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REPORT OF THE COMMITTEE

APPOINTED RY THE

PRESIDENT OF THE LOCAL GOVERNMExNT BOARD

UPON TFIK

PROVISION OF EMPLOYMENT FOR SAILORS AND SOLDIERS DISABLED IN THE WAR.

lUreernteli to botfi ^ome^ of l^arltameiit t^ «rommanlr of iQt^ fHaie^tn,

LONDON:

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[Cd. 7915.]

1915.

Price l^d.

DISABLED SAILORS AND SOLDIERS COMMITTEE.

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MINUTE OF APPOINTMENT.

I hereby appoint —

The Right Hon. Sir George H. Murray, G.C.B.,

W. H. Beveridge, Esq.,

Major-General Sir Charles Crutohley, K.C.V.O.,

George Franklin, Esq.,

The Right Hon. Arthur Henderson, M.P.,

J. Hodge, Esq., M.P.,

Patrick O'Brien, Esq., M.P.,

C. E. Price, Esq., M.P.,

F. PULLINGER, Esq., C.B.,

Leslie Scott, Esq., K.C., M.P.,

R. Russell Scott, Esq.,

A. V. Symonds, Esq., to be a Committee to consider and report upon the methods to be adopted for providing employment for soldiers and sailors disabled in the War.

And I further appoint —

Sir George Murray to be Chairman, and

H. J. CoMYNS, Esq., of the Local Government ]3oard, to be Secretary to the said Committee.

(Signed) HERBERT SAMUEL, Whitehall, S.W., President of the Local Government Board.

16th February J915.

SUPPLEMENTARY MINUTE OF APPOINTMENT.

I hereby appoint the Right Hon. Lord Sandhurst, G.C.S.I., G.C.I.E., as an additional Member of the Departmental Committee on Employment for Soldiers and Sailors disabled in the War.

(Signed) HERBERT SAMUEL,

Whitehall, S.W., President of the Local Government Board.

19th February 1915.

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REPORT OF THE DISABLED SAILORS AND SOLDIERS COMMITTEE.

TABLE OE CONTENTS.

Section Introduction -------.» 1-3

Estimiited number of disabled sailors and soldiers - ... - 4-6 ,

Methods to be adopted for the restoration of the health and the industrial efficiency of

the disabled ........ 7-9

The provision of employment and training for the disabled .... 10-16

Central and local organisation ....... 17-26

Schemes for the settlement of disabled men on the land - - - - 27

Operation of the Workmen's Compensation Act, 1906 .... 28-29

Conclusion .-....-.- 30-32

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: Report of the Disabled Sailors and Soldiers Committee.

To the Right Honourable HERBEnx Samukl, M.P., President of the Local Government Board.

Sir,

The Committee appointed by your minute of the 16tli February last, to consider and report upon the methods to be adopted for providing employment for sailors and soldiers disabled in the war, beg leave to submit the following report.

Introd^iction.

1. Tte subject of our inquiry may be considered under the following heads : —

(i) The methods which shoidd be adopted for tlie restoration of the disabled man, as far as possible, to health ;

(ii) The provision of surgical appliances by means of wdiich his condition may be alleviated and his industrial eflSciency increased ;

(iii) The provision of training designed to fit him for some new occupation when he is unable to resume that to which he has been accustomed ;

(iv) The finding of suitable employment for him when he is in a condition to accept it.

2. At the outset, we desire to express our opinion that the care of the sailors and soldiers, who have been disabled in the war, is an obligation which should fall primarilv upon the State ; and that this lialulity cannot be considered as having been extinguished by the award of a j^ension from public funds. We regard it as the duty of the State to see that the disabled man shall be, as far as possible, restored to health, and that assistance shall be forthcoming to enable him to earn his living in the occupation best suited to his circumstances and physical condition.

3. We ought, however, to add that, in expressing this view, we are far from wishing to exclude or discourage the very valuable assistance which may be rendered voluntarily by persons and associations who take an interest in the welfare of our sailors and soldiers.

While the primary responsibility for the care of tliose who have suffered in the service of the country rests \vith the State, the best results of the action of the latter can only be secured with the co-operation and assistance of the other agencies to which we have referred.

Estimated Numbci' of Disabled Sailors and Soldiers.

4. The first point to wliich we directed our inquiry was the number of men who might be expected to be discharged from the Navy and the Army on account of disability.

At the present stage of the War, it is, of course, impossible to form even an approximate estimate of the number which nmy ultimately have to be dealt Avith', depending as it does on the duration of the war, and the number of men engaged in hostilities.

5. The only data now available are the discharges which have actually taken place since the beginning of the war.

We are informed that the number of warrant officers, non-commissioned officers and men who were discharged from the Army as disabled through the war, between the 4th August 1914 and the 15th April 1915 inclusive, was 2,874, and that the numbei- of petty officers and men who were similarly discharged from the Navy between these

REPORT.

3

dates was 103. The following statement shows the general nature of the disablement jErom which the men were suffering : —

	Army. Navy.	Total.
Eyesight eases ------- ^Founds and injuries to leg (necessitating amputation) arm ( „ » ) „ ha7id( " . . " ) Wounds and injuries to leg (not necesBitating amputation) „ arm ( „ „ ) - Wounds and injuries to hand (not necessitating amputation of complete hand) ------ Wounds and injuries to head - - - - - Hernice - - - Miscellaneous wovnds and injuries (uot ineluded in above) Chest complaints ------ Rheumatism ------- Heart disease - - - . - - . Epilepsy - - - - - - - JVervous diseases - - ... Insanity ....... Deafness ....... Frostbite ....... Miscellaneous disabilities .....	245 205 170 15 277 272 224 123 96 129 298 116 284 47 54 29 134 6 150	9 10 6 6 9 3 11 4 5 6 4 6 11 13	254 215 176 21 286 275 235 127 101 135 302» 122 284 47 65 29 134 6 163
Total	2,874	103	2,977

* Including 200 cases of tubercle of the lungs.

6. The earliest discharges from the Army took place in the week ending the lltli September, and the total of 2,874 therefore represents the product of abont eight months of war, giving an average of about 360 a month. But the present rate of discharge appears to be about 1,000 a month. If this rate is maintained, and the other conditions remain the same, we might expect a total of about 7,000 at the end of the first 12 months of the war, and about 12,000 at the end of December next. Even if the rate of discharge were raised to 1,.500 a month, the number at the end of December would not exceed 16,000.

Of these a proportion would be permanently and completely incapacitated and some of the others would probably find employment without assistance.

The total number to be dealt with would, therefore, be consideraljty less than the published lists of casualties might lead us to expect.

Methods to he adopted for the Restoration of the Health and the Industrial Efficiency

of the Disabled.

7. Under present arrangements, the naval and military authorities assume responsibility for the medical or surgical treatment of the disabled man. until he is discharged from the Service as unfit ; but their responsibility for the provision of treatment ceases on discharge, and it rests with the medical officers under whose care the man has been placed, to decide whether the patient is fit for discharge, and, if so, to set in motion the necessary machinery.

This decision is often taken as soon as it has become clear that the man will not be able to return to active service, and without much regard to the question whether his health or his physical condition can be improved by further treatment.

8. We suggest that the State should take a liberal view of its duties in this respect, and that it should assume the responsibility for the treatment of the disabled sailor or soldier and his restoration to health, when practicable.

9. There are several classes of disabled men to whom this suggestion is applicable.

(a) Those who, upon discharge from hospital, require prolonged or special after- treatm.ent, in order to render them fit to resume a civil occupation. We think that where there is a reasonable prospect of restoration to health,

arrangements should be made to enable these men to receive treatment, free of

charge, for such period as may be necessary.

The cases which we have in mind are those of heart disease, I'heumatisra, stiff

joints, &.C., for which electrical treatment or massage may be suitable.

a 30788 _^ 3

4 DISABLED SAILORS AND SOLDIERS COMMITTEE :

The arrangements suggested should also extend to the provision of treatment where there has been a recurrence of the disability which caused the discharge of the man from the Service.

(6) Those whose disability is due to tuberculous disease.

We understand that in such cases the prospect of obtaining a cure is often most favourable, because the existence of the disease has usually been detected at an early stage, and the man is placed under treatment at once.

As regards the Navy, we are informed that it is the practice to treat cases of tuberculous disease, down to the date of discharge, in the Royal Naval Hospitals, where special wards and shelters are provided.

As regards the Army, it Avas at one time the practice to discharge forthwith any soldier who was suffering from tuberculous disease, but we understand that, at the present time, a soldier who has contracted the disease in and by reason of the Service, is not allowed to be discharged to his home. The practice is to distribute such patients, in the first instance, among the large military hospitals, whence in some cases they have been drafted to civil sanatoria, provided by various private associations. The cost of the man's maintenance in the sanatorium, prior to his discharge from the Army, is defrayed from Army Votes.

Many of these patients are " insured persons " under Part I. of the National Insurance Act, 1911, and become eligible upon discharge for " sanatorium benefit " under the Act. Special arrangements have, as we are informed, been made by the Insurance Commissioners, to ensure the admission of such patients in all cases to civil sanatoria at the cost of insurance funds immediately upon discharge.

Where, however, the tuberculous sailor or soldier is not eligible for sanatorium benefit under the National Insurance Act, we suggest that the responsibility for the cost of his treatment in a residential institution should be undertaken by the State and should be continued until he is either cured or declared to be incurable.

(c) Those loho are mentally affected.

There will probably be many cases in which the incidents of active service have produced temporary unsoundness of mind ; and some of these men might, on a strict view of their mental condition at the moment, be certified as being fit cases for detention in a lunatic asjdum ; but it is most desirable that this course should only be taken after a suitable interval has been allowed for recovery.

In many instances, confinement in a lunatic asylum might not be the most suitable means of promoting the recovery of the patient, and would certainly prejudice him on his return to civil employment. The extreme measure of detention in an asylum should only be taken when it is clear that treatment in a hospital or other institution is unavailing, or that the patient cannot be retained in such an institution without danger to himself or others.

(d) Those who, owing to the loss of limbs or to other cause, require surgical appliances

to fit them for the resumption of civil employment.

The present practice in regard to these cases is sufficiently liberal. Upon the discharge of a disabled soldier fi-om the Army, he is supplied, through the Commis- sioners of Chelsea Hospital, with any surgical appliance which may be needed to alleviate his condition ; and we understand that the Commissioners are willing to procure, at the cost of Army funds, any appliance which may be recommended by the medical officer who has been in charge of the case. Similar arrangements for the supply of surgical appliances are made by the Naval Authorities. There has, however, been a marked advance in orthoptedic surgery during the past few years, and we are disposed to think that sufficient advantage has not been taken of the special knowledge and skill, which are now available, with regard to the provision of artificial appliances for the relief of the disabled. It has, in fact, become a highly specialised branch of the surgeon's art, and the advice of experts is essential if the best results are to be attained.

We recommend that instead of the appliance being prescribed by the doctor in attendance on the patient, any man who requires an artiiicial limb should be seen by an orthopaedic surgeon of repute, who would presc]-ibe the particular kind of appliance which should be supplied, with special regard to the requirements of the individual and the occupation which he intended to follow.

IlKPORT. 5

The services of more than one consultiug surgeon will be required for the purpose ; and inasmuch as the bulk of the men will have been discharged from hospital before they are in a Ht condition to bear artificial appliances, it will be necessary to arrange that the services of an orthopasdic surgeon should he available within a convenient distance of their homes.

The provision of Employjiieiit and Training for the Disabled Saihr or Soldier.

10. Up to this point we have been dealing with the problem of restoring tlio disabled sailor or soldier, as far as possible, to physical health, so as to enable •him to earn his living.

It remains to consider in what way employment should be found for liim when he stands in need of such assistance, and how training can be provided when it becomes necessary for him to learn a new trade.

11. Many of the disabled men will, no doubt, be in a condition to resmne the occupation which they were following before the war, and will be absorbed in the ordinary labour market ; others, from the nature of their disability or from other causes, will be unable to do so, and should be given an opportunity of learning a new trade.

12. Such training should, we think, be provided as far as possible in the locality where the man resides. As a general rule it would probal)ly be undesirable to set iip special institutions in which disabled sailors or soldiers would alone be received; but if any institution already existing can be utilised for the purpose, this course should be followed.

In dealing with this question, it should not be forgotten that the problem of finding employment for the disabled sailor or soldier will diminish year by j'^ear after the close of the war, and that any large expenditure on the provision of buildings or apparatus for a temporary purpose should be avoided.

The creation of central training institutions would also involve the removal of the disabled person to the vicinity of the institution during the period of training, and would frequently result in separation from his wife and family.

13. We think it is probal^le that training of the kind to which we refer might to some extent be undertaken in London and the larger provincial towns by the Local Education Authority by means of the existing polytechnics, technical institutes and trade schools. In this case it Avould be very desirable, if not essential, that the nature of the employment, for which a particular man was to be trained, should be determined by some responsible authority before tlie commencement of the coui-se, and that the prospect (jf a vacancy being available, uppn the completion of the training, should be carefidly examined beforehand.

14. We suggest that the co-operation of the Local Education Authorities should bo invited and that, where the Authority is in a position to provide the training necessary for disabled sailors and soldiers residing in the area, this course should be adopted. In default of the Local Education Authority, any private institution, which may be in a position to afford such training, as may be needed, should be utilised in preference to the establishment of a special institution.

It ought pei'haps to be stated that, in our view, a man should not be regarded as disqualified for training, merely because he is classed for purposes of pension as " totally disabled."

15. An alternative course to the provision of training in an institution would be to apprentice the disabled person to an employer, Avho might be willing to train the man. This method would, however, only be feasible in isolated cases, but such a scheme might be useful in a locality in which no training institution was available.

16. As regards the provision of_ employment, we think that this duty should be undertaken by the Central and Local Organisations, whose appointment is recommended below. These bodies would work in close co-operation with the Labour Exchanges, through which a comprehensive organisation is supplied for dealing in every district with any disabled man who may desire to avail himself of it.

Arrangements should be made for registering every disabled man, on or before his (.lischarge from hospital, at the Labour Exchange of the district to which he is going. This could be done by means of a form to be filled up for him in hosj)ital shortly before his discharge, showing the district in which he proposed to reside, tlie occupation which he desired to follow, and the name of his former employex if in that district.

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DISABLED SAILORS AND SOLDIERS COMMITTEE

Central and Local Organisation.

] 7. We liave already expressed the opinion, on Avhich we desire to lay particular stress, that the care of the sailors and soldiers avIio have ])een disabled by reason of service in the War is an obligation which should be Undertaken by the State. But it is evident that no single Department of Government could conveniently exercise functions so varied and so extensive — including, as, in our view% they should, the care of the disabled man's health, the provision of industrial training, and the finding of employment for him.

18. Until his discharge has been actually completed, the responsibility for his treatment wall rest with the Admiralty or the War Office, as the case may be. But after his discharge, the duties to which we have referred wouhl naturally fall to one or other of the Civil Departments. It will, however, be desirable that the cases referred to in paragraph 9 {d) should remain tmder the charge of the Admiralty or the War Office.

19. In order to ensure that proper attention is paid to the various needs of the disabled men we recommend the appointment of a Central Committee for the care of disabled sailors and soldiex"s, acting under the direction of some existing Government Department and charged with the duty of providing, through the agency of the appropriate Department, siiitable assistance for those who may require it. For example, the cases referred to under section 9 (a) and (6) would probably fall within the scope of the National Health Insurance Joint Committee. Those under 9 (c) might be dealt with by the Home Office or the Local Government Board. In dealing with cases under 9 (d) the Committee would act in conjunction with the Admiralty or the V\'ar Office. Industrial training would be within the purview of the Board of Education and the Local Education Authorities ; while the Board of Trade, through the Labour Exchanges, would give assistance in linding employment.

20. The comparatively small number of cases which did not fall within the scope of any public department would be dealt with by the Committee itself. For the above purposes it would require to have funds placed at its disposal.

21. Such a Committee should include representatives of the Admiralty, of the War Office, of the Board of Trade, of the Local Government Board, of the Board of Education (in relation to technical training), of the Board of Agriculture and Fisheries, of the National Health Insurance Jcnnt Committee, of employers of labour, of trade unions or other labour organisations, and of the existing voluntary agencies for obtaining employment for discharged sailors and soldiers.

Having regard to the special requirements of Ireland and Scotland, a Subordinate or Branch Committee should be formed for each countrj^ to act in co-operation with, and subject to the general control of, the Central Committee. Each of these Branch Committees should be represented on the Central Committee.

The Committee should have a paid secretary and a suitable staff.

22. The functions of the Conunittee would be —

(a) to arrange for the care and treatment of all disabled sailors and soldiers, immediately on their discharge, with the view of restoring them to health when possible, and enabling them to earn their own living ;

(h) to obtain early information of approaching discharges from hospital, and to arrange for the registration of every disabled man, who was capable of work, with the Labour Exchange of the district to which he was going ;

(c) to commimicate with Public Departments with the view of obtaining

employment therein for such disabled men as could properly be appointed to vacancies ;

(d) to organise public or private appeals to enjployers in order to secure

their goodwill in iilling any vacancies which were suitable for disabled men ;

(e) to appoint local committees (where necessary), or local representatives,

to assist the Committee generally in the performance of its duties anil especially in finding employment and negotiating with employers ;

(/) to organise and assist schemes for training men who were desirous of obtaining technical instruction to fit them for skilled occupations ; and to arrange for their maintenance during the period of training.

(g) to consider and deal with schemes for employing disabled men in agriculture and the industries allied with it ;

Qi) to arrange for the emigration of men who were desirous of settlmg in other parts of the Empire.

REPORT. 7

23. While tlie Central Committee would be responsible for the general organisa- tion and control of policy, it must be recognised that a considerable proportion of its work would require to be dealt with locally.

The sailor or soldier will on his discharge naturally tend to return to his own neighbourhood, and will wish to find employment as near to his home as possible. There should consequently be in every district someone ready to deal promptly with every case that may arise.

On the other hand, it is clear that when the total number of disabled men, who will require attention, is distributed among all the urban and rural districts, the number to be dealt with in am' one locality will scarcely he sufficient to justify the creation of a new local organisation in every district.

24. But if, in any particular locality, having regard to the number of disabled men and to the degree of local interest, it were possible to form an effective local committee to assist the Central Committee, we think that this should be done.

Even where it did not seem woi-th while to appoint a local committee, it might be possible to obtain the services of one or more residents in the locality to act as representatives of the Central Committee.

In London and a few of the larger towns, the numlier of disabled men is probably sufficient to make it worth while to appoint local committees forthwith. In others they could be appointed as and when the necessity arose.

25. It has been suggested to us that an organisation so created might ultimately be utilised for the pvirpose of dealing with the employment of ex-sailors and ex-soldiers of all kinds, whether able-bodied or disabled.

The numerous agencies at present engaged on this work in different parts of the country, and the complexity of tlieir operations, make it highly desirable that some step should be taken to co-ordinate their activities and to prevent overlapping.

But such a scheme does not come within the terms of our reference, and we are aware that the question has already received a good deal of attention elsewhere.

It is only mentioned in this place because it seems to us almost impossible to contemplate the establishment of two unconnected organisations — one dealing with disabled and the other with able-bodied sailors and soldiers.

26. We observe, moreover, that the Select Committee on Naval and Military Services (Pensions and Grants) has recommended the appointment of a Statutory Connnittee to deal with the pensions, separation allowances, and supplementary grants payable to sailors and soldiers and their dependants.

We therefore venture to suggest that some advantage might result from the constitution of one body, charged with all the functions to which we have alluded. In this way a more elaborate local organisation than we have recommended for the purposes of this report might be justified.

■ Schemes for the Settlement of Disabled Men on the Tjand.

27. Varioiis schemes have been placed before us aiming at the settlement of disabled sailors and soldiers on the land. We think the matter is of great importance, but we are unwilling to express any opinion upon the merits of the schemes, because the proposals put forward are of a very tentative character and would require much further elaboration before practical eftect could be given to them.

We suggest that the subject should be further considered by the Central Committee, whose appointment we have recommended, at the earliest possible date.

Operation of the Wo7-k7nen's Compensation Act, 1906.

28. We understand that in various quarters difficulties are apprehended in inducing employers to accept the services of partially disabled men, by reason of the liability imposed on the employer by the Workmen's Compensation Act, 1906, to pay compensation in respect of accidents arising out of and in the course of the workmen's employment. We thought it right, therefore, to make special inquiry with regard to this question ; and we are assured that no such difficulty need be anticipated in cases where the employer is insured against this liability. It appears that so far as the insurance companies included in the Accident Offices Association are concerned, the unifonn premium, ordinarily charged by the companies, covers all classes of employees, whether able-bodied or partially disabled ; and that, save in very exceptional cases, no additional premium is charged on accoimt of physical disability.

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DISABLED SAII-ORS AND SOLDIERS OOMMITTEK : REPORT.

29. We think, therefore, that no objection is likely to he taken on this ground to the emi^loyment of a disabled man, except where the employer had refrained from covering his liability by insurance. Any such employer would usually be in a small way of business and would employ only a small number of workmen.

Conclusion.

30.

In the foregoing report, we have thought it right to confine ourselves, in the main, to recommending the establishment of machinery for the i)urpose of dealing with the problem of the care of the disabled, and Ave assQme that this view corresponds with the intentions of His Majestj-'s Government.

But we desire to bring to your notice the urgency of the questions into which we have inquired. Although the number of disabled men, hitherto discharged from the Navy and the Army, is less than might be expected, it is ]no.st desirable that an organisation should be set on foot, at the earliest possible date, for the performance of the duties which we regard as properly falling to the State in relation to those who have suffered in its service. The number of men to be dealt with is growing day by day ; and it is important that the new organisation should be in working order as quickly as possible.

31. A summary of our recommendations is appended : —

(i) The care of the sailors and soldiers disabled in the War is a duty which should be assumed by the State.

(ii) This duty shoidd include —

(a) the restoration of the man's health, where practicable ;

(h) the provision of training facilities, if he desires to learn a new

trade ; (c) the finding of employment for him, when he stands in need of

such assistance.

(iii) For the discharge of these duties, a Central Committee should be appointed, and empowered to act, either through the agency of the appropriate Public Department, or independently, as the case may require.

(iv) The Central Committee should have the assistance of Sub-Committees for Ireland and Scotland, and Local Committees in any part of the United Kingdom, where the circumstances justified the establishment of such an organisation.

32. We desire to place on record our appreciation of the services of our Secretary, Mr. H. J. Comyns, who has rendered all the assistance in his power, both in the conduct of the business of the Connnitteo and in the preparation ol this ropoit.

We have the honour to be. Sir, Your obedient Servants,

G. H. MUERAY (Chairman).

W. H. BEVERIDGE.

CHARLES CRUTCHLEY (M.-Geul.).

GEORGE FRANKLIN.

ARTHUR HENDERSON.

JOHN HODGE.

PATRICK O'BRIEN.

CHARLES E. PRICE. FRANK PULLINGER. SANDHURST. LESLIE SCOTT. R. RUSSELL SCOTT. A. V. SYMONDS.

Henry J. Comyns (Secretary), 4th May 1915.

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