DIGRESSION ON LOCAL GOVERNMENT BOUNDARIES
The Nature of the Problem
This book is not in any sense a history of local government under war conditions. It is a history of social disturbance and the attempts of public policy to control or temper it. But public policy in this field involved the action of a number of central departments and a great many local authorities. The processes of action, the obstacles encountered and the results achieved, cannot possibly be separated from the jurisdictional and geographical fragmentation of responsibility. Many examples to be given later will show that the success or failure of a particular policy was determined, in large measure, by the way in which responsibility was defined and distributed. The present chapter, therefore, though it may appear at first sight to be off the main track, covers essential ground for Great Britain's war history. It is a study of frontiers—the frontiers dividing hundred of independent local authorities of different types, responsible by statute for providing a great variety of services, and the frontiers dividing and defining the contributions of local and central finance.
This approach to the subject of local government is, of course, limited. In any comprehensive inquiry into the effects of the war on the functioning of the system, many other issues would have to be considered. Nevertheless, the problem of boundaries came to be very important during the war. It affected the operation of many of the emergency social services—the evacuation scheme, the post-raid services and, to a less degree, the emergency hospital scheme. Instead of discussing under each of these headings the question of boundaries, and its associated problem of mixed financial responsibility, the material has been brought together and studied in this chapter.
In the interests of good management and ordered development, a limit to the responsibilities of local government has always had to be drawn somewhere. What more natural and proper than that the duties of locally elected bodies should be confined to those who dwell within the boundaries of their districts? From this conception of local needs and responsibilities has arisen the system of local government itself. A simple law of settlement, determining that every person should belong to some parish 'is coeval with our earlier authentic
institutions'.1 From the beginning of a general system of relief of the poor it was therefore understandable that parishes should restrict their liabilities, in the way of relief, to those whom they felt to 'belong' to the parish.
The Statute of Elizabeth in 1601 laid an obligation upon each parish to maintain its own poor. From this there arose the need to defend the economic resources of the parish against strangers and those who wandered abroad. The, by the Settlement Act of 1662, localism, and the removal of poor persons to their place of birth, were firmly and harshly practised on a national scale. Over two hundred and fifty years later, the cruelties of removal had long since gone, but the principle of settlement remained as an integral part of many of the social services administered by local authorities.
In the twenty years before 1939 the pressure of economic forces had compelled the central government to recognise that certain services—notably the relief of the unemployed—could no longer be left to the vagaries of local boundaries and the inflexibility of house-rates as the main source of local finance. The problem of unemployment, as one of the components of poverty, was seen to be a national, and not a parochial, responsibility. During the Second World War the process continued; local authorities were further relived either wholly or in part of certain of their functions, while in respect to other duties they became, not independent policy-making bodies, but local agents and managers for the central government.
Upon the continuance of this trend will no doubt turn the whole future of local government as it has been known in the past. So large an issue cannot be discussed here. It is necessary, however, to point out that the trend towards the centre had, by the end of the war in 1945, hardly touched those particular services affecting mothers and children with which this book is greatly concerned. There remained, then, an important group of services in the fields of health, education and welfare, during 1939–45, were still locally based. The range and quality of these services, their accessibility and cost, were still very largely matters for some hundreds of local authorities to decide.
The function of these local bodies, it will have been noted, was to provide and make accessible certain services for their own people: sanatoria for the tuberculosis, clinics for mothers and children, help for the poor. Some services had by law to be provided; others were permissive. The patterns that emerged were of great variability, showing wide differences in quantity and quality of services as between one local authority and another. Some citizens in one part of the country were much better off than others in another part; some used the services much more; some needed them much more.
These two features of local government, variability in service and localism in responsibility, were part and parcel of the system when war broke out in September 1939. The full and efficient working of the system—that is, absolute hardship and ease of access to services—rested on the postulate of a relatively immobile population; on a limited volume of movement of people over local boundaries.
This was particularly true of some of the more important services. Applicants for local authority houses had to show residential or work qualification varying, according to the authority, from six months to ten years. Non-residents were not willingly accepted by many authorities into their tuberculosis sanatoria were often experienced in respect to maternity accommodation, education and, in particular, the poor law services. Much more research would need to be done before it would be possible to measure, even roughly, the effects of all restrictions of access to these services imposed by local boundaries and the spirit of localism. They may only have meant a certain amount of annoyance and some delay. What is unquestionable, however, is that they led to a vast amount of inter-authority accountancy.
This was by no means a new problem in 1939. It had undoubtedly changed in character from the days when 'men, women and children in all states of health and disease, perpetually criss-crossing the kingdom under expensive escort, which lasted two whole centuries', cost the country, in lawyers' fees alone, over £10,000,000.2 By the nineteen-thirties the number of poor persons bodily removed was small,3 while the annual expenditure of local authorities in pursuing settlement and removal inquiries had fallen substantially from the extravagant sum of £258,604 in 1833–4.4 Nevertheless, on poor law services alone, it was still as high as £52,740 in 1936–7.5
In some areas just before the war the amount of administrative labour of this kind in poor law departments was still considerable. Thus, in March 1938, over 1,000 persons who had moved under re-housing schemes from Liverpool to the borough's Huyton estate (outside the boundaries of the city) were being relieved by the Lancashire County Council which was recovering about £400 a week from Liverpool.6 In each case, inquiries were necessary to find out
whether the individual concerned had or had not acquired a status of irremovability.7 On the outbreak of war in 1939, the elaborate and expensive apparatus of the national law of settlement and removal hardly differed at all from that ruling before the labours had started of Beatrice and Sidney Webb and the Royal Commission of 1905–9.
The estimate that has already been quoted of the annual cost during the nineteen-thirties of settlement and removal work greatly understated the total annual cost of inter-authority accountancy involved in the administration of all the social services. To this expenditure on bookkeeping by public assistance authorities there had to be added, first, the cost of operating the arrangements for recovery set up under various public health and education acts,8 secondly, the cost of the complex accounting within the counties, thirdly, the cost of transferring monies between different types of local authorities and four or more central government departments and, fourthly, the cost of personal recovery—the local task of administering a bewildering variety of twenty or more means tests and of collecting small sums of money from the millions who used the health and social services.9 The range of these services in 1939 and, therefore, the potential field for recoupment, accountancy and auditing, had grown immensely since social help was confined to poor relief.
It was with this burden, laid upon them by Parliament, that both central department and local authority entered the war in 1939. It was to be a war which was to strain this system of microscopic accountancy to breaking-point. For the question whether this system, as it affected the health services, was compatible with war on civilian society does not seem to have been considered at any time by Parliament or Executive.
When the evacuation of mothers and children was being planned before the war the Government took pains to inform receiving authorities that they would not be put to any expenditure. This was the first principle; full reimbursement for extra costs arising from the evacuation scheme.10 the second principle, to which no reference was made before the war by the Ministry of Health,11
laid down that evacuating authorities could not be allowed to benefit; that they should, in some form or another, pay up what they were saving as a result of the removal of mothers and children from their areas.12 Receiving authorities were therefore told to recover 'normal' costs from evacuating authorities. So far as possible,accounts were to be settled between the two authorities by 'day-to-day operations', receiving authorities recovering expenses attributable to individual evacuees from the evacuating authorities, who might have had to bear the cost if evacuation had not taken place.13 The latter authorities were, in turn, advised to follow their peacetime practice of recovering in appropriate cases from parents and responsible relatives.14 Any costs not recovered by the reception authorities from the evacuation authorities would be a proper charge on the Exchequer.
The influence of poor law doctrine can easily be seen in the formulation of these principles. Local authorities were to be responsible for the cost of health and social services rendered to people who had been living in their areas before the war, provided that such services were available to these people before they moved. Irrespective of where these people went, the authorities of the areas receiving them had therefore the duty of recovering the cost of such services from the sending authorities.
Admirable as the intention was to separate the 'costs of war' from the 'costs of peace', and to distribute justly and precisely the respective financial burden of the local authorities and the central Exchequer, nevertheless, the practical application of these principles over a large sector of the social services was bound to give rise to a great many difficulties. As soon as they had to be translated into day-to-day operations, not only by the trained and experienced staff of the London County Council but by those who ran the affairs of rural and urban district councils, their abstract nature became apparent.
Some of the practical difficulties seem to have been visualised in the Ministry of Health when evacuation was being planned, for circulars to local authorities referred vaguely to the desirability of general financial adjustment at the end of 'the emergency'.15 The idea of a grand local government inquest embracing public assistance and other forms of expenditure was, however, generally superseded by the announcements, in October 1939, of the principle day-to-day recovery
from evacuating authorities. Not that this announcement solved the problem for good and all. Whenever a particular financial riddle appeared to be insoluble, the idea of a post-war settlement was temporarily resurrected, and the problem was gratefully deposited in to the arms of time.
But only a few of the more intractable issues could be disposed of in this fashion. The vast majority had to be postulated, argued about, minuted on and judicially weighed against a background of relevant facts, precedents and legal interpretations. These processes, which required of officials an enduring patience and an attitude of abstract detachment from the troubles of man, also forth and nourished a flair for detective paper-work and a capacity for memorising the minutiae of precedent books and legislative enactments. Human problem dissolved into 'cases'; it was a rare official who could spend his life in service of this kind without having his sympathies blunted and dulled.
All this affected the work of the local authorities and the central departments concerned with the social services. The former not only had the duty of continually arranging a great number of financial adjustments among themselves (which inevitably meant referring many questions to the centres for adjudication), but they were also involved in the numerous accounting tasks of dividing and allocating responsibility between central and local administration. The new 'costs of war' and the decision in 1939 to divide them from the 'costs of war' added to these burdens. They soon became formidable for at least five reasons:
- the constant movement of population over local government boundaries. Between the outbreak of war and the end of 1945 there were about 34,750,000 removals from one national registration area to another in England and Wales;16
- the setting-up (for civil defence purposes) of new boundaries defining evacuation, neutral and reception zones, and the consequential introduction of new categories of eligibility for this or that service;
- the separation of migrants into two classes (a) 'official evacuees for whom the Government accepted financial responsibility in respect of certain additional costs and (b) 'unofficial' evacuees—those who made their own arrangements to move for whom the Government accepted only partial responsibility, and then not until February 1941;
- the Government's decision to distinguish between 'normal' or peacetime costs and 'emergency' or wartime costs;
- the provision of new social services and the extension of certain of those already in existence.
There were in addition many other reasons which, at different periods of the war, made it extraordinarily difficult to answer the questions: to whom do these people belong? who is responsible? who should pay? It will be best if, without further discussion, a series of concrete examples are given to show the nature and extent of the problem, the effects of the war and, in particular, the influence of the five factors that have already been mentioned.
First Example: Residential Nurseries
The first example, selected from a wide field, relatives to the wartime provision of residential care had existed in peacetime for children under the age of five.17 The need for residential care had existed in peacetime and had been met to a very limited extent by public assistance authorities. The war, bringing in its train an immense and unceasing flow of people from one part of the country to another, a great mobilisation of men and women to work and fight, and a consequent breaking-up of families and neighbourhoods, multiplied the need for some kind of residential provision for young children. The need was acutely felt when mothers were ill, confined, unmarried (and generally compelled to work), homeless or dead, and there was no one available to take are of their young children.
One figure is given to show how important this problem was. Early in 1944—that is, on the eve of the invasion of Normandy—it was estimated by the War Office that compassionate leave was being granted, chiefly for the kind of reasons that have just been mentioned, at a rate of over 100,000 men a year. This volume of leave applied only, of course, to men stationed in Britain. Most of these soldiers were being released from the Army for periods up to a month to go home—to cook meals, wash, feed, shop and generally look after babies and young children. To grant leave on this scale was a serious matter at a time when the Army needed its full strength; but to refuse it might gravely imperial morale—for soldiers could hardly be expected to fight with spirit when they knew that their families were breaking down under insupportable strain.
The historian does not know the domestic circumstances of all those and many other families,and whether they were eligible or not for help from the poor law. The need for residential care, which increased in volume and changed in character as the war went on, was partly
met by two main sources of provision. Voluntary effort led the way. A group of voluntary organisations established a large number of residential nurseries in the reception areas. Many of these nurseries were, at first, financed by private donations and out of gifts from the United States and the Dominions, and later, under the guiding hand of the Ministry of Health, they were linked to the evacuation scheme and paid for by the Government. In general, these facilities were restricted to the children of parents who lived in evacuation areas. The second main source of relief lay in the nurseries and other accommodation provided by public assistance authorities who were bound, under various poor law acts and orders, to receive and maintain children in their institutions in cases where the parents applied for such help and proved their need.
There existed, in consequence, two financial types of nurseries; one for public assistance cases, the other for non-public assistance cases. When the problem of under-fives began to grow serious early in 1940, the Ministry of Health suggested that more provision should be made by the public assistance authorities. But the London County Council (as one of the authorities chiefly concerned) considered that this would have the effect of charging the rates with the maintenance of many children who, in peacetime, would not have satisfied the poor law test. Why should London ratepayers be saddled with expenditure which was due to social changes produced by the war? And should not these children be evacuated from London, and was not this a responsibility of the Government? But, replied the Ministry of Health, the relief of social distress is not the object of the evacuation scheme. The difference of opinion arose because many of these cases in London and other areas could be described as eligible both for evacuation and for help from the public assistance authorities. The children required residential care; they needed to be moved to safer areas, and they also had to be paid for.
Although there were several statutory (and a large number of voluntary) bodies in the field, all of whom were prepared to accept a child if it passed certain tests of eligibility, nevertheless, there was an all-round shortage of accommodation. From the first to the last day of war there were never enough residential nurseries. The deficiency was more serious in some places and during some periods than in others, and the total effect was, of course, to increase the severity of the tests of admission.
To the prevailing confusion about boundaries and responsibilities the wartime creation of civil defence areas added a further complication: for a social casualty aged two on one side of a boundary might
be eligible for evacuation to a Government sponsored nursery, while on the other side there was often nothing except public assistance. Thus, when a case of family distress reached a selection panel (through a citizens' advice bureau, voluntary worker, army welfare officer or some recommending body), the decision as to whether the child was eligible for admission to a nursery turned upon such factors as:
- poor law chargeability,
- home address (whether evacuation, neutral, reception and/or public assistance area),
- condition of mother (expecting a baby, short or long-term illness, cause of death),
- occupation of father (Armed Forces or other),
- occupation of mother (on or entering employment under the Essential Work Order, the Women's Forces etc.).
Some examples of how these tests of eligibility operated will now be given. Until March 1943 a soldier's child aged under five, whose mother was seriously ill in hospital or had died, was not eligible for a place in the Government's evacuation nurseries unless the home address was in an evacuation area. After this date, neutral and reception areas were included. If, however, residential care was needed only for a short time; that is, if the mother was confined, or if her illness was 'expected' to be of less than three months' duration, the case was still, after March 1943, left to the relieving officer.18
The disposal of a child of an unmarried mother who was ill, or incapacitated from looking after it, was also most complicated. It was laid down that the evacuation scheme should not be used to solve the social and economic problems of illegitimacy.19 According to the
Ministry of Health, the residential nurseries should not be employed 'in any way calculated merely to relieve those social services which are or should be provided out of the rates'. The exceptions allowed were the unmarried mothers in uniform (or desiring to return to uniform) and those mothers in occupations to which the Essential Work Order had been applied. In these instances the Government, instead of the rates, bore part of the cost of maintaining illegitimate children in nurseries.20
A mother could not have access to these nurseries just because the child was born out of wedlock21 and she was forced to earn a living. But if the mother resided in an evacuation area the child might be accepted by an evacuated nursery maintained by a public assistance authority. When a parent ceased to be chargeable to the poor law, fresh application had to be submitted if the parent desired the child to remain in a nursery, the cost now being borne by the Government. It would have been possible for a child (legitimate or illegitimate where the mother lived in an evacuation area) to have been transported backwards and forwards half-a-dozen times between the two types of nurseries, according to the number of financial crises in the family and the resulting incidence of 'in-and-out' chargeability. But this, of course, was hardly practicable. It is not known if the costs of nursery maintenance, varying in amount from one nursery to another, after the deduction of different sums of money recovered from parent or grandparent, were precisely apportioned on each occasion between the public assistance authority and the Exchequer. That a voluminous amount of inter-authority accountancy went on is evident from the experience of the London County Council.22
The problem of allocating expenditure also arose, for instance, in the accounts of the public assistance nurseries which were evacuated in 1939. The Government accepted financial responsibility for the additional or 'evacuation' costs. The same principle was also applied to all new public assistance nurseries established in reception areas during the war by evacuation authorities. These 'deficiency payments', as they were called, involved a great deal of analytical bookkeeping, partly because any savings by the authorities in the form of rents or upkeep of buildings formerly used for nurseries in the evacuation areas had to be credited to the Government. Such savings were
difficult to define and to measure, even when (as in this instance) changes in price levels were ignored.
Similar arrangements for deficiency payments were made for evacuated nursery and special schools. But here, expenditure had also to be analysed and allocated between the 'educational' and 'billeting' element. The former attracted varying rates of grant from the Board of Education (the rest being borne by the local authority), while the 'billeting' or additional costs arising from evacuation was wholly met by the Ministry of Health. It was not easy to judge, for example, when extra accommodation or kitchen staff was needed in an evacuated residential nursery school, whether the 'educational' or 'billeting' element was responsible.
The dissection and distribution of financial responsibility for the maintenance of residential nurseries in the evacuation areas for short-stay cases of social distress was equally formidable. The need for help of this kind, generally by mothers who were ill or confined, was very acute during 1943–5. In London, the County Council (as the public assistance authority) accepted urgent cases arising in its area, although only about one-half could be labelled destitute in the public assistance sense.
When the children aged under five were received into the public assistance short-stay nurseries they were sorted—on paper and for accounting purposes—into two groups, 'evacuation'23 and 'public assistance'. The test applied was whether the need for nursery care was 'due to reasons which would have operated in any case but for the war, e.g. unsatisfactory conduct on the part of the parents, or whether the child was at a disadvantage as a result of the war, e.g. the father's absence on service, etc.'24 If the latter, the cost was charged to the evacuation account and recovered from the Government. Thus, the labelling of these children and, in some instances, the kind of clothes and toys they received, the type of medical, educational and other service provided, depended on assumptions reached about the behaviour of the parents to each other or to the child, and to the extent to which this parental behaviour had or had not been influenced by a war already four to five years old. These decisions, or tortuous sociological analyses, had to be made to determine whether the financial liability (after deducting parental contributions) was to be borne wholly or partly by the Exchequer or wholly or partly by the London ratepayer.
The existence of these two types of nurseries meant that separate arrangements had to be made for different kinds of services. It was necessary, for example, to organise for one group of these under-fives public assistance clothing, medical, dental, ophthalmic and other services, in addition to the provision of staff and equipment. Similar services had to be separately organised for the non-public assistance nurseries. Many complications and much duplication of effort resulted from the attempts of local authorities and central departments to keep with in the letter of the law laid down by Parliament and avoid expenditure which might legally be the concern of some other authority. A shrewd public assistance official might improve his chances of promotion if he could show his committee a saving in expenditure by transferring borderline cases to other authorities, just as, in the fifteenth century, beadles were allowed fourpence extra for every beggar expelled from the town.
This point may be illustrated by one striking but not untypical example. In October 1943, a child who had been evacuated from Acton in Middlesex to Dorset needed some clothing. No reply was received from the mother (she could not be traced and it was not known whether she was still alive). The Dorsetshire public assistance committee therefore applied to the local education authority in Acton. Acton, having failed to find the mother and begin unsuccessful in obtaining any money from an amount in Acton, refused to pay on the ground that either Middlesex or the Dorsetshire public assistance committee was responsible. Middlesex disclaimed responsibility because the child was not destitute when it had lived in Acton, while Dorsetshire held that destitution could not arise since the evacuation scheme provided board and lodging. A rumour (subsequently found to be false) that the mother had been heard of in Bolton introduced another authority and more delay.
This type of case was by no means rare, and each one consumed much time and energy and involved the risk of distress.25 In addition to the mixture of central responsibilities and local duties there were other complications, such as responsibility for the cost of education, which often interposed more authorities. There was, for instance, the financial problem of some of the London County Council's evacuated education institutions which contained children who, in August 1939, resided outside the boundaries of the county. For some of these
children Middlesex was responsible as the public assistance authority. Thus, there were five parties concerned in (a) the initial or peacetime costs and (b) the addition or war costs. These five parties were the London County Council, the Middlesex County Council, the Ministry of Health, the Board of Education and the parent. The parent's share was the easiest to settle, but to whom it should be paid and who should collect it? And how should the total costs of maintaining the child be divided among the four public bodies according to (1) the evacuation element, (2) the education element and (3) the public assistance element?
When, to this kind of situation, there were added the complications introduced by changes in the circumstances of each parent the problem of accountancy became almost insoluble. Homes were moved from evacuation to neutral or reception areas and vice versa; mothers entered and left employment, were taken ill and recovered; fathers entered and left the Services and the scale of dependants' allowances rose, and children were taken home for a time and then had to be sent back, or else they reached the age of five and had to be discharged from nurseries and billeted in the reception areas.
It was only the level-headedness of some officials which kept the amount of clerical work from reaching, in relation to the size of the problem, fantastic proportions. 'It has become long since utterly impossible;, wrote one official of the London County Council, 'to keep an exact analysis of the cost of evacuated special parties so as to charge the precise amounts due to the Government, to the Council under its different statutory accounts and to each local authority concerned. If we had attempted to do it we should have incurred a scandalous waste of manpower. I should like to abolish all distinctions between these evacuated special parties … I would hazard a guess that if it were accepted the saving of men and women now employed in public offices on analytical book-keeping up and down the country would be of the order of 10,000 persons'.26
The spectacle of this army of book-keepers, all busily and conscientiously engaged in transferring and retransferring items of expenditure, seemed just an incongruous to some observers during the war of 1939–45 as, in the past, the bodily removal of poor persons had appeared to students of local government. The report of the Select Committee of the House of Commons, appointed in 1837 to inquire into the administration of the Poor Law Amendment Act of 1834, had ironically remarked:The poor law functionaries employ 'a great portion of their time, and a larger portion of the public money, in carrying the labourers about
from one end of the kingdom to the other, parcelling them out with the nicest adjustment amongst the fourteen thousand little divisions called parishes, and determining with whatever circumstances existed in any one of these fourteen thousand parishes to make the presence of the labourers desirable or otherwise, they should go, and they should stay where they had been born or apprenticed or last lived for a year.'27
All the transactions that have been recorded above suggest that comment in the same ironical strain would have been appropriate more than a century later.
Second Example: Health and Welfare Services
So far, this study has examined in detail only the problems of boundaries and financial responsibilities as they affected one small section of that part of the population who used the statutory social services. This section comprises a proportion of the parents with children aged under five years. It is now necessary to broaden the field of inquiry, and to apply the same tests and address the same questions to a much larger group. In the main, the people concerned are mothers, children of all ages, and certain other groups with special needs, such as those requiring hospital treatment and medical attention. The characteristic common to all these groups is their need for service of one kind or another.
The present study is only indirectly concerned with questions of family income and the need for cash aid. This makes the inquiry harder. In many ways it is easier for the social investigator to measure the need for monetary help and the extent to which such help is accessible and is given, than it is to assess the qualitative working of a social or medical service.28 More is known, for instance, about the economic circumstances of old age pensioners than about the medical standards of service provided by doctors under the National Health Service Acts. The problem of ascertainment and measurement is a very difficult one.
How is it possible to find out, for example, the number of children
who, because of the closing down of clinics in some areas or their absence in others, were left at the end of the war with uncorrected squints? Or the number of children stigmatised—perhaps for life—as hereditarily 'backward' because of the disorganisation of their schooling during the war? Or the number of mothers left with pelvic damage after childbirth as a result of the effects of the war on the maternity services?
No departmental file or statistical analysis can answer such questions as these, many of which belong, in the first place, to the clinician. The only approach that can be made here is to examine the effect of the war on access to the services needed by these people. Even this can be attempted only indirectly and incompletely. The documentary material for this study is defective, for it is scattered in the form of odd notes, minutes and reports among some hundreds of thousands of departmental files of which only some 600 (comprising about 75,000 papers) have been thoroughly sifted by the present writer.
An earlier paragraph, looking at some of the social consequences of the war, gave five reasons to explain why the problems of boundaries and divided responsibilities increased in size and complexity, namely: population movement, new geographical boundaries, the division of migrants into different grades of eligibility, the distinction between the costs of war and the costs of peace, and the general expansion in the provision of the social services.
On the outbreak of war the first four of these factors began at once to operate. Throughout the next five years, the movement of population was much the most important of all the factors. Consequently, the periods of greatest stress were experienced in 1939 (the first exodus), in 1940–1 (evacuation from areas on the coast and from the cities during nine months of air raids), and in 1944–5 (evacuation during the flying-bomb and rocket attacks). The material for this study has been drawn mainly from the records relating to the first two periods.
Before describing what happened, it is necessary to say something about the scope and character of the agencies of social welfare in town and country. In contrasting the urban and rural scenes, two generalisations have to be made: first, the mass of the people living in London and the large cities had need of, and had come to rely on, a much wider range of statutory and voluntary help than dwellers in rural areas and small country towns: secondly, many of the statutory services were permitted, rather than enforced, by legislation, and for this reason and partly because of their specialist nature, provision was mainly confined to the cities. Moreover, most of these services were largely financed out of the rates, and the cities had more money to spend than the country districts. Also, and for a host of rather different reasons, most of the voluntary case-work agencies and charitable
organisations operated only in London and a few of the large urban areas.
So when the mothers and children left London and the big towns, they left behind them nearly all the agencies of help which had supported their day-to-day lives in a stressful environment. These supporting agencies, social, economic and institutional, had, by a combination of continual need and use, become ties—or barriers to mobility.
There were the savings clubs and sickness associations which bound contributors to a particularly voluntary hospital or firm of doctors; the well-known school treatment clinic or 'welfare' where you could get different forms of help from people who understood your trouble; the friendly society, insurance agent or cooperative, upon one of which you were relying for a small sum to buy new blankets or an extra bed; the medical officer to whom you could look for cod-live oil for the baby or advice about Mary's ear trouble; the health visitor—an old friend—who had done so much when Jimmy was ill and had seen him grow up and leave school; the midwife who had made arrangements for a friend to look after Jane when the last baby arrived; the lady at the Charity Organisation Society who had helped when father had all his teeth out; the school nurse, the teacher, the lady at the hospital, the assistance man and, finally, the serried ranks of check traders, second-hand dealers, hire purchase firms and club roundsmen. These were the people who were known, liked, disliked or tolerated. They fitted into a part of life that had meaning. They were the people who help to stop the leaks, who patched and repair and encouraged in the cycle of birth, marriage, illness, death and all the 'rude inelegance of poverty'.
To move to a strange town, or even stranger village, meant a complete severance from nearly all these supporting agencies. In the country some source of help had never been heard of, tickets and vouchers for hospital treatment were now useless,29 while those services which were available were often run by people who did not at first seem to understand what was wrong.
It is possible to identify among these many influences some which were partly responsible for the rapid return of mothers and children to the cities. But this matter has already been discussed elsewhere. The factors have simply been re-stated here in aid of the generalisations about the importance of the social services in the lives of city dwellers, and the need that the felt in other parts of the country as a result of the passage of several million people over local government boundaries.
During the first twelve months of war there arose, in consequence,
thousands of individual problems. Urban and rural district councils and municipal boroughs questioned county councils, and many individuals and all types of receiving authorities sent inquiries to the Ministry of Health, the Board of Education, the London County Council and other evacuating authorities. The London County Council reported that it was being 'bombarded' with request for officials from the reception areas to visit London for the purpose of assessing parental incomes and collecting charges for services provided. At the same time the Council was asked by other authorities to recover from parents the cost of cleaning the verminous heads of their children. In Cambridge, the provision for London children of dental treatment under the school medical service was held up for two months until it was settled whether the London County Council should pay or whether the costs were recoverable from the Ministry of Health.30
In many fields confusion as to financial responsibility was widespread, and even as late as December 1940 it was said in the Ministry of Health that 'local authorities are not too sure of the position owing to the difference of emphasis' in various circulars issued by the Ministry.31 The kind of questions that were asked, and the attempts that were made to answer them, are illustrated by the following series of problems.
Who should pay for the costs of dispensary treatment, institutional accommodation and after-care for tubercular persons (i) turned out of London hospitals and moving to reception areas, (ii) arriving in reception areas as official evacuees, (iii) arriving as unofficial evacuees? Class (i) were usually regarded as unofficial evacuees, and until February 1941 the Ministry of Health refused to sanction expenditure on these people as an evacuation charge: it advised local authorities to follow their pre-war practice, which generally meant recovering the money spent from the authority of the area of 'normal' residence.32 Among official evacuees, unaccompanied schoolchildren were accepted as a Government charge. Other official classes, such as adults and accompanied children, were sometimes paid for in full by the Government (after vain attempts had been made to recover from other authorities); sometimes only 'war' costs were met; while occasionally—and particularly if the case could be labelled 'poor law'—full recovery was sought from the sending authority.33
Who should pay for the cost of immunising evacuated children against diphtheria? Local authorities were permitted to provide this service under section 177(1) of the Public Health Act, 1936, for 'the poorer inhabitants of the district'. The cost varied from 3s. to 8s. a child. Until the end of December 1939 receiving authorities were told to recover from the evacuating authorities if such a service had been provided before the war; otherwise expenditure could be charged to the evacuation account. From January 1940 all costs for evacuees were borne by the Government, while local authorities continued to be responsible for children who 'normally' resided in their areas.34
Who should pay for the cost of returning to London for burial (at the request of 'necessitous' relatives) the bodies of patients who had previously been evacuated as sick persons, on Ministry of Health instructions, from the County Council's hospitals to institutions elsewhere in the country? The first claim from the Council in January 1940 for £322 in respect of 110 bodies was paid by the Ministry, because, hitherto, no ruling had been given. It was then decided to refuse to meet such expenditure on the ground that the number of patients 'dying in outer areas might in certain eventualities be considerable'.35 Many letters from bereaved relatives, asking for repayment of fares or costs of transport, were referred by the London County Council to the Ministry, the latter then advising the writers to apply to a relieving officer. Permission was given for public assistance authorities to meet the costs of burials in receiving areas, and the fares of necessitous relatives to attend burials, after an inquiry into means.36 Over a year later—in April 1941—the Ministry of Health authorised37 public assistance authorities to meet claims for the costs of transport of the dead after inquiring into the mean of relatives, and after the production of a death certificate and evidence that the deceased was a person transferred under the emergency hospital scheme.38
Who should pay for the cost of providing maternity services (including institutional accommodation, extra milk and food, etc.) for evacuated women? The Ministry of Health maintained that, apart
from the special maternity scheme,39 the financial liability rested with the evacuating authority, assuming such services had been made available before the war in the area of 'normal' residence. If this authority had not arranged under its maternity and child welfare service for (say) the supply of dentures to expectant mothers, then the cost could be charged to the Government.40
But these principles seldom solved the difficulties of finding out who was financially responsible. To take as examples, there were large numbers of mothers who had been officially evacuated from London—but not as expectant mothers—and there were also many mothers who, after bombing, made their own arrangements to stay in a reception area. In these areas they needed help in their confinements. Who, in the area of 'normal' residence, should pay? Officials in the reception areas kept asking this question. If these mothers had remain in London they might have been confined:
- in a maternity home provided by a metropolitan borough,
- in a voluntary hospital grant-aided by a metropolitan borough,
- in a voluntary hospital,
- in a maternity home or hospital provided by the London County Council,
- in a maternity home or hospital provided by the London County Council,41
- in their own homes and delivered by midwives provided by a voluntary organisation,
- in their own homes and delivered by midwives provided by a voluntary hospital,
- in their own homes and delivered by midwives provided by the London County Council,
- in their own homes and delivered by midwives provided by a voluntary hospital or organisation grant-aided by the London County Council.
After vain attempts for about twelve months to unravel these issues, the Ministry of Health agreed in August to allow reception authorities to charge the evacuation account with expenditure on these London cases, after the deduction of amounts recovered from
the mothers. This expenditure was then to remain 'in the melting-pot for the ultimate financial adjustment'.42
This simplification of some of the London problems did not solve the questions that were raised about the confinements undertaken by public assistance authorities in receiving areas. Recovery of expenditure was sought by these authorities in accordance with pre-war practice on settlement and removal cases. Then there was the problem of financial responsibility for other categories of expectant mothers; for instance, the wives of Servicemen who moved to be near their husbands. In these cases, some local authorities objected to meeting part of the cost of the confinement when these non-local mothers could not afford to meet the whole bill.43
Who should pay for the cost of milk provided for evacuated children at schools in the reception areas? In a circular to local authorities on the eve of war, the Board of Education stated that children who had been receiving free milk before evacuation should continue to be supplied with it, the cost being recovered from the evacuating authority.44 'Close consultation', remarked the circular—about these matters of halfpence—'between the receiving authority, who are immediately in touch with the children, and the evacuating authority who will be responsible for the expenditure, will be necessary'. As regards those not on the free list, it was hoped that 'arrangements may be found' for them to benefit; but 'the position of such children presents difficulties'. The foster-parents could not be expected to produce the halfpennies, and they would thus have to be sent by the parents.
This doctrine of recovery from the evacuating, similar to the policy adopted by the Ministry of Health, was maintained by the Board in a further circular issued in December 1939.45 Later, it was agreed that for children who had not been receiving free milk before evacuation, but who were found to need it in a reception are, the cost could be charged to the evacuation account.
This microscopic recording of halfpennies for tens of thousands of children according to whether the cost should fall on the rates—less Exchequer grant—or wholly on the Exchequer46 was, in effect, made unnecessary when the Government raised the rate of grant to education authorities to one hundred percent for milk supplied free to
needy children.47 This was in October 1941. but this did not solve the problem for those children who were not classed as 'necessitous'. The London County Council tried to find an answer by collecting 10d. a month from parents when it recovered the cost of billeting. But this entailed so much administrative work in the reception areas and in London that the 10d. scheme was abandoned in April 1943 after a trial of six months.48
So far, only the simpler and more straightforward issues have been presented. All these—and many other—problems concerning responsibility for the costs of social services provided for people who moved over local government boundaries became much more complex later in the war with the classification of migrants into different grades of eligibility for different services.
By the end of January 1941, when the bulk of official evacuation movements had been completed, evacuated people were roughly classifiable into five groups:49
- Unaccompanied schoolchildren, officially evacuated.
- Expectant mothers, officially evacuated under the special scheme.
- Mothers and accompanying children, officially evacuated.
- Other adults, e.g. aged, infirm and homeless people, officially evacuated.
- Unofficial evacuees—those, including many homeless people, who made their own arrangements and found their own accommodation.
For groups 1–4 the Government accepted financial responsibility for the additional, or war, costs of certain health and welfare services provided by receiving authorities. Apart from two or three exceptions, such as the treatment of infectious diseases in hospital50 and the London maternity services, the evacuating authorities were given to understand that they were morally, if not legally, responsible for reimbursing receiving authorities who provided 'normal' or peacetime services. The same doctrine applied to the school medical and milk services. For unofficial evacuees, the Government accepted no financial responsibility whatever. By 1941 this group was very large, for many bombed-out people had simply gather up their families, and had taken a train out of London, Liverpool or other raided city in
the hope of getting fixed up somehow, perhaps with a friend or relation. They did not know that because they had left without having the blanket of 'officialness' thrown over them, they would set in motion a complicated business of local government counting, bargaining and debt-collecting if they applied for help from certain of the social services.
As time went on, the list of rules and precedents became longer and more involved with sub-classification following sub-classification as the definition of what was 'official' and 'unofficial' broadened and change. Moreover, fresh perplexities were added when the boundaries of evacuation areas were altered and new areas were included in the evacuation scheme. Thus, in July 1940, when invasion threatened, and areas on the east and south-east coasts were scheduled for evacuation, additional expenditure on health services provided in reception districts for people from these areas was borne by the Government. For private evacuees—even those who obtained official travelling vouchers—'it is not proposed to accept as an evacuation charge any authority to whose area they go'.51
Broadly, then, a newcomer to a reception district52 presented to the local authority four problems in terms of financial responsibility for services rendered:
- Is this person an 'official' or 'unofficial' evacuee?
- When and how did he or she arrive, and where from?
- Is the service required a 'war' cost or a 'peace' cost, or a combination of both elements?
- Was the service available to this person in his or her area of 'normal' residence?
Some authorities, in considering these questions for tens of thousands of evacuees, had to communicate with as many as ninety different local authorities.These questions were appropriate, not only to the services described above, but also to the following:
- Elementary and secondary education. The processes of apportioning expenditure and income between local children and children from many different areas on such items as teachers' salaries, school chairs, electric light, fuel, cleaning, books, pencils and ink, became so involved that the Board of Education set up a committee to construct some kind of formula to economise on book-keeping.53 Many of the recommendations of this committee were found by 1941 to be unworkable.54 The committee met again, and in July 1941 proposed that inter-authority adjustments should be made on the basis of £1 per child per year for elementary children, and £3 6s. 8d. per term for secondary children, in respect of certain services.55 This still left other items to be separately adjusted for individual children.56
- School medical inspection and treatment. The Board of Education recommended that the same method of financial adjustment should be adopted for these services as for education. There were certain exceptions, however, such as tonsil and adenoid treatment, the cost of which was to be dealt with by 'day-to-day' recovery methods.57 It is not generally known how far these proposals for flat-rate adjustments simplified the work, or to what extent they were in fact accepted and used by local authorities who had carried on for nearly two years without them. There is some evidence to show, however, that later in the war local authorities were still trying to recover small sums of money from other authorities in respect of individual children.58
- Disinfestation, cleansing facilities, sanitation, water supplies, disposal of refuse and other services. A number of local authorities argued that an influx of evacuees with scabies caused the disease to spread among the local population, and led to extra expenditure falling on the rates which should properly be borne by the Exchequer. Representations were also made that increased expenditure on sanitation and water services was due to the presence of evacuees. The Ministry of Health made payments in some instances and refused in others.59
Nor was this all. The same problems of localism, boundaries,
grades of eligibility and so forth affected in one form or another the emergency hospital scheme,60 the post-raid services,61 sanatorium treatment for men discharged from the Armed Forces with tuberculosis,62 and the emergency public health laboratory service.63
A sufficient number of examples have been given to illustrate the range and complexity of problems which derived in part or in whole from the application of localism and divided financial responsibility. By the end of 1940, when air attacks on Britain had been experienced for four months, some of the personal hardships which arose from the employment of these principles were sufficiently impressive, at a time when social distress was politically important, to being about certain changes in policy. These took place not because of the waste of accounting manpower nor in the interests of an efficiency audit in place of a money audit, but because the Government was led to realise that the doctrine of recovery was preventing the extension of certain health services and prohibiting mothers and children from getting access to some of the help they needed.64 The question was not examined in all its bearings; the whole field was not mapped out and the fundamental issues reviewed in relation to the working of the social services. Only certain of the services for which the Ministry of Health was responsible were considered. The functioning of these services was looked at more carefully with the principles of inter-authority recovery in mind.
One problem which was examined in the winter of 1940 was the provision of medical care by general practitioners for mothers, accompanied children, and certain other classes of refugees and evacuated persons, both 'official' and 'private', who were outside the scope of national health insurance. To understand the direction of Government policy it is first necessary to explain what arrangements for medical care had already been made, and what remedies were proposed to improve a bad situation.
On the outbreak of war the Government had made arrangements with the British Medical Association for general practitioners to give treatment at the homes of the foster-parents to unaccompanied child evacuees. The school medical services were to continue with their normal work, but nor more; as the Association was 'specially anxious that the services should not be used for giving treatment to a greater extent than in peacetime'.
For this home treatment, practitioners were paid 10s a year for each evacuated unaccompanied schoolchild.65 This was 1s. less than the 11s. paid for adults under national health insurance. Although neither the Government nor the Association had any adequate data about the incidence of sickness as between children and adults, the fee was fixed at a lower figure for children partly because it was to be believed that they had not 'such a passionate desire for medicine as adults'.66 There were other reasons too, for the Government argued that doctors would have more patients to see in the homes they normally visited, and that the additional work did not justify a fee of 11s. a year.
Unaccompanied schoolchildren were, therefore, provided by the Government with a free domiciliary medical service, in addition to sick-bays for minor ailments, and hospital treatment under the emergency hospital scheme.67 No such arrangements were made for other evacuated groups, particularly mothers and accompanied children. If they could not afford a private doctor they would have to use the district (poor law) medical service provided by public assistance authorities.
Within only four days of the outbreak of war the British Medical Association reported that a serious situation had arisen because of the inability of evacuated mothers to afford to pay doctors, and the failure of the poor law medical service to provide what was needed. The position was worse in Scotland, where medical relief, like all poor relief could be given only when the father or husband was unemployed.
Apart from relief for 'temporary' sickness, the cost of medical and hospital treatment provided by poor law authorities for these
evacuated people had, moreover, to be recovered in most instances from their opposite numbers in the evacuation areas. Consequently, all the problems discussed above of boundaries, settlement and eligibility, complicated the provision of these forms of medical aid for mothers and accompanied children in the reception areas.
Despite evidence of hardship both to evacuees and to charitably disposed doctors, there the matter rested until the period of air attack and the fresh waves of evacuation in the winter of 1940. By then, the question had got linked up with the wider problem of inter-authority recovery for the cost of health services because of more evidence that mothers and children were returning to the cities as a result—it was thought—of lack of access to medical and other services.
Towards the end of 1940 it was believed in the Ministry of Health that the expenditure involved, and the doubts of reception authorities as to whether they would be able to recover costs from the evacuation authorities, were discouraging the extension of health services for evacuees. In November, a circular was issued which attempted to remove some doubts, promised yo pay all additional expenditure caused by official evacuees, but left unsolved many other issues.68 Finally, after more complaints of hardship, of the insufficiency of the services in the reception areas, and of the crippling work of day-to-day book-keeping,69 another effect was made to lower the administrative and financial barriers.
In a new circular, issued in 4th February 1941,70 local authorities were told of the Minister's 'anxiety that action … should not be hampered by any misunderstanding as to the incidence of the cost'. The general effect of this circular was to extent certain health and welfare services to 'unofficial' evacuees: the Government was now prepared to reimburse local authorities for additional expenditure on services made available to such people. To encourage authorities to expand their poor law medical services to provide for the needs of all evacuees, preferably by means of the 'open choice'—or panel—system, the Government was ready to repay on the same broad principle. At the same time, the facilities for treatment in the emergency scheme hospitals, already available to unaccompanied schoolchildren, were extended to include all evacuees.
These changes represented an advance on the doctrine laid down at the beginning of the war so far as it affected the financial relationships of one local authority to another. It is important to recognise,
however, that the new policy did not embrace all services, for although it applied to some which were supervised by the Ministry of Health, it did not affect the position of the school medical service, the emergency laboratories, public assistance apart from medical relief, and other services. Instances had already been quoted of how the principle of inter-authority recovery was still being worked after 1941, and others are given later.
Moreover, the circular of February 1941 was open to different interpretations. After it was issued, the Ministry still took the view that a financial liability remained with evacuation authorities 'for the provision of services to persons normally resident in their area by reception authorities on their behalf'71 The government undertook to reimburse only net additional expenditure incurred by reception authorities. Recovery and accounting still went on, although for a few services catering for evacuated mothers and children the volume of transactions between local authorities (but not between local authorities and central departments) was somewhat reduced.
This alleviation came too late to effect much improvement in the poor law medical service. The 'open choice' system, which the Ministry of Health recommended in February 1941, after a year and a half of disapproval,72 entailed long negotiations with the British Medical Association on scales of payment for doctors. This delayed progress in extending the service until after April 1941. In the autumn complaints were still being made that some mothers and children were unable to obtain medical care in the reception areas.73 A departmental minute in September 1941 summed up these complaints quite bluntly: 'the present system of domiciliary medical treatment is a real stumbling block to evacuated mothers and children'.
By October 1941 the 'open choice' system had been adopted wholly only by one country in England; ten others had adopted it partially. The Ministry's regional offices reported that there had been few demands by evacuees on the poor law medical service and that hardly any complaints had been received. One or two offices thought that there had been 'a failure to ensure that evacuees are notified of existing health services and of how and where to make use of them'. With the increasing return of evacuees to the towns from the summer of 1941 onwards, no further action was taken by the Ministry to stimulate the authorities during the rest of the war. A comment by
the Curtis Committee on the way public assistance authorities discharged their child care functions seems equally appropriate to this matter of medical aid. 'We feel very strongly', the committee wrote, 'that means at present available to central departments for bringing sub-standard authorities up to the level of the best where inspection and exhortation have failed are either insufficient or not used'.74
To have brought about any radical change in the poor law medical service would have involved a review of the existing law on settlement, removal and chargeability. early in 1940 there were some discussions between the Ministry of Health and the local authorities about the possible effects of the war on the poor law system but did not last long nor did they probe deeply. A circular on poor relief generally, issued by the Ministry in April 1940,75 attempted to achieve three purposes:
- prevent removal questions arising with homeless or evacuated persons,
- limit inter-authority discussions on chargeability likely to result from the working of the evacuation and homeless persons schemes,
- reduce the amount of work on adjudication and committee meetings.
So that these recommendations might be adopted by poor law authorities the Minister suspended article 5 of the Relief Regulation Order, 1939 for the duration of the war.76 In announcing this, the Minister expressed the hope that authorities would exercise great discretion in using removal orders, and especially that persons who had moved away from vulnerable areas, either under the Government's evacuation scheme or otherwise, would not be moved back.
In the absence of extensive local researches, it is impossible to say how far these proposals were adopted,77 or the extent to which they simplified administration.78 It can be said, however, that the intricate body of law on settlement, removal and chargeability was, throughout the war, fundamentally the same as in the nineteenth century. The only material difference in the administration of the law was the substitution of accounting for the bodily removal of poor persons.
No comprehensive study has been made by the writer of the administration, practice and problems of the poor law during 1939–45. There exists, however, much evidence in central and local files, and
in such papers as the Public Assistance Journal, to suggest that the elaborate mechanism of transferring small amounts of money from the pockets of one authority to another represented a disproportionate and wasteful consumption of time and labour.79 The problem was by no means insignificant, for in 1939–40 there were 140,130 persons in England and Wales receiving institutional relief, and in 1944–5 there were 128,684. Despite the removal of many widows and old persons from the service of the poor law as a result of the payment of supplementary pensions by the Assistance Board, the total number of people receiving domiciliary assistance from the poor law in 1944–5 was still as large as 282,971—a figure higher than at the end of the First World War.80 The cost of such assistance in 1944–5 amounted to over ten million pounds.81
Much of the present chapter has been concerned with the practice of inter-authority accounting and with the recovery of individual items of expenditure by one local authority from another. But it has also to be remembered that these authorities had the duty of distinguishing, when applying for central department grants for administering many of the new wartime services, between residents and non-residents. That is to say, local people could not have access to these special services—e.g maternity homes, hostels, nurseries and so on—unless their local authority bore a proportionate share of the cost. This division of financial responsibility was, of course, a part of the principle, adopted in 1939, of separating the 'costs of war' from the 'costs of peace'. In practice, this meant a further sub-division of accounts, and another splitting-up of the capital costs, expenditure on maintenance, administration and so forth. The dissection of expenditure was a particularly heavy burden in the running of the
emergency hospital scheme. When, in a municipal hospital some beds were used by the local authority and others were reserved for the Government's scheme, all the main heads of expenditure had to be analysed and apportioned between the central and local authorities. In some areas, for instance, Plymouth, the Ministry of Health proportion was laboriously, but not necessarily precisely, computed to seven decimal places.
Then there was all the work done by local authorities in recovering expenditure incurred on behalf of individual users of the social services, and in assessing and collecting the cost, or part of the cost, of services rendered for milk, meals, dentures, surgical equipment, spectacles, hospital care, maternal confinements, tuberculosis treatment, secondary education, housing, billeting in homes and hostels, nursery services, burials, travel vouchers and a hundred and one items. Such questions as these cannot be discussed here. Some have been dealt with, under their appropriate headings, in other chapters.82
The subjects discussed in this chapter extend over a large and varied sector of the health and social services. They illustrate, in microscopic form, some of the defects of a system which rests on two basic principles: first, local independence, which means local boundaries; secondly—since local independence is limited—a substantial measure of responsibility by the central government for general policy and for finance. Such a partnership of interests, with its mixture of local responsibility and central government supervision and grants-in-aid, must inevitably carry with it certain defects. Some price inefficiency has always to paid for local self-government. But if it is genuine, this self-government has many advantages, some of great merit, some essential of a democratic society, and some of unquestionably higher value in peace than in war.
It is outside the scope of this book to assess the place and function of local government in present-day Britain. Such an assessment would indeed be necessary, even for the limited purposes of war history, if all the defects that have been revealed were found to be inevitable and unavoidable. But the qualification is an important one. Were all the hardships that have been chronicled an essential consequence of the
system? The question can be put in more concrete terms. How many people were adversely affected in one way and another each year, or were unable to gain access to the help they required, because of these hindrances of boundaries and divided financial responsibilities? What was the cost, in money and men, of all this inter-authority recovery and accountancy? Could the cost, or at least part of the cost, have been avoided? What would have happened if the Government in 1939 had anticipated these problems; if it had attempted to avoid them by stabilising in some way the total income and expenditure of local authorities at some agreed pre-war level, and had met all subsequent deficiencies from its own resources? Could not some formula have been devised which might have substantially reduced the amount of accountancy without doing harm to local government?
As earlier paragraphs have explained, these problems existed in various forms before 1939; for the principles of inter-authority adjustment are to some extent implicit in any system of local government based on a mixture of rates and central Exchequer grants. An experience student of the administration of public medical care in the United states, surveying the multitude of state, local and voluntary agencies involved, condemned the system as 'unwieldy and wasteful'.83 His account, which was published after this chapter had been written, contained an analysis based on a set of questions similar to those which the present writer has raised.84 'An army of clerks', he said, 'is required to figure out "who pays for whom, for what, and how much", and another army of auditors is needed to check the accuracy of the payments'. In Britain, the effects of the war greatly aggravated the problems of accounting and auditing, and added first one and then another new service to which all the old principles were systematically applied.
If a change were to be made, then the most favourable time for decision was 1939. The available historical evidence on the work of
the health services does not suggest, however, that Parliament or, indeed, any political party, had identified this problem of twentieth century governments.85 Nor had anybody advocated any reform of a far-reaching character. Once the decision had been taken in 1939 to divide the 'costs of war' from the 'costs of peace', and to continue to distinguish, according to place or residence and other criteria, between the rights of access to various social services belonging to this or that person, than as one precedent led so easily to the making of another it became progressively harder to visualise any fundamental change.86
What is astonishing is that harassed officials of central and local government somehow made the system work. There is no doubt that immense numbers of people used, and were helped by, the social services that have been discussed in this chapter. So much can be said with assurance. But—and here the essential questions return—were all the hardships and inefficiencies necessary? The impression that emerges from this study is that many of them were avoidable;' that many of the niggling questions and letter-writings and accountancies could have been discarded without any lasting injury to the fundamental principles of local government. This conclusion, however, lacks the support of arithmetical fact. Without much more inquiry and research, it would be impossible to provide estimates of the number of people who suffered in consequence of the system, of the cost in men and money, or even of the extent to which each authority obeyed and enacted the rules and regulations laid down by Parliament for allocating innumerable items of income and expenditure to their appropriate pockets.
The philosophy and practice of localism, by which every neighbourhood was held responsible for the support of its own poor and sick people, has been the theme of this study. What has been written is little more than a brief reconnaissance; a glance at the historical origins of localism, a reference to its great accretions of strength through the developing influence of the poor law, a mention of the
chain of inheritance which attached the principle of local responsibility to many of the social services and, finally, a short account of how this principle collided with the need for social help on a national scale during the Second World War.
In a great many ways, this collision resolved itself into not one but a whole series of administrative and organisational problems. That is one reason why it was never seen and faced by the Government as a single problem. Even in the Ministry of Health, the struggle to find a way through a medley of scattered principles and precedents rarely reached the higher administrative levels. The interminable corresponding, interpreting, minuting and accounting on this or that issue went on steadily among the lower and middle ranks of officialdom. Their task, and the task of local officials all over the country, was to see that the law—contemporary law, accepted and publicly approved law—was justly and conscientiously administered. And the task of the district auditors, for long a power in the land of local government, was to see that the precepts and regulations of the central departments had been followed with rectitude and precision.
The problems that have been discussed concern many of the subject narratives to which other chapters of this book have been devoted. To have dealt in each successive chapter with the same questions of boundaries and divided responsibilities would have led to constant repetition and cross-reference. The main elements of these recurring problems have therefore been extracted from the different subject histories, brought together, and presented as one important aspect in the administration and work of the social services during the war. This chapter has attempted no more than that. It contains no coherent story of Government policy, no complete diagnosis of a social ill, no proposals for its betterment, no certain conclusion.
Contents * Previous Chapter (XI) * Next Chapter (XIII)
1 Coode, G., Report on the Law of Settlement and Removal, H.C. No. 675 of 1851, (p. 7).
2 Webb, Sidney and Beatrice, English Local Government: English Poor Law History, part 1, 1927 (p. 322).
3 See, for example, the annual reports of the Public Assistance Committees for London and Liverpool, 1936–8.
4 Ninth Annual Report of Poor Law Commissioners, 1843.
5 Ministry of Health estimates. The figure of £52,740 is probably an underestimate, for it is believed to exclude that proportion of the salaries of officials and administrative expenses incurred on this work in central departments, as well as certain items of expenditure by local authorities which are difficult to apportion, e.g., office accommodation, salaries and so on.
6 Annual Report of the Public Assistance Committee for Liverpool, 1938.
7 A note on the law of settlement and removal is printed in Appendix 6.
8 Some indication of the work involved as a result of these arrangements in London alone is given in para. 81 (recovery of use of swimming baths by schoolchildren) and 99–10 (recovery of costs of education) of A Survey of London Local Government, Lloyd, E. J. D., and Humphries, J. H., 1944.
9 The question of means tests and personal recovery was discussed in Chapter X, pp. 154–61.
10 Ministry of Health circular 1800, 1st May 1939.
11 The Board of Education did, however, make it clear before the war that, so far as educational expenditure was concerned, both receiving and evacuating authorities should neither benefit nor lose as a result of the evacuation of schoolchildren. The Board's policy on this matter is the concern of the education volume in this series of histories. [Never published.]
12 'Evacuation does not, and cannot, mean the evacuating authorities are to be relived of all existing burdens in relation to their transferred populations merely because services are being provided for them, for the time being, largely through the agency of the authorities of reception areas.' (Ministry of Health circular 1882, 3rd October 1939).
13 Ministry of Health circular 1998, 19th April 1940.
15 E.g. Ministry of Health circular 1800, 1st May 1939.
16 For details and source of reference see Chapter XX.
17 A fuller account of this service, is published in Civil Defence, O'Brien, T. H., (1955).
18 Unless the mother was fortunate enough to get the child accepted by one of the voluntary agencies handling such cases, e.g. the Soldiers', Sailors' and Airmen's Families association. If not, then responsibility fell on the public assistance authority of the area in which destitution arose. If the authority could show that the child was—for settlement purposes—removable to an evacuation area then it could be sent to a reception area via a public assistance residential nursery. If the authority in the evacuation area could not provide accommodation in an evacuated nursery under its control, admission might be made to a nursery maintained under the Government's evacuation scheme provided that the public assistance authority made a payment of 23s. per week for maintenance. According to circumstances, the authority then recovered the cost of maintenance from the War Office, the mother (if alive) or, under section 6 of the Act of 1601 (re-enacted in section 14 of the 1930 Act), from the maternal or paternal grandfather or grandmother.
19 This particular form of social distress among unmarried mothers during the war was, on the whole, left to be dealt with by the public assistance authority. Approximately 61,000 additional illegitimate births occurred in England and Wales during 1941–4 (over the average for 1939–40). The total number of such births registered during 1941–4 was 165,000, or roughly 41,000 a year as compared with 26,000 for 1939 and 1940. But a very large number of these children who were born out of wedlock were prevented by war factors from legitimised. While the illegitimate birth rate rose, the proportion of legitimate births occurring within eight months of marriage fell steadily to the end of 1943. Thus, for the first four years of war the proportion of extra-marital conceptions did not differ very much from that obtaining before the war. Nevertheless, it is probably that the public assistance authorities were called upon to accept more illegitimate cases because the war prevented marriage and the legitimation of the child. If this situation had been properly understood, these authorities might with justice have argued that the Exchequer, and not the rate, should have accepted financial responsibility.
20 In addition, some other applications which conformed to the criteria drawn up for admitting children to the Government sponsored nurseries were accepted during the later years of the war regardless of whether the child was legitimate or not.
21 See footnote on p. 211. The emphasis on status at the termination of uterine life is important, for, as the Registrar-General for England and Wales has shown, forty-two percent of first maternities to married women aged twenty or under were conceived before marriage, thirty-one percent at age twenty, twenty-two percent at age twenty-two, ten percent at ages twenty-five to twenty-nine, and eight percent at ages thirty to thirty-four (Registrar-General's Statistical Review, 1938, Part II, civil).
22 See reference on p. 215.
23 'Evacuation' was often only a book-keeping label, for short-stay cases were not necessarily evacuated from London.
24 Ministry of Health ruling. During the three months ended 11th December 1943, 760 new cases were admitted to these nurseries. Of this number, 376 were classified 'evacuation' and 384 'public assistance'. A proportion (unknown to the historian) were subsequently transferred from poor law chargeability to the Government's evacuation account.
25 For example: 'Mrs. X, a young woman with two small children, lived in the county of Z where there was little provision for maternity in-patients. When she was expecting her third child she tried to book at the rate-aided hospital in a county B almost within sight of her home. As she was not a ratepayer and could not afford full cost, her application was refused. Reference to the medical officer of health of her area brought no solution for their available beds were full, and eventually she booked at a small inexpensive nursing home. Owing to a complication after birth she was rushed to the same hospital where she had previously applied for admission, the nursing home being situated in its area. Mrs. X died.' (Social Work,, October 1942.)
26Letter to the Ministry of Health, 3rd November 1942.
27 The Parish and the Union, or the Poor and the Laws under the Old Systems and the New: Being an Analysis of the Evidence Contained in the Twenty-two Reports of the Select Committee of the House of Commons, Appointed in the Sessions of 1837, to Inquire into the Administration of the Relief of the Poor, under the Orders and Regulations Issued by the Commissioners Appointed under the Provisions of the Poor Law Amendment Act, London, 1837.
28 An analysis of Hansard for the years 1939–46 illustrates this point, for it shows that the number of questions asked by M.P.s about accessibility and treatment under a social service were infinitesimal in comparison with the number asked about rates of allowances, pensions and insurance.
29 Many London mothers, for instance, belonged to contributory associations which, in order to aid the funds of voluntary hospitals, restricted maternity benefits to mothers having their babies in certain of these hospitals in London.
30 Eventually, the County Council accepted responsibility. On 17th April 1940, the Education Committee of the Council decided to recover from parents the costs of special medical and dental treatment provided by reception authorities for London children.
31 Departmental minute, 3rd December 1940. The circular referred to were 1882 (2nd October 1939), 1943 (1st January 1940), 1998 (19th April 1940) and 2204 (16th November 1940).
32 Ministry of Health circular 1953, 19th January 1940.
33 The statement of the problem in this paragraph covers the period September 1939 to March 1941.
34 The statement of the problem in this paragraph covers the period September 1939 to January 1940.
35 Letter from the Ministry of Health to the Metropolitan Boroughs Joint Standing Committee, 23rd May 1940.
36 Ministry of Health circular 1991, 4th April 1940. If, after a means test, the public assistance authority refused help—as it did in some cases—no reimbursement was made. In the case of visits to 'dangerously ill' people, fares were advanced only for two relatives once a week for journeys over fifteen miles, (Ministry of Health circular 1943, 1st January 1940).
37 Ministry of Health circular 2267, 21st April 1941.
38 The statement of the problem in this paragraph covers the period December 1939 to November 1944.
39 The special maternity evacuation scheme only applied to women who registered themselves for evacuation as expectant mothers, and who were sent to the reception areas as 'official' evacuees under the scheme. These arrangements are more fully described in a Studies in the Social Services in this series of histories.
40 Letters to Buckinghamshire and Devonshire County Councils, March 1941. Also Ministry of Health circulars 1998 (19th April 1940), 2204 (16th November 1940) and 2283 (4th February 1941).
41 In these and other cases a further complication was that the Council paid the hospital a specified sum per day for each occupied bed, and the hospital charged the patient on the Council's assessment scale and passed over the amount collected. How long would a mother have occupied a bed if she had not been evacuated, and would she have been able to pay a larger sum?
42 Letter from the Ministry of Health to the London County Council, 20th August 1940. No proper records were kept as to what went into the melting-pot.
43 This statement of the problem in these four paragraphs covers the period September 1939 to November 1942.
44 Board of Education circular 1475, 31st August 1939.
45 Board of Education circular 1490, 14th December 1939.
46 On this question of who should pay that portion of the halfpenny (reduced by Board of Education grant to local authorities) for one-third of a pint of milk, it should be remembered that the Exchequer was, in addition, subsidising the milk trade to the amount of about £3,000,000 a year, so as to enable milk to be sold to schoolchildren at 1½d. a pint instead of the ordinary retail price of 4½d.
47 Board of Education circular 1567, 21st October 1941.
48 The statement of the problem in these three paragraphs covers the period September 1939 to April 1943.
49 Apart from such people as transferred workers, civil servants, offices staffs, teachers, helpers, nurses, hospital patients and others.
50 Because it could not be argued that child would have developed (say) scarlet fever if it had remained in an evacuation area, the Government agreed to meet all 'additional' expenditure in the receiving areas on infectious disease accommodation provided for evacuees. (This reasoning adopted for certain formed of sickness accommodated in infectious disease hospitals, was not applied to other diseases, e.g. tuberculosis.) In defined 'additional' expenditure, regard was had to deficiencies in the receiving authorities peacetime accommodation, and so far as extensions could be classified as merely making good deficiencies the cost was not borne by the Exchequer. This concept of additional expenditure was abandoned in February 1941.
51 The receiving authority would, therefore, have the task of finding out, if a non-resident applied for help, how he or she had arrived in the district. (Ministry of Health circular 2095, 13th July 1940.)
52 Those who went to neutral districts presented problems of a rather different order. They are not discussed here.
53 Board of Education, Committee on Financial Adjustments, first report, 31st January 1940.
54 For example: one recommendation was that expenditure on dark blinds for schools containing both local and evacuated children should be apportioned between the rates and the Exchequer. It was one of the duties of His Majesty's inspectors to 'determine the proportionate cost attributable to each class of children'. If dark blinds were needed so that the schools could be cleaned in the evening the cost could only be charged against the Exchequer if the school was working on a double shift system.
55 Board of Education, Committee on Financial Adjustments, second report, July 1941.
56 These questions and all the associated problems of the effects of the war on the Board of Education's formula for paying grants to local authorities are the concern of the education volume. [Never published.]
57 Board of Education, first and second reports of Committee of Financial Adjustments, 1940–1.
58 For example: in January 1942, Llanelly education authority claimed £5 12s. 9d. from Liverpool for cod-liver oil supplied to evacuated Liverpool children who were considered to need it in the reception area. As it was not the practice of Liverpool before the war to supply this food to necessitous children Llanelly appealed to the Board of Education for a decision. In May 1942, on an inquiry from Bootle, the Board of Education ruled that Herefordshire was entitled to claim £17 10s. 0d. in respect of dental treatment to evacuated secondary schoolgirls from Bootle.
59 For example: in 1940 Lexden and Winstree rural district council asked for grant to cover the extra expense of employment a contractor to empty E.C. pails and closets in the parish of East Donyland. At first, the Ministry refused on the ground that the payment of billeting allowances to householders included the use of sanitary facilities by evacuees. Subsequently, it relented and made a contribution.
60 See Chapter XXIII.
61 See Chapter XIV.
62 Many local authorities refused to accept such patients generally because it could not be proved that the men concerned had 'normally' resided in their areas before enlistment.
63 In November 1944 the question of how much the Government sponsored laboratories, which had been established five years earlier, should charge local authorities for each specimen examined in connection with epidemics was still under discussion. Local authorities were supposed to pay for 'normal' outbreaks, the Exchequer for 'abnormal'. But no one could foretell whether a few cases, say, of cerebro-spinal fever would develop into a 'normal' or 'abnormal' epidemic.
64 A minute by a senior official of the Ministry of Health in December 1940 concluded that the failure of the evacuation account to recognise 'unofficials' had discouraged local authorities from extending their ordinary health services. The second report in July 1941 of the Committee on Financial Adjustments set up by the Board of Education found it necessary to emphasise that 'no child's education or health should be allowed to suffer, even temporarily, through differences of opinion as to the allocation of the financial responsibility'.
65 Plus a specified mileage allowance for transport.
66 Letter from the Treasury to the Ministry of Health, 11th July 1939. Although a sum of roughly £900,000 was paid to the profession during the war, the Ministry of Health never knew how many children were actually treated or how many calls doctors made under the scheme. After consultations with the British Medical Association the Ministry refused to investigate complaints from parents of evacuated children alleging negligence by doctors. In several instances, children died. The parents were told that if they were dissatisfied with the treatment given to take such legal or other action as they thought appropriate.
67 These services were free, apart from the inclusion of 2d. a week for medical care in the sums recovered from parents for billeting allowances, (Ministry of Health, memo. Rec. 3., 24th October 1939).
68 Ministry of Health circular 2204 to local authorities, 16th November 1940.
69 The Bristol regional office of the Ministry of Health reported, for instance, the arrival of over 200,--- persons in the South-West region during September and October 1940; the inability of many of them to pay for medical attention; the insufficiency of the poor law medical service, and the burden of accountancy and correspondence with a great number of evacuation authorities.
70 Ministry of Health circular 2283, 4th February 1941.
71 Letter to Berkshire County Council, 8th March 1941, in connection with maternity and child welfare services, and Ministry of Health letter to Treasury, 27th August 1941, on the subject of maternity costs for transferred war-workers.
72 The alternative was to appoint additional poor law medical officers. This was the method approved by the Ministry in September 1939 on the ground that it would be impracticable to have one poor law system for evacuees, and another for the local population.
73 Notably by the Women's Voluntary Services on 23rd September 1941.
74 Report of the Care of Children Committee (the 'Curtis' report), Cmd. 6922, 1946 (pp. 140–1).
75 Ministry of Health circular 2000, 19th April 1940.
76 Relief Regulation (Amendment) Order, 1940.
77 Any more than it is possible to say whether the poor law authorities continued to allow, during the period of rationing, relief in kind, and whether every infant under eighteen months old was examined by a medical officer 'not less than once in every two weeks'. (S.R. & O. 1930, No. 185 and 186.)
78 The experience of one large authority (Birmingham) was that these proposals complicated, rather than simplified, administration.
79 Three examples may be given. (1) During the first three months of war London was asked by other public assistance authorities to pay for about 1,500 poor law cases. Of these, 1,340 had been receiving relief prior to evacuation, buy only 930 had a prima facie settlement in London. Practically every case demanded careful scrutiny, inquiry and legal interpretation. (2) During the last year of the war, Southend county borough's 'Settlement Office' investigated 329 settlement cases. The borough's Collecting Officer reported that some £7,000 had been recovered in 1945 from other poor law authorities. A number of Service patients 'where no residential settlement could be established during their lifetime' were 'successfully placed on their birth settlement' with other authorities (Public Assistance Journal, 23rd May 1947). (3) the following represents a typical administrative questions addressed to the Public Assistance Journal (1st March 1946): 'A is settled in the county of Z. He goes to reside in county X and gains a status of irremovability there. In September 1939 A joins H.M. Forces from county X. In June 1943, A's children become chargeable to county Y, the father still being in H.M. Forces. A is discharged from the Army in November 1945, and goes to reside in county Y, but does not himself become chargeable. In January 1946, county Y asks county Z to accept chargeability and arrange for the reception of the children in one of their institutions. Can the county of Y remove the children to county Z?' Answer: 'Yes, as the last place of settlement of the man and his children.' The writer does not know whether the children were removed to county Z, and, if so, what effect it had on them.
80 In December 1918 there were 273,500 persons in England and Wales in receipt of domiciliary relief (Poor Law Relief Return, 15th December 1919).
81 Annual Report of the Ministry of Health, 31st March 1945.
82 See, for example, Chapter X for a discussion of means tests in relation to the question of recovering the costs of billeting evacuated children.
83 Goldmann, F., Public Medical Care: Principles and Problems, 1945 (p. 155). An authoritative statement from Washington was equally critical. 'Complex residence laws make it possible for person to lose residence in one locality before he gains it another. The length of time required to secure legal settlement in the various States ranges from one year to many years. A person who leaves on State may lose his residence after one year's absence but may not yet have become a legal resident of his new State. If he becomes ill, it is necessary to determine his place of residence to ascertain eligibility for medical care and often neither State wishes to assume responsibility. It may be months before the matter is resolved, with consequent difficulty for the patient. Intrastate, as well as interstate, residence problems exist when individuals have lived in the State long enough to gain State residence, but not long enough to gain county residence. In such instances, the State can assume the responsibility with or without charge to the county. The patient who is a nonresident of a given locality is just as much a health menace as the patient who has residence. Even if we ignore human values, it is obvious that the community's health is endangered when hospitalization is refused to the nonresident. There are many instances of refusal or delay in providing medical care to sick people who have no residence.' (U.S.A., Public Health Reports ,Washington, 2nd April 1938.)
84 See especially p. 209 above.
85 It is interesting to find the Care of Children Committee recommending in 1946, in reference to children boarded-out, that 'where the child is in the area of an authority and not chargeable for its support, there should be power to recover this cost from the authority which is chargeable'. (Report of the Care of Children Committee, Cmd. 6922, 1946 (p. 159).)
86 When the Government's evacuation scheme was wound-up in 1946 the initial financial responsibility for maintaining the orphans and other children still evacuated was placed upon the county and county borough councils in the reception areas. these authorities then had the duty of recovering part of the cost under a great many heads for each individual child from the authority of the area which had originally evacuated the child, while certain expenses, such as domiciliary medical care, were paid for by the Government. Although the number of children involved was not large (about 10,000 early in 1946) the amount of administrative work was proportionately very great. (Ministry of Health circulars 183/44, 16th December 194, 78/45, 1st May 1945, 82/45, 2nd May 1945, 225/45, 31st December 1945 and 133/46, 22nd June 1946.)