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m , , f W m I L M U o m , 3 Britannic Majesty'8 G o v e r n m e n t ) .

7 5 S/.2& / M I N I S T R Y OF HEALTH BILL:

Memorandum by the P r e s i d e n t of the Local Government Board.

' 1, Whatever B i l l t h e Government e l e o t to i n t r o d u c e must be the B i l l of the Government and t h e y commit themselves to the c l a u s e s and t o t h e p o l i c y embodied in t h e c l a u s e s . I t i s t h e r e f o r s impor tan t t h a t the p r o v i s i o n s of the B i l l should be w e l l c o n s i d e r e d b e f o r e they a r e brought i n . I t i a p a r t i c u l a r l y n e c e s s a r y t h a t t h e p r e s e n t B i l l should be agreed upon by a l l t h e Departments whose f u n c t i o n s i t may touch . I t ia not enough fo r t he M i n i s t e r of R e c o n s t r u c t i o n to say t h a t such and suoh a c l a u s e i s p u t i n t o c o n c i l i a t e suoh an such an i n t e r e s t o r i a the p r i c e a t ^h ich such an such an o p p o s i t i o n can be withdrawn. U n t i l t h e B i l l i s be fo re the House i t i s s p e c u l a t i v e t o say what l a t h e s t r e n g t h of a p a r t i c u l a r i n t e r e s t oar f a c t i o n , and i t la t h e r e f o r e unwise t o admit c l a u s e s mere ly t o appease a s e c t i o n o f p u b l i c o p i n i o n u n l e s s t he Government e i t h e r accep t t h e i r views o r f e e l t h a t t h e i r o p p o s i t i o n cannot be w i t h s t o o d .

3 . I t ia a l s o n e c e s s a r y for t h e Government t o have cone to some d e c i s i o n on t h e scope and purpose o f t he B i l l . The ob j eo t of t h e measure a s d e s c r i b e d i n the Report of the S u b c o m m i t t e e of which Dr. Addison w a 3 t h e Chairman, was t o secure t he more e f f i c i e n t working of e x i s t i n g p u b l i c h e a l t h s e r v i c e s . By oomaon consen t i t i s agreed t h a t i t s h a l l on ly ex tend t o t h e powers of t h e C e n t r a l Government r e l a t i n g t o H e a l t h . The s e v e r a l Depar t ­ments enumerated i n t he Report a s concerned w i t h t he p u b l i c h e a l t h a r e t h e Local Government Board, the E n g l i s h and Welsh Insurance Commissions, t h e Board of E d u c a t i o n , t h e M i n i s t r y of P e n s i o n s , t h e Home O f f i c e , t h e Board of Trade , t he Board of A g r i c u l t u r e , t he Pr ivy C o u n c i l , t he Admira l ty and the War O f f i c e . A l l t h e arguments c u r r e n t l y u s e d i n s u p p o r t ' o f a M i n i s t r y e f Hea l th aye based on t h e i d e a of c o - o r d i n a t i o n . Though I am i n favour of a M i n i s t r y of H e a l t h , I do no t b e l i e v e t h a t complete c o - o r d i n a t i o n of the h e a l t h f u n c t i o n s of the C e n t r a l Government In one w a t e r ­t i g h t compartment would eve r be p o s s i b l e . But whatever we a r t t o do we must know what we a r e doing and w i t h what f u n c t i o n s u n d e r what Departmenta we a r e p ropos ing t o d e a l .

3 . The comments on t h e B i l l t h a t fo l low a r e made mainly w i t h two o b j e c t s , one t o a n t i c i p a t e p o i n t s which I f e e l su re w i l l be r a i s e d and w i l l have t o be answered i f the B i l l i 3 i n t r o ­dueed as i t s t a n d s , and t h e o t h e r t o avoid the i n c l u s i o n of u n n e c e s s a r y m a t t e r .

Clause 1 . - I t i a not p o s s i b l e to divorce Health from l o c a l Government of which i t forms so large a part and with which i t i s i n e x t r i c a b l y in ter twined . P r a c t i c a l l y a l l the Local A u t h o r i t i e s whether Councils o f Count ies , Boroughs, D i s t r i c t s or Par ishes or Boards o f Guardians are concerned in g r e a t e r or l e s s decree w i th h e a l t h . And they a l l are a l s o engaged with ques t ions not r e l a t e d to h e a l t h . S i m i l a r l y the Local Government Board, though l a r g e l y occupied with hea l th Q u e s t i o n s , dea l s with a v a r i e t y of t o p i c s not s p e c i a l l y r e l a t i n g to h e a l t h . Thus i t sanc t ions loans for a l l purposes, approves byelawe on a var i e ty of s u b j e c t s , a u t h o r i s e s a l i e n a t i o n of l a n d s , d e a l s wi th highways, r a t i n g , a u d i t , o l d age pens ions , l o c a l s t a t i s t i c s , l o c a l Aots &e* &e. I there fore think i t would be more appropriate to c a l l the Min i s t er the "Minister of Local Government and Health".

Clause 3 . - I think t h i s c lause should de f ine with

SUFFICIENT ELAARIIEAS FCFCE FTAOTIOIW WHIOO a*f TE PASS F I D ETHER DOPERTAENTE TO THO NEW MINISTRY EITHER AT ONCE OR SUBSEQUENTLY. I T my BE A QUESTION WHETHER A TIME LIMIT SHOULD BE IMPOSED FOR THE TRANSFER OF THE SERVIOES WHIOH ARE NOT TO PASS AT ONCE. PARLIAMENT AND THE DEPARTMENTS AFFECTED WILL I THINK CLAIM TO KNOW WHAT ARE THE INTENTIONS OF THE GOVERNMENT. REMEMBERING THAT THE WHOLE OF THE EASE FOR a CENTRALISED MINISTRY OF HEALTH I E ARGUED ON THE VITAL NECESSITY OF IMMEDIATELY CO-ORDINATING

ONE DEPARTMENT THE HEALTH FUNCTIONS OF SOME DOGEN DEPARTWENTE, I CAN HARDLY SUPPOSE THAT QUESTIONS WILL NOT BE ASKED AN TO THE POSSIBLE IMMEDIATE TRANSFER TO THE NEW MINISTRY OF THE FOLLOWITTC POWERS?­

( A ) THE POWERS OF THE BOARD OF EDUCATION WITH REFERENCE TO THE INSPECTION AND TREATMENT OF THE AILMENTS OF SCHOOL CHILDREN:

(b) Tha POWERS OF THE HOME OFFICE I N RALATION TO THA B $ A M OF CONTROL AND I N RELATION TO INFANT LIFE PROTECTION:

It)) Tha POWERS OF THA PRIVY COUNCIL UNDER THO HEDIOAL ACTS ; AND THA TLIDWIVEE ACTS:

( D ) THA POWAXS OF THA BOARD OF AGRICULTURE I N REGARD TO MILK AND OTHER FOO&SJ ,

AND AA TO THE PROBABLE TRANSFER WITHIN A ABORT PERIOD O F T ­

( A ) THA POWERA OF THA MINIOTAR OF PENSIONS I N RA^ARD TO THA TREATMENT OF S I OK AND DISABLED MAN;

("p) THA POWERS OF THA BOARD OF TRADE I S REGARD TO THA i HEALTH OF THE HSROANTILE MARINE:

( O ) Tha POWERS OF.THA-HobA OFFICE RELATING TO TNOAT WHO / WORK I N FACTORIAA AND M I N E S . '

I T la NET POSSIBLE TO BASE THE B I L L ON THA NEED FOR CO-ORDINATION AND TO LEAVE ALL THAAE POWERS UNCOORDINATED AND THA P O S S I B I L I T Y OR PROBABILITY OF-THEIR CO-ORDINATION A NEFCILOUE BLANK. Tha PROPER OOUREA AS I T SEEMS TO MI IO TO INDICATE ( A ) THE- POWARS WHIOH ARE TO BA TRANSFERRED AT ONCE AND LB) THA POWERE WHIOH ARE TO BE TRANSFERRED WITHIN A FIXED TIME, SITTING AACH

. CATEGORY OF POWARA OUT I N THA B I L L .

I m NOT I N FAVOUR OF ANY TRANSFER FROM THA MINISTRY OF LOCAL GOVERNMENT AND HEALTH OF POWERS NOT STRICTLY CONCERNED

' WITH HEALTH. MAJOR ASTER EU/R$EETED FOR. EXAMPLE TBAT AUDIT MIGHT ^ BE TRANSFERRED. THIS WOULD BA A MOAT RETROGRADE ATOP. THA M A L T

OF THE aooounto OF LOCAL AUTHORITIES WHO. ARE THA PUBLIC HEALTH AUTHORITIES SHOULD OBVIOUSLY BE UNDER THA CONTROL OF"THA MINISTER

^ WHO I S I N CHARGE OF THE CONCERNS OF THOSE AUTHORITIES. .

THE COURSE WHIOH I AM DISPOSED TO SUGGEST I S THAT, BEFORE ANY B I L L I S CIRCULATED, THA HOME AFFAIRE COMMITTEE SHOULD .

A COMMUNICATE WITH ALL THE MINISTERS OONOEMED AND SHOULD INVITE THAM TO CONFER ON THE QUESTION OF THE EXTENT OF POWERS TO BE TRANSFERRED, WHEN THIS I S DONE THERE WOULD BA NO DIFFICULTY I N

- DRAFTING THE NECESSARY OLAUSOS. UNLESS THIS I S CLOW AMENDMENTS MAY BA SPRUNG ON U S FOR THA TRANSFER OF POWARS OF VARIOUS DEPART-MEATS, TO WHIOH I T WILL BE DIFFICULT TO REPLY.

CLAUSE G R .- I ASSUME THAT THIS I S REGARDED AS

necessary i f a l l the powers of the Insurance Commissioners art t ranaferred . I should myself have preferred a l e s s ambitious aoheme which would have rendered t h i e o lauee unnecessary.

Clause 4 , - I have already urged my o b j e c t i o n s to t h i s c l a u s e on c o n s t i t u t i o n a l grounds. I think the olauee should be omi t t ed . I f i t be re ta ined , i t should be in the

ttItfo l lowing t erms: - s h a l l be lawful for the Min i s ter to " e s t a b l i s h an Advisory Oounoil for adv i s ing him on any matter *wbioh he may think f i t to r e f e r to them". An Order in Council i s unneoossary. The i n i t i a t i v e must l i e with the Minis ter and with no one e l s e , and he must have the r ight of determining the appointment of any member of the Advisory Counci l , To s u g g e s t , as appears to be intended, that members of the Council s h a l l be nominated by the Crown for f ixed per iods independently of the Minis ter i s t o put him in to an almost untenable p o s i t i o n , could d i smiss h i e permanent o f f i c i a l s but could not g e t r i d of members of h i s Consultat ive Committse.

Clause 5 . * This c lause i s not I oonoeive necessary to the B i l l . Subject to the consent of the Treasury, and of t o t House o f Commons i n connect ion wi th h i s Vote, the Minis ter can maintain a bajanch o f f i c e a^ay from London i f i t i s necessary . The c lause a s d r a f t e d reads r a t h e r a s though i t was Intended t o e s t a b l i s h a new o f f i c e . I presume a l l that i s r e a l l y contemplated i s the continuance of a National Health Ineruraaoe Offioe at Cardiff .

T

^ ^ ?* t d 9 8 l O T O TJ ^ ? G 8ghedule. I have a lready expressed my ooj r t (

T ? y ^ i n c l u d i n g paragraph 1 o f t h i s s K S . g ive d f f e o t , and i t s mere presence w i l l bring in to being a l l the

? U wJ E E / V J l ! ? 0 0 Ouardiana whom i t i s proposed t e \ b o l i s h S S * 8 br inging to the a id of the G o v e r m e n f the S w P S ? n L ? r a t 0 i o n / 0 l ^ a o n 8 l 4 0 r e d ******* ** reforming our P^or

W. HAYES FISHER.

al Government Board, Whitehal l , 8 . W . I . ,

16th Ju ly , 1918.

WAR CABINET,

Tho a t t a c h e d Paper has "been

r e f e r r e d t * . t h e Committee of Hame

A f f a i r s .

2t Whi teha l l Gardens,S.W.