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O b s e r v a t i o n s by the P r e s i d e n t of tho Local Govern­ n t Board on tho Draft B i l l and memorandum (G.T. ) c i r c u l a t e d by the h l n i s t e r f o r h e c o n a t i - u c t i o n .
I have always e x p r e s s e d myself i n favour of a ifcinistry of H e a l t h to e f f e c t u n i f i c a t i o n of h e a l t h a c t i v i t i e s a t the c e n t r e . I f t h e r e f o r e I c r i t i c i s e t h i s
B i l l i t io with a view of e l i m i n a t i n g from i t tho p r e v i s i o n s which a r e l i k e l y to provoke a c u t e c o n t r o v e r s y and so impede i t s P a r l i a m e n t a r y p a s s a g e .
The i n t r o d u c t i o n of Clause 4 , which p r o v i d e o f o r v the e s t a b l i s h m e n t of a C o n s u l t a t i v e Council to be a t t a c h e d
' to t h e M i n i s t r y of H e a l t h , r a i s e s ,a c o n s t i t u t i o n a l i s s u e of f a r - r e a c h i n g importance a f f e c t i n g t h e independence of
M i n i s t e r s and t h e i r r e s p o n s i b i l i t y to P a r l i a m e n t . This body which i s to g i v e a d v i c e and a s s i s t a n c e to t h e
M i n i s t e r touching".bio powers and d u t i e s , i s to c o n s i s t of
" p e r s o n s of b o t h sexes having p r a c t i c a l e x p e r i e n c e of l o c a l government, of p u b l i c health.? of n a t i o n a l h e a l t h i n s u r a n c e , of h o u s i n g problems,, of h o s p i t a l work, of g e n e r a l and s p e c i a l medical p r a c t i c e , of r e s e a r c h and of pharmacy".
The c l a u s e has been i n s e r t e d a s "an i n d i s p e n s a b l e con­ d i t i o n of the agreement of the B r i t i s h medical A s s o c i a t i o n and the Health I n s u r a n c e o r g a n i z a t i o n s to the B i l l " . I t i o a q u e s t i o n whether the agreement of t h e s e b o d i e s may n o t be too d e a r l y p u r c h a s e d . Ho t h i n g i s s a i d i n the B i l l about the powers of t h i s body, which i s to be a S t a t u t o r y
Body. The powers a r e l e f t t o be c o n f e r r e d upon i t by
Order In C o u n c i l . But to a p p r e c i a t e i t s importance and i t s r e l a t i o n s h i p t o the M i n i s t e r f o r H e a l t h we must look to the scheme which has been p u t forward by the Council of the B r i t i s h nodical. A s s o c i a t i o n and to the D i l l c i r c u ­ l a t e d l a s t y e a r emanating from c e r t a i n - I n s u r a n c e o r g a n ! za-* t i o n s . The scheme of the B r i t i s h Medical A s s o c i a t i o n s e t s up t h i s C o n s u l t a t i v e Council a s a S t a t u t o r y Body. *
I t s r e p r e s e n t a t i v e s a r e to be nominated by the g e n e r a l k e d i c a l Council and tho B r i t i s h medical A s s o c i a t i o n .
They a r e t o h o l d o f f i c e f o r a number of y e a r s . A l l , o r c e r t a i n members of them, a r e to. be p a i d f o r expenses i n c u r r e d o r s e r v i c e s r e n d e r e d . They a r e to meet n o t l e s s than once a month. They a r e to have the r i g h t n o t only of a d v i s i n g t h e M i n i o t B ^ b u t , in a d d i t i o n , of r e p o r t i n g to
P a r l i a m e n t , so t h a t when they d i f f e r from the M i n i s t e r ,
P a r l i a m e n t w i l l have "tho advantage of having a reasoned s t a t e m e n t on b o t h s i d e s before i t , The Council " i s to be made a s independent as p o s s i b l e of tho K i n i s t c r and h i s o f f i c i a l s " ; , i n f a c t the h i n i s t e r may go b u t the
Council w i l l r e m a i n . Moreover, t h e a d m i n i s t r a t i v e f u n c t i o n s of the U i n i s t r y a r e to be c a r r i e d out by a s t a f f c o n t a i n i n g members r e p r e s e n t i n g t h e p r e v e n t a t i v e and c l i n i c a l s i d e of m e d i c i n e .
The £ i l l of the I n s u r a n c e O r g a n i z a t i o n s p r o v i d e d f o r tho c o n s t i t u t i o n of a Board of H e a l t h under t h e C h a i r ­
' man s h i p otji M i n i s t e r , comprising r e p r e s e n t a t i v e s of v a r i o u s b o d i e s ( i n c l u d i n g n a t i o n a l I n s u r a n c e ) connected w i t h q u e s t i o n s of H e a l t h .

^ "HfheFoHT&h Tab""hlPdHuBTTE^tpreooTng f o r the C o n s u l t a t i v e Council both tho B r i t i s h Medical
A s s o c i a t i o n and the I n s u r a n c e o r g a n i z a t i o n s have i n view n o t an Advisory Committee i n the h i t h e r t o a c c e p t e d sense of t h e term b u t an a c t i v e p r o p a g a n d i s t body c l a i m i n g a d e f i n i t e share in a d m i n i s t r a t i o n and i n t e n d e d to keep the M i n i s t o r up to tho mark which they a p p o i n t for him,
The c l a u s e i n f a c t p u t s the M i n i s t e r i n s h a c k l e s . T'e have seen a good d e a l r e c e n t l y of p r e s s a g i t a t i o n s * One can r e a d i l y f o r e s e e the f o r c e s which would bo brought to boar on a M i n i s t e r who was n o t p r o ­ p a r e d to a c c e p t tho " a d v i c e " of h i s C o n s u l t a t i v e Council on any q u e s t i o n of p o l i c y or. which ho did n o t see eye to oye with them, even when the p o l i c y had boon approved by the Cabinet. Mis would be the r e s p o n s i b i l i t y and he would bo the v i c t i m , t h e i r s would be the I r r e e p o n s i ­ b i l i t y and they would be f r e e to c r i t i c i s e and a t t a c k .
I cannot u n d e r s t a n d any Government w i l l i n g l y p l a c i n g any h i n t s t o r i n ouch a p o s i t i o n .
I f an Advisory Committee i s n e c e s s a r y f o r tho g a l v a n i s a t i o n of tho M i n i s t e r of H e a l t h , i s i t n o t e q u a l l y n e c e s s a r y f o r t h e home O f f i c e , the Board of
T r a d e , and o t h e r d e p a r t m e n t s ? The d e b a t e in t h e House of Commons on 19 th Larch, gave Mr* Balfour an o p p o r t u n i t y f o r d e a l i n g with a p r o p o s a l f ^ r a somewhat s i m i l a r appendage to tho Foreign O f f i c e . h i s arguments a r e in p r i n c i p l e a p p l i c a b l e i n t h i s c a s e . X do n o t t h i n k tho e x p e r i e n c e of t h e . I n s u r a n c e Commission or of the
- Board of Education with r e s p e c t to the Advisory
Committees s e t up under t h e Board of E d u c a t i o n Act,
1899, and tho N a t i o n a l I n s u r a n c e Act, 1 9 1 1 , i s so encouraging an to w a r r a n t u s a t t a c h i n g t h i s Council to the M i n i s t e r of h e a l t h . I f e e l s u r e t h a t g e n e r a t i o n s of M i n i s t e r s of H e a l t h w i l l rue t h e p r o v i s i o n .
In my view t h e r e i s no need for t h e ' c l a u s e a t a l l . A m i n i s t e r can always c o n s u l t whom ho w i l l and every -Minister t a k e s f r e q u e n t o p p o r t u n i t i e s of gauging o u t s i d e and i n s t r u c t e d o p i n i o n on a l l s o r t s of m a t t e r s b o t h by t h e appointment of Committees and by informal methods of c o n s u l t a t i o n and c o n f e r e n c e . S i m i l a r l y o u t s i d e o r g a n i z a t i o n s can always make r e p r e s e n t a t i o n s to M i n i s t e r s and they show no d i s i n c l i n a t i o n tp do s o . l't. c e r t a i n l y seems to be t a c t i c a l l y unwise f o r a
Government to i n t r o d u c e a B i l l f o r t h e e s t a b l i s h m e n t ^f a new M i n i s t r y c o n t a i n i n g a c l a u s e , which i s n o t in t h e l e a s t e s s e n t i a l to i t . I f the Clause i s i n t h e B i l l t h e Government a r e committed to i t . I f i t bo o m i t t e d end an amendment i s p r o p o s e d for i t s i n s e r t i o n , i t can t h e n be seen whether i t can be s u c c e s s f u l l y r e s i s t e d or i n what form i t should be conceded.
P a r a g r a p h o of Dr. A d d ! s o n !
s Minute d e a l s w i t h tho q u e s t i o n of the reform of Poor Law A d m i n i s t r a t i o n r e f e r r e d tc i n p a r a g r a p h 1 of t h e F i r s t -Schedule to the
B i l l . : I q u i t e ' a g r e e w i t h him i n t h i n k i n g ' t h a t , in view of t h e i s s u e of the Report of S i r Donald M a c l e a n 1 s
Committee (which recommends t h a t t h e p r e s e n t f u n c t i o n s of Poor Law A u t h o r i t i e s nhould be t r a n s f e r r e d to the
County and County Borough Councils) i t i s i m p o s s i b l e to a v o i d some r e f e r e n c e to t h i s m a t t e r i n c o n n e c t i o n w i t h

a B i l l which so intimately concerns the Local Government
Board, and I f e e l . i t w i l l be necessary to wake a p r o ­ nouncement of Government p o l i c y on the s u b j e c t , though I
R e a l i z e that the V.'ar Cabinot have had l i t t l e opportunity
' of making themselves conversant with the Committee'a p r o p o s a l s . That pronouncement might I think take the form of a guarded approval of the goneral l i n e s of reform which the Committee have recommended. i t i s ho v/ over q u i t e evident that when l e g i s l a t i o n on the s u b j e c t comes to be attempted a very considerable o p p o s i t i o n from 1 Boards of Guardians and t h e i r supporters w i l l have to bo faced,, and i t therefore seems to me t h a t i t w i l l be wiser to l e t the matter bo debated - as i t must be - on Second Reading when the suggested p r o ­ ncunceroont could be L ,ade, and to omit from tho P i l l any d i r e c t reference to i t . Paragraph 1 , of the F i r s t
Schedule i s i n no sense a necessary pert of the B i l l .
I t i s merely a declaratory p r o v i s i o n , and a l l that i t e n u n c i a t e s can be done under Clause 2 ( 3 ) .
I f the paragraph remains, i t i s c o r t a i n to g i v e r i s e to p r o ­ longed debate in Committee and on Report i n both
Houses. I am strongly of opinion that for the sake of the B i l l i t i s d o s i r a b l e to omit the paragraph.
/fh.
With regard to the fcitlo o f / B i l l , i t i s d i f f i c u l t to f i g h t about a name. But I hope that i f a c o n c e s s i o n -is made on t h i s p o i n t i t w i l l not bo taken
, as implying that the Government agree to the new
Ministry being shorn of f u n c t i o n s , not d i r e c t l y connoctod with Health, which are at p r e s e n t performed by the Local Government Board.
-iuite apart from the p r a c t i c a l d i f f i c u l t i e s of drawing the l i n e between f u n c t i o n s which are and are not i n c i d e n t a l to Health a d m i n i s t r a t i o n , i t soems to me to be moot d e s i r a b l e that there should be one
Central Department which i s pro-eminently r e s p o n s i b l e f o r Local Government, and to which the Local
A u t h o r i t i e s can look f o r control and a s s i s t a n c e i n the dischargo of t h e i r miscellaneous d u t i e s . I t has been of great n a t i o n a l value that the Local Government Board has been a b l e to d i r e c t the a c t i v i t i e s of the various
Local A u t h o r i t i e s In the performance of the new d u t i e s which the war has c a s t upon them.
Secondly, I b e l i e v e i t would be a grave error and a most retrograde stop to divorce Health a d m i n i s t r a t i o n from the a d m i n i s t r a t i o n of other forms of Public A s s i s t a n c e . Public A s s i s t a n c e as a whole and i n i t s widest sense i s in j u s t as great need of c o - o r d i n a t i o n as that part of i t which forms Health
A d m i n i s t r a t i o n .
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Thirdly, I- am convinced t h a t , while the
Ministry of Health may now be somewhat prominently i n tho l i m e l i g h t , once a L i n i s t r y of Health i s e s t a b l i s h e d , i t w i l l , i f d i v e s t e d of othor* Local
Government f u n c t i o n s , rapidly f a l l i n t o the p o s i t i o n of " a second-rate public o f f i c e , To what other
Department, moreover, are the discarded f u n c t i o n s to appertain?
Apart from tho F i r s t Schedule the B i l l does not deal i n terms with questions of Local machinery,

but although X know i t to be tho view of the Minister of Reconstruction that discussion on these questions can be - avoided, I feel bound to warn my colleagues that in ray opinion they will certainly bo raised, and here again X dosire to bring to their notice the proposals or the British Medical Association, The Association
"are definitely of opinion that' the advantages" of unification at the Centre "would not bo groat unless a corresponding unification of local a u t h o r i t i e s were carried into effect". This change i s in t h e i r view
"an integral part of the scheme for a Ministry of
Healtli" and they hold that "to delay dealing with tho local part of the problem will not lessen but increase the d i f f i c u l t i e s of the new Ministry".
I fear those (juostiono may seriously endanger the prospects of tho Bill and I regret that ­ i t has not been found possible before introducing tho Bill to come to some conclusion on policy and on questions of local administrative machinery.
Failing that, i t seems to me that tho Bell'' should bo s t r i c t l y confined to tho minimum necessary for securing u n i t y of central administration by the fusion of existing Departments.
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W. HAYES FISHER.
Local Government Board, loth May, 1910.