HC Deb 24 May 1911 vol 26 cc270-387

Order for Second Reading read.

Motion made, and Question proposed, "That the Bill be now read a second time."

The PRESIDENT of the BOARD of TRADE (Mr. Sydney Buxton)

I ask the indulgence of the House in Moving the Second Reading of this Bill, on the ground that it raises very large problems of some difficulty and complexity. On the First Reading I was able, on behalf of the Government, to recognise the very friendly and generous spirit in which this Bill had been met, and I think we are entitled, on the Second Reading, to draw attention to the fact that, though the Bill has been before the country some little time, and information in regard to it has been circulated among Members, while no doubt in respect of many of the details there will be considerable controversy and discussion, with regard to the main principles of the Bill there is an apparent almost unanimous feeling. I think it is also satisfactory, I was almost going to say remarkable, in regard to the Bill, that, considering the number of interests affected by it it has been received in a generous and unselfish spirit and with a readiness to make sacrifice on the part of the various interests concerned. The Chancellor of the Exchequer recognises that this does touch a considerable number of interests, and he is prepared, as he has already stated across the floor of the House, to consider such representations as may be made to him from various quarters in regard to the matters which are under consideration, and I am sure he will receive them, as he always does receive such representations, with an anxious desire to do justice to the interests involved and to meet the matters put before him.

The Bill, apparently, is a somewhat complex Bill; but, as a matter of fact, the principles involved are simple. The idea on which it is based is that under existing conditions the whole burden of sickness, invalidity, and unemployment over which the working man has no control, falls directly with crushing force on the individual whether he be provident or improvident, and I think the House is generally agreed that it is time that the employer and the State should enter into partnership with the working man in order as far as possible to mitigate the severity of the burden which falls upon him. The principle on which these two schemes are based is that the burden of insurance against sickness and unemployment should be shared by workmen, employers, and the State. The system must be contributory and compulsory, and it should not as far as can be avoided interfere with existing voluntary machinery. It should also aid as far as it can towards the diminution and prevention of sickness and unemployment as well as towards their alleviation. It is important also that both sections of the Bill should bring into touch and into partnership the various interests concerned, so that they may have a direct interest in the efficient carrying out of this scheme. The question is whether a scheme of insurance against invalidity and unemployment is a feasible one. The principle of the insurance of late years has enormously increased. You can insure practically against anything. I believe there were insurances given against the effects of the Budget of my right hon. Friend a year or two ago. I believe you can now get an insurance against the House of Lords throwing out the Veto Bill, though what premium is charged at the present moment I have been unable to ascertain. The two parts of the scheme—the invalidity part and the unemployment part—are practically interdependent, though in some respects they are naturally worked differently. The scheme is a large one, and with the permission of the House I shall desire to confine myself largely to the consideration of the Second part of the Bill.

May I make this personal observation. I do not desire, in moving the Second Reading of this Bill, especially in regard to Part II., to claim its parentage. The first idea was that of my right hon. Friend the Chancellor of the Exchequer. The details were carefully worked out by my right hon. Friend the Home Secretary, assisted, as I am sure he will be the first to agree, by the very able staff which the country fortunately possesses at the Board of Trade, and I know that one of his principal regrets when he was leaving the Board of Trade was that he had to leave it before he had been able to bring this particular proposal to fruition. I took it over at the Board of Trade, and with the assistance of my advisers I hope I have done something to improve the Bill. It is now presented to the House, as we believe, as a workable and water-tight proposal. I can say for myself that, although I am only the foster-parent, I have a profound interest in this question, and a profound belief that the proposals we are making will do something towards the solution of the question.

The point is, will this scheme actually carry out the object we have in view? We believe it will. We believe, further, that it will not only prove a palliative, but, by the various provisions of the Bill, especially in connection with our Labour Exchanges, which are, after all, the corollary of the Unemployed Bill, we shall be able to do something, by organising in various ways, towards the steadying of labour and the regularity of employment. Let me deal with some of the criticisms which have been directed against the Bill since it came before the country. There are two points of great importance: one is a criticism, the other is a suggestion. Both are of serious moment to the life of the Bill. The criticism is this: that the unemployment part of the Bill is a hazardous experiment. The suggestion is that it is premature, and that it ought to be divided from the other part of the Bill and taken at a later stage. All I can say is that it is not the view of the Government, and that we consider the two parts are interdependent, and that they are one and indivisible and ought to be carried simultaneously into effect. The criticism which is made is that this is a financial experiment, a financial leap in the dark, an attempt to insure unknown and unfathomable risks. I admit that it is an experiment in a sense, but I deny that it is a hazardous experiment, or that the proportion of the unknown has such a large share in the. proposal that we ought not to undertake it and undertake it at the earliest possible moment. I will endeavour to show the House as shortly as I can, that so far from being a hazardous experiment, it is a proposal which will not involve in any sense of the term, unlimited liability of any description on the three parties concerned, the workmen, the employer, and the State.

It was assumed on the First Reading, I think, that we had no substantial available data on which we could found our proposals, but the very able report of the very able actuary, Mr. Ackland, to whom the matter was referred, has, I think, dispelled that illusion, and shows that we have sufficient information and that the safeguards which we present in the Bill are sufficient to enable us to offer the proposal as an acceptable one to the House of Commons. May I point out this, that the postponement of the proposals would give us no further information than we have at the present time. Such data as we have, such bases for calculation as we have at the present moment will speedily increase, and we hope if the Bill is passed and these insurance proposals are introduced and applied to certain trades, before long we shall have better experience in order if necessary to extend the system still further. I would point out, and I think it is an important point, that the data on which we are acting—the data of our actuary on which he proceeded—are based on the actual experience for many years past of the great trade unions including in insured trades something like 300,000 persons, and the data seem to me to be very sound, direct data founded entirely on the payment of unemployed benefits. Hon. Members who have read the report will feel that the actuary is very cautious in his estimates. He founded his report on a very conservative basis and on a very conservative estimate. Where he had no actual figures of the various branches of a trade, for instance, in some of the branches of the building trade, he doubled the estimated figure of unemployment, so as to be on the right side. He gave the doubtful points against the Fund, and he also omitted points in favour of the Fund. If we assume that the estimates as to liability are wrong and over-sanguine estimates, then I contend to the House that we are safe in the proposals that we have made, and that we have ample safeguards against any likelihood of the Fund becoming insolvent, or against any unlimited liability being thrown upon the parties connected with the matter.

The scheme is automatic. It adapts itself to contingencies. The benefits are strictly limited in duration and to a large extent proportionate to the contributions, and we start with a considerable estimated margin of over £200,000 a year, or 10 per cent. If, therefore, our estimate is not over-sanguine we shall be able to improve the benefits conferred by the scheme if we are allowed to start at once, as I hope we shall be, and we shall, under this Bill rapidly accumulate a large reserve, which will be of assistance when times of depression come, and if continuous good or medium times come, we shall be able to vary the benefits from time to time either in the amount or in the period. So that we have elasticity in that way, and we can call upon the Treasury in time of prolonged depression to come to the assistance of the Fund and to make advances to be subsequently repaid without burden on the public as better times come along. Finally we are able to vary the contribution within strict limits, because no one desires an unlimited liability contribution should be thrown upon either the employers or the workmen, and we are able within limits to alter and change the contribution. So that in all these respects, in the matter of contribution, in the matter of benefits, in the matter of the surplus margin on estimate and the advances of the Treasury, we really have a triple line of defence against the existence of insolvency in the Fund, and at the same time that the actual liability of the trade is known the possible burden on the public is strictly limited. The House ought to remember this, and I think it is an important point that the State in this matter is not brought in to make up a deficiency. The State contribution is strictly limited in proportion to the contribution paid by the employers, on the one hand, and the workmen, on the other. Therefore, in regard to all these matters, there is no unlimited liability upon any party, and I say that this experiment may be a bold one, but it cercertainly is not a hazardous one. We have founded it upon very good information—upon good actuarial calculations—and the safeguards to which I have referred are of a character which I think will meet any possible criticism, directed against the supposed hazardous nature of the Fund.

4.0 P.M

Then the next suggestion is that the proposal is premature, and that we ought to delay or postpone it; but I hope very sincerely the House will not listen to such an appeal as that. This measure is long overdue, and I hope when the question is put the word "now" will stand part of the question. There is a very special reason why that should be so, and why we should get into working order at the earliest possible moment, because the principle of workmens' insurance applying to such a matter as this is of course based on average risks, average contributions and benefits, extending over a number of years. The benefits and contributions are not fixed on a single year, but in regard to an average of years. Good years produce a surplus, bad years may produce a deficit, and the good years having to pay for the bad years, it is, I think, very important indeed, and I think hon. Members will agree, for the sake of the future of the Fund, that we should start it if we possibly can in years of fairly good trade and in years when the percentage of unemployment is low, so that we can accumulate substantial reserves and be enabled, when depression comes, to meet it with greater equanimity and with greater solvency of the Fund. On the other hand, if we wait till a period of depression has come—though I am glad to think that at the present the outlook is good, yet the outlook is always uncertain, some accident may occur, or something may happen to destroy the existing prosperity, and we might be in bad times—if we wait it would be a very serious matter from the point of view of such a Fund as this, if instead of being started in a good year, it was started in a year of depression and overweighted. And may I point out to the House that even if we pass this Bill this year, as I hope we may, it will not come into full fruition until the end of 1912. It is very important therefore that we should be forward in this matter, and that we should be provident, so that we should use the good time we have at present in order to meet the bad. I would recommend to the House the example of Joseph in Egypt, which, I think, is the first recorded instance of insurance against times of depression and an average of risks. He, after all, took his seven good years and put them against his seven lean years. I admit that the statistical information at his disposal was of an exceptional character—a character which, unfortunately, we cannot entirely aspire to at the present moment—but I think that is only an additional reason why, when we have a good opportunity of starting a matter of this sort, we should welcome it and receive it and put it on the Statute Book. May I enter this emphatic protest—we are all just as responsible as one another—against the method that this country always takes in regard to this great question of unemployment. We are always, when employment is good, tempted to ignore the question, but, when a period of depression comes, suddenly conscience is awakened and we rush into all sorts of ill-judged and ill-conceived schemes, which very often do more harm than good. I would appeal to the House in this matter for once to be provident, to anticipate the bad times which are coming, and to make due provision for them in times that are good. That is the scheme which we are proposing to the House, and I think anyone who opposes it, on the ground of delay, will be taking a great and serious responsibility upon himself.

Then there is a further argument, perhaps of a rather more specious character, which has been raised on the First Reading and since. It is that we should not carry out the compulsory part of this scheme, but make a beginning with voluntary insurance alone. That also, I hope, will be strenuously resisted by the House, because without the compulsory part we cannot make a real effort—we cannot carry out a comprehensive system of National Insurance against unemployment. All the experience abroad goes to show that a purely voluntary scheme will not really be of an effective character. It naturally includes bad risks, and almost from the beginning it is bound to be more or less financially unsound. The only scheme—a scheme which has some supporters, and which no doubt in itself has had some success—is what is called the Ghent system. That scheme we have already partly adopted in our Bill as regards the voluntary part of it, but, as the sole contribution to the solution of this great question, it is totally and wholly ineffective. The Ghent system is this: It is a simple and direct contribution of recognised associations, which in this case means trade unions alone, and of a State contribution to such unemployment benefits as they give. We desire to encourage not only those who are at present able to insure for themselves, but we are even more desirous by compulsion to secure the provision of unemployed benefits for those who for any reason at present are unable or unwilling to insure themselves.

The position of the purely voluntary system is that, while it provides additional unemployed benefits for those who at present insure, it gives very little encouragement to the insurance of those who are not already insured. What will be the result if we adopt that system alone here? We have in our trade unions something like a million members who insure for substantial unemployed benefits. Thus if you had the Ghent system you would certainly not double that number, but you might possibly add half a million to it. The cost of that system would be something like £500,000 a year. That is half a million additional men would come under the system of insurance, and the State would contribute something like £500,000. Under our scheme, as we propose it, for a sum of something like £750,000 we not only insure 2,000,000 persons who are at present totally uninsured, but we assist and add to the insurance of those already under insurance schemes. Therefore, I think we may say that if we are to make this system of national unemployed insurance at all effective in this country we must add to our voluntary side a compulsory part of the scheme. I agree that there is no precedent for a system of national compulsory insurance, but as far as I am concerned that is no reason for our not attempting it here. We have had a good lead from other countries in insurance against sickness, and I think it would be a good thing if this country were to give a lead to other countries in regard to National Insurance against unemployment.

If the scheme is based upon compulsion it must obviously be based on a trade basis, and I think everyone who has considered the subject recognises that in this matter you must have the foundation of a trade basis. On this part I know there has been a great deal of criticism. This Bill starts on the system of a limited number of employments, and we include in this proposal certain trades, the ship-building trade, engineering, building, the construction of vehicles, and we have for the moment excluded other trades and interests from the purview of the Bill. We have done that on two grounds. In the first place this is an experimental measure, and we want, before extending it further, some greater financial experience to enable us to decide whether and to what extent other trades ought to be brought into the scheme. I think there is this also to be said. Under this scheme we obtain ample power to extend it to other trades where it is thought advisable, but it does not necessarily follow that this scheme will be advantageous or will be desired by all the trades of the country. For instance, probably a trade like the railway industry, where employment is practically continuous, would not desire it. And it is possible, in the case of the mining industry and the textile industry, where they meet unemployment rather by short time than by discharges, that they might not desire it to be applied to them. They might consider that short time, and the encouragement we give to voluntary insurance would be a better method of meeting their difficulties. I am not prejudging these cases. They can all be considered after the Bill has passed. What I am asking is that, for the moment at all events, this portion of the Bill may be treated as an experiment, and I think in this matter it is probably better to do it slowly than to go too quickly.

Then, assuming that there are selected classes, the House may ask why particular classes are in fact chosen. The trades to which I have referred are the trades in which we found, on the whole, that the fluctuations of employment were the greatest and, on the whole, they were the trades most sensitive to ups and downs of depression and good times. I find that in the trades concerning which we have information in the twenty years on which we have actually based our estimates, taking the trades as a whole, the unemployment percentage varies between 2 per cent. and 7.8 per cent., while in regard to these particular trades the figures vary between 2.7 per cent. and 18.4 per cent., which shows that in these trades the fluctuations are greater than in the rest of the industrial field. They are trades also in which I have already said the difficulty is met rather by discharges than by short time. They are trades worked on the time basis, in which there is no homework, and for other reasons we have selected them as the most suitable for our experimental proposal and the ones which clearly ought in the first instance to be brought under the purview of the Act. These trades themselves include no less, to start with, than a third of the whole industrial population and they include no less than 2,500,000 of workmen who will be brought under the Act at once. They are not by any means the better-paid trades. They consist largely of those who are in receipt of the lower rate of wages.


The right hon. Gentleman has just said these trades include one-third of the whole industrial population. What is his definition of industrial population? Is he including agriculture, for instance?


I was including all the adult males of the industrial population. Agriculture is excluded from this.


And all women? The scheme introduced by the Chancellor of the Exchequer deals with 15,000,000 people. The right hon. Gentleman now tells us that 2,500,000 is a third of the industrial population.


True, the industrial population is not a very good definition. The Chancellor of the Exchequer in the first part of the Bill included classes which are not included in the second part. These are purely industrial workmen in the ordinary sense of the term—men in the engineering trade, the shipbuilding trade, the building trade, and so on—they are about a third of the adult male workmen in industrial occupations, excluding agriculture, and excluding the clerical classes, which are largely included in the other portions of the Bill. What I was saying was that we are starting, I think, on a large and comprehensive basis. We are able, if cause is shown, after inquiry and after consideration, to extend easily the provisions of the Bill to other classes of the industrial population. But I will deprecate for the time being any pressure for the immediate inclusion of other classes on the sole ground that in this matter it is, I think, advisable that we should obtain the information, both financial and administrative, which we can obtain before long from the inclusion of these classes before we attempt to extend it to all the other classes as well. The next criticism which I think we ought to meet is one which I am not sure the right hon. Gentleman (Mr. Austen Chamberlain) himself did not make on the First Reading of the Bill. That is, objection was taken to a State contribution in aid of a limited scheme. It is said that we are asking the population of the nation as a whole to pay towards the advantage of a particular section or a particular class. That I really found, to a certain extent, is not a correct statement of the case. It may be that if this scheme is successful, it will practically be extended to all the industrial population; but I must say that, so far as I am concerned, I dissent altogether from such a proposition as that. If such an objection were taken and accepted that the State ought not to contribute to a limited scheme affecting a limited class, then I admit that is perfectly fatal to the proposals we are making to the House. The scheme is obviously confined to certain classes of the population, and it would certainly be fatal to any scheme of insurance to say that it must not be applied to limited classes. That has never deterred us from attempting any social reform or any social legislation which, in the first instance, applied to a limited class. I contend, on the other hand, that we are entitled—and we are doing it every day—to utilise the resources of the community for the purpose of instituting such reforms, even although of a limited character, and applying them only to limited classes. I think we can say that, although in a sense this contribution is to a limited class and a limited number, it is really a contribution benefiting all trades and all classes of the community.

All trades are interested in and dependent on the stability of one another, and unemployment in one trade seriously affects the state of employment in other trades, so that anything that will tend to equalise employment in one trade will certainly be of advantage to other trades, and to the nation at large. Of this I am quite sure, you cannot have a compulsory system of this sort unless you gild the pill and give State assistance, for otherwise that would mean that you are merely compelling the more regular workmen to pay for the less regular workmen. I think that when you enforce this on all classes of employers and workmen it is only right and fair that the State should bear its share of the burden. I do not think it is unfair to the employer to ask him to contribute something to mitigate the evil which is forced on others on account of the fluctuations incidental to the industry in which he is interested. He, after all, depends on the existence of the whole body of workmen in his trade, and he should be prepared to contribute to the general expenses of the trade, and the burden that falls on the trade. How far the employer in future may be able to transfer his burden to other shoulders remains to be seen. I believe it will be a profitable investment, and I am quite sure it will be a humane investment. He will save by preventing the deterioration of the morale and the physique of his employés, and he will benefit by the better organisation, increased efficiency, good conduct, and regularity of his workmen. Hon Members have seen in the reports from Germany, issued by my right lion. Friend, that there, at all events, employers have recognised that the system of insurance already applied has been of advantage to them. We talk of competition, but even adding this charge for insurance the British employer in future will pay a smaller charge than German employers for similar things. I am bound to say, in justice to the employers, that, so far as I am concerned as to Part I of the Bill, and so far as my right hon. Friend is concerned as to Part of the Bill, there has been no protest received on the part of the employers against bearing their share.

Then we come to the question of the workman's burden. As regards the provident man who is already making provision for unemployment, this scheme will not only not impose any new burdens on him, but it will positively and actually be a real relief to him. At present he has to bear the cost of insurance entirely from his own resources. In future, as regards the provident man, he will receive a contribu- tion from the State and a contribution from the employer, and his burden, therefore, will be less than it is at present. That he can realise in one of two ways. He can reduce his contribution as a whole for the same benefits, or, if he prefers, for the same contribution he can get improved benefits. So far as regards the workman who has been unable or unwilling to obtain unemployed benefits, he will in future be able to do so, and for his enforced contribution he will not only receive back his own contribution but that of the employer and that of the State as well. Translated into pounds, shillings, and pence, for every shilling he contributes he will receive back the 1s. with 1s. 8d. added from the other contributions. At all events, his contribution will be a good investment for him.

That brings me to another point. Allegations have been made in many quarters that the scheme of the Bill as a whole is going to throw great additional burdens on workmen, employers, and the State. That I deny altogether. Insurance against sickness and unemployment will involve no new burden. The burden exists at present, but in future it will be better distributed and more easily and equitably borne, and more people will be benefited by this system of insurance. Take the case of unemployment. At present the burden appears in the national ledger as pauperising Poor Law expenditure, as systems of State or municipal doles, and as sudden emergency works which very often are a waste of money. So far as the provident workman is concerned, it is met by the contribution to the trade union, and where he is improvident it is met by the neighbourly assistance he receives, and which is so freely and ungrudgingly given among the working classes, and by the costly realisation of his belongings, costly credit, and costly arrears. In connection with these operations, the man is subjected both mentally and physically to the suffering which unemployment brings in its train. I think it will stand to reason that it must be infinitely better to have permanent machinery to anticipate the "rainy day," and to distribute the money more equitably over various interests and more uniformly over the period. I think one can safely assert that the burden, far from being greater, would really be less than before.

There is one other objection to the scheme upon which the House will allow me to say a word. We are told that we ought to differentiate—this is an important point—our contributions and benefits according to the risks of a trade as a whole, and that we ought to distinguish more between trade and trade, and even distinguish between various sections of a trade. I do not think that will receive the support of my hon. Friends below the Gangway. Trade unionism has always preached the solidarity of labour, and that, so far as it goes, the regular man and the irregular man should be put together. We are providing in this Bill for certain differentiation, and as our experience extends we may be able to provide that still further, but I think, at all events, in the first instance, it is very important that we should, as far as possible, take what is called the flat rate and apply it to engineering and shipbuilding and to the other trades in the building construction group, and see how it will work out, and with what justice, to the various interests concerned. "We ought to remember that in this matter the State contribution is largely intended to cover the extra risk in certain trades, and so far as the individual member of those insured trades is concerned he gets the benefits from the employer's contribution and also from the State contribution.

I wish to refer to another point upon which I think there has been on the part of my hon. Friends below the Gangway considerable apprehension, and that is in regard to the effect this Bill may have upon trade unions—whether the provisions are drafted sufficiently wide to enable a trade union to become and to remain an approved society without necessitating any effective alteration in its practice, or in its ordinary functions as a trade union. I can well understand the anxiety that all trade union men have if they feel that the real effect of this Bill is going to be to undermine or to destroy trade unions. These great organisations, built up during many years in the past, and whose position has become so strong, might very well feel that any proposal whereby their general position was in any sense weakened or undermined would be indefensible, and that no such Bill ought to be put on the Statute Book. I am one of those—I have always said so publicly—who believe, and I believe it is the opinion of the House now, that it is not only in the interest of labour itself, but in the interest of employers as well, that these trade unions should be strong, representative, and independent, and I can assure my hon. Friends and the House generally that nothing is further from the object and desire of the framers of the Bill than that when it becomes an Act it should be used as a disruptive force against any trade union. I am convinced that a good deal of the misapprehension has been based on some misunderstanding of the intention and the effect of the provisions of the Bill. The intention and the effect of the provisions, as regards Part I., is that a trade union should be recognised as an approved society. If the representatives of trade unions can show to my right hon. Friend or myself that any provision in the Bill would make it impossible or difficult to come into the scheme, I need hardly say that attention will be given to these matters with the view to a modification of the Bill, and the avoiding of such a difficulty as that. One of the objections taken to the scheme is with reference to the deposit of security, and the separating of the Funds. It may be thought, or it may be held, that that is detrimental to the interests of trade unions. May I point out that the deposit Clauses are drawn in an elastic form, and that the only security required on behalf of a recognised association is in order to guard the Insurance Fund against any defalcation on the part of the officers of the association in respect of the Funds which are committed to their care. That is an obvious and necessary precaution. But it does not necessarily follow that security in the sense of deposit would have to be given in every such a case as that. But with regard to the other question of the separation of the Funds, my hon. Friends are aware that the accumulating Funds are to be held by the Insurance Commissioners Department, to be repaid to recognised associations either by way of payments on account or by way of refund for expenditure already incurred. As to payments which are made by way of refund, it is quite obvious that there is no question of necessity for the separation of funds at all, and if it might appear to the trades unions, in view of their peculiar position, more agreeable to them in that form, I am quite sure that my right hon. Friend is quite willing to meet them in every respect in making these payments as far as they can be made by way of refund, rather than by payments in advance. That, of course, would incidentally meet the difficulty of deposits. As regards the question of triennial valuations, I do not think that the trades unions are really touched by it at all. This ap- plies to friendly societies as well. There is no question of valuation of the whole assets and liabilities of the trades unions or recognised associations.


May I ask for information on one point? I want to have it quite plainly whether or not it will be possible for trades unions to use those funds for other purposes than those of unemployment—that is, for strikes—and how can that be avoided if security is not given?


I was about to come to that in one minute. For the moment I am speaking of Part I. of the Bill, in which that matter does not, arise in the same way or so acutely as in Part II. What I was saying is this: As regards valuation, there is no question of valuing the general assets or liabilities of trade unions or recognised associations. My right hon. Friend has already pointed out that this valuation is absolutely and entirely confined to that portion of the Fund which is accumulating in the hands of the Insurance Commissioners, and which is separated altogether from the ordinary fund of the trade unions. Therefore as regards that point, and the other points to which I have referred, if my hon. Friends are under the misapprehension that these proposals would in any way interfere with the organisation, administration, or liabilities of trade unions, I hope I have done something to relieve their apprehensions, and I am quite sure that my right hon. Friend would be very glad to receive representations in regard to any Amendment which may be required. Then turning, if I may, to Part II. of the Bill and to the question of the position of the trade unions, as I have already stated in regard to Part I., there is no intention to interfere between the trades unions and individual members. They can fix their own contributions and their own benefits as they do now and they will be entirely free to accept or refuse members of their own. All we do is, if trade unions desire it, and only if they desire it, in regard to their own members, to utilise their machinery for the payment of benefits, and this, it will be observed, only by way of refund for money which has already been expended. There is no interference, therefore, of any sort in that part of the scheme in their administration, organisation, or autonomy.

On the other hand, this brings me to the point of my hon. Friend the Member for Bootle (Mr. Bonar Law), that is the questions of the position of trade unions in Part I. and Part II. of the scheme. I have endeavoured to show, as far as we are concerned, that their autonomy is in no sense interfered with, but we have, on the other hand, to consider the position of employers in this respect. They are going to contribute and the State is contributing for these purposes of sick benefit and unemployed benefit, and it is quite clear from what my hon. Friend says that they are afraid lest the funds so contributed may be used for fighting purposes by trade unions. They are afraid that the kid will be stewed in. its mother's milk, and that these funds would go to strengthen and assist the ordinary general funds of the union. I think I have already made it clear to the House that that cannot in any sense be so at all. In the first place—I am speaking now of unemployment: it does not arise with regard to sickness—no benefit will be paid with respect to unemployment to trade unions in case of a strike or lockout. That part of the unemployment question for the moment will not arise, and in both cases, as I have already said, we do not propose to pay, any money to trade unions, except for refunding money which they have already expended on legitimate and proper unemployed benefits, apart from any question of strike or lock-out. Therefore, so far as I can see, no question of the contributions of the employers or of the State being used to assist trade unions in their fights can possibly arise. I am quite sure that my hon. Friends below the Gangway will be the first to say that this is the proper and fair position in regard to this matter.

I have endeavoured to deal with the chief criticism, most of which has been directed against Part II., and some of which has been directed against Part I. of the Bill. There is just one other point which I may refer to incidentally. I have seen the scheme criticised with reference to its being too bureaucratic. We are, after all, going to deal with it through the Labour Exchanges, and the voluntary associations through the combination, and we hope cooperation, by means of joint committees of representative employers and workmen. If it can be shown in any way that those panels of referees can be made more representative than those proposed by this Bill we shall very much welcome any suggestions that can be made; but I can assure the House that our sole desire is to put the system as far as we can on a representative basis. I apologise to the House for having kept it so long, but I thought it necessary to endeavour to meet various points which have been made in the course of criticisms outside the House, and I hope that by what I may have said now I may have anticipated also some criticisms which otherwise might have been made. This is our proposal, and this is our contribution to social reform. I am sure that my right hon. Friend, and certainly I, would be the last to claim that in any sense this is a final solution of the problem of sickness or of unemployment, but I think that it has this great merit, that while it is a considerable step forward in the direction which we all desire to follow, it is not only no obstacle, but I think it is an avenue towards the extension of other various systems, also in the same direction. We have founded it, as we believe, on a business basis and on sound actuarial calculations, and we offer it to the House as a great and beneficent step forward, which, if the House accepts it, will do much to achieve that which we all desire, the improvement of the social condition of the working classes.


After the speech which has been delivered by the President of the Board of Trade (Mr. Buxton), I regret more than ever that the Government did not adhere to what was generally regarded as their original intention of dealing with the kindred problems that are dealt with by this Bill in two separate Bills. This Bill is in reality two separate and distinct measures. Each part of it deals with a different question, and I am bound to say that the Government throughout, as far as we have gone, have treated this Bill as if it were in reality two. The First Reading of the Bill was moved by the Chancellor of the Exchequer, who dealt almost exclusively with Part I. The Second Reading of the Bill has been moved by the President of the Board of Trade, who has dealt almost exclusively with Part II. The position of these two right hon. Gentlemen reminds me of the old instrument for indicating the likelihood of a change in the weather which many of us knew in the days of our boyhood. An old gentleman used to come out on some occasions and an old lady used to come out on others. I am not going to assign to each of the two right hon. Gentlemen opposite the functions of the two individuals to whom I have referred. The President of the Board of Trade has made an exceedingly interesting speech dealing with an exceedingly interesting subject, but I would like to deal with one aspect of the problem, a new side of the question, which has not hitherto aroused so much general interest, or, at any rate, has not excited so large a measure of criticism as might have been expected; and I hope that the right hon. Gentleman will not think me guilty of any attempt at discourtesy if I do not follow him throughout his arguments with reference to Part II., but turn at once to the consideration of Part I. and some of the questions which have been exciting public attention.

I think that while the President of the Board of Trade did make reference to Part I. he might have spared a word for the Paper issued yesterday containing the actuarial calculations on which the figures of Part I. are based, and he might have said something, at any rate, about the creation of a debt amounting to something like £63,000,000 which this scheme will start. We seem in these days to be so accustomed to dealing with millions of money that the addition to the debt of the country, even though it might be extinguished within the next fifteen or twenty years, of £60,000,000 at one stroke of the pen, seems to pass without exciting the attention of the President of the Board of Trade. I can well believe that the Chancellor of the Exchequer may have had some tremors of doubt as to the reception on the part of the public which would be accorded to a Bill which, while it deals with an object with which everybody sympathises, is founded upon a basis of compulsion, because our people, after all, do not like compulsion. They do not like it especially while it is applied to themselves. I confess, speaking for myself, I still believe that in the main a voluntary system is the best, provided that a voluntary system will give you the result at which you aim; I should be glad, speaking personally, if I could see a prospect of success for creating a system of National Insurance against ill-health founded upon a voluntary basis. I regret to say I cannot do so.

The experience of every foreign country goes to prove the contrary. You may expunge from this Bill every element of compulsion which it contains, you may place it upon a purely voluntary basis, and yet you may fail of your object. For this reason, while your scheme may be national in conception, I think if it were placed on a voluntary basis it would be only local and parochial in its administration and operation. If you are going to create a national system, if you are going to em- ploy the national funds, if you are going to place both upon the employers and employed alike the heavy burdens which this Bill does place upon them, you are only justified in doing that if you can show to the House and the country that the scheme is going to be national in its application as well as in its conception. It is remarkable that in the last few years there seems to have been a general consensus of opinion throughout the older countries of the civilised world, at any rate, that the health of the individual is no longer and can no longer be treated as a matter of purely individual concern. If that be so, and if it be admitted that the best method of treating this difficult question is by a policy of insurance, then I am forced to abandon my natural predilection in favour of a voluntary system, and to accept the compulsory basis upon which the Bill is founded. We have tried the voluntary system for many years, and we have tried it as far as it has gone with splendid success. We owe a great debt of gratitude to those great voluntary institutions which have done so much to encourage thrift on the part of our people. But we must take care, in anything that is done in connection with this Bill, that we do not injure them. Though the work of those institutions has been great, yet there are vast numbers of people who have no provision against bad times or a rainy day.

It would appear that there would be no great or rapid increase of the numbers who make of their own volition and initiative provision for themselves, and, as there are great numbers who are still without any provision of this kind, then I say we are forced to accept the necessity of taking such steps as may be required for bringing within the scope of National Insurance the great body of people who are now standing outside. A national scheme necessarily involves a contribution from the State, and imposes that duty, as well, upon those who are to benefit by the result of this scheme. It may be that the employer is in many respects directly responsible for, as well as deeply interested in, the health of his workmen, and on that account, if on no other, he may be asked to make a contribution towards the cost of the plan. In brief, that is the scheme of the Government. Although the President of the Board of Trade offered some argument in justification of the precise proportion which each class is to contribute under Part II., we have had nothing from the Government so far in justification of the precise proportion of contributions which it is proposed to levy in respect of Part I. I hope the Chancellor of the Exchequer, or some right hon. Gentleman on the Treasury Bench who is to speak, will take an early opportunity of telling us on what basis is calculated the precise proportions which are demanded from the different contributors—the contributions which are to be taken from the employer and the workmen are specified in precise terms; they are to be so many pence a week each. But the contribution of the State is not prescribed so clearly nor laid down so definitely. So far as I can see, the master and the man will pay to cover the risks which may or may not be incurred, but the State will only pay part of the benefit—that is to say, part of the money that will have to be paid after the risk has been incurred. I do not think that this imposes any sort of equality of burden, nor do I think that there is any element of equality of risk about the proposal.

May I refer to another point in connection with the proportion of contributions? The Bill provides that if the wages of an employé are below a certain sliding scale laid down in the Schedule, then the burden shall be shifted from the shoulders of the man to the shoulders of the employer. That is, if a man receives very low wages, he cannot be expected to bear the weight of this burden. But I am afraid that the employer who is forced to pay the low wages will find it difficult to bear the burden in the workman's place. Take for instance the case of a farmer who is farming in a part of the country where wages are low. The expenditure in those neighbourhoods bears some relation to the figure at which the wages stand. Everything is in proportion—the rent the farmer pays for his farm, and the rent the labourer pays for his cottage, and other matters—to the wages paid. The rents may be low, and the financial conditions generally may be low, because of the difficult character of the soil to be cultivated. It may be, in addition, that the farm is situated in a remote part, and that the market for its products is difficult of access. The industry, therefore, cannot bear higher charges. That is the point I want to make. The mere fact that the wages are low does not necessarily mean that the employer is prosperous; it does not necessarily mean that he is doing any better than he would do if he had a farm in another part of the country, and was paying double the amount of wages. Everything is in proportion where wages are low, and I do not think we should be able to find any justification, under conditions of that kind, for throwing an enormously increased burden such as the Bill proposes upon the shoulders of the employer. The President of the Board of Trade (Mr. Buxton) said that there had been no representations received from the employers with reference to the provisions of the Bill. I think the employers are willing and anxious to do all that can fairly be demanded of them. Perhaps one reason why no representations have been received from them is that they have not yet fully grasped the weight of the burden which is to be placed on their shoulders. I would remind the right hon. Gentleman that computing the wages, or in ascertaining what wages men actually receive, there must he taken into consideration various allowances that are made in addition to the weekly payment.

You must also take into consideration the rent of the workman's cottage. It may be a cottage which, if it were let as a purely economic transaction, might let for a higher sum than that which is paid for it by the workman, and in that way you may be able to show that a man who actually receives in cash 14s. a week, out of which he has to pay 1s. a week rent, really ought to be treated as a man receiving 18s., or even 20s. a week wages. By doing that you might relieve the employer of a part of the burden which he has to bear; but then you are throwing a heavy weight on the shoulders of the man, who cannot really afford it. Difficulty will he found in persuading the labourer with 14s. a week that it is fair to make him pay as much as the man who has got 50s. a week, though you may be able to show him that such a demand is justified, and that the benefits which he gets under the Bill are of a character to make it worth his while to accept the burden. I come to another question which really lies at the root of the whole of the proposals contained in the Chancellor of the Exchequer's Bill—the question of the doctors. Everybody admits the great debt of gratitude that the country owes to the medical profession for the signal services they have rendered either by way of charity or out of pure philanthropy to the people amongst whom they work. The whole of the great fabric which the Government proposes to erect depends upon the loyal and whole-hearted co-operation of the medical profession. So far as I can gauge the opinion of the medical profession at the present time, and it seems to be expressed with extraordinary unanimity, it is that the provisions of the Bill as they stand will not do. I am not going into this question in detail; all the points have been referred to in the public Press, and I know that the details have been brought to the attention of the Chancellor of the Exchequer. I hope, from the various sentences that have fallen front the right hon. Gentlemen, either by interview or by letter, that he will meet the objections which the medical profession take.

May I emphasise one or two points to which I have not seen any reference made, and make a suggestion which may at any rate obviate some of the difficulties? The Bill proposes to use the great friendly societies in this matter of insurance. It leaves each individual friendly society to make its own terms with the doctors who look after its members. To that proposal the doctors are wholly opposed. There is nothing in the Bill, as far as I understand, that either declares specifically or lays it down that the payment to the doctors should be made either by a flat rate or a capitation fee. That is the suggestion which was certainly conveyed in the speech in which the Chancellor of the Exchequer introduced the Bill, but I hope, at any rate, alterations may be made if that is the intention of the plan. In giving the friendly societies the payment of doctors the Chancellor of the Exchequer makes use of the present practice; but the present practice does not work well; I do not believe it 1s wholly satisfactory to the friendly societies; I am quite certain it is not satisfactory to the medical profession. I would ask the Chancellor of the Exchequer to bear in mind that the Bill is going to extend so far beyond the present numbers who are dealt with—in other words, it is going to bring into your net such an enormous increase of membership of friendly societies, that I do not think it is fair to ask the doctors to go on tinder the same conditions as at present either as to employment or as to pay.

5.0 P.M.

I think a change could be made in the appointment of the doctors which would go far to ease the working of the Bill. I think that the Bill itself contains the machinery by which the appointment might be made satisfactory both to the friendly societies and to the doctors themselves. In the Bill you call into being a new health authority, the local health committee. Those committees are composed of repre- sentatives of the friendly societies, of the deposit contributors, of the existing local health authorities, and of the Government by the Insurance Commissioners. You have here, therefore, a body upon which is represented every class of person interested in the management and carrying out of the scheme which we are now building up. That is the authority which is going to appoint the doctors in respect of deposit contributors, and why not allow them to have the appointment of all the doctors in the scheme? If you do that, and if you at the same time give them the assistance of an advisory committee composed of medical men practising in the area over which the local health committee will have jurisdiction, then I say that you will have gone a great way and taken a long step to remove some of the very natural objections which the doctors have. I think you will not incur in doing so the dislike or the enmity of the friendly societies themselves. After all, the friendly societies have got direct representation upon those local health committees. I believe that the friendly societies have found the appointment of doctors an occasion of constant friction, a matter that is irksome to them, and a matter from which they would gladly be relieved. I hope that the suggestion that I make will be weighed by the Chancellor of the Exchequer, who may be able to ascertain further information as to the view which the friendly societies adopt towards it.

There is then the question of payment. If you were to hand over the appointment of all the doctors to the local health committee, assisted by a medical committee, I see no reason why you should not be able to come to a satisfactory arrangement with the doctors as to the manner in which the payment is to be made. After all, the Chancellor of the Exchequer knows pretty clearly in his own mind what the medical benefit is going to cost. He calculates by laying down a flat rate to have so much paid by the contributors, and he calculates how many contributors there are to be, and he can ascertain pretty clearly how much it is going to cost. As long as the sum which he sets apart for medical benefit is not exceeded I do not think it would really matter to him whether the actual payment is going to be by way of a flat rate, or whether it is distributed throughout the areas by the local health committee, acting in conjunction with the doctors themselves. What you want to secure is such a system of pay- ment as that it will be satisfactory to those who receive it, and such a system of payment that will not be wasteful to the public who provide the money, and such a system as will give you satisfactory results, not only from the point of view of the State, not only from the point of view of the doctor, but as well from the point of view of the patient.

The patient will very naturally take very considerable objection to any system which will impose upon him the obligation of being examined and treated by a doctor with whose appointment he has nothing on earth to do. Our people in this country do not like State officials interfering with them any more than they can help, and there would be, I am afraid, an inevitable tendency on the part of a great many people if those people were visited by a doctor whom they did not, invite, whom they may not like, and a doctor in whom they may have no confidence. I am afraid there would be a great disposition to treat him as a State official. I do not want to press the matter unduly upon the Chancellor of the Exchequer, but I hope I have said enough to show the view that we take of this question, and that he will turn it over in his mind, or rather, give us the result of what he has been turning over in his mind within the last few days. There is one thing certain to my mind in connection with the creation of this new local health committee, and that is that it will lead in the near future, and it must lead in the near future, to a complete revision at any rate of the medical side of our present Poor Law institutions. I think there is no doubt about that whatever. I think it must lead to it because you must place under one control all those institutions for the care and cure of the sick, which, after your Bill once starts, will be under different administrations. You will have hospitals under one set of administrators, you will have sanatoria under another, and you will have the workhouse infirmaries under a third. That is a system that cannot last, as it would lead to over-lapping, wade of time and money and energy. It is a system that cannot endure. Therefore I say that the creation of local health committees must force this House and Parliament generally to undertake a complete revision of our Poor Law at a very early date.


Does the hon. Gentleman suggest that the local health committee should decide what remuneration should be paid to the doctors?


No, that is not a thing I would even suggest at the present moment. I think all that we can reasonably ask at the present time is that the Chancellor of the Exchequer should consider the matter, and to see if he could be able to show to those who appoint the doctors and the medical profession that there would be so much money to be distributed for the payment of the medical profession, and then see what arrangement the local health committee and the medical profession and, if necessary, the insurance commissioners could arrive at. We have no basis, and the difficulty of the doctors really is that they have not sufficient experience upon which to go. The flat rate payment of the friendly societies does not carry us far enough. We are really setting out upon a new task without sufficient experience of the matter, and it is only after some years of experience that we shall be able to say really what remuneration to the doctors is fair. I referred a few moments ago to the work clone by our friendly societies and the necessity for providing that their position is not adversely affected. I should like to say a few words about the position of friendly societies under the Bill generally. The number of friendly societies in point of membership or in point of their constitution that can become approved societies under this Bill when it first becomes law is extremely small. There would be a vast number of friendly societies that must re-constitute themselves, and a very large number that can only hope to share in the approval of the insurance commissioners by amalgamating with other societies which are larger than themselves. Perhaps they will have to recast the scale of benefits that they now pay. I am afraid that some of the smaller benefit societies that have done a great deal of good work will find it very difficult to carry on their work under the provisions of the present plan.

I do not quite see why societies which are solvent should be wiped out merely because they do not come up to the very high level of membership—namely, 10,000, the number which the Chancellor of the Exchequer has laid down. We are told that the existing funds of the friendly societies will not be brought into the scheme, and that the funds which are now in the possession of the friendly societies at the beginning of this scheme will remain in their possession unaffected by anything this Bill contains. That will give to the rich societies, to the societies, if there are any, which have a superabundance of funds, the chance of securing all the best risks in the future after the Bill becomes law. The funds of which they are in possession already will enable them to give benefits in addition to the statutory benefits of so tempting a character as to enable them to get all the best risks. They will be able to give death benefits, as well as other benefits, on very easy and satisfactory terms, which will, I think, lead to some competition with the industrial societies now doing that class of work. The Chancellor of the Exchequer says that the position of the industrial societies will not be affected by anything that the Bill contains. That, I think, is true, but I think that the operation of the Bill will affect the industrial societies and their agents. I think it must do so. I think I cannot do better than read a few sentences from a letter which I have had from one of my Constituents, in which he expresses very clearly the fears of those who are engaged in the work of those industrial societies. The grounds on which he bases his fears are these:— (1) The public, being compelled to insure against sickness with an affiliated order, will be brought into direct contact with the affiliated orders. (2) As the public must insure against sickness through an affiliated order, and as these orders insure against death also, it is practically certain that the public will transact their death assurances with these orders (most people preferring to do all their insurance business with one office). (3) The affiliated orders, in consequence of the forced increase in membership, and the subsidy they will receive from the State, will increase their funds, and consequently be able to give exceptional benefits, thus giving better attractions to the public to insure against death with them rather than with other offices. (4) The affiliated orders being backed by the State will appeal to the public on the grounds of high status and absolute security. (5) The public, being compelled to pay so much per neck for sickness insurance, will have less to spare to assure against death, thus the opportunities of the industrial offices for securing clients will be diminished. I have read this to the House because it shows the kind of doubt that is working in the minds of those who are engaged in carrying on this kind of work. It will not do for us to shut our eyes to the fact that these people are going to be affected by the operation of the Bill, although they may not be injured by the terms of the Bill as they stand.

Following on what the President of the Board of Trade said in reference to the position of trade unions under Part I., I want to ask the Government whether they are willing to apply the same elasticity in regard to the deposit to another class of society which has done a great deal of good work during past years. I refer to dividing societies. The President of the Board of Trade, speaking in reference to trade unions, said that the only object of the deposit required from friendly societies under the Bill was to secure everybody concerned against bad management, that the provision was elastic, and that it would be stretched in this direction or in that. If we are going to make it elastic for trade unions, we should also, I take it, make it elastic for the dividing societies. I have here some observations made with reference to their position by the National Federation of Dividing Societies, which has a membership of 365,000. It is there pointed out that while they have no reserve funds which would enable them to make the deposit required under the Bill, they are quite prepared, in order that there shall be no doubt as to the safety of their administration, to take out guarantee bonds from ordinary societies that do that kind of work. I hope the position of these societies will be protected. I will not detain the House by speaking of the great work that these dividing societies have done, and the satisfaction with which their members view their management, but I hope the right hon. Gentleman will see that they are not harshly treated under the Bill.

One word in reference to the position of the new class of contributors which the Government are creating—the deposit contributors. Most of these deposit contributors, I take it, will be brought into the scheme on the ground of ill-health. After the Bill comes into operation everybody will be given the chance of joining a friendly society, and as friendly societies will pay far better terms than contributors will get under the Post Office, it is only natural to assume that everybody who can will be brought within the friendly societies. Therefore the deposit contributors will consist almost entirely of people whom the friendly societies will not take. The contribution levied on these people is precisely the same as that paid by the most healthy member of a friendly society. How do the benefits compare? The Chancellor of the Exchequer says it will not do to give the same benefits to the deposit contributor as to the friendly society man, because if you did you would establish a system which might compete unfairly with the friendly societies. I do not want to see unfair competition with the friendly societies, but I do want to see that the deposit contributor gets fair value for the money which he pays. Is the amount, of the benefit that he is to get commensurate with the demand made upon him? His benefit is strictly limited by the number of payments that he himself makes to the fund. He cannot draw out more than the proportion of the Fund represented by the number of contributions that he has made. His proportion is swollen by the State con tribution, but the amount is strictly limited by the number of payments that he himself has made.

The CHANCELLOR of the EXCHEQUER (Mr. Lloyd George)

In addition to that he gets the bonus, which will gradually accrue from the contributors who have not drawn their proportion.


I am speaking of the beginning of the scheme. No doubt in course of years that would be a very valuable asset and a fruitful source of increase for subsequent members, but at the beginning you are demanding from these people insurance premiums and paying only deposit rates. I do not think that you are, as a matter of fact, giving the first of these deposit contributors quite sufficient consideration. With regard to the Insurance Commissioners, you are creating a new body, to whom you are giving enormous powers. As far as I recollect, there are something like thirty different sets of regulations and provisions that they will have to frame when they come to exercise their powers under the Bill. There is one instance in which they may actually vary the provisions of the, measure after it has become an Act. I do, not think that is desirable. If the necessity for making an alteration in the Act arises, Parliament ought to be consulted and the alterations made by Parliament itself. I do not think it is right or proper that any Government Department should have the power to alter any provision that Parliament has made.

I am greatly obliged to the House for their forbearance. The vast scope and complexity of the measure must be my excuse for detaining them so long. But seeing that it has taken two Cabinet Ministers nearly four hours to explain the scheme to us, I am sure the House will forgive me for the time I have taken. I regret that the Government have not been able to allow a longer period to elapse between the introduction of the Bill and the Second Reading. We have been almost overwhelmed with a flood of memoranda. Probably no Bill was ever accompanied by so much explanatory matter. We are very grateful to the Chancellor of the Exchequer for having supplied it, but a great deal of the information contained in those memoranda we have not had time thoroughly to assimilate. The Bill bristles with difficulties that we have got to face, and difficulties which I hope we shall solve. We are willing to help the Government to the full extent of our power. But let it be clearly understood that if our proposals for alteration and improvement, which will be moved in good faith, cannot be accepted, if Amendments which we may feel compelled to move cannot be adopted, we must not run the risk of malicious interpretation of our action hereafter. We are willing to do our best to help the Government to carry out their object, with which we sympathise. We recognise, and the Government must recognise, that it will probably be necessary to make very considerable alterations and amendments in Committee. If we are to approach the question with free hands and free minds—and it is no use attempting the task if we cannot approach it in that way—we must preserve ourselves from the possibility of charges of bad faith at a later stage. So far as I can judge, this Bill is not popular. I do not agree with the President of the Board of Trade that it is a popular measure; but I think that it may very possibly be unpopular because it is not yet fully understood. If we were to set our minds to the task we could make considerable party capital out of the feeling which exists in the country at the present time. I can assure the House that we are not going to do it. The mere fact that a Bill is unpopular in its early stages is no valid reason or excuse why we should not go on and pass it into law if we are convinced that it will do a great deal of good to the general community. It is because we believe that the object which this Bill sets out to secure will confer lasting benefit upon the community as a whole that we are going to pass the Second Reading, I hope without dissent.


I desire to speak on the Second Reading of this great Bill on behalf of the party with which I have the honour to act. This is a Debate on the general principle, and I do not imagine that anyone will go to the length of dividing the House against the Second Reading. A generation ago a measure such as this, if any Ministry had had the hardihood to introduce it, would have been scouted not only as impossible of acceptance, but as almost improper in its conception. A different idea of the duties of the State towards the individual existed then. All the old theories have now been buried. With the advent of democracy to power new views regarding the duty of the State towards its individual members have come into being and find expression in this House. This Insurance Bill is the latest of a series of efforts made in the last generation to cope with the evils and miseries which have been produced by generations of class legislation in the interests of the rich—miseries and evils that have affected practically only the poor and the labouring classes. Something like this measure we were bound to see. Speaking on behalf of the party to which I belong, as well as on my own behalf, I ant extremely glad that it has come now, and not later.

Without wishing to interfere in the domestic affairs of Great Britain, to interfere with the operation of British thought upon this subject, I may say, on behalf of those for whom I speak that they will endeavour in their actions on this Bill to help the democracy of England to make this Bill assume a shape which they think it ought to in the interests of their constituents. I am perfectly certain if this Bill passes that a great step will have been taken towards social reform of a higher kind. How far this measure suits Ireland is a different question. With the question of how it suits Great Britain I do not propose to interfere. I leave that to others. Great, Britain is represented by a respectable party in this House; they do not require assistance. On the other hand, may I say that I think that the Irish representatives have a peculiar claim to be heard on the question of how far this Bill suits Ireland, and what are the modifications that ought to be made in it. I confess on this point I do not feel at this moment competent to express any satisfactory answer to the question I have put. I confess I did not find it easy to read the Bill and master it, or to master the memoranda that accompanied it.

When I remember that the Chancellor of the Exchequer took, I think, two years to prepare this Bill, and took two and a-half hours to explain its outlines only, and that we uninstructed Irish Members have only had two weeks, without expert help, to master its details, I think we are not to be blamed when we say that we have not had time yet to come to a definite conclusion upon its provisions. We have, however, done our best in that direction. My hon. and learned Friend the Member for Waterford (Mr. John Redmond) on the First Reading of this Bill, invited an expression of public opinion in Ireland upon its provisions. He especially called upon the county councils and the rating authorities in the rural districts to express their views upon the measure which so deeply concerned them and their constituents. Some of the public bodies have expressed their views, and we have been very glad to get them. Some of these views, many of them, contain matter of importance which it will be proper for us to give full consideration to before deciding upon any particular line in regard to the Bill. We are, in fact, inquiring and gathering information. This will enable us yet to come to definite conclusions on a multitude of points which inevitably arise for consideration in the discussion of a measure of this kind. In this direction I may observe that we have not derived much help from the discussion which has already taken place in this House and in the British Press on that aspect of the measure which relates to England and Scotland.

This Bill has plainly and naturally been drafted and framed mainly with a view to the social conditions which prevail in England and Scotland. That means that the Bill is primarily cognisant of and applicable to, industrial conditions. But Ireland, although it has several large centres of industry—I am glad to say that Irish industries have not been altogether extinguished by British legislation—is mainly an agricultural country. Therefore Irish representatives are plainly bound to see, so far as they can, that the exact proportions under this Bill as regards Ireland are appropriate to its peculiar needs and interests. The Chancellor of t he Exchequer himself, by his Bill, practically draws attention to this very fact, for in the centre of exemptions from compulsory insurance against sickness and disablement, there is an express exemption for employers and employed where no wages are paid, and where the employer is an occupier of an agricultural holding valued at not more than £20. I cannot help thinking that in making this exemption the Chancellor of the Exchequer had in view in particular the case of Ireland. For holdings which are valued at £20 and under, and on which the persons employed are the occupier's own family, constitute about three-fourths of the agricultural holdings in Ireland. This condition of things, I think, does not prevail in any part of England; nor, I think, any part of Scotland.

Nor is this the only matter in the Bill itself, as anyone may see by referring to Clause 59, which deals with Ireland; which says that Ireland cannot, he treated in the same way in this matter as England, and, accordingly, Irish representatives must necessarily take time to consider the Bill and to see how far separate treatment is necessary for Ireland. I do not propose on the present occasion to enter into any details. I do not see much advantage, I confess, in discussing this or that particular detail when what we have to consider in discussing a measure on Second Reading is the principle of the thing itself. I would like, however, to ask one or two questions. The first, is whether as regards the first or second parts of the Bill any separate statistics have been prepared for Ireland, or whether any separate actuarial calculations have been made as regards Ireland? Such separate actuarial calculations may be of great importance in arriving at the conclusions upon the various points of the Bill as it affects Ireland. I would like also to ask the Chancellor of the Exchequer if he has considered the justice—and this is really a point of vital importance as regards Ireland—of making or prescribing the same rates of contribution from employers and employed over the whole of the United Kingdom. This matter seems to me to lie at the root of a good deal of this Bill so far as Ireland is concerned. The health conditions of the United Kingdom, as a whole, constitute the basis on which these contributions or rates of contributions have been fixed.

The health conditions, however, are not uniform. They are not the same throughout Great Britain and Ireland. If Ireland be taken as a whole, it will be found that the rate of sickness there is less than in Great Britain. The simple reason is that whereas the overwhelming majority of the people of Great Britain live in towns and urban centres, a similar overwhelming majority, if not a larger majority, of the population of Ireland lives in the rural districts. I suggest to the Government that that is a matter to be inquired into. If it be so, the consequence will be there will always be proportionately smaller demands from Ireland upon the Insurance Fund in respect of sickness and disablement than from Great Britain. So that if the rates of contribution be sufficient to provide fixed benefits for Great Britain they would be more than sufficient to provide similar benefits in Ireland. In other words, smaller contributions, from Ireland, from both employers and employed, would suffice to produce the same benefits as in Great Britain. I would like to know whether this point, a matter of prime importance, has been considered by the Government, and I would like to know their view upon it? I would like in a sentence to refer to one point of detail. We have in Ireland at present many medical services for the poor, which are among the few bright spots on the social horizon. I do not think there can be found anywhere a more devoted, zealous, and deserving body of public officers than the doctors in our Poor Law service. I desire to say that we deem it to be our duty to secure, if we can, that the changes which this Bill, if passed, will bring about in the administration of medical relief in Ireland to the poor and working classes, shall not prejudice directly or indirectly the medical officers or dispensary doctors in Ireland. Subject to the modifications which a thorough examination of the provisions of this Bill may show to be absolutely necessary from the point of view of Ireland, we on these Benches will heartily spport the application of the Bill not only to Great Britain, but to Ireland.

Speaking as one of those few Irish representatives who happens to represent a constituency which, although mainly agricultural, contains one of the largest centres of industry in Ireland, I venture to say, on my own behalf, I welcome the provisions of insurance against unemployment with equal cordiality to that with which I look upon the provisions against sickness and disablement. The conditions of life of the poorer classes in the large centres of population in Ireland are, in many instances, simply shocking. Something must be done to alter things in that respect. It is said that the expense that would be entailed by the working of this measure upon industry would be ruinous. Personally I do not believe anything of the kind, even if there were no compensating advantages, but the compensating consequences to my mind are absolutely certain. The provision against sickness and disablement in this measure appears to me to be a real step in advance towards the abolition of the workhouse, and a corresponding decrease in rates as well, and a general uplifting of the social life of the masses of the people, which in its turn, in my opinion, will also lead to beneficial consequences to the whole community. I recognise that we ought not to be deterred from the task of trying to accomplish that most desirable end by any but the most overwhelming consideration.


I rise on behalf of the Labour party to offer a few words of observation upon this Bill, and, in doing so, I am not ashamed to say that I am at a disadvantage in not knowing fully the whole provisions of the Bill. I am not ashamed to say that, because it is, after all, a very large and complicated Bill, and has taken, I suppose, nearly two years to prepare, during which period the Chancellor of the Exchequer has had the opportunity of consulting the experts at the Treasury and expert officials outside and of obtaining all sorts of expert advice, and then after two years it is submitted to us a fortnight ago, and it is too much to expect the average man like myself to understand fully all that has been soaked into the minds of these experts during those years of consultation. While I rise without professing to fully understand the significance of the relationship of all the Clauses of this Bill one with the other I am not afraid to say that I welcome the Bill on my own part and on behalf of those with whom I am associated. The hon. Member for Sevenoaks (Mr. H. W. Forster) a little while ago said that in his judgment the Bill asked too much. I do not know whether that is so or not. At all events, he promised his support, and I suppose he speaks for the party with which he is associated as well. At all events, this Bill has met outside with no warm opposition, but a quiet acquiescence on the part of those who are affected by it, and will be called upon to administer it.

I think we may take the introduction of this Bill as marking a distinct step forward on the part of the community and as a recognition of its duties towards the poorest and weakest amongst us. For that reason I welcome the Bill. I also welcome the statement made by the hon. Gentleman the Member for Sevenoaks that he was in favour of the blessed word "compulsion," and further, I welcome his statement about trade unions and friendly societies. I am a member of a trade union and a friendly society, and I appreciate the fact that from all quarters the work of these voluntary organisations is now pretty generally appreciated. They have done a great deal in cheering homes that otherwise would be without cheer; in helping people to help themselves, and in aiding and helping the State, because after all, if they had not dipped their hands into their own pockets the State would have had to help them. But while that is so with the highest and better-paid body of workmen, I am glad it is also now recognised that voluntary effort among the very poorest is practically out of the question, and it is, I take it, a justification, or at least one of the justifications, for this Bill that voluntary organisation for this purpose among the very poor is out of the question.

I associate myself with the hon. Member for Sevenoaks in regard to Post Office Deposit contributors when he pleaded they are being dealt with less favourably than should be. I think the hon. Gentleman did not fully state the case. He said these depositors were persons not eligible for trade unions or friendly societies—I am not sure whether he mentioned trade unions, but at all events he mentioned friendly societies—and he said quite correctly that these persons would be paid only what they paid in, whereupon the Chancellor of the Exchequer interrupted they would get the benefit in the lives that drop out. Well, it is a poor consolation to the widow of the person who has dropped out. These Post Office contributors are not only not eligible to join friendly societies and trade unions, but they consist very largely of casual labourers and men who cannot join any organisation. Of course it will be said that the machinery of this Bill does something to encourage them to join voluntary organisations, or friendly societies or trade unions. But there are so many poor people that I am afraid that you will not be able to do that, and therefore I think the two classes I have mentioned might be more favourably dealt with under the Bill.

The next point I wish to allude to is in regard to separation. If there is to be separation—and I am not saying that there ought to be any separation, but it has been suggested by the right hon. Gentleman the Member for East Worcester, and I rather think also by the hon. Member for Sevenoaks—I hope it will not be the unemployment portion of the scheme that will be dropped. I think it would be most unfortunate to drop either part, but if either part is to be dropped I hope it will not be that dealing with unemployment, because after all that is a small part of the scheme, and the one which would get through with the least trouble. More than that, it is a question that ought to be settled when trade is good and when there is money to finance the scheme. I am afraid if it is shelved now and the other parts proceeded with we probably would hear no more about it, or it might be brought forward when trade was bad and the demands upon the Funds so heavy that it might be stillborn. Therefore, I hope that that part will not be thrown over. With regard to the general scheme, I commenced by saying I do not profess to fully understand the whole scheme. We have had many meetings to consider the matter, and we propose to have many more, because we want to thoroughly understand it, and I do not think it is any disgrace to say that we cannot fully understand in a fortnight a scheme of this magnitude which is produced after two years of consultation by the right hon. Gentleman the Chancellor of the Exchequer and his experts. But in so far as we have yet made up our minds upon the scheme we support it, although our support is tinged with some misgiving as to its working and its probable effect upon the efficiency of trade unionism, and, therefore we support the Second Reading with the distinct understanding that our future action will be very largely determined by what takes place between the Second and Third Reading.

There are some parts of the scheme which we all endorse, and which we are very glad have been brought forward. I refer particularly to the parts of the scheme dealing with maternity, consumption, and medical aid. It is one of the most pathetic things in connection with modern life that women have to bear, not only burdens incidental to sex, but also the heaviest part of life's industrial burden as well. Their wages are lower and their hours of work longer and their conditions more onerous than men, simply because they are more dependent; and, although the Bill does not do all we should like it to do to relieve their industrial burden, yet, if carried into effect, it will provide at the most critical period of their lives a little of that skilled attendance and of the necessaries of life which they cannot otherwise procure, and, therefore, we have nothing but admiration for that part of the Bill. With regard to consumption, we are glad to know that this country has at last began to follow the example of Germany in dealing with the ravages of this fell disease. We are glad to know that responsible Government, acting in accordance with the wishes of the community, are at last beginning to recognise that consumption carries off every year more than the number who fall by the battle murders and sudden death of a war, and that, to a very large extent, consumption is preventable, and is very largely caused by poverty. We are glad, therefore, to know that something is to be done through scientific re- search and otherwise, not only for the cure of this disease, but for its prevention. We are glad to know that this House has come to recognise in this Bill that human life is, after all, a valuable asset.

6.0 P.M.

We are glad to know that in the future, if this Bill becomes law, a person in receipt of medical aid will have the same right of access to the doctor as the owner of property to the services of the fire brigade. I notice in the papers that there is a controversy going on about the doctors, and I am not going to express an opinion as to whether the Chancellor of the Exchequer's provision is ample or not; but on the general question of the payment of doctors, I hope they will be treated generously. We want the best medical advice we can get, not only for the poorest of the people covered by this scheme, but for the whole of the people. If you have doctors poorly paid, or if they are so paid that they have to do the work in a perfunctory manner, only the poorest people will go to them, and there will be a social stigma attaching to those who do go. I hope this matter will be settled by so arranging the provision dealing with the doctors that everybody will avail themselves of the medical aid provided.

The provision for the scheme being worked through voluntary societies is somewhat different to the German scheme. I know we are differently placed to Germany. When Germany introduced her scheme there were practically no voluntary agencies there, and we are fortunate in having those agencies in this country. Therefore I think it right and proper that the Chancellor of the Exchequer should avail himself of the existence of those voluntary agencies. I am glad he has done so, because I believe the administration of the scheme will be less costly in consequence, and he will avoid the need of setting up great bureaucratic departments, with all they involve in cost and irritation. I come now to the more debatable part of the scheme so far as we are concerned. The valuation of the society is not very clear in the Act. It is not clear whether it is the intention of the Government that a valuation of all the property of the approved societies should take place, or whether it relates to only a part of the property with which we are dealing under this Bill. I gather that the latter is the proper interpretation. To that we have no objection, and therefore we may reckon that point as settled. Now I come to the premiums and the compulsory deductions. The premiums are theoretically unsound, and I think the State ought to bear those burdens. But we are willing to face facts. We recognise that workmen are to administer funds drawn partly from outside sources and we do not push theoretical considerations too far. As for deductions, workmen have hitherto been very chary about accepting deductions from wages, and rightly so. Up to the present those deductions have been associated in their mind with something far different to that which is provided for under this Bill. As a rule deductions have been associated with truck or with the grandmotherly, or shall I say grandfatherly, schemes of employers who very often organise superannuation funds and schemes connected with shop clubs, not altogether for the benefit of the workmen, but incidentally having the effect, if not the intention, of splitting the workmen up into sections all over the country, and it is very largely because of that that the workmen have been so bitter against any deductions from their wages. That does not apply, except in so far as the Government recognises shop clubs in Clause 19. If I read it correctly, it encourages the formation of those shop clubs, but so far as we are concerned, we shall have to very carefully consider Clause 19 as it goes through Committee, because we do not want the formation of shop clubs encouraged and multiplied, because the direct effect of this would be to discourage and weaken trades unions organisation, and it would enable employers in a few years' time to throw the burden which now goes on to their shoulders on to the shoulders of the workmen.

There are one or two other things which may have the effect of operating against trades unions organisation. Take, for example, Clause 18. I know that an explanation has been given to the effect that this Clause does not mean what it says. Unfortunately, as we have so often observed in Acts of Parliament, when we pass a measure we try to put into it what we mean, and the judges pay precious little attention to what our intentions were, and they interpret what they find in print. Clause 18 expressly sets out that a society shall not become an approved society unless it satisfies the following condition:— It must be precluded by its constitution from distributing any of its funds otherwise than by way of benefits (whether benefits under this Act or not) amongst its members; The Chancellor of the Exchequer has stated that the word "benefits" means only provident benefits. If that is so that might partly meet our objection, but I want to put it that the trade unions of this country have often given money away and lent money to fellow trade unions and borrowed money for all sorts of objects, and I am very glad, indeed, that they have been able to do so. I know many years ago that the engineers' society, with which I have been connected, gave £1,000 to assist the cause which Mr. Plimsoll advocated, and we also gave £1,000 to Joseph Arch when he was engaged organising the agricultural labourers of this country. Within the last few years the engineers' society has given money, not only to people in this country, but to people in Germany and Denmark, to assist workmen struggling to be free. We want to use our money absolutely as we like, and, therefore, we cannot assent to Clause 18, which would prevent us continuing to do in the future with our money what we have done in the past.

With regard to Clause 20, I should like to put several things together here. Having made no preparation, I am afraid I may be somewhat obscure on these points. Let me remind the House that the trade unionists of this country have always held that there should be no separation of their funds, and we are not going to have any separation of funds imposed upon us now by law. Some of us separate our funds and many of us advocate that course, but I do not want the House to think for one moment that we want to be compelled to do it. We hold that we ourselves should determine how we are going to use our funds. I want to lay down another principle. The first principle of trade union organisation is the industrial betterment and the economic advantage of their members, and therefore we claim that, although we pay sick benefit and many other benefits, our first consideration is that we should be in a position, if we think proper, to spend at any particular time every halfpenny in our coffers in industrial benefits. We have often done that. I went through a great dispute in 1897 and 1898, which cost the society with which I am connected over £750,000, and on that occasion we spent not only the whole of the money that might fairly be allotted to trade union purposes, but we spent all our sick money as well. To a person who does not understand the trade union movement this might seem a very improper thing to do, but if you go back in history you will find that trade unions have frequently done that, and never once can it be said against a trade union that it has not always paid its sick pay and superannuation pay and all the promises made to its members. It has more than fulfilled those promises, because the benefits have been increased from time to time since trade unions started. We claim a right to continue that course.

Hon. Members will be wondering how it is that that is cut into by this Bill. It has to do with the scale of benefits, which I suggest to the Chancellor of the Exchequer, is too low. I take the case of the society with which I am more particularly connected, the society of engineers. I have compared the scale of benefits given by my society with the scale provided under the Bill. Under this measure you propose as sick benefit 10s. per week for thirteen weeks and 5s. per week after that. The engineers' society pay 10s. per week for twenty-six weeks and 5s. per week after the expiration of that period. Therefore our scale is more liberal than your scale. You propose to deduct 4d. compulsorily from a man's wages. I assume that that 4d. is going to cut into the contribution to the union, because the man is not likely to be able to pay 4d. over and above his present contribution. I take the engineers' contribution to his union to be 2s. per week—that may be a little over or under what he actually pays, but it is somewhere about the mark. I take it that 1s. 8d. of the 2s. contributed by the workman remains with the union, and instead of getting 2s. as before, the union will, under this measure, get 1s. 8d. I am told that that does not matter, because the union is going to get back all it has paid out, and, therefore, it is not going to lose anything. We are told that instead of losing anything the trade unionist is going to gain something, because he is going to get a lot more than 4d. in the way of benefits, such as maternity benefits, medical aid, and the rest of it. That, however, is not the point. My point is this: I want the House to be alive to the fact that by your scale you are giving two-pence and you are taking four-pence. You may not believe that, but I want to show you the figures. I have here some leaves torn from this year's report of the Engineers' Society. I tore them out today, and they give the experience of that society from its beginning. It is a rather large experience, extending as far back as the year 1851. The sick benefit on the more liberal scale I have mentioned costs the members of that society, in round figures, 2¾d. per week, so you see we pay on a scale which costs us 2¾d. I assume your scale to be 2d., and we are stopped 4d. for it. Therefore, at the end of three or six months we are out to the extent of the difference between the 4d. and the value of your scale, and to that extent you have cut into the principle I have mentioned of the trade unions having the right to use their own funds in their own way.

I cannot say I fully understand Clause 20 now, but, so far as I understood the right hon. Gentleman (Mr. Buxton), who was on the point when I came into the House this afternoon, it is only under certain circumstances that the societies are to be required to find a sum of money as a guarantee. I understand they are required to find a guarantee if they want advances made to them, or something of that sort. Supposing they require advances to be made to them, they have to find a sum of money equal to one-half of the contributions of the whole of the members covered in this scheme. That is the Bill. Let us look at an extreme case. We will say the Engineers' Society are covering 50,000 of their members. The contributions under the Bill amount to 28s. 4d. per year, so that every man will have to be covered by this guarantee to the extent of 14s. 2d. Fifty thousand times 14s. 2d. amounts in round figures to about £30,000 or £40,000. The society, therefore, is going to be deprived of the use of that money for all time, and for a considerable period of time—three or four months—of the other amount I have mentioned. We cannot assent to that taking place, and in that respect there must be considerable modifications in the Bill. I have illustrated the point by taking a union that may be said to be at the top. Let me illustrate it by a union that may be said to be at the bottom. I think the thing is much stronger then. My hon. Friend the Member for West Ham (Mr. William Thorne) is the secretary of a society with many thousand members. You require the unskilled labourer to pay 4d., and I want to know what is left and where there is any margin for the unskilled labourer in receipt of 16s. or 17s. per week if you deduct 4d. from his income. You say a society can become an approved society, even although a trade union, for the purposes of this scheme, but if 4d. is deducted from that man's money what is left for him to pay into his trade union to defend his economic interest. It seems to me there is very little left. I am reminded that it is not 4d., but 6½d. that you are going to deduct, and we say that, after deducting 6½d. for the purposes of this scheme, there is going to be very little left. Therefore, we are very much in favour of a liberal gradation. You have recognised that no man in receipt of a wage under 15s. per week is to be charged the full amount. I should say that a man with a wage under 15s. per week should not be charged at all, but, whatever may be the ultimate decision, we do say, and I press this point strongly, that the Bill must be amended and altered in such a way as to relieve these men with wages at the bottom of the scale from full payment, and perhaps from any payment for the purposes of the Act.

I am rather glad the unemployed part of the scheme can afford to pay higher benefits in proportion to the contributions than the sick part. The difficulties I have mentioned therefore do not on the whole arise there. There are just two Clauses, however, to which I should like to draw the attention of the Chancellor of the Exchequer with regard to the unemployed part of the scheme, and they are Clauses 62 and 64. There is considerable danger to the trade union position, and I want to see the trade union position maintained. It is made a condition in Clause 62 that a workman shall not be deemed to have failed to fulfil the statutory conditions by reason only that he has declined an offer of employment" … "at a rate of wage lower than the rate which he habitually earns when in employment. We think that does not go far enough. Take the man of progressive wages up to twenty-three or twenty-four years of age. The Government themselves, as a matter of fact, employ men up to twenty-five years of age before they come to what may be called the standard rate of wages appropriate to their trade or calling. If this man refuses an offer of work at wages not higher—put it like that—than what he had while in the progressive period, it seems to me the literal interpretation of this Clause would prevent him getting the benefit. I do not know whether that is the intention of the Government, but, if it is, then that particular part of the scheme must be rectified before we can assent to the Bill, and I hope it will be rectified. Then a man is not to get his benefit if he refuses a job at wages lower than the current rate in the district in which the job is offered. Here, again, we say—and I think we are strengthened in the statement by all that has taken place in regard to the controversy about the determination of current rates under the Fair-Wages Clause—that a man should not be refused his benefit if he refuses to work at current rates? What are the current rates? It would puzzle a Philadelphia lawyer to find out what are the current rates in any particular district. I have put questions to the First Lord of the Admiralty (Mr. McKenna) about current rates of wages in London. I do not know what he means, and whether he knows what I mean or not I cannot say.

We stand for a perfectly easily understandable principle when we say we are banded together to maintain a standard rate of wages. We say that as workmen we are just as much entitled to a standard rate of wages as Cabinet Ministers, or anybody who find their way on that Front Bench, and we are not going to assent to any Bill or anything which will endanger the maintenance of that standard rate of wages. We say this Bill literally interpreted, would prevent a man getting his benefit under the Act if he refused to work at the current rate, which might be less than the standard rate. Therefore, I hope the Government will give their mind to that matter. Clause 64 says:— All claims for unemployment benefit under this Part of this Act, and all questions whether the statutory conditions are fulfilled in the case of any workman claiming such benefit…. shall be determined by one of the officers appointed under this Part of this Act for determining such claims for benefit. We object to that. We think the proper agency for distributing the unemployment benefit is the trade union. We have had a lot of experience of it. I think it may be claimed without any egotism that we know how to do it. At all events, we have done it for nearly 100 years, and we are the only people who have done it. The State has not done it, and nobody else so far as we know. The trade unions have been distributing unemployment benefit for nearly 100 years, and we ask that we should continue to be the agency for the distribution of unemployment benefit. We do not want to interfere with the Government with regard to the administration of the other part of the scheme, but in respect of our own members we ask the Government to entrust us with the pay- ment of that benefit. There is a good claim for that even from the point of view of time, because after all, if a man is out of work, he wants his money promptly. He has no time to run about looking for the Insurance Officer, possibly making long claims on paper, and answering no end of questions.

The trade unions have a simple form, understood by all the members, for the administration of these benefits. At given times they attend at certain places and sign their names, and we think that ought to be sufficient for the purposes of this scheme. If you do otherwise, you will have a man first of all running to the Insurance Officer to fill up forms and to get 7s., that part of the benefit he is going to get under your scheme, and then going to the trade union to get his other 3s. It will involve two journeys, two signatures, and filling up various forms, and it will cause endless confusion, endless irritation, and needless expense to the individual. These are some of the points which obviously need attention from our point of view. I do not put them forward in any factious spirit. We are very glad the Bill has been introduced. We think it marks a great step forward, because it brings many millions of workmen into direct contact with the State, and is therefore going to be of immense educational value. We believe people have been too much inclined to look upon the Stale simply as a big policeman, and this Bill will enable a great many of them to realise that the State, after all, is what they like to make it. We welcome the Bill from that point of view. We hope it may get over all the hurdles of opposition and criticism to which it may be subjected, and that, as amended and altered in the form I have suggested, it will ultimately pass and become law.


I think everyone in this House will agree no Bill has ever come before this Assembly that has met with fairer treatment. Every Member of this House is most anxious to do all he can to make the Bill a success, and at the same time not to do any injustice to any vested interest which this Bill may affect. The question of the friendly societies is one which they themselves will be able to deal with. But there are a number of other societies, such as slate clubs, which have done a great deal of good work in the past, and which, to my mind, have been very much more useful in suppressing malingering than such recognised societies as the Oddfellows and the Foresters. In the ordinary slate club the member pays in 6d. or 7d. per week, and, at the end of the year, there is a division of what is over, after keeping back a certain balance sufficient to prevent them getting into difficulties in the next year. I think if the ordinary friendly societies adopted a similar practice, they would find it easier to deal with the question of malingering. Most of these societies divide up at Christmas, and they run the sickness fund on something like 7s. or 8s. a year. I throw that out as a suggestion; of course, the right hon. Gentleman must he guided by the actuaries who advise him in this matter.

Of course, the great blot in this matter is the entire leaving out of married women. I refer principally to those who have young children. It is not right to say that a married woman does not work for her living at home. She has her household duties to perform, and I think some effort should be made to bring her into this scheme. The only reason I have heard against this is that you cannot prevent malingering. But I do not think there is likely to be any malingering in the case where a woman has to provide for a family; she cannot possibly declare on the funds having regard to the demands of her Young children. It would be greatly to the advantage of the State to have married women with a young family looked after in a satisfactory way.

As regards the question of Ireland, I do not propose to offer many remarks, because the hon. Member for County Dublin has put the case very clearly. I think we shall all agree that this Act can be made very useful, and when it comes into Committee every effort will be made to put it in practicable form. The people in Ireland are absolutely in a different position. The Bill suggested by the hon. Member for Dublin must receive many Amendments.

I arrive at a point on which I wish to offer a few remarks, because it is a point on which I have had some practical experience. I may say, at the commencement, that there is no member of the medical profession throughout the length and breadth of this country who will not do his best to make this Act a success, provided that the result will not be to interfere with his wife and family, and with those who are relying on him for support. This Bill is perhaps one of the largest Bills that has ever been brought into this House. The right hon. Gentleman took two and a-half years, and employed any number of actuaries to assist him in getting evidence from all classes and condi tions of the people, and he came to this final result that three-fourths of this Bill could safely be put before the public. Then came the question of medical relief. The right hon. Gentleman was told it was absolutely impossible to put any definite principle on insurance in the form of a medical benefit. What has he done? He has asked the medical profession to underwrite an insurance which he, with all his millions at his back, would not undertake. The medical profession do not want anything unreasonable, but they want at least to have some say in the premium which the right hon. Gentleman is going to demand from them. It is not fair or right that he should demand that the medical profession should underwrite this scheme without at the same time allowing them to fix the premium which shall be paid. If that were possible the principle might he extended, and we should all be able to insure our lives in a most satisfactory manner to ourselves.

With the starting of friendly societies we had the origin of what is known as the "club practice." I should like to explain to the House how that practice arose. Many years ago, it was possible for a medical man to employ unqualified assistants. He would give them 30s. a week, and provide them with top hats and frock coats. But all that is completely altered now. Still, that was the start of the system known as the club practice. No longer is it possible when an antiseptic dressing is required for a medical man to put simply a rag around the finger of the patient. Much more is now demanded. I take it if the Government want this Bill to be a success, if they want to insure its proper working, that they will have to bring about a very different state of affairs; the best dressings and the best drugs will have to be used, and every facility will have to be given to the medical man.

There are three classes of medical men. I am not claiming that the medical man is immaculate. But I venture to say that this class of men are not the class of men we should attempt to bring into this Act. On the other hand, you have the consultant and the specialist, the man who has got a kind of practice, almost between the general practice and the consultant's practice. The people you want to bring in are the bonâ fide family doctor, the respectable steady man who will put all his interest into the working of this Bill. There is an impression abroad that everything is satisfactory to the profession in regard to this Bill. But I have received over a hundred letters during the last few days, and I can assure the House that the feeling of the profession has been aroused in this matter as it has never been aroused before. We have no trade union in our profession, and it is because I am anxious not to see any trade union started in the profession that I hope the right hon. Gentleman will give us some assurance which will be satisfactory that the amount of money to be offered for the work required to be done will be sufficient. After all, the medical man is not, merely a medical man. He is the friend of the house. He is brought into the house under sad conditions, and he receives confidences which are necessarily respected by upright, straightforward men. If you bring a trade union society into our profession, you will find a very different state of affairs would arise. It would not be for the benefit either of the profession or of their friendly relations with the public.

There are three points which I think it is right, at this stage, should be mentioned. The first is that you will not have the friendly societies as an intermediary between you and the working classes of this country. I do not believe that 5 per cent. of the whole of the medical profession would agree that it can be worked on this basis. The next is that they view with great alarm the £160 limit. They consider that £160 is altogether in excess of the amount which they ought to be fixed per annum. The vast majority of the medical men who are attending in suburban districts would lose a very considerable amount of their income if this limit were insisted upon. We think it ought to be reduced. I wish the right hon. Gentleman would give the medical profession, who are unanimous on this point, some assurance. The third point is that the profession think there ought to be a free choice of medical men. I believe that is a point upon which the Chancellor of the Exchequer is very determined. He does not think it ought to exist, but what will be the position of affairs if it does not? The club doctors of the present day would receive all the benefits of this Act, and those medical men who have not clubs at the present moment would see their patients whom they have treated for years, and their families perhaps, go over to other doctors. Even though they continue to treat the family, the man himself would go to another doctor, and I do not think that would be fair or reasonable. I do not think, moreover, it will work well, because I think it is very much better that a man should be treated by his family doctor, who attends both him and his wife and children, even if he does become a member of a scheme under this Act. In those instances in which doctors have passed cases of malingering, or have been guilty of some other misconduct, I think it would be very easy to bring such men before the Local Medical Association, who would be only too glad and anxious to see that no discreditable action on the part of medical men should take place under this Act.

Coming to the question of the Capitation Grant, the feeling about that among medical men in this country is that they ought not to be asked to accept Capitation Grant because they are asked to go completely outside their work. They are medical men, and if they are going to succeed in doing good to their patients and in curing diseases should not have too much put upon them, but the Government, under this Bill, are transforming them into brokers as well as doctors. I recognise, as one who has done a great deal of work for benefit societies, and, indeed, we all recognise, that if the members of the medical profession do not come forward for a certain number of years and give the necessary medical benefits there will be no prospect of this Act effectively coming into force. Therefore, I do not think that the medical profession ought to be asked to do this work, which should be done efficiently, unless they are properly paid. The sum of 4s. 6d. has been mentioned, and the amount of 6s. has also been brought forward as payment for medicine and drugs, and upon this point I think it would be well if an amount were mentioned, and for this reason. To-morrow the right hon. Gentleman is going to reply to the various criticisms on his Bill. There is a strong feeling in the profession on this subject, and they are looking forward most anxiously for some reassurance from him. Some people may think one figure is right and other people may think another figure is the proper one. I have very carefully considered the matter, having had long experience in all conditions in London and in the country, and I have come to the conclusion that it is a most difficult thing for anyone to fix the exact amount. What have we to fall back upon, therefore, except the Government opposite, and not only the Government of the day, but the Government before that. They have the Post Office officials. I was a doctor under the Post Office, and I received for each healthy individual—a good life, a man who had been examined and who lived the healthiest life of anyone in the country in the open air—I was paid a fee of 8s 6d. per member, and that included visiting and medicines and consultation at home.

I say that is reasonable. I do not say the medical profession will accept that, but I only express my own opinion, and I do so for this reason, that I do not believe that the last three or four Governments have been throwing money away in paying 8s. 6d. a head, and I do not think the Post Office Department, either, are anxious to throw money away. Some of us who live in country districts cannot get our letters for three days, and there is no attempt to alter that state of things, and therefore I do not think the Post Office is inclined to go to unnecessary expense. If it is fair for one Department of the Government to pay 8s. 6d. for healthy lives in London, I do not think that another Department can put the figures below that amount. People have got an idea that every healthy man will go into an insurance company, but I do not think that. I think you will have many a healthy man going into the Post Office scheme, and under these circumstances I think the State should only have to pay the doctor as a friendly society would pay for men who were in good health. Beyond that you have a very serious element to deal with where the people are chronically ill. You have cases which require daily or constant medical or surgical advice, and those cases must he treated on a separate basis. But I do feel that if the right hon. Gentleman to-morrow were to say that he is prepared to offer the same terms under this Act generally that his colleagues offer for the Post Office, that the medical profession as a whole would make an honest attempt for some years to see whether they could not do something towards making this Act a success.

I do not think it is an unjust proposition to put forward. The profession is not a lucrative one, and there are less men going into it every year, while the country is increasing in population. Moreover, we are populating other portions of the world, where it would be advisable for us o have British doctors, and not to allow foreigners to come in. If you are going, therefore, to lower the standard of the profession you will not have men of equal character coming into it to those who have come into it in the past, and I think it will be to the advantage of the State to lift up the profession rather than to set it back. We are only too anxious in the profession to do everything that lies in our power, and to take a fair share in paying the taxes of this country, but I think we have a right to appeal to every Member in this House that we who have clone much in sacrificing our time to forward charitable ends and in attending people who never pay us—I think we are entitled to at least the consideration which would be given to every other profession when it is attacked by the State. I think, however, we are safe in the hands of the House of Commons, and I do not think this body, representing the great masses of the country, would be prepared to do an unjust act to a profession which has done its duty to the best of its powers.


In the few remarks I propose to make I intend to deal with that part of the Bill which touches the treatment of consumption. My excuse for doing so is that this in itself is a sufficiently large and important matter to be separately considered, and that it requires a great deal of elucidation. If properly interpreted and if properly managed, as I hope they will be, I think the proposals of this Bill in regard to consumption will do more good than any other single proposal in the Bill. I will not touch at any length upon the justification for bringing forward these proposals in the Bill. They are two-fold. First of all there is the humanitarian, and then the economic necessity for dealing with this question. We have to consider the charge which it is proposed to make, the expenditure which is proposed by the Chancellor of the Exchequer, and compare it with the cost to the community of the disease of consumption at the present day. It is difficult to arrive directly and indirectly at the exact cost of consumption, but I am sure I should underestimate it if I put it at £5,000,000, and I should still probably be underestimating the direct and indirect cost if I put it at £10,000,000. Therefore, without labouring the point, it becomes evident that it is much cheaper, and it is economically sounder, to spend money in order to do away with this disease than to go on as we are now, supporting nearly half a million of people who are suffering from it. The objects of the Bill, as I understand them, are twofold. It provides not merely for the curing of the disease, not only for the treament of those who have it, but also for the prevention of the disease. No general ever won a campaign by merely attending to the wounded and by merely giving ambulance treatment to those who were disabled. He has to prevent the enemy from attacking and overcoming the rest of his army, and, in dealing with this particular scourge, if we are to stamp out consumption we must not only alleviate the sufferings and cure the people who are afflicted with it, we must also make provision for preventing its spread to others —to the rising and unborn generations. We, as legislators, wherever we sit in this House, or whatever party we belong to, are convinced that it is our duty to make it year by year more unlikely that fresh people should succumb to this disease.

I want to deal with the two chief criticisms which have been directed outside this House against the proposals of the Government. First there is the criticism in regard to bricks and mortar. We are asked what is the good of spending so large a sum upon bricks and mortar? This criticism, to be valid, presupposes two things. First of all, that you are going to be extravagant in erecting your sanatoria. Secondly, that when you have erected them it will never be possible at some future time, to use them for other purposes. If it were proposed to erect the sanatoria at a cost of £1,000 a bed I should oppose the proposal, but it is perfectly possible to erect sanatorium buildings at £100 a bed. As to the other part of the criticism it is obvious that, although you are building these sanatoria for the purpose of stamping out the disease, if you are lucky enough to do so, it will be possible to use these buildings for other purposes, such as convalescent homes. Our duty surely seems to be not to say that we should not spend this money, but that we should watch those who have the spending of it in order that they do not waste it. The second criticism that is directed against the proposal is based upon the fallacy that sanatorium treatment has failed in the past, and the critics say why spend £1,500,000 on treatment of that character. But sanatorium treatment has not failed, and it is not proposed to spend the whole of the money on erecting fresh sanatoria. The Bill does not say that we must spend the whole of the money for that purpose. If it did I should oppose it. Sanatoria are only a part of the proposals for dealing with this disease. The Bill says that we shall make provision for the erecting of sanatoria and other institutions for dealing with consumption. Therefore the point that I want to put before the House is that the proposals contained in this measure are sound because they are sufficiently wide in their scope, and there is sufficient latitude to deal with the whole aspect of this question.

7.0 P.M.

Why is it that sanatorium treatment has been criticised? First of all, it seems to me that too much has been expected of it. It was imagined that you could send any sort of consumptive to a sanatorium and have him cured. It was thought that fresh air and what was known as sanatorium treatment would almost cure the dying and bring about miracles. As a matter of fact some of the cures brought about in sanatoria have been almost miraculous. The second point is that the sanatorium treatment is particularly effective if the patients are sent there in the early stages of the disease, but the difficulty has been in the past that in many cases the general medical practitioner has not had the training or aptitude to recognise the consumptive in the early stages. I have come across innumerable instances of consumptives who have been sent to a sanatorium recommended as early cases by the general medical practitioner, going there full of hope. When they got there the specialists in charge of the institution had to tell them they were not early but advanced cases. Disappointment naturally resulted to the individual, but because of this external mistake it is not fair to criticise sanatorium treatment in itself.

Another reason why there has been criticism is that it has often been difficult to get men belonging to the working classes to stay sufficiently long in a sanatorium. If a man is a good father and a good husband, and knows that on his weekly earnings his family depend, unless you make provision for the maintenance of the family it is very difficult for that man to remain on in the sanatorium week by week when he feels all right, and a large number of persons in the past have left before the cure was completed. They have gone because they felt they must work to support their families. I hope the Chancellor of the Exchequer will bear this in mind. I believe provision is now made to give a benefit of 10s. a week for three months. I hope he will realise that if an extra month were added in the large majority of cases a real cure would be accomplished. It would be money well spent. It would only after all be a matter of another £2, and you would probably prevent that person coming on your fund in one or two years' time for a disablement pension. It would often be not only humanitarian but it would be economical to give additional treatment for more than three months in order to get a real cure. Another reason for the criticism that has been directed against sanatorium treatment is that to apply to consumption the expression "cure" is practically a misnomer. We should rather say that the disease has been arrested. You get small-pox and go to a fever hospital, and when you come out you know that you are cured and are practically immune as far as that disease is concerned, but it is not so with consumption. I regret to say one occasionally has evidence of a man leaving a sanatorium and celebrating his return home by a glorious orgy. Little by little he forgets the lessons on hygiene which were taught him there. He goes back to the old conditions, to the old ways, and as a result a few months or a few years afterwards relapses and breaks down. But because the general public has not understood the difference between the cure and the arresting of consumption as a disease there is no reason why this criticism which has been directed against sanatoria should be listened to.

So much for criticism. Now for the value of sanatorium treatment. Let me turn, first of all, to Germany. There a large number of sanatoria have been erected, but not by special provision as is contained in this Bill. The sanatoria have been erected in Germany by those who are responsible for the management, the accumulation, and the investment of the accumulated funds. They realised that a large number of the cases that came to them for sick benefit, for disablement pensions, for death benefit, were attributable to consumption. They looked into the matter, and they found that it was a good business proposition to spend money out of the accumulated funds on sanatoria and to give sanatorium treatment, and that they as trustees were justified in making this expenditure. I think this is a most valuable evidence that the proposal contained in this measure for the erection of sanatoria is a good and a sound one. The second point is the educational value of sanatorium treatment. You have some cases which can be practically cured. You have others who may be given years, perhaps not of full efficiency but years of comfort, if they have been taught how to live. After all, sanatorium treatment does not, as many people imagine, merely mean sitting in a draught and drinking cream for a certain number of weeks. You go to a sanatorium to learn the principles of hygiene, of fresh air, of sobriety, of good food, and cleanliness, and it is much easier to learn these in a sanatorium than it would be at home. In a special institution, under constant medical supervision, where a certain amount of discipline is enforced, you learn these lessons as you never could learn them at home, and there is the great advantage that a man leaves with the disease arrested. A new arrival sees the effect of carrying out the orders given by the doctor in charge, and is likely to carry them out.

The next benefit of sanatorium treatment is an indirect benefit. A man goes there and is taught not only how to increase, to lengthen and to prolong his own life. He is taught how to become noninfectious as regards the rest of the community. He goes out and he brings into his own home the principles of hygiene and sanitary living which he learnt in the sanatorium, and thereby he makes it more unlikely that his family, living as it is necessary for them to live under these improved hygienic and sanitary conditions, will contract the disease at some future time. In fact, if I may put it so, the patient who has been to a sanatorium and has been discharged becomes a centre of hygienic education and a centre of prevention instead of, as he was before, a centre of infection. He becomes a centre of health instead of a centre of disease. There is a very large percentage, I believe it is put by authorities at over 70 per cent., of the persons discharged from sanatoria who become a source of strength instead of a source of danger to the community. It will be necessary to spend a great deal of money in providing additional beds. A great difficulty in the past in getting a working man to go and be examined has been the lack of accommodation. He had probably seen a friend of his who suffered from consumption. He had seen him go to a doctor, be examined, and be condemned. He had seen him wait week after week, month after month, hoping to get accommodation in a sanatorium, but unable to get a bed. He had seen the disease get a grip of that man, and had therefore said to himself, "what is the good of my going to get examined when there is no chance of my getting into a sanatorium?" If you compel by Act of Parliament a man to insure against a particular disease, you are in honour bound, if he contracts that disease, to give him adequate treatment.

I said just now that a sanatorium was not the only link in the chain, not the only part of the weapon which was required to combat this disease. Roughly, you can divide this chain into four links. Naturally, there is a great deal of overlapping. First of all, there is the education, that is prevention. Secondly there is the diagnosis, and let me impress upon the House that you cannot depend for detecting this disease in every case upon the general medical practitioner. You cannot depend on the out-patient department of the hospital. You must have a special consumption dispensary, with a specialist, and you must give him a good salary. You must get the best man, because upon getting the early cases will depend to a large extent the successful treatment and the successful spending of this money which you propose to give. The value of the dispensary is twofold. You not only get the patient himself, but you know at once in what house to go in order to get a likely case of infection. You examine the family, and thereby you are able to detect a large number of incipient cases. Even if you have not actually got tubercle, you can keep them under observation. That is why it is so necessary to provide in towns this particular link, the tuberculosis dispensary where suspected cases can be examined. The third link is that connected with treatment. You have to give treatment to the curable. You have to give treatment to the educational cases; people who have lost part of their lungs and cannot have there restored, but to whom you can promise a prolongation of life. Then there is the treatment of the advanced pauper consumptive, and I come to the most important question of isolation and segregation. I could quote figures showing that in certain towns where there had been outdoor relief, where the poor consumptives had been treated in their homes, the mortality had not adequately diminished; it had, in fact, in some cases even gone up, whereas in other towns, where there had been indoor relief, and the poor consumptive had been treated in a special institution and had been isolated, the mortality from this disease had largely decreased. Therefore you have to make provision under this Bill for treating these three classes of persons. The fourth link is connected with the after-care. When you spend money on a man you do not want that money to be wasted. You want to keep a tactful, benevolent eye upon him to see that he carries out the instructions which he learned in the sanatorium and see that he does not come back to you with a relapse in a few months or years afterwards—to see that he does not come upon your pension fund to draw a disablement pension for a long number of years.

Now as to what I may call the weak points—shall I call them weak points?—perhaps it is unjustifiable, because it will depend a great deal upon the interpretation and the elucidation of the Clauses contained in this Bill. First of all I want to put before the House the question of the educational campaign of your local health committees. Is it going to be absolutely decentralised? Are you going to allow every local health committee in every county and in every county borough to carry on its own educational campaign in its own way? If you do you will have one county advocating sanatorium treatment, another adjacent to it advocating tuberculin treatment, and probably a third looking upon this disease as being purely or largely hereditary. I do not say that it should be absolutely centralised, because then you would not have opportunities for experiment, but it seems to me that if you are going to get full value from these committees in the educational campaign, the country ought to be divided in large comprehensive groups, and that you should have in a general way similar treatment, similar education, and similar opportunities for treatment in these groups. The next point I will put before the House is the question of the sanatorium doctor. Are you making provision to give him an adequate salary? It must be realised that you want quite an exceptional man to make your sanatorium a success. He must be not only an expert in this particular disease, he must be not only a specialist, but he must be able to manage and control some 200 men collected in a building under his charge, and therefore it is necessary to give a really adequate salary to attract the best men with the necessary qualities.

The next point I would put before the Chancellor of the Exchequer is, what is the position in the future of the voluntary associations which have been connected with the disease in the past? Are you going to safeguard these associations, some of them connected with sanatoria, some with providing dispensaries, some purely educational, and others with giving assistance to poor consumptives? What is going to be their position? Are you going to give as much help to those who have helped themselves as to those who have not? I think you ought to give due and adequate recognition to those bodies of philanthropic people who have worked so hard, and who have prepared the ground in such a way that it is now possible for the Chancellor of the Exchequer to propose the expenditure of a large sum of money, and to have his proposal welcomed as being wise, instead of being opposed as being extravagant. I do not know whether a Government Department is expected to have a feeling of gratitude, but I think, in any case, they should realise that it is to their interest, if they are going to do the best work under the Bill, to have the hearty support and co-operation of the big associations in all this work. As representing in a minor degree some of the voluntary bodies which have been dealing with this question in the past, I would say that just as we welcome State aid as additional to our work, I hope those responsible for this State aid will look upon it also as additional to, and not in substitution for, the work which has been already done. I have one advantage perhaps not possessed by every hon. Member in this House—I have studied this question, not only from outside, but also from inside a sanatorium. It is because I have felt the benefits to be derived from this treatment that I heartily support this part of the Bill.


I desire to join in the congratulations to the Chancellor of the Exchequer on the reception the scheme has met with throughout the country. It is undoubtedly a great scheme. In my judgment it is the greatest scheme of social reform that has been introduced during my political experience, and I would suggest that this is not going to inflict an increased burden on the community as a whole. It is a burden that is now borne by somebody, that is to say, it is borne by those who suffer. It is borne now by those who are least able to bear it, and what the scheme does is to spread this burden over the community as a whole. I suggest that sickness and unemployment are especially suitable for insurance. What you want, in connection with any insurance matter, is that it should be something to which a very large proportion of those insured are liable, it should be something that is uncertain, it should be something that is serious to those on whom it falls, it should be something that can be averaged, and the burden should be one that is quite manageable. The ideal condition would be that everyone should insure himself. We know, as a matter of fact, that many cannot and that some will not, but it is in the interest of the community that all those who are not in a position to protect themselves should be insured. It is the interest of the employer that those who work for him should be fit and well. It is also extremely desirable that we should have this medical help available speedily. That is a thing in which delay is very costly, and nowhere is it more true that a stitch in time may save nine.

Personally I think it is reasonable that all should bear this burden, and in my remarks I shall confine myself to insurance against sickness and invalidity. I notice the hon. Gentleman opposite—the tone of whose speech we all desire to acknowledge—stated that this would create a debt of £63,000,000. It is a debt which is practically a paper debt. We are not going to borrow £63,000,000, and it is a debt which is to be balanced and wiped out by compulsory contributions, and if the contributions cease then the liability would cease. It is merely a paper debt to enable a valuation of friendly societies to be made on sound principles. I was interested in the hon. Member's remarks as to the contribution of the employer where wages are low, and particularly in the case of the agricultural labourer and the farmer. I submit, as a matter of political economy, that in the long run that would come out of rent. If you put a burden on the farming industry and render it less remunerative, the land will bear the loss. But if this scheme results in an improvement in the efficiency of the agricultural labourer, then there would be no possibility of loss. The difficulty of the man who has a low wage paying the same contribution as the man who has a high wage and getting the same benefit is a real difficulty. It is a little inconsistent to complain that the employers pay more. Somebody would have to pay more if the workmen paid less. As to the county committee, I notice the hon. Member was not quite clear whether that committee should fix the fee of the doctor. Unless the payment is fixed under the Bill those who fix the fee must be those who pay the money.

The hon. Member for the Blackfriars Division (Mr. Barnes) referred to the amount of the benefits. Are these benefits sufficient and can trade unions and friendly societies do better than the Bill is going to do? If you take the Bill as a whole, the amount of the contributions—namely, 9d.—is undoubtedly high for the benefits under the Bill; but the man's payment is 4d. It is therefore worth his while to pay 4d. If the benefits are not good for 9d. they are good for 4d. There are reasons why at first the benefits are not so good. There will be a large number of less satisfactory people brought into the scheme. At present the friendly societies get the pick, but you are going to bring in others. In order to have State management of the funds there will be a lower rate of interest than the friendly societies get. Then the doctors will be better paid. The payment of the doctors by friendly societies has not been quite creditable to the friendly societies. Under this scheme there is to be non-payment of contributions during sickness or unemployment. That is not the rule in most friendly societies, though it is in some. That is a very important matter. If you are relieved of payment, of course that trenches on the funds from which payment is made. The hon. Member for the Blackfriars Division suggested that the Society of Engineers could do very much better. He said they could do it for 2d. If they can do it for 2d., they will be able to give very much better benefits for 9d. to their members. Everyone will wish to be an engineer. If they can do it for 2d. and they get 9d., they will have a surplus for incresed benefits.

It may be asked why not leave this work to the friendly societies? Well, the friendly societies cannot get all the people in. At the present time it is estimated by Mr. Watson, who is the highest authority in this country on friendly societies' actuarial work, that there are in permanent benefit friendly societies of the United Kingdom about 4,500,000 people. This scheme is going to deal with about 14,000,000. Then the benefit and friendly societies are not making headway. They are not increasing. They are rather losing ground in. the matter of numbers. There is no indication that, apart from this scheme, they are going to grapple with the 14,000,000, and therefore you must have compulsion to bring the people in. If you are to have compulsion there must be control of the funds, and supervision by the Government, in order to ensure solvency. Our friendly society friends may not like it altogether, but it is absolutely essential. The experience of friendly society work and of benefit society work is that untrained persons cannot understand the necessity for accumulating sufficient and adequate funds for future responsibilities. They seem to think that as long as income exceeds the outgoings it is all right, whereas very often it is all wrong. The result is that a large proportion of the branches of the friendly societies are unsound and actuarially insolvent. Even in that great organisation the Manchester Unity of Odd-fellows, it is shown that a large number of the branches show a deficiency at last valuation amounting to £850,000. A number of others show a surplus, but those who show a surplus are not legally liable to those which have no surplus. The Foresters show a much bigger deficiency, the Shepherds show a deficiency, the Rechabites show a deficiency, the Hearts of Oak show a deficiency which is increasing and is becoming important. The Rational Society has a deficiency of nearly £750,000. That is a very serious position. Actuarially the experience in this matter shows by the returns for the five years ending 1908 that 2,340 of these benefit societies had a total deficiency of £5,200,000.

Then we know that a large proportion of the railway benefit societies are actuarially deficient and unsound, although they get a special rate of interest from the companies. It is understood that the railway companies stand behind the benefit societies. My impression is that some shareholders will have rather a lively awakening on that point. I cannot speak too highly of the actuarial memorandum which has been submitted to us. It is a most able document by actuaries whose judgment may be taken as being as sound as anything that can be found in. this country. I venture to say that the financial proposals in the Bill are of vital importance. It is extremely important that the auditors and valuers should be appointed by the Government.

It is also very valuable that each branch of a society should value separately. Of course there you come to the difficulty of the insolvency. It is a very good provision that if a society shows a surplus, half that surplus is to go to make up deficiencies in branches of the same society where they have deficiencies. That gives every branch in that society a strong interest in keeping down deficiencies in every other branch, and if the branch with the deficiency still has a deficiency after it has got the assistance of half the surplus from the others, then the benefits are to be reduced, or the contributions are to be increased. That brings you down to the bedrock of the whole Bill, which is that the individual members will suffer in their benefits unless the management is good and the claims are kept down. Without that provision there is no limit to the extent to which sick payment might go up. It gives every member of every society a keen interest in keeping shirkers and shams off the benefit list. Good management will secure for all increased benefit. Lax management will secure for all diminished benefits. That is the best safeguard you could possibly have. After what I have said, I think it is perfectly clear that you could not introduce compulsion and entrust the working of this arrangement to friendly societies without stringent supervision. But I differ from the hon. Member from Ireland in this respect, that I think the insurance must be done through the friendly societies. It will have to be done either through the existing friendly societies, or what would be practically government friendly societies, and you must use the experience which those great organisations have built up.

It is essential that the schemes should be worked by the people who are themselves interested in their success. Otherwise you would never get the supervision and checking done as well as they are done. All persons connected with friendly and benefit societies know that malingering and slackness are the great danger and the great difficulty They will tend to increase under this scheme for the very reason that you are going to bring in another class of the population, many of a less successful class, and a great many of a less satisfactory character, and altogether a less satisfactory element. It would be more difficult to deal with them, and therefore there would be more risk of shirking and malingering. This sickness claim is the ever present difficulty of friendly societies. The sickness claims are continually growing, although the health of the population is improving, as shown by a diminished death rate. Yet in spite of this diminished death rate, which means improved health, there is an increase in the sick claims of the friendly societies. The problem is how to grapple with it. We must have close, interested, and personal supervision, and in the next place benefits must not be too large. It is a curious thing that sickness goes up as the benefits go up. Here is a case. In North Yorkshire in a large society in a mining and manufacturing district where the sickness is above the average because of accidents, there are three grades of sickness benefit in that society. Where 10s. a week is paid the sickness claims are 126 per cent. of the expectations; where 15s. a week is paid the sickness claims are 184 per cent.; and where 20s. a week is paid they are 203 per cent. of the expectations. I may give another instance. In a large county society in the South of England, in an agricultural district, where the benefits are 6s. and less per week under full benefit the sickness claims are 75 per cent. of the expected. When you get to half-pay, which would be 3s. or less per week they are only 36 per cent. of the expected. In the same society with the class of benefit of from 9s. to 10s., the full pay sickness experienced has gone up to 85 per cent. and the half-pay to 158 per cent. Where the benefits are from 14s. to 15s., you get the full experience of sickness on the full pay and 150 per cent. on the half-pay, and where the benefits are 18s. and over the experience on full pay is 134 per cent. and on half-pay 196 per cent. It is practically the same experience as we had before.

Another very important point is the size of the branches. The provision in the Bill about having the organisation where there are 1,000 members suggests that the number of members should be reduced, as you will then get a much more close supervision. Where you have small branches every man knows the other; in big branches they do not. Here is an experience that Mr. Watson took out over a large number of cases. In branches where the members were eighty or less, 41 per cent. of the branches had an excess of sickness above the average, while in the same organisation in the branches with 500 members or more, 82 per cent. of them had an excess of sickness. When the branches get big you cannot have the effective supervision which you have when the branches are smaller. The next point is that the benefits must not be too large. I have given some figures as to that. There is a provision in the Bill that the sickness benefit is not to exceed two-thirds of the wage, and that the other benefits that a man may be getting in combination with the sickness benefit must not altogether come to more than a man's wage. I think it would be better if a lower proportion were fixed. If a man can get as much when he is ill as when he is well, that is, in combination with the other benefits, the claims are high.


Many of them have it now.


It is a disadvantage, and societies are suffering from it. I have shown how the claims go up with the payments. You have got to deal with human nature as it is. There is one provision in connection with this which I venture to suggest is a mistake. That is the provision that there may not be any execution or distress for rent or rates while the man is suffering from sickness. Upon that I would say this: There is a great deal to he said for relieving a man of payment of rent when he is sick, but if the community feels that a man who is receiving sick benefit ought not to pay rent then the community ought to pay the rent; it has no business to put it upon the owner. If the community feels that a man's rent ought not to be paid when he is getting sick benefit the community ought not to be generous at somebody else's expense. The next point is that that is a distinct increase in the benefit, and if a man is getting these large benefits and he need not pay his rent for six months and a-half, the temptation to him to remain on the fund is increased thereby. I would suggest that a month would be sufficient. That would mean that six weeks altogether would be allowed to the sick man. One more fact. There is a society Which every seven years adds to the death benefit which will fall to members' families any surplus that there is, if that man has had no sickness claim during the seven years, and if he has had a sickness claim it is deducted from what is added to his death benefit at the end of that time. That society has got a sick list claim of one-third the average expectation. In that case that mere fact brings the claims down to one-third, and I have shown you how the other state of affairs sends them up. It is a most important point to remember, especially when you bring this large number of people in.

An extremely valuable provision, I think, is the one which says that where compensation for accident or disease is obtained it is to be deducted from the sick benefit. I think that is both just and expedient, and will do a great deal to equalise the sick claim in employments. A very large amount of the difference in the proportion of sick claims in various employments arises first from accidents, and, secondly, from diseases for which compensation can be obtained. I will illustrate this by some figures. Taking ordinary societies, which comprise the large proportion, perhaps four-fifths, of those benefit societies, taking the occupations of persons of the ordinary average employment as the normal, and taking the sickness claim at 100, the sickness claim among persons working in iron and steelworks, chemical works, and quarries is 140 per cent., or 40 per cent. more. With miners it is 180 per cent., or 80 per cent. more, and nearly the whole of those extra sickness claims arise from accidents and disease for which compensation is payable. It is the same with the railway societies. The sick claims are above the average expected, but that excess is entirely due to accidents, and ordinary claims, apart from accidents, in the railway societies are rather below the average. The addition is purely owing to accident, and it is a well-known fact that friendly societies cannot be successful in mining, quarrying, and iron-work distress, unless accidents are excluded from benefits. Germany separates accidents from sickness. Another interesting thing is that accidents are most numerous among the youngest men. The older men are more cautious. There is a suggestion here that excessive sickness should be charged on localities and on owners. In principle I do not think there is any objection to that, but I do suggest that it is impracticable and will cause endless litigation, and I think it would be better to leave it out. The next important point, which is not dealt with in the Bill definitely, is this: Should men be allowed to earn something while they are receiving sickness payments? It makes a wonderful difference. If you allow a man on sick benefit to earn a little up goes the sickness claim. There is one society—a well-known and well-managed society—which does that under certain limited conditions. The effect is to send up the sickness claim in that society by over 50 per cent. The moment you allow a man to earn anything in addition he tends to stop longer on the fund. I gather, I am not quite sure whether I am correct in my interpretation, that the Bill makes no provision for it, but leaves the regulation of this point to the ordinary rules and conditions of the various societies.


May I ask my hon. Friend to repeat that point?


My point is that to allow a person to work while receiving sick benefit would increase the amount of sickness, and that the member should not be allowed to work during the time he is receiving sick benefit. I think the condition provided under the Bill is that it is left to each friendly society to work according to its own rules. But what about those who come under the Post Office scheme? There ought to be some provision made in their case, and I would suggest that they should not be allowed to work while receiving benefit. Another important point in connection with friendly societies is this: I said that they were not increasing so rapidly as formerly and that they are not making much headway. The result is that the number of older members in these societies is increasing, and the amount of sickness among the older members is from four to six times as much as amongst the young members. Consequently the position of these societies becomes more precarious as the proportion of older members increases. One of the strongest societies, the Hearts of Oak, has now three times as many members over seventy years of age as it had ten years ago. It only shows the tendency of the membership, and that is a very important point. There is an impression abroad that the present generation of contributors are to pay in order to take in the older persons, and when you are commencing a scheme you have to take them in at all ages—you have to begin. I would suggest that is scarcely an accurate way of putting it, and that it is the Government contribution which pays. The Government contribution pays for having in those who are above the average age, and what it means is that when that debt, of which the right hon. Gentleman the Chancellor of the Exchequer spoke, has been wiped out in something like sixteen years, the whole of that contribution will be so much available for extra benefit.

With reference to the doctors, I think it is very important indeed that they should receive adequate remuneration. You will not get much out of them if they are discontented. The friendly societies have paid them inadequately. I am a little impressed by what was said by the hon. Member for Glasgow, who pleaded so eloquently for a standard wage, but he did not plead for the doctors. [HON. MEMBERS: "No, no."] He did not, and it is a fact that sometimes working men are the hardest employers of others that you can have. There is no doubt about it. There are reasons for it, but it is a fact, and really the treatment of medical men by friendly societies has not been quite what I think we should like to see.


When a man is poor he cannot be generous.


I do want this opportunity to be taken to put the remuneration of the doctors on a satisfactory footing. If you pay too little you will get the blacklegs, the failures, and the undesirables of the medical profession. That which is low in price is seldom really cheap, and I think the doctors ought to have better terms. The profession as a whole resent very strongly indeed the treatment to which they have been subjected in the past by friendly societies, and unless their position is to be very considerably improved there will be difficulty in working this scheme. I do not know whether it would be the best method, but I am not sure whether there should not be a minimum payment fixed. I do not agree with the suggestion that you can pay by fees. I think there must be a capitation grant. When you have got the capitation grant, the annual payment is made to the doctor, who receives it, whether the member is ill or not. It is to the doctor's interests, if the member be ill, to get him well and out of his hands. Therefore, the doctor would have a distinct interest in checking malingering. But if he be paid so much an attendance—even doctors are human beings—then his direct personal interest in getting the member off his hands would not be so great as I think it should be. A strong desire has been expressed that members should be allowed to select their doctors. There is much to be said for that in many ways, but I also see difficulties. As I understand the scheme, the doctor is to be paid so much a year per head, whether the man is sick or well. A man will not select his doctor when he is well, and if he selected him when he is ill he might select a doctor who had not had fees from him during the five years that he was well.

The matter is not quite so easy as may be thought. I think something might be done by requiring the approval of the Insurance Commissioners or the County Commissioners as to the appointment or dismissal. It is very important that the doctor who is to be in attendance should be independent. If the doctor is to be selected by the members, then there will be a temptation to him to be somewhat lenient in order that he might become more popular and be selected. We want to ensure the independence of the doctor, and we must remember that not only the member but the employer and the State are all interested in this scheme, and they require the protection of the doctor. I think our friends, the doctors, are more alarmed than is necessary. I think they are exaggerating the effect of the Bill on private, practice. Roughly speaking, we have about forty-five millions of people in these islands. Fourteen millions of them are going to be insured. That leaves thirty-one millions for private practice still. Some of the doctors have been writing to the papers as though you were putting in the whole family. But you leave out the women and the children in the main, although I am not sure that they do not require the most doctoring. However, there are thirty-one millions still left for private practice. Another important point is that of the fourteen millions who are going to be brought into this scheme, in the case of a very large proportion of them the doctor gets nothing out of them now. Some of them he attends and he does not get paid; and you must remember that under this Bill the doctor will get his money.

I have carefully taken out some calculations which show that of the persons who will be insured between sixteen and sixty-five years of age, according to the expected experience, there will be on the average one-and-a-half weeks' of sickness per year per person. Of course the young people are less, and the older people are more, but the average of sickness will be one-and-a-half weeks per year per person. The suggestion is 6s. per year for doctor and medicine, and that will be 4s. a week for the sickness duty. All these people will not have to be attended; some of them will go to the surgery. The doctors are afraid that an immense number of their private patients will leave them. I do not think the number will be so large. I do not think the inducement is very great for a person, above the average of poor people, to join. In the first place, a man would have to pay over 30s. a year on the chance of wanting a doctor. I do not think he would do it. The weakest place in the scheme, a very difficult one to get over, is the Post Office contributor. Practically, he is not going to be insured. Insurance depends on averages and other considerations in regard to benefit; but the Post Office contributor is merely to get the amount of benefit that attaches to him on his own payment, the Government payment, and the employer's payment. Therefore he will get no average benefit; his benefit will depend on the amount of his deposit, and not on insurance. That means that some of the most unfortunate, some of the weakest some of those who need the help most will get the least, and the general result in that instance will not be good. It is quite true that there will be an addition in accumulations and in the matter of bonuses. But as a rule you will have the least satisfactory of the cases, the rejected and the refused from the benefit societies, in the Post Office contributors, and, therefore, the results as a whole are not going to be good. It means that those who need the help most will get the help least.

I do not know whether it can be managed, but it would be much more satisfactory if they could be averaged with the others. One point more about future pensions. The Chancellor of the Exchequer made a very interesting suggestion that when we get through the sixteen years the money that will be available would possibly provide pensions at sixty-five years of age. My point is that at the present time about 50 per cent. of the men over seventy years of age are getting pensions. This scheme would have it in about 70 per cent. of the male population over seventy years of age. That means that 20 per cent. of the people who are paying these contributions will not be eligible for the pensions, because they have some other income. I think their contributions ought not to be taken to provide pensions for the others. Five-sevenths of them, will get the pensions, but there will be two-sevenths who will pay contributions, but, having other income, will not come into pension. I do not think their payments ought to be used to provide the pensions of others. In conclusion I would urge the House to be careful not to overload this Bill with cost, not to extend it too much in every direction. It will cost more than we expect. It is an admirable memorandum which has been furnished by the Government actuaries, but all these projects cost more than is expected. We have had experience of the Old Age Pensions Act, and this scheme will cost more. It is very important that we should have it on a sound financial footing to begin with. Let us err on the safe side, because provision is made in the Bill that as the money accumulates the larger will be the benefits that can be paid. Hon. Members opposite say that the Bill is not very popular. There is some truth in that. For all that, it is a splendid scheme. It is never popular to tax people, and this is levying a contribution on a great number of people. Some of those who are getting benefit from it will not welcome it, I am sure, when they are called upon to pay, and many will grumble. But I cannot help feeling that the institution of a scheme like this—I am referring now both to sickness and unemployment—will be such a boon to the community that this Session in the future will be looked back upon as a red-letter Session in the history of our Parliament.

8.0 P.M.


I do think that the Chancellor of the Exchequer has no reason to complain of the manner in which this Bill has been received. There has been a great deal of criticism, but none of it has been in an unfriendly spirit. The machinery by which the objects of the Bill are to be promoted is intricate and complicated. I cannot help offering one word of criticism. I think it is very unfortunate that the Second Reading was taken so early. The matter is one of such interest and importance that I think the Debate would have been of an even more satisfactory character than it has been if the country had been given time to master the main features of this measure, and to arrive at a, mature judgment upon it. I believe that time would have been saved in the end, and that the taking of the Second Reading at this very early stage may afford another illustration of the truth of the adage "the more haste the less speed.' That consideration applies very markedly to one aspect of this measure with which I desire to deal, and that is in relation to the medical profession. The interests of the medical profession and of the country in this matter are identical. I have the honour to represent a University constituency, very many of the graduates in which are medical men. They do not approach this matter from any purely selfish point of view. They recognise that their interests and those of the country are identical. But I say with some confidence that great care must be taken that a measure of this kind, intended to promote the public interest, is not unfair to the medical profession. It is only by the cordial co-operation of the medical profession that this measure in one of its most important aspects can be effectively worked. The Chancellor of the Exchequer is reported to have said the other day when he was approached by some interviewer that this was not a medical endowment Bill. I daresay the Chancellor of the Exchequer may have been misreported. I hope he was, because I think that no profession ever less deserved something like a taunt of that kind than the medical profession. The expression of the Chancellor of the Exchequer, if it was used, was, I think, an unfortunate one, because there is no profession in the country which gives more gratuitous labour for the benefit of the community than the medical profession.


I said so in introducing this Bill, and stated that there was no profession that gave its services more gratuitously. I recognised that at the very first time. I may just add that the remark which the right hon. Gentleman has quoted was a reply to something that was said to me in the form of a question. A suggestion was put to me by the interviewer, and I do not think it is fair to take the sentence separated from the other.


I absolutely accept the statement of the Chancellor of the Exchequer, and am very glad to have heard what he has now said. I think, though, that care must be taken that the measure does not operate as a medical disendowment Bill.


Hear, hear.


If it did it would be calamitous in its effects, not merely upon the profession, but upon intended beneficiaries in the country. If it lowered the status of the profession by lowering the remuneration to a point which would not attract good men into it, that would be a most calamitous thing. It would not merely affect the run of the general practitioners throughout the country, but it would affect the whole profession, because the highest branches of the profession in its highest walks are recruited from those who start in life as general practitioners. If any measure, however well intended, were passed which prejudicially affected the status and remuneration of the ordi- nary medical practitioner, it might have in the future a very serious and calamitous effect upon the profession as a whole, and would have results in every branch of the profession which everyone would deplore. It is not a case of the doctors against the people. In this matter the doctors and the people ought to go hand in hand, and I believe that both parties to this Bill—those whom it is intended to benefit and the doctors, who are to play so important a part in administering it, are desirous that it should be worked in that spirit. I listened with very great pleasure to what was said by the hon. Member for the Blackfriars Division (Mr. Barnes), when he pointed out that it was only by adequately remunerating the doctors that the people of this country could get the work which would achieve the best results.

There are certain points on which I desire to say that from the point of view of the medical profession reservations must be made in any support which is given to this Bill. The first point is this. I think it is most important that the patients who have to benefit under this Bill should have the choice of their doctors. A very great deal depends on the relation of doctor and patient, and in the personal confidence which the patient has in the doctor. A very great deal depends on the influence which the doctor has upon the will of the patient, and influence of that kind is, I venture to think, more valuable even than those expensive drugs about which we heard so much in the Debate on the First Reading. It is not an ideal state of things that all those who benefit under this Bill should be compelled to go to one State doctor for the district. Such a system I believe would be demoralising for the profession and disastrous for the patient. Freedom of choice of the doctor, freedom to choose any doctor who is qualified and of good character in the district I believe ought to be an essential feature in any measure of this kind. The second point is this. The remuneration that has been mentioned, 6s., to include drugs which would work out as 4s. or 4s. 6d. for the doctor, is absolutely inadequate.


It is 4s. now.


That is far too low.


I agree.


You are going to extend that system which does not work satisfactorily, and you are going to put it at a figure which would not give satisfaction to the profession, and which I believe would end in the deterioration of the profession. Various suggestions have been made. It has been suggested that the doctor should be remunerated according to the work done. It has been suggested that there should be a contract price, and that the contract price should be at a much higher point than has hitherto been suggested. A good deal might be said with regard to both those proposals. My own impression is that something in the end like local option and the choice of one or other system, according to the necessities of the district, might be a desirable thing. I hope that that matter will receive the earnest attention of the Chancellor of the Exchequer. There is a third point in which the Bill may very prejudicially affect the interests of the medical profession. It brings under its compulsory operation all workers having incomes up to £160 per year. That was selected as being the point at which Income Tax commences. There is no necessary connection between the incidence of the Income Tax and the compulsory operation of this Bill. I would put this very strongly for the consideration of the Chancellor of the Exchequer. Where a man is getting more than £2 a week is it desirable that there should be the compulsory application of a measure of this kind? Workmen with more than £2 a week form a large portion of the clientèle of the general practitioner in town and country. They choose their doctor, they are ready to pay the fees that are asked, and the relation subsisting between doctor and patient is one of mutual regard, and it achieves satisfactory results. I would most earnestly ask that it should be considered whether this compulsory portion of the scheme should be carried so high as to those who receive up to £160 per year, with the result that you would be cutting off from every medical practitioner a considerable amount of income, and in some districts a very large proportion of the income which he derives from his general practice.

The fourth point to which I should be very glad the Chancellor of the Exchequer would give his consideration is this: What is the effect of this Bill as regards domestic servants? In a very large number of houses the master of the house pro vides, as a matter of course, medical attendance for the servants when they are ill. Will you be benefiting the servants by introducing this compulsory system, with all the botheration of a 3d. or 4d. stamp every Saturday? Will a system of gratuitous medical attendance, which the master provides, survive the introduction of such a system? I do put it to the Chancellor of the Exchequer that unless some provision is made for excepting domestic servants in cases where the employer makes provision for medical attendance the results of this measure may be not to benefit one section intended to be benefited, but the effect may be of the very opposite description. The fifth point is this. It is well known that the relations between the friendly societies and the doctors have not given satisfaction on either side. I do not think it is desired on the part of the societies to retain the control of the relations which exist between them and the doctor, and certainly it is most repugnant to the doctors that this matter should be left in the hands of the friendly societies, and not only left in their hands, but vastly extended. I put it to the Chancellor of the Exchequer that it is a matter for the most serious consideration whether such matters should not be transferred to the health committees, instead of being left to the friendly societies in the vastly extended operation which their duties will assume under the Bill. A suggestion worth considering which has been ventilated is that there should be advisory committees selected from the medical men of the district.


I wish to understand quite clearly. Is it the suggestion of the hon. and learned Member that the whole of the doctoring under this scheme should be taken out of the hands of the friendly societies and transferred to the local health committees?


That the control of the relations with the doctors should be in the hands of the health committees and not in those of the friendly societies, because the arrangement has not worked well in the past, and it would cause great friction in the future. I have mentioned five of the most important points—there are others, but I desire to be brief—which affect the medical profession, and through the medical profession the public. The whole subject of this Bill in its bearing on the medical profession requires the most thorough consideration. If we are to arrive at a settlement which shall be beneficial and durable—and no settlement can be beneficial unless it is durable—the measure must not be rushed through. There must be time for its full and complete consideration, not only in the House, but in the country. The measure is one which must be based upon sound lines, capable of bearing the test of experience. The medical profession is entitled to justice, and justice to the medical profession will turn out to be justice to the beneficiaries under the scheme. No system based on injustice to a great profession can possibly work for the public benefit, when, as regards one of its most important parts, it is to be worked through that profession. You must have a system which will promote the self-respect both of the doctor and of the patient. The ideal is not a State doctor working by contract, but rather the relation which subsists between a doctor called in by a patient who has confidence in him.

I would suggest, for the perusal of the Chancellor of the Exchequer, two lay sermons, as they were called, delivered many years ago by the late Dr. John Brown, of Edinburgh, who was well spoken of in "The Times" when one of his early works appeared—I think it was "Rab and his Friends." It was said: "Of all the John Browns commend us to Dr. John Brown, physician, humorist, and man of letters." There are two lay sermons delivered to workmen by Dr. John Brown on the subject of their relations with their medical attendant, their duties to the doctor, and the duties of the doctor to them, which I submit form very profitable reading for the Chancellor of the Exchequer and those who are helping him in this matter. Let us have time for full consideration. May I remind the Treasury Bench of what was said by Lord Bacon about undue haste. Using a medical simile, he says:— Deceptive despatch is one of the moat dangerous things in business that can be. It is like what the physician calls pre-digestion, or hasty digestion, which is sure to fill the body full of crudities and secret seeds of disease. If we hurry through a measure of this kind we may be sure that there will be in it a plentiful crop of crudities and seeds of disease which will bear unpleasant fruit afterwards. Lord Bacon went on to say that he knew a very wise man with whom it was a by-word when he saw anybody hastening to a conclusion to say. "Steady a little; you will make an end the sooner." I think that ought to be written up in letters of gold, and I most respectfully commend the advice to the special consideration of the Chancellor of the Exchequer in connection with this measure.


Like the hon. Member for Plymouth (Mr. Astor), I regard the provisions dealing with tuberculosis and the establishment of sanatoria as the most important in the Bill. The House must realise the immense gravity of the problem of tuberculosis. Remembering that this country spends directly or indirectly something like £7,000,000 a year in fighting this disease, we cannot over-estimate the importance of the provisions of the Bill dealing with the matter. This view has been forcibly impressed upon public opinion throughout the country as the result of the special campaign carried on in England by the National Society for the Prevention of Tuberculosis, especially by the Committee presided over by Lord Derby, and in Ireland by the movement initiated by Lady Aberdeen, which has done so much to fight tuberculosis in that country. In Scotland also there has been an awakening, and in Wales a fund has been started for this purpose. I submit, therefore, that public opinion is ripe for the proposals embodied in the Bill, and I congratulate the Chancellor of the Exchequer on having inserted these provisions. I hope the House will consider very carefully the position of these voluntary societies which have paved the way for this Bill and have accomplished so much useful work. I suggest to my right hon. Friend that in connection with this measure he should do nothing to hinder the progress of these organisations or to cool the ardour of those who are interested in this great work.

I am quite prepared to admit, and most people will admit, that voluntary institutions cannot tackle this great problem alone. The State must come to their assistance, and it ought to come to their assistance in such a way as to stimulate them to other endeavours, and to carry those endeavours to success. Therefore we welcome the proposals contained in the Bill, and we welcome them because we conceive that the underlying principle upon which the whole Bill is based is that the State should contribute by subsidies, and should utilise the voluntary associations of this country for promoting the whole question of health and insurance. The principle in this Bill is applied to friendly societies. I do not see why it ought not also to apply to health associations and kindred associations which deal with the whole question of public health. The Poor Law Commission, both Majority and Minority Reports, recommend that the State and voluntary associations should work hand in hand in securing this end.

There is another principle that I should like to see definitely established in the Bill. That is that these subsidies or grants from the State should be in some sort of proportion to the funds which are raised locally, and in different parts of the country, to carry on the erection and maintenance of sanatoria. In the memoranda prepared by the right hon. Gentleman the Chancellor of the Exchequer we find that 1s. 3d. per head is given towards sanatoria, and it is further proposed to pay a capital sum of £1,500,000 into a special fund to be used in making Grants for building sanatoria on condition that funds are also raised locally; also to make an additional grant of 1d. per member to the Sanatoria Fund. That is the principle we find laid down in the memoranda to the Bill. But when we come to the Bill itself, Clause 47, it is very vague and indefinite as to how this grant of public money is to be apportioned. I sincerely hope that the Bill will be strengthened in this respect, and that we shall find this principle clearly enunciated.

I hope, also, that this principle will be applied to the circumstances at present existing in Wales. There is already there a national or State memorial started in memory of the late King Edward. That country, when looking for something on which all could unite in perpetuating the memory of the late King, agreed that the only possible object was a crusade for stamping out this great scourge of consumption. It was agreed by the majority of people that this great object should be dealt with from the national point of view, especially in view of the interest which the late King had taken in fighting this disease. To a certain extent it is true that the progress of this fund has been somewhat arrested in consequence of this Bill, but if this principle which I have already alluded to, the principle of the allocation of public money proportionately to the amounts raised locally, was definitely and fully stated in the Bill, I think it would increase the confidence of the country and stimulate still more private subscriptions towards funds of this character. In Clause 47 I think you will find that powers are given to group counties together for the purposes of administering sanatoria benefits under this Bill. I hope that there will be an extension of that principle so far as Wales is concerned.

The hon. Gentleman the Member for Plymouth, in a most interesting speech, pleaded that there should be a certain amount of central control in the administration of these grants. I think, so far as Wales is concerned, the Welsh National Fund, which has already been subscribed, should take the place of local contributions alluded to in Clause 47. I think there is a very great deal to be said in favour of the proposal for a central body or association to administer the Fund for sanatoria benefits. In the first place we ask that associations of this character should be national. At the present time the Welsh nation are beginning to realise that their position, so far as consumption and tuberculosis is concerned, is a national disgrace. Also, I think the associations should be national because, as I have already said, we have a fund in existence which will take the place of the local contributions. Therefore I think Wales should be treated as a unit for the purposes of administration. There are other reasons which ought to appeal to this House. In the first place, if you group all the counties together and make a central body or association you will avoid overlapping to a considerable extent. You will have more efficiency. You will pay your doctors better salaries. There will be greater economy. Extravagant buildings will not be put up. I think also a campaign could be conducted with a view to the needs of the country as a whole. A campaign conducted on these lines would be much more efficient and do much more good than separate efforts in the different counties.

One of the objects, as I understand it, of local health committees is that they should form public opinion and criticise the administration and general doings of the sanitary authorities—in fact, that they should keep the sanitary authorities up to the scratch. I think that this object; will be much more likely to be achieved if these local committees are federated together into a central organisation, for that central organisation will be able to bring much more pressure to bear upon local sanitary authorities than simply the local health committees in each county. We want to consider more closely how an association of this kind should be constituted. I think the House will agree that it should be a body representing the various interests involved. You should have representatives on such a body of the county councils, the local health committees, of approved societies under the Bill, of the medical profession, and of subscribers to the memorial fund. We have already precedents in Wales for an association of this kind. There is the national museum, the national library, the national colleges, etc. As to its relation to the State, I think it ought to bear the same relation as the other approved societies under this Bill. There should be no difficulty on that score.

I have given an outline, as briefly as possible, of what a great many people—and I think I speak for a large number of people in Wales—consider to be the best means of carrying out the provisions in this Bill as regards sanatoria and sanatoria benefits. And when the Committee stage is reached I shall press upon my right hon. Friend Amendments dealing with the whole position in Wales, and I shall respectfully urge him to give these Amendments his very careful consideration. I have only one word more to add, and that is with regard to the scope of sanatoria and to sanatoria benefit as defined in the Bill. We have had, as the hon. Member for Plymouth pointed out, some criticism during the last few weeks as to the wisdom of spending so much money upon sanatoria. There has been some kindly criticism from the Leader of the Opposition and there has been some criticism in a leading article in "The Times," but I think those who do criticise have not quite realised the scope of the sanatoria and the benefits which my right hon. Friend has in his mind. I do not pretend to know everything that is in the mind of the right hon. Gentleman, but so far as the definition in the Bill is concerned it includes provision for education, exhibitions, for dispensaries and for diagnosing early cases—in fact, all the category mentioned by the hon. Member for Plymouth.

I should like the Chancellor of the Exchequer, when he replies in this Debate, to tell us the whole scope and definition of sanatoria in this Bill. Then as to value of sanatoria, there is amongst medical men a very wide divergence of opinion on the point, but so far as an ordinary layman can understand the pros and cons, I think sanatoria must play an important part in any comprehensive scheme for dealing with this question of tuberculosis. We cannot find any specific remedy for this disease, and it is impossible to separate tuberculosis from the whole question of the general health of the community. The State or any other body must practise in two ways, first by strengthening the resisting powers of the nation, and that you can only do by better housing, better food supplies, improved sanitation and the application of the simple laws of health; and, in the second place, by cutting off the source of infection. I hope the Local Government Board will make up its mind to deal with the milk supply; the other source of infection is that carried by human beings, and it seems to me the value of sanatoria treatment is that people go there and are educated and taught how to prevent the spread of this disease when they eventually return to their homes.

I was talking the other day to the head of a very large sanatorium, and he gave instances of people who, when they left the sanatorium, actually going the length of stealing the sputum flasks which they were unable to purchase, so that they might take them home and prevent themselves from spreading infection amongst their relatives and their friends. Therefore the Chancellor of the Exchequer can be sure in his own mind that in erecting these sanatoria he is not taking a backward step, but is following the example of Germany in erecting schools of health, which will go a long way to prevent the spread of the disease. Of course, we are told there are people who come back from these places and return to their homes, and are no better for the treatment they have undergone and absolutely disregard the instructions and the lessons they learned, and have no sense of responsibility in the matter of preventing the spread of infection. It seems to me the only way in which the Government or the State can deal with this sort of people is to absolutely detain them and lock them up in colonies where it would be impossible for them to spread the disease. I appeal to the Chancellor of the Exchequer that this Bill should be an elastic measure, and that efforts should be made to meet the different needs in various parts of the country, and more especially that we should have these benefits of sanatoria administered in Wales by a central body and not by local health committees. I can assure him that if these things are incorporated in the Bill it will commend itself to the majority of the people in Wales and also promote the efficiency of the measure.


The hon. Gentleman who has just sat down has made various criticisms and suggested alterations in the Bill, but I think he gave it his general blessing. I do not think the Chancellor of the Exchequer can complain of the temper in which his proposals have been received by hon. Members in all parts of the House. Those of my hon. Friends who have been giving a good deal of study to this problem during the last few months are as anxious as the right hon. Gentleman himself to keep this question outside the field of party warfare and to co-operate with all sections in doing their best to make it a useful social reform. It is in this spirit that any criticism with which I should venture to trouble the House shall be made. The Bill, in my humble opinion, is a sincere attempt to diminish the great mass of human ills. There is not a man who in his heart does not look upon that attempt with sympathy, but at the same time I feel it is the duty of every Member of the House jealously to keep watch to see that in alleviating suffering in one direction, the Government are not inflicting undeserved hardship and injustice in another; that in relieving distress they will not be discouraging and in many cases practically extinguishing these great organised bodies for the promotion of thrift which have done so much in this country to stimulate a spirit of self help in the last few decades.

For the first time in the history of friendly societies the Government are proposing to introduce direct State control and direct State interference of the most uncompromising kind in every branch of friendly society business. This may possibly be inevitable. The advantages may be a good deal greater than the disadvantages, but let there be no secret about it and no attempt to slur it over or hush it up. Do not let the Chancellor of the Exchequer pretend that the friendly societies are going to manage their own affairs in their own way in the future because they are not going to do anything of the kind. To all intents and purposes their independence and their autonomy will be a thing of the past. They will become merely distributing agencies for a Government Department. They will become a subordinate machine, and practically without any existence outside. [HON. MEMBERS: "Oh, oh."] Indeed, there is very little doubt that voluntary work in connection with their administration and accounts will gradually languish and eventually disappear altogether. I will take only one point. Friendly societies and their branches are to be compelled in future to submit schemes to a Government official for the disposal of their accumulated voluntary funds, and if the scheme is approved of other schemes entailing further expense will have to be handed in. The Manchester Unity alone has 4,000 branches in the United Kingdom, and the actuarial cost for the submission of such schemes would work out at a moderate estimate at about £2 a branch. That is to say, that this one provision alone would cost the Manchester Unity over £8,000, or about 2d. per adult subscribing member.

If this has got to be done, and if these friendly societies are to be forced in future to submit these schemes, surely it is only fair that the Government should pay the actuarial expenses, and not throw this State-created burden upon the societies' funds. If it is to be done, let it at any rate be done in a businesslike manner. There is no provision whatsoever in the Bill before the House as to the conditions upon which the Registrar of Friendly Societies is going to confirm the schemes submitted to him. This surely is a very serious omission indeed. The confirmation of these schemes by the Registrar-General will inevitably operate as the Government guarantees. Unless a provision is included in the Bill that confirmed schemes should be financially sound many existing societies, and many new societies which will be established in the future. will hasten to offer extravagant and very often impossible benefits in order to attract the millions who will be compelled to insure. Financial disappointment will be the inevitable result, and the cry will immediately be, "We placed faith in the society on the authority of the Government official, and the State is responsible for the loss we have incurred." In addition to the submission of schemes every society wishing to become an approved society is to be compelled in the future to give security against possible malversation of its officers of a value not less than half the aggregate contribution in respect of its insured members. If the society happens to have branches, security will have to be given under the Bill in respect of every one of those branches. How are the Government going to make sure that half the aggregate value has been given in security unless they appoint a Government accountant to go through the books and satisfy himself that a correct financial calculation has been made?

It is perfectly clear, although the Chancellor of the Exchequer says it is not really the case in the Bill, that even the voluntary funds of friendly societies will be subject to the most stringent Government examination and the most complete Government control. If security is necessary surely it will be sufficient, as was suggested by an hon. Member on this side of the House this afternoon, if guarantee bonds were given by all those persons whose duties will require them to handle the funds. If not the Hearts of Oak Society will have to deposit about £300,000, and the Manchester Unity about £600,000. Moreover, these sums are to be found by the society and not by the branches. But the affiliated orders have no central funds worth speaking of. The Manchester Unity, although it will have to deposit £600,000 if the whole of its funds have to contribute, and even over £300,000 if it only relates to the voluntary section. The Manchester Unity has only £32,000 in its central fund. Practically the whole capital of these affiliated orders is in the hands of the branches, and how the Manchester Unity or the Foresters for instance will be able to find this enormous deposit it is quite impossible to conceive. If the branches are asked for deposits, a branch with 300 members, might have to deposit nearly £150. The habit of well-managed branches is to keep their funds invested close up very largely on mortgage security. It would be a very unseemly thing indeed for a friendly society to deposit its mortgage deeds as a security with the Insurance Commissioners, and for the Insurance Commissioners then to come down and impound the house of a member for the society's debt.

It seems to me this part of the Bill is quite unworkable as it stands. Even domestic differences between a society and its branches and between one branch and another will be caught in the meshes of the Government net. Clause 21 says that the rules for determining such disputes are to be made by the society and by the Insurance Commissioners, but later on Clause 50 proceeds to cancel this privilege; and, although the rules may have been approved, it gives the Government officials absolute power to settle these disputes in the last instance. Surely it is particularly hard that a society in order to become approved should be obliged to have 10,000 insured members. A large number of financially unsound societies will be able to enter the scheme, and a still larger number of admirable local societies which are independent and unconnected with any affiliation or association will be left out in the cold. The mere fact that one set of clubs happen to be linked up to an order does not necessarily mean that they are superior to those which are wholly independent. In some parts of the country, as hon. Members know, the affiliated orders are scarcely represented at all. The population there practically depend upon independent societies which have been established in connection with churches or chapels or schools, or particular trades and occupations. Many of their members are agricultural members, and among the poorest of the population and totally unable to afford two insurances. What would be the effect upon these people under the Bill? The effect of compelling them to join an approved society will not only be to drive them perhaps into some small local branch of an unsound order, with its headquarters at a great distance, but it may force them to relinquish the valuable rights they have acquired in their old society in respect of deferred pensions. The Stoke and Melford Union Association, for example, has 1,900 members and a surplus of nearly £5,000. They will he shut out of the scheme. So will the Royal Berkshire Friendly Society, with over 700 members and £4,000 surplus, and the Dunmow Friendly Society, with 1,000 members and a surplus of £3,700, will be in the same position.

I have here in an envelope the names of many other such societies with a very large membership and big surpluses. They will all be shut out. On the contrary, a society like the Rational Association Friendly Society, with 94,000 members and a deficiency of over half-a-million, will be let into the scheme. So will the Ashton Unity of the Loyal Order of Ancient Shepherds, with a deficiency of a quarter-of-a million, and the United Patriots' National Benefit Society, with a deficiency of £150,000. All those will be let in merely because they happen to have the requisite number of members, while the others will be left out. These are not the only hardships under the Bill. Members of a friendly society cannot afford as a rule to pay a double contribution. The Chancellor of the Exchequer, in reply to an inquiry, I think, made in the Press the other clay, stated that they will not have to pay twice over. That may be perfectly true, but in many cases, if they do not pay twice over, they will have to forfeit their sick pay for nearly six months. A man may have voluntarily contributed to a society for five years, and be entitled to 10s. per week sick benefit directly he falls ill, but on the Government scheme coming into force, if he cannot afford to pay a double contribution, he will cease to be assured for sick pay in the voluntary section, because he will pay his sickness contribution into the compulsory section instead, and he will not be entitled to sick pay under the compulsory section until six months after he begins to contribute. If he falls sick one month after he begins to pay his compulsory contribution, the voluntary section may possibly give him a few weeks' protection, but nothing more, and for the greater part of those five months he would be out of benefit, because he will have dropped out of the voluntary insurance for lack of means, and he cannot claim on the other, although forced to contribute. Again, it will be the poorest people who will be the hardest hit. They will suffer all round.

The Bill provides, if on valuation any branch of a society happens to have a surplus, that surplus shall be applied to first making good any deficiency of other branches, and the right hon. Gentleman the Member for the Spen Valley (Sir T. Whittaker) was rather pleased with that provision, but the lowest wage class are the agricultural labourers, with the lowest sickness rate, whilst the heaviest sickness rate will be found among the well-paid artisans, such as the tin-plate workers of South Wales, the artisans employed in railway workshops, and the workers in the light metal trades in the Birmingham district. The result, therefore, will be a ceaseless flow of surplus from money contributed by the lowest wage class to subsidise the funds of the better paid classes. No doubt the Government intend to counteract the effect of mere fluctuations on the theory that a branch will sometimes be a contributor and sometimes a recipient of a surplus; but in practice one set of branches will constantly be passing over funds to another set of branches, and the branches persistently mulcted in this manner will inevitably be those composed in a large measure of the poorest men. Whether the working classes of this country will welcome the provisions of the Bill when they have succeeded in penetrating into their mysteries is a matter largely for conjecture. Possibly they may deem the advantages outweigh the disadvantages, but, on the other hand, they may think, quite apart from Government interference, that there are so many defects and omissions in the Bill that, until the thing has been re-shaped in many particulars, and until the whole question has been considered at length and in detail, the central principle will have no fair chance when put on its trial.


The Chancellor of the Exchequer has not treated the House quite fairly as to the finances of the Bill. The actuarial report was only issued yesterday, one day before the Second Reading, and anyone who has glanced at it will have realized at once that so short a period of time is quite inadequate for a proper understanding of all that it contains. One thing, however, is very nearly certain. The right hon. Gentleman has greatly under-estimated the cost of his scheme. The actuarial basis of his sickness calculations has been largely founded upon the extensive investigation into the sickness experience of the Manchester Unity by Mr. Watson, the eminent actuary of that society. This is admitted in the Report of the two Government actuaries, and the admission largely vitiates the financial estimates, which confessedly are built up on the sickness experience obtained under a totally different system. Under the Bill the Insurance Commissioners are to make regulations as to the manner in which contributions are to be paid and calculated in the future. In the ordinary friendly society payment of contributions necessitates attendance at the place of meetings and affords means by which officers keep in touch with their members and by which they obtain their knowledge of them and their circumstances, which is regarded as an indispensable condition to effective supervision. This system is now to be largely swept away. Under the proposals of the Government some millions of people will join the friendly societies, and, after their enrolment, they will pay their contributions to their employers by means of stamps and deductions from their wages, and they will be completely lost sight of by the societies concerned until they present their claims for sick pay. It is perfectly clear that under those circumstances supervision will be utterly ineffectual. Malingering, as an hon. Member on the opposite side of the House acknowledged this afternoon, will be certain to increase, and before many years are over there will be such a Bill to pay as will stagger any Chancellor of the Exchequer who has got to deal with it. The Government, as in the case of the Old Age Pension Scheme, will be out of their reckoning by millions. The Government actuaries have omitted suffi- ciently to qualify their calculations, which they have based upon the Manchester Unity tables, by the very important consideration that friendly society supervision will inevitably be weakened in the future under the new condition, and their financial conclusions cannot be otherwise than unreliable and therefore misleading. That only shows how carefully the whole scheme will have to be considered if people are not to be deceived by false hopes and rash promises, and how gravely unwise and unfair it would be to the community at large to try and rush the Bill through on any pretext whatsoever.

May I deal with the medical side of the question in a very few words. What is the Chancellor of the Exchequer going to do for the doctors, the healers of the sick, under his scheme? Nothing is more certain than that unless he can get the medical profession to co-operate wholeheartedly with him the whole of his National Insurance scheme will fall to the ground. It is in the interests of the insured and of the Fund that prompt, efficient, and willing services should be rendered to every sick person on the list, and unless the right hon. Gentleman can persuade the doctors that they are going to work for a living wage, the scheme will break down tragically and completely, and will deserve to break down. The right hon. Gentleman says he is going to set aside four and a half millions sterling for medical benefit, exclusive of the maternity and sanatorium benefit. But what does he intend the four and a half millions to cover? Is it to cover drugs and dressings and instruments and various appliances for patients who may have to undergo operations? Is it to cover fees for special consultations between doctors in difficult cases, or is the patient himself to pay extra for the second medical practitioner who may have to be called in? Is the four and a half millions to cover operations at home, and the whole of the expense of institution treatment outside of the sanatoria for tuberculosis, or is the insured person to pay extra out of his own pocket? If the four and a half millions is to pay for all these things, and if this is the right hon. Gentleman's policy—and there is absolutely nothing in the Bill to show at the present moment what his policy really is—has he calculated what net sum approximately will be left for ordinary medical attendance? If he has not left enough, after these considerable deductions have been made, to give a living wage to the medical profession, where is the supplementary sum coming from? Is the Government going to pay the deficit, or will the friendly societies or the patients have to stand the racket. There is nothing in the Bill to show what the right hon. Gentleman has in his mind. I feel that the House has a right to insist on some definite assurance that the amount set aside for medical benefits will be sufficient to give remuneration to the medical profession on a fair scale. Surely it will come very ill indeed from a House which is just about cheerfully to vote itself £400 a year per head to bargain with doctors for their service to the country at less than a living wage. Surely, too, there ought to be a wage limit in respect of the medical benefit. Under the Bill insured persons, however large their income, will be able in the future to obtain cheap medical treatment, thereby inflicting great financial loss on the medical profession. It is true that persons whose income is under £160 per year, are to be forced into the scheme. Up to the present they may have been perfectly well able to pay for ordinary medical attendance, but not, perhaps, for special medical treatment, and although the Government are now going to give them cheaply what up till now they have been able to afford ordinarily, they are not going to get special institutional treatment outside the sanatoria for tuberculosis. One very satisfactory feature in the Bill, from the right hon. Gentleman's point of view, is that it is so vague and so indefinite that the right hon. Gentleman will undoubtedly be able to say in the future that the Bill does not contain what he hoped he would be able to put into it. Certainly there is ample room for improvement. The scheme on the whole is grand in conception. Like all great ideas, it springs from the heart; but that need not blind us to its defects, nor should it deter us from doing everything in our power to try and make it a practical measure of social reform.


I will not endeavour to follow the hon. Member who has laid before us a very useful criticism on the financial aspect of this great measure. I propose to confine myself to two parts of the Bill. It affects manifestly, above the ordinary members of the community, two great organisations, the friendly societies and the medical profession. It contains within it additional incentives to thrift and healthy living, which, I am sure, we shall endeavour heartily to promote. It provides an additional inducement for the people to join friendly societies, in view of their having greater security for receiving the benefits under this Act, and certain additional benefits which may be available for them. With regard to the medical profession, one has to recognise that it stands, in some respects, in a very different position from any other party affected by this Bill. This measure affects their daily labour, whereas most of those who otherwise come under this Bill are more or less in the character of beneficiaries. The medical practitioners see that it concerns their livelihood. I feel certain myself, from having been in very close touch with their chief organisations, that the medical profession are thoroughly desirous of co-operating in this measure in a hearty manner. I am confident that they would not desire for one moment that those who speak on their behalf in this Debate should put forward any ignoble considerations, or should pretend that class interests should supersede the general public interest.

At the same time I feel certain that no party in this House will desire for one moment to treat the profession which really has to do most of the work under this scheme in any unfair spirit. We recognise that after all the real success of this scheme depends on the hearty cooperation of the men who are called upon to attend those who are sick. The treatment of sickness is not a wholesale affair; it is an individual matter in each case, and, unless you continue the hearty and cordial relationship between the doctor and his patients, you cannot hope to make this scheme a success. I think it would be of no use to blind ourselves to this fact, that the relations of the medical profession with the friendly societies have not been altogether of the best. I am not for a moment seeking to inquire into that, or to impart blame to either side. I daresay there may be a certain amount of blame on both sides, but there are some features of what is known as the club practice, which, I am sure, we ought to do our best to eliminate. It is perfectly evident that the success of this scheme depends on keeping the people well. The interests of the societies and the reputation of the profession point to the fact that under what is known as the club practice it becomes necessary for a medical man to see his patients at the rate of one in every three minutes, if he is to make any revenue at all. It is not necessary to go into details or to point out that successful diagnosis or proper treatment is, under these circumstances, absolutely impossible, and, if the operation of this Bill were to intensify or stereotype that practice in any shape or form, we should be rendering a very great disservice to the people.

More than that, it is, I think, obvious that in so doing we should be unable to induce the best men in the medical profession to participate in this work. It is desirable we should make it possible for the best men to feel some self-respecting enthusiasm which may induce them to take part in the work, otherwise an inferior type of men might be put upon it, and possibly the general standard of the profession might be damaged. I am certain myself that if the friendly societies were consulted it might be possible to come to some proper arrangement whereby both the interests of the friendly societies and of the medical profession would be adequately protected. I think, under this scheme, their interests are not safeguarded. After all, the real success of the Bill depends on the development of preventive measures. In old days the bottle of physic might have been appreciated, it is not so now, and we want here to build up a structure which will provide us with the means of establishing a national system for the prevention of disease.

One of the points on which the medical profession feels most strongly is the choice of a doctor. It is better to make it clear that the circumstances anticipated by the friendly societies under this scheme would be entirely different from anything which has occurred up to the present. Millions of people will ultimately join these societies. We know that now, in many parts of the country, members of the societies, under the present system, do not go to the club doctor, but pay somebody else whom they prefer to attend them. It is evident that no Act of Parliament can force a person to have a medical man whom he does not want, and it would not be desirable that we should aim at any such thing. Conversely it will be very difficult for any Act of Parliament to compel a doctor to attend anybody whom he does not want to attend, because, after all, successful individual treatment depends to a great extent upon a hearty sympathy between the two parties. Let me give a case which is not hypothetical. I have in my hand letters from men exactly on this line. A large number of practitioners build up their practices perhaps not having any club practice at all, but the men who I think I may fairly say are doing the best work among the working classes of the people whose incomes are from £2 to £3 a week are the men who attend their patients and get moderate fees and are paid very regularly. It is quite evident that when these patients go into a scheme they will desire to bring their particular doctor with them, they will still want him to attend them, and, as a matter of fact, it would be very undesirable that it should be otherwise, because if it were otherwise the patients would have a grievance, and the doctor would be left high and dry without his patients who are drawn into this scheme, and he would be distinctly impoverished. I think, however, the fear in this respect has been decidedly exaggerated, because one must remember that the greater portion of the attendance is with respect to the children and the wives who would not come into this scheme at present.

Then, again, it is quite evident that not only must there be this choice of doctor within a considerable range, but there must be some considerable machinery devised which would overcome the very proper objection of friendly societies with regard to the choice of the doctor who is lenient in regard to this matter of malingering. The friendly societies very naturally insist, from their point of view, on being able to allot a particular doctor to their members, and they say that if people are allowed to choose anybody, they would be, very likely to choose somebody who would be lenient. That is true as far as it goes, but if we examine the actual conditions we know that there are friendly societies who take men on their books and who receive certificates from men who are not friendly society doctors. I would like to suggest to the right hon. Gentleman that these difficulties can be met more or less under the Bill by a modification on these lines. There will be a great body of new entries into the societies in any particular district. A large number of people will become members of the societies who are not now members, and who pay for their medical attendance themselves. I think it should be open to the reputable practitioners in every district to be enrolled upon a panel, and within that panel those who join a society in that particular district should be entitled to choose their medical man, and they should be able within that panel to continue their medical attendance, provided the doctor is content to attend them on the terms proposed.


Who will select the panel?


My suggestion is that in any specified district all the medical men in that district, unless you can bring some serious charge against them, should claim the right to be enrolled upon the panel, and that from that panel the patients should be able to select their medical attendant. I think we might join with that, the protective privilege that a man who was not enrolled upon the panel might have some machinery devised for ascertaining why he was not enrolled upon it. Here we come to a natural, practical and effective check upon malingering. You must bring the two parties together. It is in the interests of the society to prevent malingering, and it should also be in the interests of the doctors. In Leipsic they have a system which is fairly successful, and it is on these lines. The members of the society naturally report to their officials or complain if certain parties are on the sick list too long. That is the check of the members. If members of the society seek to get on the fund by attending any medical man who is unduly lenient and it is found by the society that a particular doctor always has a larger number of people sick on his list than anybody else, it is quite possible that that particular man is attracting to himself patients from any other man enrolled on the panel and is operating to their discredit. In Leipsic they have arranged the system of a medical jury within the panel which sits and decides upon these cases and has power to have a man's name removed from the panel. In that way you have the united co-operation of the friendly society and of the practitioners both united in putting down malingering, and I believe that system has worked very successfully up to the present.

Then I think that the arrangements which are made must as far as possible be made on some fairly well defined general principles, and the medical profession naturally desire that the arrangement made with any local committee or any private society shall be approved of by somebody capable of expressing a proper opinion—namely, the advisory committee and also the local health committee. But I pass away from that point to discuss for a very few minutes the points connected with the income limit. This is a very serious question which wants to be very properly thrashed out at an early stage in these proceedings. Many medical men attend a large number of people with incomes varying from 30s. to £4 a week, and they say, quite rightly, if persons with incomes of £3 or £4 a week who have hitherto paid my fees come into this scheme, whatever the rate may be, it means that the scale of pay must necessarily be higher than the average. For this reason it is obvious and is well known that in general medical practice the better-to-do patient pays to some extent for the worst-to-do patient, and a large number of patients do not pay at all, and it is well known, and I think it entirely equitable, if the whole position is looked at that the better-paid patient should pay higher fees than the poor one. The practitioner, therefore, says if you force my patients who pay me good fees into this general average, roughly it means that those people who provide me with my income will be taken away, and therefore the average I have to charge to the poorer people will have to be higher. That is to say, the greater the income, the higher would have to be the capitation fee.

Various suggestions have been put forward which I am sure the Government will consider sympathetically, in regard to meeting this representation. In the first place, you might say, and I think it would be a fairly good suggestion, that a sliding scale should be established for the higher incomes. I know myself, for example, a man who has £2,000 a year who goes to a club doctor to whom he pays 4s. 6d. per annum. It is all very well, but it is manifest that it is not to the public interest. Some people say, and I believe the Chancellor of the Exchequer thinks, that a great many people with better incomes would not become voluntary contributors. I am not quite so sure. Of course, if the service was inefficient they certainly would not, but if the service is a good one, as we all want to make it, I think it quite rightly would. I am sure a large number of people with £100 to £250 or £300 a year will certainly join this scheme of voluntary insurance, and I should certainly hope myself that the working of the scheme will be so good and so efficient that people will want to join it. Otherwise it will be greatly a wasted effort.

Another suggestion which I am sure is worthy of consideration is that there should be an income limit fixed. That is to say, that above a certain income people should not be allowed to join. I think myself the proposal for a sliding scale is the better one, but still it is manifest that if people with greater incomes become voluntary contributors the average scale of pay must necessarily be raised the higher the income. Of course, an objection which will be put to me is that, after all, everyone who pays into this as a taxpayer has a right to its benefits, and I should be the last to dispute that. But we all contribute in our various degrees to old age pensions, though we are not open to receive them if our income is more than a certain number of shillings a week, so we cannot very well attach too much importance to that consideration. I have here an analysis of the income of a large practitioner in this district, and I hope the Chancellor of the Exchequer will inspect it or have it examined by an actuary. I believe it will be obvious that unless something is done with regard to an income limit a large number of these men will be very seriously injured.

We then come to another point which perhaps is not material to the Bill but is more a matter of machinery, and that is the method of payment. I am quite sure myself that it will be entirely impracticable as a National scheme to adopt simply payment by attendance. It must be coupled with something else. There are manifest drawbacks to every single scheme. I could bring arguments against payment by head or payment by attendance. One of the chief of them is that it tends to keep patients out of institutions. If you pay a man by attendance he is not so likely to want to send a phthisical patient to a sanatorium as he would otherwise be. I think at this stage in our discussion it would be a great mistake for the Chancellor of the Exchequer to lay down any hard-and-fast line. These matters can be very much better thrashed out when we get to closer grips with the actual problems involved, and therefore, while I am confident that it is necessary to make very liberal provision—which I agree will cost considerably more than is at present anticipated—yet at this stage it would be desirable not to make things too cut-and-dried.

The most hopeful part of this scheme is with regard to the general administration. I believe the friendly societies have everything to gain by unifying their service under this scheme. There will be the local health committee, which will administer the Post Office contributors. The friendly societies, as the matter stands, cannot be expected to make a profit out of medical attendance. It is to their interest, for instance, to get their members into a sanatorium or a hospital as soon as ever they need it. The local health committees have control of part of these funds, and those who are contributors under the Post Office will, of course, have direct access to it, and it is very desirable that members of the approved societies shall have equal facilities. That is to say, I think it will be to the advantage of the societies if they were to allow the local health committees to manage the treatment of the sick, whilst at the same time the manifest advantages of becoming members of the society remained in the Bill and were even strengthened. The first step which I think must inevitably follow out of this Bill is that our Poor Law infirmaries will have to cone within its ambit. I sincerely hope the Chancellor of the Exchequer will allow the word "institution" to be used in a very liberal sense. It would not do, I think, to limit it too much to the sanatorium; and as institutional treatment for an operation or anything of that kind is necessary, it will be very important that the local health committee shall have access to well-equipped institutions; and I believe one of the first results of this scheme must be the improvement of our Poor Law infirmaries and the separation of them from the Poor Law itself.

With regard to the provision for treating tuberculosis, it is hardly necessary at this stage to say anything in praise of them. The country is convinced, I believe, of their necessity. But it may be perhaps an advantage just for a moment to look at the existing state of affairs. There are something like 60,000 deaths a year from this disease in various forms, and the friendly societies spend themselves considerably over £1,000,000. I believe 15 per cent. of the expenditure of the Ancient Order of Foresters is in virtue of treating this disease, and the average cost of each patient in that society is £41. According to the Report of Dr. Bulstrode to the Local Government Board, there are only about 2,000 beds at present available in this country for proper open-air treatment, and there are on the average 250,000 cases of this disease existing at any one time. Many of the beds are in very small institutions, which are inadequately staffed. I was very glad the Leader of the Opposition the other day put in a plea respecting bricks and mortar. I sincerely hope the Insurance Commissioners will see to it that this £1,500,000 is not wasted in bricks and mortar. There is, for example, at Chelmsford now a very interesting and useful experiment being carried on by Dr. Lister, who is treating a large number of people at a very cheap rate by means of shelters in gardens, and there are other parts of the country where the same kind of thing is being done. One hundred pounds is a generous allowance for a sanatorium bed. A great many patients could be treated fairly well in cheap shelters costing not more than about £20 or £30 a bed. Here, again, coming back to the work of the local health committee, not only is it important that in the cases of the patients in the sanatoria, but in the cases of phthisis under local treatment, they must of necessity, whether they belong to approved societies or whether they are Post Office contributors, come under the supervision of the local health committee. This is only another reason for supporting the contention which is running all through this scheme that it is to the benefit of the whole community that the administration of this machinery should he unified and in one hand. For example, the local health committee should be the agent. I am not now criticising the constitution of the local health committee. I must leave that to somebody else. But as a part of the whole campaign against tuberculosis we must establish cheap tuberculosis dispensaries, so that if you remove a man for four or five months, you must see that his own home is disinfected and that his children, if they have the disease, are treated adequately. In one of the works on this subject there is a striking and well authenticated case given of one particular block of dwellings where all the tenements had been free from the disease for eight years, and then there came into one of the dwellings a family a member of which had tuberculosis. During the twelve years that followed four separate families inhabited that same flat, and were all infected, and finally there were thirteen deaths in the twelve years in that one dwelling. The supervision of dwellings of that kind must be carried out by the local health committee, the sick visitors, and the nurses. Whether the person belongs to a friendly society or is a Post Office contributor makes no matter from this point of view. That is to say, the actual domestic preventive measures must be under the supervision of the local health committee, and I am sure that here again we see again the wisdom of unifying the whole of this machinery.

The same remark applies to that valuable provision in the Bill which gives power to the local health committees to deal with recalcitrant and neglectful local authorities, and to bring them up to the scratch. I see, for instance, provision is made in respect of milk supply. It is obvious that the proper supervision of milk is the first interest not only of the local health committee, but of the members of the approved societies. One good thing introduced in the Bill is the provision that requires measures to be taken for the proper sterilisation of milk. I have here the Report of the Medical Officer for the County of London for 1907, which states that out of the ninety-two samples of milk examined no fewer than twenty-two, or 23.9, were found to be tuberculous. It will be to the interest of the local health committees as well as the members of approved societies, that this disgraceful state of affairs should be brought to an end.

I should like to say a little about the provisions of the Bill with respect to women. In some respects they are the weak provisions in the Blil. I would be the last to urge the Chancellor of the Exchequer to make the scheme too expensive. Already, I think, it will cost more than is anticipated. With regard to women there is, first of all, the munificence of the maternity benefit which cannot be overestimated, but coupled with it there are one or two strange anomalies which I do not understand. A woman may be an insured person, and yet sickness benefit is now allowed during maternity. If she has the measles, she will get sickness benefit, and I think that in the case of an insured person during maternity it should be arranged that she should have greater benefit than is provided under the Bill. I think it will be a great advantage if in connection with this in the case of a woman who is an insured person before her marriage, and who has paid in premiums for several years previous to her marriage, she should have her benefit made up to some extent and used in the form of a dowry at the birth of children, or a percentage of it might be so used. You might have a woman who has paid her premium for ten years, and who then gets married. I think we may fairly suggest to the Chancellor of the Exchequer that he should take this into consideration. It would seem very hard on this woman that, having paid in these premiums all this time, she should, when she comes to the time of her greatest need receive no benefit. I think it should be open to married women during pregnancy to pay the premiums—I will not say for how many weeks, but for a certain number of weeks. If she pays the premiums, she ought in that way to be able to get considerable sick benefit during the time of her need and for some weeks afterwards. I think that something should be done to extend the benefits to married women who have, while single, paid premiums. That would be a valuable addition to the Bill. Another thing should be mentioned in this connection as something which will show that we have in our minds the attendance given by qualified midwives for whom we have passed legislation. The majority of cases are attended by midwives, and the benefit in maternity cases should cover the attendance given by them. As far as I am able to understand the scheme, a mother is not able to receive the sanatorium benefit. That, I think, is a serious drawback, because the mother of a family is the one in a house it is most desirable to get out of it in the case of illness. It is exceedingly important that something should be done so that married women should obtain the sanatorium benefits.

I hope the House recognises that while I advance these criticisms on the question as to who shall administer these sick benefits with regard to the treatment of sickness, I am strongly of opinion that it would have been best for the whole thing to be in the hands of the local health committees, for the reasons which I have mentioned. The necessity of providing within reasonable limits for a free choice of medical attendance and the consideration of the matter so far as it affects people whose incomes are over and above the Income Tax limit are matters as to which practitioners of medicine and the general public should be more fully informed without much delay. It would be unreasonable to expect that so complex a measure, which of necessity is full of difficulties and of necessity affects a multitude of interests would not cause a great deal of apprehension in many quarters. It is manifestly necessary that we should do all things possible to encourage and stimulate those great societies which have done so much to promote self-help in our midst. At the same time, I am sure we all recognise that the smooth working and ultimate utility of this measure must depend upon the hearty cooperation of that great profession whose livelihood and daily work are immediately involved, and concerning whom this scheme is full of possibilities of failure. I believe that they are only too anxious, if satisfied that they will be able, to cooperate with confidence and self-respect, and if their assistance and hearty union with this House and with the community in general can be obtained, we shall then be in the way to obtain in this country the most efficient engine for the prevention of disease which is possessed by any civilised community.

The ATTORNEY-GENERAL (Sir Rufus Isaacs)

I am quite certain that no one in this House, and certainly no one on this side of the House, will venture to complain in any way of the comments or criticisms that have been passed with regard to this Bill during the discussion today. I cannot help thinking that the speeches on both sides of the House during the course of this Debate have shown the House of Commons at its best, from one aspect. That is from hon. Members whom we are accustomed to regard as the Opposition, we have received comments, we have heard criticisms, and suggestions have been made which are all designed to help the Bill and not to oppose it, and I am quite sure that the Government recognises to the full and appreciates thoroughly the spirit in which we have been met; and also during the whole of the discussion that will take place on this Bill I trust that we may meet with the same spirit and that we may all fully and frankly recognise that the only object that we have in this House with regard to this Bill is to make the best possible measure of it, and not in any way to prevent the passing of what we believe to be a beneficent measure.

The objections which have been made with regard to this Bill on the Second Reading may be readily summarised, I think, under three heads in the main. The first is some objection, and I cannot help thinking it a very weak objection, has been raised to the Second Reading of the Bill being taken at so early a date, as it was suggested, after the introduction of the Bill. No doubt many hon. Members of this House have received letters in what I think I may describe as a stereotyped form from our constituents and sometimes from those who are not our constituents, pointing out to us how desirable it is that we should postpone the Second Reading of this Bill, with the object of giving time to make amendments. I cannot help thinking that most of the writers of these epistles have not fully appreciated the Parliamentary situation. They do not recognise that it is only when you get past the Second Reading of a Bill that you begin to consider the alterations and amendments, and as everybody who has written about it seems to be animated with the most earnest desire that the Bill should pass as quickly as possible—




Except my hon. Friend.


No; the London "Standard."


If the suggestion of my hon. Friend is that the London "Standard" does not want the Bill to pass, I understand the interruption. But if he means the London "Standard" wishes the Bill to pass, as do all my hon. Friends opposite, then it was quite unnecessary for him to correct the statement which I made, which is to this effect, that if you wish a Bill to become law, but desire to amend it—which is what I conceive to be the situation on both sides of the House—then the sooner you get to the Second Reading and carry your Bill in Committee the sooner you will arrive at a point of agreement upon some matters which are at present in dispute. The second objection which has been made to the Bill is on behalf of the medical profession. I do not propose to discuss at length the various proposals that have been suggested, some of them very valuable suggestions, emanating from both sides of the House, and worthy of the most careful consideration, and which are really helpful to any Government which is desirous of meeting the profession that has given ungrudgingly and generously its assistance to patients, without caring whether they are able to pay or not.

But I am quite confident of this, that the Chancellor of the Exchequer, who is in charge of this Bill, will be only too anxious to deal in a fair and just and equitable spirit with this medical profession when he gets an opportunity of meeting them, so that any suggest ions that may be made not only may be considered, but, if useful, may be accepted, and then dealt with in a Committee of this House. So I do not propose to spend more time in the discussion of that part of the objection which has been raised, because I conceive that it is not really a matter which goes to the principle of the Bill, but that it is one which will be dealt with in Committee of the whole House when we come to consider Amendments. The third abjection is principally with reference to approved societies. Observations have been made as to the numbers, and the 10,000 which is named as one of the conditions, as to the security to be lodged, and more especially with reference to the trades unions, on which I shall have an observation to make when I come to deal with that part of the Bill. I postpone that for a moment in order to deal with what I conceive to be in logical order the various points of the Bill to which I desire to call attention. For instance, I may point out to the House what I think has been made apparent during the course of this discussion—that there is no dispute between us as to the main principle of this Bill. We are all agreed, first of all, that there must be a compulsory insurance. It cannot be rested upon a voluntary basis.

There is no doubt upon any side of the House as to that, and, further, if you have compulsory insurance it must be upon a contributory basis. Secondly, it must he remembered that this measure was intended not only to provide for compulsory insurance, but also for the cure and prevention of disease. In the framing of this measure the Chancellor of the Exchequer and those who have been privileged to take any part at all in the discussion of the details of this measure have had the incalculable advantage of the experience of the German Empire in relation to this compulsory insurance. Germany has gradually built up a system which by common consent is of a most beneficent character, and is working to the advantage not only of the employer, but also of the employed. The White Paper which has been circulated quite recently contains the opinions of a number of German employers which really are most valuable in considering what we can anticipate as the probable result of this measure, certainly upon employers. I am not going to attempt to read them or to quote them to this House, but I will summarise them in two or three sentences, and I believe fairly, having regard to the opinions therein expressed. The general opinion in Germany is that by freeing the working classes from anxiety by reason of sickness, infirmity and accidents, their conditions of life have been materially bettered, and, from the employers' standpoint, the contributions they make have proved an excellent investment. The insurance law has tended to improve the relations between the employer and employed, without impairing the independence of the workers.

Indeed, if you study the history of the last twenty-five years, the period covered by the insurance legislation in Germany, it will be discovered that trade unions have flourished and multiplied exceedingly in the German Empire, concurrently with the progress and development of this industrial insurance legislation. On the either hand, so satisfied are the employers with the result of this legislation that it is roundly asserted by one prominent employer, speaking, as he believes, on behalf of the employers, or the majority of the employers in Germany, that they do not desire, and indeed would oppose, the repeal of these insurance laws, which, nevertheless, necessitate their making a contribution to certain funds according to the legislation of the country. At one time as was naturally to be expected, when this scheme was launched or mooted in 1881 by Prince Bismarck, there was the greatest anxiety amongst German employers as to what was to be expected as a result of his proposal. It was said, at first, that it would fine employers, that it would tend to cripple industry, and that the cost of production would be increased without any co-relative advantage. It was explained, according to their views, that these new contributions to be made by the German employer would act injuriously upon the employers' interests, and that it would consequently re-act to the disadvantage of the employed. But all these apprehensions have long since disappeared, and Germany has continued to develop under this insurance legislation, and at the present moment—it is a curious coincidence worthy of observation—that during this very week, in the German Reichstag, there has taken place a debate on the Second Reading of a measure for the consolidation and codification of the German insurance laws, running, I believe, to something like 1,517 paragraphs. That is the position at the present moment.


It has been in Committee for twelve months.

10.0 P.M.


Of course, if there are from 1,500 to 1,700 clauses, I am not at all surprised that it has been in Committee for twelve months. But we, during these twenty-five years, have not progressed along the same line as Germany. But, nevertheless, we have made great strides. We have ourselves instituted workmen's compensation. We have instituted—it was originally introduced by the present Opposition and developed and extended by the Liberal Government since 1906—old age pensions, which in this country are on a non-contributory basis. In Germany, as, no doubt, the House is aware, it is on a contributory basis. The difference is that at the present moment, for the year 1911–12, the Government requirement for old age pensions is £12,840,000, whereas in Germany there will be required of the State as its contribution to old age pensions, £2,575,000, which is a contribution to the £7,500,000, which is the total amount provided under old age pensions for the working classes in Germany. The average old age pension under the scheme in Germany works out at 3s. 1d. per head. It is not surprising, therefore, to know that, notwithstanding that there is this scheme of old age pensions, very often, and indeed most often, the working classes who are in receipt of old age pensions have to have recourse to the Poor Law. One of the striking features of the system in Germany to which I desire to call attention is this, that the compulsory provisions for sickness and disablement insurance has proved a stimulus to thrift in other directions. This is confirmatory of the views which we hold. It shows that the habit of saving increases as you make provision, and as you help by contributions either from the employer or the State, so you induce the worker to make further insurance for his own benefit. He comes to realise what is the true advantage of insurance.

He would, further, appreciate that, in the case of sickness or of some temporary destitution, when he has either to withdraw or to exhaust the fund which he has managed to accumulate with great difficulty and great trouble because of the receipt of sick benefit or disablement insurance benefit, the money which he has managed to save for himself is still there in the savings bank, still accumulating from day to day, increasing in amount, and to which he can add his little store from week to week, and month to month. The desire to save becomes greater, and the appetite for it increases daily, and, consequently, as we believe, if we can only, manage in this country, by reason of these contributions, to instil into our people the desire to save, not only by those contributions that they have to make under this Insurance Law, but to save in order that they may be able to make their own provision, to create their own independence altogether apart from this scheme, I do believe that we shall have taken a most notable step along the path of progress, the self-respect and the independence of the workpeople of this country. One further point which we learn from Germany is that the curative and preventive effect of the treatment of disease by means of sanatoria and other institutions, such as convalescent homes and kindred establishments, in Germany, have not only succeeded in arresting the ravages or the disease of consumption, but have helped to prevent it. As the hon. Member for Plymouth said, in what I would like to describe as not only his most interesting, but most graceful and eloquent and sympathetic speech, in this respect, from one who had undoubted knowledge, and who gave the House the most valuable information, which he had acquired doubtless with much study and labour, from the result of all those efforts in Germany it has been established that you do assist in checking and preventing the disease by having resource to sanatoria. I am not going to travel over the ground which the hon. Member traversed, because I could not, if I attempted, say so well what he has said during the course of this Debate. My attention was also attracted to the speech of the hon. Member for Montgomeryshire (Mr. David Davies), who from his knowledge and study of this subject contributed from this side of the House valuable information. I can assure the hon. Member for Plymouth and the hon. Member for Montgomeryshire, and others who have spoken on this subject, that every word that has fallen from them has fallen upon ears that are open to suggestion, and that are really most anxious and desirous to find the best means of meeting what we all believe to be the most terrible scourge of this country. I pass from that subject with the observation that in the data to which I have called attention we have the most valuable experience from Germany, which has assisted us in formulating the scheme in Part I. of this Bill.

Let me make this observation to hon. Members, so that they may bear it in mind in criticising the actuarial calculations of our actuaries, who are men of the highest standing in the country, and who have of course devoted their whole lives to their science, and who speak with a skill which I am quite sure is certainly unexcelled, although it may possibly be rivalled, throughout the country. The observation to which I want to direct attention is that in Germany workmen's compensation for accidents and old age pensions form part of the contributory system, and therefore must be taken into account and borne in mind. When you are criticising our actuarial calculations as compared with those, those are factors which must not be lost sight of. Let me point out to the House how we stand with regard to this matter. Before I pass to some of the criticisms and to some brief exposition of some of the points which I think have not yet been elaborately dealt with, I think that it is a great satisfaction to us to find that Germany, which has been the pioneer in this movement, and which has hitherto held the leading place in the world for social legislation of this kind, is itself much impressed by the measure which has been introduced by my right hon. Friend. I noticed in reading the German newspaper dealing with the introductory speech of my right hon. Friend that the German criticism of the measure is that, owing to its directness, its simplicity, and its comprehensiveness, it will excel what one German newspaper, the "Tageblatt," calls the "bureaucratic hotchpotch of the German insurance system." Let us note as we pass the compliment that is paid to my right hon. Friend the Chancellor of the Exchequer. In German Press articles, German experts are advised to study the pleasure which has been introduced by my right hon. Friend, lest they should be left behind, and, indeed, one German newspaper I happened to read said that the introduction of this measure had earned for my right hon. Friend a statue in Westminster Abbey. I hope the time is long distant before we shall have to consider whether it will be desirable to erect a statue for him in Westminster Abbey.

I cannot help thinking that there has been a considerable amount of misapprehension with regard to some of the details of this measure, not in this House but outside the House. There are some points upon which I would like to dwell, and I will just call in rapid review the main provisions of the sickness and insurance part of this Bill. It is first of all obvious to the House that it would not be possible, I think all must agree, to compel the working classes to insure against sickness and invalidity unless you gave material assistance both from the employer and the State. In the most interesting speech which was made by the hon. Member for Sevenoaks (Mr. H. W. Forster) this evening, and will he permit me to say in the high-minded speech which he addressed to this House, we were all perfectly conscious that he agreed with us, as every man must agree when you come to consider the imposition of a measure of this kind upon the industrial classes in the community, that it is idle to talk of it or to think of it as a voluntary scheme. You can only make it effective if you make it a compulsory scheme. It is not necessary to dwell further on that, having regard to the complete unanimity of the House upon this subject. Under the Bill we have included all those who were not provided for outside the Bill, and we have sought to include under it all those whose incomes do not exceed £160 per annum, with certain exemptions which are to be found in the schedule of the Bill. We have sought to do this upon a principle which I think is novel, or, at least, it is so to me in the history of insurance. The Government recognised that when it said to the working classes, "You must come into this insurance scheme and you must pay your contribution," that it is useless to say to a man of forty-five years of age, "You must pay your proper age contribution in order to get your benefit." The Government recognise that if you ask him to do that you are imposing on him an impossible task. He cannot afford to do it. He probably has not done it because it may be he has not sufficiently or fully appreciated the benefit of insurance, or it may be that he has at first joined a society and has then fallen out because he has not been able to continue his contribution, or it may be because he has at no time been able to afford the contributions demanded of him in order to secure benefit. Whatever may be the case, the fact remains that you find again and again that out of some 15,000,000 people in this country insurance provision is made for, at most, only 6,000,000. Now the Government say, "We must help the men of thirty-five, forty, forty-five, fifty years of age and onwards "—and this is what I consider to he the novelty and the boldness of the scheme." Every man, whatever his age up to sixty-five, shall be entitled to insure by a payment which is properly applicable to a lad at the age of sixteen." In other words, what the Government say is, "For the purpose of this insurance, all who come in during the first year shall be allowed to come in at the premium which would be the premium if the entrant were sixteen years of age. You shall regain your youth for the purpose of insuring at the present moment, and you will have to go on paying that premium during the rest of the time "—although the man may be forty-five years of age, and has the great advantage that from sixteen to forty-five he has not been forced to pay a premium at all.


We are all anxious to get information, and that is my excuse for interrupting the hon. and learned Gentleman. He says that a man of forty-five years of age, for instance, is to pay a premium which would be the correct premium for a youth of sixteen.


For the benefits.


Is that so?




Is it not the case that the youth of sixteen has to pay more highly for the benefits which he is to receive? I am not criticising; I am only asking for information. Is it not the fact that for the first fifteen years or so he will receive less than the benefits applicable to his premium, because you take in the man of forty-five? In other words, is it not the case that the expense of bringing in the men of forty-five is charged on the young men rather than on the State?


I do not complain of the question in the slightest degree; I am glad to have the opportunity of answering it. The contribution is that which would be applicable to the age of sixteen for the benefits offered. If I may refer the right hon. Gentleman to the actuarial report, pages twenty-three and twenty-four contain really the pith of the whole matter.


I am sorry I have not had an opportunity of reading the report.


I have studied it for this purpose. It is a table which may require a little explanation; but if it is studied it will be found that the premium payable is the premium which would be payable by a youth of sixteen to obtain the minimum benefits granted by the State. If a man loses the opportunity of joining on those conditions during the first twelve months of the scheme and comes in afterwards, he will have to pay his proper age contribution. It is for that reason, and only for that reason, that the Government have to assume what has been referred to in the Debate as a debt of £60,000,000, or £63,000,000, counting the married women provision. It is simply for the reason that you impose on the approved societies the obligation to take entrants at a flat rate, based upon the contribution payable by a lad of sixteen for the minimum benefits, the Government have to meet the societies by giving them a credit for their aggregate annual reserves. What it means is that a society has to get credit corresponding to the age reserve of its members, with 3 per cent interest added, in order that it may be placed in what I may call a position of present actuarial solvency. If a society were to liquidate to-morrow, after having taken in all those members who applied at forty, forty-five, or fifty years of age, with the addition of the credit which the Government give on the basis of its aggregate annual reserve, that society would be actuarially solvent on any valuation that you might make.

The right hon. Gentleman knows better than I do that this is a matter of mere calculation, and it is carried out as, I might almost say, an exact science. With the knowledge and data that our actuaries have, and with all the materials before the House, and as the memorandum of the actuaries show, there is not the slightest doubt but that this has been calculated upon a very conservative basis indeed. Although it does not appear, from Table S, page 23,—which is the material table—if you work it out it will be found that a man would have to pay 6¼d.—to be exact 6.288d.—in order to obtain the minimum benefits per week. For that, of course, there is the contribution both by the employé and the employer of 7d., supplemented by the Government, and the margin between that 6¼d. and the 7d. is a margin which my right hon. Friend has allowed for the purpose of providing for any present contingencies, and to allow for further benefits which may be allowed upon that basis. There is, of course, another margin for a sinking fund which is to be created for the next fifteen and a-half or sixteen years approximately, in order to wipe out a sum year after year, so that eventually the scientific annual reserve will disappear altogether, and a paper debt of £60,000,000 will be completely wiped out. Everything will then be upon an actuarily solvent basis. These contributions, which are made, are more than sufficient, as I have I think pointed out already, to provide the benefits under this scheme.

I want to call the attention of the House to three very important provisions in reference to the payment of these contributions, and benefits to be given, which I think have hitherto escaped observation. They are most material matters in the making of our actuarial calculations, and they are of great benefit to the working community. The first is that no contribution is payable when a person is in receipt of sick benefit, or if he would have been in receipt of sick benefit but for the fact that he is receiving compensation either for an accident, or is the inmate of a hospital. In other words, the Government, by their scheme, say that when a man is receiving sick benefit the money is to be paid out to him without any deduction. He has no contribution to make during the time he is sick. Under a friendly society scheme, suppose that the benefit is 10s. and the contribution 9d., he would have 9s. 3d. handed out to him, the deduction being made from the sick benefit before the money is paid over. That, of course, is a very valuable benefit to him. But we do not stop there. If a man is unemployed—and I am sure the House will appreciate the value of this concession—notwithstanding that he is not paying his contribution, although he is in arrears with his contribution, until his contributions have fallen into arrear for four weeks, that is under the wording of the Bill beyond three weeks, he will receive his sick benefit without alteration, and he is under no obligation to pay; and, further, if the case goes beyond four weeks and provided it does not exceed on the average thirteen weeks of the year, he is entitled to receive his sick benefit, notwithstanding that he is in arrear with his contribution for this period. In order to make that plain let me take a concrete example. Suppose a man has been insured for twenty years and has paid his premium, and at the end of twenty years he loses his employment, he may be out of employment then and in arrear in his contribution for five years before he will be under suspension of the payment of sick benefit. Again, suppose a man after twenty years is unemployed, and after a time is unable to pay his contribution for one, two, or three years, and I will assume that for three years ho has not paid a single penny of contribution, if he then falls sick he is entittled to his benefit under the Bill, notwithstanding that he is in arrear, because he is not in arrear more than 25 per cent. of the time during which he was contributing; that is to say, he is not in arrear for more than thirteen weeks on the average per year. That is a most valuable concession, because the difficulty that must always occur to a man in keeping up his contributions is experienced either in time of sickness with which I have dealt, or in time of unemployment, which we have expressly met in, I think, a very generous spirit.


There will be great temptation for a man to avail himself of such generous terms as that. Is there to be any check upon his statement that he is unemployed for the purposes of Part I. of the Bill?


Yes, there is this check. If it gets beyond the period of four weeks the benefits he receives will diminish in proportion to the arrears of contribution. There is a schedule in the Bill which deals with that in detail. His benefit never can go below 5s., but it would decrease to 9s. 6d., to 8s. 6d., and so forth, according to the number of weeks he is in arrear. If there is not sufficient check some such check must be provided. I will not pledge myself that it is already provided in the Bill, but it must be remembered that all these benefits have to be dealt with by the friendly societies who are responsible, and who themselves have to make up any deficiency in consequence of lax management if they allow too much to be expended or paid over in benefits. I have pointed out what the value of this provision is. The House will remember what the benefits are. I am only going to deal now with what I may call the main benefits applicable to persons from sixteen to twenty-one, and if married from twenty-one to the age of seventy. In all these circumstances the scale of benefits are from 10s. to 5s. for three months for maternity, sanatoria, medical attendance, and similar other benefits provided under the Bill. In reference to the speech made by my hon. Friend the Member for the Black-friars Division (Mr. Barnes) I want to compare the rates in Germany of contribution for sickness and invalidity. We are making a business proposition, and we are very anxious that it should be made clear to the House that not only is our scheme actuarially sound, but also that it is conceived on real business lines, and will stand comparison with any other scheme. For my own part I will defy any hon. Member of this House, or anyone outside, to compare any scheme of benefits with those which are given under this Bill for the rate of contribution which is exacted from the employer. There is no scheme which can approach the benefits given under this Bill. I am not unmindful of what the hon. Member has said in reference to this point.

Let me turn to Germany as an instance, because to Germany we owe this industrial insurance. In Germany, as hon. Members no doubt know, there are various rates of contribution, and they vary according to the weekly income. I will take a fair average in order not to weary the House with a series of calculations. I take a man with a weekly income of 20s. A man with that income will pay in Germany 5½d. for sickness and l¾d. for invalidity, making 7¼d., as against 4d., which is the contribution under this Bill. That is the employers' contribution. It is quite clear that the employed has got the benefit of this 4d., as against the 7¼d. in Germany. The total amount payable therefore is 11¾d. The employer in Germany pays 2¾d. sickness and 1¾d. invalidity, making up the 4½d., whereas under this Bill they only pay 3d. A workman in Germany does not get the full benefit because he does not get the three probations to which I specially referred when I pointed out the valuable nature of this exception, which was made by us to the payment of contributions during the time of sickness and of unemployment. I daresay hon. Members are well aware that the figures I have taken are only taken as one instance out of the series of instances given in a White Paper. Any hon. Member can take any other instance he likes. I do not stop to explain the details now because it would take up too much time.


Is it not a fact that in Germany the workmen are insured against accident also and they pay two-thirds and the employer one-third, and after thirteen or fourteen weeks they are transferred to the sickness fund.


I pointed out earlier that that was a fact which had to be taken earlier into consideration. I do not want, however, to get into a discussion of that because for the purpose of a Debate of this kind I am afraid it would make it impossible to discuss the other part of the subject. I have gone into the matters very carefully myself, and the hon. Member can do the same by reference to the White Paper. I am now taking the Manchester Unity of Odd Fellows, and I have worked out the benefits of a similar character for sickness and invalidity and I find that for a contribution of 4d. it actually works out for a man at forty years of age, that he gets up to 1s. 4½d. in order to get anything, approximate to the sickness and invalidity benefit which is given under this scheme. You must add to that—unless you do, you will very likely be misled by the tables you may construct—1d. for management expenses and 1d. for medical benefit, so the real contribution is not what it appears in that table, but 6d. per week, as compared with 4d. per week which I give. Mark also, you have not for that contribution the addition of either the sanatorium or maternity benefits to which reference has been made. Neither have you the great advantage upon which I at any rate lay very great stress, of immunity from contribution during the period of sickness or during the period of unemployment. All these benefits are calculable in money actuarily, and I think it would be no exaggeration to say they would make at least another contribution approaching 2d. per week. I take that only as a typical society, because it is a very good one to choose. The result is you do get an enormous advantage. Of course, it naturally follows you do. These schemes are all based on calculations and tables by the actuaries, and, when you have the contribution of the workman only at 4d. and the contribution supplemented by the employer's contribution and the State contribution, it necessarily follows. It is no merit of the Government—it is so. I only want to point out to the, workmen that they get the enormous benefit of having only to pay 4d. for what otherwise would have to be purchased at 8d. or 9d.


Do not the Oddfellows give death benefits?


Of course they do, but I was purposely taking the sickness and invalidity benefits. I quite admit, if you get death and funeral benefits, the premium is greater, but in making comparisons, and in order that there should be no confusion in the mind of the House I have compared like with like. I pass from that part of the scheme to another part which has been very much discussed, and that is the approved societies. Let the House consider what is the position of the Government. On the one hand you may do what they do in Germany; you may have a vast bureaucracy, a great organisation, an army of officers and inspectors, who have all, at any rate in Germany, had a military training, and who will go to the working man and ask him various questions by the right which he will have as an official. If a Government in this country were to start an army of that character, apart from all other considerations or arguments which might very properly be addressed to the Government against it, let me ask what possible security would there be against the evil which is the very crux of insurance of this character against sickness and invalidity—the evil of malingering? Anybody who has had any experience of friendly societies, and has had to examine their accounts, go into their figures, or deal with the facts must recognise that is a great evil. The friendly societies do their best to suppress it. They cannot succeed in entirely suppressing it. Of course no friendly society or any Government society could do that. So long as human nature is what it is there will always be those who have sick benefit who will appear, at any rate, to be a little sicker than they really are.

What is the alternative? It has been the subject of much careful consideration on the part of the Chancellor of the Exchequer. He found to his hand societies with a large membership, with great accumulated funds, based on the principle of self-help and mutual aid and brotherly feeling. When the members of the societies who are formed to relieve the sick and assist the distressed and elevate their members to positions of self-respect and independence, and managed their own affairs without State control, elected their own representatives, and really opened up a career for their fellow members, surely these societies are deserving of the highest respect and admiration. They have had to check malingering. The trade unions have exactly the same difficulties to deal with; for this purpose they are in exactly the same position as the friendly societies. They have won for themselves a position of high esteem and respect among the community. Therefore we find at hand societies ready to do the work which no Government can properly and efficiently do: that is the work of looking after the men themselves. Who can do it best? It is the men themselves. If there is any malingering, if a man is seen at the corner public-house enjoying himself he will be called to account by his friendly society. It is to them that the Government has turned for co-operation and assistance in carrying out and administering this Insurance scheme.

Of course, when the Government turns to friendly societies, trade unions, and kindred societies it necessarily, when dealing with State Funds, lays down conditions which must be observed by all those societies. If the Government says that State money and the money of employers is to be administered for the purpose of paying out benefits under a State compulsory insurance scheme, it behoves the Government to see that the State moneys are properly administered. The hon. Member for the Blackfriars Division of Glasgow (Mr. Barnes) made some observations in reference to trade unions, and the hon. Member for Bootle (Mr. Bonar Law) also asked a question on the same subject. The Government position on this is quite clear. The one thing that is plain is that the Government cannot sanction a scheme which would permit of money levied by Act of Parliament from the employer to be paid into the coffers of a trade union fund to be used by that trade union as a war chest against the employers. I am perfectly certain from a considerable knowledge of the executives of trade unions that not one of them would ask that.


That was not the point. What I wanted to know was, are the contributions of a man for this special purpose of compulsory insurance to be available for any other expenditure?


That seems to me to be the same point, only it is not for the purpose of a war chest, but other purposes.


Then it is not available?


No, it is not available. Money which is provided for the State scheme is to be used for the State scheme, and for no other purpose.


May I ask whether it can be paid in with money which can be used for any other purpose?


The answer to my hon. Friend would be "No"; for this reason. The Government is by this legis- lation providing that a State benefit should be paid out to the man—that is to say, that a minimum benefit should be paid out under the State scheme to a member of the society, and the Government view is—of course there may be considerations which may be brought before my right hon. Friend in Committee—the Government view is that you must keep the State fund separate. I do not mean by that that you have necessarily to pay it into a separate coffer. That may not be necessary. There may be other means. You may meet it by a system of crediting. I am not going into the actual working, but what I do mean is that the Government view is that you must keep these funds collected under the scheme separate and distinct, and it follows necessarily from this that in dealing with these societies you must have a Government valuation, you must have a Government audit, that is, so far as it affects the scheme, and not otherwise, and all the funds belonging to a trade society and which have accumulated hitherto and which are there for their ordinary benefits will be untouched. Trade union funds will be in the same position, they will be untouched, and they are in no way interfered with, except those contributed for this purpose. What is affected is the money under the State scheme. I will take a concrete case, which is so much easier. Of course the trade union or friendly society may be receiving 9d. under the State scheme in respect of a member from whom it has received 9d. for benefits under the friendly society or trade union before the Government scheme came into existence. A man being for years a member, may have been paying 9d. for, it may be, some other benefit, which may include the sick benefit and invalidity, and also some other benefits. He may be doing that under the Government scheme. If the trade union or friendly society or other private society receives the 9d., which will be the 4d. and the 3d., and the contribution from the State in respect of this member, it cannot collect the money for the same benefit both from the member, and in this respect from the three sources. It will, of course, have got 4d. from the member which will have been deducted at the source by his employer, and a stamp will be put upon the document, but that is all that the employé has to pay. It is quite true that some of our critics say in the newspapers what becomes of the rest? The other 5d. is received from the State and the employer. In respect of that other money, that is for the friendly societies to deal with, and provision is made under the Bill that they may deal with it. The workman's power to contribute is just the same before the Government scheme as it is after, or rather it is a great deal more. He has much more in his pocket to pay over to the friendly society and the trade union for other benefits than he ever had before, because if he has only to pay 4d. to get the benefit which he will have to buy for 9d. from the friendly society, and the State and the employer pay the 5d., making up with the 4d. paid by him the 9d., he has that 5d. in his pocket to contribute to the friendly society or the trade union for other benefits which do not come into our scheme at all. He may do it in that way, or, if he likes, he may go to one of the insurance societies and insure his life, or he may take a larger funeral benefit, as the case may be. The effect of insurance is to beget insurance, and the effect of this scheme is to release money in the pockets of the working classes which in the ordinary course will go amongst the various friendly societies, trade unions, and industrial insurance societies. I suppose nothing will be clearer than this, that if an approved society manages to secure a person as a member who has not hitherto been a member of any one of these societies, he has money in his pocket to invest in insurance, and as long as he is treated fairly, with civility and courtesy he will desire to continue with the same society in a new kind of insurance which has nothing whatever to do with the Government, instead of going to some other society. It is just the same as if I am accustomed to go to a shop for the purchase of one article. I have been well served and properly treated, and I want another article which I might buy equally well at another shop, but I will not go to the other shop if I am once in this shop which I know and where I have been served well. So it will be and thus it will continue with the friendly societies. They will all get an enormous advantage by the scheme because there will be an increase in their membership. Instead of having as now 4,500,000 in friendly societies—6,000,000 really all told, distributed all over the country—you must have something like 14,000,000 members. They must join either of these various societies or must become members of the Post Office scheme.

In dealing with these societies, I have pointed out the enormous advantage which the Government have given them. What is it that the Government ask from them? I want members of friendly societies to bear in mind, first the benefits which are conferred upon friendly societies, trade unions, and industrial insurance societies. There is a large and deserving body of men who are collectors in these industrial insurance societies, men who must not be treated with any want of consideration by this House. They are men who have helped to make the way for this insurance scheme. They have helped to stimulate thrift. They know the position of members, and are able to locate the various members in the localities, and know them as no one else can. Their co-operation, of course, would be of the highest value to the Government. Nothing that can be introduced into this Bill is intended to prevent their coming in. They can come in if they choose, but it must always be on the same terms as everyone else. They must conform to the prescribed conditions. There is not a word in the Bill which prevents them conforming to the prescribed conditions. They may have to form, and doubtless would have to form, branches or subsidiary societies, in order that they may work under these prescribed conditions. It is all to their interest to do it. They get the money paid over to them from the society, and in that way they get a largely increased clientele among insurers. It is all to their benefit to get these people. If they do that, and come under the scheme, and work and administer the scheme in the same way as the friendly societies and the trade unions, it would be all to the advantage of everybody concerned, because then we should not lose the great benefit of the knowledge they have acquired and of the experience they have gained, and we should not be accused of placing in jeopardy the livelihood of any of these men.

Some fear seems to have been occasioned in the minds of these men that under the Government scheme we are proposing to deal with life insurance or death benefit. There is not a single word in the Bill which would entitle the Government to take up that form of insurance under any circumstances whatever. There was not a single word in the speech of my right hon. Friend the Chancellor of the Exchequer which would warrant any such assumption. On the contrary, he pointed out that we did not contemplate to deal with death payments. Those must be left to voluntary effort. The men are, of course, quite entitled to make what bargain they please. Voluntary effort must do it. The Government cannot do it. Even if you consider the extended benefits which the Government may be able to distribute at a subsequent stage, you will find that there is not a single word which would enable the Government to make payments for death or funeral benefit. Therefore I do hope that any apprehensions which may have been in the minds of any members of these societies may be allayed with reference to this scheme, and that they may not think that their livelihood is placed in jeopardy by the proposals now before the House. I think it will be better to adjourn now till to-morrow, before entering on another part of my speech. I beg to move, "That the Debate be now adjourned."

Question put, and agreed to.

Debate adjourned; to be resumed tomorrow (Thursday).