§ (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 246 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—
- (a) no fine imposed under any such rule shall exceed ten shillings, or, in the case of repeated breaches of rules, twenty shillings;
- (b) no such rule shall provide for the suspension of any benefit for a period exceeding one year;
- (c) every such rule relating to the visiting of insured persons shall provide that women shall not be visited otherwise than by women;
- (d) every such rule relating to behaviour during disease or disablement shall be in the prescribed form.
§ (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.
§ Mr. WILLIAM PEARCEI 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 247 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 248 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.
§ Mr. BOOTHMay I ask whether any discussion in regard to the formation of approved societies would be in order before Clause 18?
The CHAIRMANThe 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.
§ Mr. W. PEARCEThat is so.
§ Mr. W. PEARCEThat 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 249 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.
§ Sir RUFUS ISAACSI 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.
§ Mr. W. PEARCETo help the establishment of approved societies.
§ Sir RUFUS ISAACSBut 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 250 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.
§ Dr. ADDISONI 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 251 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.
§ Mr. LLOYD GEORGEOn 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.
§ Dr. ADDISONThey are kept separate.
§ Mr. LLOYD GEORGEI want it to be quite clear that they are kept separate.
§ Dr. ADDISONI 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 252 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:—
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.253 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 254 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 255 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 256 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 257 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 258 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 259 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 260 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.
§ Mr. FORSTERI 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 261 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 262 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- 263 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.
§ Mr. GLYN-JONESI 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- 264 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 265 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.
§ Sir PHILIP MAGNUSI 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. 266 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- 267 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 support
Dr. ESMONDEI 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 268 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.
269 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 270 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.
§ Sir ROBERT FINLAYI 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.
§ Sir ARTHUR MARKHAMI 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 271 certain sick benefits and certain benefits outside the sick fund. The members contributed 3d. in the £ out of their wages.
§ Dr. ADDISONThat very point is met by an Amendment to Clause 14, which is down on the Paper.
§ 8.0 P.M.
§ Sir A. MARKHAMIf 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.
§ Sir HENRY CRAIKThere is an immense amount of private practice now yielding a very good return to the doctors which will be embraced in these small payments.
§ Sir A. MARKHAMYes, but most of the doctors in my Constituency, which is purely industrial, tell me that nearly half of their practice consists of making 272 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.
§ Mr. G. A. GIBBSI 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 273 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.
§ Mr. J. WARDI 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- 274 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——
§ Mr. J. WARDIt 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 275 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.