§ Paragraph (b) of Sub-section (1) of Section thirteen of the Education (Administrative Provisions) Act, 1907, shall be amended so as to read "The duty to provide for the medical inspection of children immediately before or at the time of or as soon as possible after their admission to a public elementary school and on such other occasions as the Board of Education direct, and to make such arrangements as the Board of Education may direct and approve for attending to the health and physical condition of the children educated in public elementary schools."—[Mr. Bowntree.]
§ Brought up, and read the first time.
§ Mr. ROWNTREE
I beg to move "That the Clause be read a second time."
The effect of the Clause will be clear. It wants taking in conjunction with Clause 18 of the Bill wherein it is enacted that the local education authority for the purposes of Part II. of the Education Act of 1902 shall have the same powers and duties with reference to making provision for the medical inspection and treatment 1771 of children and young persons as a local education authority for the purposes of Part III. of the Education Act, 1902, have under paragraph (b), Sub-section (1), of Section 13 of the Education (Administrative Pensions) Act, 1907. In that Subsection it is laid down that it is the duty of the authority to inspect the children and that they have power to provide treatment. The object of my Clause is to alter that Sub-section and to make it a duty not only to inspect children, but also to treat children. I feel that this is a Clause of very great importance, and I should like to say at once, that, though I think it is probably brought forward in the best way, I am not at all wedded to the actual words, and, if I get the substance, I shall be satisfied with any words that the right hon. Gentleman may think best. Any one who has read the masterly Reports that have been issued from the Board of Education under the signature of the Chief Medical Officer of Health for the past ten years must have been impressed with the extraordinary value of the work that has been done by that department of the Board. We feel that the facts that have come to light with regard to the condition of the children attending school have been of very great and vital importance to the country. It is immensely important at a time when we are passing a Bill of this magnitude through the House to consider what are the facts that have been revealed, with regard to the physical condition of the children. Let me take an extract from the Report of the Chief Medical Officer of Health for 1916. He says:Of the children in attendance at school. 6,000,000, we know by medical inspection that many, though not specifically feeble-minded, are so dull and backward mentally as to be unable to derive full benefit from, their schooling. Upwards of 10 per cent. suffer from a like disability on account of uncleanliness, and 10 per cent. also are badly nourished.He then goes on to point out how not less than one half of the children suffer from dental troubles, how 500,000 have been found to suffer from defective sight, and how 250,000 suffer from complaints of the ear and throat. He then goes on to say:And in addition there are numbers with skin diseases, weak hearts, and tuberculosis.He gives utterance to a very remarkable statement which I hope the Committee will consider very carefully. He says that 1,000,000 children are so physically or 1772 mentally defective or so diseased as to be unable to derive reasonable benefit from the education which the State provides. It really is an appalling statement that one-sixth of the children in these days are in such a state physically and mentally that they are unable to derive reasonable benefit from the education which the State provides. I have been surprised that that sentence has not been quoted against the right hon. Gentleman by some of those who are rather seeptical of his measure, because if it is impossible for 1,000,000 children to enjoy the full benefits of the education that is provided in the elementary schools, it goes without saying that it is impossible for them to get the full benefit of the continued education which the right hon. Gentleman is hoping to provide in the new schools which he is setting up. Figures like these have made a very deep impression upon all social students in the country, and they feel that to-day, when we are mourning the loss of so many lives, it is enormously important for us to do all that we can to make the best use of the young who are coming forward, not only for their own sakes and for the sake of the development of their personalities, but also for the sake of the general welfare of the country.
If hon. Members have read the Chief Medical Officer's Report, they know perfectly well that a large amount of treatment has been undertaken by a number of progressive authorities, and that diseases and physical defects have in many cases been removed by the work-of the education authorities, who have treated the children in the schools or in some other way. The evidence of what has been done in a large number of districts, both rural and urban, in removing these defects by wise treatment, has naturally created a demand in the country that this treatment should be universal, and that it should be the duty of the education authority to treat these diseases in the same way that it is the duty of the authority to inspect the children. The Chief Medical Officer in his Report for 1916 says that not more than half of the children suffering from serious but remediable defects are cured of those defects during their school life. Not half at the present time are being treated. Yet these are defects that can be overcome by wise treatment, and the time has come for this House to take the opportunity of the passage of this Bill to ask the President of the Board of Education 1773 whether it is not possible to make treatment compulsory, at any rate in the elementary schools; and when I say "treament," of course I mean treatment in the broad and generous sense as defined in the Chief Medical Officer's Report. If hon. Members will look into this question, they will find that some of the results of the treatment are very remarkable indeed. I suppose, as far as clinics are concerned, the city of Bradford, perhaps, is the best example of an up-to-date service, and if hon. Members would get the last report of the medical officer of health for Bradford, they would find that the number of cases treated has advanced from 841 in 1908 to 14,559 in 1916. If you take two very serious defects, defective vision and defective throat, you will find that about 90 per cent. of the cases are dismissed as cured and the others are simply carried forward, the treatment not being finished.
Take the case of 500,000 children in areas where there is no treatment at all, and you will find that in those areas, according to a reply given by my right hon. Friend a few days ago, it is estimated that 17 per cent. of those children are suffering from defective vision and 11 per cent. from defective hearing. There are 85,000 children suffering from defects of vision and 55,000 suffering from defects of hearing, and nothing is being done to remove those defects in those areas. The experience of Bradford and other places show that, at any rate, 90 per cent. of those cases would yield to treatment, and that those children, after treatment, might be considered cured of those defects.
§ Mr. ROWNTREE
Possibly some of the children are deaf as well as blind, but the figures do not show how many are blind and how many are deaf.
§ Mr. ROWNTREE
Yes. It seems to me that there are four points upon which there will be fairly general agreement, or at least I hope so. I submit, in the first place, that the imposition of the duty of inspection by the State carries with it as a natural corollary the duty of treatment, and that the one without the other is a barren remedy and really somewhat of a mockery. Secondly, I believe that there 1774 is general agreement that compulsory secondary education can never secure results in cases where the physical basis is poor. The extension of the aid demands a simultaneous treatment of the physical needs of the young, who are supposed to benefit by it. Thirdly, a healthy childhood is the foundation of education. Fourthly, that whilst we ask for this extended treatment because we want a full personality of the children developed, yet it is wise for us at this time to look at the question from the economic standpoint as well.
There is a phrase, which my right hon. Friend uses in one of the Clauses setting up extended continuation classes, in which he speaks of helping the children to prepare for the freedom and responsibilities of adult life. I want to suggest that the first help we can give the children in order to prepare them for the freedom and responsibilities of adult life is to make them physically strong and fit. I am perfectly certain that my right hon. Friend will agree that this has a very important bearing on the industrial position as we find it to-day. In all up-to-date factories now it is the custom, and probably the right custom, to medically inspect applicants before they are placed on the list of employed. If some hon. Members have seen that inspection going on, they must again and again have felt how cruel it seems for a boy or a girl to be told, "You are not strong; you have got a physical defect, and you cannot be admitted to the factory." This is all the more cruel when you know that by wise treatment those physical defects could have been removed. [An HON. MEMBER: "How do you know that?"] I have tried to show that the facts, as revealed by the Chief Medical Officer of Health, prove that these defects can be remedied; that officer, in his Report, definitely said that there are 500,000 children who are not being medically treated, but who, if they were so treated, their defects could be remedied.
This really has a very important bearing on the industrial position to-day. I am sure every hon. Member of this Committee is anxious to see a new level of wages in the country, and those who know something about industry are hopeful that a higher standard of wages may be attained; but if this is to be attained, it can only be done by having the men and women physically fit and in possession of all their powers and capacities. At the present 1775 time we know that in a number of districts in England year by year children are passing through these schools with these defects, and nothing is being done to remedy them and give those children the inestimable advantage of a healthy and vigorous physique. In support of what I say I ask hon. Members to look at some of the Reports that have recently been issued with regard to the health of munition workers, and if they will read those Reports they will see again and again references to the enormous importance of dealing with the health of the people when they are young. Here is a short extract:There we are reminded that if a man is to live a life at the top of his capacity in body and mind and able to work with the highest powers and to grow in strength and the joy of life, the seeds of disease must be uprooted at their earliest beginning.The subject of industrial efficiency is in a larger degree one of preventive medicine.So, from all these standpoints, I hope my right hon. Friend will be able in this measure to go further than he has in the direction of securing further treatment for those in elementary schools. The Report for 1916 says:It cannot be too clearly understood that every step in the direction of making and keeping school children healthy is a step towards diminishing the prevalence and lightening the burden of disease for the adults. A relatively small rise in the standard of child health may represent a disproportionately large gain in physical health capacity and energy of the people as a whole.I think my right hon. Friend will agree that this is a question which should have the most careful consideration by the Committee before the Bill leaves this House. Talking this question over with some of those who are doubtful about the wisdom of this Clause, two or three objections have been raised. I am told that there is a shortage of doctors, and that it will be very difficult to carry this Clause out. I admit there is a shortage of doctors, but there is a shortage of teachers as well, and I would remind those who think that that is a difficulty that the measure is very gradual in the way it comes into operation. I have also been told by some of my hon. Friends that it is unwise to do this pending the establishment of a Ministry of Health. No doubt there is something in that point, but I think it is important for us to bear in mind that a Ministry of Health has not been set up yet. We know the enormous 1776 difficulties between Department and Department which are preventing that Bill from being brought forward in this House. I would also remind those who use that argument of the fact that my right hon. Friend when he was dealing with this question of treatment upon an Amendment before the Committee the other day, said definitely that, as far as the Board of Education were concerned, they looked upon the arrangement as an interim arrangement, recognising that there might be certain changes made if the Bill for a Ministry of Health became an Act.
I believe that those are the main objections to my proposal, and I hope the President and the Committee will feel that they are not adequate arguments to prevent the adoption of a Clause like this, which, I believe, would have the effect of doing so much to develop the health and the physique of the children. I apologise to the Committee for having spoken at some length on this matter, but I do hope that my right hon. Friend will be able to respond to a very wide sentiment outside, and I believe inside, this House in favour of some action being taken in this direction, and in that way he will do something to repair effectively the awful ravages that are being made by this War.
It was quite unnecessary for my hon. Friend the Member for York (Mr. Rowntree) to offer an apology for the length of his speech. He has spoken out of the fulness of his heart with great eloquence and sincerity upon one of the fundamental topics which meets every social reformer and everybody concerned with the progress of public education in this country. Although I cannot follow him in his precise proposal it is not from any lack of sympathy with the object he so eloquentlycommended to the Committee. Nobody who has studied the Reports of the Chief Medical Officer of the Board of Education can fail to be impressed with the gravity of the evil to which my hon. Friend has drawn attention or with the necessity for providing a remedy, but when we are asking in this Bill to impose upon local education authorities the duty of providing medical treatment we have to bear in mind two considerations. In the first place, that the school medical service is a plant of recent growth, and that although it was only established in 1907 its progress has been one of the most remarkable facts in our social life. The hon. Member drew attention to the 1777 number of authorities which do not at the present time provide treatment. Let me draw the attention of the Committee to the great growth and expansion of treatment provided by the local education authorities since the establishment of the school medical service in 1907. In 1908 there were fifty-five local education authorities who made arrangements for medical treatment. In 1916 that number had grown from fifty-five to 276. In 1908 there were seven local education authorities which provided school clinics. In 1916 there were 219. In 1908, eight local education authorities made contributions to hospitals, and in 1916 the contributions to hospitals were made by eighty-seven local education authorities. In 1908 twenty-one local education authorities made provision for the supply of spectacles to school children. In 1916, 216 local education authorities made such provision. I think, therefore, that although we have not achieved everything, the Committee may be satisfied that the progress under our present system has been very rapid and very encouraging, and it is the view of the Board that we may leave the progress and development of medical treatment to the voluntary action of local education authorities, stimulated and encouraged, as it will always be, by the constant pressure of the Board of Education. After all, the Committee must remember that the task of remedying the ailments of childhood is a great task, and in the words of the Greek philosopher,Nothing great can be done without time.I submit it would be the wisest course, at any rate, to continue to allow treatment to be provided by the voluntary action of local education authorities, so long as the Board is satisfied that there it a constantly expanding and developing area in which the treatment is taking place. Then I think there is a second consideration which ought to be borne in mind by the Committee. If you are going to make it mandatory on the local education authority to provide medical treatment, I think it will be necessary to define more closely than the hon. Member has attempted to do in this Amendment the amount of treatment, and the character of the treatment, which the local education authority ought to be required to provide. Also I think it will be necessary to circumscribe and define the number of ailments to be treated, and I submit to the Committee that that may be a matter of some difficulty. It is tolerably easy to make 1778 inspection mandatory on the local education authorities, but inspection is a very definite and circumscribed tiling, and the local education authorities when they are instructed to provide inspection should know exactly what they are required to do. If they are compelled and required to provide treatment, then I think they would need more information. For these two reasons, and not from any lack of sympathy with the general object the hon. Gentleman has in view, I feel it is impossible to accept his Amendment.
§ Mr. SHERWELL
The Committee will appreciate the force of the considerations which the President has just addressed to it, but he will forgive me if I say that we feel that his arguments do not dispose of the plea of my hon. Friend the Member for York (Mr. Rowntree). After all, this Bill is imposing very much higher standards of education and making very much greater demands, not merely upon the intellectual, but upon the physical powers of the children in our schools. It is quite true, as the right hon. Gentleman has suggested, that to provide for the compulsory medical inspection of children is a comparatively simple thing. It was because of its supreme simplicity that this House originally contented itself with making that provision in its Statutes, but the comparative worthlessness of that simple provision, which was commended to the House by its simplicity, speedily became apparent in practice. You discovered, in the process of your inspection, the existence of serious physical ailments, for the remedying of which you had made absolutely no provision. When the Insurance Act of 1911 was before the House some of us urged upon the then Chancellor of the Exchequer, the present Prime Minister, the futility of setting up a national scheme of health insurance when you were doing nothing to stop the sources from which the physical ailments of the adult population proceeded. It was in consideration of that that I urged upon the Chancellor of the Exchequer then the necessity of making provision, by State Grant, for the medical treatment of school children. He was good enough to accept the proposition, and since then a certain State assistance has been given for that purpose. The question is really of very much larger dimensions than the President has suggested to the Committee.
Take the present position of things. You have provision made in your Statutes 1779 for the medical inspection of school children, but the machinery by which that inspection is effected is so inadequate that you have to spread your inspection over a series of years and take only certain elements of your school population in a given year. At the present time you are never able to get, within an easy period of time, a complete inspection of the whole of the children in a particular school, so that your inspection to-day, even though it has been in force for so many years—I gratefully acknowledge it has extended itself in the course of its history—is not adequate to-day even as inspection. You are not securing an efficient inspection or a discovery of the physical condition of your school children. In a certain measure of time, by the limitation of the machinery for inspection, you have a large proportion of physical ailments, very materially affecting the educational attainments of your school population, undiscovered for a period of time, which is extremely unfortunate in its ultimate effects. This question of physical treatment lies at the very foundation of any educational arrangements. I believe it is really an extremely shortsighted policy to make demands of a higher kind upon the minds of your children, and, very properly, to raise the standard of your educational qualifications, unless you secure at the very beginning that the children are physically fit to profit by the educational opportunities you offer them. Very much more might be done than the President has suggested, and I would urge him to give further consideration to this point between now and the Report stage. I am quite satisfied that our experience so far has pointed conclusively to the fact that there is a physical condition among the school population of the country which intakes them unable to secure the benefits of the whole of the newer provisions you are providing in this admirable Bill. That being so, it is surely an unwise economy, both of finance and machinery, at the present time to set out with a new, greatly improved, and ex-tended educational system, when you know from the beginning that that new and extended system will be handicapped because of the physical deficiencies of the children which are known to exist. I earnestly entreat the President to give further consideration to this matter between now and Report, and to give his own most admirable scheme, as embodied 1780 in this Bill, a much better chance by looking to the foundations upon which that system must rest.
§ Mr. ALDEN
I trust that the President has not given us an absolute non possumus this afternoon. I know that his sympathies are with this new Clause. I am convinced that in his own mind he wishes it, but he does not see his way at the moment to put it into operation for various reasons. I should like to re-enforce what the hon. Member for Huddersfield (Mr. Sherwell) has said. I do not see how the children of this generation are going to benefit by the education which the President is so anxious to give them unless they are adequately equipped from a physical point of view. You cannot expect that they will benefit by the education which we so lavishly bestow upon them at such great pains and such great cost to the nation, unless, in the first place, they are fit and well, or are made fit and well by proper medical attention. I do not sec how anyone can meet that point. Is it economical to spend such vast sums of money on education if, by the admission of the Chief Medical Officer of the Board of Education, the children are not capable of receiving it? I have never heard anybody who was really able to cope with that contention. The only answer I have received is, "It is the best we can do in those circumstances." I would point out to the Committee that if this were a question which concerned the War at the moment, if you could imagine that these boys and girls were potential fighters and that in six months time they would be in the trenches or in France, is there anybody who would hesitate for a single second about medical treatment? There is not a single person in this Committee who would not say immediately, "Let them be inspected and medically treated at any cost in order to make them fit." I admit that the War, in a certain sense, predominates all other considerations at the moment. But we have to think of the future. If I were speaking as a soldier in the House, I should certainly say, "Think of the future, and see to it that the boys and girls who are in our schools to-day grow up to be strong and healthy and capable of having strong and healthy children." We know exactly what will happen. We know perfectly well that a very large proportion of them are not strong and healthy and will not be strong and healthy citizens. From the industrial 1781 and the economic standpoint, it is equally true that if you want to succeed in the future you ought to see to the medical treatment as well as to the medical inspection. The hon. Member for Huddersfield pointed out, what the President knows perfectly well, that even medical inspection is not adequate at present, and only touches a certain proportion—I admit that it is now a large proportion—of the children in our schools.
One other point, which I am perfectly certain the President will admit to be true. Wherever a local education authority has taken up this question seriously, and has instituted medical treatment as well as medical inspection, has done it scientifically and thoroughly, and been willing to spend a little money on it—by the way, of course, they get their Grants from the Board of Education—that education authority saves its money over and over again in the attendance of children at the schools. I am sure the President is as anxious as anybody could be for the further extension of this medical treatment. May I make a suggestion? I should very much like the new Clause moved by the hon. Member for York to be adopted, but the speech of the President did not seem to be very hopeful on that point, though it was so conciliatory and so sympathetic. Would it not be possible for him to define just how far the local education authority can go in this matter if he thinks it cannot go the whole way? Would it not be possible to say of these diseases of the head, the eye, the ear, and the throat that they should be treated? Because is there anybody who doubts that a child who comes to school with a defective condition of the eyes or nose or ears cannot benefit by the education?
We all admit that, and I do honestly think that the Committee would be consulting the best interests of the nation in making it compulsory on every local educational authority to see to it that the child, as far as these special ailments are concerned, is medically treated. You get your money back again if you look at it from that point of view. It is really a sound investment, and I cannot believe that, if all the Members of the House of Commons were present and could hear the President of the Board of Education make his own statement, apart altogether from the Front Bench, as an educationist 1782 putting forward the facts he knows to be true, and for the moment dissociating himself from his office and speaking as one who cares for these children as he does, he would have any difficulty in converting the whole House in a moment, if the House wanted to be converted. I do not believe there is very much opposition to this in the House. I believe it is really a question of whether the local education authorities are willing to stand this little bit of extra pressure being put on them. Will it not be possible to make, if necessary, extra Grants-in-Aid for this special purpose? I do not say the treatment of all diseases, but of those special ailments which make it impossible for the child to benefit by the education we are trying to give it. I put that point before the President. I hope very much his speech does not mean an absolute non possumus, but that he will try to meet us, if not the whole way, half-way, and try to make it a little more possible for some of these boys and girls to live a decent life in the future. In my experience in East London I have seen so many lives crippled and maimed and so many boys and girls going through life utterly unable to compete with their neighbours because they never had a fair chance. They were never medically inspected or treated in those days. The State ought to be in these cases in loco parentis, and if the parents do not care enough to get the children attended to—although it is generally ignorance in these cases and not carelessness—the State should see that it is done, not merely for the sake of the child, if you like, though I am thinking of the child too, but for the sake of the nation. If you do not do it, this nation is going to the wall. If you do not make the nation strong and healthy, you cannot compete with the times that are coming. I hope the President will meet us a little way and enable us to let this Bill go out with a clear conscience.
§ Lord H. CAVENDISH-BENTINCK
I would like in one word to express my deep disappointment that my right hon. Friend has not accepted the new Clause moved by the hon. Member for York. Nobody is more grateful than I am to the right hon. Gentleman for the introduction of this Bill, and I can quite understand his anxiety to follow the line of least resistance to get the Bill through the House as quickly as possible, but I must say I am astonished he does not give a more friendly acceptance to a thing which I 1783 think is obviously necessary in the best interests of the country. There is, as hon. Members know, an immense amount of talk going on now about reconstruction. Surely this is obviously one of the most necessary bits of reconstruction the House of Commons could put in hand. There is an enormous amount of inefficiency, unemployables, and physically defective people in this country. They are unemployable, they are physically defective, because their fathers have been physically defective before them, and their sons will probably be physically defective after them. The only way to break down this vicious circle is to provide a good educational system, and our educational system must also provide means of effecting a physical improvement in their condition. Therefore, I am personally deeply disappointed, as I think the whole House will be, that the right hon. Gentleman has not consented to do a thing which I am sure the whole country would have regarded as one of the most necessary things to be done at the present moment. The right hon. Gentleman gave an encouraging account of the progress that has been made. He also quoted the number of pairs of spectacles given out.
§ Lord H. CAVENDISH-BENTINCK
That does not alter my point. I would like to point out that the Chief Medical Officer finds great fault with the authorities for merely doling out spectacles and thinking they have solved the question of defective vision. It is, as he points out, very largely a physical question, and requires good air, good treatment, and good food. As to the progress that has been made, I would like to remind him of what Sir George Newman does say. He says that less than half of the authorities have made any attempt whatever to provide dental treatment, and, with one or two exceptions, the provision made by the 146 authorities is at present wholly inadequate. There are still approximately 100 authorities which have done nothing for minor ailments or defective vision, and 200 have done nothing for diseases of the ear and throat. What is the consequence? Of the children in attendance at school 6,000,000, we know by medical inspection that many, though not specifically "feeble-minded," are so dull and backward mentally as to be unable to derive 1784 full benefit from schooling, that upwards of 10 per cent. of the whole are at a like disability on account of uncleanliness, and that 10 per cent. are malnourished. Perhaps the largest contributor is dental disease, which handicaps the children almost as seriously as it does adolescents and adults. Probably not less than half the children are in need of dental treatment, and a substantial number—not less than 500,000—are urgently so. Again, upwards of 500,000 children are so defective in eyesight as to be unable to take reasonable advantage of their lessons. I think when we read this Report of the Chief Medical Officer we are impressed by the enormous amount of work to be done here, and I hope my right hon. Friend, particularly if he gets pressure from Parliament, as I hope he will before the. Report stage, will reconsider his attitude.
§ Sir J. D. REES
I hope it is not out of order, Sir Frederick Banbury, to express a belief that had you not been in the Chair you would have called attention to an aspect of the discussion to which no one has referred, but which at least will be allowed to be relevant. It is with much diffidence that I venture to intervene among the educational experts and enter the sacred congregation of the social reformers. The real fact is, I submit, with profound respect to the Committee, that a debate has been taking place on social reform, and not on education. The President of the Board of Education most properly expressed his sympathy with my hon. Friend the Member for York. I suppose there is not one Member of this House who does not wish that there should be no diseases of children, that they should all be healthy and strong. One hon. Member addressing the House said every child should have good air, good food, and medical treatment. I heartily wish it might be so; but at whose expense? It is not possible. It is dealing with an ideal and not an actual state. There is a feeling in the country also which I venture to express, because if it be unpopular it is none the less one's duty to express it, that it is rather an odd thing at this moment, when the country is engaged in the War and is incurring unparalleled burdens, which it will meet, if at all, with the greatest difficulty, that the House of Commons should be engaged in busily adding to its commitments. Every day an hon. Member comes forward, in connection with this 1785 Bill conspicuously, with some fresh measure of expenditure. As to this Amendment, the hon. Member who introduced it made no effort to deal with the cost. The President of the Board of Education, very properly, said he sympathised with this. Of course, everybody sympathises with sickness and disease and wishes everybody should be healthy. But he said he could not introduce medical treatment into this Bill. I submit it is perfectly clear he could not. He made a rough estimate once that the cost of this Bill would: be £10,000,000. This would be at least another £10,000,000, and what would be the limit? Most children are imperfect in health. Take the greatest schools in the country, where there is no want of money in the parents. They can lavish money in support of the education of their children, and you find these congenital defects remain. The hon. Member (Mr. Alden) said this was a good investment. One hears that over and over again, but surely in investing public money you must look for some immediate return.
§ Sir J. D. REES
As an arithmetical proposition, that is one of the most absolutely foolish I ever heard. In the first place, it is absolutely incapable of proof, and, in the second, it is improbable to an extent that makes it almost ridiculous. No hon. Member of this House can for a moment deny that this admirable proposal, which I long to see carried out, is absolutely impossible on financial grounds, probably at any time, but certainly at present. Why, then, jeopardise the Bill by piling Pelion upon Ossa, and adding one expense to another, and trying to fit in, by an additional new Clause, no small part of the whole programme of social reform?
§ Mr. BOOTH
As one whose voice is usually heard on the side of retrenchment, and also of voluntaryism, I am glad to see that support of this proposal is general, with very few exceptions. I really cannot understand the attitude of the Government with regard to this question of voluntaryism. The President of the Board of Education suggested that the voluntary methods now being taken should be encouraged. I was one of the four Members who suggested that the great Insurance 1786 Act should be voluntary, and I have repeatedly intervened in the Debates on this Bill with regard to certain provisions for continuation education that they should start by being voluntary. But if you have compulsory elementary education at all, and particularly if you have compulsory secondary education as this Bill provides, and on the top of that you have compulsory inspection, there is no case whatever in answer to this proposed Clause. Really, to have compulsory attendance at school up to eighteen, and to compel the whole population to come under the Insurance Act at sixteen, if they commence to earn money then, and to take no steps whatever to see that the young people, when they go to the secondary schools, or when they go to work and come under the Insurance Act, receive adequate medical attention is utter folly on the part of the State. I do not think the expenditure will be anything like £10,000,000. While there are some parts of the Bill where I think compulsion by the State is unnecessarily introduced, yet surely at this point, when it is concerned with the health of the boys and girls, it is utter folly for the State to stop there. Whether the inspection is spasmodic or regular, it means that you lay the position bare, you discourage the teacher, you label the scholar, and there you leave him. Anything more preposterous I cannot understand.
It is not only the physical effect upon the child. What is the effect upon a child to be told that it is suffering from a physical ailment? It affects the child's mental condition. It gets disheartened. It thinks it is in an inferior position when it sees healthy boys in the playground, or girls with skipping ropes, and the child begins to think he has not a very good outlook in life, and the tendency is to become mentally deficient. It is repeatedly the case. When boys and girls of these tender ages are told they are suffering from marked defects which make them inferior to the rest of their companions, you are inviting them to despair, and as they grow up they keep cherishing this grievance and it hinders them from attaining their maximum capacity. They find when commencing work that they would have been saved from a life of agony and trouble if only the State, which had forced them into the school, had also taken care by some provision of a medical character to save them from disease. How do you expect them, after you have educated them and 1787 taught them to know the seriousness of their position, to be contented in after life? With regard to the expense, it seems to me it does not matter what it would cost. It does not need any argument to show that it will pay the community. Surely we have long got past the point that any money spent on seeing that they are healthy and strong needs to be recouped in some indirect or roundabout manner. It is recouped a thousandfold every year they live. My hon. Friend (Mr. Rowntree) made a contention which I am sure no business man would answer. How can you say it is all satisfactory to tell young boys and girls that they have a physical defect? How do you expect the increased wages to be paid after the War and during the period of reconstruction unless they are paid to healthy people? I quite agree they will not all be healthy, no matter what we do; but, at any rate, we can do our best. Is the hon. Gentleman (Sir J. D. Rees) in favour of doing nothing? He not merely said it would cost a little money, but he does not say he is prepared to spend a penny. What is his figure? If an hon. Member says it will cost £10,000,000 and that is too much, he ought to say that whatever can be done for £1,000,000 or £500,000 he will contribute. The hon. Member does not really carry us very far.
§ Sir J. D. REES
I said this was not educational business, and that no estimate had been made of the cost.
§ Mr. BOOTH
I do not agree with that at all. If there is one Clause which has been put down which is distinctly and strictly educational, this is the Clause. You are now asking boys and girls to attend school even up to eighteen years of age, you are asking them to labour jointly in education and industry for several years of their life and yet, when they come into school at an early age, you satisfy yourself whether they are healthy or not and then do nothing for them. I cannot understand how we can be content simply to lay these diseases bare, to schedule them in Blue Books, convert them into statistics, frighten social reformers, and dishearten teachers and the general public, and leave it there. Surely that cannot be the answer at all! It cannot be the last word of an enlightened President of the Board of Education. If so, it throws us into despair.
I have listened to all this Debate, and as it has proceeded I have rather modified my views. I began to listen to it with considerable sympathy for the views advanced by the hon. Member (Mr. Rowntree), but I shall not be prepared to support him if he goes to a Division. No one expression which has been let fall during the Debate has made a greater impression on my mind than that which fell from the hon. Member (Mr. Alden) in which he said the ill results and the failure of the parents to attend to diseases in the early ages of their children were due not to poverty, but to ignorance. That exactly coincided with what I have always believed to be the truth, and I was pleased to be confirmed in my view by the hon. Member, who has had more experience than most of us. I regard the principle of the State paying for medical treatment for children as a bad one. It is the work of the parents to see their children fed and looked after in all ways. You cannot and never have been able to apply that principle without modification. Therefore, if the parents are unable, through poverty or other cause, to provide the medical treatment that the children want, the State was morally bound, and in 1902 it recognised its obligation, to make it possible for local authorities to do what the parents could not do for themselves. That brings you to the point, Is the State to make it compulsory upon local authorities to do these things or are we to be content to leave it merely permissive? I arrive at my conclusion for two reasons. In the first place, the local authorities know, and will always know, much better than the State what the conditions of the locality and of the parents concerned are. In the next place to lay down the principle of medical treatment as it is sought to lay it down in this Clause is really dealing with the question piecemeal. I suspect the hon. Member (Mr. Alden) is right when he says it is ignorance and not poverty. The remedy for that is to train and educate your parents. Have your medical inspection, let it be real, and bring the information home to the parent and see what effect that has. But further than that it is the duty of the State, and it will be the duty of all of us after the War, to take such steps as we can to secure that the parents themselves receive adequate wages to do these things for themselves. But I would only support the principle, or would have supported it in 1902, if I felt that I could not get it in 1789 any other way. If I am told the reason I am not getting it to-day is due rather to ignorance than to poverty, I say remove your ignorance and do not embark upon the slope, which I certainly would not wish to do, unless you are absolutely convinced that it is essential for what you wish to achieve.
§ Mr. CHARLES ROBERTS
I should have thought that so far as argument went there was really no great difficulty in accepting this Clause. I should have thought you might very safely have extended the powers of the State to the medical inspection and treatment of children without it having any demoralising effect or any loss of parental responsibility. I cannot imagine a more innocent or less harmful extension of the State's power. I have been careful in the discussions on this Bill not to press the President of the Board of Education further than he was willing to go. One realises his difficulties, and the difficulties of a Minister in charge of a Bill are best judged by the Minister himself, and though it is always an attractive role to press him to go further than he is willing to go, that course is sometimes attended by ill results on the fortunes and fate of a particular Bill. Therefore, if on full consideration he thinks that he cannot go any further on this particular matter, I should not be in favour of pressing him beyond the point that he thinks it is wise to proceed. The whole Committee has such complete respect for his educational zeal and his educational judgment that I am quite sure we are prepared to give him very largely a blank cheque in what he thinks it wise to propose. At the same time, I cannot help thinking that on this particular occasion this is not quite his last word. I do not think it would be wise to press this Clause to a Division at the present moment. I think it would be a Division which would mean absolutely nothing, and it would not in the least show the strong feeling in the Committee, because for various reasons a great number of hon. Members who are in favour of it and who would wish to vote for it would either abstain or find reasons for voting against it. However, if the right hon. Gentleman can, give us some hope that before the Report stage he will consider the matter, with a view of making his own proposals, it would be very wise to wait until the Report stage. I quite realise, and I think the whole Committee must realise, that this is 1790 largely a question of time. It is obvious you cannot do the thing at the present moment. You have not got the doctors. You cannot establish the service, because they are not there. Therefore, there must be some time before it comes into force. There may be other questions of arrangement which the right hon. Gentleman's advisers might suggest. There might be counsels of prudence and limitations on points of detail. No doubt the matter does require further consideration, and I think if the President, in deference to the strong feeling there is in the Committee, could hold out some hope of a more specific and more definite proposal on the Report stage it would give a great deal of satisfaction to a large body of feeling.
As there seems to be a very large body of opinion in the Committee in favour of further consideration of this question, I should be very glad to do what I can to review it and see whether I can bring forward any proposals which are watertight and administratively possible on the Report stage, If my hon. Friend would withdraw his Amendment on that understanding, I will undertake to consider the mater.
§ Mr. ROWNTREE
Having regard to what the President has said, I gladly ask leave to withdraw the Amendment and to express the hope that when the Report stage comes we shall find that the President is able very largely to meet the wishes of the Committee.
§ Motion and Clause, by leave, withdrawn.
§ The CHAIRMAN
The next Clause, standing in the name of the hon. and gallant Member for Montgomery (Major Davies)—(Advisory Committee to the National Commissioners in Wales)—is out of place.
§ Sir J. D. REES
I have the same Clause on the Paper, and confess I followed my hon. and gallant Friend who has rendered such great service to education in Wales. It was he who put the cart before the horse, or, if that expression be unworthy of the dignity of Parliament, committed a [...]. At any rate, in his absence, I shall not move it.