CLAUSE 8.—(Rates and Conditions of Benefits.) (Hansard, 11 July 1911)

HC Deb 11 July 1911 vol 28 cc301-40 301

§ (1) The benefits conferred by this Part of this Act upon insured persons are—

(a) Medical treatment and attendance, including the provision of proper and sufficient medicines (in this Act called "medical benefit");
(b) Treatment in sanatoria or other institutions when suffering from tuberculosis, or such other diseases as the Local Government Board with the approval of the Treasury may appoint (in this Act called "sanatorium benefit");
(c) Weekly payments whilst rendered unfit to provide their own maintenance by some specific disease or by bodily or mental disablement, commencing from the fourth day after notice thereof is given, and continuing for a period not exceeding twenty-six weeks (in this Act called "sickness benefit");
(d) In the case of the disease or disablement continuing after the determination of sickness benefit, weekly payments so long as so rendered unfit by the disease or disablement (in this Act called "disablement benefit");
(e) Payment in the case of the confinement of the wife of an insured person, who is not herself an insured person, or of a woman who is an insured person, of a sum of thirty shillings (in this Act called "maternity benefit");
(f) In the case of persons entitled under any scheme made in accordance with this Part of this Act to any of the further benefits mentioned in Part II. of the Fourth Schedule to this Act (in this Act called "additional benefits") such of those benefits as may be distributable under that scheme.

§ (2) Subject to the provisions of this Part of this Act, the rates of sickness benefit and disablement benefit to which insured persons are entitled shall be the rates specified in Part I. of the Fourth Schedule to this Act.

§ (3) The right to sickness benefit and disablement benefit shall not commence before the insured person attains the age of sixteen and shall cease on his attaining the age of seventy, but, save as aforesaid, the right to benefits (other than additional benefits) shall continue throughout life.

§ (4) Except with the consent of the society or committee administering the 302 benefit, no insured person shall be entitled to any benefit during any period when ho is resident either temporarily or permanently outside the British islands, or to medical benefit during any period when he is resident outside the United Kingdom.

§ (5) Where an insured person, having been in receipt of sickness benefit recovers from the disease or disablement in respect of which he receives such benefit, any subsequent disease or disablement, or a recurrence of the same disease or disablement, shall be deemed to be a continuation of the previous disease or disablement, unless in the meanwhile a period, continuous or discontinuous, of at least twelve months has elapsed, and at least fifty weekly contributions have been paid by or in respect of him:

§ Provided that the benefit in respect of such subsequent or recurrent disease or disablement shall not commence to be payable before the date at which it would, apart from this provision, have commenced.

§ (6) Where a woman is herself entitled to maternity benefit she shall not be entitled to sickness benefit, disablement benefit, or medical benefit at and for a period of four weeks after her confinement.

§ (7) Notwithstanding anything in this Part of this Act, no insured person shall be entitled—

(a) to medical benefit during the first six months after the commencement of this Act;
(b) to sickness benefit unless and until twenty-six weeks have elapsed since his entry into insurance, and at least twenty-six contributions have been paid by or in respect of him;
(c) to disablement benefit unless and until one hundred and four weeks have elapsed since his entry into insurance, and at least one hundred and four contributions have been paid by or in respect of him;
(d) to sickness benefit in respect of any disease or disablement which commenced during the twenty-six weeks, or to disablement benefits in respect of any disease or disablement which commenced during the one hundred and four weeks, next following his-entry into insurance;
(e) to sickness benefit or disablement benefit during any period when he is provided with board and lodging by his employer;
(f) to maternity benefit unless and until twenty-six, or in the case of a voluntary contributor fifty-two weeks have elapsed since his entry into insurance, and at least twenty-six, or in the case of a voluntary contributor fifty-two, contributions have been paid by or in respect of him.

§ (8) As soon as a sum has been accumulated by investment sufficient, to provide interest at 3 per cent. per annum on the amounts then standing to the credit of all approved societies the benefits payable to insured persons under this part of this Act shall be extended in such manner as Parliament may determine, but in determining the distribution of such extended benefits amongst the persons who become entitled thereto regard shall be had to the claims or special considerations of persons who have entered into insurance at an early age.

§ Dr. ADD1SON
I beg to move, in Subsection (1), after the word "persons" ["upon insured persons"] to insert the words, "subject to the provisions of this Act."
The purpose of this Amendment is to clear the ground for other qualifications proposed to be introduced in the Bill. I believe the Chancellor of the Exchequer has expressed his willingness to accept the Amendment, and for the general convenience of the House I do not propose at this time to make a long speech upon it. I may say that the object of the Amendment is mainly to facilitate the introduction into the Bill of such Amendments as will satisfy, in accordance with the opinions of this Committee, the reasonable requirements of the medical profession with regard to the administration and the style of various benefits. Unless some such qualifying words are introduced it will be impossible hereafter, without referring the Bill back, to introduce those Amendments.

§ Mr. RAMSAY MACDONALD
Are we in possession of the Amendments to which the hon. Member refers? Do we know what we are voting for or rejecting?

The DEPUTY-CHAIRMAN
It does not appear to me to be a case which requires that the Amendments should be put on the Paper. I take it that the purpose of this Amendment is that the Sub-section should not entirely close the question as regards rates and conditions of benefit. Possibly in a new Clause there might be something which would only be in order if 304 these words are inserted now. The hon. Member did not explain very fully what his Amendments are.

§ Dr. ADDISON
There is a large number of Amendments on the Order Paper, which would necessitate this Amendment, and in order to save the time of the House I refrain at this stage from referring to them.

§ Mr. McKENNA
The Amendment simply enlarges the freedom of the Committee. If these words are not inserted, it would be impossible to discuss some of the Amendments of which notice has been given. If they are accepted, it will be possible to discuss them. The Amendment does not necessarily bind the Committee to accept any of the Amendments.

§ Mr. JAMES HOPE
I understand this Amendment is to enable further benefits to be moved. Surely we cannot discuss the benefits which are already set out in Clause 8 unless we know what are the further benefits to be proposed, and whether they will come within the financial limits.

§ Mr. LLOYD GEORGE
The Committee will not be in a position to discuss the medical position at all unless words are put in to give freedom to the Committee to discuss alternative proposals.

§ Sir PHILIP MAGNUS
I think it is very desirable that these words should be introduced. The Amendment does not necessarily involve an increase in the number of benefits, but it will enable the Committee to discuss the conditions under which the benefits are to be given.

§ Mr. JOYNSON-HICKS
I beg to move, in Sub-section (1), to leave out paragraph (a). I merely move in order to ask the Chancellor of the Exchequer to afford the Committee some information as to the present position of negotiations with the medical profession. He told us on the first day on which this Bill was in Committee that he had practically settled with the medical profession.

§ Mr. LLOYD GEORGE
This should be discussed on Clause 14 and not on Clause 8. But for other reasons also it is extremely undesirable that this matter should be debated at this stage.

§ Mr. JOYNSON-HICKS
With great deference to the Chancellor, it really is not out of order to move the omission of this 305 Sub-section. I move the omission of the Sub-section regarding medical benefits in order to obtain from the Government a statement of what those medical benefits are or how far the negotiations regarding them have gone. If the statement of the Chancellor should prove unsatisfactory, then I should be perfectly in order in going on with my Amendments to omit the medical benefits from the Bill altogether as being unsatisfactory. It is a constant practice to move the omission of provisions of a Bill in order to ascertain the views of the Government upon it. If the Chancellor appeals to me on the ground that this is not an appropriate moment for him to disclose negotiations that is another matter.

The DEPUTY-CHAIRMAN
I cannot rule this Amendment out of Order in this place on the ground that the subject comes up again in a subsequent Clause. If the hon. Member confines himself to the lines which he has indicated he is not out of Order.

§ Dr. ADDISON
If the Amendment were negatived should we be able to discuss it again on Clause 14, where it is much more relevant and much more necessary that we should discuss it?

§ Mr. LLOYD GEORGE
In Section 14, Sub-section (1) we have got the arrangements to be made with the medical profession. "Every approved society and local Health Committee shall for the purpose of administering medical benefit make arrangements with duly qualified medical practitioners for insured persons to receive attendance," and so on. That raises the whole of the arrangements with the doctors. I should like to know whether it is in Order to discuss on the character of the benefits given, the arrangements to be made with the doctors.

§ Mr. JOYNSON-HICKS
I have been approached by large numbers of doctors in my own Constituency, and their position is that unless they get satisfactory arrangements from the Chancellor they would prefer to leave medical benefits out of the Bill altogether, and leave the doctors to make their own arrangements with the insured, as they do at the present moment. It is impossible for me, as the representative of these doctors in the Brentford Division of Middlesex to decide whether these benefits should be included or not unless I know something of the views of the Government on the point. Everybody knows that negotiations have been taking place between the Government and the doctors.

306

§ Mr. CAVE
Looking down the Amendment Paper there is a whole series of what I may call medical Amendments to this Clause. The point must come up over and over again. We have got the Chancellor of the Exchequer here to-day. We may not have him to-morrow. It would be impossible to deal with all the Amendments on this Clause without knowing something about the arrangements.

§ Mr. LLOYD GEORGE
I think the arrangements are under this Clause.

§ Mr. AUSTEN CHAMBERLAIN
May I appeal to the Chancellor of the Exchequer to give more favourable consideration to the plea put forward by my hon. Friend.

The DEPUTY-CHAIRMAN
We are still on a point of Order. Does the right hon. Gentleman wish to address the House upon that point?

§ Sir PHILIP MAGNUS
I myself have an Amendment on Clause 8 which goes to the very root of the matter and is very important. The Chancellor of the Exchequer in reference to the first Amendment suggested that it should be limited to the medical benefits, and that the question of medical practitioners arises under Clause 14. The right hon. Gentleman probably knows very well that there is a very important Amendment to Sub-section (7) of this very Clause, and it will not be very easy to discuss the subject without some statement from the Chancellor of the Exchequer as to the position in which he stands with regard to the medical practitioners.

§ Sir R. FINLAY
There is no doubt that my hon. Friend is in order in moving the Amendment, and it rests with the Chancellor of the Exchequer whether he chooses to make a statement. The medical benefits have a direct bearing upon the question of the medical profession, and I respectfully submit that as the Amendment is allowed to be in order by the Chair the only question which remains is as to how far the Chancellor of the Exchequer proposes to go in stating what is applicable to the Amendment.

The DEPUTY-CHAIRMAN
I think the right hon. and learned Gentleman has correctly stated the question of order. I have allowed the Amendment because it is not out of order. The extension of the Debate on the Amendment of course is another question, and if I may say so, not a very easy one. Clause 14 is set apart for 307 the arrangements to be made with the medical profession for carrying out the benefits under Clause 8. Therefore it would obviously be proper to leave to the later Clause the consideration of the details of the methods to be adopted. I do not think the hon. Gentleman would be out of order in asking the Chancellor of the Exchequer whether he has expectation that a statement can be made, and therefore, whether it is practicable or not. But I think he will see that it will be desirable to go further than that, and to get an assurance from the Government whether it is worth while to go on discussing paragraph (a), which is the one proposed to be omitted.

§ Mr. FORSTER
I think there would be no disposition whatever as far as any Member of this Committee is concerned to question the ruling of the Chair, but it seems to me when we are dealing with a Bill of this kind, that we should save time and make the passage of the Bill easier if we put our cards upon the Table. The Amendment of my hon. Friend is in order, and the question really comes to this, whether or not the Chancellor of the Exchequer will give us an indication or some idea of the arrangements he proposes to put into the Bill with reference to the medical benefits. It is absolutely impossible to discuss the question of the medical benefits divorced from the attitude of the medical profession towards them. I submit on the point of Order, that the Chancellor of the Exchequer might give us some general indication of what he proposes to do on this Amendment, or some other Amendment dealing with the same subject.

The DEPUTY- CHAIRMAN
The Amendment is in order, and the hon. Member might ask the Chancellor of the Exchequer to answer a question on the subject. It remains for the Government to say how far they think it necessary to discuss the medical question on Clause 14. Otherwise, of course, a discussion on that Clause could not be allowed now.

§ Mr. GEORGE ROBERTS
On this Amendment the Debate will be confined to medical benefits and attendance, and whether or not the medical treatment shall or shall not be applied under the Bill. That would be the whole scope of the debate. Therefore it will be practically useless for the purpose desired on the 308 other side of the House. I myself have met doctors on this subject. I received a representative deputation of doctors, and I am just as keen to represent their point of view as is the hon. Gentleman opposite. But I contemplated that Clause 14 would be the proper place for such a discussion, and I thought it would be too restricted upon this Clause.

The DEPUTY- CHAIRMAN
The Amendment is in order, and we shall see later on the course of the discussion.

§ Mr. JOYNSON-HICKS
I was beginning my remarks when the Chancellor of the Exchequer raised a point of order, and I will try to confine the Debate within narrow limits. Under this Bill certain benefits are given to all insurers, and one of these is medical treatment and attendance, including the provision of proper and sufficient medicine. I submit to the Government that we cannot vote "Aye" or "No" in favour of rejecting these medical benefits unless we know what they are. We are not bound to vote blindfold for giving medical benefits unless we know in the first place what the medical benefits are; in the second place how they are going to be given, and, in the third place, whether they are likely to be given at all. These are three points upon which we are entitled to information. First, as to what the benefits are. I think we are entitled to know. There have been deputations to the Chancellor of the Exchequer, who has had negotiations with the doctors. Most important of all, it is of no use our passing medical benefits which are to cost a certain amount of money under the provisions of this Bill, unless there is a distinct certainty, or something approaching to a certainty, that the Chancellor of the Exchequer is able to make such arrangements with the medical profession that they will give these medical benefits that we the House of Commons are offering to the people insured under this Bill. It is perfectly obvious that it is of no use putting into the Bill that you are going to give insured people medical benefits if you cannot do it. You cannot give medical benefits unless you have been able to arrange with the medical profession. You might put into the Bill that you will give free legal advice, but unless you arrange with the legal profession it would be of no use putting such a provision into the Bill. Unless you can arrange with the medical profesion it is idle to pass a Clause giving medical benefit. Supposing this Committee passes in a blind way the giving of 309 medical benefits, those hon. Gentlemen who are more directly representing the views of the doctors, among them my Noble Friend, the Member for the University of London, would be largely prejudiced in the Amendments which they wish to move. The Chancellor of the Exchequer told us the other day—and I do not think he will really dissent from my words—that he had practically arranged the question of medical benefits with the medical profession. It so happened that within five minutes afterwards I was receiving a deputation from the doctors in my own division, and they told me, on the authority, they assured me, of the British Medical Association, that no arrangement had up to that time been come to between the Chancellor of the Exchequer and the medical profession.
I tried to follow out the Chairman's ruling without going into details, though personally I think it would be in order to do so. I am entitled to move this Amendment for the express purpose of asking a declaration from the Government, and the Chancellor of the Exchequer when he sat on these benches must have done so scores of times, and he must have made it far hotter for the Government than I can ever hope to make it for him, with the best intentions in the world. I do ask what arrangements he has made, or is making, with the medical profession. If he tells the House that the negotiations are in a critical condition, then the proper thing to do would be to postpone paragraph (a), and, if he prefers, I should be willing to alter my Amendment and leave the Debate on the medical question until we get to the end of the Clause. On the other hand, if he has to any extent come to an agreement with the doctors, then we are entitled, as Members of the House of Commons, to know of it. We are being bombarded by Constituents, doctors and others, and. as the Chancellor knows, I say, with all respect, it is his duty to tell us, in order that we may assuage the very reasonable interest of members of the medical profession and our own Constituents as to what the position is going to be.

§ Mr. LLOYD GEORGE
I think, in the first place, if I were to go into the whole question of the arrangements with the medical profession, I should be raising a Debate which clearly arises on Clause 14. It might act to the prejudice of any arrangement which may be arrived at before we come to Clause 14, and that is 310 obviously the time. There is another reason why I think the Committee would not press me. Nobody knows better than. the right hon. Member for the University of St. Andrews (Sir R. Finlay) that negotiations are pending, and it is no fault of mine that I am not in a position at present to inform the House. If I were at present, to venture into the whole of that position, and raise a Debate which is not relevant on this Clause, and no Amendment as to the proposed method of payment would be relevant to this Clause, and the difficulty is with regard to the method of payment and the arrangement under which they are to be paid, if I were to open a Debate of that kind it would undoubtedly prejudice the discussions which are now going on. I do not believe that that is the desire of any hon. Member on the other side of the House. By the time we arrive at Clause 14 I feel very sanguine that an arrangement will be arrived at which will be very satisfactory to the medical profession, and satisfactory to those who want to see medical treatment under the very best conditions. The hon. Member says how can you consider paragraph (a) without first of all knowing whether you can give the benefits that it proposes. For the simple reason that paragraph (a) is the first charge on twenty-five millions. I have not seen any proposals which would make it impossible for us, whatever happens, to secure medical benefits for those who are included. I do hope, under those conditions, that the hon. Gentleman will not press the Amendment, which will make it very difficult. I am sure nobody wants to make it difficult, and it would make it really difficult, I can assure you, to proceed with the negotiations. I must decline to enter into full particulars until1 I hear the views of the medical profession on certain proposals which are before them. Otherwise there would be difficulty in the negotiations.

§ 10.0 P.M.

§ Sir R. FINLAY
The point the Chancellor of the Exchequer has made would be fully met if he adopted the modified proposals my hon. Friend indicated, namely, that the consideration of this paragraph should be postponed. The medical profession do not desire that medical benefits should be excluded from the Bill, but their approval of the inclusion of medical benefits is conditional upon this, that the Chancellor of the Exchequer will show clearly that his attitude towards the medical profession is such as 311 to render the Bill intolerable to them and tolerable to the public so far as its relations with the medical profession are concerned.

§ Mr. LLOYD GEORGE
How could you postpone it?

§ Sir R. FINLAY
If the Chancellor will indicate that he is willing to hold this subject over I do not ask him, and no one asks him, to go into full particulars with regard to those negotiations. We do ask that he should definitely indicate what his attitude towards the main proposal of the medical profession is likely to be.

§ Mr. LLOYD GEORGE
Does the right hon. Gentleman really know what the proposals are?

§ Sir R. FINLAY
I do. I know something of the subject. The Chancellor, I am sure, knows a great deal more. I know that in the view of the medical profession and in the view of those who understand how far the interests of the public are identified with those of the medical profession it is essential that before we commit ourselves to the inclusion of medical benefits we should know in general terms, without going into great details, what the attitude of the Chancellor of the Exchequer is going to be. I do most respectfully submit that the Chancellor of the Exchequer must be aware that successful working of this Bill, so far as medical benefits are concerned, must depend on the attitude of the medical profession towards the proposal which he finally adopts. Let the Chancellor of the Exchequer inform us how the matter stands. We do not ask for further details. They would have to be considered when we crane to a later stage of the Bill. If the altitude of the Chancellor of the Exchequer is unsatisfactory in the matter it may be that it would be much better that the sum spent in medical benefits should be applied towards the increase of benefits in sickness, or for the other purposes to which the Bill is directed. I hope the Chancellor of the Exchequer will not persist in the, as I think, unreasonable attitude which he has adopted of refusing in any way to commit himself or to state definitely what response he is going to give to the demand of the medical profession.

§ Dr. ADDISON
I hope the Chancellor of the Exchequer will resist this proposal. It would not be possible on a Motion of this kind to discuss in detail any suggestions which may be made by members of 312 the medical profession as to the conditions under which they should work. Nor would it be any gain whatever to the House to postpone the Sub-section or to strike out of the Bill the medical benefits. If that were done the Bill would be useless for the betterment of national health. For the reasons the Chancellor of the Exchequer has indicated, I am confident that to engage in any detailed discussion at this stage would be thoroughly mischievous, and I sincerely hope the right hon. Gentleman will continue to resist the Amendment.

§ Sir PHILIP MAGNUS
I think it would probably be desirable that the Chancellor of the Exchequer should not at the present moment enter into any detailed statement in regard to the negotiations with the medical profession, and particularly for the reason that possibly those negotiations have not yet arrived at any absolutely satisfactory conclusion. On the other hand, I think the Chancellor of the Exchequer might be well advised to assent to the modified proposal of my hon. Friend that we should postpone for the present the consideration of Sub-section (a). That Sub-section implies that arrangements have been settled between the Chancellor of the Exchequer and the medical profession, because unless the members of the medical profession are prepared to give medical treatment and medical attendance the passing of this Clause would be absolutely futile. It seems to me that that is an indispensable preliminary to the passing of this Clause, and that the negotiations now in progress, which we all hope will be brought to a satisfactory conclusion, between the Chancellor of the Exchequer and members of the medical profession should be completed before we commit ourselves to saying that any number of millions of pounds shall be spent on medical treatment. I have no doubt it would be a wise course for the Chancellor of the Exchequer, whom we are all anxious to assist in these difficult negotiations, to postpone, for the moment at all events, the consideration of Sub-section (a), and to go on to some other of the benefits which can be given without having arrived at any settlement of the negotiations now in progress.

Mr. J. W. WILSON (Worcestershire, N.)
On a point of Order, would it be possible to postpone Sub-section (a)?

§ The CHAIRMAN (Mr. Emmott)
No; a part of a Clause cannot be postponed.

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§ Mr. GEORGE ROBERTS
I hope the Chancellor of the Exchequer will resist this Amendment, because I apprehend that those who are promoting it are rendering the greatest possible disservice to the medical profession. It is highly desirable in the state in which the negotiations at present stand that the atmosphere should be perfectly clear and cool. Everybody who has received deputations from the medical profession knows something of the negotiations which are proceeding and of the position in which they stand at present. I agree that without the hearty cooperation of the medical profession the whole scheme is doomed to failure. I believe it is possible for an equitable adjustment to be attained, but time is required. I know there are certain doctors in my own Constituency who desire further time for consideration and to approach other members in the district. As far as I have been able to gather, there is everything to be said for the postponement of the disclosure of the state of the negotiations until we reach Clause 14. Precipitate action might prejudice the situation and render it extremely difficult for an adjustment to be arrived at. We on these benches are often involved in similar circumstances. We are often engaged in delicate negotiations with employers, and if our members insisted that we should make public the exact state of the negotiations we should often thereby render nugatory the whole of our proceedings, and destroy any possibility of an agreement being arrived at. I am as desirous as any member of the House that an equitable settlement may be ultimately arrived at with the doctors, and I think that we shall best serve the interests of the medical profession by not pursuing the matter further to-night, but by allowing a little more time for matters to develop. When we reach Clause 14 we shall be in a better position to consider and discuss the whole question.

Mr. J. W. WILSON (Worcestershire, N.)
On a further point of Order: If medical treatment and attendance is left out of the benefits provided by this Clause, would it be in order to discuss Clause 14 at all?

§ Mr. JOYNSON-HICKS
Having amended Clause 8 by inserting the words, "Except as hereinafter provided," would it not be in order to leave out Sub-section (a), and to insert a fresh Sub-section in Clause 14 providing that in addition to the benefits comprised in Clause 8 medical benefits shall be so and so?

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§ The CHAIRMAN
I do not want to give a positive answer to the question of the hon. Member, but I think it might be rather difficult to deal with Clause 14 if this Sub-section were omitted.

§ Mr. JOYNSON-HICKS
Surely it would be in order, if this Sub-section were struck out, to move an Amendment on Clause 14 in the sense that I have suggested?

§ The CHAIRMAN
Either you must keep the words in or you must leave them out. If the words are left out it might be difficult to deal with the matter on Clause 14. I think it would be better not to give a definite reply on the point raised by the hon. Member.

§ Sir H. CRAIK
As the Chancellor of the Exchequer knows, I speak on this question with an amount of interest that is equalled by very few Members. I have at least 5,000 doctors in my Constituency. I know quite well that the right hon. Gentleman is anxious to come to a fair and reasonable settlement with the doctors, but I am not quite sure that it is necessary for their sake to postpone this particular Subsection. I hope hon. Gentlemen will not jump down my throat on a point of Order if I raise this difficulty. The right hon. Gentleman seems to contemplate going on with the whole of Clause 8. He knows quite well that there are two schemes, one of which must be adopted if there is to be satisfaction. Either you must restrict your range of benefits, restrict the number of those who come within any general scheme of medical attendance, or you must increase the payments made under Clause 14. The right hon. Gentleman knows that if the restriction upon those who are to receive medical benefits is to be made at all, it must be made by the Amendment that stands in the name of myself and several others as a Sub-section following Sub-section (7). We propose to add a certain Subsection later in the Clause. If the right hon. Gentleman would assure us that we shall have an opportunity of discussing on Sub-section (7), paragraph (a), that very important, that almost essential point of restriction or no restriction of the number of people who are to benefit, we shall be glad. If he will look at our Amendment, I think he will see that it is not altogether contrary to his own proposal. I think he will see to prejudge to leave that open and to pass Clause 8 in its present form, and to postpone the whole question to Clause 14, would so prejudge the whole position of the medical profession as to 315 make any further discussion almost useless for them. I would beg the right hon. Gentleman if we allow him to get this general Section not to press the other matter at present, or until he is in a position to give a full statement as to the terms which he has arranged with the medical profession—to postpone that later Sub-section (7). I know he understands the matter very fully.
He has told us that he hopes to secure and conciliate the medical profession, but I can assure him that, speaking for those whom I represent, unless they have changed their minds within the short while they will not be satisfied with anything short of the alteration of the final Sub-sections of this Clause 8—unless he is prepared to change materially and absolutely Clause 14. If we allow him, without discussion, to get the later Sub-sections of Clause 8 we are absolutely giving up the battle; we have given away our position in advance. He must see the reasonableness of our position. I recognise, too, the position taken up by the right hon. Gentleman. I am fighting only to make this Bill as satisfactory as possible; and if possible to get the cordial co-operation of the profession, upon whose co-operation the success of the Bill must to a very great extent depend. I trust the right hon. Gentleman will be able to satisfy those whom I represent; that he will at least give us a chance of discussing more fully these last Subsections of Clause 8.

§ Mr. LLOYD GEORGE
I am certainly very ready to respond to the appeal made by the hon. Member. I must ask the Committee to take notice of the fact that three hon. Members specially entitled to speak on behalf of the medical profession in this House, on both sides of it, accept the view that it would be undesirable to precipitate a discussion on this great question now. I hope the Committee as a whole will realise the importance therefore of the Debate not proceeding upon those lines at this moment. Within the last hour or two I have received a communication from the British Medical Association, and I think it would be very hard to be called upon at once to deal with that just now, and I hope the Committee will not press me to enter upon that matter at this moment. The hon. Member very fairly said there was one question of very great importance just now, namely, the limit of income—in fact it is the only question that presents any difficulty just now.

316

§ Sir H. CRAIK
That comes under Clause 8.

§ Mr. LLOYD GEORGE
I submit to the hon. Member it comes under Clause 14.

§ Sir H. CRAIK
How?

§ Mr. LLOYD GEORGE
If the hon. Member will listen he will see. It is very important:—
"Every such society and local health committee shall for the purpose of administering medical benefit make arrangements with duly qualified medical practitioners for insured persons."
The persons who are to receive medical treatment come under Clause 14, and if you want to make exceptions that is exactly and obviously where they would come in. You would put it into that Clause, and the words which we will put in, in order to safeguard the position, will not prejudge the question here, because we are discussing it subject to the provisions in this Bill. We agree to the insertion of words so as not to prejudge under Clause 8 any discussion as to the limitation of persons who will receive medical benefit.

§ Sir P. MAGNUS
The persons who will receive medical benefit are not necessarily the same as the insured person. There may be insured persons who will not receive medical benefit but who will receive other benefits.

§ Mr. LLOYD GEORGE
That is exactly what I am pointing out. That is why, under Clause 14, you are entitled to say, "Except or provided that persons whose income is over £2 a week."

§ Sir R. FINLAY
With great deference to the right hon. Gentleman, surely Clause 8 provides who are the persons to be insured for medical benefit. Clause 14 enters into the details of the administration. The proper Clause to say who are insured for medical benefit is Clause 8, and not Clause 14.

§ Sir H. CRAIK
Where does the right hon. Gentleman propose to introduce the words, "Subject to the provisions of this Bill?"

§ Mr. LLOYD GEORGE
I accept that from the hon. Gentleman. The hon. Gentleman has a special interest in the matter. We have done that purposely not to prejudice Clause 8. There were exceptions introduced yesterday in the Amendments which I gave an outline of with 317 regard to sick benefit. You do not include them here. You simply safeguard the position in order to enable you later on to make restrictions with regard to sick benefit. I hope hon. and right hon. Gentlemen opposite will not press the Government, not even when we come to Sub-section (7) to enter upon a discussion which the representatives of the medical profession in this House agree with the Government is so very difficult. There is practically only one question left. A certain question put forward for the consideration of both sides and it is very undesirable that there should be a Debate until we are ready to act upon it.

§ Mr. AUSTEN CHAMBERLAIN
I think that the primary object of my hon. Friend who moved this Amendment was to ascertain from the Chancellor of the Exchequer the exact position in which we stood at this moment, and not to obtain exact information as to the Chancellor of the Exchequer's intentions. Certainly, I do not think there will be found on this side of the House any desire to prejudice an amicable settlement of a most difficult question by insisting upon a discussion in public when private negotiations are not yet completed. I do not know whether I correctly interpret what the hon. Member for Norwich said when I say that he stated that it would be as inconvenient to have a discussion on this question now as it would be to have a Debate on diplomatic negotiations. We do not wish to prejudice a future settlement by insisting upon a discussion at a time when the state of those negotiations makes a public discussion undesirable.
On the other hand we do desire that there should be nothing in the portions of the Bill we pass that in any way prejudices our liberty of action when the result of those discussions is known. All private Members in this matter are in a great difficulty. The Chancellor of the Exchequer is negotiating with certain representatives of the medical profession and in the meantime the movement which those medical authorities focus has spread all over the country, and the individual Member of the House is being pressed to receive deputations which are not informed as to the state of the negotiations, and they ask us for information and pledges and request us to tell them what is in the mind of the Chancellor of the Exchequer and what is the meaning of the hints he has thrown out, and we are unable to give them any such information. It really is a position 318 of great difficulty of which the Chancellor of the Exchequer must take account. May I say one word, not as to the time at which, but the place in which, this subject ought to be dealt with. If the Chancellor of the Exchequer refers to Clause 14 of the Bill he will not find a single exception to medical benefit. He will find that it deals exclusively with the arrangements which are to be made over what I may call the executive part of the medical benefit. The only exception to medical benefits are contained in the Clause we are now discussing, and Sub-section (7) lays down a series of exceptions of people who are not to receive medical benefit. I think there is great force in the case put by my hon. Friend the Member for Glasgow and Aberdeen Universities (Sir Henry Craik) that Sub-section (7) of this Clause ought not to be taken until the Chancellor of the Exchequer is in a position to take us into his confidence.
I do not wish in the least to dictate to the Chancellor of the Exchequer as to the time at which he should make his statement, but what I do press upon him is that he ought not to enter upon Subsection (7) of this Clause, which deals with exceptions from medical benefits, until he is in a position to make that statement. That is the real trouble. As a general rule in the case of a Bill of this kind, unless the Minister in charge is willing to accept many Amendments, while he is engaged in such extensive negotiations, he ought not to attempt to carry through his proposal until those negotiations have been brought to a conclusion and until he is able to place on the Notice Paper the alterations which he himself suggests. The trouble in this Bill is being pressed on with such haste with the double desire of getting it through this Session, and not keeping the House of Commons sitting late, that the Chancellor of the Exchequer is not able to do what I think has been done almost without exception in similar measures that have been introduced during the time I have been a Member of this House. The Chancellor of the Exchequer must recognise he is asking the House to take a very unusual course, and under those circumstances, he must go the utmost length he can to meet the convenience, not of one side of the House or of the other, but of Members in all parts of the House, by consenting to the postponement of those parts of the Bill which are dependent on negotiations which he is not yet in a position to disclose until such time as he is in a position 319 to disclose them. If the right hon. Gentleman will give that undertaking, I will heartily support him in adjourning any attempt to press him to disclose his mind until he is in a position to do so without injury to the cause, and I think if we are ready to support him in that respect he is bound to have so much consideration for us as not to commit us to those parts of the Bill which deal with this question before he is in a position to take us into his confidence.

§ Mr. LLOYD GEORGE
The right hon. Gentleman has argued on the assumption that this is not merely the proper place, but the only place to move this exception. I still contend it is not the proper place. The Amendments which have been drafted are all in Clause 14, and there is nothing to prevent the representatives of the medical profession from raising the whole question on Clause 14. Apart from the very natural anxiety of Members, who have been pressed by their Constituents, to know what is the position, there is no reason why this should be discussed in Clause 8, and had it not been for that fact it never would have been discussed on Clause 8. It would have been postponed to Clause 14. That is the proper place to discuss it.

§ Mr. AUSTEN CHAMBERLAIN
These are the exceptions.

§ Mr. LLOYD GEORGE
I am including them. That is part of the arrangement. The point is that the medical profession shall not be obliged, unless the terms are satisfactory, to attend under contract terms persons of an income of £2 per week and upwards. I say that is distinctly a Motion for Clause 14. If it is found it is not either in order or convenient to discuss that question on Clause 14, I will undertake the responsibility of moving the re-committal of Clause 8 in order to enable hon. Members to move it on Clause 8. I still contend that Clause 14 is the proper place, but perhaps that would meet the view of the right hon. Gentleman.

§ Mr. HARVEY DIXON
As far as I can see, this Sub-section is putting the Committee in a false position. It is, I think, a great piece of presumption for this House within these walls to decide what the medical profession are to do. The members of the medical profession are not slaves to be ordered about by this House. The Chancellor of the Exchequer may do 320 what he likes inside this House by the backing he gets here, but he cannot order the medical profession about. He says there is only one question outstanding between him and the profession. Will he say they are not to be put under the guidance and management of the friendly societies? That is a much more serious question to the medical profession than the question of an income limit of £2 per week. He said just now there was only one question, and that was the question of the limit of £2 a week. But I believe that the members of the medical profession have another and far more serious point to raise: they are against being put under the guidance and management of the friendly societies.

§ The CHAIRMAN
That is clearly a question which should come under Clause 14.

§ Mr. DIXON
The Chancellor of the Exchequer made use of the words—

§ The CHAIRMAN
The Chancellor of the Exchequer, in answering a question, no doubt made a certain reply, but the actual discussion of the question must come under Clause 14, because it is naturally raised there and not here.

§ Mr. DIXON
I do not wish to discuss it, and I only wish to say, in regard to the remark of the right hon. Gentleman, that he had twenty millions surplus with which to deal with this question that the medical profession are not to bought off like that. They are in a very strong position; they are determined to have their rights recognised, and we ought not to be asked to vote before knowing what their wishes are.

§ Sir H. CRAIK
I know that the medical profession are anxious to carry on these negotiations. They recognise that it is a difficult matter to deal with at this stage, and, on the undertaking of the right hon. Gentleman to recommit the Bill in respect of Clause 8, if necessary, I am willing to agree to the right hon. Gentleman's suggestion.

§ Mr. DAVID MASON
I am simply astonished at the arguments advanced from the other side that we should not discuss the point whether medical benefits should come into this Bill because the right hon. Gentleman is not ready to go into details as to how those benefits are to be applied. The object of the Bill is to provide insurance against loss of health. It consists of eighty-seven Clauses. Do 321 hon. Members suggest the whole matter of the Bill is concentrated in the first few Clauses? What we are discussing now surely is whether medical benefits should be applied under this Bill. We have to decide "Aye" or "No" in regard to that. The conditions how they are to be applied are stated in Clause 14. The hon. Member who moved the deletion of Sub-section (a) is apparently opposed to any medical benefits being applied at all under the Bill. That is really what we have to decide, and I hope the right hon. Gentleman will stick to his guns. We on this side will support him loyally and consistently.

§ Mr. JOYNSON-HICKS
I am not going to follow the remarks of the last speaker, because they were a gross travesty of anything I or my hon. Friend ever said. Beyond that it is absolutely unnecessary to take any notice of such a speech. I speak within the recollection of the Chancellor of the Exchequer himself, and I said when I moved this Amendment that I did so in order to ask for an explanation from the Government, and I added—I am sure the Chancellor of the Exchequer will bear me out—that if he assured the House that it was not in accordance with public policy to make that statement to-night I should not press him for it. He has assured us of that, and he has told us that he is prepared to recommit the Bill if we are unable to move the Amendments we desire on Clause 14. I accept the Chancellor of the Exchequer's offer, and ask leave to withdraw the Amendment.

§ Amendment, by leave, withdrawn.

§ Mr. LEIF JONES
On a point of Order. An Amendment is moved from the other side of the House, and have we not a right to express our opinion upon that Amendment? You put this Motion from the Chair, and as soon as you had finished speaking I said "No." I beg to ask you whether I had not a right as a Member of this House when an Amendment was moved from the other side, to have a vote taken?

§ The CHAIRMAN
I did not hear any hon. Member say "No." If I had heard him I should have done what I always do under such circumstances.

Mr. BATHURST
I beg to move in Subsection (1) paragraph (a) after the word "Medical" ["Medical treatment and attendance"], to insert the words "and dental."
322 I do so because I believe that prevention is better than cure. The word "medical" would not, used in the general sense, include any kind of surgical operation. I should like to emphasise the enormous importance of giving attention to dental defects, in order to avoid a very large amount of subsequent medical treatment. It is common knowledge at the present time that the state of the teeth of this nation is very serious, and that is evidenced by the reports of the medical inspection of the school-children. From the last of these reports it has transpired that something like 40 per cent. of the children attending elementary schools in this country are suffering from serious dental defects, which would have a serious influence upon the assimilation of their food, and, through the non-assimilation of their food, would have serious effects upon the nutrition of their bodies and the state of their digestion. If this is the cases with the children, how much more serious must be the state of affairs in the later stages of life. It must be well known to most hon. Gentlemen in this House that young persons between the ages of twenty and thirty at present have most seriously defective teeth. I am sure there is no one who employs domestic servants but must be aware of the serious trouble that they suffer from in connection with their teeth. Bearing in mind that prevention is better than cure, I want to ask the Committee particularly to accept the Amendment in order to prevent the necessity of a large amount of medical treatment, which would be rendered unnecessary if the teeth of the young people of this country were properly attended to. It must be perfectly clear to anyone who has any knowledge whatever of the medical profession that most of such complaints as enæmia and malnutrition, which are so common amongst our working classes are primarily due in their origin to the state of the teeth. I ask the Committee to elaborate the term "medical" so that it shall include the treatment of teeth.

§ Mr. McKENNA
There is a certain difficulty about this. It would add considerably to the cost of medical treatment. It is quite conceivable that when the scheme has been at work for some time it will be found that the margin, both in the hands of the Commissioners and in the hands of the approved societies, will enable the societies to give considerable additional benefits. Part II of the Fourth Schedule 323 contains a scheme of additional benefits. My right hon. Friend authorises me to say that he will include in the additional benefits provision for dental treatment. It would be undesirable to do more than that so long as the question of cost is so uncertain, and knowing as we do that we are limited to the possible margin of contribution which you can expect from the employer, the workman and the State, to commit ourselves to further expenditure for medical treatment at the present time, but if experience shows that there is a margin, as I believe there will be, dental treatment shall be included amongst the additional benefits.

§ Mr. C. BATHURST
Do I understand that the right hon. Gentleman is prepared to specifically mention dental treatment amongst those matters?

§ Mr. McKENNA
Yes.

§ Amendment, by leave, withdrawn.

§ Mr. LANSBURY
I beg to move, after the word "attendance" ["(a) medical treatment and attendance"] to insert the words "for such insured person, or the wife, or child under sixteen of such insured person."
If you are embarking, as we are told by the Chancellor of the Exchequer, on a great scheme of national insurance against bad health, you cannot possibly leave out of account the wives and the children of the men who are insured. It is well known to everyone who has had anything to do with administering education and the medical expenses and medical treatment orders of the Education Department that, I was going to say nearly every child attending elementary day schools has something or the other the matter requiring medical treatment. You have just heard the figures about children and their teeth. I venture to say that diseases of the ear and nose, to say nothing of the eyes, prevail in a very disastrous manner among the great mass of children. Those who have been sent to investigate the causes have reported that it is the very worst economy to leave these children untreated, because very little treatment of a disease when it first shows itself would get rid of it, whereas the leaving of it practically unattended makes it more or less chronic. There is one set of children not connected with the elementary schools. I mean those who are not of school age. We are providing maternity benefit which for a few weeks will 324 bring to the mother and the child the medical attendance they need if the husband or the mother herself is an insured person.
I suppose we may take it for granted that for the mass of women and new-born babies the evils depicted in the evidence given before the Poor Law Commission will be to a large extent got rid of. Everyone of the medical officers, from the chief medical officers of the large Local Government Departments of the United Kingdom downwards, pointed out that there was always in working class families a tremendous amount of sickness which led to all kinds of diseases later in life, and which ought to be attended to. One of them is rickets. The evidence put before the Commission showed perfectly clearly that this disease, which some people are apt to think of not very much account, leads, if neglected, to all kinds of dreadful diseases among these people when they grow older. A national insurance scheme under which a mother and child are attended to for three or four weeks and then left without any attendance is not a national scheme at all. There are children who go to the elementary day schools. I think those who are connected with the London education authority will agree with me when I state that that authority is at present holding its hand to see whether under this Bill provision is going to be made for these children at all. I do not want to harrow up the feelings of hon. Members in regard to the tremendous number of children who are requiring treatment in London at present. They have run into, not merely tens of thousands, but hundreds of thousands.
These children are not getting the attention required, because it is held in some quarters that it will be provided under this Bill. I may be asked where the money is to come from to deal with the children in this way. I will not attempt the same kind of argument that I received the other night though it was perfectly sound. But you are already spending a large amount of money through various authorities in a very wasteful manner in the matter of public health. The school authorities attempt to deal with it in a very slipshod manner, and there are also the Poor Law Guardians and the public health authorities. Would not it be very much better, even at the cost of putting on the localities some portion of the charge for the children to bring them into the Bill and secure that every child who needed medical treatment should 325 receive it at the hands of the community? It may be argued that this ought not entirely be put on the National Exchequer. I would put. against that the money which to a very large extent is not being efficiently spent at present which could be used to supplement anything that we can get out of this scheme. Everyone must agree that we must at as early an age as possible arrest disease in the children by giving them the best treatment possible. The particular diseases singled out by the Chancellor to be dealt with by the Bill are tuberculosis and phthisis, of which there is a great deal among certain classes in the community. I happen to represent people who are very poor. Twenty-five per cent. of the workers in my Constituency are casual labourers, and I have to come face to face almost every day with people who have children needing medical treatment. I beg and borrow hospital letters and institution letters from people of all kinds. Any man in the East End is bound to have that kind of thing to do. The other day a mother came to me with three little children, each one of whom, although I am not a medical man, I could see at once was tubercular and ought to have been receiving proper treatment. Not one of these children was going to get proper treatment because the mother, with that spirit of British independence which some people admire so much, would rather see her children suffer than take parish relief to see them dealt with. That family is only one of many thousands of families in the East and South-East of London, and I believe in every industrial centre. I want that these children should be brought in, and that the necessary medical treatment should be provided. With regard to the women, you deal with them under the maternity benefit, which is for a certain short period. But it seems to me that the wife is just as much a wage earner as the husband. She takes charge of his home, she works just as hard as he, and she is just as much a wage earner as he is. If the employer shifts the 3d. on to the consumer or the workman, if you take 2d. from the Income Tax and put it on the consumer or worker, it is the wife in the home who will feel the burden. It is she who pays the 5d. tea duty, and it is she alone who will have to shoulder the burdens imposed upon working class families. I know, as do many Members, how in working-class families, the wife puts by the husband's contributions regularly week by week or quarter by quarter. 326 Such a woman is going to get the maternity benefit, for which indeed I am very thankful, and we should be less than human if we did not give it. But I submit that she and the children should share with the husband the benefits given under this Bill. People talk about malingering, but so far as women are concerned, my experience is that they work too hard, and, after their lying-in get about far too quickly. There are no malingerers among them taken as a whole. One or two may be found here and there, but the women of the working-class families work as hard as anyone and harder than many, and we want to see them with their children share in these benefits, even if it does cost more money.

§ 11.0 P.M.

§ Mr. AUSTEN CHAMBERLAIN
I do not wish to delay the Chancellor of the Exchequer's reply to the hon. Member, but I wish to ask him, for the convenience of the Committee, whether he can say how far he proposes to go to-night. We have had a very arduous day, we have another before us, and there are other big subjects to come on, though not on the Sub-section on which the hon. Gentleman has just spoken. There is the question of sanatoria, a subject on which we could not well enter at this time of night.

§ Mr. LLOYD GEORGE
Before I reply to the hon. Member for Bow and Bromley, in answer to the appeal of the right hon. Gentleman, I agree that perhaps it would not be desirable to enter upon a fresh subject to-night. The question of sanatoria is a very very important matter, and we might very well begin our proceedings to-morrow with that, if we get paragraph (a) to-night, and there are only one or two more Amendments which I think are in Order. I come to the Amendment of the hon. Member (Mr. Lansbury). Of course, we should all very much like to make an arrangement in the Bill to provide medical attendance not merely for the insured person, but for his wife and for his children, but let us not close our eyes to the fact that we would do so at the expense of the scheme. We have got a provision in the Fourth Schedule No. I., and it is the very first of the additional benefits we suggest:—
"(1) Medical treatment for any persons dependent upon the labour of a member."
That would include the wife and children, so that if there is any money left for the purpose it is one of the additional 327 benefits to be provided under the scheme. I believe there will be enough money for the purpose, and when the deficiency is wiped out there will be money to enable them to make provision for the wife and children, but I do not think it would be desirable that we should make it one of the compulsory benefits as otherwise it might very well be that a given society might not be able to find money for the purpose of other benefits. I think it is far better to leave it to the society itself to decide that question. May I also point out that it would add enormously to the difficulty with regard to the doctors.

§ Mr. LANSBURY
Hang the doctors; I am sick of hearing about them. One would think there was nobody but the doctors.

§ Mr. LLOYD GEORGE
I am in the position of having to try and make the best bargain I can between the doctors and the others. I can hardly adopt the language of the hon. Member; if I did I think I might very well announce to the House that negotiations were at an end. In the meantime I think it would be very undesirable to make it compulsory. If the funds allow them there is power under the Bill to give the additional benefits, and this is the first mentioned in the Schedule. I think the hon. Gentleman will find that that is just as far as it is possible to go within the limits of the means at our disposal.

§ Mr. HUNT
I am rather inclined to agree with the hon. Gentleman who moved the Amendment. The Chancellor of the Exchequer raises the difficulty about the money. Very little is done in this Bill for women and children. You are making the children pay, but you are giving them very little benefit at all. I think a very strong case has been made out, and I would like to see it settled now that the children should have the right to go to sanatoria—

§ The CHAIRMAN
Sanatoria treatment comes up on the next paragraph. I allowed the hon. Member for Bow and Bromley (Mr. Lansbury) to mention it, because I thought he was going to deal with the two questions at the same time. But if the question is going to be raised again it cannot be discussed here.

§ Mr. BARNES
If my hon. Friend goes to a Division I shall have no option but to support him. I have heard with great regret the statement of the Chancellor of 328 the Exchequer. He says there will be immediate benefits for the women and children in the event of the fund being able to stand those benefits. The word "immediate" seems to me rather out of place, because there are no benefits until such time as there has been an actuarial examination, which cannot take place for some time. Although medical benefits of the kind mentioned are first-named in the Schedule, there is nothing to compel those concerned to make them the first benefit in point of time, and in a scheme drawn up for additional benefits by an approved society this particular benefit instead of being the first might be the last. The women and children deserve and demand our sympathetic consideration, and I shall support my hon. Friend if he carries his Amendment to a Division.

Mr. MacCALLUM SCOTT
I appeal to the Chancellor of the Exchequer to lend a more sympathetic ear to the Amendment. The Bill undoubtedly confers great benefits upon certain sections of the community, but it is possible for a Bill which confers benefits also to confer great disabilities. If those disabilities are imposed upon people who are rich and powerful, we can regard them as negligible; they are part of the price which such people pay for the security they enjoy. But if the disabilities are imposed upon people who are helpless and dependent, more helpless and more dependent than those who receive the benefits, then they are of a very harsh and cruel nature. The married women of this country who are not wage earners have by this Bill not merely a negative disability, but a positive disability of a most harsh and cruel nature imposed upon them. I can quite understand that the Chancellor only excluded them from the full benefits of the Bill with the greatest pain and reluctance. But it is not necessary, it is not desirable that married women who are not wage earners should receive the full benefits of the Bill. When a married woman is ill the family income is not stopped. Therefore she does not require sickness or disability pay. What we are asking for just now is something very much smaller. It is merely medical attendance, which will cost infinitely less—

§ Mr. LLOYD GEORGE
How much?

Mr. MacCALLUM SCOTT
The Chancellor is in a better position to estimate what it will cost than I am; but I make the obvious statement that medical attendance alone will cost infinitely less than to pay 329 full benefits. I do not profess to have the information which the Chancellor has at his disposal. The Chancellor of the Exchequer has referred to the fact that medical benefits for women are included in the additional benefits which may be paid if there is anything left over. That is the position of the married woman. She has to wait until the period when we can ascertain whether there is "anything left over," which may be a period delayed for many years, as we have been reminded by my colleague from Glasgow. I said that this exclusion of married women is not merely a negative, but a positive disability. I will try to establish that point.
The hon. Gentleman the Member for Bow and Bromley has already given a clear statement about the economic position of the married woman who is not technically the wage-earner. That woman is doing as great and valuable a part of the world's work as a man is doing. She maintains and keeps the home. She toils and scrubs and carries on the whole business of the house, and by her labour enables the man to concentrate his attention upon productive industry outside the home. Apart altogether from the rearing of the family she, by her labour in the home, enables the man to go out and do his work. How does she get paid for that work which she contributes to the general stock of the world's work? Her husband's wage includes hers. The hon. Gentleman the Member for Bow and Bromley was perfectly justified in maintaining that this 4d. which is nominally charged on the husband is also paid, and paid in full, by the wife of that husband. I believe that 4d. will represent a diminution in the amount which that woman will have to spend upon the family, upon the food and clothing of the family. She is paying every whit as much as the man for this insurance scheme, and by it she is directly ruled out and forbidden to receive any benefit in spite of the contribution—

§ Mr. LLOYD GEORGE
Surely, the hon. Gentleman knows better than that?

Mr. MacCALLUM SCOTT
I am referring to the married woman who is not a wage-earner, who is living with her husband. While she is living with her husband she receives maternity benefit, no other direct benefit. Technically this maternity benefit is the benefit of the husband. I would point out that this maternity benefit is one of the benefits which in 330 the event of deficiency may be reduced or may be abolished, whilst the husband's medical benefits may not be reduced. Consider the position of the married women who constitute the vast majority of the women of the country. [HON. MEMBERS: "NO."] The single woman who is a wage-earner is protected; the woman who does not care for housework —the married woman who dislikes it and goes out to work to the detriment of the race and of the home and the family and of social welfare—she also is cherished and protected. The paid housekeeper is cherished and protected, and the unmarried mistress of a man who becomes a volunteer insurer is cherished and protected; but the married woman, the bearer and rearer of the race, the mother of men, the woman upon whom everything depends, she alone is excluded from receiving any benefit under the Bill. I consider that this is not merely a negative, but a positive disability of the harshest kind. The Chancellor, in the few remarks he made upon this most important Amendment, referred to the fact that there would be some difficulty with the doctors; the doctors would not for the same terms undertake to do the attendance upon these women. But he has already included some women, married and unmarried. If the doctors could be induced to attend them they could also be induced to attend married women. And lastly, there was one point which the Chancellor ignored. This Amendment, if I recollect aright, includes children, but the Chancellor said not a word about children. I think the Chancellor might consider whether it might not be actually cheaper and more economic to include children. If you have medical attendance for the children you would prevent a vast amount of disease, and clear the scheme from an enormous amount of preventable disease. "A stitch in time saves nine," and therefore I appeal to the Chancellor to give some consideration to this point in the Amendment to which he omitted any reference.

§ Mr. LLOYD GEORGE
Before the Committee comes to a decision upon this subject I should like really to consider what this means as a financial proposition. I asked the hon. Member if he had any idea what it would cost; he thought that a most irrelevant question. I cannot take that view of the matter. Does he know what the charge for medical attendance is where doctors undertake to attend families? There are several cases.

331

§ Mr. PRINGLE
Thirteen shillings a year.

§ Sir A. MARKHAM
Ten shillings a year in some cases.

§ Mr. LLOYD GEORGE
That is double the figure in this Bill.

§ Mr. PRINGLE
It includes medicine.

§ Mr. LLOYD GEORGE
So does the 6s. in the Bill. The hon. Member's figure would represent an additional charge of about £5,000,000. Has the hon. Member thought where the money is to come from?

§ Mr. LANSBURY
I do not want to make the same kind of suggestion as that which I made the other day as to where the money is to come from. I want the right hon. Gentleman to consider the frightful waste and overlapping in the administration of public health, which money could be spent more economically and efficiently in dealing with women and children. I put that suggestion forward and the right hon. Gentleman took absolutely no notice of it.

§ Mr. LLOYD GEORGE
I quite agree with the hon. Member. I have no doubt a great deal of money is wasted in overlapping. What I want the Committee to understand is that this proposal means the imposition of a fresh charge on the funds of about £5,000,000. I am fully in sympathy with the objects of the hon. Member, but after all the expense is an enormous one, and we cannot consider this question apart from the expenditure. There is nothing which has been said in regard to providing medical attendance for women and children that I do not agree with. I believe that eventually by this scheme you will be able to do it. You will have eventually a margin of £6,500,000, and then it may be possible to provide medical attendance for the whole of the family. The hon. Member and his supporters want to do the whole thing at once, but we cannot do it. We are engaged upon a very big task, and we are beginning our scheme with enormous benefits. We are making a good start, and I do not wish to endanger the carrying of this scheme through by doing something which may wreck the whole scheme. It is purely a question of ways and means. There is not the same urgency in the case of a married woman who has got a bread winner in full work as in cases where the bread winner is stricken down, when there is no one earning anything for the family. I am amazed to hear from the hon. Mem- 332 ber that the 30s. maternity benefit has nothing to do with the woman. The provision is that the money should be spent upon the woman and that it should be given to the woman. For these reasons I say that the present position represents an enormous advance upon anything that has been done for married women.

§ Mr. HILLS
I do hope that even at this late hour the right hon. Gentleman will reconsider his position. There is a feeling on both sides of the Committee that a Bill which is so unfair to women ought not to be allowed to pass. May I deal quite shortly with the arguments the right hon. Gentleman has used and restate the case of the women in a very few words. You give the man two sorts of benefits. You give him sickness and disablement benefit which is an insurance against his loss of wages through sickness. Besides that you give him medical benefit which is both curative and preventive. We do not ask for sick pay for the women because they are not wage-earners, but we do ask for medical benefits for them, and for that they have exactly the same claim as the men. Why should the fact that man's work is paid for by wages put him in a preferable position? After all, it is not the fault of the woman that her work is not wage paid. It so happens that by economic laws she does work that is not paid by wages, and this Bill would penalise her just because of that economic fact. That is the position of women under this Bill. They stay at home and mind the home, and they are excluded from medical benefit. The Chancellor of the Exchequer has used certain figures. Will he listen to these figures which I think are applicable? The cost of medical benefit for women, according to Table S of the Report is about 1½ per week per head, which comes to about 6s. 6d. per year. Assuming there are some 6,000,000 married women who are not engaged in industry, if you give the whole of the State grant of 2d. per week, it would come to £2,250,000. I quite agree that is a very large sum of money.3

§ Mr. LLOYD GEORGE
What about the children?

§ Mr. HILLS
I am arguing first of all the case of women, because I think that is the more important. It is a large sum, but just think what you get by it. First of all, you get a fair Bill, and then the cure of the health of these women. I should be prepared, if it were insisted 333 upon, to agree that some small contribution should be made by the woman or the husband, but do allow her some chance of coining into the medical benefits. Assume a woman is sick and cannot pay for the doctor. At present she can get a doctor free by going on the Poor Law. We do now pay for the cost of doctoring all women who cannot afford to pay for themselves. I want to keep her off the Poor Law. Look at this thing broadly. I want the Committee to realize that now the community, either through charities, hospitals, or the Poor Law, pays for the doctoring of all married women who cannot afford to pay for themselves. Surely the cost to the community would not be great even if it did cost £2,250,000. I agree with the hon. Member for Bow and Bromley (Mr. Lansbury) that the waste in the Poor Law is now so great that you could easily save this and more. I do not base my case on that alone. I base it on. simple justice. I am sure the Chancellor of the Exchequer wants to make this a good and fair Bill, and I do suggest to him that he should reconsider his position. I shall certainly support this Amendment, and I am certain the country will not approve of a Bill which excludes the women.

Mr. MacCALLUM SCOTT
The Chancellor of the Exchequer challenged me upon one point, which is a new point, and which I avoided because I thought it would be out of order on this Clause. He has asked me if I have any proposal to make with regard to providing for the extra cost of this. It so happens I have upon the Paper an Amendment which is directed towards providing at least a part, and I think a considerable part, of the cost. It is a new Sub-section to Clause 9:—
"(2) In the case of insured males who are over the age of twenty-one years and unmarried, sickness benefit and disablement benefit shall be at the reduced rates specified in Table C, in Part I., of the Fourth Schedule to this Act."
The rates specified in that Schedule are the same as the rates specified for women. You reduce the benefit for unmarried men so as to put them in the same position as women who are insured. They will get 7s. 6d. instead of 10s. They have not the responsibility of a family to maintain. I submit that this proposal goes some way towards the cost of providing medical benefits for married women.

§ Mr. CLYNES
The Chancellor of the Exchequer has given us some encourage- 334 ment to press this Amendment further on the attention of the Committee. He asks us to rest assured of his sympathy, and the only difficulty he presented to us was a financial one. We have already had in these Debates, since we began the discussions on this Bill, arguments supplied from the Front Bench indicating how easily the money may be found if serious attempts are made to find it. We do not in this case require to procure fresh money—that is in addition to what we now spend. We rather desire to change the form and place of money that is now wasted. We want to change the character of the expenditure. The difficulty with regard to the doctors can be overcome; like most persons, they will do what they are paid for if only proper terms are arranged. Early this afternoon the Chancellor of the Exchequer told us that this Bill was particularly intended to assist those unable to help themselves. Of all classes affected by this Bill that which is particularly unable to help itself is the one composed of women and children. Statements have been made to the effect that thirty per cent. of the persons who are in receipt of Poor Law relief are driven to that state of impoverishment because of sickness, and, further, that one-half of the money spent on Poor Law relief is expended in relieving impoverishment of that kind which is now seen in the workhouses of the country. Furthermore, I find that the great majority of the 600,000 persons who are in receipt of Poor Law relief are in that position because they have lost the bread-winner. They are women and children. The facts supplied by the Government appear to prove this, that we spend in relieving impoverishment which is due to sickness seven and a half millions a year. The Chancellor of the Exchequer tells us that to carry out this Amendment would cost five millions sterling, and the conclusion I am therefore driven to is that if we alter the form and character of this expenditure of seven and a half millions we can save money and at the same time deal with sickness at the right time before persons are driven by it into our workhouses.

§ Mr. PETO
As I understand the speech of the hon. Member who has just resumed his seat, he proposes we should at once proceed to deal with the whole system of Poor Law relief, and that we should revise our expenditure on it before proceeding further with the consideration of the Bill before the House. He says there is a sum, of seven and a half 335 millions spent on the Poor Law and medical relief now. I propose to vote in opposition to his view. It is not very often that I find myself in agreement with the Chancellor of the Exchequer, but I cannot help feeling that there is an immense amount of force in the appeal which he made that we should not attempt to proceed to do everything at once. If I have learned anything in business it is that if you want to absolutely wreck anything you propose to do you have only to attempt to do at one swoop everything that may appear to be of advantage to your business and the same applies to legislation for the country. I think the hon. Member for Durham (Mr. Hills) is mistaken in trying to include at this stage of the Bill and in this particular Amendment the whole case of the married women. I see that the Amendment states, "The child under sixteen years of an insured person," but it does not refer to all the children of the family.
As the Chancellor of the Exchequer has indicated it is absolutely impossible to get a double benefit for a single contribution. On that ground, that you cannot get a quart into a pint pot, I have to oppose the Amendment. This is not the time to propose an addition to the maternity benefit and the medical attendance to a married woman or her children, but I have an Amendment at a later stage in which I propose to give some modified form of sick pay in addition to the maternity benefit. I believe I know how it can be done, and I believe there are benefits that ought to be given to married women, but at this point it is not reasonable, unless it is desired to make the Bill unworkable, to propose that the whole cost of medical attendance to married women and children should be borne out of a single contribution made by the wage-earner. I know the hon. Member for Durham said he would be willing that some additional payment should be made in respect to it, and he said it would cost l½d. in respect to wives. But he did not say what it would cost for the whole of the family. It would not be less than a double contribution from every wage-earner, and I do not think that when making the first step in a great scheme of this kind it is the time to propose that men in receipt of 20s. to 25s. per week should be asked to contribute 6d. instead of 3d.

§ Mr. LEIF JONES
I desire to ascertain the position in which we shall be with regard to married women if this Amendment 336 is rejected. As the Sub-section (a) stands at present it provides for medical treatment and attendance, but it does not say who it is to be for. It does not confine it to the insured persons. I understand that that question was really left over until Clause 34, when the Chancellor of the Exchequer promised that we should have a full and unfettered opportunity, without any technical difficulties in the way, of discussing the position of married women under the Bill. That would be the practical outcome of the statement the other night. The hon. Member (Mr. Lansbury) proposes to put in medical treatment and attendance for married women and children. If that Amendment is rejected shall we have decided once for all that married women cannot under any circumstances under the Bill receive medical benefit? We have not had a full discussion on the position of women, and I feel confident that the House does not at all realise, or has not expressed, the strong feeling that there is in many quarters that married women are receiving scant justice. Under Clause 34 we hoped for a full opportunity to put that matter right. If we come to a hasty decision now which cuts out married women because the Amendment is proposed in the form of coupling them with children, which makes it too big an undertaking for the right hon. Gentleman it is very unfortunate that we should be compelled to vote upon it now, and I would ask my hon. Friend to-withdraw the Amendment and leave us free to do it on Clause 34.

§ Mr. LLOYD GEORGE
The point that is raised on Clause 34 is a totally different point. It is the case of a woman who has-been an employed contributor. She subsequently marries and the question then was whether she would come under the medical benefit. I assume that would be still open. This is much more sweeping and would, in my judgment, absolutely wreck the Bill. I do not think it ought to be withdrawn after an hour's discussion so that it could be moved again later in the proceedings.

§ Mr. LEIF JONES
Are we quite clear that the Chancellor of the Exchequer is right in that matter? Shall we be free to consider the position of the insured woman receiving medical benefit even if married?

§ The CHAIRMAN
If the Committee decides as I suppose it will on this particular-Amendment, the decision must carry its 337 ordinary consequences, but to some extent the question must come up again on Clause 34.

§ Mr. WATSON RUTHERFORD
I am entirely in sympathy with the hon. Member (Mr. Hills). I consider that one of the blots, and there are several very serious blots, upon this Bill is the very unfair treatment that is meted out to women generally, and especially to

338

§ married women. If a little more time and trouble had been taken with this branch of the subject to do fairer justice to women, and particularly married women, with regard to medical benefits it would have been far better.

§ Question put, "That those words be there inserted."

§ The Committee divided: Ayes, 62; Noes, 167.

339

Division No. 269.]	AYES.	[11.50 p.m.
Adamson, William	Gill, Alfred Henry	Ponsonby, Arthur A. W. H.
Ashley, Wilfrid W.	Goldsmith, Frank	Pryce-Jones, Col. E.
Balcarres, Lord	Goldstone, Frank	Richards, Thomas
Barlow, Montague (Salford, South)	Greene, Walter Raymond	Rutherford, Watson (L'pool, W. Derby)
Barnes, George N.	Haddock, George Bahr	Sanders, Robert A.
Barnston, Harry	Hancock, John George	Sandys, G. J. (Somerset, Wells)
Benn, Arthur Shirley (Plymouth)	Hardy, Rt. Hon. Laurence	Scott, A. MacCallum (Glas., Bridgeton)
Bennett-Goldney, Francis	Henderson, Arthur (Durham)	Smith, Albert (Lancs., Clitheroe)
Bentinck, Lord Henry Cavendish	Hodge, John	Smith, Harold (Warrington)
Brace, William	Hohler, Gerald Fitzroy	Taylor, John W. (Durham)
Carlile, sir Edward Hildred	Hudson, Walter	Touche, George Alexander
Cassel, Felix	Hunt, Rowland	Valentia, Viscount
Chaloner, Col. R. G. W.	Jones, Leif Stratten (Notts, Rushcliffe)	Walsh, Stephen (Lancs., Ince)
Clynes, John R.	Jowett, Frederick William	Ward, A. s. (Herts, Watford)
Cooper, Richard Ashmole	Kebty-Fletcher, J. R.	White, Major G. D. (Lancs., Southport)
Crooks, William	Lansbury, George	Whitehouse, John Howard
Dalrymple, Viscount	Locker-Lampson, G. (Salisbury)	Wilson, W. T. (West Houghton)
Davies, David (Montgomery Co.)	Macdonald, J. Ramsay (Leicester)	Wood, John (Stalybridge)
Duncan, C. (Barrow-in-Furness)	Mills, Hon. Charles Thomas
Eyres-Monsell, Bolton M.	Nicholson, William G. (Petersfield)	TELLERS FOR THE AYES.—Mr. George Roberts and Mr. Hills.
Faber, Capt. W. V. (Hants, W.)	Parker, James (Halifax)
Fletcher, John Samuel (Hampstead)	Pointer, Joseph
NOES.
Abraham, William (Dublin Harbour)	Delaney, William	Johnson, William
Addison, Dr. C.	Doris, W.	Jones, Edgar R. (Merthyr Tydvil)
Agnew, Sir George William	Duffy, William J.	Jones, William (Carnarvonshire)
Alden, Percy	Edwards, Clement (Glamorgan, E.)	Jones, W. S. Glyn- (T, H'mts, Stepney)
Allen, Arthur Acland (Dumbartonshire)	Ellbank, Rt. Hon. Master of	Joyce, Michael
Anderson, Andrew Macbeth	Esmonde, Dr. John (Tipperary, N.)	Kelly, Edward
Anson, Rt. Hon. Sir William R.	Essex, Richard Walter	King, Joseph (Somerset, North)
Armitage, Robert	Esslemont, George Birnie	Kyffin-Taylor, G.
Baker, Harold T. (Accrington)	Falconer, James	Lambert, George (Devon, S. Molton)
Baker, Joseph Allen (Finsbury, E.)	Ferens, T. R.	Lambert, Richard (Wilts, Cricklade)
Balfour, Sir Robert (Lanark)	Ffrench, Peter	Lane-Fox, G. R.
Banbury, Sir Frederick George	Field, William	Lardner, James Carrige Rushe
Barran, Sir J. (Hawick)	Fiennes, Hon. Eustace Edward	Law, Hugh A. (Donegal, West)
Barton, William	Forest, Baron de	Lewis, John Herbert
Beach, Hon. Michael Hugh Hicks	Gelder, Sir William Alfred	Low, Sir Frederick (Norwich)
Beale, William Phipson	George, Rt. Hon. D. Lloyd	Lundon, Thomas
Beauchamp, Sir Edward	Gibson, Sir James Puckering	Lyell, Charles Henry
Beck, Arthur Cecil	Glanville, H. J.	Macnamara, Rt. Hon. Dr. T. J.
Beckett, Hon. Gervase	Goddard, Sir Daniel Ford	Macpherson, James Ian
Benn, W. W. (T. H'mts., St. George)	Griffith, Ellis Jones	MacVeagh, Jeremiah
Boland, John Pius	Guest, Hon. Frederick E. (Dorset, E.)	M'Callum, John M.
Booth, Frederick Handel	Gwynn, Stephen Lucius (Galway)	McGhee, Richard
Boyton, James	Hackett, J.	McKenna, Rt. Hon. Reginald
Brady, Patrick Joseph	Harcourt, Robert V. (Montrose)	M'Laren, F. W. S. (Lincs., Spalding)
Brunner, John F. L.	Harvey, T. E. (Leeds, West)	Manfield, Harry
Bryce, J. Annan	Harwood, George	Markham, Sir Arthur Basil
Buxton, Noel (Norfolk, N.)	Haslam, Lewis (Monmouth)	Marshall, Arthur Harold
Carr-Gomm, H. W.	Havelock-Allan, Sir Henry	Mason, David M. (Coventry)
Cawley, Sir Frederick (Prestwich)	Haworth, Sir Arthur A.	Meehan, Francis E. (Leitrim, N.)
Cawley, H. T. (Lancs., Heywood)	Hayward, Evan	Millar, James Duncan
Chancellor, Henry George	Helme, Norval Watson	Money, L. G. Chiozza
Chapple, Dr. William Allen	Henderson, Major H. (Berkshire)	Montagu, Hon. E. S.
Clay Captain H. H. Spender	Henry, Sir Charles S.	Morgan, George Hay
Collins, Godfrey P. (Greenock)	Higham, John Sharp	Munro-Ferguson, Rt. Hon. R. C.
Collins, Stephen (Lambeth)	Hinds, John	Neilson, Francis
Cotton, William Francis	Hobhouse, Rt. Hon. Charles E. H.	Nicholson, Charles N. (Doncaster)
Craig, Herbert J. (Tynemouth)	Holt, Richard Durning	Nolan, Joseph
Crawshay-Williams, Eliot	Howard, Hon. Geoffrey	Norman, Sir Henry
Crumley, Patrick	Hughes, Spencer Leigh	O'Brien, Patrick (Kilkenny)
Davies, Timothy (Lincs., Louth)	Hunter, W. (Govan)	O'Doherty, Philip
Davies, Sir W. Howell (Bristol, S.)	Isaacs, Rt. Hon. Sir Rufus	O'Dowd, John
Dawes, James Arthur	Jardine, Sir John (Roxburghshire)	Ogden, Fred
O'Neill, Dr. Charles (Armagh, S.)	Roe, Sir Thomas	Trevelyan, Charles Philips
Palmer, Godfrey Mark	Ronaldshay, Earl of	Ure, Rt. Hon. Alexander
Pearce, Robert (Staffs, Leek)	Rose, Sir Charles Day	Ward, W. Dudley (Southampton)
Pearson, Hon. Weetman H. M.	Rowntree, Arnold	Wason, John Cathcart (Orkney)
Pease, Rt. Hon. Joseph A. (Rotherham)	Samuel, J. (Stockton-on-Tees)	White, Sir George (Norfolk)
Peto, Basil Edward	Scanlan, Thomas	White, Sir Luke (York, E.R.)
Price, C. E. (Edinburgh. Central)	Seely, Col., Right Hon. J. E.B.	Williams, Penry (Middlesbrough)
Price, Sir Robert J. (Norfolk, E.)	Sheehy, David	Wilson, John (Durham, Mid)
Radford, George Heynes	Sherwell, Arthur James	Wilson, Rt. Hn. J. W. (Worcstr'sh., N.)
Rea, Rt. Hon. Russell (South Shields)	Shortt, Edward	Winfrey, Richard
Reddy, Michael	Simon, Sir John Allsebrook	Wood, Rt. Hon. T. Mckinnon (Glas.)
Redmond, John E. (Waterford)	Stewart, Gershom
Roberts, Charles H. (Lincoln)	Taylor, Theodore C, (Radcliffe)	TELLERS FOR THE NOES.—Mr. Illingworth and Mr. Gulland.
Robertson, John M. (Tyneside)	Tennant, Harold John
Roch, Walter F. (Pembroke)	Toulmin, Sir George

Lord HENRY BENTINCK
I beg to move, in Sub-section (1), paragraph (a), after the word "medicines" to insert the words "surgical instruments, spectacles, and other necessary appliances."
The object of the Amendment is to make quite certain that surgical instruments and necessary appliances are included in the benefits. It may be that they are automatically included in medical benefit, but there is nothing in the Bill to show that medical benefit contemplates anything more than drugs and medicines. The Amendment is of so reasonable a character that it is not necessary to say anything more to commend it to the Chancellor of the Exchequer. It would foe a very great hardship on a subscriber for medical benefits if ordered a truss or something of that sort to be obliged to pay for it himself.

§ 12.0 M.

§ Mr. LLOYD GEORGE
What we propose to do is to follow the ordinary friendly societies' rules in this matter. The friendly societies generally supply simple appliances, but when complicated cases arise these are always treated institutionally. You cannot possibly expect the ordinary medical practitioner to treat complicated cases which involve operations. In all these cases it is simply a question of institutional treatment. We do not propose to go beyond that. If the Noble Lord will confine his Amendment to the terms of the Amendment standing in the name of the hon. Member for York (Mr. Rowntree)—"And such medical and surgical appliances as may be prescribed by regulations to be made by the Insurance Commissioners"—I would accept it. I suggest that the Noble Lord might put. his Amendment in that form, which would be more convenient for us. If we were to depart from the ordinary practice of friendly societies we might be committing ourselves to greatly increased liability.

340

Lord HENRY BENTINCK
I ask leave to withdraw my Amendment.

§ Amendment, by leave, withdrawn.

Lord HENRY BENTINCK
I beg to move, in Sub-section (1), after the word "medicines" ["and sufficient medicines"] to insert the words, "and such medical and surgical appliances as may be prescribed by regulations to be made by the Insurance Commissioners."

§ Amendment agreed to.

§ Committee report Progress; to sit again to-morrow (Wednesday).