asked the Secretary of State for Foreign Affairs whether any definite progress has been made in the conversations between Sir Miles Lampson and the Nanking government: and what measure of agreement has been reached?

I would refer the hon. and gallant Gentleman to the reply returned yesterday to the hon. Members for Northampton (Mr. Malone) and Shore-ditch (Mr. Thurtle).

I am much obliged. May we take it that the conversations are now at an end and that agreement has been reached on all points?

Sir Miles Lampson has returned to the North, but of course there may be matters still to be settled between the two Governments.

asked the Secretary of State for Foreign Affairs, whether the capital of China has now been set up in Nanking instead of in Peking; and, if so, whether it is proposed to station His Majesty's representative at Nanking?

Nanking is the official capital of the Nationalist Government of China; but the transfer of the administration to the new seat of government is not complete. Practical considerations make it impossible for His Majesty's Minister to reside in Nanking, but arrangements are being made for a member of the Legation staff to reside at Shanghai as the Minister's personal representative and to visit Nanking as and when required in order to maintain touch with the National Government.

Do we understand that His Majesty is not represented at the moment at Nanking, and will not be represented by anyone there in future?

No, Sir. There is no accommodation for His Majesty's Minister at Nanking. Practical difficulties make his residence there impossible.

asked the Secretary of State for Foreign Affairs if, now that a Treaty has been concluded with the Chinese Nationalist Government, he is in a position to state when the remaining units of the Shanghai defence force will be withdrawn from China?

I would refer the hon. Member to the reply given yesterday by my right hon. Friend the Secretary of State for War to the hon. and gallant Gentleman the Member for Central Hull (Lieut.-Commander Ken-worthy).

Is the Foreign Secretary aware that at the time when these troops were sent the Government gave a public pledge that, as they were sent to meet a special emergency, as soon as the emergency had passed away all troops would be withdrawn? In view of that fact, ought not all the troops to be withdrawn now?

We have no desire to keep troops there a day longer than is necessary, but at present the conditions are not such as to admit of the total withdrawal of troops, though their numbers have been steadily reduced.

asked the Secretary of State for Foreign Affairs whether he has any further report to make on the action of the League of Nations in reference to the dispute between Paraguay and Bolivia?

I have no report to make on this subject, but the hon. and gallant Gentleman will find full information respecting the action taken by the Council of the League in the White Paper which was laid on the 16th instant.

asked the Secretary of State for Foreign Affairs if he is in a position to make a further statement with regard to reparations and the withdrawal of troops from the Rhineland?

As regards reparations the hon. Member will have seen in the Press the various announcements which have been made recently relative to the constitution of an international Committee of Experts to submit proposals for the complete and final settlement of the reparation problem. It is expected that this Committee will meet shortly. It is clear that any further statement on this subject is impossible until the Committee has formulated its proposals and these have been studied by the various Governments concerned. With regard to the second part of the question on the subject of the Rhineland, there is at present nothing to add to the statement which I made during the Debate on the Adjournment on the 20th December last.

asked the Secretary of State for Foreign Affairs if he is now in a position to make a statement on the negotiations for a renewed arbitration treaty with the United States?

There has been no change in the situation since I spoke on the Adjournment of the House.

Does the right hon. Gentleman expect to make a statement soon?

I cannot say.

asked the Secretary of State for Foreign Affairs if he can indicate whether any further steps have been taken towards an understanding for naval disarmament since the abandonment of the recent negotiations between Great Britain and France?

No, Sir. The whole question is still under consideration.

May I take it that the First Lord was speaking for the Cabinet in this matter when he stated recently, in a public speech, that nothing was to be gained by any further negotiations?

I am afraid that I have not read the speech of my colleague, to which the hon. and gallant Gentleman alludes, but I have no doubt that my right hon. Friend the First Lord bore in mind the obligations of Cabinet responsibility.

With reference to the White Paper that was laid before we rose, on the subject of the Geneva Naval Conference, has the right hon. Gentleman paid any attention to the last letter of the United States Government, in which the door is left open for further negotiations?

Oh, yes, Sir. I have paid a great deal of attention to all parts of the reply of the United States.

Is anything to be done?

asked the Minister of Labour what was the number of people employed at the end of November, 1928, as compared to 1924, and, if the figures are available, as compared with 1913?

It is estimated that at the end of November, 1928, there were approximately 9,847,000 insured persons aged 16 to 64 in employment in Great Britain, as compared with 9,566,000 at the end of November, 1924. In forming this estimate, persons unemployed and persons directly involved in trade disputes have been excluded and allowance has been made for sickness and other non-recorded unemployment, exclusive of temporary holidays. Comparable figures in respect of November, 1913, are not available.

asked the Minister of Labour under what authority his Department questions applicants for benefit about private income other than that for dependants' benefit; if he is aware that at courts of referees persons who are called upon to show that they are genuinely seeking work are fully questioned as to their private incomes although no notice is given to them that this is to be done; and if any penalty is imposed on persons who refuse to answer questions regarding private income of their relatives?

As I told the hon. Member on 19th December last, the authority is contained in the Unemployment Insurance Acts. The right of the Court of Referees to ask such questions was challenged in an appeal to the Umpire, and upheld by him in a decision of which I am sending the hon. Member a copy. Claimants cannot be compelled to answer questions, but in order to obtain benefit they must furnish evidence sufficient to establish their claim.

Will the right hon. Gentleman answer the question as to what part of the Acts gives him authority to challenge a man's income?

My Department is bound to see that the qualifications are observed. That follows from the general duty laid upon it by the Act.

Is the right hon. Gentleman aware that in the passing of the Act one of the inducements held out to the House and the country was the alleged abolition of the income fest, and is the right hon. Gentleman aware that tie income test is still being applied to applicants for benefit?

No, Sir; I have no knowledge of any inducement of that kind being held out, and at present, in fact, there is no income test of any kind. There are questions put in order to get evidence sufficient to decide whether a person is genuinely seeking work or not.

In view of this being termed an Insurance Act, would the right hon. Gentleman say what bearing the income of another member of the family has upon the insurance benefit which a person is entitled to receive for contributions paid?

In certain circumstances it may very well be that the amount of income enjoyed by the rest of the family may or may not influence the zeal of the person in question in the search for work.

Are we to understand that the position of the Minister is that, if there is a certain family income, it is assumed that the person concerned is not seeking work?

No, Sir. Not at all, and it is very kind of the right hon. Gentleman to give me the opportunity of answering that question in the negative. It is only one among many circumstances which may be considered material in this connection.

Will the Minister kindly tell us what bearing the income or financial circumstances of a person may be on the question of whether that person is genuinely seeking employment?

I have already answered that question.

Are we to understand that the incomes of the right hon. Gentleman's friends behind him prevent them from seeking work?

I cannot be responsible for what the hon. Member understands.

Is it intended to carry on the inquiry as to income after the transitional period?

I cannot say whether the Courts of Referees or the Umpire will put this question after the transitional period is over. So far as the Courts of Referees and the Umpire are concerned, I have no right to interfere with what they consider desirable.

What would be the purpose of the inquiry then?

The same as now.

What standard of income is taken as representing that comfortable position which prevents a person seeking work?

Taken by whom?

Taken by the referees.

And by the umpire.

I have no right to answer for either the Courts of Referees or the umpire. They have to judge by their own discretion. With, in this case, the support of the whole of the party opposite they were put in a position entirely independent of my Department, and they can take their own decisions.

Is the Minister not aware that applicants for benefit are disqualified by his own officials on the ground of income?

Is the right hon. Gentleman not going to take Parliamentary responsibility for the actions of the Courts of Referees; or are we to understand that the Courts of Referees are outside Parliamentary jurisdiction?

I am certanly not going to take Parliamentary responsibility for decisions given by the Courts of Referees or the umpire?

Why?

The independence of the Courts of Referees and the umpire was expressly established with the concurrence, as I have said, of the party opposite, in order that they should not be influenced by my Department. That being so, I cannot accept responsibility for their decisions. They have their own discretion.

asked the Minister of Labour the number of claims to unemployment benefit at the nearest available date this year; the number of claims rejected; and the corresponding figures for last year at the same time?

As the answer is in the form of a Table I will, if I may, circulate it in the OFFICIAL REPORT.

asked the Minister of Labour the number of claims by men and women for unemployment benefit under the transition arrangements for the first two weeks of January, respectively, and the number of claims rejected?

These figures are obtained for monthly periods and those for the period ending 14th January will be available about 18th February. They are published in the Ministry of Labour Gazette and those for the period ending 10th December will be found on page 23 of the January issue.

asked the Minister of Labour if he has yet come to any decision regarding the continuation or otherwise of what is known as the transition clauses of the Unemployment Act of 1927; if so, can he state the nature of his decision; and, if not, when he will be in a position to come to a decision?

No change can be made in this matter without legislation, and I am not at present in a position to say whether legislation will be proposed.

Will the Minister answer the last part of the Question? When will he be in a position to make a statement regarding the position, in view of the great anxiety which is felt in many quarters about this matter?

I cannot say at the moment when I shall be able to do so, but it will be in ample time for hon. Members to debate the matter, or to raise it, if they wish.

Is the Minister aware that many local authorities are very anxious about this matter; and is it not possibly one of the factors which they will have to take into account in connection with the de-rating proposals?

No, I am not aware of that fact.

Is the right hon. Gentleman not aware that this matter is one of tremendous urgency to local authorities and great numbers of comparatively poor people; and will he take steps, as early as possible, to relieve anxiety which exists about it?

I have already said that, while I was not able beforehand to give adequate information about the matter, I believed the anxiety was grossly exaggerated. I hope hon. Members opposite will do their best to allay anxiety—as they have no doubt done up to the present.

With your past record!

asked the Minister of Labour how many unemployed young people are receiving training in Glasgow at the present time, and the percentage of those trained previously for whom permanent employment has been found?

As the reply is somewhat long, I will circulate it, if I may, in the OFFICIAL REPORT.

asked the Minister of Labour if he has made any new move towards carrying out the spirit and intention of the Washington Convention of Hours of Labour since his last statement on this subject; and, if so, can he state the nature?

As the hon. Member is aware, the policy of the Government in this matter is to secure such revision of this convention as will make possible the effective international regulation of hours of work. Since my last statement in this House the Governing Body has laid down the procedure to be followed in regard to the revision of conventions. In pursuance of that procedure the International Labour Office was instructed to prepare a draft report on the Hours Convention, and this report will be discussed at the next Session of the Governing Body, to be held next March.

Has the Minister ever stated precisely what his objections are; or, when is it his intention to make a statement?

I have already in this House stated my objections.

asked the Minister of Health whether he can give the total number of recipients of Poor Law relief in 1913, and on the last available date?

The total number of persons, all classes, in receipt of Poor Law relief on the 1st January, 1913, was 794,227, and on the latest available date, 5th January, 1929, approximately 1,260,000.

Do those figures include Scotland?

No, I could not answer for Scotland.

They are only for England and Wales?

asked the Minister of Health the number of women in the Lancashire area who were in receipt of widow's pension in January, 1929, and the number of children in receipt of allowance at the same period?

The information asked for is not available as the records of pensioners are not arranged on a territorial basis.

asked the President of the Board of Education the number of nursery schools in Lancashire, and the number in England and Wales?

There are four nursery schools in Lancashire, and 27 in England and Wales.

Are there any proposals before the Noble Lord's Department for the opening of a number of additional schools?

Yes, Sir.

How many?

I could not say without notice.

asked the Secretary of State for War the number of men and women employed at Woolwich Arsenal and the Small Arms Factory, Enfield, in January, 1929; and how many of these are pensionable?

I have been asked to reply. The number of employés of industrial and non-industrial grades at the Royal Small Arms Factory, Enfield, and the various establishments in Woolwich Arsenal is approximately 12,400, of whom 950 are established.

Is it the intention of the Department to increase the number of pensionable servants?

I should have notice of that question.

asked the Minister of Agriculture how many urban district councils have bought land for allotments under the machinery of the last Allotment Act?

Assuming that the right hon. and gallant Gentleman desires the information to include boroughs as well as urban districts properly so called, the answer is that 82 borough councils and 78 urban district councils purchased 1,954 acres of land for allotments during the years 1925, 1926 and 192V. It is not possible to say what proportion of these purchases was effected before the 7th August, 1925, when the Act referred to came into operation.

asked the Secretary of State for the Home Department whether he has any further information to give the House with regard to the proposal to establish traffic police?

Yes, Sir, I hope to call this Conference at once.

Does the right hon. Gentleman or his Department propose at the Conference to submit any scheme for the consideration of the Conference?

No. As at present advised, the purpose of the Conference will be to ascertain the views of local authorities and whether it is desirable to formulate a scheme.

Can the right hon. Gentleman say whether the proceedings will be public?

Oh, I think not.

asked the Financial Secretary to the Treasury the number of persons in possession of in comes exceeding £2,000 per annum in 1913 and the number on the last available date?

I have been asked to reply. No information is available as to the numbers of incomes in 1913 exceeding. £2,000 but not exceeding £5,000, which was the limit of liability to Super-tax in that year; but the hon. Member will find particulars of incomes exceeding £5,000 for the year 1913 in Table 70 of the 59th Report of the Commissioners of Inland Revenue. Particulars of the numbers of Super-tax payers for recent years will be found in Table 64 of the 70th Report of the Commissioners of Inland Revenue.

asked the Prime Minister whether he can give an opportunity for discussion of the Motion on Ecclesiastical Powers standing in the name of the right hon. Member for New-castle-under-Lyme (Colonel Wedgwood) and others? —[That, in the opinion of this House, it is desirable to reaffirm the Resolution of this House passed on 15th December, 1640, namely, that The Clergy of England, convented in any Convention, Synod, or otherwise, have no powerto make any Constitutions, Canons, or Acts -whatsoever, in matters of Doctrine, Discipline, or otherwise, without common consent of Parliament.]

No, Sir; my right hon. Friend can hold out no hope of facilities being given for the discussion of this Motion.

Does the right hon. Gentleman not think that, in view of the indications that the present Bench of Bishops contemplate issuing for use the Prayer Book recently rejected by this House, it is desirable either to reaffirm the ancient Resolution of this honourable House or to reserve promotion in the (Church of England to those clerks who do not disobey the laws of the land, or resent the control by the State, or disregard the Thirty-nine Articles of Re-ligion to which they swore allegiance at their ordination?

The right hon. and gallant Gentleman is, I think, going considerably beyond the terms of his question. He asked my right hon. Friend whether he could give an opportunity for the discussion of a certain Resolution on the Paper, and the answer that I have given, on behalf of the Prime Minister, is that there is no hope of any such opportunity, certainly this Session.

But does not the right hon. Gentleman think that the Prime Minister would desire to have reaffirmed by this House the ancient Resolution, as to the supremacy of this House in matters of faith?

If that had been the question which the right hon. and gallant Gentleman had addressed to the Prime Minister, I have no doubt my right hon. Friend would have provided a satisfactory answer.

Does not the Home Secretary think that enough mischief has already been done by this House attempting to dominate the Bishops?

(by Private Notice) asked the Secretary of State for Dominion Affairs whether he can inform the House as to whether Messrs. Wigg and Cochrane and other ex-British civil servants in the Irish Free State have now received the compensation to which they have on two occasions been held to be entitled by the Privy Council under Article 10 of the Irish Treaty?

I hope to be able to make a statement at an early date as to the position arising out of the decision of the Judicial Committee in this matter.

Will my right hon. Friend say when I may put a question down again?

Perhaps if my hon. Friend will put down a question in a fortnight's time, I may be able to answer it.

The first Amendment on the Paper—in page 54, to leave out from the first word "The" in line 19 to the word "in", in line 20, and to insert instead thereof the words:

"following grants, that is to say:

(a)The grants payable out of the Consolidated Fund or the growing produce thereof into the Local Taxation Account; and

(b)Such road grants as have heretofore been made as classification grants in respect of roads and bridges classified by the Minis' r of Transport as roads and bridges of Class I or large Class II in London or county boroughs and as grants for the maintenance of unclassified roads in counties

(which are)"—

unduly interferes with the structure of the Clause and raises points that can be considered on subsequent Amendments. Therefore, I do. not select it. In regard to the next three—

(1), in line 19, after the word "grants", to insert the words:

"other than grants for maternity and child welfare services";

(2), in line 19, to leave out the words "set out in the Second Schedule to this Act", and to insert instead thereof the words:

"payable out of the Consolidated Fund or the growing produce thereof into the Local Taxation Account"; and

(3), in line 21, after the word "Grants", to insert the words:

"except the grants in respect of classified roads"—

I would suggest, for the convenience of the Committee, that a Debate might be taken on all three. They are all in order, but, if the first were taken alone, I think it would be difficult to confine the discussion within the limits of the special services concerned, but, of course, it would be no prejudice to taking separate Divisions. On the other hand, if the Committee preferred, we could have a limited discussion on the first and a longer discussion on the second, but I think probably in practice that would give rise to considerable difficulty.

We should prefer the general discussion, but the Amendment standing in my name, the second of the three you mentioned, Sir, raises the whole question of principle. That, of course, I take it, would be allowed to be raised on the general discussion?

Certainly.

I beg to move in page 54, line 19, after the word "grants", to insert the words:

"other than grants for maternity and child welfare services."

This Amendment is to exclude the maternity and child welfare services from being discontinued grants; in other words, to keep them, as at present, on the percentage system instead of bringing them under the block system. There are very good reasons why this should be reconsidered by the Ministry of Health. The actual cost of the maternity and child welfare grant last year was but £1,052,000. The service is a young and growing one and a very important one. The ante-natal work is only just beginning to be considered under the maternity schemes, and as for maternal mortality, that has hardly been considered at all under the maternity and child welfare schemes. The service, as I say, is a growing one, and the expenditure also is a growing one. In the last five years the expenditure has increased by 36 per cent. I need not, I am sure, refer either the Minister or the Parliamentary Secretary to the importance of the ante-natal work or to the desirability of better treatment of children up to five years of age. That has been well pointed out by the Medical Officer to the Ministry, Sir George Newman, in his latest report, in which he states that 25 per cent. of the young children entering the elementary schools to-day are suffering from some physical defect which could have been prevented had they had better treatment before entering school.

The service, as I say, is not by any means so fully developed as to secure for the children of the country the whole of the benefits which are made possible by the Maternity and Child Welfare Act. Hitherto, 50 per cent. of the expenditure has been borne by the Ministry itself, but under this Bill a block grant will be made to the appropriate local authority, which will itself decide how much of the money shall be spent in maternity and child welfare work, and the question naturally arises, Will the maternity and child welfare services receive an adequate proportion of this block grant to allow for the much-needed expansion in the work, and how far is there security under the Bill to prevent local factors operating to restrict the expenditure and to hinder the progress of this vital work? The Minister, in the wonderful speech in which he presented the Bill, referred to Clause 86 as giving him the fullest and widest powers to deal with cases of this kind, but the Committee will find in this Clause that the power of the Minister is to

"reduce the grant payable in respect of any year under this Part of this Act to any council by such amount as he thinks just—

(a) if he is satisfied—

(i) That the council have failed to achieve or maintain a reasonable standard of efficiency in the discharge of their functions relating to public health…and that the health of the inhabitants of the area of the council or some of them has been or is likely to be thereby endangered; or

(ii) that the expenditure of the council has been excessive and unreasonable, regard being had to the financial resources and other relevant circumstances of the area."

It seems to me that that is hardly what would be considered a reasonable safeguard to induce a laggard authority to expedite the work of maternity and child welfare, or to increase the amount which was necessary in view of the growth of population or other circumstances of the locality. It hardly seems a safeguard upon which the Committee can rely. All those interested in this matter will be grateful if the Minister can explain how far he considers it a safeguard, or how he can make use of that power to force an unwilling locality to spend more money, and not less, for the benefit of the public health of the young people.

The block grant under the Bill is to be fixed for a term of years. Originally, the term was five years, but I am glad to see on the Paper to-day that the Minister is proposing to alter that, and to suggest that the first period should be three years, the second four years, and the subsequent period five years. I say at once that that is a great improvement, because most of us who are interested in maternity and child welfare felt that a block grant for five years was a very long time, for a great many things might happen in five years. Even three years is a considerable time, for much may happen in three years, and, if there is an increase in the necessities of the neighbourhood, the increase will have to come out of the local rates, and cannot possibly be made up in any other way. That is another serious disadvantage to the successful prosecution of maternity and child welfare services, and must have a discouraging effect upon those who are engaged in the work.

I would like to deal with another point which has been raised by the Minister and by other speakers, that the continuance of the percentage grant makes for the advantage of the richer boroughs and to the detriment of the poorer or necessitous boroughs. It has been said that at the present time a richer borough spends more because of the percentage grant, and the necessitous borough spends less. I am not prepared to admit that that is true, but, if it be true now, it cannot be true after this Bill comes into operation, because there will be this very large sum of £45,000,000 to be distributed among the boroughs according to their necessity. The Minister himself said in his speech, when he referred to two necessitous boroughs in particular, Merthyr and Tynemouth, that as a result of the distribution of this money, they would, in the final adjustment, in one case be advantaged to the extent of 108d. per person, and in the case of Tynemouth over 210d. per person. If that be so, these necessitous boroughs in future will have no excuse for not supporting and proceeding with maternity and child welfare to the full extent that any of the richer boroughs have done in the past. They will, according to the terms of this Bill, be in such a financial position that they will have every opportunity of proceeding with the work. I therefore suggest that the argument that the percentage system works to the benefit of the richer borough and does not operate to the success of the poor borough will no longer have application when the provisions of this Bill are carried out, and the grants of new money and so on are made to the boroughs.

Another point raised in regard to the percentage system was that it implied a considerable amount of official interference with the local authorities. I have been interested in local government work for many years, and I have never heard anything but praise of the official interference of the officers of the Ministry of Health in connection with work such as maternity and child welfare. On the contrary, the advice of the officials of the Ministry has been a great help to local administrators, and I believe that it has acted as a stimulant to many lagging authorities.

A further point which I am particularly asked to raise, and which I do so with pleasure, is the question of the voluntary associations. Much of the work of maternity and child welfare is being done, and no doubt will in future be done, by the voluntary associations. They consider themselves very much discouraged by the provisions of this Bill. The country owes a deep debt of gratitude to the large number of men and women who have so splendidly given of their abilities, time and money to form the voluntary associations which have been such an effective help in promoting this work, and helping the local health authorities in every district. I hope that the Minister will be able to give them some crumbs of comfort, so that they will be able to feel that they will have full opportunities for work in the future. Up to now some of them have received grants from their local councils, but not all, and in every case. they have received from the Ministry 50 per cent. of their approved expenditure on maternity and child welfare work. That, of course, passes under the Bill. The Minister has some power, although I do not consider enough power, to see that these associations are recognised by the local authorities, and whatever they receive now they will have to get through the local authorities, and the amount will be calculated, I imagine, on the figures of 1928–29. That may be all right for one year, but in the case of such a growing service it will hardly be the right amount for the third year. One can hardly be surprised that these voluntary associations are uncomfortable at the present time. Although they may be doing work which gives satisfaction to the Ministry of Health, many of them feel very doubtful about their own local authorities.

I would remind the Committee that in my own borough of Kensington we started maternity and child welfare work over 23 years ago, with the help of the then President of the Local Government Board, Mr. John Burns. We had awful figures of infant mortality at that time— there were 140 deaths per 1,000 births. We started this work under a medical officer of health who was in full sympathy with the voluntary side of the work, we got together a band of enthusiastic voluntary workers, and a great deal of good work was done. But that particular medical officer died and was succeeded by one who said that all he cared about was the official worker; he did not, he said, care about "having any truck" with voluntary associations. In those circumstances the voluntary effort naturally died down, and it is only in the last eight or 10 years, under a new medical officer of health with larger and wider views, that the work has again proceeded apace. I am thankful to say that now we have at least seven centres for maternity and child welfare work, and the infant mortality has been reduced by 50 per cent., having fallen from 140 deaths per 1,000 to 70, entirely owing to the efforts of both the official workers and the voluntary associations.

The Minister can be assured that I and those who have moved me in this matter are not in the least degree inspired by hostility to him, to his Department or to the Bill. There is much in the Bill which we all like. But I would point out that there are many other services which will still be run on the percentage grant system. There are the roads. The roads are very important, but they are not more important than the maternity and child welfare work. The contributions towards the main roads, classified as 1 and 2, and towards the improvement of rural roads, are to be worked out on the percentage system. The London roads are to come under the block system. If the roads can be divided up between the two systems I think it is not too much for us to ask that maternity and child welfare work might -be put on the percentage system instead of on the block grants system. Other services, including education and police, have not been altered. Not long ago there was an idea that contributions to expenditure on education might be paid under the block grant system. That was carefully considered by all the education authorities, and I think no one would now be bold enough to suggest that educational expenditure should be dealt with by block grants. Nor, I imagine, would anyone say that the police should be put on the block grant system. I saw the Home Secretary here a moment ago. I do not suppose he would desire to have block grants in respect of the police forces of the country. The cost of the police forces and of education takes up a great deal more money than the public health work of the country.

In conclusion, I would impress upon the Committee that the exclusion of these maternity and child welfare services from the block grant system is regarded as of very great importance by those who know best about the matter and have been working these services for a number of years. Resolutions in support of my Amendment have been sent to me from all sorts of societies, including the National Council of Women, the Society of Infant Welfare and from the Ragged School Mission. A resolution in support of it has also come to me from a society of which the Minister of Health is himself President—the Society of the Unmarried Mother and her Child. I do not know whether this society had submitted the resolution to their President before I had the honour of receiving it, but I confess that when it came to me I felt there might be some hope that the Minister would be able to deal favourably with the Amendment. I am doubtful whether I have done this Amendment the justice which it deserves, and I hope the Committee will excuse any deficiences on my part.

I need hardly say that my hon. Friends on these benches are fully in agreement with the Amendment which has just been moved by a supporter of the Government. I wish to raise the whole principle which underlies this subject, and to use the maternity and child welfare services as an illustration. I challenge the reversion to the block grant system as being injurious to the develop- ment of the social services. Those who have followed the remarkable development which has taken place in recent years in social services administered by local authorities know that the chief factor in promoting that growth has been the percentage grant system. The public health services and the education services have thriven and have grown to their present dimensions because of the stimulus of the percentage grant system. It is quite clear that when any new service is being established, when Parliament is giving new powers to local authorities, those powers will never be exercised adequately unless the expenditure which (he local authority itself bears is assisted in some way or other by the State. In the case of maternity and child welfare service, the Ministry of Health is well aware that we should not have had even the inadequate service we have to-day but for the existence of the percentage grant on the 50–50 basis. I believe that fact is quite undeniable. It is clear that for every new social service you must have the share-and-share principle from the outset if that particular service is to come into effective operation.

There is another extremely important point which those interested in social services have appreciated, and it is that the percentage grant system has always been a powerful stimulus to the pioneering local authority. Our social services have grown up largely owing to the example set by the pioneering local authority which, armed with the assistance of the percentage grant, and knowing that it has the support of the State behind it, has been prepared to forge ahead of its fellows and set up a standard which other local authorities have followed in the course of time. That is an undoubted truth, and we owe much to, say, the City of Bradford which, under the inspiration of the percentage grant, has made new developments which otherwise would never have been possible.

In the case of every new development, the sharing of the expenditure on the percentage basis is the most workmanlike method of financing that service. Remember that all these services arise out of the legislation passed by Parliament conferring powers on local authorities. Those powers are conferred, presumably, to be used, and are not intended to lie musty and forgotten on the Statute Book. Until every local authority is exerting 100 per cent. of its powers, Parliament has no right to discourage local authorities in their efforts to achieve that position. It is wise economy and certainly wise statesmanship, when Parliament has devoted valuable time to promoting legislation, to use all those powers in order to secure effective administration. Where services have developed for a number of years, it is wrong to do anything which is not going to encourage the further development of such services.

Every service which is being administered by local authorities to-day is in process of development. Nobody will contend that there is a single social service administered by local authorities to-day from which they are extracting 100 per cent. of its possibilities. Every social service to-day is undergoing development, and that is particularly true of maternity and child welfare. It is equally true of the provisions for the treatment of tuberculosis and the treatment of mental deficiency and venereal diseases. There is not a single health service which has been utilised to the extent which Parliament permits, and any step which under these circumstances would tend to hinder even one local authority from continuing to develop its work must be disastrous to our social services.

In the case of maternity and child welfare we have to-day—or rather we had on 1st April of last year—847 ante-natal clinics struggling with a mass of work with which they cannot possibly cope effectively. Is there any hon. Member in this House prepared to say that 847 antenatal clinics are sufficient for England and Wales? Nobody can say that. As a matter of fact, there is room for 1,847, and oven more than that, and there will continue to be room for more clinics until the community has been assured that every expectant mother can have the care she needs. The financial Clauses of this Bill destroy the real partnership (between the State and the Government are delivering a felon's blow against that particular service which is not even extracting 10 per cent. of its possibilities, to say nothing of 100 per cent. The same is true of every other health service, which ought to be stimulated and not impeded.

The real opposition to the development of these services comes from the Treasury. What is the argument which is generally used? It is that the percentage grant system involves increasing expenditure which is uncontrollable and cannot be forecasted accurately. I do not believe it is true to say that expenditure on these services is uncontrollable, and it is not true to say that such expenditure cannot be kept within reasonable limits. It is not difficult to forecast such expenditure. Everybody who has studied local expenditure on our social services from year to year knows that you can within very narrow limits forecast what they are going to spend next year. You will never find that 600 local authorities have suddenly decided to double their expenditure upon maternity and child welfare. You know that you are dealing with a developing service, and you can easily tell how much the expenditure upon it is likely to be.

It is not true to say that the expenditure is not controlled, because every penny that is paid for these services is in respect of expenditure which has been approved by the State department. The health services are based on a percentage grant system in respect of approved expenditure, and that is the real check of the State upon such expenditure. The State is in a position to say that any particular expenditure is an abuse of existing legislation, and it can decide whether it is unnecessary, or has been diverted into channels which are not as productive as other forms of expenditure. On those grounds, the State can rule out expenditure which it thinks ought not to receive assistance from the Exchequer.

I do not pretend that the percentage grant system in itself is an ideal system. I do not believe that you can ever find a simple single formula which will settle the financial relations between the State and the local authority. The great advantage of the percentage grant system is that it treats wealthy and poor areas in precisely the same way. If the rich borough of Westminster spends £5,000 on its maternity and child welfare service and the poorer borough of Batter-sea spends the same sum, they both receive from the State a grant of £2,500. Therefore, our experience in the past has shown us that we may have to modify the percentage grant system. The Education Grant has been modified in order to bring in other factors to make up the difference which certainly results from the percentage grant system as between the rich and the poor local authorities. I claim that a grant which shares with local authorities under a proportionate system the expenditure on social services -modified, by density of population, or poverty, or the other necessary factors—does realiy approach as closely to the idea! as it is possible to get.

I have already said that this alteration has not been dictated by consideration for the well-being of these social services; it has been dictated purely on grounds of economy. The spiritual father of this scheme is Sir Eric Geddes. After the War, in the days of the Coalition Government, when millions meant nothing, there came a period when the Government suffered very badly from "cold feet," and when the order of the day was economy; and the Government of the time established an extraordinary committee under Sir Eric Geddes, for the purpose of making suggestions which would promote economy. One of the most important suggestions which that Committee made was this:

"We consider that the percentage grant should be abandoned in the interests of economy, and be replaced by fixed grants, or grants based on some definite unit."

That is where the Treasury first got its own way. The percentage grant was to be condemned, not because it was not) assisting social services—indeed, it was doing it too well—but it was to be condemned because it meant the expenditure of Treasury money, and it had to be superseded by something on the lines of the Bill and the Clause now before this Committee.

The most mysterious contribution, however, to this discussion on the relations between the State and municipal authorities, is the history of the Meston Committer. I know of few more scandalous things than the way in which this Government has deliberately suppressed all the evidence given before that Committee. I wish there were not imposed on me certain restrictions of speech about the origin of that Committee, but the course of its history is a story of the most appalling kind. A draft Report was submitted to the Com- mittee, and no meeting has ever been held since. Why? Because the draft Report was drafted in violation of nine-tenths of the evidence that came before the Committee; it was a repudiation of the evidence that the Committee had received. I have said that in the House before, and I ask for a contradiction from the Minister if what I say is not true, that the great bulk of this evidence, including masses of evidence from Government Departments, from local authorities, from bodies representing local authorities, and from prominent publicists, was for the percentage grant and against the block grant.

We have had no Report from that Committee; we have never had made available to us the evidence which was submitted to it; but, in the face of that evidence, the Government have come forward with a series of proposals which would be reduced to a laughing stock in the country if that evidence were ever to be published, and, as I am reminded, the draft Report that was submitted was so bad that the Committee itself refused to accept it. The Committee, so far as I know, technically exists, but is moribund, and will remain so, for the Government dare not publish the real results of its deliberations. Only two or three years ago the President of the Board of Education tried this kind of principle in dealing with education, and he had one of the most serious times that any Minister has had in recent years. I do not know how he can ever appear in public, certainly before education authorities, without hanging his head in shame. He was beaten. The local authorities realised that, if he had his way and destroyed the percentage grant basis of the Government giants, the whole of their work would go to pieces, and he had to give way. That is the reason why, in this block grant, education is not included. But it does not mean that education is not going to suffer as a consequence.

We are really back again now to economy. What do the Government's proposals amount. to? In 17 years from now, local authorities are going to be penalised in order that the Treasury may gain. It is going to take them 17 years before they dare reach that point—17 years of transition. They dare not put their scheme fully into operation now, because they know what the effect of it would be upon local finance. They know that the effect of the block grant will be to penalise local authorities, to put added burdens upon the ratepayers. Consider what is going to happen next year, and the year after, and the year after that. This year the Government are going to determine their block grant for the ensuing three years on the basis of the expenditure of this year. Any local authority that establishes a new maternity and child welfare centre, or enlarges one, or extends its work in any way which means increased expenditure, will have to bear the whole of the cost. Nobody can deny that. Every new development of maternity and child welfare work which takes place after the grant has been fixed is going to be entirely a local burden, without one single penny from the Minister of Health. Does he suppose that in those circumstances hard-pressed local authorities are going to undertake the developments which many of them would desire to undertake? If they are driven to a choice between higher rates or more service, when higher rates mean bearing the whole additional cost, it will not be surprising if many local authorities, however reluctantly, refuse to raise their rates. The local authorities will not proceed with this work, the new developments will not be undertaken, and that will be to the detriment of the public health of the people of this country.

4.0 p.m.

That is how this scheme is bound to work. It is bound to affect injuriously the development of this great health service. It will not do for the Minister to say that he is giving an overriding guarantee of Is. per head. What does that amount to? It amounts to about a 2d. rate. Is it supposed that that is going to recompense local authorities for their loss of rateable value? Is it supposed that it will recompense them for the cost of the necessary health developments for which they will have to pay out of their own pockets? It certainly will not do so, and in the case of every health service in the country to-day that is run by a local authority or by a voluntary organisation, those bodies, many of them doing very valuable pioneer work, are going to be penalised if they desire to be progressive. The block grant, stabilised for a term of years, lumping in services that have nothing to do with one another, is bound to hamper the free development of what are really vital services in this country, and, whatever else may be said in favour of this Bill—and there is not much—I would vote against the Bill on the ground of this Clause alone, as being a disservice to the development of health services of all kinds on which the future well-being of our people ultimately depends. Let me quote a few words from Sir George Newman's last report. It is referring especially to maternity and child welfare:

"Adequate ante-natal provisions, whether provided by doctors or midwives, with the assistance of the municipal clinic or the maternity hospital, is the only sound foundation upon which an effective scheme for a maternity service can be built."

The right hon. Gentleman deliberately, with his eyes open, is helping to make that foundation itself unsound, is going to destroy the heart of people who have devoted years to the development of these services, and he is going to do it by the instrument of a block grant dictated to him by the Treasury, without any regard whatever to the wider human considerations involved.

I would like to offer a few observations on the Amendment before the Committee, because while the hon. Member who introduced the Amendment mentioned a large number of bodies, chiefly composed of women, who were in favour of this Amendment, I know there is a very great deal of diversity of opinion on this subject among women in this country who are interested in these particular services. At the same time, I admit that there has been apprehension as regards the possible operation of the block grant versus the percentage grant, and this seems to be chiefly based on the assumption that it is easier to induce a local authority to develop a health service if you can offer that local authority something in the nature of a good bargain. Bargains are supposed to appeal more particularly to the feminine mind, but it certainly has been assumed that this species of bargaining acts as a very great incentive in inducing local authorities, who, apparently, do not move at all without it, to take steps to develop their health services. Of course, it only applies to the areas which can afford to take advantage of the bargain offered. There is no question of a bargain where there is no ability to pay anything, and I do not think it can be denied that it is the richer areas which have benefited most under percentage grants. I myself cannot see upon what the argument can be based when we realise that areas like Gateshead receive 3d. per head of the population for the development of maternity and child welfare services and Eastbourne receives 9½d

The hon. Gentleman who has just spoken referred to pioneer local authorities who go forward while others hang back. Why should it be allowed only to the richer local authorities to be pioneer authorities? The poorer areas have not got now the ability to pay, but the hon. Member for North Kensington (Mr. Gates) was quite on the point when he said that, after this Bill becomes law, these poorer authorities will be in such a financial position that they will have every opportunity of developing these services [AN HON. MEMBER: "By the block rants?"] Block grants mean a fairer incidence of grants from the Exchequer. The suggestion is that particular health services should be exempted from the operation of the block grant. I, myself, cannot see why, if these arguments were germane, they should not apply to all the health services, and not only to maternity and child welfare services. As a matter of fact, mental deficiency, tuberculosis and venereal disease could equally be exemptd from the block grants. The exempting of all health services, of course, would whittle away the whole basis of the Bill, and leave the present inequality between the richer areas and the poorer areas. The real advantage to those of us who are interested in health services comes in another Clause of the Bill. At the present moment, under the percentage grant, all that the Ministry of Health is able to do is to say to those areas which can afford to put up some money, "We will pay half if you will pay the other half," and in those circumstances the richer areas benefit more. Under the Bill a much larger sum of money will be at the disposal of the poorer areas, and under another Clause the Minister will be in a position to say, "You have now more money than you have had up to the present, and it is up to you to provide a reasonable standard of efficiency in dis- charging these functions." Anything which could be done to strengthen that Clause, although I hardly think that it needs any strengthening, I am sure the Minister would be ready to do. Provided the Minister of Health has those powers, I cannot see how any apprehensions can arise in relation to the block grants. Poorer areas will have more money to expend.

The hon. Gentleman told us that the local authorities are very anxious for the advice of the Ministry of Health. I have no doubt that in devising their schemes for the development of health services, that advice will certainly be at their disposal in the future, and under Clause 86 the Ministry will have new and special powers whereby they can assure that those authorities who now have money at disposal for the development of those services shall develop them to the greatest possible extent. I am prepared, and I ask Members who sit with me on this side, to trust the Minister of Health to put that Clause into operation in such a way that we shall have no fear of the development of those services which many of us have so much at heart. This Measure is admittedly a very complicated one, and I think in connection with this Clause, as in connection with every Clause, we all suffer from an inability to see the wood clearly on account of the trees, but I venture to prophesy that those who come after us will recognise this as being the greatest piece of constructive legislation of our generation.

When the Noble Lady intervened in this Debate I thought that she was going to be a help towards persuading the Minister, at any rate on this particular Amendment, to make a concession. There has been a remarkable unanimity amongst all those interested in health questions, at any rate in regard to child welfare, that some departure in the principle of the Bill should be made. I am not going to raise the larger issue, but a number of organisations, largely composed of people of Conservative political sympathy, view with great distress the departure from the partnership of the Ministry of Health in this great new work. because this great new pioneer work is still largely of an experimental character, in a state of evolution, the progress of which depends on stimulus from some central organisation. I am going to give great credit here to the Ministry of Health. I confirm what the hon. Member for North Kensington (Mr. Gates) said, that much of the good work done in the country has been done through the direction, advice and assistance of the Ministry and its officials. I know more than one case where the guiding hand of the Ministry of Health has been of tremendous assistance. As I understand it, that direction is to be disturbed, and the future of this great-new work is largely to be left now to local authorities.

I am very glad the hon. Member for North Kensington particularly referred to voluntary organisations. There can be nothing more unfortunate than to leave the whole work of infant and child welfare entirely to local authorities, particularly at this stage, and these local organisations are afraid—and, I think I can show, rightly afraid—that the result of leaving it entirely to local authorities must be, in the end, to sterilize their effort. I have in view one particular organisation in my own borough. The work is by no means limited to my own district. The services go over a very large part of London not only East of London, but also in other parts, north, south and west, patients come for care and treatment at the most critical time in their lives to this particular institution. It is not unnatural that the local authority in that east-end district, with money strictly limited, rationed as this Bill proposes, will hesitate before giving financial assistance to an institution that does its work all over London instead of limiting it to one particular borough, because it must be remembered that under the scheme of the Bill, the boroughs are only to have a particular amount of money, quite apart from the services. Whether the services expand or not, the money is to come in just the same, and as they are to he rationed under this scheme, naturally they will hesitate to give their limited money to institutions that do work largely outside their own districts. If the Minister really wishes, as I understand he does wish, to encourage voluntary institutions to do this work, he is going the wrong way about it, because, inevitably, under the system of rations, he is bound to force local authorities to confine their work to their own particular district, and that will make it impossible for these larger institutions to go on. At any rate, I have received, like most Members of this House have received, letters from a great number of splendid men and women who have given many years of work to this responsible business, who feel that this is the death-blow to all that they have been doing in the last 10, 15 or 20 years.

It is interesting to remember that the whole of this work really dates from almost the first week of the beginning of the War. It was on 30th July, 1914, that an Estimate, a comparatively small one, I believe, of £12,000, was brought before this House to encourage maternity and child welfare services. Owing to the outbreak of the War this Estimate went through practically without discussion, and, in spite of the War, in spite of all pressure of conflicting interests, once it was started it very rapidly expanded, and from comparatively small figures it jumped up very rapidly, so that in 1918, when the War was over, a Measure passed through Parliament known, of course, as the Maternity and Child Welfare Act, which put the whole organisation on a stable basis. In 1916, there were 650 centres. In 1928, there were 2,684 centres. It is a great mistake to think, as the Noble Lady suggested, that those centres are to be found mostly in the richer areas. On the contrary, at any rate in London, probably there is more activity in the poorer areas, and rightly so, because the need is greater. In Bethnal Green, the poorest borough in London, we have had more activity probably than in any other part of the county. Our infantile mortality rate has gone down so much that we were actually successful in getting the prize for the best work in that direction as compared with the whole country. That is a big burden on poor districts, and we are actually in this Bill abolishing the equalisation fund. You are removing the assistance that comes from the central authority under the percentage grant.

I do not think that is the right way to help local authorities in poor districts in their struggle to deal with this tremendous problem. Since the inception of the whole system of child welfare the death rate per 1,000 has gone down from 105 to 70. There is still a tremendous amount, of work to be done. A number of boroughs in London are very much behind and there are whole districts which are not adequately catered for. If there is anything for which an exception should be made surely it is this new pioneer work of looking after the mother at a critical time in her life when she has to go through such a tremendous strain and stress and experience. I beg the Minister not to try to make the Bill logical. Logic is all very well in some things but when you are dealing with a great social problem like this he would be justified in making an exception.

I am sure Members on both sides are anxious that nothing should be done to interfere with the development of this service. It is simply because we differ as to the best means of dealing with the subject that the hon. Member has put down his Amendment. I do not agree with it. I am definitely opposed to the percentage grant for this service and in favour of the block grant. We have heard from more than one speaker of the objections to the percentage grant, but I do not think they have been stressed as much as they might have been. Under that system the money is not given according to need but simply according to ability to pay. We also know that percentage grants tend to encourage extravagance amongst local authorities. One can always be extravagant with a service when one has only to pay half the cost. There is also the other very grave objection that a percentage grant necessitates very careful Government control of expenditure. Percentage grants were given in the first place as a stimulus for the development of a service. The essential nature of a stimulant is that it is temporary. If you make it permanent it tends to become a narcotic, and there is a danger of this happening with maternity and child welfare service. The percentage system has been in existence for some time and all local authorities have had the opportunity of taking advantage of it, yet a very large number have not done so. In certain cases, owing to lack of interest in this service, they have not troubled even to start it. In other cases, in wealthy districts, there has perhaps been the fear of an increase in the rates and therefore they have not started. But I think the main cause has been the poverty of different districts. They really cannot afford to pay their 50 per cent. quota, and it is on behalf of the poorer authorities that I think we should welcome the action of the Minister in bringing in the block grant.

I have noticed more than once that there is a tendency in the House and in the country to value the success or otherwise of a service by the amount of money spent upon it and to say that if the expenditure increases by 10, 15 or 20 per cent. the service, of necessity, is improved. But the increased expenditure does not necessarily mean increased efficiency, and the point we have to consider particularly with regard to the block grant system is, will the money be sufficient for the service, and we have the assurance of the Minister on the Second Reading that that is the case. He then told us that the average grant per head for the maternity and child welfare service, eliminating one or two particular towns, was in the region of 5d. By means of the block grant, in certain towns the increased money will come up to 200d. per head of the population or more. No one can legitimately say that these services are going to be starved for want of money. The money will be there under the block grant if the public care to have it. By Clause 86 the Minister is given such power that he can either initiate or see that these services are carried on in an efficient manner. I also think that public opinion, knowing of the new money that will come into the district by means of the block grant, will begin to insist upon local authorities using it for this specific purpose, and that will have a very marked effect. As far as I can see, being a very keen supporter of maternity and child welfare work—[An HON. MEMBER: "It sounds like it!"]. It may sound invidious to remind the hon. Member that I speak from experience. I have initiated and carried on such a service and it is as the result of my experience that I am convinced that the day of the percentage grant for maternity and child welfare services is over.

The success of a child welfare centre does not necessarily depend upon the money spent on it. Money, of course, is essential for success but what you need in a centre are an enlightened public authority, and, above all, a conscientious, well trained, tactful woman as nurse. If you get a thoroughly well trained nurse with an instinctive love for mothers and children, and a medical officer with the same characteristics, you will have a successful maternity and child welfare service irrespective of the money you have to spend, because it is a voluntary service and people will only attend it if they have the fullest confidence in the nurse and the doctor and are received with tact, goodwill and sympathy. You can have two centres in neighbouring towns, one costing two or three times as much as the other and yet not half as successful on account of the personnel. This matter of personnel in welfare service is very much more important than money. As far as I can see, the result of this block grant will be, first of all, an increased number of centres, particularly in necessitous areas, which up to the present have not been able to afford them. We shall also find that we shall have an efficient standard in all the centres. Finally it will act as a stimulus to initiative and efficiency that there is no Government control of expenditure. I am convinced that these services will not suffer in any way by the substitution of block grants for percentage grants. They will benefit by the influence of an increased local autonomy, fortified by an insistent public opinion and by a deliverance from the insidious charm of the stimulating cocktail of percentage grants to the lasting and beneficial effect of the tonic block grants, which will enable enlightened and progressive local authorities to build up this young but very lusty social service.

I am sorry the Noble Lady the Member for Southend (Countess of Iveagh) who spoke has left the House because I shall deal with her speech rather in detail. The hon. Member for Royton (Dr. Davies), who has just sat down, has told us that tact and sympathy are a very good substitute for money. If you have tact and sympathy from the nurse flowing out over the locality you can apparently dispense quite easily with a great sum of money. The Noble Lady made very much the same plea. Her speech, indeed, was full of tact and sympathy and it ended by applauding everything the Government is doing to cut down and ruin these services. First of all she said that poorer authori- ties will have plenty of money to spend and, secondly, that the Minister would have power to enforce health services. Both those remarks are entirely and completely mistaken. What guarantee is there that local authorities are to get anything extra? They are to have a minimum of a shilling per head of the population over what they have lost in the standard year 1928–29. First of all, what is a shilling per head of the population? We have no detailed figures except as regards the county boroughs. If you look down the county boroughs, there are several who have either exactly a shilling per head of the population or who have their increases made up to one shilling. The amounts they actually get in rate relief are in some cases 1 d. and in some 1½d The best is 2½d. Blackburn will get 2.4d. Here is Bolton. Bolton will get 2.3d. The formula does not in the least, as I have frequently pointed out, correspond with the distinction between rich and poor. The incidence is so capricious that some rich places might gain a great deal and some poor places, under the unrestricted operation of the formula, might lose a great deal. I need not again go over the careful estimates of the accountants as to what would be the effect if the whole of the grant were distributed under the formula. If the whole of the grant were distributed under the formula, the industrial North would lose and the seaside towns would gain. But let us suppose that for the first three years the poorer districts get a penny or twopence off the rates. That is not very much. This has to account for all the losses with regard to the possible rise in rateable value of properties and to account for all the new road work, all the maternity work, tuberculosis work, venereal diseases work, and the rest. That little extra will leave some of the districts worse off if they do anything at all commensurable with regard to their health.

The Noble Lady seems to be under the impression that Clause 86 gives the Minister power to insist upon the maternity work being undertaken. It does not do so. No Clause asking for a reasonable standard can turn optional services into compulsory services. These services—tuberculosis, venereal disease and others—are optional. The authorities have secured an undertaking from the Minister that if any new service is imposed, including the changing of an optional service into a compulsory service, fresh money must be provided. No words said with regard to the maintenance of a reasonable standard of health can undo the expressed action of Parliament which has made venereal disease, maternity benefit and tuberculosis optional services which the councils can, if they like, carry out or leave alone. This is indeed a very badly drafted Clause.

I come to the question as to whether pound for pound does not encourage local authorities. Here I can leave behind what amateurs in local government have said. I appeal to people who have done work and to experienced officials. We have great, estimable voluntary associations, of which the Council for the Care of the Unmarried Mother and Her Child is one. First of all, as has been said, the whole of the evidence before the Meston Committee was in favour of proportional grants, and, if the Minister desires to know why proportional grants were necessary, I would advise him to ask the Home Secretary what was the evidence given with regard to the police, and whether the Home Secretary would, for a moment, admit a block grant for the police? There is plenty of evidence before the Meston Committee and otherwise—

On a point of Order. Is it in order for an hon. Member to refer to a Committee of which the evidence is not before the House?

What about the Safeguarding Committee?

I think the hon. Lady is not out of order.

When the police were to be reformed and placed under the control of the Home Office, the essential need was a proportional grant. No Home Secretary in his senses would dispense with a proportional grant for the police paid on efficiency. The reason is that the Government are in earnest in maintaining the efficiency of the police, and they do not very much mind leaving the efficiency of the health services to the local authorities. Each rate is determined for three years. If they desire to put it into their pockets, or use it to relieve the ratepayers, they can do so, but if they spend an additional farthing on health work, it will be additional expense, and they will be subjected to what I think is very illusory control under Clause 86.

I turn from the police. I have here two quotations, one of them from Sir George Newman, who says in his Report for 1927:

"There can be no doubt that the percentage Exchequer grants-in-aid on health services (Tuberculosis, Maternity and Child Welfare, Welfare of the Blind, Venereal diseases, Mental Deficiency, and the School Medical Services), have been of the highest possible value and incentive during the last 15 years, (a) in getting special medical services into operation, and (b) in guiding their direction. Those two advantages would not necessarily he lost by a system of quinquennial block grants, though some definite adjustments of administration will be necessary to secure them."

A block grant is quite a different thing from a fixed grant. We are dealing with a fixed grant. A block grant every five years on a programme may be a very good thing indeed and a thing which in the case of education authorities properly administered can be an excellent thing. I quote again from the minutes of evidence taken before the Royal Commission on Local Government. This is the evidence of the Ministry of Health:

"As is to be expected from the permissive character of the Maternity and Child Welfare Act…the schemes at present being administered differ widely as regards their efficiency and completeness. It has been the policy of the Minister and his predecessors to stimulate local authorities to initiate schemes, and so on."

There is no power to compel these authorities, and there is no power under this Measure to force what is an optional service on to local authorities.

"There is no power to compel local authorities, but the Minister has a lever in the form of the grant of 50 per cent. of the approved net expenditure."

And it goes on to say that

"it has in practice, achieved a fair minimum of efficiency."

I come to the extraordinarily unfortunate position of the health grants to voluntary societies. At the present time the Minister can make grants— proportional grants—direct to voluntary societies. Under the Bill, all they are to get is whatever the local authorities may give them by way of a scheme approved by the Ministry. This means that what the local authorities give them by means of a scheme will be taken away from the rest of their grant. The Council of the Unmarried Mother and Her Child stressed the point that they are the property and protege of no local authority. Their institution may be in London or in Plymouth or anywhere in the country, but they serve the country as a whole. It is part of then-technique that that should be so, and that these women should be sent far away from their native place in order to ensure the strictest possible privacy. These associations are the proteges of no local authority. They are the children of no local authorities. Some local authorities have already expressed the opinion that it is unfair to give grants which belong really and strictly to their own residents to a national society. That feeling, unreasonable as it may be, is very strongly felt. That Association consisting of experienced and devoted women, women who are doing a much more difficult task even that the local authorities do, have passed a definite resolution condemning the principles of the Bill and asking every woman who has a heart to rally to their defence. These women—most of them are not my friends politically—are good women who are doing one of the most difficult, dis-agreeable and humane pieces of work in the whole world. I will read what they say.

"This meeting of the National Council for the Unmarried Mother and Her Child views with the most serious apprehension the Government's proposal that the distribution of Exchequer grants to residential homes for unmarried mothers and illegitimate children should he entrusted to local authorities. While acknowledging the support at present given by a few local authorities to such homes, the Council is of opinion that should the new proposals come into effect, the work which has made so much progress in England and Wales since 1918 for the care of unmarried mothers and their children under the sympathetic and practical encouragement of the Ministry of Health and the Treasury must he gravely imperilled. The Council considers that owing to the particularly difficult social problems with which this branch of child welfare is bound up, it must be continued on national and not local lines if its progress is to continue, and therefore urges the Government to keep in the hands of the Minister of Health the allocation of State assistance for such voluntary institutions."

I have spoken of child welfare. The Noble Lady seemed to think that it was reductio ad absurdum to say that you must care for the sufferers from tuberculosis, care for the blind, take over the care of venereal disease, and the care of mental deficiency. We stand for a logical extension of the principle. Those interested in mental deficiency have pointed out that their grants are similar to those for maternity and child welfare. They have pointed out the deplorable state of the child mental deficiency and the adult mental deficients who are not looked after. Anyone who knows about the casual wards knows that mentally deficient casuals are going up and down the roads and from casual ward to casual ward, because no proper steps are taken to deal with their condition. Take the question of venereal disease. So reluctant were local authorities to take up the question that a grant of 50 per cent. was not enough; 75 per cent. had to be given. Do you think that local authorities who have been bribed by such an enormous percentage to undertake this work are going to carry it on when they have to take every additional penny they spend out of the block grants handed over for other purposes? And if the Minister had powers of compulsion! What are powers of compulsion? Unless the authorities are really willing, you cannot get them to do the work. It is desired by every local authority that the percentage grants should continue. Nobody can quote any local authority that is whole-heartedly and completely in favour of the Minister's proposals. Some of them have said that if these concessions were made they would not oppose the proposals. That is the utmost support the Minister has got for his local proposals. With regard to those persons who understand the business and charitable institutions; they are uttering one cry of alarm with regard to social services. When we are told that we must logically extend it to the other services, we say that these new services, so new, so important, so little developed, varying so much from county to county, are the services which of all others needs a proportional grant, and we express, along with the authorities I have quoted, our deep terror and apprehension at the effect of the Government's proposals.

There is, I think, general agreement as to the importance and the need for the development of these particular services, and I cannot claim in any way to share the apprehension which appears to be felt on the opposite benches as to their future under a block grant system. The hon. Member for East Ham, North (Miss Lawrence) referred to the attitude of the local authorities. It may be a matter of some interest to the Committee to know, in view of the hon. Member's observations, that this morning at a meeting of the County Councils' Association reference was made to this question and the Association were unanimously of opinion that the exclusion of the mental deficiency and maternity and child welfare services should not be made from the block grant system. In other words, that important organisation supports the proposal contained in this Bill.

I do not agree with the hon. Member for East Ham North, or with other hon. Members opposite that this change will be to the detriment of the maternity and child welfare service. On the contrary, I believe that the proposal will tend to stimulate the interest of local authorities in this service. Local authorities will in future be set free from the meticulous and often unnecessary and generally unwelcome supervision and control of Whitehall. That in itself is a very considerable gain. The local authorities will have more liberty of action, and more power of initiative, and I think they will be more likely to experiment and expand their services. The percentage grant system has led to considerable progress but, as has been pointed out on this side of the House, it is the rich boroughs and the rich places which have been able to make that progress most easily. Under the proposed block grant system the poor authorities and those less well blest with this world's goods, will be put on the same plane as their richer neighbours.

So far as the Government's proposals are concerned, surely it is a reasonable proposition that the local authorities should prepare a carefully considered scheme for the advancement of the services, and surely it is more likely to lead to the advancement of the services if a properly considered scheme is prepared. It will help to direct the service into those quarters where it is most useful and most required. I cannot share the doubts which have been expressed as to the willingness of the major local authorities to carry out these services. In the past, local authorities have not been found wanting; they have done their duty. What reason is there to think that they will be less active in doing their duty in the future than they have been in the past. If they do fail to do their duty, the remedy is to be found in Clause 36. That Clause penalises them by a reduction in grant if they fail to carry out their obligations. That will prove a more effective instrument for making local authorities carry out their duties and meeting their obligations than the present inducement of a percentage grant. It will be better, too, for many of the voluntary associations concerned. At the present time, in many eases voluntary organisations interested in maternity homes have to make applications to numerous different boards of guardians for contributions towards the financing of their homes. In future, instead of having to make application in so many quarters, these associations will be able to make application to the major authorities, who are more readily approached and more likely to be sympathetic. It is, therefore, a gain from the point of view of such voluntary organisations. I hope the Committee will reject the Amendment and support the proposal for the block grant, which will operate for the general advancement of the services which we have so much at heart.

It is a little difficult to speak quite patiently on this matter when we have to follow people whose own children have every care that money and service can possibly give them. We are dealing with a problem which is very difficult for hon. Gentlemen on the other side of the House to understand. We are dealing with problems of people who have not the money with which to feed their children properly or to give proper care and attention to their children. In the conditions under which we are living to-day, when whole areas of people are admittedly below the poverty line, the situation is becoming desperate. There is not enough money for proper medical attention and not enough money for nursing, and if we are not to have a C3 population that money must be provided by the local authorities. Hon. Members opposite seem to take it into their heads that the parents are the proper people to provide all that is needful; quite so, if they have the money with which to do it, but, under the conditions that exist to-day, the statisics tell their own tale. We cannot get away from the fact that the deaths of mothers in childbirth is the one cause of death, with the exception of cancer, which has not considerably decreased in the last 23 years. We have to remember that this is not a disease from which women die; it is the natural function of motherhood, and it is a function in which very few mothers ought to lose their lives; but they do lose their lives in increasing numbers because of the conditions of poverty in the necessitous areas. Therefore, I suggest that what this Committee ought to be doing to-day is not to see in what way this service can be standardised, but in what way it is possible to increase the money, the care and the attention necessary for it.

It is less easy to speak with patience on this subject when a doctor who really knows the conditions—I regret that he is not here—because he is the representative in this House of an area with a very high infant mortality—he represents one of the South Lancashire Divisions—takes up the attitude which he does, and when a lady who is herself a millionairess and has never known what it was to lack anything that she happened to need—I regret that she is not here—should take up the attitude which she does on this question. We are faced with this tremendous problem, which is not only a problem of the child as a child but a problem of the whole future life of the child. As Sir George Newman has repeatedly said, it is in the first few years of life that so many of the evils of the future are laid up. If the Minister of Health really cared about the economy of which he talks so much, he would be thinking of the future of the medical service, and of the necessity of giving these children a start in life. The hon. Member for Southend (Countess of Iveagh) is now present. May I repeat what I have said in her absence, that it ill behoves a lady who is herself a millionairess, and who has had for her children every care that can be given to them, to oppose the extension, or what is practically in effect opposition to the extension, in every possible way of maternity and child welfare services.

indicated dissent.

The Noble Lady shakes her head. I am not going to argue to prove it. [HON. MEMBERS: "Oh !"] One can state a proposition, and then leave one's opponents to disprove what one has stated. That does not seem to be an illogical procedure.

Would it not be just as illogical to say that because you are not a mother you have no right to talk about children?

One expects that type of cheap sneer.

What about your sneer about the millionairess?

We are getting rather far from the question of the block grant.

We are, surely, dealing with a matter which is, or ought to be, a matter of knowledge for every single person who is here. The remark of the hon. Member for the Sutton Division of Plymouth (Viscountess Astor) might be used against every man who happens to be sitting in this House.

They are fathers.

They do not, therefore, look after their children; I wish they did.

Do not they? I do.

The argument of the hon. Member for the Sutton Division would seem to be that because one is not married, whether one is a man or a woman, one cannot deal with a matter of this kind. One might as well say that one does not understand anything about the solar system because one does not happen to be a scientist.

One does not have to be poor to have a heart. Women who have money are just as much interested in infant welfare in this country as any other people.

You are more interested in keeping your money.

Oh, rats!

We are getting far away from the subject before the Committee.

I do not want it to be thought that I have ever suggested that all women who have money have no hearts. Some of the wealthiest women in this country have been connected with the council whose Resolution was read out by the hon. Member for East Ham North (Miss Lawrence) and who are opposing the Government's proposal in this connection. I merely suggested that this is a matter which vitally concerns the necessitous areas and which vitally concerns very poor people who have not the money to get the necessities of life for their children. The facts are shown in the statistics of the last 25 years in the stationary number of deaths from maternal mortality in childbirth, while there has been a decrease of deaths from all other diseases or causes. Let me come again to the necessitous areas, because it is with them that I am concerned more than anything else. Those who are supporting this Clause and who are referring to Clause 86 as giving the Minister power to deal with those authorities which are not doing this work properly, forget the strain that is going to be put on local authorities when this Bill comes into operation, especially those areas which may be called necessitous areas. Let me refer to the conditions in the area I represent, where they have the beginnings of an excellent maternity and child welfare service. If you are going to relieve the whole of the works of three-quarters of their rates, it means, if these services are to be expanding, that in the future these enormous works will only pay 3d. in the £ towards their development. When you have a block grant system, stabilised on the 1928–1929 expenditure, it means that, if an authority is doing its best to expand this service, which is bound to be in its infancy at the moment, and wants to show a similar expansion in the next five years, three-quarters of the extra expenditure will have to be found by the cottage population and shopkeepers of Middles-brough. The works which are to be derated to the extent of 75 per cent. will not share in that increased expenditure.

If the maternity and child welfare service was the only service affected it would not be so serious because the town council would be able to find the money, but when in an area already overcrowded every other service is going to be similarly hit it means that the extra expenditure, some of which would have been contributed by the works, will have to be found by the working people and shopkeepers of Middlesbrough. It is going to be a perfectly appalling problem; and the difficulty is that the maternity and child welfare service tends to be overlooked because it is such a small service. If everybody, every local authority, were really keen on the development of this service, I do not suppose it would matter very much because we could get the money, but the Minister of Health and his Department know that while certain authorities have done wonderful work there are others who have not troubled much about it. These people, whose grants are to be standardised on what they are spending at present, are the very people who ought to be encouraged to spend more. At present the encouragement is for local authorities to standardise their expenditure at what it is at present; and then Clause 86 cannot come into operation. If they are standardised at their present small expenditure the Minister of Health, from what we have seen of him, is not likely to press them to spend more under present conditions.

We have to realise also that a number of voluntary societies are doing excellent work in regard to maternity and child welfare. The good they have done cannot be measured; you have many women who are doing good voluntary service and excellent work. Many of them get no encouragement from local authorities at all and have to depend on the grants made by the Ministry. Here, again, grants in the future will be fixed on the amount received in 1928–29 and any increase in expenditure will have to be borne by the local authority. There again, instead of getting encouragement, you are getting standardisation. This is what I want to press most strongly upon hon. Members opposite, many of whom are as keen on this subject as hon. Members on this side. It depends entirely on the spirit in the local authority. If this was a service which had got into more or less good routine lines there would not be very much to be said about it; but it is so largely experimental. In dealing with children there is a very great deal which at present is only in the experimental stage, and when you are dealing with a service which is in an experimental stage it is surely not the time for standardisation. If, instead of the spirit of standardisation, you had the spirit of expansion you would get an entirely different spirit behind the development of the maternity and child welfare service.

The Minister of Health has provided that the extension of the road services must be left on the percentage basis. If that is true of that service it is infinitely truer of a matter which concerns the lives and welfare of children. It is difficult for any of us here to realise the appalling difficulties of a child in a slum street in a town. There is a lack of sunshine, a lack of privacy, a lack of quiet, and a lack of rest; and when we go round and talk to the mothers of these children we wonder how some of them ever grow up at all. We desire to bring to all these mothers the very best that medical service and medical science can offer. We ask that everything possible should be given to the development of this service. Yesterday we gave £650,000 rebate to the liquor traffic and tobacconists. Here you have £1,000,000 out of £45,000,000, a ludicrous amount at which to standardise the expenditure on this service. I want to plead for the maternity and child welfare service. I know it is possible to argue that under a block grant system certain authorities may be gingered up, but the Minister of Health has only to refer to the opposition which the President of the Board of Education encountered when he tried to do the same thing in education. Education is a highly-organised vested interest, so to speak, and it was able to resist the block grant system. Here you have a new system which is not organised. There are only groups of women who realise the importance of the service, with groups of medical men, and I appeal to the Minister, whose post bag I know must have been heavy with a tremendous number of appeals and resolutions, to accede to the request of those who are interested in this work and see whether it is not possible to remove the maternity and child welfare service out of the block grant system.

Many of us feel, with some Members of the Opposition, that we are not entirely satisfied with some of the health services being left under the block grant system, and we are anxious that the Minister should reassure us on one or two points. Under Clause 83, I think the voluntary associations are all right; they art; in a good position. In fact, I think their position is stronger than it has ever been before. As the hon. Member for East Ham North (Miss Lawrence) pointed out, the Minister of Health has no authority now to force maternity and child welfare centres on any locality, but with the increased grant for health services I think he may be able to bring them into line. What I am worried about is the extension of health services under the block grant. These health services have not grown because of popular demand. Indeed, they have grown in spite of general apathy, because they have been inspired by the central authority working mainly through voluntary associations in local authorities. The lead has generally come from the central body, and we feel that they are now going to be left entirely to the local authority. Every hon. Member knows, and no one better than the Minister of Health, how difficult it is, even with the percentage grant, to make some local authorities do what the central authority want them to do. If the maternity and child welfare service were older than it is, I should not worry about the block grant, but with all due respect to local authorities, the inspiration in vital matters, like housing, slum clearances, and health services, has generally come from the central authority. Very seldom do local authorities move unless they are prodded by the Minister of Health.

I hope the Minister of Health will make it quite clear how health services are going to expand under the block grant; and I should also like to know what he is going to do about new services. If a local authority wants to start a completely new service, how is that to be done? If it is left to the local authority, with a block grant, we know how difficult it will be. Nobody understands the difficulties better than the Minister of Health, and I am sure he would be the last person to discourage voluntary organisations throughout the country. At the present the voluntary associations dealing with maternity and child welfare do not understand the position and are nervous about the expansion of the work. I do not like to say anything about men in this connection. This is mostly women's work, and, while men in some local areas have taken an interest in the matter, the pressure has mostly come from the women. It has been a tremendous uphill fight; and I am sure the Minister does not want to do anything which will discourage voluntary societies. There is a real nervousness among the societies.

I wish to ask the Minister a question regarding Clause 86. You have an authority like that at Manchester. It is doing very well and you cannot say it is inadequate. But still it might do much better. How is the Minister going to make it possible for that work to expand under his block grant? How can it be as easy to secure expansion under the block grant as under the percentage grant? We find expansion difficult now under the percentage grant, and we do not want to make things more difficult under the block grant. I realise that the Minister has difficulties. He has to deal with the backward areas which have plenty of money and yet are failing to do their duty. That is one. of the real problems. On the Second Reading of the Bill I pointed out that the county councils were now doing less than half of what they could do under the percentage grant. How is. the Minister going to make them do more under the block grant? It is not a case of the poorer areas; it is a case of areas which can well afford to have this service and have not got it.

I am sure that the hon. Lady opposite, in referring to the Member for Southend (Countess of Iveagh), did not mean it when she referred to some of us, because we happen to be well to do, not being interested in children. I know that that was just a slip and did not resent her attitude at all. I have found that when it is a question of these services all classes of the community are interested. We have the tremendous problem of the children between one and four years of age. That problem has not been faced by the country yet. Does the Committee realise that 82,000 children under 14 years of age died last year, and that 23,000 died when between one and four years of age? We who are interested in child welfare want to be assured that we can go on as well under the block grant as under the percentage grant. We wish to be fair in the matter. I cannot follow the mind of any hon. Member who thinks that be- cause political opponents bring in a thing it is necessarily bad. I have heard condemnation of this Bill simply because the Minister of Health has brought it in. The hon. Member for Nelson and Colne (Mr. Greenwood) said that the Bill was bad from start to finish. I hope that when the hon. Member has the chance of bringing in a Bill which will try to deal in a statesmanlike way with a great social problem, we on this side will not get up and condemn it and say that, simply because it has been brought in by the other side, there is nothing good in it. That is a poor spirit to show.

We have a colossal problem to face and it calls for the goodwill of all sections of the Committee. I say quite frankly that if I thought for one moment that the Minister of Health was economising on the children of this country, I should be the first to denounce him. I do not believe that such is the case. But I do ask him to clear up the point I have put to him. If he does not do so, some of us reserve the right, on the Report stage, to move an Amendment for excluding the health services from the block grant. I hope that we shall not have to do that, but we would do it. The Minister has to convince some of us, and he has above all to convince the voluntary workers throughout the country who have given their lives to this task. It is not a popular work, as the hon. Member for East Middlesbrough (Miss Wilkinson) has said. It is work in which we have to meet tremendous apathy, and when it comes to the case of the local authorities we have to fight many vested interests which belong not to one class of the community but to all classes. If it had not been that the Minister of Health took up the question of housing some of the local authorities would never have made a move in that matter. The same remark applies to slum clearance. We are not willing to give up the percentage grant until we are assured that the health work is not to suffer, and we shall be grateful to the Minister if he can clear up the point.

We have now been discussing this subject for two hours, and perhaps it would be for the convenience of the Committee if I took the opportunity of making one or two observations upon the various views that have been put forward. Surely, it there be any subject in this Bill which ought to be outside all ordinary party controversies, it is this particular subject. In spite of any casual and perhaps unpremeditated observations that may have fallen from hon. Members on the other side, I do not think for one moment that they really believe that there is any difference of opinion between Members on one side or the other as to the value, as to the importance, as to the desirability of an expansion of our maternity and child welfare services, the results of which have been so remarkable and of which I think every one of us feels proud. Only to-day we have seen published in the newspapers the results of the Registrar-General's review of the figures of last year. We find that the infant mortality rate last year came down to 65 per 1,000, which is four per 1,000 lower than the previous best record in this country. So that, whilst it would be no doubt wrong to say that the whole of the tremendous improvement that has taken place in that rate is due to the maternity and child welfare service, yet I do not think anyone would have any doubt that the service has materially contributed to it.

If that be so, why should we not argue this question out on that assumption, that: all of us want the same thing and that really all we need to discuss is, what is the best way of getting it? Why should the hon. Member for Nelson and Colne (Mr. Greenwood) import the question of the Meston Committee, which was appointed by another Government and of which this Government has no cognisance at all because it has never reported? Why should he say that the real motive for introducing a system of block grants instead of percentage grants for the maternity and child welfare services is one of pure economy? Take the figures that the hon. Member quoted. They demonstrate the absurdity of his statement. What is this country spending yearly? £833,000,000. Out of that how much are we spending on maternity and child welfare? £1,000,000. Double it; make it £10,000,000. It still is only a trifling fraction of the total expenditure of the country. It is not conceivable, therefore, that the Treasury should seek to impose on the Ministry of Health a change of policy which, according to the suggestion made, is one that is likely to injure a service in which the Minister of Health takes the greatest interest and in respect of which the greatest tribute has been paid to the Ministry in this Debate. It is inconceivable that the Treasury-should seek to impose a change of policy on the Ministry of Health in respect of a service on which it can only gain a few hundred thousand pounds. No. Do not let us bring such obvious absurdities into our Debate. Let us seriously consider what are the arguments for and against the introduction of a change of system with regard to this particular service.

The hon. Member for Nelson and Colne said that he did not wish to confine his objections to the maternity and child welfare service: he wished only to take that as an illustration. Let me say again that I hope we shall not get into the sort of attitude about block grants and percentage grants that people take up about Protection and Free Trade. Do not let us be too abstract and theoretical about these matters. You may very well find that one system is best for one kind of service and another system best for another service. I myself take that attitude. I am disposed to judge the question of block grants or percentage grants on their merits as applied to particular services. Take housing, for instance. I am not attempting to interfere with the percentage grant in housing, because I do not think a change would be an improvement. One Member opposite, I think it was the hon. Member for East Ham North (Miss Lawrence), said that we were leaving the police on a percentage grant basis, and she inferred from that that we cared move for the police than for mothers and children. That is a very unfair assumption. Obviously the control of the police is to some extent still centralised, and there is a very clear distinction, therefore, between the case of the police and the case of a health service.

We are really now considering the maternity and child welfare service. An hon. Gentleman opposite said that whatever the case might be for treating the maternity and child welfare service differently from other services, any argument which could be adduced in favour of that could be adduced with a great deal stronger effect on behalf of the mental deficiency service. It has been said that this maternity and child welfare service is not popular. It is quite evident that the mental deficiency service is far more unpopular. It means a much greater responsibility on the part of local authorities, and there is a very much wider field that has to be covered than in the case of maternity and child welfare. Therefore, I agree with the hon. Member for Southend (Countess of Iveagh) that you could not possibly stop at the maternity and child welfare service, but would have to go on from one service to another, and it is very difficult to see where you could draw the line. But I am not going to put my arguments on the score that if you once open this door you cannot close it again. In my view it is in the best interests of the maternity and child welfare service that we should change the present system.

Why do I say that? It is a curious fact which must have struck other hon. Members as well as myself, that when, as one would have supposed, the whole argument of those who oppose any change would be that the present system is so perfect that you cannot improve it, that it has worked so well that it would be a crime to interfere with it— whereas that ought to have been their argument, on the contrary they are arguing just the opposite. The hon. Member for Nelson and Colne said that the present system approached as nearly to the ideal as it was possible to reach. What was the next thing he said? He said there was no service to-day that had been developed to the extent to which Parliament intended it ought to be developed. He took as a particular example maternity and child welfare services; and he said that there were only 847 ante-natal clinics in the whole of the country and that there ought to be 1847, or perhaps very many more. I quite agree with him. But, surely, that is a curious illustration of a most perfect and ideal system. I really cannot understand how the minds of hon. Members opposite work. They seem to think that the fact that the present system is not giving us the service that we ought to have, the fact that it has resulted in, as the hon. Member for Nelson and Colne says, not a single service being developed in the way that Parliament intended, is an argument for the present system.

I cannot understand how even the most illogical mind could come to such a conclusion. It is a conclusion which I cannot accept, and it is precisely for that reason that I do not think there is any question of any warmth of feeling in this matter. It is, perhaps, the difference in the way in which our minds work. This is a question which we must take into account in considering whether we are running a serious risk in changing the system under which we are working to-day and I assure the Committee quite fully and quite calmly that at the Ministry of Health, where I am not looking at one particular locality, but where I have to consider the reports that come in from all localities, I do not find the present system satisfactory. I do not find that, where local authorities are indifferent or, let us say, niggardly, that the offer of pound for pound is sufficient to make them "willing" as the hon. Member for East Middlesbrough (Miss Wilkinson) put it. It does not make them willing. That is just the trouble. On the contrary, many of them remain unwilling, and, when they are unwilling, I have no power, nor has anyone in my office any power to put compulsion upon them. As the hon. Member for East Ham North quite truly said, the present services are optional and not compulsory. Therefore, if an authority says either that they cannot afford to do any more, or that they do not choose to do any more and that they are going to spend the money on something else, then, under the present system, the Minister of Health has no power whatever to force them to take any other course. I ask the Committee not to allow that particular point to leave its mind for a moment.

That is really the key and the kernel of the whole situation. That is why it is impossible to get along faster than we do under the present system. We were told by the hon. Member for South-West Bethnal Green (Mr. Harris), from his experience in London, that there are whole districts which are not adequately cared for at all. That is under the present percentage system, and that is exactly the difficulty with which we are faced. After all, there is at present an enormous difference in the financial resources and position of various localities throughout the country. The hon. Member for Nelson and Colne him- self recognised that it was very unfair that two places, each spending the same amount, but one poor and the other rich, only received the same amount of money from the Exchequer. The hon. Member recognised that fact, but that is under the very system which he said approached as closely to the ideal as it was possible to conceive. Yet he admitted that it had the fatal defect that the district which is poorest—and we may be quite sure that the poorest district is the one with the greatest need—is the one which gets least from the Exchequer.

I think the right hon. Gentleman is under a misapprehension as to what I said. He will find that to be so, if he will look at the OFFICIAL REPORT in the morning. I referred to the percentage grants, as modified by those other factors to which I alluded.

I am sorry if I misunderstood the hon. Member. I certainly do not want to make an unfair point. I, therefore, leave that point entirely, as far as the hon. Member personally is concerned. But my argument is not affected. The hon. Member was arguing in favour of the percentage system. I am pointing out where I think the percentage system fails. Some figures were quoted by the hon. Member for Southend. I would like to quote one or two other figures to show how the present system works. These are figures relating to four towns which are certainly poor relatively and which, certainly. do need maternity and child welfare services very badly. I am comparing them with four other towns which are comparatively well off. I want to show what is the difference in the assistance which they now get from the Exchequer. The figures which I propose to give are figures of the grants per child under five years and they are the figures for the year 1926–27. Here are the four towns: Gateshead, 2Vd. per child under five: Dudley. 21d.; Tynemouth, 36d.: Merthyr Tydvil, 43d. No one will say that these towns are not poor and that they are not just those towns where there ought to be very good services. Here are the others: Manchester, 128d. This I may again remind the Committee is per child and there is therefore no question of population. Liverpool, 107d.; Leeds, 140d.; Eastbourne, 200d.

How can you defend distribution of that kind? How can you say that that is likely to encourage the institution of adequate maternity and child welfare services in those poor districts? The worse off the districts are, the less they get. I say that is not an ideal system. It is really begging the question to say that we are opposing the extension of maternity and child welfare services if we advocate this change of system. The whole question is what is going to make for extension, or what is going to encourage the extension of the maternity and child welfare service. What do the Government propose? In the first place they are going to give the funds. Remember that the amount of money required per head to give an adequate maternity and child welfare service is very little. It is trifling when compared with such things as education and roads. The rate for such services add shillings in the pound, but in this case the amount is only about 5d. per head, taking an average over the country as the service is to-day. Even double it; make it 10d., and then remember that many towns and many counties under our scheme are going to gain three, ten and twenty times that amount and even more. Two hon. Members opposite spoke as though all the gain that was going to come to the counties and county boroughs was a shilling per head. I do not suppose they meant it. They must know quite well what are the circumstances in connection with the shilling per head. That is a guarantee, and the guarantee only comes into operation in quite a small number of cases.

In the vast majority of eases there is no need for the guarantee because the gain under the scheme is going to be much more than a shilling per head. I could not allow that point to go, because what was said might be misunderstood by some who had not that complete knowledge of the scheme possessed by those who used those words. That shilling per head is actually only a guarantee to those few places which are not going to gain a great deal more. Therefore, the position is that under this scheme it will not be possible, in future, for a local maternity and child welfare authority to say: "We cannot afford to have a proper service" because they are going to have sufficient money under the scheme to enable them to give sufficient services.

How much of this money is going to these services?

That will be for the local authority to determine. I must make one point at a time, and the point I was making at that moment was that there would be enough money. That cannot be denied. If the local authorities spend the money in the right way is another point. I have shown that, as things stand now, if a local authority chooses to spend the money which it has got on something else and not upon maternity and child welfare services, I have no power to say to that local authority: "You must bring your service up to the proper standard." Once I have given them sufficient funds to enable them to do it, without imposing, as one might say, an undue rate upon their ratepayers, I am given also, by this Bill, power to say to them: "Now, then, I am going to demand that you provide an adequate service." An hon. Member opposite has said that nothing in Clause 86 can convert optional into compulsory services. Of course that is perfectly true. I cannot force local authorities to give adequate maternity and child welfare services. But if I had a lever before, in being able to offer them something on condition that they spend a little themselves, I would have a much more powerful lever under this proposal, for I could take away from them that which they had got and there is no limit to the amount of their grant which I could take from them.

That power is subject, no doubt, to the presentation of a report to Parliament, and Parliament might not agree, but we are not concerned for the moment with the question of the exercise of the Minister's powers. What I am saying is that the Minister will have a lever which he never had before and, quite probably, instead of having to put that lever actually into operation he will only have to whisper into the ear of the local authority "Clause 86," and I think it will be unnecessary for him to go to extremities, because no local authority is going to resist a reasonable demand for adequate services of this character, and no local authority is going to risk the loss of a grant which will, in future, form a large and, in some cases, a very large part of its whole income. I said when moving the Second Reading of this Bill that I was quite willing to consider any Amendments which hon. Members put forward which might seem justified with a view to strengthening further the powers of the Minister. As my object, and I believe the object of everybody else, is to ensure adequate health services not only in the best and most progressive areas but everywhere throughout the country, I have myself examined the provisions of the Bill over and over again in the light of the various criticisms and suggestions which have been made.

Of course, I recognise that, as has been said by various hon. Members, there has been a considerable amount of apprehension in the minds of people in the country who were not actuated in any way by partisan motives, but who were genuinely interested in work in which many of them had been engaged, but who feared lest they should in some way be prejudiced by a drastic alteration of this kind. I think some of these bodies who passed resolutions have been a little hasty. They have passed those resolutions on some account which perhaps has been given to them, but they have not heard the other side. People who come to hasty resolutions of that kind have one disconcerting habit; they do not, if one may use an American colloquialism, "stay put." When somebody else comes along and puts the other side, they very often change their first view, and, in fact, that has happened in a number of cases; and it is not true to say that all these associations which are particularly concerned with women's work in one form or another have taken up an attitude of relentless hostility to this change. Many of them at first sight thought this was something which was going perhaps to injure their work, but when they understood better what it was, some of them have changed their minds; and only recently, in my own town, there was a meeting of the branch of the National Council of Women where this subject was debated, with the result that only four, out of a considerable number of people there, voted for the continuation of the present system. That was because an informed view of the differences between the two systems and of the provisions in the Bill was put before the meeting.

I want to say that I attach great importance to the work that is done in this connection by the voluntary associations. I have the greatest admiration for their work. I have always been in favour of the association between voluntary workers and municipal workers in social matters. I am certain that these voluntary associations bring into the common pool something which no municipal organisation can supply—something personal. After all, these are people who are doing the work, not because they are paid to do it, not because it is their livelihood, but because they are really themselves definitely and personally interested in it. I am quite certain that anything which would destroy a partnership of that kind would be very unfortunate and very wrong, and, therefore, I am very anxious that the voluntary associations should be assured that their interests have been properly looked after in this Bill. Under Clause 83 the Minister himself is brought in to see that their interests are properly looked after.

The hon. Member for South West Bethnal Green spoke about the work of a voluntary association in London which he thought might be prejudiced, because, as he said, it did work for the whole of London, and individual Metropolitan boroughs might not care to contribute to an association which was not specifically connected with their particular area. I do not think he can have read the Clause, for, if he had, he would have seen that it provides that the Minister himself has got to make a scheme for London, after consultation, under which it is to be stated how much the London County Council and how much the borough councils are to contribute to any particular voluntary association; and, therefore, the interests of that voluntary association are amply protected in that particular Clause.

So, too, with the associations in the country. Do not let them suppose for a moment that what they call the guiding hand of the Ministry is going to be withdrawn. The inspections of this work by the officers of the Ministry will still continue, though in a different form than in the past. The Minister, by his officers, will be kept in the closest touch with the work that they are doing; and although it is true that those institutions and associations which have in the past received a grant direct from the Ministry will now have to take that grant from the local authority, yet I think it will be seen that, since the Minister's approval to the scheme, under which the contributions of the local authorities to the associations are fixed, has to be obtained, it is in the power of the Minister to look after the interests of these voluntary associations in the future just as he has been able to do it in the past.

In the case of an association which, though it has its headquarters in London, operates in different parts of the country, such, for instance, as the one relating to unmarried mothers, is the right hon. Gentleman satisfied that he has sufficient powers to protect their interests?

Yes. The institutions of that particular society, which now get direct grants from the Ministry, are serving, although they may be centralised in some respects, in particular localities and areas, and any schemes which may be approved by the Minister will secure that they get at least as much, as they are getting now from the Ministry of Health, from the various local authorities which will be called in to support them in the future. I was going on to say that there was one point which has been put to me, which I thought did require some further attention, and it was this: It was said to me, "It is all very well for the Minister to say that at the beginning of a quinquennium or of a fixed grant period, as we shall now call it, be may make a scheme which is perfectly satisfactory in the conditions that then exist, but supposing that in the course of a fixed period some voluntary association desires to extend its services, or some new body of people wish to form a new voluntary association, and supposing they go to the local authority and ask them for assistance, and the local authority say No, our scheme has been approved, and you must wait until the end of the grant period before we make any alteration, what then? Is not this body going to be rendered helpless for the rest of the fixed period?" It seemed to me that that was a point which ought to be met, which had some real substance in it, and some hon. Members may perhaps have noticed that I have put down on the Paper a new Clause to deal with this question, under which it will be possible for Such. a voluntary association to make a representation to the Minister, and that, on receipt of that representation, the Minister will have power, after consultation with the local authority, to call for the scheme which has already been approved and to alter it in such way as he thinks fit. I think that ought to meet the particular point that, whilst schemes that might be approved at the beginning of a fixed period may be adequate in themselves and for the time, yet there is no sufficient room for expansion in the Bill.

That, really, is the second Amendment that I have got down on the Paper.

There is one other point dealt with in that Amendment on which I was going to speak, and that is the case of new services. That, of course, is a different point. There, there is no question of discontinued grants, because by hypothesis these are services which do not now exist, but if Parliament should impose on local authorities a new service which is going to mean new-expenditure on the part of the local authorities, clearly it would be only just that Parliament should make, some provision for an additional contribution from the Exchequer towards the cost of that service. I did not originally put a Clause to that effect in the Bill, because I thought the thing was so self-evident, that it was quite clear that Parliament could not impose upon an authority new expenditure of this kind without helping them to find new resources, but in deference to the desire of some associations of local authorities, with whom I have been discussing these matters, I have now put down a Clause, which hon. Members again will find on the Paper, which declares the intention of Parliament that such provision should be made in the future in the case of such new services.

There are one or two other Amendments, which I do not think I ought to discuss at this stage, but they are Amendments to Clause 86 and other Clauses, all of which have in view the strengthening of the powers of the Minister and the additional security of the voluntary associations which are now engaged in this work. I ask the Committee to consider the points that I have put before them; I ask them to consider whether the present situation of the health services under the conditions of the percentage system are so satisfactory that we can be content to go on in the future as we have been doing in the past; I ask them to remember that there is not a single hon. Member who has supported the Amendment who has not, in the course of his speech, pointed out the deficiencies of our present system; and I say, in those circumstances, seeing that those deficiencies are to a considerable extent, at any rate, to be traced to the actual operation of this percentage system, that there is a good case for a change. My final word is this: After all, the whole system, the whole of the changes which are produced by this Bill, will have to be reviewed before many years are over, and there will be an opportunity then for people to compare the working of the old system with that of the new, and in these circumstances surely it is wise to accept the provision in the Bill as it stands.

I am very disappointed to hear the speech of the Minister. After an experience of administration of infant and maternity welfare schemes from their inception, I think that the percentage grant has been the finest lever that progressively-minded people could use in order to get them established, and although the Minister may say that he is not influenced in the slightest degree by a desire for economy in changing the system of grants, I cannot divest my mind of the fact that all along, since municipalities started to spend money on the percentage grant; system, all the reactionary bodies, such as ratepayers' associations, chambers of trade, and so on, who are opposed to this new development, have been demanding the abolition of the percentage grant system. It may be true, as the Minister says, that in the main there may be possibly a larger sum of money at the disposal of some authorities for this purpose if they choose so to use it, but having regard to the fact that infant and maternity care centres have been established in the teeth of a very fierce opposition on the part of those who ought to have supported them, I have some doubts, because these pioneering associations have not been established, as the Noble Lady suggested, at Eastbourne and places like that, but in industrial centres, where the evils of the child labour system have existed, where people have been made millionaires out of the blood and sinew of little children. It is in such places that these child welfare centres have become necessary. To-day, instead of those sights of twisted limbs and blinded children, due to their mothers having had to go to work in the mill, we can see the dawn of a better day, and then comes the blighting influence of the Minister of Health to change the whole system by which this work has been made possible. This is essentially a national service, and the nation is proposing under this Clause to evade its just share of the responsibility for the work. People of good-will who really want to see a healthy nation will come to the conclusion that the Minister's speech was a brilliant debating effort, but that it was no good from the point of view of developing the cause for which he claims to stand. I feel that this Clause is a breach of faith with those authorities who have, on the promise of the percentage grant, established these beneficent institutions, because the whole weight of the expenditure does not come upon the local rates in the first year. It is very often an increasing burden. Such cities as I represent are faced with a possible reduction in income, because I am satisfied that even on the Minister's showing places like Newcastle-on-Tyne and Bradford are not likely to receive an increase in the amount that will be available, although Gateshead may benefit, and it well needs it. I am just afraid that, having regard to the fact that this Bill is going to leave these large municipalities with heavy burdens of debt, which the Minister has not adequately dealt with, and that there will be a tendency to meet these obligations, there will not be the money available for those schemes which the Minister expects.

I am satisfied that, as a measure of economy, the money spent on infant and maternity welfare centres is the wisest expenditure that any municipality can make. We already see evidence of it, particularly in regard to blindness in children. I was very gratified to find that a school for blind children in the locality where I live had to be closed because there were not sufficient scholars to keep the school fully employed, and that the beneficent work of the infant centre had reduced the number of blind children who required a specialised form of instruction. Therefore, by spending money on infant welfare, we are able to save money in the provision of instruction for blind children, to say nothing of the alleviation of unnecessary sufferings. Illustrations of that character could be multiplied, and I am satisfied that the same thing would apply in that other costly form of service, mental deficiency centres. I sincerely trust that, even at this late hour, better counsels will prevail. I do not question the Minister's interest in this matter. He does know, and he has the light, but the curse of it is that he is sinning against the light. He has seen all, and he knows all that I could tell him and a great deal more. He has seen houses thrust up against the mill, and I have been with him when he saw them and said that it was a bad system. But, unfortunately, he is cutting away the advantages we have gained, and is discouraging the people engaged in this work. Then millionaires' wives get up here in the way they have done to-day, and I trust that it will have a reaction upon all those who support this Clause.

The Committee should remember that this Amendment was introduced by Conservative Members, and that during the Debate some of the Conservative Members have expressed their doubts of the results of the proposal which the Minister is pushing through. The Noble Lady the Member for the Sutton Division of Plymouth (Viscountess Astor) has said that she will want further guarantees and explanations as to how the block grant is to produce the result which she says she wants, before she can feel satisfied about the Measure that the Government are pushing through. I do not know what she or other Conservative Members who were responsible for this Amendment think about the Minister's speech, but I feel that while he has made good debating points, he has left no guarantee with the Committee that he will be able to produce that steady progressive development which has assisted, as he admitted, to produce a reduced death rate among infants of so low a figure as 65. That result has been obtained, not by the sort of system that he is now instituting; it is a result to a considerable extent of the efforts that have been made by local authorities, inspired and pressed forward by the system that has operated so far.

Attention has been drawn more than once in this Debate to the fact that the Chief Medical Officer, Sir George Newman, has pointed out that there are in the elementary schools, 25 per cent. of the children who are suffering from ailments which, if they had been dealt with before they came to school, would not have existed at all. Yet when they come to school, and we have to begin to deal with the question of their physical efficiency, we are apparently content to operate on the basis of percentage grants. The Minister has said that he thought we ought to treat this question as one to be applied in different ways in different services. He is willing, he says, to judge upon the merits of the question regarding each service. I take it that, as a member of the Government, he has already judged that it is right to apply the system of percentage grants when dealing with the health of the children over five years of age. It is true that the Minister of Education made an attempt some time ago to get rid of the process of percentage grants in the educational system, but by the pressure that came from the House and from organisations in the country, and because, I hope, the Government saw the light, they dropped that proposal and returned to the old method of paying percentage grants for the health of children over five years of age.

Will the Minister, or any Member on that side of the Committee, say, judging on the merits of the question, why you should alter that process when you come to deal with the question of maternal welfare? Will the Minister say why, having adopted the percentage grant system in the educational system, the Government have departed from it in this case? The Minister tried to make us believe that it was absurd to suggest that the Treasury had had any real influence in bringing about this result, and that it was in the interest of the economy pressure that the Treasury had done it. May I remind the Minister, although he does not seem in the least concerned with the arguments which we are putting before him, that it was Treasury pressure that caused him to save as low a sum as £12,000 on the milt of the babies? He would go a long way under Treasury pressure for a much smaller sum than the hundreds of thousands of pounds involved in this proposal. During the time the Minister has been in his post the Treasury has been engaged in pressing him and his Department into doing a good many things which I am sure he would not have done, having the interest of the health of the nation at heart. The Economy Bill in regard to health insurance was a case in which he yielded to Treasury pressure, and although he dismisses our contention that the Treasury has pressed him in this matter, it seems to me that, when we remember the other instances in which he has yielded, the case is very strong against him.

The action that the Government are taking will do exactly the opposite to what the hon. Member for Royton (Dr. Davies) said it would. His point seemed to be that you could effect under the block grant system such a change that with sympathetic and tactful persons like nurses and voluntary workers, you would be able to do all that you wanted to do. Would hon. Gentlemen be prepared to allow their women folk, in those great crises in their lives, to be dependent on the sympathy and tact of nurses, when skilled medical attention was most required? I speak the more feelingly about this matter because in Huddersfield, under the influence of the medical officer of health, recent experiments have been made about which I hope the Ministry of Health know something. The town of Huddersfield was divided by the local authority into three areas. In one of those areas, instead of leaving the care of mothers and children to sympathetic and tactful voluntary persons and nurses, an arrangement was made for a monthly visit before birth and after birth by a skilled medical man. Medical assistants were especially appointed for the job. In the third of the town where this experiment has been tried, the death rate was reduced some 10 or 11 per 1,000 during the short period in which it has been in operation. The Huddersfield Town Council, in my judgment, did not act quickly enough; they did not go on at once to apply that system in the other areas of the town; and I am quite certain that as the incentive-has now been taken away, and as the block grant is to rule in the future, it will be very unlikely that that advantageous experiment will he extended.

Many other towns besides Huddersfield will continue what have been called the tactful, sympathetic but inefficient processes, even though the lives of our wives and our babies are involved. The Minister talked about believing one another's intentions to be good. Of course, our intentions are good, but we know the end of the road which is paved with good intentions. What we want to hear from the Government is how they will be able to give effect to their good intentions through the local authorities; and I suggest that just as they know that in the matter of education they must keep to the percentage grant system, so they also know, if they will admit the truth, that the percentage grant system should have been retained for these services also.

I wish to support the Amendment. I listened carefully to the speech of the Minister, and in some measure certain doubts were removed, but I would like to ask him to answer the point he put as to what is going to encourage a further development in these services. Compliments have been paid to the Bradford Corporation, and every member who comes from Bradford must be proud of the health services of that city. I shall not adopt the attitude of another Member who comes from Bradford and find fault with other organisations because they happen to be very often against this particular side. I recall that not so many years ago the Bradford Corporation, who had been running a maternity home, closed it. The voluntary associations of the city then took up the work, and I believe they have carried it on efficiently ever since. I am content to believe that the Bradford Corporation and similar authorities will not neglect maternity or child welfare work, whatever may be in this Bill; but there are a tremendous number of voluntary workers in our cities who have rendered magnificent ser- vice in this direction, and it would ill become Parliament to do anything which would put back the clock as far as they are concerned.

The enthusiasm of the people who have engaged in this voluntary work ought to be encouraged at every point. They have done magnificent work. They took up this work before Parliament or the local councils awoke to the fact that it was necessary. What I ask of the Minister this afternoon is that in his reply he should answer the point which he himself put. What encouragement are we going to give to these voluntary associations to carry on and develop the work which they do at the present time? I do not agree with the hon. Member for Nelson and Colne (Mr. Greenwood) in condemning the whole system. I am just drawing attention to two new social services and pointing out that in the past few years more voluntary help has been received in working them than in (managing any other social services. That being so, we ought to say to these voluntary workers that they will not be hindered but encouraged.

As I understood the Minister's case this afternoon, it rested upon two main principles. He said, in the first place, that the scheme of the Government was better than the percentage grant system because it would provide a larger sum of money for distribution amongst local authorities. He said the Government were now going to give more money for social services than had hitherto come from the National Exchequer. His second point was that in the distribution of the money there would be a levelling-up of inequalities and the necessitous areas would gain under the scheme. I want to say quite definitely that the provisions of this Bill will not realise the statements or fulfil the expectations of the Minister. It is by now definitely clear to all who have studied it that the total sum of money which will accrue to local authorities in ensuing years will be less than would have come to them if the present system had remained in being; and, furthermore, great inequalities will still exist; you will still have the necessitous areas, and this scheme will do nothing to relieve their plight. I notice that the Parliamentary Secretary is again looking as though he were the essence of wisdom and geniality. Let me remind him of what a paper with which, I understand, Lord Birkenhead has recently become associated had to say when discussing this scheme. The name of the paper is "Britannia" and in it, under the heading of "A mistake in tactics," I find the following:

"The only mistake made by the Government over this scheme was the lip service paid by their spokesmen to the sacred cause of increased expenditure. It is time to say more openly that the limit of public assistance has been reached. The great merit of the Government Bill is that it will, wherever it is reasonably possible, stabilise expenditure."

That is the whole purpose and function of the Bill on its financial side.

Let us examine in detail what is happening. The Government have taken £16,000,000 as the figure for grant and have fixed it for all time, in spite of the fact that this grant was growing. That £16,000,000 would have grown. The Government have also taken £24,000,000, as the income which is now derived from rates, which was also an expanding figure, and have fixed that. Therefore, instead of the £16,000,000 from present grants and the £24,000,000 from the rates being allowed to expand normally, they are now fixed for all time. If we examine these figures I think we shall find there is no money left for expanding services. According to the Government's own returns, in 1926–27 the figures of £16,000,000 stood at £14,000,000. By 1928–29 it had grown to £16,000,000. On the percentage basis it had expanded by £2,000,000, an average of £1,000,000 a year. It has been found, going back into past years, that these grants, totalling £16,000,000, have been expanding at the rate of 6 per cent. per annum If we work out on that basis, the increase over a period of five years, we shall find that the £16,000,000 grows in this way. If the grant system had been allowed to remain as it is, then in 1929–30 that £16,000,000 would have automatically grown to £16,960,000; in 1930–31, to £17,977,600; in 1931–32, to £19,056,000; in 1932–33, to £20,209,000; in 1933–34, to £21,422,000 and in 1934–35, to £22,707,000.

We see that the present grant would have risen from £16,000,000 to over £22,000,000. What does the Government scheme do? It simply gives £16,000,000 each year. Therefore there will be losses varying from £1,977,000 in the first year of its operation to £6,707,000 in 1934–35. I am glad the Parliamentary Secretary is now looking into matters. Let me now take the losses on the rates. £24,000,000 is the sum now paid.

The hon. Member cannot possibly deal with the question of rates on this Amendment. That would have to be deferred to a subsequent Amendment. The question of loss on rates does not arise at all under this Amendment.

I understood that we were having a general discussion. I think the Minister's actual words were that the local authorities were going to have more money. It is impossible for me to discuss that statement unless I also take into account the income from rates. May I put it this way—that that rating income has now become grant income, and therefore I may discuss it now because it has become grant income? As I said, here is the sum of £24,000,000. How would that sum have expanded if the present system had not been interfered with? It is not right to call this a block grant, it is a fixed grant—fixed for all time. I hope the Committee will pardon me if I go into this matter in some detail. In 1928–29 it was £24,000,000, and that was the estimate made by the Government. In 1929–30, it would have been £25,260,000; in 1930–31, £26,460,000; and in 1931–32, £27,782,000.

I cannot permit the hon. Member to pursue that line of argument, because he is anticipating another Amendment which comes lower down on the Amendment Paper.

The argument we are using is that the proposal of the Minister of Health will not give much more, but much less money.

We cannot go into details of that kind on this Amendment, because that is anticipating an Amendment to the next Clause.

I do not know whether you were present, Captain Bourne, at the beginning of this discussion, when it was announced from the Chair that there was to be a general discussion. I have been present during the whole of the discussion, and I think it is admitted that the question of the rates and toe amount of the rates has been discussed.

It is a very difficult thing to compare one Chairman with another.

The hon. Lady certainly cannot do that.

Rightly or wrongly, the Minister of Health was allowed to base his whole case on the question which we desire to raise now.

With regard to what has been said by the right hon. Gentleman the Member for Boss and Cromarty (Mr. Macpherson), I may say that I was present at the beginning of the Debate and I heard the ruling which was given. The question raised was whether a block grant should or should not be taken, and that question was allowed a very wide discussion, but I cannot allow a wide discussion in reference to the question of the rates. With regard to the point which has been raised by the hon. Member for Wellingborough (Mr. Cove), I must point out that hon. Members must deal with any question of rates very briefly, because it is anticipating arguments which must arise on the next Clause.

I will try to keep within your ruling, Captain Bourne, and I will leave out one or two years with which I intended to deal, and come to the sum total. I wish to point out that there is a large sum of money lost by the expansion being replaced by fixed grants and by replacing expanding rate income by a fixed rate income. Taking these incomes for a period of five years, if you do not take into account the Road Fund, the authorities throughout the country will lose no less than £22,000,000. Therefore, the Government cannot argue that this scheme, by the provision of a greater national pool, is going to allow the local authorities to spend more money on social services. There is a definite loss of income both from the point of view of grants and rates, and the whole object of the scheme is to stabilise expenditure on social services, thus throwing an increasing burden upon the ratepayers of the country.

I hope we shall be able to pursue this question further on the next Clause. It has been suggested that the expansion during subsequent periods will rise according to the expenditure of the local authorities, but I would like to point out that there will be no such expansion in the case of individual local authorities. The Minister of Health has claimed that each individual local authority which needs the money as an individual authority will get more money from the Exchequer, but that is not true. It is perfectly true that expenditure may be embarked upon by progressive authorities upon social services of various kinds, but the whole of that increasing expenditure will be thrown more and more on the restricted rateable field. Tie rates are bound to go up under this scheme, and I hope to show, if I have an opportunity of addressing the Committee on the next Clause, that the rates will go up on account of education and on account of other social services. Generally speaking, the whole weight of this scheme will have the effect of killing social services, or those services will be thrown as a burden upon the restricted rateable areas throughout the country.

As my name is associated with another Amendment dealing with this particular subject, perhaps I may be allowed to make one or two remarks in the general discussion of this question. There is no doubt whatever that the maternity and child welfare services are the common interests of everyone who takes an interest in the health services of this country I have always felt that the percentage system is full of dangers and defects, and those defects have been so well pointed out by the Minister of Health that it is not necessary for me to stress them. On the other hand, there is not the smallest doubt that there is a great deal of apprehension on the part of many organisations that the particular work which they carry on may be affected by the change over, although they admit that the change over is a preferable system of grants.

I endeavoured to give an instance of this kind in the course of an interruption during the speech of the Minister of Health and it was the case of an association with its headquarters in London which interests itself in the question of the interests of unmarried mothers throughout the country. Of course, the work of those societies has to be undertaken under conditions of the greatest possible secrecy. The work of this particular organisation was undertaken in an area outside the area of the headquarters which, in this particular case, happened to be in London. Consequently, this is a case in which the local authority concerned might reasonably consider itself aggrieved if it had to pay to an organisation of that kind expenses which in the past have been largely defrayed by a direct grant from the Ministry. I can see no provision in the Bill by which the Minister could make grants directly to an association of that character nor can I see where its funds are to come from.

I agree with the Minister of Health that the question of the exclusion of maternity and child welfare services from the block grant system, whether that is good or bad, must be considered in relation to the whole of the Bill, and for that reason I must reserve my right to move an Amendment to this Clause on the Report stage. Of course, we cannot say at the present time whether these societies are justified in their apprehensions or not until we have seen the final form assumed by Clause 86, which I consider is the most important Clause of the Bill. As far as voluntary associations are concerned, they appear to be in an excellent position under Clause 83; in fact, they appear to be in a better position than they have ever been in before, because under that Clause the Minister has power to direct how much a local authority shall contribute to voluntary organisations operating in their respective areas.

As far as backward authorities are concerned, I think their position is likely to be improved. Under Clause 86 there will be power to level up the standard of health services throughout the country. Other organisations do not seem to receive the same encouragement under the Bill as those classes to which I have alluded. In the case of a municipal child welfare centre that is comparatively well run at the present time, there is certainly no stimulus given to it under Clause 86. Probably I should be out of order if I went more closely into that subject. It is in respect of areas in which these new services have already been established, though not so well as we should have liked, that there is some ground for apprehension as to what their position will be under this Measure as a whole. I do not believe that any of the constructive Amendments under this Clause can be satisfactorily dealt with until the whole Bill is considered on the Report stage. For my own part, I keep an open mind as to whether in the case of these new services, the importance of which is not denied, it is not worth while stretching a point of principle in order to secure that they shall not suffer from a lack of finance. I think the Noble Lady the Member for the Sutton Division of Plymouth (Viscountess Astor) will agree with me that the proposal she has in view would not be relevant in face of the proposed alteration of the first period to which the Minister of Health has suggested an Amendment. A very large part of the principle for which we have contended has been conceded in the new Clause which stands in the name of the Government relating to new services.

It seems to me that all those who have spoken from the Government Benches have proved the case for the retention of the percentage grant, since they have expressed fears again and again as to what would take place if the block grant—or, as it was called by my hon. Friend the Member for Wellingborough (Mr. Cove), the fixed grant— came into operation. One would imagine, from the speech of the Minister, that someone on this side of the Committee had stated that the percentage grant system was a perfect system under which maternity and child welfare work should be continued. No one on this side made such a statement. What we did say was that the method proposed in this Bill is not a better, but a worse method of operating the system which we claim should be put in operation to a greater extent than it is at the present time, tinder the block grant system which is now proposed, those districts which have not taken up this work as they ought to have done are not going to be encouraged in the way that we have heard suggested during this Debate. An amount of money is to be granted to those districts, but there is to be no allocation of a proportion of that money for the purpose of these welfare centres, and those districts which have not been carrying out this good work up to the present are not going to be encouraged, even with the threat of Clause 86 hanging over them. Therefore, in opposing the method of the Bill, and in supporting this Amendment asking that maternity and child welfare work shall not be placed under the block grant system, I believe we are acting in the interests of the women and children of this country.

With regard to the remarks of the two Noble Ladies who spoke from the other side of the Committee, I was not quite sure where the Noble Lady the Member for the Sutton Division of Plymouth (Viscountess Astor) stood on this question, since, while not expressing herself very strongly in favour of the one system or the other, she apparently would be satisfied if the Minister answered certain questions. I could understand to some extent the attitude of the Noble Lady the Member for Southend (Countess of Iveagh), because one can see that they are expecting at Southend to receive considerable help from this Measure as compared with someother parts of the country. I would ask the Parliamentary Secretary whether he is going to show us how this block grant system is going to help those districts where we are now doing our best with these services—how it is going to help us to extend those services, and how, if we are able to prevail upon many of the districts to extend their services and give greater attention to this work, we are going to get greater assistance under this method of working. The Minister told us that the present method has not given us the best system, and that, therefore, we should change it. It has, however, taken a number of years to bring into the life of this country the centres for carrying out this work which is so essential to the community. I am not going to say a word against those who have been engaged in this voluntary work; I have been associated with many of them, and I know how difficult it has been to bring this work into operation to such an extent as to be of real advantage to the child life of this country.

My hon. Friend the Member for Huddersfield (Mr. J. Hudson) referred to the fact that the Government are convinced that the percentage grant method is much better than the block grant method when the child reaches school age. Surely, if it is good enough for that school period, it ought to be of advantage during these earlier days. The only argument used by the Minister to defend himself with regard to the percentage grant in the case of the police was that this particular service was centralised, but, if there is one service which should be centralised, seeing that it affects the whole nation rather than a particular district, it is the work of child welfare and the work on behalf of the women of this country. It is suggested that if we succeed in securing the continuance of the percentage grant we shall be tending to extravagance. The hon. Member for Royton (Dr. Davies), in his speech this afternoon, indicated the mind of the Government on this question when he said that it did lead to extravagance when the Government were prepared to make a grant of 50 per cent. I do not know that there is the smallest [piece of evidence that would justify such a statement. The hon. Member further stated that there are some people in the House of Commons who judge results by the money that is spent, but I think that that statement again was not justified. On this question of maternity and child welfare, it is not the amount of money that is spent, but the result in the health of the children and the women, and the point that we make to-day is that we are not being given sufficient money under this proposal to enable the work to be done that will give that health both to the children and to the women with whom we are concerned. I trust, therefore, that this Amendment will be pressed to a Division and carried, and that we shall not change to this block grant method, which has not been proved, by any speech that has been made in this Committee, to be of advantage to the children and women of this country.

After the absolutely devastating reply of the Minister of Health, there is really very little to be said on the general question, but I would like to make one or two comments on the arguments used by the hon. Member for Wellingborough (Mr. Cove) and, earlier in the Debate, by the hon. Member for Nelson and Colne (Mr. Greenwood). Hon. Members on the other side of the Committee have been talking a great deal to-day about stabilisation, and they have given the impression, whether intentionally or not, that under the Bill, the contribution which is going to be made by the Exchequer to the local authorities, that is to say, the amount of money which local authorities will have to spend, is to be stabilised on the amount that those authorities spend in the year 1928–29. That is perfectly true as far as it goes, but hon. Members have always omitted to remind the Committee that, in connection with the loss of rates, there is going to be a substantial grant of new money amounting to some £7,000,000 a year. The hon. Member for Wellingborough talked about the normal increase in the diecontinued grants—

May I point out that in my calculation, on which I arrived at a final sum of £22,000,000, I took into account the £5,000,000 of new money? I did not have enough time to develop it, but I would like the hon. Member to know that I did take into account the £5,000,000 of new money.

If I understood the hon. Member correctly, and I think I shall be within the recollection of the Committee, he said that there was a normal increase every year in the discontinued grants, and that the discontinued grants, which would amount this year to £16,000,000, would, in the ordinary course of events, be increased by 6 per cent. per annum I took down his figures. He said that the grants which are the subject of this Clause would have amounted next year to £16,960,000, in the following year to £17,977,000, and so forth, until at the end of six years they would amount to £22,000,000. His argument was that local authorities, in the normal course of events, would, at the end of six years, have had a total of £22,000,000 more to spend than they would under the present Bill. He based his argument on the assumption that there is a natural and inevitable increase in these discontinued grants, but he has no justification for imagining that what has happened in the past will necessarily continue to happen in the future. [Interruption.] Perhaps, before the hon. Member sneers, he will listen to what I say—

I am not sneering.

There is included in the £16,000,000 a definite sum of nearly £5,000,000 which is fixed and does not rise or fall, whereas the only important item which normally rises or falls is the money arising from the Estate Duties, which have been consistently rising since the War. Because, however, they have risen in the years since the War, it does not in the least necessarily follow that they will continue to rise during the next five or six years at the same rate. The hon. Member has, therefore, no possible justification for suggesting that, if things had gone on as they were before, the local authorities would have had more money to spend. Even supposing that he were right, and that, if things had gone on as they were before this alteration, the local authorities would have been £22,000,000 better off at the end of six years, he omitted to tell the Committee that, under the Government's proposal, the local authorities will be better off by six times the annual new money. That annual new money is going to be something like £7,000,000 a year, and, therefore, at the end of six years—the hon. Member need not shake his head—the local authorities in the course of the next six years will have received from the Exchequer £42,000,000 of new money which they would not otherwise have received, and they will, therefore, be better off even under his own calculation.

You have mistaken me altogether.

It is that sum of £42,000,000 which is going to provide the margin for increased expenditure. It is, therefore, totally inaccurate for hon. Members opposite to try to make the Committee think that the grants to local authorities are going to be stabilised at the exact figure for 1928–29; they are going to be stabilised, as hon. Members know perfectly well, at the figure for 1928–29 plus the new money.

The Minister has put forward the argument, as illustrating the difference between the present system and that proposed in the Bill, that he will be able, under the powers given to him by his system, to tell a local authority that they are not spending enough money on a particular service, and that they must spend more money. He said he would use his powers to compel them to spend more money in that direction. In order to deal with that argument I will take the grants for Sheffield for the year ending March, 1928, which amounted to £56,000. Of that sum, £37,000 was on account of tuberculosis, and less than £500 for the welfare of the blind. Supposing the Minister tells Sheffield that they are spending too little of his grant on the welfare of the blind, and that they must readjust their figures in order to give more to the blind. The Corporation will then say: "Very well, we will increase our expenditure to meet the demands of the Minister, but we shall have to reduce the amount coming out of the rates at the present time." As the Corporation is spending not £500 on the blind but £6,500, the actual effect upon improving the welfare of the blind will, therefore, be that they will not be any better off than before.

It seems to me the same argument might be used in regard to the whole of those services. Take the case of maternity and child welfare. The Minister knows what Sheffield is doing in regard to that, because he opened the new centre some months ago. I would point out how disastrous it would be if there were to be a transfer of some of the money we are spending in some directions to other services. Take the case of infantile mortality, which has dropped about 15 per cent. since 1923. During the same period, however, the mortality from puerperal fever and other accidents of childbirth has gone up by 88 per cent., which is a very serious matter. It is perfectly clear that we cannot cut down that grant with any hope of improving matters. In the case of tuberculosis, an attempt might be made to cut down the grant because the death rate has dropped by 18 per cent. since 1921, but the notifications of tuberculosis have gone up during the same period by 40 per cent. When you come to the case of the maternity centres, which have been developed so much in recent years, you find that the number of cases going to the centre has gone up by 238 per cent. in that period. It seems to me that, although it would not happen in the case of an authority like Sheffield, which has been so advanced for a number of years in these matters, in the case of other authorities, if they were compelled under the powers which the Minister gets to transfer money from one part of his grant to another service, it would not necessarily mean that they were really going to improve their health services. That is a very great danger, and I fear from what I heard in the Minister's speech that there is not going to be any real improvement in the health services of the country through the use of these powers.

We shall be going into the Lobby soon on this question of principle whether health services in future are to receive the block grant or are to remain under the present system. The Minister did not contribute as much helpful matter as usual this afternoon. His main argument was that the present system was a bad one, and therefore we ought to have a change, and that any sort of change was better than the present system. It is not enough to say that the present system is bad, and then to ask the Committee to take it for granted that what he proposes is better. The Committee would have been more gratified with his speech if he had brought forward evidence to show that this proposed change was for the benefit of the nation. There is such a thing as passing from the frying pan into the fire. I agree that we ought not to let considerations of economy come in. The point is which is the best system for the public health services of the country? Those who are connected with the administration of the public health services are singularly unanimous in having a strong preference for the existing system of percentage grants. The Minister said he had evidence to the contrary, but the only evidence he brought forward was of one meeting, that of the National Women's Council, and he would lead us to infer that that was the only meeting at which the whole truth in regard to this Bill was presented. It has been the King Charles's head of this Debate that the people who are concerned with public health administration prefer the present system.

I suggest to the Minister that there is a very plain way of showing to the Committee that his main consideration is the-improvement of the public health system of the country, and that is by taking com- pulsory powers in this Bill. We admit that 847 ante-natal clinics, which have been inspired to a large extent under the percentage grant system, are a very small number in proportion to the need of the country, and that 684 welfare centres are a very small development in relation to the widespread national need. Why will he not implement Clause 86 of this Bill with compulsory powers? His main argument is that he is going to confer greater benefits upon the towns and cities with the greatest need in the country. There is no guarantee, however, that the money they get will be used for this or that particular service, or for the introduction of services which at the present time are non-existent. Why, then, will he not apply the principle of compulsion and try to get maternity centres, ante-natal clinics, and tuberculosis services really established by compulsion in all places where real need can be established? If he will take up that position, it will make a very great difference.

The other point I would submit is this. In view of the overwhelming testimony of all concerned with the administration of these services that the percentage grant system is sound and beneficent, why, instead of throwing it overboard, does the right hon. Gentleman not try to work out some method of grafting his block grant system to the existing system, which has been proved to be good? All parties admit the inadequacy of the present system, and also admit that there is something good in it. Is it necessarily the last word in statesmanship to throw overboard what has been proved to be good, and merely to bring in change for its own sake? That is the kind of argument which the Minister applies to Socialists at their worst, that they are so fed up with the present system that they will make any kind of change without consideration. There is a good deal of evidence in favour of maintaining what is good and valuable in the existing system and of trying to graft on to it something which will do what he has been claiming his system will do. If he would do that, the Committee would adopt a different attitude towards this Bill.

The borough which I have the honour to represent shows even more progress in regard to maternity and child welfare ser- vices than Birmingham. For three years we have secured the Astor Shield for the best maternity and child welfare services. We should also have secured the shield this year if we had not given it up to the next best borough on the list, Kettering. My friends in this very excellent work, ladies who give up their own time to this volunteer work, which is having such excellent results for women and children, are very much perturbed at the result which will accrue after the passing of this Bill. I want to know exactly what will happen. No case has been put yet of the example of a small service which has an approved estimate progressing over a number of years. When I say approved, I mean encouraged under the guidance of the Ministry of Health. Suppose that this year you are spending £2,000 on this service, that next year you are going to spend £2,600, and the year after £3,000. In the ordinary course of circumstances, you would get under the percentage grant system £l,000 this year, £l,250 next, and £1,500 the year after. Under the Bill you are going to be fixed at the lowest figure. You will get £l,000 this year, next year and the third year, and the local authority will have to find from their rates an increase of £260 next year and £500 the following year. The Minister will doubtless say that the services are not going to be reduced. He says that there is a provision in the Act to preserve a reasonable standard of efficiency. I hope, when we come to it, he will include the word "adequacy." A microscopie maternity service can at least be efficient, but it is certainly not adequate.

I have been requested to ask the Minister to give special consideration to residential maternity homes. These are a special branch of maternity service that can be considered quite apart from the rest of it. We have one of these homes in my constituency which deals with unmarried mothers and their babies. The grants for these homes have hitherto been made direct from the Ministry of Health according to the number of girls accommodated in them and quite without any regard to the locality from which they come. It is one of the principles of these homes that girls are exchanged from one part of the country to another, because it is advisable to remove them from bad associations in their own district. That part of the usefulness of their work will be impaired, because the suggestion that the local authority will recover the cost from the girls' area will mean that these institutions will only deal with girls actually in the area in which the institutions are situated and that will militate very considerably against their usefulness. They have done very valuable work and they have received very valuable assistance from the Ministry of Health inspectors, who are able to supervise these homes all over the country and compare the work that is being done. This advantage will be lost if the homes are put under the parochial attention of the local authority. This work is extremely unpopular. It is work which un-instructed persons may not see the need for, and if there is a sudden call on the funds of our local authorities, such as an increase of unemployment, this very unpopular and, to many, unknown service will probably suffer.

I only rose to ask the Minister to give this matter his particular attention, and, if he cannot accede to the general discussion, he might see his way to include these homes in the other exceptions contained in the second Schedule. A very simple Amendment to that Schedule in my name will class these residential maternity homes with the training of midwives and health visitors, who are also exempted from the block grant. I urge the Minister to give the matter his special consideration.

I hope I may be allowed to make two points as an old medical officer of health who has been in close touch with these voluntary associations and in active co-operation with them for 30 years. I am bound to say, when the first general lines of the Bill were announced, I shared the very great anxiety that has been expressed at the abolition of the percentage grant. I will say no more at present than that under certain conditions I am convinced that the Bill as a whole is a very great advance and we have to make the most of it. But there are two points which have not been mentioned. Those on the opposite side especially who have spoken with such warmth on the subject of the ideals that are common to us all, seem to have left out of account the question of the distribution of the grant which is the alternative to the percentage grant which they were advocating. When you are contrasting the percentage grant and the block grant it is essential to bear in mind that the Bill introduces into what has been roughly called the block grant the new principle of weighted population.

We medical officers of health, looking at the thing from the point of view of the health of the people, must recognise that an extraordinarily interesting new factor is introduced into the world of administrative public health. This weighting of the population according to the number of children under five years old, and the number of unemployed, has very great possibilities. It is obvious that there will be a great deal more money in the new Bill, and it is obviously germane to consider how it is going to be distributed in future. Yet we have the hon. Member for Nelson and Colne (Mr. Greenwood) giving a philippic as if we or the public wanted to be convinced that we want to save maternal life. That is not in the least what he should have done. Representing the party that has made us spend days and weeks in discussing necessitous areas, he should have said, "Here is a Bill which is going for the first time to help to deal with necessitous areas on a new principle." He knows it will be extraordinarily helpful in dealing with really indigent people. But it would not do at all to be lauding the Government for a new principle of helping the necessitous areas, with which the opposite side wish to deal but can never bring forward any constructive proposal.

The second point is this: Obviously, a good deal depends upon how the local authorities of the future are going to use the powers given them under this Bill. That is a point that must appeal to those of us who have the administration of health measures. Over and over again we have felt that it is almost impossible to get a move on because of the lethargy of many local authorities. Some are keen, more especially those in industrial centres, others are indifferent and some are actually apathetic or hostile. You simply have your 30 or 40 per cent. going to the poll and very little interest is taken in the matter. If you look honestly at the Bill as a whole there is a great opportunity for getting greater interest and responsibility and focusing attention upon local government on business lines. Much will depend, quite independent of party, on trying to make use of the Bill to rouse local government. It is a difficult thing. I do not believe there is going to be a revolution but it will give a very large measure of support in that direction and, coupled with the enormous extension of the franchise, when the Bill becomes an Act, then will be the time to press upon new and old electors the great responsibility thrown upon them, and I believe if we can get a large measure of increased interest in local government we may find that we can trust the local authorities to carry out the block grant properly with very great advantage compared with the present system, and in that sense I look forward to the Bill as being the Magna Carta of local government.

I should like to follow the hon. and gallant Gentleman for a few moments to show how this discourages the extension of maternity and child welfare centre work. The poor districts are going to lose not only directly the amount of the Government grant but also a large amount of their rateable value. In my district, to raise £1,000 for maternity and child welfare will cost a penny rate. With that and the Government grant we can spend £2,000. If in the future we want to spend £2,000 we not only have no Government grant but we have to raise the rate on a restricted rateable area, so that to get the same amount of work we shall have to spend three times the amount, and that is going to be a very serious discouragement to poor local authorities, already heavily rated, to extend services which so greatly need extension. That will apply all the way round to optional services. Instead of encouraging it will discourage advance and it will encourage further restriction, if we get a reactionary council in our district. That is why I oppose the application of this system in these services.

It is a matter of great congratulation to us that at last the House of Commons almost unanimously accepts the Socialist principle that care for the health and well being of women and children is a matter for Parliament and for the country generally. We have got away from all the old ideas of individual responsibility and now everyone agrees with the Socialist argument, which some of us have grown old and grey in advocating, that the State has a responsibility for the life and well being of the masses.

Disraeli expressed it in 1875.

Whether he said it or not, it is only during the last very few years that the Tory party have given even lip service to the doctrine that you ascribe to one of your leaders of a generation ago. We are disagreeing to-day as to how we shall administer public money for the preservation of public health. It is a matter of very great regret that the House, instead of devoting the time we are devoting to this and similar Measures, does not tackle the question of why it is necessary that this sort of legislation should be passed, and why it is that masses of women and children are in such a plight that they must be assisted out of it by public effort and public money. It would be much better if we devoted our time to prevention rather than cure, and to getting rid of the causes of the evil rather than tackling the results of the evil.

I have got up to ask the Committee to remember that my hon. Friend the Member for Nelson and Colne (Mr. Greenwood) has been subjected to a good deal of criticism from speakers opposite, but nobody has met his point, namely, that first of all it is under the percentage grant system that the toll of death has been lessened in this country during the last 10 years. Nobody, I think, can deny that the bulk of the money has been spent in very poor areas. [Interruption.] No one will deny this anyhow, that in those districts where the system of percentage grants has operated, the very poor districts, such as the poorer districts of London and the poorer districts of Leeds, Bradford, Bristol and other towns of a like character, the death-rate among children has been halved. Nobody can deny that in London, in the poorer districts where my Friends have been in control and where we have gone to the Minister of Health and obtained a percentage grant in respect of the expenditure we ourselves could incur, the death-rate of our children has gone down in some cases by more than half.

I say that, before you scrap a system like that, you ought to give us some reasons for doing so. There are reasons in the increase of the preservation of the health of the people, and especially the preservation of the lives of children, for continuing the system which you are now upsetting. It is because-of this fact that the death-rate is so low. I have always tried to give credit to those members of the Coalition Government which was in office immediately after the War for instituting the legislation which has been under discussion this afternoon. Before it was possible to set up these health services under the municipalities, the conditions were very terrible indeed. We were only able to deal with the evil because the various Governments of the day have allowed us to have these percentage grants to carry on the work. There is a great deal of difference of opinion whether under the formula we are to have more money or not; whether under this system we shall get more during the next few years or less. There is one thing that no one can controvert. The money we are going to get will be based on the assumption that conditions are going to remain the same. In the district which I represent, our need has gone up year after year, and, if we are to have any lessening of the amount of money available through the operations of this Bill when it becomes an Act—and we shall have to get the money through the county council—if it means that we shall get less than we are getting now, it will, I am quite confident, result in a rise in the death-rate among our children and the lessening of the social services.

It is nonsense to think that this question can be dealt with in the poorer areas by private charity. There is no one living in the district in which I live who can give the necessary time and labour to the carrying on of such work. The only charity which carries on work of this kind is that in connection with the fund which, I think, was originally organised by the late Queen Alexandra. Even that charity has to carry on this work very largely in conjunction with ourselves and with the help of public money. Therefore, the least falling off of money and the stopping of our opportunities to develop that work must mean that we shall have an increase in bad health, and, I am certain, an increase in the death-rate among children. The real answer to the right hon. Gentleman and his very clever and adroit speech is that the figures of which he is so proud are figures which record the fact that under this system which is being condemned the death-rate among babies has gone down. That fact stands right out.

There is a further fact which neither the right hon. Gentleman nor anyone on those benches has yet attempted to controvert, and that is that not one farthing of expenditure under the percentage grant can be incurred without the approval and the definite sanction of the Minister and his Department. No one can controvert that fact. The right hon. Gentleman says that he is going to exercise control, but he forgets that he exercises control to-day, and that not a farthing can be spent, not a brick can be laid on a centre, not a nurse can be employed, no salary can be paid, not a dentist can be employed, not an instrument can be bought, without the sanction of the right hon. Gentleman if we want a percentage grant in aid of such expenditure. The right hon. Gentleman knows that as well as I do. It is sheer nonsense for some hon. Members to get up and talk as if the giving of these grants must of necessity mean lavish, extravagant expenditure of money. The right hon. Gentleman controls that money. Actually he is able to lay down conditions under which a mother shall receive a grant of milk or under which a person shall receive dental treatment.

Why should we be told to-day that this system must be altered? There is only one reason. Whether the right hon. Gentleman means it or not, it is believed that by this system money can be saved. Perhaps you can save money, but you will save it at the expense of the well-being of little children and the mothers of the country. That is the price which you will pay for it. It is because that is so, and because no one has met the points, that under this scheme the lives of children have been saved, the health of mothers has been preserved and that the Government control every halfpenny of expenditure that they grant, that we on this side are going to stand by the system which has brought about these results. If no one else goes into the Lobby in defence of that system, we intend to do so.

After the very sympathetic speech of my right hon. Friend, and subject to a careful perusal of the Amendments which I understand he is proposing to Clause 86, I am quite prepared to withdraw the Amendment.