25 March, 1926.]

are not mainly maternity homes. That, 1 think, would meet the point you have just made to a considerable extent, assuming that the Amendment was accepted.

Chairman.] Exactly; that, Sir Richard Luce, is your point?-A bill may go through.

Sir Richard Luce.] Yes. A Bill may be passed before we have finished our findings.

Chairman.] Would you like to ask any question about that point now?

Sir Richard Luce.

8. Supposing the Maternity Bill passed in its present form, it might, to use the expression, queer the pitch of our findings in this Committee?-I doubt if the overlapping is as great as all that.

Chairman.

9. You have no figures in the Ministry which will tell us that?-No; I do not think such figures are in existence.

10. I thought perhaps in view of the fact that this Maternity Bill was on, you would have some figures about that point? No, because I do not think the Ministry have ever had occasion to consider the question of the registration of nursing homes as such until this Bill of last session was introduced.

11. But they have had before them the question of registering maternity homes?-Yes.

12. And maternity homes, as I understand it, are very largely also nursing homes-it may be accidental?-Then, as I say, this Amendment would differentiate between the two to a very great extent.

Major Price.

13. Every nursing home as defined by our Bill includes every maternity home? -And a great many other institutions too.

14. But, as I say, the greater includes the lesser?-Yes.

15. There is the Maternity Bill which includes a certain number of nursing homes; in fact, the definition in the Bill is "any premises used or intended to be used for the reception of pregnant women "?--Yes.

16. That is pretty wide. That practically includes every nursing home that

[Continued.

has accommodation suitable for a woman in that state?-Is that altogether so? I should think that there were a very large number of midwives who took in a case or two possibly even in their own house, exclusively maternity cases, apart from the larger maternity homes and the maternity hospitals, and those are the sort of cases with which the Maternity Homes Bill was at any rate intended to deal.

Dr. Shiels.] But does this matter at all?

Chairman.] It does matter, in view of this Bill.

Dr. Shiels.] But suppose we make certain findings with regard to nursing homes, any legislation which follows these findings will take account of this Maternity Bill, if it is really passed into an Act, and will make the necessary modifications to distinguish between the

two.

Sir Richard Luce.] It depends upon the point of view of the Members of this Committee. Their action with regard to the Maternity Bill should be, it seems to me, based more or less on the evidence that they are going to get now; that is why I think it is important that we should get the Maternity Bill held over until the findings of this Committee are made. That is the important point really. Dr. Shiels.] I agree.

Chairman.

17. I was trying to get from the Ministry how far it was a case that those two kinds of homes overlap and dovetail into each other. That seems to be not very generally known, or rather, there does not seem to be much evidence one way or the other on that point; I cannot go any further than that.-(Mr. Brock.) Unless the supervising authorities were different in the two Acts I do not know that in practice any very great difficulty would arise.

Chairman.] That, as Dr. Shiels says, could easily be arranged by legislation as to who is to be the authority.

Dr. Shiels.] You could modify the legislation following our Inquiry according to the provisions of the Act.

Chairman.

18. That is only a preliminary point. I only took it because Sir Richard Luce drew my attention to it before we began,

25 March, 1926.]

and I thought the Ministry might be able to help us about it.-(Mr. Gwyer.) Could I add one thing? Of course, the Ministry have a great mass of evidence as to the desirability of the registration and inspection of maternity homes as such. I think, so far as the evidence in their possession goes, there is a general admission that some kind of legislation on those lines is required. So far as the nursing homes, apart from their maternity aspect, are concerned, they have next to no evidence.

19. But in so far as there are also other cases besides maternity cases, and in so far as if you have registration you must have inspection, does the Ministry contemplate that in a mixed home of that kind it should be possible for the inspecting authority for the maternity home to inspect the nursing home side of it?-No. That is the object of that Amendment to the Bill of which I spoke.

Sir Richard Luce.

20. Is it a Government Amendment?It has been discussed with the Ministry, and I understood that the Promoters of the Bill had agreed to it.

Dr. Shiels.

21. Would it be possible for our recommendations to cover both, and if this Bill were held up, instead of having one Bill for a maternity home we might have a Bill for both ?-There is only this: of course, I do not know, but supposing the Committee were of opinion that a case had not been made out for the registration of all nursing homes, then the Maternity Homes Bill, for which I think there is a great public demand, would be lost at any rate for the present year, which I think the Ministry would regard as unfortunate.

[Continued.

widespread abuses as to justify us in putting forward a case for registration. The Minister, of course, would accept the recommendations of the Committee; he has got an entirely open mind. All that we have to say is, that so far as the information at present available to the Department goes, there is no demand and we are not aware of evidence of any widespread abuses.

23. Still, although you would say there is no demand you would not necessarily say there was no reason for legislation?No. I am rather assuming that it is a question of introducing legislation which imposes restrictions on a perfectly legitimate industry, and that those restrictions would have to be justified by proof that they were called for by the existence of abuses.

Miss Wilkinson.

24. May I ask how the evidence with regard to maternity homes has come into the position of the Minister? Has it been supplied by the patients, has it been supplied by nurses, or has the Ministry itself undertaken any kind of investigation? (Mr. Gwyer.) All the Local Authority Associations I think have asked for those powers, or have suggested that powers of that kind are necessary. There have been the representations from Society of Medical Officers of Health, and, I think, from other Medical Societies. There has been a great deal of material put before the Minister by individual Medical Officers of Health whose attention has been drawn to abuses in their particular areas, and, of course, the Minister's own Officers and Inspectors get to know of these things. The mass of evidence has been ample to convince the Department of the need for something to be done.

Chairman.] But the feeling for that need proceeds almost entirely, does it not, from the public health point of view? It is the health of the mother and the child that has been the governing factor there, both for the Ministry itself and for the Medical Officers of Health throughout the country? Is it not a definite part of public health work; is not that so, Dr. Davies?

Dr. Davies.] Not necessarily. There are other things besides. It would have some slight bearing on the question but I do not think the principal bearing. Chairman.] But all this question of maternity and child welfare is so much A 2

26. But it does not recognise with regard to a woman who is suffering from a nervous complaint and goes to a nursing home? And also, of course, there is the future generation, the babies, to consider. (Mr. Brock.) Of course, the special duty of the State is relation to maternity and child welfare has also been recognised by the Exchequer grantin-aid. It is a grant aided service; that in itself is an admission of the importance that the State attaches to it.

Miss Wilkinson.

27. Supposing there were abuses, would not they go to the Home Office rather than to the Ministry of Health?―(Mr. Gwyer.) That depends what the nature of the abuse is. If it is an offence against morality, yes, but the sort of abuses which I think Mr. Brock and I had in mind when we prepared this document were bad nursing, bad food, insufficient staffing, and that sort of thing; there is no general evidence of that.

28. Overcrowding, ventilation, and so forth? We have no general evidence of that, no.

29. And therefore it is very much a question of your taking one view of it and the Home Office taking another?— I do not know that the Home Office have any views on the subject of nursing homes.

30. But some of the things you have mentioned just now fall rather under the Home Office jurisdiction?-Yes.

Captain Ernest Evans.

31. I suppose you have in the Ministry of Health evidence that a good many houses are used for maternity purposes by unqualified persons?-Oh, yes.

32. Have you any similar evidence bearing on nursing homes as apart from

[Continued.

maternity homes?-You cannot have an unqualified person in the case of a nursing home.

33. A person need not qualify to carry on a nursing home?-Perhaps I ought to explain what I mean. What I meant was that an unqualified woman is not allowed except in very special circumstances to attend women in child birth, but the fact that a nurse is not a registered nurse does not prevent her from nursing people; there is no law against it.

Major Price.

34. Is not the position really this, that the Ministry of Health have, owing to legislative action, made far greater inquiries and received for more information with regard to maternity homes than they have ever sought with regard to ordinary nursing homes?-(Mr. Brock.) That is so; they have been brought more in contact with maternity homes not only because of their responsibility for the enforcement of the provisions of the Midwives Acts but also through the administration of the Exchequer grant in aid. (Mr. Gwyer.) On the other hand, there has been nothing to put us on inquiry with regard to nursing homes in general.

use

35. No, but had there been no legislation there would have been nothing to put you on inquiry with regard to maternity homes. You had not set about yourself to discover the question of the or abuse of maternity homes; that has been brought to you?-(Mr. Brock.) No. All that we can say is that we have not in fact received any substantial body of complaints. That does not, of course, prove that there may not be grounds for complaint, but we have not received them. I can only recall two cases in which specific complaints of a serious character have reached us.

36. Would you attribute the fact that you have not received them to the fact that they do not exist, or to the fact that there has not been the facilities for your receiving them as in the case of maternity homes? (Mr. Gwyer.) No, I do not think I should agree with that, because people write to the Ministry on all subjects; there is no subject on which they will not write to us. (Mr. Brock.) The public are very imperfectly acquainted with the statutory limitations on the Ministry's powers; still I think probably both things are true. Partly we have

25 March, 1926.]

not received complaints because we had no powers and no duties, but to some extent I think it is evidence that the abuses have not been very serious or widespread; if they had been I think people would have complained to us.

Miss Wilkinson.

37. Can you give us any idea of the type of complaints in the two cases that you have had sent to you?-The first case related to a home for senile chronics. In that case the allegation was that the home was grossly overcrowded, that the inmates were not receiving proper attention, and that the conditions were altogether insanitary. We had, of course, no power to inspect. Such inquiries as we were able to make informally through the Medical Officer of Health suggested that the conditions at the home were not satisfactory, but that the complaint made to us was greatly exaggerated and was based on statements made by people who were in such a physical and mental condition that they could not be accepted as reliable witnesses.

Sir Richard Luce.

38. What class of home was this; was it a private home?-Well, it called itself a charity; in fact, it made a charge but it also appeared to receive a certain number of subscriptions. Whether it was really run in the interests of one or two people I could not say; we were not able to obtain sufficient information with regard to it.

Mr. Davies.

39. Do you think, speaking of nursing homes as we generally understand them, that people go there for specific purposes, pay a certain fee, and if they are dissatisfied and there are certain abuses, they come away and tell their friends: "Well, if you are ever ill do not go to that home," but they have not the knowledge that there is anybody to whom they can make a formal complaint; it is just like going to a bad hotel. Do you not think that may be the reason why you have heard of none of these abuses

because people would not know that you were open to receive complaints?—I do not think it would be always safe to assume that people of the senile chronic type would necessarily leave or be taken away if they were not properly looked 57082

[Continued.

after, because they may be very helpless, and it sometimes happens that they are sent there by relatives whose main anxiety is to get rid of them and who are not disposed to ask any questions, and whose one anxiety is to get them out of the way but without sending them to a Poor Law Institution because of the stigma that is sometimes associated with the Poor Law. (Mr. Gwyer.) These things, if they exist, I think would come to the knowledge of the local Medical Officer of Health.

Chairman.

40. They are within his province, are they not? Yes, I think you could say that they would be within his province.

Major Price.

41. Only if they break the sanitary laws; they would not be in his province from a moral or a mentally afflicted point of view; they would only be within his province from a health point of view?Yes, from a health point of view.

Chairman.

42. If it was crowded?-Yes.

Major Price.

43. And insanitary?—Yes; and if there were scandals connected with it they would sooner or later, I think, come to the ears of the Medical Officer of Health.

Miss Wilkinson.

44. The nursing might be bad without it actually forming a scandal, might it not?-Certainly, yes.

Dr. Shiels.

45. Has the Sanitary Inspector power to go into a nursing home to see whether it is overcrowded or not? Is it not possible for many nursing homes to be overcrowded without the Ministry of Health knowing anything about it?-I speak without my books before me, but I am almost sure that he has the right of entry-either he or the Medical Officer of Health-for the purpose of ascertaining whether a nuisance exists.

46. I think not?-I think so.

A 3

was a

49. Could we have particulars of the second case? (Mr. Brock.) The other case was a case of a complaint coming from a nurse who had herself been employed at the home, and it statement that she was required to nurse almost simultaneously, or at any rate in very rapid succession, an advanced case of syphilis and a maternity case. In that particular instance, though certain inquiries were made, it was not possible to take any action, because in fact the home closed down very shortly afterwards, and, as far as I know, it has never been reopened.

Chairman.

50. Are these the only two cases that have come to your notice at the Ministry of Health? Those are the only two cases I can recall of specific complaints having been made to us.

Sir Richard Luce.

51. Was that a case that would have come under purview as a maternity home? That particular home was one of these mixed homes; it was probably more a nursing home than a maternity home, but it certainly had maternity

rooms.

Mr. Cecil Wilson.

52. Supposing there were abuses and neither the patient himself who had been in the home nor the relatives desired that during any period of convalescence they should be troubled with exposing these abuses, then you get the

“Well,

position where it would be said: this is a long time ago; it is not worth while raising it now."?-I think that is true. Most people who go into a nursing home hope that they will never have to go into it again, and in any case they probably have got no very definite idea of anybody before whom they could lay a complaint.

Chairman.

53. At any rate, the long and short of this is that there is very little evidence in the Ministry of Health that will help us to see what the abuses are, which may render it necessary for us to advise registration of nursing homes?—I am afraid there is very little indeed.

54. If we want evidence of that kind we must get it from other sources?--I am afraid we cannot help you.

Major Price.

55. In the last case you mentioned, if the amendment as and suggested, apparently with the approval of the Ministry, is carried out that particular type of home would be excluded from the Maternity Act?-(Mr. Gwyer.) No. The amendment proposes, as I understand it, to allow the local authority to exempt such a place if they think fit from the provisions of the Act.

56. Yes. But they would have to be satisfied that it was the sort of place that they could exempt provided they could grant exemption.

57. Does that mean an annual exemption, or what?-I suppose for as long as they thought. They would no doubt impose conditions.

Sir Richard Luce.] That comes to much the same thing as registering it.

Major Price.] Yes; I do not see much difference.

Miss Wilkinson.] May I refer to the actual written evidence? Chairman.] Certainly.

Miss Wilkinson.

58. On page 9 the three points that you put as objections to registration are (a) that it presses unduly the claims of the registered nurse, and (b) that the local registration authority could not be expected to decide whether a nurse is eligible to be registered on the general part of the Register, and (c) that beyond allowing a period of grace no considera