The supreme reform which must be undertaken by any Government that seeks to remove this great blot on Irish administration is the abolition of the present workhouse system on some basis which, while effective, will make no addition to the rates. The two chief reports (those of the Viceregal Commission and the Royal Commission on the Poor Laws) are in agreement, not merely as to this necessity, but as to the guiding principles of reform. They recommend classification, by institutions, of all the present inmates of the workhouses—the sick in hospitals, the aged and infirm in almshouses, the mentally defective in asylums. Appalling evidence was given before the Viceregal Commission and the Royal Commission on the Care and Control of the Feeble-minded with regard to the present association of lunatics, epileptics, and imbeciles with sane women and children in the workhouse wards. The latter Commission recommended the creation of a strong central authority for the general protection and supervision of mentally defective persons.
The reforms do not contemplate the amalgamation of Unions and the complete closing of only a certain number of workhouses. They suggest rather the bringing together into one institution of all the inmates of one class from a number of neighbouring workhouses, and the closing of all workhouses as such. The sick should be sent to existing Poor Law or County Hospitals, strengthened by the addition of Cottage Hospitals in certain districts. Children should be boarded out. The bulk of the remaining inmates, classified with regard to their defects and infirmities, should be segregated according to counties or other suitable areas. On the treatment of able-bodied paupers there are different opinions. It is suggested by the Philanthropic Reform Association, which includes some of the most earnest and disinterested philanthropists in Ireland, that the well-conducted of this class should be placed in labour colonies, and the ill-conducted in detention colonies—both classes of institutions to be maintained and controlled by the State, and not by the County authorities.
The areas and resources of the existing Unions are in most cases too limited, and the numbers of necessitous persons too small, to warrant the present Boards of Guardians in erecting as many types of institutions as there are classes of inmates. The break-up of the workhouse system involves, of necessity, the establishment of larger areas of administration. It is clear that the County must be substituted for the Union in any radical scheme of reform. On this point the Royal Commissioners and the Viceregal Commissioners are agreed. County rating must take the place of Union rating, since the inmates of the different institutions would be drawn from all parts of each County or County Borough. Substantial economies in administration might be expected from this plan. Hospitals should be brought into a County Hospital System, with the County Infirmary as the central institution, and nurses should be trained there for the County District Hospitals (now Workhouse Infirmaries).
About such a general scheme of decentralised reform there is little or no disagreement. There is, however, a good deal of disagreement concerning the control of the new institutions. The Viceregal Commission advocates the retention by the Poor Law Guardians of many of their existing functions. It suggests, for instance, that County Hospitals should be managed by a Committee consisting of all members of the present District Hospital Committees, strengthened by nine members appointed by the County Council; and that the Chairman of the Board of Guardians should be the Chairman of the District Hospital Committee. The Royal Commission, on the other hand, votes boldly for the abolition of the Boards of Guardians. It argues that, if we are to have a County system of institutions maintained by a County rate, we must adopt the logical consequence that the County Council which strikes and collects the rate should have the direct or indirect management of the institutions. It proposes that the Council should appoint a statutory Committee (one-half to be taken from outside its own members), to be called the Public Assistance Authority, and that this Authority should manage and control all the institutions in the County. The Philanthropic Reform Association, which has given much study to this question, suggests a via media between the two official schemes. It recommends that all the institutions should be controlled by the County Council, through Committees directly responsible to it, to which persons of experience from outside should be added. Such committees need not be elected by the Poor Law Guardians, as recommended by the Viceregal Commission, or by the Statutory Committee of the County Council, as recommended by the Royal Commission. The Association desires, and it has a large volume of Irish opinion behind it in this, to minimise the existing powers, and reduce the numbers, of the Poor Law Guardians. It is also very earnestly impressed with the need of bringing women into the Poor Law administration. In this it is absolutely right. The Women's National Health Association and the United Irishwomen have demonstrated triumphantly the value of women's services in improving the social, economic, and sanitary conditions of rural life in Ireland. A recent Act of Parliament qualifies women for election to the Irish County and Borough Councils. No great reform of the Poor Law system can be effective without their aid. The Unionist Party will only be acting consistently with its social ideals if it encourages, by every means within its power, an Irish feminist movement, full of hope for the country and wholly dissociated from party politics.
Any thorough reform of the Irish Poor Law system will demand an increased expenditure of Imperial funds. The growing severity of Irish taxation under recent Radical budgets forbids the possibility of addition to the ratepayer's burdens. The anomalous distribution of the grants in aid of Irish local taxation has done much to complicate the Poor Law question. The Royal Commission reported that "no account whatever is taken of the burden of pauperism, the magnitude of the local rates, or the circumstances of the ratepayers and their ability to pay rates in the different areas." Under this system the minimum of relief is extended to the districts in which the weight of taxation is most oppressive. The Commission proposed a scheme by which the old Union grants within each county would be pooled and credited to the common fund in aid of the poor rate in that county. The Viceregal Commission also complained of inequality of expenditure, and advised a reapportionment of the grants in aid of local taxation, on the basis of the recommendations of the minority of the Royal Commission on Local Taxation (1902). That Commission was unanimous in recommending increased grants for Poor Law service in Ireland. The distribution of such new grants would be a matter for discussion; of the necessity for them there is no doubt. The Unionist Party must not rest content with reforming the Irish Poor Law system; it must help the reformed system to pay its own way. No fair-minded Englishman who reads Sir George O'Farrell's evidence as to the distribution of the Irish Church surplus (Report of the Royal Commission on the Care and Control of the Feeble-minded, page 468) will dispute his country's obligations in this matter. The cost of Irish Poor Law Reform is one of the strongest arguments against Home Rule. The Unionist Party's full and generous recognition of its duty to Ireland in this respect will establish a new argument for the Union.
One vital factor in Poor Law Reform remains to be considered—the Poor Law Medical service. The 740 Dispensary districts of Ireland are now administered by a little more than 800 Medical Officers. The salaries of these doctors, amounting in all to nearly £100,000 per annum, are paid as to one half by the Poor Law Guardians, and as to the other half out of the Local Taxation (Ireland) account. Most of the doctors, in addition to their public duties as servants of the poor, engage in private practice, of which, in most of the rural areas, their official position gives them a monopoly. A large—perhaps, a surprisingly large—number of the Dispensary doctors are earnest and self-sacrificing men; but the system is corrupted by one radical defect. Owing to the security of private practice involved, there is a fierceness of competition for these appointments out of all proportion to their financial value. The elections are made by the Guardians, and it is a fact so notorious as even to be acknowledged by Mr. Birrell that flagrant canvassing and bribery are a common feature of these elections. Candidates have been known to distribute sums of £400 or £500 to Guardians, in order to secure appointments of £150 or £160 a year. Another serious and extending feature of the present system is the boycotting by the Guardians of all candidates who have not graduated at the new Roman Catholic University. The most highly qualified men from the University of Dublin have now practically abandoned competition for these Dispensary offices outside the Protestant counties of Ulster. Moreover, throughout the whole country local candidates are consistently preferred to superior men from outside. Both the Viceregal and Royal Commissions recognise the necessity of radical reform in this system, but they suggest different remedies. The Royal Commission proposes that the election and control of all the Dispensary Medical Officers of a County shall be vested in the Public Assistance Authority for that County; and that little or no change be made in the present financial basis of the payment of salaries. The Viceregal Commission suggests a bolder and more drastic remedy. It advocates the establishment of a State Medical service on the lines of the existing services in Egypt and India. This would require the payment by the State of the whole, instead of half, of the salaries of Medical Officers. The Commission regards it as proper and equitable that such a service should be, in the beginning, at any rate, restricted to candidates educated in Ireland. A representative Medical Council should elect the candidates by competitive examination, and deal with all important questions of promotion, removal and superannuation. The Commission maintains that the creation of a State Medical service in Ireland would mean a very small increase in the Parliamentary grant in comparison with the benefits involved. This I believe to be the ideal system, but one must recognise that its accomplishment is confronted with many difficulties. The Irish Local Authorities would not willingly relinquish a privilege which is a primary element in their influence and prestige. Irish medical opinion is acutely divided on the question, which is now further complicated by the prospect that the medical benefits under the National Insurance Act may soon be extended to Ireland. It would be outrageous to expect the Dispensary Officers to add the heavy medical duties under the Act to their present responsibilities without adequate payment. Indeed, the extension of the medical benefits to Ireland would make inevitable an early reform of the whole Poor Law system. This is one reason why the Unionist Party, when it returns to office, should be ready to tackle the subject without delay. To no department of the work will it be asked to apply greater sympathy, knowledge, tact and firmness, than to the problems of the Poor Law Medical service.
During the last three years the Irish Unionist Party has made three vain attempts to bring the reform of the Irish Poor Law before Parliament. Its Bill, which now stands in the name of Sir John Lonsdale, asks for the appointment (as recommended by the Viceregal Commission) of a body of five persons with executive powers to carry out the recommendations made by that Commission. These temporary Commissioners would have authority to draft all necessary schemes, to consolidate or divide existing institutions, and generally to reform the whole administration of the Irish Poor Law service. The Bill assigns to them an executive lifetime of five years—hardly, perhaps, an adequate time for the establishment of reforms which, in their making, must affect nearly every aspect of Irish life, and, in their operation, may reconstitute the basis of Irish society. It is to be supposed that, when the whole Unionist Party addresses itself seriously to the question, it will give further and careful attention to the principles of reform before setting up this, or some other, executive machinery. I can think of no more thirsty or fruitful field in Ireland for the exercise of the highest constructive statesmanship that the Party may possess. The need is urgent, the time is ripe, all the circumstances are favourable. The Old Age Pensions Act and the Insurance Act, if not vitiated by further increases in Irish taxation, will greatly simplify the task of Poor Law Reform. The former Act has reduced the number of old inmates in the workhouses; the Insurance Act should lead to a reduction in expenditure on outdoor relief. Moreover, it may be hoped that the infirm and pauper classes will be henceforward, like the old age pensioners, a diminishing fraction of the population of Ireland. They are, to a large extent, flotsam and jetsam over the sea of Ireland's political troubles. Land agitation, with its attendant vices of restlessness and idleness, the emigration of wage-earners, the discouragement of industry under Governments indifferent to the administration of law and the development of national resources, have all contributed to the Dantean horrors of the Irish workhouse system. These poor people are an excrescence on the body of Ireland which good government, if it does not wholly remove, may reduce nearly to vanishing point. Hitherto the chief rewards and blessings of British administration in Ireland have gone to the hard voters and to the strong agitators. It is time for the Unionist Party to think of the hapless, the helpless, the voteless, and, therefore voiceless, elements in Irish life. Ireland, as she becomes better educated, gives more thought and truer thought than formerly to her social and economic problems. Her gratitude and loyalty will go in abundant measure to those who take counsel with her about these problems and help her to solve them. The Government which cleans up many sad relics of the past by a complete reform of the Irish Poor Law system will put all Irishmen and Irishwomen under a deep sense of obligation to it. Policy, not less than duty, should give this reform a place in the forefront of the Unionist Party's constructive programme for Ireland.