§ [SECOND READING.]
§ Order of the Day for the Second Reading read.
§ EARL BEAUCHAMP
My Lords, this Bill, which I beg leave to ask your Lordships to give a Second Reading to this afternoon, is a Bill to amend the Midwives Act which was passed in the year 1902. That Act set up a precedent in a good many directions, and, as is often the case with new legislation, experience has shown that it is desirable that there should be amendment in one or two directions. It is in order to carry out these amendments that this Bill is introduced. There are one or two results which I should like to mention to your Lordships; they are partly the effect, I think, of the Midwives Act of 1902.
During the last few years there has been a remarkable decrease in deaths of a character which might be prevented by competent and skilled midwives. We do not by any means wish your Lordships to imagine that we ascribe the whole of 304 this to the Midwives Act, but we say that this is one of the various tendencies all working in the same direction. In the year 1902, before this Act came into force, there were 2,000 deaths from puerperal sepsis, and the rate per million of women living was 118. In the year 1908 the figure had gone clown to 76 per million women living, which is a very considerable reduction. Taking the rate of mortality in the same disease calculated in proportion to 1,000 births, the figure has gone down from 2.12 to 1.48, which, again, is a considerable decrease. The death-rate per thousand births from puerperal sepsis and accidents in child-birth in 1902 was 4.6; last year it was only 3.57. So that your Lordships will see there has been a very real and considerable decrease since the Act of 1902 came into force. A Departmental Committee was appointed to see how far the Act had been a success, and the amendments embodied in this Bill are substantially founded on the recommendations of the Departmental Committee.
I should like to take this opportunity of paying a tribute to the admirable work which is being performed by Sir Francis Champneys, the Chairman of the Midwives Board, who has devoted a large amount of time to successfully working the Act. The discharge of their functions by the Board has, I think, earned general commendation, and that is very largely due to 305 the judgment and tact shown by the 'Chairman, upon whom His Majesty was lately pleased to bestow a Baronetcy. During the whole of the seven years Sir Francis Champneys has devoted his time and energy unremittently to the service of the Board over which he presides, and I am sure your Lordships will agree that it is fortunate that the Board should have bad the guidance of a man who at once enjoys the confidence of the medical profession and has a disinterested care for the objects of the law which the Board is called upon to administer.
I now come to the clauses in the Bill. The first clause deals with the constitution of the Board. With regard to that matter I may say at once that a considerable quantity of correspondence has reached me on this subject, and representations have been made by various bodies, some of which are anxious to increase their representation on the Board. That is not, strictly speaking., I suppose, a Second Reading matter, but rather one to be dealt with in Committee: but in this matter I shall throw myself wholly upon your Lordships' mercy. Nobody who has had experience of this matter can be ignorant of the fact that there is nothing more difficult in the world than to secure the properly-balanced proportion of various interests on a body that you want to be thoroughly representative of those various interests. There are a number of considerations to be taken into account, and the nicely balancing of the various interests concerned makes it very often a difficult matter, and if once you admit any alteration in the scheme it is very difficult indeed to know where to stop. Admit one alteration and then the other bodies concerned come and ask for further alteration. That becomes an exceedingly difficult matter, and I wish, if any noble Lord is going to move an Amendment on Clause 1, that he could be persuaded at the same time to explain to your Lordships how he would also deal with the other interests concerned. It is easy enough to move that a certain body should have representation, but the effect which that must have on the other interests concerned should be explained. And therefore I hope that if any Amendment of that kind is discussed it may be combined with a general scheme for the reorganisation of the Board.
I might mention, in case any noble Lord has any fears with regard to this, that we 306 have in the second clause a provision under which the Privy Council, if after a certain length of time they find the various bodies are not sufficiently represented, take power, after bringing the matter before your Lordships' House, to alter the constitution of the Board. In this matter we follow the precedent in the Medical Act of 1886, which has been found to work satisfactorily. Your Lordships will see that if we find after the Act has been working for some time that there is any real ground for complaint, we take power to make an alteration in any direction which may seem advisable. In Clause 3 we deal with the finance of the Bill, and after the discussion which we had last week on the subject of the rates I am anxious to explain to your Lordships that it really is not a very large charge that we propose should be borne by the rates of this country. Take the Report of the Departmental Committee which went into the question, and your Lordships will there see in parallel columns, on page 33, the amount which is paid by the various authorities under the existing scheme, and alongside of it the amount which would be paid if the scheme which is proposed in this Bill were adopted in its place. I will take the large county of London. London would have to pay an amount of only £77 11s. 8d., and that on the rates of London does not involve a serious or heavy charge. I next take my own county, which is a rural county. The county of Worcester would pay £34, which, again, even in the case of a rural county, cannot be described as a large amount to pay for the benefits derived from this Act.
Clause 7 is, perhaps, the next important clause, and that provides for the imposition of an annual registration fee of a shilling upon every midwife who wishes to keep her name on the roll. The Committee were informed that the roll was not in a satisfactory condition, and we think that by imposing this fee, which is not a large one, we shall be enabled to keep the roll better, and that the midwives will derive benefit from their names being upon the roll. Your Lordships will see that under the general scheme of the Act the midwives enjoy a monopoly of practice, and I do not think it is very much to ask them to pay this fee considering the advantages which they get from the existence of the Act.
307 Then we come to Clause 17, which deals with a difficulty of perhaps the greatest importance. Under the rules of the Central Midwives Board a midwife was required, if she noticed certain symptoms of danger or complication, to advise the woman or her relations to send for a doctor. Her responsibility was entirely confined to giving that advice, and she was not hound to secure the doctor's attendance, although as a matter of practice she very often was willing to relieve the family of trouble by communicating with the doctor herself. But the difficulty which arose was this, that the doctor who so attends is at present under no secure expectation of receiving payment for his professional services, and in some cases the medical man has refused to attend unless his fee is paid beforehand. In other cases he has only attended after so much delay that the life and health of the mother and child may have been in danger. Apart from this there has been a movement set on foot by which medical men have pledged themselves not to attend in such cases unless the fee was either paid beforehand or guaranteed by some responsible authority. The Local Government Board issued a Circular in 1907 on the subject, but the matter has been dealt with in different ways. In Liverpool and Manchester the city councils have taken the matter into their own hands, and have provided for the payment of doctors called in under such circumstances; but that is purely a voluntary proceeding on their part; and what is applicable in a city like Manchester or Liverpool is not applicable in a large and scattered area. A considerable volume of evidence was laid before the Departmental Committee on this question, and it was quite conclusive as to the necessity of some intervention by the State so that a doctor—and I think quite rightly—should be assured of receiving his fee from some public authority if he could not secure it from the woman or her relations. The only question which was at all open to doubt was with regard to the particular authority which should make the payment, and the Local Government Board, in a Memorandum, expressed themselves very strongly in favour of designating boards of guardians as the responsible authority.
This particular provision was subjected to very severe criticism in the original form in which the Bill was introduced by my noble friend Lord Wolverhampton, 308 and as it stands in the present Bill Your Lordships will see that some alterations, which I hope will be considered important, have been introduced. Clause 17 provides that where a duly qualified medical practitioner has been summoned upon the advice of a certified midwife attending a woman in child-birth to render assistance in a case of emergency, he shall be entitled to recover from the board of guardians of the Poor-law union in which the woman resides such fee in respect of his attendance as may be prescribed; and such fee may, if the board of guardians think fit, be recovered summarily as a civil debt from the patient or person liable to provide the patient with medical aid. Relief of this nature, whether recovered or not, will no in any case entail disfranchisement, and we hope there will be no disagreeable incident connected with it. If no provision was made for the recovery of the money, gratuitous medical attendance at the cost of the State would for the first time be introduced, and whether that be right or wrong it did not seem that an amending Bill of this nature was the proper occasion for allowing such a provision to be entered on the Statute Book. An endeavour has been made to make this Bill as far as possible non-contentious by avoiding raising any large issues connected with Poor-law relief, and I hope the course we have taken will secure that result.
The other matter to which, perhaps, I ought to allude is one which is not directly referred to in the Bill, but one upon which some communications have reached me. I refer to the omission from the Bill of any reference to Ireland. I would point out that one reason why there is no mention of Ireland in this Bill is that this is an amending measure. We only propose to amend the Act of 1902, within the scope of which Ireland was not included. As Ireland was not brought within the scope of that Act it is not desirable in an amending Act to introduce any new principle, or such a great change as the inclusion of Ireland would be. That is the first reason we have for not including Ireland in this Bill. Our second reason is that the system in Ireland is quite different. In that country there are dispensary midwives, and we do not think it would be easy to work that system in connection with the Central Midwives Board in London. But if any noble Lord would introduce a Bill relating specifically to 309 Ireland we would be glad to place at his disposal all the information which we have concerning the subject.
§ EARL BEAUCHAMP
If a strong opinion were expressed by your Lordships in favour of such a Bill I would make representations to the Irish Office on the subject. I think it is a matter which ought to be dealt with by that Office rather than by the Department which deals with this country. I hope your Lordships will allow me to take the Committee stage of the Bill next week. The original Bill was introduced into this House in March of this year, so that I do not think we can be accused of dealing with this matter with unnecessary or undue hurry. The matter has been fully before those who are interested in it for something like three months, and being anxious to get the Bill through during the present portion of the session I hope your Lordships will allow me to take the Committee stage one clay next week.
§ Moved, That the Bill be now read 2a.— (Earl Beauchamp.)
§ THE MARQUESS OF LONDONDERRY
My Lords, I should not have intervened in this debate had I not received representations from Belfast bringing before me reasons why it is hoped that the case of Ireland will be considered in connection with this measure, and that benefits similar to those which this country will receive from the passing of this Bill will be extended to Ireland. The subject is not an entirely new one with regard to Ireland. A Question was put to the Chief Secretary in another place, and he replied—I do not propose to introduce legislation on the subject, at all events during the present session. 1 would point out that there is not the same urgency in the matter in Ireland as in England, having regard to the powers boards of guardians in Ireland already possess.I do not think that answer would satisfy the gentlemen in the North of Ireland who have brought their case before me, claiming that Ireland beyond all doubt ought to have the same benefits as are proposed in this Bill with regard to England. The noble Earl said that the Act of 1902 did not include Ireland. I cannot agree with that statement. If the noble Earl 310 will refer to the Act of 1902 he will see that Section 2 included a certain amount of relief for the people of Ireland, but it was provisional for only two years, and. after the two years Ireland was left entirely out of the benefit of the Act. It is on these grounds that these gentlemen ask that their claim may be recognised at the present moment.
I would ask your Lordships to allow me to read an epitome of what was put before me when I was in Ireland. I ask for that indulgence because your Lordships never like any document to be read, but my frends who put before me very clearly their requirements only sent me their views in writing shortly before I entered your Lordships' House, and although I have run through the epitome of what they want I have not got the points clearly in my mind. Therefore I ask your Lordships to allow me to read the views they put forward. The reasons the Irish people think they have a grievance at the present moment are as follow. They say—At the present time the Midwives Act only applies to England. By this Act it is enacted that after April 1, 1910, it is an offence for any woman not a legally qualified medical practitioner, unless certified under the Act, to attend women in childbirth, habitually and for gain, except under the direction of a medical practitioner, unless in case of emergency, under a penalty not exceeding 220. The result is that a fully-trained Irish midwife who has passed the examination and holds the certificate of an Irish Maternity Hospital, suffers no disability so long as she is attending a case along with a doctor; but if she has not, in addition to an Irish midwifery diploma, the certificate of the Central Midwives Board, she is not legally qualified to conduct cases herself in England, nor to accept an appointment as midwife under the local supervising authority of an English county, a borough, or an urban or rural district. If she attempts to do so, notwithstanding that she holds an Irish midwifery certificate, she is liable to be penalised.Also it is now an almost universal requirement in advertisements fur appointments in the Colonies that the State degree must be held. Unless, therefore, an Irish midwife is prepared to go to the expense and inconvenience of crossing to England, remaining there for ten days, and spending money for a diploma, thus contributing to the support of the English Board, she is practically debarred from receiving a Colonial appointment. Further, the military authorities at the Curragh when advertising for a midwife in this, the very centre of Ireland, require that she should hold a diploma from the Central Midwives Board.The injustice is all the more pronounced since the Irish midwifery training is even more thorough than that given in England. The Central Midwives Board in England require a period of only three months study, while in the Rotunda Hospital, the Belfast Maternity Hospital, and all other training schools in Ireland a six months period is the length required. Further, the Central Midwives Board 311 require only fifteen lectures to be given to midwives, while in the Irish Maternities the number of lectures is greater, the pupil midwives are more closely supervised, they have opportunities of seeing more cases, and are trained only in sufficient numbers for the efficient care of he patients in the Irish Maternities; in other words, no nurses are trained who are not kept busy constantly throughout the whole six months course.These facts show that the Irish certificated midwives have a distinct grievance, and that the limitation of the Act to England inflicts upon these trained midwifes a clear injustice. The remedy lies either in introducing a Midwives Bill for Ireland, though from Mr. Birrell's answer to a recent Question in the House of Commons there would seem to be but little prospect of this, or an Amendment might be made to the present measure providing that the Central Midwives Board in England shall certify those Irish certificated midwives who apply, so long as the training and examination for the Irish certificate does not fall below the standard adopted by the English Board. The latter would seem to be the easier method of removing what must be acknowledged to be an unmerited restriction on trained and certificated Irish midwives.I do not propose to say any more in bringing under your Lordships' notice this document, except to express the hope that after what the noble Earl has said he will consider the points I have ventured to read to him, and will hold out a hope to Ireland that something will be done by the Government to do away with what seems to me unfair treatment and hardship on these Irish midwives.
My Lords. I wish to support in every way the speech which has been made by my noble friend who has just sat down. He said very much what I intended to say in support of the view that this Bill should be extended to Ireland. I am fortified in the opinion that it would be well to do so from communications I also have received from people who are very well able to judge. The Royal College of Physicians, the Academy of Medicine, the Rotunda Hospital and the other medical bodies in Ireland are all in favour of this, and I may say I have received a letter from Sir William Smyly, the eminent physician in Dublin, in which he says—The Act is a good and useful one, and will tend to reduce the mortality from puerperal fever in England. In this country Ireland, the deaths from this cause are lamentably frequent. The inclusion of this country under the Midwives Act would be of the greatest importance, and as the Act is at present undergoing revision in the House of Lords it appears to be a favourable time to propose that it should be extended to Ireland.I think that is a manifest proof that it would be of great advantage to Ireland to 312 have the Act extended to it. I have heard it stated that there are difficulties in the way, owing to the fact that the Privy Council in this country have no jurisdiction in Ireland; but surely this might be met by the Privy Council here appointing certain qualified people in Ireland—say, for instance, three to be appointed by the Local Government Board, one of whom should be a woman, and the other two medically qualified, and one duly qualified medical practitioner to be appointed by the College of Physicians.
There is no doubt about the question that my noble friend raised with regard to the present position of Irish nurses. I may say that I received very much the same kind of memorandum from the Rotunda Hospital—it is almost in the same words—as that which the noble Marquess read, pointing out the excessively unfavourable position in which these midwives, who have been trained in a school certainly second to none, are placed. As my noble friend stated, the military authorities at the Curragh when advertising for a midwife require that she should hold a diploma from the Central Midwives Board, thereby excluding Irish midwives. I feel so strongly on this that I should like at the next stage of the Bill to propose an Amendment which would as far as possible bring Ireland within the scope of this Bill. The matter is so important and affects Ireland so closely that I hope His Majesty's Government will either consent to this, or will introduce a Bill for Ireland separately. If the Government will undertake to bring in a Bill with the same provisions as in this Bill and affording perfectly reciprocal treatment to nurses in England and Ireland, the end will be attained. But when will that take place? How long may we have to wait before a Bill is introduced by His Majesty's Government? That is a point to be considered. I hope, therefore, that the noble Earl will look indulgently on the Amendment that I intend, in Committee, to propose.
THE EARL OF MAYO
My Lords, I should like to say a few words with regard to this Bill. First of all, let me congratulate the noble Earl on his very clear description of the Bill. I quite understand that this is an amending Bill, amending the Act of 1902, and I appreciate the difficulty there would be in applying the whole of the Bill to Ireland. Let me say—and I say it with some pride—that we consider the midwives 313 in Ireland more highly trained at present than are the midwives in this country. That is to say, they have received a longer training in the Rotunda and the Coombe Lying-In Hospitals. I quite appreciate that to propose to apply the whole of the Bill to Ireland would at this stage of the session jeopardise the Bill; but I think the noble Earl might consider the possibility of inserting an amendment allowing midwives who possess the diploma from these hospitals in Dublin to be engaged as Army nurses, to be employed in the Colonies, and to take their position in this country in the same way as English midwives. That seems to be a provision which would not in any way interfere with the whole scheme of this very important Bill. But, as I have said, I quite follow that applying the whole Bill to Ireland would require a great many changes throughout the Bill. I hope that before we decide on the Second Reading of the Bill, the noble Earl will tell us what his views and the views of the Government are with regard to the particular Amendment which I have foreshadowed.
§ LORD ASHBOURNE
My Lords, there is considerable feeling in reference to this Bill in Ireland, not at all by way of disapproval of its provisions or of its excellent objects, but there is a strong feeling that in this case injustice is being done to a large and deserving class in Ireland. It is true that Irish midwives were left out of the Act of 1902 on representations being made not at all dissimilar to those which are now presented from the Government Bench. Nothing has since been done. And now when an amending Bill is proposed covering modifications and developments the Irish nurses who are affected find that still nothing is done for them.
The noble Earl referred to the introduction of a Bill relating specifically to Ireland, and said that if any noble Lord would bring forward such a Bill the Government would place at his disposal all their information concerning the subject. That is not exactly treating us as if we were unwise, but it is not a practical way of dealing with the question. Even to bring in another Government Bill limited to Ireland would not meet the case. If a separate Bill were brought: in with reference to Ireland it might be dropped, or it might not be pressed on with the same insistence that is going to be applied to this Bill. I can see no practical difficulty in so amending this Bill 314 as to extend such of its provisions as can reasonably be extended to Ireland. The noble Lord behind me (Lord Clonbrock) has indicated that he proposes to place. Amendments on the Paper. I am sure the noble Earl will consider them and see if they cannot with advantage be introduced into the Bill. But everything depends on the point of view. If the Amendments are read with a view to giving reasons for not adopting them that is one point of view, and a very easy one for those to take who object to them; but if they are read with the object of seeing how many of these Amendments can be fairly introduced and seeking at the same time to satisfy the natural wishes of Ireland on the subject, that is another point of view.
It is to be borne in mind that although this discussion is important, and although I can see the reasonableness of the noble Earl wishing to pass the stages of this Bill before the adjournment which will now take place very soon, that does not mean the end of the Bill. It has then to go elsewhere and there are many people there who will have their attention directed to this question in as full a way as the attention of some members of this House has been directed to this matter; and I have no doubt that if the case of Ireland is not earnestly considered with a view to adopting some of the Amendments moved, it will be found that the Bill may not have as rapid a progress elsewhere as is desired. I merely say that to indicate that I think there are many reasons which should induce the Government to consider this question, not only with an open, but with a favourable mind. I do not think it would be fair to ask the noble Earl now to indicate in any detail what he would be prepared to do, but I think he might, when he reads the Amendments of my noble friend Lord Clonbrock on the Paper, consider them with a fair and reasonable mind, in concert with his advisers, and with a desire to meet the case of Ireland as far as he possibly can.
LORD BALFOUR OF BURLEIGH
My Lords, rise to say a very few words with regard to this Bill, and I shall not express any opinion as to the expediency in the abstract of extending the operation of the principal Act to Ireland. From all I hear, similar provisions to this Bill would be welcomed in Ireland; but I think there would be considerable technical difficulties in fitting this Bill, which is an amending 315 Bill to the Act now on the Statute Book, to the circumstances of Ireland. I speak with some knowledge on that point, because had the privilege of piloting the original Bill through this House, and at that time I knew perhaps better than I do at the moment the technical difficulties of applying the same certifying authority to both England and Ireland, and, as a matter of fact, to Scotland.
As one of those responsible for the original Act I heard with the greatest possible pleasure the satisfactory statement of the noble Earl of the results of the operation of that Act during the past five or six years. It seemed to me to be extremely satisfactory and to entirely justify those of us who were responsible for the original Board; and I think the noble Earl did no more than justice in paying what was really a well-deserved tribute to the chairman who has given the most self-denying service to the work of the Board. The noble Earl passed in review some of the clauses of this Bill. I think I appreciate the motives of the noble Earl in withdrawing his predecessor's Bill and bringing in a new one. There were a certain number of Amendments suggested to that Bill, and I think probably on the whole it was a convenient course to the House and more satisfactory to himself that lie should bring in a new Bill rather than attempt to amend the Bill of the noble Viscount. Lord Wolverhampton, in light of the criticisms which it had provoked.
But, my Lords, undoubtedly on some points some of those keenly interested in Lord Wolverhampton's Bill are rather dissatisfied with the amount of effect which their representations have had, and to this extent they think they have a grievance. I do not express an opinion upon it myself. I merely am acting as the mouthpiece for others. The Bill of the noble Viscount having been long before the House and the public and then withdrawn, it was hoped that larger changes would be made in it; and bringing it in at this period of the session in a renewed form and proposing to pass it through this House in some eight to ten days has an appearance, at any rate, of not being altogether fair to those who did not know what was likely to be done when the former Bill was withdrawn. I do not express an opinion. I merely say that these criticisms are made, and I think that if the noble Earl perseveres in his intention to pass the Bill through this House next 316 week, he will find those criticisms more loudly expressed by other noble Lords.
I am bound to say that so far as Clause 17 is concerned—the clause which makes provision for the recovery of the medical fees—I venture to agree with the noble Earl that that clause is a great improvement on its predecessor. The noble Earl in calling attention to the amendment which lie has made, clearly stated the undoubted difficulties which surround the whole subject.; and it is very satisfactory to me, at any rate, and I think to most of those who are interested in the subject, that what I would venture to call the Poor-law taint has been very largely removed. It was one of the points in Lord Wolverhampton's Bill more adversely criticised than any other, and I am bound to say that in the main I agreed in that criticism. But the Poor-law taint is not altogether removed. No penalty attaches to the fact that the family may not be able to pay the doctor's fee, but there is still the undoubted disadvantage that that money has to be found through the Poor-law authority. I am not sufficiently versed in English local government to express a confident opinion as to whether any better substitute can be found. I think it is much more a point for Committee than Second Reading, and I content myself with saying that I rejoice at the direction in which Amendments have been inserted. They are undoubtedly a great improvement on the Bill as it stood although I venture to think the provisions are not yet wholly satisfactory.
There is one other point on which I want to say a word—namely, as to the representation of various bodies upon the Board. The noble Earl threw himself upon the sympathy of the House, and I think the difficulty of deciding between the conflicting claims of various people, all of whom think they ought to have a majority on the Board, will be admitted by any one who has had experience of such matters. The noble Earl said to those of us who are not satisfied with the present constitution of the Board, "If you are going to make a change in one particular, you must make a corresponding change so as to keep up the balance over the whole Board." That would have been a very fair challenge if he had told us the reasons which had satisfied him in producing these provisions in the Bill, but it can hardly be said that criticism is not justified unless you are prepared 317 to produce a wholly complete scheme when you are in ignorance of the reasons uppermost in the minds of those who proposed the scheme before us; and it does seem to me—and this is the only criticism I shall venture to make—that the certified midwives; are rather shabbily treated in only having two representatives, one of whom is to be a. certified midwife. I should have hoped that an additional one might have been added to their representation, so that they, the body so largely concerned with the administration of the Bill, might have had larger representation on the central authority. I fully agree, however, having made that remark, that it is much better that it should be left over for those who are more deeply concerned in it than I am to make the exact suggestion as to the representation which they would like to have on the Board.
There is one other matter. I venture to think that the noble Earl has not paid quite sufficient attention to some of the representations made. I refer to Clause 11, the notification clause. It must, I think, be obvious that many of those actually concerned and practising as midwives are not highly skilled in technical forms, and to impose two or three different forms of notification upon them seems to me to require rather more justification than has yet been given. I frankly admit that this clause is an improvement upon its predecessor. The time before which a practising midwife has to give notice has been extended, and the penalty has been reduced; therefore it is not quite so drastic or terrible an engine as it appeared in the former Bill. But many of these women, excellent as they are in the practice of their profession, are not skilled in filling up forms and giving notices, and I venture to say that the requirements as to this class of writing work should be made as easy and as gentle as possible.
Then, my Lords, those who have made representations to me are also afraid that the particular provisions of Clause 11 will have a very detrimental effect upon the employment of midwives when a doctor is in attendance. It is, of course, an advantage that the nurse who is attending along with the doctor in a case of confinement should as often as possible be a certified midwife, but if all the obligations laid upon certified midwives are to be put upon them even when they are in attendance along with a doctor, it seems to me that the 318 certain result will be that you will place them at a. disadvantage and recourse will be again bad by the doctors to the employment of women as monthly nurses who are not certified midwives. The only quotation I shall read is a representation which has been made to me on the point that I have endeavoured to explain to the House. It is this—We suggest that the only effect of this clause will be to induce medical men to abstain altogether from their growing practice of employing a certified midwife as monthly nurse, for the clause operates to compel the certified midwife, under penalties, to report the medical man for being absent front whatever cause at the minute of birth.If the monthly nurse is not a midwife and not endowed with that power and not put under that obligation, it is quite obvious, it seems to me, that medical men not of the first class will have a tendency to run the risk mentioned. The result of that will be to the disadvantage of the population, and will tend to annul to some extent the advantages of the existing Act which the noble Earl laid before us. I have, perhaps, gone rather too much into detail; but, as your Lordships know, I shall not have, or it is most unlikely that I shall have, the opportunity of speaking at the subsequent stage, and so I thought it best to make these criticisms for the purpose of showing the noble Earl the sort of questions he is likely to have to meet in Committee.
§ EARL BEAUCHAMP
My Lords, I have every reason, I think, to be grateful for the reception which has been given to this Bill. The danger, it seems to me, is that the Bill is likely to be smothered with too much kindness in the anxiety of noble Lords opposite to apply it to Ireland. As to the application of this Bill to Ireland, I think the position is this. The original Act may be described as having a double effect, first of all as a scheme for the general benefit of the country, and also having regard to the individual qualifications of the midwife. With regard to the first, I venture to think there would be serious difficulty in applying this amending Bill to Ireland, or applying the scheme of the original Act through an amending Bill to the whole of that country. But if the noble and learned Lord, Lord Ashbourne, would be good enough to draw up some Amendments, I can assure him they will receive very careful attention.
With regard to the other point., the hardship on the individual, I will be very glad 319 to do what I can to meet the noble Marquess. He called attention to the fact that Section 2 of the original Act did give certain advantages to women who had been trained either at the Royal College of Physicians in Ireland or at the Rotunda Hospital in Ireland. If the noble Marquess introduces an Amendment carrying out that, I shall be very glad indeed to consider it favourably and to do what I can to meet the claims of these individuals. But may I point out that that is one of the objects of Clause 12 in this Bill. Perhaps the noble Lord, Lord Clonbrock, and the noble Marquess will look at that clause. The object of it is to give reciprocal treatment to any women who produces to the Central Midwives Board satisfactory evidence that she has been trained as a midwife and certified in any other part of His Majesty's Dominions. So that one of the objects of the amending Bill is to see that a woman who can produce satisfactory evidence that she has been certified by a public authority qualified to give her the certificate shall come under the Act and receive the advantages of it.
THE EARL OF MAYO
Does the noble Earl think that will cover the individual cases he has mentioned, because I had not noticed that clause.
§ EARL BEAUCHAMP
Subsection (1) of this clause reads—Any woman who produces to the Central Midwives Board satisfactory evidence that she has been trained as a midwife and certified in any other part of His Majesty's dominions in which there is for the time being in force any Act or ordinance for the certification and registration of midwives under a public authority, and which admits to its register midwives certified under the principal Act on reciprocal terms, shall on payment of the like fee as is payable in ordinary cases be entitled to be certified under the principal Act; provided that the standard of training and examination required in such other part of His Majesty's dominions is equivalent to the standard adopted by the Board.I am not prepared to say, without consideration, whether that would apply to the various cases mentioned by the noble Marquess, but if he and his advisers think it will not, I shall be very glad to consider any Amendment, and perhaps in consultation with the noble Marquess, be able to arrive at some agreement before the Committee stage. I can assure the noble Marquess that it was not in our minds to affect adversely any woman from any country so long as she is properly trained.
320 Perhaps I might say, in answer to the two points on which Lord Balfour of Burleigh chiefly spoke, that the object of Clause 11 is to meet certain cases which we are afraid may happen in which women not properly qualified may be regularly employed by a doctor, the doctor himself not meaning to be present at the actual moment. Our idea is to prevent such a practice taking place, so that when the doctor makes a habit of not being present then by virtue of these notifications which will reach the central authority they will become aware of its being a practice and take steps in order to prevent it. But I quite agree with the noble Lord that this is a matter for Committee, and I had in mind a possible Amendment submitted to me with regard to which we may come to an agreement at the Committee stage. Then as to the slight criticism by the noble Lord with regard to the small alterations to the original Bill, might I say that if the alterations are small it seems to me not unfair to ask that the time given to the consideration of this Bill may also be small. If I had made alterations enlarging the scope or revolutionising the effect of the Bill, it would have been only fair to have given several weeks to its consideration; but the amendments being, as the noble Lord said, of a somewhat small character, I do not think it unfair to ask your Lordships not to delay too long before taking the Committee stage.
§ THE MARQUESS OF LONDONDERRY
My Lords, may I draw attention to one remark of the noble Earl? I fully recognise the spirit in which he has met the representations from Ireland and our desire to remove what we think a hardship. As to Section 2 of the original Act, he promises that if we bring forward an Amendment based on the lines of that section with regard to Ireland, lie will consider it very favourably. The noble Earl then referred us to Clause 12 of the Bill under discussion, but I would point out this difficulty. This clause refers to the Colonies more or less. It is meant to be reciprocal. It is given to the Colonies because there is an actual ordinance in force. In Ireland there is no actual "ordinance" in force, but only a good system. Perhaps the noble Earl will consider that before he brings the Bill forward again.
§ On Question, Bill read 2a, and committed to a Committee of the Whole House on Tuesday next.