§ (1) A local Health Committee shall be constituted for every county and county borough.
§ (2) Such number of the members of the committee as the Insurance Commissioners, having regard to the circumstances of each case, determine, but in no case less than nine or more than eighteen, shall be appointed—
- (a) As to one-third thereof (which shall consist wholly or in part of members of the local sanitary authorities) by the county council or the council of the county borough:
- (b) As to one-third thereof by such approved societies as have members resident in the county or county borough who are insured persons, or, if such societies cannot agree upon the appointment, by the Insurance Commissioners:
- (c) As to the remaining one-third thereof by any association of deposit contributors resident in the county or county borough which may have been formed under regulations made for that purpose by the Insurance Commissioners; provided, that if no such association has been formed, such one-third shall, subject to the approval of the Insurance Commissioners, be appointed by the other
1668 members of the committee, or in default by the Insurance Commissioners, from amongst, so far as practicable, such deposit contributors as aforesaid.
§ (3) Any members appointed by the Insurance Commissioners under paragraph (b) of the last preceding Sub-section shall be appointed from among insured persons resident in the county or county borough who are members of approved societies, and in making such appointments regard shall be had to the desirability of securing that, so far as practicable, this representation of the several societies should correspond to the number of such insured persons who are members thereof.
§ (4) The Insurance Commissioners may, in any case where it may be desirable to do so, by regulations vary the proportions in which the county council or borough council, the approved societies, and the deposit contributors respectively are entitled to appoint members of the committee, but any such regulations shall be laid before Parliament as soon as may be after they are made.
§ (5) The remaining members of the committee, not exceeding in number one-fourth of the members appointed in manner aforesaid, shall be appointed by the Insurance Commissioners, but so that at least two of the members so appointed shall be duly qualified medical practitioners.
§ (6) The Insurance Commissioners may make regulations as to the appointment, quorum, term of office, and proceedings generally, of the committee, and the use by the committee, with or without payment, of any offices of a local authority, and any such regulations may provide for the appointment of auxiliary committees consisting wholly or partially of members of the committee, and for the powers and duties of any such auxiliary committee.
§ (7) Any local health committee may, and shall if so required by the Insurance Commissioners, combine with any one or more other local health committees for all or any of the purposes of this Part of this Act, and where they so combine the provisions of this Part of this Act shall apply with such necessary adaptations as may be prescribed.
§ The CHAIRMAN
I think it would be for the convenience of the Committee if I were to indicate before we approach this Clause in what order it seems to me best to take the Amendments. A number of 1669 them appear earlier on the Paper than they should, having been put down earlier. Sub-section (1) of the Clause deals with three points—firstly, the establishment of local health committees, and all that will arise on the question as to whether the existing health committees are to act or some new authority to be set up; secondly, if the scheme of the Bill is approved, what duties fall to the new committees; and thirdly, the area. Then on Sub-section (2) we come—first, to the question of the members; secondly, to the authority or persons who are to appoint the members of the committees, and the arrangements for their election; and thirdly, to the provision as to the representation of special interests amongst the members. If the Committee agree to take the Amendments in that order, we will be able to deal with one thing at a time and avoid overlapping.
§ Mr. FORSTER
I understand the course you indicate, Mr. Whitley, is intended to keep separate various points to be discussed, and that I think is a suggestion the Committee would welcome; but I wish to make it plain that I think we should be allowed to refer when discussing some of the matters you have alluded to to refer to the concessions made by the Chancellor of the Exchequer in Amendments, although we have not actually reached them.
§ Mr. HARRY LAWSON
Would not a general discussion on the subject of getting up these public authorities be allowed as a prelude to a detailed discussion?
§ The CHAIRMAN
I think that would only lead to confusion and to overlapping. As regards the point raised by the hon. Member for Sevenoaks, I hope the Committee will support me in my endeavour to prevent overlapping. I quite recognise that in some cases the arguments must run into one another a little, but I desire, as far as possible, to assist the Committee in dealing with points seriatim as they arise.
§ Sir ALFRED CRIPPS
I beg to move, to leave out Sub-section (1), and to insert instead thereof the words "The existing health and sanitary committees for every county or county borough shall be empowered to carry out the duties imposed by this Part of this Act."
I will try to carry out what the Chairman has laid down and endeavour to prevent overlapping arguments. At the same time I wish to raise what is really an important question whether new committees 1670 are to be constituted for the administration of this Act or whether we ought to have recourse to existing authorities. It is unnecessary to emphasise the importance of the administrative side of this Bill, and I am sure the Chancellor of the Exchequer will agree with me in that respect. This is the first time during the various discussions we have had on this Bill in Committee that we have had an opportunity of considering how the Bill is to be carried out as apart from the financial matters already discussed, I want to make this point clear at the outset. If the local health committee be strictly limited in its power to insurance matters only, then the main object that I am going to raise would not have arisen at all. My main objection is that these so-called health committees have been given power in connection with local expenditure and local administration which in my opinion will produce hopeless chaos as regards our present local administration. According to my view, it would be much better to give these powers to existing authorities instead of creating new authorities for this particular purpose. Supposing we were dealing with insurance matters only, I do not think it is a question of great importance whether you take existing authorities or whether you constitute new authorities. In regard to existing authorities, of course it would be quite possible to make provision by co-option or otherwise of parties particularly interested in insurance matters. You might have a proper representation of friendly societies and deposit contributors, and there would be no difficulty about the matter. In my opinion you would have to start from the existing representative sanitary body and proceed by additions to that body which of course is quite distinct and different from putting that body on one side and seeking to create a new authority not in existence at the present time.
Let me indicate quite shortly why I think the proposal to create this new body ought not to be admitted. In the first place, it is not a representative body, and without going into minute distinctions between the existing bodies and any such new body, I may point out that existing bodies are representative in the full sense in which we see it in local government, whereas in the case of the new body this would not be the case. When you are dealing with questions of local government and local rating, it is extremely important that we should maintain the principle, which is the foundation of the 1671 authority of our local bodies, that they represent the ratepayers and persons on behalf of whom they exercise their particular duties and authority. What is proposed here is an illustration of a tendency to supersede by bureaucratically established bodies, the legitimate duties of representative bodies which exist. I want to point out the enormous extent which these new bodies, being constituted, would under the terms of this Bill improperly and unduly interfere with our existing local bodies. There would not only be interference and overlapping, which are bad enough, but if you interfere with the rights and duties of existing bodies, you cannot expect to get the same level of administration which you are getting at the present time. It is the essence of good administration that those who serve on these bodies should have not only the right but the duty and responsibility as regards the various matters of local government.
Without going into any details let us consider what the character of the duties are which would be thrown on this committee by Clause 44. I am aware that the Chancellor of the Exchequer proposes to modify the existing form of Clause 44, but that does not interfere with my argument. Whether you give general health committees power or not under the form of protection of the insured, it really makes no difference. Either in one form or the other this newly constituted body would, as regards all questions of public health, be able to interfere with existing sanitary authority. Not only is this provision in the Bill wholly inconsistent with the true principles of local government, but it is also likely to produce inefficiency as regards those very matters of health and sanitation which everybody in this House is anxious to preserve in the highest state of efficiency. If you interfere with these bodies you cannot expect them to give the same time and care as they do at present. As another illustration I might take Clause 46, and again I do not propose to go into matters of detail. Section 46 practically gives to this new authority power of inquiry into a large number of matters which immediately and directly concern the administration of existing local bodies. I do not believe that there is a single local governing body in this country which does not resent the improper power of interference which Section 46 will give. Without any restriction 1672 under this Section the newly constituted body might put into operation machinery for inquiring into some of the most difficult matters dealing with local administration, and having done that what is the result? The inquiry is made and the expense is thrown upon the existing local authorities in certain cases. The Health Committee would not have to pay itself, but it would apply to the Treasury to have its expenses paid. What is the position of the existing sanitary authority? It is put on its defence in an improper manner by the action of this newly constituted body.
§ The CHANCELLOR of the EXCHEQUER (Mr. Lloyd George)
I wish to raise a point of Order. The hon. and learned Gentleman is now entering into the question of Clause 46. I certainly do not object if I am entitled, on the other hand, to defend the position. He is giving what purports to be his view of what Clause 46 is, and if the hon. and learned Member is allowed to enter into that question, I should claim the right to defend it.
§ The CHAIRMAN
An hon. Member was consulting me with regard to an Amendment on the Paper and I was not following the hon. and learned Member's argument.
§ 4.0 P.M.
§ Sir A. CRIPPS
I am dealing with the constitution of these new committees and with their powers. I am proposing, as against the new committee, to bring in the existing sanitary authorities, and I am giving, as an illustration of my argument, the overlapping powers which would be given to the new committee, and the powers which would be inconsistent with those already exercised by the existing authorities. I do not intend to go beyond that, but in order to illustrate my argument I submit I am entitled to do this, and no doubt the Chancellor of the Exchequer would be entitled to answer on the same basis. I am entitled to show that the Bill as it stands, by Clause 46, gives enormous power of overlapping and inconsistent authority to this new body. The fact that the new committee, in a large number of matters, may call into question the working and operation of existing local authorities is, in my opinion, a matter of great importance indeed when you are considering whether you are to have an ad hoc committee or whether you are to give these powers to the existing sanitary and public health bodies. That is really the point of my present Amendment. It 1673 raises the objection which I know is entertained by a large number of authorities and particularly by the county authorities, against a committee part of whose powers will be to interfere in the way which is indicated in Clause 46. I hope, when the Chancellor of the Exchequer comes to reply, he will not be ruled out of order in dealing with this point. Why does he seek to give to a committee primarily constituted for insurance purposes local government powers of this wide and indefinite character? What reason is there as regards these matters of health, which are now submitted to representative local government bodies—
§ The CHAIRMAN
I think the hon. and learned Gentleman is now reaching the point mentioned by the Chancellor of the Exchequer. The hon. and learned Member would not be in order in discussing that, but he would be quite in order in referring to the powers given under Clause 46 as an argument in support of this Amendment. So far, he would be perfectly in order.
§ Sir A. CRIPPS
I obey your ruling at once, because there can be no doubt it is of great importance in these Committee Debates to prevent overlapping of discussion. I think I have made my point without going into details. These large powers, which ought to remain in the hands of the existing sanitary authorities, are given to the new bodies. If it were made clear these new powers were not going to be given and it was going to be an insurance committee only, then I would ask leave to withdraw my Amendment. There are one or two other matters to which I wish to draw attention in objection to the constitution of these committees. In the first place, I object to the mere multiplication of authorities dealing with questions of this kind. The more you multiply the number of authorities, the worst administration you get, and the result in my opinion of constituting a new committee with these health powers would merely be to increase difficulties, friction, and antagonism, and in the result undoubtedly to have a worse administration than at the present time. The other point is this. Incidentally and possibly, these local health committees would have the power of incurring expenditure which would be placed upon the rates. I object altogether to any body which is not really representative, and representative of the ratepayers, having any power in that direction at all. We ought not to 1674 allow any charge for local purposes to be put on the ratepayers except not only on the authority of the existing local body, but also on their initiation.
§ Sir A. CRIPPS
I am very glad to hear what the Chancellor of the Exchequer says, because I think it is an extremely important matter, but, looking at the powers in the Bill as it stands, I do not think that can be said to be true of the local health committees as it is proposed to be constituted. It is on those grounds I move this Amendment. I do so really to test the question: Is it right to constitute a new authority with overlapping and interfering powers as against the existing authorities for health and sanitary purposes which are now constituted on a representative basis?
§ Mr. LLOYD GEORGE
I find it rather difficult to reply to the hon. and learned Gentleman, because I think he will admit his real objection to this lies not in this Clause but in Clause 46, and, of course, if Clause 46 were eliminated he would not be moving this Amendment.
§ Mr. LLOYD GEORGE
That has been amended in accordance with the representations of the county councils and the municipal authorities, so there is no point raised between us and the county councils on Clause 44. I think the hon. and learned Gentleman will admit the real objection rests rather on Clause 46 than on Clause 44. Indeed, I think he said so. My difficulty is I cannot answer him. He can ask me all sorts of questions, but I should be out of order to reply to them. I shall have to give the best answer I can within the limits of order. What is it the hon. and learned Gentleman proposes? He proposes that the authority which is to be exercised by these local health committees should be transferred from the representatives of the friendly societies and trade unions and other approved societies to the county councils. I have two objections to that. First, the county councils have not asked for it, and, secondly, all the societies are opposed to it. They have opposed it unanimously. There is nothing about which they are more unanimous than this. Although they have agreed to the Amendments of the Government in every other respect, the great friendly societies of the Kingdom 1675 are still holding meetings and carrying resolutions with great unanimity and enthusiasm, imploring the Government not to assent to this proposition. There must therefore be very strong reasons why we should not depart from the position we have already taken up in the Bill.
The hon. and learned Gentleman seems to assume that in some sort of way the societies will have control over the rates. I agree if they had any power to hypothecate the rates, or even to initiate expenditure which the ratepayers would have to honour and meet, his contention would be almost irresistible, but they have not. What is the money they spend? The hon. and learned Gentleman used the words "the ratepayers, persons on whose behalf they exercise this authority." They do not exercise the authority on behalf of the ratepayers; the ratepayers have nothing to do with it. They do not contribute a single penny. What money have they got to expend? They have got, first of all, practically the whole of the medical benefits of these approved societies. I assume, in spite of the Amendment which my hon. Friend the Member for Luton (Mr. Cecil Harmsworth) has got in to protect existing rights, it will be found that at least ten million insured persons will have their medical relief administered through the local health committees, and gradually I think the existing societies will find it to their interest to give up even the rights which my hon. Friend won for them. I think in the long run they will find it better for them financially to hand over these powers which involve great financial responsibility to the local health committees. You will, to begin with, therefore have ten million insured persons to whom medical relief will be administered by the local health committees. That means a sum of £3,000,000 will have to be paid over by the approved societies to these local health committees. Who pays that money? It is not the ratepayer. The money comes from the approved societies.
What else have they got to administer? They have got to control the sanatorium funds. I do not say they have got control of the sanatoria. That is a very different thing. They will have control of the Insurance Sanatorium funds. A sanatorium may be erected by the local authority, and, if it is, it will be controlled by the local authority. The only control which the local health committee will have will be 1676 that which is necessary to make a bargain with the local health authority for the admission of insured persons and their dependents and for the payment of a sum of money for the purpose of covering them. Surely that is a matter of the most vital importance. The local health committee ought to be able to make a bargain on behalf of insured persons. The hon. and learned Gentleman wants to have the whole thing done by the county councils which represent the whole body of ratepayers, and not the societies. There is £4,000,000 coming from the friendly societies, the trade unions, and the other approved societies, and not a penny coming from the ratepayers, and the hon. and learned Gentleman proposes that the body which represents the ratepayers should practically have the whole control. The agitation I have had to face from the friendly societies is as nothing to the agitation with which the House of Commons would be confronted if they effected this change to-day.
Let me put another argument to the Committee. We propose that the majority of the representatives on the local health committees should be elected by the insured persons. That means that the control of these committees will be in the hands of the insured persons. Are the county councils of this country really composed of the same class? How many working men are there on these bodies? I do not believe that you will find 2 per cent. of the working classes represented on the county councils throughout this country—certainly not 5 per cent. What is the reason for that? It is that, owing to the business they have to transact, they have to meet in the daytime. They have to consult the convenience of the general body, and, as the majority of the members of the councils are not working men, they do not meet at hours most convenient to working men. Another reason is that membership of the county councils involves considerable expenditure of time and money; often it is necessary to travel to the county town the night before the meeting. Working men cannot do that. But what would happen in the case of the local health committees? Approved societies will see that the men whom they succeed in getting on to those committees shall have their expenses paid. No doubt, the Oddfellows, for instance, will make a great effort to secure a certain number of representatives on the local health committee. The Foresters will do the same, and these and other societies will undoubtedly see to it 1677 that their representatives have their expenses paid. The committees, too, will probably meet in the evening in order to meet the convenience of working men.
I think there are overwhelming reasons why we should leave this body as we originally proposed it in the Bill. We propose that the majority of the representatives shall come from the insured persons; we propose that taxation and representation shall go together in this matter. The hon. and learned Gentleman suggested that we were going to interfere with the county councils. As a matter of fact, we shall not do so at all; there will be no interference with them of any sort or kind—no more interference than you have at the present moment in the powers given to any ratepayer who thinks he has a grievance against a council to demand an inquiry. The only difference will be that in the future it will be an organised power, whereas now it is unorganised. Who will suggest that any four individual ratepayers would undertake the enormous cost and responsibility of investing the conditions of housing in this country?
Again there will be no overlapping. There is not a single power conferred on the county council that is taken away by this proposal, and there is not a single power given to these health committees which would in the slightest degree overlap the powers of the county council. The only power given is the power of demanding an inquiry, a power already possessed by ratepayers. You can now have that inquiry in a court of law, but then it is a most unsatisfactory form and most protracted. Here we provide a more summary method. We give power to inquire into the health conditions of any insured persons. In so doing we do not interfere with the county council. A friendly society already has the power to report on what it sees in its own district. Is that an interference with the medical officer of health? Surely that gentleman would be only too delighted to get every assistance he can. It is not interference, it is assistance and co-operation. The Amendments we propose are of vital importance, and they have been agreed upon by those most concerned. We propose that every report shall be sent to the county council and to the sanitary authority, and one of the things insisted upon most emphatically during the negotiations that have taken place was that there should not be any sort of rivalry. If you are going to prosecute an inquiry into the health of your 1678 own members, the report should not be a rival report to our own. All that is desired is to give assistance to the county councils in the exercise of their functions. There is no function of a county council which may be exercised by this body, and, therefore, there is no overlapping.
§ Mr. LANSBURY
Is not a duty imposed by Clause 44 in regard to lectures, etc., and is not that a duty already exercised by county councils acting as the educational authority?
§ Mr. LLOYD GEORGE
Does the hon. Gentleman mean to say that because there are certain authorities outside a county council giving lectures on health, that that is an interference with the county council and an overlapping of their authority? I really cannot argue or debate the point with the hon. Member. I would point out that, after all, these are purely lectures to the insured as to the best methods of complying with health conditions, and they are calculated to reduce the cost to the societies. Suppose the Oddfellows were to issue a leaflet to their members warning them against certain practices and to give them lectures as to ventilation, diet, etc. Would it be said that that was a case of interference with the county council, or that it would be an impertinence on the part of the society to do it? These are purely lectures to insured persons, given with a view to securing efficiency, and if you can reduce the charge on the funds, if, instead of providing a man with medical attendance and paying him 10s. or 5s. a week, as the case may be, you effect your object by giving him a pamphlet which costs one halfpenny, is not that an economical proposal and one which does not constitute any interference with the county council?
I have never heard any county council raise any objection to this proposal. The only objections which were raised by them in the course of the very prolonged discussions have been met by Amendments, and there is only one point outstanding between us now; that I shall deal with when we come to Clause 46. They never asked for these powers or for this responsibility. I cannot recall a single resolution carried by any county council in the whole kingdom demanding that these functions should be exercised by the county council. They certainly raised objections on Clauses 43, 44, and 46, but on these we have met them, there being, as I have said, only one point still outstanding. I trust that the 1679 Committee will come to the conclusion that the demand of the friendly societies and trade unions and others is a perfectly fair one, namely, that as much of the money is to be contributed by these bodies, the power of administering it should also be given to them. Surely it would be perfectly ridiculous to give a committee of a county council power to demand an inquiry into the manner in which the rest of the council exercises its functions! If the Amendment were carried it would mean wiping out Clause 46 completely. But apart from Clause 46, I still maintain that this is a function which ought to be administered by the insured. You cannot hypothecate the rates to the extent of a single farthing without the consent of the county council. You cannot incur expenditure from the rates without the consent of the county council, and we have agreed that when expenditure has to be undertaken the local health committee must submit estimates to the council before the outlay is incurred. They have no right to first spend money and then send the bill into the council. The moment they are face to face with the prospect of spending more money, they must draft their budget and send it to the treasurer of the county council, and the county council will have the power, inasmuch as it will have to find the money, of demanding, if it chooses, a larger representation on the local health committee.
§ Mr. FORSTER
We have come to a part of the Bill which is of extreme importance and which has raised grave apprehensions in the minds of many people. I think it is a very good thing that we have reached this stage, and I hope we shall be able to clear up certain points which have aroused these feelings of apprehension. I wish the Chancellor of the Exchequer had felt himself able to take advantage of the ruling of the Chair to the extent of explaining a little more in detail the Amendments which he has agreed to with the various bodies of people who have conferred with him outside this House.
§ Mr. FORSTER
Yes, I certainly think the right hon. Gentleman could have done so in view of the ruling given by the Chair that it was in order to refer to later Amendments on the Paper by way of 1680 illustration. The right hon. Gentleman, however, in the course of his speech, told us that he would explain the Amendments as they were reached. We naturally want to know what the agreed Amendments are, and we cannot, in the absence of that information, make up our minds whether or not legitimate points have been met. I can only, therefore, deal with the right hon. Gentleman's speech as he made it and not as he might have made it. I am bound to say that, in my judgment, some of the fears and apprehensions which have been excited in the minds of local authorities have been created by the inflated and exaggerated language which the right hon. Gentleman has used in describing the merits of his own proposals. If he went about the country saying to people: "What, under Clause 46, have you to fear, as we are only giving to the new councils the authority and the powers now resident in the hands of every four ratepayers." That would not have caused the grave alarm which has been excited by the description of the measures which the right hon. Gentleman says will be taken to bring about a new heaven and a new earth. But when he says it will be possible for the local health committees to interfere with, overlap, and compel the various local authorities to do what they do not want to do, you cannot blame the local authorities for having taken alarm. I say that the right hon. Gentleman has only himself to thank for a great deal of the apprehension that has been caused. The right hon. Gentleman, in answer to the argument of my hon. and learned Friend (Sir A. Cripps), says it is absurd and ridiculous to talk about these new authorities having the power to hypothecate rates. Of course, they have not the power to hypothecate rates. Anybody who reads the Clause will see that. That was not the contention of my hon. and learned Friend. There are ways of practically and morally compelling the expenditure of ratepayers' money without actually enjoying yourself the power of putting your hands into the ratepayers' pocket. What are the powers the local health committee will have? They will be able to advocate a policy or to recommend the extension of benefits beyond the point to which their own finances will contribute. They will then go to the county council and say, "We think it essential that these benefits should be given. We have not got the money and we call on you to provide your proportion." When you are able to exercise persuasion of that kind, when you 1681 tell the county councils that they must put their hands into the pockets of the ratepayers and make contributions to a scale of benefits of which they may not approve and which they do not deem desirable, you are giving a new authority the opportunity of bringing practical compulsion to bear upon the county councils. I do not think the remarks of the right hon. Gentleman have really met the case developed by my hon. and learned Friend. The Chancellor of the Exchequer said that these people will not deal with the rates. He asked what are their funds and when do they come? He reminded us that the local health committees will administer the sums provided by the contributions of members of approved societies. They will administer a sanatorium fund to a total of something like £4,000,000.
§ Mr. FORSTER
£1,000,000 for sanatorium benefit and £3,000,000 for medical benefit. The Chancellor of the Exchequer says that all the funds they are to manage are to be provided by the societies, and, therefore, on that ground, the societies ought to have a majority of representation on the local health committee. Are all these funds provided by the societies? If people who contribute the funds are to have representation on the authority that administers them, is there no other body which ought to find representation on the committees. What about the employers? They are contributing three-fourths, and there is no provision for a single employer being on the committee.
§ Mr. FORSTER
What I meant to say is that the employers contribute as three is to four, and yet they are not to have a single representative qua employer upon the local health committee. The argument the right hon. Gentleman has used is not very complete, and I hope that when we come to discuss the composition of the local health committee, if this Amendment is not carried, he will bear that in mind.
I have never hesitated to express my own opinion that we should not be wise to hand over the administration of all these benefits to the existing authorities. My 1682 hon. and learned friend made this point exceedingly clear when he said that he would use existing authorities as the basis on which to build the proper authority to whom might fairly be entrusted the task of administering these responsible duties. I think there is one point which is fatal to the argument in favour of using existing authorities, and that is that the whole administration of the insurance scheme should be kept totally distinct and separate from any branch of local administration. My hon. and learned Friend told us that if the powers and duties which were to be given to these new authorities were to be confined wholly to insurance, then there was no difference of opinion between us. I quite agree with him. I think the Committee will accept the proposition I have referred to without discussion. If that be so, every argument my hon. and learned Friend has addressed to the Committee is valid in so far as it recommends us to make alterations in Clauses 44 and 46, but it does not carry the conviction to my mind that we ought to hand over these duties to existing authorities. I hope the Committee will agree to take such steps as may be necessary to confine the duties of these local health committees wholly and entirely to insurance business. There will be plenty of it. If you gave this work to the county councils they could not do it. Sometimes their own duties compel them to meet three times a week, and they have to travel half a day to get to the place of meeting. I believe that these local health committees will have to meet every day of the week. If you are going to establish great central committees administering these powers and duties over a wide area, I do not believe you will get the working man to do the work. I do not believe they will have time to get from the place of their everyday work to the place of meeting where they have to work every night. It is desirable that the operations of these committees should be confined to exclusive work. Speaking solely for myself, I should not be able to vote for the Amendment.
§ Mr. GEORGE THORNE
I approach the consideration of this very important question from the standpoint of municipal corporations. After the very interesting speech to which we have just listened, I do not know whether there is anything for us to discuss this afternoon. Practically the suggestion just made to us is that the present Amendment should be withdrawn, 1683 and that we should discuss the other matters to which the right hon. Gentleman referred on the subsequent Amendments. That would seem to be the wisest course to adopt, but unless the hon. Member who has moved the Amendment desires to take that course, it is necessary for us to take a different view from him and to express our own views. I had the privilege of being one of the municipal deputation, which, in company with the county council's deputation, represented by my hon. Friend below me (Sir Ryland Adkins), waited some months ago upon the Chancellor of the Exchequer. I do not wish to commit myself to saying that in the subsequent Amendments the Chancellor of the Exchequer has met us on every point, but he has treated us most sympathetically and with a desire to approach us so far as he possibly can. In the interests of the municipal corporations I strongly object to these very large responsibilities and duties being thrown upon them. They have a vast amount of work to do at present. There are constant complaints from the municipal authorities that further burdens are being thrown upon them. If this particular burden were thrown upon them it would be disastrous to the municipalities and to insurance work as well. I do not know whether the hon. and learned Member who moved the Amendment claims to represent any corporation or any county council, but I am satisfied from inside knowledge, that municipal corporations do not desire to have this burden thrown upon them. I hold in my hand a letter from the secretary to the Association of Municipal Corporations, which carries out that view.
We are bound to have regard to the duties proposed to be devolved upon these local health committees, so far as they will affect the general health of our communities. Speaking from the standpoint of one who has for many years been the chairman of a health committee, I should be very chary indeed to consent to any proposals which, in my view, militated against the proper duties of such committees. I believe that the health of the localities has to be looked after by the health committees of our municipalities and county councils. I should strongly object to their duties being in the slightest degree lessened or removed, but I do not believe that the proposals in the Bill, as they are going to be modified, are intended in any way to have that effect. I know by experience what the position of 1684 a health committee is. A health committee's duty is to do what it can to promote the health of the locality. Its members are differently composed. There are always sections more progressive than others, and the progressive sections are always glad to have indications outside the council which tend in the direction of promoting public opinion on the question of health. I have had that experience many times in trying to improve the health of our own community. If we had somebody outside our own body which was trying in a reasonable way to educate public opinion it would have been an enormous advantage. Hitherto that has simply come from individuals. It has been inchoate, unorganised, and spasmodic. Now for the first time we have something which we have long desired—a body organised outside our body who will reasonably help to educate public opinion in the direction in which health committees ought to go. Consequently, instead of looking to these local health committees with fear and misgiving I believe there is great hope to come from them, because of the education they will give to their members, which will help to educate the community and so promote the public welfare of the community. Therefore I only want to make sure that certain conditions are maintained in following the course we propose to do today, especially in regard to the name and the functions of these committees. In the meantime all I desire to say is, that with the modifications the Chancellor of the Exchequer has suggested, so far as the local health committee has to do with general health, it is not to undertake the work of the municipal health committees, it is not to entrench upon their responsibilities, and it is not to compete with them, but that what they have to do is to provide the necessary stimulus to enable us to do our work better in the future than we have done in the past. I refer to the proposals of the Chancellor of the Exchequer as set out in the Bill and the Amendment, and in his speech, and I think from the standpoint of the municipalities it would be a grave mistake to throw upon them the burdens of work which this committee would have to undertake, and it would be injurious to the work of the Insurance Committee as well, and consequently I am altogether opposed to the Amendment, reserving myself reasonably to discuss the various Amendments which the Chancellor of the Exchequer proposes later.
§ Mr. HARRY LAWSON
Of course I do not for a moment question the wisdom of the Chairman's ruling, but I think it a great inconvenience to the Committee that in this great departure in local organisation we have not had an opportunity of taking a general review. It seems to me that it would have conduced to the shortening of the Debate. I wish, too, the Chancellor of the Exchequer had taken the same course as he has suggested in respect to other Amendments for the general convenience of the Committee. I fancy that a great deal of the apprehension which has been excited in the public mind by these proposals is founded entirely on the Chancellor's version as he gave it in public meetings. Of course he has a very eloquent tongue, but he has also a very barbed tongue, and he did not speak with great respect of the local authorities of the country. In one speech—I am not trying to make a party point—he spoke of the local authorities as being the worst offenders in respect of sanitary matters. I do not think that is just to the local authorities. There are of course defaulters among them but, as a rule, there has been an immense increase in their efficiency from the sanitary point of view, and there never was a time when the public health committees of the various corporations were doing so much in the direction of improving the public health. Of course we know corporations have no souls to be saved nor bodies to be kicked, but I think he would have avoided some of the objections which have been raised if he had given them anything in the way of the just meed of praise which I think they deserve. I am sure if the President of the Local Government Board were present he would agree in that opinion. May I give one example in point? There is no better test, I suppose, of the improved health of a community than a decrease of infantile mortality, and taking the last Report of the London County Council for the county of London we find that last year was the lowest on record in respect of infantile mortality, and I believe there has been a subsequent decrease since that time. These things might have been said, and the Chancellor might not have prophesied that a new era was to come about merely because a new set of petitioners was to arise in the health committees which he is setting up under the Bill. I cannot support my hon. and learned Friend, as I generally do, because it seems to me that to introduce the local authority in respect of insurance matters would be 1686 a great mistake—almost an impossibility—in administration. I observe that the Hearts of Oak in a letter written to me, as I suppose to other Members, speak of this body having solely to do with insurance matters and insured persons. From that point of view it would be absolutely impossible to introduce the local authority. But that is not so. What the Chancellor of the Exchequer has said in regard to their interference in the administration of public health and in regard to sanitary affairs I know is technically true, but it will not be so in effect. You are to a certain extent setting up a rival authority which will be liable to public attack by public opinion if it does not constantly interfere in local administration in respect of public health. The power that is possessed by the private citizen is not at all comparable to what you are at present instructing your local health committees to do.
I want to avoid friction in the administration of the Bill. I am afraid that if the Chancellor does not modify a Clause with which we are not dealing now he will have, instead of a reign of law, a reign of friction. I quite agree that in respect of matters of pure insurance you could not possibly bring in the local authority. You want to get the dominant opinion of those whose interests are concerned, and I am bound to say that in the Amendments down on the Paper to this Clause I think the Chancellor is taking the best way he can do it. But I do not want by a side wind to set up rival authorities to those which are representative of the people, constituted by law, because I believe that leads to inefficiency in government. Insurance is one thing and local government is another, and I have always found, in London, that where you have this multiplication of authorities, instead of getting a better standard of administration you get a worse. You do not and cannot get men to serve on local bodies and to do their duty properly if they feel that they are subject to constant and petty interference, and that they are being held up constantly to public condemnation by those who have almost a direction from above to do so. For that reason I cannot support the Amendment, but I want to ensure for the vast and complicated machinery we are setting up in this country for social purposes that you do not let in the grains of dirt and sand which so easily render it useless, or at all events do a great deal to diminish its chance of success. I am sorry I cannot support the 1687 Amendment, but later on I hope to support the Amendment which the hon. and learned Gentleman will no doubt move as consequential to the next Clause or the one after.
§ Sir RYLAND ADKINS
I happened to be a member of the deputation of the county council the right hon. Gentleman met, and which went into the various points with a great deal of care and the expenditure of a good deal of time, and I wish to support this Clause as it stands and to oppose the Amendment, because I am quite certain, speaking generally, that the county councils neither desire to have these powers nor are they well adapted for their exercise. The attitude of county councils towards this part of the Bill can, I think, be expressed in two or three sentences. They desire to be consulted, and there are Amendments on the Paper suggesting that they should be consulted as to the composition of these committees, and as to any scheme, in order that their point of view may be heard in respect of matters in which there is not specific overlapping in executive concerns but in matters which are of interest to them in common with the local health committee. They also desire the name altered, and they desire that the provisions which my right hon. Friend has put in in answer to our recommendations, of receiving reports from these committees, should be almost automatic and not dependent upon the decision of the Insurance Commissioners. Apart from these points of importance, which will all be debated in their proper time, as far as I can ascertain I have no quarrel with this Clause or the next, though there are matters arising under Clause 46. I desire to associate myself with what has fallen from the hon. Member (Mr. G. Thorne) and to assure the Chancellor that we appreciate the way in which he has met us on the main points we put before him, and to ask his favourable consideration to those other points which remain outstanding, for they are not urged by local bodies who are antagonistic to him, but by local bodies who desire to co-operate with him in the work.
§ Lord ALEXANDER THYNNE
I cannot help regretting that when a subject which affects so vitally the interests of all the great municipalities and all the great corporations of this country, and which impinges on the sphere of the Local Govern- 1688 ment Board, is before us the representative of that Department should not be in his place in order to advise the House as to how the measure proposed by the Chancellor of the Exchequer will affect municipal bodies. I should like to endorse what has been said by the hon. Member (Mr. G. Thorne). I quite agree that municipalities in this country do not seek to have these duties put upon them, and that they are not in many respects suited by their composition to discharge these particular functions, but I regret at the same time that both of the hon Members opposite did not go a step farther and say that the local authorities of this country, averse as they are to having these functions put upon them, are still more averse to certain provisions in this Clause, to the indirect financial responsibility which will fall upon their shoulders and to the very imminent danger of interference and overlapping which has been very deftly described by the Chancellor of the Exchequer. Of course the composition of these local health committees must depend to a very large extent upon the functions which they are called upon to discharge. If it was proposed to confine these functions to matters relating to insurance alone the local authorities of this country would not wish to have anything whatever to say in the matter at all. But, unfortunately, the right hon. Gentleman has thought it wise to introduce into this measure certain matters and functions which may be said to have hardly an indirect relation to this question of insurance—functions which impinge upon the ordinary duties of local authorities. No doubt they were introduced with the object of popularising the Bill at its first introduction. At the same time I cannot help feeling that the right hon. Gentleman and those who are acting with him at the back of their minds have another motive, that of bringing into being some outside body to galvanise these local authorities, which, in their opinion, do not at present satisfactorily discharge their public health duties. It may, or may not, be necessary to deal more severely to galvanise into greater activity some of the local authorities who may be backward in exercising their powers under the Public Health Act; but I suggest that this Clause is not the proper opportunity to take to rectify the delinquencies of such local authorities.
I will suggest further that there exists in the machinery of the Government at present adequate means to make local authorities who are delinquents in this 1689 matter do their duty in a proper manner. Local authorities would be glad to be absolved from the indirect financial responsibilities which are placed upon them under this measure. Of course, it is perfectly true that no hypothecation of the rates can take place without the consent of the council concerned. What is the position of a council which is asked to contribute to place in a solvent condition the insurance fund and which withholds its consent? The Chancellor of the Exchequer knows perfectly well that it is not a permissive power at all, and that whatever the actual words of the Bill may be, it places a direct liability and a moral obligation upon the local authorities to insure the solvency of these funds. Then I notice that the right hon. Gentleman's chief opposition to this measure was the position of the friendly societies. I understand that he has given a direct pledge to the friendly societies that he will oppose any attempt on the part of municipalities to have these functions thrown upon their health committees. I think if he has met the wishes of the friendly societies in this direction he might meet the very legitimate wishes of the local authorities, who are working it in the interests of efficient administration in the direction set out in the last portion of the hon. Gentleman's (Mr. Forster's) speech, and absolve the municipalities from all interest or responsibility, direct or indirect, under this measure.
§ 5.0 P.M.
§ Mr. LANSBURY
I wish to clear up a point which I attempted to clear up a few minutes ago. I understood the Chancellor of the Exchequer claimed that in no sort of way would these proposed committees undertake any work which local health authorities were carrying out and were called upon to carry out to-day. I would point out that Clause 44, Sub-sections (1) and (2), is in the following terms:—
I venture to say that these provisions have reference to every local health committee set up in the length and breadth of 1690 the land. These local health committees are to have powers to embark on educational courses which are now carried on, and have been carried on for some years, by the local education authority, which is part of the public health authority now. That statement is not got rid of by telling me that there is no Debate allowable between the right hon. Gentleman and myself on that matter, because the words of the Bill are there and can be read. I wish to join with those who say that if this had been an insurance committee pure and simple, I do not think many of us would have taken strong objection to the proposal. At all events, for my part I would not have done so. I wish to say at the outset that it is extraordinary that, as I understand, this local health committee is to be under the control, not of that central public health department of the country, namely, the Local Government Board, but under the control of the Treasury and the Insurance Commissioners, so that, not merely locally will you have conflict and friction, but I should say that you would have conflict centrally also between various departments. I want to say here that if the health authorities have failed in carrying out any of the duties which they could have carried out legitimately, the Local Government Board is as much to blame as the local health authorities, because each year the medical authorities are expected to publish, and do publish, reports as to the health conditions of their various boroughs and counties. These reports go to the central authority, and it is the business of that authority to supervise the work done, to make recommendations, and to strengthen, where possible and where necessary, the local health authorities who are doing the work. This is all apparently to be knocked on the head, and we are to have set up this voluntary committee.
- "(1) It shall consider generally the needs of the county or county borough with regard to all questions of public health, and may make such reports and recommendations with regard thereto as it may think fit;
- (2) It shall make such provision for the giving of lectures and the publication of information on questions relating to health as it thinks necessary or desirable."
I am rather surprised to find people who tell us that according to the amount a man pays in so his representation on a certain committee entrusted with the spending of the money should be reckoned. That is a new doctrine for the Liberal party anyhow. I have heard it put forward from the other side in regard to education. It is the doctrine that those who find most of the money should have most of the representation. I think I have heard speeches of the right hon. Gentleman in which he soundly controverted that theory of local government, but apparently under this Bill it would work out 1691 like this if we were dealing with education: Parents would be represented, and that I understand is what hon. Gentlemen opposite desire; ratepayers would be partially represented; and finally teachers would be represented, so that they might have a voice in settling their own salaries. I wish the Postmaster-General were here, because I wish to know whether in future he is going to allow representatives of the Post Office to be on committees to fix their salaries. Under this scheme doctors have been called in to assist in settling the amount of remuneration they are to receive for the services they render. I think that is a wrong sort of representation for a committee of the kind proposed to be set up here, and therefore if this Amendment goes to a division I shall vote for it.
I join with the Noble Lord opposite (Lord A. Thynne) in saying that it is rather a pity we could not have discussed this matter in a general manner. We have discussed several other subjects in a general manner. It may be that there are good and valid reasons why we could not do so in this case. I would point out that if there is anything in the elaborate machinery proposed in the next two or three Clauses—anything in the setting up of new local health committees at all—it is the assumption that the present public health authorities are in some way responsible for bad housing and bad health conditions, and that you hope in these voluntary committees to galvanise them into action and work. I speak as a member of the London County Council, and also of a local health authority in London, which has jurisdiction in a very poor district, and I say that if the local health authority at Poplar, or the central authority at Spring Gardens, were to carry out their duty under the Public Health Acts merely in respect of housing, they would put 100,000 people on the streets to-night. Why do they not carry out the law? It is because they know perfectly well that the unhappy people concerned could not pay any more rent than they are paying now, and they never will be able until they get very much more wages than they are receiving.
You need not put before the people that these local health committees which are to be set up are going to get rid of slums. I wish they were able. All of us want to get rid of slums, but this is not going to do it. You may set these committees to 1692 inquire, and to do what eminent men like Mr. Charles Booth and others have done in the way of piling up statistics on the matter, but that will not help the local health authority to get rid of slums and unhealthy districts. You have to face that. This House ought not to put such machinery into a Bill of this kind, knowing quite well that, if anything, it will make confusion very much worse confounded than it is now in regard to local authorities, and also cause a very great deal of friction between different sets of authorities when the committees are set up. There is another point. It is said that people cannot attend county councils and borough councils and these committees as well. That is true to some extent. I would ask the House to remember what it is doing. At present in the Metropolis we have all sorts of machinery for investigating the conditions of the people—care committees, visitors, poor law guardians, inspectors, medical officers, and school visitors. All kinds of people are being paid directly or indirectly to go into the homes of working people. Now we are going to set up another committee with another set of officers responsible to nobody. You are setting up committees to go and harry the poor again instead of spending money in some more helpful way. If this were insurance work pure and simple, it would probably be necessary that these committees should have power to go and investigate the conditions of the poor. I would invite the Chancellor of the Exchequer and the Government to go and investigate the conditions of the rich for a change, and let us know how it is that they are in the position they occupy. Once the House understands that, we will realise that the poor are there because the rich are in the other place.
§ The CHAIRMAN
I think the Debate is now in danger of getting rather wide of the question before the Committee. I allowed at the opening of the Debate, and I think rightly, a certain amount of latitude, but I cannot allow a discussion on subsequent Clauses to take place on the Amendment now before the Committee.
§ Mr. HILLS
The difficulty in which the Committee is placed in discussing an Amendment of this sort is caused by the dual nature of the Bill. The sickness insurance part of this Bill has two aspects, and sometimes one aspect is accentuated and sometimes the other. We have been 1693 told to-night by the Chancellor of the Exchequer that all this Bill is purely an Insurance Bill, but when he goes to the country he does not talk so much about insurance as about prevention.
§ Mr. LLOYD GEORGE
I have never said so. I have always put in the forefront that it was not only insurance but health as well.
§ Mr. HILLS
I do not think I misrepresented the Chancellor of the Exchequer. In his speech he dwelt at great length on the insurance aspect of the Bill, and his whole answer was comprised in that. He said, "You cannot give these duties and hand over all these funds to the local authority, because this is an Insurance Bill, and these are insurance premiums." I confess that when I first read the Bill the part that struck me as best was the preventive part, and I very much regret that as we go on that part is getting shouldered aside. So far as this Bill is purely an Insurance Bill, I think the Chancellor of the Exchequer has a good deal to answer for. But it is not purely an Insurance Bill; it is a Public Health Bill, and so far as you deal with public health you ought to work through and not alongside of existing authorities. What was the answer of the Chancellor of the Exchequer? He said, first of all, that existing authorities did not want these powers. That has been repeated by several speakers. It may be true, but it does not meet the whole case. It may be right in the interest of the community that these powers should be given to them, although they do not want them. Everybody knows that the local authorities are overworked, and that at present they are not paid. It is very likely that they rather draw back at the thought of these extra powers being given, but you do not answer the argument by saying that the county councils object, and still less do you answer it by saying that the friendly societies object. A friendly society is purely an insurance body, and it wants the committee to deal with insurance alone. It would prefer a body on which it had a large amount of representation, and my real objection to this Clause is that it cuts at the very root of local self-government and stultifies and makes abortive the most promising part of the Bill.
If you give power to deal with health and insurance questions to a body attached in some way to the local authorities—I cannot go into the composition 1694 now because I should not be in order—but it is perfectly clear that if you could have a body on which the local authority did not get a majority, then you would have brought all the machinery of your Bill into line with what we have done now. You are giving the local health committees, very large powers indeed. It is no good for the Chancellor to say that since he has put down certain Amendments to subsequent Clauses these powers are diminished until they become subsidiary to the action of the existing authority, and that he has limited all these inquiries to insured persons. How do you inquire into the health of the insured persons unless at the same time you inquire into the whole health of a district? Insured persons live somewhere, and when you investigate the conditions in which they move and live you must investigate the whole health of a district; you put down a Clause that the health committee is to report on this and that. You include in those words all functions for which we employ an army of inspectors in the factory, the mine, and the home, and for meat and milk. All these have got to be inspected, and unless your committee is purely nugatory it must employ this vast machinery. You cannot inspect by first principles. You must have ears and eyes. You must send out inspectors to the street, the factory, and the mine to find out why and where there is excessive sickness. I do not object to that being done, but we know a great deal and we do very little. I believe we know enough and we do not do enough. Why do not you, instead of spending a large amount of money—and it must be a large amount—on all these inquiries, which would overlap existing inquiries, spend a certain amount in furthering the public health of the community?
I quite agree that you cannot spend any of the insurance fund on public health, but we cannot regard this Bill solely as an insurance Bill, and in so far as you start the germ of a really new and increasing system of public health, do start it on some lines that give a reasonable chance of success. The Chancellor minimised the powers which he gives to these committees and compared them to the power which the Housing Act gives to four ratepayers to petition? Surely he is hardly serious in the comparison. The Housing Act gives power to four persons to make representations. In this Bill you are creating vast machinery for this body which they will have to set in motion. 1695 There is no power in the Housing Act to employ a staff of inspectors, doctors and nurses, which your committee must employ. Here you are starting alongside the existing public health authority vast new machinery that must come into conflict with it. A great many of us supported this Bill from the first, being attracted by its preventive side, and those are the lines on which I think the Bill ought to be extended. You cannot increase the efficiency of public health by interfering with the existing committees. What you are doing here is to put a spoke in their wheel. You have already the existing authorities for public health, also the Poor Law, which is largely a public health authority, and those between them spend from £7,000,000 to £8,000,000 a year. Alongside and in conflict with them you are starting a new authority, which is bound to cause friction. Nobody proposes that all the insured persons should be handed over to the local authority to do what they like with, but I do suggest that you should attach your local health committee to the existing organisations for local self-government, and then I believe you will have made a real step forward in the prevention of preventible disease.
§ Mr. FRANCE
I was somewhat mystified by the interesting speech of the hon. Member (Mr. Hills) who has just sat down. With him I feel most enthusiastic towards this part of the Bill, which is preventive, but his speech seemed to be a speech against this part of the Bill. I was also very much astonished at the speech of the hon. Member for Bow and Bromley (Mr. Lansbury). A few days ago I heard an eloquent and impassioned speech from him as to the necessity for prevention, rather than insurance, a feeling which is largely shared by hon. Members on the other side of the House. To-night he speaks strongly against that part of the Bill which has most of prevention in it. The hon. Member for Bath (Lord A. Thynne) spoke just now of sanitary and health committees in counties and boroughs not wishing for assistance or co-operation in their work with regard to health. I think that is a libel on those bodies. As a member of a health committee, I think I may say that the majority of health committees welcome assistance and co-operation in the work they have to do. I quite agree that anything in the nature of undue interference or overlapping would be a mistake, and should be 1696 guarded against. But the idea that the fact of this committee being called in to investigate the cause of any extra amount of sickness in a given locality or district is going to interfere with the work of health committees of boroughs or counties is a great mistake. An hon. Member said there was too much inquiry now-a-days. I agree that there may be too much inquiry in the abstract, but this, an inquiry in the concrete. A certain result is discovered by a committee, because of the heavy payment for insurance in the certain districts and a concrete inquiry is then made as to the cause of the particularly heavy charge upon the funds of this great scheme. I should have thought that the hon. Member for Bow and Bromley would have welcomed an inquiry into the causes as to why large sums have to be paid for curing sickness and for the relief of poverty caused by sickness, and it is mystifying to me to find him objecting to this part of the Bill. The hon. Member politely warned the House that he was going outside the bounds by complaining that the poverty of some was caused by the richness of others. But what that has to do with the Insurance Bill and with the health of the people in those districts I fail to see.
§ Mr. LANSBURY
You cannot get rid of the sickness due to poverty until you get rid of the riches that cause the poverty.
§ Mr. FRANCE
Is that the line of argument to adopt when we have those in our own families or those around us, or those with whom we are concerned in anxiety, sickness, or trouble? We do not leave them to continue suffering because there are rich people in the world. That is what I object to in the hon. Member's argument. There is great sickness which is due largely to insanitary conditions and overcrowded conditions and other matters over which the health committees have some control. This part of the Bill calls upon the health committee to make some inquiry, when the funds are called upon by a certain locality to an exceptional extent, with a view to finding out whether there is a concrete cause for that excessive call. I should have thought that the hon. Member for Durham (Mr. Hills) would have welcomed this concrete inquiry in presence of a great difficulty. He complained that the Chancellor of the Exchequer had compared the powers of the four ratepayers to the powers of the health 1697 committees. I do not think that the right hon. Gentleman to imply that the powers were exactly parallel, but they are the same to this extent. Admittedly the power of the four ratepayers in the past have been very ineffective. He pointed out that in order to make such powers more effective there was the opportunity given to these committees to deal with a special aggregation of sickness and distress in a certain locality. I think that enough has been said to ensure that health committees throughout the country will welcome assistance and co-operation in their work. As the hon. Member for Wolverhampton said this afternoon, it is a work with which they have been contending for many years in face of the great difficulty of overriding those who believe that low rates mean economy. My own belief is that low rates in the matter of housing and the alleviation of sickness by the removal of insanitation is not economy. It is rather an economy in these matters to spend money where necessary in order to make existing conditions better. I think that those who have been working in that direction will be helped by educated outside opinion in the direction of improving the health in a given locality.
§ Mr. W. PEEL
I do not wish to follow the last hon. Member into the question whether rates should be higher or lower. I only wish to point out that this is the central point in the machinery of the Bill. I am afraid that I cannot quite support my hon. and learned Friend below me, though I have great belief in his sagacity and differ from him with great respect. At the same time I am not sure whether we can accept the confident assurance of the Chancellor of the Exchequer about the position of the local authorities. After all it is easy sometimes to persuade local authorities. When a deputation comes in with a great deal of fear and trembling into his parlour, no one is quite himself. He is afraid that the right hon. Gentleman may fall upon him in the way in which he fell on my right hon. Friend the Member for St. George's (Mr. Lyttelton) the other day. If he finds, on the contrary, a totally different Chancellor, an extremely agreeable and persuasive Chancellor, I cannot help thinking that sometimes he is influenced by results which he had not intended when he went into the room. After all there is a case of what is known, I believe, as leading. They will say, "Very well, we do not want any rival authorities." Then their courage oozes out, after they 1698 have gone so far as that. If the Chancellor says, "I quite understand you do not want a rival authority, but surely you would not mind somebody who co-operates with you and helps you," of course they admit that. The word "co-operation" is so often used by people who want to conceal their own point, and of course there is a very great difference between co-operation which is persuasive and that which is mandatory. I am not in one sense very much impressed by those statements as to the different representatives of local authorities, because, after all, this matter must be looked at rather more widely. Whatever may be said of the particular powers of those bodies, everyone knows that if you have a body set up which is a representative body, and is, therefore, bound to be a powerful body, you establish an authority which must increase in power even though it begins rather humbly and lowly. It is noticeable that all elective bodies endeavour to draw to themselves all the powers they can, oven though, in the first instance, you put some limits to their powers. Very rightly, as is admitted, the Government have tried to work the administration of the Bill through the friendly societies and the local health committees, on which are to be representatives of the friendly societies. Those health committees have to deal with the deposit contributors, who are in one sense the failure of the Bill, and with various other matters; they are going to be large bodies, and they are bound to have a very large number of officials under them. The whole tendency of those authorities will be to set up a large bureaucracy in every county. If you must have these local health committees, then let them deal with only insurance work, and do not give these powers, which must be vague, to those bodies with great numbers of officials. I have had a good deal to do with these matters, and I know how a self-respecting officer is always trying to increase his power and position.
These forty-eight gentlemen are going to meet some time in the evening, or at some convenient period, and in time they will not be able to control the large bureaucracy which they are going to set up. The proposal in regard to these health committees will certainly have a very serious effect, for the rates may be called upon and may be increased. Under the Bill I should like to separate the local authorities entirely from those committees. The representation on these local bodies is either too much or too little, 1699 because it is too little really for the purpose of controlling the expenditure of the local health committee, and it is too much in the sense that if you give the second body, with a representation of the local authority upon it, the right of looking to that local authority, that would be made an excuse, and used as an excuse, for drawing rates from the local authority, especially when you recollect that many of the people on these local health committees are, most of them, interested in throwing expenditure on the rates. If they do that, they can spend more in their ordinary benefits, and they may be able also to spend more in additional benefits. Therefore we have got forty-eight people, including the medical people, also interested in the expenditure, who will have the power to call upon the local authority to fill up any gap. They could say, "We have not got enough money to spend from the friendly societies, and we call upon you, quite in a friendly spirit, of course, and the Treasury as well, to supply part of the money required to fill up the gap; and, please, gentlemen, you will do so." That is very real and serious to the local authority, and I must say that I, as a member of a local authority, would much rather have no representation at all on the health committee, and be left perfectly free to handle this subject as I like, keeping my hand pretty tightly on my own purse-strings, and thinking that by so doing I was only performing my duty to the ratepayers.
§ Mr. HUME-WILLIAMS
It seems to me that we have got in this Bill a new and complex system. You desire that all the different classes should be represented, including doctors and others, on this new body, and a great number of them for the first time are touched by the ramifications of this Bill and desire to be represented on the committee. The functions which are proposed are such that it is quite impossible for the health committee to properly carry them out. Under the Bill the duties of the new bodies will be copious in the extreme. They have finance to consider, they have health to consider, they have to consider that to which the hon. Member for Bow and Bromley attaches so much importance, the prevention of disease as well as cure, because the surest means of prevention is to inquire into the origin of disease, in order to see how it can be treated successfully; and I venture 1700 to say that, all of a sudden, to throw such a number of duties on a gratuitous body, is more than commonsense demands. How long such a body will remain unpaid is, of course, what nobody can tell. I presume that in the future they will be paid. I suppose a time is coming when we shall all be agreeably occupied in claiming salaries — a condition of things compared to which the tradition of living by taking in each other's washing will be positively unremunerative. But if they are going to be paid, then, for goodness sake, let us get as much for our money as we can. Let us have an expert body who can undertake the new duties with the enthusiasm and knowledge which appertains to the new broom that will sweep so clean. Do not let us at this stage of the Bill put these entirely new duties upon men and women already overburdened with work.
§ Mr. JOWETT
Several Members on this side of the House have spoken in favour of the proposition to establish health committees which shall have other duties than those dealing with insurance. I differ from the view they expressed, and I think I have had as much experience as those hon. Members of the administration of health committees. I was eight years chairman of the health committee of the town I have the honour to represent (Bradford), and the municipal authority in my Constituency has passed a resolution which is uncompromisingly hostile to the establishment of this committee. I do not wish to represent that the authority I refer to has any reason to complain of a local committee being set up to deal with insurance business only; but directly it goes beyond that business, and undertakes other functions, and deals with various other questions, it is bound to overlap the duties of the ordinary health committees now established by the municipal corporations. I ask the Committee to remember that under the Clause with which we now have to deal the new committee will be able to call upon the medical officer of health, who would be practically serving two masters. They would deal with health work and education work, which is done now quite freely by the bodies already in existence. It may be news to the Committee to learn that at least one authority, that to which I have already referred in my own town, has recently carried through a week's health mission. Every night a lecture was given in the public hall by an 1701 expert in this or that department of health work, and everything has been done by that municipal authority which this new committee is supposed to begin to do. The whole work is already being done by the authorities in existence. The new committee is to make representations regarding any excessive sickness from overcrowding or other insanitary conditions. It is not because the local authorities have not sufficient information on the point that overcrowding exists. It exists because they are unable with present facilities, and with the assistance they receive from the State, to deal with these open sores as they ought to be dealt with. Instead of setting up new bodies, the course to pursue is to give some assistance to existing local authorities, and to give them encouragment in connection with the work they have to perform. If they show bad results, if they do not do the work properly, then do not pay them, but at least give them some assistance if they are doing the work adequately. What is the alternative you set up in this Bill? It is to allow an outside body, forsooth, to fine them for not doing the work. As a matter of fact, they have not the wherewithal to do it, and the Government should provide them with the necessary means to discharge their duties. I trust a Division will be taken, and that the whole question of the committee to be established under this Clause will be rejected.
§ Mr. HAYES FISHER
I entirely agree with the main contention of my hon. Friend who introduced this Amendment, that these new bodies should be entirely confined to and concerned in insurance work, and in insurance purposes. I think it is a very great pity that this new-fangled body was set up in the very middle of the Insurance Bill, and I thoroughly agree that if we are to discuss local government in relation to our municipal bodies, we should at least have the benefit of the presence of the President of the Local Government Board. If the great municipal bodies of this country have failed in their duties with regard to health and sanitation, surely that is a matter to be dealt with in a separate Bill dealing with local government, brought in by the head of the Local Government Board, who is responsible for local government throughout the country, after consultation with the local authorities. This Bill, so far as local government is concerned, should confine itself to insurance work. As one who has been largely responsible for the 1702 finances of London during the last few years, I anticipate there will be a sad lack of thrift and economy when these new local bodies are set up, because if those bodies have power to order expenditure on the rates, that must lead to neglect of economy and thrift in many cases, and impose upon the county council a large expenditure which I think altogether unnecessary, and indeed wasteful.
We are told, of course, by the Chancellor of the Exchequer that after all the county councils are to have options in this matter, that the bill is to be presented by these local health committees, and that the county councils need not foot the bill unless they like. First of all, the bill is to be presented to the Treasury. I am not sure that in this case the Treasury is going to be of any assistance to the local authorities as a safeguard against this unnecessary and wasteful expenditure, and for this reason. Let me deal with London, which I do know. Suppose that the health committees, and I do not know how many you are going to have for London, make schemes for medical, sick, sanatorium, and maternity benefits, which result in their having a deficit, and which are schemes which cannot posibly be made up by contributions from the employed, the employer and the State, and which result in a very heavy deficit, what is going to happen? The bill for those schemes, as I understand, is to be presented first to the Treasury, and the Treasury may or may not sanction that expenditure. If they do sanction it, then the bill is to be passed on to the county council, and the county council— [An HON. MEMBER: "No."] I will take my contradiction from the right hon. Gentleman opposite or from somebody who knows the Bill, but as I read it the bill for the deficit is to be presented first of all to the Treasury. Does anybody deny that? Supposing that the deficit were something like £400,000, what is a couple of hundred thousand pounds to the Treasury? It makes practically next to no difference, they would say, when raised in taxes. But what is a couple of hundred thousand pounds to the London County Council? It is rather more than a penny rate. Therefore I say that the Treasury may not mind the incurring of an expenditure of £200,000, while the county council may well say, "This will run us into another penny rate," and those who are responsible for the finances of the county council I may find themselves most unpopular with 1703 the ratepayers at the next election because they incurred this expenditure which has been forced on them, not from inside their own body, but from outside their own body by persons whom they cannot control.
I should like to criticise this matter from another point of view. We have parted with all our old maxims. Representation and taxation should go together, so we have always been led to believe. Where is the representation here? Take the composition of these forty-eight gentlemen on this Committee? Who voted for them? The constituents who voted for them are not those who are interested in the expenditure, but those who are anxious to get as much as they possibly can for new schemes. Are the doctors going to be of any assistance? The doctors are naturally going to ask for every single thing they can get for themselves. This is a new rate-creating authority in London, and the same applies to all county councils. How is it elected? It is not elected by those people who have to pay rates; it is not elected by the big ratepayers; they have nothing to do with it. It is elected entirely by people with incomes of under £160, and mostly by people who pay very little, if anything, in rates at all. All the big ratepayers, and all the representatives of the big ratepayers who pay heavy rates, would have no possibility of electing anything but a very small proportion of that committee. I say that is a great blot on those committees. Representation and taaxtion no longer go together, and there is no safeguard whatever to the ratepayers who have got to foot the bill that they will have some voice in the expenditure which they cannot possibly control. This Government, famous as it is for dislocating local finances, only gives another instance of coming in and overriding the local authorities and local control. They say to the local bodies of the greatest importance and to the county councils all over the Kingdom, "You shall incur certain expenditure and you shall place that expenditure on the ratepayers," although they have no voice whatever in the consideration of this question. I know that the Debate has now spread over a considerable time, and I may be able to add something on some future occasion.
§ Mr. RAMSAY MACDONALD
I do not propose to give a silent vote on this Amendment, because, whilst I find myself in agreement with the speeches that have 1704 been delivered on these benches, yet I am not going to vote for the Amendment. If the Amendment was drafted in such a way as to express the fact that the popularly elected health committees should be responsible for public health, then I would support the Amendment, but that is not the Amendment that the hon. and learned Gentleman has put on the Paper. The Amendment is that the existing health and sanitary committees for every county or county borough shall be empowered to carry out all the duties of this part of the Act. I am not in favour of that, but I think it is a great mistake to have mixed up public health with these committees. With that part of the Clause I am in profound disagreement. I do not think that we are going to improve public health by creating a sort of watch-dog committee like these. I do not believe that the effect is going to be what the Chancellor of the Exchequer imagines it will be. As a matter of fact, in a great many cases I think it is going to enable public health committees to go more to sleep than they do now, and that is saying a very great deal indeed. I do not think that the principle of creating committees representing interests, even if they be the interests of friendly societies and trade unions, to watch from the point of view of those interests the general public administration—I do not think that that is giving sound democratic government. I do not think it is good representative government, and even if democratic government on its administrative side has broken down, and we have got to admit in many of those districts it has broken down, the way out is not the way that is proposed in the Clause. If the hon. and learned Gentleman had confined his Amendment to expressing that point I should have voted with him, but the Amendment says that the charge of these insurance funds, or of portions of the funds, shall be handed over to the existing public authorities, and that I cannot support. I think it is going out of the frying-pan into the fire. Therefore, when I will go into the Lobby against the Amendment, it must not be assumed I am doing so because I resist the arguments that have been made, and which I think have been made unanswerably, against these committees interfering with the public health. If the Government had only made the local health committee more powerful than it is by giving it an independent public health medical officer or something like that, if it had pursued that line of policy and given it a better 1705 financial position, and put more compulsion on it from, say, the Local Government Board, and increased the standard of efficiency it had to reach, then it would be doing far more than establishing a watch committee such as this. I want to associate myself with my hon. Friend the Member for Durham when he said we are not to delude ourselves by this cry for inquiry. Nobody is in favour of inquiry more than I am, but we want no more inquiries in the matter, for instance, of slums. We know all that. We could inquire for the next twenty years and not be one iota wiser than we are now. The time has come for action in a great many of these things, and I do not believe that we can get action by creating two concurrent authorities and setting one authority, from its own interested point of view, to watch the actions of the general representative authority. I do not believe you are going to get progress in that way, so that while I associate myself absolutely with what my hon. Friends here have said, still I think they are mistaken in supporting the Amendment, because it does not carry out what they desire.
§ Mr. CAVE
I cannot support the Amendment now before the Committee. I do not think a committee consisting entirely of a local authority is the right committee for carrying out this particular Bill. The Amendment would, indeed, exclude from any part in the operation of this Bill all insured persons as such, and all members of the medical profession as such, making it no longer possible to entrust the administration of the Bill to a committee containing representatives of the interests affected. On the other hand, I entirely agree with what has been said by more than one Member that the scheme of the Bill would really make local government impossible, for the proposal to set up a new health committee having new health powers is really the negation of our present system of local government, and would do very much more harm than good. In that I entirely agree with the hon. Member for Bradford. It is proposed to make this a health committee, but why a health committee at all? There is a health committee in every local district, and there is another one in every county. I agree with the Amendment on the Paper to leave out the word "health" and to insert the word "insurance," or words to that effect.
Again, Clause 44 seems to me to be entirely a mistake. You are going to give 1706 to this Committee the power of considering the public health in the district. That is the duty of the sanitary authorities, and if you are going to give two bodies exactly similar duties you will probably find them neglected by both. The same thing applies to Clause 46. You are going to sot up not a voluntary committee, but a committee with statutory powers with control of public money, to criticise the local authorities and call in, if they think fit, the medical officer of health of the local authority and ask him whether he thinks his authority is doing its duty or not, and, if need be, to make a complaint to the Local Government Board as to administration by the local authority of its powers relating to health, housing, water supply, and matters of that kind; and in the end, if they think fit, to demand an inquiry, and so possibly cause a very great expenditure of public money. If it is desired to make representations to the Local Government Board there is ample power now for any ratepayer, or any body of ratepayers, to do so. Inquiries, and special inquiries, have often been held, but to set up a new body with public money to spend and to encourage them to make a kind of roving inquisition into the manner in which the elected authorities perform their duties, and to make complaints against the central authority is, I think, to do very much more harm than good. I am glad that the discussion upon this Clause has been somewhat extended, because it has enabled us to express our opinion upon the whole scheme of the Bill in this respect.
§ Sir R. FINLAY
The Amendment is based upon the feeling to which my hon. and learned Friend gave expression, and which is very largely shared in the Committee, that the proposed committee under the Bill is unfit for the health duties that are to be put upon it. On the other hand, it is the case that the existing health and sanitary committees in counties and boroughs would be unfit for the insurance duties that will devolve upon the committees under the Bill. In these circumstances I feel that I cannot support the Amendment. What seems logically to follow from all that we have heard is that we shall require to consider very stringently the Clauses imposing health duties upon these Committees.
§ Sir A. CRIPPS
My real object was to point out the evil of giving these concurrent health powers to what ought 1707 clearly to be an insurance committee. I think I made that quite clear when I proposed the Amendment. As regards the substituted body, I pointed out that it would be very much in accord with the body suggested in the Bill itself. The amount of support given to the views I have expressed would be quite misunderstood if I took a Division upon the present Amendment; therefore, to prevent misunderstanding, I will ask leave to withdraw.
§ Amendment negatived.
§ Mr. LEES SMITH
I beg to move to leave out the word "health" ["a local health committee shall be constituted"], and to insert instead thereof the word "insurance."
§ The ATTORNEY-GENERAL (Sip Rufus Isaacs)
There is a difficulty in accepting the Amendment at this stage, because we have passed many Clauses in which the local health committees are referred to; but I think it would be the general wish of the Committee that I should make some statement as to the intention of the Government. The form of carrying out that intention may be discussed hereafter. It may have to be done by a series of Amendments on report, or there may be some shorter way. In substance the Government take the view that, on the whole, it would be better to leave out the word "health" and insert the word "insurance." They also think it would be better to leave out the word "local." One of the reasons for thinking it would be better to do that is that we are proposing to set up auxiliary committees, and there would be a considerable danger of those auxiliary committees being called the local insurance committees. In order to avoid confusion it would be better to use the term "insurance committee," which would doubtless become coupled with the name of the particular place; for instance, the Cardiff insurance committee, or whatever it might be. That would be a convenient form of dealing with the matter, and I think it would be in accordance with the views of Members of the Committee.
§ Mr. HARRY LAWSON
That is the case in regard to the Territorial Associations. You have the county of Buckingham Territorial Association, or whatever it may be.
§ Mr. BOOTH
In avoiding confusion with the local health committee other confusion may arise if you use the term "Cardiff insurance committee." I am not an advocate of municipalities going in for insurance, but it is possible in the future that these authorities may be able to develop a well-devised scheme of their own. Some indication in the title that the committee was part of a national or State scheme would, I think, avoid that confusion.
§ Sir RYLAND ADKINS
On behalf of those for whom I put down this Amendment I accept what the Attorney-General has said. On the whole, for the reasons he has given, I think the term "insurance committee" with the local designation will meet the case admirably.
§ Sir RUFUS ISAACS
I understood that the discussion was merely as to the name. If we discuss Clause 44 or Clause 46 we shall be opening up the very discussion which I understood the Chairman to rule would not be in order.
§ Sir R. FINLAY
If you use the term "insurance committee" there may be some danger of confusion with the Insurance Commission.
§ Amendment, by leave, withdrawn.
§ Mr. JOHN TAYLOR
I beg to move, after the word "borough" ["for every county and county borough"], to insert the words "and urban district."
To measure the intent of the Amendment it is necessary only to look at the Bill and read the duties that are likely to be imposed upon the new committees. They are to administer the local post office fund, medical benefit, and sanatorium 1709 benefit; to group small societies; to make reports and suggestions as to the health of insured persons; to submit their reports to the local authorities; and to disseminate and spread particular information about the promotion of health. Considering the large area to be covered in some of the counties, and remembering that the success of the Bill will largely depend upon the efficiency and effectiveness with which these provisions are carried out, there are few Members but will at once admit that in most counties the committees will be called upon to carry out an almost impossible task. The Chancellor of the Exchequer practically admits that some such extension as we propose may be necessary, because he has put down an Amendment with the object of setting up auxiliary committees for boroughs with 10,000 people, and in urban districts with 20,000 people. Why should we perpetuate the folly of distinguishing between borough councils and large urban district councils? Is it that the population of an urban district is considered to be only half the value of the population of a borough, or is that an urban district council can administer with greater efficiency the affairs of 20,000 people as compared with a borough council and 10,000 people? Considering the large duties that will devolve upon the committees when established, and the great areas that will have to be covered, we ask that this Amendment should be accepted. We believe that it will have that effect, and that it will lead to closer supervision of the Act when it is put into operation.
§ Mr. EDGAR JONES
I wish to support this Amendment and to press some considerations of the importance of devolution in this matter upon the Government before they reply. I notice that the Government are endeavouring to meet the matter for urban districts of over 20,000 inhabitants and boroughs of over 10,000 inhabitants by giving the local health committees the power, if they like, to appoint auxiliary committees. I wish to point out to the Government that this method has been tried before, and with very disastrous results. It was tried in the Education Act of 1902 in regard to Part II. Members of the Committee will remember that urban districts with a population of 20,000 and boroughs of 10,000 were given autonomy for Part III.—the elementary portion of the Education Act—but they were not given autonomy in respect of Part II.—that dealing with secondary 1710 education. The result has been endless friction, as I am sure the President of the Board of Education will be able to say, particularly in the county of Glamorganshire. At the present time, after all these years, the Rhondda Urban District, the Mountain Ash, Aberdare, and several other big urban districts are trying to get a scheme. They have been prosecuting that since 1902; they have been trying to get something like effective control over this part of education.
You cannot work a huge county like Glamorganshire, with urban districts like that of Rhondda with a population of over 150,000, with one committee. I do hope the Government will consider the necessity of adopting some sort of devolution. Since the Paper was circulated this morning, I have handed in an Amendment something like this. I wonder if the Attorney-General will accept it. Roughly speaking, by it you give the local health committee of every authority that now has autonomy under the Education Act of 1902 autonomy in this matter. I need not now repeat what the hon. Gentleman who moved this particular Amendment has said with regard to the work of the local committees. I have had a little experience myself of committees who have nothing to do but manage a medical fund in a village or town, and I can assure the right hon. Gentleman that simply to manage the ordinary medical business of one group of villages is a very considerable amount of work for one committee. When you have a local health committee that is going to run the whole concern for the future—medicine, the drug business, and the various departments—you will have difficulty. If these local health committees were to deal with one department in London, or with the Insurance Commissioners, you might expect them to get on with their work; but if they have to deal with the Treasury, the Local Government Board, the Commissioners, and so on, we will never get anything done. There are some big urban districts whose populations are greater than that of some counties, and I ask the Government to give these a health committee of their own.
§ Lord ALEXANDER THYNNE
I cannot support the Amendment brought forward by the hon. Gentleman in the form in which he has placed it upon the Table, because he will notice that in that section of the Bill no reference is made to the ordinary boroughs, as distinct from the county boroughs. If you are going to 1711 extend this privilege to urban district councils, it ought equally, on the same argument, be extended to the ordinary boroughs—boroughs of a certain population limit.
§ Lord A. THYNNE
I quite admit that the distinction between the urban district area and the borough area, is, as the hon. Member has said, in many districts purely an arbitrary distinction, resting on no real administrative lodgment. I therefore should welcome this Amendment if non-county boroughs were being covered by it, and if some limit as to population was also added. I cannot agree with the hon. Member who has just spoken, that we ought to accept the limit of 10,000 population set up under Part III. of the Education Act. I think such limit is too small. I quite appreciate, and I think the hon. Member will appreciate, the objection to multiplying indefinitely these insurance committees, as they are to be called. But I hope that the Committee will at a later stage consider the Amendment which stands later on the Paper in the name of three Members, including that of my hon. Friend the Member for Liverpool, which suggests a population limit of 20,000.
§ Sir EDWARD BEAUCHAMP
I have an Amendment down later on in the Paper to include large non-county boroughs, and perhaps it would be as well that I should make my remarks now at this period when the question of urban district council is on, so that there should not be unnecessary repetition. The hon. Member below the Gangway who moved the Amendment defined the duties which fall upon the local health committee. I think it is obvious to Members of the Committee what those duties are. I think it is obvious that one of the principal qualifications for membership of a committee is that a man should have local knowledge. I can speak more particularly in regard to my own Constituency and the county of Suffolk. The county council of that county has to appoint a local committee, and you are face to face with certain difficulties connected with the carrying out of their duties.
In the first place, my principal non-county borough is Lowestoft, which is a place of 33,000 inhabitants. It is forty miles from Ipswich, the place where the county council meet. There must be a 1712 large number of members of the committee who are working men. They would experience considerable difficulty in getting from Lowestoft to Ipswich. The difficulty, of course, will be the time of meeting. Probably the most convenient time is in the evening. That would necessitate these working men members, who represent the friendly societies, going to Ipswich, and remaining there over night. I have been informed that the members of friendly societies residing in Lowestoft are equal to the whole of the rest of members of friendly societies in the rest of the county. It does seem to me that these large non-county boroughs ought to be the people to appoint the local health committee. I know it is suggested in the Amendment that the cases will be met by the appointment of auxiliary committees. I do not think this will at all satisfy some of the large non-county boroughs, because the duty and powers of the auxiliary committees are not defined, and it is not stated exactly how they are to be composed. I think some of the objections which they have to the health committees being formed by the county council will not be met by the appointment of the auxiliary committees. They would, I suppose, be under the county council, and that is a thing which those to whom I refer particularly object. They might have to refer often to the county council, and it would, or might, produce a certain amount of friction. Therefore I shall be glad to see the Amendment not only cover urban districts, but refer to non-county boroughs.
§ Mr. LLOYD GEORGE
We have considered this question very carefully, for it is a very perplexing problem. It is by no means as easy to solve as my hon. Friend seems to imagine, because there are two sides to this question. I think the Committee will find the suggestions we have put forward are a very practical compromise between the two views. Our view is this: that there is an advantage undoubtedly in getting a fairly large area of control. It has a strengthening tendency, because you get away further from local interests when you get a large area. The same applies here. You are able to equalise the risks to a much larger extent, and the strong come to the rescue of the weak. You may have a district with a very heavy epidemic. At present the whole burden is cast upon that district, whereas if you equalise over a large area it is an advantage undoubtedly from the 1713 financial point of view, and it is also an advantage from the administrative point of view. You are more likely to get a strong body of administrators whose advice will be very helpful in administration throughout the whole of that district. At any rate I think it is of the first importance that the supreme control should be vested in an authority covering a wide area rather than a small one. I can quite see the point of view of my hon. Friend, and those who have been in favour of having urban council areas. They like to decide things in the district for themselves.
We have met that view by an Amendment on the Paper for the setting up of auxiliary committees in boroughs with a population of 10,000 and urban districts with a population of 20,000. That will mean that these districts will have committees to administer the functions of the local health committee under the supervision of the county insurance committee. I cannot help thinking that this will be a much better method of working. I know my hon. Friend does not agree. He has asked the Committee to set up local health committees all over the country. That will be a very expensive process. You would not get the broader view. It is of supreme importance, when you are undertaking any business of this sort, to get a broader view. You would not get the broader, proper view; you would get no organisation on county basis; you would be dominated very largely by local and sometimes even personal interests, whereas if you get supreme supervision of the county as a whole, you get the advantages of larger areas, and also the advantage of local knowledge combined. You get the advantage of local management from the auxiliary committees, and you get the advantage of a proper spirit and remoteness from local and personal interests to the extent that you have supervision of the county association. I am sure these local committees would be very much stronger if they had a body of that kind behind them. They would be stronger financially, and certainly from the point of view of administration, and I trust the Committee will consider my Amendment about the auxiliary committee before approving of this. I cannot in any case accept this Amendment, which is an impossible Amendment. Some urban districts are very small. You have an urban district in Yorkshire, with a population of 244, and to set up separate machinery for a district of that kind is perfectly absurd. Under no conditions 1714 could we accept these areas. I suggest to my hon. Friend that he should withdraw this Amendment, and that we should consider the whole problem when we come to the Amendment that stands in my name.
§ Mr. LLOYD GEORGE
If my hon. Friend makes up his mind that there should be no time, of course there would not be, but I am perfectly certain that if this Amendment is withdrawn now, we should certainly get along quicker to my Amendment.
§ Mr. EDGAR JONES
Under the auxiliary committee scheme, I take it, it is the county rate should be charged when the time comes, whereas if my Amendment were accepted, it suggests that each urban district and borough would have its own rate.
§ Mr. LLOYD GEORGE
Before dealing with that point, may I say that my Amendment would give effect to the recommendations of the County Councils Association, which urged very strongly that the unit should be a county unit. With regard to the suggestion of my hon. Friend that the local rates should bear the cost, I do not know how that would be regarded by non-county boroughs.
§ Mr. EDGAR JONES
Putting the figures of the boroughs at 10,000 and the districts at 20,000, if you give them an autonomy, the local health committee rate comes upon them locally; but if you consent to the auxiliary plan, I take it that the local health committee will have to get the county rate.
§ Mr. LLOYD GEORGE
If my hon. Friend is very anxious to spend local rates, well and good. If his anxiety is that the local ratepayers in a district should bear the whole of the burden and exempt the rest of the people, of course that is not a matter of the least difficulty.
§ Mr. FORSTER
I think what we ought to see is that the new insurance committees should be constituted so that they can give the best and most efficient management to the area with which they have to deal and to the duties they have to discharge, and I think the Chancellor of the Exchequer omitted to remind the Committee of how detailed and how very important these duties will be, and how very largely they will depend upon the close personal efforts of the members of the 1715 committee if this scheme is going to succeed. I want to support the plea of the hon. Member for Merthyr that we should even go beyond the terms of this Amendment, and that we should create local insurance committees for each district, whether it be urban or whether it be rural.
§ Mr. FORSTER
No. Of course the Chancellor of the Exchequer is not able to be here always, and he must not be too quick to interrupt.
§ Mr. FORSTER
Yes, but there was a little note of truculence. [HON. MEMBERS: "Order, order."] There is no ill-feeling; if the right hon. Gentleman was present he would find that the suggestion of the hon. Member for Merthyr was that all districts should have a limited population such as that for administration education, roughly 20,000. What I want to bring to the notice of the Committee is this, that unless you are going to have separate local insurance committees for local areas as well as boroughs, and other places, you are going to make it infinitely more difficult for people in these areas to give efficient administration or for the members of the local health committees to look after them properly. The right hon. Gentleman's proposal is to establish separate local committees in the counties and county boroughs. You will have apparently one insurance committee, I suppose, in the county. I have already alluded to the difficulty that the insured persons who will constitute the majority of the actual insurance committee will have in travelling from the place where they work by day to the place where they will have to carry on the business of the insurance committee at night. I believe the amount of work thrown upon them will be so large that the committee will have to meet practically every night for a long time, at any rate, after the Act comes into force.
Let us recollect what these insurance committees have to do. They have to make all arrangements for administration; they have to make all the arrangements for the doctors; they will have to make all arrangements by which a free choice of doctors will be given to every- 1716 one of the insured persons; they have to make arrangements for the chemists and for the supply of drugs; they have to make arrangements to see that medical benefit is properly given to everybody entitled to it, and also that the use of medical benefit is not abused. That means, I take it, that they will have to undertake the work that the friendly societies have hitherto discharged; and to provide visiting committees to carry on the business of checking, malingering, and so forth. I say it is absolutely impossible that that should be done over sparsely populated areas if you are going to have one authority representing a county as a whole. You cannot do it. The right hon. Gentleman says, "If you look at my Amendment you will see I propose that there should be established auxiliary committees." But the auxiliary committees will be sub-committees, and cannot spend a penny without reference to headquarters; they cannot make any arrangements without reference to headquarters, and everything they do will have to be sent up from the area in which they work to the county town in which the central committee meets. My point is, if these committees are only sub-committees to the central authority, you will get endless delay owing to the correspondence which would have to take place and by having to go to headquarters in order to get sanction for everything, including the selling of two pennyworth of drugs. They will have to go through so much red tape that these sub-committees will find themselves tied hand and foot. The whole essence of careful and efficient administration of these benefits is to place them in the hands of small authorities.
The right hon. Gentleman, in the speech in which he introduced this Bill, referred to the importance of preserving local management. Many of us who heard that speech will remember how he dilated upon that fact. He said the best check you can get against malingering is in a society locally managed, and he laid great stress upon the necessity of preserving the activity of local management. You will not create efficiency of local management if you make these committees sub-committees and drive them to headquarters to get authority for everything they do. I hope the right hon. Gentleman will not lose sight of the necessity for prompt and efficient action on the part of the committees, but I do not think he will secure it if he sets up merely auxiliary committees or sub-committees.
§ Mr. LLOYD GEORGE
The hon. Gentleman has asked me to explain one or two points with reference to the committees I propose to set up under this Clause. Before I do so I would like to say a word or two about his speech. I think he was under the impression that he was supporting the Amendment of my hon. Friend. He was not. He was supporting another Amendment not suggested by anyone, and completely wide of the Amendment of my hon. Friend, and he showed how thoroughly incompatible his suggestion is with the real facts of the case. "Take a very large county," says the hon. Gentleman. "How are you going to deal with administration by one committee over the whole area?" I accept that condition, and I agree to smaller committees, but just think what will happen under the Amendment of my hon. Friend. In a great county like Glamorgan you would have Merthyr Tydvil with a local health committee.
§ Mr. LLOYD GEORGE
You would have Aberdare and the Rhondda Valley with a local health committee. You would have a huge scattered area of villages all over that place which would be administered by the county council. That is not the purpose of the hon. Member at all. You have the same difficulty and a still greater difficulty, and the only difference would be that you would not be able to obtain the assistance and advice of those other districts. Aberdare would not be there and Rhondda Valley and Pontypridd would not be there. You would simply have a few scattered areas, and my hon. Friend would simply have a mutilated county which nobody knows. This proposal does not meet at all the view of the hon. Gentleman, because you still have the county areas unrepresented. If the county committees deal with these villages, surely they can deal with cases in places like Aberdare. There is another point I wish to put. This proposal really means that all the poor districts will suffer. As a matter of fact you are picking the eyes out of the county, and all the poor districts will suffer. All you have to do is to apply to London to see what it means and how it works. If you are going to have in every little borough of 10,000 a separate health committee, how are you going to refuse it to the boroughs of London? It means that the poor districts will have to stand upon their own responsibility and finance. If you make it the county area, then, in the case of London, the whole of the west 1718 will come to the aid of the east. They will probably appoint a local health committee at Westminster and another in Kensington. Of course, it will be a very small matter there, because there will not be so very many insured persons.
§ The CHAIRMAN
I want to point out that the very next Amendment deals with the question of the Metropolitan boroughs, which is rather a separate case.
§ Mr. LLOYD GEORGE
I want to make this point because the hon. Gentleman pointed out what would happen in rural districts. If this is granted I cannot refuse the other, and then I must show that that is the inevitable result.
§ Mr. CASSEL
I have an Amendment dealing with the case of London, and if the point is raised now, should I be in order in replying to the argument of the Chancellor of the Exchequer, otherwise the case with regard to London might be prejudged.
§ The CHAIRMAN
I should advise the hon. Member not to take that course. If the point is argued on this Amendment I should not allow it subsequently.
§ Mr. LLOYD GEORGE
If you are going to do this in regard to every borough with a population of 10,000 you cannot resist it with regard to London. This is a proposal by which all the poorer districts would suffer. The Amendment of my hon. Friend means a separate local health committee for all these districts, and then they must rate themselves. The inevitable result of that will be that instead of spreading that rate over the whole country and the poorer districts sharing in the prosperity of the more prosperous parts, this proposal will have the effect of crowding the whole burden upon areas which may be poor in regard to rateable value. You have districts in Glamorganshire where there are very few large houses and where you have just a group of small workmen's cottages, where the rateable value is low. Very often in such places you get the work outside the district, and you do not get the advantages of those works in order to increase your rateable value. What does that mean? In those districts the rate will fall upon the smaller districts and upon the cottages, and the rich works or the rich districts outside will not share at all their proportion of the burden. That is what would happen. Supposing you have an epidemic in one of those small districts—and they 1719 are just the places in which epidemics are more likely to happen. In such a case you make the expense of medical relief double, whereas this would not happen if you put the burden upon the whole county and spread it over a larger district. In this instance it will put the cost upon these poor districts, and the rate will have to be put up. [An HON. MEMBER: "Hear, hear."] I quite admit it, and if you do not resort to this you will only have to resort to it through the Poor Law without 50 per cent. from the State which we are offering.
§ Sir A. CRIPPS
I think that would apply only to the heavy rate in the poor districts where there is a low rateable value.
§ Mr. LLOYD GEORGE
Yes, the rateable value being low, the rate would be a very heavy one. You have these two conditions: first of all there is a greater liability due to the fact that the dwellings are small and crowded together, because there is not the same efficient sanitation and there is overcrowding. Very often, too, there is lack of proper ventilation. My hon. Friend's Amendment would be the worst thing that could happen to the poorer districts in this country, and I shall certainly resist it. I know the temptation, for I have seen it before with regard to Education Bills. I saw one Education Bill wrecked by an Amendment of this kind. I was very glad of it, because I hated the Bill, and no doubt I supported the Amendment. I did so because I wanted to kill the Bill, and I frankly said so at the time. This Amendment is the one way to make this thing quite worthless. Under this Amendment you will have any number of these very small health committees working independently of each other, dominated by little local interests, without having the pick of the whole county to draw upon. I know it is an attractive proposition to be able to go to your constituents and say, "I have got a local health committee all on my own for your borough, and but for me you would have been governed from Pontypridd instead of from Aberdare."
Let us really rise above these local jealousies and take a broad and courageous view of the matter. These committees will be infinitely more efficient if you adopt the suggestion of the County Councils Association, in which I felt at the time they made it there was great force, and it 1720 was a very sound suggestion. The view of the County Councils Association is that it would be far better to have local committees. The hon. Member opposite said that if we have local committees you will have to refer every little thing back to the central body. That is a preposterous idea, and I cannot imagine them drafting regulations which would compel the local committees to refer every little thing back to them. It is the very essence of delegation that they should have full powers. I know that before they decide upon anything which involves new expenditure and launching out upon new schemes, no doubt the county committee would exercise control, and it is quite right that they should do so; but they will not refer back to the county committee such questions as whether they ought to pay John Jones's medical attendance, or little questions of that kind, or how much they should pay for drugs in the district. They will submit their accounts to the council health committee as a whole, and get full powers of delegation. The great thing is you have a county committee at their back to exercise control over them, and that will mean efficiency, economy, a broader and a more enlightened administration. For these reasons I ask the Committee not to give way to little local petty considerations, but think of the best way of administering this Clause in the broadest possible fashion.
§ Mr. HARMOOD-BANNER
I am in accord with what the Chancellor of the Exchequer has stated to a great extent. The Amendment which the right hon. Gentleman has referred to, which will be proposed later on, meets a great many of the difficulties with which we are now dealing. First of all, I was rather horrified by the speech of the Chancellor of the Exchequer, because a great part of it was devoted to showing that this Insurance Bill was going to put a very heavy charge upon the rates. I do not think he could have meant that, but in his appeal to the hon. Member below the Gangway he distinctly put it that one of the great advantages of his proposal would be to equalise the charges in cases where but for his proposal the poor districts would have to pay for the rich.
§ 7.0 P.M.
§ Mr. LLOYD GEORGE
If these committees are confined to small areas, it must necessarily fall upon the rates, because there is no fund by which you can equalise things; but, if you have a large area, it 1721 need not necessarily fall upon the rates, because they can equalise the effect of an occasional epidemic in some of the districts.
§ Mr. HARMOOD-BANNER
I was rather in hope the Bill was going to pay for itself without any help from the rates, and I really hope it will be so notwithstanding what the Chancellor of the Exchequer has said. Of course, the Clause establishing these auxiliary committees and giving them power to embrace other areas really meets the point of the Chancellor of the Exchequer and the requirements of other hon. Members. I think, however, the right hon. Gentleman ought to assure us that these committees will have independence. It is absolutely essential they should be independent. It is clear from the Amendment and also from what the Chancellor of the Exchequer has said they are to be sub-committees of the county committee. We have in Cheshire, the county borough of Wallasey, and that large district with its thousands of inhabitants would be subject to the insurance committee of the county. That would be a very undesirable position. The position would be exactly the same in the case of Scarborough in Yorkshire, and Accrington in Lancashire. All these big towns are going to have sub-committees of the county committee. I gladly accept the Amendment of the Chancellor of the Exchequer, because I believe it meets the case in every way except so far as these auxiliary committees having the power to act for themselves is concerned. If he would give us that, I believe the point would be met. Their whole power and usefulness will be taken away if the auxiliary committees of the big urban districts are to be made subject to the county committees. I am quite certain if the Chancellor of the Exchequer would only consult with the county committees he would find they do not want the power. If he would give independence to the committees of the big urban districts and county boroughs, we would gladly accept his Amendment, believing it would usefully meet the necessities of the case.
§ Mr. J. SAMUEL
There was one remark of the Chancellor of the Exchequer with regard to the constitution of these committees which I think ought to be somewhat qualified. I understood him to say his Amendment was suggested by the county councils. I should like to say none of these schemes are ever considered at all, either 1722 by the borough or county councils. I have been a member of a county council for twenty-two years, and I can say there has never been any power given to them to discuss schemes such as this with a view of giving these powers to local committees. Personally, I am in favour of giving autonomy to these committees such as is contained in the Education Act of 1902—that is to boroughs with 10,000 population and to urban districts with 20,000 population. I think the Chancellor of the Exchequer, since Clause 43 was originally introduced, has seen it is quite impracticable that a county committee with twenty members can govern or administer this Act. I wish to speak quite frankly on this matter. It is no use making a very grave error at the present time. I say it is practically impossible for any twenty men in a big county to undertake to supervise these local committees if they are to have any power. I say that advisedly. I live in the county of Durham. We have five non-county boroughs; we have twenty-five urban districts, with populations of 31,000 and 25,000, and we have fourteen rural districts, some of which have a population of 64,000. We have been compelled, owing to the want of knowledge on the part of the central educational authority, to distribute over the county fifteen sub-educational committees, or what are called district committees, in addition to the central committee. Those committees are practically breaking down. Men will not sit upon them for the simple reason that they have no power. No man who believes in local government will sit upon committees of this nature.
I am a genuine friend of this Bill, and I want to see it working a complete success, but you cannot have a county committee sitting in the centre town and controlling very large non-county boroughs. I represent a non-county borough with a population of 54,000. We have large sections of friendly societies and trade unions in the borough. These members will not sit upon the auxiliary committee if it has to send to Durham to obtain the consent of the county committees. I am going to make a suggestion which I think is a practicable one. I suggest these auxiliary committees should be made autonomous, and that the central authority in the county should have the power of supervision to see that the work under the Bill is carried out. I hope the Chancellor of the Exchequer will reconsider the position. I do not quite 1723 understand what he said with regard to the rates. I understood the Bill was going to be self-supporting, and a rate was a very far-fetched idea, because even in regard to medical and sanatorium benefits there would be power to levy in case of a deficiency. If I understand the Chancellor of the Exchequer to mean that the local health committee can bring pressure to bear upon the local authorities for any neglect from the point of view of sanitation, then I would point out that every local authority has its own sanitary rate, and the county council, as such, has no sanitary rate at the present time. The county health committee is a supervising authority. It does not levy a rate. It supervises the rural and urban sanitary authorities, but it has no control over the non-county boroughs. They have absolute control, under the Public Health Act, to manage their own health affairs. The assumption underlying all this is not, I think, fair, especially to the non-county boroughs. The assumption is that the county councils will bring greater independence to bear upon the local authority in regard to these matters. I have in my hand a most important report of the county medical officer of health of the county in which I live, and in that he points out that in the five non-county boroughs of that county there have only been seventeen enteric cases, as compared with a very much larger number in the county proper. He goes on to say it is due to the fact that the sanitation in towns is very much better administered than in the counties. Everybody who has had anything to do with the county administration of health matters knows that there are unpaved streets and open sewers—
§ Mr. J. SAMUEL
I think it is better to have the administration of the non-county boroughs than the county administration at the present time. I hope the Chancellor of the Exchequer will give these committees power at least to administer this Bill within their own areas, and, if needs be, place a county committee to supervise them, but not to interfere with them. I hope the Chancellor of the Exchequer will admit that principle.
§ Mr. J. SAMUEL
I am glad to hear that. I had rather understood, from the 1724 Amendment which the right hon. Gentleman has later on, that these were simply to be auxiliary or subordinate committees, and that is what we on this side take very strong exception to.
§ Mr. POLLOCK
If I recollect rightly, under the Public Health Act, if one is dealing with a non-county borough, he is dealing for the purpose of administration with the case of urban districts. The Chancellor of the Exchequer asks us to disagree with this Amendment on the ground that he meets the case by another Amendment. He puts a very important consideration before the Committee. He says, "you must necessarily have very large areas in order that you may distribute your burden, and, unless you can do that, you may have a particular locality which may be penalised by severe sickness." When the right hon. Gentleman has dealt with the affairs of Wales, perhaps he will tell us what are the funds that are available for the purpose of compensating one area to the advantage of that area as against another area which has suffered from excessive sickness. What we are asking for is that these authorities which at the present time are in the habit of working together, and have almost complete autonomy, should also have that autonomy reserved to them for the purposes of this Bill. The Chancellor of the Exchequer's Amendment makes it possible for the local health committee to have power to set up auxiliary committees.
These committees apparently, under the Amendment, are to be sub-committees, and the Chancellor of the Exchequer recommends them to us and says he cannot imagine any overriding authority restricting the powers of the committees, so as not to leave them full powers. But if they are auxiliary or sub-committees they must remain sub-committees for the purposes of administration, and you have not met the point by saying it is quite likely that they will be given very considerable freedom, because, whether they have freedom or not, whether their requisitions are accepted or not, you will still have the system of going back to the central authority in order to have the power confirmed. You have consequent delay. There is another disadvantage in this Amendment of the Chancellor of the Exchequer. He does not give the committee in non-county boroughs or urban districts, he makes it entirely a matter for the discretion of the local health committee to 1725 say if they consider it expedient that, in the case of such a borough or urban district it shall not be a separate committee or that another adjoining area shall be grouped with it. In fact they are to establish a system of groups, and consequently you will not have a system of autonomy. What is the alternative scheme? The Amendment definitely asks that these areas which are treated as independent areas with autonomy at the present time should be given the same autonomy under the Bill. I am not content to allow the matter to be left to the local health committee—to allow that body to decide whether or not there should be an auxiliary committee set up. We have now decided that this committee is to be an insurance committee, and when the Attorney-General said it was to be an insurance committee I think we all understood the meaning of that to be that the duties of the committee should be more closely confined to the working of the insurance part. One cannot see what are the duties to be performed by the committee. It seems to me it will be necessary to have smaller areas so that the members of the committee may have closer personal knowledge and be nearer in touch with the requirements of the district. I for one do not see any fund for which we are to have arid districts watered, unless it be the right hon. Gentleman directly invites us to look to the rates as a necessary part of this insurance scheme. I am sure he does not mean that. At the present time this alternative scheme of the Chancellor of the Exchequer does not provide sufficient autonomy for these non-county boroughs, and I am not prepared to accept it as an alternative to the Amendment now proposed.
§ Mr. MUNRO-FERGUSON
The English, not to speak of the Welsh, case has been exhaustively discussed and I will endeavour now to put the Scotch one forward. The Chancellor of the Exchequer has defended the case of the county area with great force, and certainly, as far as it is practicable, I adhere to it. But in Scotland there are counties divided into districts where it would be impossible to act except by means of the district committee, and these committees are the public health committees which form the strongest units of local government in Scotland, including the smaller boroughs. The counties of Ross and Fife are divided into districts. In the case of the county of Ross one district is an island somewhere out in the Atlantic. In another case it 1726 takes two days to reach the county town where the meetings are necessarily held. But I do not want to go into all these details. What I feel is that a great deal of discussion might be saved if this Bill were treated on the same lines as the Town Planning Bill. Here we have an English Bill which requires to be modified in some respects for Scotland. It would be an enormous advantage if the Scottish Office could be induced to take the interest which it was induced to take in the Town Planning Bill. Eventually the Scottish Office, in that case, after a conference with the Scottish Members, allowed them to put Amendments down. I am convinced there will be considerable difficulty in working the Act in Scotland in consequence of the scattered nature of the population. I am quite as sincere a supporter of this Bill as the hon. Member for Stockton-on-Tees, but I would like to point out that people in the scattered districts in Scotland cannot join friendly societies, and therefore I fear the Act would be inoperative under the conditions proposed. I think the time has come when the Scottish Office, in conjunction with the Scottish Members, should put down Amendments which are necessary to make this Bill work in Scotland.
§ Sir RYLAND ADKINS
Although I am not personally responsible for the drafting of the Amendment, I admit it represents very much the position taken up by the County Councils Association. There is nothing here to grab and no one to grab it. We are simply trying to suggest a plan by which an important part of this Bill may be made to work more easily. Under this Clause the authority we are dealing with is the district borough or council and the insurance committee, as they represent the larger or smaller areas. Surely every Member's desire is to secure the most direct action by members of local committees in the areas with which they are acquainted, and to combine that with the best financial reserve you can have in case the rate is to be called upon in order to work this part of the Act of Parliament. The real issue raised by the Amendment is whether, if you do have to come on to the rates, it is to be the district or the county rates. I know hon. Members are equally desirous with ourselves to make the Act a success, and I believe that in the vast majority of cases the county area can better bear the liability than any smaller area. Therefore we are up against the point, 1727 how can we combine a large and comparatively wealthy area, in case of emergency, with a small and businesslike area for the working of this Act? That I believe can be done by the Amendments of the Chancellor of the Exchequer, with some minor modifications. Take the case of old age pension committees. They are appointed by the county council. They work exclusively in the districts, but when once they are appointed by the county council they are left to do their admirable work. That is how you can have the first step taken by the central area and the administration left to the smaller area. It is important to preserve the substance of administration to these smaller areas, particularly in those parts of the country where the smaller areas are highly organised units of local government. For that purpose I make these two suggestions, which are moderate modifications of the Amendment of the Chancellor of the Exchequer. He says that the local health committee should form auxiliary committees in every county area. Amendments down in the names of hon. Members suggest that these should be formed by the county council. I suggest that they should be formed in every county by the Insurance Commissioners, but that, before any scheme for a county is brought out, the county council and the district council and the county borough council should be heard by the Commissioners who are drafting this scheme.
It is certain that the needs of these localities in the different parts of the county require separate treatment. You cannot have a cut and dried scheme which applies to Lancashire and Rutland without modifications. There may be some cases in England, as in Scotland, where it will be desirable, for special reasons, to divide the county area, although in the majority of cases the county area is itself sufficient. I would submit to my right hon. Friend these modifications. With these I believe you have practical autonomy in the district with the important value of the larger area for rating which may have to come. If the authorities themselves have an opportunity of putting their views before the Commissioners who make the scheme, very little friction will ensue. On these grounds I am obliged to oppose the Amendment, not on the ground that I am trying to get more power for the county councils, but from the point of view of people who represent the district. I know how keen 1728 they are for autonomy in regard to administration. I entirely concur with the attitude taken up by my right hon. Friend, but I think it will help him, and the understanding of the Bill in the country, if, before the Report stage, the details, or at any rate the main outlines, of this proposed delegation were made clear. For instance, it might be made clear that it will, for a committee sitting in Preston, or in any one of the large Lancashire towns, to decide the delicate question relating to medical men—a committee of men who know all the needs of the locality and insurance, and difficult points of that kind, which are not per se involved in a county rate. If you will make it clear that these are parts of the necessary duties of your auxiliary committee, in which they have full authority, then we shall combine the two things we require, the largest and soundest basis of finance, and the closest and most intimate basis for administration.
§ Mr. WALTER REA
I would like to support the appeal made to the Chancellor of the Exchequer to give us an assurance that these committees are to be autonomous. It is all very well for the right hon. Gentleman to talk of the small difference it makes to Pontypridd or to Aberdare. In other districts it is important that we should be allowed to deal with our own local problems in our own way. In my own Constituency the difficulty we are under relates to the supervision of the county authority. It takes us a day and a-half to go to the county town to do our business and come back. We want an assurance that the auxiliary committees do not mean merely committees which are to give local information, and leave the decision to the county, who will really do the work.
§ Mr. LLOYD GEORGE
I certainly agree that these local committees must be real live committees endowed with authority. It is really a question of supervision. I want hon. Members to remember this, that the finance must necessarily be county, and that it is to the interest of these areas that it should be so. Let me take a case in point. Say that 6s. is the average for drugs and doctors. In some districts you will not spend 6s., in other districts 6s. will not do it, and these districts are some of the very districts hon. Members have been pleading for. That shows the desirability of having a county as the unit for financial purposes. You cannot allow a local committee to draw a 1729 blank cheque upon the county. You must allow the county to sit in judgment on the proposal. The county will say, "Yes, we have to spend less in such and such a district, where 6s. would not be required, but in this district we must spend 7s. That will be taken into account." That will be to the advantage of the other area. If they depend on their own 6s. there will be 1s. deficit when they start. Where must that come from? It must inevitably come from the rates of the county as a whole, and the county as a whole may have sufficient money to provide the whole thing without resorting to the rates. I want the Committee to bear in mind that it is financially to the advantage of these areas to come into the county pool, and also that as much work as possible should be delegated. The control of the finance must be county, otherwise they will be the very areas that will suffer. But the control of administration must be as much as possible upon these areas. That is the view the Government take in the matter, and I hope that will satisfy my hon. Friend.
§ Mr. JOHN TAYLOR
As this matter has widened out considerably, and after listening to the last speech of the Chancellor of the Exchequer, I ask leave to withdraw the Amendment.
§ Amendment, by leave, withdrawn.
§ Mr. CASSEL
I beg to move, at the end of Sub-section (1), to insert the words,Provided that in the administrative county of London a local health committee shall be constituted for the City of London and every Metropolitan borough, and in this Section, as well as Sections 33, 44, 45, and 47 the expression 'county borough' shall be deemed to include the City of London and Metropolitan boroughs.This Amendment deals with the case of London. I should like to call the attention of the right hon. Gentleman to the special case of London. It must be remembered that the County Councils Association does not include the London County Council. London has four and a-half million inhabitants, so that London has one-ninth of the whole population of the country, and therefore probably one-ninth of all the persons who will come upon this fund. For so large a body of persons it is absolutely impossible to have one committee. If the right hon. Gentleman will consult some of the large friendly societies which 1730 operate in London—such as the Hearts of Oak—who have expressed themselves strongly on this question, he will find that they consider that one committee for London will be an impracticable proposal. Let me remind the right hon. Gentleman of the population of the London boroughs. According to the recent Census the largest borough is Islington, with a population of 327,000. Wandsworth has 311,000, Lambeth 298,000, Stepney 280,000, St. Pancras 218,000. All these are boroughs with a larger population than the largest county borough to which you are giving a separate committee. What rule is there to prevent Metropolitan boroughs from having the same rights as the county boroughs? I would ask Members who represent county boroughs how they would like it if their county borough did not receive a separate committee. Supposing some of the great county boroughs in Wales did not receive their separate committee, I think the right hon. Gentleman would be one of the first to protest. So with regard to these great London boroughs like Islington, with a population of 327,000, I submit that they are entitled to a separate committee, and that without a separate committee for each of these Metropolitan boroughs the Act really cannot be satisfactorily worked. The Metropolitan borough councils are the authorities for the boroughs under other Acts of Parliament, and by the Local Government Act of 1899 they were specially incorporated as municipal corporations and, as such, naturally they take a pride in the fact that they should be treated as self-sufficient municipal authorities and not as appendages to the London County Council. They do not desire to be merely auxiliaries or appendages to the London County Council, and their population is great enough to justify their having a separate authority.
The suggestion is made that there might be auxiliary committees for each borough authority. That would not meet the case. To begin with, the borough councils themselves ought to have the right of appointing their proportion of members of the committee. Unless they are made the committee themselves that will go to the London County Council. Why should the London County Council exercise, in respect of a borough like Islington, with 327,000 population, a power which no county council would exercise over any county borough in the kingdom, though the population in the majority of cases is less? There are not more than seven 1731 county boroughs in the kingdom with a greater population. Again, with regard to these auxiliary committees, the Bill leaves it very much in the air what the formation of these auxiliary committees is to be. It leaves it a matter of discretion with the Insurance Commissioners to make regulations for them or not. How is the auxiliary committee in Islington or St. Pancras going to be constituted, or what are to be its powers? It is left absolutely vague and nebulous under the Bill. It is left absolutely to regulations to be made hereafter, and, moreover, it is only to come into force, if at all, some time after the commencement of the Act. At the commencement of the Act, which will be the time when you will get the great rush, how on earth are you going to work this Bill for London? How on earth are you going to work it before you have these auxiliaries? It will be absolutely impracticable to work this with a central committee for London.
We have had the Old Age Pensions Act mentioned, but that stands on an entirely different footing. The county council there appoints the whole of the members of the Old Age Pensions Committee. It is true they appoint sub-committees, but they have to deal with a very much smaller number of matters than these committees will be called upon to deal with. They have only to deal with questions of old age pensions, a matter which is much more easily verified. You can find out from the register whether a person is entitled to an old age pension or not, and there is a comparatively small number. But there will probably be something like 1,250,000 people in London who will be insured persons, and that one committee has got to supervise and deal with and check the whole of that very large number of persons, and it is mainly these committees which will have to check malingering, because they administer medical benefit. If a doctor says a man is ill you must pay him sickness benefit, and, although the society administers the sickness benefit, it is really the committees to whom you must look for checking malingering. If you want to make the Bill work more smoothly and more effectively so far as London is concerned you will do better to create separate committees for each London borough, and that, certainly, is the strong wish of the London boroughs themselves. Several London boroughs have passed resolutions to that effect, including the 1732 borough which I represent, and certainly I think there is very great force in the consideration they have put forward that they ought not to be treated worse than the county boroughs in this matter. With their large population and large rateable value they have a large fund to look to.
I now come to the question of finance, and that is the one point which the right hon. Gentleman put forward, which to a certain extent, appeals to me. I would rather throw the burden on the whole county council than throw it on the single boroughs. Take the case of a county borough. The London boroughs are quite equal in size and rateable value to the county boroughs. Again, in London you have a special provision which deals with this matter under the Equalisation of Rates Act, which would, to a very large extent, neutralise the effect of its being borne by a particular borough. The Government are treating these boroughs so badly now that the Government Grant is inadequate even to enable the London County Council to pay its half share of the sanitary officer's expenses, and because the Government Grant is inadequate for that purpose the boroughs now have to pay themselves, and if the right hon. Gentleman is anxious to relieve the boroughs he will have an excellent opportunity of doing it by considering the question and doing more justice to London in the administration of the Grants which are made to local authorities. Unfortunately it is the fact that the boroughs now have to find a proportion of the expenses of the local sanitary officers which ought to be borne by the county council, but cannot be borne by them owing to the inadequacy of the Government Grant. So far as that particular point is concerned it would be met by an extension of the Equalisation of Rates Act. In any case I cannot see why the London boroughs with great populations and great rateable values should not be treated on the same footing and with the same dignity as county boroughs. I would press the right hon. Gentleman under these circumstances to take into consideration the special case of London and to bear in mind the fact that, so far as auxiliary committees are concerned, they are in a most unsatisfactory position. If he can show me how, in the case of London, to make them satisfactory it would be another matter, but as the Bill stands at present, certainly London is left in a most unsatisfactory position.
§ The UNDER-SECRETARY for the HOME DEPARTMENT (Mr. Masterman)
I must confess to some surprise at the proposal put forward by the hon. and learned Gentleman, and to the rather airy way in which he has brushed aside what is the kernel of the whole proposal—that is the question of finance. He maintained that, owing to population, the London borough councils are as important, and should have as much dignity as the provincial county boroughs. I have no criticism to make on that. And he asks us to accept that as an analogy whereby the London borough councils should be completely isolated in committees both as regards the working of the insurance scheme and any necessary obligation for half rates in return for a half contribution from the Treasury. He knows as well as we know, who have been working on London government for twenty years, that there is no analogy between the London borough councils and the county boroughs, because the London borough council system is a system of cutting up London into boroughs of the rich on the one hand, and boroughs of the poor on the other, whereas the county borough includes the rich and the poor in one unit, and, as he knows also as well as I do, for twenty years those who have been concerned with London government have been pleading for relief from the almost intolerable burden that has been thrown especially upon the poorer boroughs of London. I am not sure whether he was in the House during the past five years. If he was he will remember that, time after time, in debate after debate, Members who make the government of London their special concern, have protested, and I think proved their case, that the Equalisation of Rates Act was entirely inadequate in any real manner to equalise the burden upon the rich and the poor in the Metropolis. What he asks us to do is to say that in those very boroughs where sanatorium treatment for insured persons and dependents is most needed the only fund which will be available for that treatment should be the rate which is laid upon these poor boroughs, which have not only a lower rateable value, but a much higher proportion of patients who need that sanatorium treatment. The hon. Gentleman will see what we have done in our Amendment. I should have thought he would consider that adequate. Speaking as a representative of a poorer borough I consider that the dignity of the borough I represent is fully realised in that Amendment, and I am quite sure my 1734 borough, in conjunction with most other poorer boroughs, would sooner lose some dignity than to be locked up in a closed circle where the poor alone are to pay for the poor. The Chancellor of the Exchequer has explained the large powers which, he contemplates, will be given to these so-called auxiliary committees. We shall have auxiliary committees in a borough with representatives from the borough. We shall have the fullest demonstration in the borough compatible with a general London rate, that a rate is needed in order to provide for the extra expense of sanatorium and medical treatment. The scheme is impossible unless we can have that general rate. It is impossible to imagine that Poplar or, I should think, even Islington or Hackney would be content to levy an extra rate for sanatorium if the rate is only to be levied upon the poor ratepayers of those boroughs and not made a general London rate, and it is because a central committee is necessary, if you are to have a general London rate, that those of us who represent the poorer boroughs consider this essential to the Bill.
§ 8.0 P.M.
§ Mr. FORSTER
The hon. Gentleman has put the matter on a totally false basis. He says the kernel of the problem is finance. I am very glad. Let us look at the finance. We are dealing with an Insurance Bill, and it is supposed to be started upon a tolerably solvent basis. It is supposed that the financial arrangements which the Government have made are going to make this scheme solvent at the start. What is all this talk about rates? The hon. Gentleman says it is impossible to imagine that any poor borough can face the terrible prospect that is suggested by my hon. Friend's Amendment because it is a matter of rates. The Chancellor of the Exchequer, in the speech he made a very short time ago, suggested very much the same thing. He said, "What have these committees got to do?" They have to provide medical benefit. What is allowed for medical benefit? A matter of 6s. for the doctor and drugs." Where is that allowed in the Bill? When this question was raised on one of the early Clauses of the Bill the Chancellor of the Exchequer said, of course 6s. is only the amount the actuaries estimate you can secure medical benefits for. If you cannot do that, then you have a great margin of 11 per cent. on the finance of the Bill. That margin amounts to about £2,000,000 between you and the rates. 1735 What becomes of the hon. Gentleman's contention if we treat London boroughs as separate entities, and establish in each a local health committee of its own? You are bringing the poor boroughs to ruin because of their rateable value.
§ Mr. MASTERMAN
I think that is an unfair representation of what I said. I specially took an example in dealing with sanatorium benefit.
§ Mr. FORSTER
Do you admit that the amount you have provided for sanatorium benefit is insufficient? It is a very simple question.
§ Mr. FORSTER
I suppose the Chancellor of the Exchequer would say that the extension of sanatorium benefit to the dependents of insured persons is going to be so general that it must throw an enormously increased charge upon the fund, and that the increased charge can only be met out of the rates. Well, I think it would be very much better that we should have this matter brought out perfectly plainly. If we are going to start this insurance scheme upon a financial basis, that is inevitable. If you are going to make it depend for its solvency on the rates, let us say so, and know where we are. If you say so, then you are bound to give the representatives of the ratepayers full representation on the local health committee. If, on the other hand, you say that you have placed the scheme on a financially sound and solvent basis, then I do not think you are entitled to be always calling in this question of the rates to your assistance whenever you find it difficult to meet arguments advanced against it.
§ Mr. LLOYD GEORGE
The hon. Gentleman described a very innocent interjection of mine as a truculent one. I wonder how he would describe the speech he has just delivered in replying to my hon. Friend. The hon. Gentleman seems to think that we are now referring to the rates for the first time. Well, three or four months ago, in a discussion we had, I referred to the question of the rates. I said at that time that the rates were in the background if the cost of medical benefit, and especially sanatorium benefit, became so great that you had not sufficient money in the fund. I referred, not only to sanatorium 1736 benefit, but I went beyond that. I said that I had not the slightest doubt that the moment dependents came in you would have to go to the rates and the Treasury for the balance. I have never disguised that from the House of Commons. It was my anticipation that when you put the cure of consumption altogether under this Bill it would inevitably involve another grant from the Treasury and another contribution from the rates. The fund under the Bill simply contemplated sanatorium treatment for insured persons.
Since then we have extended the scheme so as to apply, not only to insured persons, but to women and children. How could that enormous addition possibly be met by the £1,000,000 which we had contemplated as only just sufficient, with a reasonable margin, for the cure of insured persons themselves? What the hon. Gentleman opposite ignored was that by the process of casting the liability of each borough on its own resources he inevitably drives us to resort to the rates. What does it mean? Consumption may be but a small matter in Kensington, but it is a very serious matter in Poplar, Shoreditch, Bethnal Green, and all those districts where the poor live. If you say that the cost of the cure of consumption is to fall entirely on those districts, what does it mean? The fund will be insufficient, and you will drive those districts to resort to the rates, whereas if you say that the whole contribution of London is to be pooled, that the immunity of the West End from consumption should be regarded as its own reward, and that the balance should be given to the cure of those people in the East End, then there will be no need to resort to the rates at all. The same thing would apply in regard to medical benefit. The hon. Gentleman asks where is the 6s.? The 6s. is in the finance of the Bill. I have always said so, and if you go beyond that, then, of course, you have got to impinge on the margin. The hon. Gentleman asks why you do not impinge on the margin? Is there not a margin of £2,000,000? Of course there is a margin of that amount, but why should you impinge upon it to save the west-end boroughs? They will probably have a margin even on the medical benefit, but the east-end boroughs will not. Six shillings would be inadequate if you do not spread the charge over the whole of London, and the result would be that you would bring it up to 7s. or 8s. in the east-end. By spreading it over the whole town 6s. would be enough. Is it not 1737 reasonable that you should spread the rate over the whole town? The hon. and learned Gentleman opposite admits that there is something in that argument. It is no use quoting the figures for the county boroughs and saying that a surplus in one could be applied in making up a deficiency somewhere else. That is not the point. These county boroughs elsewhere than in London are self-contained boroughs. You have there rich people living more or less in an area occupied also by the poorer, but here in London you have got poor people living in one corner and rich people living in another. That is not quite the case in such towns as Liverpool and Manchester. There you have districts within boundaries, and the rate is spread over the whole area. That is not the case when we come to deal with the London boroughs, and it is for that reason that London should be treated as a unit.
§ Mr. HARRY LAWSON
I think the speech to which we have just listened shows that we were not far wrong on this side of the House in saying that these insurance committees and local health committees are to all intents and purposes rating authorities. I think the Chancellor of the Exchequer has admitted that, because he said that a rate may be necessary, and if so, that it will be spread all over London. Of course, I am perfectly well aware that the county council will be the rating authority, but it can hardly refuse the petition of the insurance committee set up, and therefore indirectly, but none the less effectively, the insurance committee becomes a rating authority.
§ Mr. LLOYD GEORGE
I think the hon. Gentleman has not represented correctly what I said. What I was trying to point out was that by equalising the fund and distributing it over the whole area of London the necessity for a rate will be obviated, because the surplus of the west-end would be available to make up the deficiency of the east-end. I went on to say that if there was a deficiency, it would be equalised.
§ Mr. HARRY LAWSON
We always look for the best, and I wish to take the rosy view. The Chancellor of the Exchequer said that in London we are cut up into boroughs of rich and poor, and that the rest of the country is different. He knows that there are many county boroughs outside of London which are almost as poor as that which I represent here. If you go to the black country and take the new 1738 borough which the Government has constituted out of the five towns, you will find the conditions very similar to those obtaining in the east-end. I do not want to labour points of controversy. I am torn by conflicting emotions in regard to this Amendment. Financial considerations point one way, and administrative efficiency points another way. I wish to make a practical suggestion. The Chancellor of the Exchequer will be the first to admit that it is impossible for the central committee properly to control the administration of the Act throughout all the boroughs of London with those great varieties of conditions. The Hearts of Oak Society has circulated to all the Members of the House a paper in which it says:With regard to the medical benefit, it is impossible that a central authority for London can have a full knowledge of all that relates to the personnel and the necessities of outlying suburban districts. Unless, however, there is a controlling power in the immediate locality of their work, it is more than humanly possible that laxity will be produced and one of the most important features of the Bill will thus be practically frustrated.We must all admit that that is so, and it has been the vigilant and careful administration of friendly societies which has done so much in the past, and which the Chancellor of the Exchequer wishes to ensure shall continue under the new system which is being set up. Under those circumstances it seems to me that the Chancellor of the Exchequer ought to do more to define the constitution and powers of the auxiliary committees in such a county as London. The relations between the London County Council and the borough councils are fairly good, but they have never been very cordial. In view of the relations between the separate districts into which London is broken up for municipal purposes, there is great necessity for getting at local opinion. In London we suffer from too much officialism. With all its merits, the London County Council is too much a bureaucracy, and I think if we are to get at local opinion, it is necessary for the Chancellor of the Exchequer to provide some method by which the central insurance committee shall ascertain at first hand exactly what is required by public opinion in the various boroughs. I do not think that in the Bill there is any sufficient provision. London is lumped with the rest of the country, and there are practically no lines laid down on which the selection is to proceed. Besides that, it is necessary, I think, to give these committees statutory powers in this Bill. I do not think it ought to be left merely to a central committee, or even to the 1739 Insurance Commissioners; but I am quite certain that if we have to choose it would be better to have the matter settled by the Insurance Commissioners than by a central committee. London is not in pari materia with the rest of the country. I will beg the Chancellor to consider that ours is a special district. I quite admit that I am not able, representing the poor of the East End, to say that we ought to be broken off from the rest of London. I think it is quite impossible. I quite agree with everything that the Chancellor said on that proposition. It seems to me that we must produce an undue proportion of sickness, and that means, of course, that there must be more money required for the medical benefits, and there will be more required to fight this scourge of consumption.
That is all very true. We gain a great deal by being linked up for these purposes of this Bill with the rest of London, and I cannot quite accept the suggestion of my hon. and learned Friend that the Equalisation Act provides a sufficient relief. It is quite true that we have a common poor fund as well under the Act of 1869 which does give 4d. per head of the indoor poor, while the Equalisation Act gives 6d. in addition for sanitary purposes; but that is nothing, or very little, as compared with the inequality from which the poorer boroughs of London suffer. We cannot increase those inequalities. We all hope that in time they will be substantially diminished. Therefore I cannot accept myself, speaking for the East End of London, anything less than an equal measure over the whole of London, east, west, north and south; but surely while we can preserve that financial control can remain in the central committee, we yet can have—I do not like the term auxiliary committee; I think it gives a false impression—we can have local committees in the various boroughs, with definite and responsible duties, and manned and composed on the principle that local opinion shall have its full sway. I respectfully suggest to the Chancellor that he should undertake to do something of the kind. I think the term auxiliary committee is almost in itself an undue belittling of the duties which they will have to perform, and is calculated to prejudice them in the eyes of men of public spirit who might otherwise be induced to go on them and serve their fellow citizens in this responsible way. Although I cannot speak for 1740 the rest of London, yet so far as I am concerned a pledge of the sort which I have indicated would remove any doubt I have. In any case I am afraid that the weight of gold carries me to the Chancellor's side.
§ Mr. LLOYD GEORGE
I am inclined to agree with the suggestion made in the very admirable speech delivered by the hon. Gentleman. I do not quite like the name and I am not sure whether local committee would not be better.
§ Mr. LLOYD GEORGE
No. I think local committee would be better. It was the original name intended for the committee, and therefore it cannot be a belittling of their authority. I think they ought to have a name to indicate that they have a standing position of their own. I also agree with the hon. Member that it is clearly impossible for a central committee in London to administer the whole area without the assistance of these committees, and I am not sure that it would not be possible now to carry out the suggestion that there should be a further definition of the powers of these committees. I will consider on the Report stage whether something of that sort could not be done. I think that that is one of the things that could be done on the Report stage, because it does not involve an additional charge. I think the suggestion quite admirable.
§ Mr. WILLIAM PEARCE
To my mind, the case which the Chancellor has made is irresistible that the poor of the East End boroughs cannot by any means be divorced from the rest of London. On the other hand, I do feel that there is a great deal in local responsibility and freedom of administrative action, and these local committees could, in a sense of the word, be made statutory. There is all the difference in the world between a statutory committee with powers of its own and being merely a committee of the London County Council itself. The suggestion made by the hon. Member for Mile End I think is a very valuable one, that the local committee should be given a certain amount of power of their own. We do not want them to be entirely free from control, but if they have to submit all their laws and regulations entirely to the control of the London County Council and have no power of initiative themselves, there will be a great deal of delay and confusion, and I am sure that an enormous 1741 amount of detail that will fall into the work of these committees will not be properly done unless something is effected in the way of giving them powers of their own as statutory bodies. I am glad that the Chancellor is inclined to accept the suggestion, and I hope that he may yet see his way to make the thing definite upon the Report stage.
§ Lord A. THYNNE
It is very satisfactory that the Chancellor is going to give a statutory definition to the powers of the local committees. I should like to invite his attention to the advisability of considering carefully the areas which these local committees are to administer. I call his attention, first of all, to the analogy of the Pensions Act, in which the local committees administer, not single boroughs, but groups of boroughs, two and three boroughs. I also call his attention to the analogy of the British Medical Association, who, for the purposes of local administration, have taken a good many areas of groups of boroughs, and not areas of single boroughs. For instance, they group Islington, with a population of 300,000, with St. Pancras, with a population of 236,000, so that in one area they administer with a population of over half a million. I also quote the analogy of the distress committees, who group together such boroughs as St. Pancras, Holborn, and Finsbury in one district for the purpose of local administration. The reasons which have led to the grouping of boroughs in these particular instances for the purpose of administration will apply with almost equal force to administration under this Insurance Bill. I think that under the grouping of boroughs you not only get all the local supervision you require, but you also have a larger catchment area to draw upon for recruiting the committees. What the Chancellor of the Exchequer said just now on the question of equalising the financial burden over the whole of London casts a new light upon the whole of this question from the point of view of municipal authorities. Earlier in the afternoon we were told by the Chancellor of the Exchequer that there was no question of the hypothecation of the rates without the sanction of the local authority. For a long time during the afternoon this discussion in regard to the position of the municipal authorities on this question proceeded on that basis. There was no question of the hypothecation of rates at all without the consent of the local authority. What the Chancellor of the Exchequer said in his 1742 last remarks will undoubtedly give rise to a considerable amount of alarm amongst those who are responsible for municipal finance in the various municipalities of the country. I should like to congratulate the Government on at last realising the heavy financial burdens under which London is groaning at this moment. I should like to remind the Under-Secretary for the Home Office that you cannot place a financial burden upon the whole of London without the weight of that burden being felt by the poorer boroughs, and just in proportion as you relieve the burden on the whole of London, whether under this bill or under an Exchequer contribution, you are also pari passu relieving the burden on the poorer districts.
§ Mr. CASSEL
The object I had in view in submitting this Amendment was with regard to the question of administration. If we have a clear undertaking by the Government, which I understood the right hon. Gentleman to give, that so far as London is concerned it should be obligatory to have a separate committee for each borough, that is to say, it should not be optional, as it is at present optional, for the Commissioners to make regulations for having separate committees in each borough, but that there must be separate administrations by a local committee in each borough, and that the mode in which those committees are to be constituted is to be more satisfactorily defined—at present it is absolutely vague—then, under those circumstances, I ask leave to withdraw the Amendment.
§ Mr. HUME-WILLIAMS
As I read the Chancellor of the Exchequer's Amendment, the scheme for London is to be administered by the health committee, and the Commissioners are to have power to provide for the appointment of an auxiliary committee in each borough, including the City of London, within the county, having a population of not less than 10,000. That seems to lead to the conclusion that the county should have the health committee, and, where there are more than 10,000, you are to have an auxiliary committee. You have the one single committee for the whole of the Metropolis, and only one auxiliary committee in each borough, which I regard as a whole county.
§ Amendment, by leave, withdrawn.
§ Sir PHILIP MAGNUS
I beg to move, at the end of Sub-section (1), to add the words "consisting of not less than fifteen, 1743 or more than thirty members, as may be determined in accordance with the requirements of each locality by the Insurance Commissioners."
That Amendment stands on the Paper, but it could not be moved in the place in which it stood. I put down the Amendment with those words in order to restore the Amendment of the Chancellor of the Exchequer to the terms in which I understand it was placed upon the Paper some few days ago. I think I am justified in entering a very strong protest against the action of the Chancellor of the Exchequer in placing so complicated an Amendment as that referring to the constitution of the health committees on the Paper only twenty-four hours ago. The discussion which has taken place to-day has shown how important are the duties in the administration of this Bill that will be thrown upon the health committees. Their constitution and their duty are matters of the greatest importance to this House and to the country. The entire constitution of the health committee has been changed within the last twenty-four hours without any opportunity to the Members of this House to consult their friends and the various interests concerned as to the advantage or desirability of those changes. I wish to emphasise the fact, which is well known, and as the Chancellor of the Exchequer has frequently said that there have been many interviews within closed doors at Downing Street or at Whitehall, between members of friendly societies and members of the medical profession with regard to the constitution of the health committees. I understood that something like an agreement by way of compromise had been arrived at by which the number of members sitting on the health committees should not be less than fifteen and not more than thirty. Looking at Sub-section (2) of the Clause as it stands, I doubt whether there is a single Member except, perhaps, one or two on the Government Bench, who could tell the House of how many members the Chancellor of the Exchequer intends that the health committee shall consist. Nearly every one to whom I have spoken has given up the problem as a puzzle which he is unable to solve. I think an important Clause like that, dealing with the constitution of the committee which has to administer all those benefits, ought to have been so clearly defined that anyone who ran might read. The committee, as defined by the Bill, which it is pro- 1744 posed to amend, might consist of a maximum of twenty-two members. In the Amendment put down by the Chancellor of the Exchequer, which we are not likely to reach, the maximum number of members has been increased from twenty-two to eighty. I think everyone will admit that this is a very considerable change in the constitution of a committee to be made with twenty-four hours' notice.
I am credibly informed that some weeks ago a private conference was held between some members of the medical profession and members of the friendly societies at the residence of the Chancellor of the Exchequer, at which a compromise was arrived at by which the number of the members of the committee should not exceed thirty. It is for that reason I have placed this notice on the Paper. No opportunity has arisen since yesterday at two o'clock, when we were informed of this fresh change in the constitution of the health committees, of communicating with any of the interests concerned, either with the members of the medical profession or of the friendly societies. In the Amendment which I understood was accepted by the Chancellor of the Exchequer and the members of the medical profession as a compromise, the representation of the medical members on the health committees was to have been three at least out of a maximum of thirty. It has now been reduced, without consultation with anyone, to three at least out of a maximum of eighty. I feel quite certain that the members of the medical profession will regard that as nothing less than the betrayal of their interests, and it certainly must be regarded, unless some explanation can be given, as a breach of faith. I should like, with regard to this point, to refer the Committee to the number of the "British Medical Journal," which was published only on Saturday last, and in that number the proposed constitution as agreed upon is given in detail. In a letter which I received from the secretary of the British Medical Association, who has been doing his utmost throughout the country to induce the medical profession to be satisfied with the terms which it was understood had been arrived at with the Chancellor of the Exchequer, he says, in sending me a draft of those particulars:—From it you will see that the question is settled so far as we are concerned, provided that the Chancellor does not spring fresh Amendments upon us of the Amendments he has already put down, and to which we have agreed.Those Amendments have been sprung—
§ The DEPUTY-CHAIRMAN (Mr. Maclean)
I am afraid I could not allow the hon. Member to proceed on those lines. He must confine his remarks rather more strictly to the question of numbers. We are not dealing with the question of the medical profession.
§ Sir P. MAGNUS
I am suggesting that the total number of members of the health committee shall be smaller than is suggested in the Amendment of the Chancellor, in order that a representation of the medical profession on that committee may be larger than it would be in accordance with the Chancellor's proposed Amendment. It is very desirable that this larger proportion of medical members should be accepted on account of some of the duties which it is understood these health committees are likely to discharge. The Attorney-General has not been able to give us an assurance that the change of name of the health committees to insurance committees will involve the withdrawal from those committees of the duties which are assigned to them in the Amendment of the Chancellor's. If we were assured that those health committees would be strictly insurance committees there would not be the same necessity as there is at present that the medical profession should be better represented on them. I venture to think that the health committees will scarcely be able to discharge their duties if they are unwieldy bodies such as is suggested in the Amendment of the Chancellor, and consisting of a large proportion of persons who have not sufficient education to discharge the important duties that will be assigned to them. It is understood that part of the duties of those health committees will be to collect statistics of health conditions in the neighbourhood and to draw inferences from those conditions. I am quite certain that the President of the Local Government Board, whom I am glad to see here, although it is to be regretted that he has not taken part in the discussion of this Bill, must be well aware that the duty of collecting and collating statistics with a view to arriving at conclusions which may be of use in questions of sanitation and health is not an easy matter, and requires some amount of scientific knowledge and scientific experience. I noticed that the Chancellor of the Exchequer, speaking on Saturday, the 21st, said that a medical officer of health cannot visit every home in his district, but that "here, on the other hand, you will have tens of thousands of 1746 medical men who will be serving these local health committees, and visiting in the course of the year almost every home, and sending faithful reports to the health committees upon which the majority will be representative of the working classes." Of course, one must look for some exaggeration when one is speaking on a platform. The Chancellor of the Exchequer spoke of tens of thousands of medical men, while I think the total number of medical men in the country is less than 35,000, so that tens of thousands are scarcely likely to serve on the committees. What he intended to imply was that the medical men appointed to those health committees would visit all the homes in the district and will send reports to the health committees. For that reason it is very desirable that those committees shall have an adequate number of medical men to represent the profession. If I may refer to the Amendment of the Chancellor of the Exchequer—
§ The DEPUTY-CHAIRMAN
I am very sorry I cannot allow the hon. Member to proceed on that line. The only line which the hon. Member can take is as to the question of the representation either of and whether they are too large or too small. I have intimated to him that any question of the representation either of the doctors or others is not in order on this Amendment.
§ Sir R. FINLAY
On a point of Order. Surely with regard to the representation of the doctors the size of the committee was extremely important. If the committee is indefinitely increased without any corresponding increase in the representation of the doctors then their representation becomes wholly illusory.
§ Sir RUFUS ISAACS
What we are discussing now is the maximum and the minimum numbers of the committee. The relative proportions of the various interests must, I submit, form the subject of discussion later on.
§ Mr. SANDERSON
Surely it is relevant for the hon. Member to give his reasons for proposing why the number of the committee should be limited to thirty. One of his reasons, I understand, is that if it is not limited to thirty, the representation of the doctors will be totally illusory.
§ Sir P. MAGNUS
There may be another reason for anticipating some of the Amendments upon the Paper, as has been permitted by the Chairman in other Debates, namely—
§ The DEPUTY-CHAIRMAN
I must adhere to my ruling that the Debate on this Amendment must be confined to the question of number, whether maximum or minimum.
§ Sir H. CRAIK
Is it not perfectly relevant to the question of the total number of the committee, whether that total does or does not give adequate representation to medical men?
§ Sir P. MAGNUS
I shall not attempt to deal with any matter which is ruled out of order; but one reason why we might be allowed to refer, at any rate, to the Amendment of the Chancellor of the Exchequer, is that we have already spent five hours of the limited time at our disposal for the discussion of three of the most important Clauses in the Bill, and during those five hours we have succeeded in dealing with two lines out of about five pages of the Bill. Therefore, if we are not allowed in this Debate, even to refer to Amendments later on the Paper, there will be no possibility of doing so whilst the Bill is passing through Committee. I cannot help thinking that the Debate is almost a farce so far as enabling the Committee fully to discuss the important provisions of these Clauses is concerned. Under these circumstances, I have no desire to occupy much more time. It is very desirable that the number of members should be limited very much as it was in the second Amendment of the Chancellor of the Exchequer. The new Amendment was put down twenty-four hours ago, under what conditions we do not know. Have we any reason to believe that if there had been an opportunity for discussing the Amendment, the Chancellor of the Exchequer might have put down an Amendment of a different kind altogether? A committee which may consist of a maximum of eighty members is very much too large for the duties assigned to it. I have risen mainly, not with a view to enforcing the Amendment standing in my name, but to protest very strongly indeed against an Amendment of this great importance being placed upon the Paper only twenty-four hours before its discussion, after an arrangement, as I understand, had been arrived at, and without any opportunity being given for conference with the various interests concerned.
§ Sir RUFUS ISAACS
The protest which the hon. Gentleman has made would have been much more effective if his speech had been briefer, because the result of that speech is that a considerable amount of time has been taken up in discussing a question which has been ruled out of order, and which therefore I cannot go into in reply. I must confine myself to the concise Amendment before us, which has reference to the minimum and maximum numbers of the committee. There is no doubt that the number had been considerably increased. It has become apparent that that will be necessary. I gather that the hon. Member himself agrees on that point, because he suggests that it should be increased to a minimum of fifteen and a maximum of thirty. On considering further what the representation should be, the conclusion come to was that there should be a minimum of forty and a maximum of eighty. The hon. Gentleman is quite in error in suggesting that by accepting a proposal that the name should be changed from "health committee" to "insurance committee," I indicated any change of policy on the part of the Government. I thought I had made that quite plain.
§ Sir RUFUS ISAACS
It is possibly what the hon. Member had in mind, but what he said was, first of all, that it might be inferred that the change of name was intended in some way to show that the committees would have less to do with health and more to do with insurance, and that if I had been able to give a definite assurance on the point it would have been more satisfying. It is to that that I am referring. There is no question of giving a definite assurance nor ground for suggesting that I had given any indication that with the change of name there would also be a change of policy. What I said quite clearly was that we were dealing only with the name. As to the hon. Member's Amendment, he will not be surprised that we cannot accept it, but the question of the composition or the relative proportions of the representation of the various interests concerned must form the subject matter of further discussion. I quite appreciate the point that he is seeking to make, but I do not desire to say anything about it at the present moment. I agree it is a point which has to be met. All I will say about it is that I do hope we may now proceed to a discussion of other 1749 Amendments, in order, at least, if there are Amendments which the Committee desire to discuss, that we may not be losing time over one which under the circumstances cannot arise.
§ Sir R. FINLAY
I think what the Attorney-General has said has most amply justified my hon. Friend's Amendment. The Attorney-General said that it is proposed largely to increase the number on the health committees from a maximum of twenty-two to a maximum of eighty. It is very well known that one point which the medical profession have always attached the very greatest importance to, one of the six points which they consider vital, is that the control of the medical arrangements should not be committed to the friendly societies. Why is it that the increase in the number on the health committees which the right hon. Gentleman has referred to is to be made? It was arranged with the doctors that the control should not be with the friendly societies, but with the health committees. This increase is simply part of an arrangement for, under another name, sending back the control of the medical arrangements to the friendly societies from whom it was to be withdrawn. I think my hon. Friend was amply justified in bringing this point forward.
§ Sir RUFUS ISAACS
On a point of Order. On the ruling of the Deputy-Chairman I was precluded from answering the various points that have been made in relation to the proportion of interests represented in the constitution of the Committee. We have been confined to a discussion of numbers only. The point which the right hon. Gentleman is now making is on this very question of the proportion, and he is referring to the very subject upon which the hon. Member was called to order, and upon which he was not allowed to proceed, and I was not allowed to reply.
§ Sir R. FINLAY
I was almost at the finish of my observations, but I submit I am amply justified in saying this: that the increase to which my right hon. Friend himself referred was part of the arrangement for very largely increasing the representation of these friendly societies and the deposit contributors. The result of that will be that by this arrangement, under another name, the control of the medical arrangements will be given back again to those persons from whom we believed it had been taken.
§ The CHAIRMAN
On a point of Order. The Committee will remember that at the beginning of the Clause I stated that in my opinion we should discuss the various questions one by one, and that the question of the numbers of the committee was a separate point, and apart from the representation of the various interests. The Committee as a whole, I think, accepted that. I have advised hon. Members interested in various points that way, and certainly it would not be fair to allow this Amendment to branch out into the consideration of that question. The Deputy-Chairman has only upheld the ruling I gave earlier.
§ 9.0 P.M.
§ Mr. SANDERSON
My hon. Friend's Amendments raised quite clearly a question of the minimum and the maximum of these committees. He has invited the representatives of the Government to give us some reason why the original numbers have been altered. The original numbers in the Bill were a minimum of nine and a maximum of eighteen, to which a few were to be added, if necessary. For some reason those numbers are to be entirely altered, and we are to have a committee which is to consist of a maximum of no less than eighty members and a minimum I think of something like forty. That is a startling change. I should have thought that everybody would have been of the opinion that if you want to get a business-like committee it was well to keep the numbers of that committee within reasonable limits. People say that the numbers of this House are too large, and judging from my own experience of committees, the one object you have is to make them as small as you possibly can having regard to the interests to be represented. This Amendment has been moved with a view of keeping the limits of these committees within a minimum of fifteen and a maximum of thirty. The Attorney-General has said that it has been found necessary to increase these numbers. Consequently he asks this Committee to reject the Amendment. I submit that we ought to have had some reason given to us why it has been found necessary to increase these numbers. What is the object? At the present moment we have not the slightest idea. I should have thought that the Attorney-General would have seized his opportunity to have given this Committee some idea of why this startling change is to be made. I do not speak in the interests of 1751 the doctors or of the friendly societies. I am simply speaking as a Member of this Committee. I desire to emphasise the protest made by my hon. Friend, for why in the world should this be at the last moment, when we have had no opportunity—twenty-four hours is not much for men who have other things to think about, and whose time is fully occupied—to communicate with our constituents to inquire whether or not they approve of this. I submit that the Committee has not been treated fairly.
§ Sir RUFUS ISAACS
Very briefly, let me say that I am afraid the hon. Gentleman did not hear quite what I said.
§ Sir RUFUS ISAACS
Then if the hon. Gentleman did I am sorry he did not appreciate it. What I did was to point out what I believed to be the object of the remarks of the right hon. and learned Gentleman the Member for Edinburgh and St. Andrew's, that the whole object of the moving of this Amendment was not to find fault with the increase in the numbers, so much as that it was intended to draw attention to what the hon. Gentleman thought—he suggested it, if he did not use the term—was a breach of faith to the medical profession. His point was that we did not go so far as to increase the numbers of the medical representatives, and he complained that the Committee had not been dealt with fairly. I replied that I thought the question was one very properly raised, and one upon which the Government would make its answer, but that I would not take up the time then discussing it, because he himself had no point whatever, except in relation to the proportion to which the Amendment did not refer. That was the whole point, and he made what I thought was a very effective speech upon that. What I ventured to point out to him was that it had no reference whatever to the question of the increase in the numbers. I also pointed out to the hon. Gentleman that the effect of making that point upon this Amendment was this, that once the object he had stated in his opening sentences, which was that he might be enabled to raise the question of proportion, was ruled out of order I was not entitled to reply, and could not discuss it; and it seemed to me that I should be taking up the time of the Committee if I dealt 1752 with it further and prevented the Committee coming to the point I was anxious should be discussed; and I stated I would not say anything further in regard to it then. The hon. Member himself had agreed that there should be an increase in the number. He does not object to an alteration from a minimum of nine and a maximum of eighteen to a minimum of fifteen and a maximum of thirty. He agrees there must be an increase.
§ Sir RUFUS ISAACS
Yes, some increase. The only question is what increase. He knows perfectly well there has been a great amount of responsibility and work thrown upon the local health committees which was not in the Bill at first. I need only refer to the administration of the medical benefits to show at once what that will mean and how necessary it is that we should have a large number of members. Hon. Members will bear in mind this question was thrown open to the Committee, and by a very large majority we made this important change in the Bill, and, having made it, it became essential we should increase the numbers of Members of the Committee.
§ Sir RUFUS ISAACS
Yes, but that was not the hon. Member's object in moving his Amendment. I am not misrepresenting one word of the hon. Member, who is a most courteous debater, when I say that that was the point he made in his speech, and the only reason why I did not go into it at length and discuss and explain it was that it would have been out of order to do so.
§ Mr. SANDERSON
I am glad to hear what the Attorney-General has said. I think he was under a misapprehension. My hon. Friend's point was not the numbers of this committee, but one of his points was that he wanted to know why there should be this startling change from a maximum of twenty-two to a maximum of eighty.
§ Question put, "That the words 'The committee shall consist of not less than fifteen or more than thirty members and' be there inserted."
§ The Committee divided: Ayes, 42; Noes, 193.1753
|Division No. 378.]||AYES.||[9.10 p.m.|
|Ashley, Wilfrid W.||Gretton, John||Perkins, Walter Frank|
|Balcarres, Lord||Hamilton, Marquess of (Londonderry)||Pollock, Ernest Murray|
|Baldwin, Stanley||Henderson, Major H. (Berks, Abingdon)||Ronaldshay, Earl of|
|Bathurst, Charles (Wilts, Wilton)||Hills, John Waller||Rutherford, Watson (L'pool, W. Derby)|
|Beach, Hon. Michael Hugh Hicks||Hohler, Gerald Fitzroy||Sanderson, Lancelot|
|Beresford, Lord Charles||Hope, Harry (Bute)||Talbot, Lord Edmund|
|Bridgeman, William Clive||Hume-Williams, William Ellis||Terrell, Henry (Gloucester)|
|Clyde, James Avon||Ingleby, Holcombe||Thynne, Lord Alexander|
|Duke, Henry Edward||Joynson-Hicks, William||Williams, Col. R. (Dorset, W.)|
|Eyres-Monsell, Bolton M.||Lane-Fox, G. R.||Wood, John (Stalybridge)|
|Falle, Bertram Godfray||Lonsdale, Sir John Brownlee||Yate, Col. C. E.|
|Fetherstonhaugh, Godfrey||Lowther, Claude (Cumberland, Eskdale)|
|Finlay, Rt. Hon. Sir Robert||McNeill, Ronald (Kent, St. Augustine)||TELLERS FOR THE AYES.—|
|Forster, Henry William||Ormsby-Gore, Hon. William||Sir Philip Magnus and Sir H. Cralk.|
|Abraham, William (Dublin Harbour)||Hardie, J. Keir (Merthyr Tydvil)||O'Connor, John (Kildare, N.)|
|Acland, Francis Dyke||Harmsworth, Cecil (Luton, Beds.)||O'Dowd, John|
|Adamson, William||Harvey, A. G. C. (Rochdale)||Ogden, Fred|
|Addison, Dr. Christopher||Harvey, T. E. (Leeds, W.)||O'Neill, Dr. Charles (Armagh, S.)|
|Adkins, Sir W. Ryland D.||Harvey, W. E. (Derbyshire, N. E.)||O'Shaughnessy, P. J.|
|Ainsworth, John Stirling||Harwood, George||Parker, James (Halifax)|
|Alden, Percy||Haslam, James (Derbyshire)||Pearce, Robert (Staffs, Leek)|
|Allen, Arthur A. (Dumbarton)||Haslam, Lewis (Monmouth)||Pearce, William (Limehouse)|
|Allen, Charles Peter (Stroud)||Havelock-Allan, Sir Henry||Pointer, Joseph|
|Baker, Joseph Allen (Finsbury, E.)||Hayden, John Patrick||Ponsonby, Arthur A. W. H.|
|Balfour, Sir Robert (Lanark)||Hayward, Evan||Power, Patrick Joseph|
|Barnes, George N.||Helme, Norval Watson||Price, C. E. (Edinburgh, Central)|
|Beauchamp, Sir Edward||Henderson, Arthur (Durham)||Priestley, Sir W. E. B. (Bradford, E.)|
|Benn, W. W. (T. Hamlets, St. George)||Henderson, J. M. (Aberdeen, W.)||Primrose, Hon. Neil James|
|Bentham, George J.||Herbert, Col. Sir Ivor||Radford, G. H.|
|Black, Arthur W.||Higham, John Sharp||Raphael, Sir Herbert H.|
|Booth, Frederick Handel||Hinds, John||Rea, Walter Russell (Scarborough)|
|Brace, William||Hodge, John||Reddy, Michael|
|Brady, Patrick Joseph||Holt, Richard Durning||Rendall, Athelstan|
|Brocklehurst, William B.||Hughes, Spencer Leigh||Richards, Thomas|
|Brunner, John F. L.||Hunter, William (Lanark, Govan)||Richardson, Albion (Peckham)|
|Buckmaster, Stanley O.||Isaacs, Rt. Hon. Sir Rufus||Richardson, Thomas (Whitehaven)|
|Burt, Rt. Hon. Thomas||Johnson, William||Roberts, Charles H. (Lincoln)|
|Buxton, Noel (Norfolk, North)||Jones, Edgar R. (Merthyr Tydvil)||Robertson, Sir G. Scott (Bradford)|
|Cawley, H. T. (Lancs., Heywood)||Jones, Henry Haydn (Merioneth)||Robertson, John M. (Tyneside)|
|Chapple, Dr. William Allen||Jones, Leif Stratten (Notts, Rushcliffe)||Robinson, Sidney|
|Collins, Godfrey P. (Greenock)||Jones, William (Carnarvonshire)||Roch, Walter F. (Pembroke)|
|Condon, Thomas Joseph||Jones, W. S. Glyn- (T. H'mts, Stepney)||Roche, John (Galway, E.)|
|Cornwall, Sir Edwin A.||Jowett, Frederick William||Rowlands, James|
|Cotton, William Francis||Joyce, Michael||Rowntree, Arnold|
|Crawshay-Williams, Eliot||Keating, Matthew||Samuel, Rt. Hon. H. L. (Cleveland)|
|Crumley, Patrick||Kelly, Edward||Samuel, J. (Stockton-on-Tees)|
|Dalziel, Sir James H. (Kirkcaldy)||Kemp, Sir George||Samuel, S. M. (Whitechapel)|
|Davies, David (Montgomery Co.)||Kilbride, Denis||Scanlan, Thomas|
|Davies, Ellis William (Eifion)||King, Joseph (Somerset, North)||Schwann, Rt. Hon. Sir Charles E.|
|Denman, Hon. Richard Douglas||Lansbury, George||Scott, A. MacCallum (Glas., Bridgeton)|
|Dillon, John||Lawson, Sir W. (Cumb'rld., Cockerm'th)||Seely, Col. Rt. Hon. J. E. B.|
|Doris, William||Leach, Charles||Sherwell, Arthur James|
|Duffy, William J.||Levy, Sir Maurice||Shortt, Edward|
|Duncan, C. (Barrow-in-Furness)||Lewis, John Herbert||Simon, Sir John Allsebrook|
|Duncan, J. Hastings (Yorks, Otley)||Lundon, Thomas||Snowden, Philip|
|Edwards, Enoch (Hanley)||Lynch, Arthur Alfred||Stanley, Albert (Staffs, N. W.)|
|Edwards, Sir Francis (Radnor)||Macdonald, J. R. (Leicester)||Taylor, John W. (Durham)|
|Elverston, Sir Harold||Macdonald, J. M. (Falkirk Burghs)||Thomas, James Henry (Derby)|
|Esmonde, Dr. John (Tipperary, N.)||Macpherson, James Ian||Thorne, G. R. (Wolverhampton)|
|Esslemont, George Birnle||MacVeagh, Jeremiah||Wadsworth, John|
|Farrell, James Patrick||M'Callum, John M.||Ward, John (Stoke-upon-Trent)|
|Ferens, Thomas Robinson||M'Laren, H. D. (Leices.)||Ward, W. Dudley (Southampton)|
|Ffrench, Peter||Mason, David M. (Coventry)||Wardle, G. J.|
|Fiennes, Hon. Eustace Edward||Masterman, C. F. G.||Warner, Sir Thomas Courtenay|
|Flavin, Michael Joseph||Meehan, Francis E. (Leitrim, N.)||White, J. Dundas (Glasgow, Tradeston)|
|Gelder, Sir William Alfred||Menzies, Sir Walter||White, Sir Luke (Yorks, E. R.)|
|George, Rt. Hon. D. Lloyd||Millar, James Duncan||Whitehouse, John Howard|
|Gibson, Sir James Puckering||Mond, Sir Alfred M.||Whyte, Alexander F. (Perth)|
|Gill, Alfred Henry||Morton, Alpheus Cleophas||Wiles, Thomas|
|Goddard, Sir Daniel Ford||Munro, Robert||Williams, John (Glamorgan)|
|Goldstone, Frank||Munro-Ferguson, Rt. Hon. R. C.||Wilson, John (Durham, Mid)|
|Greenwood, Granville G. (Peterborough)||Nannetti, Joseph P.||Wilson, Rt. Hon. J. W. (Worcs., N.)|
|Greenwood, Hamar (Sunderland)||Needham, Christopher T.||Wilson, W. T. (Westhoughton)|
|Gulland, John William||Neilson, Francis||Wood, Rt. Hon. T. McKinnon (Glas.)|
|Gwynne, Stephen Lucius (Galway)||Nicholson, Charles N. (Doncaster)||Young, William (Perth, East)|
|Hackett, John||Nolan, Joseph||Yoxall, Sir James Henry|
|Hall, F. (Yorks, Normanton)||Norman, Sir Henry|
|Hancock, John George||Nuttall, Harry||TELLERS FOR THE NOES.—|
|Harcourt, Rt. Hon. L. (Rossendale)||O'Brien, Patrick (Kilkenny)||Mr. Gulland and Mr. G. Howard|
Question put, and agreed to.
§ Amendment made: In Sub-section (2), leave out the word "nine" and insert instead thereof the words "twenty-four."—[Mr. Lloyd George.]
§ Mr. LLOYD GEORGE
I beg to move, in Sub-section (2), to leave out the word "eighteen," and to insert instead thereof the words "forty-eight."
§ Mr. FORSTER
Shall we be able to discuss the question of numbers on the long Amendment to be proposed by the Chancellor of the Exchequer later on? I do not see why we should increase the numbers of this committee to the extent the right hon. Gentleman proposes, if the real powers are to be given to what he calls the auxiliary committees. If the real power was to remain in the central committee, I could understand this increase, but if the real power is to be delegated to the auxiliaries, I cannot see any reason for this change.
§ Mr. LLOYD GEORGE
The auxiliary committees only refer to boroughs of 10,000 and to urban districts of 20,000. There will be an enormous tract of country in every county where there will be no committees of that kind. There will be sub-committees, but apart from that the real reason for the increase is on account of the changes made since the drafting of the Bill in regard to administering medical benefits. Since the Bill was introduced the administration of the medical benefits have been transferred to the county committee, and that makes it a much more important committee. It is therefore necessary that we should have representation from every corner of the county, and with eighteen you could not have such representations, and it would simply mean that the largest districts and villages would get no representation.
§ The CHAIRMAN
The Amendment just put to the Committee is to leave out the word "eighteen" and to insert the words "forty-eight," and the question put to me was whether on the long Amendment of the Chancellor of the Exchequer it would be open to discuss the numbers. Of course, we shall then have put in "forty-eight." With regard to the number, it is for the hon. Member to take exception to "forty-eight" or not, as he pleases.
§ Mr. FORSTER
The reason given by the Chancellor of the Exchequer is a reason, but I do not think it is a very good one, for the increase in the numbers. He says it is quite hopeless to expect a committee 1756 of eighteen to undertake the management of medical benefits.
§ Mr. FORSTER
I understood him to say that the committee of eighteen would be too small to manage the whole of the duties you are throwing upon them in connection with medical benefits. In the Bill, as introduced, it was contemplated that some portion of the administration of medical benefit would be given to the local health committee. I cannot see, on the face of it, that the increase of numbers is justified on that ground alone. If it is necessary to increase the numbers in order to give a majority to the representatives of friendly societies I could understand it, but I cannot understand why it is necessary to increase the numbers in this way, because you could give the majority of representatives to this or the other class by keeping the numbers strictly limited as the Bill was introduced. I thought there might be some overwhelming reason why the number should be increased, but I confess that, so far, I have not heard it stated.
§ Mr. LLOYD GEORGE
As the Bill was originally drafted the vast majority of insured persons were to have their medical benefit through the approved societies, but now the administration of the medical benefits is transferred to the local health committee. That means a difference of medical benefit being administered to 10,000,000 instead of 2,000,000, and, therefore, the task is a much bigger function. The hon. Member says, seeing that the local committees have to administer this benefit, what do you want with a large committee for this purpose? That is true with regard to the small boroughs and the urban districts, but it is not true with regard to the county areas. I have no doubt there would be local committees in the rural districts, but not autonomous committees. I have no doubt there would be local managers for the purpose of carrying the thing through, but that would be a different thing altogether. It is the county committee that will have the allocation of the fund. You average your medical benefit at the rate of 6s. per head, but that does not mean you give to every district 6s. per insured member. You will give less to some districts and more to others, according to their need. The only committee that can decide that is the county committee, and it is very important 1757 therefore you should have a very fair representation of every part of the county on that committee. It would not be possible to do that with eighteen members, but with the larger number it would be possible. That is the real reason for the Amendment, and I think on the whole it is in the interests of the insured persons, of the doctors, and of every class of the community, that you should have the larger body rather than the smaller one.
§ Mr. FORSTER
I do not suppose there would be any objection so long as the proportion which the doctors understood they were to have on the old committee is maintained.
§ Mr. LLOYD GEORGE
There was no question of proportion at all. The doctors asked for two and one, and that was promised them, but nothing was said about proportion. That, however, cannot be debated upon this Amendment.
§ Mr. C. BATHURST
Is the Chancellor of the Exchequer quite correct in saying that in the ordinary county area the auxiliary committee will not be appointed. I think his own Amendment goes to show that in every case it will be appointed except where special circumstances are found to exist.
§ Mr. WATSON RUTHERFORD
We have found by the experience of the last twenty-five years in the county borough of Liverpool that a committee of eighteen is the proper one to manage practically each department. We have a largo number of departments, such as the tramways, the health of the city, and so on, and each committee consists of eighteen members. We made the experiment of increasing the number to twenty-four, but we found the committee was too unwieldy for practical purposes. I admit that in an area like the county of Lancashire it would be impossible to get proper representation with a committee of eighteen or twenty-two, and I think the Chancellor of the Exchequer has made out a very good case for a larger committee in large county areas. If the Chancellor of the Exchequer would accept a compromise and would restrict the number of the committee for a county borough to, say, twenty-two, and take the larger number for a large county area, so as to secure adequate representation of every part of the area, then I do not think there would be the same objection. We feel that to allow the numbers of each committee, both for the county 1758 borough and for the county area to be increased to the large number now suggested would end in having an entirely unwieldy committee, exceedingly difficult to work. There would be men who would habitually stay away, because they would feel there was a large number of people there already, and it was not necessary for them to attend. It is very difficult to secure the attendance of a proper number of people when you have a large committee, such as forty-eight, and if that is going to be increased to eighty it will be preposterous. You would have a deliberative assembly instead of a committee, which would apply itself to practical work.
§ Mr. POLLOCK
Is this intended to apply to all the committees? If so, it would apply to the committees to be set up by the Chancellor's Amendment. Surely he does not intend to have committees of the same size in the boroughs.
§ Sir RUFUS ISAACS
The numbers mentioned in reference to the local health committees have nothing whatever to do with the numbers on the auxiliary committees mentioned in the proviso.
§ Mr. C. BATHURST
I have not had a definite reply from the Chancellor of the Exchequer, but I think I am right that except where special circumstances exist, an auxiliary committee will be appointed even in the rural areas.
§ Mr. LLOYD GEORGE
It does not necessarily follow. The area can be prescribed in such a way as to include them, but it need not necessarily be so.
§ Mr. C. BATHURST
If auxiliary committees are not going to be appointed for the ordinary rural county area, I do not consider that even eighty would be too large a number, but if they are to be appointed that puts rather a different complexion upon the matter. We have a parallel in the case of the county education committees. They are committees, and they do their work exceedingly well. They number at least eighty in large counties, and I do not think the county would be properly represented unless they did number something like that.
§ Mr. C. BATHURST
They have sub-committees amongst whom the work is 1759 apportioned, and they have, I quite agree, local higher education committees. I do not think, from my own experience, if these small societies which are going to be in the county group are to be properly represented, eighty is too much for a county like Gloucester or Wiltshire.
§ Mr. CASSEL
I do not think eighty too much if London is to have only one committee. That would not allow more than two for each borough.
§ Question, "That the word 'eighteen' stand part of the Clause," put, and negatived.
§ Mr. LLOYD GEORGE
I beg to move, to leave out from the word "appointed" in Sub-section (2)
"but in no case less than nine or more than eighteen shall be appointed—
(a) As to one-third".…
all the words down to the end of Sub-section (5), and to insert instead thereof the words "in such manner as may be prescribed by regulations of the Insurance Commissioners so as to secure representation of the insured persons resident in the county or county borough who are members of approved societies, and who are deposit contributors in proportion, as nearly as may be, to their respective numbers; and the regulations so made shall provide for conferring on the approved societies which have members resident in the county or county borough the power of appointing the representatives of such members, and, where an association of the deposit contributors resident in the county or county borough has been formed under such regulations as aforesaid for conferring on such association the power of appointing the representatives of the deposit contributors.
"Of the remaining members of the committee, who shall not exceed two-thirds of the number of members appointed in manner aforesaid, one-half shall be appointed by the council of the county or county borough, two shall be elected in manner provided by regulations made by the Insurance Commissioners, either by any association of duly qualified medical practitioners resident in the county or county borough which may have been formed for the purpose under such regulations, or if no such association has been 1760 formed by such practitioners, and the others shall be appointed by the Insurance Commissioners.
"Provided that the members appointed by the council of the county or county borough shall consist wholly or in part of members of the local sanitary authorities and two at least shall be women, and of the members appointed by the Insurance Commissioners one at least shall be a duly qualified medical practitioner and two at least shall be women.
"The Insurance Commissioners may, where any part of the cost of medical benefit or sanatorium benefit is defrayed by the council of the county or county borough, increase the representation of the council and make a corresponding diminution in the representation of the insured persons."
§ The CHAIRMAN
No. We are considering the leaving out of the words in the Bill down to Sub-section (5) and the proposed substitution of the words on the Paper.
§ Mr. C. BATHURST
As this is a somewhat revolutionary alteration in the Bill, perhaps the Chancellor of the Exchequer will make a short explanatory statement.
§ Question, "That the words proposed to be left out down to the words 'one-third' stand part of the Clause," put, and negatived.
§ Mr. LLOYD GEORGE
I quite agree that an explanation is due to the Committee as to the alterations we are proposing to make. The proposal is first of all that there should be a nucleus of members representing the insured persons, and the proportions are to be arranged by the Insurance Commissioners after the numbers are ascertained for each district. It would be quite impossible to lay down any definite rule, as at the present moment one cannot tell what will be the proportion of Post Office contributors to the members of approved societies. It is absolutely essential that the proportion should be settled for each district according to the distribution of insured persons in that particular district. The minimum nucleus will be twenty-four. We take two thirds of that and distribute it between 1761 the doctors, the county council, and the Insurance Commissioners. That will mean there will be two representatives for the doctors, half the representation (namely eight) will go to the county council, and the Insurance Commissioners will have six. Then suppose the nucleus is forty-eight, two-thirds will be thirty-two, half the representation for the county council will be sixteen, two representatives will go to the doctors, and the rest will be appointed by the Insurance Commissioners. There are also provisions in the Bill that at least two women shall be appointed by the county council and two by the Insurance Commissioners; thus there will be four women on each committee. There is a further provision that the Insurance Commissioners shall nominate one doctor, and, consequently, there will be at least three doctors on each committee. That is the plan we now propose. I shall be happy to give explanations, if desired, on any further point.
§ Mr. FORSTER
There is, I think, one rather important question arising in connection with the proportion which the Chancellor of the Exchequer has himself suggested for the representation of the county council on the committee. At an earlier stage the right hon. Gentleman admitted that as soon as the suggestion had commended itself that dependents of insured persons should receive sanatorium treatment it became almost inevitable that recourse should be had to the rates. The right hon. Gentleman has very properly admitted that representation must go to a certain extent hand in hand with taxation, and he has also included in his Amendment a proviso that where a county council is called upon to provide part of the funds it can claim increased representation from the Insurance Commissioners. The Insurance Commissioners may, in fact, increase the representation of the council, and make a corresponding diminution in the representation of insured persons. I think it is practically certain that recourse is to be had to the rates under the sanatorium provisions of the Bill, and, in that case, while we are settling one proportion of representation on the committee the Insurance Commissioners will have to settle another proportion. They will have it in their power, and I think they will be driven by force of circumstances and the pressure of the rating authorities to make variations in the proportions we are now 1762 settling. I do not know that we can contemplate that with any great degree of satisfaction. If the county councils are called upon to provide part of the money they are entitled to representation, and I think we may be satisfied they will not give the money unless they get representation. But I should have thought that the representation which the Chancellor of the Exchequer gives them, not exceeding one-fifth of the maximum, would be sufficient under the circumstances.
Then I do not think that the proportion which the right hon. Gentleman allows for the doctors is going to be entirely satisfactory to the medical profession. I do not see why we should not take care now to see that the medical profession gets a larger proportion of representation on these committees. If you are giving to the approved societies the majority of the whole committee you cannot be doing anything which threatens a grave danger to the insurance, societies if you give the doctors adequate representation. The right hon. Gentleman has told us that there was no proportion laid down in the understanding arrived at between himself and the representatives of the medical profession, but I think it was agreed, and expected, by the medical profession that they were to have two members out of a maximum of twenty-two. That is a very different proportion from the three out of eighty. I think the Chancellor of the Exchequer would be wise, in the interests of the peaceful administration of the Bill by these health committees and in the interests of facilitating arrangements between committees and the medical profession, to see that the medical profession have a greater proportion of representation on the committees than that which he is giving them under this Amendment.
§ Mr. HOLT
In this connection there is one thing which must strike every Member at once, namely, that there is absolutely no representation of the employers as such provided for on these committees. The employers are going to provide one-third of the money for the purposes of working this Bill. I understand the reason why they are asked to supply the money is that the good health of their servants is a matter of great importance to them. So far as I can find out, the employers in the country at large have taken no exception to that. Speaking as an employer, I accept the proposition that the health of our employés is a matter of concern to us, and for which we may be rightly asked 1763 to pay insurance. Having accepted that, surely we are entitled to have some control over the fund which is being raised largely from ourselves. No one can suggest that the employers as such are not people who are vitally concerned in the operations of the health committees, especially in the extended form that they are to act under the Bill, and in view of the fact that they are being given the power to report whether premises are sanitary or not. Employers are vitally interested in the proper working of the health committee. There are not many classes who choose to throw themselves into the working of the Bill more likely to have the knowledge which would ensure the successful working of the scheme. I think, therefore, it is essential, in the interests of fair play and the proper working of the scheme, that the employers should be represented on the committees.
The curious thing is that in the special scheme which my right hon. Friend has agreed to for the insuring of seamen, the employers are fully represented. There cannot be anything wrong in the principle that employers should be represented on the committee, because it has been agreed to by the Government in the case of that special fund. I will also appeal for their inclusion for another reason altogether. Many of us think that it is not impossible that the immediate result of this Bill will be to bring about industrial trouble, and that there will be considerable friction with regard to the deduction of the 4d. or the non-deduction of the 3d. The events of the last two months do not make me very sanguine as to the probability of there not being industrial friction after this Bill comes into force. If anything is likely to put a stop to industrial friction—everybody must be anxious to see good relations established between employers and their workmen—it is the collaboration of both sections of employers and men, on equal terms, with a common object. I believe it is the want of a personal touch which has been responsible more than anything else for the friction which has taken place lately.
Here is exactly the opportunity that arises for enabling the employers and their servants to work together. We are asked to contribute to the very great cause of the health of the working classes. We are quite ready to do it, but I submit that we ought to have full recognition by way of representation on 1764 the committee that is to manage that sum. It is quite evident that if the minor number is chosen for this committee, that the claims that have been made by the county councils, the borough councils, the women, and the doctors, will leave absolutely no opportunity for placing employers on the committee. I appeal to the Chancellor of the Exchequer to see if he could not amend his scheme so as to say that the employers shall be properly represented on the committee which is to manage the fund to which they make such large contributions.
§ Mr. LLOYD GEORGE
My hon. Friend has raised for the first time the question of employers' representation.
§ Mr. LLOYD GEORGE
I am not making any point about it, I only gave the fact that it was the first time it has been raised as an excuse for getting up. I think it is a point that is to be met. The reason why we, after some consideration, decided to leave out the employer from representation is this. The employer is called upon to pay his 3d. or 4d., as the case may be. If the fund is badly managed, the deficiency falls not upon the employer, but upon one or two persons. It falls on the workman himself, who is called upon to make up the deficiency either by way of reduced benefits or increased levy. There is no additional liability cast upon the employer. Therefore he is not personally interested in good or bad management, beyond the fact that he would like to see the fund well administered. He has no practical financial interest in good or bad management. He might vote in favour of lavish expenditure, and then the only thing that would happen would be that his own workmen would have to find an additional levy.
§ Mr. JOYNSON-HICKS
This is most interesting, but we cannot hear what the right hon. Gentleman says. Come over this side.
§ Mr. LLOYD GEORGE
That flatters me rather. There is no liability cast upon the employer in the matter, whatever the extravagance in the expenditure may be, and if he votes in favour of a proposition that puts an additional burden on the society he is not called upon to pay. The liability falls upon the workmen and upon the ratepayer or the taxpayer. I come 1765 to the second proposition, as to the burden falling not upon the workmen, but upon the ratepayer or taxpayer. There the employer comes in. If it falls upon the rates, he is represented on the county council. If it falls on the taxpayer, he is represented by the Insurance Commissioners' nominees, by the Treasury. The Treasury, of course, has control of the taxes, and the representatives of the taxpayer would be on the committee, and consequently the representatives of the employer.
§ Mr. LLOYD GEORGE
Why should we assume that a woman cannot be an employer of labour? There are still three left even in the minimum representation. As to the county councils, a county council has eight even with minimum representation; with the maximum it has sixteen, and therefore the representatives of the ratepayer will be on the committee. The employer cannot come in, except as either a taxpayer or a ratepayer, for any contingent liability. If he comes in as a ratepayer or taxpayer he then has the same voice as anyone else. Besides, I do not see why the hon. Member should assume that the county council will not put employers on. I think it is very likely they will put employers on. There are many more employers than workmen on the county councils.
§ Mr. LLOYD GEORGE
I should be only too pleased to stand like this. I shall then address a perfectly impartial authority rather than a hostile one. That is the real reason why we came to the conclusion that the employer could not, qua employer, be represented upon these bodies. It is very little use being upon this medical and sanatorium committee unless he is to be on the societies as well, because, after all, what is the proportion of the funds which is to be expended by these committees? It is £4,000,000 out of something like £24,000,000. My hon. Friend proposes that the employer shall be represented upon committees which administer one-sixth of the fund and that there may be left out committees which administer five-sixths of the fund. Can you 1766 imagine any scheme which would be acceptable to the committees whereby employers of labour should be elected on the Oddfellows, the Foresters, and the trade unions, because that is what it comes to. If he is going to force employers of labour on one of them he must have employers of labour represented on the trade unions. Talking about friction, I should like to know what his opinion is about harmonious proceedings upon trade unions if a few employers of labour go there to administer their funds. I should not have put forward that suggestion in the interests of harmony and good feeling. I think my hon. Friend would do wisely in the interests of the employer not to insist upon representation, because representation and taxation go together, and the next step will be that the employers will be called upon to stand the same share of the deficit as they have got in the representation. Is that his proposal?
§ 10.0 P.M.
§ Mr. LLOYD GEORGE
That is the first time that has been made. If the hon. Gentleman's idea is that the employer should stand his share of the deficiency and that when a levy comes to be made the employer will have to bear an equal proportion of the levy, that is a proposal that it is worth while for labour to entertain. In Germany when the employers asked for greater representation they also proposed that there should be increased taxation upon themselves. [HON. MEMBERS: "Why?"] For a very obvious reason. They wanted control of the funds, and that is one reason why I do not think the societies would be too anxious to increase the employers' representation in this country. I do not think it is in the interests of the employer. It is certainly not in the interests of the society. When he wants to come in as a taxpayer he can do so. My hon. Friend has quoted the case of seamen. It is an absolutely different proposal from beginning to end. The liability of the owners as regards seamen is much greater than the responsibility which they have to bear with regard to any other portion of the community, and therefore, being a special plan, special arrangements are made. The case of shop clubs might also be quoted, where the employer is supposed to have separate representation; but in this case the employer practically guarantees the solvency, and that is the real reason why he goes on. No employer of labour 1767 who has a shop club will ever dream of allowing it to get into bankruptcy. The honour of his business—of his firm—is involved in it, and, therefore, he practically guarantees the solvency of the fund. Therefore we felt there was something to be said there for having representation of the employer. That is not the case with regard to the societies. They do not guarantee the Oddfellows, the Foresters, the trade unions, or any other body, and they certainly do not guarantee the local health committees.
§ Sir R. FINLAY
I think it adds a touch of humour to the not very lively proceedings on this Bill that at 10 o'clock, when the guillotine is about to fall on this and two other Clauses at Half-past Ten, the Chancellor of the Exchequer should have introduced a very long Amendment of this kind entirely remodelling the most vital part of the Bill—an Amendment which would have given material for a long debate if the Bill had been conducted under the conditions which used to prevail in the House of Commons. All that is ancient history. The Chancellor of the Exchequer has changed all that, and this House has ceased to be a deliberative assembly.
§ Sir R. FINLAY
I do not propose to wander off into the Education Committee. I cannot help sometimes wishing that we could only for an hour see the present Chancellor of the Exchequer engaged in opposing this Bill as he opposed that Education Bill. I do not know what the rate of progress would be, but I have a very lively recollection not only of the ability, but of the persistency of the right hon. Gentleman on that occasion. Surely it is not a matter to be turned off with a passing jest. All deliberation in this House is stifled when not only is a Clause of this kind introduced when the guillotine is about to fall, but when the Chancellor of the Exchequer should have only deigned to bestow upon the House some two or three sentences in introducing that most important Amendment. With regard to the Amendment itself. [HON. MEMBERS: "Hear, hear."] I think the other matter to which I have referred is even more important than the Amendment, The position and the dignity of this House are more important 1768 than any particular Amendment which may be brought before the Committee. The Chancellor of the Exchequer is trifling with the House in the way in which he is treating this Bill. He has said that employers are not to be represented because there is no contingent liability upon them. He referred to a levy which might be made upon the workmen. I am not aware that any levy would be made in respect of expenses incurred by the health committee. The ultimate recourse, as the right hon. Gentleman has let us see only too clearly to-night, will be to the rates. Is not the employer a ratepayer and very often the largest ratepayer? But the Chancellor of the Exchequer says he cannot have the employers represented. What results inevitably? You must give increased representation to the local authorities, who are the representatives of the ratepayers. On the scheme of this Amendment a majority is given to the approved societies and to the deposit contributors. Taking the figures as we have got them—I will take the maximum for convenience—it would be eighty members. Of these the friendly societies and the deposit contributors would appoint forty-eight, the local authorities would appoint sixteen, two would be elected by medical men, and fourteen would be appointed by the Insurance Commissioners. Surely, where it is made practically certain that recourse is to be had to the rates, those with whom the control of the rates rests and who represent those who pay the rates should have a controlling voice in the deliberations of this committee. [An. HON. MEMBER: "No."] It is all very well to say that the ultimate decision as to making the rate will rest with the local authority. That may be so, but I say that the practical decision will depend upon the conclusion arrived at by this insurance committee. The pressure brought on the rating authority if the insurance committee determine in a particular way will be such as to force the hand of the rating authority. I say on the statment made by the Chancellor of the Exchequer this evening with regard to recourse to the rates being not only possible, but very probable indeed, it follows irresistibly that his scheme is vitally wrong in putting the local authority in a permanent minority on this committee. [An HON. MEMBER: "No."] He does, indeed, because of the total number the friendly societies and the deposit contributors are to appoint a number which may vary according to the total constitution of the committee, but 1769 the remaining members of the committee, including those who are to be appointed by the local authority and the Insurance Commissioners, are not to exceed two-thirds of the total number appointed by the friendly societies and the deposit contributors.
§ Mr. LLOYD GEORGE
The right hon. and learned Gentleman has overlooked the last paragraph of the Amendment which says:—
"The Insurance Commissioners may, where any part of the cost of medical benefit or sanatorium benefit is defrayed by the council of the county or county borough, increase the representation of the council and make a corresponding diminution in the representation of the insured persons."
§ Sir R. FINLAY
The word in that paragraph is "may," but I say it ought to be obligatory, and that in the constitution of this committee you ought to be sure that those who represent the ratepayers shall have a controlling voice so that their hand may not be forced in regard to expenditure. The last paragraph of the Clause to which the right hon. Gentleman has referred does not meet the matter at all. What is necessary is that you should ensure from the first that the hand of the committee shall not be forced in the matter of rates. Further than that, I venture to say that this Amendment has a most serious aspect as regards medical men, upon whose cordial co-operation the working of this Bill in relation to medical benefit must inevitably depend. The Chancellor of the Exchequer is very well aware by this time that it is a vital point with the doctors that the control of medical benefit should not rest with the friendly societies, and we all understood that that was conceded by the Chancellor of the Exchequer to the medical men.
§ Mr. LLOYD GEORGE
Does the right hon. and learned Gentleman say that I agreed with the medical profession that the Government should not give a majority on the local health committee to approved societies?
§ Sir R. FINLAY
That is another point altogether. What I was saying was that the Chancellor of the Exchequer was understood to have agreed with the medical profession that the control of medical benefit should not rest with the friendly societies. If I am wrong I will be glad to be corrected.
§ Mr. LLOYD GEORGE
It is very important that there should be no possible mistake about this. What I did agree to, and what is now provided in the Bill, as amended, was that the local health committee should have the control of medical benefit, save in existing rights. That is already incorporated in the Bill. I certainly never agreed to anything but that the majority of the committee should be elected by the insured persons.
§ Sir R. FINLAY
The right hon. Gentleman has really not in any way qualified what I have said. I do not think he has made it at all clear. What I said was—and the fact remains uncontradicted—that the right hon. Gentleman agreed with the medical men that the control of medical benefit should not rest with the friendly societies, but with the health committee. We are now told that medical benefit should not rest with friendly societies, but with a majority of the health committee representing insured persons. That is precisely the same thing.
§ Mr. LLOYD GEORGE
This is a matter that involves, if I may say so, a question of faith between the medical profession and myself, otherwise I should not take the trouble to interrupt the right hon. Gentleman. What I understood him to say was that I agreed that the control of medical benefit was to be left to the local health committee, and not the friendly societies. I want to make it clear that that did not involve, as the right hon. Gentleman now puts it, that I agreed that the control should be with the local health committee and not the majority of the insured persons.
§ Sir R. FINLAY
The right hon. Gentleman propitiated a great many medical men, who thought the pledge would be observed in the spirit as well as the letter. Now it turns out that by manipulation of the health committee the control is to be given to the insured persons, namely, the friendly societies and the deposit contributors.
§ Mr. LLOYD GEORGE
Does the right hon. Gentleman suggest that a breach of faith is involved in giving a majority on the committee to the insured persons? If he does, will he quote a single note or any statement made to a responsible medical man in which I said that the control was to be given to the local health committee without having regard to the majority of insured persons being represented?
§ Sir R. FINLAY
The right hon. Gentleman certainly never told the medical men that such a change as this was going to be made in the constitution of the health committee, and if he had told them they would not have been so satisfied as they were at the time. What I do say was that this change vitally alters the conditions on which the medical men were disposed to be satisfied with what the right hon. Gentleman said. The right hon. Gentleman has transformed at the last moment the composition of the health committee. He has transformed it by increasing the number to eighty from twenty-two, and whereas the medical men were necessarily to have two out of the twenty-two, out of this maximum of eighty, which the Amendment proposes, they are entitled necessarily only to three. That is a totally different state of things from what the medical men thought they had got. That an Amendment of this kind was in contemplation ought to have been revealed to the medical profession when they accepted the statements of the Chancellor of the Exchequer. The truth is that the Chancellor thinks he has made his peace with the friendly societies, and at the expense of the medical representatives, who had trusted to what they understood he said. I make no apology for referring to this matter at some little length, because the co-operation of the medical men is absolutely essential to the working of this Bill. I am very much mistaken if the feeling in the profession is not that in this matter they have not been treated fairly.
§ Dr. ADDISON
I think that the version of the hon. and learned Gentleman (Sir R. Finlay) has been given somewhat under a misapprehension. The medical men fully realised that the representatives of insured persons should be in a majority on these committees, and they never, so far as I know, at any time demurred to that proposition. What they were and are anxious for is that their case should be properly and fairly stated before these committees. So far as that goes, I quite recognise that the alteration in the numbers of the committees does make a very material difference in the position as it stood originally, and when the arrangement was originally made. It is true that the maximum number of the local health committee has been raised from twenty-two to eighty. The medical men believe that their case is strong enough to stand its ground, but they are anxious that it should be considered without prejudice, so far as pos- 1772 sible, and as this Amendment introduces a material alteration, I would ask the Chancellor of the Exchequer to assure us that, so far as the precise numbers are concerned, he does not commit himself finally, but will leave it open for representations to be made between now and the Report stage to see if the profession is satisfied with this alteration, which perhaps they have not yet had full opportunity to consider. They are perfectly satisfied that they have a good case. All they want is to have it fairly stated, and I would ask the Chancellor, in view of the altered circumstances, to give them an opportunity of making representations between now and the Report stage, if they wish to do so.
§ Mr. GLYN-JONES
I wish to appeal to the Chancellor of the Exchequer on behalf of the pharmacists, as I have no opportunity of moving an Amendment to his own proposed Amendment. I do not grudge to the medical men their three representatives, but the position of the pharmacists is that they have no one on the committee at all. I would point out that the Chancellor of the Exchequer has provided for the representation of the medical profession on the Insurance Commission, and he moved an Amendment last night that there should be medical representation upon the advisory committee. There were Amendments to provide representation for pharmacists, but they could not be moved. I now appeal to the right hon. Gentleman to provide representation for the pharmacists on the committee for the reason that the committee have to make arrangements for obtaining drugs, appliances, and dispensing for the district. In the interests of economy and efficiency it is necessary to have on that committee an expert pharmacist to advise in regard to those matters. An expert might advise the use of less expensive appliances where more expensive would be unnecessary. Seeing that the medical profession has representation on the health committee, the advisory committee, and the Commission, I would appeal to the Chancellor of the Exchequer to give some representation on the health committee to the pharmacists, whose assistance would help the working of the scheme. I am perfectly certain that the right hon. Gentleman has no intention of slighting the pharmacists, but their being entirely ignored is not unlikely to lead to that impression. The actuaries' estimate of the medical charge is 6s., and a third of that 1773 is for the cost of medicines and drugs, and it is in the interests of the scheme that someone with expert and technical knowledge should be on the committee to advise as to the cost of medicines and drugs. I hope the Chancellor of the Exchequer will see his way to provide that there shall be at least two pharmacists on the committee whose minimum is to be forty. Surely there might be two among forty.
§ Mr. HICKS BEACH
In view of the committee having been so largely extended, there is a good deal in the plea of the hon. Member opposite. There is another body to which I wish to refer, namely, boards of guardians, who ought to have some representation on these committees. The right hon. Gentleman has met us half way, because in his Amendment he has provided for the representation of local sanitary authorities. In the rural districts those authorities and the boards of guardians are composed of the same people. The committees will, I believe, be able to make use of the sanatoria erected by the boards of guardians, and the members, with their knowledge of the way in which those institutions ought to be conducted, would be of real advantage and assistance to the health committees. Quite apart from that they have in their public capacity experience in dealing with sickness and medical assistance in the workhouses, and also as to out-door medical relief. I would also appeal to the right hon. Gentleman to grant representation to the employers on those committees. He said if he did so, he would also have to give representation to trade unions. I do not think that is quite a fair argument, because the employers pay contributions to the funds to be administered by those committees, while trade unions, in their corporate capacity, do not pay a single farthing to the funds. Surely it is an old principle of the Liberal party that there should not be taxation without representation. It is to the interests of the employers to see the funds properly administered, and I do not suppose any of them would vote for any extravagant administration. In addition their business instinct would be of valuable assistance to the committees, and would do away with some of that friction which exists now between employer and employed. I cannot help thinking that instead of being a check and a hindrance their business capacity would be a real advantage to the committees. We have no time to move Amendments to 1774 the Clause, but I sincerely hope that in Sub-section (3) the Chancellor will have the word "may" changed into "shall." It is a provision that the Insurance Commissioners "may" increase the representation of the county council. When the council are to be called on to pay large sums out of the ratepayers' pocket it is only fair that the Commissioners should be compelled to increase the representation of the county council on the committees. I hope the Chancellor will also seriously consider whether he cannot include some representatives of the urban boards of guardians on the committees. The rural guardians are included, because for the most part they are members of the rural district councils.
And, it being Half-past Ten of the clock, the Chairman proceeded, pursuant to the Order of the House of 25th October, successively to put forthwith the Questions on any Amendments moved by the Government, of which notice had been given, and the Questions necessary to dispose of the business to be concluded at Half-past Ten of the clock at this day's sitting.
§ Amendment agreed to.
§ Further Amendments made: In Sub-section (6), after the word "and" ["of the committee, and"], insert the words "the employment of officers and the provision of offices by the committee, including."
§ After the word "authority," insert the words "but subject to the consent of such authority."
§ Leave out the words "consisting wholly or partially of members of the committee."
§ At end of Sub-section (6), insert the words "Provided that the regulations so made shall require the local health committee of every county (except in cases where, owing to special circumstances, the Commissioners consider it unnecessary) within six months after the commencement of this Act to prepare and submit for approval to the Commissioners a scheme for the appointment of an auxiliary committee for the county and prescribing the area to be assigned to each such committee, and in particular the scheme shall provide for the appointment of an auxiliary committee for each borough (including the City of London and a Metropolitan borough) within the county having a population of not less than ten thousand, and for each urban district 1775 within the county with a population of twenty thousand, unless the local health committee consider it expedient in the case of any such borough or urban district that there should not be a separate auxiliary committee for the borough or urban district, or that any adjoining areas should be grouped with such borough or urban district for the purpose of the appointment of an auxiliary committee."—[Mr. Lloyd George.]