HC Deb 04 August 1911 vol 29 cc720-33

(1) Where the mother of the child is herself an insured person maternity benefit shall be treated as a benefit for her, and shall be administered by the approved society of which she is a member, or if she is not a member of any society by the local health committee; if she is not herself an insured person the benefit shall be treated as a benefit for her husband and shall be administered by the approved society of which he is a member, or if he is not a member of any such society by the local health committee, and shall be payable in respect of a posthumous child.

(2) The money payable by way of maternity benefit shall be expended in such manner as may be prescribed, and no payment shall be made by way of maternity benefit if the mother of the child has failed to comply with such conditions as may be prescribed.

The CHANCELLOR of the EXCHEQUER (Mr. Lloyd George)

I beg to move in Sub-section (1) after the word "person" ["is herself an insured person"] to insert the words "and is not the wife of an insured person"

This is in order to transfer the maternity benefit. It is in accordance with a pledge that I gave in the course of the proceedings. As the Bill was drawn originally she was only to get maternity benefit, and no sick pay. She will now get sick pay and maternity benefit when she herself is an insured person.

Amendment agreed to.

Mr. CASSEL

I beg to move in Subsection (1), after the word "administered" ["administered by the approved society "] to insert the words "in cash or otherwise." As the Bill stands at present the administering of the benefit is left to the friendly society, but there might be cases in which they might think it right to make a payment in cash.

Amendment agreed to.

Mr. LLOYD GEORGE

I beg to move in Sub-section (1), to leave out the words "if she is not herself an insured person" ["if she is not herself an, insured person, the benefit shall be"], and to insert instead thereof the words" in any other case."

Mr. CASSEL

I do not wish to resist those words being put in, subject to a point to which I wish to call the attention of the Chancellor of the Exchequer. It is a mere drafting point. If you insert the words "in any other case," they will read very awkwardly with the words at the end of the Sub-section. There is no Amendment to omit those words, and they would read awkwardly with the words" and shall be payable in respect of a posthumous child." So long as that point is dealt with, I have no objection to the Amendment.

The ATTORNEY-GENERAL (Sir Rufus Isaacs)

It is a drafting point, and if the Sub-section is left as it is now the whole matter will be put right on Report.

Amendment agreed to.

Amendment made: In Sub-section (1), after the word "administered" ["administered by the approved society of which he is a member"], insert the words "in cash or otherwise."

Mr. LEES SMITH

I beg to move to add at the end of Sub-section (1) the words "(2) The mother shall decide whether she shall be attended by a duly certified midwife or by a duly qualified medical practitioner, and any payment in cash shall be made direct to her."

The Midwives Institution have calculated that at the present moment 50 per cent. of child births are attended by mid-wives, and that the proportion amongst those insured under the Bill will be still larger. In an ordinary case for the sum of money given, a woman will receive a larger number of visits from a midwife than she would from a doctor. In all cases of normal labour the midwife's attendance is all that is required. The second part of the Amendment asks that the payment shall be made direct to the mother.

Dr. HILLIER

I am sorry to interrupt the hon. Member, but I rise to a point of Order. I have an Amendment which is earlier on the Paper than that of the hon. Member for Northampton (Mr. Lees Smith), and which I desire to move.

The CHAIRMAN

I think the point is already settled.

Mr. LLOYD GEORGE

It is.

Mr. LEES SMITH

My Amendment asks that payment in cash should be made direct to the mother. This will reduce the number of cases in which payment will never reach her at all. By the latter part of the Amendment the responsibility for the administration of the maternity benefit would be entirely on the mother, under conditions imposed by the Insurance Commissioners.

Mr. LLOYD GEORGE

My hon. Friend has rather mixed up two questions. One is the question of the right of the mother to choose as between a doctor and a certified midwife. That I shall accept, but I do not think it will come in here. I think it would be better on the Amendment of the hon. Member for Merthyr (Mr. Keir Hardie) as follows:— Provided always that the mother shall decide whether she shall be attended by a registered medical practitioner or by a duly certified midwife and shall have free choice in the selection of such practitioner or midwife. The second question is a totally different question. I may take this opportunity of indicating the intention of the Government in regard to it. Our view is that it should be left to the society itself. The omission of Sub-section (2) and the little word removed by the hon. Member will put the matter right, and will leave the friendly society or the approved society to make its own rules. I think that is far and away the best method. If my hon. Friend will assent to that course and withdraw this Amendment I shall agree to the omission of Sub-section (2) and afterwards to the proviso of the hon. Member for Merthyr to make it perfectly clear that she shall have the right to choose between the midwife and the doctor.

Mr. PETO

I think it is desirable to point out that if the question of whether payment in cash is to be made to the woman or to the husband is to be left to the society to take their own view of it it seems to me that the case of the woman will be left entirely to go by default. The committees of the societies will consist of men, and it appears perfectly obvious that in the very cases where you want a check it is extremely likely that they will not agree to handing over the cash to the wife, and will think in all those cases that the cash appertains to the man, and the woman has got to get what she can. I think it would be very much better for the hon. Member to stand by the principle of his Amendment. It is supported by the Women's Committee, by the Midwives Institute, by the Society for the Training of Midwives, and by all people who appear to know what the facts of these cases of confinement really mean among the poorer classes. They think the cash ought to be handed over to the wife. I think that would be very much better than leave it to a society with the rules framed by men.

Mr. CASSEL

I hope this Amendment will not be accepted, and that the course indicated by the Chancellor will be followed. If the hon. Member has withdrawn his Amendment—

Mr. LEES SMITH

I have not.

Mr. CASSEL

I submit that the friendly societies which have been administering this benefit satisfactorily ought to be allowed to do so. The Hearts of Oak Friendly Society, which has some 305,000 members and has been paying this benefit for a considerable time, has paid something like a million benefits in this way. I am not aware that any case has arisen where it has been administered unsatisfactorily. Certainly, I can imagine no greater insult to the friendly societies or to the working men in this country than that they cannot be trusted to properly administer this maternity benefit. Let any Member of this House put himself in the position that he is to receive some benefit or some payment, and that the person who gives it to him tells him. "You are not fit to be trusted with the administration of this money. I do not trust you to pay it to the doctor or the midwife. I am afraid you will spend it on yourself." I cannot imagine a greater insult to anyone, and I think the working men have as much pride in this matter as any other member of society. And to record it in an Act of Parliament—[HON. MEMBERS: "Agreed."] If it is agreed, I suppose the hon. Member will withdraw.

Mr. LEES SMITH

I did not on the ground that it was stated in a confused manner. The same point comes up on line 25, where the two questions are separated. I should like the position on the latter point explained as to whether the money is to be paid to the woman.

Mr. LLOYD GEORGE

I thought I had made myself fairly intelligible. Evidently the hon. Member does not understand. What I said was this, that we were prepared to omit Sub-section (2). That means that it is left entirely to the friendly societies to do it in their own way. Thus, the Hearts of Oak, for instance, pays in cash straight to the person who is entitled to the benefit; but it is administered by the Society itself if we omit Sub-section (2). With regard to the first part of my hon. Friend's Amendment, I think it is a bad one. I think the Amendment of the hon. Member for Merthyr is a better one. I want to put it still more emphatically. The Amendment of the hon. Member for Merthyr puts it quite clearly and well. Therefore I propose to accept it. It effects what the hon. Member designed to achieve by his Amendment and gives full and free right to the woman to choose whether she will spend the money by employing a medical practitioner or a midwife. That is a complete acceptance of the first part of my hon. Friend's Amendment. I thought everybody understood that. With regard to the second part, it is left to the society of which the woman is a member to do exactly as they like in their own way.

Amendment, by leave, withdrawn.

Amendment made: At the end of Subsection (1), insert the words "(2) Provided always that the mother shall decide whether she shall be attended by a registered medical practitioner or by a duly certified midwife, and shall have free choice in the selection of such practitioner or midwife."—[Mr. Barnes.]

Mr. CASSEL

I beg to move to leave out Sub-section (2). I have already stated my reasons for thinking the Sub-section unnecessary. The matter may well be left to the friendly societies.

Mr. J. W. HILLS

I suppose we may assume that the administration of this benefit is left to the health committees or to the approved societies as the case may be, and that the health committee is just as free to administer the benefit as the approved society. In cases where the health committee is the administering body, I take it their hands will be just as free as those of the approved society.

Mr. LLOYD GEORGE

indicated assent.

Amendment agreed to.

Motion made, and Question proposed, "That the Clause, as amended, stand part of the Bill."

Mr. H. W. FORSTER

Maternity benefit in the case of a woman who is not an insured person will be treated as a benefit for her husband; therefore, the position of the wife of a deposit contributor is likely to be a hard one Take the case of a woman who has had to pay her contributions up to the time of her marriage. Her insurance is then suspended. She becomes the wife of a deposit contributor. In the event of the deposit contributor himself being ill some time in the year prior to the confinement of his wife, his deposit may very well be exhausted when the woman is confined, and there will be no fund standing to his credit out of which the maternity benefit can be paid. I think that that is a very hard case; in fact, it is a monstrous state of things for a woman about to be confined of her first child to contemplate.

Sir ALFRED MOND

There is one point that I am not sure is covered by the Clause as amended. Where the midwife requires the aid of a medical practitioner, is there any fund out of which to pay the medical practitioner? This is really a point which requires explanation, especially in view of the provisions of the Midwives Act. I hope the Government will look into the matter between now and the Report stage.

Mr. J. W. HILLS

I have an Amendment later on to meet the point to which reference has been made. It is a small but important matter. In certain cases a midwife is compelled to call in a medical man, and unless the cost is charged on the insurance fund I suppose it must be paid by the mother. I am sure that that is not the intention. It will not be a very large extra charge on the fund, and certainly if the mother is insured it ought not to fall on her.

Mr. BOOTH

I was very much struck by the point raised by the hon. Member for Sevenoaks. I do not think the question will arise in many cases; at least, I hope it will not. There will be a rivalry amongst the approved societies, and I believe that they will be public spirited enough, provided the cases are not very numerous, to make an ex gratia payment in such instances. If, on consideration, it is found that the cases will be at all numerous, I think something should be done later in the Bill. We are travelling over new territory, and in working the Bill occasional points are sure to be found where hardship will arise. I am hoping that the approved societies will rise to the occasion and make some little payment in extraordinary cases.

The FIRST LORD of the ADMIRALTY (Mr. McKenna)

The Chancellor of the Exchequer has suggested that when we have finished Clause 17, beyond which we do not propose to go to-day, we should, with the leave of the Chair, have a general discussion, in which Members might touch on many points which are now outstanding, in order that we might close with a comprehensive survey of the state of the Bill as far as it has gone. It would be much better that that discussion should take place when the Chancellor of the Exchequer is here; therefore I should not enter at length into the various points which have been raised. In regard to the observations of the hon. Member for Sevenoaks, it is inherent in the scheme of the Bill that persons who are not insured in an approved society, and who get only the benefit of the deposit system, will suffer hardship in certain cases. That is a difficulty that has been explained. When the insurance money of the insured is exhausted, there must inevitably arise cases of individual hardship. I think the question that the hon. Gentleman has stated is one that ought to be taken into account on the general survey of the Bill, which does not arise only on Clause 16, but equally in regard to other benefits under the Bill. Another point—and a very material one—was raised by the hon. Gentlemen the Members for Swansea and Durham City. Upon that point I would only say that the Government are considering it. Undeniably it is a very difficult matter that in the case where the wife of an insured person is receiving maternity benefit, but under the scheme of the Bill not receiving medical benefit, she should then be unable to obtain the services of a suitable practitioner where such a doctor is called upon by the midwife. That point will also be considered. Having said this, I would ask the hon. Gentlemen whether they could not agree to postpone the general discussion until we have completed Clause 17, in order that we may have the advantage of the presence of the Chancellor of the Exchequer?

The CHAIRMAN

I think I ought to intervene here. The right hon. Gentleman has indicated that there will be a general discussion on the Motion to report Progress——

Mr. McKENNA

I said "with the leave of the Chair."

The CHAIRMAN

The Chair has to consider whether or not it is a wise precedent to set up. If on this occasion it is done at the request of the Government, on some other occasion it may have to be done at the request of someone else. I do not feel inclined to allow anything of the kind without due consideration. I am opposed to anything like a general discussion. It is quite right for the hon. Member to ask about the future progress of the Bill and so on, that is a legitimate matter and relevant to the Motion to report Progress, but not a general discussion on the Bill.

Mr. McKENNA

May I be allowed to say that a general discussion having been suggested that it might be taken with the general consent of the House, and with the leave of the Chair.

Sir ROBERT FINLAY

On a point of Order, Mr. Emmott, the right hon. Gentleman has said that this matter has been arranged with the General Consent of the House——

Mr. McKENNA

No, no.

Sir R. FINLAY

I am afraid, then, I have misunderstood; he said something about "general consent." I am not aware of any such consent. It is only a couple of minutes ago that I heard anything or knew anything about a general discussion. It seems to me most irregular.

Mr. McKENNA

Allow me to finish what I was going to say. I said that it had been suggested that if the general consent of the Committee were obtained, and by the leave of the Chair, it would be advantageous to have a general discussion on these matters so far as we have gone rather than on Clause 16 only, and that probably that would be a good use of the hours left to us this afternoon.

Sir R. FINLAY

At the same time it would be very inconvenient to have a general discussion of that kind on a Friday afternoon; most certainly when it was not generally known to Members of the Committee. I think it would be setting a very bad precedent that a discussion of that kind should be taken without ample notice, and when hon. Gentlemen who might de-sire to take part in it were not here.

Mr. LLOYD GEORGE

I think it is perhaps necessary that I should say that I did indicate yesterday afternoon——

Sir R. FINLAY

No, no.

Mr. LLOYD GEORGE

The right hon. Gentleman is wrong in saying no notice was given. I did yesterday indicate to the hon. Gentleman who is in charge of the Opposition what my desires were. If anybody objects to a statement of the kind being made on the Motion to Report Progress it could only be done, I fully realise, with the consent of the House. If the Opposition declines to do that it will be the first time that it has ever been done. [HON. MEMBERS: "The Chairman."] It can only be done by the leave of the Chairman and with the general consent of the House, I fully realise that. But the Chairman never refuses to give his consent. If I may be allowed to say so, I have never known the Chairman or the Speaker to refuse their consent to a statement of the kind being made, with the general consent of the House. I remember perfectly well with the general consent of the House a discussion of the kind being allowed, or a statement being allowed to be made by the hon. Gentleman in charge of the Opposition.

The CHAIRMAN

I would explain to the right hon. Gentleman—I cannot repeat exactly what I said before—but the substance of it was this: The words used by the right hon. Gentleman the First Lord of the Admiralty were, "A general discussion." I do not know any occasion on which a general discussion has taken place on a Motion to report Progress. It is quite a different thing for the right hon. Gentleman to ask leave to make a general statement, perhaps with a word or two of comment on it.

Mr. LLOYD GEORGE

That is all I want.

The CHAIRMAN

It would be a most undesirable precedent for the Government to set up—to indicate that a general discussion may be taken on a Bill on the Motion to report Progress.

Mr. LLOYD GEORGE

The point was that I should just like to make a statement as to the position at the present time of outstanding questions, that being, I understood, quite an uncontroversial matter. This was rather with a view of inviting hon. and right hon. Gentlemen to direct their attention to two or three questions especially which were still outstanding; also to stimulate suggestions on the part of Members of the House to assist the Government in coming to a right conclusion. It is purely because I am doing my level best to carry out the principle that this is a Bill which should be fashioned by the whole of the House that I thought it would be desirable, if I pointed out two or three outstanding difficulties which still remained, and invite the House during the Recess to consider what suggestions they could offer. If that is refused I have nothing more to say.

Mr. FORSTER

The concluding sentences of the Chancellor of the Exchequer fairly represents the conversation that he had with me yesterday afternoon. He came to me and said that, in the event of our being able to dispose of these two Clauses before 5 o'clock, he hoped to take the opportunity, on the Motion to report Progress, of making a general statement, of giving the House some idea of what he proposes to do in reference to the future stages of the Bill; possibly of taking the opportunity of making a short review of what had happened—

Mr. LLOYD GEORGE

indicated assent.

Mr. FORSTER

The right hon. Gentleman asked me if that course would be agreeable to the Opposition. I told him quite frankly that in a matter of that kind one cannot bind one's own supporters beforehand before we know what is going to happen. We cannot ask Members of the House to refrain from moving Amendments or unduly curtailing discussion upon Amendments. Therefore, I told the right hon. Gentleman, as he will remember, that I could not be taken as necessarily assenting to a course of that kind. Of course, so far as the statement which the right hon. Gentleman proposes to make is concerned with the Rules of Order that has nothing on earth to do with the Opposition. That entirely rests in the decision of the Chair. Members of the Opposition do not in any way desire to prevent the right hon. Gentleman making a statement of that kind, but that is all we can say. We have endeavoured at all times to assist the discussion of this Bill, We do not want to prevent the right hon. Gentleman, or anybody else, from giving his views. Of course, as far as the Rules of Order are concerned, the Chair must interpret them.

Mr. BARNES

I think this is a very convenient time for a general stock-taking of the proceedings so far as we have gone, and possibly also as to what the Chancellor of the Exchequer intends to do in the future. I should like to associate myself most fully with the observations of the hon. Member opposite in regard to the case of a woman who is a Post Office contributor, and whose account has gone down. I think it would be a monstrous thing to leave a woman in a position of having no money from which to draw maternity benefit. On this point, might I draw the attention of the Committee to the Amendment in my own name, and that of one of my hon. Friends, in favour of using the surplus of the approved societies for that and other purposes. I only hope the Chancellor will find some means of dealing with this matter. The only other matter I wish to touch on is in reference to the question raised by an hon. Member opposite as to who is going to handle the cash. The hon. Member, so far as I understood him, said the approved societies would be managed by men, and I suppose we may also assume the Post Office contributors will be similarly managed, and that, therefore, something unfair would happen to the women. I do not for a moment believe that would happen. As a matter of fact, as has been pointed out, the Hearts of Oak has long experience, and I have practical experience because I have had the Hearts of Oak benefit five times, and as a matter of fact no difficulty arises. The assumption that a man is going to do something unfair towards the woman in a case of that kind is altogether groundless. At any rate, even if he was disposed to do so, and if the woman is handed over the maternity cash benefit, is not the woman helpless at such a time. I am satisfied with the provision of the Chancellor of the Exchequer about the money being paid through the approved societies.

Dr. HILLIER

I regret the Clause should be passed without the Amendment of the hon. Baronet the Member for Swansea. The hon. Baronet was not called upon to move his Amendment.

The CHAIRMAN

If the hon. Gentleman wants to know the reason why, it was because the first part of the Amendment was already dealt with, and the second part would create a charge, and I should have to know where the money was to come from.

Dr. HILLIER

I shall say nothing further with regard to that except to express the hope that this point will be one of those which the Chancellor will deal with in the statement he proposes to make to the Committee at the end of Clause 17. It is perfectly true that a new charge may possibly be created, but undoubtedly this matter ought to be met. I hope the Chancellor will deal with the point raised in the Amendment of the hon. Baronet, for although the Amendment has not been dealt with it raises distinct points which should receive consideration.

Mr. ALBERT SMITH

What is to be the position of the mother who gives birth to a child in unforeseen circumstances, when neither doctor nor nurse were present. Hundreds of such cases occur, and I think it would be very hard if she should be deprived of the benefits.

Mr. LLOYD GEORGE

We have already decided that this matter should be left to the approved societies, and the suggestion that the local health committees should make arrangements for maternity was negatived, I think, on Clause 13. At any rate, that was the place where it should be decided. At any rate, I know there were several Amendments down, and I feel certain that if they had been moved they would have been negatived. The general feeling was that this benefit should be left to the administration of the friendly societies.

Mr. PETO

I should like to ask one further question. The matter seemed to be introduced by the First Lord of the Admiralty almost in a new form.

The CHAIRMAN

The hon. Member can raise that later; the question now is that the Clause stand part.

Mr. PETO

On that point then I should like to say a word as to the woman who is herself insured and becomes the wife of a Post Office contributor. She would be left without any means by which this benefit could be paid. The hon. Member for the Blackfriars Division referred to the same case. The First Lord of the Admiralty said that individual hardship in the case of Post Office contributors must inevitably occur, but as long as it is confined to individual hardship it does not touch the point raised by the hon. Member for Sevenoaks. Where a woman has been herself a contributor up to a few months before she marries a Post Office contributor, on the birth of her first child there is no provision for her under this Bill. This matter of the selection of a medical practitioner and how he has to be paid are matters to be dealt with on this Clause. The Asso- ciation for the Training of Midwives is supporting an Amendment precisely on the same lines as that put down in the name of the hon. Member for Durham (Mr. Hills), and they ask that this question shall be settled definitely and that there shall be means to pay the doctor's fee in order that there will be no dispute or question at the time when there ought not to be any dispute. It should be laid down that if the midwife wishes to have medical opinion in a case of urgent need there must be no question about the doctor's fee. I wish to protest against the opportunity given to the Chancellor of the Exchequer of making a statement being used as a sort of a threat over the heads of the Committee to prevent hon. Members dealing with these specific points.

Mr. LANSBURY

I wish to join in the appeal which has been made to the Government to take into consideration the case of the insured woman who marries a Post Office contributor. I hope some means will be taken to ensure that she, at least, gets medical attendance and sufficient nursing attendance at the time of maternity. I think the whole House will agree that in some way we must secure that. With regard to the other point which has been coming up ever since midwives have been brought in for this work, I suppose the House is aware that local authorities, through the Poor Law guardians, are the people who are called upon to pay in these cases. I want to suggest that the Government should take this opportunity of putting this duty on the ordinary public health committee of the district in which the woman resides. It seems to me that that is the only logical way out of it. No one will be pauperised and there are not a large number of these cases. I know that is so from my experience of a very poor district.

Mr. BOOTH

Does the hon. Member mean the public health authority?

Mr. LANSBURY

Yes, I mean the public health authority or the county or urban district authority. At present you have to do this through the Poor Law guardians, and I think they ought not to do it in this case. If the Government could put in some words that the public health authority should be the authority to pay for the medical practitioner called in you would only be carrying out what is being done at present through the Poor Law authorities.

Dr. ADDISON

Under the administrative provisions of the Midwives Act there is machinery for providing for the payment mentioned by the hon. Member.

Mr. LANSBURY

I do not think the hon. Member is quite accurately representing the case.

Dr. ADDISON

I think this is a golden opportunity to deal with this question, and I sincerely hope the right hon. Gentleman will introduce words which will empower approved societies to make an arrangement of this kind.

Mr. McKENNA

The views which have been expressed on this point meet with a great deal of sympathy from the Government, and they shall certainly be taken into account. It is quite obvious that as we are now discussing the Clause as a whole it would be impossible at this moment to suggest the particular form of Amendment required or to consider whether it would be practical in this Bill to carry out that object. I hope hon. Members will be satisfied with the statement that the views they have expressed are shared by the Government.

Question put, and agreed to.