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National Health Service (Superannuation)

Volume 440: debated on Thursday 24 July 1947

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10.6 p.m.

I beg to move,

"That the Draft National Health Service (Superannuation) Regulations, 1947, proposed to be made by the Minister of Health under Subsection (1) of Section 67 of the National Health Service Act, 1946, a copy of which Regulations was presented on 3rd July, be approved."
These regulations, although clear in principle, are somewhat formidable in detail. That is because of their scope, and the desire for the utmost flexibility. They have been fully discussed with all the representative associations concerned, and I am not aware of any opposition to them. Nevertheless, I think the House would wish me, in asking for approval of them, to give a summary of their proposals. The regulations provide a superannuation scheme, on an insurance basis, which will cover all employees of regional boards, governing bodies of teaching hospitals, executive councils, and other bodies set up under the Act, also the practitioners providing the general medical and dental services. It is estimated that the scheme will cover more than 300,000 people. The scheme is a contributory scheme based on remuneration, 6 per cent. for the employee and 8 per cent. for the employer, except in the case of manual workers, where the rates are 5 per cent. and 6 per cent. respectively. The employer's contribution will be paid by the Exchequer, from the accounts of the hospital boards and other bodies. The benefits are substantially similar to those of the Civil Service, and the provisions relating to contributions are similar to those in local government service.

Perhaps I may say a little more, in detail, about the benefits. These are based on 8oths of the final average remuneration, except for the practitioner, in whose case the basis is 1½ per cent. of remuneration throughout service. The pension provisions take into account the new National Insurance pension and, apart from that, there is a lump sum retiring allowance, a death gratuity for death during service, and the right to a pension for incapacity. There is also provision for an injury allowance, and within the same actuarial cost as for a scheme like the Civil Service scheme, we have included a provision for a widow's pension—something which, I am sure, many Members will welcome.

The scheme, one can claim, is probably unique in the extent to which provision has been made for interchangeability with other public services. This will be complete between the health service, local government, Civil Service and the teaching service. Arrangements are made to carry over into and from services subject to the federated superannuation scheme for nurses and the federated superannuation scheme for universities, and for other interchanges. To facilitate interchange with the local and school health services, it is proposed to modify the local government superannuation scheme by Parts III and IV of the regulations, so as to apply the same benefits as in the central scheme for the medical, nursing and allied staffs. The aim has been, and will be, to secure that the superannuation scheme will serve genuinely those who come under it rather than tie them up in a system which might erect barriers whenever they wished to move from one employment to another. At the same time, the needs of the service have been kept in mind, and the extensive interchange arrangements will, I am sure, be of value in helping to secure wider experience among the staffs.

The transfer provisions, which cover a number of regulations, are very detailed. The "teething stages" of the scheme will set us substantial problems. The new scheme will cover a large number of persons coming from local government service, where they are subject to a number of different schemes. It will take in a considerable number from voluntary hospitals, who, at the moment, are subject to a variety of schemes and arrangements, ranging down through moral expectations to nothing at all. There are, too, the insurance committee officers, covered by a separate scheme, and some civil servants. The aim has been to preserve existing rights so far as possible, and to ensure that nobody will be worse off than they were before. No difficulty arises with the local government and insurance committee officers and the civil servants, because their schemes are actuarially equivalent to the new one. Voluntary hospital officers are at the moment subject to a very wide variety of arrangements. Those who are now subject to the federated schemes will have an option to continue on the same condition, if they wish, or to come into the new scheme and do what they like with their policies. Those subject to other arrangements will be allowed to carry on with them, if they can show that otherwise there would be undue hardship. In assessing this hardship, we shall, of course, have regard to any change of remuneration on the transfer. We have undertaken to refer any causes of dispute to whatever tribunals are set up to deal with compensation, under Section 68 of the Act.

Where a voluntary hospital officer with at least To years' hospital service comes on to the new scheme, who in the past had only expectations without any rights at all, the value of the expectations in relation to past service will be assessed, and, subject to Treasury approval, a supplementary payment will be made on retirement in addition to what he earned in the new scheme. In dealing with these provisions we intend to take a sympathetic and generous attitude, as in many cases it will be very difficult to assess the value or existence of expectations which might normally only have been stated specifically on the occasion of retirement. The scheme also provides that all previous hospital service will count for qualification purposes in the new scheme. This is of substantial benefit to those who have now no rights at all, because, although this service will not count in the calculation of benefit, it will mean that such an officer may immediately become eligible for benefits, some of which have minimum amounts as, for example, the death gratuity which has a minimum of one year's salary. The scheme, as I have said, will be complicated at the outset and for some years to come by the transfer problem and the change-over from the miscellaneous variety of existing service. The wide scope of the arrangements for interchange with other services will also necessarily add to the administrative labour. It is proposed to set up a new division in the Ministry of Health to deal with this.

These draft b Regulations have been discussed with over 60 representative bodies, and I am glad to be able to say that there is an almost unanimous measure of approval. We have not been able in some cases to do everything we have been asked, but by and large there is satisfaction with the scheme and, indeed, in some quarters it has been hailed enthusiastically. I believe that this scheme should provide a sound background for the new service and give the staff a substantial feeling of security.

Before the hon. Gentleman sits down, would he say a word about mental workers, with reference,to the Mental Workers Act and the early retirement at 55, and how they are affected by the new superannuation proposals?

I think it would be convenient if later on, with the leave of the House, I dealt with any points that arise.

10.17 p.m.

The Parliamentary Secretary said that these regulations were somewhat formic -able in detail though clear in intent. I hope he will not think it churlish of me to say that that is a masterly understatement. I doubt whether I have ever seen a Parliamentary document of this kind which was so complicated and so difficult to read and descended at moments to such depths of incomprehensibility. Indeed, there is hardly a regulation that one turns up in which one is not referred to some later regulation and then referred back to some earlier regulation, and it is a great deal more difficult to understand these regulations than it is to do a Torquemada crossword puzzle. That is a defect in these regulations because it shows the kind of thing that is bound to happen when one nationalises great services like the health services of this country.

The point I would like to put to the Parliamentary Secretary now is this. The people who have to understand these regulations are, as he said, everybody in the health services—doctors, practitioners, dentists, nurses, midwives, manual workers and everybody else. I do not think it is insulting the intelligence of anyone if I say that it is not fair to expect the ordinary layman to be able to grasp Parliamentary draftsmanship as it is exemplified in these regulations. I suggest to the Parliamentary Secretary that it is very desirable that some simpler guide to these regulations should be published for the benefit of the members of the new Health Service. Otherwise, I feel that in many cases they will never know when they enter the service what their prospects and rights are with regard to superannuation. I hope the Parliamentary Secretary will consider that point.

We on this side of the House do not propose to divide against these regulations, and, of course, even if we do divide the House, we have no means of amending them—we have either to take them or leave them. In this case we propose to take them. Nevertheless, my hon. Friends and myself have some criticism to offer and some questions to ask. I hope that any criticisms we may make the Parliamentary Secretary and the right hon. Gentleman the Minister of Health will bear in mind for the future, because one of the elements in the present position, so far as the National Health Service is concerned, is that the Act has passed through Parliament but is not yet in operation, and there are some elements in the proposed Health Service which have not yet decided whether they will come in to help to make the Act work or not. I imagine—I cannot speak for them—that it would be of some influence with those elements if the Minister were prepared to consider favourably any points we may put to him on this side of the House tonight.

The first question I would ask the Parliamentary Secretary is this. He referred, in his very clear opening statement, to the question of interchangeability, and I am not quite sure that I understood entirely what it was he was telling the House. As I understood it, there is under these regulations complete interchangeability between all sections of the National Health Service, and between the Health Service and the teaching side of the service. I was glad to hear that, because my impression was that there was no provision for interchangeability between medical officers of local authorities and the universities, and if I am wrong in that, I shall be glad to have some reassurance on the point.

My second point concerns regulation 38 (m), on page 38, which is the regulation dealing with the position of a practitioner, whether doctor or dentist, who has a contract with an ordinary life assurance company and who is allowed under these regulations to opt out of the superannuation proposals. The health authorities, on their part, will pay to him the share that they would have paid under the proposals to help him to pay his life insurance. What I do not like particularly in this regulation is the fact that it will only apply if, as I understand it, the practitioner opts into the service on the appointed day. If he does not do that, if he is rather suspicious of the service at first and then finds in practice that it is a good service and one he would like to be in, then he loses this advantage. That is introducing an element almost of blackmail in the sense that it is exercising very strong pressure on these practitioners to enter the service in which it may be, they do not as yet have full confidence, and I would like to know what is the justification of that.

My third point is what is technically known as the question of the added years. The scheme covers everybody in the service. A manual worker may enter the service at the age of 18, and is covered from that date, and all his years of service from the age of 18 onwards count towards his pension. But the medical practitioner cannot enter at i8. He has to qualify. and may not qualify until he is 23, 24 or 25. In present conditions the age of qualification tends to get later and later. It seems to us that the medical practitioner is at a very decided disadvantage as compared with other members of the Health Service, because he loses anything up to five, six or seven years merely because he is unable to enter the service at an earlier age.

The last point I wish to put to the Parliamentary Secretary is also concerned with the question of added years. That is the position of the elderly practitioner. I assume that it is the Government's purpose to get every competent and experienced doctor into the service. There is a great shortage of doctors, and there will be for some time to come, and I assume that it is the intention of the Government to get every doctor they can into the service. What is the position of the man who enters the service at the age of 56, say? Many practitioners would. be most useful to the service at that age. The retiring age is 65, and from 56 to 65 there are nine years but the practitioner does not begin to qualify unless he has had to years' service. I suggest that this is a real injustice, and if ever the Minister is looking at the regulations again that should be corrected.

Of course it may be argued that the doctor who comes into the Service is getting compensation for the loss of his practice and that that would be sufficient compensation for a man of 56 who entered the new Service at that age. I can imagine the Minister going on to argue that the Government having paid compensation once, cannot do so again by giving some added years under the scheme. I suggest that that argument is not really sound No one can possibly say what the value of money will be in io years' time. I think it would be a bold man who would say that it would be greater than today. Most of us would suppose that the value of money is likely to depreciate very considerably. That means that the practitioner who will be compensated for his practice in terms of money as it is today may find himself in a position when he retires where that money is worth considerably less than it is at present. I do not think it is fair to expose the average practitioner to a risk of that kind if the Minister wants him to come into the Service. I will be grateful if the Minister can touch on these points when he replies I do not want to detain the House any more on the matter although I cannot guarantee that other points will not be made by other hon. Members on this side of the House.

10.30 p.m.

I agree with the right hon. Gentleman the Member for South Kensington (Mr. Law) when he speaks of the great complexity of this problem and its great extent. But, although it is very complicated, it has in fact been explained in the medical and technical Press to a particular audience with which that particular Press is concerned. It was also explained at the time in the daily and weekly Press very lucidly indeed, and I congratulate the Press on the way in which they did a very fine job on this very difficult subject. I also congratulate the Government upon getting out this very comprehensive scheme, for it is, as far as I know, as comprehensive, if not more comprehensive, than anything that has previously been done. What I want to ask the Minister is a simple question with regard to this interchangeability in relation to other forms of medical service than those which fall within the scope of the National Health Service. If there is interchangeability—and I take it hypo- thetically—in a case such as the Industrial Health Service, which is not inside the scope of the scheme, it will be of very great assistance in achieving the integration of the service when the time comes for that to take place. I hope that the Minister will be able to assure me and a good many others interested in this particular point, that this very important feature of interchangeability will be kept open to enable different sectors of medical work to be brought in on an equal footing as regards the provisions of this particular document.

Then there is a matter I particularly wish to put to the Minister and to get an assurance upon, for it is a point of very great importance. We stand at the beginning of a health service. At the moment it does not include more than the foundation of a health service, but it may in the future be widely extended to include a great deal more, some of which at present cannot even be seen. This scheme has then the possibility of being the foundation of a complete medical service in every respect and I hope that the Minister will be able to assure us that it is the intention of the Government to frame that intercommunication of heath services as affecting different bodies with n the National Health Service, so that interchangeability will be maintained and that any necessary changes can be introduced in the future.

10.33 p.m.

I find that this draft regulation is not only formidable in its detail but also in interpretation, and as a newcomer to this House, if I do not interpret it as it is meant to be interpreted, I hope that the Parlimentary Secretary will put me right, as I have no intention of misleading the House in what I have to say. I think that this is a very important draft regulation, for upon it depends a considerable amount of happiness and contentment for the people who work in our hospitals, our nurses, our hospital staffs, our doctors and dentists and many other people. We are only going to get happy, contented patients if we have happy, contented people to look after them. This is a most important regulation which has come before the House tonight. I wart to ask one or two questions and try to elucidate some answers with regard to some of the matters.

I would ask first about Regulation 4 which lays down what contribution shall be paid. Paragraph (1, b) of the regulation says that these contributions can be laid aside in certain cases. Can the Parliamentary Secretary tell the House when, and in what sort of cases, the Minister intends to dispense with the compliance with the provision? In Regulation 9, the benefits which can be passed on from an insured person to his spouse and dependants are referred to, and throughout it speaks as though it refers only to males. Can a female pass on the benefit to her spouse, who would, of course, be a husband, and so on? Does this refer only to male officers, or female as well? Regulation 20, on page 22, is, in my view, rather an important regulation because it says that where someone under the age of 60 years has been ill and receives a pension, and is then found to be better and able to take employment, that person can be sent to any part of the country to find employment where the Minister or the employing authority may think fit. That, in my view, is a very serious regulation because it says, more or less, that a person who is now well enough to work after having received a pension, can go where he or she is sent. This brings in the direction of labour, and I think it refers just as much to females as to men, and that means one is getting direction of female labour. I am certain that the Minister does not intend that, and I feel that this is a very badly worded regulation. I hope that there is no intention to have direction of male or female officers of the Ministry of Health.

Regulation 24 deals with persons subject to non-statutory superannuation schemes and arrangements, and it permits the Minister to pay contributions under any federated superannuation scheme if the policy of insurance was taken out before 18th March, 1946. That was the day on which the Act was passed through all its stages in Parliament, and I would ask why has that day been put in and not 5th July, 1948? What happens to those officers appointed after 18th March, 1946? I know of three officers who will be outside this regulation. Are they going to lose one or two years of their superannuation benefits because this scheme is operative from 18th March last year instead of 5th July next year? The latter is the appointed day, and I would ask, why has not the appointed day been used in this regulation? If some other regulation is not published which alters the date, we shall have a lot of disgruntled officers who will be grieved, and consequently will not provide their best services. That is something we do not want to see. Regulation 25, on pages 26 and 27, paragraph (2) and paragraph (3) is another section to which I would like briefly to refer. This regulation I think can be very valuable in dealing with certain classes of voluntary hospital officers. I want to know with what measure of generosity does the Minister intend to interpret this regulation. What is the precise definition of the words in lines 8 and 9. paragraph 2, where it is stated,
"he had reasonable expectations"
The same words,
"reasonable expectations"
occur in line 6, paragraph 3. Can the Minister give some precise interpretation of what is meant by a "reasonable expectation"?

I now turn to Regulation 26, which is on page 28. There the Minister speaks about exceptional reasons. If this regulation is generously applied it can be of very great benefit to the servants of the voluntary hospitals—those who transferred from the voluntary hospital scheme to the State scheme but may have difficulty in establishing claims for superannuation. If that is interpreted generously, I think it will solve a lot of difficulties which are troubling those people. Would 20 years' service in the voluntary hospitals before the appointed day be considered as "exceptional reasons" for those benefits going to those people? I would now like to refer to Regulation 38 (m), about which my right hon. Friend spoke. The question I would raise is why a life assurance policy has to be one taken out before the appointed day, and why a request has to be made to the executive committee three months after the appointed day in order to get the necessary contributions to that policy.

I want to support my right hon. Friend, and point out that doctors and dentists enter their professions at a very much later age than people who go into other trades and professions. It is right and proper to expect that before the age of 25 a doctor or dental student should have taken out a life insurance. It must be remembered, also, that one may have to be in this scheme for ten years before the majority of the benefits of the scheme can come to an individual. It is right and proper that a young doctor or dentist should want to make some preparation or to take some action in case he is struck down by illness or injury or, if married, that he should want to make some preparation in case he should leave a widow. Therefore, I want to ask why it is necessary for the life assurance policy, if it is to have assistance from the Ministry, to be one taken out before the appointed day and not one taken out before the individual joins the National Health Service. I do not see why the significant date should be the appointed day, and not the day on which a person enters the National Health Service.

I would like to pass on to widows' pensions, which are dealt with on pages 54, 55 and 56. I must say that a third of the earnings or pension of the husband is a very small sum for a widow's pension. But if there is a discrepancy in age there is a further reduction of the pension. If one takes an extreme case of a man who dies aged 85, and leaves a widow 15 years younger, that is aged 70. She would only get 31 per cent. of the pension instead of a third, which is a very small amount for someone who, at the age of 70, is unable to earn a living. I suggest that there should be a larger pension even if we have a larger rate of contribution. I think that should be fully considered. The regulation also states, with regard to widows' pensions, that where marriage or co-habitation takes place, a woman loses her pension. I want to ask the Minister how he is going to decide that co-habitation has taken place, and what machinery he will use? Is he going to have officers, or snoopers, who will give him that information and help him to make a decision that co-habitation has taken place? I feel that when a husband has made contributions there is no reason why the State should withhold the pension. I can find no mention whatever in the whole of these regulations about widowers' pensions. I want to know what happens where an officer happens to be a lady. She may be a lady doctor. When she dies, if she is in receipt of a pension, does her husband, the widower, get a pension? I think it is most important, because we hear so much in these days about equal pay for equal work. I hope we are not going to hear about unequal benefits for equal contributions, because that would appear to be what this regulation suggests.

I want to ask the Parliamentary Secretary one more question. Where the husband and wife are both doctors, or both officers as far as this regulation is concerned, if the husband were to die, does his wife, although she is probably drawing a retirement pension, get a widow's pension? They have both made contributions to this superannuation scheme, and I can see no reason why, if they made these contributions, they should not both receive two pensions if they have a right to them. These regulations are, indeed, most important, and I hope the Minister will consider them sympathetically a ad generously, because, after all, if we are to build up the great health service that we intend to build up in this country, we have to have happy, contented people in it. It is quite easy for the Minister of Health to coerce voluntary hospitals and to direct local authorities, but when it comes to dealing with the personnel of the health services, I think he has got to show a wise and "motherly" attitude to these people and to show that he is interested in every aspect of their welfare. I believe that he is building up a great health scheme which will, in future, be associated with his name just as in the past when anyone was ill, benefits were associated with the name of Lloyd George.

10.48 p.m.

I want only to make a few general observations on this very important subject. I want to ask the Parliamentary Secretary what protection there is for the contributor to this pension scheme? Who is to control this scheme? In schemes of free enterprise people who pay have some control over the scheme. They usually have representation on the management committee. If I am compelled to come into this scheme, as all of us will be, what control shall I have over the management? Have I any court to which I can appeal if I believe the regulations are being misconstrued? Have I any rights of protest, or am I to understand, as often appears in these regulations, that the Minister always "directs"? Nothing has disappointed people more during the last 20 years than the pensions they get and no one is satisfied. Hon. Members from time to time are in receipt of poignant correspondence from persons who for a lifetime have contributed to a pension, which, when they get it, they feel is quite inadequate. This scheme, of course, provides no method by which we can protect ourselves against those abuses. As the right hon. Gentleman said, who can say what the purchasing power of money in the next year, or next 10 or 15 years from now, will be? This is a new scheme. Is there not some device, other than the seven years' actuarial review, so as to strengthen the pension scheme and so get over the inevitable difficulties?

There is an item on page 33 to which I would draw attention. On that page Regulation 33 states:
"An officer who is dismissed, resigns or otherwise ceases to hold his employment in consequence of an offence of a fraudulent character…shall, if the Minister so directs, forfeit all claim."
Who is to be the judge of an offence of a fraudulent nature? Does that mean a conviction? Is this to be an arbitrary decision to be made by a medical superintendent, or a hospital matron, or by whom? These cases of dismissal are very serious for anyone in employment but they are very serious indeed for one in superannuated State employment and his opportunity for employment is obviously much lessened indeed. I want to know particularly about that regulation because in my experience I have met with a good deal of difficulty in interpretation. These regulations should be scanned and read and I would like them to have been more sympathetic. If the machinery does not exist machinery should be created by which a compulsory contributor is able to review his contributions in the light of his experience, and in this question of dismissal there ought to be someone properly defined as arbitrator to decide whether justice had been done or an irregularity made.

10.53 p.m.

I shall be brief and I do not want to ask the Parliamentary Secretary to answer any puzzles about double pensions or widowers coming into this scheme. I propose to deal with three points. I am concerned with the question of ineligibility because it depends at present on certain legal procedure. Cases have occurred where a health worker working for one authority and getting superannuation, gets another post and goes to another authority, and because of not giving formal notice of the people she is going to, she has lost her right to superannuation. I want to see that there is a genuine ineligibility, and that a worker of this sort is covered in circumstances of this kind. Secondly, I want to see that no health worker will suffer any loss. Under the Asylum Officers Act a person can retire at the age of 55, with pension. Now the retiring age is to be 65, and I want to make sure that an officer does not suffer. At present a health worker in a mental institution retires at 55 on pension. I want to make sure that if he is to be made to serve up to the age of 65, he is going to get an additional pension to the one which he would have got at the age of 55, for the additional to years he is made to serve, and that he will suffer no loss of pension through having to serve an extra 10 years.

The third point I wish to raise is on the question of the difference betwen superannuation and pension. I always interpreted superannuation to be in relation to the person who has to make, unfortunately sometimes on health grounds, an early retirement. I can understand the case of a person who is entitled to a pension after working a certain number of years—up to 65. I want to make sure, if for health reasons a workman is compelled to retire prematurely, that superannuation will be given after a proper hearing and a proper trial and exchange of medical evidence and testimony. Now under this scheme, in Government Departments persons are entitled to a pension, or superannuation. But sometimes on the ground of a wrong medical diagnosis a man is told he must retire at a certain date because of a certain diagnosis. Frequently in the course of my medical work I have found that the diagnoses do not justify a man being compulsorily retired. I want to make sure that the same procedure followed in these cases is built up here.

I know there is to be a Ministerial inquiry but I want to make sure that under the new Health Services Bill the procedure will be adequate—the exchange of views, medical evidence and testimony in regard to cases of a person supposedly going to retire prematurely. I want to make sure that superannuation on medical grounds is not left as in the case of the Post Office —except since the last 20 years—where a person might be prematurely retired without having an adequate hearing and without having his case stated properly. I want the man's case dealt with fairly. squarely, tolerantly and with justice.

That is all I have to say. I think this is a very complicated subject. But people, looking at the scheme from top to bottom, should be able to satisfy themselves that this is a really genuine attempt to meet a very difficult situation. I hope these regulations really will bring that justice to the Service in the future.

10.57 p.m.

I am not sure how many taking part in the Debate tonight have been without sleep for 48 hours. Those of us who have, may be excused if we find this set of regulations particularly difficult to follow at this time of night. The difficulty about this procedure is that constructive criticism is rather futile because any improvement we might suggest would be difficult to incorporate between now and the time the Order comes into effect. I would like to make a few criticisms, and to ask the Minister, first, to tell us the meaning of the explanatory note at the end of the Order. It says:

"The scheme, which will be administered by the Minister of Health, will be financed by contributions from the participants in its benefits and by contributions made out of Exchequer moneys."
I take it that the contribution out of Exchequer moneys in this context means the contribution in respect of the 8 per cent. employers' contributions, that the scheme is in fact actuarially watertight, and that the 6 per cent. and 8 per cent. contributions together cover the entire payments. I would like an assurance that there is no additional expense to the public over and above the provision for the contributions provided for in the Order.

Then I wish to know whether the scheme is in fact so worked out as not to differentiate between the various classes of pensioners within the scheme itself. I have some misgiving that that cannot be quite so, and in one rather startling respect. I think I am correct in saying that with some special exceptions men and women are treated in precisely the same way as regards their contributions throughout the scheme. Of course, if it happens that the rate of emoluments of men are generally higher than that of women, the contributions in respect of men will be higher than those of women, but the proportion of contributions to salaries for each sex is precisely the same. But the benefits of, the two sexes are different, because the widow's benefit can only inure to the benefit of males who contribute to the fund. In other words, the effect of this scheme is that quite a substantial proportion of the contributions paid by women will go to the benefit of men to provide benefit for their wives in due course. It seems to me there is a disparity in treatment as between the sexes sufficiently wide to be something of a blemish on the face of the scheme. There may be some equivalent and women may get some benefit through some other channel, but at the moment I cannot see that they do. I think the scheme is a little unfair as between men and women, and I hope that, if there is an opportunity, that may be put right.

I would like to ask the Parliamentary Secretary a question on the disability pensions. They arise under Regulations 5 and 7. Under Regulation 5, an annuli pension is payable if the contributor
"has completed ten years' service and is incapable of discharging efficiently the duties of his employment by reason of permanent ill-health or infirmity of mind or body."
That is a pension calculated in accordance with this elaborate scheme, and I think I am right in saying that it is a pension payable as a right. Under Regulation 7:
"where an officer ceases to be employed in consequence of his being permanently incapacitated by an injury sustained by him in the actual discharge of his duty and without his own default, and specifically attributable to the nature of his duty, he shall be entitled to receive from the Minister an annual injury allowance of such amount, not exceeding two-thirds of his average remuneration, as the Minister considers reasonable, having regard to all the circumstances of the case."
Regulation 7 is, of course, limited to the case of an officer whose disablement is attributable to his duty, but I think I am right in saying that Regulation 5 would be equally applicable to such an officer and that there will be a considerable class of disabled officers who will fall under both regulations and become eligible for benefit under either of them. I imagine there is no question of duplication, but: It an officer were disabled doing his duty he would be entitled to a pension as of right under Regulation 5 and also eligible to s pension at the discretion of the Minister under Regulation 7. I am not certain how that is going to work, and it seems to me that these two cannot quite be reconciled as they stand. It is presumably correct that an allowance payable under Regulation 7 would normally be greater than an allowance payable under Regulation 5. That need not be so, however, for the allowance payable under Regulation 7 is at the discretion of the Minister and is to be adjusted, after taking into account other pension rights; and it might well be that the amount payable under Regulation 7 will be quite a small amount if the officer has a National Health or some other pension, perhaps a disability pension. I do not see how these two are to work together and I would like to get an explanation from the Government

One regulation deals with accidents and diseases in industry, and therefore they come under the Industrial Injuries Act. The other deals with a person disabled from any ordinary illness and incapacitated, and who, therefore, cannot work, in accordance with the provisions of the Health Scheme.

I fully appreciate that; I hope I have made that clear; but z. person incapacitated, even by reason of attributable injury, is nevertheless incapacitated, and falls under both Regulations. If the hon. Member's implication is correct, that if an officer is injured in attributable circumstances he is ineligible under Regulation 5, then this Order might perpetrate a very great injustice, for it might mean that an officer injured in attributable circumstances might get less than if he were injured in non-attributable circumstances. I do not think that is the intention at all. I am obliged to the hon. Member for bringing it out in that way. I hope that we shall be able to get some information.

The other point I would wish to make is in connection with the amount of the widow's pension. I appreciate the logic which has led the Government to put in the adjustments which are contained in the. Second Schedule to the Regulations, the adjustments requiring a reduction to be made from the widow's pension where she is younger than her husband and permitting an addition to be made where she is older than her husband. It may be that actuarially and in strict logic this adjustment should be made, but I cannot help feeling that it may work out quite unfairly. Take a simple example of the case of an officer dying at the age of 79 and leaving a widow eleven years younger than himself. If that officer was eligible for a pension of, say, £600 a year, his widow would be eligible for a pension on the basis of one-third of that amount, that is, £200. But this has to be reduced by 39 per cent. and it will leave her only £120 a year. That will be found to be a very common case. A doctor dying at 79 and leaving a widow aged 68—I am assuming a pension of £600—will be able to leave his widow only £120 by reason of this very harsh adjustment against him. Conversely, it will be found that an elderly lady of some 83 years on the death of her husband, if he happens to be a little younger than she is, will receive a very substantial increase on her basic pension of £200, assuming the husband to be eligible for a similar pension of £600, bringing her up to nearly £300 a year. I cannot think that that is fair, and it would be an improvement, and no more expensive, to cut out these adjustments. It would be no more expensive to the public because the public would gain in the one case and lose in the other, and the individual would get something nearer to the flat rate—the pro rata rate—of one-third of the husband's pension in every case.

11.10 p.m.

I would like to congratulate the Minister on having produced this code of allowances and pensions because it will do a great deal to weld the whole of this hospital service into one. The Minister is also to be congratuated in getting some 60 organisations in the medical profession to agree on this draft. That, in itself, must be a record.

The point which I want to raise is the meaning of "service" for the purpose of the regulations, and it arises in Regulation 13. When the Parliamentary Secretary commented on these regulations, he made two simple and helpful statements. He said that the Minister wanted to be generous, and that all previous hospital service would count as contributory or non-contributory service for the purpose of calculating pension. I understand that but, when one looks at Regulation 13, and particularly paragraph (2) one finds that the simple statement of the Parliamentary Secretary does not help. I could best illustrate it by reading part of Regulation 13 (2). It says:
"Where a person, before entering the employment in which he is an officer, had been entitled by virtue of any such employment as is mentioned in the next succeeding paragraph to participate in superannuation benefits, and on leaving that other employment any period of employment or any war service or national service would have been reckonable for the purpose of determining whether he was entitled to receive a superannuation benefit, that period of employment, war service or national service, shall be reckonable as service in relation to the employment in which he is an officer, if he entered that employment within twelve months after leaving that other employment…"
and so on. I do not find, even allowing that I have not been to bed for forty-four hours, that that is very comprehensible as a record of employment. There will be many officers of one kind and another who are coming into this new service out of private practice. I am thinking not only of doctors, but also of such people as radiographers, physiotherapists and speech-therapists, who have been in private practice and who think that private practice is going to disappear because of State control, and who will, therefore, want to come into the public service at a late stage of their lives. These people will have had little hospital service on which to calculate for superannuation. Would it be found possible to extend, in spirit, hospital service to cover at least some of these older and experienced practitioners? They will be compelled to come in for lack of other employment, and they will have no proper opportunity of getting a pension at the end. I hope the Minister will be able to give some indication that the last word has not been said in relation to calculating the period of service for the purpose of some of those people who are going to enter very late in life, with no public service or hospital experience behind them.

11.16 p.m.

We have covered a good deal of ground tonight, and if I do not answer every point which has been raised, I think that hon. Members will see that my reply ties up with them when they read the OFFICIAL REPORT. The right hon. Member who opened the discussion drew attention to the difficult character of the Regulations. I agree with him on that point, but I do not think they could have been made any mere simple. We have in preparation a simplified version with, I hope, examples, which we shall distribute to everyone who wants it. I hope also that we shall be able to provide some leaflets on the exercise of the options. It is not, I think, our business to give advice on what these people should do; but we do think that it is our business to present information in such a way, and in such a form, that they can take an intelligent decision.

As to inter-changeability, the right hon. Gentleman, drew attention to a gap in the provisions as between the staff of local authorities and universities. The reason we have left that out is that we are advised that it would be ultra vires to put it into these regulations at all. But we recognise the gap, and intend, subject to agreement with the local authorities, to put this rig ht at the first opportunity. The right hen. Gentleman was bothered about the restriction of claims in regard to insurance policies. We have tried to keep in step with all the other options on transfer. It would be very difficult for us to have a different option in this respect from the options which we permit in other cases, where the appointed day is the operative date. We think that these exemptions must have a limit in application. We really cannot go on indefinitely into the future with people coming along and asking for these options. We had not originally intended to have any such option at all. We put it in because the representatives of the British Medical Association asked for it. It was their idea, not ours, and I hoped we had met them when this regulation was put in.

The right hon. Gentleman referred to added years for practitioners' training. Again, it is impossible for us to single out doctors for preferential treatment in this regard. If we gave preferential treatment to one doctor we would have to do so in all those cases where we have any say at all. A scheme like this can only deal with actual service. Doctors would now enter it when they were qualified, at the age of 23 or 24. They could complete the full 40 years before they retired at 65, and thus could earn the full pension. I would ask the right hon. Gentleman to bear that in mind. Another point raised concerned the elderly practitioner. At the moment the practitioner has no pension coming to him. He is relying on the value of his practice for the time when he retires. That is his position. He will not be any worse off under these arrangements, and in addition he will earn something in our scheme. We take him as we find him, as we do everybody else who comes in and we recognise that he relies on the value of his practice when he comes to retire and we compensate him for. it, but we cannot, at the same time, give some special benefit here because he has come in late in life.

I really think that we cannot here make the concession of the kind for which, I understand, the right hon. Gentleman was asking. It would be to discriminate in favour of this group and would lead, I think, to very substantial difficulties by way of repercussions on other fields. I hope the right hon. Gentleman agrees that we cannot at one and the same time provide to compensate for the loss of practice on his retirement and do something special in this field.

It is true that he is being compensated for the loss of practice when he retires, but he is being compensated on the money values of today and when he retires these money values may be meaningless.

Yes, but I think that the right hon. Gentleman will agree that this is a problem common to all pension schemes and it may very well be—as we find, for example, in the Civil Service scheme—that it is necessary to make adjustments when you have substantial changes in the value of money. I would not rule it out but I do not think we can provide for it here. One last word—a doctor has got the possibility of going on beyond 65 years and that may sometimes be important in the qualifying period.

If I may turn to the point made by the hon. Member for North Islington (Dr. Haden Guest) about interchangeability, I would give him the assurance for which he asks, We want this scheme to be as broad in scope as we can make it, and I would assure him that if at any stage we find that the scheme is restricted, we shall not hesitate to alter it. I am satisfied that we have gone as far as we could in providing for interchangeability. In congratulating the Press for their lucid statements he was, by implication, congratulating the Ministry of Health.

The hon. and gallant Member for Pudsey and Otley (Col. Stoddart-Scott) put to me a whole lot of posers which I will do my best to answer. The first was about the provision in Regulation 4 under which the Minister may dispense with contributions. It is purely an administrative provision. If it were convenient, in fact, to take the money direct from the Exchequer instead of its going through the hands of the employing body, we would do it. It is purely a matter of convenience, and I am not at all sure in what circumstances we would want to do it. In Regulation 9, the word "spouse" covers both man and woman. Man embraces woman in this context. The allocation of pension provisions in Regulation 9 applies equally to the woman doctor and to the man doctor.

In Regulation 20, I agree that the words are a little harsh, but I would ask the House to believe that there is no intention of putting in a regulation which really gives power of direction of labour. A better way of putting it, perhaps, would have been to say that the Minister will not withhold a pension without first offering a man a job. If the man finds a job for himself later on, under the regulations the Minister may agree and not tell him where to go, but if there is any difference of opinion between the Minister and the man or woman, then we have provided in this Regulation for appeal to a referee appointed by the Minister of Labour. I am quite sure there is no real intention for using this power in a punitive way. We want to be sure we are able to require people who are able to work to do so and not permit them to draw a pension when they are fit to work and no longer need a pension.

The next point the hon. and gallant Member raised was, I think, on Regulation 24 where there is a reference to March, 1946. This is the date of the introduction of the Bill—that is to say, the date on which it can be assumed that the Minister's intentions were known and the date on which we reckon the Minister's assurance about generous terms and so on really should be regarded as known. We cannot put down another date because we must safeguard ourselves against any wangle. On the other hand, later in the same regulation there is a specific provision for those who entered after March, 1946, to be permitted to come in and for the Minister's discretion to be used as though it were before March, 1946. I would say that in all normal cases that discretion will be exercised. This is only put in to safe- guard the Minister against anything which is done after the date on which the Bill was introduced and which would be to our disadvantage.

With regard to Regulation 25, on the point about a definition of reasonable expectations, I do not think that it is desirable to define this in any precise way. We have said that it is our desire to be as generous as possible here. We shall go to endless pains to try to deal fairly with persons. But when one studies "reasonable expectation" it is hard to define it precisely in a way which will not react to the disadvantage of the people who say they have reasonable expectation. The hon. Member I think is wrong in his interpretation of Regulation 26. It is not intended to deal with the person who has worked for a period of his service in a hospital. It is solely intended for the super-specialist, rather like the person who rather late in life is taken into the Civil Service at top level—people whom it is desirable to bring in. It is not intended to cover people who have hospital service. This concerns exceptional reasons.

Widows' pensions, the hon. Member said, were too small. I think with the funds at our disposal, and granted that we are going to have a common scheme covering everyone—we really cannot contemplate at this moment a different scheme for different sections—this is the best we can do. We are not able to come to special arrangements under which they would be able to pay a higher premium, in respect of a higher widow's pension. I would remind the House that this is something new. It may not mean an adequate widow's pension but this is the first time we have had a national scheme with widows' pensions in it. We have had the allocation of a pension, but we have never had a widow's pension provided as a right. The hon. Member had difficulty in defining cohabitation. We have the same thing in the National Insurance Scheme, Army and Navy Pensions and the like, and I do not think we are going to find greater difficulty than they are having.

Then as regards the widower's pension. I am sorry to say that there is no pension for the widower, but the woman doctor does not lose any more than the bachelor. Where there is a widow's pension available, it is carved out of the retiring allowance, and where there is no such pension the retiring allowance is higher in consequence. There is no loss here.

Is there actuarial equality between the value of the widow's pension and the pensions and the total of the amounts carved out of the retiring allowance?

Yes, this is an actuarial basis on which we work. Where one has a man and wife in the scheme a wile is not eligible for a widow's pension in addition to her own pension rights, but she does get her full sum in pension, so that she is not actually losing as a result.

The hon. Member for South Edinburgh (Sir W. Darling) was very bothered about the contr over the scheme, but I think he has completely misunderstood the character of the scheme. We are here dealing with something which has statutory force —a State scheme—where the rights of the beneficiaries are laid out, and the Minister has no power to vary them without coming to the House with amending regulations. There is no question of contributors having any control as in a private scheme. We have had a long experience of this kind. There is legislation for civil servants, teachers' schemes and so on, where it is provided precisely as in these regulations; this trouble does not arise in the form in which it arises in private industry. As to the loss of rights due to misconduct, we shall expect in the new service to have a disciplinary code which will be worked out in collaboration with the people representing this new service, and I have no reason to suppose that the negotiation machinery will find it difficult to handle these cases.

The hon. Member for Rochdale (Dr. Morgan) raised three points, the first being about interchangeability I do not think that kind of case, which can arise now, can arise under the new scheme. It is not our intention in the case of a genuine technical mistake to prevent interchangeability. As to the mental workers, it is laid down in the regulations that a man of 55 can go or continue until 60 and we have that carry-over period which is to the advantage of the mental hospital worker. As to the retirement of health workers—

That means that the mental workers should be retired at 55 and the ordinary health workers at 65.

It means that he can go at 55 or can stay to 60. On the third point, I hope that here again we shall have, when we get to our new negotiating machinery, procedures properly laid down to cover this type of case.

I will turn to the points made by the hon. Member for South Hendon (Sir H. Lucas-Tooth). As to contributions out of Exchequer funds, the scheme is intended to be actuarially water-tight when it really gets going, but in the beginning it will cost more. We cannot from the word "Go" avoid what is in a sense a deficiency, and therefore Exchequer contributions will at the beginning be necessary in order that the scheme may be sound. In the end it will right itself. I do not think it is right to say there is a disparity in the treatment of men and women because, as I pointed out earlier, where the widow's pension is paid out there is a smaller lump sum on retirement. Within the limits of an enormous scheme of this kind there is no real injustice done to any class of contributor.

With regard to disability pensions in relation to injury allowances, I think the point here is that we must provide for two things—for men who fall sick and who prematurely go out of the job, and for the person injured in the course of his employment. We must specially provide for the injured person, and all we are doing here is that the second type of case is more generously treated than would be done in the ordinary way.

If the injured pensioner is more generously treated, I take it that the contributory injured person would get benefit accordingly?

Yes, of course. I do not. think I need say anything more about the amount of widows' pensions about which I have talked a good deal.

I am afraid the hon. Member for Putney (Mr. Linstead) got me wrong. I did not say that all hospital service counted in the sense of counting towards pensions. What I said was all hospital service counted for qualification, which is a different thing. It means that people get into the scheme earlier, but it does not mean that all service counts for pension benefits. I hope I did not give the wrong impression on that point.

May I ask the Parliamentary Secretary a question on this point? The point I was trying to make was that in bringing in the general practitioner doctors, you are treating them extremely generously by giving them pension rights so to speak and sometimes taking over insurance premiums they are paying themselves. I desire to emphasise the generous provisions. It seems to be restricted to general practitioners, and other practitioners in health services are apparently not to receive the same generous treatment.

I think the hon. Member is wrong about that. What we are doing about all transferred people is to say that if they are in a scheme, they can stay in it if they prefer to and they think it really benefits them When we pay these premiums we do the same thing, except that the individual doctor has taken out a policy.

Does the right hon. Gentleman close the door to any further consideration of that type of case?

No. Perhaps I may say this in conclusion. This scheme is as good a scheme as we have been able to contrive after consultation with everybody concerned. We all know that we cannot foresee everything, and if in the light of experience we find a need for modification, then we will certainly modify. We do not claim that this is absolutely the last word. We do not pretend that, but it is not a bad effort on a very difficult job, and it is easily the most flexible scheme we have ever had in this country and one which is to the advantage of the people in the service.

Question put, and agreed to.


"That the Draft National Health Service (Superannuation) Regulations, 1947, proposed to be made by the Minister of Health under subsection (1) of Section 67 of the National Health Service Act, 1946, a copy of which Regulations was presented on 3rd July, be approved."