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National Insurance Act

Volume 47: debated on Wednesday 29 January 1913

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Medical Benefit

31.

asked the Chancellor of the Exchequer if, in view of the misapprehension as to the Government's intentions with regard to free choice of doctors by insured persons, he will, in order to prevent a similar misunderstanding in future, give some kind of official form to the pledge given by him on the 2nd January to deal with any grievances which may arise as regards the working of medical benefit?

34.

asked which, if any, insurance committees have permitted doctors to join the panel and limit, by their agreements, the number of insured persons to be treated by them to those whom they agree to treat without having others assigned to them?

The conditions under which insured persons in each area may be allotted to the doctors on the panel are laid down in Section 15 (2) (d) of the National Insurance Act, and the Regulations of the Commissioners. It is within the discretion of the insurance committee, subject to those conditions, to make such arrangements as will limit the number of insured persons for whose treatment any particular doctor will be responsible. I am not aware which insurance committee have made arrangements with doctors on the panel granting such limitations.

Will the right hon. Gentleman inquire whether any insurance committees have made these arrangements? Will he also notify insurance committees that they can act in this way?

I think my answer will be quite sufficient notification. I have no knowledge that they are in ignorance on the subject.

35.

asked whether local insurance committees are entitled to fix a limit of five days in which insured persons desirous of making their own arrangements for medical benefit have to apply for the form, thus excluding a large number of persons who had not received the medical benefit ticket, which in certain cases it has been stated must be brought when application is made, from availing themselves of the provisions of Section 16 (3) of the Act?

I am not aware of any case in 'which such a time limit has been fixed. If the hon. Member has any case in mind, and will supply me with the particulars, I will make inquiries.

37.

asked where Messrs. Morgan and Dimmock practised as doctors prior to their appointment under the National Insurance Act?

Dr. Morgan practised in London. Dr. Dimmock has held important hospital appointments in London and the provinces.

Has either of these doctors practised in the district in which he now resides?

In the districts in which they have now taken up residence? I do not think that either of them has.

38 and 39.

asked (1) upon what terms Messrs. Morgan and Dimmock have been engaged as doctors for the purpose of the National Insurance Act to work in the Isle of Ely, and whether they have been assured that they shall have a monopoly of practice among insured persons in that district; and (2) whether the insurance committee having jurisdiction in the Isle of Ely have allowed insured persons to make their own arrangements with doctors not on the panel in that district, or is the right of free choice of doctor limited to Messrs. Morgan and Dimmock?

The Insurance Commissioners, upon the application of the Isle of Ely insurance committee, and after inquiry, have satisfied themselves that the number of doctors on the list in two districts was not such as to secure an adequate medical service, and have, therefore, authorised the committee to make special arrangements for the attendance of insured persons in these districts. Under these arrangements one doctor in Chatteris and three in Wisbech have undertaken complete responsibility for all the insured persons in these districts.

Has the panel system been superseded in this district? If so, was it by the insurance committee or by the Insurance Commissioners?

The ordinary system—the list system, if I may so describe it—under Section 15 of the Act, has been suspended, and a scheme suggested by the insurance committee has been accepted by the Commissioners.

Has the panel been closed? If so, for how long? Is it true that it is closed for two years?

Will the right hon. Gentleman answer the question on the Paper—

I was asking for an answer to the question on the Paper. I submit that it has not been answered.

I really think that that is enough, considering the number of other Members who have questions on the Paper.

55.

asked the Secretary to the Treasury whether, in the interests of insured persons, he will arrange that the names of all doctors willing to serve on the panels shall be placed on the public lists immediately on receipt of the knowledge of their willingness to serve?

Names of additional doctors joining the panels are kept at the offices of the insurance committees. Revised lists are published by the insurance committees at convenient intervals, but it would not be practicable for each committee to print and distribute a new list upon the receipt of each additional name.

Would it not be possible, without much trouble, to put the names of the additional doctors down in handwriting?

The list goes round to many hundreds of places, and it would be difficult to arrange that.

56.

asked if the Insurance Commissioners have received complaints from doctors on the panels that an excessive and unnecessary amount of their time is taken up in filling up forms and returns and doing other clerical work to the detriment of their useful medical work; and if steps will be taken to diminish this clerical work and arrange for it to be carried out in some other manner?

The Insurance Commissioners are anxious to receive any suggestions from doctors on the panel for simplification or improvement of the methods of keeping records and returns which their experience may show to be desirable and inquiries are being made by officials of the Commission from doctors on the panel in various districts as to their experience of work under the Act. Such suggestions as are being obtained, either by inquiry or correspondence, are receiving the careful consideration of the Commissioners.

Why was this work which was formerly carried out by club secretaries ever put upon the doctors at all?

The work of keeping the records of illnesses when the Bill was being passed through this House was regarded by both sides as being a most important piece of work.

Is there any necessity for the doctors to take three copies of the record of illnesses?

I think there is, as at present advised, but that may be a point for consideration.

Insurance Commissioners And Ministers

45.

asked the Prime Minister how long a period is likely to elapse before the National Health Insurance Commissioners will be in a position as regards departmental matters to act independently and to come to decisions on their own initiative and without oversight by and on instructions from Ministers?

The relation of the Commissioners to Ministers is as explained more than once by my right hon. Friend the Financial Secretary to the Treasury, and defined in a Treasury minute of which I will send a copy to the hon. Gentleman. It will be impossible for the Commissioners or any other Government Department at any time to act without oversight or instructions of Ministers, who are responsible to Parliament for the expenditure by those Departments of money which Parliament votes for the purpose.

Are not the Insurance Commissioners, who have this matter particularly under their care, more conversant than Ministers with what is most for the benefit of the insured persons?

The hon. Member must know that the constitutional responsibility of Ministers means the responsibility of Parliament. If you allowed anybody else to act instead of Ministers, you would infringe the authority of Parliament.

Insured Persons (Number)

53.

asked what are the numbers of insured persons under the National Insurance Act who are members of approved societies and deposit contributors, respectively, and the proportion in each case of single and married women?

The approximate numbers of members of approved societies and of deposit contributors are 13 ¼ millions and 480,000, respectively. The numbers of men and women are about 10 millions and 3 ¾ millions, respectively. The numbers of single and married women are not available at present, as the distinction is not required for immediate administrative purposes.

Will the right hon. Gentleman take the necessary steps to see if it is possible to obtain the numbers both of single and married women?

I think as soon as I have the full particulars I shall be able to get at that.

Does the right hon. Gentleman know that the doctors themselves attribute importance to this information as regard the two different sections?

Bricklayers And Joiners (Widnes)

62 and 63.

asked (1) whether the bricklayers and joiners employed at the Vine Works, Orr's Zinc White Paint Works, Widnes, are insured under Part II. of the National Insurance Act; and, if not, whether the Umpire has given any decisions in these cases; what is the name of the firm or company employ- ing these men; and have any letters or communications passed between the Board of Trade and the employers concerning the inclusion or exclusion of these men; and (2) whether the boilermakers, blacksmiths, bricklayers, and stonemasons employed at Deacon's Works, Widnes, are insured under Part II. of the National Insurance Act; and, if not, whether the Umpire has given decisions in the cases of these men and what is the name of the firm or company employing these men; and have any letters or communications passed between the Board of Trade and the employers concerning the inclusion or exclusion of these men?

I am making inquiries into the points raised in the hon. Member's two questions, and will communicate the results to him as soon as they are available.

Can the hon. Gentleman say whether any communications have taken place between the employers and the Board of Trade already, and what are the names of the employers?

Contributors' Cards

69.

asked the Postmaster-General if he will give facilities for persons insured under the National Insurance Act to return their cards through the post without a stamp, as is the case in Income Tax matters?

I would refer the hon. Member to the answers given by the Financial Secretary to the Treasury to questions on this subject asked by the hon. Member for Tewkesbury on 31st October last and by the hon. Member for Stratford-on-Avon on 6th December last.

Agriculture Statistics

40 and 41.

asked the President of the Board of Agriculture (1) what is the average yield per acre in the United Kingdom, France, Germany, Holland, Belgium, the United States, Canada, and any other country having official Returns, of hay, cereal corn, and root crops, respectively; and (2) what is the average number of horses, bovine cattle, sheep, and pigs per acre in the United Kingdom; and what is the average number of the same live stock in France, Germany, Holland, Belgium, the United States, Canada, and any other countries making official Returns?

The information for which the hon. Member asks in these two questions is contained in Part V. of the Board's Agricultural Statistics, which is now in the press. I shall be pleased to send him an advance copy.

Small Holdings

42.

asked whether any county councils, other than the Cheshire County Council, have constituted small holdings on the colony system; whether this system is developing; and whether the Board, through the Small Holdings Commissioners, advise its adoption by county councils wherever practicable?

Several county councils besides Cheshire have acquired large estates for the purpose of small holdings and may therefore be said to have established small holdings on the colony system. The Board are certainly in favour of the purchase of land in large blocks whenever possible, and county councils are usually of the same opinion. But, owing to the fact that applicants for small holdings are often not in a position to move from their present homes, it is not possible to satisfy the whole of the demand by means of the establishment of colonies.

Could the right hon. Gentleman give in a written answer the county councils other than the Cheshire County Council which have adopted the system?

Yes. If the hon. Gentleman will put down an unstarred question I will arrange to have full information circulated with the Votes.

43.

asked whether, in consequence of the bad harvest season and floods of last year, any applications have, to the knowledge of the Board, been made to county councils by statutory small holders for remissions of rent; and whether, in conformity with the practice of private landowners in the locality, such applications have been acceded to in any and, if any, which counties, and at whose expense have such remissions been made?

No official communications on the subject have been made to the Board, but I understand that in some cases county councils have received applications from small holders for remission of rents in consequence of the losses caused by floods last year. If a remission is made, the deficiency falls upon the small holdings account of the council, and, if that account cannot meet the deficiency, the Board may pay one-half of the loss in accordance with the conditions laid down in the Treasury Minute of the 31st December, 1907, a copy of which I shall be pleased to send to the hon. Member.

Have any applications been made for half to be paid out of the small holdings accounts of the Board?

I do not think that any applications have actually been received, but I understand that one or two are coming forward.

Is not the difficulty of the small holders more due to high rents and rates?

No. The difficulty is entirely due to a flood which destroyed the whole of their produce.

Irish Hay And Straw (Removal Of Restrictions)

44.

asked whether it is intended to remove on 1st February the restrictions that have been imposed on the importation of hay and straw from Ireland; and, if so, what steps will be taken to prevent hay and straw coming from districts still affected by disease?

An Order has been issued, and will come into operation tomorrow, removing the restrictions at present imposed upon the importation of Irish hay and straw into Great Britain. I have no reason to believe that any part of Ireland is now affected with foot-and-mouth disease.

In view of the very grave danger that, at such a short distance of time, infection may still be lurking in hay and straw from infected districts, would it not be far wiser to put off the removal of restrictions for a considerably longer period?

The last confirmed case in Ireland was on 2nd November. I am advised that there is no risk of the conveyance of infection by hay and straw, considering the long lapse of time, and particularly the fact that no hay or straw is coming forward or is likely to come forward from that particular district.

Will this arrangement include hay and straw which has been used for packing abroad, and subsequently transhipped from Ireland to this country?

There are no restrictions on hay and straw used for packing, as the hon. Member, having been a Member of the Departmental Committee which considered the matter, knows.