# The Slippery Slope/Some Recent Developments of Poor Relief

APPENDIX II

SOME RECENT DEVELOPMENTS OF POOR RELIEF

A few years ago it was possible to ascertain by a glance at the statistics of the Local Government Board the exact position of the country in regard to the public relief of the poor, and to answer with certainty the vital question as to what proportion of the poorer population lives by its labour, and what proportion lives by some sort of State subsidy. There was then practically no form of public relief which was not included in those statistics, and the greatest importance was attached to their accurate keeping in order that the nation might, at any time, take stock of the position by the light of evidence which was both clear and comprehensive. But this is no longer possible. The official statistics of pauperism now cover only a portion of the ground. The movement known as "the break-up of the Poor Law" has set in with increasing rapidity within the last few years, and to-day some four or five different bodies administer public relief where there was one before. These bodies work almost entirely independently of one another and overlap in many directions. Their finance and accounts are, of course, quite separate, and no attempt is made to bring the relief that they administer into a common account, although in fact they distribute as much relief as the Poor Law itself. We are therefore in the position that we have at present two Poor Laws, the one of which is guided by certain principles based upon past experience, and keeps careful statistics both of its expenditure and of the number of people dealt with, whilst the other is guided by no such principles and its statistics are confused with those of other branches of administration.

The principal Acts by means of which this "break-up" has been effected are the Unemployed Workmen Act of 1905, the Provision of Meals Act of 1906, the Old Age Pensions Act of 1908, and the (Education) Administrative Provisions Act of 1907. An appreciable amount of relief is also administered by Borough Councils under various Acts dealing with public health. The Home Office has been making excursions in the same direction through its Reformatory and Industrial Schools, and the late Home Secretary even proposed to give to the police the duty of seeing to the clothing of ragged children in London, as is already done in several important provincial towns. One effect of this break-up of the Poor Law has been that the total public expenditure for the relief of the poor has in the last twenty-five years risen from about £8,000,000 to approximately £30,000,000. The last Annual Report of the Local Government Board shows that Poor Law expenditure was £15,000,000, whilst about £12,000,000 was spent under the Old Age Pensions Act, and £183,500 under the Unemployed Workmen Act. To this must be added an, at present, unascertained sum expended under the Provision of Meals Act, whilst a fresh movement, of which it is impossible to foresee the ultimate results, has been started for the provision of medical relief to school children under the (Education) Administrative Provision Act of 1907. No one appears to have the least idea as to what the cost of the Insurance Act is likely to be.

Meanwhile the whole tone of public opinion upon questions of poor relief appears to have changed. At one time it favoured thrift and self-reliance, and self-support was held to be more creditable than dependence upon public funds. Now all this is altered. Old age pensioners, many at least of whom might have provided for their own old age by reasonable prudence in their earlier years, are designated without distinction as the "veterans of labour." Since the removal of the pauper disqualification a good many people who have been in receipt of parochial relief for years have become these veterans of labour, and have obtained, or are qualifying for, an old age pension. The able-bodied unemployed are now promised "honourable" maintenance. We are asked to abolish the last "stigma" of the Poor Law by doing away with the word "pauper." The electoral disqualification has been removed in the case of outdoor medical relief. Schemes of Poor Law reform are in the air, which all tend to make the receipt of relief more honourable and more acceptable.

The object of this paper is to examine the relations of these various forms of public relief to one another, and to watch their general tendency. We will take them in order under their several heads:—

The Unemployed Workmen Act, 1905.

This Act was the direct outcome of Mr Chamberlain's Circular of 1886, by which local bodies were instructed to give work, outside the Poor Law, to the better class of workman "ordinarily in work and temporarily unemployed." The Circular, intended for a special occasion, was issued again and again by his successors at the Local Government Board, and for twenty years vestries and other local bodies were occupied in trying to make work for the unemployed. It is of special importance because it made the first breach in the unity of the Poor Law. The work given was quite inadequate, often only amounting to one or two days a week, and it was found to interfere with the work of those ordinarily employed by the local authorities. Meanwhile a generation was brought up to look to the vestries for employment-relief, and crowds gathered, winter after winter, round the offices of the local authorities, demanding it. Ultimately the position became intolerable, and in 1905 the Unemployed Workmen Act was passed as an attempt to regularise this relief, and to liberate the local authorities from the pressure. It has undoubtedly had this last effect, but it has only transferred the difficulty elsewhere. The Central Unemployed Body has since 1905 issued five reports, and these reports show:—

(1) That the vast majority of those applying have been casual labourers and certainly not those for whom the Act was intended;

(2) That the work provided has done nothing to permanently improve the position of those who have received it, and that the same people apply year after year;

(3) That it has been impossible to provide work for more than a very small proportion of those who apply.

Though, by the Unemployed Workmen Act, the period for which work is given has been extended from the odd days previously given to a maximum period of sixteen weeks, it is none the less a form of casual employment which the casual labourer comes to look upon as part of his normal means of subsistence. The last Annual Report of the Central Body shows that there were 51·3 per cent, of recurrent applications. The same people are also being assisted at other times, in a large proportion of cases, by the Poor Law, or their children are being fed by the Education Authority. In a return for a single district which was presented to the Royal Commission on the Poor Law it was shown that of 437 cases assisted by the Distress Committee, 234 were already known to the Guardians, and 81 again resorted to the Poor Law. These figures may be taken as fairly typical of the conditions prevailing elsewhere. It was pointed out when the Unemployed Workmen Act was under consideration that its effect would probably be to increase and perpetuate the evils of casual labour. In fact, it has established 23 schools of casual labour in London and nearly 150 in the whole country. When the Act was passed the hope was held out that the work given would be provided by voluntary subscription. Mr Long, addressing a meeting at the Local Government Board shortly before the Act was passed, expressly stated that under no circumstances could a Government grant be made for the purpose. But very soon, as is always the case under similar conditions, voluntaryism was driven from the field, and a year or two later Mr Burns had to promise a grant of £200,000. Again, the Act, like Mr Chamberlain's Circular, was intended for times of exceptional distress. It has now become the normal procedure of the winter months.

The Provision of Meals Act, 1906.

Here again the hope was held out that the meals would be provided by voluntary subscription, and much opposition was disarmed thereby; but permissive power was given to charge them upon the rates. For two years the L. C. C, which had a small and precarious "Municipal Reform" majority, relied upon voluntary associations such as the "London School Dinners Association," but in December, 1908, Socialist pressure became too strong, and the cost was thrown upon the rates. Since then the average number of children fed weekly has gone up from 29,000 to 42,000 and the number of meals provided from 74,000 to 203,000.[1] There is now a strong agitation to feed the children during the school holidays. But, further, the hope was held out that it would be possible to recover a large part of the cost from neglectful parents. The expenditure last year was £88,000, and the amount recovered was £5 10. This is of special interest, because now there are large schemes of Poor Law reform in the air which are based upon the principle of "charge and recovery." We may form some opinion from these figures as to what the prospects would be if they were carried into effect.

This Act provided, for the first, time, for the medical inspection of all children in public elementary schools. Previously only abnormal children had been so inspected. An immediate result was the increase of the medical staff of the Education Committee from twenty-seven full or part time doctors, and thirty-two school nurses, to one hundred and thirteen doctors and eighty-nine nurses. But the Act gives the power "to make arrangements for attending to the health and physical condition of the children," and inspection inevitably led at once to the provision of treatment for children found to be physically ailing. The precedents of the Unemployed Workmen Act and of the Provision of Meals Act have been closely followed, in that the L. C. C. are attempting in the first instance to provide treatment through voluntary charity, and have entered into arrangements with the great hospitals upon the basis of a contribution by the public body in respect of the children treated. But there is already strong pressure for the establishment of rate-supported school clinics, and it remains to be seen how long this pressure can be resisted. Praiseworthy attempts are being made to throw the responsibility for this treatment upon the parents and to recover part of the cost, but the ultimate responsibility for ensuring that the children receive treatment rests with the public authority, whether the parents pay or whether they do not. The School Care Committees bear the chief burden of the work—"the responsibility for securing that appropriate action is taken in every case devolves upon them."[2] They have to classify the cases according to their nature, and to assess the parents' payments under the Act of 1909. "Considerable difficulties have arisen in connection with this part of the work, and steps are being taken to introduce a method of assessment less complicated than that originally introduced."[3] This method, which has now been decided on, provides for a maximum payment of is. and a minimum of id. In 1910, though the scheme had hardly yet begun, the cost of this medical inspection and treatment amounted to £26,880, whilst the amount recovered was £329. There are many who prophesy that the minimum charge of id. will soon become the maximum. It is significant, moreover, that already "arrangements are being made for remitting the charge in necessitous cases,"[4] whilst in another place we find that no hard-and-fast rule for determining necessity has been adopted by the Council."[5] The Council are thus already face to face with the old difficulty of a test. But as yet they hardly appear conscious that there is such a difficulty, either in regard to the means of the parents or to the actual needs of the child. " There is (they say) no absolute standard of what is, and what is not, healthy nutrition. Necessitous children are not necessarily ill-nourished, at the time of application for aid, though they would become so if relief were withheld."[6] The italics are ours.

The difficulty of collecting the small sums required under the assessment is enormous. A story is told of a collector who climbed twelve times to the top floor of some model dwellings to collect one penny, and sooner than attempt it a thirteenth time, paid it himself. It appears from all this that we are within sight of free medical treatment in all cases where the parents are unable or unwilling to pay.

It is estimated that some 30,000 children were satisfactorily treated under the above arrangements in 1910. The parents are not altogether satisfied, as they consider in some cases that they are deprived of the free treatment at hospitals to which they have been accustomed, and they resent the X-ray treatment for ringworm, and the provision of spectacles which they believe prejudice their children's chances of getting work. A large extension of the system is foreshadowed in regard to dental treatment. "It is evident that the needs of London will have to be met by special provision for the work."[7] In regard to medical treatment generally there appears to be no system of co-operation with the Poor Law, and yet in 1911 no less than 111,000 outdoor medical orders were issued in London, many of which were undoubtedly for children of school age. Is it not time that the matter should be considered from this point of view?

The Education Officer commences his report thus:—"Formerly (he says) education was in the main confined to (1) the growth of character; (2) the growth of the mind. Now education looks increasingly at the social problems that present themselves for solution in the case of the individual child, the problem of physical deterioration, of under-feeding, of impoverished homes and unsuitable employment. The State has come to see that it is not enough to impart knowledge, but that it must also see that the child is capable of assimilating that knowledge and that his environment is such that it will not entirely undo the effect of the school training." This is a startling definition of the scope of education as coming from a body such as the L. C. C.; the new development is referred to euphemistically as the "widening" of education; in fact, it may easily be made to cover the entire State maintenance of children.

The Old Age Pensions Act, 1908, and its Effect upon the Poor Law.

The Old Age Pensions Act came into force on 1st January 1909, and the pauper disqualification was removed on 1st January 1911. The Local Government Board have published a return (Cd. 5612) showing the number of paupers transferred to the pension list in the month of January, 191 1. The transfer was practically complete by the end of the third week. The table on the next page shows the number of indoor and outdoor paupers remaining in each London Union on 21st January 1911, and the number of these who were transferred to the pension list during the month. This will enable us to form some opinion as to the situation at that time.

 Union or Parish. Population. Paupers not Transferred. Paupers Transferred. Census, 1911 Indoor Outdoor Indoor Outdoor West District— Paddington 143,976 1,995 378 15 131 Kensington 176,628 2,631 173 48 114 Hammersmith 112,239 1,348 848 10 236 Fulham 137,289 1,677 316 41 109 Chelsea 73,842 1,630 136 13 134 St George's 128,256 2,705 488 35 208 Westminster 33,081 693 88 5 21 Total for West District 805,311 12,379 2,427 167 953 North District— St Marylebone 133,301 3,446 316 36 157 Hampstead 81,942 570 128 6 54 St Pancras 235,317 4,387 1,336 53 408 Islington 334,991 5,111 4,913 92 1,286 Hackney 270,519 3,687 1,994 39 587 Total for North District 1,056,070 17,201 8,587 226 2,292 Central District— St Giles and St George 31,436 965 111 11 45 Strand 21,674 1,293 96 14 38 Holborn 128,691 3,800 1,222 40 463 City of London 27,664 836 130 4 55 Total for Central District 209,465 6,894 1,559 69 601 East District— Shoreditch 118,637 2,717 680 27 237 Bethnal Green 129,680 2,682 198 59 149 Whitechapel 78,768 1,722 22 13 1 St George-in-the-East 49,068 1,231 18 13 0 Stepney 57,937 1,833 146 29 84 Mile End Old Town 112,827 1,792 794 30 309 Poplar Borough 168,822 4,169 3,633 33 984 Total for East District 715,739 16,146 5,491 205 1,764 South District— Southwark 206,180 5,281 2,030 52 499 Bermondsey 130,760 3,189 2,048 21 632 Lambeth 301,895 4,330 1,888 77 787 Wandsworth 400,941 4,778 1,312 58 616 Camberwell 259,339 4,093 3,672 21 1,036 Greenwich 189,034 3,132 1,468 47 556 Lewisham 134,721 1,434 1,325 11 322 Woolwich 131,086 1,665 1,018 12 197 Total for South District 1,749,956 27,902 14,671 309 4,655 Total for London 4,536,541 80,822 32,825 1,168 10,265

The table shows that 1168 indoor and 10,265 outdoor paupers were so transferred, whilst there still remained 80,822 indoor paupers and 32,825 outdoor; that is to say, practically the whole of the indoor paupers and two-thirds of the outdoor. Still the official figures of outdoor pauperism naturally showed at once a large decrease, though this decrease loses its significance because we know that these 11,000 paupers have only been transferred to another form of relief. But a fresh tendency at once revealed itself. It is pointed out in the half-yearly return of pauperism for 1st January 1911, that already there were 3554 more people under 70 in receipt of relief than on 1st January 1910, and this tendency continues. A recent return for the Lambeth Union shows that at the date of the return there were about 200 more outdoor poor under 70 than at the corresponding period of the previous year, and this was ascribed primarily to the operation of the Old Age Pensions Act. Nor is it difficult to understand the reason: Guardians who are prone to give out-relief, finding that the people over seventy have been taken off the rates, are by no means loth to fill their places with younger people. Moreover, there is always now the almost irresistible plea that people should be kept out of the workhouse for a year or two until the old age pension becomes due.

A return of the L.C.C. for the first quarter of 1911 showed that there were 60,500 pensioners in London at that date. This represents at a moderate estimate an addition of half a million to the cost of outdoor relief in the metropolis. The total out-relief for all classes in 1910 was only £307,231.

Certain other Forms of Relief outside the Poor Law.

But there still remains an appreciable amount of public relief administered by bodies other than Boards of Guardians. For example, many Borough Councils provide sanatorium relief. Some outside London have their own sanatoria. The L.C.C, in addition to the outdoor relief and medical treatment of school-children, maintain a large number of defective children in residential homes, where they are provided with board and lodging, of the cost of which the parents bear a very small proportion. Again, they spend a large sum—last year £128,000—in scholarships, or maintenance allowance for the children of poor parents, which cannot be ignored when we are considering the question of public expenditure upon relief. Neither can we leave out of consideration the Insurance Act, which came into operation in July, and which to the extent of "ninepence for fourpence" is admittedly eleemosynary. It is clear that this measure, whatever its advantages, must result in a large subsidy to the wages of the working classes.

Summary of the Position in regard to London.

On 1st January 1912 the total number of paupers in London, excluding lunatics and casuals, was 109,481. But to this 109,481 we must now add (say) 60,000 old age pensioners, an indefinite number of able-bodied men receiving relief on that day under the Unemployed Workmen Act, a weekly average of 40,000 children receiving meals under the Provision of Meals Act, an indefinite number of children receiving medical relief under the (Education) Administrative Provisions Act, and an indefinite number of people receiving public relief outside the Poor Law in other ways above indicated. These figures have now to be collected from some half-a-dozen different reports.

We have seen that as the result of the removal of the pauper disqualification there was a large transfer of outdoor paupers to the pension lists and corresponding reduction of pauperism; but that the present tendency is to fill the places of those transferred to the pension list with outdoor paupers under seventy. This tendency became especially marked in the third week of the Lady Day quarter of this year. If it continues we shall before long have as many outdoor paupers as before the disqualification was removed, and the old age pensioners and others into the bargain. It has been shown also that many pensioners are receiving Poor Law relief as well. In one Union it is reported that pensioners have discovered that they can supplement their pensions, which are notoriously inadequate, by continuous outdoor medical relief and nourishment, and that they do so systematically. Many others enter Poor Law infirmaries and receive their pensions as well, so that ratepayers and taxpayers pay for them twice over. Again, last year nearly 5000 able-bodied men received jobs of work from the Central Unemployed Body. But we have to consider the effect of the Act not only upon those who receive work, but also upon those who are encouraged to apply to the Distress Committees, and we find that there were 25,268 applications, of which 51 per cent, were recurrent, that is to say, that the applicants had applied in former years. Only about one in five get work, and that of a casual nature. It is plain that many of them gravitate between Distress Committees and the Poor Law and various charities, whilst their children are fed at the schools. The general public is probably unaware of the wretched and precarious existence that is led by these unhappy victims of State bounty. Jobs of work, school dinners and the like, are in reality subsidies to the casual labourer, who is able to produce children much faster than the State can maintain them.

And so we have in London at the present time a lamentable confusion of relief. So far from one form of relief being the substitute for another, relief leads to more relief, and there is constant and continuous increase. There is little or no co-operation between the administering bodies, and no reasoned plan for dealing with the problem of poverty. Everything is piecemeal and chaotic. And as the result we have an ever-growing proletariat population, chiefly composed of casual labourers, who are maintained in turn (and sometimes simultaneously) by Poor Law Guardians, Distress Committees, Education and Health Authorities, and other public bodies. By the admission of everybody casual labour is one of the most crying evils of the day, and we meet it by establishing centres of casual labour all over the country. What is worst of all, perhaps, is that we are fast losing the power of taking stock of our position, because we bury public relief in the statistics of various branches of public administration and disguise it as education, public health, or the reward of industry.

We shall never get back to a healthier position until the public realise that the problem of public relief is the most difficult and critical that any nation has to deal with, and is one which requires the undivided and concentrated attention of the community as a separate branch of administration. We have had many lessons in the past, and the question has engaged the attention of our best thinkers since the passing of the Act of Elizabeth. It is said now that the conditions have changed, and it is quite true that industry is far more complex than it was a hundred years ago. But the underlying problem is one of human nature, which remains the same as it has always been, and the magnitude and complexity of modern industrialism render the position far more dangerous than it has ever been before.

December 1912.

POSTSCRIPT (1914).

A good deal of water has passed under the bridges since the foregoing article was written. The National Insurance Act has come into force, and the benefits paid under it, whether in respect of sickness or of unemployment, have now to be added to the resources available for poor people in times of distress. Let us recapitulate these resources:—

(1) First there is the Poor Law (1601), with its workhouses, infirmaries, residential schools, and outdoor relief. In London we have in addition the numerous institutions of the Metropolitan Asylums Board.

(2) Next in order of time comes the Unemployed Workmen Act (1905), with its network of Distress Committees throughout the country, its Labour Colony at Hollesley Bay, and its system of allowances to the families of the men for whom it provides work.

(3) The Provision of Meals Act (1906) and the (Education) Administrative Provisions Act (1907) provide food and medical treatment for school children through the Education Authorities.

(4) The Old Age Pensions Act (1908) provides old age pensions for people over 70.

(5) The National Insurance Act provides benefits for practically all people between 16 and 70 who come within the income-tax limit.

(6) There are also certain other forms of direct public relief. In many cases Borough Councils provide sanatorium relief, and give, from time to time, a considerable amount of employment relief. It may not be irrelevant to point out that nearly two millions of money has been returned to the pockets of the poorer classes by the abolition of school fees.

There is practically no co-ordination of, or co-operation between, these agencies. In the case of old age pensions co-operation is, as we have already seen, expressly vetoed. There have been a few sporadic attempts at co-operation in certain directions, but, generally speaking, it is safe to say that most of these agencies are in the dark as to what the others are doing, and that all the tendencies are towards isolated, rather than towards co-operative, action.

The natural and inevitable result is a huge mass of overlapping relief, which is administered as chance may direct. Even where these agencies are aware of each other's action, there is no plan of action for the permanent benefit of the people relieved. Indeed, it is not uncommon for relief by one agency to defeat the object of the relief given by another agency. It often happens that Guardians who are trying to get children away from bad home surroundings into the Poor Law schools find themselves powerless, because meals are being given at the elementary school. Moreover, the most unscrupulous and importunate beggars get most, whilst the most self-respecting people get least, even though their need may be greater. Fraud and deceit are encouraged, and the relief given is frequently misapplied. Meanwhile, the sum total of expenditure steadily increases, and the worse forms of poverty remain untouched.

The most extensive evidence of overlapping between the Old Age Pensions Act and the Poor Law is furnished by a recent report of the Central Committee of the Poor Law Conference,[9] which is based upon information received from about 130 Unions in town and country, to which those who desire further information must be referred. Further corroboration is afforded by a remarkable memorandum recently presented to his Board by the Superintendent Relieving Officer of the Wandsworth Union. The memorandum is too long for quotation here, but the substance of it is contained in a paper upon "Old Age Pensions and the Poor Law," which may be obtained from Mr W. G. Lewis, publisher to the Central Poor Law Conference.

It is not only difficult, but impossible, for any individual to obtain comprehensive evidence upon a subject where the field of inquiry is so wide. But the following particulars of a limited number of concrete cases which have been dealt with quite recently in a single Union may serve to illustrate some of the points above mentioned, such, for instance, as the multiplicity of the public relief agencies that are at work upon individual cases of distress, the inadequacy of each form of relief taken separately, and the not infrequent misapplication of the relief given. The cases are grouped under two headings:—

(1) The overlapping of Old Age Pensions with the Poor Law.

(2) The overlapping of the Insurance Act with the Poor Law.

The cases given under the latter head cover a period of three months only. It may be pointed out with regard to the overlapping pension relief that, in the great majority of cases, the pensions continue to be paid either to the pensioners or their relatives, the amount recovered by the Guardians being practically nil. The same applies in the main to benefits received under the National Insurance Act.

Another striking case came before the Guardians of the same Union as lately as 18th November, in which the father, an insured person, was in the infirmary at a cost of 25s. a week, the wife was receiving sick benefit at 10s. a week, and the children were being fed at the

 Case-paper. Period. Days in Infirmary. Observations. 25798 Oct. 1913 Since 20th Oct. Still there. 2349 Oct. 1913 22 days 18328 Feb. 1913 10 days„ Also had two DispensaryOrders. 25106 April 1913 64 days„ 20520 August 1913 46 days„ Two admissions. 25530 Sept. 1913 51 days„ Also had three DispensaryOrders. 15349 August 1913 7 days„ 6184 Sept. 1913 8 days„ Also had two DispensaryOrders. 15227 Feb. 1913 25 days„ Sept. 1913 21 days„ 25448 July 1913 44 days„ Oct. 1913 Admitted 4th Oct. Still there. 3549 Nov. 1912 11 days ${\displaystyle \scriptstyle {\left.{\begin{matrix}\ \\\\\ \ \end{matrix}}\right\}\,}}$in work-house Oct. 1913 22 days„ 3714 Sept. 1913 49 days„ Cases of Special Interest. 86 Infirmary21/4/13 to 15/5/13 States "daughter Martha took herpension all the while she was inthe infirmary." 2000 Infirmary20/9/12 to 1/11/1228/7/13 to 12/9/13 "O.A.P. 5s., rent 3s. Does a littlespinning when well enough.""Friends assist with food." Workhouse15/10/13, still there15/10/13 "Applies for admission; destitute.Cannot manage on Old AgePension." 23738 Woman in Infirmary12/2/12 to 12/3/123/9/13, still there Both man and wife Old AgePensioners, but they live apart. Mantakes both pensions whilst wife isin infirmary. 120 Woman in Infirmary Both Old Age Pensioners. Man takespension when wife away. 25628 Infirmary, 29/9/13 Still in infirmary. Son John beforeBoard on 7th October 1913, and"excused." He has since beentaking the pension "to pay therent," but from the report of theR.O. it would appear that thepauper did not pay rent.
 Case-paper Number. ⁠Period. 1918.⁠ Particulars. 18364 June to October Man in infirmary. Wife and five children receiving 10s. weekly from N.H.I., and 7s. weekly outdoor relief. Man now (13/11/13) in infirmary, children in Poor Law Schools, and wife apart. 23575 October Man in infirmary. Wife receiving 10s. weekly from N.H.I., and four children being fed at school. 25462 July and October Man in workhouse (mental wards). Wife receiving 10s. from N.H.I. 25112 May to October Man phthisical. Ill May to Oct., 10s. weekly from N.H.I. Out-relief, food; 3s. 6d., four weeks (August). Man in infirmary 27th May to 1st July. Now at Sanatorium. 20645 July to August Man sick, 17/7/13. Wife applies for parish doctor because the panel doctor has a notice exhibited in his surgery that he would only see panel patients at their homes on alternate days, and man had suddenly become worse. 2lst July to 23rd August out-relief, 39s. 3d. on account of sickness of man, and sickness benefit not yet available. 3890 September Widow and four children chargeable at intervals since 1900. 3rd September, woman applies for parish doctor. She is an insured person, but not entitled to panel doctor because the sickness is the result of an accident. 13/9/13, woman reported to be receiving 7s. 6d. weekly sickness benefit. 2534 May to July 9th June, man admitted to infirmary. No Insurance benefit. "Card three stamps short." Out-relief in kind, seven weeks. 18458 24/7/13 to 30/7/13 Out-relief. Man sick, and Insurance benefit not sufficient. 7th to 21st Oct. Has had six weeks' benefit at 10s. week and 30s. maternity benefit. Benefit exhausted and out-relief granted. 25601 September Man in infirmary, 24/9/13, 8th to 11th Oct. Out-relief to wife and four children because Insurance benefit not yet received. 19295 October Widow. Has been relieved indoor and outdoor for four years past, at intervals. Out-relief 4th to 17th Oct. 14/10/13, applies for relief, under panel doctor, because no Insurance benefit yet.

schools. Since this was written, several similar cases have come before the writer in his capacity as Chairman of a Board of Guardians.

There have been several recent cases in the same Union in which women have come into the lying-in wards for their confinement, where, of course, they received every medical care and attention, and where they are encouraged to stay till they are entirely convalescent, and have then gone out and claimed maternity benefit either themselves or through their husbands before they were really fit to go. It should be noted that, where the husband is an insured person, he usually regards the maternity benefit as his by right.

It must be remembered that all the above-mentioned cases have occurred within a few months in a single London Union, and that there are some 640 odd Unions in England and Wales only, where the same conditions prevail. Some information, though not so detailed, has been obtained from certain other parts of London, and this information seems to point in the same direction. One Relieving Officer writes: "I have had in several instances to supplement inadequate sickness benefit. Several persons have applied, not being satisfied with their panel doctor. Single women have been admitted to the lying-in wards and have obtained maternity benefit after leaving." Another Relieving Officer from the same Union writes: "I have had to supplement unemployment benefit." In another case sanatorium benefit was provided by the Insurance Committee, and four of the children were taken into the parish schools.

The Superintendent Relieving Officer of a third Union gives the following information:—

"On making inquiries into the matter of the National Health Insurance, I find we have given nearly 700 certificates to enable inmates of our infirmary and lying-in wards to draw their benefits under this Act. In very few cases, certainly less than a dozen, have the Guardians recovered anything towards their maintenance. Married men have sent their wives into the workhouse for their confinement and then applied for a certificate to obtain the maternity benefit. I also find that certificates have been given to several single women for the same purpose, but I am unable to say for certain whether they have obtained the benefit. The same thing also applies to single persons, without dependents, who have been in our infirmary. Cases needing sanatorium treatment are always referred back to the Commissioners, but we have two cases who are receiving home treatment and the family is in receipt of relief. In one case a man, after waiting nine weeks for admission, was sent for, receiving only two hours' notice, but, as he was a widower with three children, he had to wait a further two days while arrangements were made to take his children into the workhouse, where they remained from February to July without payment. The father returned in May and went to work. In August he re-married, and we have now received another application from him for his admission to the infirmary and his children to the workhouse, as his wife has gone off and left him. He has been told to make another application for sanatorium treatment."

"The giving of 700 certificates must have entailed an enormous amount of labour on the infirmary staff, and when you consider that, in addition, over 500 reports were made for the Pension Authority, it can hardly be said that the Acts have decreased our labour."

The fact that 700 certificates under the Insurance Act have been given in a year in a single Union gives some indication of the extent of the overlapping between the Insurance Act and the Poor Law.

It will be noted that in all these Unions there have been many cases in which women, either married or single, have come into the lying-in wards for their confinement, and have subsequently claimed maternity benefit after their discharge. This is clearly contrary to the intention of the Act, which contemplated that the maternity benefit would be used to provide nourishment and proper treatment for the woman during her confinement; whereas, in these cases, the Guardians have provided all that is required. Some light is thrown upon the ultimate destination of the maternity benefit in many cases by a letter written to "The Times" in July last by Miss Margaret Bondfield, the well-known woman trade unionist leader, who cites the following cases:—

"A woman having been confined, her husband went to claim the maternity benefit to which he was entitled. On the way back he met some friends, and they decided to go and have a drink. After some time, as the husband did not return, the wife got some one to go and look for him. He was found in the public house with only 1s. 3d. left in his pocket, all that remained from the maternity benefit.

"A man went away with another woman on receipt of the benefit.

"A man returned home drunk with only 14s.

"A man of respectable appearance changed a sovereign at a public-house. When asked how he came by it he said, 'Oh! I've been to see Lloyd George.'"

A Guardian of a very important extrametropolitan Union informed the writer, quite recently, that the Local Government Board are at the present moment criticising the action of his Board because, in spite of recent social legislation, there has been up to now no sort of proportionate diminution in the amount of outdoor relief granted by them. His explanation was that recent social legislation has rather increased than decreased the demand for relief.

It is unnecessary to labour the point as to the overlapping between the Unemployed Workmen Act and the Poor Law in view of the return, already referred to, which was presented to the Royal Commission on the Poor Law, but evidence upon the subject continues to accumulate, and a large proportion of the able-bodied men dealt with by the Guardians have at some time or other received relief under it. Quite recently in a certain Union a woman whose husband was found to be in Hollesley Bay, and who was therefore in receipt of an allowance during his absence, applied for outdoor relief, and it is quite possible that without that constant vigilance which is by no means universal, duplicated relief might be granted in such cases. It would appear that in many places there is not systematic co-operation between Distress Committees and the Poor Law.

Several illustrations have been given of cases in which it has been found necessary to supplement benefits under the Insurance Act by Poor Law relief, and this tendency will probably continue. It is noteworthy that it was extremely rare in old days for any member of a friendly society to apply for parish relief, and no one can fail to remark the lowering of the standard of self-reliance under the new order of things.

But more than that, an opinion has been freely expressed that there will be a tendency for panel doctors to order into the infirmary their longer and more troublesome cases. Not long ago a panel doctor in Chelsea advised a patient to apply for admission to the infirmary, not because he was destitute—it was admitted that the relatives were in a fairly comfortable position—but because in his opinion the care of the patient was too great a strain upon them. The Guardians refused, but were eventually severely censured by the coroner.

An interesting illustration of overlapping between Part II. of the Insurance Act and the Unemployed Workmen Act came recently to the notice of the writer. It is interesting because it indicates a sequence of events which certainly would not have been anticipated by the promotors of either of these Acts, and because it illustrates the failure of two public agencies permanently to improve the condition of the person assisted. In the case in question, a builder's labourer, out of work, had applied to the Distress Committee and was admitted for the prescribed period to Hollesley Bay colony. He came out when his time expired in December last. Being still without work he applied for unemployed benefit in January and received an allowance for some weeks. When that was exhausted he was still out of work and applied to a charitable agency for assistance, and through their intervention he was emigrated to a colony, where we may hope that he has once more become self-supporting.

School dinners and school medical treatment are a fertile source of overlapping, with the Poor Law and many other relief agencies, both public and private. The nature and extent of the overlapping varies, of course, with the vigilance of the agencies concerned. But such vigilance is not very fashionable; indeed it is frequently condemned as "inquisitorial," and the dice are heavily loaded against careful administration.

It would be possible to multiply illustrations of overlapping between the ever-increasing number of public relief agencies to almost any extent. But it is hardly necessary to labour the point. It stands to reason that if we multiply relief agencies without establishing any systematic co-operation between them, overlapping will increase in proportion. The confusion at present is almost indescribable.

Since the first part of this paper was written there has been a fresh development which is of better augury for the future. Last June the President of the Local Government Board presented to Parliament an important return dealing with the total amount of direct "public beneficiary assistance," and promised to repeat this return in future years. The return is for England and Wales only, and therefore not complete; moreover, it only contains the details of the expenditure and not the numbers of people assisted. Still, it is a step in the right direction, and goes some way towards meeting the evils pointed out in the earlier part of this paper.

The return includes expenditure upon (1) The relief of the poor; (2) The Unemployed Workmen Act, 1905; (3) Hospitals provided by local authorities other than Poor Law infirmaries; (4) Education (Provision of Meals) Act, 1906; (5) Medical inspection and treatment of school children; (6) Other expenses of elementary and higher education; (7) Old age pensions for England and Wales, 1910-11.

The return covers a period of twenty years from 1890-91 to 1910-11, and shows that expenditure in England and Wales upon "direct beneficiary assistance" has grown in that time from £14,250,000 to £51,896,000. We have now to add to this £7,500,000 for the first year of the National Insurance Act, but this last item is for the whole country. So long as we have a regular return of this kind, completed and brought up to date, the public, at least, cannot say that they are acting in the dark and that this huge and growing mortgage upon the industry of the country has been imposed without their knowledge and consent. We are chiefly indebted for this return to the wise importunity of Mr Geoffrey Drage, who pointed out in a letter to "The Times" that this is in no sense a party question, and in fact the return was asked for by members on both sides of the House. Mr Drage, however, points out that these figures do not reveal the whole truth.

"When (he says) we have got these figures completed for direct beneficiary assistance we can then turn to indirect assistance such as that involved in cheap railway and tram fares, labour exchanges, public baths and washhouses, etc. Even so we shall leave out the vast expenditure on public health and sanitation, factory and workshop and mine inspection, which appears to me to be more in the category of what I should term sanitary police." We may perhaps now add to "indirect beneficiary assistance" the provision by the State and municipal authorities of housing accommodation at less than an economic rent.

But the return is of course not complete unless it includes the number of people assisted as well as the total of the expenditure. For this is an even more important question from an economic point of view. There is at present a tendency to live in a fool's paradise. The official returns of pauperism have of late shown moderate decreases, upon the strength oi which certain writers in the Press and certain prominent politicians have shown a tendency towards complacency, and even towards exultation. But, as has been already stated, the official statistics no longer cover the ground. When we say that pauperism has decreased we are juggling with words, because the actual burden of pauperism and the actual number of de facto paupers is far larger than it has ever been before in the history of the country.

Such being the existing conditions, what is the remedy? Some of us would consider that the best and most obvious remedy is to be found in the recommendation of the Majority Report of the Royal Commission that all public assistance should be brought under one authority. But if this is impossible in the present state of public opinion, then we must look elsewhere for a remedy. Hitherto the course of legislation has followed the lines of the Minority Report rather than those of the Majority. It has extended public relief in most of the directions indicated by the Minority, and has carried into effect many of their recommendations. But one of these recommendations—the only one for introducing some sort of co-ordination and control into this chaos—namely, the suggested registration of all forms of public relief, has been ignored altogether. It is rather significant that no one of the signatories of that report has, as we might have been entitled to expect, raised any sort of protest against the omission. If we are to have the policy of the Minority, we must have it as a whole and not in part. It is always an easy and a popular step to extend public relief. It is quite otherwise when it is proposed to establish any sort of control. Mr Charles Booth recognised this long ago when he proposed a scheme of universal pensions, because he recognised the impracticability of the then proposed limitations. But under the guidance of the authors of the Minority Report we have travelled far beyond old age pensions, and now practically anyone who comes within the income-tax limit is qualified for some form of State endowment, either for themselves or for their dependents. The onus is surely upon those who have led us into this labyrinth to lead us out. Perhaps even now, at the eleventh hour, they will come forward and press for the initiation of a scheme of registration which formed originally an integral part of their proposals, and for a system of organised co-operation.

The first practical step appears then to be to press for a searching and judicial inquiry into existing conditions, an inquiry from which politicians and theorists alike should be rigorously excluded. Disorganised voluntary charity is an evil, but disorganised State charity is a far worse one, because it is on a much greater scale and is much less capable of control. Surely the time has come when public-spirited men of both parties should agree to exclude these questions from the sphere of party politics, and to put a stop once and for all to this legislative chaos which is supplementing wages, increasing the cost of living, pauperising the poor, and perpetuating poverty. Modern free traders may be reminded once more of the words of Cobden, which indicate a very different social policy:—

"Mine," he says, "is that masculine sort of charity which would inculcate in the minds of the working classes the love of independence, the privilege of self-respect, the disdain of being patronised or petted, the desire to accumulate, and the ambition to rise."

The Prime Minister recently used these words:—

"I do not think there is any doctrine more fatal to the root principle of democratic government than that it should consist in the constant amelioration, at great expense to the community, of the social conditions of the less-favoured class in the country at the sole and exclusive expense of other classes" ("Times," 12th July).

They may be commended to the attention of the democracy of this country.

1. Ann. Report of L. C. C, 1910, vol. iv., p. 38.
2. Ann. Report of L. C. C., 1910, vol. iv., p. 43.
3. Ibid., p. 43.
4. Ann. Report of L. C. C, 1910, vol. iv., p. 48.
5. Ibid., p. 35.
6. Ibid., p. 35.
7. Ibid., p. 48.
8. Note.—Cf. a recent report by the Committee of the Central Poor Law Conference and a report by Mr Rutherglen, Superintendent Relieving Officer to the Wandsworth Board of Guardians, October 1912.