HC Deb 15 November 1911 vol 31 cc389-448

This Part of this Act, in its application to Ireland, shall be subject to the following modifications:—

  1. (1) The reference to the Lord Chancellor shall be construed as a reference to the Lord Chancellor of Ireland.
  2. (2) A reference to the Housing of the Working Classes (Ireland) Acts, 1890 to 1908, shall be substituted for the reference to the Housing of the Working Classes Acts, 1890 to 1909, and a reference to the Public Health (Ireland) Acts, 1878 to 1907, shall be substituted for the reference to the Public Health Acts.
  3. (3) Where the number of members of any society being insured persons exceeds five thousand, the society may receive the approval of the Insurance Commissioners notwithstanding that the number of such members is less than ten thousand, and in the provisions of this Part of this Act with respect to the approval of societies "five thousand" shall be substituted for "ten thousand" accordingly.
    1. (4) (a) If it appears to any county council that, having regard to the number of employed contributors resident in the county who are not members of any society approved under the foregoing provisions of this Act it is desirable that steps should be taken by the council for the establishment of an approved society for the county under the council (in this Section referred to as a county society), the council may at any time before the expiration of one year from the commencement of this Act submit to the Insurance Commisisioners a scheme for the establishment of a county society;
    2. (b) The scheme may provide for—
      1. (i) the representation of the council on the committee of management of the society;
      2. (ii) the appointment of officers and district and other committees by the council;
      3. (iii) the delegation of powers to committees;
      4. (iv) the giving of security by means of a charge upon the county fund or otherwise;
      5. (v) the restriction of membership to insured persons resident in the county not being members of any other approved society;
        6. 391
      6. (vi) the reduction of benefits below the minimum rates fixed by this Part of this Act; and
      7. (vii) such other matters as may appear necessary and in particular such further modifications of the provisions of this Part of this Act with respect to approved societies as may be required for the purpose of adapting those provisions to the case of a county society;
    3. (c) The scheme may be approved notwithstanding that the number of members or prospective members of the society is less than five thousand;
    4. (d) Where such a scheme has been approved by the Insurance Commissioners, the provisions of the scheme shall have effect notwithstanding anything to the contrary in this Part of this Act; and, subject to those provisions, the county society shall be an approved society for all the purposes of this Part of this Act;
    5. (e) A county council desirous of submitting a scheme under this Section may at any time after the passing of this Act take such steps as appear necessary with a view to ascertaining what insured persons resident in the county are eligible and willing to become members of the proposed county society, and generally for the formation of the society;
  4. (5) The local health committee of a county shall consist of such number of members as may be determined by the Insurance Commissioners, and of that number not more than one-fourth shall be persons appointed by the Insurance Commissioners, and the remainder shall be appointed by the county council.
  5. (6) Subject to the provisions of this Section the rules of a local health committee of a county may provide for the performance of duties by officers of local authorities in connection with the administration of benefits administered by the committee, and those officers shall perform the duties so assigned to them, and shall in respect thereof be entitled to the remuneration fixed by the rules.
  6. (7) The following provisions shall have effect with respect to the adminis- 392 tration of medical benefit by a local health committee of a county in the case of deposit contributors resident in the county:—
    1. (a) It shall be the duty of the medical officer of health of each dispensary district in the county, without the production of any medical relief ticket, to attend and treat every deposit contributor resident in his district and requiring medical attendance or treatment, and at the expense of the guardians to supply proper and sufficient drugs and medicine to the contributor;
    2. (b) There shall be paid to the medical officer in respect of his services under the last preceding paragraph such yearly sum as may be prescribed in respect of each deposit contributor resident in his district;
    3. (c) There shall be paid to the guardians of the Poor Law union in respect of medicine and drugs supplied to deposit contributors resident in the union, or the part of the union within the county as the case may be, a sum calculated at such rate as may be prescribed;
    4. (d) Any sums so payable to a medical officer or board of guardians shall be paid in the prescribed manner and at the prescribed time by the local health committee out of the amount paid or credited to the committee on account of sums payable in respect of deposit contributors resident in the county for the purposes of the cost of medical benefit.
  7. (8) If a grant is made to a county council or county borough council out of any sum made available under any other Act of the present Session 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 may with the approval of the Treasury appoint, the council may, subject to the sanction of the Local Government Board, exercise for all or any of those purposes the powers given to them by Part II. of the Tuberculosis Prevention (Ireland) Act, 1908, in like 393 manner as if those purposes were purposes authorised by that Part of that Act, and any expenses of the council so far as not defrayed out of the grant shall be defrayed in manner provided by that Part of that Act.
  8. (9) If on a representation made by an approved society the Insurance Commissioners are satisfied that the society is unable to make arrangements upon reasonable terms for the administration of medical benefit in the case of members resident in any specified locality, the Commissioners may authorise the society in the case of members resident in that locality to suspend medical benefit and out of the moneys otherwise payable for the cost of that benefit to distribute any one or more additional benefits among those members in accordance with a scheme approved by the Commissioners.
  9. (10) For the purposes of proceedings in Ireland under the provisions of this Part of this Act relative to disputes regulations of the Insurance Com missioners may apply all or any of the provisions of the Common Law Procedure (Ireland) Act, 1856, with respect to arbitration.

Amendment proposed [14th November]: To leave out paragraph (c).—[Mr. Lloyd George.]

Question, "That the words proposed to be left out stand part of the Clause," put, and negatived.

Mr. LLOYD GEORGE

I beg to move to leave out Sub-sections (5) and (6), and to insert instead thereof the following Subsection:—

(5) The provisions with respect to the appointment of local health committees shall have effect subject to the following modifications, namely:—

The number of members of a local health committee shall be twenty-four, and of that number—

  1. (a) twelve shall be appointed in such manner as may be prescribed by regulations of the Irish 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 394 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 representatives of such members, and where an association of 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,
  2. (b) eight (of whom at least one shall be a member of a local sanitary authority and at least two shall be women) shall be appointed by the council of the county or county borough; and
  3. (c) four (of whom at least two shall be duly qualified medical practitioners) shall be appointed by the Irish Insurance Commissioners;
Provided that the Irish Insurance Commissioners may, where any part of the cost of 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.

Mr. FORSTER

Shall I be in order in offering one or two general observations on this Amendment? They will not take very long.

The CHAIRMAN

It is a question of striking out Sub-sections (5) and (6), and inserting instead thereof the new provisions with regard to the appointment of local health committees. Anything on that point would be in order.

Mr. FORSTER

I wished really to call attention to the position of the deposit contributors, and this seems to me the only place where I can do it. So far as I can see the deposit, contributor comes in the earlier lines of this Amendment.

The CHAIRMAN

The hon. Gentleman can only refer to the deposit contributors on this particular Amendment in so far as he refers to their representation on the health committees. I think that is the only way in which we can go into this matter.

Mr. FORSTER

I think that pretty well covers the point I want to make, which is this: I think we have got to face the possibility, at any rate, of the proportion of the deposit contributors being larger in Ireland than elsewhere. In my judgment the proportion of deposit contributors amongst all the classes of insured persons will be larger there than in other parts of the country. Therefore, I wanted to refer to the difficulty which might arise in getting representation on the local health committees. The reason why I say that in my view there is a possibility of the deposit contributors being more numerous in proportion in Ireland than elsewhere, is this: Supposing there is any strong opposition on the part of the lower members of the community towards the approved societies in Ireland, not to put too fine a point upon it, supposing that the Roman Catholic hierarchy are directly against the approved societies, then it seems to me that those members of the Irish community who give the fullest measure of obedience to the direction of the hierarchy, will not join the societies, but will become deposit contributors. I make no secret of the fact that I speak in the very greatest ignorance of the condition of affairs in Ireland, and I am perfectly unable to say whether or not there is any real danger to the scheme in the suggested hostility on the part of the Roman Catholic hierarchy. Hon. Members sitting below the Gangway told us yesterday very frankly—and they quoted statements in support of what they said, and they were not wholly contradicted by those who did not agree with them—that the Roman Catholic hierarchy are opposed to the establishment of those approved societies.

Mr. LLOYD GEORGE

I have never heard of that. They are opposed to a particular society.

Mr. FORSTER

They are opposed to a particular society. Supposing they could not get that society eliminated or disqualified, and that there was risk that they would carry their opposition further, would there not then be ground for believing that the number of deposit contributors would be larger in proportion? What facilities are offered to the deposit contributors to form associations by means of which they can secure representation on the local health committee? There would be no one among the deposit contributors to take the lead, and the right hon. Gentleman knows how much depends upon the lead which is given in starting an association of any kind. The existing societies have their leaders and their organisations, but to start new associations of new deposit contributors all over the country seems to me to be a very difficult undertaking. Who is going to take the first step? There is nothing in the Bill to say that the first step is to be taken by the local health committee, or whether the Insurance Commissioners are to stir themselves in the matter. It is left entirely to the deposit contributors themselves to take their own initiative. When you remember that, whereas in all probability the deposit contributors may be drawn from scattered districts, the right hon. Gentleman will see how difficult it will be for anyone to undertake the lead in forming associations—which are their only means of obtaining representation upon the local health committee—in connection with the administration of the benefits. The reason for my rising to put the question to the right hon. Gentleman is that the machinery proposed to be created is in order that the deposit contributor may have representation on the local health committee.

Mr. LLOYD GEORGE

I think the hon. Gentleman is arguing on a false assumption altogether with regard to the facts. Last night, no doubt, there were statements made as to the hierarchy and that they were opposed to one particular society, and that that was for a special reason. Whether that is true or not, I do not know, but assuming that it is so, that does not mean that the Roman Catholic bishops are opposed to the formation of other societies. As to the facts in Ireland, I do not pretend to have any special knowledge, but I trust that there will be fewer deposit contributors in Ireland than in this country. I believe it will be found that other societies will be formed, and the more opposed the Roman Catholic hierarchy are to the Ancient Order of Hibernians the greater, I should have thought, would be the incentive to form other societies in opposition. I do not doubt that there will be other societies formed in Ireland. I am sure that if the Irish people find it to their advantage to be in a society rather than to be deposit contributors, that they will join the societies. It is to their advantage undoubtedly to join societies of one kind or another, rather than to be deposit contributors. There is no difference really in Ireland from England, Wales, or Scotland, as to the position of the deposit contributor. There is no doubt there is a difficulty if they are scattered, but that is the difficulty of the deposit contributor. It will be very difficult no doubt to form associations of them. If you get a man amongst them of great organising ability and force of character to gather together these poor remnants and form them into associations, then you will get them. Otherwise, there is a real danger that you cannot have them organised and that they will not get representation on the committees. That is one of the difficulties of the deposit contributor, and that is why we are making the deposit contributor a purely temporary provision rather than a permanent one.

Mr. T. M. HEALY

The right hon. Gentleman has made a very interesting statement, with which I would agree but for one thing. He is thinking of England, where you will have medical benefits in your society, while in Ireland in the society the man would have to pay on the double. What are societies formed for? They are formed largely for the purpose of getting medical benefit and the position in Ireland will now be that you will have to pay into your society to get medical benefit from the society as you get none from the State. You are to pay the State contribution also, so that really the right hon. Gentleman, I must acknowledge, has been forced into making a visionary concession, but he is omitting to take into account the effect of this so-called concession. I am disposed, therefore, while agreeing with the right hon. Gentleman under normal conditions, to agree with the hon. Gentleman on the Front Opposition Bench. You are giving the friendly societies in England an enormous attraction so far as the working man is concerned. You are relieving them of contribution for medical benefits. Why should a man in Ireland join a society if that society is not going to give him what he most expects—I mean medical benefit. You may tell me that he will get other advantages, such as sick benefit and maternity benefit, and so forth, but I respectfully think, although I do not pretend to any special knowledge on the point, that most people join societies for the purpose of getting medical benefit. A great many societies give medical benefit not only for the members but for their wives and children. While I am not disposed to doubt the right hon. Gentleman's statements generally, I think his forecast in this case is extremely unsound.

Mr. MOUNT

I would like to ask, what is the reason of the difference in the com- position of the health committee in Ireland as compared with England? The county councils in England get a representation of one-third and in Ireland two-thirds. I think, if there was any reason why any part of the United Kingdom should have a greater share of representation than another on the health committees it should be in the case of England, partly for the reason which the Chancellor of the Exchequer has mentioned of the difficulty of organising the deposit contributor and in getting his opinions formulated for the committees, and, secondly, because in Ireland no medical benefits are to be given to insured persons. One of the reasons why representation is given to the county councils in the case of England is because there is a possibility, and, I think, a great probability, that certain burdens will be placed on the rates because of the excessive expenditure that will have to fall on the local health committees for medical benefits. That cannot occur in the case of Ireland. I should very much like to know what is the reason why you have got in Ireland a greater proportion of representation of the county councils than in England? The Chancellor of the Exchequer in a Debate we had the other day with regard to the composition of the local health committees, said:— I trust that the 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 triven to them."—[OFFICIAL REPORT, 8th November, 1911, col. 1682.] If that is true with regard to England, it is even more true with regard to Ireland.

The CHIEF SECRETARY for IRELAND (Mr. Birrell)

There is this great difference between Ireland and England and Scotland, that there are already in England and Scotland some five millions of persons in friendly societies and trade unions, whereas in Ireland, although I should be sorry to say what the existing figure is, it is a very small one. Our hopes are that in the future there will be established in Ireland a large number of friendly societies. At present what is called the friendly society feeling does not get its full and free play in Ireland. Consequently it is necessary in the absence of those societies to give the county councils in Ireland a larger share of representation than would be undoubtedly given to them if the position of things had been the same there as in England.

Mr. LARDNER

The view of the hon. Gentleman on the Front Opposition Bench is entirely unfounded. I am a member of a society, a friendly society incorporated under Act of Parliament. It is a non-sectarian society, but the majority of its members are Catholics. On several occasions we have received the approval, not alone of the clergy of the various parishes, but also of the Cardinal and Archbishops and Bishops of Ireland, while many of the clergy are honorary members. No doubt what is operating in the mind of the hon. Member is that, in bygone days, owing to various political exigencies, there were secret, oath-bound societies, which the hierarchy never failed to denounce. Those are not the societies that will have representation on the health committees. The hon. and learned Gentleman the Member for North East, Cork (Mr. T. M. Healy), expressed the view that the very reason why insured persons would not join friendly societies was because there was no medical benefit under the Bill. That is the very reason why they will join, because the friendly societies at the present moment are giving medical benefits, not alone to the insured persons but to their wives and families for a smaller contribution than the Bill provides here per individual, so that, as circumstances are at present, assuming that the Bill was passed, not alone is it not likely that the Irish people will be such fools as to remain as deposit contributors, but there is an inducement owing to the absence of medical benefits to go into the societies, and as quickly as they can.

Mr. MOUNT

I should have thought that the arguments of the Chief Secretary were in favour of greater representation for insured persons in Ireland rather than for uninsured persons.

Mr. MAURICE HEALY

So far as I can make out, the representation of the county councils in England is to be one-third, and it is to be the same in Ireland.

Mr. MOUNT

It is not a third in England.

Mr. MAURICE HEALY

The original Clause provided that a third should be elected by the members of the county council. The amended Clause provides that two-thirds shall be elected in a particular manner, and that one-half of that two-thirds, which, I take it, is one-third, shall be elected by the county council.

Mr. MOUNT

It is not two-thirds of the whole number, but of the number appointed under Sub-section (2).

Mr. MAURICE HEALY

Of the remaining members of the committee one-third is to be appointed in England. The criticism I would make on this Clause is as to the number of persons selected by the county council who are members of local sanitary authorities. The original Clause provided that of the one-third selected by the county council that they should consist wholly or partly of members of the local sanitary authority. The amended Clause provides that the local sanitary authority is to get substantial representation. In Ireland the one-third of the local health committee, which is to be selected by the county council, need only contain one member of a local sanitary authority. I understand that the function of these health committees is to exercise a kind of general supervision over the sanitary work of the local bodies to see that the local sanitary authority does its duty in sanitary matters. If it neglects its duty in carrying out sanitary work or in looking after sanitation or seeing that the dwellings of the people are kept in a sanitary condition, the local health committee have in such a case jurisdiction. To some extent it may call for a levy on the rates if disease follows through neglect by the sanitary authorities of their duties in that respect. That being so, it appears to me that the English precedent has been partly followed in giving the local sanitary authorities larger representation on the public health committee. In Ireland, and I suppose in England, the county councils have never anything to do with sanitary work. They do not enforce the sanitary laws. When you come to deal with a county borough it is different, because the council is both county council for the borough and sanitary authority. My complaint is that that has no application to my own Constituency, because the county council for the borough is the sanitary authority. Take the case of the great county of Cork. There are plenty of local sanitary authorities in that county—the urban sanitary authority of Queenstown, and so on. To give these bodies only one representative on the local health committees is to deal with them rather unfairly. In the first place it would be an ambiguous distinction to make. For one body of the local authority in a county to have representation on a local health committee and none of the others, would set up rivalry and complaints of unfair treatment. The object of giving these local sanitary authorities any representation on the local health committee is to enable their voices to be heard and to enable them to defend themselves. I confess that if I had the framing of this Clause I would not at all quarrel with making the county council the selecting body, but I would be disposed to say that the representatives selected by the county council should be drawn in a much larger proportion from the local sanitary authorities than is proposed.

Mr. O'SHEE

Probably 800,000 persons will be insured under this Bill in Ireland. At the present time there are certainly not 100,000 persons in benefit societies in Ireland. There are only 20,000 or thereabouts members of the Ancient Order of Hibernians in the benefit section of that society, and probably there are only 20,000 more in the Foresters. Ireland, practically speaking, is unorganised as regards the vast majority of the persons who could be insured under this Bill. It is most desirable that at the beginning of this system of insurance men of affairs, such as representatives of the county councils, should have at least one-third of the entire membership of the local health committees. County councils are entitled to appoint eight. At least one of those shall be a member of the local sanitary authority, and at least two shall be women. May I point out that the county councils include the chairmen of every rural district in that county, and the rural district council is the sanitary authority in the rural district. Therefore we should have the chairman of every rural district council members of the county council by reason of their office. The county council can select from the chairmen of the rural district councils in the county their representatives on those committees, and they can also select women. Women are in increasing numbers becoming members of rural sanitary authorities. Therefore the sanitary authorities in Ireland can have a full and fair representation on these committees. It is not desirable that the sanitary authorities should have any large representation on these health committees, one of the principal objects for which they are set up being to supervise and stir up the sanitary authorities themselves. The proposal that insured persons should have half the entire number on these committees is a reasonable and fair proposal. Very few people in Ireland out of the vast number who will be insured under this Bill will have any experience of benefit societies and their work.

Amendment agreed to.

Mr. LLOYD GEORGE

I beg to move to leave out Sub-section (7), and to insert instead thereof the following words, (7) An insured person in Ireland shall not be entitled to medical benefit under this Part of this Act, and the provisions with respect to medical benefit shall not apply;

Provided that medical benefit for an insured person being a member of an approved society shall be deemed to be included amongst the additional benefits specified in Part II. of the Fourth Schedule to this Act;

(8) As respects employed contributors in Ireland, the employed rate shall be the rate specified in Part II. of the Second Schedule to this Act, and the contributions by the contributors and contributions by the employers shall be at the rates specified in Part II. instead of the rates specified in Part I. of that Schedule, and there shall be credited to the society of which any employed contributor in Ireland is a member or, if he is a deposit contributor, to his account in the Post Office fund, the difference between the amount of contributions actually paid by or in respect of him at the rate specified in Part II. of the Second Schedule to this Act and the amount which would have been paid if those contributions had been at the rate specified in Part I. of that Schedule, and the amount of that difference shall be treated as having been expended on benefits and the proper proportion thereof shall accordingly be paid out of moneys provided by Parliament;

(9) The foregoing provisions of this Section as to the crediting of differences shall apply in the case of voluntary contributors in Ireland, with the modification that where the voluntary rate is not the same as the employed rate the difference to be credited shall be the difference between the amount of contributions actually paid at the voluntary rate and the amount which would have been paid if the contributor had been a voluntary contributor in Great Britain;

Provided that in the case of a married woman in Ireland becoming a voluntary contributor at reduced rates of benefit under the special provisions with respect to married women, the rate of contributions payable by her shall be one penny halfpenny a week instead of three pence a week, and the difference to be credited shall be one penny halfpenny a week accordingly;

(10) In estimating for the purpose of valuation the liabilities of an approved society having members in Ireland who are insured persons, and in ascertaining the voluntary rate applicable to voluntary contributors in Ireland in cases where that rate is not the same as the employed rate, regard shall be had both to the provisions of this Section as to the crediting of differences and to the proportion of benefits to be paid out of the contributions payable by or in respect of such members or contributors;

(11) Rules of an approved society or local health committee under this Part of this Act may provide for the inspection of medical relief registers by officers of the society or committee at all reasonable times and for the furnishing to the society or committee of such medical certificates as may be necessary for the purposes of the administration of the benefits administered by the society or committee and for the payment by the society or committee to duly qualified medical practitioners of such remuneration in respect of the furnishing of those certificates as the Irish Insurance Commissioners may sanction and all payments so made by the society or committee shall be treated as expenses of administering the benefits aforesaid.

5.0 P.M.

Mr. MAURICE HEALY

May I have an explanation from the Chancellor of the Exchequer as to the finance of this Amendment? I think I am correct in saying that this is the third form the Amendment has taken since it was drafted. I would like to get from the right hon. Gentleman some explanation as to how the provision works out. I may be grossly wrong, but it is all, I understand, for the purpose of enabling the original computation of two-ninths still to stand, and to enable a society or a deposit contributor to claim two-ninths as being the original figure instead of paying a reduced contribution. If I am right in so considering this, it is a very complicated and unnecessary machinery to achieve a simple result. At any rate, I shall be glad of the assurance that my reading of the Clause is correct. I do not understand why the original framing of it did not contain these important words now proposed: "and the proper portion thereof shall accordingly be paid out of moneys provided by Parliament." It appears to me that these words were absolutely necessary to keep up the State contribution at its original figure.

Mr. LLOYD GEORGE

The hon. and learned Gentleman has stated so fairly and so clearly the case that I have little to add. This is the nature of the operation. It would be all very simple if you were dealing with persons entering at the age of sixteen. There is a deficiency credited owing to the fact that the ages have been equalised. Therefore we put it in the form of two-ninths in regard to England and Wales, and in this form so far as Ireland is concerned. If you put two-ninths here in this Amendment, Ireland would get less. In order to give Ireland her 2d. we have got to put it in this form. Each individual contributor must be treated as if he were paying the same amount as we pay in England so far as the State is concerned; but only so far as the State contribution is concerned. The matter is complicated. The words have been put in, it being discovered that they were necessary, as the only way in which we can carry out the intentions of the Government, and so make it perfectly clear that Ireland shall get exactly the same State contribution as England, Scotland, and Wales, in spite of the fact that her own contribution is less. We have got the same operation, more or less, in the case of the agricultural labourers in this country, where the contribution is reduced.

Mr. FORSTER

I sympathise with the hon. and learned Member who has raised the point. I am not in the least surprised at his difficulty in interpreting the meaning of the Amendment. I confess I found it extremely difficult in following the various suggestions contained in it. It took me a considerable time before I was able to discover what was the effect of treating a reduction of contribution as a benefit. That is a thing that really restores to the contributor the full value of the State contribution. The hon. and learned Gentleman was perfectly right when he said that it is crediting the society with a fictitious sum which it does not actually receive, and you debit it with a benefit which it is not actually paying. That describes the operation quite accurately. The hon. and learned Gentleman read out the words of the Clause to which he attributed the receipt of the State contribution in full. It is only that we are going to treat a reduction of contribution as a benefit in respect of a benefit which the society actually receives in cash from the State the proportion of the amount which the State ought to pay. So far as I can see this does actually raise the State contribution to 2d. in the case of the younger members of societies.

I do not know whether I will be in order to say a few words about the proposal of the Chancellor which is contained in the opening lines of the Amendment. I think it ought to be amended. I refer to the elimination of the medical benefit altogether from the scale of ordinary benefits which the Bill proposes. As I understand the matter, you take out the medical benefit here because there is throughout Ireland a network of dispensaries from which all the poorer members of the community can get medical treatment. I have talked the matter over with Irishmen, and it seems to me that some people take the view that that medical administration suffers from the taint of pauperism. People who take these medical benefits and get their doctoring and free drugs at the cost of the rates are branded, it is said, with the taint of pauperism. On the other hand, some say that this is not so; that people do not think any the worse of their neighbours in Ireland because those who are poor go to these dispensaries. There is not, in a word, the same feeling against these things as there would be in England. I have always been very anxious to keep the question of pauperism, and so forth, wholly out of our scheme of insurance. If I were left to my own free will I am not at all sure I should not stick to the medical benefit provided under the Bill, and not keep it out as the right hon. Gentleman has done. He says that he has acted in concert with those who claim to represent very largely the poorer members of the community. If they are able to assure us that this risk of the taint of pauperism is not so widespread as it would be in this country under similar circumstances, then perhaps the experiment is worth trying.

I should like someone who speaks with authority from the opposite benches to tell me whether or not there are some people amongst the poorer members of the community who will, when this Bill becomes law, refuse to avail themselves of the dispensary treatment which is now open to them. If there is any danger of that, then I am not sure that we ought not to give an option to them—if one can be given—either to pay their full contributions and get full benefit under the Bill, or at their own option to make payment on the lower scale of contribution and take their medical benefits at the hands of the community. This is a point that ought to be considered, and I do not think that we ought to lay down hard and fast terms in respect of it. The right hon. Gentleman will say that this medical treatment may be given by way of additional benefits. They may be given after the expiration of three years after there has been a valuation and if the funds of the society show a sufficient surplus to enable that to be done. But the poor deposit contributor, who is always presenting his hard case to my mind, has no opportunity of getting any additional benefits at all. The deposit contributor, under this Bill as amended will have to make up his mind either to take his doctor and drugs at the cost of the rates, or else pay for them out of his own pocket.

The right hon. Gentleman told us yesterday that the success of this scheme in Ireland would depend on its administration. I agree. I believe that the societies in Ireland will take a most careful and scrupulous care in administration; only they are saddled with the burden, and I am not sure how heavy a burden it is, but it is this: Medical benefit is given at the cost of the rates. Sickness benefits come out of the funds of the society, with the aid of the contribution of the State. Sickness benefit is only payable on the certificate of a doctor. In England the certificate will of course be given by the doctor who attends the patient. There will be no charge, as I apprehend. The certificate will be included in the cost of medical benefit. But, if I understand the matter aright, in Ireland the doctor who attends the patient is not necessarily the doctor who will give the society the certificate. If I read the Amendment aright the society will be able to employ doctors of its own, and to grant a certificate for the payment of sick pay. Is the cost of paying for that certificate to be paid out of the administration charges of the society? I do not know whether it is going to be a heavy burden or not, whether it is to be 6d. or 1s. or what. It is going to constitute a charge which the societies will have to bear, not as far as the expense of medical benefits are concerned, but as part of the Irish administration, and that is a charge which the Scotch societies will not have to bear.

I am a little anxious about the administration of this scheme in Ireland, because, as hon. Members from Ireland have told us, the friendly society movement has covered very little ground there, and comparatively speaking, there are very few men in Ireland who have any experience of friendly society work. I do not envy the task they will have to undertake when they create approved societies and are saddled with the responsibility of carrying out this scheme. We all know, and are rather glad to admit, that the Irishman is generally speaking, a very able man, but I do not think he is ever abundantly distinguished for strict economy. Strict and ruthless economy will be essential if the funds of the Irish societies are to remain solvent. The Chancellor of the Exchequer told us that the creation of a body of Insurance Commissioners in Scotland necessarily meant the establishment of a purely Scottish fund. The same thing occurs for Ireland. The establishment of Insurance Commissioners for Ireland necessarily involves the creation of a separate fund for Irish insurance. I confess I am not very happy about the prospects of the Irish fund. I am not going into the matter at any length, but I wish to suggest one or two lines of thought that I should like the Committee to have before them. I have had a conversation with an eminent Irish actuary about the question whether it would be easy to find an actuarial basis upon which to build up an Irish contribution and an Irish fund, and he said it was more difficult in Ireland than in England. He told me he had to examine the tables of some societies and to look through their accounts, and he found that in the case of Ireland it was necessary to add cent. per cent. to the Irish tables on account of the higher rates of sickness, not because the Irishman was more unhealthy or suffered from more sickness than the Englishman, but because there was always a difficulty that seemed insuperable of ascertaining with precision the age of an Irishman.

That difficulty has not been unknown in the case of old age pensions. In this case, I think there is the danger of the Irishman taking part in that process of rejuvenation which lies so close to the heart of the Chancellor of the Exchequer, and that might easily constitute a danger to the fund. That danger cannot be left out of account when considering whether or not the fund for Ireland is going to start on a solvent basis. Of course, in Ireland, in the case of the younger men the same difficulty does not exist in ascertaining ages. There is a registrar of births and so on, as there is in England. You can prove the ages of the younger men in Ireland as easily as in England or Scotland, but in the case of the men in middle life who come into the scheme for the first time if they have an opportunity of rating their age five years too low that may very well have the effect of making every fund in Ireland insolvent.

Mr. DILLON

Similar statements were made with regard to old age pensions.

Mr. FORSTER

Yes, but the fact here is far more serious than in the case of old age pensions. In the case of old age pensions it was a question of whether a man was seventy or not. If he was seventy he got his pension, and if not, he did not get it. Every man interested in this scheme in Ireland will have to see that these things are put upon a fairly sound basis. There is the further point of the doctor who treats a patient being wholly independent of the society that administers the sick pay. Of course, everybody knows the warm and generous instincts of the medical profession. The Irish race and everybody who had a chance would feel the temptation of saying to a man who thought himself sick he might have the benefit of the doubt, and would recommend that at any rate he should get such treatment as would enable him to draw-sick pay from his society. Unless the societies are able to exercise the most rigid supervision over cases of sickness for which they have to pay there will be thrown upon their funds a burden they will not be able to stand, and some means should be found to give the friendly societies power, either by employing doctors of their own, or by visiting the man who is sick, for the purpose of ascertaining for themselves whether or not he is fairly entitled to sick benefit before it is paid.

These are the reasons which prompt me to think that the outlook for the Irish fund is not so rosy as I should like to see it. Of course, there is the argument which tells in the other direction. It may be said, "granted that you are right, at any rate there is a margin which would protect the fund from any dangers such as you foresee," and it may also be said that the general wages of agricultural labourers in Ireland are so low that the benefits the funds would have to bear would not be the full benefit of 10s., which would have, to be paid to more highly paid labourers in England, and that as the average wage of agricultural labourers in Ireland is little over 11s. a, week, it is more than likely in a very large number of cases the full benefit would not be paid and on that account the funds would gain some credit. That is an argument which would console me from the point of view of finance, but it does not console me when I inquire whether a man is to get full value for the contribution he pays. The contribution he pays is a contribution that will provide for full payment of 10s. a week in case of sickness, and it will be no consolation to the Irish labourer to know he must pay full contribution, but will get no more than 8s. or 9s. a week benefit when he falls sick.

There is one further source from which the Irish fund will derive contribution free of charge. Under the Amendment we are told that the migratory labourer who is not an employed person in Ireland, tout comes over to Great Britain to take part in harvesting operations and so forth, has to take back with him as credit to the Irish fund all contributions his British employer has provided, while he was employed in Great Britain. That is very desirable from the point of view of the Irish fund, but will it commend itself to the British employer? This labourer is not an employed person in Ireland; he is an independent man in Ireland; he comes over to work in this country, and simply because he is employed here his British employer has to put the stamps into his book. These stamps are going to confer no benefit upon that man; when he goes back to Ireland he is going to derive no benefit from the Irish fund. That means an extra from the British employer that may well prevent him employing Irishmen in that task. I think that we in Great Britain will make a very strong endeavour to get any money contributed by British farmers reserved to the credit of the British fund, and not reserved to the credit of the Irish fund. One other point, and that is in connection with the remarks which fell from the Chancellor of the Exchequer yesterday, when he said that Ireland would derive the full benefit of every sixpence contributed under this insurance scheme, and that every penny would be spent in Ireland. They will up to a certain point, tout we were reminded yesterday of the man who leaves Ireland and comes to Glasgow or some other place and becomes an employed contributor in Great Britain. He has to change his insurance from the Irish to the British fund, and in respect of him there is to be paid the transfer value, and this time it is not a probable transfer value, but the full rate of contribution toy the man himself and the full benefits. That may throw an additional burden upon the Irish fund. Hon. Members who have followed the Debate on the financial part of this Bill will remember that the transfer value stands at a higher figure than the reserve value. The transfer value will have to be made good out of the Irish fund, because I cannot see any other fund from which the money can be drawn. I have said this because I do not feel entirely happy at the prospect of the solvency of these Irish funds. The administration is bound to be put into the hands of men who are not experienced in these matters, and I am afraid lest they should take a more charitable view of their duties than they would take if they had had more practice in similar institutions which had to stand wholly and entirely on their own bottom. I confess that the Debate of yesterday augurs ill for the success of this scheme in Ireland. Yesterday we saw how largely personal matters enter into proceedings which ought to have no party bias, or personal bias of any sort or kind. Unless hon. Members belonging to all parties in Ireland are going to combine in an endeavour to carry out purely for the good of the general community this Bill, they will not succeed, and if they bring disaster by allowing their own personal, bitter differences to prevent this Act toeing carried to a successful issue, then they, and they alone, will have to bear the blame.

Mr. DILLON

I wish to say a few words on the question of medical benefits, but before I come to that particular subject I wish to allude to one or two points made by the right hon. Gentleman who has just sat down. With regard to the case of the migratory labourers to England—and I have 8,000 of them in my Constituency—I wish to explain to the hon. Member for Sevenoaks (Mr. Forster) that it is a matter of absolute indifference to us whether the English farmer has to pay the Irish labourers' contributions or not. That has got to be settled by the representatives of the English farmers, and it is a matter for the English people to consider themselves. If they do pay those contributions, clearly it is manifestly just that the contributions should follow the labourers. Any contribution by the State or the employers really goes to the labourer, whether he resides in England, Scotland, or Ireland.

Mr. FORSTER

I have given the hon. Member a false impression. The labourer will not have to pay anything, because he will have an exemption. This money will only be paid by the British employer, and it cannot confer any benefit upon the labourer.

Mr. DILLON

It would confer a benefit on the man, because he might become a voluntary insurer. In the future, when the benefits of this Insurance Bill come to be understood, a great many of these men will become voluntary insurers. Whenever the migratory labourer decides to become an insured person all these contributions will be carried to his credit. We do not urge that the English farmer should pay the contributions of the Irish labourers, because it is for them to judge in the matter, but I must point out that the English farmer is not conferring a benefit on the Irish labourer by employing him. For years and years I have been intimately connected with these men, and I know there is a competition amongst English farmers to get their labour. They are exceedingly valuable labourers, and the English farmers are competing for this labour. The Irish labourer has this peculiar value, that his labour is always available when you want him at times of great pressure, and when it is no longer wanted it is cleared away, and the men return to their own homes and give no trouble to anyone, and they are ready to return again to this country when the pressure arises here for their work. Therefore it is not a question of a favour to these men to employ them. I may mention that many hon. Members of this House have come to me on more than one occasion and have asked me to put them in communication with the local labourers in Mayo, so that they may be able to get some of those labourers from my district. These men are sought for, and I really do not think that the hon. Member need trouble his mind upon that score. If any hon. Member chooses to move that the English employer should be exempted from all charge in respect of these casual labourers, we are not disposed to oppose it.

Hon. Members have expressed commiseration for the large section of the Irish people who will be in the position of Post Office contributors, and the hon. Member said he was afraid that would have a strong tendency to make this Act a failure in Ireland. I do not share that alarm. I think that one of the greatest benefits to be conferred upon the Irish people by the working of this Act is that the system which is so prevalent in this country, and which is much less prevalent in Ireland, of the labouring people being banded together in benefit societies, will enormously spread in Ireland, and I believe great masses of people in the various districts in Ireland where these societies have not hitherto been formed, when they realise that up to the present the machinery of these societies has not been understood—the Irish are very quick to take up anything new—when they see how much better off that section of the working people are who have enrolled in these societies, you will find those societies springing up all over Ireland like mushrooms. I think this Bill will confer a very great benefit on the Irish workers altogether outside the money benefits of the Act. It will induce them to form these societies, and on that point I Jo not think the right hon. Gentleman the Member for Sevenoaks, need be troubled. The right hon. Gentleman mentioned his great anxiety because the Irish people are not distinguished for strict economy, and I know it used to be generally accepted as one of the characteristics of the Irish people that they were very free with their money. I heard the same warning addressed to this House when the Local Government Act was passed. I remember that we were told that the great danger was that extravagance would become rampant and that the taxpayers and the ratepayers would become bankrupt. What has been the result of the operation of the Local Government Act in Ireland during the last sixteen years? If the right hon. Gentleman will consult the annual reports which have been issued on this subject, he will find that they bear overwhelming testimony to the economy and good administration of Irish local bodies.

Mr. W. MOORE

The rates have gone up.

Mr. DILLON

At any rate in my district the rates have been reduced. I know that in some of the rural districts the rates have been increased by expenses put upon them by Parliament for the cost of extra police, but this has not been a voluntary charge. The Local Government Act in Ireland has proved that by throwing responsibility upon the people, you always have a tendency towards economy. If people have no sense of responsibility and their economy does not relieve their own pockets, you will never find people economical. The one way to practice economy is to bring home to the people and to those who represent them, their responsibility and the effects of extravagance. It is a very curious thing that throughout these discussions, both on the Scotch night and on the two days given to the Irish Clause, the Chancellor of the Exchequer has been over and over again attacked for yielding to opinion. Really this is a most extraordinary charge. I have been in this House for a great many years, and I have been continually hearing English Ministers abused and attacked because they would not give way to public opinion. Now the Chancellor of the Exchequer has given way to Irish opinion on a great many points, and amongst others he has given way upon this question of medical benefits. So far as I am personally concerned, I agree with the right hon. Gentleman, and I would rather see the medical benefits left untouched. If I had had my own way I would have left the Bill as regards contributions and medical benefits untouched, but we have to give way to Irish opinion, and I have yielded to it. We took the greatest possible care to ascertain what, was the popular opinion in Ireland. We have heard a good deal about the pauper taint and the grievance inflicted upon Ireland by the omission of medical benefits.

When this Bill was introduced we were assailed in many parts of Ireland by the very men who are now lamenting the loss of the medical benefits, and we were attacked for giving medical benefits which they said they had got already all over the country. That argument emanated from the critics of the Bill, and they asked why the Irish people were to pay twice over for the same thing. We were told that they had medical benefits, dispensaries, and doctors, and I was greatly amused to hear at meeting after meeting, and on platform after platform, the most extravagant eulogy of the magnificent dispensary system we have got in Ireland. Really, to hear some of the speeches one would wonder that anyone ever paid for any doctor at all in Ireland. Now, because we have yielded to this strong expression of popular opinion, now that we have asked the Government to reduce the Irish contributions and drop the benefits out of the Bill, the very men who called upon us to do that say, "What good is this Bill. You are leaving the pauper taint and you are giving up the only good thing that was in it." That is the kind of criticism we have had to face. As regards medical benefit, there is no doubt that there is a system of medical relief in Ireland which is more or less efficient. During the recent conference it has been preposterously praised, and I have also heard it unjustly abused. It largely depends upon the medical officer. I have known districts in Ireland where there was a conscientious, devoted, and enthusiastic medical officer, where the poorest of the poor got every kind of attendance, and, on the other hand, I have known other districts where the most disgraceful neglect took place. It all depends upon the man, and there is no machinery of the law which can secure, under the present Poor Law system, good medical attendance, because there is no power to force the doctor to do his duty if he does not do it upon his own initiative. I must say that I think their salaries are entirely too small. Therefore, so far as I am concerned, it was with the deepest and most profound regret I saw the medical benefits dropped out of this Bill, but I do not yet despair on this question of the medical benefits. I think a great revulsion of opinion has taken place, and that in many districts, where three or four months ago a loud clamour existed, created by misrepresentations and abuse of this Bill, those who were in favour of dropping out the medical benefits are now anxious to get them back again.

We, as well as the Chancellor of the Exchequer, have had strong representations made to us mainly from the great centres of industry in Ireland, from Belfast, Dublin, Cork, and other towns, begging us to reinstate the medical benefits. We cannot reinstate them without raising the contributions. It is all very fine, but you cannot expect the Chancellor of the Exchequer to give us large benefits in Ireland with reduced contributions and to leave the higher contributions in this country. We cannot, therefore, get back the (medical benefits without raising the contributions, and I doubt very much whether Irish opinion would tolerate that at the present moment; but, so far as I am concerned, I look forward with hope to an early day when popular opinion in Ireland will demand restoration of the medical benefits. There are such things as amended Bills, and, if popular opinion in Ireland should demand it, it would be easy to reinstate the medical benefits in an amended Bill suited to Ireland. I looked upon the medical benefits as one of the greatest advantages of the Bill, because I think they laid the foundations for the complete abolition of the whole system of pauper medical relief. We have sat here silent for weeks listening to criticisms of the details of this Bill from above the Gangway on this side of the House and from below and above the Gangway on the opposite side of the House. Those criticisms were sometimes helpful, but sometimes they were far from helpful, and I think far from fair. I have gradually come to form the view that, if these critics were listened to, the day of any measure of insurance would never come. Does any man for a moment suppose that human ingenuity could devise an Insurance Bill which would be watertight against criticisms in detail from any quarter of the House? An Insurance Bill is a most complicated measure. The Insurance Bill in Germany, so far as I know, is contained in two volumes.

I am reminded by the criticisms made upon this Bill of the long experience we had on the Old Age Pensions question. We had five or six Commissions, we had endless discussions, we had Motions, we had promises, and finally the Government made up their minds to come down and pass the Bill. Although everybody in this House declared on their word of honour they were in favour of the principle of the Bill, still it was met with a storm of criticism and with every possible attempt to defeat it. It is the same thing with the Insurance Bill. I would like to know, if the Chancellor of the Exchequer had not had the courage to come forward and propose the Bill, how long this House and the country would have had to wait, if it had waited, until it could get a measure which could not be criticised. Therefore, I think we in Ireland, as well as English Members, have very reason to thank the Chancellor of the Exchequer for taking his courage in both hands and bringing forward a Bill and giving us an opportunity of criticising it. I have no hesitation in saying I am sorry we have had to leave out the medical benefits, although I recognise Irish public opinion renders that necessary. The hon. Member below me laughs at that, but he wants to laugh the whole Bill out and have no benefits of any kind. Hon. Members talk about pauper benefits, but, supposing the Bill is defeated, what becomes of the pauper taint; then? We have every reason to be grateful to the Chancellor of the Exchequer for offering us an opportunity of criticising this Bill and getting some kind of Bill, and I, for my part, sincerely hope the day is close at hand when Irish opinion will be so altered that we can restore the medical benefits to Ireland.

Mr. BIRRELL

A desire has been expressed that somebody who could speak with some authority should say a word or two about the existing medical system in Ireland, because, having regard to the Amendments before us, insured persons in Ireland will not be entitled to medical benefits under this Act. Consequently, we have to consider what provision is made at present for the class of persons who will be largely insured persons under the provisions of this Act. I think it is rather important the Committee should understand what the dispensary system is, how much it costs, and how it works. I find there are in Ireland 810 doctors who are retained under the Medical Charities Act for the purpose of affording free medical attendance and relief to the poorer classes in Ireland. There is no definition in the Act of a poor person, and it is generally interpreted, I think, to mean any person who cannot afford to pay a doctor's fee. Doctors' fees in Ireland are not very low, but the Irish people, on the other hand, have a kindly feeling towards doctors, and I think respond far more generously to their demands than corresponding persons in equally good circumstances do in England.

The average income of each of these doctors—that is to say, the fee he gets—for attending persons who have either a red or a black ticket, either at the dispensary or at the patients' homes, they also being provided free with medicines and surgical appliances, may be said to be between £160 and £170 a year. That probably includes £20 which he obtains as medical officer. You have these doctors attending all the persons in their very large dioceses or domains who obtain these tickets and they receive that attendance free. They do not devote their entire time to the work. They are not required by their contracts of service to devote their entire time to attendance upon the poor. They are free to have a private practice, and many of them succeed in getting a very considerable private practice. These dispensary doctors in the majority of cases are amongst the most devoted members of society. Their kindness is remarkable, considering the circumstances in which they live, the very long distances they have to travel through tempestuous weather—they are not all supplied with motor cars—and I am bound to say their duties have been very much increased by the Old Age Pensions Act. If an old age pensioner at 5s. a week begins to cough in the middle of the night so much anxiety is displayed by his family that the doctor is dragged out of his home and brought ten or twelve miles to prolong the life of this eligible member of the family. I am not joking. That has perceptibly increased the labours of this estimable body of men.

There is great competition for these posts, and I am bound to say, although I have set my face against it as much as I could, so eager are the doctors to get these positions that they very often expend, no doubt in perfectly legitimate canvassing, amongst all persons who have any chance of saying a good word for them as much as I think would acquire for them a small practice in England. There is, however, no feeling in Ireland that this system is declining or dying. On the contrary, the number of cases treated increases every year, although the population does not increase. The number of cases treated at the dispensaries and at the patients' homes runs into very large figures. Last year 479,644 were attended at the dispensaries and 163,115 at the patients' own homes. Those are large figures. I see on the average twelve cases per week are treated at the dispensaries and four cases per week at the patients' homes. You ask how is the cost of this system of dispensary relief provided. It is provided about equally from the Local Taxation Fund and the Poor Rate. The cost last year was £193,153, and that cost, as I say, was divided between the Local Taxation or Imperial Fund and the Poor Rate. Of this £118,793 is paid as salaries to permanent and temporary medical officers, £17,833 to midwivas, £18,399 for medicines, £8,000 to doctors for vaccination fees, and the balance is made up by compounders and caretakers. I can assure you the utmost care is taken in the matter of the quality of the medicines, far greater care than in any other portion of the United Kingdom. The contracts are carefully examined by the Local Government Board, and I think the Irish poor person who receives treatment at the hands of a dispensary doctor probably gets better medicine and almost as good surgical appliances as the wealthiest people in other parts of His Majesty's dominions.

With regard to what is called the pauper taint, of course I need scarcely say that obtaining this relief carries with it no disfranchisement of any kind or description. The person who gets his red or black ticket, and who has medical relief for it, either at his own house or at the dispensary, remains an elector, possessed of any measure of freedom any of us electors enjoy. Therefore, what is meant in England by the taint of pauperism does not apply. When we speak in England about the taint of pauperism attaching to outdoor relief we mean that the right of citizenship of the person is destroyed. That is not so in Ireland. The tickets are obtained of the guardians or of the relieving officers, and that, no doubt, is a circumstance which calls to the mind of the person that he is not paying his own way. I agree that is true, but I do not think it is fair to say the taint of pauperism in any way attaches to the use of these tickets. I quite share the view of the hon. Member for East Mayo (Mr. John Dillon), and I regret personally that the medical benefits have been struck out of the Bill. I think public opinion in Ireland has already veered round somewhat on that question, and I am hopeful that as time goes on the dispensary system may be revised, reinforced, and strengthened, and the salaries of these doctors, whom I greatly admire, largely increased by their being able to come in under the Act and the benefits of the Act by some reasonable provision.

6.0 P.M.

I hope it may be possible to include in the Act some reasonable provision whereby a fee may be fixed, not only for the treatment of the insured person but of his family as well, and that we may be able to supplement an admirable system of which I think Ireland may fairly be proud. Irish doctors play a great part in Irish society and in Irish life, and, although there are black sheep in all professions, and occasionally a doctor is in a position, owing to the nature of his work, to show inhumanity and hard-heartedness which perhaps no other professions have any opportunity of exhibiting, they are as kind-hearted a class of men as can be found anywhere. As a rule, I may say, they are decent and kind-hearted men, and no one can suggest that £166 to £170 per year on the average is a big fee for the large amount of work that they do, both in the dispensary and in the home. Ireland has a good system of dispensary doctors, and the cost, £193,153, is divided between Imperial taxation and the rates.

Mr. T. M. HEALY

Not now.

Mr. BIRRELL

That is, at all events, the scheme upon which we proceed, that the charge should be equally divided, and in the same way it applies equally to medicine and to medical appliances. I can only say I think the opinion which obtains in Ireland necessitate this Amendment, and I think the arrangement will work very well. At the same time, I do not wish to disguise from the Committee the fact that ere long an arrangement will be made of the kind I have already indicated, whereby larger salaries will be secured for these men and greater benefits conferred not only upon insured persons, but upon all the members of their families. Hon. Gentlemen opposite asked me to say how the particular scheme would work. I reply, that it is a workable scheme, which can work without inflicting upon any person any taint of pauperism.

Sir J. LONSDALE

With regard to the issue of certificates by the dispensary doctor, is it proposed to give him an additional remuneration for the additional work that will be entailed?

Mr. BIRRELL

It is necessary to get a medical certificate in order to secure, for a member of an approved society the benefit of the Act—in other words, to show that they are sick—and that certificate will of course have to be paid for.

Sir J. LONSDALE

By whom?

Mr. BIRRELL

That will be treated as "expenses for administering the benefits."

Sir J. LONSDALE

But suppose the certificate is issued by the dispensary doctor? There are many parts of Ireland at which there is no surgery but that of the dispensary doctor.

Mr. BIRRELL

The dispensary doctor will be entitled to the same fee as any other doctor.

Dr. ADDISON

I think, after the defence made by the Chief Secretary and by the hon. Member for East Mayo, it would be well to press this question a little further. After all it was a very halfhearted defence of this Amendment to say that it rests practically on public opinion, and to suggest that Ireland is not ripe for the inclusion of medical benefits in the Bill. We do sometimes legislate, I hope, a little in advance of public opinion, and we can consider this matter apart from the existing state of public opinion; we can look at it on its merits as it affects the usefulness of this scheme. Under the present system the dispensary doctors attend practically the working-class population in country districts. There are certain features of this practice I should like to have considered for a moment. Who does the dispensary doctor attend? He attends an individual who receives a ticket entitling him to that attendance. Who gives the ticket? The ticket may be given by the relieving officer, by any member of the board of guardians, or by someone elected by the guardians to issue it. The ability of the person to pay or otherwise is not specially gone into. The ticket is issued on the responsibility of the individual entrusted with the duty of issuing it, and the doctor has to attend the person presenting it at the earliest possible moment. Under this Bill an insured person as such has no right to the receipt of a ticket entitling him to medical attendance, and he will be unable to get such attendance unless he presents a medical certificate.

It is suggested that there will be a certain amount of the increased work in respect of the signing of the certificate, but, as far as I can understand it, the idea underlying the exclusion of medical benefit comes down to this: that the Poor Law guardians are at the present time paying a salary for the attendance of people in their area, and, therefore, the contention is that the doctors will be paid twice over for attending the same individual. Surely this is no objection to the inclusion of medical benefits in this Bill; it is only a matter of administration. Some people think they may gain an apparent advantage from the fact that the contribution is 1½d. less than it otherwise would be. In certain districts the dispensary system has been a success, and no doubt the right hon. Gentleman has spoken quite fairly on that point. The hon. Member for Mayo said it depended mainly on the amount of work done by the doctor, but the fact remains that it has not been a success. An Irish practitioner told me yesterday that his salary was £110 a year, and that he had a district extending eight miles in one direction and six miles in the other.

Mr. T. M. HEALY

In what county was that?

Dr. ADDISON

I do not propose to mention names, but I would like to point out in connection with this, that if one examines the return of deaths it will be found that many cases are entered in which the cause of death is uncertified. In certain districts very nearly a quarter of the deaths are registered in that way. And why? Simply because the deceased had not been attended by someone who had sufficient knowledge to be able to state what was the actual cause of death. We do not want to perpetuate this system under which so large a section of the population are without proper medical attendance in their last days. It is not a (matter which commends itself to this House. It is not a system which we desire to be perpetuated.

Let me take the question of tuberculosis. In 1855 the deaths from tuberculosis in Ireland numbered 2,500 per million. In England and Wales at the same time they were 3,300 per million. We have had fifty-five years' sanitary service since then, and what is the result? In England and Wales the percentage has fallen to 1,600. In Ireland it has fallen to to 2,400—a negligible decline. At the same time the death rate in England has declined while that in Ireland has increased. These are the fruits of fifty-five years' work. Nobody can look at these results with satisfaction. We do not want to continue the present system. We want to find something better. I am a supporter of this Bill because I believe it will do a good deal to diminish poverty. Statistics show that since 1865 the number of people in receipt of Poor Law relief in England has declined, while in Ireland it has gone up. Test the system in Ireland as you will, you cannot defend it as an adequate system of relief. There are certain manifest drawbacks to the omission of medical benefits in this case. As the Bill stands an insured person falling sick will require to get a sick certificate, and a doctor will give it or he will not, accordingly as may be convenient. There are men who will be anxious to act thoroughly in the interests of the whole scheme, and that is the reason why some of us contended earlier in the proceedings that it was desirable the local insurance committee should administer the Act. We want to concentrate in one body all the interests which will promote adequate attendance.

What is there in this Bill which will secure to the insured person in Ireland adequate medical attendance? There will be no impulse, and nothing will do it. The local insurance committee has no power; the society has no power. What is there to satisfy us that the insured person will the sufficiently frequently visited? Nothing. All these things necessarily follow from the alienation of the payment of sick pay from the administration of medical benefit. In any scientific arrangement they are inseparably associated. An insured person in Ireland, if we approve of this scheme, has no claim whatever to medical attendance. The society will pay for the giving of the certificate, but the giving of a certificate is not medical attendance, and it does not get a person better. Hon. Members may say that the Poor Law doctor is required, as a part of his duty, to attend the person. True; but what about all the workers in Belfast and in the urban districts who are in societies? They will want the man to whom they have been accustomed to apply, and he may not be a Poor Law doctor, and he has no claim upon the medical relief committee. There is nothing in the Bill to show that the person has any claim to medical attendance; all he requires is a certificate. In the country districts I am quite sure that the Poor Law doctors will do their very best, but the amount of work they will have to do will be greatly increased. The society will do their best to bring pressure upon them, but they will have no power to do it. Unless you want a man to fill up a certificate in his own surgery without seeing the patient at all, he will have to make more journeys. This doctor, with a district eight miles long and six miles wide, with £110 a year, will have to do more work still. Is that going to ensure more adequate medical attendance?

If we put medical benefit in the Bill, insured persons will have a claim to the best treatment that can be given by a society or committee. The insured person in Ireland will miss the whole force of public opinion, the whole force of the opinion of his society, or of the local insurance committee backing him up; and this I believe will be one of the most potent influences for the improvement of public health in England and Scotland. The whole interest of the societies under this Bill will be directed to securing the best possible attendance for their members in order to get them off sick pay. No machinery of that kind will be provided in Ireland under the present scheme. One of the most serious drawbacks is that the insured person is entirely deprived of the free choice of a medical attendant where it is possible for him to have any choice. I know that in country districts that does not apply, but in the towns he will have no opportunity of selecting his own man except for the purposes of this certificate. I for one object to a monopoly in this matter on every side. We have done our best before to break it down. The general view of the masses of the population in this country, and I believe it will be the same in Belfast, is that they ought to have their medical benefits from any man they choose. That is entirely left out in the case of Ireland. I hope that if a society administers the medical benefit it will be secured that the members of the society shall have some free choice in selecting their medical attendant as we have given to them in England.

A much more fatal objection than all these is that the ultimate success of this scheme depends upon the development of preventive medicine. If you separate medical benefit from it there is no machinery for the promotion of the prevention of disease. I do not know anything of the actuarial considerations; I do not know how fine the margin is which is allowed in Ireland, but I feel certain of this, that unless the margin is a very liberal one it will be absolutely essential to link up medical benefit with the payment of sick pay, because only in that way will you be able to provide machinery to focus public opinion and all the power of society on the prevention of disease. You will have domiciliary attendance entirely dissociated from the public authorities working through this Bill for the prevention of disease. To make the Bill a success in any way we shall have to combine all the machinery of the State for the prevention of disease. I hope the anticipations of the hon. Member for East Mayo (Mr. Dillon) and of the Chief Secretary, that this defect may soon be remedied will prove correct. I should even hope that it would be possible to devise an arrangement before the Third Reading by which we could get medical benefit in. If public opinion in Ireland on this matter is developing at a rapid rate, I hope it will be found possible before the Third Reading to incorporate some scheme for medical benefit in the Bill.

Mr. T. M. HEALY

I cordially concur in the remarks of the hon. Member for Hoxton (Dr. Addison) except where he says that this difficulty will soon be removed. If this Bill passes, this defect will never be remedied. We have been promised, for instance, Poor Law reform in Ireland ever since I became a Member of this House. It has never come. Why? Because it is a matter on which there is no political kudos to be made. The ordinary forms of legislation, such as statute law revision, is anybody's job, and therefore to suggest that there is anybody in Ireland, in the official life, shepherding the life of the people or taking the slightest interest in it except as voters—well, that view may prevail in Hoxton, but so far as this House is concerned it only deals with the Irish people as voters or agitators. Therefore the suggestion that this defect will be remedied is an absolute illusion. The hon. Member says that he hopes Irish opinion is being ripened and instructed about the matter. What chance has Irish opinion to ripen or to be instructed about the Bill? The first news the unhappy people of Ireland got on this matter they got last Friday.

Mr. DILLON

Not at all.

Mr. T. M. HEALY

Then was it Thursday?

Mr. DILLON

It was three months ago.

Mr. T. M. HEALY

I am a very fair student of what is going on in Ireland—it is part of my business I hope—and so far as I am concerned, until these Amendments were placed upon the Paper on Thursday or Friday last, I never heard that this was the particular form that the blessed Amendments were going to take. Therefore, for ignorant persons like myself, at all events Thursday last was the first occasion that I had an opportunity of becoming acquainted with the facts. If there should be other persons in the same depths of ignorance in which I am sunk, I should like to ask them what chance there was of getting Irish opinion acquainted with the fact that what was the kernel of the Bill in England, the heart and soul of the Bill in England, has been taken out and eviscerated so far as Ireland is concerned? What the statesmen and the financiers who have had the manipulation of this matter have decided upon is this. They said the coffin was too short for the patient; either his legs or his head had to come off. They determined, for the sake of convenience, to take off the patient's head, and accordingly Ireland is now beautifully fitted into the coffin with its head off. That is the present state of this scheme. But it is not merely of that fact that we have to complain.

The astonishing thing to me is that we have never got from any quarter—and I have been drumming on this point until I am tired—anything to show us what is the figure, what are the proportions, what is the actuarial value of this £110,000 of medical rates that the poor people in Ireland contribute. What comparison does that bear to the total cost of the scheme in Ireland, and what should be the proper amount of deduction we should get from the employers' and workmen's contribution? Nay, more, what is the estimated cost? On this point I am glad to have the Chief Secretary present, as he was one of the financial experts who discussed the matter with the Treasury on the great historic occasion on which the hon. and learned Member for Waterford (Mr. J. Redmond) sent his two ablest financial lieutenants to the Treasury. There must be some estimates for all this business, for I am quite sure that these two able men were not taking a pig in a poke. I am quite sure they calculated that this £110,000 of Irish rates, which is now to be put into the pool as part of the Lloyd George contribution towards the inhabitants of Ireland, must have borne some relation to the amount of the reduction of the employers' and workmen's contribution and to the cost of the other benefits in the Bill. I have put a plain question. The benefits of the Bill are recited in Clause 8, and they are mentioned under six heads. I think we are entitled to know what is the cost for Ireland under each of those heads to the State; what figure was put down by the Treasury, or the two able men belonging to the hon. Member for Waterford, having regard to the fact that that contribution for medical relief was going to be dropped. Here are the eight heads of blessing which were to have been given. "Medical treatment and attendance." That must have been ear-marked with some figure of £ s. d. in the minds of the Treasury experts. The next is "treatment in sanatoria." How many do you intend to build in Ireland? That is a very easily ascertained figure. "Weekly payments while rendered unable to provide for their maintenance by mental disablement." If we have not asylums enough in Ireland at present, it is an extraordinary fact that we are to have more lunatics and more lunatic asylums than any part of the British Islands. Be that as it may, a figure attributable to that sub-head (c) ought to be forthcoming, and ought to be given to the House of Commons. The next is (d), "Disease or disablement continuing after the termination of sick benefits." I presume there was an estimate as to the amount of sickness in Ireland and the amount of relief which will be attributable under that head. The next is (e), "Maternity benefit." If anything can be ascertained with ease it is the maternity benefit, because there are the figures of the annual births, and you can easily calculate that. The last is not so easy to describe—(f), "In the case of persons entitled under any scheme made in accordance with this Part of this Act, further benefits, called additional benefits, under Part II."

Of these six heads of blessings one has entirely disappeared. It can be represented in £ s. d., and we are entitled to have an estimate from the Government as to how much in their opinion is going to be expended for the distribution of that form of blessing, and how much has been saved. I should like to know why, of the six heads of blessings, the first, and No. 1 in the Act itself, is the one that you have elected to decapitate. Is it because it saves the Treasury most? Instead of knocking off medical treatment, why did you not behead, for instance, the sanatoria or the weekly payment in the case of specific disease, or (d) disease or disablement benefits, or the maternity benefit, or the other benefit called the additional benefit? The reason is plain, because, if you had deprived Ireland of the other benefit, there was no system in the country which would have supplied them. Who supplies the system of medical benefit? The Chief Secretary said—and this is part of the delusion—that there are, I forget how many hundreds of dispensary doctors in Ireland. I am very pained to hear from the hon. Member (Dr. Addison) that anyone is getting £110 a year. It is shocking that the wages of a poorly-paid artisan should go to an unfortunate man who has been to college and passed an examination, and at the end of it he should not get more than £2 a week. It is shocking that such a system should continue in any country to expect these men to brave disease and death and all the horrors and squalor for £110 a year. It is a perfect disgrace to the nation. I suppose he has to keep a horse and trap out of his £2 a week. The Chief Secretary suggested—he did not state—that practically the Government provide half of that. No doubt it was upon that basis that it was started. The system was started after the famine and after the famine fever and every other fever and horror that existed in the country, and when our taxes had been very largely increased by this House, of course it was necessary to give us some form of so-called State boon, and therefore the State undoubtedly provided half of that amount. But supposing the guardians, taking heart of grace, raised the salary of this poor gentleman, as they ought to do, to £150 a year, will the State pay half of that? Nothing of the kind, because the late Government, when they were making that rash experiment which the Chief Secretary has referred to, of passing Local Government for Ireland, earmarked the sum, so that if there is any additional contribution either in the case of medical benefit or of medical relief of any kind, surgical instruments or medicine, it is the Irish ratepayers who will have to provide the whole of the extra sum, and if there are additional doctors required it is the Irish ratepayers who will have to provide the whole of the additional sum. So that it is utterly absurd to suggest—I do not suppose the Chief Secretary intended it—that if this system is extended or enlarged the State will continue to pay half the additional medical benefits.

That being so, let us now consider what would be the effect of this Bill in its present form. The hon. Member (Mr. Dillon) said I was opposed to the Bill altogether. That is one of the reckless statements which he is in the habit of making which no one except his own claque pay the smallest attention to. What must happen with the extraordinary form of economy which the Irish party has decided upon for the purpose of making this Bill tolerable in the agricultural districts of Ireland? Here I ask for explanation. I give my own opinion, but I will ask for information. I do not say that the conclusion I have come to is right. I first take the Post Office contributor. He has been contributing, we will suppose, for ten years and let us suppose he is an artisan and therefore unwilling to apply for relief. Take the ordinary tradesman in a town who has held his head high—the carpenter, the shoemaker, the plasterer, or any of these respectable trades. That man is a Post Office contributor. He falls ill. How is he going to get his medical benefit? We have had no answer upon that subject. It has not been suggested how it is going to be done. If he is a member of an approved society he can send his wife to the society to say he is ill and probably in return for his contributions he will get something. But take a man who is not a member of a society. First and foremost he is too proud to send for the dispensary doctor, because he does not want to be on the red ticket list, and still, although we have our £400 a year, there is a little pride left among the artisans in Ireland. What is he to do? He has to employ a doctor. Doctors, like everyone else, must be paid. How is he to get a certificate from the doctor? The doctor has first to visit him. He has to diagnose his case. He has to give an honest opinion. He has not only to provide him with medicine, but to write out a certificate for him. What is that going to cost the patient? In the case of a man who has only been a year, or two or three years insured, the doctor's fee might easily amount to the whole of the Post Office benefit. Yet this is the portion of the Bill which hon. Gentlemen behind me have decided to amputate. They had six heads of benefit to get rid of, and accordingly they gave a grave blow to the most useful benefit under the Bill.

Take now the case of the poor man who gets a red ticket—a labourer who is entitled to dispensary relief and, for short, without offence, I will call him the red ticket patient. Do you mean to say, after the confession, of the Chief Secretary that your old age pensions have already greatly added to the duties of these doctors, that you are going to place upon them the additional burden of giving certificates for coming under this Act? You will have a strike of doctors. Why should they? I want to know if these doctors are going to give certificates all over the country for nothing, and if they are not going to give the certificates for nothing, who is going to pay for them? Not the Treasury, but the Irish ratepayers. In other words, their salaries are to be increased for the addition to their duties, and that is why I take issue with the Chief Secretary when he says the State pays half the medical benefits. No. If the doctor's salary is increased by reason of his additional duties, the whole excess of salary which he is entitled to will be paid by the Irish ratepayer. Is that nothing? This House now, of course, has a Budget of £180,000,000, and no one thinks at all of a little country that ought to be run with a Budget of £5,000,000. I quite agree, we have all got swelled heads. When I came into the House first the Budget was only £60,000,000. I remember when Mr. Gladstone brought it up to £100,000,000, and the fact was published in large letters on every placard in London. Now it is £180,000,000, and it is nothing that the Irish ratepayers should have to pay an additional sum to doctors. It is only a bagatelle.

Mr. LLOYD GEORGE

The Irish ratepayer will not pay.

Mr. T. M. HEALY

We are improving under criticism. [HON. MEMBERS: "We all know it."] Everyone knows everything on that side of the House. I do not belong to the infallibles. I do not belong to the intelligent section of the House. The right hon. Gentleman has now told us that he is going to make a grant to the rates. [HON. MEMBERS: "No."]

Mr. LLOYD GEORGE

If the hon. and learned Gentleman had only taken the trouble to read it he would have saved all this, because there is the same arrangement exactly in Ireland as in England for the payment of certificates. You must get your certificate in England and Wales as well as in Ireland, and it is provided for in the provision made for management expenses of the Bill.

Mr. T. M. HEALY

The right hon. Gentleman is very kind, but I take leave to say to him that when he put his Irish provisions into his Irish Clause, and when he had the assistance of two of the ablest Members of the party of the hon. and learned Gentleman (Mr. John Redmond), the least he can do would be to have expressed that in the Amendment he has put upon the Paper. May I remind them that it was only this morning or yesterday in consequence of criticisms of one of my hon. Friends that he changed one of his Amendments. It was only put down this morning. Of course, the intelligent party behind him did not know that. I accept the statement of the right hon. Gentleman that in the case of that contributor he is not going to allow the Irish ratepayers to be further mulcted.

Mr. J. REDMOND

If the hon. and learned Gentleman will look at the Irish Amendment he will find it set out.

Mr. T. M. HEALY

You have limited the Irish discussion to two days, and I am going to take my share of it. The hon. and learned Member for Waterford is, in regard to this whole question of insurance, determined to confine the Irish discussion to two days, or practically a day and a-half. That is to say, whereas between thirty and forty days have been allowed for the discussion of these questions as regards England, so far as Irishmen are concerned Ave are to be limited in criticising the Bill to two days. Therefore, if the hon. Member for Waterford has any intention of enlightening the House, I would suggest that he should do it in his own time. Now I come to the case of the persons who are members of an approved society, which is the third branch. I should like to ask in the case of members of approved societies what is the view of English members who belong to these societies as to the proportion of sick benefit—of which we are to be deprived—which is paid for out of the 3d. and 4d. contributions. I do not know. The Government must remember that we are dealing with this matter, not with the experience of the Gentlemen of the Labour party, and not with the expertness of Liberal Members. I know that the hon. Member for Waterford and his friends have experience, but so far as the general run of Irishmen are concerned, the members of these approved societies are few and far between. The whole benefit is confined to a few towns in Ireland, and practically until recently it was confined to the Oddfellows and the Ancient Order of Foresters.

Therefore, we are groping in the dark, and we expect to be provided with information. I beg the Chancellor of the Exchequer to treat me, at all events, as one largely in the dark and quite willing to sit at his feet and at the feet of some of the more intelligent of my Friends behind me. I therefore ask some information as to how much in the approved English societies of the contributions of the members is represented in the shape of medical benefit for the payment of 1d., 1½d., and 2d. per week. I think we are entitled to that information. The English member of an approved society has the advantage of sickness benefit for himself, and, as I understand, for his wife and children, and within reasonable limits of all the members of his household. I am not speaking about this Bill at all. I am speaking of the benefit he derives from his society, and I repeat that he has medical benefit for himself, and, as a rule, for the members of his family. Under this Bill in Ireland there would be no such advantage in belonging to an approved society as there would be in England, and I want to know whether that does not point to the fact, in the first place, that you are striking a blow at the formation of approved societies, because it means that after you have got your approved society and joined it no medical benefit will be given in Ireland under the Bill. Therefore a man has to pay his State insurance for the five benefits mentioned in the Bill, and he has to pay the approved society for his medical benefit. That brings us to this—that the members of the approved society in England are in a better position than the members of the approved society in Ireland. I should like to know whether the reduced contributions which the Irish employer and workman have to pay would entirely account for this. It is on that matter that calculations and figures are absolutely wanting. It is on that matter that we are denied any actuarial calculations and figures. We put two questions to the Secretary to the Treasury long ago. One question was put in July, and another question was put in May. We asked whether there were any actuarial calculations made separately for Ireland. The answer was "No." The actuarial calculations were made for the United Kingdom as a whole. I could quote the answers to the questions. Therefore I now ask whether an actuarial calculation has been made separately for Ireland. How is any body of experts, including the intelligent Members of the Irish party, to arrive at the facts as regards this matter? Where do they get the actuarial figures? The figures, we are told, have been calculated not for Ireland, but for the United Kingdom, and if you have calculated for the United Kingdom only, I assume that the figures for Ireland have been taken out separately since these Amendments were agreed to. All I ask is that the House should be put in possession of these figures.

Sir EDWARD CARSON

I only rise to make a few observations in consequence of the speech of the hon. Member for Hoxton (Dr. Addison), which I am bound to say very much impressed me. My own view is—and I think it is the view generally held by hon. Gentlemen from Ireland—that it is a great pity, though I do not blame the Government for it, that these medical benefits have been eliminated from the Bill, and I really think it is even now worth while, remembering what the hon. Member for Hoxton has said, considering whether at some subsequent stage this matter may not be reconsidered and the benefits again put into the Bill for Ireland. At the same time it is very easy to see how this matter has arisen, because the history of the agitation with reference to this Bill in Ireland is one that has given every Irish Member a great deal of anxiety. So far as I am concerned, my whole anxiety has been to see what was generally thought best on the whole for Ireland. So far as I have observed, that opinion varied absolutely from day to day. When the Bill was brought in so far back as May, I thought the general feeling in Ireland was absolutely against it. So far as I could see, nobody had a good word to say for it. We had several resolutions passed by important bodies, including the Irish Roman Catholic bishops, though I do not see why any more particular attention should be paid to them than to any other public body. Their resolution was read in the House yesterday, and it looked to me as if the Bill were to be in jeopardy as regards Ireland. That was not my own personal reason, for I think that, so far as this kind of legislation goes for the social betterment of the people, it is a great mistake to legislate for this country and Scotland and not to legislate for Ireland, because one thing which, above all others, we ought to try to carry out is, that Ireland should not be left behind in the race, for if Ireland was allowed to drop out of a scheme of this kind, or the old age pension scheme, the matter would never be taken up again, and Ireland would be left out entirely.

I may say, in passing, that I think we made a vast mistake when we severed the scheme in Ireland from the scheme in England. I have grave doubts whether the scheme in Ireland will prove solvent. It was part of the scheme in England that if it did not prove solvent, it would be set right. I am not sure, if it is not solvent in Ireland, that it will not have to be dealt with in some purely Irish way. I have in my mind what happened in the case of the elementary school teachers' pension scheme. When the scheme proved insolvent the burden had to be borne by the school teachers themselves, and I suppose that if this scheme proves insolvent in Ireland it will be in some purely Irish way that it will have to be made good. I am perfectly certain that one of the most vital mistakes that could be made in putting forward these schemes for Ireland is that we should dissociate ourselves from the schemes put forward for this country, which is the vastly richer country, and being far the most extensive part of the United Kingdom, the moment anything of that kind happens it is far more likely to be taken up than if it were merely a branch matter in relation to the other country.

7.0 P.M.

I think it will turn out to be a mistake to have severed the schemes. What happened was this. The Bill was unpopular when it was brought in, and I think not unnaturally, because even now the putting of this tax on the industries of the country is really a gamble. None of us know what effect it will have in Ireland. I do not know whether anybody knows the effect it will have in England. At all events, as regards Ireland and its industries, there are, as we know, very grave apprehensions among many people as to what may be the effect of this tax upon them. Therefore, it was not unnatural that there should be a good deal of misgiving at an early stage. Then came this idea of reducing contributions and making that reduction by leaving out the medical benefit, and, very naturally, it fell back on what the Chief Secretary has described as the very excellent dispensary system which we have in Ireland.

Now we are told there is a change in the other direction, and that people are beginning to think that medical benefit ought to come in. I am rather inclined to think that a change had to come in, because the contribution has been reduced, and they think it might come in under the reduced contribution, and, therefore, there is a certain amount of popularity attached to the idea. But I am bound to say that to have in your society, or its administration of this matter, a number of people who will not be entitled to medical benefits, whereas the others will, is an unbusinesslike method of conducting the whole scheme, and cannot but, I think, in due course of time, give rise to very great dissatisfaction with the administration of this scheme. People who are paying exactly the same amount of contribution will be receiving exactly the same benefit, not under the scheme, I admit. One party will be receiving the dispensary relief, and the two things will come to be so mixed up from the necessity of having to employ these same dispensary doctors for the purpose of certificates and other matters for the working of the scheme that I think you will find in the end you will be driven to having the medical relief brought in. I believe that the position of dispensary doctors, if you had this medical relief in the Bill, could be, and would be, enormously improved, and I think it would aid greatly in checking one of the most disastrous consequences that occur in Ireland through not being sufficiently able to look after particularly the preventive side of various diseases. For my part, I hope before the Bill becomes law we may again have some opportunity of reconsidering, with proper actuarial tables, the whole of this question.

Mr. MAURICE HEALY

Might I ask the Chancellor of the Exchequer whether it is possible, in the case of either the whole of Ireland or in the case of those urban districts where there is undoubtedly a strong feeling that medical benefit should be given, to give either the whole of Ireland or those districts the option of coming in under the first part of the Schedule instead of the second part, of the Schedule which he has now set up? I recognise that that would necessarily be the option of the worker and would bind the employer. Still, it appears to me, having regard to the strong feeling that exists in the Irish cities, that the loss of this medical benefit is a serious subtraction from the Bill as a whole, and that is why I put this question.

Mr. POWER

May I point out before the right hon. Gentleman replies that I think many difficulties in the working of this measure—

Mr. LLOYD GEORGE

Does the hon. Gentleman want to ask me a question?

Mr. POWER

I want to make some allusion to the statement which has been made.

Mr. LLOYD GEORGE

It is rather important for me to make some allusion to the very interesting and important statement made by the right hon. and learned Gentleman (Sir E. Carson), and to answer the question put by my hon. and learned Friend (Mr. Maurice Healy). The right hon. Gentleman put the case very clearly, straightforwardly, and I think very fairly as to the position in Ireland. I have not a word of criticism of what has fallen from him. I think he stated quite accurately what really happened in Ireland. I will say frankly that the question whether Ireland should be in the Bill or not was to my mind a question whether Ireland really wanted to be in the Bill. If Ireland felt on the whole that the Bill was inapplicable to its conditions I should certainly not have pressed for Ireland to remain. And it is because I believe there was a very strong feeling among the working classes in Ireland that they would like to come in, that pressure was first of all brought to bear on hon. Members opposite and also, I believe, on hon. Members sitting on those benches to see that Ireland was included in the Bill; and I think the general feeling in the whole of Ireland is, in spite of what my hon. Friend has said, that they would prefer to be in the Bill than to be left out. That is apart altogether from criticisms of detail. I come to the question put by the right hon. and learned Gentleman about medical benefits. As he has been perfectly frank with the Committee, I will answer him just as frankly, I did regret that medical benefits went out. I believe that is the feeling among my hon. Friends sitting above the Gangway. It is purely in deference to the wishes of not merely Members from Ireland, but of their constituents, that we decided to leave these medical benefits out. The right hon. and learned Gentleman asked me was there any chance of this question being reconsidered. If there is any feeling in Ireland in favour of medical benefits being incorporated in the Bill I should certainly not resist it on behalf of the Government, if that is the real feeling of Irish Members of all sections in the House.

Then the right hon. and learned Gentleman asked me what would that cost actuarialy. When you come to tackle that subject it is not so much an actuarial question. I have discovered it is rather a question of the best bargain you can make with the doctors. I do not find that Irish doctors are any easier to bargain with than British doctors. On the contrary, I was advised that where doctors now get about 4s., if 6s. were put down as the financial basis off the Bill that would be really ample. But the whole of the doctors of the kingdom, including the doctors from Ireland, revolted against it and demanded a sum which, I think, was quite impossible, certainly impossible financially, and we made an arrangement with the medical profession in this country. A deputation of the British Medical Association came to see me, and began by asking for 8s. 6d. for each individual. Financially, that was quite impossible. It is true that after they discovered that medical benefits might not be included in the Bill there was a more reasonable spirit as to the financial aspect of the question, and if the right hon. Gentleman and his Friends the hon. Members from Ireland, make some arrangement with the medical profession I should certainly not resist recommittal of the Bill in order to include Ireland in medical benefits if they really desire it. But I do not think it would be possible to do it under the 1½d. included in the Bill. A 1d. a week would make 4s., and 1½d. means 6s. That is the whole question. It is really a question of what bargain can be made with the Irish doctors. The actuaries cannot help with the Irish doctors. My hon. and learned Friend the Member for Cork knows just as much as any actuary as to the probability of making arrangements with Irish doctors and what terms he can make. There cannot be a separate actuarial computation for Ireland with regard to medical benefits for that very reason. All you can do is take a kind of average for the United Kingdom and say doctors 4s. a head. If you add 50 per cent. to that that leaves a very good margin for making arrangements both in Ireland and Great Britain. That is all I have got to say with regard to that. I understand that a dispensary doctor in Ireland holds a position which is quite different from the position of parish doctor in this country. My hon. and learned Friend the Member for Cork asked me whether it was possible to discriminate between rural and urban areas. I should like to know what his point is?

Mr. MAURICE HEALY

Whether they can be left the option to come in under the first part of the Schedule instead of the second part.

Mr. LLOYD GEORGE

I think it would be fatal to the finance of the Bill to leave an individual option.

Mr. MAURICE HEALY

Not an individual option to be insured, but an individual option as to which Schedule they would come under.

Mr. LLOYD GEORGE

I quite appreciate the point. The hon. Member means the option of saying he will take the full benefits and therefore pay an extra penny and the employer pay an extra ½d. I think that that would lead to hopeless confusion, because you will get one workman on the higher scale and another on the lower scale, and the same workman might change from one scale to another. The reason why it is impossible is that there is only one thing which enables you to make a bargain with the doctors at 6s., and that is the fact that they are dealing with large societies with both old and young. If you deal with individuals it is impossible to make an arrangement of that kind with doctors. I have been considering the question whether it would be possible to divide areas, but that eventually had to be abandoned as perfectly impracticable. I also agree with the right hon. and learned Gentleman that eventually Ireland will I think come into medical benefit and into the whole of these benefits. What I think will probably happen will be this. There are a great many workmen in Ireland who object to have the dispensary doctor, as they think it carries some sort of suspicion of pauperism if they get a red ticket. I am told that is the case in Belfast. They would rather pay the doctor like an Englishman.

Mr. MAURICE HEALY

It is the case in Cork also.

Mr. LLOYD GEORGE

It is certainly the case in England. As long as a workman has a penny in his pocket he prefers to pay his own doctor rather than go in for the parish doctor. What I think will happen will be this, that workmen who join these societies will have an additional voluntary subscription for medical benefits. There will be some societies which will impose this additional contribution; there are others which will not, and they will not get the benefit of the employer's contribution. Eventually, I think, hon. Members from Ireland will be found inviting the Imperial Parliament to amend the Bill as far as Ireland is concerned by imposing an additional 1½d.

Mr. T. M. HEALY

That will be called dissension.

Mr. LLOYD GEORGE

My hon. and learned Friend criticises this, but he will not take the responsibility of moving its omission.

Mr. T. M. HEALY

I preferred the Bill as it originally was, with the exception of the local control in Ireland; but as regards the contribution, I am in favour of the full Bill as introduced rather than the truncated Bill.

Mr. LLOYD GEORGE

That is an admission.

Mr. T. M. HEALY

It is a declaration, and not an admission.

Mr. LLOYD GEORGE

I need hardly say, of course, that I prefer the Bill as I introduced it, and it is purely because I found that Irish opinion as a whole prefers the 1½d. that I made this alteration. With regard to the certificate, there is a provision in the Amendment to the Bill in the last Sub-seotion— For the payment by the society or committee to duly qualified medical practitioners of such remuneration in respect of the furnishing of those certificates as the Irish Insurance Commissioners may sanction, and all payments so made by the society or committee shall be treated as expenses of administering the benefits aforesaid.

Sir J. LONSDALE

Under this Bill an additional amount of work will be thrown upon the dispensary doctors, and I wish to ask the right hon. Gentleman whether they can be allowed to employ assistance in view of the fact that this additional work will be thrown upon them? Will the right hon. Gentleman at the same time state what remuneration will be given to the dispensary doctors?

Mr. LLOYD GEORGE

That is entirely a matter for arrangement between the local health committee and the doctors.

Sir J. LONSDALE

Under the Local Government Act the dispensary doctor is not allowed to employ a qualified assistant, and, in view of the additional work to be thrown upon the dispensary doctors because of the issue of certificates, there is a very strong feeling among the country doctors in Ireland that they ought to be allowed to employ assistants, especially as dispensary doctors receive no superannuation. They are the only people under the Local Government Board who are not superannuated, and many of them, in consequence of the absence of superannuation, remain in their positions until a very advanced period of life. I therefore ask the right hon. Gentleman if he will be good enough to consider the desirability of inserting something in the measure which will ensure that the dispensary doctors employed in the issue of these official certificates shall be permitted to employ assistants for that purpose. It may appear a simple question to the right hon. Gentleman, but it is a matter of very great importance to the dispensary doctors in Ireland; and I urge upon the right hon. Gentleman the necessity of inserting some provision in the Bill, and not leave it to the local committee to decide whether or not these professional men may be allowed to have qualified assistants to enable them to do all the additional work which this measure entails. The right hon. Gentleman at the same time might seriously consider, in view of the advanced age of many of those who occupy the position of dispensary doctors, the desirability of having this Bill carried out in an efficient manner by giving these men, at the usual age of sixty-five, some superannuation, in the same way as others are provided for.

The CHAIRMAN

The question of superannuation does not arise on this Amendment.

Dr. ESMONDE

Like my colleague the Member for Mayo, I am one of those who are sorry that medical benefit is not included in the Bill. Our position in Ireland is somewhat different from what it is in England. In Ireland seven out of every ten in the rural districts are already provided for in respect of medical attendance and medicine. You have got, then, probably three out of every ten who would come in under the Bill as better class workmen who have never applied to the Poor Law Board. In England the question is not the same as it is in Ireland. In Ireland you would have a doctor who has already been paid for a certain number of people whom he is attending, and you would have a doctor who would be taking the insured people who had never had any parish relief before. The Chancellor of the Exchequer said that 8s. 6d for Irish medical men was not a fair and reasonable proposition. I hope and trust that he will be able, if not on Report, at some later time, to bring in and include medical benefit. Speaking as a medical men who knows something about the feeling of medical men in Ireland, I am absolutely certain some arrangement, should be made by which medical benefit should be brought into the Bill, and a reasonable sum paid to medical men. A small capitation grant could be paid to the dispensary doctors, and a somewhat larger contribution should be paid to those men who are not dispensary doctors, because I look upon it as one of the most important things that we should bring medical benefit into this Bill, and that we should have a big choice of doctors. Therefore I hope that some attempt will be made on behalf of the profession in Ireland to make some proposition in which we might all be able to acquiesce.

Mr. P. J. POWER

I suppose this is one of the most complicated measures that have ever been submitted to the House of Commons. I quite agree with the remarks which fell from the right hon. Gentleman the Member for Dublin University (Sir E. Carson) when he said that at first this Bill was disliked throughout Ireland, but as time has gone on that dislike has lessened, and I think the vast majority of workmen in Ireland are now in favour of the provisions of this Bill. As far as Irish Members are concerned, many of us really could not understand it, and we appointed a committee of our own party which took great trouble in going into the pros and cons of the Bill. They devoted a good deal of time and study to it, and brought out a report which was submitted to the party. A good deal of ridicule was thrown upon that committee and their findings, but as a humble member of the Irish party I think we are all indebted, and Ireland is indebted, to the committee for their great care in investigating this complex measure, and giving us their views after careful consideration. I quite agree that there are more difficulties in the way of Ireland working this Bill than there are for Great Britain, because, after all, in the rural districts we do not know what the friendly societies are, and the working of this Bill will be largely affected by that circumstance. In England the people generally are conversant with the usages of these friendly societies and will be able to work them more easily. I wish to call attention to the dispensary committees and the Poor Law unions in Ireland generally. The working of the Bill will throw a great deal of the onus on the Irish people. To my mind they are not wise in trying to overwork themselves and undertaking all the provisions that are applicable to England. The Chancellor of the Exchequer some months ago referred to the dispensary committees in Ireland and the working of the Poor Law in general. He was misinformed, no doubt, and though misinformed, his remarks caused a certain amount of resentment in most parts of the country.

I quite understand the working of the Poor Law in most parts of Ireland, and I have a fair knowledge of the working of it in Munster. I know from personal observation and knowledge that the remarks the right hon. Gentleman made did to some extent give offence, though they were made through misinformation. He said that the dispensary committees and the Poor Law unions were abused very largely throughout Ireland, and that in a great number of cases people applied for free medical relief who were not entitled to receive it. I speak with knowledge of the unions in my own immediate neighbourhood, and I must say, as far as my information goes, that the statement is not founded on fact, and the information given to the Chancellor of the Exchequer was not accurate information. I was chairman of a large board of guardians for many years, and in that capacity I had the distribution of the red tickets. During all those years not a single person applied for a ticket who was not entitled to it—not a single person applied either to me dircetly or to the relieving officer. If anything, our people are supersensitive in these matters, and they decline to apply for a ticket when they are able to pay for medical attendance. I am surprised that people have not oftener applied for these red tickets. I do not wish to say a word against the medical profession, who as a rule are not a mercenary profession, and they behave with great charity and consideration throughout the country. But the system which has hitherto prevailed in Ireland is one which leads me to feel surprised that many more men have not applied for red tickets. The doctors pay four and six visits for £1, and where a man is in a position to pay, he will not make one visit without getting £1. With many men pounds are few and far between, and I repeat that I am surprised that many of the poorer classes in Ireland have not more often applied for these red tickets. I am surprised that many of them who have paid have not tried for those red tickets. I believe that the medical profession now recognised that that is an unwise system, and that by charging smaller fees they can get on better, and certainly it would be better for the people. I am sorry the Chancellor of the Exchequer was not in the House when I made these remarks in explanation of the statement that he made inadvertently, and through misinformation, that there was a wholesale system of fraud practised, and that people obtained red tickets in Ireland who should have paid for doctors. I know that that is not the case. I am quite certain if the right hon. Gentleman had heard the statement of the Irish representatives on the subject, that he would candidly admit he was misinformed, and that what he said of the people was not true and was not fair to them.

Mr. LARDNER

The Member for North-East Cork (Mr. T. M. Healy) said that the party to which I have the honour to belong had got rid of the medical benefits in order to make the Bill acceptable to Ireland, or as he put it, the coffin was too small for the body and either the legs or the head had to come off. The head did not come off because the coffin was too small, but because the head was too big. Or in other words, the demands of the doctors for medical benefit were so extortionate and oppressive, that it was impossible to consider the possibility of working the Bill in Ireland. I have here the demand made by the doctors:— Payment by capitation, with a minimum fee of 8s. 6d. for medical attendance alone. (b) Extra provision for special services, such as (1) anæsthetics; (2) operations; (3) consultations; (4) night work. Mileage reckoned from doctor's house to patient.

Dr. ADDISON

I hope the hon. Member is not attributing that to me.

Mr. LARDNER

No. I will refer to that in a moment. That was the proposition we are up against, and that is what we had to consider. We knew that the argument would be raised against this Bill, that it would be the perpetuation of the pauper taint, and that argument was made yesterday as the reason why medical fees were being left out. Take the original Bill as introduced, and what do you find. In Clause 59:— It shall be the duty of the medical officer of health for each dispensary district in the county without the production of any medical relief ticket to attend and treat every deposit contributor resident in his district and requiring medical attendance, and at the expense of the guardians to supply proper and sufficient drugs and medicine to the contributor. Our committee started with this principle and with this idea, that the foundation of any successful scheme of medical benefits or an insurance scheme as outlined in the State Insurance scheme should be one in which the man would get what he paid for and pay for what he got. At present the patient would have been getting a dispensary doctor and the medicine from the guardians. What is the Amendment we are now discussing? It simply provides that a medical officer who certifies illness will be paid for that. I should like to know from the Committee what is the difference between the situation in the Clause and in the Amendment we are considering. It is going to be the same doctor, and he is going to be paid the same salary from the board of guardians. One of the reasons given in justification for this Bill was that it will mean a very serious reduction in the cost of Poor Law administration and a very great economy. What is the economy going to be? The advantage was held out to the patient of a choice of doctors. Is the dispensary doctor to be paid the same capitation grant as the private practitioner who takes a man under the State Insurance scheme? Where, then, is your choice of doctors, because if a man goes to a private practitioner and says, "I am a State Insurance patient," the doctor will say, "I will not take you, you are a dispensary patient." The impossibility of the whole situation is only realised by those in touch with the question, and who have studied it and looked at it from the standpoint of the people and of the friendly societies. I say that the elimination of the medical benefits is the only possible solution of the difficulty, unless, and until the medical profession come forward with their reasonable and proper scheme, so that we will not have the wearying and bitter experience of the past six months, meeting to-day to have one promise and to find that promise broken the next day. This is the last demand for 8s. 6d. We had that in October. What about the wife and family? They must get the red ticket or be paid for.

Mr. BOOTH

May I ask whether that 8s. 6d. includes drugs and medicines? [HON. MEMBERS: "No, no."]

Mr. LARDNER

May I read it again? It is a most interesting document. "Payment by capitation, minimum fee 8s. 6d." That is for medical attendance alone. In addition to that the doctor is to get a shilling per mile from his own house to the patient, and is as well to get special payment for night-work, for anæsthetics, to which I do not object, and for operations and consultations.

Mr. BOOTH

Is there anything extra for wet weather?

Mr. LARDNER

I think we will have that claim yet before we are done. It is easy to talk about perpetuating the pauper taint, and chopping the heads off. People with the facts before them consider that the real reason for the head-chopping is that the head was swelled too big in Ireland by people who were not friends of this Bill, and who rather considered that the Bill was intended not for the improvement of health, not for the improvement of the working classes, but rather as a doctor's endowment scheme, because that is how it has been looked at and treated. I, for one, would like to see everyone entitled to get a doctor he has paid for for himself and his wife and family. What I say is that the question of whether we are to have medical benefits lies with the medical profession to make a suitable proposal, and I hope it will come from the hon. Member for Hoxton (Dr. Addison). If there was a suitable proposal I would be prepared and ready to vote for the inclusion of medical benefit for Ireland. I say that any proposal that is made must be a proposal made in the light of our present experience. Our present experience in friendly societies is that the minimum contribution is somewhere about 2s. 6d. or 3s., and that it does not run higher than 6s. 6d., with the exception of one special case in the South of Ireland of I believe 8s.

Dr. ADDISON

Do I understand that the hon. Member is speaking for his party in saying that if I can arrange between him and the medical profession that he will have no objection to it going in the Bill.

Mr. LARDNER

I am only speaking on my own behalf, and I have no authority to commit the party. After six months of negotiation and struggle they are not prepared at this last moment, but I say if any reasonable offer be made that I for one will vote for it. At present the minimum is 3s. and the maximum is about 6s. with an average of 5s. For that, we get the insured member, the doctor of the friendly society, and his wife and family attended and medicine supplied. That contrasts very strangely with 8s. 6d. for medical attendance and 1s. per mile and special fees for night work. Recollect that if a friendly society wants a doctor, it has not to go begging for him. The doctors rather come asking to be selected. I say if there is any offer or proposal to be made by which Ireland is to get medical benefit the remedy lies in the hands of the doctors in making a reasonable and fair offer.

Mr. O'SHEE

This new Amendment includes the following Sub-section: (11) Rules of an approved society or local health committee under this Part of this Act may provide for the inspection of medical relief registers by officers of the society or committee at all reasonable times and for the furnishing to the society or committee of such medical certificates as may be necessary for the purposes of the administration of the benefits administered by the society or committee and for the payment by the society or committee to duly qualified medical practitioners of such remuneration in respect of the furnishing of those certificates as the Irish Insurance Commissioners may sanction and all payments so made by the society or committee shall be treated as expenses of administering the benefits aforesaid. Most of the rural portions of Ireland have only got one doctor, who is the dispensary doctor. How are you to arrange for certificates for insured persons in the district, probably ten miles away from the nearest other doctor. If the medical practitioner says "I will not take you," are those insured persons to be deprived altogether of sickness benefit because they cannot got a certificate from the local man, who goes out on strike against the capitation fee, because the doctors have published resolutions threatening us with a strike because we did not give the 8s. 6d. and the mileage and the extra remuneration for night work. As far as I can see, the petition cannot be met, except by the inclusion of some such provision as was in the original Clause, which imposed the duty on the dispensary doctor of doing certain work. Many duties have been imposed on dispensary doctors by Acts of Parliament for reasonable and proper remuneration, and, of course, you must properly pay them. I greatly fear that unless the duty is imposed under this Bill on the dispensary doctors of doing this work, they being the only persons available, we shall have great trouble in many parts of Ireland in putting this Bill into operation at all as regards sickness benefit.

The new Sub-section in the Amendment before us provides that the employed rate shall be the rate specified in Part II. of the Second Schedule to the Act. I wish to call the attention of the Chief Secretary to one matter which arises on the Schedule which is specified. At the last investigation by the Board of Trade in Ireland the average rate of wages for agricultural labourers was 11s. 3d. There was a sum included in that 11s. 3d. as being the equivalent value of board and lodgings. Board and lodgings are given in many parts of rural Ireland. Very few weekly men are employed. They have practically nobody but a servant girl and a boy, who live in and get board and lodgings just as servant girls in the ordinary course. The last Report of 1907 gives the average wages of agricultural labourers in each county in Ireland, and it gives the average rates for the three different classes of labourers. It estimates that the average for those who receive cash weekly and are not provided with board and lodgings is 11s. 2d. For men paid weekly cash wages, and provided with board and lodgings, it works out at 11s. 7d., and for men paid yearly or half yearly cash wages and provided with board and lodgings it works out at 11s. 2d. In that calculation of 11s. 2d. the Report says that for Ireland the value of board and lodging has been computed at 5s. per week, and the value of a cottage at 1s. per week. I want to know whether that standard is to be adhered to, because it has a very important bearing on the contribution that would have to be made by the labourer. If you raise your 5s. to 6s. and state that the value of board and lodgings is 6s., you immediately get an average of 12s. 2d. instead of 11s. 2d. The result would be that every labourer who has only to pay ½d., provided his cash wages and board and lodgings is estimated at 12s. per week, would have to pay 2d. a week if the average is 1d. over the 2s. per day. The Treasury would be relieved of 1d., and the fund would be relieved of the other ½d. It is to the interest of the Treasury and the farmer to put a higher estimate on board and lodgings. The result of a higher estimate would be that the farmer would save 2s. 2d. in respect of each man per year, and the Treasury would save 4s. 4d.

As it is to the interest of both the farmer and the Treasury to put up the estimate, I should like the Chief Secretary to give some assurance that that will not be allowed to be done to the prejudice of the labourer. It is most important in this matter of the value of board and lodgings that the precedent set under the Old Age Pensions Act should not be followed. We know how extravagant the Treasury have been in estimates of the value of real board and lodgings in Ireland. The pension officers and the Local Government Board estimated the value of board and lodgings of an aged person, living on the benevolence perhaps of a near relative or distant relative, at 12s. a week, although it ought in that case to have been less than 5s. I ask the Chief Secretary's attention to that point and to the point I referred to concerning the absolute necessity, if this act is to do good in the rural parts of Ireland, of imposing duties on dispensary doctors in the matter of furnishing these certificates. In the rural districts where the people are few and scattered it is reasonable that the rate should be larger. It ought to depend to a great extent on the number of insured persons in the doctor's district. The matter is an important one, and ought to be looked into and considered before the Report stage.

Mr. CHAMBERS

I should like to make a friendly observation, particularly having regard to what the hon. Member for Monaghan said. He told us the real reason why medical benefits were excluded as regards to Ireland, and I think if it be the real reason it is a great pity an arrangement could not be at once made whereby those benefits could be extended to Ireland. It was alleged during the progress of this Debate that the reason why medical benefits were excluded as regarded Ireland was the dispensary system. Having some knowledge of the dispensary system in Ireland, I was somewhat astonished that some of those who represented Ireland should be satisfied with that system as a substitute for medical benefits. A moment's reflection would show that the system, particularly having regard to the fact that you are dealing with a country where friendly societies' system has not been generally applied, is wholly inadequate. There are 810 dispensaries in Ireland, and there is an average to each dispensary district of 25,728 acres. That is the medical capacity so far as the dispensary system of Ireland is concerned. I approve of the Bill, and am delighted with it, but I want the Bill to be the best that can be for Ireland, and to see if anything can be done to include medical benefit for Ireland. I was delighted to hear the hon. Member for Monaghan saying he welcomed medical benefits for Ireland, and I was delighted to hear the hon. Member for Mayo give expression to similar sentiments. On behalf of Belfast I wish to say we will be delighted there, also, to have the medical benefits included, otherwise the system is altogether inadequate.

8.0 P.M.

I believe there will be more deposit contributors in Ireland proportionately than elsewhere, and I am afraid their plight will be pitiable as regards medical benefit. Friendly societies do not exist very largely in Belfast. Section 24 of the Act prescribes that if the rules of the society permit they have the option to reject any particular applicant for membership. If the rules of the society prevent a person from becoming a member he is bound to adopt the position of a deposit contributor in Ireland. The very fact that few societies exist in Ireland show that there are a great number of people who may be forced to resort to the deposit system. Their position will be that they will be absolutely deprived of medical benefit, because, as already stated in the House tonight, only the very poor are to be allowed to get this relief from the dispensary. The deposit contributor, a very numerous class in Ireland, will be absolutely shut out from medical benefit of any description. I think that would be a great blot upon this Bill. Take the case of those who become members of approved societies. They will get no medical benefit for at any rate three years. It will all depend on their luck whether the society will turn out to have a surplus at that time. They are the people who demand our sympathy. I respectfully press upon the House that steps should be taken before the Bill passes into law to secure that the medical benefits will be extended to Ireland. I was not aware of the negotiations, or of the claims of the doctors of Ireland, but if there is a surplus in connection with the working out of this Bill—I am not in a position to say whether their demands are extravagant or not—I do know enough of the medical profession in Ireland to know this; if yielding on their part to a certain scale of charges would result in the inflow of benefits such as this Bill will undoubtedly bring into Ireland, that they will deal loyally and kindly. If that be the only obstacle I would most strongly and earnestly appeal that steps should be taken to bring the medical benefits into the country I live in.

Question, "That the words proposed to be left out stand part of the Clause," put, and negatived.

Question, "That the words proposed be there inserted," put, and agreed to.

Further Amendment made: Leave out Sub-section (9).—[Mr. Lloyd George.]

Question, "That the Clause, as amended, stand part of the Bill," put, and agreed to.

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