NATIONAL INSURANCE BILL.

HC Deb 01 August 1911 vol 29 cc285-342

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.

Mr. J. WARD

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.

Mr. SANDYS

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.

Mr. BOOTH

The hon. Member will pardon me. I presume he means that under the Bill, without a subsequent Amendment, they would be in that position?

Mr. SANDYS

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.

Mr. BOOTH

Not the Bill as it stands.

Mr. SANDYS

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. …

Mr. BOOTH

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.

The DEPUTY-CHAIRMAN

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.

Mr. SANDYS

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:— 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.] 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.

Mr. CECIL HARMSWORTH

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.

Sir HENRY CRAIK

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.

Sir A. MARKHAM

One third of it is not in the Act.

Sir H. CRAIK

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.

Sir ALFRED MOND

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.

Mr. R. COOPER

They can have the same doctor, can they not?

Sir A. MOND

No, the friendly society can appoint Mr. Smith if they wish, while the local health committee may appoint Mr. Jones.

Sir P. MAGNUS

They will not do that.

Sir A. MOND

But they can do it if they like.

Dr. HILLIER

The Chancellor of the Exchequer's Amendment provides their duties.

Sir A. MOND

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.

Mr. BARNES

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.

Mr. SANDERSON

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.

Mr. GEORGE THORNE

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.

Sir A. MARKHAM

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.

Mr. G. THORNE

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.

Sir A. MOND

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.

Mr. G. THORNE

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.

Dr. HILLIER

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.

Mr. BARNES

I did not say it in any tone of disparagement of the doctors, on the contrary, I think I rather congratulated them on it.

Dr. HILLIER

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.

Mr. GEORGE ROBERTS

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.

Mr. LLOYD GEORGE

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.

Sir A. MOND

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?

Mr. LLOYD GEORGE

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.

Sir A. MOND

Where will the local health committee get the money from?

Mr. LLOYD GEORGE

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.

Mr. GEORGE ROBERTS

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?

Mr. LLOYD GEORGE

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.

Mr. AUSTEN CHAMBERLAIN

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

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.

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.)
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

Question, "That the Clause, as amended, stand part of the Bill," put, and agreed to.

Sir ALFRED CRIPPS

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."]

Mr. JOYNSON-HICKS

I wish to know whether the point can be raised on Clause 43, or whether we should raise it here.

The CHAIRMAN

There is no need for the discussion to be raised here.

Mr. FORSTER

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."

Mr. LLOYD GEORGE

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.]

Sir ALFRED CRIPPS

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.

Sir RUFUS ISAACS

They will not in any way interfere with the other rules of the society which apply to its other work.

Sir A. CRIPPS

Then I do not wish to move my Amendment.

Amendment, by leave, withdrawn.

Colonel HICKMAN

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——

Mr. LLOYD GEORGE

It only refers to visiting.

Colonel HICKMAN

As far as I know there are not sufficient lady doctors in the country to carry on the work.

Mr. LLOYD GEORGE

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.

Colonel HICKMAN

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.

Mr. LLOYD GEORGE

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.

Colonel HICKMAN

Then I will not proceed with my Amendment.

Amendment, by leave, withdrawn.

Mr. BOOTH

I beg to move to add to paragraph (c) the words "and men by men."

The CHAIRMAN

Is the hon. Member moving this Amendment in. a spirit of ridicule?

Mr. BOOTH

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.

Mr. LLOYD GEORGE

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.

Mr. GEORGE GREENWOOD

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."

Mr. LLOYD GEORGE

I accept this Amendment.

Dr. HILLIER

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.

Mr. LLOYD GEORGE

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.

Dr. HILLIER

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.

Mr. LLOYD GEORGE

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.

Dr. HILLIER

If he refuses to follow the doctor's advice.

Mr. LLOYD GEORGE

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.

Dr. ADDISON

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.

Mr. FORSTER

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.

Mr. LLOYD GEORGE

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.

Mr. AUSTEN CHAMBERLAIN

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.

Sir HENRY NORMAN

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.

Dr. ESMONDE

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.

Mr. DUKE

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.

Mr. LLOYD GEORGE

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.

Mr. AUSTEN CHAMBERLAIN

No, I did not say that.

Mr. LLOYD GEORGE

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.

Mr. DUKE

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.

Mr. LLOYD GEORGE

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.

Mr. AUSTEN CHAMBERLAIN

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.

Mr. LLOYD GEORGE

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.

Sir ARTHUR MARKHAM

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.

Mr. DUKE

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.

Mr. LOUGH

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.

Sir RANDOLF BAKER

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.

Mr. POINTER

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.

Captain CLIVE

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.

Mr. KEIR HARDIE

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.

Sir RUFUS ISAACS

I accept the Amendment, subject to any alterations rendered necessary in drafting.

Amendment 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