§ 23. Sir PHILIP MAGNUSasked the right hon. Gentleman what additional sum he is prepared to recommend Parliament to set aside for the provision of medical benefit under the National Insurance Act; and, if so, what would be the normal amount offered for each insured person, with or without drugs, and what arrangements have been suggested for securing, where necessary, exceptional medical or surgical treatment?
§ Mr. LLOYD GEORGEAs this subject is of great importance, the House will, I am sure, bear with me if I exceed somewhat the limits of an ordinary reply. After careful consideration and consultation with the members of the Advisory Committee, the Government have decided to increase the sum available for medical benefit to an amount which they are satisfied will secure an improved medical service for the industrial population, and at the same time afford an adequate remuneration to the medical practitioners for the work which they will be required to do under the Insurance Act. The House will remember that on the Second Reading of the Bill I stated that there was a margin 2189 [...]hich would have enabled an increased amount to be paid to the doctors where a case was made out. But during the passage of the Bill provisions were inserted, particularly as to the free choice of doctor and the system of providing drugs, which tended to increase the cost of medical benefit, while other charges had at the same time absorbed the margin originally available for these purposes over and above, the 6s. assumed in the actuarial estimates. The Government have always recognised that as they could not throw the burden on the societies these charges would necessitate an additional contribution from the Exchequer. At the same time the Government recognise the reasonableness of the demand that the medical profession should receive a guaranteed minimum rate of remuneration without trenching upon the sum necessary for an adequate supply of drugs. It was always contemplated also that provision must be made for extras including mileage. This cannot, however, be unlimited and provision for it is included in the addition which it is now proposed to make.
The financial proposals which the Government intend to submit to the House may be briefly summarised. It is proposed to add to the amount already available for medical benefit a further sum equivalent to 2s. 6d. per insured person per annum. This will enable the provision for medical benefit to be raised to 8s. 6d. per head of insured persons, with a small additional sum to be reserved for extra drugs required at times of excessive sickness. Of this amount it is proposed that a minimum of 6s. 6d. should be definitely assigned for medical remuneration and 1s. 6d. for drugs. A further 6d. will be available for drugs where required, and will otherwise be available for medical remuneration. Counting a further 6d. which will be applicable from the sanatorium benefit fund for the treatment of tuberculosis by general practitioners the total remuneration which the doctors will receive (exclusive of drugs) will amount to 7s. or possibly 7s. 6d. per head of the insured This additional grant, the total annual cost of which is estimated at £1,650,000, will be made under such conditions as to secure enhanced efficiency of medical service, and that the doctors will give such certificates as are necessary for sickness and disablement benefits, and will keep such simple records of disease as are requisite. I am publishing at once a full statement of the effect of these proposals.
§ Viscount HELMSLEYDoes the 8s. 6d. include mileage, or is a further sum to be provided?
§ Mr. LLOYD GEORGEIt is an inclusive fee.
§ Mr. GINNELLThe right hon. Gentleman does not say how his alterations, including a further contribution from the Exchequer, and greater efficiency, will apply to Ireland.
§ Mr. LLOYD GEORGEThe Irish Members of all sections deliberately pressed me to leave medical service out. [HON. MEMBERS: "Not all."]
§ Mr. BARNESDo we understand that the certificates are to be given free by the doctors?
§ Mr. LLOYD GEORGEYes.
§ Mr. GINNELLCannot the right hon. Gentleman apply some proportionate part of this further contribution to Ireland?
§ Mr. JOHN WARDDoes this mean that a proportionate sum, amounting, I think, to nearly 3s., which it was expected at the time 'the Bill was passing through the House might be available for extra benefits, is now taken entirely by the doctors?
§ Mr. LLOYD GEORGENo. That is exactly what I explained. The margin will not be trenched upon at all.
§ Mr. LANE-FOXWill this require a further special Supplementary Estimate?
§ Mr. LLOYD GEORGEYes.
§ Mr. LANE-FOXWhen will it be taken?
§ Mr. LLOYD GEORGEI cannot say.
§ Mr. CLYNESCan the right hon. Gentleman say whether, in the event of this announcement not having the desired result, he contemplates any organisation of a State medical service?
§ Mr. LLOYD GEORGEI think my hon. Friend had better wait until he sees the full statement, because I deal with that question there. I could not deal with it in answer to a question.
§ Mr. LARDNERWould not Ireland be entitled to a share in the increased grant in regard to sanatorium benefit?
§ 73. Mr. WATTasked whether, under the National Insurance Act, any division has ever been made of the 6s. per head for medical attendance and drugs between the doctors and the chemists; and, if so, will the right hon. Gentleman say how much of that sum it is intended shall go to the doctors and how much of it to the chemists?
§ Mr. MASTERMANI would refer my hon. Friend to the statement just made by my right hon. Friend the Chancellor of the Exchequer.
74. Mr. WORTHINGTON-EVANSasked how many schemes of arrangement to provide medical treatment under the National Insurance Act have been submitted by insurance committees to the Insurance Commissioners under Section 3 of the National Health Insurance (Administration of Medical Benefit) Regulations, 1912; and which schemes (if any) have been approved by them?
§ Mr. MASTERMANPending the statement just made by my right hon. Friend, no schemes of arrangement for providing medical treatment have been submitted by the insurance committees to the Commissioners; the second question does not therefore arise.
75. Mr. WORTHINGTON-EVANSasked when the promised Paper dealing with the cost of medical benefit in Germany, and the scope and nature of the medical attendance and treatment there, giving copies of the agreements made by the German doctors and showing the fees payable to them, will be published?
§ Mr. MASTERMANAn officer of the Commissioners has visited Germany to make the necessary investigations, and his Report is now in preparation.
Mr. WORTHINGTON-EVANSDoes the right hon. Gentleman remember that he stated the Report was in preparation in July last, and yet it has not been published?
§ Mr. MASTERMANThat is quite true, but the hon. Gentleman is aware that the Gentleman representing the Commissioners has been spending a considerable time in Germany in thoroughly investigating the matter.