House Of Commons
Tuesday, 1st August, 1911.
The House met at a Quarter before Three of the clock, Mr. SPEAKER in the Chair.
Private Business
Provisional Order Bills [ Lords] (Standing Orders applicable thereto complied with),—Mr. Speaker laid upon the Table Report from one of the Examiners of Petitions for Private Bills, That, in the case of the following Bills, originating in the Lords, and referred on the First Reading thereof, the Standing Orders which are applicable thereto have been complied with, namely:—
Education Board Provisional Orders Confirmation (London) Bill [ Lords].
Gas and Water Orders Confirmation Bill [ lords].
Gas Orders Confirmation (No. 4) Bill [ Lords].
Ordered, That the Bills be read a second time To-morrow.
Belfast Corporation Bill,
Lords Amendments to be considered upon Thursday, at a quarter-past Eight of the clock.
Gloucester Corporation Bill,
Metropolitan Electric Tramways Bill,
Lords Amendments considered, and agreed to.
Middlesbrough, Stockton-on-Tees, and Thornaby Tramways Bill [ Lords],
Read the third time, and passed, with Amendments.
North-Eastern Railway Bill [ Lords],
As amended, considered; to be read the third time.
Westbury Estate Bill [ Lords] (by Order),
As amended, considered; to be read the third time.
Standing Orders (Private Business)
The alterations of Standing Orders which I have to propose are merely to bring the trolley vehicle system within the purview of our Standing Orders. Bills for a trolley vehicle system are presented which do not now come under our Standing Orders, and it is obviously necessary that they should do so. I desire to make one or two alterations in the proposals with reference to Standing Orders 10 and 13a by adding in each case to the words on the Paper the words "except that part of it which refers to plans deposited."
I beg to move, "That the Standing Orders relating to Private Business be amended as follows:— Standing Order 1 (Definition of 1st class Bills) Part I., after the words 'stipendiary magistrate, or any public officer—payment of,' insert the words 'trolley vehicle system.'"Amendment agreed to.
Further Amendments made:
In Part II., after the words "Tramroad and Motor Road," insert the words, "the term 'trolley vehicle system,' means a system of traction whereby vehicles propelled on roads by mechanical power conveyed by overhead wires trolleys."
In Standing Order 10 (Posting of Notices in case of Tramway or Underground Railway Bill) at end add the words "This Order shall apply to a trolley vehicle system in like manner as to a tramway, except that part of it which refers to plans deposited."
In Standing Order 13a (Notice to Owners and Lessees of Railways, Tramways, or Canals, crossed, affected, or interfered with by proposed tramway) at end add the words "This Order shall apply to trolley vehicle systems in like manner as to tramways, except that part of it which refers to plans deposited."
In Standing Order 25a, after the word "tramway" ["laying down a tramway"], insert the words "or trolley vehicle system."
After the word "tramway" ["of the proposed tramway"], insert the words "or trolley vehicle system."
After the word "office" ["at that office," insert the words "and in the Private Bill Office of the House of Commons."
In Standing Order 33 (Deposit of Private Bills at Treasury and other Public Departments), paragraph (4), after the word "tramway," insert the words "trolley vehicles."
Local Government Provisional Orders (No. 7)
Bill, Read the third time, and passed.
Electric Lighting Provisional Orders (No. 4) Bill [ Lords],
Gas Orders Confirmation (No. 2) Bill [ Lords],
Pier and Harbour Orders Confirmation (No. 1) Bill [ Lords]
Read a second time, and committed.
Merthyr Tydfil Corporation Water Bill [ Lords],
Reported, with Amendments; Report to lie upon the Table, and to be printed.
Provisional Order Bills
I beg to move "That, in the case of the Electric Lighting Provisional Orders (No. 1) Bill [Lords], Electric Lighting Provisional Orders (No. 2) Bill [Lords], Electric Lighting Provisional Orders (No. 3) Bill [Lords], Electric Lighting Provisional Orders (No. 4) Bill [Lords], Pier and Harbour Orders Confirmation (No. 1) Bill [Lords], Gas Orders Confirmation (No. 2) Bill [Lords], and Tramways Orders Confirmation Bill [Lords], Standing Order 211 be suspended, and that the Committee on the Bills have leave to sit and proceed on Thursday, 3rd August."
This Motion is to enable the Bills referred to be dealt with by the Committee on Unopposed Bills at its sitting on Thursday, although the six days will not then have expired. It is a usual Motion at this period of the Session. There are no petitions against the Bills, and consequently no one can be prejudiced by the shortened interval between Second Reading and Committee.Question put, and agreed to.
London (Equalisation Of Rates) Act, 1894 (Accounts Under Section 1 (7) Of The Act)
Return ordered, "showing, according to the Accounts for the twelve months preceding the 31st day of March, 1911, furnished to the Local Government Board under Section 1 (7) of The London (Equalisation of Rates) Act, 1894,—
Telegraph (Construction) Bill
Reported, with Amendments, from the Select Committee, with Minutes of Evidence.
Report to lie upon the Table, and to be printed.
Bill, as amended by the Select Committee, re-committed to a Committee of the Whole House for To-morrow, and to be printed.
Chile (No 1, 1911)
Copy presented of Award pronounced by His Majesty King George V., as "Amiable Compositeur" between the United States of America and the Republic of Chile, in the matter of the Alsop Claim [by Command]; to lie upon the Table.
Treaty Series (No 20, 1911)
Copy presented of Exchange of Notes between the United Kingdom and Honduras extending until 6th April, 1912, the operation of the Treaty of Commerce and Navigation between the two Countries of 21st January, 1887. 5/19 April, 1911 [by Command]; to lie upon the Table.
Licensing Statistics, 1910
Copy presented of Statistics as to the operation and administration of the Laws relating to the Sale of Intoxicating Liquor in England and Wales for the year 1910 [by Command]; to lie upon the Table.
Charitable Donations And Bequests (Ireland)
Copy presented of Sixty-sixth Report of the Commissioners of Charitable Donations and Bequests for Ireland for the year ending 31st December, 1910 [by Command]; to lie upon the Table.
Commonwealth Of Austealia
Copy presented of Papers with reference to the Referendum and its working in Australia [by Command]; to lie upon the Table.
Oral Answers To Questions
Indian State Railways (Contracts And Rates Of Wages)
I beg to ask the Under-Secretary of State for India whether he is now in a position to state the result of his inquiries into the rates of pay to workmen engaged in connection with the Government contract for rails at Dowlais ironworks; and what action he proposes to take to secure the proper observance of the Fair-Wages Clause attached to this contract?
I beg also to ask as to the result of the inquiries concerning the wages paid to workmen engaged by Messrs. Guest, Keen and Nettle-fold, upon contracts for the Indian State Railways?
The Secretary of State is in communication with Messrs. Guest, Keen and Nettle-fold regarding the allegations made against them, and I will communicate with my hon. Friend as soon as the firm's reply has been received and considered.
When may the reply be expected. Seeing that the matter has been before the India Office several weeks is it not time it arrived?
I will make inquiry of the Secretary of State.
Why not send down an inspector, instead of waiting for the reply?
I will communicate that suggestion to the Department.
Yeomanry Staff Sergeants
asked the Under-Secretary of State for War whether he can now make any statement with regard to the recent order as to the employ- ment of sergeants instead of sergeant-majors as the permanent staff of the Yeomanry?
It has been decided to revert to the system in force before the recent changes in regard to the appointment of the permanent staff of the Yeomanry, but it will, of course, be made clear that no instructor will be retained or appointed who is not efficient in every respect.
When may the order be expected?
At once.
How will sergeants who came in under the new order be affected?
They will stay on for now. The change will not be retrospective.
War Office And Boys' Organisations
asked whether representations have been received by the War Office from Territorial associations asking that the order regarding the inspection of unrecognised boys' organisations by officers in uniform be rescinded, and that drill halls may be lent or hired to such units if it does not entail expense to the public; and whether the War Office will look favourably upon such representations?
Representations to this effect have been received from six County Associations, of whom only two have recognised any Cadet units. It is not considered justifiable to give military aid to bodies which do not comply with military requirements and maintain no military connections.
Is it the desire of the War Office authorities to force these boys' organisations to become purely military organisations by a system of boycott, and does the right hon. Gentleman consider that these units are injuring the military spirit in this country?
I mean exactly what I said in the last sentence of my answer. Everyone must, of course, be glad to see these boys' organisations prosper; but I do not think a charge on Army funds justifiable.
I never suggested expense; I merely asked whether boy scouts and kindred organisations could be inspected by officers and have the use of drill halls without expense to the public?
All that is included in the phrase I have used.
Territorial Associations (Allowance For Quarters)
asked whether an extra grant or allowance may be given to Territorial associations wherewith to furnish the quarters of non-commissioned officers of the permanent staff, as, owing to the proposed lower scale of pay and shorter period of appointment, non-commissioned officers cannot afford to furnish quarters on their present allowance?
The question is under consideration.
asked the Under-Secretary of State for War whether he has received representations from county Territorial Associations that the present 4d. lodging allowance is insufficient to provide sergeant instructors with quarters suitable to their position, and that the billeting allowance of 1s. 0½d. for lodgings which includes supper and breakfast does not conduce to the popularity of and the respect for the Territorial Force?
Yes, Sir. Representations have been received on these matters. The 4d. rate of lodging allowance has been raised to 9d., with effect from 1st April last, and Commands were so informed on the 1st July. The billeting rates are being reconsidered in accordance with the pledge given in Debate on the Army Annual Bill this year.
Voluntary Aid Detachments
asked whether pay and allowances will be issued to members of voluntary aid detachments when mobilised; and whether, in view of the financial burden cast on these detachments, a small grant can be given to authorised detachments that are efficient?
The question of the grant of pay and allowances on mobilisation is now under consideration. As regards expenditure in peace it is not proposed to make any grant. The expenses involved should be very small.
Herts Yeomanry
asked whether permission will be granted to the Herts Yeomanry to wear the scarlet collar and cuffs on the service dress jacket as approved on 2nd May, 1902?
The answer is in the negative.
Dowlais Works (Fair-Wages Clause)
asked the Secretary of State for the Colonies whether he is aware that the Fair-Wages Clause is being systematically and continuously violated by Messrs. Guest, Keen, and Nettlefold whilst executing Colonial Office contracts at their Dowlais works; and what action he proposes taking to secure its enforcement?
The firm has been communicated with in the matter; but, pending receipt and consideration of their reply, I am unable to answer the hon. Member's question.
Is there any idea when the answer will be ready?
I hope in a day or two.
asked what action the First Lord of the Admiralty proposes taking to secure the enforcement of the Fair-Wages Clause at Dowlais, where the moulders make the moulds for the ingots from which the plates for battleships are rolled, and also the various parts of the machinery employed in the rolling process, and where the pattern-makers make the patterns for the moulders, and are thus in both cases directly employed in connection with the contracts now being executed by Messrs. Guest, Keen, and Nettlefold on behalf of the Admiralty?
The point which the hon. Member raises was referred yesterday by the India Office to the Fair-Wages Advisory Committee for an opinion.
Will the right hon. Gentleman accept their decision?
The point having been referred, I cannot say. I do not want to prejudge the case.
Federated Malay States
asked why the same precedence is not granted to the Chief Judicial Commissioner of the Federated Malay States as to the Chief Justices of Crown Colonies?
The circumstances of the Federated Malay States, which are not part of His Majesty's Dominions, differ from those of a Crown Colony, and it is impossible to argue by analogy from one to the other.
Has not soreness been caused in the Malay States by the fact that their chief officer should take a lower rank?
I do not know if there is any question which leads to greater soreness than that of precedence.
asked whether, in view of the number of natives of India residing in the Federated Malay States, the Government will grant them a representative on the Federal Council?
The answer to the hon. Member's question is in the negative.
Are there now 172,000 Indians in the Federated Malay States, and have they not brought a considerable sum of money into the country, and as the Chinese are represented on the Council ought not India also to be represented?
There is a large number of coolies in the Federated Malay States. If the hon. Member would like further information on the subject will he communicate with me privately?
Secondary School Grants
asked the President of the Board of Education if it will be possible to provide in the current year for increased grants to secondary schools, and to earmark the increase for augmenting the salaries of the teaching staff in such schools; and, if not possible this year, whether such a provision can be made next year?
The answer to the first part of the question is in the negative. With regard to the second part of the question, I am not yet in a position to say whether it will be possible next year to make grants to secondary schools in advance of the present rate. I am doubtful whether it would be practicable in any case to earmark any additional grants expressly for augmenting the salaries of the teaching staffs. I am, however, considering the question.
Tubercle Bacilli
asked the President of the Local Government Board if he will state whether the bacilli of tubercle have been found to be in butter?
Tubercle bacilli are occasionally to be found in butter, when they have been present in the milk from which the butter was made. The risk to health from such butter may be regarded as relatively slight.
Mitford And Launditch Union
asked the President of the Local Government Board if he is aware that the action of the Board in compelling the master of the Mitford and Launditch union to resign has occasioned dissatisfaction locally; if the guardians have unanimously protested against the action of the Board; and if, considering that the master's offence consisted in carrying out specific resolutions of the guardians, and that he has had a number of years' service, he will comply with the request of the guardians for a public inquiry into the whole matter?
I am aware of the facts indicated in the earlier part of the Member's question. I may observe that, since I called upon the master to resign, his wife, the matron, resigned owing to ill-health, and her resignation automatically brought her husband's office as master to a close on 30th June. I have already informed the guardians that the case is not one that calls for further inquiry as suggested.
Have not several unions in Norfolk protested against what they consider the high-handed action of the right hon. Gentleman in dismissing the master and practically ignoring the guardians of this particular union?
That may be so, but when the whole circumstances of the case and the reasons for the master's dismissal and his wife's resignation are brought before the House and the public I am sure the House of Commons will side with the Local Government Board rather than with the guardians or the master.
Shall we have an opportunity of discussing this?
Yes.
Vaccination Acts (St Marylebone Guardians)
asked the President of the Local Government Board whether he is aware that on various public buildings in the parish of St. Marylebone notice boards are exhibited by the board of guardians purporting to deal with vaccination and re-vaccination, and citing the exemption provision of the Vaccination Act, 1898, but without any reference to the Vaccination Act, 1907; and whether he will direct the guardians to withdraw these notices?
My attention had not previously been drawn to the matter, but I am in communication with the guardians with regard to it.
Bethnal Green Poor Law School
asked the President of the Local Government Board if his attention has been called to the fact that nearly 100 children out of the 500 maintained in the Bethnal Green Poor Law School have been suffering from what appeared to be ptomaine poisoning; whether the cause of the illness has been discovered; and what steps, if any, have been taken to prevent a recurrence of the outbreak?
I have received reports with reference to this matter, and one of my medical inspectors has made personal inquiries into the circumstances. I understand that 124 of the children suffered from what appeared to be slight ptomaine poisoning. It has been suggested that the cause may have been a fish dinner. All the children have recovered. There is no evidence of any want of vigilance on the part of the officers of the school, and I understand that there was nothing to suggest that there was anything suspicious about the fish when it was received.
Was it tinned fish?
No, Sir.
Old Age Pensions
asked the President of the Local Government Board whether he will issue a circular to the various boards of guardians informing them that when an old age pensioner receives medical relief they are not entitled to apply any money received in respect of the pension to the maintenance of the pensioner in relief of the rates, that if a pensioner is asked to allow the agent of the guardians to collect the pension the pensioner should be at the same time informed that he is entitled to all money collected, and that an assurance must be given to the pensioner that all such money will be paid to him?
The whole question of the receipt by pensioners of their pensions while in Poor Law institutions is receiving consideration, and I could not promise to issue a circular as suggested at the present time.
Consumption
asked whether Dr. Kaye, the medical officer of the West Riding County Council, has, at his request, investigated the claim made by Mr. A. Bryant, of Thornton, Bradford, that he has cured and is curing consumption in an advanced stage of the disease by means of gases which are given out by the maggots infesting putrifying meat; and, if so, with what result?
I have not made any such request to Dr. Kaye.
Is the statement reported in all the papers that the right hon. Gentleman has made this investigation untrue?
Like nineteen-twentieths of what appears about some Ministers in the papers, the opposite is the truth.
Post Office Clerks (Examination)
asked the Postmaster-General if he can state when the next examination for third-class clerks, Engineers and Stores Department, will be held; and whether any extension of age will be allowed in view of the length of time since the last examination?
I cannot yet name a date, but I anticipate that an examination will probably be necessary before the end of the year. I see no sufficient grounds for any extension of the present maximum age limit of twenty-six.
Telegraphic Communication
asked the Postmaster-General whether he is aware that upon his inquiries last March into the conditions of telegraphic communication between London and Liverpool there was for a time a marked improvement, but that latterly there has been a recurrence of frequent delays between the London Com- mercial Sales Rooms and Liverpool, particularly in the opening business hours of the day when celerity of communication is of urgent importance for the effecting of sales and purchases; and whether he will at once and at somewhat short intervals in the future repeat his departmental inquiries which, on the last occasion, produced good results and, if necessary, provide additional lines or instruments?
The delays which the hon. Member now mentions were, I believe, due to interruptions of the wire and temporary failures of apparatus—contingencies which I fear are bound to occur sometimes in any telegraph service. As the hon. Member knows, the merchants dealing at the Commercial Sales Rooms enjoy the 'advantage of the assignment to their use of a special wire, so that their telegrams need not pass through the Central Telegraph Office. But that very advantage is liable at times to turn to disadvantage, because there is no case for more than one wire at the Commercial Sale Room, and it is not possible to counteract the effect of failure of wire, at a moment's notice, by distributing the work over other wires. I am fully aware of the great importance of maintaining a prompt service to those for whom the hon. Member speaks, and no pains are spared to that end.
asked the Postmaster-General whether he will publish quarterly returns which will enable the public to judge of the telegraphic facilities afforded between the principal commercial centres of the United Kingdom, stating in such returns what in his opinion is a reasonable time for the transmission of a telegram between each couple of commercial centres during the busy hours of the morning, the percentage of telegrams delivered under that time, the percentage which took double that time, and so on, giving sufficient information to enable this House to form an opinion as to whether the service has been satisfactory or not and whether additional facilities ought to be afforded?
I fear that it would be quite impracticable to publish such returns. The telegraphic facilities between different centres are constantly varied—even from hour to hour—as the work fluctuates. To record the time taken by all telegrams between the centres would entail a great amount of labour and expense which would not be justified by the result.
St Anne's-On-Sea Sub-Post Office
asked the Postmaster-General whether he is aware that women are employed at the St. Anne's-on-Sea sub-post office on duties which entail almost continuous standing for periods of nine to ten hours, and that, in answer to complaints, it is stated that the same conditions exist at other offices and that the duty is not unduly trying; whether the necessity for this condition of affairs is caused by shortness of staff; and what steps he proposes to take to remedy this condition of service?
There is one duty at St. Anne's-on-Sea which involves attendance at the public counter from 12.30 p.m. to 9.30 p.m. during the summer season only, the last hour's attendance being paid for as overtime. In the winter the duty finishes at 8.30 p.m. There is an interval of half an hour for refreshment from 4.30 p.m. to 5 p.m. The duty is performed on alternate days by two women clerks in rotation with another duty of eight hours. When not engaged with the public the officer performing the duty can. sit down, if she wishes, a stool being provided for the purpose. The arrangement of an eight-hour counter duty is normal, and is not considered irksome. I have, however, altered the practice of appending an hour's overtime daily to this duty during the summer season, and I am considering whether special circumstances at St. Anne's-on-Sea render any further alterations advisable.
Automatic Telephones
asked the Postmaster-General if he intends, to introduce into England the automatic telephones known as the Strowger and the Lorimer systems; what has been, the cost to date in connection with this experiment; and what amount is it calculated it will cost to continue the same for say six months?
Contracts are in course of arrangement for two experimental exchanges to be constructed at Epsom and Caterham Valley on the Strowger and Lorimer Automatic Systems respectively. No special expense has at present been incurred for this purpose, nor can I say now what cost will be involved in working and maintaining these exchanges. The determination of this cost is one of the chief objects of the experiment.
Postal Facilities, Portsoy, Banffshire
asked the Postmaster-General whether representations have reached him regarding the inadequacy of the postal facilities in Portsoy, Banffshire; and whether this town is now of sufficient commercial and social importance to warrant the establishment of a salaried post office?
I have recently been considering the question of post office accommodation at Portsoy. The circumstances there do not warrant a provision of a salaried sub-post office. I have made arrangements that the sub-postmaster shall devote one side of his shop exclusively to post office business, and I consider that the requirements of the case will then be met.
Is the right hon. Gentleman aware that in the neighbouring town of Cullen, which is much smaller than Portsoy, there is a sub-post office? Why should not Portsoy have equally generous treatment?
Perhaps the question is, whether Cullen ought not to be reduced to the level of Portsoy.
Telephone Operators (Health)
asked the Postmaster-General whether he is aware that ten of the women telephone operators employed at the General Post Office, South, were seized with fits of fainting and hysteria while on duty on 7th July; whether any women telegraphists at the Central Telegraph Office were similarly affected on the same date; and whether he can now say when it is proposed to publish the report of the medical inquiry into the conditions of the London telephone service?
The facts are as stated by the hon. Member. The incident is attributed to the heat, which, on the date in question, caused a temperature of 87 degrees in the Central Exchange. There were no similar cases in the Central Telegraph Office on that day. I hope to publish the report of the medical inquiry into the conditions of telephone working at an early date.
Telephone Exchange, Hew Oxted
asked the Postmaster-General whether he is aware that the Post Office Exchange at New Oxted, with fifty-one subscribers, is closed from 10 a.m. to 10 p.m. on Sundays; and that an extra charge of 3d. is made for trunk calls after 8 p.m., with a further fee of 3d. on calls put through after 10 p.m., whereas the National Telephone Company's Exchange at Harlow, with only thirty-three subscribers, is available all day on Sundays and no extra charge is made for late calls; and, in view of the announcement that the use of Post Office trunk lines is granted to the subscribers to Post Office Exchanges on terms as favourable as those to subscribers to exchanges of the National Telephone Company, will he take steps to rectify the present inequality in this and other cases, and will he give instructions for Post Office charges in excess of National Telephone Company's charges to be refunded or not enforced in future?
The Post Office telephone exchange at New Oxted is an instance of the exchanges referred to in my answer to a recent question by the hon. Member as having been opened by the Post Office in districts which had not been served by the National Telephone Company. The amount of support given at first was not sufficient to justify the extra cost of attendance on Sundays, or a continuous service at night without the payment of special fees for calls. In view of the increase in the number of subscribers I am now trying to arrange for a continuous service on Sundays and at nights without any special charge to subscribers. I cannot, however, in view of the expense incurred, undertake to refund the charges previously made to subscribers.
Telephone Staff, Stoke-On-Trent District
asked the Postmaster-General whether his attention has been called to the discharge of a number of workmen by the National Telephone Company in the Stoke-on-Trent district; whether his pledge that the workmen should not suffer through the transfer of the telephone system from the company to the Post Office is still the policy of his Department; and, if so, will he indicate to the company that wholesale discharges so near the actual date of transfer are not in accordance with his declared intention?
I understand that the men referred to in the question were not part of the regular staff of the company, but labourers engaged temporarily for a special work. Their discharge is in no way due to the approaching transfer of the telephone system to the State.
King Edward Memorial
asked the hon. Member for Southampton, as representing the First Commissioner of Works, whether any recognised authority on town-planning or civic design has been consulted by the King Edward Memorial Committee in order to do justice to the architectural and other aesthetic opportunities of London?
Although the Committee did not consult any individual, a number of suggestions were brought before them by gentlemen well qualified to advise in such matters. The Committee have entrusted the work to Mr. Lutzens and Mr. Mackennal, whose plans will in due course be placed before Parliament.
asked the hon. Member for Southampton, as representing the First Commissioner of Works, whether he will lay before the King Edward Memorial Committee the plan for improving Hyde Park Corner, prepared by Mr. Adshead, Professor of Civic Design, with a view to providing an adequate memorial to King Edward?
The First Commissioner of Works will be happy to do this.
May I ask if the hon. Gentleman will have the plans placed in the tea room?
Yes, Sir.
Shops Bill
asked the Secretary of State for the Home Department whether certain costermongers in London have received permission to trade after the time at which shops should be closed; whether he is aware that it would be most inconvenient to many of the inhabitants' of Portsmouth, and vitally affect the trade of the Portsmouth costermongers, if they were unable to do business after the shops were closed; and whether he can inform the House if Clause 10 of the Shops Bill will prevent costermongers trading after the shops are closed?
The effect of Clause 10, which has now become Clause 15 in the Bill as amended, is to make it unlawful to carry on any class of retail trade elsewhere than in a shop at a time when under the Bill or a Closing Order shops carrying on that class of trade are required to be closed. No exceptions to this rule are made by the Bill for costermongers either in London or elsewhere; though, so far as regards Closing Orders, a general discretion is left to the local authority making the Order to authorise sales after the closing hour in emergencies or other special cases if they think fit. It would obviously be a great hardship to shopkeepers if they were required to be closed while a similar trade to their own could be carried on without let or hindrance in the streets outside and would inevitably lead many shopkeepers to carry on a street trade themselves after the closing hour, and so defeat the very object of the Bill. No representations on the point have reached me from Portsmouth, but I have no reason to suppose that the conditions there are different from those in many other towns.
Is the right hon. Gentleman aware that the costers carry on a totally different trade from what is carried on in shops? That certainly is so in Portsmouth.
asked whether the Government has decided to omit all the provisions relating to Sunday trading in London from the Shops Bill?
By Clause 8 of the Bill, as amended in the Standing Committee, the administrative county of London and some other areas are to be exempted from the provisions of the Bill as to Sunday Closing up to two o'clock in the afternoon; but I propose on the Report stage of the Bill to move to insert a provision which will keep in force the provisions of the Sunday Observance Act, 1677, so far, at any rate, as regards the areas to be exempted from the Sunday Closing provisions of the Bill.
Metropolitan Police (Disciplinary Courts)
asked the Secretary of State for the Home Department if he can now report the result of the inquiries which he has been making into the various disciplinary courts connected with the Metropolitan Police, with a view to seeing whether there should be some modification of the present system; and if in this connection he will take into consideration the formation of an independent board of appeal, including men with a judicial training, such as barristers or magistrates, so as to secure that those who are called upon to act as members of the court may not be closely linked with men whose own actions may be in question on some other occasion?
I find that in the year 1910 eighteen men were dismissed and seven others were reduced in rank out of a total force exceeding 19,000. I do not believe that so high a state of discipline has ever been maintained throughout so large a force at the cost of so few punishments. Further, in the last ten years the incidence of all punishments, including minor punishments, in the Metropolitan Police, fell from 11.3 per cent. to 6.3 per cent. There are many other figures, which could be cited, of a similar character; but these are sufficient to satisfy me that it would be difficult to improve upon the results which are obtained under the present system. It must also be remembered that the police authorities have no disciplinary powers other than those possessed by the private employer, and this fact renders the achievement even more remarkable. The formation of the Board of Appeal such as suggested in the question is impracticable, and I am certain that it would not be to the advantage of the constables that their failures should be dealt with by persons who have no experience of the difficulties and trials to which they are exposed.
Duration Of Session
asked the Prime Minister if he can now state for the convenience of Members what Bills the Government intend proceeding with and what Bills they propose to withdraw; and can he state the approximate date on which he proposes to bring the Session to a close?
I must remind the Noble Lord that I have already stated that I will shortly make a statement as to the course of business for the remainder of the Session.
May I ask the right hon. Gentleman if, in view of the late period of the Session which we have now reached, and with the view of saving time, he will consider the advisability of including the Finance Bill in the Expiring Laws Continuance Bill?
Franchise And Payment Of Rates
asked the Prime Minister whether his attention has been given to the case of Kent v. Fittall, No. 5, whereby many thousands of electors will be in future deprived of their vote; and whether, in order to retain on the registers of electors those persons who have been prospectively disfranchised, he will initiate immediate legislation?
I cannot add anything to the answer that I gave yesterday to a similar question.
Tea Imports (Home Consumption)
asked the President of the Board of Trade if he will supply details up to the latest date available of the imports of tea into this country for home consumption, showing how much is imported from India and Ceylon, from China, and from Java, respectively, in the last twelve months, and the same for the previous twelve months?
The latest figures available are those for the twelve months ended June 30th, during which period 288,503,000 lbs. of tea were cleared for home consumption, as against 274,105,000 lbs. in the previous twelve months. No separate figures are available with regard to the quantity of Java tea cleared for home consumption, but I will have a statement showing the quantities imported from the other sources mentioned in the question printed with the Votes.— [See Written Answers this date.]
Disturbance At Castletown Road, Dundalk
asked the Chief Secretary for Ireland if he is aware that on the night of the 12th July a Protestant, named Evans, residing at Castletown Road, near Dundalk, had the windows of his house smashed and other injury done to his premises by a Nationalist mob; that he lives in dread of further violence, and his children have been threatened and cannot attend school; and what steps are being taken to afford protection to this man and his family?
The police authorities inform me that on the 12th July a few boys marched past Mrs. Evans' house beating a toy drum, and that some of them threw stones at the house and broke a window. On the following day some factory girls used abusive language to Miss Evans. The police do not anticipate any further interference with the Evans family, but they are keeping an eye to the house.
May I ask whether the right hon. Gentleman is aware that both Catholics and Protestants had their heads broken in Cardiff recently?
Labourers Enfranchisement (Ireland) Bill
asked the Chief Secretary for Ireland whether the Government favour the main purpose of the Labourers' Home Enfranchisement (Ireland) Bill introduced this Session; and if he will say by what alteration, if any, an opportunity can be obtained for discussing it next Session?
I am not prepared to express an opinion on the Bill introduced by the hon. Member or to advise him as to its Amendment.
Untenanted Lands (Ireland)
asked the Chief Secretary for Ireland whether he is aware of the number of landless applicants refused allotments of untenanted land on the Pakenham, estate, Westmeath, who have since emigrated in consequence of that refusal; whether he still approves of the ranchers' scheme by which they were excluded, while two allotments were given to a widow and her only son residing together on an adequate farm; and what action, if any, the Estates Commissioners are now taking to check emigration from that depleted county by distribution of the untenanted lands?
I have nothing to add to my reply to the hon. Member's question on 26th July, 1910, regarding the estate referred to. As I have already informed the hon. Member the Estates Commissioners have acquired for distribution over 7,000 acres of untenanted land in county Westmeath, and are in negotiation for an additional 6,000 acres in that county.
asked whether the untenanted land on the estate of Lord Massy, at Castleconnell, county Limerick, has yet been acquired by the Commissioners; has the land been inspected; and, if so, how soon may it be distributed?
The Estates Commissioners have directed an inspection to be made of the untenanted land on the estate referred to which the owner has offered for sale. They are not in a position at present to reply to the last paragraph of the question.
Ventry Estate, Castlegregory (Mr D Courtney's Case)
asked the Chief Secretary for Ireland whether any steps have been, taken to re-instate Mr. Daniel Courtney, evicted tenant on the Ventry estate, in his holding at Clahaneanode, Castlegregory; and whether, as the estate is now in the hands of the Congested Districts Board, steps will be taken to have this man's case dealt with as soon as possible?
The Congested Districts Board inform me that they are in communication with the Estates Commissioners in regard to the case of Mr. Daniel Courtney.
Training Colleges (Ireland)
asked the Chief Secretary for Ireland whether he will state the number of students attending each of the Irish training colleges in the year ended June, 1911; the number of such students in each college who studied Irish during their course; the number in each college who entered for the final certificate; the number of hours per week in each college which each student has the services of the Irish professor; and whether he will state the number in each college who qualified in 1910 to teach Irish?
I would refer the hon. Member to my reply to his question on this subject on the 20th July. The Commissioners of National Education have no information as to the number of students in the training colleges who studied Irish during their course as distinct from those who entered for the certificate examination in that language.
King's Scholarships (Ireland)
asked the Chief Secretary for Ireland if he will say how many students passed the entrance examination for King's scholarships in Ireland last Easter, in first and second division, repectively; how many first and second division students were called to each of the Irish training colleges for the session beginning next September; whether any and, if so, what colleges have called second division students passing over first division; and will he explain why this is done; and what control do the National Board possess as to admission of students to the various training colleges?
The Commissioners of National Education inform me that the numbers of candidates who passed the King's scholarship examination of 1911 are:—In the first division 48 men and 156 women, and in the second division 192 men and 684 women. Returns of the candidates selected for the training session commencing in September next have not yet been furnished to the Commissioners. In the case of Marlborough Street Training College the candidates (other than recognised teachers) who pass the King's Scholarship examination are selected for admission to the college in the order of merit. In the case of the other colleges the selection of King's Scholars is made by the college authorities from the list of candidates who have been declared eligible by the Commissioners.
Welsh Services In London Churches (Grants)
asked the hon. Member for the Doncaster Division, as representing the Ecclesiastical Commissioners, what grants are made by the Ecclesiastical Commissioners to churches in London in which the services are conducted wholly in the Welsh language; and whether such grants amount to more than £l per annum per head of those in average attendance at such churches?
The Commissioners have made grants, amounting to £450 per annum in perpetuity, to two Welsh churches in London under special statutory provisions. The Commissioners have no information as to the average attendance at these churches.
Evicted Tenants (County Limerick)
asked whether any steps have been taken recently by the Estates Commissioners to transfer Patrick Whelan and Martin Ryan, planters on the estate of Lord Cloncurry, Murroe, county Limerick, and thus bring peace to the district as well as to allow the representatives of the evicted tenants back to their old homes?
The Estates Commissioners are making inquiries as to the possibility of providing other farms for Whelan and Ryan.
Old Age Pensions
asked the Chief Secretary for Ireland whether he is aware that Mrs. Maria Morgan, of Ballintoy, county Antrim, has been refused an old age pen- sion by the Local Government Board, although the local committee had approved her claim; whether he is aware that the reason assigned by the Board is that she is an American subject, although she lived only two years in America, returned to Ireland sixteen years ago, was never out of Ireland except for those two years, and never at any time became an American subject; and whether further investigation will be made?
Mrs. Morgan has made three claims. Two of these were passed by the local pension sub-committee, but were disallowed by the Local Government Board not on the ground that she was an American subject, but because she had not retained a home in the United Kingdom during her absence from it, and because she failed to show that she had attained the statutory age. Her third claim was rejected by the sub-committee, and also by the Board when she appealed to them. Further investigation can only be made by the Board in the event of an appeal being lodged on a fresh claim.
Is the right hon. Gentleman aware that the Local Government Board wrote to this applicant asking her whether she could supply evidence that she had not been more than two years in America, and that that was the only ground they gave for rejecting her claim?
No, I do not understand that that was the only ground. They sought that information from her; but they came to the conclusion that she had not maintained her home in the United Kingdom during her absence, and also that she had not proved that she had attained the age of seventy years.
Having regard to the fact that this woman has lived sixty-eight years in Ireland, and only two years in America, does not the right hon. Gentleman think it a great hardship on her to be deprived of a pension, and will he see that in the Amending Bill to the Old Age Pensions Act cases of this kind will be dealt with?
The Amending Act was necessary in order to enable the Local Government Board in future to deal in a different manner with these cases from that in which they have hitherto been bound to deal with them. She can make a fresh claim.
asked the Secretary to the Treasury if several old age pensioners in the sub-pension district of Baltinglass No. I. have been kept out of their pensions for many weeks, in some cases for eleven and even twelve weeks; and, if so, will immediate steps be taken to prevent the recurrence of this hardship to the pensioners?
I regret that some delay occurred recently in the delivery of the new pension order books in this district. Steps have been taken to secure punctual delivery in future.
Will the right hon. Gentleman make inquiries to see if the pension officer is overworked, and, if so, will an assistant be provided?
asked why Catherine M'Namara, of Glin, county Limerick, a recipient of outdoor relief until this disqualification for an old age pension was removed, did not get the pension book until 8th July last, although she applied for it in December, 1910, and was then qualified for the pension in the matter of her age; and whether she has yet received the amount of pension due to her since last January?
I find on inquiry that the pension officer has no record of an earlier claim by Catherine M'Namara than one made on 20th March, 1911. This claim was allowed by the committee on 23rd June, 1911, and a book of pension orders dated from 30th June onward has been delivered to her. The pensioner appears in the circumstances to have no title to payment of pension in respect of any earlier date.
asked the Secretary to the Treasury why James Brummel, of Glin, county Limerick, was not provided for four weeks with an old age pension book when the old book was used up; whether he is aware that Brummel has been refused the £l which accrued to his credit in the meantime; and whether, as he was not to blame in the matter, will he take steps to see that this man gets the money that is due to him?
I find on inquiry that, according to the records kept by the local pension officer, Brummel has been supplied with pension orders in unbroken sequence for the whole of the time that he has been entitled to a pension, i.e., from 22nd January, 1909. I will, however, make further inquiries if the hon. Member will furnish me with fuller particulars as to the sum of £l of winch Brummel says he has been refused payment.
asked the Secretary to the Treasury why the pension officer for Glin district, in the county of Limerick, has only attended the meetings of the Glin sub-committee on one occasion since the Old Age Pension Act passed; and whether, as in many cases of applicants for the pension there is no positive evidence of age but the decision is left to the officer's personal judgment of appearances, he would see that the pension officer attends those meetings, so that he would know the reasons that influence the local committee, consisting of a body of representative men of both sects and generally presided over by a clergyman, in coming to a decision in such cases and further give them a voice in those decisions which at present they do not get?
Attendance at the meetings of the local pension committee or sub-committee is the right, but not the duty, of the pension officer (No. 11 (3) of the Statutory Regulations of 1908). I am not prepared to require the officer in question to attend all meetings of the Glin sub-committee as a matter of course, as this would seriously interfere with the regular duties of his station.
Agricultural Organisation Society
asked why the Development Commissioners have made it a condition of their proposed grant to the Agricultural Organisation Society for the purpose of promoting agricultural co-operation in England and Wales, that the society shall cease to be registered under the Industrial and Provident Societies Acts and become incorporated as a company under the Joint Stock Companies Acts; whether such proposed incorporation involves the appointment of directors; and, if so, whether they will be paid salaries, and out of what fund?
I understand that the Development Commissioners thought it desirable that the Agricultural Organisation Society should be incorporated under Section 20 of the Companies (Consolidation) Act, 1908 (not, of course, as an ordinary joint stock company, but as an association not trading for profit), in order to secure that stability of the reorganised constitution and publicity of the accounts and proceedings which the Commissioners deem essential before any con- siderable advances can be recommended for the society to administer. It is not contemplated that the members of the governing body of the association shall be paid any salary.
Does the hon. Gentleman mean to say that there is no stability in the case of those societies, which are very numerous, which have been constituted under the Industrial and Provident Societies Acts?
No, I do not mean to say that.
Poultry Industry
asked whether the Development Commissioners have received any application for or contemplate making any grant out of the Development Fund for the purpose of specialised research work in connection with the poultry industry?
The Development Commissioners have as yet received no application for this purpose. It is understood that such an application is about to be made, and it will, of course, receive full consideration.
Carriage Licence Grants
asked the Chancellor of the Exchequer if he is aware that the county council of Cornwall received from carriage, etc., licences during the year ending 31st March, 1909, the sum of £9,262, and that was the fixed sum which in future would be paid to the county, but in the following year, when the county council had had the full charge of collection, the total received from such licences in the county amounted to £11,661, being an increase of £2,399; if he is aware that in other counties the same inadequacy of the grant compared with the actual receipts of these licences prevails; and will he consider the urgency of making the annual grant equivalent to the average receipts for the previous three years?
I believe it is the case that the yield of these licences was greater in most counties in 1909–10 than in 1908–9. But this does not seem a sufficient reason for altering the arrangement adopted by Parliament last year, and my right hon. Friend is not prepared to assist the ratepayer by transferring a sum from the income of the Road Board in anticipation of the recommendations of the Committee on Imperial and Local Taxation.
Does the hon. Gentleman realise that the increased motor traffic causes increased cost of maintaining the roads and that the local ratepayers have to pay this increased cost?
National Insurance Bill
Medical Qualifications
asked whether a British subject duly qualified in the United States of America to practice the botanic system of medicine under the Medical Act there, and who is now practising in this country, would be entitled to render medical aid under the provisions of the National Insurance Bill?
Such a person would not be a duly qualified medical practitioner unless registered under the Medical Acts; but those Acts entitle persons holding foreign diplomas, which are recognised by the General Medical Council as furnishing a sufficient guarantee of the possession of the requisite knowledge and skill, to be registered without examination.
Botanic Medical College (Southport)
asked whether a person who has undergone a course of study at the Botanic Medical College, Southport, and has obtained a diploma therefrom entitling him to practice the botanic system of medicine, would be considered a duly qualified medical practitioner under the provisions of the National Insurance Bill?
Such a person would not be a duly qualified medical practitioner unless he has passed the examination required by the Medical Acts and been registered under those Acts.
Is the hon. Gentleman aware, in connection with the Botanic Medical College at Southport, that the course of instruction there extends over five years, and that all the subjects which a doctor or medical man is supposed to be versed in are gone through; and in view of the strides that have been made in the departments of medical science is he prepared to reconsider his decision in view of the facts and circumstances?
No. I do not think that that would be recognised by the General Medical Council.
What I want to know is not whether it would be recognised by the General Medical Council, but whether, for the purposes of this Bill, the Government could not make further inquiries to see whether, after all, those whom some people do believe to be and refer to as medical men should not be brought within the scope of the Bill?
I will convey that to my right hon. Friend.
What happens in the case of Christian scientists?
Land Valuation (Ivory Case)
asked if the original valuation and the revised valuation in the Scottish case stated by Mr. Holmes Ivory applied to different areas; and, if so, what the difference was?
The original valuation was in respect of a net area of about 586 square yards, and the amended valuation of about 655 square yards. The inclusion of the additional area which had been formerly excluded changed the character of the site, and secured the permanency of lights for the main building.
Is the hon. Gentleman aware that Mr. Holmes Ivory denies that there was any alteration of the area of the site between the first and second valuations?
No. I have given this reply which was prepared after inquiry.
Has inquiry been made since the Debate?
So I understand.
Valuations (Estate Duty And Increment Duty)
asked the Chancellor of the Exchequer what steps he proposes to take to prevent the valuers of property for Estate Duty making valuations showing a value in excess of the valuation made by the valuers under the Finance-Act who are valuing for Increment Duty; and whether all these valuers are acting under the instructions of the Treasury?
Valuations for Estate Duty purposes of property passing on death, as well as valuations of the same property for the purposes of Part I. of the Finance (1909–10) Act, 1910, are now being made in each case by the same valuer and at the same time, and consequently valuations returned for Death Duty purposes are being adjusted daily by way either of increase or of decrease. All valuers are acting under the instructions of the Commissioners of Inland Revenue.
Is the hon. Gentleman now convinced that this will prevent cases such as were brought to the attention of the Chancellor on his Vote the other day arising in future?
That is the hope and the intention of the reply which I have given.
Finance Bill, 1911–12
asked why the Finance Bill has not been proceeded with in due course?
The Finance Bill will be proceeded with in due course.
Medway Floating Dock
asked the First Lord of the Admiralty, how far the moorings for the new floating dock in the Medway are from Sheerness and Chatham dockyards, respectively; whether it is proposed to convey daily the men working on the floating dock from and to Sheerness or Chatham dockyards; what additional time for the conveying of the workmen will be allowed, and what additional cost of transit will be incurred per week, when the dock is in full work, if the men are brought from Chatham instead of Sheerness?
The moorings are situated 5½ miles from Chatham and 2| miles from Sheerness. The men working on the floating dock will be conveyed daily from and to Chatham dockyard. It is estimated that the men will spend 1½ hours daily in making the journey to and from the dock. If they are employed at work or on the journey beyond the ordinary working hours of the yard, they will be paid for the extra time at the usual rates. The men will be taken from Chatham, and not Sheerness. The estimated additional cost of transit by taking the men from Chatham instead of Sheerness during the annual refit of a battleship is £80 for each week of six days that the dock is actually occupied.
If there is such an increase in expense in working the dock from Chatham, why has Sheerness dockyard been neglected?
The question of expense was very carefully examined, and it was found to cost so much more to equip Sheerness as a dockyard suitable to undertake these refits that on the whole it was decided that it was better to work the dock from Chatham.
Naval Dock Workers (Wages)
asked whether men employed at minimum wage on naval work at Deptford and the West Indian Dock have had their wages increased 1s. a day from 1st April, 1911; if so, whether the First Lord of the Admiralty will state the rate of wage these men are now receiving; and whether he is aware that the minimum wage at Portsmouth for men doing similar work is 21s. a week?
The minimum wage in the London establishments was increased on the 1st April last from 23s. to 24s. a week. The minimum wage at Portsmouth is as stated by the Noble Lord.
Has the minimum wage been increased or not?
The question of the minimum wage depends on various things, among them the cost of living, which in and around London is higher than elsewhere.
Hms "Superb" (Mishap)
asked what was the decision of the court of inquiry held to ascertain the cause of the death of the victims of the mishap on board His Majesty's Ship "Superb" on 30th June, 1911?
The report of a court of inquiry is of a confidential nature, but it may be stated that the death of the men in question was due to asphyxiation by poisonous gas.
Naval Officers And Men (Number)
asked whether the First Lord of the Admiralty's attention has been called to the fact that the total number of officers and men serving on the active list of the Royal Navy down to 15th June last was 131,862, inclusive of the Royal Marines, who number 17,083, and that our Reserves number 24,700; and whether the sixteen cruisers attached to the Fourth Division of the Home Fleet can only be manned by Royal Naval Reserve men after war is declared?
With regard to the first and second parts of the question, the numbers quoted by the Noble Lord as borne on the active list are correct; the numbers quoted for the Reserves, however, are not correct, as there are more than twice that number. The reply to the last part of the question is in the negative.
The right hon. Gentleman having answered these questions, may I ask him why he regards his duties in Grand Committee as prior to those in this House?
I came down in what I hoped would be ample time, but, unfortunately, I found that it was a few minutes after my questions had been passed.
Evicted Tenants Act (Case Of Michael Kavanagn)
asked the Chief Secretary for Ireland if he can state why Michael Kavanagh, a tenant evicted on the estate of Colonel Tighe, county Carlow, has not yet obtained any benefit under the Evicted Tenants Act, although it is more than eight years since he first made art application for reinstatement; and whether the farm of Ballyredmond from which he was evicted has been sold by public auction recently.
The Estates Commissioners inform me that Kavanagh's former holding is in the occupation of another tenant and cannot be acquired compulsorily under the Evicted Tenants Act. His name has been noted for consideration in the allotment of such un-tenanted land as the Commissioners may be able to acquire. Their powers to acquire land are limited to the purchase of lands in fee-simple, and they have no power to bid for a tenant's interest.
Land Purchase (Ireland)
asked why the Estates Commissioners have refused to proceed to acquire the untenanted lands of Raheenbown, county Carlow, on the estate of Mr. C. B. H. Weld; and what objections, if any, the landlord has raised to the sale of such lands?
The Estates Commissioners instituted proceedings with a view to the compulsory acquisition of the lands referred to under the provisions of the Evicted Tenants Acts, 1907, but on consideration of the objections filed by the owner under that Act they decided that the lands could not be compulsorily acquired to provide holdings for evicted tenants.
Business Of The House
Can the Prime Minister inform the House what business he proposes for Thursday and Friday?
The Supply we propose to take on Thursday is the
Division No. 298.]
| AYES.
| [3.37 p.m.
|
| Abraham, William (Dublin Harbour) | Doris, William | Kilbride, Denis |
| Abraham, Rt. Hon. William (Rhondda) | Duffy, William J. | King, Joseph (Somerset, North) |
| Acland, Francis Dyke | Duncan, C. (Barrow-in-Furness) | Lambert, George (Devon, S. Molton) |
| Adamson, William | Duncan, J. Hastings (York, Otley) | Lambert, Richard (Wilts, Cricklade) |
| Addison, Dr. C. | Edwards, Clement (Glamorgan, E.) | Law, Hugh A. (Doneyal, West) |
| Agar-Robartes, Hon. T. C. R. | Edwards, Enoch (Hanley) | Lawson, Sir W. (Cumb'r'ld, Cockerm'th) |
| Ainsworth, John Stirling | Edwards, Sir Francis (Radnor) | Leach, Charles |
| Alden, Percy | Edwards, John Hugh (Glamorgan, Mid) | Levy, Sir Maurice |
| Allen, A. A. (Dumbartonshire) | Elibank, Rt. Hon. Master of | Lewis, John Herbert |
| Armitage, Robert | Elverston, Sir Harold | Lough, Rt. Hon. Thomas |
| Asquith, Rt. Hon. Herbert Henry | Esmonde, Dr. John (Tipperary) | Low, Sir Frederick (Norwich) |
| Atherley-Jones, Llewellyn A. | Esmonde, Sir Thomas (Wexford, N.) | Lundon, Thomas |
| Baker, H. T. (Accrington) | Essex, Richard Walter | Lyell, C. H. |
| Baker, Joseph Allen (Finsbury, E) | Falconer, James | Lynch, Arthur Alfred |
| Balfour, Sir Robert (Lanark) | Farrell, James Patrick | Macdonald, J. Ramsay (Leicester) |
| Baring, Sir Godfrey (Barnstaple) | Ferens, Thomas Robinson | Macdonald, J. M. (Falkirk Burghs) |
| Barlow, Sir John Emmott (Somerset) | Ffrench, Peter | McGhee, Richard |
| Barry, Redmond John (Tyrone, N) | Field, William | Maclean, Donald |
| Barton, William | Gelder, Sir William Alfred | Macnamara, Rt. Hon. Dr. T. J. |
| Beck, Arthur Cecil | George, Rt. Hon. David Lloyd | Macpherson, James Ian |
| Benn, W. (Tower Hamlets, St. Geo.) | Gibson, Sir James Puckering | MacVeagh, Jeremiah |
| Bentham, G. J | Glanville, Harold James | McKenna, Rt. Hon. Reginald |
| Birrell, Rt. Hon. Augustine | Goddard, Sir Daniel Ford | Manfield, Harry |
| Boland, John Pius | Goldstone, Frank | Markham, Sir Arthur Basil |
| Booth, Frederick Handel | Greenwood, Granville G. (Peterborough) | Marshall, Arthur Harold |
| Bowerman, C. W. | Greenwood, Hamar (Sunderland) | Martin, Joseph |
| Brady, Patrick Joseph | Greig, Colonel James William | Mason, David M. (Coventry) |
| Brigg, Sir John | Griffith, Ellis Jones | Masterman, C. F. G. |
| Bryce, J. Annan | Hackett, John | Meagher, Michael |
| Burt, Rt. Hon. Thomas | Hancock, John George | Meehan, Francis E. (Leitrim, N.) |
| Buxton, Rt. Hon. S. C. (Poplar) | Harcourt, Rt. Hon. L. (Rossendale) | Meehan, Patrick A. (Queen's Co.) |
| Byles, Sir William Pollard | Hardie, J. Keir (Merthyr Tydvil) | Millar, James Duncan |
| Cawley, Sir Frederick (Prestwich) | Harmsworth, Cecil (Luton, Beds.) | Molloy, Michael |
| Cawley, H. T. (Lancs., Heywood) | Harvey, A. G. C. (Rochdale) | Molteno, Percy Alport |
| Chancellor, Henry George | Harvey, W. E. (Derbyshire, N.E.) | Mond, Sir Alfred M. |
| Chapple, Dr. William Allen | Haslam, Lewis (Monmouth) | Money, L. G. Chiozza |
| Churchill, Rt. Hon. Winston S. | Havelock-Allan, Sir Henry | Mooney, John J. |
| Clancy, John Joseph | Hayden, John Patrick | Morgan, George Hay |
| Clough, William | Helme, Norval Watson | Morrell, Philip |
| Collins, Stephen (Lambeth) | Herbert, Col. Sir Ivor | Morton, Alpheus Cleophas |
| Compton-Rickett, Rt. Hon. Sir J. | Higham, John Sharp | Munro, Robert |
| Condon, Thomas Joseph | Hinds, John | Munro-Ferguson, Rt. Hon. R. C. |
| Cornwall, Sir Edwin A. | Hodge, John | Murray, Captain Hon. Arthur C. |
| Cotton, William Francis | Holt, Richard Durning | Nannetti, Joseph P. |
| Crawshay-Williams, Eliot | Hope, John Deans (Haddington) | Needham, Christopher T. |
| Crooks, William | Home, C. Silvester (Ipswich) | Nicholson, Charles N. (Doncaster) |
| Crumley, Patrick | Howard, Hon. Geoffrey | Nolan, Joseph |
| Cullinan, John | Hudson, Walter | Norman, Sir Henry |
| Dalziel, Sir James H. (Kirkcaldy) | Hughes, Spencer Leigh | Norton, Captain Cecil W. |
| Davies, David (Montgomery Co.) | Hunter, William (Lanark, Govan) | O'Brien, Patrick (Kilkenny) |
| Davies, Ellis William (Eifion) | Isaacs, Rt. Hon. Sir Rufus | O'Connor, John (Kildare, N.) |
| Davies, Timothy (Lincs., Louth) | Jardine, Sir John (Roxburgh) | O'Doherty, Philip |
| Davies, Sir W. Howell (Bristol, S.) | Johnson, William | O'Donnell, Thomas |
| Davies, M. Vaughan (Cardigan) | Jones, Sir D. Brynmor (Swansea) | O'Dowd, John |
| Dawes, James Arthur | Jones, Edgar (Merthyr Tydvil) | O'Kelly, Edward P. (Wicklow, W.) |
| Delany, William | Jones, H. Haydn (Merioneth) | O'Malley, William |
| Denman, Hon. R. D. | Jones, Leif Stratten (Notts, Rushcliffe) | O'Neill, Dr. Charles (Armagh, S.) |
| Devlin, Joseph | Jones, William (Carnarvonshire) | O'Shaughnessy, P. J. |
| Dewar, Sir J. A. | Jones, W. S. Glyn- (T. H'mts, Stepney) | O'Sullivan, Timothy |
| Dickinson, W. H. | Joyce, Michael | Palmer, Godfrey Mark |
| Dillon, John | Kelly, Edward | Parker, James (Halifax) |
| Donelan, Anthony Charles | Kennedy, Vincent Paul | Pearce, Robert (Staffs, Leek) |
Local Government Board Vote. I will make an announcement about Friday's business to-morrow (Wednesday).
Motion made and Question proposed, "That the Proceedings on the National Insurance Bill, if under discussion at Eleven o'clock this night, be not interrupted under the Standing Order (Sittings of the House)."—[ The, Prime Minister.]
The House divided: Ayes, 260; Noes, 150.
| Pearce, William (Limehouse) | Robinson, Sidney | Thorne, G. R. (Wolverhampton) |
| Pease, Rt. Hon. Joseph A. (Rotherham) | Roch, Walter F. (Pembroke) | Toulmin, Sir George |
| Phillips, John (Longford, S.) | Roche, Augustine (Louth) | Verney, Sir Harry |
| Pointer, Joseph | Roe, Sir Thomas | Wadsworth, J |
| Pollard, Sir George H. | Rose, Sir Charles Day | Walters, John Tudor |
| Ponsonby, Arthur A. W. H. | Rowlands, James | Ward, John (Stoke-upon-Trent) |
| Power, Patrick Joseph | Samuel, Rt. Hon. H. L. (Cleveland) | Ward, W. Dudley (Southampton) |
| Price, C. E. (Edinburgh, Central) | Samuel, J. (Stockton-on-Tees) | Waring, Walter |
| Price, Sir Robert J. (Norfolk, E.) | Scott, A. MacCalium (Glas., Bridgeton) | Warner, Sir Thomas Courtenay |
| Priestley, Sir A. (Grantham) | Seely, Col. Rt. Hon. J. E. B. | Wason, Rt. Hon. E. (Clackmannan) |
| Priestley, Sir W. E. B. (Bradford, E.) | Sheehy, David | Wason, John Cathcart (Orkney) |
| Primrose, Hon. Neil James | Sherwell, Arthur James | White, Sir George (Norfolk) |
| Pringle, William M. R. | Shortt, Edward | White, Sir Luke (Yorks, E.R.) |
| Raffan, Peter Wilson | Simon, Sir John Allsebrook | White, Patrick (Meath, North) |
| Rainy, Adam Rolland | Smith, H. B. Lees (Northampton) | Wiles, Thomas |
| Rea, Rt. Hon. Russell (South Shields) | Smyth, Thomas F. (Leitrim, S.) | Williams, John (Glamorgan) |
| Reddy, Michael | Soames, Arthur Wellesley | William Llewelyn (Carmarthen) |
| Redmond, John E. (Waterford) | Spicer, Sir Albert | Williams, Penry (Middlesbrough) |
| Redmond, William (Clare) | Strachey, Sir Edward | Wilson, J. (Durham, Mid) |
| Rendall, Athelstan | Strauss, Edward A. (Southwark, West) | Wilson, Rt. Hon. J. W. (Worcs., N.) |
| Richards, Thomas | Summers, James Woolley | Wood, Rt. Hon. T. McKinnon (Glasgow) |
| Richardson, Thomas (Whitehaven) | Sutherland, John E. | Yoxall, Sir James Henry |
| Roberts, Charles H. (Lincoln) | Taylor, John W, (Durham) | |
| Roberts, George H. (Norwich) | Taylor, Theodore C. (Radcliffe) | TELLERS FOR THE AYES.—Mr. |
| Roberts, Sir J. H. (Denbighs.) | Tennant, Harold John | Illingworth and Mr. Gulland. |
| Robertson, John M. (Tyneside) | Thomas, Abel (Carmarthen, E.) |
NOES.
| ||
| Agg-Gardner, James Tynte | Falle, Bertram Godfrey | Mount, William Arthur |
| Anson, Rt. Hon. Sir William R. | Fell, Arthur | Newdegate, F. A. |
| Anstruther-Gray, Major William | Fetherstonhaugh, Godfrey | Newman, John R. P. |
| Arkwright, John Stanhope | Fitzroy, Hon. Edward A. | Newton, Harry Kottingham |
| Ashley, Wilfrid W. | Fleming, Valentine | Nield, Herbert |
| Bagot, Lieut.-Colonel J. | Fletcher, John Samuel (Hampstead) | Norton-Griffiths, J. |
| Baird, John Lawrence | Forster, Henry William | Ormsby-Gore, Hon William |
| Baker, Sir Randolf L. (Dorset, N.) | Gardner, Ernest | Parker, Sir Gilbert (Gravesend) |
| Balcarres, Lord | Gilmour, Captain John | Parkes, Ebenezer |
| Balfour, Rt. Hon. A. J. (City, Lond.) | Goldsmith, Frank | Pease, Herbert Pike (Darlington) |
| Banbury, Sir Frederick George | Gordon, Hon. John Edward (Brighton) | Peto, Basil Edward |
| Banner, John S. Harmond | Gordon, John (Londonderry, South) | Pollock, Ernest Murray |
| Barnston, Harry | Greene, W. R. | Pretyman, Ernest George |
| Barrie, H. T. (Londonderry, N.) | Guinness, Hon. Walter Edward | Pryce-Jones, Col. E. |
| Bathurst, Charles (Wilts., Wilton) | Gwynne, R. S. (Sussex, Eastbourne) | Quilter, W. E. C. |
| Beckett, Hon. Gervase | Haddock, George Bahr | Rawlinson, John Frederick Peel |
| Benn, Arthur Shirley (Plymouth) | Hall, Fred (Dulwich) | Rawson, Colonel Richard H. |
| Benn, Ion Hamilton (Greenwich) | Hamersley, Alfred St. George | Remnant, James Farquharson |
| Bennett-Goldney, Francis | Hardy, Rt. Hon. Laurence | Roberts, S. (Sheffield, Ecclesall) |
| Bentinck, Lord Henry Cavendish | Harris, Henry Percy | Rutherford, John (Lancs., Darwen) |
| Beresford, Lord Charles | Harrison-Broadley, H. B. | Sanders, Robert Arthur |
| Bird, Alfred | Henderson, Major H. (Berkshire) | Sanderson, Lancelot |
| Boles, Lieut.-Col. Dennis Fortescue | Hickman, Col. Thomas E. | Sandys, G. J. (Somerset, Wells) |
| Boyle, W. Lewis (Norfolk, Mid) | Hill, Sir Clement L. (Shrewsbury) | Smith, Rt. Hon. F. E. (Liverp'l, Walton) |
| Boyton, James | Hill-Wood, Samuel | Smith, Harord (Warrington) |
| Bridgeman, William Clive | Hoare, Samuel John Gurney | Snowden, Philip |
| Burn, Col. C. R. | Hope, James Fitzalan (Sheffield) | Spear, Sir John Ward |
| Butcher, John George | Home, William E. (Surrey, Guildford) | Stanley, Hon. Arthur (Ormskirk) |
| Campbell, Rt. Hon. J. H. M. | Horner, Andrew Long | Starkey, John Ralph |
| Campion, W. R. | Houston, Robert Paterson | Stewart, Gershom |
| Carlile, Sir Edward Hildred | Hunter, Sir Charles Rodk. (Bath) | Sykes, Mark (Hull, Central) |
| Carson, Rt. Hon. Sir Edward H. | Ingleby, Holcombe | Talbot, Lord Edmund |
| Cassel, Felix | Joynson-Hicks, William | Thompson, Robert (Belfast, North) |
| Castlereagh, Viscount | Kebty-Fletcher, J. R. | Thomson, W. Mitchell- (Down, North) |
| Cautley, Henry Strother | Kerry, Earl of | Thorne, William (West Ham) |
| Cave, George | Kinloch-Cooke, Sir Clement | Tobin, Alfred Aspinall |
| Cecil, Evelyn (Aston Manor) | Kyffin-Taylor, G. | Tryon, Captain George Clement |
| Cecil, Lord Hugh (Oxford University) | Lane-Fox, G. R. | Tullibardine, Marquess of |
| Chaloner, Col. R. G. W. | Lansbury, George | Valentia, Viscount |
| Chamberlain, Rt. Hon. J. A. (Worcr.) | Law, Rt. Hon. A. Bonar (Bootle) | Walker, Col. William Hall |
| Chambers, James | Lawson, Hon. H. (T. H'mts., Mile End) | Walsh, Stephen (Lancs., Ince) |
| Chaplin, Rt. Hon. Henry | Lee, Arthur Hamilton | Wheler, Granville C. H. |
| Clive, Captain Percy Archer | Lloyd, George Ambrose | White, Major G. D. (Lancs., Southport) |
| Cooper, Richard Ashmole | Locker-Lampson, G. (Salisbury) | Willoughby, Major Hon. Claude |
| Courthope, George Loyd | Lockwood, Rt. Hon. Lt.-Col. A. R. | Wilson, W. T. (Westhoughton) |
| Craik, Sir Henry | Lyttelton, Rt. Hon. A. (S. Geo. Han. S.) | Wolmer, Viscount |
| Dickson, Rt. Hon. C. Scott | McNeill, Ronald (Kent, St. Augustine) | Wood, John (Stalybridge) |
| Dixon, Charles Harvey | Magnus, Sir Philip | Younger, Sir George |
| Duke, Henry Edward | Wallaby-Deely, Harry | |
| Eyres-Monsell, Bolton M. | Mason, James F. (Windsor) | TELLERS FOR THE NOES.—Mr. Arnold Ward and Earl of Ronaldshay. |
| Faber, Captain W. V. (Hants, W.) | Morrison-Bell, Major A. C. (Honiton) | |
National Insurance Bill
Further Considered in Committee.
(IN THE COMMITTEE.)
[Mr. EMMOTT in the Chair.]
Clause 12—(Provisions In The Case Of Contributors Who Are Inmates Of Hospitals, Etc)
(1) No payment shall be made in respect of sickness disablement or maternity benefit of any insured person during any period when he is an inmate of any workhouse, hospital, asylum, or infirmary, supported by any public authority or out of any public funds or by a charity, or of a sanatorium or similar institution established under this Part of this Act.
(2) During such period as aforesaid any such benefit which would otherwise have been payable to such person—
(3) For the purpose of this Section, the expression "dependents" shall include such of the following members of the insured person's family as are wholly or in part dependent upon the earnings of such person at the time when he became an inmate of any such institution as aforesaid—that is to say, his or her wife or husband, father, mother, grandfather, grandmother, stepfather, stepmother, son, daughter, grandson, granddaughter, stepson, stepdaughter, brother, sister, half-brother, half-sister.
(4) The society or committee by which the sickness, disablement, or maternity benefit of any insured persons is administered, may enter into any agreement with the proper officers or authorities of any convalescent home or sanatorium, admission to which is conditional on the payment of the whole or any part not less than one half of the cost of maintenance, for the payment thereto of any sickness, disablement, or maternity benefit which would, apart from this Section, be payable to or in respect of any such person who becomes an inmate of such home, during any period for which he remains an inmate.
Amendment proposed [ 31st July] in Subsection (2), after paragraph (6), to insert the words "or
( c) if such person is an inmate of a hospital or infirmary supported by charity and has no dependents, shall, if an agreement for the purpose has been made with the hospital or infirmary, be paid in whole or in part according to such agreement towards the maintenance of such person in the hospital or infirmary;
Provided that in the case of a married woman or widow who is entitled to sickness benefit in addition to maternity benefit no part of the maternity benefit shall be paid or applied for the relief or maintenance of her dependents, but may be paid to the hospital or infirmary of which she is an inmate as aforesaid in like manner as if she had no dependents."—[ Mr. Lloyd George.]
Question again proposed, "That those words be there inserted."
I should like to withdraw this Amendment.
Amendment, by leave, withdrawn.
I beg to move, in Sub-section (2), after the end of paragraph (b), to insert the words "unless such person is not a member of an approved society."
I have looked into the matter that was raised last night by the hon. and learned Member (Mr. Cassel). I think there is something in his criticism, as far as paragraph (b) is concerned, but not so far as paragraph (a) is concerned. Under paragraph (a) the Post Office contributor is not to be drawn upon at all, and the fund would not be impoverished by a single penny by the operation of paragraph (a). Paragraph (b) is rather different, because it provides:— "If such person is an inmate of a sanatorium or similar institution in which he is receiving treatment in accordance with the provisions of this part of this Act, and has no dependents, shall be paid to the local health committee towards the general purposes thereof." Undoubtedly the hon. and learned Gentleman is right in respect of paragraph (b) in so far as it affects the deposit contributors, because during the time they are in the sanatorium the whole of their fund to the extent of 10s, per week would be paid over to the sanatorium, and by the time they left the institution they would find they would have nothing to draw upon, and that the whole of their fund has been exhausted in paying benefits to that particular institution. I agree with the hon. and learned Member that that is not fair, and I do not think it is all desirable. That is not the case with the member of an approved society. It does not matter to him, because when he leaves the institution his fund is not impoverished. Therefore I withdraw the previous Amendment in order to meet the case, and I propose the Amendment now before the Committee, which means that the benefits of the Post Office contributor would not be drawn upon during the time he is in the sanatorium.The words meet the point I raised. I agree with the Chancellor of the Exchequer that does not apply to paragraph (a). The other point which I raised, and which the Attorney-General told me he would give me an opportunity of dealing with at a later stage, is not met by the new Amendment. I handed in a fresh Amendment to deal with that, but so long as it is understood that the point has not been disposed of, I agree that this Amendment meets the particular point in regard to deposit contributors.
Amendment agreed to.
I beg to move, after the words last inserted, to insert the words "or
(c) if such person, being a member of an approved society, is an inmate of a hospital or infirmary supported by charity or by voluntary subscriptions, and has no dependents, shall, if an agreement for the purpose has been made between the society or committee and the hospital or infirmary, be paid in whole or in part according to such agreement towards the maintenance of such person in the hospital or infirmary; "Provided that in the case of a married woman or widow who is entitled to sickness benefit in addition to maternity benefit no part of the sum which would otherwise be payable on account of maternity benefit shall be paid or applied for the relief or maintenance of her dependents, but such sum may be paid to the hospital or infirmary of which she is an inmate as aforesaid in like manner as if she had no dependents." We have made an alteration, in response to a criticism from an hon. Member below the Gangway, to make it perfectly clear what "agreement" means. We have made it quite clear, that the agreement is between the society and the hospital. The second point we want to make clear is that we are confining the payment to members of approved societies.I beg to move, as an Amendment to the proposed Amendment, after the word "hospital" ["inmate of a hospital"], to insert the words "convalescent home."
We will accept that.
Amendment to the proposed Amendment agreed to.
Further Amendment in the proposed Amendment made. After the word "hospital" ["Committee and the hospital"], insert the words, "convalescent home." —[ Mr. Austen Chamberlain.]
I beg to move as an Amendment to the proposed Amendment, after the word "infirmary" ["between the society or committee and the hospital or infirmary"] to insert the words, "with the authority of such person."
Unquestionably the Amendment proposed by the Chancellor of the Exchequer is a great improvement upon the words of the Bill. The right hon. Gentleman evidently assumes that the mere fact that it is an approved society that must make the agreement with the hospital or infirmary is sufficient protection. I think that at least the man himself ought to be consulted in the matter. I did not understand that the proposal was really to subsidise these institutions or almost to fasten them on to the fund contributed by the workmen under this Bill, but that is practically what it amounts to. I think that the man who has had part of his wages stopped for the purpose of providing this benefit ought to have a voice in deciding whether or not an agreement should be made between the society of which he is a member and the hospital. The present proposal is a great improvement, because it distinctly states that, where a man is a member of an approved society, unless the approved society makes the arrangement the deduction is not necessarily to be made. At the same time I think the man himself should decide whether his benefit may be taken in this way, and for that reason I move this Amendment. We have heard a great deal of talk about the necessity for protecting the rights of minorities in relation to other matters connected with societies of this description. A ballot might be taken as to whether the members of an approved society were in favour of such an agreement Being made, and a member might vote against it. Yet if misfortune in the shape of an illness or an accident overtook him, necessitating his becoming an inmate of a hospital or an infirmary, although he had protested and voted against the arrangement the institution would be entitled at once to take the benefit he is supposed to have secured. I do not think that that is quite fair; therefore, I move the insertion of these words.4.0 P.M.
I hope my hon. Friend will not press his Amendment; it renders the whole of this other Amendment quite nugatory. After all the inmates of the hospital would not under any conditions receive the benefit; it has been decided that the benefit is only to be paid to the inmate's dependents, because if he is in the hospital his maintenance there, the care that he receives, and so on, means a good deal more money being spent on him than the 10s. Under those conditions, I think the very least that can be done to the hospitals, where there are no charges, that whatever benefit the man is receiving from his society should be paid to the hospital. Yesterday the Committee decided that if he had dependents no part of the money should go to the hospital, but the whole of it to the dependents. When he has no dependents at all I think the money ought to go to the hospitals.
The case I was particularly referring to is one in which a young fellow has no one dependent upon him. At the same time he has got some little property, and it is necessary for him to hold that together in some way. A few shillings at least must be devoted to that purpose—a shilling or two shillings, it may be. Then there is his previous lodgings. To say that the Committee should absolutely hand over all to some institution, and that he should not be in a position, as it were, to maintain some sort of place like that, some place that he could go to the moment he comes out, is I think somewhat unfair. I am not against the hospital. It is against that sort of thing that I have referred to.
That sort of case is covered. It has been taken into account. A case of that kind I have no doubt will be considered.
I have very great pleasure in supporting the Amendment of my hon. Friend the Member for Stoke. I would go a little further even than he does. I think it is very hard upon a young man who is compelled to contribute 4d. per week under this Bill, and also to contribute, as they do in thousands and thousands of eases, to the hospitals. I gave cases yesterday within my own knowledge where all the young men employed in the works are compelled to contribute towards the maintenance of the hospital, where they have a right to go into in cases of illness. In the case of the young man going into the hospital, I think it is very unfair that he should have these benefits deducted by the approved committee and the hospital in the case such as has been suggested. Let me give a case of a young man under the Bill. As a boy starting work, say, at the age of fourteen years, he pays up till sixteen without any benefit. From sixteen up to twenty-one, if he has no dependents, he gets 5s. per week. From the age of twenty-one he gets full benefits.
Let me put the case in this way:—Supposing that that young man has been contributing from the age of fourteen up to the age of forty under this Bill towards the maintenance of the hospitals where he would have the right to go into in the case of illness; I want to know what right anyone has to deduct from him the benefits under this Bill? I contend that that man, if he has no dependents, has a right to obtain the benefit if he has contributed towards the maintenance of the hospital. Let me put it in another way. If he is a member of a friendly society, the Foresters or Hearts of Oak, or any other society, he will, as a matter of right, be entitled to his benefit. They would not think of deducting anything from the amount of benefit for his maintenance in hospital; and I contend, Mr. Emmott, that we ought to place men who do maintain hospitals upon the same footing under this Bill. I can quite understand the matter with regard to London. As I pointed out yesterday the Chancellor of the Exchequer, who has had a deputation from the London Committee ——It was introduced by a provincial hospital trustee, a Manchester representative. There were only one or two gentlemen from London, the rest were all from the provinces.
I am sorry, but I read that Mr. Holland had made a certain statement. But what I contend is this: So far as a large number of the provincial towns are concerned, they are governed entirely upon a different system from London. The fact is that men are very much surprised when they come to London to receive begging circulars. We have no begging circulars. Our hospitals are well maintained. They have plenty of money. They are well contributed to by the working men. Where, under this scheme, the miner, the iron worker, the shipyard man, and the engineer, contributes to the maintenance of the hospital, whether it is a fever hospital, a small-pox hospital, a surgical, or a general hospital. I hold that under this Bill no power should be given whatever, if a man has no dependents, to deprive him of his benefit. He may, under this Bill, pay from the time that he is fourteen to the time that he is forty. If he is then stricken down with cancer, say, if he is taken into hospital for an operation, he will have his benefits that he has paid for, deducted from him. I say I hope the Chancellor of the Exchequer will reconsider this matter, and that he will put words into this Clause to the effect that where a man is a contributor, that he shall be exempt, whether he has dependents or not. I think that would be a much fairer system under which to place the Bill before the working men of this country. I want, further, to say that I am a strong believer in this Bill. I am a defender of it, both publicly and privately. But it is very hard, I confess, especially to go before my Constituents, knowing as I do that they are contributors, and handsome contributors, towards the maintenance of the hospital, and defend a Clause like this. I hope the Chancellor of the Exchequer will listen to the appeal and put in a proviso that where a man is a contributor he is exempt from this Clause.
I do not think the hon. Gentleman who has last spoken was quite right in his facts with regard to the existing practice of friendly societies. As I understand it, the existing practice of friendly societies is that where a man who is in benefit is in a hospital or an infirmary which is maintained at the public expense, he does not get his benefit money. That is quite contrary to what the hon. Gentleman has just told us. That is really the intention, of this Clause—that where a member of a friendly society is at a hospital which is maintained out of the rates, a town infirmary or so forth, he does not get the benefit money to which he would otherwise be entitled. There is a paper issued by the Manchester Unity on this very point. They say:—
This is in accordance with the approved rules of the Manchester Unity. So far as this Clause has gone it is in accordance with the principles of the Manchester Unity. We yesterday decided that where a man is taken to a public hospital or infirmary he is not to have the money which he is otherwise entitled to; either it has to go to his dependents or to the hospital. The sole question for us to-day is as to whether a hospital provided for from voluntary sources is to be treated differently from the hospital which is provided for out of the rates. Let us see the ridiculous position which we will be put in if we do not accept this or some similar Amendment. Two men receive an accident in a town. Both are members of approved societies. One of them is taken to the town infirmary, and there so long as he is in that infirmary, being maintained out of the rates, under the Clause as we have already passed it, he gets no benefits."It is agreed that where a member is maintained out of public funds, he shall not be entitled to sick pay, unless he has dependents upon him."
You mean the workhouse infirmary?
No, no. The ordinary Town hospital maintained out of public funds.
They are maintained by private subscriptions.
Where they are maintained by private subscriptions—that is the point! We are dealing with that one. The hon. Member I think yesterday told us that a large number of hospitals were not maintained by voluntary subscriptions.
I was referring to the fever hospitals and small-pox hospitals, not the surgical or general hospitals. These latter are maintained by private subscriptions, and not out of the rates.
Very good, very good. Let us be perfectly clear. I think I understood what the hon. Member was saying yesterday. Two men, let us say, in one town are stricken down, one by typhoid fever, whilst the other breaks his leg. The one stricken down by typhoid fever goes to the ordinary infirmary, where he is maintained out of the rates. In that case he will get no benefit under this Bill. The other man, whose leg has been broken, goes to the voluntary hospital, and the hon. Member suggests that he should get the benefit and that the man who has got the fever should not. Those are the facts. Surely——
I only claim that where a man has been a contributor— where the approved society helps to maintain the hospital—then I contend that that man ought to be exempt.
How are we to find that out? The hon. Member suggests that where a man has been a contributor! You will have to ask whether a man has ever given 1d. or 1s. to the hospital. It is impossible to know whether a man is a contributor. Probably the man who is a ratepayer pays more to the infirmary than the man who pays 1d. a month by way of voluntary subscriptions. Yet the man who is a ratepayer does not get benefit. This is the principle of it. I think this Clause should be supported upon the main principles of the working of ordinary friendly societies to-day. It would be impossible though, I submit to the Committee that a man who has voluntarily subscribed to a hospital should have an extra benefit against the man who goes to an ordinary fever hospital. Under these circumstances, I do not think it is possible to support the Amendment of the hon. Gentleman the Member for Stoke. The Clause, or some such Clause, as the Chancellor has put before us, must be carried in order to put the two classes of hospitals and the benefits derived by the two men, the one who has the fever and the other who has received the accident, exactly on the same lines.
I am very unwilling to take the time of the House, but as this is my first speech on this Bill in this House, perhaps the Committee will bear with me for a few moments. I am, like my hon. Friend behind, a very earnest supporter of this Bill, but I am as anxious as hon. Gentlemen who sit below the Gangway and in other parts of the House to see it improved. I shall vote for this Amendment if the Chancellor of the Exchequer pushes it to a Division, but I confess at once that I do not like it one bit. I am thinking not so much of class interest as I am of the sick man and the sick woman. You make them contribute to this scheme. They have no choice. They are obliged to do it. Then you take from them the benefits which I hold they ought to have under certain circumstances. When you have taken those benefits from them, you give them no right of decision as to where their money shall be paid. Shall I be in order to ask about further restrictions? Look at the restrictions already placed upon sick men or sick women. First of all we decided yesterday that when a man is in an institution he shall not receive any of his sick benefit. When his wife is confined, this Bill will prevent her getting the maternity benefit in cash.
dissented.
I shall be very glad to know that I am wrong, and that I have misunderstood the Bill, but if I understand it correctly, she is not to have in cash the maternity benefit. It is to be expended for her by someone; but I shall be delighted to know that I am wrong. In this Amendment you have further restrictions. Even if these women were in an institution and even if they had dependents they are not to have any sick benefit. There may be children and others in the home who sadly need this money, yet they are not to have it. You also compel a sick man when he gets back to work to pay, not only his own subscription, but the employer's subscription also, and you make him contribute to sanatoria, to hospitals, and to infirmaries. I am one of those who think that hospitals ought to be supported, and I agree entirely with the hon. Member who said we ought to face this question of the hospitals and not leave them any longer dependent upon charity; but we certainly ought not to make these hospitals receive their support out of the sick pay which is due to the sick man.
I am sorry to interfere with the hon. Member, but he is speaking now on the Amendment of the Chancellor of the Exchequer. I think that it would be better for him to deal with the Amendment to the Amendment, and he might speak later on upon the Amendment of the Chancellor.
I was afraid, Mr. Emmott, you would call me to order, but I was trying to show that under this Amendment of the Chancellor you are making a man contribute to these various institutions, and I was trying to show that you have already made a man who suffers an accident contribute 1s. for every 10s. paid him in sick benefit. That is a very serious matter, and does not seem quite right. I think it would be better to give a little more consideration to the sick father and mother and less to class interests. We think of the doctors and the friendly societies and the convalescent homes, but we think very little about the person who is suffering. I hope the Chancellor will not push this to a vote, but if he does I will vote with him.
I cannot help thinking that the hon. Member for Stockton and the hon. Member who has just sat down have not quite appreciated the effect of this Amendment. Both hon. Members base their arguments upon this, that we are making the insured person contribute to these institutions. [HON. MEMBERS: "No, no."] That was what the last hon. Member said just now, and that, therefore, you should not allow the distribution to be made between the committee and the institution without the man concerned being consulted. If we look at the Amendment proposed by the Chancellor of the Exchequer we see it is confined to hospitals, convalescent homes, and infirmaries supported by charity or voluntary subscription. These are not the institutions to which an insured person is bound to contribute by this Bill at all; they are outside this Bill altogether, and, therefore, it seems to me that the arguments put forward by hon. Members opposite are not applicable to this new Section at all. If an insured person is treated in an infirmary or convalescent home which is supported entirely by voluntary subscription or by charitable people to which he is not a subscriber at all, and if there is a fund which is applicable to that purpose, is it not fair that some part of it, at all events, should be allocated to the hospital? If it turned out that that individual or insured person was a voluntary subscriber to the hospital—and that is the point which the hon. Member for Stockton makes—do not hon. Members think it would be perfectly safe to leave that matter in the hands of the local health committee and the institution? They would take into consideration that he was a man who had been a subscriber, and if that was so we may be perfectly certain no reduction would be made.
The hon. Member who spoke last really put his finger upon an important point. I take it that the Amendment under discussion is, that the subscription of the man should be reserved, that a particular majority that may have decided in circumstances of which he had no knowledge shall not be entitled to take away the man's discretion and right of saying how his money shall be devoted or what shall become of the benefit to which he is entitled. I have in my mind the case of the Royal Albert Edward Infirmary at Wigan. That infirmary supplies the needs of a population of not less than 40,000 people. There are deductions made every week for that institution from the wages of the colliery workers top and bottom. That deduction is made from the wages of tens of thousands of men, yet it is a voluntary institution. There is no compulsion, but yet they pay. In fact, I think I may say that probably after all it is the highest form of compulsion, because there is not a single person, men, women, and children for miles around that refuse to pay their penny towards that infirmary, and those very people who may have been paying for twenty or twenty-five years, and who never may be at a meeting at which it was determined that their benefits should be allocated may be deprived of a portion of their sick pay. There is not the slightest doubt that the approved societies will meet under conditions that will make it very difficult for the vast body of contributors to attend, and therefore decisions may be arrived at upon points as to how the money shall be allocated to this fund in respect to persons and without their knowledge who have already paid to these institutions for a quarter of a century, and their money may be allocated at the very time when they themselves need it most and require the benefits to which they are entitled under this Bill. I believe the Chancellor of the Exchequer has not taken that kind of case into consideration. This infirmary of which I speak is not one of the ordinary big institutions; it is dependent upon the pennies per week willingly given by the coal miners, and it gets this money more regularly than any other institution in the country. At the same time, it is a voluntary institution. No one would say the payment is compulsory, yet the boys in the mines and the girls upon the pit hills who pay this money, any one of them overtaken by accident might find their benefits under this Bill allocated under conditions over which they have no control. This Amendment reserves to the sick person an unquestioned right which they possess. Why that right should be forfeited or taken away simply because the approved society or local health committee determine it, I cannot understand. I shall have great pleasure therefore in voting with my colleagues in favour of this Amendment.
I want to know what it is we are really discussing? As I look at the Bill, we decided yesterday that the amount of the sick benefit shall not be paid to the insured person in certain circumstances, hon. Members think it may be if this Amendment is carried.
I understand it is paid over to the committee of the infirmary— that is that the sick pay the man is receiving is to be paid over, and therefore that a man will lose the sick pay which he should receive.
It is not a fact that the money is taken from him. There are thirteen weeks in which he loses nothing at all, but the hospital in which he is a patient, benefits.
I think there is some misunderstanding between the general hospital and the infirmary, especially as they exist in the North of England. In the North of England the infirmary hospitals had a meeting the other day at which it was publicly stated that 75 per cent. of the subscriptions of these hospitals came from the workers. The system under which we run these hospitals is that the workers subscribe one penny a week; they appoint representatives from each works upon the house committee of these infirmaries, and they are entitled to so many tickets in accordance with the amounts of the subscriptions they pay. These tickets are not charity tickets, they are tickets paid for, and they are the workmen's by right, and therefore I say that to deduct anything from the holder of a ticket of that sort is unfair. If my hon. Friend the Member for Stoke goes to a Division I shall have pleasure in voting with him.
The hon. Member for Kingston (Mr. Cave) has stated that the whole of this question was decided yesterday. If that be so I regret the decision, but I did not understand that it was so. I think the real central point raised originally by the proposal to omit the words "or by charity" was reserved for discussion today by the Amendment of the Chancellor of the Exchequer. I understand the Mover of the Amendment under discussion also thinks that was so, and his desire is that the decision should be left to the contributor. I take a rather old-fashioned view of this matter. I speak entirely for myself, and I am not in harmony with those who sit behind me, but that is not only my view, but it is also the view I promised to lay before the House. It is a fact that members of friendly societies in the past received their sick pay when in hospitals not supported by public funds. At any rate, it was so in some cases. I am so informed by the friendly societies, and I believe what they tell me, and on that ground alone I think a man entering into such a contract as he does under this Bill, ought not to be lightly deprived of the benefit of that contract. But there are cases of people who in addition to having paid to friendly societies are also voluntary contributors to hospitals. If these two conditions prevail, surely we have to consider whether it is desirable that such a man should be deprived of the benefits which he is entitled to expect; and the other question, namely, whether it is necessary to this Bill that that which is on the face of it undesirable should be done. My opinion of it is that it should not be done, and unless a strong case is made out showing that it is necessary that it should be done, I shall vote for the view which I have undertaken to lay before the Committee.
I desire to support what the hon. Member for Middlesbrough has said. I speak also from close knowledge of these infirmaries. I am connected with the largest industrial ironworks and colliery works in the country, employing over 50,000 men. We have in connection with these works hospitals which the men support. One penny per week is deducted from their wages for the upkeep of these hospitals. It is a voluntary contribution, although it is deducted from the men's wages in the office. If any man refused to pay the contribution he could do so and no one would blame him. It is absolutely cheerfully, and voluntarily, given. The men pay for all the expenses of the hospital. The directors of the company pay nothing. It is absolutely in the control of the men who pay, and if they have accidents, or are ill, they go to their hospital and have the best medical attendance that can be secured for them. That is only one instance of many in my own business experience. I say that these men have, for years and years, provided for the expenses of that hospital, and it would be absurd to take away from them the benefit of the 10s. a week. I am sure the Chancellor of the Exchequer does not know of these institutions. I say therefore that in a case of that kind the workman is as much entitled to 10s. a week when ill (though he is in hospital) as if he wore in——
The question is whether the worker is to have any say as to the agreement made between the hospital and the society.
I support the hon. Member for Stoke on the ground that he would require that contributors in large works should receive for their contributions what they are now receiving. I know that in the city of Bristol—and that part of Bristol which I particularly represent— there are many very large works in which many thousands of men and women contribute weekly funds for the general hospital. The result is that the firm has a very large number of in-patients' votes sent to it. If these workers (who may be members of approved societies and have been regularly contributing in the ordinary way for the support of the hospital), when the occasion comes, go to the firm for a vote, it does seem to me they ought to have some voice in asking for the contribution they would receive under the approved societies. I am convinced that if these people who are now giving these voluntary contributions are not to receive some personal benefit they will lose——
This really does not arise. I have explained what the Amendment is about, and the hon. Member is not keeping to it.
The criticism of this new Amendment is largely based on a confusion between sickness and medical benefits. What is this penny a week being paid for? Is it being paid for medical attendance or maintenance of the man, his wife, and family, and the upkeep of the home? This Section relates solely to sickness disablement and maternity benefit. It has nothing to do with medical benefit. I venture to submit to the Committee that it is only fair that, while a hospital maintains a man who has no dependents—that is to say, supplies him with the equivalent of his wages—it is right the hospital should obtain whole or part of this sickness benefit. It is not medical benefit you are dealing with. The medical benefit is in no way applied towards the maintenance of this individual in the hospital. So far as the argument of the hon. Member for Stoke is concerned I agree that if you are. through this sickness benefit, contributing towards the maintenance of the man, his family, and home, the home cannot be properly maintained in his absence, and that some proportion of this should go to the maintenance of the home. I venture to suggest this is perfectly fair. This applies only to the inmate of the hospital. The hospital is maintaining the man entirely, and is doing for him what he would be doing for himself out of his wages. I think it is a very fair Amendment.
This grievance, this hardship, seems more imaginary than real. If you analyse the case fully you will find it is not even a theoretical grievance or hardship, for you are dealing with the case of a man who has no dependents. When this man is in hospital he is receiving additional benefits to those provided by the Act. Of the benefits provided by the Act, he is receiving medical attendance and medicine in the hospital. But he is also receiving board and lodgings. He is receiving shelter and food, and these are not provided in the Act. It is only reasonable the man should pay for this; that he should pay for the board and lodging he is receiving in an institution which is not supported out of public funds. Now there is a supposition that he has been contributing to this hospital for years. That is not affected by this Amendment, which does not propose to rule out such a man, and the point to which the hon. Member referred is one which ought to be raised by a separate Amendment. It is not raised by this Amendment.
I think it is very difficult to consider one Amendment without considering another. I, for one, am decidedly opposed to any use of any part of this fund for charitable purposes. It is an insurance fund set up by the contributions of the workmen. If we take Sub-section (a) it is true we deny the sickness benefit to the man, but we give it to his dependents. In Sub-section (b) we deny it to the man, but we give it to the general insurance fund. We now propose, if a man has no dependents to take the money out of the Insurance Fund. That is a new feature of the Bill. That is the reason why I object to this Sub-section.
We are only on the Amendment to the Amendment. Let us settle that.
I pointed that out at the beginning of my remarks. I shall support the Amendment of the hon. Member as a means of opposing the new Sub-section.
I support the Amendment with a view to finally opposing the whole Clause. It seems quite
Division No. 299.]
| AYES.
| [4.45 p.m.
|
| Abraham, Rt. Han. William (Rhondda) | Gwynne, R. S. (Sussex, Eastbourne) | O'Grady, James |
| Adamson, William | Hamilton, Marquess of (Londonderry) | Palmer, Godfrey Mark |
| Agg-Gardner, James Tynte | Hancock, John George | Parker, James (Halifax) |
| Archer-Shee, Major M. | Hardie, J. Keir (Merthyr Tydvil) | Parkes, Ebenezer |
| Ashley, W. W. | Hardy, Rt. Hon. Laurence | Peel, Captain R. F. (Woodbridge) |
| Bagot, Lieut. Colonel J. | Harvey, W. E. (Derbyshire, N. E.) | Pointer, Joseph |
| Baker, Sir R. L. (Dorset, N.) | Henderson, Major H. (Berks, Abingdon) | Pollock, Ernest Murray |
| Balcarres, Lord | Hickman, Colonel Thomas E. | Price, C. E. (Edinburgh, Central) |
| Banbury, Sir Frederick George | Hill-Wood, Samuel | Richards, Thomas |
| Barnes, George N. | Hoare, Samuel John Gurney | Richardson, Thomas (Whitehaven) |
| Barnston, H. | Hodge, John | Rolleston, Sir John |
| Bennett-Goldney, Francis | Hohler, G. F. | Rothschild, Lionel D. |
| Bird, Alfred | Holt, Richard Durning | Samuel, Sir Harry (Norwood) |
| Boles, Lieut.-Col. Dennis Fortescue | Home, Charles Silvester (Ipswich) | Samuel, J. (Stockton-on-Tees) |
| Bowerman, C. W. | Hudson, Walter | Sanders, Robert A. |
| Boyle, W. Lewis (Norfolk, Mid) | Hunt, Rowland | Sandys, G. J. (Somerset, Wells) |
| Burn, Col. C. R. | Jessel, Captain Herbert M. | Smith, Rt. Hon. F. E. (Liverp'l, Walton) |
| Butcher, John George | Johnson, W. | Snowden, Philip |
| Campion, W. R. | Jowett, Frederick William | Stewart, Gershom |
| Castlereagh, Viscount | Kebty-Fletcher, J. R. | Sykes, Alan John (Ches., Knutsford) |
| Cautley, Henry Strother | Kinloch-Cooke, Sir Clement | Sykes, Mark (Hull, Central) |
| Cecil, Lord Hugh (Oxford University) | Kirkwood, John H. M. | Taylor, John W. (Durham) |
| Clive, Captain Percy Archer | Kyffin-Taylor, G | Thomas, James Henry (Derby) |
| Cooper, Richard Ashmole | Lane-Fox, G. R. | Thomson, W. Mitchell (Down, North) |
| Cripps, Sir Charles Alfred | Lansbury, George | Thorne, William (West Ham) |
| Crooks, William | Lloyd, George Ambrose | Tobin, Alfred Aspinall |
| Davies, Sir W. Howell (Bristol, S.) | Locker-Lampson, G. (Salisbury) | Toulmin, Sir George |
| Dixon, C. H. | Locker-Lampson, O. (Ramsey) | Tryon, Captain George Clement |
| Duke, Henry Edward | Low, Sir Frederick (Norwich) | Wadsworth, John |
| Duncan, C. (Barrow-in-Furness) | Macdonald, J. Ramsay (Leicester) | Walker, Colonel William Hall |
| Edwards, Enoch (Hanley) | Mackinder, Halford J. | Walsh, Stephen (Lancs., Ince) |
| Eyres-Monsell, Bolton M. | M'Laren, Walter S. B. (Ches., Crewe) | Wheler, Granville C. H. |
| Faber, George D. (Clapham) | McNeill, Ronald (Kent, St. Augustine) | White, Major G. D. (Lancs., Southport) |
| Falle, Bertram Godfray | Mallaby-Deely, Harry | Williams, John (Glamorgan) |
| Fell, Arthur | Martin, Joseph | Williams. P. (Middlesbrough) |
| Fetherstonhaugh, Godfrey | Mason, James F. (Windsor) | Wilson, W. T. (Westhoughton) |
| Fitzroy, Hon. Edward A. | Molteno, Percy Alport | Wolmer, Viscount |
| Fleming, Valentine | Money, L. G. Chiozza | Wood, John (Stalybridge) |
| Forster, Henry William | Morrell, Philip | Worthington-Evans, L. |
| Foster, Philip Staveley | Needham, Christopher T. | Wyndham, Rt. Hon. George |
| Gardner, Ernest | Neville, Reginald J. N. | |
| Goldman, Charles Sydney | Newdegate, F. A. | TELLERS FOR THE AYES.—Mr. John Ward and Mr. G. Roberts. |
| Goldstone, Frank | Newman, John R. P. | |
| Gordon, Hon. John Edward (Brighton) | Norton-Griffiths, J. (Wednesbury) |
NOES.
| ||
| Abraham, William (Dublin Harbour) | Asquith, Rt. Hon. Herbert Henry | Barrie, H. T. (Londonderry, N.) |
| Acland, Francis Dyke | Atherley-Jones, Llewellyn A. | Barry, Redmond J. (Tyrone, N.) |
| Addison, Dr. C. | Baird, J. L. | Barton, William |
| Agar-Robartes, Hon. T. C. R. | Baker, H. T. (Accrington) | Bathurst, Charles (Wilts, Wilton) |
| Ainsworth, John Stirling | Baker, Joseph Allen (Finsbury, E.) | Beck, Arthur Cecil |
| Alden, Percy | Balfour, Sir Robert (Lanark) | Beckett, Hon. Gervase |
| Alien, Charles P. (Stroud) | Baring, Sir Godfrey (Barnstaple) | Benn, W. VV. (T. H'mts., St. George) |
| Anstruther-Gray, Major William | Barlow, Sir George Emmott (Somerset) | Bentham, George Jackson |
| Armitage, Robert | Barran, sir John N. (Hawick B.) | Bethell, Sir John Henry |
unjustifiable to take money subscribed for insurance purposes and to apply it to other purposes. I admit that subscriptions have got to be got for hospitals, but to take money from this fund and to apply it to hospitals is not business at all. It is proved it is not business, for if when a man has dependents it is not to be taken, when a man has no dependents it should not be taken. A man, whether he has dependents or not, pays the same contributions, and the Chancellor of the Exchequer is mixing up charity with business.
Question put, "That those words be there inserted in the proposed Amendment, as amended."
The Committee divided: Ayes, 128; Noes, 263.
| Bigland, Alfred | Harris, Henry Percy | O'Donnell, Thomas |
| Birrell, Rt. Hon. Augustine | Harvey, A. G. C. (Rochdale) | O'Dowd, John |
| Black, Arthur W. | Harvey, T. E. (Leeds, West) | O'Kelly, Edward P. (Wicklow, W.) |
| Boland, John Plus | Haslam, Lewis (Monmouth) | Ormsby-Gore, Hon. William |
| Booth, Frederick Handel | Havelock-Allan, Sir Henry | O'Shaughnessy, P. J. |
| Boyton, James | Hayward, Evan | O'Sullivan, Timothy |
| Brady, Patrick Joseph | Helme, Norval Watson | Pearce, William (Limehouse) |
| Bridgeman, William Clive | Herbert, Col. Sir Ivor | Pease, Rt. Hon. Joseph A. (Rotherham) |
| Brigg, Sir John | Higham, John Sharp | Phillips, John (Longford, S.) |
| Brunner, John F. L. | Hill, Sir Clement L. | Pollard, Sir George H. |
| Burt, Rt. Hon. Thomas | Hinds, John | Ponsonby, Arthur A. W. H. |
| Buxton, Noel (Norfolk, N.) | Hope, John Deans (Haddington) | Priestley, Sir W. E. B. (Bradford, E.) |
| Buxton, Rt. Hon. S. C. (Poplar) | Horner, Andrew Long | Primrose, Hon. Neil James |
| Byles, Sir William Pollard | Houston, Robert Paterson | Pringle, William M. R. |
| Carlile, Sir Edward Hildred | Howard, Hon. Geoffrey | Pryce-Jones, Col. E. |
| Carr-Gomm, H. W. | Hughes, Spencer Leigh | Quilter, William Eley C. |
| Cassel, Felix | Hunter, William (Lanark, Govan) | Radford, G. H. |
| Cave, George | Isaacs, Rt. Hon. Sir Rufus | Raffan, Peter Wilson |
| Cawley, H. T. (Lancs., Heywood) | Jardine, Sir John (Roxburghshire) | Rainy, A. Rolland |
| Chaloner, Col. R. G. W. | Jones, Sir D. Brynmor (Swansea) | Rea, Rt. Hon. Russell (South Shields) |
| Chamberlain, Rt. Hon. J. A. (Worc'r.) | Jones, Edgar R. (Merthyr Tydvil) | Reddy, M. |
| Chancellor, H. G. | Jones, Henry Haydn (Merioneth) | Redmond, John E. (Waterford) |
| Chaplin, Rt. Hon. Henry | Jones, Leif Stratten (Notts, Rushcliffe) | Rendall, Athelstan |
| Chapple, Dr. William Allen | Jones, William (Carnarvonshire) | Roberts, Charles H. (Lincoln) |
| Churchill, Rt. Hon. Winston S. | Jones, W. S. Glyn- (Stepney) | Roberts, Sir J. H. (Denbighs.) |
| Clough, William | Joyce, Michael (Limerick) | Roberts, S. (Sheffield, Ecclesall) |
| Collins, Stephen (Lambeth) | Kelly, Edward | Robertson, John M. (Tyneside) |
| Compton-Rickett, Rt. Hon. Sir J. | Kennedy, Vincent Paul | Robinson, Sidney |
| Condon, Thomas Joseph | Kilbride, Denis | Roche, Walter F. (Pembroke) |
| Cotton, William Francis | Kimber, Sir Henry | Roche, Augustine (Louth) |
| Craik, Sir Henry | King, J. (Somerset, N.) | Roe, Sir Thomas |
| Crawshay-Williams, Eliot | Lambert, George (Devon, S. Molton) | Rowlands, James |
| Crumley, Patrick | Lambert, Richard (Wilts, Cricklade) | Samuel, Rt. Hon. H. L. (Cleveland) |
| Dalziel, Sir James H. (Kirkcaldy) | Law, Hugh A. (Donegal, West) | Sanderson, Lancelot |
| Davies, David (Montgomery Co.) | Leach, Charles | Scanian, Thomas |
| Davies, Ellis William (Eifion) | Lee, Arthur Hamilton | Scott, A. MacCallum (Glasgow, Bridgeton) |
| Davies, Timothy (Lincs., Louth) | Levy, Sir Maurice | Seely, Col. Rt. Hon. J. E. B. |
| Davies, M. Vaughan- (Cardigan) | Lewis, John Herbert | Sheehy, David |
| Dawes, J. A. | Lockwood, Rt. Hon. Lt.-Col. A. R. | Sherwell, Arthur James |
| Delany, William | Lough, Rt. Hon. Thomas | Shortt, Edward |
| Denman, Hon. R. D. | Lundon, T. | Simon, Sir John Allsebrook |
| Devlin, Joseph | Lyell, Charles Henry | Smith, H. B. Lees (Northampton) |
| Dickinson, W. H. | Lynch, A. A. | Smyth, Thomas F. (Leitrim, S.) |
| Dickson, Rt. Hon. C. S. | Lyttelton, Rt. Hon. A. (S. Geo., Han. S.) | Soames, Arthur Wellesley |
| Dillon, John | Macdonald, J. M. (Falkirk Burghs) | Spear, Sir John Ward |
| Donelan, Anthony Charles | McGhee, Richard | Spicer, Sir Albert |
| Doris, W. | Maclean, Donald | Strachey, Sir Edward |
| Duffy, William J. | Macnamara, Rt. Hon. Dr. T. J. | Summers, James Woolley |
| Duncan, J. Hastings (York, Otley) | Macpherson, James Ian | Sutherland, John E. |
| Edwards, Sir Francis (Radnor) | MacVeagh, Jeremiah | Talbot, Lord Edmund |
| Edwards, John Hugh (Glamorgan, Mid) | M'Laren, H. D. (Leicester) | Taylor, Theodore C. (Radcliffe) |
| Elverston, Sir Harold | Magnus, Sir Philip | Tennant, Harold John |
| Esmonde, Dr. John (Tipperary, N.) | Manfield, Harry | Thomas, Abel (Carmarthen, E.) |
| Esmonde, Sir Thomas (Wexford, N.) | Markham, Sir Arthur Basil | Thorne, G. R. (Wolverhampton) |
| Essex, Richard Walter | Marshall, Arthur Harold | Valentia, Viscount |
| Faber, Capt. W. V. (Hants, W.) | Mason, David M. (Coventry) | Verney, Sir Harry |
| Falconer, J. | Masterman, C. F. G. | Walrond, Hon. Lionel |
| Farrell, James Patrick | Meagher, Michael | Walters, John Tudor |
| Ferens, Thomas Robinson | Meehan, Francis E. (Leitrim, N.) | Ward, Arnold S. (Herts, Watford) |
| Ffrench, Peter | Mildmay, Francis Bingham | Ward, W. Dudley (Southampton) |
| Field, William | Millar, James Duncan | Waring, Walter |
| Flavin, Michael Joseph | Mills, Hon. Charles Thomas | Wason, Rt.- Hon, E. (Clackmannan) |
| Fletcher, John Samuel (Hampstead) | Molloy, M. | Wason, John Cathcart (Orkney) |
| Gelder, Sir William Alfred | Mooney, John L. | White, Sir George (Norfolk) |
| George, Rt. Hon. D. Lloyd | Morgan, George Hay | White, J. Dundas (Glasgow, Tradeston) |
| Gibbs, George Abraham | Morrison-Bell, Major A. C. (Honiton) | White, Sir Luke (York, E.R.) |
| Gibson, Sir James Puckering | Morton, Alpheus Cleophas | White, Patrick (Meath, North) |
| Gilmour, Captain John | Mount, William Arthur | Whittaker, Rt. Hon. Sir T. P. |
| Glanville, Harold James | Munro, Robert | Wiles, Thomas |
| Goldsmith, Frank | Munro-Ferguson, Rt. Hon. R. C. | Wilson, John (Durham, Mid) |
| Gordon, John (Londonderry, South) | Nannetti, Joseph P. | Wilson, Rt. Hon. J. W. (Worcs., N.) |
| Green, Walter Raymond | Newton, Harry Kottingham | Winfrey, Richard |
| Greig, Col. J. W. | Nicholson, Charles N. (Doncaster) | Wood, Rt. Hon. T. McKinnon (Glagow) |
| Griffith, Ellis Jones (Anglesey) | Nolan, Joseph | Young, William (Perth, East) |
| Hackett, John | Norman, Sir Henry | Younger, Sir George |
| Haddock, George Bahr | Norton, Captain Cecil W. | Yoxall, Sir James Henry |
| Hall, Marshall (E. Toxteth) | O'Brien, Patrick (Kilkenny) | |
| Hamersley, A. St. George | O'Connor, John (Kildare, N.) | TELLERS FOR THE NOES.—Mr. |
| Harcourt, Rt. Hon. L. (Rossendale) | O'Connor, T. P. (Liverpool) | Illingworth and Mr. Gulland. |
| Harmsworth, Cecil (Luton, Beds.) | O'Doherty, Philip |
I beg to move, as an Amendment to the proposed Amendment, to insert after the word "infirmary" ["made with the hospital or infirmary"], the words, "save in the case of injured persons who have themselves prior to admission been regular contributors to the upkeep of such institutions." This Amendment will really give the people who are continuous contributors to such institutions the right to be exempted from the condition that the Committee has been previously discussing. The point I have raised with regard to the infirmary is parallel with scores of other institutions throughout the country where you have men, women, and children in their thousands contributing from the outset of their working life, and completely maintaining those institutions. I think the equity of my proposal will be apparent to everybody. Where the institutions of which the injured or sick persons are inmates have been maintained continuously by the contributions of such persons it would be utterly inequitable that at that time they should be deprived of the benefits for which they have been compelled to pay under the Bill.
On a point of Order. I wish to point out to you, Mr. Chairman, that the hon. Member is raising substantially the Debate we have had before. It will be quite impossible to go on discussing this Amendment without using the same set of arguments for and against as were repeatedly used in support of the other Amendment. If we were to go on in this way we should never get to the end of this or any other Bill ever proposed in this House.
This Amendment puts forward the exact point that was made the principle reason for supporting the last Amendment, and a great deal more was said about it than was in order. I do think to argue this Amendment would be going absolutely over the same ground again.
I beg respectfully, Mr. Chairman, to differ. This is not the same as the Amendment that was before the Committee at all. The last Amendment simply reserved the right of the injured person to say whether or not his benefit should be allotted. That particular Amendment, if carried, would deprive the committee of an approved society of the opportunity of making the arrangement in the case of those who are regular contributors to the institutions in which they find themselves. The two things are quite distinct. The hon. Member for Stoke desires that the man should have a discretion, but my Amendment goes further, and says that in the case of people who are continuously—
I do not say that the Amendment is not different, but I think in a case like this it is rather an abuse to discuss the matter over and over again. If the hon. Member wants to move this Amendment I think I had better put it, and he can take a Division upon it.
Is it not a fact that the point involved in this Amendment was used only as an illustration in support of the last Amendment? This Amendment is now limited to that point, and surely it is not out of order.
The Committee can decide the point, but I should deprecate having another discussion upon it. It was not used merely as an illustration, because it actually formed the main subject of the Debate.
I regret that other people have traversed the ground which I intended to keep for my own argument, but that is no reason why the Chancellor of the Exchequer should make an appeal to prevent me debating a point of real substance. There are tens of thousands of people throughout the country who purely from goodwill and because of their desire to keep up these noble institutions, maintain them altogether, and they have been maintained by men, women and children week after week throughout the year for a quarter of a century; and yet we are told that when a poor man is injured or sick that the approved society may take away altogether his liberty of action.
The argument of the hon. Member is that in such cases as he deals with in his Amendment the money is the property of the individual and something which he ought to have. May I point out that if his Amendment is carried that will not be the result. The man will not have the money, because under Sub-section (1) the House has already decided that he must not have the money. The choice now is between the general fund of the society to which he belongs and the hospital if the society is prepared to make an arrangement to contribute to the hospital. The hon. Member's point is, I admit, a serious one and worth arguing, but I am afraid his Amendment would not achieve the object he has in view.
Question, "That those words be there inserted," put, and negatived.
Amendments made in proposed Amendment:—
After the word "hospital" ["made with the hospital"], to insert the words "convalescent home."
After the word "hospital" ["paid to the hospital"], to insert the words "convalescent home."—[ Mr. Austen Chamberlain.]
Question proposed, "That the words of the proposed Amendment, as amended, be there inserted."
5.0 P.M.
I think anybody who has listened to the discussions yesterday and to-day must feel we are dealing with an extremely difficult problem, and, accustomed as we are to difficulties in this Bill, it is unusually difficult to arrive at a result of which all the House will approve, and which is fair to all the parties concerned. I do not suppose any of us desire that workmen who, as individuals or as members of societies, are making a fair and suitable contribution, and continue to do so, to the voluntary hospitals of their town, should be expected to double that contribution. It would be something more than reasonable to expect that of them. Two considerations have moved me, and I think must have moved the Chancellor of the Exchequer in the action he has taken. In the first place, the knowledge that a great number of people who might make some contribution to the hospital, though they could not pay for the whole of their treatment, make no contribution at all; and, in the second place, that when a general system of insurance is established by compulsion, men who have made voluntary contributions to hospital funds, whether they be employers or workmen, will be likely to lessen their contributions, and the hospitals may find themselves deprived of that support which is necessary for the health of the community, for the maintenance of those great institutions, and for the progress of medical and surgical science, which is enormously dependent upon the success of those institutions.
I am bound to recognise that I myself tried my hand at a solution which was not satisfactory to the Committee. The Chancellor of the Exchequer had himself put down a solution which the course of the Debate showed would be open to Several of the objections which had been taken to my own, and accordingly between yesterday and to-day he has made yet another attempt to find the via media which should escape these different objections and deal fairly alike with the insured and with the hospitals. I am afraid we must all admit that well-intentioned as the endeavour was, it has not been wholly successful. It is not wholly satisfactory from the point of view of many of those who have spoken in the Debate as representing the friendly societies or the insured people. The friendly societies, I think, have very little to complain of under this Amendment of the Chancellor of the Exchequer, because no agreement can be made without their assent. Those who take the view expressed by the hon. Member who moved the last Amendment (Mr. Walsh) that this money is the property of the insured person, and is indefeasibly his, and that no one else has a right to deal with it, are, of course, not satisfied with the solution at which we have arrived. I only say, in passing, with regard to their position, that I do not understand the attitude they take up towards sanatorium benefit. Why, if a man who has no dependents has an indefeasible right to receive sick pay, although he is being provided with treatment, board, lodging, nursing, and all that he requires in a hospital, has he not the same right when he is in a sanatorium? I do not think their position is logical. I admit they can draw cases which are very effective from the point of view of anybody who desires to make unfriendly or damaging criticism of the Bill. I will not say more about their position at this stage. My interest in the matter has been really on behalf of the hospitals. I do not wish it to be understood that I am in any way authorised to speak on their behalf, or that I have received any commission from them to represent their views, but I have, from the first, felt their position was jeopardised, and I have made some efforts to inform myself as to the views of the hospital authorities. I began by admitting that the much larger proposal which I made yesterday did not commend itself to the Committee, and I do not blame the Chancellor of the Exchequer for not accepting it, but I am afraid the proposal which we have been debating to-day is so whittled down that though it has not met all the objections of hon. Gentlemen below the Gangway or of hon. Gentlemen opposite, or, indeed, of some of my own Friends, because we were divided on this question, as hon. Gentlemen on that side of the House, it has very seriously detracted from the value of the proposal from the point of view of the support the Amendment would give to the hospitals. What is now the position of the hospital? If a man has dependents, they get nothing. If a man has no dependents but his society has not made an arrangement that his money is to go to the hospitals, they still get nothing. The only condition under which the hospitals get something is where the man has no dependents, and where the society, having the option between using the money which would have been payable to the dependents, if any, for the general purposes of the society, or in applying it to the hospitals, chooses by an arrangement made beforehand to pay it to the hospitals. I am afraid they would very seldom so choose, and I am quite certain no voluntary hospital, largely dependent upon any sources of supply, can count with safety on this Amendment to make good the gap in their funds, which may arise through the action of the Bill I am driven to the conclusion, whether this Amendment suits or not, and if the Chancellor of the Exchequer thinks it desirable to pursue it, I shall vote with him in support of it—that it is not in itself adequate to the needs of the hospitals, and I think the Committee and the Government ought to consider whether the whole question could not be better or more adequately dealt with in another way without giving rise to the objection which has been expressed in many quarters of the House. I am not entitled, of course, to argue about another Clause here, but any hon. Member who will turn to Clause 15 will see it is the duty of the local health committee to make arrangements with institutions for the administration and provision of the sanatorium benefit. I have been forced to the conclusion—it is one which will not come wholly as a surprise to the Chancellor of the Exchequer, because I think I did suggest it as an alternative way of dealing with the matter the other day—that in the case of these compulsorily insured people you ought to provide a hospital benefit as well as a sanatorium benefit, and you ought to treat that hospital benefit in the same way as you treat the sanatorium benefit in Clause 15. You ought to make it a charge upon the general fund, and you ought to make it the duty of local health committees or responsible people to arrange for the provision of hospital treatment for insured persons who need it and who cannot be adequately dealt with in their own home for insured persons who need hospital treatment of kinds to which persons of that class do not habitually have recourse in rate-supported institutions. I do not mean to say they are to take upon themselves the provision of fever hospitals which is now done by the public health authorities, but they ought to have the same power to make arrangements for hospital treatment as they have under Clause 15 to make arrangements for sanatorium treatment. I make this suggestion in no unfriendly spirit—I am sure the Chancellor of the Exchequer will recognise—to the Bill. I believe, if he can see his way to adopt it, it will relieve him of the very considerable difficulties with which he is now confronted, and I feel sure it is a much more satisfactory proposal for the hospitals than to leave them dependent on these strictly limited and occasional arrangements with societies, or on chance subscriptions made under Clause 17. I do not press the Chancellor of the Exchequer, if he does not wish to give it, for a definite statement on this point at once, but I hope he will at least give it the most favourable and friendly consideration that he can, and perhaps he will consult, if he has the opportunity, with the hospital authorities themselves, to see whether that is not the way in which they would prefer to be treated under the provisions of the Bill.I am rather alarmed at the prospect of having to follow the right hon. Gentleman in the very wide field of inquiry which he invites me to pursue. I agree with him, it is of first-class importance we should consider the general position of the hospitals. I do not think the present position of the hospitals in this country is by any means satisfactory. I think it is very undesirable they should be dependent upon the precarious kind of income upon which they have now to rely in order to carry on operations which in themselves are essential to the well-being of the community. I do not think any great community like ours ought to rely upon such an unsatisfactory method of carrying out what, after all, is a great communal obligation. That, however, is opening out a question which is strictly irrelevant to this Amendment, and it is one which could not be discussed now. I agree with the observations which appeared in one of the papers to-day that one of the results of the Bill will be to force the community to reconsider the position of the hospitals generally throughout the country. I am not sure it would be desirable for us to attempt to deal with it in this Bill. I gave a good deal of consideration to the matter before I submitted the Bill in its present form to the House of Commons, and I came to the conclusion it would be undesirable to make even any attempt to deal generally and thoroughly with the position of the hospitals. It is far better we should attempt this experiment first. Then in a very short time we shall see what is the position of the hospitals. We shall have, in the meantime, a great organisation or a series of organisations dealing with questions of public health, each and all of them primarily and directly interested in the well-being of the hospitals. Having had a good deal of experience in the meantime, the hospital authorities will either be prepared to take steps themselves or to advise the Government for the time being as to what steps ought to be taken, if it turns out Government intervention is desirable. In the meantime, I think it is far better we should deal in this tentative way with the hospitals, interfering as little as possible with them. If we give them a very large slice of these funds, we should certainly have to introduce some measure of control. It is undesirable that we should, and, indeed, we are not prepared to take upon ourselves the whole responsibility for the hospitals. We cannot possibly contemplate that, and I think that, on the whole, we have adopted the wiser course of interfering as little as possible with them. If it is found, as a matter of experience, that the hospitals are seriously injured in their finances by the operation of this Bill, it will be for the Government to find some remedy in some direction or other.
I am unable to agree with either of the two right hon. Gentlemen who have spoken. If we begin dealing in this way with the hospitals, giving them but a very small fraction of what they might expect, we are liable to arouse in the minds of present contributors to hospital funds an idea that they are going to get something out of the Bill, and that in consequence it will not be necessary to continue their subscriptions. I am afraid the hospitals may find themselves in a much worse position if this Amendment of the Chancellor of the Exchequer's is carried than if it were left out altogether. I am of opinion that if you are not going to give the hospitals a considerable amount to make up the deficiency, if you are not going to deal with them under Clause 15, it would be much wiser not to put this in at all, for the reason I have stated, i.e., that it is likely to arouse in the minds of insured people an idea that as they are going to get something out of the hospitals it is not necessary to contribute voluntarily to their support as they have done in the past. I repeat it would be much wiser to leave this Sub-section out altogether, and deal in another place and on a more generous basis with the hospitals.
I agree with the Chancellor of the Exchequer, speaking from the hospital point of view, that it would be most dangerous to take away their voluntary character, and that, therefore, any measure calculated to put them on the rates or public funds would diminish their voluntary character and greatly depreciate the spirit in which they do their work. I think it is inevitable that the operation of this Bill will both diminish the revenues of the hospital and increase their obligations towards the sick. One af the most undesirable results of this Bill will be to force on the hospitals a necessity for further specialisation than that which they at present undertake. I believe the idea is that the immense organisations for the relief of the poor which already exist, and which extend to millions of people in this country, will be greatly added to by this Bill. We ought, therefore, to place hospitals in their true position, and that is as consultants and operators of the poor. In hundreds, I might say in thousands of cases, people go into hospital at the present time and receive treatment at the hands of skilled operators and physicians—very highly specially skilled persons—when they might be perfectly well dealt with by general practitioners, and I hope some day it may be made a condition precedent to entering a hospital that there shall be a certificate by a general practitioner that it is a case proper for hospital treatment. There must of course be wide exceptions to meet cases of emergency. I think it is highly important that it should be noted the Chancellor of the Exchequer has admitted that the real problem of hospital administration is left outside this Act.
Question, "That these words be there inserted," put, and agreed to.
I beg to move after the words last inserted to insert the following words:—" (c) Such sum or any part thereof not paid or applied as aforesaid shall be paid to or applied for the benefit of such person, or, in the case of a deposit contributor, placed to his credit in the Post Office funds, as the society or committee administering such benefits, after consultation whenever possible with such insured person, think fit."
It is at the request of the Attorney-General that I have brought this point forward at this particular place. The object of the Amendment is, in the first place, to meet the case of a man in a hospital, infirmary or convalescent home, who has dependents, for whose benefit part only of his sick pay is applied. Under Sub-clause (a) it is possible for the sick pay to be applied either wholly or in part for the benefit of the dependents. The case cited by the Attorney-General was that of a man who had, previously to his illness, been allowing his grandmother 5s. a week. When he goes into hospital it is unreasonable that the grandmother should, in consequence, receive the whole 10s. Thus there is 5s. a week available, and my suggestion is that at least there ought to be an opportunity of applying it for the benefit of the man himself. Assuming that he desires to purchase certain surgical appliances the money ought to be available for that purpose, as it is well known that it is not the practice in hospitals to supply surgical appliances gratuitously. The man, it must be remembered, has paid in order that he may receive a sick benefit of 10s., and if only half of that amount is required for his dependents he ought in justice and in equity to be allowed to have the remainder applied for his own benefit. It might even be utilised for providing him with some extra comforts. I do not know whether the Labour Members have realised that in the case where there is no agreement with the hospital under this Bill the whole of the 10s. is forfeited.What does the hon. Member mean by "forfeited"?
A friendly society at present pays the 10s. benefit where the man is in a private hospital supported by charitable contributions. My information, which comes from the hon. Member for Mile End (Mr. Harry Lawson), one of the arbitrators of friendly societies, tells me that a man in a private hospital receives his 10s. a week.
Does the hon. Member mean a hospital in which the man pays?
No, I mean such an institution as the London Hospital or St. George's Hospital, any ordinary convalescent home, or any infirmary not maintained out of the rates. I quite understand that friendly societies do not pay the sick benefit when a man is in an institution maintained out of the rates. But if my information is correct they do pay the 10s. when he is in a private hospital, and their obligation to pay will still continue so far as existing members of friendly societies are concerned, unless, indeed, this Bill abrogates their contract. If it does not abrogate the contract, then friendly societies will be in a difficulty, because, so far as existing members are concerned, in cases where there are no dependents they will still be liable to pay the 10s.
Labour Members have been objecting to the 10s. going to the hospital. Are they satisfied it should not go to the man at all, whether there is an agreement or not, but that it should simply go into the general fund? Surely what they were contending was that the 10s. should go to the man himself where the man has no dependents, and where there is no agreement with the hospital. Where the amount is partly required for the dependent of course it will be so applied, but with regard to the balance of the 10s. not so required you are under the Bill forfeiting it; you are not at any rate proposing to give an opportunity of applying it for the benefit of the man himself. It would be an extremely hard case where a man is in hospital, and 5s. only of his sick benefit is being paid to a dependent, if the remaining 5s. were not allowed to be used for supplying him with surgical appliances which he may require, or for providing him with some additional comforts which might be of great use in helping forward his recovery. Owing to the somewhat hasty manner in which I have drafted the Amendment, its scope goes a little beyond what is intended, but that may be met by putting at the beginning the words, "in the case of a person in a hospital, infirmary, or convalescent home supported by charity or voluntary contributions." I maintain you should treat persons insured under the Bill on the same footing as friendly societies have treated them in the past. It is only fair that the man who has paid in order that he may receive a 10s. benefit should get that benefit, and where only a part is required for his dependent or dependents, or in a case where there are no dependents and no agreement with the hospital, it is unfair that he should not have his 10s., or that, at all events, there should be no opportunity of applying the 10s. for his benefit.Although the hon. and learned Gentleman sent me a copy of the Amendment, unfortunately I have been unable to deal with it, and we have had no opportunity of considering it. The Amendment as it stands is out of order on more than one point, and it is not quite in proper drafting form, but we desire to deal sympathetically with the argument of the hon. and learned Gentleman. There is some kind of case made out certainly, and we should like to consider it very carefully and see whether we can meet it with reference to surgical appliances. For example, take the case of a man who has met with some accident, or in consequence of some illness requires a surgical appliance which he is not able to buy. There is, I think, certainly a case which requires very careful consideration. I suggest that the hon. and learned Gentleman should withdraw the Amendment and that we should deal with the matter in some form before we get to the Report stage, so that we can introduce some Amendment which will give him some benefit from the money which would otherwise be kept in hand. It is not a very easy thing to do in this way, but in some form or other we desire to meet the Amendment.
What the Attorney-General says does not quite go far enough. I applied this not only to the case of surgical appliances. I will take the Amendment at any point that is most convenient, but I cannot narrow it down to the case of purchasing surgical appliances only. I only gave that as an illustration. There are numerous other things which may be absolutely necessary and may help to save a man's life.
It was an illustration which I thought it was convenient to adopt.
If the hon. and learned Gentleman will tell me he will give favourable consideration to the whole of this Amendment before the Report stage, I am in the hands of the Committee as to when it is most convenient to discuss it.
Amendment, by leave, withdrawn.
I beg to move, to leave out the words, "such of the following members of the insured person's family as are wholly or in part dependent upon the earnings of such person at the time when he became an inmate of any such institution as aforesaid, that is to say, his or her wife or husband, father, mother, grandfather, grandmother, stepfather, stepmother, son, daughter, grandson, granddaughter, stepson, stepdaughter, brother, sister, half-brother, half-sister," in order to insert instead thereof the words, "any person ordinarily dependent wholly or in part upon the insured person, whether such dependent be a relative by blood or marriage or not."
The Amendment has for its object to take out the list of dependents in Subsection (3), and to substitute words of a more general character, which will cover a number of persons as dependents who are not included in the list. In that list no mention is made of an adopted child, and there is a very common case where an uncle or aunt takes the children of a late brother or sister. I think this is art Amendment which might be accepted, because it seems to me it is not a question of relationship, but of whether a person is a dependent or not.The Government have deep sympathy with the principle of the Amendment, but the wording is not quite adapted to the Clause as it stands. I propose in a subsequent Amendment to make the position quite plain, and to leave the society or committee to determine whether or not a person is dependent. With the Amendments I propose it will read thus:
"For the purpose of this Section the expression 'dependents' shall include such persons as the approved societies or local health committee may determine to be wholly or in part dependent on the earnings of such inmate of any such institution as aforesaid."So far as I can see that covers the point.
Will that include illegitimate children?
Yes, it will.
There will be no power on the part of the health committee to deprive an illegitimate child?
Yes, it will depend entirely on the local health committee.
Is it intended that whether a person is dependent or not will depend on the local health committee?
The approved society or the local health committee.
Supposing a local health committee in one county took the view that an illegitimate child was a dependent, and the health committee in the next county took a different view, would the Bill be differently administered in the two counties?
Do the Government intend to accept the Amendment in my name, to insert the words, "whether legitimate or not"?
Is not the only question which the society or local health committee have to determine whether the person is dependent or not? Whether legitimate or illegitimate, so long as he or she is a person, they are bound to give it. The question of legitimacy or otherwise is an irrelevant consideration from their point of view, and, I think, rightly. If a person is illegitimate he ought to be entitled to receive assistance just as much as a legitimate person. There ought to be no distinction made while the insured person is in the hospital.
Certainly, that is the intention, and, I think, the effect of the words. They make it quite plain that there is one thing which the approved society, if you are dealing with an approved society, or the local health committee, if you are dealing with a local health committee, has to do, and that is to determine whether or not a person is dependent. It is left purposely in this way as a clear question of fact, irrespective of relationship, whether legitimate or illegitimate, or an adopted child, or no relation at all.
Amendment, by leave, withdrawn.
I beg to move, to leave out the words, "of the following members of the insured person's family as are wholly or in part dependent upon the earnings of such person at the time when he became an inmate of any such institution as aforesaid—that is to say, his or her wife or husband, father, mother, grandfather, grandmother, stepfather, step- mother, son, daughter, grandson, granddaughter, stepson, stepdaughter, brother, sister, half-brother, half-sister," and to insert instead thereof the words, "such persons as the approved society or local health committee may determine to be wholly or in part dependent upon the earnings of such inmate of any such institution as aforesaid."
I desire to have the point I raised made perfectly clear. The Amendment now proposed is certainly a very great improvement on the Clause as originally drafted, and if the Attorney-General will give me an assurance that an illegitimate child would have the same right to pursue a case in a court of law under the Bill as a legitimate child would have, I would not press my Amendment. I do not wish to see included in the Bill any form of words which would leave that matter in doubt.
We will consider that point, and I give an assurance to the hon. Gentleman now that we will take out any words which would leave doubt in the matter. The question of legitimacy or illegitimacy is not relevent to the question whether a person is a dependent. The point which the hon. Member has raised is, I think, covered by the Amendment.
The Amendment now proposed by the Attorney-General really comes to this, that the question whether any particular person is to be deemed a dependent so as to get advantage of the Act is to be entirely decided either by the approved society or by the local health committee. I think that is entirely wrong. We ought to lay down in the Bill who dependents really are. Let me put this to the Attorney-General. One approved society may desire to limit the area of the dependents as much as possible. It might be in their interest to do it. It would be in their interest to do it under certain circumstances. Why leave the Bill in a form which will enable different local health committees and different approved societies to lay down different regulations?
That is entirely irrelevant. The question as to what is the position of a particular person, and whether he is or is not a relation is entirely irrelevant. The whole question which has to be considered is simply this: Is that person at the time that an insured person goes into an institution dependent or not? Anything else would be irrelevant.
May I say that that really makes the matter much more wide? You are going to have nothing at all in the Bill in regard to the relationship of the dependent. But the question whether a person is a dependent in the sense of receiving help from an insured person at the time he goes into a hospital is to be left to the discretion of the local health committee or the approved society. It does not appear to be a question of legitimacy or illegitimacy. I should be strongly against giving an illegitimate child the right to make a claim, but I do not go into that question now, because the Attorney-General says it is not relevant to this particular Amendment. A dependent may be a son or a daughter, a grandson or a granddaughter, a stepson or a stepdaughter, and he or she might be ruled out by the local health committee, although according to my view and the view of the Attorney-General that person might be a dependent at the time the insured person went into an institution. The decision is to depend on the ipse dixit of the local health committee or the approved society. I think that is a most dangerous part of the Clause. It is a dangerous privilege to give to either the approved society or the local health committee. You ought really in the same spirit in which the Section was originally drafted to define the person who is to get benefit under the conditions. That ought not to be left to the mere ipse dixit of an outside body. That body might decide very harshly. You might have a local health committee who took a very generous view and side by side you might have another local health committee who took a very ungenerous view. This Bill ought to be so framed that it could be administered irrespective of the separate views taken by different committees over the country.
This is really a question of fact which has to be determined. The whole thing to be decided by an approved society or local health committee is whether a person is a dependent. I would suggest to the Attorney-General that the words "supported by" would be better than "dependent upon." I think the words "dependent upon" are vague, and therefore I would like to move that the words "dependent upon" be omitted and the words "supported by" put in their place.
The Committee should first decide whether they will leave out the words proposed to be left out. It will then be possible to move an Amendment of the words proposed to be inserted.
I wish to say a word in support of my hon. and learned Friend (Sir A. Cripps). I think what he stated has entirely destroyed the argument of the Attorney-General. As I understand my hon. and learned Friend, the word "dependent" has no meaning in law. There is no phrase in law such as "dependent upon." Therefore various health committees and approved societies would be able to put whatever interpretation they liked upon the words "dependent upon." We will suppose that there is a health committee composed of members who are very kind-hearted. I happen to know that sickness is coming upon me, and I make a present to my hon. and learned Friend. He says, "I am dependent upon that man. He gave me a present before he became ill, and he entered into an undertaking to give me something during his illness." The health committee says: "Certainly, it is State money. Let us give it away." [An HON. MEMBER: "That is not serious at all."] I think it is a very serious question. I do not. know what the hon. Member means by saying it is not serious. I think Members of Parliament should not allow in Acts certain phrases and words which allow different interpretations to be put upon their meaning by different people throughout the country. I think this is a very serious question for working men themselves, for they cannot tell what decision will be given by health committees or approved societies. Although the Amendment does not propose to spend money, that does not alter the question. I understand that under the Amendment it will be open to different people to give different decisions as to who is and who is not dependent. That is a very serious question, and it is one I wish to have some explanation upon from the Attorney-General. If he says I am wrong, I am perfectly willing to be convinced.
The hon. Baronet is wrong in the view he takes in so far as he seems to consider that different societies may take different lines on the matter of principle. All that a local health committee or an approved society has to deal with is a question of fact. It seems to me the point is perfectly clear. There is no doubt as to what is to be done. The only question is whether a person is dependent, and it is not relevant to that question to ask the relationship between him and the insured person who goes into an institution. The sole question is whether that person has been either wholly or in part dependent upon the person who is accommodated in an institution. If the society or the local health committee find that that is so, what they have then to do under the Bill is to apply the money. The only point of the Sub-section is to make it clear that the approved society or the local health committee has to determine that question. We tried at first to introduce not a definition, but a statement of the persons to be included. We came to the conclusion, after considering the various Amendments of which notice had been given by hon. Members on both sides of the House, that it was necessary to find the most elastic words possible, because the last thing desired was to deprive a person who up to that moment had been receiving money from the breadwinner of the help he had been getting because that breadwinner was the inmate of an institution. What was intended was that the same state should continue. We do not want courts of law in this matter. That is impossible machinery for a matter of this kind, and therefore it is left to the approved society who are themselves interested, and who therefore may very well, if you place any confidence at all in friendly societies, be left to determine the question of fact on broad lines. All the Committee will be doing by accepting the Amendment I am proposing is to leave the question of fact to be determined by the local health committee or the approved society without any question of principle being gone into at all.
6.0 P.M.
There is considerable danger that the intention of the Attorney-General will be disappointed by the use of the words he proposes. The Attorney-General proposes to use words which will leave it absolutely in the discretion of the approved society or the health committee to say whether a particular person is or is not dependent. I am sure that is not the intention. It certainly will not carry out the intention of the hon. Member for Merthyr Tydvil (Mr. Keir Hardie) who asked the hon. and learned Gentleman just now whether an illegitimate child would have the same right in a court of law as a legitimate child. The fact is that neither of them will have any right, and as regards their absence of right they will be quite equal. That is not the intention of the Attorney-General. I am sure it cannot be intended that a health committee in some part of the country shall set itself up as a tribunal to exercise its discretion uncontrolled as to whether there is dependency or not. There is a method by which a decision can be secured, and that is to put on a named authority the duty of ascertaining who dependents are. Then they could be controlled in the county court, or you might introduce some words which would give to a person claiming to be a dependent the right to have reviewed an unreasonable decision of the local health committee. Nobody wants any interference by courts of law with these committees, who are exercising domestic jurisdiction. One knows quite well there are rare occasions on which these committees exercise domestic jurisdiction, not only harshly, but in a manner totally contrary to the very principles of equity. They are left uncontrolled by the words of the learned Attorney-General; it is left to their unfettered determination. If they are to be left without any review, it should be left to be ascertained and not to be determined. On the other hand, I think it would be a wise and proper precaution to see that any unreasonable action in this respect should be controlled, and in any event I do not think that the word "determined" is the word which will meet the intentions of many Members of this Committee.
The definition of "dependent," which this House has already passed in another Act, has worked exceedingly well, and that definition in the Workmen's Compensation Act of 1906 might very well be left in this Bill. The Clause of this Bill appears to be taken almost entirely from Clause 13 of the Workmen's Compensation Act, 1906. There you have the definition: "Dependents mean such of the members of the workman's family as were wholly or in part dependent upon the earnings of the workman at the time of his death, or would but for the incapacity due to the accident have been so dependent," and so on; and then it defines in the next paragraph what the members of the family are. Those members of the family are exactly the ones that are set out in this Bill. If you accept the suggestion of the learned Attorney-General, and leave it to the approved societies themselves to say who is and who is not a dependent within the meaning of this Act, you make it quite possible to have rival definitions of the word "dependent" in regard to the very same man. You will have the Act of Parliament of 1906 deciding who is a dependent within the meaning of that Act if he has an accident, and you will have the approved societies coming along with reference to the same man and the same accident, and saying "that person is not a dependent in. our opinion." There you get a cross set of purposes between the two definitions.
The definition in the Workmen's Compensation Act of 1906 is a legal definition, and cannot be controverted. It is a definition which has worked exceedingly well during the last five years. I do not think there has been the least difficulty in my experience in deciding under that Act who is and who is not a dependent, and I would venture to suggest that in the interest of the workman himself it is very much better to stick to that definition which you have already got than to attempt to impose a new definition at the arbitrary will of the committee of an approved society, who may in one town say so-and-so is a dependent, and in an adjoining town may come to quite a different decision. If we accept the Clause in the Workmen's Compensation Act we shall have one Clause defining dependents throughout the length and breadth of England, and if a man asks if he is a dependent it will be perfectly easy to say whether he is or is not, but if he has to ask under the learned Attorney-General's Amendment whether he is a dependent or not, the answer will be, "I cannot say; you must wait until your approved society has made up its mind." I trust that the Government will not press the Amendment, but will accept the Bill as it stands, carrying out the definition of the Workmen's Compensation Act of 1906.The Attorney-General, in explaining his Amendment, used the words, "irrespective of relationship." Has he any objection to inserting those words in the Amendment?
I hope that the Committee will not take up time in settling a long table of consanguinities. Look at the table of consanguinities we have already got and the cases it omits. It omits nephews and nieces; it omits the case of an adopted child, and it omits numerous other cases which I could mention. If we try to settle a table the chances are we shall omit the cases which most of all require to be included, and it would be safer to put in general words which would cover the case that we want to meet. That is the case where the bread-winner is in hospital and we want the person who has previously been dependent upon or supported by his earnings to get the sick benefit. The only question raised by my hon. and learned Friend the Member for Exeter (Mr. Duke) was the question as to what tribunal was to either ascertain or determine this. It is a question for the Committee whether it does not think that the health committees and the societies are not good enough to decide this question without further appeal to a court of law. I should have thought that that was a question that might be well left to those societies to settle. The only question they have got to settle, either to determine or to ascertain—I do not think it makes very much difference which it is—is whether the particular person in question is dependent upon or supported by the earnings of the person in hospital. That is the only relevant question. They are able to decide on the Clause as it stands, and it is a question which would still remain for their decision even if you put in the table of consanguinities.
For my part I much prefer the way this Clause now stands to the table of consanguinities to which the Member for West St. Pancras (Mr. Cassel) referred. I think it might be advisable to have some right of appeal to some person. A court of law, perhaps, would be a cumbersome method, but if some right of appeal were given, it would meet most of the objections which have been raised to the Attorney-General's words.
May I ask whether it is the intention of the right hon. Gentleman, in his proposed Amendment, that the decision as to who is a dependent shall rest with the approved society in the case of one of its members and with the health committee in the case of the Post Office depositors? I venture to suggest to him that as his Amendment is framed, it would be an alternative to the dependent to appeal to either one or the other according to his own discretion. You will notice that in Sub-clause 4 it is specifically laid down that the persons concerned in each case are the persons by whom the sickness disablement or maternity benefit of the insured person is administered. To make it absolutely clear, I would suggest that some similar words would be necessary in order that there shall not appear to be an alternative to every applicant to choose either one authority or the other.
May I give an instance of a problem which might be put before people who are unaccustomed to deciding legal matters? Take the case of a man who has abandoned his wife and children. As a rule he has formed an irregular connection by which he has other children. He is incapacitated; the issue arises between the two sets of persons, which are dependents. The illegitimate children and the illegitimate mistress are those who have been in immediate receipt of the earnings of the worker. Which would be entitled as between those two sets of parties to the insurance money? I have a serious doubt as to whether that is a question which ought to be left to the decision of an approved society.
You put a complicated question of fact that has to be dealt with. I am not presuming for a moment to say what the decision would be, because it would not be a legal decision: it is a question of fact. I can quite conceive cases in which if the irregular family has actually been receiving money at the time the man goes into the institution, they would have some right to the money. I can also conceive that the legitimate wife and her family have some right to the money. If I were an approved society I would consider that they were both entitled to a portion of the money between them.
I think it would dispose of the point to the satisfaction of the whole Committee if we have come to the stage at which an Amendment could be moved to the right hon. Gentleman's words.
We have not come to that yet.
I would suggest without moving that if we adopt the words "shall ascertain" instead of "shall determine," then the whole Committee might agree. If I am in a position to move that Amendment, I would venture to do so.
Question, "That the words 'of the' stand part of the Clause," put, and negatived.
Question proposed, after the words "shall include" to insert the words "such persons as the approved society or the local health committee may determine to be wholly or in part dependent upon the earnings of such inmate of any such institution as aforesaid."
I beg to move in the proposed Amendment to leave out the words "may determine" and to insert instead thereof the words "shall ascertain."
I agree.
Amendment to proposed Amendment agreed to.
Question, "That those words, as amended, be there inserted," put, and agreed to.
I beg to move to leave out Sub-section (4):—
"The society or committee by which the sickness disablement or maternity benefit of any insured persons is administered, may enter into any agreement with the proper officers or authorities of any convalescent home or sanatorium admission to which is conditional on the payment of the whole or any part not less than one half of the cost of maintenance, for the payment thereto of any sickness disablement or maternity benefit which would, apart from this Section, be payable to or in respect of any such person who becomes an inmate of such home, during any period for which he remains an inmate."Question proposed, "That the words of the Sub-section down to the word 'convalescent' ["officers or authorities of any convalescent home"] stand part of the Clause."
I do not think this Sub-section should be left out unless there is some good ground shown for it. The Sub-section as I read it is the only provision, which enables the society or committee to enter into an agreement with the proper officers or authorities of the convalescent home or sanatorium—an agreement which may be of great importance to a convalescent home or sanatorium. All that the Sub-section gives is permissive power to a society or committee to enter into an agreement with the proper officers of the convalescent home or sanatorium. Surely we ought to leave some power in the Bill for that purpose, and I do not see any reason why the Subsection should be deleted. What the Committee have done this afternoon is to provide how the money which will be deflected from the insured person during certain periods while he is an inmate of the hospital or infirmary or convalescent home shall be made use of or deflected into the hands of either his dependents or possibly in part to a hospital, and so on. We still want the power conferred by the Sub-section by which the approved society or health committee can make an agreement with the convalescent home or sanatorium authorities. It does not require that an agreement shall be made, but if the approved society or health committee think that the position of the person to whom they have regard, and whose interests they are looking after, would be preserved by making an, agreement with the convalescent home or sanatorium, surely there ought to be power for them to make that agreement. It is not compulsory; it is only permissive; it seems to fill up what is really a gap, and if you were to delete the Sub-section you would restrict the power of the society or committee to make these agreements, and I think it would be a great misfortune if the Sub-section were left out. No sufficient ground has been shown for it, and I hope the Committee will not delete the Subsection, but will leave it in the Bill for the purpose of serving the object for which it was originally placed there, namely, to give permissive powers in circumstances in which may be thought wise by the health committee or by the society to exercise them.
I only rise to appeal to the Attorney-General to give some answer on this matter. I really do not understand why it is that the Government wish to keep out Sub-section (4). The reason cannot be so far as any Amendment already put into this Clause is concerned, that is to say, the Amendment which the Chancellor of the Exchequer moved earlier this afternoon, because that only relates to the particular category of insured persons. It might very well be that the approved society and local health committee may find it desirable in the interests of their members to make such arrangements as are suggested in the Subsection. I think the Attorney-General ought to tell us the reason why the Government move to leave it out.
I was about to reply when the hon. Gentleman rose. The Government desire to leave out Sub-sec- tion (4) in consequence of the adoption of the Chancellor of the Exchequer's Amendment, which, it is quite clear, provides for an agreement being made, and we have introduced the words "convalescent home." It is, therefore, intended that an agreement shall be made, and having introduced those words they make it quite plain that an agreement can be made by the society or committee, and it is not necessary to retain this Sub-section (4), which was intended to cover the ground which has been dealt with. We think that the ground is sufficiently covered already by the provision we have made.
The only question I have in my mind is whether or not the power will be given to the society to make special arrangements with regard to these persons.
I think so.
As long as that is quite clear then I think the case is at an end. As long as the Attorney-General can assure us that the position is safeguarded, then I think we might dispense with Sub-section (4). But I do think that we ought to leave the approved societies and health committee power to make those arrangements.
What we are dealing with under this Clause has reference to money which we have already decided should not be paid to the member, and then it is provided that either in whole or in part, under an agreement, it may be paid to a hospital. As far as this Clause goes, Sub-section (4) becomes unnecessary. Later on, when we come to discuss what an approved society can do, we may want to introduce some more general provision, but this Clause with which we are dealing treats the matter of money which otherwise would go to the insured person.
I should like to draw the attention of the Attorney-General to the fact that the Chancellor of the Exchequer's Amendment makes no reference whatever to a sanatorium. This-Sub-section, which it is now proposed to delete, does specifically use the word "sanatorium," and it is provided that arrangements shall be made with the officials of the sanatorium. Is it proposed to leave out such an arrangement altogether?
It comes later on.
Will it be inserted later on?
It will be dealt with, and it would be unnecessary to do it here.
I am not quite satisfied that the Amendment of the Chancellor of the Exchequer, which has been inserted in the Clause, really covers the same ground. The whole of Sub-section (3) only deals with the case where an inmate has no dependents. I am not satisfied that some powers are not needed such as are contained in Sub-section (4). If it is convenient that those powers should be inserted elsewhere, will the Attorney-General undertake that we shall have an opportunity of considering it from that point of view? If so, I will be satisfied; but if the Attorney-General says that he has covered the ground by the Amendment put in Sub-section (3) a short time ago, I do not think that is sufficient. I hope the Attorney-General will say that by leaving out Sub-section (4) at the present time, we are only leaving it out so that it may be dealt with more conveniently at a later stage of the Bill.
Amendment agreed to.
Question, "That the Clause, as amended, stand part of the Bill," put, and agreed to.
Clause 13—(Benefits To Be Administered By Approved Societies Or The Local Health Committee)
(1) Sickness benefit, disablement benefit, and maternity benefit, and, subject to the provisions of the next succeeding Section, medical benefit, shall be administered, in the case of insured persons who are members of an approved society, by and through the society, and in other cases by and through the local health committees; sanatorium benefit shall in all cases be administered by and through local health committees.
(2) Subject to the provisions of this part of this Act, an approved society may, with the consent of the Insurance Commissioners, provide for the application of its existing rules or make new rules with regard to the manner and time of paying or distributing and mode of calculating benefits, suspension of benefits, notices and proof of disease or disablement, behaviour during disease or disablement, and the visiting of sick or disabled persons, and for the infliction and enforcement of penalties (whether by way of fines or suspension of
benefits or otherwise) in the case of any member being an insured person who is guilty of any breach of any such rule, or of any imposition or attempted imposition in respect of any benefit under this part of this Act, and may from time to time with, the like consent alter or repeal any such rules; but—
(3) The local health committee shall, subject to the approval of the Insurance Commissioners, make rules in respect of any of the matters mentioned in the last preceding Sub-section for the purpose of regulating the payment or distribution of benefits administered by the committee:
Provided that no such rule relating to-anything to be done by, to, or through the Post Office shall be made without the consent of the Postmaster-General.
(4) Where, under any such rule as aforesaid, payment of sickness or disablement benefit is suspended on the ground that the disease or disablement has been caused by the misconduct of the person claiming the benefit, such person shall nevertheless continue to be entitled to medical benefit.
(5) Where under any Act regulating the constitution of an approved society the rules of the society are required to be registered, any rules approved under this section by the Insurance Commissioners shall forthwith be registered, but till so registered shall have effect as if they had been duly registered.
I beg to move in Sub-section (1) to leave out the words "disablement benefit" ["sickness benefit, disablement benefit, and maternity benefit"].
As the Bill now stands, I feel that there is very little chance for the really poor coming into this benefit. I cannot help feeling that if the disablement benefit were transferred from the approved societies to a central administration, the chance of the very poor getting benefit will be very much improved. There must be many Members of this House who, like myself, represent very poor districts, where regular employment is the lot only of the very few; whereas irregular employment, leaving long periods of unemployment, are the rule rather than the exception in those districts where the workers, whose lives depend on their ability to keep misfortune from the door, have the greatest possible need of this disablement benefit. They of all the people in the country require disablement benefit, and it is really their position which is the actual cause and occasion of this Bill. In order to get these people into approved societies, I desire to see those societies multiplied. By multiplying them you introduce competition, and as a result of competition favourable regulations would be made by the societies themselves which might permit of an easy entry into them, and also, after interrupted contributions, permit of an easy re-entry into those societies. The increase in the number of societies, by introducing competition, would, to my mind, increase very largely the prospect of the poorest classes obtaining this disablement benefit. I would remind the House in regard to the Post Office contributor that there is no disablement benefit. I see the difficulty of the situation. It is hard to make a proposition to cover it. But it is really, speaking from the point of view of the poor districts, a great blot upon the Bill. The class who most needs disablement benefit under the Bill as it now stands is the very last to get it. My proposal to the House is to make it easy to establish approved societies. By the Bill, as it now stands, the fact that the approved society is responsible for the disablement benefit leaves them with a very large obligation to the Chancellor of the Exchequer and to the House. The right hon. Gentleman is obliged to make very stringent regulations, and it is obvious that if this obligation as to disablement benefit was removed from the approved societies, the whole of those regulations might be very much cased down. The removal of this obligation means that the same requirements would not be necessary, and it would delete very largely Clause 29, which I think is one of the most awkward proposals in the Bill. It is a Clause which provides, under present conditions, quite properly for the examination, every three years of all accounts of these various approved societies If we remove the disablement benefit from them, they would be in a very different position, and some of the provisions contained in the Bill would not then be required or necessary. You at the same time have an awkward position under Clause 31, where you are obliged in cases of insolvency to proceed in all sorts of ways to recover. Thus from the point of view of administration there are large difficulties, but that is only a secondary object. My real object is in order to ease the conditions of approval for approved societies and to make it easy for those societies to be established. It will indirectly help the employés' societies to be recognised by the Government—that is, societies like the South Metropolitan Gas Company and numerous industrial societies. In many cases those societies, while they provide benefits which are equal to those provided in the Bill, still do not deal with superannuation or disablement. It is in that regard that it would be very much easier to allow the employés' societies to become approved under the provisions of the Bill.May I ask whether any discussion in regard to the formation of approved societies would be in order before Clause 18?
The hon. Member is adducing reasons for his Amendment, which, taken in conjunction, I presume, with these later Amendments, takes disablement benefit out of the hands of the approved societies and will hand it over to the Insurance Commissioners.
That is so.
I think the hon. Member is speaking to that point.
That is the point I am really trying to make. If you remove disablement benefit from the approved societies and hand it over to a body which is centrally administered, you give a much better chance to the poorest class in the land to obtain disablement benefit, for under the present provisions of the Bill I say that their prospects are remote indeed. This Bill has created great hopes and has excited all sorts of good people to think that there is going to be a real change for the better in the economic conditions of the very poorest districts in the country. I am bound to tell the House that the prospects for those very poor people as the Bill now stands has given the greatest possible disappointment. I quite understand that every Member of the Committee may not look at the matter from the same point of view as I do. I have tried to describe to the Committee the sort of conditions that exist in the districts of which I speak, where regular employment is the exception rather than the rule., where nearly everybody has long periods out of work, where they are all engaged in the stern struggle for existence, and where, as the Bill stands, though they obtain some benefit, it is not nearly so much as I believe that both this House and the country desire. After all they are the real occasion of this Bill, and I do feel myself they will come very much worse off than more fortunate members of the working classes and the better-to-do. These very poor people who have the greatest struggle for existence do not receive the benefits that have been anticipated and expected, and I do appeal to the Committee in order that their condition may be in some way improved.
I really fail to understand how the hon. Member thinks that the condition of those people will be in any way improved if his Amendment were accepted. The Bill as it is framed puts the administration of disablement benefit into the hands of approved societies. I understand that his Amendment, taken in conjunction with a consequential Amendment, would remove the administration of disablement benefit from the approved societies and transfer it to Insurance commissioners. His object is, he says, to help the very poor, but the effect would be, according to his arguments, to help the friendly societies.
To help the establishment of approved societies.
But the Amendment would take away from them what I should have thought was one of the most important benefits to be administered by approved societies in the district. If my hon. Friend had his way, and if this was to be entrusted to a central committee like the Insurance Commissioners, I do not know whether he has considered what the result would be. There would have to be a whole army of Government inspectors, who would have to spend their time in looking about to see whether a person was entitled to disablement benefit or not, instead of leaving the matter, as we do at present, to be dealt with by the approved societies or the local health committee While sympathising with the condition of the people for whom the hon. Member has spoken, I cannot help thinking that this Amendment would not improve their lot, but would go very far indeed to destroy the advantages which are given under this Bill. The. Government cannot accept the Amendment.
Amendment negatived.
I beg to move, in Subsection (1), to leave out the words "and subject to the provisions of the next succeeding section, medical benefit."
I have a consequential Amendment which would introduce the words "medical benefit" before the word "sanatorium." The effect of the Amendment I now propose would be to transfer the administration of the medical benefit to the local health committee. I am sure this Committee realises, as does the country, the gravity of the issues that are involved in deciding on the machinery of the administration of this benefit. We recognise that under this Bill something like ten millions of people will become insured persons, and it will be necessary to devise machinery for the administration of their benefit. As a matter of fact, when this-Bill is in full operation there will probably not be more than one and a-half millions of adult males left outside the scope of the Bill throughout the whole country. It is perfectly obvious, therefore, that the effect of the Bill upon the practice of medicine and surgery in the whole country will be most profound. It will, as a matter of fact, entirely transform the conditions of general medical practice from one end of the country to the other. And the ultimate effect not only upon the medical profession, which is merely incidental, but the ultimate effect upon the public health and also upon the future of this country and the welfare of future generations will largely depend on the machinery which we provide in this Bill for administering this benefit. Why is this Bill required at all? I think in order to answer the question as to what should be the machinery for the administration of the Bill, it is fair to ask ourselves this question—Why is it that nowadays we propose an Insurance Bill of this kind? I think it really is due to the fact that we are convinced by sufficient evidence that it is possible, by united efforts, to prevent a great amount of disease. Otherwise there would be no justification for such a Bill at all. I do not think that any stateman in any country would feel warranted in proposing a Bill of this kind if he were not satisfied that there was good hope for the increased prevention of disease, because the whole financial success of the Bill ultimately depends on that being realised.On a point of Order. I am not sure, but I rather think my hon. Friend is opening up the whole question of the transfer of medical benefit to the local health committee. It is not in my interest to have the matter discussed twice over, and I think, in the interest of what my hon. Friend has in his own mind, that it would be far better that the question of maternity benefit and the question of medical benefit should be kept separate.
They are kept separate.
I want it to be quite clear that they are kept separate.
I am afraid I have not made my position clear. The Amendment is simply to transfer the administration of medical benefit to the local health committees. I was beginning to argue that unless we could see and devise machinery for administering the medical benefit in this country so that we could increasingly prevent the occurrence of disease that this scheme is destined to fail, and that its ultimate success depends, and the stability and the increased prosperity of its fund, upon a less number of people becoming a charge upon those funds. If we could devise machinery which would prevent people becoming sick the sick funds would benefit greatly. As the Bill stands un-amended the medical benefit with regard to Post Office contributors would be administered by the local health committee, but it might be possible, I do not think it is at all likely, that under the Bill as it stands the medical benefit for thirteen-and-a-half millions of insured persons would be administered by the various approved societies to be recognised under the Bill. That is as the Clause stands. What does that really mean in actual fact? It means that in any county or county borough there would be a considerable number, seven or eight or a dozen, perhaps, different approved societies, dividing societies, friendly societies, industrial societies, and so forth, in addition to the local health committee, all administering medical benefit. Between those different societies in any one county or county borough there would be various jealousies and friction at times undoubtedly. There would certainly, so far as this particular department of their work is concerned, be no common ideal, no common purpose, and no definite mode of co-operation amongst them to obtain the same ends. They would in themselves have no definite standing relation to all the other machinery that we create for promoting public health. They would have, as they stand, no definite relation, to the machinery which we have created and shall create for increasing the sanitation of dwellings and for educating the people in these matters. All these things and all this machinery will be entirely outside the operations of these various societies in any one district.
I ask the Committee seriously to consider whether in all this we shall obtain an effective machinery for bringing to bear upon the whole domestic and living interests of the mass of the insured persons all the forces which the State possesses to improve their health. I feel confident that if we were to allow the administration of the medical benefit under this Bill to be entrusted to this machinery, within a very short time the whole Bill and the whole interests of the scheme would be involved in confusion and disaster. In moving this Amendment I would like to say, with great earnestness, that I am not in the least seeking to throw stones at friendly societies. I believe that we must do everything possible to promote their interests, and that we shall get by the method suggested in Amendment a more effective method of so doing. We shall develop machinery which will prevent there being so great a drain on their sick funds. Let us consider what is called club practice. I say it in no depreciatory sense; let us try to look the actual facts in the face. We have, for example, the reports of the Royal Commission on the Poor Law. Neither the Majority Report nor the Minority Report can say anything very good for the methods and ideals of so-called club practice. This is what the Minority Report says:—It is obvious, if that is anything like true, that if we were to extend to the whole country, to practically all the industrial population, a system which in itself is inherently inimical to the prevention of disease, this scheme could only fail. What are actually the conditions at work in connection with the so-called club practice? I have here the report issued some years ago by the British Medical Association of an inquiry into contract practice, and I find that 167,405 attendances were paid for at the rate of 10½d. What really happens is this. During a man's surgery hours he has a large number of club patients waiting, and they can of necessity receive only a small amount of attention each. If he is to earn a sufficient living he cannot possibly give to each individual the detailed care and attention which are really necessary. It is obvious, and it is a common-place, that one result only follows from that. Many cases are not diagnosed as to their real character as soon as they might be with advantage, and in many cases, I do not doubt the treatment of necessity, in consequence of the very small amount of time available for each case is inaccurate and insufficient. I am not seeking blame to either party. I am only stating what is the actual fact. Throughout the whole country we know that there have been for some years past a series of strifes between the club doctors and the clubs themselves. No doubt sometimes one has been at fault, sometimes the other. In any case, it is manifest that it would be a highly dangerous experiment to apply to practically the whole population such a system as heretofore has been accompanied by constant strife. I do not think—and one tries to speak quite fairly on this point—that the great objection which medical men entertain against contract practice is the outcome of mere cantankerousness. It is not that. It is really because they' find that there is something in it which is against, not only their own interests, but their ideal of work. The fact remains anyhow that at the present time the great majority of the medical practitioners of the country—I am not now saying whether I think it is a wise move or not, out it is the fact—have declared they cannot work on club practice lines in connection with this Bill. Notwithstanding that, if it were really for the best interests of the community it would be right to go on with it. But it is a material consideration to which the Committee will give full attention. As a matter of fact, in the county of Leicester every medical man has signed that declaration. There must be some reason. What is it? It is that the essential character of club practice work is against the development, either of the best treatment or of preventive measures. What is necessary to prevent disease in connection with any one case? Surely it is that you should consider the case in connection with its environment. You should be able to look at the man's house, and to see his family. The whole conditions collateral to the case have to be gone into. When people are crowding into a surgery and being seen at a very rapid rate, all these considerations are necessarily outside. This defect is inherent in the present system. It loses sight in the main of a person's environment, which it is necessary to consider most carefully if you are to adopt preventive measures. The best type of private practice does not do that. We know that the whole family considerations are gone into by the practitioner. The other day the hon. Member for Bow and Bromley (Mr. Lansbury) said that ho wished us to hang the doctors. Of course, that was only a good-humoured way of expressing the fact that they have caused perhaps a considerable amount of annoyance. But whilst I am quite sure we all recognise that there are members of the medical profession, as there are members of any other class, who say things that they are hardly warranted in saying, especially when they get alarmed, yet the fact remains that the possibiity of the prevalence of club practice from one end of the country to the other is viewed with unmixed alarm for the reasons I have stated. But there is another reason. The system has laid itself open for clubs to beat down the doctor in the matter of price. I am sure that when we go to our constituents, and also in this House, we speak freely on the evils of cheap labour. Cheap labour is admittedly bad, even if it is of a merely mechanical kind, or of a type that can be controlled. But cheap labour when it is professional, which nobody can control, which is essentially a personal matter, is surely worse than any other kind of cheap labour that can possibly be employed. No doubt we are all prepared to judge the whole community in this matter from our own point of view. If we are ill, or if a child is ill and we require attendance, we want the best man we can get. There is no question that that is our first solicitude. If we can afford it we say at once, "never mind the expense, I want the best man I can get." Any system which encourages or places a premium upon the employment of cheap professional labour is essentially bad, because it does not meet that which is the very first demand of any person who is ill. 7.0 P.M. But there is another reason. No man engaged in club practice on these lines has any time to think for himself. For myself, I never heard of a man carrying on an extensive club practice who had any time for research or for independent inquiry. It is almost inconceivable. Yet we know that the whole advance not only of this scheme, but of public health depends upon this being encouraged. If we cast our minds back for twenty-five or thirty years, if we consult, for example, the excellent volume published some time ago by the Local Government Board on "Public Health and Social Conditions," we shall find that since the year 1880 there has been a very striking fall, not only in adult mortality, but in disease amongst young persons and indeed amongst all classes, coincident with and mainly dating from the development of modern pathology. This development has gradually worked its way into the public mind, and as these things work their way into the public mind so they get translated into practice in daily life. These discoveries and so on do, as a matter of fact, influence the daily life of large masses of the people, and are accompanied by a corresponding fall in the mortality. Another consideration is that if we were to place this administration in the hands of great numbers of societies up and down the country— with these conditions inherently attached to this type of practice, it would mean that the best type of man would not take it up. It would mean that the medical practice of four-fifths of the population was not such as to attract the best men. The result of that would be that in the course of a generation there would be a serious depression of the whole standard of the medical profession. I am quite sure the House would not wish to risk that. As I pointed out before, the success of this scheme depends upon an efficient service. We want the insured persons to receive adequate treatment at as early a moment as possible of their disease. The diagnosis should be as accurate as possible, so that they will not be a charge upon the sick funds any longer than can be helped. The friendly societies say, and quite rightly: "If you are going to place the administration of the medical benefit in the hands of the local health committees, we want to know where our liabilities end." I think that is quite right and perfectly proper. I have no doubt it will be the first thing that will be done by the friendly societies and by other societies, to know what is the limit of their liability in respect of medical benefit. Then we are told: "Yes, but we shall want control over our doctors." I will examine that in a moment. But it would be quite evident, of course, that any machinery which the friendly societies in their interests ought to employ, both in the selection of their lives, and in the detection of imposition, they will employ. But it was urged on me the other day as against this Amendment, that it would put an end to all sorts of consultations between the societies and their doctors over the different patients. As a matter of fact very few men care to discuss the details of their individual cases with outside persons. It is a very delicate, even a very private matter, and patients naturally object to their cases being canvassed about, even among other medical men, and the more so amongst laymen. In this Bill, as it stands, the three chief ingredients of control over the doctors by the societies will be removed. The first is that there will not be free choice. You are bringing into this scheme something like 9,000,000 of people who have not hitherto been members of friendly societies. It is inconceivable but that that mass of people must have the right of choice of their medical attendants within reasonable limits. It is not a mere fad of the doctors. Let us look at ourselves. We are living in some place, say, and some outside organisation comes along and says: "We have brought a man down from London; he is going to attend you." We say: "I prefer Dr. So-and-so, who is in the next street. I have always had him, and I intend to go on having him." As a matter of fact, the people will demand that they shall be able to choose their medical attendant, just as much as medical men will also desire this, and, of course, I am quite sure that this House-will not desire for a moment to deprive reputable practitioners of their clientele by any Act of Parliament when they are dealing fairly by them. So that we may say without any misgivings that that free choice of doctor must, of necessity, come with this great measure. The next ingredient of control, namely, payment, is also removed by the Bill. The Bill lays down that the Insurance Commissioners will approve this, that, and the other. Not only will they approve payment, but also conditions of employment, so that these societies will not be able to choose the medical men; they will not be able to decide what the payment should be; and they will not be able to decide upon the conditions of the medical man's employment. After these three things are certainly removed from their control under the Bill, what is there of control left? The underlying motive, of course, for the suggestion of control over the doctor is a very right and proper one. It is not that they suspect the doctor of doing anything wrong. It is that they may control malingering. [An HON. MEMBER: "And the doctor."] And the doctor as well; I do not dispute that. It is quite evident that it will be quite imposible by this Bill to adopt any machinery that makes it easier to malinger than it is at present. That is quite obvious. How are we to prevent malingering? There are two classes of people whose interests we may call in to prevent malingering. The first is the insured person, and secondly is the medical men. At the present time in any average club it is obviously to the interest of members themselves to prevent malingering. It will still be so under this Bill. But if Dr. A attend the members of a certain club and the members of another club whose headquarters are in the next street are attended by Dr. B, it is not at all to the interest of Dr. A to prevent malingering in Dr. B's club. So far as the doctors themselves are concerned, It does not matter at all as to what malingering goes on. No medical man wants to encourage the humbug more than he can help. But putting that on one side, there are no particular means at present in operation which brings in the interest of the whole of the medical profession in the locality—mostly concerned, of course, with the disease—to prevent malingering. What will be the case if we had the whole administration in the hands of the local health committee? This is what would happen. The Chancellor of the Exchequer himself has an Amendment down on this point. There would be set up, no doubt, various bodies for putting the medical men themselves, say, under this Bill, or there would be a committee of doctors in a neighbourhood. Say a doctor was lax in granting his certificates. Say he was a medical man attending the members of five or six different societies, as is often the case. If he were detected in the case of one society, and suppose he lost his appointment, he would still have the other societies to fall back upon. If you have the whole administration in the hands of the local health committee and the man is on the panel of doctors, and is then proved to have encouraged malingering, what does he stand to lose? His whole livelihood! If he is knocked off the panel of doctors of the whole district—I am assuming the very worst ease against the doctors that can be put—it then becomes, I say, much more dangerous for a man to encourage malingering. Not only so, but the interest of all the other medical men or the panel is directed to the same end. For it is quite evident if anyone were so unscrupulous as to seek to attract to himself patients by being lax in signing certificates, it would be to the interest of every medical man on the panel to check him doing so. If you have the whole administration in the hands of one committee, both those conditions will be provided for. It would be then just as much the interest of the medical men on the panel to prevent malingering in the whole district as it would be to the interest of the individual insured persons. If you place the administration of this benefit in the hands of these committees we shall inevitably, for reasons which I will outline, gradually get a better type of men. We shall get a better and more efficient service; but more than all these, we shall get a service which will enable us to create machinery for the better prevention of disease. If you have all these various societies with their different methods administering medical benefits, as I have pointed out, you will have conflicting interests; conflicting representations of various authorities on different points; the impossibility of their consulting with one another, the impossibility of there being any uniformity of method. If you have the whole thing concentrated in the hands of the local health committee you will have a body which would be able to take a view over the whole field of public health in that locality. They will be in touch both with sickness records and with the domestic conditions of the insured in the locality. They will be in touch with that machinery provided for giving better sanitation, for looking into the conditions of factories and employment, so far as they are incidental to the prevention of disease conditions. These local health committees of necessity before very long will, I am quite confident, become more closely as you go on linked up with all other sanitary authorities that we provide in any area. They will then come into close co-operation with the educational machinery, for example. It will be to their interest to see that the inspection and treatment of school children is carried on in that locality effectively, because it will mean that the charge on the funds as these children grow up will be so much less. That is to say, these committees becoming increasingly interwoven with the authorities existing in the districts, all types of sanitary administration for the promotion of public health in all its various forms will be grouped together, and it will be possible to review the whole situation in the light of all the facts. It will be possible to bring to bear upon the insured classes all the machinery of public health provided in the area. Not only so, but these authorities which have at the present time the sanatoria before very long, I have no doubt, will have all institutional treatment of all sorts under their control. More than that even, gradually, as this system becomes developed, all insured persons in the area will become increasingly alive to the fact that it is their interest to promote the activity of sanitary administration and of sanitary laws in that locality. We can just contrast—before I conclude—what would be the actual conditions under the two plans which I have discussed. In the one where it was left to the various societies, you would have a multitude of conflicting interests in any locality. It would be unpopular with the medical men who had to do the work. The work would be done grudgingly and accompanied by continual friction, and lead inevitably to a depression of the standard of service. This set of bodies would be entirely divorced from the bodies which have been created for the improvement of the public health and for the prevention of disease. On the other hand, in accordance with the terms of the Amendment which I bring before the House, whilst you would not interfere in the very least with the independence or provident work of any approved society, you would, in fact, increase its prosperity by preventing disease and so diminishing the charge upon its funds. You would provide a nucleus of a national organisation directed to the prevention of disease. It would be popular with the men who have to work it. It would therefore work more smoothly, it would attract to itself a better type of men. Its methods would improve, and, more important than all, I think eventually it would lead to the provision of what is really necessary for the due support and effective action of any Act of Parliament. I believe it was the late Lord Salisbury who said that what we lacked in this country was ''the impulse behind the instrument of government," and I believe that is so in many districts, and here we would have the machinery which would gradually create the impulse among the people which would give them the interest in the administration of this great machinery and would lay the basis of what will eventually become a great national health service. In saying this, I would like to conclude with the caveat that, what I mean by national health service is not something created by any one Act of Parliament. We surely, in deciding upon the mode of administration of the medical benefits of this Bill, must so mould the Bill that it will dovetail in with the existing organisations of the country for the promotion of health. We have the Local Government Board machinery for dealing with it, and it is becoming increasingly efficient. We have all the machinery of the Board of Education for dealing with children, and at the other end of life we have the Old Age Pensions Act. This Bill when it becomes an Act must necessarily be so devised that it will fit in and work with these great and beneficent Acts. This Bill deals with that period of life between childhood and old age. We take the people in that working period of their lives when no existing Act, except in an indirect way, bears upon them, and our main purpose, I take it, is to prolong the later years of life, the working days that at present exist. We want people not to be worn out at forty, but to be able to work until they are seventy, and it is only by creating machinery which will fit in and work harmoniously with our existing Acts and ultimately lead us by the creation of public interest in the development of a better national health service—only and in that way, I am confident, shall we rightly make this Act a success."The contracts between medical men and the clubs so extensively made by the organised friendly societies for the medical attendance of their members are constantly producing strain and friction in the relations between societies and the local practitioners whom they employ, breaking at intervals into open warfare. The doctors allege that the remuneration allowed to them is so insufficient as hardly to cover expenses, while many persons of substantial means take advantage of society membership. We need not consider these mutual recriminations except in so far as they reveal conditions inherently inimical to the cure and prevention of disease."
I want to say a few words to reaffirm the views I have already expressed in reference to the matter under consideration. I think I was the first man in this House to suggest a method of settling the difficulty between the doctors and the friendly societies which has now found expression in the Amendment of the hon. Member who has just sat down. I want to make it clear to all Members of the Committee that I speak solely for myself, and in what I have to say I am giving merely my individual views; it will be open to my Friends to state theirs, and possibly different views. What the Chancellor of the Exchequer is going to do I do not know. Somebody has whispered ho is going to accept the Amendment; others think he is going to bless it, and only to accept it if the Committee compels him to do so. I understand the suggestion is made that the matter should be left an open one, and that all Members should be free to vote as they choose, and that the Chancellor of the Exchequer will accept the product of our united wisdom. I am glad we have come at last to face this difficulty, and that we have got to settle it before we go further with this Bill, because really unless this difficulty is settled and got over I think the Committee will agree we are wasting our time on the discussion of the Bill. It is quite obvious that unless we can secure the hearty goodwill and co-operation of the doctors the Bill will be no good to anybody. On the other hand, if we were by mistaken action to inflict lasting injury upon our great friendly societies then we should be doing damage to the nation at large. We have got, therefore, to see whether or not the solution suggested by the hon. Member is one that affords a fair prospect of avoiding either of those difficulties. In my judgment it does.
The hon. Member who has just sat down has sketched very briefly some of the objections which are entertained by friendly societies to the proposal that he makes. One of these objections is that they will lose the control of their doctors—the control of the appointment and the control of the work as far as the appointing authority can control the work which the medical man has to do. The hon. Gentleman has very rightly pointed out that in a sense it appears to be the general wish of the Committee that a free choice of doctors should be given to persons brought under the operations of this Bill, and that the objection raised on the part of the friendly societies falls to the ground. There is one objection to which he made no reference, an objection which the Chancellor of the Exchequer will find himself forced to deal with in some way or other. One of the objections stated to me is, the friendly societies say, that under their present rules which will continue to exist when the Bill becomes law, everyone who wants to join their society has to pass a medical examination. Who is going to pay for that medical examination? I have looked through the Bill, and I cannot find any reference to any proposal for the payment of medical examination of those who wish to join friendly societies. I do not wish to labour the point, for no doubt it has been considered by the Government, and no doubt the right hon. Gentleman will tell us in due course under what part of the Bill it is provided to pay a rate to the doctors for these medical examinations that will have to be made. I have taken these two suggestions that have been made to me by the friendly societies, and I cannot see how, in view of the decision which I think the Committee will take as to the choice of doctors by the patients, the. position of the friendly societies is going to be jeopardised. We have got to keep in mind, and ought to keep in mind, when considering the rival claims of the friendly societies on the one hand and the doctors on the other, the main purpose we have in view in passing this Bill. The main purpose is described on the back of the Bill itself. It is a Bill "to provide for insurance against ill-health and for the prevention and cure of sickness." That is the main purpose we ought to keep in view, and the step which the hon. Gentleman has asked the Committee to take is a step which I believe will make in this direction. After all, what we ought to aim at is to secure the best possible medical service for the whole body of our people. In addition to that we want uniformity of practice and administration. We shall get that better and secure it to a far larger extent if the medical benefit is placed in the hands of the local authority, rather than leave it in the hands of the approved societies. In the speech which I made on the Second Beading of the Bill I said I looked forward to the time when the mere creation of these local health committees would compel the House to undertake the revision of the whole system of our national medical service. I believe the time will come, and come shortly, when all parties will unite in coordinating and co-relating the various measures that affect the national health, so that we shall be able to create and bring about a more uniform system than we have at the present time. I have received a vast amount of correspondence, and I have had the opportunity of inter- viewing a great many people in connection with these difficult problems. All I can say is that the views I expressed on the Second Reading of the Bill remain unchanged, and I intend now to vote in support of the Amendment of the hon. Gentleman opposite.I gladly support this Amendment for several reasons, but the principal is because I think that the control of all medical benefits should be transferred to the health committee. We are told that the medical profession are strongly of opinion that if they are to be brought into this scheme, they ought to be brought into it under circumstances which should be brought about by this Amendment. I am not suggesting that the medical men have a right to dictate the terms under which they should come into this scheme, but I think they are entitled to express an opinion and that that opinion ought to receive the fullest consideration at the hands of the Committee. In a lesser degree, perhaps, I think another section affected by this Bill, namely the dispensers who are brought into this scheme, have a right to be considered, and I think I have a right to speak for the whole of those who would be entitled to supply dispensed medicines in saying they are at one with the doctors in asking that the control of the medical benefits should be transferred to the local health committee. There are several reasons why that should be so which could be put forward in the interests of the insured persons themselves. The health committee is, according to the Bill, to have control of sanatorium benefits. It is also to control the medical benefits of all those who are not members of approved societies. So under the Bill as it stands you have this position, that the health committee will be responsible for the medical and sanatorium benefits of some of the insured, and will be responsible for the sanatorium benefits of all. The medical committee will have persons for whose medical treatment they are responsible. I suggest, in all probability, there will not be enough sanatorium benefit to go round, and if that is so, it will be only natural that the health committee should see that the people on their own sick list get first claim to sanatorium benefit, and if that is so those coming within the control of approved societies will come off second best when it comes to par- ticipating in sanatorium benefits. It will only be natural that the health committee will want to get people off its sick lists—namely, all those outside the approved societies. And obviously those persons will have the first claim upon the sanatorium benefit, in my opinion, to the disadvantage of those who would remain under the approved societies. I think it is obvious that no one ought to make a profit out of the administration of the medical benefit, and, if that is so, and if the friendly societies are not in a position to make profit out of the administration of the medical benefit, why should they seek what might mean a loss? I do think it is of the utmost importance that there should be uniformity of treatment for the insured irrespective of the particular society in which they are insured; not only uniformity of treatment for the insured, but uniformity of treatment for the doctors. You can only get that uniformity if you have set up in a district a health committee controlling these benefits. They would see the conditions are the best that can be devised for that district. If they set up a scale for the payment of doctors they will see that scale is uniform, and that all the doctors in the same district will receive the same terms.
If you leave it to the approved societies to make their own terms, you will find these terms unequal, and that would work detrimentally in the interests of the insured and the whole scheme. I cannot see how the Chancellor's Amendment in regard to the treatment of medical men under this scheme can possibly work unless you have uniformity in each district for the administration of medical benefit. I am satisfied it has not been in the interests of the insured that the doctors should have been so much under the control of the insurers—the friendly societies. I speak from experience. I spent twelve years dispensing in a doctor's service. I can tell the House from practical experience that the past club-practice system, with the treatment of the poor in private dispensaries throughout the great towns of the country, would, if it could have been brought to the light, not have been tolerated in this country for a day. I do not blame any friendly societies or doctors. The conditions have been such that it has been impossible to provide efficient treatment. No one has been satisfied. The members of the friendly societies have complained, and the society officials have complained, and the medical men have complained. An hon. Member asked me why did they do it? He knows that in that profession, as in every other, there are people who have to make a living and submit to conditions to which they would rather not be subjected. It is not what this House should require, that people should be sweated; for that is what it comes to. I ask the House in the interests of the insured persons, and in the interests of the friendly societies, that they will support this Amendment and secure uniformity of treatment for the insured and his doctor and chemist.I wish to say one or two words in support of this Amendment. I sincerely hope that after the speeches just delivered—all of them in favour of the Amendment—the Chancellor of the Exchequer will not only show his interest in the Amendment which has been recommended for the acceptance of the House, but will accept it as an improvement on the Bill as it stands. It must be remembered that under any circumstances this Bill creates very great changes in the conditions under which medical benefit have for many years been administered by the friendly societies. No one who supports this Amendment desires to say one word against the friendly societies, or the great services they have rendered in promoting thrift, and in many other ways, amongst the workers of this country. At the same time friendly societies in this country cannot suppose they will be in the same position when this Bill is passed as they are at the present moment. It creates very vast and considerable changes in many respects. It is an entire revolution in the way in which medical practice is carried on. The hon. Member proposes to take very little away from the duties which are at present discharged by the committees of friendly societies. Sickness benefit, disablement benefit, and even maternity benefit, will still continue to be administered, in the case of the insured persons, by the societies. It is only the medical benefit which, under this Amendment, will be transferred. I do not propose to follow the hon. Member for Hoxton through the several subjects on which he dwelt in the masterly and interesting speech delivered to this Committee, but I venture to think that some of his arguments were a little destructive of the foundations on which this Bill is raised; and particularly those in which he dwelt upon the disadvantages of the contract system in general medical practice. We may have to consider that question more in detail and more generally, when we come to some of the other Amendments, in respect of which we hope to receive the support of the hon. Member for Hoxton. I think this Amendment should be accepted by the House because the medical profession are unanimous at last. It has been said we cannot grant everything the doctors require, but this is a matter of very great importance.
When you are introducing a Bill for the preservation of health and for preventing disease, you should take into consideration what are the requirements of the members of the profession who are assisting you. Now the medical profession are absolutely unanimous in expressing their desire that these medical benefits shall be administered by the public health committees to be set up in all parts of the country, rather than by the committees of friendly societies. We are quite certain doctors would not urge this unless there was some good reason. It has been suggested, by more than one speaker, that in the past there has been a certain amount of friction between the friendly societies and the doctors. We certainly in assisting to give effect to this Bill do not want to do anything which will continue the friction. We must all feel that unless the doctors put their whole heart into the provisions of this Bill, and desire to give effect to it, the Bill will become inoperative and the great purposes so eloquently sketched by the Member for Hoxton must fail. Let me point out one advantage the transferring of these functions to the health committee will give. The health committee will be a composite body. It will not consist only of members of the friendly societies. A public health committee will have representatives from the friendly societies, it will have representatives from county and borough councils—and it is most important that regulations in connection with health conditions should be in harmony with borough or county councils. The committees would also have representatives of the medical profession, and it cannot be doubted for one moment that a committee so constituted is better able to discharge the important functions to be assigned to a body of this kind than a committee of the friendly societies which consists of their own members and of none else. For this reason, if for no other, I think it is advisable that these duties connected with the health of the people should be admini- stered by bodies constituted as the public health committees will be. Great weight also should be attached to the reason that, "if there is to be a choice of doctors, it is almost indispensable that the administration of this medical benefit shall be in the hands of the health committee. The health committee will have to be concerned in the appointment of the doctors. It will be concerned with their control, and we may be quite certain that any body on which doctors are represented will be far more able to exercise control over doctors than any other body. I am in hopes that no one will oppose this Amendment. At any rate, Members on both sides of the House are agreed as to the advisability of this Amendment being carried. It cannot be I said there is party spirit in this suggestion. In order that we may go on smoothly through the many difficulties this Bill represents—difficulties which no one better understands than the Chancellor of the Exchequer himself, and, I am sure, at the same time, no one is more anxious to meet the views of the doctors if he can do so— I sincerely trust there will be no division of opinion on this important proposal, and that the Chancellor will do his best to give effect to the Amendment to which the Committee generally agreed, and which I very heartily supportI rise for the purpose of supporting this Amendment. I am sure the Committee will be glad that we have now reached a stage when this important question can be dealt with. Perhaps I may say that this is the first shot fired in this controversy, or probably I should be more up to date if I said this is the first ditch we have arrived at in which the controversy of whether the medical profession are going to throw themselves heart and soul into the working of this Bill, or whether they are going to repudiate it, or whether they will undertake it in a halfhearted way. The friendly societies in the past have undoubtedly done a great deal to benefit the working classes of this country. They have, in fact, done what the State ought to have done in years gone by, and there is not the slightest doubt that they are not entirely to blame for the fact that, although they gave good value for the money contributed in the way of sick benefit and medical benefit, they did not find sufficient money to ensure proper medical attention for the members of both societies. After all, there was nothing to prevent them from getting medical attendance in the cheapest possible way they could.
I think it would be well to explain to the Committee at this stage how it is that doctors throughout the great portion of this country accepted a fee so low as, I am sure, they did, although I never knew it was so low as that which has been stated. When a doctor is qualified in this country he is generally between twenty and twenty-three years of age. He has not got any practice to go to, and when a person has once got his own family medical attendant he does not throw him over unless there is some very good reason for it. The consequence is that a young man starting life in that way and trying to get a practice together must either have capital to buy a practice or else he must go down into the poorer districts and accept some appointment for which he is often badly paid. That is probably the reason why a great many of the societies have been able to get qualified medical men to undertake attendance upon their members at such miserably low fees. But that is not the class of medical man we want under this Bill. There are two classes of medical men associated with clubs. In the first place, there is the class of doctor who takes on the club members because he wants to get an opening. It may be that he does not succeed sufficiently well either from want of intelligence or because he does not look after his work sufficiently well. He may get a small practice together, and he may want to sell that practice to some young man in order to give him a start. Then there is another class of doctor who takes on the clubs in the country districts. There you get a very much better class of medical man undertaking club practice than in the towns, because the friendly societies exist in every village and in a great many of those villages there is only one doctor. He generally has a fairly good lucrative practice of his own, and he takes on friendly society work because that society happens to be in the district, and because there is nobody else to take it. If we are going to have the work done in the same slipshod fashion as in the past —I do not say the doctors have not given value for the money paid to them—but any man who speaks honestly will tell you that the way in which club patients have been treated in this country is not the way you ought to adopt if you desire to make this Bill a success. The medical profession have spoken clearly upon this question. Whatever difference there may be upon the question of the capitation grant or any other matter the doctors are undoubtedly unanimous upon the point that they will not have anything to do with this Bill unless this difficulty is got over. I admit that the friendly societies have a grievance. I also admit that the doctors who are now doctoring friendly societies also have a grievance. The friendly societies say we have had our doctors for years, and we have had no difficulty with them and do not want to lose them. My answer to that is if a doctor has done his work honestly and straightforwardly to the working men in a particular district that doctor will continue with them. If he has not done his work honestly and straightforwardly and neglected his patients then they should have an opportunity of choosing a fresh doctor. With regard to the question of malingering, there are clubs which dictate terms to the doctor in the case of approved societies. If there is any difference about malingering between a doctor and an approved society, that doctor will have to go before the approved society, and, in nine cases out of ten, it will be a question of every member turning up and taking sides, and it will not be financial interests that will be studied, but you will have the society in all probability backing up their own member. In the case of a doctor attending a member of an approved society if he neglects his duty what is the consequence? You find the members of that friendly society looking out and watching to see that the doctor does not allow a man to go on to the funds to impose upon them. A man in that particular club affected in this way might demand an inquiry which would be held before the local health committee, which would not be afraid to give its opinion, and would be influenced by the other members of the particular friendly society themselves. They will be able to hear the case and give their opinion honestly and straightforwardly, and in that way we shall be able to get rid of a number of medical men who might be anxious to give certificates in the way complained of. It is impossible to work this Bill without the doctors. You cannot create 500 doctors like you can peers, and you cannot possibly work this Bill without about 7,000 medical men, and unless you can find medical men anxious and willing to assist us in every possible way to see that nobody imposes upon the fund. Under the Insurance Bill a doctor will not be seeing twenty or thirty cases in half-an-hour. He will have to produce a paper, take temperatures and pulses, and put it down in black and white, so that a reference afterwards may easily be made. I hope there will be no Division on this Amendment, and I trust it will be unanimously accepted. I hope we are going to make this a successful Act, and that we are going to study not the friendly societies, not the doctors, but only what is going to be for the best. It is a national health Bill, and you cannot work it without the goodwill and the good feeling of the medical profession.I hope the Chancellor of the Exchequer will accept this Amendment which I regard as essential for the successful working of the Bill so far as medical benefits are concerned. I think we ought to have a fresh start in this matter. The history of the relations between the medical profession and the societies has been touched upon very lightly and delicately by the hon. Member for Hoxton, who moved this Amendment, and no useful purpose can be served by going any further into details upon the history of those differences. Sometimes they were very acute, but whatever may have been the cause of those differences the result is that there is a very strong feeling indeed upon the part of the medical profession connected with the working of this Bill that the control should not be the same as it is in the Bill at the present time. I think the Chancellor of the Exchequer will feel that medical benefits ought to be properly administered, and he will see that it is essential we should make a fresh start in this, matter. All the conditions in regard to the administration of medical benefit will be changed under this Bill if it becomes law, and under these circumstances why should a society desire to retain some portion of control which beyond all question would cause intense friction, and would, in the belief of those best qualified to judge, be fatal to the successful working of the Bill.
I want to put one or two cases before the Committee in order to show that some of our existing societies will be absolutely broken up if this Amendment is passed. May I give the case of a company with which I am associated in South Wales which emplays over 5,500 men. Those men formed themselves into a sick society, giving certain sick benefits and certain benefits outside the sick fund. The members contributed 3d. in the £ out of their wages.
That very point is met by an Amendment to Clause 14, which is down on the Paper.
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If this Amendment is accepted it will mean that these existing societies which are not at the present time approved societies but intend to become approved societies will be broken up. Take this company in which I am interested. The average wage of the men employed is £l 10a. 6d., including men and boys, whilst the average contribution is 5d. per week. They pay one doctor £750 a year. They employ four assistants at £300 a year, two at £200, and one dentist at £150, and that society has been an immense boon to the working men employed by my company. The men feel they would be somewhat harshly treated under this Bill. The medical attendance provided for them includes doctoring not only for the men but for their wives and children. I believe a deputation of these men has seen the Chancellor of the Exchequer, and they have pointed out to him their difficulty. They have out of their wages provided for medical attendance, they have made all these sacrifices and provided dispensaries of their own, and now we are told that these are going to be stopped. I am quite in favour of the principle that medical men ought to be protected where they do their duty in respect of malingering. There have been cases undoubtedly where friendly societies have dismissed doctors for doing their duty, and it is quite clear they ought in such cases to be protected. We have now a Medical Trades Union which seeks under this scheme, although the amount they are to be paid is something like 30 per cent. more than they have received in the past. [HON. MEMBERS: "No, no."] Well, approximately 30 per cent. Many friendly societies pay 4s. including medicine, and under this Bill the doctors will receive much more.
There is an immense amount of private practice now yielding a very good return to the doctors which will be embraced in these small payments.
Yes, but most of the doctors in my Constituency, which is purely industrial, tell me that nearly half of their practice consists of making bad debts. They are, at any rate, under this Bill going to get paid for certainty, and there will be no bad debts. I certainly think doctors who do their duty ought to be protected instead of being fired out of their position because members of friendly societies work together, but I cannot understand why a Liberal Government should give the doctors this class benefit, which is really what it comes to. As I understand the constitution of the health committees, they are not going to be representative in the true sense of the word. They will naturally in the country district be tinged with the element of the county councils. My Constituents hate the county council and everything connected with it, and I do not wish to see them put under the domination of a body one-third of which is to be composed of the county council, because, although I live in the most democratic Constituency in England, yet the majority of the county councilors of my county are Conservatives. They have a Conservative majority on the county council because people of the working class cannot go to do that kind of work. The doctors are asking for what is unreasonable, and I think Parliament ought to resist their demands. If it comes to a Division, I shall certainly vote against the Amendment.
I should like to say one word in support of the Amendment of the hon. Member for Hoxton (Dr. Addison). I have a similar Amendment down, and I have been urged by a large number of doctors to support this proposal. There is no doubt a large majority of medical men throughout the country condemn the proposals in the Bill, and I do not suppose there is any profession to which we owe more than the medical profession. I do not suppose there is a single Member of this House who has not at some time or other been under great obligation to some member of the medical profession. It seems to me, therefore, that the greatest consideration should be shown to the members of that profession. They say this proposal in the Bill will be bad for the medical profession, and, if it is bad for the medical profession, it will be bad for the community. It will tend to lower the profession by making them the servants of the friendly societies. The doctors, as the hon. Member who moved the Amendment rightly said, have been fighting against the club practice for years. Many of them in it now wish to get out of it, and an increasing number are leaving it every year. The doctors, especially in the country districts, have as much to do at the present time as they can possibly manage. They are out all weathers, day and night, and, if you curtail their income in the way this Bill would curtail it, it will mean almost ruin to a great many of them. If they wish to bring their income up to the present level they will have to do more, and that means their work will be scamped.
I asked the other day if any compensation would be paid to any doctors who showed they had incurred a loss under the Bill, and the answer was, there was no loss, but rather a gain. It may be so with regard to doctors living in Harley Street and in that district, though I doubt it, but it certainly will not be the case with regard to doctors who work in country districts. Men who enter the medical profession have to undergo a great deal of preparation and incur a great deal of expense, and I think it is a bad thing for a country that fewer men are entering the profession year by year. It is most important to make the medical profession more attractive than it is, and thus encourage men of the highest ability to enter it. You are not doing that by this Bill. It seems to me the arrangements to be made with the societies under this Bill are liable to make practices very un-saleable. Everybody knows that doctors buy and sell their practices, and that they are worth more in one place than they are in another. There is no doubt that in some cases medical men invest the whole of their capital in a practice, and go down to the district in which it is situated, either to win or lose. If this Bill passes into law, medical men will lose heavily, and there will be no compensation. You will find a great many medical men will be ruined. I hope most earnestly the Chancellor of the Exchequer will see his way to accept this Amendment. I believe, if he does so, it will be better both for the friendly societies and the doctors.I have listened to this Debate with special interest, especially in view of the postcards I have had from some million members of friendly societies during the discussion of this Bill. I understood there was a Committee among the Opposition determined to see the interests of the friendly societies were properly championed during this Debate, and that nothing inimical to the future management of these institutions was allowed to go unchallenged. It is a rather peculiar com- mentary upon the representative character of this House that during the discussion we have not heard one word of support of these great institutions as to their past management or administration of medical benefit. Everything that has been said with regard to them has been practically a censure upon them. There has not been a word said for the way in which they have done the work in years gone by. They are, after all, the only institutions that have attempted in an organised fashion to deal with the problem and to bring medical relief and assistance to those who would be otherwise unable to secure it. Yet in a House of Commons, representing millions of these people, not a word of praise has been uttered of their past efforts, and nothing but condemnation has been so far heard. I am not anxious either one way or the other about the Amendment, but I am anxious that these institutions, which are, after all, working-class organisations, should at least have a word said on their behalf during the Debate to-night. I understood there was a Committee who were dying, as it were, or who wanted to die in the last ditch, to defend these institutions and their reputation, but not a word has been said in their defence except by the hon. Member immediately behind me (Sir A. Markham). I do not believe there is any justification for the condemnation which has been passed upon them. If it be necessary to introduce a new system of medical benefits, as is suggested by the Amendment, all well and good, but if the speech of the hon. and learned Gentleman opposite, in which he said the arrangements made between the friendly societies and the medical profession were such that no respectable people in the country could possibly defend them, is to go unchallenged——
I did not say anything of the sort.
It was clearly said the arrangements were of such a character that no one could defend them. I wish to say I believe they could be defended. When it is remembered that all the people who are going to contribute to this fund are extremely poor people, and that every penny taken out of the fund is a reduction of the benefit which it will be possible to pay to the men, I think there is something to be said for the friendly societies, who in the past have at least resisted unjust demands. Possibly some bargains have been made with the medical profession which would be open to criticism, but it certainly cannot be said the whole medical business of the great friendly societies is such as could not be tolerated in the future, and that therefore they ought not to have any power or voice in these matters at all, but that they should be handed over entirely to committees, representing,? suppose, the lord-lieutenant in the county, the county council, and the master of fox hounds in the locality. I suppose it is thought these gentlemen will do the 'work better than the men who have previously arranged these matters. I do not believe anything of the kind. I believe if the question was decided as the Bill was originally drafted the medical profession would find no hardship would be done to them. [An HON. MEMBER: "NO, no."] An hon. Member says "No, no," suggesting, of course, harm would be done to them. I simply do not believe it. I believe these institutions try to act fairly——
And, it being a Quarter past Eight of the Clock, and there being Private Business set down by direction of the Chairman of Ways and Means, under Standing Order No. 8, further proceedings were postponed without Question put.
Private Business
Local Government Provisional Orders (No 10) Bill Southport Order
Adjourned Debate on Amendment proposed on Consideration of Bill, as amended [ 28th July]. (By Order.)
Which Amendment was in Article XI., Sub-section (2), at the end of paragraph ( b), to insert:
"For the purposes of Part XVIII. of the Act of 1900 teachers who, at the commencement of this Order, are, or hereafter shall be, permanently and exclusively employed by the Corporation as the local education authority for the borough, or are permanently and exclusively employed in any public elementary school in the borough (whether provided by the Corporation as the local education authority or not), or are permanently and exclusively employed in any school, college, or hostel provided by the Corporation as the local education authority for the purpose of Part II. of the Education Act, 1902 (and any such teacher is in this Section called "the teacher"), shall be deemed, if the Corporation in their discre- tion think fit, to be persons in the employment of the Corporation whom, or some of whom (according to their qualifications or conditions of service or otherwise) the Corporation may, in their discretion, determine to be a class or classes of persons entitled to contribute to and participate in the benefit of any fund established under the provisions of the Act of 1900, and upon any such determination such provisions shall apply accordingly.
Provided that in exercising their discretion under this section the Corporation shall not differentiate between classes of teachers on the ground alone that any such class is composed of persons employed in public elementary schools provided by them or in public elementary schools not so provided, or of persons who were, before the commencement of this Order, employed in the existing borough, or of persons employed in the added area.
Question again proposed, "That those words be there inserted in the Bill."
I do not wish to detain the House long on this particular Amendment, but I think it necessary to ask for some declaration from the representatives of the teachers in this House. The hon. Member for Southport (Major White), in speaking to this Amendment the other day, used rather remarkable words. He said:
It does seem to me that if the hon. Member believes those words, he should have had the courage of his opinions and have opposed this Amendment. The only inference one can draw is that the teachers or their representatives in looking after the interests of the elementary teachers in the district, have been endeavouring to force something upon the promoters of this order which is unreasonable and cannot be justified. The teachers are just as much entitled to consideration—they are in fact rather more entitled to consideration than many of the persons who are very well cared for indeed in this order, and to suggest that the other people shall have their salaries increased and their terms extended while the teachers' demands are treated as unreasonable does seem to be unwarrantable. I think I am right in asking some representative of teachers in this House to defend their own proposal, and to say whether my interpretation is reasonably right or whether the condemnation passed by the hon. Member for Southport is justified."I have been requested by the promoters of this Order, the Southport Order, to say that, in view of the lateness of the Session and the possibility of losing their Bill, they accept this Clause but under protest. They consider it is irrelevant matter and has nothing at all to do with an order for the extension of the boundaries of the town. They think it ought to be included in some national scheme, and I personally agree, but, as it is, they accept the Clause."—[OFFICIAL REPORT 28th July, 1911, col. 1911.]
As this Motion stands in my name, I do not know whether I have exhausted my right to speak by having formally moved it.
I daresay the House will be glad to hear the hon. Member, although I think, technically, he has exhausted his right to speak.
When I moved the Amendment without a speech I did so on the understanding that it was an agreed Amendment. The hon. Member for Southport followed with the statement which has just been referred to, and that prevented the matter going any further on that particular date. I wish to point out that four Bills which contained Clauses dealing with superannuation powers on the part of local authorities have this year come before the Education Committee, and a Clause exactly similar in purport and largely similar in wording to the Amendment I have put down has been adopted, approved by the Committee, and placed in the Bills. That was done with the goodwill and approval of the Treasury. But the Committee which had to deal with this Bill refused to introduce such an Amendment. An endeavour was made to induce the Committee in the ordinary way by argument to agree to the insertion of this Amendment, but it having failed I gave notice of my intention to move the addition of this Clause in this House.
Question, "That those words be there inserted in the Bill," put, and agreed to.
On a point of Order. May I suggest I will be content with moving only one of my notices, and I do that out of consideration for the House itself. I think it will be quite possible for me to make my protest on the one Amendment, and, by way of personal explanation, I should like to add that, as the Insurance Bill was interrupted by a Debate on a private Bill last night, I feel a great sense of responsibility in occupying time which is required for the consideration of that Bill. I beg to move, to leave out Article XIII.:—
This shows that there was collusion between this group of ratepayers forming the association in Birkdale and the town clerk's office in Southport. They were arranging manifestoes together, and arranging for distribution, and quite naturally this ratepayers' association in Birkdale thought that justified a claim for the usual liberal scale of expenses and disbursements, and the president in question, in a very long letter to the local Press, is justifying his conduct in trying to get money out of the Southport Corporation for what he calls expenses and disbursements, although the association was ostensibly acting solely in the interests of Birkdale and Ainsdale. I want hon. Members to realise that if a big borough is endeavouring to look round for a desirable urban district to incorporate, and is allowed to make proposals to the officials to secure them in their posts, as this Order does, and make ample provision for them, and coax them over if you like by the well-known species of argument, and when they have sapped and mined the local authorities and the urban district, to foster and aid and buy collusion with the ratepayers' association, disseminating literature and then making financial claims, they are discrediting local government throughout the country. This is the first instance that has been brought to my knowledge, though I am in touch with a great many local authorities, and I am bound to bring it forward and make a public example of this manner of securing amalgamation. That money was expended, I think, will be perfectly clear, because it was on the advice of the solicitor of this ratepayers' association that they sought to get these funds. The president, in a letter dated from Birkdale on July 21st, says:—"Adverting to mine of the 19th instant, and the interview thereon, which you and Mr. H. T. Smith had with my Parliamentary Committee yesterday, I am directed to say that my committee cannot give financial assistance to your association. If, however, you will let me have permission to use the manifesto, which we understand you are issuing and publishing in favour of amalgamation, I am authorised by my committee to have copies printed and placed in the hands of the Birkdale and Ainsdale ratepayers."
There you see this president of the association got on so well that he thought he would be able to get a cheque for expenses, and the Committee met him to debate it with him, but he finally failed, and my own interpretation, and I can put no other on the matter, is that having failed to get this money he then proceeds to expose the whole thing in the Press, and fills two or three columns with diatribes against every one concerned. It is most remarkable. To make it quite clear I will read another letter from this same town clerk, which will show this application for money. This is a letter of 19th September, dated from the Town Hall of Southport, 1910:—"I explained to the Southport Parliamentary Committee that the disbursements of the Birkdale Kate-payers' Association incurred in furthering the cause of amalgamation, should be repaid by Southport as soon as amalgamation was accomplished. After interviewing the Town Clerk on the subject, the Parliamentary Committee gave me an appointment to appear before them and, in company with Mr. H. T. Smith, I did so appear and my request was refused."
"Dear Mr. O'Regan.—
The Chairman evidently thought it was a request that the Committee should consider. I bring this matter forward at the request of many of the inhabitants of Birkdale who by this time have repented of the whole transaction. I do not think it quite fair to the House to begin a game of obstruction against a measure that has gone so far. It may be that they can appear before the Committee in another place. I hope they can, but I want to ask, in view of these transactions, for some assurance from the Local Government Board, which takes a kind of paternal interest in all these authorities and is very carefully on the watch, that when their auditor goes down he will carefully examine all the payments and vouchers to see that no money actually did pass on such an object as this. I do not know whether the right hon. Gentleman will be prepared to send a special inspector down to inquire into the whole circumstances, but from the evidence I have been able to place before the House this is not a bonâ fide amalgamation. The agitation was spurious, the connection between the agitators in both places is entirely complicated, and I do not think that people who sincerely desire progress in local government would indulge in tactics of this kind. At this stage, though I have a number of Amendments down, if I can get any assurance from any quarter that the thing will be inquired into on the spot and that we shall get to the bottom of the charges, because the people are demanding an inquiry into the whole circumstances, it may influence my further opposition to this Order."Adverting to the interviews which you and Mr. H. T. Smith had on Saturday with myself and afterwards with the Chairman of my Parliamentary Committee, when you asked for an assurance of financial assistance for the operations of the Birkdale Ratepayers Association, the Chairman desires me to say that he will lay your request before the Parliamentary Committee at their meeting on Wednesday."
I beg to second the Amendment.
My hon. Friend is to be congratulated upon the sweet reasonableness that has characterised his proceedings this evening, because he has twenty-five Amendments down on the Paper, and, with a generosity amounting almost to magnanimity, he has decided to speak on one, and not move the other twenty-four. For this condescension many thanks. My hon. Friend has brought before the House a case which at first I thought had more in it than now appears, the facts principally being these: He makes great play of the fact that a ratepayers' association was formed in Birkdale, the urban district which was going to be included in the Southport Order, and he rather implied that that was a gross and improper proceeding. Speaking generally, I never did attach a great deal of importance to what are ordinarily known as ratepayers' associations, with whatever political party they may be associated, but the formation of a ratepayers' association is not yet an illegal or a seditious act and therefore they are within their rights in forming such an association. Then my hon. Friend quoted the town clerk's letter, and I had expected from the way in which ho read it that the town clerk had been asked and had consented to supply the money that the president and secretary of the ratepayers' association thought they were entitled to claim from the Southport Town Council through their clerk for supposed services rendered in the amalgamation of Birkdale with Southport. But my hon. Friend failed to prove any financial collusion between the town clerk and the president of the association, and therefore the suggestion that the town clerk had squandered the ratepayers' money was not maintained.
I did not suggest that.
No; but it has been suggested in correspondence. Then the piece de resistance of the hon. Member's case was some remarks about a manifesto. It seemed to me that the only thing the town clerk has expressed a willingness to do was to circulate some manifestoes in the event of their being sent to him. Whether that was so or not I have no information, but this is evident that the town clerk did decline to pay any expenses. The money may have been expected by Mr. O'Regan, but the cash was not forthcoming, therefore the town clerk seems to me not to have committed himself to the extent that was thought. That is demonstrated by the fact that a request was made definitely in one or two letters for money, but that failed. No cheque for expenses was sent, and the result of it is that Mr. O'Regan and his secretary were unable to be reimbursed what they considered the reasonable expenses they had been out of pocket in negotiating the unity of Birkdale with Southport.
My hon. Friend, as he was perfectly entitled to do, appealed to me as the President of the Local Government Board, who tries to be in these matters the guide, philosopher, and friend of these authorities, to make some promise to him as to the regularity of these proceedings. My hon. Friend has now an opportunity of knowing what could have been done in the event of irregularities taking place of the kind first suspected. To his credit he did not suggest that irregularities had occurred in the ease of the Southport town clerk. If any expense has been improperly incurred by the town council of Southport, and if their accounts are audited by the Local Government Board auditor, then it is very easy for anybody, not necessarily a ratepayer, to bring these irregularities within the purview of the Local Government Board auditor. In this case the accounts of Southport are not audited by the Local Government Board auditor, and therefore my jurisdiction does not apply. If the accounts of Southport are audited by an elected auditor any ratepayer can bring the matter before the elected auditor. In the event of irregular expenses having been incurred by the town council or one of its officers acting presumably on its behalf, any ratepayer can apply to the Attorney-General for his fiat to be issued against allowing these expenses whether the accounts are audited by the Local Government Board auditor or an elected auditor. My hon. Friend in the last resort could get a ratepayer to apply to the Attorney-General for his fiat. I would appeal to my hon. Friend not to press this further. He can rest assured that if the Local Government Board thought it was as serious as he anticipated, and if the auditor of the Local Government Board audited the accounts, it would be brought within his jurisdiction. My hon. Friend no doubt thinks he has done a public service in calling attention to this matter. I have pointed out to him how he can proceed if anything of the sort occurs again. I trust he will be satisfied with the statement I have made. I hope he will allow Birkdale to be included in Southport. If he does so, he will have the satisfaction of having discharged a public duty and of having at the same time added a picturesque interest to what would otherwise have been a quiet, dull and, perhaps, monotonous proceeding.I think my hon. Friend the Member for Pontefract (Mr. Booth) has got hold of a mare's nest. If he had been able to prove that money had passed between the town clerk and the ratepayers' association, that would have been another matter, but it is officially denied by the corporation that any money passed at all. On the contrary the ratepayers' association came to them and they refused to give them money. The Parliamentary Committee of the Southport Corporation refused to take part in the newspaper correspondence which has been so prominent lately. With regard to what the hon. Member said about the question of teachers, I would like to offer one or two words in reply to what was said yesterday. It is no lack of interest in the teachers that has led the corporation to take the line they have taken, and there is certainly no lack of interest on my part. The Southport Corporation fully desire that the question of teachers should be dealt with, but they think it should not be dealt with in a Provisional Order Bill. I know that was the feeling of all the Committee before which this Bill came. When speaking to the Chairman of the Committee he said to me that they sympathised with the teachers, but did not think their case was relevant to this Bill. I need hardly assure the hon. Member for West Nottingham (Sir James Yoxall) that it is from no lack of sympathy with the teachers that I opposed his Motion. Now that he has brought the subject before the House, perhaps he will be satisfied.
I do think that the hon. Member for Pontefract has done a service by calling attention to this matter. When these bogus associations are brought forward great harm may be done. I think that these associations meet in a hole and corner fashion, and they may do a good cause a deal of injury. I hope municipalities will not insult the intelligence of this House by endeavouring to promote their scheme by enlisting the help of bogus associations.
After the courteous and friendly reply I have got from the President of the Local Government Board, I beg leave to withdraw the Amendment.
Amendment, by leave, withdrawn.
Bill ordered for Third Reading.
National Insurance Bill
Further considered in Committee.
[MR. WHITLEY in the Chair.]
Postponed proceeding on Amendment proposed on consideration of Clause 13 [see cols. 245–246]—in Sub-section (1), to leave out the words "and, subject to the provisions of the next succeeding section, medical benefit."
Debate resumed.
I quite agree that there is a great deal to be said for this Amendment. I can understand that if it was left to the approved societies, whether in the form of trade unions or friendly societies, there would be different treatment everywhere. There would be no kind of uniformity in the decisions given with reference to most complicated subjects in connection with the supply and control of medical benefit. Therefore, the proposal of the hon. Member for Hoxton (Dr. Addison) is unquestionably well worth the consideration of this Committee. The friendly societies were the only institutions appar- ently in this country years ago that took the slightest trouble to organise this kind of assistance for the very poorest in the country, and had it not been for the efforts which the organisers of this great movement put into the work for three-quarters of a century, practically ever since 1824, and the ability they displayed in organising these poor people in such a way that they might be able to assist each other, the conditions, bad as they were, would have been much worse. I have no objection, and I am sure that none of those who represent either friendly societies or trade unions, have the slightest objection to medical men getting fair play. But we have to remember that there are more interests than one to be considered, and if a great profession is going to organise itself in such a way that it can practically enforce whatever terms it chooses to impose upon either the people or those who are going to administer this Act, and were to attempt to impose unreasonable and unfair conditions, owing to the power which I admit it possesses, it would be an injustice, not merely to the public, but an injustice to the very poorest people of the country, because, after all, the people whom this Bill seeks to assist are the very poorest.
There is a proposition contained in the Bill as to the limit of income of £160 a year. It is morally certain that the millions of people who will be attended under this measure will come nowhere near an income of that description. Some of them have only a few shillings a week. While the medical profession demand their rights, which they are perfectly entitled to demand, at the same time it should be drawn to their attention, as it has been by this Debate, and will be by future Debates upon this subject, that if they impose unfair conditions, which perhaps they have the power to do now that they are organised, that unfairness would result in depriving some of the very poorest in the community of the benefits which the Bill proposes to put within their reach. If they drive a bargain let them drive it fairly. I understand something about bargaining where trade unions and organisations are concerned, and it is possible to drive a bargain beyond what is fair. I quite agree with the proposal underlying the Amendment, but I thought it right that a word or two should be said in defence of these institutions. It seems strange that half a dozen speeches should have been delivered on either side of the House, most of them calling attention to the delinquencies or unfairness of these great institutions, the friendly societies, while not a word was said to justify the comments made. You may take it for granted that the friendly societies were not unfair because they wanted to be unfair. It was because they wanted to husband the resources at their disposal and were obliged, as it were, to make their suit according to the cloth they had. That largely represents the situation. I do not believe that at any time, even on the most critical occasions, in the discussions that have occurred between the medical profession and the friendly societies the friendly societies really wished to do any injury to the medical profession in any way whatever. Circumstances will be different in future. We are starting to deal with this subject not in a haphazard voluntary way but in a national way. I can quite see, therefore, that instead of leaving to individual societies to establish certain sets of conditions in certain localities, each one different from the other, there ought to be some unity of action about the business, which the Bill as it stands would not provide. For that reason, while I support the Amendment, I do at the same time ask the Committee to recognise the service which these institutions have done in this direction in the past.I had not the pleasure of hearing the whole of the speech of the hon. Member who has just sat down, but at the point at which I returned to the Committee, about half an hour ago, the hon. Member was making some observations in reference to the attitude which had been adopted by several hon. Members on the subject of friendly societies. I cannot help thinking, from what I heard of the hon. Member's speech, that he is somewhat misapprehending the criticisms which have been directed to the friendly societies so far as the administration of the medical benefit is concerned. I am perfectly certain that no Member of this House wishes in any way to minimise the magnificent work which has been done for many years past among the industrial classes through the medium of the friendly societies. Everybody who has had any connection with the working classes must know perfectly well that these splendid organisations keep them together and teach them lessons of thrift, of self-reliance. Therefore, I cannot help thinking that some of the criticisms which were directed against the observations which have been made in connection with the administration of the medical benefit, so far as the friendly societies were concerned, by the hon. Member on the other side, were somewhat unfair and unjust. What I think we realise who have ventured to make some observations in support of the Amendment moved by the hon. Member for Hoxton is that this Bill is going to change the character of the friendly societies altogether. While we admit the splendid work that they have done in the past, and hope that they may continue to do equally good work in the future, I think it is perfectly obvious that when this Bill actually becomes an Act of Parliament and is put into operation the whole scheme of the friendly societies, or, at any rate, their character, is going to be very largely altered.
So far from continuing as they have been in the past, it seems to me that under the Bill they are going to become a great State organisation under State management, and controlled by State officials, for the distribution of the relief arranged for under the provisions of this Act. Therefore, although we do not dispute the excellent work which these organisations have done in the past, I think the point which is taken up is considering that in future when the scheme of the administration is going to be extended so enormously, when they are going to have such a very large addition to their numbers, and, in fact, the character of their work is going to be so very largely changed, is it altogether desirable that at any rate so far as the medical benefit is concerned, it should be under the control of the friendly societies. As I understand under the arrangements which have been already concluded between the Chancellor of the Exchequer and the medical profession the appointment of doctors for the administration of medical benefit is not going to be actually under the control of the friendly societies. I believe also that their remuneration is not to be fixed by the friendly societies, nor are their actual duties to be defined by them. In these circumstances it seems to me, under the Bill as it stands, without the Amendment, that they will be left with a species of technical control which will not be a real control, but which nevertheless, from the point of view taken by the medical profession would be of a rather irritating character.
The hon. Member will pardon me. I presume he means that under the Bill, without a subsequent Amendment, they would be in that position?
That is what I intended. What I understood was that an arrangement had been come to that those suggestions should be carried out by a subsequent Amendment.
Not the Bill as it stands.
Not the Bill as it stands. The hon. Member for Hoxton (Dr. Addison), in moving his Amendment, referred to the Royal Commission on the Poor Law and said that so far as the Majority and the Minority Reports are concerned they are both agreed that the medical service under the friendly society practice was of an unsatisfactory and inefficient character. There is no question, I think, that a very large proportion of the medical profession are, as a matter of fact, dissatisfied with friendly society conditions. In many towns, I believe, there have been discussions between the members of the medical profession and the friendly societies that have in many instances ended, unfortunately, in open rupture between the doctors and those societies. I think the very fact that the doctors themselves are so extremely opposed to this friendly society control should almost in itself be sufficient for us to support the Amendment which has been moved by the hon. Member for Hoxton, because it is perfectly evident that the medical profession have it in their power either to make this Bill a success or to make it a failure. It is perfectly impossible, however carefully and skilfully this Bill may be worked out on paper, to give it any practical effect unless those who are responsible for the Bill can get the active sympathy and hearty cooperation of the medical profession throughout the country. Therefore I think the very fact that the medical profession have taken up such a very strong attitude so far as this portion of the Bill is concerned ought of itself make us receive with great consideration the Amendment moved on their behalf by the hon. Member for Hoxton.
9.0 P.M. It is quite obvious that the conditions in future under the provisions of this Bill are going to be considerably different from the arrangements which were previously made between the doctors and the friendly societies. I do not think that any doctor has ever been particularly anxious to extend his friendly society practice, and an- other point to which attention ought to be drawn is that these friendly society members whom he has to attend have to pass a strict examination before they are admitted as members. Consequently the doctors have every reason to suppose that the calls made on them professionally will, at any rate, be below the average of that which they might expect, in the ordinary way. But under the Bill a much larger number of persons are going to be included as members of friendly societies, and consequently I think the doctors have reason to anticipate that the number of persons who are members of friendly societies whom they will have to attend will be far larger and the average sickness far higher than was the case under the conditions which previously existed. Of course, we are not touching the subject of remuneration for the medical profession; that would be out of order. While the friendly society practice has not been remunerative to the doctor, neither, on the whole, has it been satisfactory to the patient. I have already referred to the remarks which were made in the Majority and Minority Reports of the Poor Law Commission as to the unsatisfactory character of the medical service provided by the friendly societies; but I think it is also well known and, on the whole, recognised by friendly societies that medical attendance is not satisfactory by the fact that in a large number of cases the patients themselves only call in the friendly society doctor in order to get the certificate, and when they have got the certificate, in a very large number of instances, they call in the doctor whom they prefer to attend them. If patients are dissatisfied under the comparatively limited scope of the present friendly society medical practice, surely the difficulties will be far greater when that has been enormously enlarged by the inclusion of a very large number of persons under this scheme. Then there is the question, the very important question, of malingering. I think it will be within the knowledge of a large number of Members who have had anything to do with friendly societies, that a great number of at any rate the smaller friendly societies— indeed, I have in my mind one of the larger friendly societies whose difficulties may be largely attributed to this question of malingering—have been brought to an untimely end by the fact that they were unable to check malingering on the part of their members. I cannot help thinking that if the medical men were under the control of the health committees, rather than under the control of the friendly societies, they would be able far more efficiently to check malingering. Any doctor will tell you that even with the most careful examination it is very difficult indeed for doctors to detect malingering at all. Though there are various methods adopted, yet it is almost impossible in some cases for a doctor to detect whether a man is genuinely ill or is only shamming. It is those cases which in many instances have done such enormous damage to friendly societies throughout the country. The doctor is placed in a very awkward position. Owing to the size of the friendly society practice he is unable to give time for proper investigation of each individual case. If he had an opportunity of visiting a man at unexpected hours, and so on, he might find out a large number of cases of malingering, which under present conditions he would be perfectly unable to detect. On the other hand, under the friendly society conditions, if the doctor suspects that the patient is malingering, he is placed in a very difficult situation. It is very awkward for him to make a definite statement to the patient himself; at the same time, if he makes a report to the lodge of the friendly society to which the man belongs, and from which he is drawing benefits, the doctor in many cases again finds himself in a very difficult position. I have heard of some instances where the doctor has reported to the lodge that the man was malingering, but, owing to the fact that this member was very popular in the lodge, they were able to get together a meeting at which the conduct of the doctor was most unfavourably discussed and commented upon, with the result that the doctor lost his popularity in the district not only amongst his friendly society patients but among other patients, besides being removed from his position as medical practitioner of the friendly society. Another hon. Member commented on the satisfactory character of the friendly society administration of medical benefits and the efficient checks which he stated were placed on malingering. Speaking on 6th July, the hon. Member said:—"It is the case of a man seen on the Monday night staggering along the road, and he was eventually found in the gutter helpless, and had to be taken home and put to bed. He has been ill now for two years, laid up with locomotor paralysis. The friendly society to which he belonged received a report from the people who saw the man and who said he was drunk and that had brought his illness about. They said it was his own fault, and they cut him off and refused to allow him one halfpenny out of their funds. The doctor appeared before that small local committee, and he told them that the staggering was due to a sympton of the disease, and that caused him to be in the gutter, and his medical man contradicted the idea that it was possible that the man could have brought on this illness through drink. …"
I should like to ask whether on this Clause we are to take the general discussion on malingering. I have an excellent speech of about an hour's duration on the subject of malingering, but I should not attempt to give it on this Amendment.
I cannot anticipate what I might say with regard to the hon. Member's speech later on. With regard to the hon. Member who is now addressing the Committee I think he is going at some length into the matter, but I could not rule that it is out of order to illustrate the practice as at present under the friendly societies and as proposed under the health committee.
What I was endeavouring to show was that the check of the friendly society and their work so far as malingering is concerned was not of a wholly satisfactory character. The hon. Member to whom I was referring proceeding said:—
The hon. Member who made that statement said he gave it to the House as an illustration of the efficient administration by the friendly societies in co-operation with their doctors of the sickness benefit. So far from being a satisfactory example, as the hon. Member who produced it seemed to think, it appears to me to be most unsatisfactory. Here was a man who was suffering from a very serious disease indeed, and who was certified by the club doctor to be suffering from that complaint, and not to be suffering from the effects of intoxication, and for two years, according to the statement of the hon. Member, that man was actually prevented by the committee of the friendly society from receiving that benefit to which he was undoubtedly entitled. It seems to me that that is only one of the examples of the possible mal- administration of medical benefit and of sickness benefit also, if the control of the medical benefit is left in the hands of the friendly societies. Therefore, in view of the fact that the doctors are so extremely opposed to this part of the Bill, and in view of the fact that the success of the Bill entirely depends on the co-operation, and the willing co-operation, of the medical profession, I certainty, if the hon. Member who has moved this Amendment presses it to a Division, shall follow him into the Lobby."But the committee would not listen to him (the doctor). One of the sick visitors had seen the man enter a club at an earlier hour of the evening, and although for two years that doctor has coaxed them, it has been no use. I give that to the House as an illustration of what is going on in these villages."—[OFFICIAL REPORT, 6th July, 1911, cols. 1427–28.]
I should be unwilling to interfere in the Debates of the Committees at so early a stage, except for the fact that the Amendment raises a point in which I was deeply concerned at my recent by-election. I may perhaps be permitted to say that I have been disappointed at the tenour of the Debate so far on the Amendment of my hon. Friend. I quite agree with my hon. Friend the Member for Stoke (Mr. J. Ward) that so far in this discussion very scant justice has been done to the great friendly societies. It may be that here and there medical benefits which they have undertaken have not been administered as perfectly as one might imagine they could be administered under other circumstances, but I do not think that in this Committee we ought to forget that those great societies have been doing for an immense number of years work that no other body in the community has been doing, and that they have been doing it according to the best of their ability and of their limited means. I have in my own mind a number of friendly societies that have administered their benefits as well, I imagine, as the benefits will be administered by the local health committees or other bodies under the present Bill. I rise especially to refer to one particular point. As a great many members of the Committee are aware, there exists in connection with the great friendly societies a number of splendid medical institutes. I believe there are nearly eighty of these in England and thirty of them have splendid buildings with all the appurtenances and full medical provision. It happens that the most important of these for the time being is situated in my present Constituency. I understand that the management of these medical institutes moves about from one centre to another. It is at the present moment located in a town in the division I represent. I would remind hon. Members that they have in their own constituencies similar institutes in which their friendly society supporters are deeply interested and anxious as to their welfare under this particular Bill. I understand that there are no less than 300,000 members of those medical institutes. In regard to that situated at Luton, with its splendid institute established in a fine building, it is managed and looked after by men who are the very pick and flower of the whole friendly society movement, and it is undoubtedly doing an enormous amount of good. It has its own salaried doctors and dispensers and I understand, on the best authority, that the doctors and dispensers are entirely satisfied with their position in the medical institute. It may be explained that for very small fees the wives and children of members of the institutes can receive proper medical attention. The question arises, if the Amendment is adopted, what is to become of these medical institutes, which are at the present time giving what we know as medical benefit? I may be pardoned if I feel some considerable anxiety on this point myself. An Amendment which I have later on the Paper seeks to find protection for these institutes under the Bill, and I think that the hon. Member for Hoxton has an Amendment which may possibly serve the same purpose. There is widespread, and I think legitimate, anxiety on the part of friendly societies as to what is to happen to these medical institutes under the Bill. They have embarked a great deal of capital in these institutions, which are run without any view to making a profit. They are run entirely in the interest of the members of the societies, and seem to me to be precisely that kind of institution which ought to be, and could be, dovetailed into this splendid scheme of insurance. I venture to appeal to the Government to take special notice of this matter, and to assist those of us who are particularly interested in it to get the institutes safeguarded under the Bill. I trust that some Members of the Labour party, who know more about friendly societies than I do, will, so to speak, restore the balance in this Debate and put their case before the Committee more strongly than it has been done hitherto.
I hope the hon. Member for Luton (Mr. C. Harmsworth) will allow me in all sincerity to congratulate him on his reappearance in our Debates, and to say how fully I recognise the moderation and the sound logic which in this instance, as always, have marked his speech. There have been very few adverse notes in reference to this Amendment, and I am perfectly certain that if I discussed the question with the hon. Member for Luton, with the moderation of view which he has expressed, he and I would not be very disagreed on the subject. We all admit that the friendly society is doing good work. No one wishes to speak against it. With regard to the medical institutes which friendly societies have established, we, like the hon. Member, desire that they should be dovetailed into the work of this Bill, and I think that that can very well be carried out without interfering with the purpose of this Amendment.
The only other notable speech made against the Amendment was that of the hon. Member for Mansfield (Sir A. Mark-ham). What was his argument? That it might possibly interfere to some extent with the financial arrangements of certain friendly societies. I do not think that that is an adequate reason for our setting aside a proposal to which I hope the Chancellor of the Exchequer will give his adhesion. The hon. Member also asked, "What are the local health committees? Are they in any sense representative? A large part is appointed as representative of the county council, and in my county the county council is entirely Conservative.'' I presume that, in the view of the hon. Member, no body can be representative in any way unless it happens to agree with himself. These health committees are public bodies, and as public bodies we may trust them. We are not speaking in any sense in antagonism to the friendly societies, and the Chancellor of the Exchequer will believe me when I say that we are not speaking in any sense in opposition or in unfriendliness to the Bill. The question has been asked, "Why have you, the doctors, attached yourselves to and taken part in the work of friendly societies if you are now opposing them?" Let me give the main reason. The friendly societies have been hitherto the one instrument by which medical relief could be brought to the most needy and the most deserving of the population. If the medical profession had in the past held aloof from the friendly societies, if they had fenced themselves round with a barricade and refused to take any part in their work, they would not have earned the praise which is justly their due from the nation at the present time. For many reasons, to meet a clamant necessity in the country, to meet the dire requirements of those who have no other means of obtaining adequate medical relief, the medical profession have given their labours to friendly societies. But bit by bit friction was growing between the friendly societies and the medical profession. Not in all cases—I bring no accusation against the mass of friendly societies—but in certain cases, there was a disposition to make the funds of the friendly societies benefit at the expense of the doctors, and to make the doctors' labours something of a sweated commodity. More and more it was becoming felt by the doctors that they must cast off the domination of these friendly societies. If you do not now place the administration of the medical relief under some public body, such as the local health committee, you will place the profession of doctors in perpetuity under the heel of private societies. However good they may be, the friendly societies are, after all, private societies. If we are establishing a Town Planning Bill we do not place the administration of the measure under the building societies, however satisfactory, financially or otherwise, they may be. Would the President of the Local Government Board for a moment have placed the administration of his Town Planning Bill with the building societies of the country; You must place them under some public body. The very fact that it is a public body secures permanency, public respect, a just tribunal in case of dispute, and I shall also say, secures a high standard of professional honour, and ousts from this important field of public beneficence any man who would lower the standard of that professional honour, and therefore undermine the foundations of public health. It is only by a public body you can maintain proper discipline, that you can impose a proper standard, and that you can insist; upon full publicity being given to every transaction in which the public is concerned. Leave it to the private concerns, to the friendly societies, however good they are; and as long as human nature remains what it is they must be affected by financial considerations. They cannot be responsible to the public in the same way as a public representative body is. Their administration will inevitably diminish public confidence, and lower the security which you ought to give to the public. I am speaking in no narrow interests of the profession. I am speaking, I am perfectly convinced, in the interests of the public health. The doctors desire—and surely it is a fair, reasonable, and just claim that they put forward—to be brought into immediate contact with the State, whose servants they are. They desire that there should be no intermediary in the shape of any private body, however advantageous it may be, or however praiseworthy its efforts and its work may be, and however many and beneficial its actions may be. They desire, and rightly desire, as public servants, to be brought into immediate contact with a public and statutory body to which they can look for maintaining the standard which they think is necessary for the public health. What is the promise of the future? Are you likely to secure the greater confidence, to attract a better part of the profession, to have the best scientific effort employed in the improvement of the public health if you bring this administration under a public and statutory body, responsible to their constituents, and responsible to the right hon. Gentleman or whatever body of administrators this Act puts up; responsible in the last stage to this House and to the people at large.One third of it is not in the Act.
I am sorry the hon. Member was not present a short time ago, or he would have heard that I intended to meet his argument in regard to that nomination being in the hands of the county council. I have been accustomed to think that the county councils were purely representative bodies. But the hon. Gentleman the Member for Mansfield seemed to point to the county council in his own particular county as not a representative body because it did not happen to represent his own particular views. I ask the Committee to listen to this unanimous opinion of the medical profession. I am convinced that here they are seeking for no personal or professional advantage. Remember that many of those with whom I have been in contact have no professional interest whatever in this matter. They are men whose interests in the future depend upon a totally different character of practice. But they, like their brethren, are convinced that by the placing of this administration of medical benefit in the hands of a public body, and by that means alone, security will be taken for the public health, and for the removal of the dangers which private societies, administrative private societies, may possibly inflict. I am perfectly certain that I am speaking as much in the interests of the working classes of this country as in those of the medical profession when I add my voice to those of many others to beg the Chancellor of the Exchequer to give his support to the proposal now before us, and to admit this, which I think is a fundamental and crucial point, and which, I think, will make his Bill more beneficial and a more advantageous Bill to the country.
We have heard from the hon. Gentleman who has just spoken with character, force, and eloquence, the opinion of the doctors on the Amendment. I wish to submit to the consideration of the House for a few moments the position of friendly societies, which, curiously enough, seems to have got rather lost in this Debate. It is rather a curious thing that in this Bill, which was set out to work through the great organisations which were lauded to the skies, and smoothed down in order to get them to support the Bill, the most crucial point on which they have passed unanimous resolutions practically has been almost disregarded in the Debate this evening. The proposition which we are discussing on the Amendment is undoubtedly one of the most difficult that we have considered in the whole range of this Bill. No doubt all of us have been bombarded and argued with on all sides, both by members of the medical profession and by members of the friendly societies. The case of the doctors, I think, is a fairly simple one. I do not think it is necessary to put it as high as the hon. Member who has just spoken. The doctors, or a certain number of them, chafe under the friendly societies' control, and naturally dislike the terms which they have been able to obtain from the friendly societies. They look forward to obtaining better terms by escaping from the friendly societies' control, and think they will be better under the local health committees.
On the other hand, the fact cannot be denied that no friendly society has ever had any difficulty in getting all the doctors it wants, and no friendly society representative that I have come across anywhere, in spite of all the resolutions passed, has the slightest fear that if we leave the Clause as it stands the friendly society will be able to obtain all the medical assistance necessary to carry through their scheme, as they have done in the past. Therefore, that discounts the united demand as to which we have heard a good deal. But there are one or two aspects of this question, so far as I know, that have really not been dealt with. One point curiously overlooked is that the friendly society covers a great deal more than the benefit to the insured person. It covers benefits to the family of every member of that friendly society. If you remove, as you propose to do, the medical benefits of an insured friendly society member from the scope of the friendly society operation, how are you going to deal with the medical benefit which still continues for the wife and children of that member? It has been put very strongly to me by the members of friendly societies in my Constituency that if we pass these Amendments 50 per cent. of the wives and children of the members of friendly societies will have to go to the parish doctor— for they will have no doctor available. If that is the case it will be a very sad result for us to bring about. If it is not to be the case friendly societies will still have to find doctors, and have to make terms with the doctors, to attend their wives and families of their members, so that the doctors will not escape from the control of the friendly societies. They will merely escape having to attend the man of the family. You will then arrive at a curious result, that your local health committee will appoint one doctor to attend to the head of the family and the friendly societies will appoint another doctor to attend to the wife and children, thereby duplicating the whole of the work of the sick fund. You get the curious position that you have two doctors in the house of the same family, one appointed by the local health committee and the one appointed by the friendly society; the one attending the husband, and the other attending the wife and children. [An HON. MEMBER: "One."] The wives and children of members of friendly societies who are insured for equal benefit are not in this Bill at all, but they will still go on being insured in their friendly societies, and when ill they will still require doctors. That is indisputable.They can have the same doctor, can they not?
No, the friendly society can appoint Mr. Smith if they wish, while the local health committee may appoint Mr. Jones.
They will not do that.
But they can do it if they like.
The Chancellor of the Exchequer's Amendment provides their duties.
We have not reached that Amendment yet, and I do not think I should be in order in discussing a subsequent Amendment at this stage. My point is a very simple one. The friendly societies can choose their doctor and the local health committee can appoint any doctor they choose. The hon. Member for London University says they would not do that, but that is the very point. The whole of your sickness insurance was to include the family as a unit. Under this Amendment you split the family up and this is one of the fundamental difficulties we have to deal with. We hear a great deal about friendly societies, but what about the thousands of workers' clubs who have more members than the friendly societies. In the large colliery districts in South Wales one policy now covers all the insured persons including the head of the house, the wife and the family. You are now going to provide that the local health authority may interfere with that arrangement. Your local health committee, after all, is a committee of the county council, and I say they have not got the machinery and are not in such a position to deal with all these local questions as the friendly societies and workers' clubs are.
We have heard during this Debate a considerable amount of discussion upon malingering. I do not want to go into that discussion at any great length or to examine what mechanism your local health committee would have for inspecting sick persons as the friendly societies do. The friendly societies have volunteer committees, which do an enormous amount of valuable work in inspecting their members who are sick and reporting on their cases to the council of their societies. Who is to replace them if this work is transferred to the local health committees? These local health committees cannot do it, and they will not get volunteers to do it. They may appoint inspectors, but they will be doing away with the vast amount of voluntary work which the friendly societies do, and which, of course, we cannot expect the friendly societies to do if we take the whole of the administration of the medical benefits out of their hands. The friendly societies look upon their doctor as an officer of their society, as the secretary is, and although the medical profession may not like that, and although it may be objectionable from some points of view, that is the position to-day. It has certain compensating advantages. The members of the friendly societies to a large extent select their doctor, the patients, as it were, select their own doctor. The statement that the medical profession are doing great public service seems to be widely exaggerated. Looking after patients is not a public service. It is really a private service. A great many of the statements in the speeches made by hon. Members to the effect that doctors render great public services are quite beyond the mark. Under the Amendment you do not set up State doctors. If you did set up State doctors something might be said for it. All the Amendment really does is to transfer them from one body to another. The only argument I have heard in that direction is that the members of friendly societies will receive Government money, and that the Government should exercise some control over the terms which the approved societies make with the doctors. That, I think, is a condition which could be easily regulated by not allowing the approved societies to make terms to which the medical men objected unless the consent of the Insurance Commissioners is obtained. That would meet a great deal of the objections of the medical men. In order to meet these objections you interfere and break up the system as regards friendly society organisations and working clubs all through the country, and you substitute for it machinery which was never meant, and which I do not believe you will be ever able to get to work, and in that way it seems to me you will make this Bill practically unworkable, and you will create a great deal of hostility among people whose sympathy we want, and you will have to alter the framework and construction of the Bill. Under these circumstances, and after a great deal of consideration, I should certainly oppose this Amendment.I shall vote for this Amendment if it goes to a Division, and I want to put before the House two or three considerations which influence me in doing so. Let me say, I am not supporting this Amendment simply because it is put forward by the doctors, nor am I supporting in any spirit of disparagement of the great friendly societies. It would ill become me to do that, seeing that I am a member of two of them. I may say, further, with regard to the doctors, that I deprecate the tone introduced into this discussion, and also introduced into previous Debates, on the part of the doctors. We were told by one hon. Gentleman from the benches opposite only an hour or two ago, that if this Amendment was not adopted the doctors would have nothing to do with this Bill. It may be as well to remind the doctors that, after all, there are something like 30,000 or 40,000 of them, and I think only about 10,000 would be required for the purposes of this Bill. And although they are very strong, and probably have become a good deal stronger during the discussions of this Bill, I say they ought to adopt a little less dictatorial tone than they have hitherto done, or otherwise they may lose support instead of gaining it. As I said, I do not support this Amendment in any spirit of hostility to the friendly societies, which, of course, everybody admits have done very great work in the country by spreading the burdens of the few over the shoulders of the many. There are other aspects of friendly societies' activities, and they have been voiced more than once during this Debate. They were voiced just a few minutes ago by the hon. Baronet who represents Swansea. He said a doctor was as much an official of a friendly society as the secretary. Let me assure him that is by no means a fact. The friendly societies started with the object of providing some money wherewith a sick man could keep the wolf from the door while he was sick. That is the sole primary function of the friendly society so far as I am aware. The medical element has been imported, more or less, in later days with the idea of the society safeguarding itself as to the conditions under which its members shall get sick benefit. It is as well to discuss this matter in the light of fact, and that is fact so far as I know.
I think there is also some misconception as to what this Amendment really is. Hon. Members have spoken as if this Amendment is going to take away all the activities of the friendly societies so far as the payment of sick benefit is concerned. If I thought it would do so, I would not vote for it. So far as I know, all these regulations there are now such in the Bill as authorise friendly societies to lay down conditions under which sick benefit shall be paid, which authorises the society to fine members for certain offences when they are ill, and, generally speaking, to determine such conditions as shall safe- guard friendly societies and safeguard the funds from abuse by their own members. All that will remain in the Bill if we pass this Amendment. The Amendment, so far as I understand it, simply proposes to unify and centralise the conditions and control of doctors in a given area, instead of leaving it to the competition of a number of friendly societies or other similar bodies. I support the Amendment in the first place because I regard it as a good business proposition. It seems to me perfectly obvious that if you have a business centralised and under the control of an authority which can lay down the conditions which shall govern the medical service for a whole area, that must be better than having it under the control of half a dozen or a dozen smaller bodies, each, perhaps, laying down conditions conflicting with one another. My hon. Friend, the Member for Stoke, made a speech which was rather more amusing than convincing in describing the body to which this was to be handed over. He said this duty was to be handed over to a body which, apparently in his mind, he thought was to be controlled by the Lord Lieutenant of the county and in which, I think, he said there was also to be a person connected with the fox hounds. This duty is to be handed over to a hybrid body—but, if rumour be true, there is some intention on the part of the Government to make that body a more representative one, and more democratic, and taken as it is we have in the first place one third of it consisting of members of the local authority. The county councils may not have upon them those persons that we would wish to see, but still they are after all representative, democratically elected authorities. If they are not what they ought to be then the electors themselves are responsible, and that may be something which may come home more than it has hitherto come home to the electors. The electors may put large numbers of landlords on that body but still, as it is a local democratic elected authority, I do not think that in a democratic House any objection can be taken to the first third. A third is to consist of representatives of approved societies. Here I think is a legitimate sphere for the friendly societies and the trade unions to exert themselves. It is far better that friendly societies or trade unions should sink their dignity and become conscious that they are acting on something which will develop into a great national service. It is far better that they should do this than that they should act in a tin-pot way on their own. They should act as part of a great authority and that, I think, is where their influence may be better exerted than in acting possibly in conflict with one another. A third are to consist of Post Office contributors and I think that is a weakness. I do not think they will figure well upon these local committees and under any reconstruction of these committees I hope the Chancellor of the Exchequer will duly consider if we may have a larger democratic infusion and a larger direct representation of the friendly societies and trade unions. That third, I think, might very well be altered and more direct representations might be larger. There is another point. I support this Amendment because it is consistent with what the Chancellor has so often said, and what so many other Members on other sides of the House have said about the free choice of doctors. You cannot have free choice when you have doctors under friendly societies. It seems to me to be very obvious, and it is one of the evils of the system of doctors under friendly societies, that these doctors acquire a monopoly of practice so far as members of particular societies are concerned. The doctor becomes the medical servant of a friendly society which may have 500 or 600 members. What choice have these five or six hundred members so far as medical services are concerned. Societies may have five or six doctors in some cases, but I think that very exceptional. I think the general thing is that a friendly society has a doctor to attend to its members in a particular area. I was looking over the rules of a great friendly society only yesterday, and there it is expressly laid down that the members are obliged to have the medical officer if that medical officer lives within three miles of their residences. There is no free choice of doctors there. Under this plan where you have doctors under a health authority, each health authority will have a panel consisting of all the doctors in that district, and every friendly society member, wherever he may be, will have a free choice of the doctors on that panel. That to my mind is an additional reason for this Amendment, which corresponds with what has been put forward during the last three or four weeks in favour of this free choice of doctor. A great deal has been said about medical clubs, and the hon. Member for Mansfield has said that these clubs are going to be worsened under this Amendment. As a matter of fact, there is an Amendment lower down on the Paper which deals with this point, and it seems to me that this is a sensible way of carrying out the arrangement with the Insurance Commissioners, who will not apply this in a cast-iron way. As common-sense men they will make regulations, and there is nothing to prevent them in the exercise of their discretion making such regulations and arranging for the continuance of those medical clubs where they are carried on satisfactorily to all concerned, and providing for the setting up of medical clubs if such a course may appear to them desirable. It is for these reasons that I support this Amendment. Even from the much-discussed point of view of malingering I think this Amendment is a good thing. Supposing we have in mind that the doctor has to be dealt with by a friendly society. The society has only the power at the worst of depriving this man of part of his practice, leaving him free to go on practising in the same district; whereas if a doctor under the proposed arrangement were to do anything dishonourable, if he were to grant certificates when they ought not to be granted or act contrary to the public interest, I think you have a far greater hold upon that man under a central authority for the district than if he were under a friendly society having control of him only for part of the district. After all, the public authority will have the power of depriving that man of an opportunity of earning his living in the whole of that district, and from that point of view the Amendment seems to be the right course. On all these grounds I support the Amendment, and I support it for the additional reason that I think now that we are about to set up a great scheme of national health and prevention of disease we ought at least to set up machinery capable of development which might be said to contain within it the germs of development for a great national service. It seems to me that, leaving the doctors to the control of competing and conflicting authorities is altogether inconsistent with that great ideal, whereas to put the doctors under an authority which, after all, is not an ideal one, but with a form of central authority, which, at any rate, is a semi-public body, is far better, because that may develop into a great national service such as hon. Members on both sides of the House wish to see.
10.0 P.M.
The hon. Member has told the Committee that, in his opinion, this Amendment re- fleets on friendly societies. I think many of those who have spoken to-night will be very sorry that that impression has been created, because I am certain that nothing is further from the intentions of those who support this Amendment. This proposal, in my opinion, casts no reflection upon friendly societies. I think the reason hon. Members have not said more about the good work which friendly societies have done in the past is because their minds for the moment have been concentrated more upon what is going to be done in the future and not upon what has been done in the past. When this Bill becomes an Act of Parliament, there are two conditions under which the medical benefits will be administered, and they will be quite different from what they have been in the past. Therefore, it seems to me that hon. Members who have spoken to-night have, if I may say so with great deference, quite rightly applied themselves to what will happen in the future instead of dwelling upon what has happened in the past. I yield to none in my admiration of the good work done by friendly societies in the past, and my keen desire that they may have much prosperity in the future. I have the honour to be a member of two friendly societies, and I have had some little acquaintance, not only with the good work which they do but of the men who are enrolled within those societies.
I would like to ask those hon. Members who have spoken against this Amendment a question. I do not really think that anyone has had the courage to speak against it, but they have expressed a sort of desire that it should not be passed. I would like to ask: Are they desirous that this Bill should become law or not? If they are, it seems to me that they must vote in favour of this Amendment. [An HON. MEMBER: "Why?"] For this reason: I think those who think that the doctors have been dictatorial have gone a little too far. The proper way to look at this question is this: Inasmuch as this is a scheme for insurance against national sickness, it seems to me quite clear that the success of this Bill depends upon the loyal co-operation of the medical profession. It is perfectly obvious from what has been said by those who represent the medical profession in this House to-night that they are most anxious that the administration of medical bene- fits should be through the local health committees, and not through the approved societies. Furthermore, if this Amendment is not adopted there will be continual friction in the administration of this Bill, and, if that is the proper way to look at it, then I say, without the slightest hesitation, this is a vital Amendment. Unless you can insure the loyal co-operation of the medical profession this Bill is doomed to failure. I would like to ask the Committee to look at it from another point of view. Are the friendly societies hurt by this Amendment? The hon. Member who has just spoken has pointed out two or three instances very clearly to which I intended to refer, but which I will not repeat. I wish, however, to call the attention of the Committee to one other point. Nobody for a moment suggests anybody is going to make any profit out of the administration of the medical benefits. We are not taking anything away from the friendly societies in the way of money, nor is it suggested that the insured person will have to pay more in consequence of this Amendment. The rate of remuneration is not going to be altered. Further than that, if this Amendment is adopted, as I hope it will be, and each individual member of the friendly societies is to be allowed to choose the medical man to attend him, what will the friendly societies lose by allowing the administration of the medical benefits to be in the hands of the health committees instead of in the hands of the societies? It is already provided in the Bill that the sanatorium benefit is to be under the control of the health committees, and it seems to me the medical benefits, being so closely connected with the sanatorium benefit, might very well be put under the same body. A great point has been made about malingering. I personally do not know much about malingering, but I have heard a great deal about it. I understand it is chiefly confined to the claim for sickness benefit. I have never heard of a man malingering in order to be attended by a medical man, because with very few exceptions members of the medical profession are men of the highest standing. They would not be parties for a moment to any man malingering, and the great check upon malingering is to have the individual attended by a duly qualified medical man. The hon. Member for Swansea (Sir A. Mond) pointed to the great advantage of the local committees of the friendly societies, who no doubt know the individuals who are to receive the benefit. They do a very good work, but surely their work is chiefly confined to claims for sickness benefit, and not to medical benefit, because a medical man is perfectly competent to find out whether a man is malingering or not. Therefore, with great respect to those hon. Members who have made the point, I submit there is nothing in it. While recognising to the full the great work the friendly societies have done in the past, and expressing my hope they will continue to do it in the future, I have, speaking really in their own interest, great pleasure in supporting the Amendment.If I understand the Amendment, there is no suggestion to propose a hard and fast method which does not admit of any fair and reasonable exception. We are facing a great national health service, and we have got to make a broad basis for the work we are going to undertake. Having provided for the general principle, if I understand my hon. Friend aright, subsequent Amendments would provide for all reasonable existing conditions. I would only support the Amendment upon the understanding that afterwards Amendments were to be moved and carried to deal fairly and reasonably with exceptional cases. I do not understand this is proposed as ruthlessly doing away with all existing conditions. It is rather looking forward and providing a broad national system. I think the suggestion made is the only means of providing uniformity of administration, and it is the best that can be conceived under the circumstances. There has been no suggestion, as far as I understand—and I certainly would not be associated with it if there were—of disparaging the friendly societies in the slightest degree. If I thought this were going to hurt the friendly societies, I would oppose it as strongly as I could. On the other hand, I do not desire to take any part in submitting to any dictation from the doctors. Although we do not submit to any dictation, if we are to have a national system which will properly and smoothly work, it can only be obtained if we can secure the co-operation of the doctors. I believe that can best be secured by this method, and I support entirely what has been proposed. The hon. Member for Mansfield (Sir A. Markham) referred to a large number of trade associations. If I thought the Amendment would ruthlessly deal with all such associations, I could not possibly support it. I take it this great scheme will take all those exceptional cases into consideration, and that they will be fairly and honourably treated.
Will the hon. Gentleman tell me how it will be possible for the men in South Wales to carry on the movement which they have carried on for the last forty years? They do not know.
It seems to me there can be no practical difficulty. We are only devising the general principle for carrying out the administration of this great measure, and details of that kind can be fairly met. it seems to me the objection raised by my hon. Friend below me, whom we are all glad to see back in the House, and the objections of the medical associations who have approached me, like other hon. Members, can be fairly treated, and that due consideration can be given to their exceptional cases. I cannot, therefore, see any objection to the general governing principle, always providing we shall have careful regard to exceptional cases. I do not really understand the point raised by the hon. Member for Swansea (Sir A. Mond). He seemed to talk of doctors being appointed by the health committees. I do not understand any doctors will be appointed by the health committees at all.
The word "appointed" was not perhaps the right expression to use. The health committee, as I understand it, will be the authority to which the doctor will be responsible and under whose control he will be. I used the word "appointed" in that sense in contradistinction to his being controlled by the friendly society.
The word "appointed" having been used, I may have misunderstood the hon. Member. I understand, under the superintendence of the health committee a panel of doctors will be provided from which the insured person can select the particular doctor he desires. The word "appointed," therefore, has not any application to the health committees. A general principle which brings in the co-operation of the doctors, which, so far as I can see, does not hurt the friendly societies, and which has due regard to the proper and careful treatment of all exceptional eases, seems to me the best way of dealing with the question, and, subject to those limitations, if we go to a Division, I shall support my hon. Friend.
The Committee have listened with very great interest to the impartial speech of the hon. Member for the Blackfriars Division of Glasgow (Mr. Barnes). He spoke as one thoroughly in sympathy with the great friendly societies and also as one by no means prejudiced in favour of the doctors. But he did point out a matter which has to some extent been overlooked by this Committee. Under this Bill the functions of the friendly societies in the future, in many directions, will be very largely and honourably extended, and their clientele will be larger in the immediate future than it has been in the past. I would refer briefly to what the hon. Member has said in regard to the doctors. He urged that they had been somewhat too dictatorial in this matter. I do not desire to speak merely as a member of the profession, for I have in this matter endeavoured to arrive at a fair appreciation of this Amendment both from the point of view of the friendly societies and from that of the doctors, and I have come to the conclusion so clearly stated by the hon. Member when he announced that after weighing the pros and cons he had decided to vote for the Amendment.
When the hon. Member and those who think with him bring against the doctors a charge that they have been somewhat dictatorial, I would ask them to bear in mind the nature of the changes with which the medical profession are confronted in this Bill. The hon. Member for the Blackfriars Division said the medical men had formed themselves into a trade union. I do not know whether he regards that as a matter for reproach, but I would point out that if they have done so it has only been under the pressure of the dire necessity brought before them by this Bill, and I scarcely think it lies in the mouth of an ex-chairman of the Labour party to bring that against the doctors as a matter of reproach.I did not say it in any tone of disparagement of the doctors, on the contrary, I think I rather congratulated them on it.
:I am sorry if I misunderstood the hon. Member, and I am delighted that the measures the doctors have taken in this matter clearly meet with his approval. If the Committee will for a moment-consider the conditions with which the doctors are confronted they will not be surprised that they should have decided to organise themselves for the purpose of dealing with this Bill. Let us consider the existing conditions. A large proportion— some 75 per cent. of the general practice throughout the country is among people whose income is below the limit set down in this Bill, and all these patients have hitherto been divided among various doctors. Now without any warning the State comes between the doctor and his patients and says to a large section of them—"Whether you like it or not, you will have, under this Bill, to contribute a certain sum weekly which will provide you with medical treatment in the future."
Is it to be wondered at that the practitioners of the country regard such an interference as this in their business as one which may well call for their serious and grave consideration? I scarcely like to conjecture what would happen if the Government followed this Bill up by another proposing that a compulsory tribute should be levied from a large section of the community for the purpose of defraying their legal expenses, and that the State should benevolently take in hand, through some piece of machinery or other, the providing of this large section of the community with their lawyer. If a proposal of that sort were put before the House no one who was not cased in chain armour would be safe in a Debate on the subject. Yet that would be nothing more or less than a parallel from a business point of view to what is proposed with regard to the medical profession. In lieu of this relationship which has existed between the doctor and his patients in the past it is now provided that the whole of this practice shall be made a subject of contract in the future. So far from agreeing with the hon. Member (Mr. Barnes) that doctors are unreasonably dictatorial in the matter, they have met this Bill in a spirit of great moderation. I ask hon. Members to consider this from a personal and business point of view, because those men have to get their livelihood just as much as any other portion of the community. That particular aspect of it is an extremely grave one for the whole profession, and bearing that in mind, so far from being unreasonably hostile to the Bill, they have, so far as they have been able to see their way, met it in a friendly and reasonable spirit. The proposal with which they are confronted is that in lieu of the old relations between doctor and patient, which they frankly avow they prefer to any new arrangement, they are called upon to enter into a series of con- tracts for giving their medical services. That being so, is it unreasonable that they should ask that the authority with whom they make these contracts shall be, as far as is consistent with the general welfare of the community, the representative of a central authority, and shall not be divided up into a number of small societies, with their branches scattered all over the country, in which there will be no guarantee of uniformity of practice and system. The fact that the doctors ask for this is only an evidence of their desire to meet the Bill in a reasonable way, and is the very least that this House ought to concede to them on this point. One argument that has been used which deserves very grave consideration is that you will have in the local health committee a committee which is largely elected, which represents the friendly societies as well as the doctors, and which will only have in this matter one motive, and that is the desire to arrive at an arrangement equitable both as regards the doctors and the friendly societies; but in so far as various motives have been referred to as influencing the doctors under certain conditions, no friendly society will misunderstand me if I point out that it is perfectly obvious that the approved societies would not be in precisely this same impartial position in making arrangements with the doctors, because I take it that anything you could save in medical benefit would be available for other benefits. On these grounds, I agree with my hon. Friend the Member for the Black-friars Division (Mr. Barnes) that there can be no doubt that in the broader interests both of friendly societies and doctors it is desirable that this Amendment should be carried It has also been urged that with this the local health committee would be in a stronger position for dealing with malingering. You would have guaranteed uniformity in the dispensation of medical benefit and in the arrangements of the doctors. My hon. Friend near me remarked that he never heard of anyone malingering for the sake of medical attendance. I think that the term malingering is a somewhat harsh one, but hon. Members are too ready to assume that the amount which you pay to medical practitioners under this Bill in respect of the insured classes may be regarded as paid in a large number of cases for what is described as malingering. There are some people who having medical attendance at their disposal, will use doctors more freely for light cases than in the past. I cannot help recalling the experience of an old medical friend. He said to me: "I had a patient, and she used to tell all her friends: 'Thank God, I am not diseased, but I am very delicate.'" That will apply to a number of those cases which may fairly be described as cases of malingering. The hon. Member for one of the Divisions of Nottingham argued that the doctors are to be benefited pecuniarily under this Bill. That is entirely, so far as I can see, an untenable position, unless the arrangements foreshadowed by the Chancellor of the Exchequer are considerably modified in favour of the doctors hereafter. Unless that can be done there is no doubt that the doctors will suffer and not be benefited. For my part I can see no reason why, if this Bill is going to be the success which we all hope it will be, the arrangements should not be so made that the doctors, together with the recipients of medical benefits, should alike receive advantage in future. The same hon. Member objected to the county council as the authority for administering medical benefits, on the ground that in his part of the country they hated the county council. The answer to that is that the county councils are the elected representatives of the people of the country, and if they are hated the majority of the people who elected them have themselves alone to blame. In this proposal we have an Amendment which will not only improve the position of the doctor under this Bill, but will, speaking broadly, be of great advantage to the friendly societies.I have been struck in the course of this Debate by the fact that this provision is very largely acceptable to the House. I rise mainly to make some observations from the friendly societies' point of view, because I am fearful that some of the implications underlying these speeches made are not altogether favourable to the friendly societies' point of view. The friendly societies hitherto have been able to arrange with medical men. As far as my experience has gone those arrangements have been satisfactory. I notice recently that some medical men who have a large friendly societies' practice are now moving among those societies and are lamenting that the Chancellor of the Exchequer should be disturbing the very harmonious relationship previously existing. Perhaps I have to regard this rather as a political than as a professional attitude. Nevertheless, I do not think that a large number of the doctors who have friendly society practices are convinced that they suffer from the very strong grievances put forward on their behalf. The friendly societies claim that if the Chancellor of the Exchequer leaves them alone they can still make their arrangements with the medical faculty. I am bound to confess that in my opinion circumstances have recently greatly altered. It was quite true to say that hitherto medical men were found practically scrambling for friendly society practice, and whatever ills now prevail are very largely the creation of the medical men themselves.
I have known medical men to compete for friendly society practice, and it is not good enough on their part to lay a whole-hearted charge against friendly societies for a set of conditions for which they themselves are very largely responsible. Nevertheless, like the hon. Member for Blackfriars, I am glad in the interests of the doctors themselves that they are learning the lesson of association and combination. But do not seek to lead me to think that they are entirely disinterested in this matter, but, simply looking to the public welfare, because I. am convinced that their motive is very similar to that of the trade union. It is economic in the last resort, and they are looking out for their own private advantage, and they are perfectly justified in doing so. Many friendly societies are constantly approaching me, not merely because I happen to be a member of a friendly society, or because I happen to fee a Member of this House or anything of that sort, but because I have been a working man and have felt the need of making provision against sickness and other incidental ills. They know I have been an active worker, and they are constantly approaching me now. Even to-day they are advancing the idea that they can make adequate arrangements for the medical men. On a previous stage of this Bill I advanced the theory, which I know receives general assent, that this scheme is doomed to failure unless it secures the general co-operation of the medical profession. I feel that nearly everybody, irrespective of party, will agree with that point of view. Hitherto the doctors have been greatly disorganised, and they have been undoubtedly left in the unprotected state which is the lot of those who stand isolated units. It may be because of that circumstance they have been, owing to the free play of competition, led sometimes to accept conditions which are not to be regarded as altogether fair. They have come together, and I believe it is perfectly true to say that they are practically a united body. They have made it known that unless certain conditions are set up they are not prepared to co-operate in the administration of this scheme. That strikes me as a new central fact which the friendly societies have to recognise. It is no longer open to them to take advantage of the best medical ability in the country because of the fact that the medical faculty are now so organised that they can say they will not come into this scheme unless they secure a certain set of conditions which are, we understand, to be fair and just. I am simply stating what I regard to be the new central fact, that the friendly societies have got to understand. Again, what the right hon. Gentleman proposes, though just to the doctors, very largely undermines the friendly societies' claim to have full control of the appointment of medical men, and that claim can no longer be sustained. I want to put a question to the Chancellor of the Exchequer. In the course of the Second Reading Debate the right hon. Gentleman was good enough to make reference to an institution which exists in my own Constituency, and of which I have some practical experience. The hon. Member for Luton (Mr. Cecil Harms-worth) in a very interesting speech claimed that in his Constituency there exists the best medical institution in the country. I have always thought that my own Constituency could uphold that claim; nevertheless, I am prepared to say on behalf of these medical institutions that they are thoroughly well equipped and established. The friendly societies have co-operated in regard to them; they have invested a large amount of capital in equipping those institutions. I believe, generally speaking, that they have been able to avail themselves of a very high form of medical attendance, and altogether I think it would be a positive disaster if, owing to the operation of this scheme, this class of institution was ruthlessly destroyed. I have gathered from previous speakers that there is a possibility of such institutions as these being dovetailed into this scheme, and I can assure the right hon. Gentleman that will go far to allay the apprehension on the part of my constituents, who are otherwise favourable to this Bill, if the right hon. Gentleman is able, in the course of his speech to-night, to give us an idea of how this can be accomplished, and how these institutions can be dove-tailed into the scheme in order that they may pursue their good work, and in order, of course, that the capital invested, and the energy which has been bestowed shall not be swept aside. I feel that I am compelled by sheer force of circumstances not to oppose the Amendment, although I must confess that from the friendly society point of view I am not very favourable to it. Therefore I am bound by the circumstances to come to the conclusion arrived at by my hon. Friend the Member for Blackfriars (Mr. Barnes), that I do not see my way to oppose the Amendment.The Government up to the present have deliberately refrained from taking any part in the discussion, because of the pledges which were given by me on behalf of the Government some time ago when this matter was discussed, that so far as we were concerned, we regarded this as an open question. It is a matter which does not affect the finances of the Bill; it does not affect the fabric of the Bill fundamentally. There was considerable divergence of opinion on this side of the House as far as I could see, and that divergence of opinion extended, though not to the same degree, to the other side of the House as well. I have indicated my opinion sometime ago. I have always felt that it would be far better that the arrangements for the medical benefit should be entirely in the hands of the local health committee. I have always taken that view. When the hon. Member for Sevenoaks (Mr. Forster) made that suggestion on the Second Reading, I then received it as a suggestion which was a very valuable one, but it is a kind of proposal which could not be carried unless there is something like unanimity on both sides of the House. That is the reason I refrained from taking part earlier in the Debate in order to satisfy myself that there was that feeling of unanimity. I do not think anyone who has listened to the Debate could come to any other conclusion, although two or three able speeches have been delivered against the proposal, but that the overwhelming body of opinion has been in favour of making the change suggested by my hon. Friend the Member for Hoxton (Dr. Addison). I think that the proposal has been discussed too much, as if it were a dispute between the friendly societies and the doctors. It really is nothing of the kind. It is a bigger matter than that, it is a more im- portant matter, it is a wider matter, and it, is a much more fundamental matter from the point of view of the public. If I thought it were purely a dispute between the medical profession and the friendly societies, I certainly would not feel the same interest in the Amendment of my hon. Friend. That was not what impelled me to take the view which I took on the Second Reading, that this would be a very desirable change to effect in the Bill.
I think it is in the interests of the friendly societies themselves that this change should be effected, and I will point out to the Committee why I say so. I am not criticising the friendly societies. The work which they have done up to the present is incalculable in the benefits which it has conferred upon millions of working men and working women in this country. For generations they were the only body to provide anything in the nature of adequate medical attendance for the working classes of the community, those who were not prepared to resort to the charity of the parish. I think the work they have done has been on the whole satisfactory, and, having regard to the means at their disposal, I think it has been a great triumph of organisation. I have no doubt there have been cases where the payment has been very inadequate. I agree absolutely with what was said by my hon. Friend the hon. Member for Norwich (Mr. G. Roberts) that the medical profession are themselves as much to blame as the friendly societies. I have heard of cases where medical men were prepared to take the whole of the work of friendly societies at a lower figure than that which had already been accepted by some of their brethren in order to capture the practice. Where you get competition of that kind it is idle to blame the friendly societies for that. The medical profession are just as much to blame, and in. some cases more to blame than the friendly societies. That accounts for the very inadequate character of the attendance supplied in some cases. But, as an hon. Member said, we have to look to the future. I think that the hon. Member for Norwich (Mr. G. Roberts), who understands the position of friendly societies as well as any, and better than most, Members of the House, has taken a very rational course in the matter. He says: "While I regret that friendly societies should not retain the medical benefit, I recognise that conditions have changed." How have the conditions changed? The expense of medical attendance is going up in future. You are going to have a higher standard of medical attendance. That standard will improve, I do not say from year to year, but from decade to decade. You are separating the drugs from the medical attendance, and that in itself will increase the charge. On the face of it there is no reason why it should, but it undoubtedly will. In fact, the very reason that prompted us to separate drugs from medical attendance is a reason that will materialise in increased cost. In many cases drugs of the most expensive character were not supplied when they might have been. In future they will be. There will be no inducement to any man not to prescribe them. That will increase the cost very considerably, and the experience of Germany is that it will do so very rapidly. The free choice of doctors also will to some extent increase the charge. I personally have always been in favour of that. After all, confidence in your doctor is essential. No man who could afford to do otherwise would have a doctor prescribed for him by any club or society. He wants his own doctor to doctor him—the doctor in whom he has confidence. There is every reason why the working classes of the country should have the same advantage in that respect as any other class in the community. In the long run I have no doubt that, although it will involve an improved medical service, will also involve a more costly service. In addition to that, you are organising health on a national basis. That will conduce to increased cost. I will point out another reason why friendly societies will do well to consider before they press their demand to retain the medical benefit. You are introducing for the first time a new element into sick and medical benefit. There will be new societies coming in. The friendly societies and trade unions cover 6,000,000 people. You have 9,000,000 still to cover. You will have new societies coming in, and I venture to predict that the vast majority of those new societies will hand over the medical benefit to the local health committees. Why? It is a better business proposition for them. Medical Benefit is a thing of which you cannot estimate the cost. All you know is that the tendency will be for it to go up, and not down, and these societies will be only too glad to make an arrangement with the local health committees by which they will get rid of an increasing charge on a limited fund. If you increase the charge, you have only the same fund to draw upon. It will always be 4d., 3d., and 2d. Medical benefit will be an increasing charge, and therefore most of these societies will transfer the whole of their medical benefit to the local health committees.There is only one sum of money for medical benefits. Will the right hon. Gentleman explain how the sick benefit can remain at the same figure, and where the money for the increased expenditure will come from?
Surely that is exactly the point I have met. If the friendly societies are willing in the future to undertake the cost of the medical benefits which will inevitably increase, they will either have to make an additional levy, or depress their other benefits. Therefore it is to their interest to part with this charge and to hand it over to the local health committee at the very outset of the administration of the Act.
Where will the local health committee get the money from?
The hon. Member must allow me to develop this matter in my own way. That is exactly the point I am coming to. Surely I would not have left such a very obvious point as that! Very well, if this is handed over to the local health committees what happens? That the excess of the medical benefit—that is the proposal—will have in future to be divided between the rates and the taxes? I have said that over and over again. What will happen if the friendly societies insist on retaining this? They will enter into competition with societies that will have limited their medical benefits, and who, when the time of excess comes, will have drawn upon the rates and taxes for the amount of that excess; whereas they can only have drawn upon their other benefits, or have increased the levy for the purpose. Is not that a position that the friendly societies had better face at once? I cannot imagine it being to their interest to defend the present system. The moment you have a scheme of this kind it must necessarily involve an increased charge for medical benefits One or two things happen. The friendly societies in a given district will utilise the whole of their power and influence for the purpose of preventing any further charge upon the rates and taxes. Is that a desirable state of things? It means that they will utilise their influence to depress the standard of medical attendance to save themselves.
That is really not in the interests of the community, which is to get the best doctors. Even if there is a little excess in the main the great thing that you should have in view is that if there is a little waste of money, it will be more than compensated for in the saving of human life; in the saving of the energy and efficiency of a vast multitude of the people of this country! Therefore, I think that is in the public interest. Certainly it is not in the interests of public health that you should have a body of 6,000,000 of men in this country the interests of whose organisation is rather to restrict the development of medical attendance. It has a double effect. First of all, drugs are for the first time supplied. They were mainly the cause of expense. In the second place it gives free choice of doctors, which will also inevitably bring increased expense. Thirdly, you have the fact that you will have societies in this country who will undoubtedly transfer the whole of their medical benefits to the local health committee, and will be able to draw for their excess upon the rates. Therefore, in the interests of friendly societies themselves, I think they should realise the changed conditions. My hon. Friend, who is chairman of friendly societies. says that some have realised the fact and have made up their minds to transfer the medical attendance at the very outset to the local health committee. There is another reason why I think it is in the interests of the community as a whole to do it. The local health committee, however composed—and by the Bill the friendly societies and the post office contributors between them will have a majority upon that body, and whatever change the Government propose to make in the constitution of that body, they certainly do not propose to make and change to their detriment—ought, as far as the majority is concerned, represent the people who contribute to the fund, and the people who contribute to the fund are the 15,000,000 members of these approved societies. This body will be cognisant of all the conditions of public health and will have to report upon them to the county councils, which may have to take steps to enforce them. Is it not better that that body should have this knowedge of the medical profession in that particular district? If all the doctors who attend upon the members and the societies and the post office contributors are more or less respon- sible to the local health committee, they will report to that committee. The experience of these doctors will become the experience of the local health committee. Does not that make it a very much more valuable body from the point of view of advising upon public health, of consulting with regard to the public health, of reporting to the county council with regard to the public health and taking steps in regard to the enforcing of the public health laws of this country? It is the old word "co-ordination." I am sure it is better in the interests of the public and in the interests of the members, and in the interests of the friendly societies and the community as a whole, that this new body which is to be set up should represent not alone the 15,000,000 members of these societies, but that it should also have control of the medical benefits as well. My hon. Friend the Member for Mansfield put a very important question to me, and my hon. Friend the Member for Norwich and my hon. Friend the Member for Luton put questions upon the same point. My hon. Friend the Member for Mansfield put the point about the work's doctor. That is a very important point. The work's doctor is not a doctor merely to the subscribing members; he is the family doctor as well, and that is the difficulty upon which my hon. Friend was good enough to say that a deputation that waited upon me the other day went away unsatisfied. It is very difficult to satisfy all deputations, especially when they ask for contrary things. On the whole I think my hon. Friend will find I am in a position to satisfy his friends, even though this Amendment is accepted. There is an Amendment on the Paper, and I am not sure it is not in the name of my hon. Friend, that recognises these societies, and all that would be necessary in that case would be that the local health committee should have the power to attend the members of this society through its work's committee. That is all. Once that is done the difficulty is disposed of. Regarding the free choice of doctors, what they have to do is to pay the institution doctor, and the payment goes to him. The local health committee has not the right to nominate the doctor the moment you set up free choice of doctors. The local health committee shall itself make arrangements that that particular doctor shall serve the members who demand his Services. You must have some check with regard to this medical expenditure, as all they have to do is for each member to claim his own doctor and then he gets the full benefit of the institution.In some instances we have institutions who do their own dispensing. Not only do these institutions supply medical men, but they supply their own drugs. How would that affect the matter?
You must insist upon the drugs being separated, otherwise the whole object of the Bill in that respect—I desire to secure good, honest drugs—would be done away with. In this we could separate the drug department from the other—it is not altogether impracticable, perhaps. Now let me say another thing, which seems to have been overlooked by most of those who have taken part in the discussion. This involves certain readjustments of finance. Up to the present there has been no fixture of the amount of the medical benefit. As I pointed out on the Second Reading, there is nothing to prevent the whole twenty-four millions being appropriated, excepting the common sense of the community. You must have some basis you can compute the amount the societies will have to contribute towards the medical benefit, otherwise the local health committee may say we make a levy upon you for 10s. a member. You cannot leave it to the local public health committee to put an unlimited amount upon the local societies. I have got my own suggestion with regard to it. You can leave it to be agreed between the local health committee and the society, and arrange that, failing agreement the Commissioners ought to decide between them. That is only one suggestion. You must have an impartial tribunal to adjudicate between the societies and the local health committee. The other suggestion is that you should fix the amount exactly as you are doing with the sanatorium benefit. You fix it at 1s. a man, and it is handed over to the local health committee. If there is any charge in excess of that amount, then the local health committee must go to the county council and the Treasury, and draw the excess from that quarter if they will agree to the expenditure. It is not necessary to debate that question at this stage, otherwise we might start another discussion upon other suggestions which are not relevant. It will be necessary for each Member to exercise his ingenuity between this and to-morrow morning with a view to finding out the best way of dealing with this question. This has been a very ample Debate, and I trust we shall now be able to come to a decision. I think it will be generally felt that the arguments have been of great benefit to us. I have already indicated my own personal view. I have promised that as far as the Government are concerned this shall be an open question, and we shall not put on the Government Whips. I hope we shall now be able to come to a decision.
Our views on this question were expressed very early in the Debate by the hon. Member for Sevenoaks, and I do not think I can add anything to what he has already said. The Chancellor of the Exchequer is perfectly right when he says that the decision we are about to take involves a financial question of some magnitude. I only rise to say that I think it is necessary that the Committee should clearly understand what the right hon. Gentleman has so clearly pointed out to-night. I confess that one of the arguments used in favour of the Amendment gave me pause for a moment, more especially in view of the right hon. Gentleman's concluding observations. He pointed out that this medical benefit is going to be an increasingly onerous charge, and that there is provision in the Bill for every approved society putting that onerous burden on to the local health committee, thereby relieving itself of a growing charge and putting itself in possession of a greater surplus, and having it at the expense, not of the working men who are members of the approved societies, but of the employers of those men and of the State itself with a larger sum to spend upon benefits which are not of the first necessity, and which only appear in the second line of the Bill; and then, having passed the liability from the
Division No. 300.]
| AYES.
| [11.15 p.m.
|
| Adamson, William | Glanville, Harold James | Thomas, J. H. (Derby) |
| Baring, Sir Godfrey (Barnstaple) | Hunt, Rowland | Valentia, Viscount |
| Barran, Sir J. N. (Hawick) | Jowett, Frederick William | Wilson, W. T. (Westhoughton) |
| Bentham, George Jackson | Kennedy, Vincent Paul | |
| Bridgeman, William Clive | Mond, Sir Alfred M. | TELLERS FOR THE AYES.—Sir A. Markham and Mr. C. Edwards. |
| Crawshay-Williams, Eliot | O'Grady, James |
NOES.
| ||
| Abraham, William (Dublin Harbour) | Anson, Rt. Hon. Sir William R. | Baker, Sir Randolf L. (Dorset, N.) |
| Abraham, Rt. Hon. William (Rhondda) | Anstruther-Gray, Major William | Balcarres, Lord |
| Acland, Francis Dyke | Arkwright, John Stanhope | Baldwin, Stanley |
| Agar-Robartes, Hon. T. C. R. | Ashley, Wilfrid W. | Balfour, Sir Robert (Lanark) |
| Agg-Gardner, James Tynte | Astor, Waldorf | Banbury, Sir Frederick George |
| Ainsworth, John Stirling | Bagot, Lieut.-Colonel J. | Banner, John S. Harmood- |
| Alden, Percy | Baird, John Lawrence | Baring, Maj. Hon. Guy V. (Winchester) |
| Allen, Arthur Acland (Dumbartonshire) | Baker, Harold T. (Accrington) | Barnes, George N. |
| Allen, Charles Peter (Stroud) | Baker, Joseph Allen (Finsbury, E.) | Barrie, H. T. (Londonderry, N.) |
shoulders of the society on to the shoulders of the health committee, what happens if there is any deficit? It no longer reduces the benefits of the members of the society; it no longer increases the contribution they are called upon to make, but it falls to be made good by the ratepayer and the taxpayer. The provision of the Bill to which the right hon. Gentleman alluded is a very vague one, and when he hopefully told the House and the country that he believes he has made full provision for the expenses of this Bill by past taxation I think he hardly reckoned with the possible burdens he is putting upon ratepayers and taxpayers under provisions such as these. It must be remembered that before the health committees can give increased benefits of this kind they have got to come—if I rightly read the Bill—to a county council or local health committee and to the Treasury and get their joint and several consent, and the refusal of either of them to contribute would be fatal to the other. That, as the Chancellor of the Exchequer said, does open very grave issues which we shall have to consider shortly—I think it is on the next Clause of the Bill. While supporting the Clause recommended by my hon. Friend, and recommended also by the Chancellor of the Exchequer upon the favour of the House, I put in this financial caveat, and I beg the Committee to be careful what they are doing with regard to additional liabilities imposed either on the taxpayer or upon the ratepayer with a view of relieving approved societies of expenses on their funds and setting free those funds for purposes which are not of the first necessity.
Question put, "That the words proposed to be left out stand part of the Clause."
The Committee divided: Ayes, 15; Noes, 387.
| Barry, Redmond John (Tyrone, N.) | Fitzroy, Hon. Edward A. | Kelly, Edward |
| Barton, William | Flannery, Sir J. Fortescue | Kerry, Earl of |
| Beach, Hon. Michael Hugh Hicks | Fleming, Valentine | Keswick, William |
| Beck, Arthur Cecil | Fletcher, John Samuel (Hampstead) | Kilbride, Denis |
| Beckett, Hon. Gervase | Forster, Henry William | King, J. (Somerset, N.) |
| Benn, Arthur Shirley (Plymouth) | Foster, Philip Staveley | Kinloch-Cooke, Sir Clement |
| Benn, Ion Hamilton (Greenwich) | Furness, Stephen | Kyffin-Taylor, G. |
| Benn, W. W. (T. H'mts, St. George) | Gardner, Ernest | Lambert, Richard (Wilts, Cricklade) |
| Bennett-Goldney, Francis | George, Rt. Hon. D. Lloyd | Lane-Fox, G. R. |
| Beresford, Lord Charles | Gibbs, George Abraham | Lansbury, George |
| Bigland, Alfred | Gibson, Sir James Puckering | Larmor, Sir J. |
| Birrell, Rt. Hon. Augustine | Gilmour, Captain John | Law, Hugh A. (Donegal, West) |
| Black, Arthur W. | Goddard, Sir Daniel Ford | Lawson, Hon. H. (T. H'mts., Mile End) |
| Boles, Lieut.-Col. Dennis Fortescue | Goldman, Charles Sydney | Lawson, Sir W. (Cumb'rld, Cockerm'th) |
| Booth, Frederick Handel | Goldsmith, Frank | Leach, Charles |
| Boscawen, Sir Arthur S. T. Griffith- | Goldstone, Frank | Lee, Arthur Hamilton |
| Bowerman, Charles W. | Gordon, John (Londonderry, South) | Levy, Sir Maurice |
| Boyton, James | Gordon, Hon. John Edward (Brighton) | Lewis, John Herbert |
| Brady, Patrick Joseph | Goulding, Edward Alfred | Lloyd, George Ambrose |
| Bryce, J. Annan | Greene, Walter Raymond | Locker-Lampson, G. (Salisbury) |
| Bull, Sir William James | Greenwood, Granville G. (Peterborough) | Locker-Lampson, O. (Ramsey) |
| Burdett-Coutts, William | Greig, Colonel James William | Lockwood, Rt. Hon. Lt.-Col. A. R. |
| Burke, E. Haviland- | Gretton, John | Lonsdale, Sir John Brownlee |
| Burn, Colonel C. R. | Griffith, Ellis J. | Lough, Rt. Hon. Thomas |
| Burt, Rt. Hon. Thomas | Guest, Hon. Frederick E. (Dorset, E.) | Low, Sir Frederick (Norwich) |
| Butcher, John George | Guinness, Hon. Walter Edward | Lowe, Sir F. W. (Edgbaston) |
| Buxton, Noel (Norfolk, North) | Gulland, John William | Lundon, Thomas |
| Byles, Sir William Pollard | Gwynne, R. S. (Sussex, Eastbourne) | Lyell, Charles Henry |
| Campion, W. R. | Haddock, George Bahr | Lynch, Arthur Alfred |
| Carlile, Sir Edward Hildred | Hall, Fred (Dulwich) | Lyttelton, Rt. Hn. A. (St. Geo., Han. S.) |
| Carr-Gomm, H. W. | Hall, Marshall (E. Toxteth) | Lyttelton, Hon. J. C. (Droitwich) |
| Cassel, Felix | Hamersley, Alfred St. George | Macdonald, J. R. (Leicester) |
| Castlereagh, Viscount | Hamilton, Lord C. J. (Kensington, S.) | McGhee, Richard |
| Cave, George | Hamilton, Marquess of (Londonderry) | Mackinder, Halford J. |
| Cawley, Sir Frederick (Prestwich) | Hancock, John George | Maclean, Donald |
| Cawley, H. T. (Lancs., Heywood) | Hardie, J. Keir (Merthyr Tydvil) | Macnamara, Rt. Hon. Dr. T. J. |
| Cecil, Evelyn (Aston Manor) | Hardy, Rt. Hon. Laurence | Macpherson, James Ian |
| Cecil, Lord Hugh (Oxford University) | Harmsworth, R. L. (Caithness-shire) | MacVeagh, Jeremiah |
| Chaloner, Colonel R. G. W. | Harris, Henry Percy | M'Curdy, Charles Albert |
| Chamberlain, Rt. Hen. J. A. (Worc'r.) | Harvey, A. G. C. (Rochdale) | McKenna, Rt. Hon. Reginald |
| Chambers, James | Harvey. W. E. (Derbyshire, N. E.) | M'Laren, H. D. (Leices.) |
| Chancellor, Henry George | Harwood, George | M'Laren, Walter S. B. (Chet., Crewa) |
| Chapple, Dr. William Allen | Haslam, James (Derbyshire) | McNeill, Ronald (Kent, St. Augustine) |
| Clay, Captain H. H. Spender | Haslam, Lewis (Monmouth) | Manfield, Harry |
| Clive, Captain Percy Archer | Havelock-Allan, Sir Henry | Marshall, Arthur Harold |
| Clough, William | Haworth, Sir Arthur A. | Mason, David M. (Coventry) |
| Coates, Major Sir Edward Feetham | Hayden, John Patrick | Mason, James F. (Windsor) |
| Collins, Stephen (Lambeth) | Helme, Norval Watson | Masterman, C. F. G. |
| Condon, Thomas Joseph | Henderson, Arthur (Durham) | Meehan, Francis E. (Leitrim, N.) |
| Cooper, Richard Ashmole | Henderson, Major H. (Berks, Abingdon) | Mildmay, Francis Bingham |
| Craig, Herbert J. (Tynemouth) | Hickman, Colonel Thomas E. | Millar, James Duncan |
| Craik, Sir Henry | Higham, John Sharp | Mills, Hon. Charles Thomas |
| Cripps, Sir Charles Alfred | Hill, Sir Clement L. | Molloy, Michael |
| Crooks, William | Hillier, Dr. Alfred Peter | Money, L. G. Chiozza |
| Crumley, Patrick | Hills, John Waller | Morgan, George Hay |
| Dalziel, Davison (Brixton) | Hill-Wood, Samuel | Morrell, Philip |
| Davies, Ellis William (Eifion) | Hinds, John | Mount, William Archer |
| Davies, Timothy (Lincs., Louth) | Hoare, Samuel John Gurney | Munro, Robert |
| Davies, Sir W. Howell (Bristol, S.) | Hodge, John | Munro-Ferguson, Rt. Hon. R. C. |
| Dawes, J. A. | Hohler, Gerald Fitzroy | Murray, Captain Hon. A. C. |
| Delany, William | Holt, Richard Durning | Needham, Christopher T. |
| Denman, Hon. R. D. | Hope, John Deans (Haddington) | Neville, Reginald J. N. |
| Dickinson, W. H. | Horne, C. Silvester (Ipswich) | Newdegate, F. A. |
| Dickson, Rt. Hon. C. S. | Horne, William E. (Surrey, Guildford) | Newton, Harry Kottingham |
| Dixon, Charles Harvey | Horner, Andrew Long | Nicholson, Charles N. (Doncaster) |
| Doris, William | Houston, Robert Paterson | Nicholson, William G. (Petersfield) |
| Duffy, William J. | Howard, Hon. Geoffrey | Nield, Herbert |
| Duke, Henry Edward | Hudson, Walter | Nolan, Joseph |
| Duncan, C. (Barrow-In-Furness) | Hughes, Spencer Leigh | Norman, Sir Henry |
| Duncan, J. Hastings (York, Otley) | Hunter, Sir Charles Rodk. (Bath) | Norton, Captain Cecil W. |
| Edwards, Enoch (Hanley) | Hunter, William (Lanark, Govan) | Nuttall, Harry |
| Edwards, Sir Francis (Radnor) | Illingworth, Percy H. | O'Brien, Patrick (Kilkenny) |
| Elibank, Rt. Hon. Master of | Ingleby, Holcombe | O'Connor, John (Kildare, N.) |
| Elverston, Sir Harold | Isaacs, Rt. Hon. Sir Rufus | O'Connor, T. P. (Liverpool) |
| Esmonde, Dr. John (Tipperary, N.) | Jessel, Captain Herbert M. | O'Donnell, Thomas |
| Essex, Richard Walter | Johnson, William | O'Dowd, John |
| Eyres-Monsell, B. M. | Jones, Sir D. Brynmor (Swansea) | Orde-Powlett, Hon. W. G. A. |
| Faber, George D. (Clapham) | Jones, Edgar R. (Merthyr Tydvil) | Ormsby-Gore, Hon. William |
| Faber, Capt W. V. (Hants., W.) | Jones, Henry Haydn (Merioneth) | O'Sullivan, Timothy |
| Falconer, James | Jones, Leif Stratten (Notts, Rushcliffe) | Palmer, Godfrey Mark |
| Fell, Arthur | Jones, William (Carnarvonshire) | Parker, Sir Gilbert (Gravesend) |
| Ferens, Thomas Robinson | Jones, William S. Glyn-(Stepney) | Parker, James (Halifax) |
| Fetherstonhaugh, Godfrey | Joyce, Michael | Parkes, Ebenezer |
| Ffrench, Peter | Joynson-Hicks, William | Pearce, Robert (Staffs, Leek) |
| Finlay, Sir Robert | Kebty-Fletcher, J. R. | Pease, Herbert Pike (Darlington) |
| Pease, Rt. Hon. Joseph A. (Rotherham) | Sanderson, Lancelot | Ure, Rt. Hon. Alexander |
| Peel, Captain R. F. (Woodbridge) | Sandys, G. J. (Somerset, Wells) | Verney, Sir Harry |
| Peto, Basil Edward | Scanlan, Thomas | Wadsworth, John |
| Phillips, John (Longford, S.) | Schwann, Rt. Hon. Sir Charles E. | Walker, Col. William Hall |
| Pointer, Joseph | Scott, A. MacCallum (Glas., Bridgeton) | Walrond, Hon. Lionel |
| Pollard, Sir George H. | Scott, Sir S. (Marylebone, W.) | Walsh, Stephen (Lancs., Ince) |
| Pollock, Ernest Murray | Seely, Col. Rt. Hon. J. E. B. | Ward, Arnold S. (Herts, Watford) |
| Ponsonby, Arthur A. W. H. | Sheehy, David | Ward, John (Stoke-upon-Trent) |
| Power, Patrick Joseph | Sherwell, Arthur James | Ward, W. Dudley (Southampton) |
| Price, C. E. (Edinburgh, Central) | Shortt, Edward | Wardle, G. J. |
| Priestley, Sir W. E. B. (Bradford, E.) | Simon, Sir John (Allsebrook) | Waring, Walter |
| Pringle, William M. R. | Smith, Harold (Warrington) | Wason, J. Cathcart (Orkney) |
| Pryce-Jones, Colonel E. | Smith, H. B. Lees (Northampton) | Weigall, Capt. A. G. |
| Quitter, William Eley C. | Smyth, Thomas F. (Leitrim, S.) | Wheler, Granville C. H. |
| Radford, G. H. | Snowden, Philip | White, Major G. D. (Lancs., Southport) |
| Raffan, Peter Wilson | Spear, Sir John Ward | White, Sir George (Norfolk) |
| Rawlinson, John Frederick Peel | Spicer, Sir Albert | White, J. Dundas (Glasgow, Tradeston) |
| Rawson, Colonel Richard H. | Starkey, John Ralph | White, Sir Luke (York, E.R.) |
| Rea, Rt. Hon. Russell (South Shields) | Stewart, Gershom | Wiles, Thomas |
| Rendall, Athelstan | Strauss, Arthur (Paddington, North) | Williams, J. (Glamorgan) |
| Richards, Thomas | Strauss, Edward A. (Southwark, West) | Williams, Penry (Middlesbrough) |
| Richardson, Albion (Peckham) | Sutton, John E. | Williamson, Sir A. |
| Richardson, Thomas (Whitehaven) | Sykes, Alan John (Ches., Knutsford) | Willoughby, Major Hon. Claude |
| Roberts, G. H. (Norwich) | Sykes, Mark (Hull, Central) | Wilson, John (Durham, Mid) |
| Roberts, Sir J. H. (Denbighs.) | Talbot, Lord Edmund | Wilson, Rt. Hon. J. W. (Worcs., N.) |
| Roberts, S. (Sheffield, Ecclesall) | Taylor, John W. (Durham) | Winfrey, Richard |
| Robertson, J. M. (Tyneside) | Taylor, Theodore C. (Radcliffe) | Wolmer, Viscount |
| Robinson, Sidney | Tennant, Harold John | Wood, John (Stalybridge) |
| Roch, Walter F. (Pembroke) | Terrell, Henry (Gloucester) | Wood, Rt. Hon. T. McKinnon (Glasgow) |
| Roe, Sir Thomas | Thomson, W. Mitchell- (Down, North) | Wortley, Rt. Hon. C. B. Stuart- |
| Rolleston, Sir John | Thorne, G. R. (Wolverhampton) | Yerburgh, Robert |
| Ronaldshay, Earl of | Tobin, Alfred Aspinall | Young, William (Perth, East) |
| Rothschild, Lionel de | Touche, George Alexander | Younger, Sir George |
| Rowlands, James | Toulmin, Sir George | |
| Samuel, Rt. Hon. H. L. (Cleveland) | Tryon, Captain George Clement | TELLERS FOR THE NOES.—Dr. |
| Samuel, J. (Stockton-on-Tees) | Tullibardine, Marquess of | Addison and Sir Philip Magnus. |
| Sanders, Robert Arthur |
I gave notice of an Amendment to leave out in Sub-section (1) the words "and in other cases by and through the local health committees; sanatorium benefit shall in all cases be administered by and through local health committees." I understand that the point raised by this Amendment can be dealt with afterwards. [HON. MEMBERS: "Yes."]
I wish to know whether the point can be raised on Clause 43, or whether we should raise it here.
There is no need for the discussion to be raised here.
I think the same will apply to the Amendment of my right hon. Friend the Member for East Worcestershire (Mr. Austen Chamberlain), in Subsection (1) to leave out the words "local health," and to insert instead thereof the word "insurance."
That was raised before, and we put off the discussion.
Amendments made: In Sub-section (1) after the word "committees" ["and in other cases by and through the local health committees "] to insert the words "medical, and."—[ Dr. Addison.]
In Sub-section (1), leave out the word "benefit" and insert instead thereof the word "benefits."—[ Earl of Ronaldshay.]
I beg to move to leave out Sub-section (2). I wish to ask the Attorney-General whether the regulations which they have power to make under Sub-section (2) apply solely to benefits under this Act, or are they intended to apply to all the work done by friendly societies? If limited to what is done under this Act I should have no objection.
They will not in any way interfere with the other rules of the society which apply to its other work.
Then I do not wish to move my Amendment.
Amendment, by leave, withdrawn.
I beg to move to leave out paragraph (c).
I put down this Amendment because I do not understand why this paragraph was put in. It provides that women shall not be visited otherwise than by women. I cannot understand why it is necessary that women should be visited by a lady doctor, because as far as I know about the medical profession, as far as ladies are concerned——It only refers to visiting.
As far as I know there are not sufficient lady doctors in the country to carry on the work.
It refers simply to friendly society visitors to the sick. If there is any doubt about it we can make it perfectly clear that it is not intended to exclude medical men.
If it is intended to provide that a woman who is supposed to be malingering should be examined by a lady doctor that is a different subject. I respectfully venture to suggest to the Chancellor of the Exchequer that he should accept the Amendment of the hon. Member for Brentford to insert the words, "except by a doctor," and if he does so I shall be glad to withdraw my Amendment.
This paragraph refers purely to friendly society visitors. It does not refer to doctors or to medical people, but if there is any doubt about it I will undertake to make it perfectly clear between this and the Report stage.
Then I will not proceed with my Amendment.
Amendment, by leave, withdrawn.
I beg to move to add to paragraph (c) the words "and men by men."
Is the hon. Member moving this Amendment in. a spirit of ridicule?
No. That is not a rôle that I would attempt to play. I want to raise on this Amendment the question of preference being given to female labour. I wish to point out that approved societies which come in under this Bill and appoint female visitors will have to decide what kind of ladies they will use. Under this Sub-section (c) it is quite clear that the female agent could visit the other sex. That is a matter which wants to be cleared up. It has a very important bearing on the business of approved societies, who will be using agents who are also paid servants in other matters. The question is where women have always to be visited by a female whether it might not lead some societies to appoint female agents in the place of the present men. Speaking on behalf of the industrial insurance societies of the country, I want to put this to the Committee. If the industrial companies form good societies, as they intend to do, will the men they employ find themselves supplanted by women? Because women would be able to visit every case, but men could only visit their own sex. I have not put the Amendment down because I think it is a solution, but I want to know what is in the mind of the Chancellor of the Exchequer. My hon. Friends below the Gangway will agree with the idea that the men who are now agents of the industrial companies may be displaced by women and turned adrift. A solution which occurred to me was that only married men or men with sisters living in the same house would be able to fully comply with the conditions. Then the solution would be quite easy. A man and his wife, or a man and his sister, would both be able to do justice to the approved society. In the case of a woman, the man has his wife, and he could so comply with the Act. Where another man and his wife have to be visited, then he and his wife could go jointly. That is the only solution I can see. I move the Amendment in order that the Chancellor of the Exchequer may give some explicit guidance for the use of the friendly societies as to the best way to tackle this very complicated problem.
What the hon. Member desires is to protect the agents of these various societies. Amendments will be moved later on that so many women should be members of the health committees, and, in this case, the paragraph of the Sub-section is really for the protection of women members of the societies, and I think it will be found quite sufficient.
Amendment, by leave, withdrawn.
I beg to move in Sub-section (2), at the end of paragraph (d), to insert the words: "(e) No such rule shall prescribe any penalty, nor shall any insured person be subject to any penalty, whether by suspension of benefit or otherwise, on account of the refusal by any such person to submit to a surgical operation, or vaccination, or inoculation of any kind."
I accept this Amendment.
I should like to put one aspect of this proposal before the Committee. I will ask hon. Members to consider what attitude the local health committee or any other authority under this Bill is to take in cases of this sort. You may have again, as we have had recently, smallpox actually in existence in this country, and you will have men, encouraged by hon. Members like the hon. Member who proposed this Amendment, who will refuse to be vaccinated though they have actually been brought into contact with smallpox cases, and who still, if they have contracted smallpox as a result of their own folly are to be entitled to claim benefits under this Bill, although they have refused to obey the instruction either of their medical attendant or of the medical officer of health of the district. I say that any provision of that sort would be a most absurd provision to make, and that the insertion of this Amendment will stultify the Bill and will be a very serious blot upon it as a measure of public health and preventive medicine. I do urge on the right hon. Gentleman, who I know has the public health side of this Bill at heart, to consider very carefully before he accepts this Amendment.
I think the speech of the hon. Gentleman proves the real necessity there is for this Amendment, because it shows that there are medical men in this country who would like to impose a penalty of suspended benefits, and what for—because a man takes advantage of an Act of Parliament. The only doubt I had about the Amendment was whether it was necessary. There are 80 many who take a very keen interest in this matter that I think it is just as well to make it absolutely clear. I think with the hon. Member for Sevenoaks (Mr. Forster) that it is unnecessary, because since under an Act of Parliament you cannot compel a man to be vaccinated if he is a conscientious objector, you stultify the law by imposing a penalty on the man, and saying, "If you do not do it, although we cannot compel you, we will suspend your benefits." That is an impossible position.
The right hon. Gentleman is not putting my view quite fairly. The case I am supposing is one in which both the medical officer concerned and the medical attendant advise the man who has been brought into contact that unless he is vaccinated or revaccinated he will incur in all probability a case of smallpox.
That is not a new argument. The hon. Gentleman is simply repeating his argument. Under the law passed by hon. Gentlemen opposite when they were in office that man is not obliged to be vaccinated. The hon. Gentleman says that although he is not compelled by law to do so, you ought to utilise this Insurance Bill, a Bill subsidised by the Treasury, for the purpose of depriving him of benefits if he refuses.
If he refuses to follow the doctor's advice.
You cannot take the man before a magistrate and get him fined 5s., but you wish to do something more effective, namely, fine him 10s. a week for thirteen weeks, and 5s. a week for the rest of his life.
I admit that the Chancellor of the Exchequer has an unanswerable case as far as vaccination is concerned, but I do not know if he has read the whole of the Amendment. It includes surgical operations and inoculations of any kind; and I hope he will not accept that portion of the proposal. People often have objections to operations which would set them right. A man might be on the sick fund for months through a loose bone in the knee, which could be put right in ten minutes by an operation. If this Amendment becomes part of the Bill he would be entitled to object to such an operation. It would be to the interest of the society to say that that man could be cured by a simple operation. It is not a question of promoting the interests of the doctors; it is simply a question of the interests of the fund. Assume that you want to give a man an inoculation to produce local anæsthesia in order to remove a cyst. If the man will not have the inoculation or allow the operation to be done without, is he to be permitted to stand out permanently? I sincerely hope that the Chancellor of the Exchequer, while accepting the Amendment, will agree to the excision of the words relating to surgical operations and inoculations of any kind.
I think that as far as vaccination is concerned the Chancellor of the Exchequer is on strong ground. The law of the land expressly declares that those who have conscientious objections need not be vaccinated. But in regard to operations I think he is not on strong ground. I do not know if he is familiar with the practice of the Treasury. When I was Junior Lord I had to administer the Pensions Department and the Compensation for Injuries Department. The Treasury constantly used to insist upon an operation, and refused to give compensation unless the man was willing to undergo an operation, which carried with it the practically certain prospect of a cure. I do not, under those circumstances, think the right hon. Gentleman occupies very strong ground in resisting the appeal that is made to him. If I may go a step further I would suggest to him the desirability of considering the case of diphtheria. Is it lawful to save a man's life against his will? [HON. MEMBERS: "No."] What about the law relating to suicide? I hope the right hon. Gentleman may be able to reconsider the matter.
I have considered both these questions very carefully, and I have come to the conclusion that you ought not to penalise a man because he has come to the conclusion that he will not risk his life in an operation. After all, it is taking great risks. See what it really means! There are many operations where the doctor says: "This is your only chance; an operation may take your life away." The chances being two to one against the man, he may prefer to drag on for weeks with the possible chance of something turning up; that something that always appeals to human nature. Is a man under those circumstances to be deprived of such benefits as there are under this Bill because ho declines to risk his life under an operation? Where a rich man is concerned he very often takes the advice of more than one doctor. Very few men would risk their lives upon the advice of one doctor, however eminent. The workman is not quite in that position. He cannot pay huge fees for the purposes of consultation; and therefore I think he is entitled not to take that risk. If he will not face the risk I think it is rather a cruel thing to say that his benefit should go. No doctor is infallible. Many doctors have advised operations where afterwards it was discovered that they were not necessary—when you consulted doctors equally eminent. The advice of those against the operation has very often turned out to be quite correct. Many operations are still debatable ground. There is a fashion in operations just as in many other things. I think in these cases a man is entitled to take his own risk, and if he does I think it is a very cruel thing to say to him: "If you do, although you may be very, very ill, perhaps dying, we shall deprive you of the 10s. per week." It is a very cruel imposition, and I shall have no part in it.
The Chancellor of the Exchequer put a case in which I am quite certain he will have the sympathy of every Member of this Committee. The Amendment goes far beyond that. He takes the case, ex hypothesi, of a dangerous operation. I heartily agree with him, and would heartily co-operate with him or anyone else to make such a case impossible. Lot me say as the Bill stands it does not lay down that a man, has to undergo an operation when it is recommended by his own. doctor or forfeit his benefit; it leaves to the health committee the discretion in this matter. Can anyone conceive a health committee, however formed, in such a case as that put by the Chancellor of the Exchequer, taking upon itself the responsibility of insisting that a man should undergo an operation or forfeit his benefit. I say such a thing would not happen. But if you need further protection in order to give a man not merely practical but moral security against harsh and improper pressure of that kind give him an appeal. Let him have an appeal to another medical man before any such rule is enforced against him.
12.0 M. I do not believe even as the Bill stands there is any danger of a man forfeiting his medical benefits in such cases as the Chancellor described, and I would not be a party to his forfeiting his benefit in such circumstances. But this goes very much further. The Chancellor did not deal at all with the cases my hon. Friend brought forward. My hon. Friend took a case of the extraction of teeth. A man may allow his teeth to get into such a state that no lesser remedy than their extraction would prove effectual. The mouth may become a manufacturer of juices poisoning the whole system. It is unfortunately a lamentably common case. The extraction of these teeth is a surgical operation, and sometimes a surgical operation of some seriousness if the decay is allowed to go far enough without remedy. A man's health in such a case is absolutely dependent upon the removal of the root causes of the disease. There is no danger to life in carrying out the operation, but there is natural reluctance on the part of many people to undergo an operation of that kind if they can avoid it, and that objection is, in many cases, increased by pure ignorance and prejudice, because people have not access to the knowledge that would guide them to a better state of things. Are we really to say that a man whose life is imperilled, or is sup- posed to be imperilled by his refusal to undergo such an. operation, must after all be allowed himself to be the judge between the risk in such a case as I have put when there is no possible danger to life, except indeed from the failure to remove the cause of the disease. And the risk is not the man's alone, but that of the funds and of his fellows who are joined with him in the same society and his employer. Are they and the State to be called upon to contribute 5s. for an indefinite number of years to the support of this man because he refuses to undergo on wholly insufficient grounds an operation which is necessary for his cure, and which cannot possibly endanger his life? It was right in evenly balanced eases to prevent a man being forced against his will, but there must be some right for those insured with the man, some safeguard for them against an obstinate man.I hope the Chancellor of the Exchequer will consent to take this matter into consideration again. What he has said about important operations and vaccination is unanswerable, but with regard to minor operations I agree with what the right hon. Gentleman opposite has said. If the words concerning operations stand in the Bill as at present it will be possible, and it will occur, that a man or woman may have 5s. a week for life for refusing to undergo a perfectly simple and everyday operation.
If the Chancellor of the Exchequer accepts this he is going to do a great injury to the finance of the Bill. The Labour Members can give opinions of importance regarding labour matters, but this is purely a technical question. What does this Amendment propose to do? I will give you the case of a medical man who is called in to attend a man who has got a bad attack of erysipelas in the leg. Under that Amendment he could refuse to allow the doctor to open the leg in two or three places. He gets disease of the bone, if he does not die from blood poisoning, and he is for ever on the funds of the insurance. If a doctor suspects you have got diphtheria he will recommend you to be inoculated. Now if a man refuses to submit to that—which is quite painless, and can do no harm at all—he will possibly be ill for three or four weeks, and will want three or four weeks for convalescence. I have every sympathy with those who disagree with vaccination, though I believe they are wrong and that there will be a fearful calamity some day in this country. Any medical man who sits in this House and does not enforce his. views on that fact does harm to the country at large. As I stated in the case of erysipelas I could mention hundreds of cases. The man who got his leg bad under those circumstances would never be cured, and ho would become a permanent charge on the funds. I hope the Chancellor of the Exchequer will reconsider his decision. Large operations have been referred to. Now there is no such thing as a large operation being done for the poorest man in the country on the advice of one doctor. That is quite a fallacy. No medical man, no general practitioner, would ever think of advising an operation of any importance whatsoever without consultation with a brother practitioner. They would probably go to the nearest hospital, and there three or four surgeons would examine the case before there was any operation. If this Amendment is accepted it will place a very great charge on the Bill.
I think every Member of the House will agree with the spirit of the observations which the right hon. Gentleman has made. I wish to mention a class of case which arises under the Employers Liability Act. I may mention as an illustration the case of a man who has an injury to his hand or arm which disables his arm where the cause of the trouble is something which could be removed by a slight operation involving no risk to life or limb, and which must be beneficial. In a case of that kind if the beneficiary wilfully and unreasonably refuses to submit to an operation his scale of benefit is reduced to a nominal amount under the Employers Liability Act, and that does not seem to me to be a great hardship. I would suggest that the difficulty in the case we are discussing might be met if there was some saving clause of this kind in the case of minor operations where there is a wilful and unreasonable refusal to allow an operation. Perhaps I might give notice if the hon. Member's Amendment is adopted to move to add at the end the words:
"Unless such refusal in the case of a minor operation shall be found by the health committee or upon appeal by the Insurance Commissioners, to be wilful and unreasonable." I think such a provision would protect the funds from any unreasonable inroads, and would give the beneficiary the right he certainly has to refuse to permit anybody to decide whether his life should be put in danger or not.I am in general agreement with what has been said by the right hon. Gentleman. With regard to vaccination the right hon. Gentleman agrees with what I said, and he also agrees with mo on the question of major operations which may endanger life. What I meant by an agreement was an agreement upon these two questions. I think the right hon. Gentleman said he was in agreement upon the question of compulsory inoculation.
No, I did not say that.
Then our agreement comes to an end there. I think there is a good deal to be said from the point of view of the right hon. Gentleman with regard to minor operations, but I am not quite sure whether the words suggested by the hon. and learned Member for Exeter (Mr. Duke) would meet that kind of case. I thought, as I listened to what he said, they were fairly reasonable, but the difficulty, of course, would be to define minor operations.
It is, I understand, a matter which is well known in surgery, and anybody who has to refer to surgical textbooks will find major and minor operations referred to in terms which leave no doubt.
May I point out to the hon. and learned Member that there is this difference between the Workmen's Compensation Act and this: Under the Workmen's Compensation Act it is a question of the continued liability of the employer, and, if the workman refuses to submit to a minor operation and is a continued charge on his employer, then the employer has undoubtedly a personal grievance. This is a question of insurance where the man himself has contributed his 4d. The position, therefore, is rather different. At the same time, I am quite willing to consider the question of what is called a minor operation, but I could not undertake the responsibility of accepting words of that kind without having further time for consideration. I feel so strongly the necessity of not compelling workmen to submit themselves to be cut up—[HON. MEMBERS: "Oh, oh."] Yes, I stand by that. [HON. MEMBERS: "Prejudice."] "Prejudice!" no, quite the reverse. It is just the experience of everybody in this matter. I think it is of vital importance we should not impose a penalty upon workmen if they refuse to risk their lives upon operations of this kind. I agree there is something to be said for considering the question of minor operations, and, if the hon. and learned Gentleman will accept my undertaking I will consider between this and the Report stage—I shall be very glad to have the assistance of the hon. and learned Member, and nobody can afford assistance better than the hon. and learned Gentleman can from, his experience—the form of words. Beyond that I could not go at present.
I think the Chancellor of the Exchequer has gone some way to meet us and has brought us within sight of an agreement. [HON. MEMBERS: "NO."] I thought all parties in the House would accept that, but, if some hon. Members are entirely opposed to the action of the Chancellor of the Exchequer, I will not include them. There is, at any rate, no great difference between what the Chancellor of the Exchequer is willing to consider and what I asked for. Surely, the Chancellor of the Exchequer ought not, however, to ask us to put the Amendment in the Bill without having considered either the words which he will take from my hon. and learned Friend or some other words in lieu of them which he will propose. I think in that case if we cannot get the full words in we ought to postpone dealing with this altogether until the Report stage, and not commit ourselves to the proposition which the Chancellor of the Exchequer himself has admitted now covers much more ground than he anticipated.
The major proposition is far and away the more important, and it should be incorporated in the Bill. I do not think we ought to run any risks in this matter. I have made what I consider to be a very fair offer, and I hope the right hon. Gentleman will accept it.
In the course of my business I have had a good many surgical cases under the Workmen's Compensation Act brought under my notice. What happens in a number of cases? A man meets with a small accident to his hand which might be relieved by an operation. If there is any dispute about it, the case is taken into Court; the County Court judge refers it to the medical referee, and if the latter is of opinion that a slight operation will enable the man to go back to work he orders it to be carried out, or in the alternative stops the compensation. There have been a number of cases in my own knowledge where men have refused to undergo the operation in the first place, but have eventually submitted to it, and have as a result been back at work in a short time. I should be sorry to wish any workman to undergo any operation whatsoever if it is likely to endanger his life. I am sure it would be the unanimous wish of the House that a workman should not be called upon under such circumstances against his will, but where you have some slight adhesion to the hand which might be removed at once by a slight operation it should be performed provided there is no danger to life, and that it is perfectly clear that the health of the man will in no way be injured by his undergoing the operation.
The Chancellor of the Exchequer seems to me to have met the proposal I ventured to make in a reasonable way. I, of course, would have preferred that he should have agreed to deal with the matter at once, but bearing in mind the great sensitiveness that prevails among the very large class affected by this comparatively limited question, I am quite content to accept the proposal of the right hon. Gentleman that between now and the Report stage he will endeavour to frame a set of words which will meet this difficulty.
The whole House appeared to be unanimous that there was a good case for not inflicting any penalty for the refusal of vaccination, but yet in the case of vaccination there is the first presumption of the law in favour of enforcing it. But when we take other operations there is no presumption of law in favour of anyone belonging to wide classes of society to submit to any operation whatever, and you will draw a most invidious distinction if you take one class of society, the largest in the country, and apply to it suddenly in a Bill a principle of law which does not apply to the better classes in any degree. The House which is unanimous in exempting vaccination should be equally unanimous in leaving perfect freedom with regard to any operation whatever. This point about the small operation is not nearly so simple as it looks. There are Gentlemen within a few feet of me who had a loose cartilage in the knee, and they were told if they had a knife applied to it they would incur the danger of having a stiff knee for life. Another hon. Gentleman was told that if he had a cyst cut out he would have to lie up for three weeks. These things which are said to be so simple really involve very large questions, and I should be extremely sorry to see my right hon. Friend move from the position he has taken up. I am convinced that the more consideration he gives to the question the more he will see the necessity for adhering to the words of the Amendment.
Might I ask who is going to penalise the workman if he does not have the operation? As I read the Sub-section the approved society with the consent of the Insurance Commissioners may do it. It has nothing to do with the local health committees at all. We have heard a great deal about trusting the approved societies, and the Chancellor of the Exchequer has based argument upon argument on it. Surely it is perfectly unnecessary to put this in unless it means that you cannot trust your approved societies, even with the Insurance Commissioners looking after them, not to penalise the working man unfairly. I should certainly be in favour of leaving out the Sub-section altogether.
The speech we have just heard emphasises the need for the insertion of this proviso. If it is so unnecessary why all this heat in attacking the proposal for its insertion. If it is unnecessary the putting of it in will do very little harm. But I really rose to emphasise the point in regard to small accidents. I am afraid the Chancellor is giving way without really knowing exactly how serious the matter is. The hon. Gentleman opposite said we on these benches knew something about labour matters, and suggested that we knew very little about surgical or medical affairs. I happen to know enough from my own experience to make me believe what has been stated to-night. I received a cut on my thumb, and the doctors wanted to take it off. I protested against that. Had it been taken off my trade would have been gone. [Laughter.] The hon. Gentleman laughs, but it was no laughing matter to me. I had to withstand the doctors, and it took some force of will to do it. The thumb is now as good as it ever was. Instead of the provision not acting in the way we wish, it will in many cases safeguard the workmen. My father had a similar experience. He was told that if his hand was not taken off he could not live with it on. Within two years of that statement being made both of the doctors who advised the amputation of the hand were dead. Both refused to undergo operations themselves to save their lives. These men had been in the habit of using the knife. They were known throughout Sheffield as Butcher this and Butcher that, but notwithstanding their reputation for butchery as to other people they preferred to die a comfortable and easy death. I would ask the Chancellor of the Exchequer to be very careful in the consideration of this matter. He must not make it too easy to bring influence to bear upon approved societies with respect to the arrangements that will probably be made between the two sections, and so leave too many of these minor accidents to be treated in a drastic fashion. I do not know whether the safeguarding words are really sufficient, but I hope the right hon. Gentleman will give the matter his serious consideration.
I cannot believe that the Committee are prepared to dismiss the question of vaccination in the way previous speakers have suggested. It is one thing to declare that no one need be vaccinated if he has a conscientious objection, but it is going a great deal further if a man who refuses the protection which the State freely provides is, when attacked by disease, to be accorded the benefit of the Act. It seems to me that the thing is illogical. -If the House thinks it right to give benefit to a man who refuses vaccination and contracts smallpox, then it should repeal the vaccination laws. It ought not to incur the trouble and expense of carrying out the vaccination laws and of providing benefits for the man who has incurred disease through omitting the protection which the State provides.
Question, "That those words be there inserted," put, and agreed to.
I beg to move at the end of the Sub-section to add the following paragraph: "(e) No such rule shall provide for withholding maternity benefit from the wife of an insured person except the said wife has herself been guilty of breach of such, or attempted imposition as aforesaid."
I move this Amendment in belief that it will commend itself to all sections of the House.
I accept the Amendment, subject to any alterations rendered necessary in drafting.
Amendment agreed to.
Question, "That the Clause, as amended, stand part of the Bill," put, and agreed to.
Committee report Progress; to sit again to-morrow (Wednesday).
And, it being after half-past Eleven of the clock upon Tuesday evening, Mr. Deputy-Speaker adjourned the House without Question put, pursuant to the Standing Order.
Adjourned at Twenty-two minutes before One o'clock