to say about it. I have great faith in the Minister of Health. He has shown, in the House of Commons and in the country, that he is a man of great knowledge and great courage. I cannot do full justice to the subject, but for years I was against birth control. Then, having looked into it, I made up my mind that the blame would be upon the House of Commons if they failed to do what I believe quite honestly to be our national duty.
I have listened to the Noble Lady expounding in the House of Commons the propaganda of Dr. Marie Stopes in regard to the question of birth control, and giving advice to the Minister of Health. I have a thorough knowledge of the poor, which the Noble Lady has not, and of the question of childbirth and the rearing of families. Every street in my neighbourhood is indicative of two things, the love of the mother for her children and the right of the child to proper sustenance. I aim reminded that this is a Protestant country. May I remind the Noble Lady that it is also a Christian country, and once the ethics in regard to propagation of the species are down it is the death knell of the country. There is a right of human life and a right of the propagation of the species, and if this knowledge is to be scientifically dispensed it will be one of the curses of the age. It may be all right in the scientific body to which the Noble Lady is attached that visits its friends once a fortnight or once a month. They may find the encumbrance of a child is a trouble, but in our neighbourhood we do not find it any trouble at all where a little child, if given healthy conditions and surroundings, will have an opportunity of becoming a useful citizen.
If the Ministry wishes to encourage the welfare of the nation, it will not be by the scientific dispensation of the knowledge of Marie Stopes. The welfare of the nation will depend upon a, healthy manhood and womanhood, not so much the knowledge of the prostitute as the knowledge that goes to make for human happiness and the welfare of the people. This nation was never made on the scientific dissemination of material. It is only fit for the gutter. It is not fit for decent homes to have any knowledge of. Is there any mother or father who would be prepared to have coming into the home this material which is coming through the post to-day? An hon. Member brought into the Library the other day a letter that had been sent through the post from one of his constituents crying out against the publicity given to this type of scurrilous literature.
The Noble Lady a few moments ago said she wanted to talk on a subject of which she had knowledge. I also want to talk on a subject of which I have knowledge. The Noble Lady would advocate that the family life of the nation must not be judged by poverty or wealth. I have yet to learn that in the wealthy homes of the country they are anxious to have children in any great quantity. [Interruption.] I have 10 and they had to go out to the War and fight. When this nation wants its manhood it will never be able to get it by the doctrines of Marie Stopes. It will never have a happy manhood or womanhood fed on the kind of tripe that the Noble Lady is bringing into the House. I knew this England long before the Noble Lady had to tell me of its Protestant character when these doctrines were unknown. I believe, although I am of a certain faith, that there is enough religion in this land of ours not to allow pernicious doctrines like this to be brought into family life. I believe it is pernicious. I believe it is the worst kind of propaganda that was ever introduced, and I am thoroughly convinced that there is no decent father or mother who would like the children to have knowledge of this kind of subject introduced into the home. [Interruption.] You have had enough to say. I am not sitting down. I have listened to you talking until I am fed up with listening.
The Noble Lady comes in when it suits her to speak, and then she clears off for two or three months. [HON. MEMBERS "NO !"] I am in the House every day when the House is sitting, and I know. We are asked that advice should be given on a subject which the medical services of the country are not competent to deal with. Where is there anyone who cannot go to a family physician or a hospital for advice? Where is there anyone who has the right to advise that methods must be used by which there shall be no child-bearing by women? The object of the speech that has been made to-night is that, without denying the pleasure of sexual delectation, there must be no children. I am against this doctrine. If a mother is in bad health, feed her, pay the husband proper wages, give them an opportunity to have decent homes. Do not come along with this kind of thing to try to make us believe that you are taking an interest in the poor. What is the use of going to poor homes where there are five or six children and saying: "You should not have had those dirty brats. You should have had a little more common sense." When the cry was raised in 1914 for men to defend England, was the propaganda of Marie Stopes required? No. They wanted the boys and girls to go out and fight for the land. If you have no land to fight for, you will have no boys or girls. If you go on with this thing there will be desolate hearths. I ask hon. Members not to have this pernicious kind of doctrine instilled into their minds. I ask the Minister of Health to consider the problems of the people—better housing, better food, better clothing, better educated children, not a nation that will fade away, but a virile England which will take its proper place in the van of the nations of the world.
I do not want to enter into the merits or demerits of the doctrine which has just been the subject of a little private debate between the Noble Lady and the hon. Member who spoke last, except to say that, at any rate, one can pay a tribute to the Noble Lady for having delivered a very courageous speech. It must have required some little effort to make a speech of that kind, and it is one of the justifications for membership of this House by members of her sex. The Debate has ranged over a very wide variety of subjects. I only want to touch on one which has not been dealt with by any previous speaker. The point with which I wish to deal very briefly is that of the administration of the lunacy laws. Two years ago I was ill-advised enough to write an article on lunacy law reform. There was very swift retribution. I suffered the penalty for writing the article which I no doubt deserved, because I was inundated with letters of complaint from all parts of the country from hundreds of people who had a private little thrust at the Lunacy Board.
I am not quite clear that this matter arises on this Vote. There is a separate vote for the Board of Control, and the hon. Member cannot discuss anything which is appropriate to that on this Vote. A certain amount of lunacy administration comes under the Lord Chancellor's Department and arises on Class III, but I do not think that the Ministry of Health has any responsibility.
I must bow to your Ruling and forbear to make any reference to the special point which was to be the keynote of the few remarks I proposed to address to the Committee, but I would like merely to say that, in matters connected with the administration of the lunacy law, a correspondence has passed between myself and the Ministry of Health, and, rightly or wrongly, I was under the impression that the administration of lunacy law came within the province of the Ministry of Health. However, I am open to your correction, and, if your Ruling forbids me to make any further reference to the subject of the administration of lunacy law, I must of necessity refrain from making any further comments upon it. Perhaps I may be permitted briefly to say that the great volume of correspondence which I received in connection with that matter caused me a very great amount of disquiet. I did not choose to accept the face value of many of the complaints which were made to me, but there was no doubt that out of the volume of evidence which was produced to me there was at least sufficient to give me very great concern, and am satisfied that a number of people are being detained—
I have now had the opportunity of looking at the Estimates. If this is a question of the administration of the law relating to lunacy, then it is a matter for the Lord Chancellor's Department and comes up in Class 3. If it is a question of the actual maintenance and running of homes for lunatics, it is a matter which comes under the Vote of the Board of Control, which is not now before the Committee, and should be raised on that Vote. The Minister of Health is not responsible.
I am much obliged to you, Captain Bourne, for having so specifically put the Ruling which clearly forbids my making any further reference to the matter. Perhaps, however, I may now be permitted to deal with another matter which I have very much at heart—the administration of what is called slum clearance under the Housing Act, 1930. There is a belief that at the moment a great crusade is being carried on against the bloated landlords of the festering slums in our great cities. I have no doubt that that is the chief objective of the energetic campaign which is now being carried on by the Ministry of Health, and I do not suppose that anyone will waste very much sympathy upon the type of landlord I have indicated, but that is not the whole story. Large numbers of decent working-class people are being ruined by the administration of the Housing Act, 1930. I have had as much experience as, or perhaps more than, any other Member of this House of what is happening in connection with these clearance schemes. I have attended in a professional capacity a considerable number of the inquiries held by the inspectors appointed by the Ministry of Health and I have, therefore, been able to obtain a personal knowledge of many of the hardships which are being inflicted under this Act.
I have no complaint whatever to make against the inspectors appointed by the Ministry of Health. They conduct their inquiries in a very courteous fashion. They are very fair and give everybody an opportunity of properly stating their case, but, as we know, their function is merely to make an inquiry and then report, the decision being left to the Minister after the report has been made. I fervently hoped that the recent Bill which was before the House would have righted some of these wrongs, but the rate of compensation which is now provided merely makes a mockery of the whole thing. I appreciate that in these matters the Ministry is confronted by a tight-fisted Treasury, but it would be idle to pretend that the compensation which is now provided in these cases is other than niggardly and inequitable. A week or two ago I was asked to see one or two small property owners in the division represented by the right hon. Gentleman the Member for Seaham (Mr. It. MacDonald), who until a few weeks ago held the high office of Prime Minister. The meeting with these people took place at the point where his constituency intersects mine. When I arrived I was amazed to find that a Church Hall had been taken for the purpose of meeting these, as I understood, one or two small property owners who were aggrieved by—
To the best of my recollection—and I have listened to many of the Debates on the Committee stage of various Housing Bills—the compensation to be paid is fixed by Statute. If that be the case, the hon. Member is quite entitled to argue that the Statute has not been fulfilled, but he cannot suggest on this occasion an amendment of the Statute law.
I appreciate that, and I have no intention whatever of making any suggestion to the Committee which would require for its approval certain additional legislation. If I find it neces- sary to do that at any time I appreciate that I must find some other occasion and some other means of doing so. This is a matter in regard to Which I cannot proceed with arguments which require additional compensation, seeing that that would require further legislation, but I should like to dispose of the idea which is very prevalent in all parts of the country that the present crusade is one against bloated landlords. My experience is very different. I was giving an instance to show that a large number of very small hard-working people are affected by the administration of this Act and the manner in which the legislative enactments are carried out by the Ministry of Health.
I was referring to what happened at a particular meeting. The people who attended were practically all of them owner-occupiers, small people, some of them old and retired; people who had expended their life's savings in providing a home over their heads for the eventide of their lives. Some were old age pensioners, some were miners in their working clothes, who at the end of the meeting were to go down the mine on their shift. All were apparently destined to lose the only bit of property they have in the world. Let me give one case. It is that of an elderly woman, over 70 years of age, who had worked all her life as a labourer on a farm. She is too old now to work. She had expended all her life's saving on the purchase of a cottage, and with her old age pension she looked forward to spending the remaining years of her life in the little bit of property that she had purchased out of her own money. I visited the house. It was scrupulously clean and kept by a house-proud little woman, who was unquestionably happy and comfortable there. That poor soul is going to have her little cottage torn from her under the administration of this Act, and all the efforts of a lifetime are to be cast into the gutter. This property is not in the heart of a slum in a big city, but right away in the country, open to fresh air and all the winds that blow.
I ask the Committee how the administration of the Act in that way can possibly be justified. The compensation which that poor woman will get will be of a niggardly description. As you have very properly pointed out, sir, the Bill when it was before the House provided for a certain measure of compensation. That measure of compensation was merely three times the rateable value. The rateable value of the cottage being about £6, the total of £18 is what will be payable to that woman. She has to bear the cast of the demolition and the carting away of the debris, and she will be very fortunate if she has left out of that small amount of money more than £2. To inflict that injury is un-English and cannot possibly have any justification. That case is typical of hundreds of cases right throughout the length and breadth of the land. There are scores of cases with which I have had personal connection.
I have in mind the case of a medical officer who, in accordance with the requirements of the Act, made what is called the necessary representation. About 115 houses were concerned in that representation which he made to the council, for demolition, but he admitted in cross-examination that he had not inspected a single one of those houses for a period of approximately 18 years. That is the type of thing that is going on. I have another case in mind where a medical officer of health was dealing with the provisions of the Act, and the political complexion of the council changed. The medical officer was called upon to schedule houses which he could not honestly condemn. Things were made unpleasant for him and he had no alternative but to resign, rather than be a party to the wanton destruction of property which was never intended to be dealt with by the Housing Act of 1930.
I have had a most difficult task to perform in making these few remarks, and, very properly, you have called me to order. The chief point that I am making is that we are not dealing under this Housing Act with property which is merely that of bloated landlords. A great number of poor, hard-working working-class people are being vitally affected by its operations. I am not making an appeal on behalf of the type of landlord that the Committee commonly has in mind. I am appealing on behalf of poor people of the kind I have described. There can be no doubt that there is a real tendency on the part of certain officials and in some cases of whole councils to be over zealous and in some eases to be even harsh and inconsiderate in the scheduling of properties for demolition. I hope that I have said enough to give the Parliamentary Secretary some cause for thought. I am perfectly certain that after all that has been said about the hardships caused by the administration of the Housing Act of 1930 it will no longer be held up as something sacrosanct. Hardships are being inflicted under the operations of that Act, and I would ask the Parliamentary Secretary to have proper regard to the representations which have been made to him under that head.
I do not intend to pursue the very interesting argument of the Noble Lady opposite and the hon. Member for the Scotland Division of Liverpool (Mr. Logan). But I was interested to notice in the latter part of his speech that he appeared at one moment to be on common ground with the Noble Lady. I understood him to say that, while he objected to the promiscuous dissemination through the post of certain information, he did approve of poor people, mothers, whose physical condition rendered further child-bearing dangerous to life being able to seek that advice, by which I presume he meant contraceptive advice, from their medical practitioners or from a hospital. That is a very right and proper attitude. I was glad to hear it from him.
I was very glad to hear the hon. Member for Faversham (Mr. Maitland) pay a tribute to the late Minister of Health. While we are all glad to welcome the present holder of the office, I think that much less than justice has been done in this debate to his predecessor. Speaking as an obscure back bench Member, I have never once on any occasion that I went to him found him otherwise than courteous and willing to take any trouble to deal with any point brought to his notice. He may have lacked a flair for self advertisement, but I suggest to the Committee with all respect that that in a politician should be regarded, not as a vice, but as a rare virtue.
I want to put, briefly, two points to the Minister of Health. The first is in regard to building in general. We are all delighted to have this immense building drive which is now under way, but I want to enter a caveat. There are three factors which limit the extent to which efficient building can be pushed at one time; they are management, skilled operatives and sound material. I speak from my experience in the locality in which I live. I am a little afraid, when we have a vast amount of money for which we are anxious to find a sound outlet and a popular urge towards buildings of all kinds, that if the, Government presses too hard we may get an artificial boom which will be followed inevitably by a slump. I know that in my own particular area, where I am doing some little building, that all these three limits are being approached. There are any number of mushroom firms rushing to tender, with bad workmanship and bad materials, and, if we do not want to have a set back, the Minister must watch carefully the capacity of the industry efficiently to meet the demands made upon it. One of the reasons why many of us are profoundly suspicious of any sort of artificial boom which some people are so anxious to create is that there is always the danger of a slump afterwards.
The only other point to which I want to refer is the Housing (Rural Workers) Act. One of the greatest misfortnues in the housing problem at the present time is the little use which is made of the best Housing Act ever put on the Statute Book. There are only two counties in Great Britain in which this Act is being properly used, one in the South-West of England, and the other Argyllshire, of which latter I have some personal knowledge. The Housing (Rural Workers) Act is an absolutely first-class Measure. When people are using their own as well as somebody else's money, they usually take care to get good value for it, and it is extraordinary with what a relatively small sum of money and with good management a veritable pigsty can be made into a good cottage. I have recently used the Act myself, and at a cost of £87 I have transformed a cottage which was not fit for a dog into a jolly good cottage. I would urge the Minister to inquire why it is that this Act is not being used more. Possibly some advertisement would help it along, and it is also possible that he may find, in view of the experience of the last nine years, that the Act is capable of some amendment as to make it of more general use. It would not be in order for me to suggest what amendments should be made. Those are the two points I desire to put before the Committee.
I want to call attention to an inquiry which was arranged for by the Minister of Health. Dr. Walker, of Sunderland and Darlington, wrote a letter to the "Times" on the 11th December, which the Ministry of Health found to be of sufficient importance to arrange for an inquiry to be held. They appointed Dr. Pearse, Medical Officer of Health to the Ministry, Dr. Glover, Senior Medical Officer to the Board of Education, and Mr. Grant, General Inspector of the Ministry of Health, to hold the inquiry. In his letter to the "Times," Dr. Walker said:
Between the Tyne and the Tees there is, in spite of what Sir George Newman says in his last two reports, a substantial and progressive deterioration in public health.
These gentlemen held the inquiry, and it seems as though they had been given a brand new brush and plenty of whitewash in order to whitewash the Ministry of Health and show that there was really no malnutrition in the county of Durham, and that Dr. Walker's statement was altogether beside the mark. My complaint is this. Dr. Walker said that there was malnutrition and deterioration in public health between the Tyne and the Tees. These doctors confined their inquiries to the north-east part of the county of Durham, including Sunderland, Seaham Harbour and Houghton-le-Spring. By far the worst part of the county of Durham referred to in Dr. Walker's statement is the south-west part, but they held no inquiry there; they simply confined their inquiry to the northeast part. The letter was written to the "Times" on the 11th December, and the inquiry was held in the same month last year. The unemployment index shows that in Sunderland unemployment was 43.5 per cent. for adults and 36.7 per cent. for juveniles. In Seaham Harbour it was 19.2 for adults, and for juveniles none. In
Houghton-le-Spring the adult unemployment was 20.7 per cent., and juveniles 14.9 per cent. If they had gone to the south-west part of the county these doctors would have found an altogether different condition of things in regard to unemployment. In Bishop Auckland the adult unemployment in December was 52.8, and juvenile unemployment 66.5 In Crook the adult unemployment was 40.9 per cent., and juveniles 42.3 per cent. In Spennymoor it was 28.4 for adults, and 48.6 for juveniles; just double what it was in the area selected by these doctors when making their inquiry. In their statement they say:
The physical condition of the majority of the individuals passed under review is good.
Another of their statements is:
From our knowledge of conditions in the county of Durham since 1928 we do not find evidence of deterioration in that county over the intervening period, but rather an improvement, more especially as regards women.
How these medical men could hold an inquiry and come to conclusions like that is beyond understanding. I urge that a fresh inquiry should be held into this matter, not confined to one part of the county but covering the whole county.
Are we to understand that the hon. Gentleman is suggesting that there is acute malnutrition in the county of Durham, including the areas he has mentioned and the area which he represents.
Do not try to be so smart. I would remind the Committee that the Under-Secretary of State for the Home Office when he was Civil Lord of the Admiralty conducted an inquiry in the county of Durham and spent a long time in his investigation. This was his opinion on the condition of the people there, set out on page 74 of his report.
In the course of the investigation it has been impossible to avoid a strong, general impression that the area as a whole is losing hope.
Again, on page 100 of the Report he states:
The general condition of the people, in spite of the slight improvement in the unemployment returns, during the last two months must be regarded as undergoing a process of progressive deterioration.
On page 76 he says:
Prolonged unemployment is destroying the confidence and self-respect of a large part of the population. Their fitness for work is being steadily lost and the necessity of living always upon a bare minimum without any margin of resources or any hope of improvement is slowly sapping their nervous strength and powers of resistance. Instances have occurred of men who have been out of employment for a long time being unable to stand the return to work.
That story is contrary to the story told by these medical men in their report. While the investigation by these medical men was being held, an interesting statement was made by the medical officer of health for Newcastle-on-Tyne. The Newcastle dispensary had expressed concern about the great increase in poverty, sickness and malnutrition among the poorest classes in the city with the result that the Newcastle corporation asked Dr. Spence, their medical officer, to make an inquiry. Dr. Spence reported that he had examined two groups of children between the ages of one and five. One group consisted of 125 children, mostly of unemployed parents selected by chance from the poorest areas in the city. The other group consisted of 124 children of parents of the professional class. Records were taken of weights and heights and zones of normal weight and height were determined. The measurings showed that while 48 per cent. of the children from the better-class homes were above the normal zone of weight and 13 per cent. below it, only 11 per cent. of the children from the poor homes were above the normal and 55 per cent. were below it.
Similarly, 25 per cent. of the children of the better-class parents were above the normal range of height and 4 per cent. were below it, whereas only 1.7 per cent. of the poorer children were above it and 47 per cent. were below it. Dr. Spence concluded that no less than 36 per cent. of the poorer children examined were unhealthy or physically unfit and appeared malnourished; that since the same incidence of malnutrition was not found among the children of the better-class parents, it was due to preventable causes and that the youngest children were the
worst sufferers. That report was made just when the inquiry by these medical men was going on, almost next door, in the north-east part of the county. But these medical men paid no attention to it and I submit that the report which they issued is not a correct report of the real condition in the county of Durham. There has been published recently a book by Mr. C. E. McNally, honorary treasurer of the Committee against Malnutrition. The book is a protest against the statement of the Ministry of Health and the Board of Education that unemployment has had scarcely perceptible effects on the national health. This books states:
There is no investigation among the lowly paid and unemployed workers which does not show that a large proportion are living below the minimum standard which the British Medical Association considered necessary to maintain life. … Our conclusion is inevitably that there exists in this country a mass of people who are nowhere near the health and nutrition standard of those more fortunately situated and still less approaching an optimum. … Experiment has shown that the barrier to better health is largely the fact of inadequate feeding.
The Noble Lady the Member for the Sutton Division of Plymouth (Viscountess Astor) mentioned this question of malnutrition but it was not long before she left it. She left it just a little earlier than she ought to have done—although possibly she said more than she ought to have said when she was dealing with it. She argued that malnutrition was not due to insufficient food. She said definitely that the mothers were not giving the children the proper food.
Since the hon. Member has addressed the question to me, may I suggest that malnutrition is wrong feeding and that under-nutrition is insufficient feeding. I thought the hon. Member was referring to malnutrition.
The hon. Lady reminds me of the medical men who have made this report. I suggest that it is worth while for hon. Members to read that report, which is Command Paper 4886. They talk about malnutrition and then proceed to divide it up into malnutrition and subnormal nutrition and so forth until you hardly know where you are, in reading it. Those of us who are not medical men, who are mere laymen, prefer to call it under-nourishment or starvation and there is no doubt in my mind that in the county of Durham at the present time thousands upon thousands are suffering from under-nourishment.
Yes, children too. There is no question but that they are suffering under-nourishment and starvation and when the Noble Lady lays the blame upon the mothers and accuses them of not feeding the children properly, she must remember the main reason why the women in the county of Durham cannot give the children the food they would like to give them. It is because of low wages. Where men have come under the means test they have been sunk down to such a level that the women cannot get the money to feed the children properly. That is the trouble. I would like to see the Noble Lady change places with some of those miners' wives for six months.
I have no doubt I could change places with some miners' wives and do better than they do on the miners' wages—and worse than some of the other miners' wives do. The hon. Member talks as if all working men's wives were alike. They are not. Some of them are very competent, and others are not so competent. The hon. Member has talked about under-nourishment. If he will show me any children in Durham who are suffering from under-nourishment I will guarantee that the Government will put it right. I will guarantee it. But he cannot show it to me.
Here is another new Under-Secretary. We shall probably have a Bill next week which may legalise her appointment in order to help the Government through this difficulty. The Noble Lady must not attempt to get out of it like this. I would like to see her change places with one of our miners' wives for six months and feed a husband and children on the wages our miners have. Low wages are the real reason for this. Do not try to put the blame on the miners' wives by saying that they are not capable of supplying their children with proper food.
I want to protest against this inquiry and this report. I submit that it is a misleading report, and that the Ministry ought to hold another inquiry covering the whole of the county of Durham. We may be laymen without medical qualifications, but we believe that we can see our people gradually sinking. We can see an immense difference in them during the last few years. We can see that with our own eyes, and nothing that any medical man may say in a report will change our opinion as to that, or make us believe that there is no under-nourishment, no poverty and no starvation. I urge the Minister to hold another inquiry covering not one corner of the county of Durham, but the whole of the county.
The sole object of this Debate is that we may discuss how best we can improve the health of the people of this country. I wish to bring to the notice of the Committee and the Ministry a subject in which I am deeply interested, and which, as far as I know, has never been spoken about in the House of Commons—the work done by the almoners attached to hospitals. I have worked with hospital almoners—with the exception of the interval of the war—for something like 30 years, and I know the advantage of having a properly trained almoner attached to a hospital. There are at present many people who call themselves almoners, and who do excellent work, but who are not trained almoners as I would wish them to be. There is to-day an Institute of Hospital Almoners which undertakes the proper training of persons for this work. It is so easy to do your best for anybody, but so very difficult to do what is best for those who approach hospitals. Let me give one or two examples. Suppose a woman is suddenly taken ill with pneumonia and removed to hospital. It is a matter of the greatest concern to her to know what is happening in her home and what is happening to her husband and children; and this anxiety may be the greatest deterrent to her recovery. It is essential, I feel, that immediately a woman comes into hospital in those circumstances she shall be able to turn to somebody who will keep her in touch with her home, and who will also look after the home and see that the husband and children are properly cared for.
Let us take another case. Suppose a man goes into hospital and has to have his leg removed, or anything of that sort, which will make it quite impossible for him to work at his previous job. There must be somebody there to look after his home and also to look after him when he leaves hospital, so as to see that he is trained to some new job in which he can support his home and family. In hospitals to-day, so far as I know, there is nobody who has a true knowledge of all that can be done for a patient. In these days you must have expert knowledge if you are to help any patient as that patient can be helped. You must have expert knowledge of all the charitable help which can be brought to bear on that patient; and expert knowledge of how to obtain Government help for that patient. So far as I know, no man or woman on the staff of a hospital has that expert knowledge to-day. Neither has any of the hospital officers.
To ensure that hospital almoners shall be able to see that there is no waste in hospitals, the Institute of Hospital Almoners first of all select the right type of person to be almoners. These persons have then to obtain a Diploma of Social Science, which means two years' work and the passing of examinations, say, at the School of Economics. They then have to work for four months in a Charity Organisation Society; and subsequently they have to work for 10 months in a hospital almoner's office. After a training which lasts for a little over three years such a woman—who, to start with, must be well educated—has really an idea how she can do scientific social service. If you have not got that knowledge and have not studied the subject, you cannot possibly go into a hospital to-day and do your best to help patients. You must have a, proper training before you can do the best for the patient. In a properly organised hospital where there is a certificated almoner every patient who goes to that hospital, after seeing the physician or surgeon in the outpatients' department or being treated as an emergency case, is at once seen by the almoner.
A woman may go into an outpatient's department and see a physician who gives very good advice, but advice which it is impossible for her to follow out. She may be a woman with a large family or a woman who is overworked, and may be quite incapable of looking after her home to the best advantage. She goes in to see the physician, and if there is not a trained almoner she goes out again sadly, and leaves the hospital with a bottle of medicine. She may never go to that hospital again. If the advice given her is looked over by a properly certificated almoner, and that advice is that she must rest much more every day, or take extra nourishment, and she says to the almoner: "It is quite impossible for me to do that on the wages my husband receives," then it is made possible for her to follow that advice through the almoner being able to call in various agencies, some charitable and some Governmental. In that way the woman, instead of giving up hope and getting downhearted, will work in co-operation with the almoner, will come occasionally to the hospital and receive help at home which will make it possible for her to carry out that advice and become well again. If you have not in the hospital a properly certificated almoner, you can imagine the misery that must attend her when she goes home after her visits to the hospital. She feels downhearted and depressed, as if there is nothing to be done about it, and she just drags on.
There are other wide fields on which I will not detain the Committee, but I will mention the question of tuberculosis. Suppose a patient comes to a hospital with tuberculosis, she is infectious to the home, and it is essential that every person, man, woman, or child, who lives in that home, her relatives, should be brought to the hospital to be certain that they are not starting with the same disease. This work with regard to tuberculosis has gone on for many years. The almoner brings all these contact cases to the hospital to be examined, and she also sees that the home is made fit for persons who are subject to tuberculosis to be properly looked after, and that it is properly aired and ventilated. If you do not have a properly certificated almoner attached to a hospital, I hope hon. Members can see, from what I have said to-night, that there must be an infinite waste of hospital work, that people come to the hospital, hear what they should do, go away, and nothing is done, and there is further misery and disease.
Therefore, I wish to bring before the notice of the Ministry to-night the importance of their keeping their eyes open to see that all hospitals in this country do have proper almoners attached to them. At the present moment the demand for almoners is steadily increasing all through the country, and the hospital authorities are becoming awake to the advantage of them and to the work of the hospitals of having properly trained almoners attached to them. I do not think the work of the almoners who are trained by the Institute is sufficiently known to the ordinary governors of hospitals Dr Members of Parliament, though I am certain that it is known to the Ministry. In fact, I have talked many times in private to the Ministry of Health on this subject, and I would ask that everybody in this House should study the importance of the subject in preventing waste, in helping people who are ill, and in preventing the spread of disease.
The number of hon. Members who wish to speak makes it desirable for me to restrict my remarks to the smallest possible compass within the wide ambit of the activities of this Ministry. I would like to address myself on this occasion to what is arising out of slum clearance, the various difficulties that have arisen and the comparative removals or otherwise effected by the Housing Acts. I will, however, stick more closely to a subject that I know more about, and that is the question of water supplies. I am sorry that neither the Minister nor the Parliamentary Secretary is here to take notes of some of the points that I would like to put. I am most anxious to discover the amount of progress that they are making in the administration of the water policy of the country. When the late drought was on, we had many debates, and many important points were raised periodically, nearly always with the assurance that affairs were nothing like so bad as had been pictured and as we had stated in this House. Lately an important official has been giving evidence, and I read that he has said:
It is not generally realised how serious was the drought last year.
That is said after all these months of being reassured on so many occasions that we were exaggerating the state of affairs. Now it is admitted, though not
in this House, how bad affairs were. I want to find out in more detail what steps are being taken. I know, of course, that there is a large grant for the purposes of assisting rural water supplies. That is dealt with in the Estimates, I think, but I should like to ask if the figure of £250,000 which is given bears any relation to the £1,000,000, or whether it is in addition to it. In the carrying out of the various schemes, we were assured and reassured that the Ministry had taken special steps, by increasing their staffs and by various other means, to afford the largest amount of technical assistance that they could, but when I look into the Estimates again, at the item "engineering inspectors," who are those concerned, I believe, with this particular work, I find that last year, in 1934, there were 33 inspectors and this year, 1935, the estimate is for only 34 inspectors. Is the activity of the Department to be represented by only one additional inspector? It is probable—at any rate, I hope it is so—that this important part of the health of the nation is being dealt with more adequately than is represented by one additional inspector.
Much has been said about the health of the nation, but there is a danger of overlooking the fact that a pure water supply is of the first importance to good health, and, therefore, we should never lose sight of it in anything that we are doing. I want to ask next what is the progress made with the setting up of the advisory committees, some of which have been in existence for quite a long time and others quite a short time, whether it is progressing at a rate that we can reasonably expect. There seems to have been a lull in the setting up of these committees, and if it was considered the right thing to do to get all the authorities concerned to come into more general, common practice within their own localities, why has this rate slowed up, if such be the case? Is it because these advisory committees have been found in practice not to be as effective as they should have been and in fact to be merely talking bodies, with no real effect afterwards on the policy of the various constituent authorities represented upon them?
May I ask next, with regard to what are called the consulting committees, those committees which are supposed to join up the activities, as it were, of other advisory committees and reduce them to a common level, what progress has taken place? We have in our part of the world two advisory committees, but the consulting committee which was proposed to join the two in their work has not been set up. What is the reason? I have asked one or two questions about it, but I have never had a satisfactory reply. Has the Minister considered the appointment of a further committee which would join up the activities of two districts, in this case South Lancashire and the West Riding of Yorkshire? Those districts and others near obtain the bulk of their water from the Pennines, and the policy of all those who draw the water from that quarter ought to be co-ordinated and made in agreement one with the other. Will the Minister consider setting up a joint committee which will have that effect in practice? I want to refer to some evidence given by the same gentleman in which he estimated the amount of water required as 20 to 30 gallons per head in urban areas, and 15 to 20 in rural areas. I think that the former is a really low estimate, because the consumption of the towns is above 30, while in many rural areas it is less than the 15 to 20 gallons mentioned.
Another authority, when estimating the future consumption of water, put the figure at 80 gallons per head. That is a figure for the future, upon which the water policy of the country ought to be formulated. I regret to say that we are continually finding that no attention is paid to this future policy. If attention is paid to it, the amount and direction of the attention is never disclosed to us. If we take the figure at 80 gallons, the total figure for this district, assuming 12,000,000 population in future, would be over three times the present capacity. Two new reservoirs that are being constructed will increase the capacity 50 per cent. Then it is said that they are not making provision for the future to the extent that that particular authority suggested it should be. Objections can be raised to this higher figure, but there are now so many people concerned who can reasonably anticipate the future, and so many towns which use over 80 gallons per head at the present time, that it seems to me risky to use the figure of 30 gallons which was mentioned in evidence before the committee which is now sitting. I want to ask whether the water policy of the Department ends with the setting up of the survey committee which is now determining the actual supplies in the country, although not their allocation, and the setting up of the committee which has just begun to take evidence. Is the Department going to wait until the new committee has reported on the evidence it has received?
There is so much evidence in existence that it will be a great pity if nothing further in the way of a development policy is brought forward until this committee has reported. I have quoted before in the House the findings of the 1920 interim report of the Board of Trade Committee on Water Supply, and I do not want to quote it again. There is so much evidence as to the position of water supplies that we should have something more than the day-to-day policy which is all I can discover from the utterances of those concerned. With regard to rural supplies, does the assistance which has been given up to now indicate the progress that the Department hope to get? Are we getting development as rapidly as we should do? I would like again to press the need for inter-connection of the existing water authorities' supply mains. By interconnecting the mains we make, as it were, a common supply, and if we go in for reserve supplies wherever they are—in central Wales or the Lake District—these reserve supplies, tapped into the network of connected mains, will always prove a reserve for any part of the country. It is strange, after all the rebuffs some us have had in speaking on this subject to be told that we ought to be planning ahead. We have been trying to get the Ministry to plan ahead for all these months. If it has been planning ahead, it has kept it very secret indeed, and I hope that the Minister will tell us to-night a little more of what he proposes to do.
I want to draw the attention of the Minister of Health to a question which affects my constituency and a comparatively few other areas. It concerns the payment of children's allowances under the National Health Insurance Acts in those areas where the school-leaving age has been raised by by-law to 15. Under the present regulations these allowances must cease as soon as a child leaves school and obtains employment.
If the employment turns out to be temporary and the child returns to school in the same area voluntarily, or in the by-law areas compulsorily, the allowances are not in any circumstances re-issued. That may be sound practice in those areas where the school-leaving age has not been raised, because one might argue that the re-issue of children's allowances to parents who send their children back to school would lead parents to send their children back to school from a job in order to get the allowance rather than on educational grounds. That, of course, would not apply in the by-law areas where parents are compelled by law to send their children back to school. There is need for a differential treatment of those districts. There are only five or six where the school-leaving age has been extended by by-law. I would ask the Minister to look into that point and see whether the regulations can be altered so that what I believe to be a real and substantial grievance affecting my constituents can be remedied
Sitting as a practising doctor through this Debate I have learned that this House exercises the utmost freedom in expressing its opinions on the weather, the National Government and the medical profession. When I listen to my hon. Friend (Mr. Batey) who represents Spennymoor and the miners with equal zeal and eloquence, I find that he takes the same attitude towards my profession as the noble Romans did towards their doctors. They are to him properly slaves, and if they do what they are told, "God bless them," but if they do not please the emperor or the hon. Member for Spennymoor he will demand another doctor and then another until one reports as he desires, and then he would endow him with a knighthood or whatever recognition or honour pleases the hon. Member for Spennymoor. But that is not a position which my profession would willingly accept. I do believe that from the highest to the lowest they are trained in our teaching schools to be independent-minded men, and whether they serve the Government or the public, the rich, the poor or even the hon. Member for Spennymoor, when they put their signature to the result of their observations, it is a signature to a piece of honest work, accurately observed and faithfully reported.
And I was a little hurt that my distinguished and right hon. Friend the Member for Swindon (Dr. Addison) gave a gentle kind of hint to suggest that even the late Chief Medical Officer of Health was not as zealous and as upright as he should be, for he suggested that when he held the doubled post of Chief Medical Officer of Health and also Medical Officer to the Board of Education, if only he had had a little stimulus from his Minister he might have given stronger and better advice on the question of the distribution of milk. These little pleasantries affecting the credit of a decent profession may be pleasant to the palate of politicians—
The question of accurate reporting can be settled by reference to the OFFICIAL REPORT, but that is most certainly the impression, the slightly hurtful impression, left on my mind by the right hon. Member, and to what he says we naturally attach some measure of importance. If I have misrepresented him he knows that my apologies would be instant and my withdrawal speedy. I do not wish to discuss the question of malnutrition at length, because the politicians have seized hold of it, but I would remind even the reddest of red politicians that the first case of death in a condition of starvation in London was publicly reported by a Tory doctor and a Member of this House, myself, and the only person who recognised it publicly was the right hon. Member for Limehouse (Mr. Attlee), and if I, vaccinated with the virus of obscurantist Toryism, could, on the eve of a London County Council election, give public evidence that an English woman had died in a condition of starvation, I am quite certain that all and any other brothers of mine would give equally frank evidence if the occasion arose.
I was very hurt by the suggestion of the happy mother of six who represents Plymouth (Viscountess Astor) when she said, "If only doctors would speak up." Sweetly she conceded to us the right to maintain and preserve the secrets of our patients. I hope my brothers, even under the pressure of Government or police, or legal inquisitor, will never give away the secrets of suffering women, but I do repudiate the suggestion made publicly by the Noble Lady that my profession has not done its duty in teaching the Noble Lady and this House that abortion is a menace to the health of English women. I was taught it when I was a young medical student, I have taught it when I was practising pathology, and I have given evidence in public, which has been reported in local papers, of the fatal danger of abortion to women, and what I have said hundreds of other doctors have better said, and to suggest that there is a kind of trade union conspiracy to keep from this House and the public the dangers of abortion is really too dreadful. We speak and we repeat this advice and this warning to the public, but when they are seized with a fear of pregnancy then what we advise is forgotten, and they seek evil and wicked counsellors, to their own danger. But do not let it be repeated, please, that we doctors do not speak up. Unfortunately this House and the public outside do not enjoy lectures on health; they would rather not hear them. That is a human and natural instinct, and I cannot find much fault with it.
The suggestion that we should have a discussion on birth control was first mooted by the hon. Lady for West Willesden (Mrs. Tate). Then we had a zealous, enthusiastic and, I am told, courageous speech by the Noble Lady who represents Plymouth on the question of birth control, and the hon. Member for the Scotland Division of Liverpool (Mr. Logan) to some extent dealt with the general issue, but, apparently, one is left with the impression that birth control is a boon which the poor are denied. I suppose that I have a familiar working knowledge of the poor, and I have never got the impression that either the poor or the rich have, since the war, been unfamiliar with birth control knowledge. I can tell the Committee that the supply of birth control goods and apparatus is a most competitive and big business. Various interested parties conduct a battle royal betwixt themselves for the profits from the public. That knowledge is lacking, is, I think, a, misrepresentation of the state of affairs, and to suggest that abortion is practised, leading to the frequent death of women, and this through lack of birth control knowledge, is, in my opinion, and only in my opinion, and I thrust it down no one's throat, a misreading of the facts as they are. I did not interrupt the Noble Lady—
Well, there is a kind of high diapason note with which we are familiar, an accompaniment which is a little discomposing. Perhaps I should not hear it. To return to the point. There is to-day a tremendous propaganda to the effect that marriage need not be associated with the production of children, and once that idea becomes bitten into the public mind there is a demand that contraceptive practice shall be efficient. The demand for efficiency becomes almost a passion, and, if birth control through contraceptive practice fails, then the woman who finds herself pregnant demands that efficiency shall be put into practice and abortion shall complete what birth control failed to do. The one grows out of the other; and when you add to that, through the same advocates, the policy of sterilisation you have a trilogy of birth control, abortion and sterilisation which, if imposed upon an unwilling Ministry, would turn it from a Ministry of Health to a Ministry of Death. Reference has been made to clinics which have Government approval. I think the position ought to be stated with much greater clarity. There are no clinics established in this country with Government approval for propagation or practice of birth prevention, but it is permitted that birth control advice should be given to women whose condition is such that further pregnancy would be a danger to their health. In the report of the Committee on Maternal Mortality the phrase used was:
Those in whose condition pregnancy would be a danger to life.
In the last Memorandum issued by the Minister that phrase was altered slightly to
Those in whose condition pregnancy would be a danger to health.
In that Memorandum, and I speak from memory, because the resources for obtaining documents during debate in this House are very meagre, a, list is given of the diseases in which pregnancy would
endanger health. It includes heart disease, diabetes, tuberculosis, cancer, epilepsy and amentia. I suggest that if a woman is ill with consumption, a condition which we all recognise, characterised by cough, night sweats, wasting and fever, she needs the utmost care that my profession can give her. She needs nursing and hospital aid, and to suggest that a woman in that condition should be taken to a birth control centre so that she in her weakness may be matched against the desires of her husband is a dreadful proposition. There are many women with weak hearts to whom pregnancy would be a danger to health, but to suggest that those women should be led by my profession to birth control centres, when they need rest from all excitement, is a misuse of the art of healing, and to suggest that those ill with diabetes and cancer and those who have no minds, the cements should be treated similarly, is a libel on men and a misuse of medicine. To suggest that there should be a frigidarium or a village pond for these lusty men would be a reasonable policy.
The hon. Member for the Scotland division (Mr. Logan) who represents in this House with others so ably the same dogma, in replying to the Noble Member for the Sutton Division of Plymouth (Viscountess Astor), stated that he was opposed to the dissemination through advertisements in the post of contraceptive information, but that he would approve of a married woman whose health would be endangered by child-bearing seeking advice from her medical practitioner or hospital. The hon. Member who is now speaking has skated round that point. Would he state quite clearly what is his view of contraception in relation to a woman to whom child-bearing is dangerous?
I heard the remarks of the hon. Member for the Scotland division on that particular point, and I gathered that if a woman sought private medical advice on such a matter the Member for the Scotland division would not act as a censor of the hospital doctor's or private doctor's conscience. He had every possible objection to using public money and giving, apparently, public sanction to a practice to which a large number of people have grave moral objections. But he did not take up the attitude of objecting, as a public man, to a perfectly private act between a woman and her doctor, who are each responsible to their Maker and not to the hon. Member for the Scotland division. Government control of contraception introduces a practice more objectionable than any imagined priestcraft, for whereas "priestcraft" might be practised to lead people to Heaven, contraception-craft might be practised to lead them to a sterile emptiness.
The hon. and gallant Member for Wellingborough (Wing-Commander James) referred to my faith and that of the hon. Member for the Scotland division. I trust that the Committee will believe that those who happen to belong to the Catholic and Roman faith have a gift of right reason. I am sure he did not refer to our "dogma" to imply that Catholic Members cannot argue reasonably and accurately upon scientific or philosophical or medical or statistical matters. We were told that this was a Protestant country. That has never been denied. Why such an obvious fact has been thrust on our notice I cannot think. All that I can say to the Noble Lady who has thrust such an obvious fact on our notice is that what she has suggested will lead in time to a population made up of the progeny of the unwanted Catholics, together with such children who have escaped birth control and abortion technique.
Might I make one appeal to the chivalry of the Committee in this matter? If the Government were to lend support to the establishment up and down the country of contraceptive clinics, great harm would be done to the good esteem of womankind. Up to now nursing has been looked upon as a great profession; we give our virginal and best daughters to the life of nursing. If the Government insist on contraception as an essential part of the practice of hospital life, then every nurse wearing the uniform, once religious and later consecrated by the austere life of Florence Nightingale, will be pointed at as an expert in every aspect of sexual intercourse. I have heard the interjection, "Disgusting!" by the Noble Lady. If the Government take charge of contraception and make it an official practice in England, those who propagate and introduce this practice to the homes of the poor will be recognised by their uniforms and their calling and the epithet of "disgusting" will be properly applied to their work. As a result of such propaganda decent married women with six or nine children are addressed by judicial persons and public officials as though they were guilty of some impropriety though their married lives may be sweet and affectionate and intercourse rare. Those who use marriage with the greatest freedom in a sterile fashion may win the approval of many authorities. And yet the women who take up the burden and heat of the day and bring up sons for England have the finger of scorn pointed at them. If I have been permitted during my membership of this House to say something for the decency of English private married life, I am grateful.
I feel very moved by what the hon. Gentleman has said, but at the same time I feel too embarrassed to follow him in a discussion on matters which have either been reserved for the bedchamber or the after-dinner port. At the same time, I agree that to-night this matter has been treated with a spirit of courage and openness of mind in this House that I have never before heard. Whether that is to the good or the bad, I do not know. I suppose that it is well that we should face facts in this House. In a matter of this sort, which is vital for the future of our country, it is essential that we should open our eyes and face the facts.
I should like to congratulate the Minister on the masterly way in which he dealt with the record of the last year of his predecessor in office, who was a proof that under an austere external appearance there can exist a warm and human heart, and that was what we all found in the late Minister of Health. I had to approach him many times on behalf of constituents, and I have never once found anything but a receptive and extraordinary understanding. There was one topic which the Minister left untouched, and with which I would like to deal. The matter obtruded itself first on the national conscience during and just after the War, and it was when our people saw the hideous disfiguration that was caused by war and the terrible wounds, especially facial wounds inflicted on our men, that we began to realise there was something which our surgery had not achieved. As very often happens when such occasions arise, someone was thrown up to deal with the emergency. I do not want to advertise anyone. I understand the General Medical Council—or I thought I did until I heard the speech of my hon. Friend the Member for Mile End (Dr. O'Donovan)—and their views against self advertisement on the part of any of their members. Members of the medical profession have been ostracised by members of their own council because of advertisement, so I want to make it clear that I am not advertising or propagandising on behalf of any member of the medical profession. I do not suppose, if Sir Harold Gillies' golf had been challenged, that the Royal and Ancient Club would take violent objection on the ground of advertisement of Sir Harold Gillies, so I do not see why the General Medical Council should do so if I pay tribute to a man who has done more to restore the souls as well as the bodies, and their hope in the future, of a large number of people, especially of ex-service men, than has Sir Harold Gillies.
Once disfigurement was found to be capable of cure, when it was disfigurement resulting from the War, there came immediately into the minds of all those who had been disfigured in mining accidents, by fire, or who had been born disfigured, perhaps with blotches on their faces which militated against their future employment or happiness in life: "Here is a chance for us; here is a possibility for our troubles to be cured." There were very few plastic surgeons, but they were overwhelmed by demands upon their skill and service. That is the position to-day. The few plastic surgeons that exist are rushing about the country spending most of their time in railway trains trying to deal with all the claims that are made upon them. That is where my suggestion to the Under-Secretary comes in. Why not devote some of the resources which are at the disposal of the Ministry to assisting in the formation of a plastic surgery hospital, where all those poor people who are disfigured by nature or by accident can find their way for treatment, just as those who are suffering from ordinary diseases can go to an ordinary hospital for treatment? That would confer upon our country one of the greatest benefits.
I suggest that it should be done in conjunction only with the London County Council and the other county councils throughout the country. I am told that Lord Dawson of Penn, that distinguished ornament of the medical profession, gives, on behalf of the profession, his friendly support to the scheme. I believe it would be the means not alone of training plastic surgeons throughout the country and enabling them to come together and be taught their jobs under skilled supervision, but of bringing fresh courage, hope and enthusiasm to millions of our fellow countrymen who at present are, and for the future will be, doomed to a life of despair and misery. If my hon. Friend cannot say anything to me tonight, I suggest that he brings my suggestion to the notice of his right hon. Friend, in the hope that something may be done during next year to rectify this omission in our national life.
The right hon. Member for Swindon (Dr. Addison) spent a large part of his speech in seeking to grove that there has been deterioration in the health of the people, particularly in the distressed areas. He quoted from inquiries and reports. I was rather surprised that he did not refer to the latest report on the subject, which has since been referred to by my hon. Friend the Member for Spennymoor (Mr. Batey). The hon. Member for Spennymoor tried to dismiss that report on the ground that it referred only to a portion of the County of Durham, but I think the Committee should know that the report was made in response to a series of charges contained in a letter written to the "Times" by a, physician in Sunderland. That physician is consulting physician on the staff of the Sunderland Royal Infirmary, and, therefore, gathers the bulk of his experience from Sunderland and the surrounding districts, so that it would seem fair that, in dealing with these charges, the inquirers should deal with the area on which his experience is based. I do not want to quote at length from the report, but it contains many disagreeable facts for those who make statements such as have been made by the hon. Member for Spennymoor and the right hon. Member for Swindon. As the right hon. Member for Swindon referred particularly to rickets, I might perhaps be allowed to quote one
thing which the commissioners said on that subject. They reported as follows:
Minor manifestations of rickets have been found by clinical examination in 4.1 per cent. of young children seen at welfare centres. Marked bow-legs and marked knock-knees due to persistent rickets were only recorded in 0.5 per cent. of children seen at schools. Without doubt the disease has been much diminished in prevalence. Instances of gross rickets may occasionally be found, but their number is small in relation to the child population, and such cases do not occur among children who have been regular attendants at child welfare centres.
That is one instance of the kind of result shown by this inquiry. It is no wonder that the commissioners were able to report that they were unable to accept Dr. Walker's statement that there has been in this area a substantial and progressive deterioration of health. I think the Committee should know these facts. This inquiry has been made in a distressed area. It indicates that there has been little deterioration of health, and that, where such deterioration has taken place, it has been partly due to the fact that people would not take advantage of the facilities offered by the excellent health services of this country.
There is another point to which I should like to refer. The hon. Member for West Willesden (Mrs. Tate) made an appeal for a co-ordinated system of hospital treatment for fracture cases. I would go further; I think the time is coming when we must consider a co-ordinated system of hospital treatment for the whole country. Hon. Members on the Labour benches would probably like to see a purely State hospital service, while most of us, knowing the good work done by the voluntary hospital system, would like to see all that is best in it maintained and extended. Probably the solution lies in co-ordinating the voluntary hospital system with the local hospital system, but I am afraid that such co-ordination is now lacking. In my own constituency we have two voluntary general hospitals and a municipal general hospital, all rendering general hospital service; but in one of the voluntary hospitals there are 50 vacant beds, while at the same time the local authority is proposing to build a new ward block containing 80 beds.
In Durham County the County Council have recently asked the voluntary hospitals to agree to the building of a new central hospital, to deal, not only with their public health work and with their public assistance work, but also to deal with general hospital work, and they want the voluntary hospitals to agree to that new hospital being built without first settling on what principles cases will be admitted to that hospital and how it is to be staffed—both points of vital interest to the voluntary hospitals in the county. The more I see of hospital work, and particularly of voluntary hospital work, the more certain I am that no efficient hospital service can be built up in small watertight compartments. The small town cannot provide the specialised equipment that the modern hospital requires, nor can it provide a living for the specialist staff which is necessary. I think, therefore, that any really efficient hospital scheme must be considered for a much larger area, such an area, I would suggest, as the whole of the North-East Coast from Berwick to Middlesbrough.
What is wanted is a co-ordinated scheme, probably centred on some large training hospital—with general hospitals wherever necessary—where there should be no overlapping of expensive equipment, where general surgical and medical services can be available at all general hospitals and where specialist services shall be available for the whole district. Such a plan must provide that equipment and services shall be available to all classes and not only, as now in the provinces very largely, available for the working-classes and the poor. I would, therefore, suggest to the Minister that the time is ripe for an inquiry into the whole hospital system of the country so as to provide a co-ordinated plan.
Such a plan would provide a guide to voluntary hospitals and local authorities in any hospital extensions that they wish to make. It should maintain all that is best in the voluntary hospital system along with a State system and help us to build up a real hospital service available to everyone, with the poor still treated free, as they are now, and those able to pay paying in accordance with their means, so that they have the full benefit of the hospital equipment and staff, and so that the staff shall be adequately remunerated and not as at present, have to seek their income from those who can afford to pay not only for themselves but for a large number of other cases. I hope, therefore, that the Minister of Health, who I know has great sympathy for the voluntary hospital system, will seek to work out such a co-ordinated plan so that all that is best in it can be maintained, and we can provide, with the help of the State, a thoroughly up-to-date and modern hospital system for the whole country.
The Debate that we have had has been the most interesting that I have heard on our annual supply day since I have been at the Ministry. The only thing that concerns me is that so many questions have been raised that I must apologise in advance if, in trying to satisfy the natural curiosity of hon. Members, I have to give somewhat dull and technical replies. Some of the big questions are so vital and so interesting that it would take half-an-hour to do justice to any one of them. I appreciate very much the warm tributes which have been paid by all parties to the former Minister of Health. I think it is no exaggeration to say that some of the tasks that he achieved will always remain as a monument to his vision and courage. The hon. and gallant Gentleman the Member for Ayr Burghs (Lieut.-Colonel Moore) referred to the work done by a distinguished surgeon. We appreciate at the Ministry that a very distinguished man has had an honour conferred in recognition of his services. The hon. Member for Chesterfield (Mr. Conant) raised the question of the continuation of children's allowances if there was a break in school attendance. That has been dealt with in the Health Insurance Bill that we passed a few days ago. If it is not, I will communicate with the hon. Member, but I am nearly sure that it is dealt with.
We then come to the very controversial topic of birth control. I have not time to enter into that, though I wish an occasion would arise when that and the sterilisation of the unfit were more ventilated. We want the guidance of public opinion on the sterilisation of the unfit. Let me in a few sentences say what is the policy followed by the Ministry of Health. We say that it is wrong for a maternity and child welfare centre or a clinic for the treatment of sick persons paid for out of public funds to be used for giving contraceptive advice, except in cases where further pregnancy would be injurious to health. That has been the well-recognised and established policy of the Ministry of Health, and we maintain that position in the circulars we issue.
I am not going to give an elaborate reply on the question of water supply. We have had so many water Debates in this House that my hon. Friend the Member for Platting (Mr. Chorlton) almost knows the answer that I am going to give him beforehand.
But he does not know this. The hon. Gentleman asked whether the £250,000 already expended in respect of rural water schemes was part of the £1,000,000 capital subsidy. The answer is, "Yes." He wanted to know whether we had appointed new inspectors to deal with the water supply, and the answer is, "Yes, we have appointed six new inspectors to introduce expedition into the rural water business."
I did not say this year, but since we started our policy. The hon. Gentleman asks about the progress of the schemes. We have given provisional approval for schemes in the rural districts in respect of 1,317 parishes, the capital cost of which will be £3,800,000. Of our 1,000,000 subsidy, grants totalling £600,000 have already been allocated, and that is in addition to loans sanctioned amounting to a total cost of £827,000 for schemes which did not attract grant. The net result is that, whereas the average sum allocated in the ten years ending 1934–35 was £425,000 a year, in the last year we sanctioned just over £1,000,000 worth of schemes. I think that that shows very substantial progress.
A number of smaller points were raised, all of them interesting. First of all, there was the effect of the block grant formula which was raised by the right hon. Gentleman the Member for Swindon (Dr. Addison). The position is as follows: I do not want to go into the very technical question, but, broadly speaking—and I am speaking from memory—we give a block grant to local authorities of some £45,000,000 a year, of which about £15,000,000 goes according to the formula. The formula is so devised that the money is tipped into the areas which most need it according to that very complicated formula, which depends upon four or five factors. The formula has been criticised in many quarters, as every formula can be, but the right hon. Gentleman will remember that we are under a statutory obligation to hold an inquiry into the working of the formula before 1st April, 1937. He will be pleased to hear that we are making preparations to start that inquiry forthwith, and for that purpose we are calling a lot of evidence and shall be getting into touch with the representative bodies of the local authorities.
It will be a Departmental inquiry in consultation with representative bodies of local authorities. My hon. Friend the Member for St. Albans (Sir F. Fremantle) asked a question arising out of the retirement of Sir George Newman, the late Chief Medical Officer of the Ministry, and asked what would be the position of his successor. The answer is that the recently appointed Chief Medical Officer of the Ministry of Health will enjoy the same salary as his predecessor, has the status of a Secretary in the same degree as his predecessor, and has the same right of direct access to the Minister.
The next question raised was in regard to rent restriction. It was raised by the hon. Member for Whitechapel (Mr. Janner) and the Noble Lord the Member for East Norfolk (Viscount Elmley). So many of the points that they raised touch legislation that I cannot reply to them. We had an exhaustive discussion on this and similar topics. No report or committee that I know of has ever suggested retrospective legislation. If we are criticised it is because we do not interfere in the innumerable cases of difficulty that arise. Heaven forbid that the Ministry of Health should ever have to sit in judgment on the innumerable cases that crop up, all of great legal complexity. The remedy under the Rent Restriction Acts is in a court of law. I know of the infinite amount of trouble that the Noble Lord has taken in regard to the North Waltham case. I know the whole history of that case and the remedy, as I have so often told him, is for some tenant's defence league, or some league of some sort, or some philanthropic person to assist the tenants who are not getting justice under the Act to seek their remedy in a court of law.
The hon. Member for Whitechapel raised the question of bugs. Very few Members who do not represent London constituencies realise the alarming extent of this problem. I was present at a disinfestation demonstration a few months ago and I was horrified to learn that out of some 311 families removed in one borough in London, not removed from the slums but from ordinary overcrowded areas, no fewer than 309 were bug infested.
I think it is pretty common to most of London. I will send my hon. Friends a copy of the report of the Departmental inquiry which gives the latest research on this question and shows the local authorities how they can best tackle this very difficult matter. So many local authorities in removing slum tenants from their houses use vans in which in the process of moving they disinfect the furniture. This is very essential, so that the tenants can start in their new homes with a new opportunity of cleanliness. I cannot conceive how some of the tenants in London after a hard day's work can go home and night after night have their sleep disturbed by bugs dropping on them from the ceiling. Very few people realise the extent of this problem and how the ordinary working man and woman in London suffers from it. Anything we can do to help local authorities to overcome it we shall do. We have a good Departmental committee which is at the moment carrying on another investigation into the habits of the bed bug.
The right hon. Member for Wakefield (Mr. Greenwood) taunted us that the number of persons on public assistance had gone up by, as he said, 500,000 during the time the National Government had been in office. Taking the figures for May last the increase has been 379,000 persons, and the bulk of this increase is due to dependants and sick persons. Let us be quite frank on this matter. There is not the slightest doubt that when boards of guardians were superseded by public assistance committees under the 1929 Act applicants were given far more generous treatment and availed themselves more freely of it. Why we should be taunted by a Socialist Opposition because we are seeing that public money is properly expended in relieving these cases I cannot conceive. I should have thought that it was a matter for congratulation. But in case an attempt is made to make party capital out of this increase let me remind the Committee that of that 379,000 householders, breadwinners, all but 20,000 were registered at the employment exchanges, so that there is a duplication of figures. When we talk about a fall in unemployment, it is an actual and real fall, and is not off-set by people leaving the employment exchange and going on to public assistance.
The hon. Member for North Hammersmith (Mr. West) raised a question relating to infantile mortality in Kensington. An hon. Member for one of the Kensington Divisions has kindly put in my hands a, letter from the medical officer of health which shows how careful one should be in quoting statistics. In one division of Kensington, Holland Ward, there is an infantile mortality rate of 133 per 1,000. That is very high, and is accounted for by the fact that there were 18 deaths. I will show the hon. Member the letter from the medical officer which shows conclusively that of these 18 deaths only three could have benefited by the maternity and child welfare services, and that in fact only three availed themselves of them. Of the 18 deaths a considerable number were of children who had been adopted by institutions in Kensington; they came from outside and had been adopted by societies. Anyone who reads the letter will see how dangerous it is to try to make party capital out of a case like this.
I have not the slightest doubt that much of the high infantile mortality rate in Kensington and other boroughs in due to bad housing conditions, but I object to statements in this House which suggest that a borough like Kensington is not tackling this and the housing problem as vigorously as any other borough in London. In so far as they have failed, it has been due to the fact that they have not had the powers, about to be conferred upon them by our new Measure, which was passed by the House of Lords an hour ago, when it receives the Royal Assent. I know Kensington, and I know that it is not a question of the slum, problem there. That has been dealt with. It is a question of the old middle-class house which is not a slum house but is grossly overcrowded and of old areas which might be redeveloped under the powers which will be secured to Kensington and other boroughs by the new Measure.
My hon. Friend the Member for Durham (Mr. McKeag) raised again the question of compensation of which we have heard so often already. Our policy on this matter was endorsed in the Housing Committee upstairs by a majority of 28 to three, and I do not propose to say anything more about it. My own view is that nobody, rich or poor, should be allowed to profit out of the ill health and bad housing conditions of other people, and that if a house is unfit for human habitation, it is no defence to say that the owner is rich or that he is poor.
I am sorry, but I cannot at this hour give way to the hon. Member. We take a strong stand on this matter, because we realise that far too much profit has been made out of this kind of property in the past.
The right hon. Gentleman the Member for Wakefield repeated the statement that the National Government were responsible for stopping the building of 40,000 houses in rural areas. I have no time to go into that charge again, further than to say that anyone who does me the honour of reading my winding-up speech in the Debate on 31st January this year will find conclusively set forth the reasons why the National Government have nothing to do with that allegation, and I am not going to keep on repeating those arguments to hon. Members opposite. Let me summarise what our housing policy has done. We have succeeded in differentiating the functions of the various agencies. We have told private enterprise to do what it best can do. We have asked the local authorities to do what they alone can do. Before we started, houses were being built by local authorities under subsidy, and were not always going to the right persons. No slums were being cleared and overcrowding was not being touched. As a result of our policy, private enterprise has provided a record number of houses for artisans and those who can afford that kind of accommodation and who prefer ownership. The slums are being cleared at a phenomenal rate and the new Measure will enable local authorities, for the first time, to rehouse and to provide accommodation at the right places and the right rents for those persons for whom the subsidy was originally intended but who have never seen the inside of a council house. I was opening an estate last week in rural England in the heart of Wiltshire. The town of Trowbridge, with a slum problem proportionately six times as big as that of London, has in 2½ years actually completed 60 per cent. of its programme. That shows how our campaign has reached into the heart, of rural England.
I come back to the most interesting topic of this Debate, and that is the question of the nutrition and health of the people, particularly in the more distressed areas. The right hon. Gentleman the Member for Swindon did great service in raising this problem to-night. One thing I must challenge him very closely upon. He suggested that we had economised on the care for children and mothers during the last four years. There is not a shadow of truth in that. In every circular we have issued we have made is plain that although economy was necessary in 1931, the question of maternity and child welfare centres must not be impeded, but must be pressed forward.
If the right hon. Gentleman reads the speech of the Minister of Health he will see the figures. There has been a steady increase year after year. The right hon. Gentleman then asked whether the Government would publish the report of the Economic Advisory Committee. He must know that the Committee reports to the Cabinet. It was set up by the Prime Minister of the Labour Government in 1929 or 1930. It made several reports to him and the Cabinet, and these reports are entirely confidential. If, indeed, they were to be published the whole purpose of the Committee and the value of these reports would be lost. What has happened as a result of that last report is that we have enlarged the Advisory Committee on Nutrition set up a few years ago, and turned it into a standing committee, under the chairmanship of Lord Luke. We have added to it a number of lay persons of great qualifications, and we now have a standing committee consisting of expert dietiticians, statisticians, medical men and people with a great knowledge of public health and social conditions. I believe there is a great deal of useful work they can do. This question of nutrition has hardly been touched. Talk about asking working women questions of diet: how many Members of this House, if I asked what is the comparative nutritive value of an oyster, a piece of white fish and a herring, would know? I did not know myself until recently. If you take an equivalent amount of these three fish, an oyster will give you 100—I am talking in terms of calories, energy value—white fish 800, and a herring 3,000.
I have not left myself enough time to deal with the question of nutrition so may I, therefore, briefly summarise some of the salient points? One would naturally expect that with continued and prolonged unemployment one would see a slow deterioration of health, and we as a Ministry of Health are always looking for that. The hon. Member for Spennymoor (Mr. Batey) raised the question of the report of Dr. Walker. He complained that the report was of a narrow area in Durham. I can only say that the investigators were in touch with Dr. Walker, and he could have asked them to go anywhere. He made no complaint at any time. This is what the report said:
While we have found in the area under review a considerable incidence of subnormal nutrition and some incidence of malnutrition, our investigation shows little evidence of any increase of disease and none of increased mortality. The physical condition of the majority of individuals passed under review is good. Realising the long-continued economic stress to which this population has been subjected and with knowledge of the home conditions of many we have often been surprised at the high standard of health and courage which has been maintained.
However, this report did show that the condition of adolescents, from 14 to 16, was far from satisfactory, and immediately we took steps to rectify it. In so fax as these adolescents came within the juvenile training centres under the Ministry of Labour, that was the easier problem, because free meals were supplied, but in so far as they did not, we instructed the local authorities in those areas that they must pay especial attention to giving relief to families containing adolescents.
The right hon. Gentleman quoted two reports of medical officers of health of a rather contrary tenour, one from Burnley and one from Newcastle. As regards Burnley, he showed that the rate had gone up from one to eight per cent., so that the medical officer of health for Burnley found that—I am speaking from memory—about 64 children were malnourished, but he added a footnote that 30 were children of the unemployed and 30 odd children of the employed, which bears out the reports of so many medical officers of health that malnutrition is not solely a question of poverty. Malnutrition should be treated—
When a person is nourished, it means that he enjoys a balanced diet of proteins, carbohydrates, vitamins, and so on. If he is malnourished, very often it does not mean that more food will rectify it. On the contrary, more food may accentuate the digestive disturbance. What is wanted is advice and instruction so as to secure that the right food is taken, and not only that the right food is taken, but that the right food is properly cooked, which is very material. My view is that if in Durham or any other area you gave 10s. per head to the families in cases of malnourished children, it might work little good. The real danger is that, whatever the circumstances, the mother of the family will always see that from the resources available the bulk will go to the children. I am far more concerned about the health of the mother, sometimes, than about the health of the child, and I see no way of stopping that legislatively or by public assistance.
There was an interesting experiment recently conducted in London which bears out exactly the same point. Dr. Simpson, in 1934, examined the condition of children in some of the poorer areas of London, and he found this result, which is borne out by the reports of so many medical officers of health: He took a sample of malnourished children, and he found that seven per cent. of a certain batch came from the homes of the unemployed, and in another area, another school, he found that another seven per cent. of malnourished children all came from homes where the means were substantial and the parents were employed, which just shows what a poor service it is to try to make political capital out of physiological facts. What is vital is that the Ministry of Health, which is the watchdog of the nation, should be on its guard constantly and in all ways, and whenever we receive reports from medical officers of health, or any evidence of any signs of malnutrition, we immediately get into touch with the local authorities. I may say, in conclusion, that the machinery of public health in this country, both national and local, has so far proved adequate, because we have weathered these four years of storm without any real general, serious, decline in health, and that is due, surely to the high efficiency of our public health machinery.