§ (1) If under any other Act of the present Session any sum is made available for the purposes of the provision of sanatoria and other institutions for the treatment of tuberculosis or such other diseases as the Local Government Board with the approval of the Treasury may appoint, such sum shall be distributed by the Local Government Board with the consent of the Treasury in making grants for those purposes.
§ (2) If any such grant is made to a county council, the Local Government Board may authorise the county council to provide any such institution, and where so authorised the county council shall have power to erect such buildings and to do all such things as may be necessary for the purpose, and any expenses of the county council, so far as not defrayed out of the grant, shall be defrayed out of the county fund.
§ (3) For the purpose of facilitating co-operation amongst county councils, county borough councils, and other local authorities for the provision of such sanatoria and other institutions as aforesaid, the Local Government Board may by order make such provisions as appear to them necessary or expedient by the constitution of joint committees, joint boards, or otherwise, for the joint exercise by such councils and authorities of their powers in relation thereto, and any such order may provide how, in what proportions, and out of what funds or rates the expenses of providing such institutions, so far as they are not defrayed out of grants under this Section, are to be defrayed, and may contain such consequential, incidental, and supplemental provisions as may appear necessary for the purposes of the order, and an order so made shall be binding and conclusive in respect of the matters to which it relates.
§ Dr. ADDISONI beg to move, in Sub-section (1), to leave out the words "the present Session" and to insert instead thereof the word "Parliament."
This belongs to the other Amendments which stand in my name and the effect 1891 will be that the operations of this Clause will be so extended as to cover not only the present Session but future Sessions of this Parliament. The point of the proposal is to enable grants of money to be given to local authorities to undertake treatment as well as the provision of dispensaries or sanatoria or whatever it may be. I want to lay down the principle that our mode of dealing with this problem will be to finance local authorities not only in the provision of sanatoria, but in the carrying out of treatment as a general principle of policy.
§ The CHAIRMANThat certainly would not be in order on this first Amendment. The only question which can arise here is whether this is to apply to an Act passed in this Session or in this Parliament.
§ Mr. LLOYD GEORGEThat is exactly why I asked the hon. Member to explain. I felt certain that the explanation, though it might or might not be a good one, was not relevant to this particular Amendment, which raises a very narrow issue. If any money was voted in any future Session, of course Parliament would give direction then as to how it is to be allocated. We have only done this because we knew that during the present Session £1,500,000 could be voted in the Finance Bill. If next year there is another £1,500,000 the Finance Bill will give further directions. We cannot bind even the present Parliament during any future Session as to what it shall do and how it shall do it or in what respect it is to spend the money. All we can do now is to say that money in the present Session shall be used in this way.
§ Mr. CASSELAre we to take it that a Finance Bill is to be passed this Session?
§ Mr. LLOYD GEORGEThat is a very old jest.
§ Amendment negatived.
§ Dr. ADDISONI beg to move, after the word "appoint" ["with the approval of the Treasury may appoint"], to insert the words "or for the treatment of such diseases."
The Amendment, as the Clause now stands, is not intended to raise the question of future policy, but to call attention to the machinery for the administration of the sanatorium benefit and the provision of sanatoria as provided for in this Clause. The point of the Amendment is to provide local authorities with money 1892 from an Exchequer Grant in aid of treatment. As the Clause stands the Exchequer Grant is limited to the provision, of sanatoria and other necessary institutions for the treatment of tuberculosis. What I want to show is that in order to make this work smoothly and successfully we must also subsidise local authorities in undertaking treatment, and draw attention to the position in which we stand at present with regard to the administration of sanatorium benefit and the position therein of the Insurance Commissioners and the Local Government Board. I am quite sure every one of us feels glad to have been in Parliament when the Chancellor of the Exchequer deliberately sets aside a great sum of money for the provision of sanatoria, farm colonies, dispensaries, and what not, for the treatment of tuberculosis. The cases that I will quote with regard to the scheme of operations which I will sketch out, will show how inseparable is the provision of dispensaries from the power of treatment. As it stands at present, or in the other Amendments in the name of the Chancellor of the Exchequer, at the request of the local insurance committee the local authority, with the approval of the Local Government Board, will provide sanatoria and other necessary means for treatment. The Local Government Board may or may not approve. This I take it will be the scheme of operations. A dispensary will be required in every district. There will be perhaps 200 in the whole country. In these there will be provided by someone, either by the local authority or by some collection of private individuals, doctors, nurses, visitors, and so forth. From these dispensaries the patients will be drafted as the case may be, after having been examined when it is determined to what kind of institution they should be sent—to an open-air school in the case of children, a children's sanatorium, or a sanatorium for early cases in the case of adults, a farm colony, and so on.
§ The CHAIRMANThis is really a matter quite outside the scope of the Clause. The whole Clause hangs on its first words: "If under any other Act of the present Session any sum is made available" for certain purposes. Clearly we cannot discuss these matters of policy under this Clause.
§ Dr. ADDISONIs it not in order to discuss the mode of allocation?
§ The CHAIRMANThe hon. Member was discussing the purpose and not the mode of allocation. His whole speech so far has been directed to what the local authorities are to do with the money after they get it.
§ Mr. LLOYD GEORGEThis deals purely with money which is to be paid for the building of sanatoria. My hon. Friend is proposing to deal with the whole question of the treatment of tuberculosis and consumption, which is a totally different matter and is not germane to the Clause. The Clause simply deals with the £1,500,000 which is to be voted for the purpose of the erection of sanatoria and other institutions, and he proposes to set up the whole machinery in this Clause for the treatment inside, which is a very different matter.
§ The CHAIRMANI think it is clear that if the hon. Member wants to divert some of this money to other purposes, he had better make the attempt on the Finance Bill.
§ Mr. MAURICE HEALYThat assumes that the Finance Bill will not be amended in that particular. If the Finance Bill came first that would be the best place to discuss how the money would be allocated, and the purposes for which it is to be allocated could be varied or extended. But the Finance Bill is to come second, and I am afraid if you limit us to the strict words of the Amendment now that will be used as an argument when we come to the Finance Bill, and we shall be told that by the Insurance Bill we have already fixed the purpose for which the money is to be allocated and it cannot be changed. I submit that you must necessarily discuss the allocation of this £1,500,000 in the Bill in which it is first raised, and if you do not do it on the first Bill you will be prevented by the words of the first Bill from discussing it on the second.
§ The CHAIRMANI do not think that is so. Perhaps the Attorney-General will give us his view.
§ Sir RUFUS ISAACSIt seems to me that if we discuss this question on this Amendment the difficulty would be that we are discussing something which cannot arise in view of what has already been settled here, and in view of the Finance Bill which is to be introduced. We are dealing with money which has been allocated for certain special purposes.
§ Mr. MAURICE HEALYNot "has been allocated," but "is allocated."
§ Sir RUFUS ISAACSIt is allocated in the Bill as it stands at present and a Resolution has been passed also dealing with that money and the purposes for which it is to be applied, and consequently you must apply the money in accordance with the Resolution.
§ Mr. MAURICE HEALYI am in this difficulty: If this Bill is left unamended on this subject, it will fix irrevocably the purpose for which the £1,500,000 is to go. The Finance Bill merely votes the money. It is this Bill which defines the purpose for which it is to be allocated. If we wished afterwards to move Amendments to the Budget Bill, it would be a conclusive reply to us to say that this Act had already decided how the money was to be applied, and it would be perfectly idle for us to propose Amendments.
§ Sir RUFUS ISAACSUnder this Bill money is made available for sanatoria. You have to deal with whatever sum is made available for sanatoria and other institutions. Whether the sum is £1,500,000, or any other sum, we have to deal with it by applying it for the provision of sanatoria and other institutions.
§ Mr. LLOYD GEORGEThe arrangements with regard to the administration of sanatorium benefit are contained in the new Clause 15. This Clause deals with the buildings.
§ Mr. MAURICE HEALYMay I ask the right hon. Gentleman to turn this way? We cannot hear what he is saying.
§ Mr. LLOYD GEORGEThere comes my difficulty again. I have to address the Chair.
§ Mr. MAURICE HEALYAddress the Chair, but speak in this direction.
§ Mr. LLOYD GEORGEMy hon. Friend asks me to perform a feat to which I am not equal, for I cannot face both ways. In Clause 15 we have laid down provisions dealing with the administration of sanatorium benefit. It says that the local health committee shall make arrangements to the satisfaction of the Insurance Commissioners as to the management of sanatoria, or other institutions, for the treatment of insured persons. Since then we have promised to make provision for the treatment of dependents, and we shall 1895 have to introduce a new Clause for that purpose. Therefore the question of treatment is prejudged by Clause 15, and if the words of this Amendment were introduced in the Clause now before the Committee, they would be absolutely inconsistent with the provisions in Clause 15. My hon. Friend (Dr. Addison) proposes to alter the Clause in respect of treatment, and I submit that he ought to move this Amendment on the new Clause dealing with dependents.
§ Dr. ADDISONI have no desire to obstruct the proper course of discussion. I wish to bring this point up at the right place. I fully intended to move an Amendment to the Finance Bill when the time arrives as to how the money should be allocated and dealt with. The point I wish to raise now is, in the first place, that this money shall be allocated in a certain way, and I want also to say that the grant shall be distributed by the Local Government Board with the consent of the Treasury. It appears to me that what is proposed in this Clause, coupled with the arrangements we have already made in Clause 15, will produce grave embarrasment in the administration of this fund. I want to raise the general question as to the mode of administering this grant.
§ The CHAIRMANIt is quite clear that this Clause deals only with a certain sum which it is supposed is going to be allocated under another Act of the present Session. That is presumably the Finance Act, and that in its turn is based on financial resolutions which are already passed, and cannot be altered. Therefore it is clear that any Amendments on this Clause or on this Bill tending to alter that sum must be out of order. I do not at all take the view suggested by the hon. and learned Member for Cork (Mr. Maurice Healy). I have not been able to find a copy of the money resolution on the Finance Bill, but whatever its terms may be, it necessarily has fixed the matter, and we cannot go outside that resolution.
§ Mr. MAURICE HEALYI submit that it is a wholly new doctrine to hold that the Money Resolution binds you in any other matter except the purpose for which the money is to be applied.
§ The CHAIRMANIt is relevant in connection with the first words already passed. "If under any other Act." That 1896 is why I am bound to rule the Amendment out of order on this Clause. I cannot go beyond that.
§ Mr. LLOYD GEORGEMay I say something for the comfort of my hon. Friend. I know he has in his mind the Amendment with reference to recouping of which the hon. Member for Cork has given notice. That question has been raised not only in Ireland, but in this country, and that is totally different from the question raised by my hon. Friend (Dr. Addison). I would respectfully counsel the hon. Member (Mr. Healy) not to get mixed up with my hon. Friend (Dr. Addison).
§ Mr. PRINGLEThere will be no provision in this Clause for dealing with money voted for other purposes.
§ Mr. T. E. HARVEYAlthough a resolution has already been passed, the Chancellor of the Exchequer has thrown out a promise that, if necessary, he is prepared to bring in a further resolution. In the event of a further resolution being proposed in Committee of Supply I venture to say that it is possible for my hon. Friend (Dr. Addison) to move his Amendment.
§ The CHAIRMANI cannot, of course, take cognisance of any suggestion of that kind. I am afraid I cannot allow the hon. Member to move the Amendment. I think the words of the Clause do cover the words in the Finance Resolution.
Mr. SHERWOODIt is certainly very desirable that an opportunity should arise on this Clause for some consideration of the relations between the Insurance Commissioners referred to in the new Clause to be moved by the Chancellor of the Exchequer and the Local Government Board. I wish to know at what point in the Debate on this Clause it will be in order to raise the question of the relations between the Insurance Commissioners and the Local Government Board.
§ Dr. ADDISONWould it be in order to make a criticism as to the machinery which will exist for dealing with those sums, and to discuss the relations, for example, between the Local Government Board and the Insurance Commissioners
§ The CHAIRMANCertainly, so far as machinery is concerned, the hon. Member is in order, but when I interposed the hon. 1897 Member was proceeding to develop an argument as to the application of the money which is totally out of order.
Amendment proposed: In Sub-section (2), after the word "buildings" ["power to erect such buildings"], to insert the words "and to manage and maintain the institution and for that purpose to enter into agreements and make arrangements with local health committees and other authorities and persons."—[Mr. Lloyd George.]
§ 8.0 P.M.
§ Dr. ADDISONOn this Amendment, can I refer to the question of the management and maintenance of these institutions? It appears to me that on this Amendment the whole point is raised as to the distribution and use of this money. The contention in that connection which I beg to make is that it is essential in the needs of the institution that the maintenance of it must be by the local health authority and that the subsidies being granted by the Local Government Board, upon them rest the general question of the relation of local authority in this connection with the local insurance committees who are ranged up on the other side; and I hope the Insurance Commissioners will make generous grants if the principles enunciated by the Chancellor of the Exchequer in his Amendment are to be carried out. The local insurance committee may desire the local authority to provide the institutions, and they may desire money to be allocated for their maintenance. My point is that, in view of Clause 46, which provides for the establishment of a sanatoria and the disposal and provision of institutions and the money for their maintenance, this duty will be best carried out by the local authority, because I hope that they will determine upon the general plan. There will be a scheme prepared by the Insurance Commissioners, and, according to that scheme, grants only will be made for certain specific purposes and for the provision of dispensaries; and the Insurance Commissioners will probably have to draw up that scheme. As the matter stands, in the words of this Clause, and under the whole of this scheme, the Insurance Commissioners will be subject to a right of appeal, and this right will be subject to the approval of the Local Government Board, not only as to the character of the institution, but as to the system upon which they are to be conducted; and I suggest that this will of necessity in 1898 many cases place local insurance committees in a serious dilemma. They will desire, among other things, to have allocated to them power for specific purposes, and it is quite conceivable that the local health authority will not be disposed to accord the most hearty welcome to the local insurance committees. These Commissioners will have statutory obligations to provide sanatoria for certain persons in a neighbourhood, and it will help them out of their dilemma if power be given to the local authority. The Insurance Committee will deal directly with the local authority, who are under the supervision of the Local Government Board, and in this way you will not get the stimulus that is essential in this matter. As we have already seen, it is quite conceivable that there may be some difference between the local Commissioners and the local authority.
§ The CHAIRMANI think the hon. member is travelling outside the Amendment. I wish to draw his attention to the words of the Amendment, which is to "provide and maintain." That is the only question before the Committee.
§ Dr. ADDISONThe maintenance of the institution is one of the essential parts to be considered under the Bill, because to maintain a sanatoria it will be necessary to have a dispensary, where you will treat patients for tuberculosis; and this deals with the mode in which the grant is to be made for that purpose. Therefore, the intervention of the local insurance committee is somewhat essential. My point is that the machinery is not best adapted to carry out that purpose, and therefore I am suggesting that in that respect the scheme should be amended. My contention is that the whole of this business should be under one authority, and that the deputation of it to others may only lead to confusion in the allocation of these grants and cause hopeless dilemma. In my judgment, the way for dealing with this Clause is to put it on a different basis and to offer to the local authorities the expenditure necessary for the maintenance of these institutions.
§ The CHAIRMANI am afraid the hon. Member is not conforming to the point.
§ Amendment agreed to.
§ Mr. ANNAN BRYCEI beg to move in Sub-Section (2), after the word "necessary" ["necessary for the purpose"], to 1899 insert the words "or expedient." The words that I wish to insert are very desirable, and I think are what are ordinarily termed a drafting Amendment.
§ Mr. LLOYD GEORGEI should not have thought the words necessary to insert here. They are redundant words, and often are very dangerous. I am very much against the insertion of these words, and I consider them quite unnecessary, being redundant and possibly dangerous.
§ Mr. ANNAN BRYCEThey surely ought to apply to the next Sub-section, where the same words come. To say that a thing is inexpedient seems to me to be the same thing.
§ Amendment negatived.
§ Amendments made: In Sub-section (2), leave out the word "purpose" ["necessary for the purpose"], and insert instead thereof the words "purposes aforesaid."—[Mr. Lloyd George.]
§ In Sub-section (2) insert at the end the words "as expenses for general county purposes, or if the order of the Local Government Board so directs as expenses for special county purposes charged on such part of the county as may be provided by the order."—[Mr. Lloyd George.]
§ Mr. LLOYD GEORGEmoved, to add at the end of Sub-section (3)—
(4) A local health committee may, with the consent of the Insurance Commissioners, enter into agreements with any person or authority that, in consideration of such person or authority providing treatment in a sanatorium or other institution or otherwise for persons recommended by the committee for sanatorium benefit, the committee will contribute out of the funds available for sanatorium benefit towards the maintenance of the institution or provision of such treatment, such annual or other payment, and, subject to such conditions and for such period as may be agreed, and any such agreement shall be binding on the committee and their successors, and any sums payable by the committee thereunder may be paid by the Insurance Commissioners and deducted from the sums payable to the committee for the purposes of sanatorium benefit.
§ Mr. SHERWELLThe point is of some importance which is raised in this new Clause. The Clause sets out the definition 1900 or delimitation respectively as far as the Insurance Commissioners are concerned, and also sets out the position of the Local Government Board as regards the proposed Amendment. The sum of one million and a-half which is allocated for the erection of sanatoria is subject, to that body. It is the Local Government Board who allots this money and makes these grants to the local authority for the purposes of institutions useful in themselves in all parts of the country. But the Insurance Commissioners will have no option and no power to determine the character of the suggested institutions which are to be built out of this money, and it may be conceivable that if the position of the Local Government Board is not defined we shall find the erection of sanatoria in different parts to that desired by the Insurance Commissioners. We desire that co-operation shall be procured and that these sanatoria shall be erected in such parts as are desired by the local authority, and it is in that view that we wish to see the basis of this Clause altered and welcome some such statement from the Chancellor of the Exchequer. It will be a calamitous thing if there are any differences between local Insurance Commissioners and the Local Government Board on the point, and I hope that the erection of these sanatoria will be in accordance with the wishes of the locality, and that the local Insurance Commissioners will have some voice in determining the character and the position of their erection.
§ Mr. LLOYD GEORGEThe Insurance Commissioners will represent the insurance side of this scheme, and the local health committee will have the general administration of this Act. Well now, I agree there is only one way in which the point is to pass, and that is that it might have been effectively raised on Sub-section (1).
§ Mr. SHERWELLI tried it.
§ Mr. LLOYD GEORGEThere was no Amendment.
§ Mr. SHERWELLI raised the point then.
§ Mr. LLOYD GEORGEThere is only one way in which the Insurance Commissioners have a voice, and it is through the Treasury. It is the only way for them. The local authority have the matter in their own hands for approval, and the Treasury will deal with the matter when 1901 it comes before them in a formal manner, and they will probably make representations to the Insurance Commissioners in regard to it. Altogether the matter involves one of an enormous expenditure of money, and I have no doubt at all the matter will be fully considered. We shall consult the Insurance Commissioners because of the large amount of money which will be in their hands and at the disposal of the Insurance Commissioners under Clause 15. The administration of further sums which the Treasury may vote for purposes of maintenance will also be under the control of Commissioners, and therefore the Local Government Board will consult the opinion of the Insurance Commissioners. This is the only way to carry out the words of the Amendment, and the Treasury will have a final voice in the matter, because the approval of the Treasury is necessary to the expenditure of any sum of money, and that is the only way Insurance Commissioners can approach the matter. I quite see the importance of the point raised by my hon. Friend.
Lord HENRY BENTINCKI beg to move, in the proposed Amendment, after the word "authority" ["enter into agreement with any person or authority"], to insert the words "other than any Poor Law authority." I am sure those words have been accidentally omitted from this Clause, and that the Chancellor of the Exchequer will agree that it is extremely desirable that sanatorium benefits should not have the taint of pauperism. It will be a pity not to use the institutions which have been established by the boards of guardians, and I think there is nothing to prevent them from handing them over to the medical officer of health, and thus bring about a consummation devoutly to be wished, the unification of the Poor Law service under the authority of the medical officer.
§ Dr. ADDISONI hope the Chancellor of the Exchequer will resist this Amendment, which, I think, would introduce a dangerous element into the Clause, because I foresee that these institutions possessed by the Poor Law authorities will hereafter form a very important branch of this work.
§ Mr. HICKS BEACHI trust the Chancellor of the Exchequer will not accept this Amendment, for I think it would be a great waste of public money if full use were not made of the excellent institutions which 1902 have been erected by boards of guardians throughout the country, and on which the ratepayers have expended large sums of money. I know that there are a great many of them. Surely, if those institutions are not filled up with patients it would be a pure waste of money to establish other sanatoria when you have those already equipped. I sincerely hope that the right hon. Gentleman will not accept the Amendment, but will, if possible, make use of existing sanatoria.
§ Mr. LLOYD GEORGEI sympathise very much with the object of the Amendment which has been submitted by the Noble Lord opposite, and I can quite see what he has got in his mind. He does not want to send insured persons to institutions which have been erected by the authorities who are in charge of the paupers of the country, because of the taint of pauperism. I am afraid however, that I cannot accept the Amendment. The boards of guardians have erected a great many of these institutions in different parts of the country, and my hon. Friend the Parliamentary Secretary to the Local Government Board confirms the statement made by the hon. Member for Tewkesbury (Mr. Hicks Beach). I think it would be rather a serious thing in these conditions to refuse to recognise them at all. I think it would be better perhaps to trust to the Local Government Board and to the Insurance Commissioners between them to see that these institutions are not of a character which would lead the insured person to regard himself as being tinder a kind of degradation in entering them. I am not prepared at this moment to accept the Amendment, and I would really like to consider it more thoroughly. I think that most of the sanatoria in Ireland have been set up by the Poor Law authorities. I sympathise deeply with the Amendment and its object, and I should feel inclined on the whole to accept it were it not for the facts stated by the hon. Member for Tewkesbury, and confirmed by the Secretary to the Local Government Board.
§ Lord A. THYNNEMay I appeal to the right hon. Gentleman to consider the question a little further, perhaps on the Report stage of the Bill. It is a very important matter indeed to keep the question of insurance entirely distinct from the Poor Law. Personally, I should consider it lamentable if insured persons under this Bill were sent into any institutions which 1903 are not wholly distinct from the Poor Law. I think the right hon. Gentleman cannot be too careful.
§ Mr. LLOYD GEORGEI am prepared to deal with the question raised by the Noble Lord, but at the present moment I am really not in a position definitely to make up my mind on the subject. I should like to consider the Amendment a little further, and I understand from the Chairman that this kind of Amendment can be moved on the Report stage. I would suggest to the Noble Lord not to seek for a definite expression of opinion at the present time, and withdraw his Amendment.
§ Mr. HICKS BEACHI hope the right hon. Gentleman will consider very carefully before he accepts the Amendment. Surely the object of the Bill is to prevent people from coming under the Poor Law. There are a number of institutions actually administered by the Poor Law authorities, and by the operation of this Bill the number of those who will enter the Poor Law institutions will gradually diminish. You have these magnificent buildings erected in different parts of the country, and surely it would be an absolute waste of public money not to make use of them merely because of a sentimental idea against buildings erected by Poor Law authorities. I think the matter is one deserving of grave consideration.
§ Mr. LLOYD GEORGEHear, hear.
§ Mr. FORSTEROne would suppose that it would be a simple and easy matter to accept the proposition that where you have good accommodation already available for the treatment of disease it should be used. But in connection with this proposition we have run up against one of the greatest stumbling blocks to legislation, and that is the question of sentiment. People experience a proper revulsion of feeling if they have to go into a Poor Law institution. Although there is great force in the argument of my hon. Friend the Member for Tewkesbury, that it would be a great waste of public money to fail to use the accommodation which already exists, I should like to point out to him that we are not going to send these people to sanatoria merely for fun, or merely because they want a pleasant holiday; we are going to send them there in the hope that they will get cured. But to send any patient into an institution, the mere thought of which is going to weigh upon a man's mind and cause in him a 1904 feeling of disgust, is to pursue a course which would put him into most unfavourable conditions for effecting a cure. The whole question really needs the most close and careful consideration. I hope the Chancellor of the Exchequer will be able, and I am quite certain he will do it with the most anxious care, to weigh the pros and cons. There are many arguments in favour of the proposal of my Noble Friend, and strong arguments urged by the hon. Member for Tewkesbury. I hope the matter will be very carefully considered before we come to the Report stage, and if we have the opportunity of debating the matter on the Report stage I have no doubt we will have to face the difficulty of coming to a decision as to it.
§ Amendment to the proposed Amendment, by leave, withdrawn.
§ Proposed Amendment agreed to.
§ Mr. FORSTERI beg to move, at the end of the Clause, to insert, "(4) In the provision of sanatoria under this Section as nearly as possible equal accommodation shall be provided for women as for men."
I move this formally because I want to make sure that some adequate provision will be made for the women who are employed contributors in the sanatoria. It is, at all events, arguable that the employed contributor, either male or female, should have the first claim, and it seems, to me that the employed contributor being a woman and paying her full contribution must have a prior claim to the dependents of male contributors. As long as the point is considered I do not want to press the matter. I think the point is one of importance. It seems to me to be a very poor prospect for an employed contributor if she is in need of sanatorium treatment, and finds that she is excluded because dependents of other contributors occupy all the available space.
§ Mr. LLOYD GEORGEThe Local Government Board take the view very strongly that there ought to be elasticity in the matter. Tuberculosis among men is much more prevalent than amongst women, and in certain districts there may be an even greater disparity, owing to the nature of the occupation. Therefore I think elasticity should be allowed, and that it is better to trust the matter to the Local Government Board.
§ Amendment, by leave, withdrawn.
1905§ Lord A. THYNNEI beg to move, at the end of the Clause, to insert: "(4) For the purposes of this Section, the expression 'county council' shall not include the London County Council."
I move this Amendment with the object of obtaining from the Chancellor of the Exchequer some statement as to the responsibility which will attach to the London County Council under the proposals. It is quite clear from the provision of the money referred to that it is in the nature of a Grant-in-Aid, and is not intended to cover the whole cost. The position of the county council is very undefined with regard to the property in the buildings. Will the buildings vest in the council, and in matters such as additions and alterations will the responsibility rest with the county council? There is the further question of rates and taxes and repairs, all of which in the sum total may amount to a considerable figure, and as to all of which our position is not very clearly defined in the measure. It is not very clear whether our responsibilities are limited simply to erection in the first instance, or whether they also extend to management. I think the right hon. Gentleman will quite appreciate our reluctance to undertake an indefinite liability of this sort without some precise statement on his part as to its extent. It is rather a novel departure to place a charge on the rates for a service which he admits himself, I think in the Bill and certainly in all the discussions, to be of a national character. I think if there was a service from which the rates should be relieved it is this particular service with regard to sanatoria, which it is admitted on both sides of the House is of national importance and which ought not to be charged on the local rates.
§ Mr. LLOYD GEORGEI do not think that the Noble Lord can have fully contemplated the effect of these words. The effect of them would be that the London County Council would get no share in the Grant, and I cannot imagine why the London County Council should take up that line. We propose to give a sum of £1,500,000, but then the Noble Lord says that so far as London is concerned it does not want any of it. The Amendment says, in effect, "We hereby wish to say that the London County Council do not want any of it."
§ Lord A. THYNNEI do not think the right hon. Gentleman quite understands. 1906 I stated in my opening remarks that my object in bringing forward this Amendment was to elicit from the Chancellor of the Exchequer a statement as to the limits of our liability in this matter. I pointed out how very indefinite the Clause reads, and that we did not know to what extent we are liable in respect of details, which I mentioned and which I am sorry the right hon. Gentleman did not think fit to deal with. I asked the question in whom the buildings will vest. I mentioned the question of repairs and asked as to whether our liability is restricted to the erection of the buildings in the first instance, or whether it is to extend to management as well. All these important details involve great financial responsibility, and are left in a very vague and unsatisfactory state so far as those people are concerned who are responsible for local finance. No doubt a million and a-half seems to be a very large sum, but it is only in the nature of a Grant-in-Aid. The right hon. Gentleman does not dispute that this is a national service. If it is a national service, it ought to be paid for wholly from national funds, and you do not get away from your obligation if you give a part payment, a Grant-in-Aid, and if you say that an undefined balance is to fall upon the local rates and be a local burden in respect of this service which you admit to be of a purely national character. That is the whole point, and those are the reasons why I brought forward this Amendment. I quite realise if I pressed it, the danger of London losing a Grant, but I am the very last person to wish to deprive London of any scanty contribution from the Imperial Exchequer. I hope that the right hon. Gentleman will give us the information of which we stand in need.
§ Mr. LLOYD GEORGESome part of the information would take us back to Clauses which have been disposed of, but the London County Council need not spend a penny unless they like under this Clause. The only thing that this Clause says is that if they do spend money they may have a share of the Grant. But there is no compulsion on the county council to spend any money at all. If there is compulsion it is outside this Bill altogether. At the present moment the whole burden of curing these poor people when they cannot provide for themselves falls on the rates. There is no contribution from the Imperial Exchequer. For the first time we have come forward and offered £1,500,000. Although the Noble Lord 1907 regards that as an insignificant contribution, at any rate, poor as it is, it is the only contribution of the kind that has ever been made. When sanatoria have been erected in the past, they have been erected out of the rates, except where they have been provided out of private contributions. Now for the first time we offer an Imperial Grant of £1,500,000. Unless the county council choose to build sanatoria, they need not do so, but if they do they will get a very substantial Grant-in-Aid. The grant so substantial that those who advised me before I recommended this sum calculated that it would be equal to something like half the total cost. Another expert thought it would cover the whole cost, but that is a more sanguine view than the Government have taken. It will, at any rate, cover something like half the cost.
§ Mr. GOLDSTONEIt is quite true that there is to be a contribution from the National Exchequer, but this type of legislation is growing very common. We have, for instance, the feeding of necessitous school children. That is an admirable idea. It is suggested from the National Parliament; a small Grant-in-Aid comes along; and no local authority feels that it can resist going forward with so estimable a type of work. But it all throws cost on the local rates. The same with medical inspection and school clinics. No progressive authority can resist the desires of its citizens to press forward with these matters. But so cleverly is the business arranged at headquarters that encouragement is given through excellent legislation, but the great bulk of the cost falls on the local exchequer, until at last we are reaching a point where the local authorities will be unable to stand the strain, and they are waiting now for a readjustment of local and national finance. As to this suggestion of sanatoria, we agree with it, but it is throwing a still further burden on the local rates. It seems to me that the appeal which the Noble Lord has made is a reasonable one, and I support him in it.
§ Lord A. THYNNEIn asking leave to withdraw the Amendment, I would combat the view advanced by the Chancellor of the Exchequer, that the Imperial Exchequer is advancing £1,500,000 to do a work which at the present moment is being done by the rates. To refute the right hon. Gentleman's statement, I need 1908 only quote figures which he himself gave in an earlier discussion. He then told us that there were in England and Ireland at present between 400,000 and 500,000 people suffering from tuberculosis, and that there were 75,000 deaths from tuberculosis every year, and that to deal with this large consumptive population there were only 4,000 beds provided, half of which were taken up by patients suffering from other illnesses. He very rightly and properly called attention to the grave scandal of having only 2,000 beds in England and Ireland to provide accommodation for consumptive patients, numbering in the aggregate between 400,000 and 500,000. It was to meet the needs of this great consumptive population, which is not being dealt with at the present moment, that the right hon. Gentleman brought forward his Grant. Therefore the money is not being provided for the performance of functions at present discharged by the rates.
§ Amendment, by leave, withdrawn.
§
Dr. CHAPPLE had given notice of the following Amendment: At the end of the Clause to add,
(4) It shall provide, where possible trained health missionaries who shall visit the homes of insured persons where tuberculosis is known to exist, in order to give instruction and guidance in the prevention of infection, and to report to the health committee on the suitability of the home to provide sanatorium conditions.
(5) It may arrange for the transfer to, and residence in, a house where sanatorium conditions can be provided of an insured person suffering from tuberculosis.
§ The DEPUTY-CHAIRMAN (Mr. Maclean)This Amendment is outside the scope of the Clause.
§ Dr. CHAPPLEOn a point of Order. The object of the Amendment is to provide for the supervision of houses in which tuberculous cases exist, but for which sanatoria are not available. An Amendment has already been accepted enabling the local health committee to provide treatment in institutions other than sanatoria, and to make arrangements with persons—
§ The DEPUTY-CHAIRMANThat is not on this Clause. This Clause deals with quite a different matter.
§ Dr. CHAPPLEThe Amendment to which I refer is one in the name of the 1909 Chancellor of the Exchequer, and under it the local health committee may with the consent of the Insurance Commissioners, enter into agreements with any person to provide treatment in other institutions. I want to enable the health committees to have supervision over those houses in which exist tuberculous cases which cannot be taken in the sanatoria. There will be a large number of cases that will not, and probably a still larger number that cannot, take advantage of sanatoria. I want to treat the houses in which they exist as infected houses, and to enable some of this money to be made available for their constant supervision.
§ The DEPUTY-CHAIRMANI cannot allow the Amendment on this Clause.
§ Mr. FORSTERIs it not the fact that the Chancellor of the Exchequer's Amendment relates to treatment?
§ Mr. HUME-WILLIAMSThe Chancellor of the Exchequer's Amendment gives power to a health committee to make arrangements with a person to treat one who is infected in a sanatorium or other institution, "or otherwise." What is the meaning of the word "otherwise," if it does not mean in the patient's house?
§ Mr. LLOYD GEORGEThe Amendment refers purely to the institutions towards which grants are to be made, and enables local health committees to enter into an agreement with reference to those institutions. The hon. Member's proposal is a totally different matter. It provides for trained health commissioners who shall visit the homes of insured persons where tuberculosis is known to exist. My Amendment deals with quite a different matter. The proposal has relevance to the Clause, because it deals with arrangements under the Bill in regard to which money is granted. I am not sure that the hon. Member's proposal is not outside the Bill altogether. In any case, it ought either to come on Clause 15, which deals with treatment, or to be moved as a new Clause, just as the one which I proposed to move in reference to the treatment of dependents.
§ Dr. CHAPPLEI rise to a point of Order. My Amendment does not deal with the home; it deals with the supervision of the home where infection exists; since infection resides in the house as well as in the person.
§ Mr. LLOYD GEORGEIt is the home of the insured person?
§ Dr. CHAPPLEWho are known to be such. I simply want some of the money that is available for management and for the prevention and cure of tuberculosis made available for the supervision of these homes where cases exist which cannot or will not go to a sanatorium.
§ Mr. LLOYD GEORGEThat is exactly the point raised by the hon. Member behind me (Dr. Addison), which was argued at great length and with the characteristic pertinacity of the hon. Gentleman, but not with my hon. Friend's usual success.
§ Question, "That the Clause, as amended, stand part of the Bill," put, and agreed to.