HC Deb 02 August 1911 vol 29 cc531-42

(1) For the purpose of administering sanatorium benefit local health committees shall make arrangements, to the satisfaction of the Insurance Commissioners, with persons or local authorities having the management of a sanatoria or other similar institutions approved by the Local Government Board for the treatment therein of insured persons entitled to sanatorium benefit under this Part of this Act.

(2) The sums available for defraying the expenses of sanatorium treatment in each year shall be—

  1. (a) one shilling and threepence in respect of each insured person resident in the county or county borough payable out of the funds out of which benefits are payable under this Part of this Act;
  2. (b) one penny in respect of each such person payable out of moneys provided by Parliament:

Provided that the Insurance Commissioners may retain the whole or any part of the sums so payable out of moneys provided by Parliament for the purposes of research.

(3) An insured person shall not be entitled to sanatorium benefit unless the local health committee considers the case one suitable for sanatorium treatment.

Mr. H. W. FORSTER

Will the Chancellor of the Exchequer give the Committee some idea as to how far he proposes to go to-night?

Mr. LLOYD GEORGE

I confess I thought it was possible to get as far as Clause 18 to-night, but I have made some inquiries and find there is rather a disposition not to go, at any rate, further than Clause 15. I understand there will not be many Amendments in order on this Clause as most involve a charge. I, therefore, suggest that we get to the end of Clause 15, provided we get Clause 16 and 17 on Friday without the suspension of the Five o'clock Rule.

Mr. FORSTER

I think that would be a fair arrangement to enable a discussion on the maternity benefits to take place during the hours of daylight.

Mr. McKENNA

I beg to move in Subsection (1), after the word "Commissioners" ["to the satisfaction of the Insurance Commissioners "], to insert,

(a) With a view to providing treatment for insured persons suffering from tuberculosis or any other such disease as aforesaid in sanatoria and other institutions.

Mr. FORSTER

In the hurry of our proceedings on this Clause I think we ought not to forget that the important question of assistance to hospitals was held over until we got to the Clause dealing with sanatoria. I should like to know when the question should be raised as to whether assistance should be given to hospitals in the same way as assistance is given to sanatoria in cases where the hospitals stand in need of it.

Mr. McKENNA

I think that will come in on Clause 47.

Amendment agreed to.

Mr. FORSTER

I beg to move in Subsection (1) to leave out the word "a" ["management of a sanatoria"].

Amendment agreed to.

Mr. McKENNA

I beg to move in Subsection (1) to leave out the word "similar" ["sanatoria or other similar institutions"].

Amendment agreed to.

Mr. McKENNA

I beg to move in Subsection (1) to leave out the words "for the treatment therein of insured persons en- titled to sanatorium benefit under this part of this Act, and to insert instead thereof the words, "and

(b) with a view to providing treatment for such persons otherwise than in sanatoria or other institutions, with persons and local authorities undertaking such treatment in a manner approved by the Local Government Board, which treatment (including the appointment of officers for the purpose) it shall be lawful for a local authority, if so authorised by the Local Government Board, to undertake."

Mr. CASSEL

May I ask the right hon. Gentleman exactly what this paragraph is intended to effect? Is it intended to give some new authority to local authorities which they do not possess at present? I think the Committee would like to know how this Clause is intended to be read together with Clause 47, which gives a similar power to county councils.

Mr. HICKS BEACH

The Amendment raises another point. What does the right hon. Gentleman propose to do in the case of sanatoria built by boards of guardians throughout the country? Does he propose to pay to them any share of the expenditure which they have incurred in providing these sanatoria? The point has been mentioned to the Chancellor of the Exchequer by a deputation which waited upon him, and the right hon. Gentleman promised to give it consideration. There is the case particularly in which boards of guardians have rendered themselves liable by entering into contracts to build sanatoria which have not yet actually been paid for. I do submit that in those conditions at any rate boards of guardians would have done their best out of the local rates to provide what is, after all, a benefit of national importance. These boards ought to be recouped as far as possible by the Treasury when they are taking over this national liability. I do not want to delay the Committee, but I should be glad if the right hon. Gentleman would kindly give us an answer on this point, which is one of considerable importance.

Mr. LANSBURY

I would like to ask the First Lord of the Admiralty, in the absence of the Chancellor of the Exchequer, whether the local authorities mentioned in this Amendment includes boards of guardians, or whether it does not relate simply to public health authori- ties? I should also like to ask, if institutions belonging to boards of guardians are used, will the persons so using them be considered paupers? I think it is rather important that we should know whether under this scheme the Poor Law authorities are going to be drawn in or not, because I think that persons who are paying to be insured will not care very much to have treatment in Poor Law institutions.

Mr. McKENNA

In reply to the last question, I may say there is no limitation in the words used by the Chancellor of the Exchequer's Amendment. The Amendment says clearly, "It shall be lawful for a local authority if so authorised by the Local Government Board." The words "local authority" there would, of course, cover any local authority; but I think this Amendment ought to be read with the Clause of the Bill to which it belongs. I do not think there is anything obscure about it. In regard to what was said by the hon. Member opposite (Mr. Hicks Beach), I would point out that the question of the cost of building a sanatorium does not come in on this Clause at all.

Mr. HICKS BEACH

On which Clause does it come in then?

Mr. McKENNA

On Clause 47.

Mr. CASSEL

Does not Clause 47 deal only with county councils?

Mr. McKENNA

As it stands, but that will have to be discussed when we get to that clause. None of the points raised by the hon. and learned Gentleman opposite (Mr. Cassel) or by the hon. Member sitting next to him (Mr. Hicks-Beach) are touched by the Amendment of the Chancellor of the Exchequer. The Amendment is an addition. The Clause says that local health committees shall make arrangements with persons or local authorities having the management of sanatoria or other similar institutions. The treatment is there limited to those institutions. Then the Amendment of the Chancellor of the Exchequer goes on to say: "And (b) with a view to providing treatment for such persons otherwise than in sanatoria." It is consequential on the Amendment already made in Clause 8, which reads now, "Treatment in sanatoria, or other institutions or otherwise." In consequence of that this clause had to be amended in order to make arrangements for the words "or otherwise." That is the whole meaning of the Amendment.

Mr. JONATHAN SAMUEL

I should like to point out that the wider definition given by the right hon. Gentleman who has just spoken will, in my opinion, certainly complicate the administration of sanatoria. I understood formerly that this matter was going to be governed and managed by the county councils and the county boroughs, and I would point out that there is no provision in the Bill delegating any powers to local authorities such as non-county boroughs and urban district councils, who now manage their own local hospitals. The fact is the definition now given by the right hon. Gentleman that "local authority" will include boards of guardians will make the new proviso very complicated indeed. I think whatever local authority should govern the sanatoria the area of its administration should harmonise with that of the local health committee. I should like, later on in the Bill, for the Government to undertake to consider the question of altering very much the character of the health committee's area, so as to include as areas not only counties and county boroughs, but also non-county boroughs and urban district councils. If the Government are not prepared to consider that, I hope to show by-and-by from my experience of the work on the education committee of a very large county that this Bill cannot be worked by the county councils, as such, but they will be bound either to delegate their powers, which is an extravagant form of local government, or to create smaller areas for the administrative work of the Bill. I would not really like to see the Clause passed in this form, because I think the areas of administration of the local authorities should harmonise with the areas of the health committees under the Bill will form hereafter. I should like to urge upon the right hon. Gentleman (Mr. McKenna) that the point is a very important one in the administration of the Bill and that he ought to consider it.

Mr. McKENNA

Certainly.

Mr. LANSBURY

May I move to put in after "authorities" in the second line of the Amendment of the Chancellor of the Exchequer the words "other than Poor Law authorities"? I want to exclude boards of guardians. I cannot imagine that the House has devoted all this time to the Bill to bring about a scheme of national insurance, and then that we will say we are going to dump those persons who have paid for insurance upon the Poor Law workhouses which are often used as hospitals and infirmaries, or even into their infirmaries. I thought everyone was agreed in this House that Poor Law institutions, and the Poor Law generally, should be kept out of the operations of this Bill. We have heard all the time that we wanted to keep people away from all that.

The DEPUTY-CHAIRMAN

I think if the hon. Member will look at the Amendment we are now discussing he will see that it does not deal with institutions for the treatment of tuberculosis, and I do not see the meaning of proposing the provision "otherwise than in Poor Law institutions."

Mr. LANSBURY

If they were to be sanatoria institutions. I want to prevent that.

The DEPUTY-CHAIRMAN

It says "otherwise than in sanatoria or other institutions."

Mr. LANSBURY

Whichever way it is —whether it is in an institution or not— whether it is giving sanatorium benefit through the Poor Law guardians or institutional treatment through the Poor Law guardians—I am totally opposed to any proposition of that kind; and I do not imagine that any person who joins an approved society would for a moment consent to be brought within the sphere of the Poor Law in any way, and I cannot imagine the Government intending any think of the kind.

The DEPUTY-CHAIRMAN

I think I can assist the hon. Member further. This paragraph is based upon the word "otherwise."

Mr. LANSBURY

That is the Chancellor of the Exchequer's Amendment.

The DEPUTY-CHAIRMAN

Quite so. It refers to treatment which is not in institutions; it refers to home treatment.

Mr. LANSBURY

I am just as much opposed to that. I am opposed in home treatment to bringing in the Poor Law at all. I think the Committee would not want that in any way. What have the Poor Law authorities to do with the business? There is always a public health authority in each Division, and the whole tendency of modern times has been that the public health authority should extend its sphere amongst the independent workers and keep them away from the Poor Law. We heard in the discussion on tuberculosis that in Edinburgh, Glasgow, Bradford, and other towns, and even in London, the tendency is to deal with this disease apart from the Poor Law. I do suggest that it is quite a retrograde step to bring in the Poor Law, and I hope the right hon. Gentleman (Mr. McKenna) will accept the Amendment and exclude specifically the Poor Law authorities. People will not expect that they will pay 4d. a "week to insure and then get treatment at the hands of the boards of guardians. I cannot argue that that is the intention.

Mr. HICKS BEACH

It would make a considerable difference if the hon. Member for Bow and Bromley (Mr. Lansbury) could move to exclude boards of guardians earlier in the Clause, after the words "local authorities" there instead of moving it after the words "local authorities" in the Chancellor of the Exchequer's Amendment.

Mr. LANSBURY

I was going to bring it up again afterwards.

Mr. HICKS BEACH

We cannot go back to that now, because we have passed it. That does deal with institutions provided by local authorities. I think it would be a great mistake if we did not make use of institutions provided by local authorities, whether boards of guardians or otherwise. They have spent a large amount of money upon them in buildings, and it would be pure waste if in future we did not use them for people who desire sanatoria treatment. I hope the Government will not accept that idea.

The DEPUTY-CHAIRMAN

I had better put the Chancellor of the Exchequer's Amendment first.

Question, "That the words proposed to be left out stand part of the Clause," put, and negatived.

Question proposed, "That the words proposed be there inserted."

Mr. McKENNA

With regard to the Amendment suggested by the hon. Member for Bow and Bromley, what the hon. Member opposite (Mr. Hicks Beach) has stated is quite accurate. He should have asked us to accept these words on the major Clause at line 37. The fact is that the boards of guardians have built these institutions, and it would be a waste of money not to make use of them. The Committee has already accepted the -Clause down to line 41. My hon. Friend wishes to make a distinction between treatment in the institutions and treatment afterwards.

Mr. LANSBURY

I want to exclude the Poor Law throughout, and that it shall have nothing to do with administering this Act.

Mr. McKENNA

The hon. Member would have been in order in moving the Amendment on the first part of the Clause, but as that Clause now stands the boards of guardians who have built these institutions may use them if the Local Government Board approves. Therefore he is limited to moving now to exclude boards of guardians in cases where the treatment is otherwise than in institutions. It is quite evident there is this similarity in the two parts of the Clause, but the Government have no particular objection to accepting the Amendment, if the hon. Member presses it. I think, however, the Chancellor of the Exchequer's Amendment as it stands covers his point. It is quite true the words "local authorities" broadly cover all the local authorities; but still the treatment must be "in a manner approved by the Local Government Board," and therefore they will have to obtain the sanction of the Local Government Board that their treatment should be undertaken by any local authority. Therefore I suggest he had better leave the Clause as it is, but if he decides to press it we will not oppose him.

The DEPUTY - CHAIRMAN

May I point out that I did not take the hon. Member for Bow and Bromley as definitely moving his Amendment? I will now give him an opportunity of moving it.

Mr. LANSBURY

I beg to move in the Chancellor of the Exchequer's proposed Amendment, after the words "local authorities" ["local authorities undertaking such treatment"], to insert the words "other than Poor Law authorities."

2.0 A.M.

Mr. JONATHAN SAMUEL

I do not think there is any reason for moving this Amendment. I think the hon. Member (Mr. Lansbury is under the impression that, according to the definition given by the First Lord of the Admiralty, there is a possibility of the boards of guardians administering the sanatorium benefit. In Clause 45 it is clearly the intention that the health committee in every area must administer the sanatorium benefit.

Mr. McKENNA

They are to make the arrangements.

Mr. J. SAMUEL

I should have thought that the administration of the sanatorium benefit would come from the county council or the health committee. I think the Amendment of the Chancellor of the Exchequer is so complicated that it would be better if the hon. Member would give further consideration to the matter and bring it up on Report if necessary.

Mr. FORSTER

I share the view of the hon. Member for Bow and Bromley (Mr. Lansbury) to a large extent. I think we are making a great mistake if we allow any part of the scheme to fall under the taint of the Poor Law. By inserting his Amendment in the Chancellor of the Exchequer's Amendment it does not wholly cover the point he wishes to make, and I suggest that he should withdraw the Amendment now, reconsider the matter and bring it up again on Report. It would be open to him to do that.

Mr. McKENNA

I asked the hon. Member to withdraw the Amendment, but said that if he insisted I agreed to accept it here.

Mr. LANSBURY

I am perfectly willing to withdraw the Amendment if the right hon. Gentleman will meet us on Report upon the Clause itself.

Mr. McKENNA

I have stated frankly to the hon. Member that in regard to the first part of the Clause, having regard to the fact that some Poor Law authorities hare already built sanatoria, I could not accept the Amendment there, and I pressed him not to press the Amendment here. If he does press it I will accept it.

Mr. LANSBURY

Everyone here who has had experience will agree with me that it would be a most unfortunate thing to bring in the taint of the Poor Law.

Mr. McKENNA

I accept the Amendment here.

Mr. LANSBURY

But you accept it in a place where it does not do what we want. What I suggest is that if these institutions must be used, and it is better to use them, let us put in some words enabling them to be taken over by the authority. That was my idea when the right hon. Gentleman suggested that we should consider the matter later on.

Mr. McKENNA

I accept the Amendment here.

Mr. LANSBURY

But I want to get back to the other point. We will get it in here, and try again for the other point.

Mr. CASSEL

May I suggest to the hon. Member that that can be done by putting in at the end of the Sub-section the words "Provided always that the expression 'local authorities' in this Sub-section shall not include Poor Law authorities."

Mr. SHERWELL

It is assumed in this discussion that there are boards of guardians with institutions which can be used for this purpose. Is that in fact the case?

Mr. McKENNA

Yes, it is the case.

Amendment to proposed Amendment agreed to.

Proposed Amendment, as amended, agreed to.

Mr. LANSBURY

I beg to move at the end of Sub-section (1) to insert the words "Provided that in any such arrangements approximately equal accommodation shall be secured for men and women respectively."

Mr. McKENNA

Why?

Mr. LANSBURY

Because I want just as much accommodation for women as for men.

Mr. McKENNA

I do not know whether the hon. Member means that the standard of accommodation for a man should be equal to the standard of accommodation for a woman. If he means that he does not mean what his words say, that there is to be half the accommodation for men no matter how many men there may be, or half the accommodation for women no matter how many women there may be. I understand he wants a common standard of accommodation.

Mr. LANSBURY

Yes.

Mr. McKENNA

The words do not mean that.

Mr. AUSTEN CHAMBERLAIN

The hon. Member can explain his own meaning. I understand that what he is anxious to provide for is a sufficient proportion of accommodation, not that the accommoda- tion for the individual woman should be equal to the accommodation for the individual man, but that the accommodation provided for women should be equal to that provided for men. I think that if anything, women want the accommodation more than men. I do not imagine that the health committees will provide accommodation for men and neglect the case of women. I think they will provide the accommodation in proportion to the necessities of the people, whether they be women or men. I do not see how we can lay down any lines to guide them in that. To say that there is to be equal accommodation for the two sexes might not meet the case at all. I am quite at one with the object of the hon. Member, which is that women should not have less accommodation in proportion to their needs than men.

Mr. LANSBURY

If the sense of the Committee is that my Amendment does not accomplish any end, I ask leave to withdraw it.

Amendment, by leave, withdrawn.

Mr. DAVID DAVIES

I beg to move to leave out the word "treatment" ["The sums available for defraying the expenses of sanatorium treatment"], and insert instead thereof the word "benefit."

Mr. LLOYD GEORGE

I accept that.

Amendment agreed to.

Mr. LLOYD GEORGE

I beg to move in Sub-section (3) to leave out the word "considers" ["the local health committee considers"], and to insert instead thereof the word "recommends."

Further Amendments made:

Leave out the words "one suitable" ["considers the case one suitable"].

Leave out the words "sanatorium treatment" ["considers the case suitable for sanatorium treatment"] and insert instead thereof the words "such benefit."

At end of Clause add—

"(4) A local health committee may, out of the sums available for defraying the expenses of sanatorium treatment, defray in whole or in part the expenses of the conveyance of an insured person to or from any sanatorium or institution to which he may be sent for treatment therein, or may make advances for the purpose."—[Mr. Lloyd George.]

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

Mr. JOWETT

The Clause as it is amended is objectionable, and will be found to be objectionable in working to the poorer classes of the community. It is so bad that in regard to sanatoria treatment Poor Law authorities can be utilised, and Poor Law authorities if they have anything to do with this scheme will most certainly create a prejudice in the minds of insured persons. I Crust the Committee-will refuse to pass this Clause in view of the importance of the point at issue. It seems to me very improper indeed that a principle so far-reaching as this should be worked in certain circumstances through the Poor Law authorities, and that we should be asked to decide that at two-o'clock in the morning, when a large number of Members are absent. It would be far better to go home. I move that the Clause be now passed.

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

Committee report Progress; to sit again upon Friday.