HC Deb 24 March 1919 vol 114 cc79-99

Order rea dfor Second Reading of the Public Health (Medical Treatment of Children—Ireland) Bill.


I beg to move "That the Bill be now read a second time."

This Bill extends to Ireland the benefits of medical treatment already enjoyed by children in English elementary schools, and enables local authorities to have medical inspection of children in elementary schools in Ireland. Similar provisions for some time back have been in existence in England, but have not yet been enforced in Ireland. I believe the Bill at present, so far as I can understand, is not opposed by any portions of the community in Ireland, and, in fact, is largely welcomed. The councils of the county and county boroughs are to be the local authorities for carrying out the purposes of the Act, and it will apply to schools of an elementary character, either national schools or schools recognised by the Local Government Board as providing efficient elementary education. The Treasury will provide an amount not exceeding one-half the expenses as may be incurred by the local authority in setting this medical relief in operation and carrying it into effect. It is hoped that it will be largely availed of in the country.

Captain CRAIG

Will my right hon. Friend inform us, if he can, whether the provisions of this Bill are practically the same as those which exist in England, and to what extent the conditions in England are mandatory?

Lieutenant-Colonel W. GUINNESS

I would also like to know why it is that this Bill is drafted in a weaker form than the English Bill. I have just looked up the Education (Administrative Provisions) Act, 1907, and I find there that it is not optional in England, but is imposed as a duty on the local education authority in England to provide medical inspection. It is quite true that medical treatment is not compulsory, but if the local authority has brought to its notice the bad state of the children's health, it is obviously very diffi- cult for that local authority to neglect its duty of providing necessary medical treatment as well. In Ireland, public opinion is very much more backward than in England, and if it is necessary to make this a duty in England, it surely is inadvisable to leave it optional in Ireland. There is a tuberculous rate higher than anyhere else in the Three Kingdoms, and it is rising, and I do appeal to the right hon. Gentleman to make this Bill really mandatory by substituting "shall" for "may."


I would like to express my dissatisfaction with the way in which this Bill has been drafted. It seems to me that the Government have lost sight of, or never comprehended, the actual conditions under which schools have to be maintained at the moment. I think the Bill shows ignorance on the part of the Government with respect to the actual conditions which prevail in elementary schools, not only in Belfast, but throughout Ireland. If the Ministry, first of all, had set up a sort of roving Commission to ascertain what are the actual conditions of elementary education in Ireland, I think they would have come to a different conclusion from what they seem to have come to, and would have modified this Bill accordingly. The fact is we either require this Bill or we do not. If we require the Bill, then it should have been more drastic and more sympathetic, and if we do not need it, why introduce it at all? It appears to me as if we were reversing the method of procedure. It is like baling a boat instead of corking the leak. The fact of the matter is that we regard it at the moment as due to the insanitary condition of the schools that it is necessary to introduce this Bill at all. We know, as a matter of fact, that children from time to time contract their ailments in the very schools where it is proposed to establish medical inspection. In my district the aristocracy have their fine schools to which to send their children, and from which they can graduate into the colleges, which are splendidly endowed. The middle class have seminaries, or model schools, in which the pupils for the greater part are of a selected character. As regards the other elementary schools, the children are herded together, and the schools are overcrowded in many instances. They are absolutely insanitary, and nothing short of a menace to the health of the children who have to attend them.

I have heard it said that the schools in Belfast can be divided into good, bad, and indifferent. A more correct definition of the matter would be that they may be divided into good, bad, and the remainder very bad. I have wandered into a few schools in the Division I have the honour to represent, and I find that some have only one room for all the scholars, and the air throughout the school hours has never an opportunity of being renewed. I, moreover, am aware of the fact that in many instances the schools have never been whitewashed and never painted. I know large schools of a voluntary character where 150, 200, or even 250 children can be accommodated, but I am perfectly right in saying the schools have not been whitewashed or painted, owing to the fact that there is no income for the purpose, and, being linked to the Church, the little endowment there is very often goes to the decoration or endowment of the church rather than to the school. The Belfast schools are no better or worse than elsewhere, but throughout Ireland there is a great need for the reform of the insanitary conditions. It must come, sooner or later, or otherwise there will be a condition of affairs both in the city and the country very serious indeed.

4.0 P.M.

The ailments of school children are in many instances contracted at school. The child is often subjected to sitting in draughts and contracts bronchial ailments. I know, as a matter of experience, that is frequently the bedrock and root of the whole thing. There are no heating arrangements made in connection with these elementary schools, and some of them have to contribute towards the fire that warms the schools. It is a deplorable condition in a city that aspires to any degree of civilisation. The fact of the matter is that in Belfast at least the schools for the most part are closed owing to the fact that one epidemic after another seizes the children and that they are decimated, and the schools have to be closed. But why is it that the cinema houses get leave to remain open while the schools have to be closed? I have no objection to cinema houses, but the fact is that the cinema houses are better looked after and washed out and cleaned more often than the schools are, and there is less risk there than there is in the schools.

My objection to this Bill is that it is permissive; not only will the district councils and rural councils be able to evade their duty in respect to this matter, but they will have no zest to carry out the necessary sanitary or medical reform. There is another thing that occurs to me. I have seen these children in the elementary schools come in with their wet clothes on. That is often the cause of illness. They come and take their seats in these schools, which are badly heated and too much ventilated, and they contract diseases by that means, and there is no provision made for that matter. Unless the Government take this Bill in hand seriously, and go to the bedrock of the whole difficulty, there is little hope that any good will attend the legislation they have in view. The people have come to see that it is necessary that their children should be educated. It is the only chance that the children of the democracy have. The working people are going to see that their children have the same chances as other children.


The hon. Gentleman is dealing with the whole question of elementary education in the schools in Ireland. That does not arise under this Bill. This Bill is limited to the provision for the medical treatment and for the medical inspection of children. The hon. Member must confine himself to the four corners of the Bill.


I bow to your ruling, but it is for the purpose of showing that we must have more than medical inspection that I make these remarks. We must have something of a preventive nature. My suggestion is that in connection with this Bill some Clause should be introduced in regard to sanitation. The people are looking forward to improvement in this direction. We know how necessary to the well-being of the community is the health of the working classes, and I hope the representatives of the Government will see that so far as possible this Bill will be amended in the interests of the working classes that I have the privilege and the honour to represent.

Captain CRAIG

I shall support this Bill, of course, and so will, I am sure, all my Friends sitting around me on these benches; but I would like to ask the Attorney-General for Ireland one or two questions, and to get information from him at this stage of the Bill. The Bill is permissive, as has been pointed out, but in those cases where the local authority put the Bill into force I should like to know what the exact position is then. So far as I can see, as soon as a local authority puts a Bill into force it lies entirely with the parent of the child whether he shall prohibit the local authority from putting the Bill into force. In Sub-section (3) of Clause 1 it says: Nothing in this Act shall be construed as imposing any obligation on a parent to submit his child to medical inspection or treatment or as authorising a local authority to establish a general domiciliary service of treatment of children by medical practitioners. When the right hon. Gentleman comes to reply I would like him to tell us how that Section can be reconciled with the idea of this Bill being made compulsory by the local government. Another point on which I should like to have some information is, what effect the inclusion of Ireland in the Ministry of Health Bill is going to have on this Bill. In Sub-section (2) of Clause 1 it says: In exercising their powers under this Section a local authority shall act in accordance with Regulations made by the Local Government Board and approved by the Treasury. It seems to me that under the provisions of the Health Bill which is before Parliament that will have to be altered, and that it will be the Chief Secretary, as the representative in whom the duty of looking after the health of the children will be vested, who will have all the powers that are contained in that Clause. As has been pointed out, just as in the case of health generally, so the condition of school children in Ireland, so far as the insanitary conditions under which they live are concerned, is far worse than in England, Scotland, or Wales. If that is so, we require more drastic measures than those even which are in the hands of the authorities in England to remedy that state of affairs. I regret, therefore, that the right hon. Gentleman has not taken the bull by the horns and made this Bill mandatory from the very beginning, and not only mandatory in the sense that the local bodies must carry out the provisions of the Bill, and hope that he intends to put much more drastic powers into their hands. If you give people power to provide for the medical treatment of children before or at the time of their admission to elementary schools, you should also give them power to carry out the treatment to its logical conclusion. Take the case of a child, say, with bad feet, a child which obviously, unless something is done, will not be able to walk properly, but who could, by a simple operation, be cured and made a much more useful member of the commu- nity—in that case, I submit that the local authority ought to be able to carry out that small operation. In the matter of health, such measures as are necessary to cure a child of tuberculosis should be carried out by the local authority. In the same way, throughout the whole range of ailments from which children suffer, it is no use giving them power of medical examination without giving them the power of treating and, if possible, making these children physically better members of the community. I hope the right hon. Gentleman will answer these questions with reference to the extent to which these powers can be carried out. It seems to me that the Clauses to which I have referred point to the fact that the local authority may direct as many things as they like, but that it lies entirely with the parents to say whether they will adopt the suggestions. In no sense is the Bill mandatory, even where the local authority decides to adopt the provisions of the Bill. As has always been the case, it is the parent who says whether he will see that his child is properly treated from the medical point of view. That is what we want to prevent in this Bill. It is assumed that if the parent was anxious for the health of his child he would have taken the necessary steps before. Not having done that, when the child comes to school then the authorities take hold of him and have him submitted to medical inspection, and if he is found to be suffering, then I maintain that the parent, having neglected his duty, the local authority should step into his place and do whatever is necessary to put the child in as physically fit a condition as is possible.


I am sure I have the sympathy of the House in speaking for the first time. I feel that even if it were the last time I should have the opportunity of speaking here I shall have been glad I had this opportunity of speaking on behalf of a Bill for which I have the very strongest possible sympathy. This Bill goes much deeper than the question of the conditions of the Belfast school children or the question of ventilation, or other questions affecting the schools. It is a well-known fact—speaking for the city for one of the divisions of which I have the honour to represent—that this city of Dublin has an unenviable notoriety for its infantile and child mortality. It is the housing question that is the imperative question as regards dealing with these children; but as you, Sir, have said, that is not the immediate question before the House, which is the question of medical treatment of these children. I have made it my business to ask the medical officer in Dublin to send me a short report on this question. This is what he says: The medical inspection of school children is absolutely essential in the interests of the public health. Children at the school age are at a critical period of life and unless they are properly looked after they cannot be expected to develop into healthy citizens. If the system of inspection was in operation children suffering from lung disease, ringworm, sore eyes, skin diseases, and other maladies, would be prevented from being placed in close juxtaposition with healthy children, and their diseases medically treated. The examination and attention to teeth would be most beneficial. Children affected with rickets and other abnormalities would also be attended to. The medical officer inspecting schools would, in the course of his visits, learn of the illness of absent children, and the homes of such children could be visited in order to see that proper treatment was being given. In England, in centres where the system of inspection is in operation, the health of the school children has been proved to have been much improved. He appends to that report a statement that last year there were 1,117 deaths of infants under one year, and that between the age of one year and five years there were 936 deaths, and between five years and fifteen years 470 deaths.

Those of us who know something of the psychology of our country know that in dealing with our public, if you were to make this simply permissive, there would be very great difficulty indeed in dealing with the matter; for this reason: if in one area the guardians of the public welfare were to put this in operation so far as they could, and the people in another district had not been compelled to comply with these conditions, these latter would regard themselves as in a peculiar position, and it would start an invidious distinction which we all know is most desirable we should not have. I am myself acquainted with the appalling condition of Dublin. We have heard a great deal in the last few weeks about Cologne. I think it was Byron who said that in the city of Cologne there were thirty distinct odours. I would undertake to say that any person who is blessed with a good sense of smell could discover a great many more than thirty in the city of Dublin. If you are walking through some of the streets you would prefer to take to the middle of the road rather than remain on the footpath. These conditions being such as they are, what is the use of talking about what happens in the schools? It is the awful conditions under which the children live. Some of us have seen these unfortunate children in the streets of Dublin trying to sell the newspapers and miserably clad in rags. We would, I think, be absolutely lacking in sympathy if we did not do all in our power to improve the health of the children. I feel most strongly that I should be lacking in my duty if, speaking on behalf of the constituency that I have the honour to represent, I did not say that I feel certain that it is their wish that I should support, with all force possible, this Bill. I do so at the same time supporting the request which has made that the Attorney-General for Ireland and the Chief Secretary for Ireland, who have introduced this Bill, will be able to see their way to make it mandatory. If it were made mandatory there is no doubt about it the result upon the health of our children would be at once apparent. With all the emphasise that I can command I desire to support this Bill.


I have on many different occasions, both by questions in the House and otherwise, endeavoured to attract the attention of the Government—and different Governments—to the necessity of dealing with this question. It seems to me, however, a very strange thing that, notwithstanding the continuous representations which we have made from these benches, that the Government have never taken this matter in hand until now. I confess it is a rather extraordinary circumstance that on the eve of the introduction of a new Ministry of Health for Ireland, when a new health authority is to be set up, that the Government should come along and introduce a measure dealing with what necessarily must be one of the vital purposes of such a Ministry as that which is about to be established. I should like to join with my hon. Friend opposite in asking why this Bill is introduced now, and why the purposes of the Bill should not be incorporated in the new health proposals submitted to Parliament for Ireland? In my judgment one of the first things that the new Ministry of Health would do in Ireland would be to set up an entirely new medical organisation. One of the greatest functions of the establishment of such a medical organisation ought to be to see to the health of the children both in and out of schools. To start a new system of rating and taxation for this purpose will, in my opinion, create very serious trouble and irritation in Ireland. The medical men appointed by the Ministry of Health could examine the children in the schools, and they could be paid from the finances for the work this Bill proposes to do. They would be paid by the State. I quite agree that in a good many matters of this sort, if they are not compulsory, they are hardly worth doing at all. Compulsion, however, is a very serious matter. This Bill not only proposes to make it compulsory on the children to be examined, but it makes it a penal offence if the parents of the children do not pay the rate for the purposes stated in the Bill. I altogether object to that. I say the way to deal with this thing is to leave it until the proposed Ministry of Health Bill is before the House, until the Public Health Department has been set up, and to include in the functions of the medical men, who are the State doctors, the very important work of the examination of the children and the fostering of their health. Finally, in dealing with a question of this sort I have dealt with it in such a way as to cause the least possible irritation in the various localities throughout the country.


For my own part I must say I am very glad the Government have introduced this Bill. I think, indeed, it is a curious commentary upon the way business is conducted in this House in relation to Ireland that this very provision has been in force in this country for twelve years, and that notwithstanding, as the hon. Gentleman the Member for Belfast has just said, the frequency with which the matter has been brought to the attention of the authorities in Ireland. This is a very small part of what is necessary for education in Ireland. I would not be at liberty, under the Rules of the House, to go into the question of the condition of affairs in relation to elementary education in Ireland at the present time, but I am free to admit that I believe that it is one of the biggest scandals existing in administration in any part of the United Kingdom. The hon. Gentleman who has just addressed us thinks that the provisions of this Bill ought to be included in the Health Bill. May I remind him that the Health Bill is purely a machinery Bill! It does nothing except set up the organisation of an office, and it is the duty of that office afterwards to take care to propose, in the way of legislation and administration, such matters as may be necessary to promote health in Ireland. I, therefore, think the Government have taken the right course in bringing in this very belated Bill for this one specific subject. I must, however, add my protest against the Bill being permissive. We have in relation to Ireland that permissive principle in almost every Bill that has reference to public health and with which the local authorities are connected—the Notification of Diseases Act, the Notification of Tuberculosis, and various Acts of that kind. These are all permissive, and they are, practically, except in a few rare instances, entirely set at nought in Ireland by the local authorities. I feel I might very well prophesy, having regard to what has taken place, that if you leave this Bill permissive, as it now is, over the greater part of Ireland it will never be enforced at all. I hope when we come to Committee—I suppose it will go upstairs—whoever is on the Committee will urge the Government to make the Bill mandatory. I have not looked at it myself, but I believe it is mandatory in England. If it is mandatory in England I cannot see why it should not be made so in Ireland.

My own opinion is that any local authority which neglects and will, after they have obtained this power, neglect this very elementary duty towards the school children is not fit really to exist at all as a local authority. As to the question of enforcing payment for treatment given, I really think it is not worth while for the Government to maintain that Section. If you look at the Section it says that the local authorities are to estimate the cost of treatment, and then have to enter into an investigation as to the ability of the parent to pay. There can be nothing more invidious than a comparison of this sort between two children sitting side by side, day after day, in an elementary school, or in any other school, and the one saying to the other, "Oh, your father is better able to pay than mine, and you have got medical treatment for nothing, whereas my father has had to pay for it," or a dialogue of that kind. It really is not worth it. I should like to ask this once more: the moment you compel children to go to school, as you do under existing legislation, why are you to provide at the public expense teachers, books, and the general organisation of education, and not include this medical part? I myself see no distinction between procuring education for the children and procuring what is necessary to make it effective. Surely the question of health adds greatly to the powers of the children to benefit from the education! The moment you say that the school ought to be sanitary and hygienic, and we are very far from that in Ireland, then everything should be done to make the course of education medically consistent, and to do the thing in such a way so that the child will be kept fit and get the greatest possible benefit. I hope the Government will consider whether they might not strike out what is, I think, an invidious and unnecessary Clause in the Bill.

May I add this one general observation as to the existing state of elementary education in Ireland? You will never make any advance there until you proceed to put the cost upon the rates. You made very little advance in this country until you put the cost upon the rates. Therefore, it is that I support this matter being put upon the rates, and everything connected with it being put upon the rates. I know there are people in Ireland who imagine, the moment you say you are going to put a matter of this sort upon the rates, that there will arise the sectarian question. For my own part, I would give each religion anything they ask for in this respect. Until you get education in Ireland put upon the rates you will never get any improvement either as regards the accommodation in the schools or the sanitary condition of them. However I am glad even for this small beginning, and I assure my hon. and learned Friend that not only will I support the Bill, but I intend shortly to ask the Government for a day to discuss the whole question of elementary education in Ireland, having regard to the recent Report of the Vice-regal Commission.


This is a small Bill, but I regard it as very important, because it is the beginning of putting the cost of education on the rates in Ireland, and until that is done we cannot have efficiency in education. In the part of Ireland with which I am associated I believe this small measure will do a great deal of good. I know you cannot expect for a long time to get such splendid school buildings as you have in this country, but we can get near to them, and at any rate in this Bill we can make a beginning. We must, however, make this Bill mandatory and not permissive, and it must be "shall" and not "may." There is one thing I am doubtful about, and it is the power of the local authorities to exercise the functions provided by this Bill. Surely the authorities to deal with this matter ought to be the small local bodies. Take, as an illustration, the county of Cork, which is about the size of Yorkshire, and it contains some big towns with large populations. The division over which I preside is over twenty miles long, and a good many miles broad, and there must be there at least between fifteen and twenty elementary schools. How is it possible for one county council to look after a great area like that, as he will be required to do under this Bill. With the best intentions in the world I do not think the county councils will be able to carry out these duties. I am not sure that they intend to do this, and they may delegate their powers to various authorities in different parts of the county, or form small sub-committees, but I do think the county councils should undertake the great duties imposed by this Bill.

I would like to know who is going to be the medical officer. Is it going to be the dispensary doctor, and will he have added to his already very exacting duties that of inspecting the schools in his area? If so, he will have to neglect half his patients. I would like to know if a special medical officer is going to be appointed to do these duties, and how is that going to be carried out. I make this suggestion: The county councils ought to have power to delegate their duties to smaller authorities. I should like to see the urban and rural district councils bound to carry out these duties. The next Bill on the Paper is one which is going to make a very radical change in the method of the election of these local authorities under the principle of proportional representation, and I have no hesitation in saying that an Irish local authority elected on that principle will be well able to carry out the duties under this Bill and will carry them out better than a great body like the county council. I suggest that the Attorney-General might insert a Clause giving a county council power to delegate their duties to the urban and rural district council. I heartily support this Bill, but I hope we shall have inserted in it the word "shall" instead of "may."


I would like to remind the House that the country councils really are the bodies who look after taxation and the expenses under this Bill. The rural district councils merely state what is required for their particular district. I think it is quite within the capacity of the county councils to carry out the duties assigned to them under this measure. I would ask the Attorney-General to see that this Bill is changed from "may" to "shall." The English Act of 1907 clearly lays down that it "shall" be the duty of the local authorities. I urge the right hon. Gentleman, however, to do away with the veto contained in the Bill which allows a parent to refuse to allow his child to undergo inspection or treatment. If this provision is left in the advantages which this House expects from this measure will never be obtained by the children of Ireland. In addition to that I would like to point out that there is one Clause which lays down that the authority is to carry out these duties in accordance with regulations made by the Local Government Board with the approval of the Treasury and the approval of the Commissioners for National Education in Ireland. I think the Attorney-General would be wise to see that some provision is put in to make either one or other of these authorities able to determine what rules and regulations shall be made.

With regard to the suggestion relating to medical inspection I do hope that the medical treatment of children in the schools will not be added to the duties of the dispensary doctors, because that would be an absolute absurdity. These dispensary doctors have duties to perform over a very wide area at a miserable salary, and it would be impossible for them to carry out their present duties if they had imposed upon them additional duties of this kind. I think this ought to be a sort of State service. With regard to the suggestion that this Bill should be postponed in some way until the Ministry of Health Bill comes to fruition, I think that would be a mistake. The Ministry of Health Bill as originally drafted simply deals with the position that arose under the Insurance Act, and made the Chief Secretary the head of the insurance instead of the Committee which sat in London. It will have to be greatly amended if we are to have anything like the benefits proposed to be given to England under that Bill. There is no reason why the children in the elementary schools in Ireland should not have the benefits of this measure, which has the complete assent of all parties.


I look upon this Bill as a long-delayed instalment of the legislation which is due to Ireland. We must not fall into the mistake that this is the first time that the principle of local control has been inserted in measures of this kind, for already we have power for the feeding of school children, and this Bill is merely an extension of that principle. I desire to enter my emphatic dissent from the general sentiment which has been expressed that the time has now come when the whole question of education in Ireland should be placed under local control. It has been said that education should be carried along such lines as would not raise the bogey or spectre of sectarianism, but the course which has been suggested by the hon. Gentleman opposite is the best way of raising the subject of sectarianism all over Ireland.

Catholics constitute three-fourths of the population, and they have not asked for any change in the control of the schools. They have supported their own schools in the past, and contributed their share towards the erection of those schools, and if schools are in a bad condition that is the fault of those who ought to support them. We do not ask those who do not share our religious views to be taxed for the maintenance of our schools, and I fail to see why we should be asked to contribute towards the upkeep of other denominational schools. If denominational education is going to be maintained in Ireland, as it will have to be, then the proper plan is to leave each denomination to provide its own schools and maintain them. We ask for no privilege or right which we do not readily concede to those who differ from us, but I protest against the assumption that there is anything like a general desire for a change in the basis of elementary education in Ireland. I desire also to associate myself most heartily with the protest which has been made by the right hon. Gentleman the Member for the Duncairn Division of Belfast (Sir E. Carson) against Sub-section (4) of Clause 1, which says: There shall be charged to the parent of every child in respect to any medical treatment provided for that child by a local authority under this Act such an amount, not exceeding the cost of the treatment, as may be determined by the local authority. That is a very invidious proposition. I do not know who suggested it, or what Government Department it emanated from, but it will be bitterly opposed in every part of Ireland. If you are going to compel children to attend schools and give them free education, why should you compel them to receive medical attention, and then make the parents pay for it? It is a very trivial point, and why it was put in at all I cannot understand. It is a cheeseparing proposition, and it is a contemptible little point. The total cost would not amount to £10,000 a year, and yet a special section is introduced to institute prosecutions against the parent and guardians of children in this respect. I hope the. Attorney-General will assure us that this Clause will not be persisted in and that the cost will be borne by the rates or by the Treasury, as I think it ought to be. I do not see why the Treasury should not bear this burden, which is very light, of providing medical treatment. After all it is recognised here that the proper upbringing of the children, and attending to their health in the schools, is one of the most important things a Government could look after. Unless children are healthy and strong they will not make strong and healthy men and women. As the whole amount is so small I hope the Attorney-General will assure us that this objectionable Sub-section will not be persisted in.

Major Viscount DUNCANNON

I desire to join with hon. Members in welcoming this Bill. It has been said that it is a tardy one. That is no reason why our welcome should be any less sincere or cordial. I feel as strongly as every Member from Ireland who has spoken that the first Clause should be turned from a permissive into a mandatory Clause, and I hope very much when the Bill goes upstairs that the right hon. Gentleman in charge of the measure will bear in mind the very strong feeling that has been expressed in the House this afternoon upon that point. It may be said, of course, that in Ireland we are not very rich in doctors, but after all the duty of inspection as set out in this Bill is not a very onerous one. I rise, however, rather for the purpose of pointing out one thing with regard to the Clause charging to the parent the cost of the treatment. The Bill is practically copied from a measure passed in 1907. I wish it had been more completely copied at the beginning of Clause 1. It is quite true that Clause 4 was not included in the Education Administrative Provisions Act, 1907, and that for two years no such charge was made in England, but the omission was found to be a serious one, and in 1909 an Act was passed to provide for the recovery by the local education authority of the cost of the medical treatment of children, and this Clause is an exact copy of Section 1 of that measure. Therefore, when the hon. Member who has just addressed the House says that it is not only a trivial matter but that it is an invidious matter, he uses an argument which will hardly hold water, because since 1909 a similar charge has been made in this country. The charge, I think, is exactly similar as in the case of the Provision of Meals Act, and I do not think that the people of this country consider that an invidious charge. It may even be said that parents do not find it inconvenient that meals should be provided on their behalf instead of by themselves direct. I hope, therefore, that this Clause will remain in the Bill. I would only add that I support the Bill very warmly, and trust that the first Clause will be altered to turn the "may" into "shall."


With every other representative from Ireland I am in total accord with the general purpose and principle of this Bill. The position taken up by my hon. Friend the Member for the Falls Division of Belfast (Mr. Devlin) in regard to this measure should not be misunderstood. A few hon. Members who have succeeded him in addressing the House seem to be labouring under a slight misapprehension. When we say that we would prefer this Bill to have been postponed, we mean that we think, as has been only too well exemplified by our constant pressure here for many years, that this question should not be dealt with here and now, but that it should be embodied in a complete and independent measure dealing with the public health of Ireland. It is perfectly true, as the right hon. and learned Gentleman the Member for the Duncairn Division of Belfast (Sir E. Carson) has said, that the present measure is merely a Bill dealing with machinery, and we want a great, complete and independent measure dealing with the whole of the question of the public health of Ireland. We asked for that on the occasion of the introduction of the Public Health Bill, just as Scottish Members desired that Scotland should be left outside its purview. Unfortunately we were not quite so successful. The Government made the excuse that it would entail bringing in two Bills, but now they have brought in a Bill which deals only with a very small portion of the problem. So far as the first Clause is concerned, I desire to associate myself with the hon. Member for Dublin (Sir M. Dockrell) in his remarks with regard to it being made compulsory. I quite agree that there is no use whatever in bringing in the Bill if it is not made mandatory. At the same time, I do not believe that Clause 4, which has been subjected to very damaging criticism, should be allowed to stand. It has been said by the Noble Lord who spoke last (Viscount Duncannon) that it should be allowed to stand, because it was found necessary to introduce a similar Clause in an English measure, but I am afraid he left us somewhat in the dark—he certainly did me—as to why it was necessary to make this change. He certainly gave the House no reason, and even if it did prove necessary to make the alteration as regards England, I do not accept that as any reason why we should be treated in a similar manner in Ireland. I desire especially to associate myself with the hon. and learned Member opposite (Mr. D. Wilson), who advocated the taking over by the State of the system of dispensary doctors in Ireland. I agree with him that the condition of the dispensary service in Ireland is deplorable, and that it should be raised into a great State service. If it were raised into a State service it would be beneficial not only to the doctors themselves but especially to the general public of Ireland, and then under that State service and under the Ministry of Health Department in Ireland this proposal that we are now discussing would find its proper place. That is why, though not by any means opposed to the principle of this measure, I am in agreement with my hon. Friend the Member for the Falls Division of Belfast in thinking that it would have been better if it had been brought beore the House in another way.

5.0 P.M.


This is another example, as it seems to me, of the tinkering way in which this House is constantly dealing with legislation affecting Ireland. Although I am one of those who welcomed the introduction of the measure, I would rather have waited until we could have had a more comprehensive Bill. The title of the Bill does not square with the Clauses. The title simply refers to the medical treatment of the children of Ireland. It says nothing about inspection. I do not wish to raise a point of order upon this particular phraseology, but it seems to me that Bills of this character have been ruled out of order on much simpler grounds. I rise on behalf of the party with which I am associated to ask the Government to make this Bill mandatory. We have had enough of this permissive legislation. I do not think there is room for Bills regarding our elementary school system and the medical treatment and inspection of children to be permissive at all, and I therefore add my voice to what has been said already on this matter. The Noble Lord opposite (Viscount Duncannon) hopes that Clause 4 will remain in the Bill because there is a similar clause in a Bill affecting the medical treatment of children in the elementary schools of England. I hope that it will be cut out of the Bill, because it is fundamentally and absolutely vicious, and I hope that the Members with whom I am associated will take care to see that the Clause is cut out of the English Act. It is bad in that Act, and it is doubly bad in an Act applying to Ireland. I trust before the Bill goes upstairs that the Minister will give the House an assurance on those two points: First, that the Bill will be made mandatory; and, secondly, that this entirely vicious Clause will be cut out. There is another Clause in the Bill which I do not like. The Bill, in Clause 1, deals with the medical inspection and treatment of children. I want to know how that is going to be done. An hon. Friend behind me suggests that a board will be set up in Ireland to deal with the question and to make appointments to effectively grapple with it, but as far as I can see there is no provision for any machinery of that kind at all. How are you going to treat the children when they get to school? Sub-section 3 of Clause 1 prevents the child being treated at all. There is no obligation on the parent to submit his child to medical inspection. I am very much afraid you cannot dissociate the two things, and clearly if you are going to insist on the medical treatment of children at school you cannot cut that adrift from the medical treatment of children at home; some provision must be made to secure the continuation in the home of that treatment. I have a word to say too about expenses. I hope that matter will be considered in no small pettifogging manner. The children of the country ought to be made a great asset of the country. Upon their growing up healthy and strong largely depends whether the country will be prosperous in the future, and therefore I submit that such matters as the medical treatment of children should be provided at the expense of the nation and that the burden should not be imposed on the rates. On the whole, I welcome the Bill, small as it is, and I hope we shall get satisfactory assurances from the Minister in charge on the two points I have mentioned.


I think the Government have every reason to be very well satisfied with the reception accorded to this Bill this evening. I notice that most of the Members who have spoken have asked that the Bill should be on the same lines as the legislation for England. I would explain why the words in this Bill are not the same as those in the English Act. The whole of the legislation dealing with these matters in the case of Ireland has up to the present been permissive. It has been pointed out in the course of the Debates which we have had on the Ministry of Health Bill how entirely undesirable that is and how very unsatisfactory it has proved in its working, as well as the great necessity that exists for introducing a real Ministry of Health Bill for Ireland. The Government have, indeed, such a proposal under consideration. If legislation of this kind is to be mandatory, it is well to ask what machinery we have at present in existence to enable its enforcement. An hon. and gallant Member objected to the county council being the health authority for this particular purpose, but we have had two Commissions—the Viceregal Commission and the Poor Law Commission—which have both pointed out the great desirability of handing over matters affecting the public health to the county councils, so as to enable the legislation to be enforced for the county as a whole by means of full-time, well-paid officials. We are now discussing upstairs the question of the Ministry of Health Bill, and it is proposed to set up in Ireland a body which will have to deal with this very question and to advise the Chief Secretary. Clearly the first duty of that body will be to consider the principles, scope, and character of the legislation to be introduced.


If it is only to be an advisory board, you may as well drop it.


Its first duty will be to consider how such a measure as this can be carried out. If you make it mandatory, you will have to set up in each county a new medical authority, and you will have to consider whether the present county councils, many of which are moribund, are the proper bodies to make the appointments for the new medical authority. Under the Bill I shall have to introduce shortly new county councils will have to be set up which will deal with these matters, and these are the reasons which have impressed upon the Government the view that it would be better in introducing this Bill to keep it on the same permissive lines as the rest of Irish legislation. But if, as appears to be the case, there is an absolutely unanimous desire in all parts of the House that the Bill should be mandatory, I will take care to represent to my right hon. Friend the Chief Secretary—who regrets very much he is unable to be present to-day to deal with this measure—the strong expressions of opinion which he have had here, and I hope when the Bill goes upstairs we shall be in a position to give such an answer as will meet the views of the House.


If the right hon. Gentleman has no machinery to make it mandatory, how can the right hon. Gentleman do it?


He may or may not think it desirable to appoint new officers to deal with this question.


Is there anything mandatory upon the county councils? If there is a mandatory provision at all, is there any way of carrying it out? Otherwise, what is the use of setting them up, or any other body; you would have just the same difficulty?


The matter can be discussed in Committee. I have undertaken to bring it before the Chief Secretary, who will between now and the Committee stage consider it in all its bearings. As the Bill now stands it is a permissive measure. I hope next year all our legislation for Ireland will be placed on a more satisfactory footing. Attention has been called to Sub-section (3) of Clause 1 which provides that, "Nothing in this Act shall be construed as imposing any obligation on a parent to submit his child to medical inspection or treatment." That Clause is taken from the Act of 1909. When that Act was under consideration very strong objection was raised to the compulsory inspection of children in England, and it has therefore been thought desirable to insert this provision in this Bill and allow the matter to be fully discussed in Committee. On Sub-section (4) I have to say that that also is taken from the Act of 1909 and I shall take care to represent to my right hon. Friend the very strong expressions of views which we have had in the course of this Debate. I will also endeavour, before we get into Committee, to see how this provision in actual practice works out in England, and whether there is any enforcement of this particular Clause making parents pay where it is supposed that they are in a position to do so. The right hon. and learned Gentleman the Member for the Duncairn Division of Belfast has suggested that it is not worth while, and that point will also be considered. My hon. and learned Friend the Member for West Down (Mr. Wilson) also made a suggestion with regard to the rules. I can only say that I do not think there will be any difficulty in making rules for carrying out the provisions of the Act, which is to be read as one with the Public Health Acts. I hope the measure will be read a second time, on the understanding that the representations which have been put forward shall be fully considered before the Bill is dealt with in Committee.

Question put, and agreed to.

Bill accordingly read a second time, and committed to a Standing Committee.