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REPORT.

TO THE KING'S MOST EXCELLENT MAJESTY.

Ministry of Health,
Whitehall,

August, 1928.

MAY IT PLEASE YOUR MAJESTY,

I beg leave, as Minister of Health, to present to Your Majesty the Ninth Annual Report of the Ministry of Health, which relates to the year ended on the 31st March, 1928.

The subjects dealt with in the Report fall under the main heads of Public Health, Local Government and Local Finance, administration of the Poor Law, and administration of National Health Insurance and Contributory Pensions. A separate section is devoted to the work of the Welsh Board of Health.

The Report is in the main a record of the more important business transacted by the Department during the year, and does not cover matters of routine or detail.

Reports by the General Inspectors on the administration of the Poor Law during the year are not included in this year's Report, as it is proposed to publish them separately together with a reprint of the section in the present Report dealing with the administration of the Poor Law.

As in previous years, the Report of the Chief Medical Officer of the Department is published in a separate volume.

NEVILLE CHAMBERLAIN,
Minister of Health.

W. A. ROBINSON,

Secretary.

PREFATORY NOTE.

CONTRIBUTORY OLD AGE PENSIONS.

On January 2, there came into operation the provisions of the Widows', Orphans' and Old Age Contributory Pensions Act, 1925, under which old age pensions become payable at the age of 65 to persons with the requisite insurance qualifications. Special steps were taken to ensure that applications should be made in good time by persons who had reason to believe that they would be eligible, and as a result no less than 388,980 claims had been admitted and pension books issued in time for pensions to be paid on the first pay day. Only 44,090 applications in respect of persons who were 65 or over on January 2 were outstanding on that day, although over 34,000 were received during the month of December. It is of interest to note that in the last month of the period under review the average number of communications received daily at the branch of the Department where these claims are dealt with was 16,960, while in four weeks beginning on January 2, 1928, the daily average rose to 71,670.

HOUSING.

The decrease in the cost of houses erected by local authorities which followed the announcement in December, 1926, of a reduction in the amount of subsidy payable in respect of houses completed after September 30, 1927, continued throughout the period. The number of houses under construction declined very considerably subsequent to the great efforts which were made in the last months of the summer of 1927 to get as many houses as possible completed in time to qualify for the higher rate of subsidy. During the concluding months of the period under review, however, a marked recovery in the rate of building took place. At the end of October, 1927, 48,212 houses were under construction in connection with the 1923 and 1924 subsidy schemes, but by the end of March, 1928, this number had risen to 55,258.

MATERNAL MORTALITY.

The year has witnessed a quickening of public interest in the problem of maternal mortality, and a demand that all possible steps shall be taken to secure a reduction in the mortality of women due to childbirth. The maternal mortality rate in this country has been practically stationary for the last 20 years, and it has become apparent that special measures are necessary if the problem is to be effectively handled. The education of public opinion on

this question, although not free from difficulty, is of the first importance, while the active co-operation of the medical profession and of the Maternity and Child Welfare Authorities is essential. The Report describes the steps which have been taken by the Ministry during the year in these directions. The need for a complete maternity service in all parts of the country has again been impressed upon Local Authorities. Two special Committees have been appointed, one to consider the training of midwives and the conditions of their employment, and the other to co-ordinate and stimulate research into questions relating to maternal mortality. The work of this latter Committee will be assisted by the arrangements which have been made, with the co-operation of the British Medical Association, for instituting investigations of all maternal deaths and all cases of puerperal fever. In dealing with a problem of this kind, immediate results cannot of course be expected from these or any other measures which may be devised, but it is hoped that the investigations and activities mentioned in the Report will lead to a gradual reduction in maternal mortality and morbidity.

LOCAL ADMINISTRATION.

Modern conditions call for increasing co-operation between neighbouring Local Authorities. What is important is that there shall be a common policy where there are common interests. The many Regional Committees in town planning have been born of the realization of this fact; and the work of the Committees brings home the further fact that, in addition to joint planning, there is need also of arrangements definitely agreed between the Authorities concerned for sharing the cost of providing the public facilities which are of material advantage to more than one Local Authority.

The demands for higher aesthetic standards keep growing. They are illustrated by the pressure for preserving rural amenities and for cleaner rivers. Cost is one of the chief obstacles, especially when the means of so many Local Authorities are straitened. As in public health so also in this sphere, it is along the line of prevention that the remedy lies, by thinking out a policy that will avoid, or at least minimize, the ills and by applying it with discretion.

POOR LAW ADMINISTRATION.

The year 1926-27, with its heavy burden of poor law expenditure resulting from industrial disturbances, has to be excluded. from any comparative statement of the poor law position. The

level of pauperism at the end of the year under review was appreciably below that prevailing at the end of 1925-26, and the reduction was especially marked in regard to the relief given to insured persons on the ground of unemployment. The reduction has coincided with or followed special investigations into the administration of out-door relief which have been made in a number of Unions.

LEGISLATION INCLUDING CONSOLIDATION.

The Minister was responsible for the passage through Parliament during the year of the Audit (Local Authorities) Act, which became law on December 22, 1927, and the Poor Law Act, which became law on July 29, 1927.

The former Act amended the law relating to audit appeals. It abolished the alternative appeal to the High Court or to the Minister. In future all cases may, and certain cases must, go to the former. Where the appeal is taken to the Minister, he may refer questions of law to the High Court and can be obliged to do so. Surcharges of large amount carry with them the additional penalty of disqualification from membership of Local Authorities; but provision is made for obtaining relief from this disqualification and from other consequences of the surcharge. Further particulars with regard to the Act are given later in this Report.

The latter Act came into operation on October 1, 1927. This Act of 246 Sections consolidated and repealed provisions contained in over one hundred Acts of Parliament.

The codification of the poor law has long been urgently required, and was essential if progress was to be made with any plans for the assignment of poor law functions to authorities other than Boards of Guardians.

In addition, three measures introduced by Private Members dealing with matters coming within the jurisdiction of the Department were passed during the year.

The Mental Deficiency Act, 1927, enlarged the definition of mental defectives as enacted in the Mental Deficiency Act of 1913. One effect of the amendment will be to enable young persons suffering from the after effects of encephalitis lethargica to be brought within the scope of these Acts. The Act of 1927 makes a number of minor amendments designed to facilitate the administration of the principal Act. It also empowers Local Authorities to provide training for mental defectives, and to establish institutions jointly with Education Authorities.

The Nursing Homes (Registration) Act, which was passed during the year and is referred to in the body of the Report, contained an interesting provision governing the relations between County Councils and County District Councils in exercising supervision

under the Act. The County Council is appointed the "local supervising authority" but is empowered on the application of the Council of any County District to delegate to the latter any of its powers and duties under the Act, with or without restrictions or conditions. Any District Council, which makes such an application and is aggrieved at the result, may make a representation to the Minister who, after consulting with the County Council, may direct the latter to delegate, with or without restrictions or conditions, such of its powers and duties under the Act as the Minister thinks proper; this direction is to be binding on the County Council. The above arrangement was accepted by representatives of the associations of local authorities as a special arrangement for the purpose of facilitating the passing of this particular measure.

The Sale of Food and Drugs Act, 1927, made the provisions of regulations as to the composition of food made by the Minister under the Public Health (Regulations as to Food) Act, 1907, effective for the purposes of sections 3 and 6 of the Sale of Food and Drugs Act, 1875.

Progress was also made in the Department during the year with the preparation of a Bill to consolidate the Sale of Food and Drugs Acts.

FINANCES OF THE DEPARTMENT.

The provision for services administered by the Department (including the cost of central administration) which Parliament will be asked to make for the financial year 1928 is £22,369,597. This gross total includes £676,927 on account of services rendered by other Departinents (e.g., postal services, printing and stationery, office accommodation, audit under the National Health Insurance Act, valuation of land by the Inland Revenue Department) to the Ministry of Health. It does not, however, include the Exchequer contribution towards the cost of the Widows', Orphans' and Old Age Contributory Pensions. This contribution, which amounts to £4,000,000 for England, Scotland and Wales, is paid into the Treasury Pensions Account and is accounted for by the Treasury. It is estimated that in 1928 the Department will recover £918,645 (including £415,000 for the cost of administering the Widows', Orphans' and Old Age Contributory Pensions Act, £277,000 recoverable from Health Insurance Funds and £200,000 in respect of Fee Stamps under the District Auditors Act, 1879, and other Acts) which will be applied in the form of appropriations in aid to reduce the gross total of the Department's Estimate. In addition, it is estimated that £157,500 will be recovered from the Unemployment Fund and appropriated in aid of the Ministry of Labour Vote in respect of work undertaken by the Ministry of Health in connection with the Unemployment Insurance Acts. The estimated net cost to the taxpayer of the services administered by

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