§ Colonel CHALONER
I beg to move, "That every effort should be made to bring the administration of Part I. of the National Insurance Act into harmony with the speeches made upon the subject by 1286 the Chancellor of the Exchequer and other Members of His Majesty's Government before the Act became law."
In moving the Resolution which stands in my name I do not so much desire to call attention to and to criticise what may be described as the wild statements that have been made by the right hon. Gentleman the Chancellor of the Exchequer and various of his supporters, but to claim that which the right hon. Gentleman himself has claimed, that the insured persons who come under the Act should have mere justice—in other words, that they shall have the advantages and benefits which the Act is supposed to give them and which Parliament, when it passed the. Act, intended that they should have. The Act, I venture to say, has not produced this result. It is not a question, I admit, of individual cases so much as the general effect of the Act. One could quote many individual cases. I know of one myself, where in the case of an old man who was so old when the contributions first became compulsory that it was impossible for him to obtain any advantage under the Act. Application was made that he should be exempted from the Act, and that neither he nor his employer should contribute. This application was refused, and the old man and his employer were forced to contribute under the Act towards benefits which personally he could never and never has obtained. That is only one case. But, after all, the real object of the Act was surely to benefit the working classes, to make things smoother for them, to smooth their path in times of sickness or unemployment. We find that that has not been done. The Chancellor of the Exchequer, though he has had ample notice of this Debate, does not consider it worth his while to be present after full notice that his Act would be challenged in this way.
He has received a series of letters, and he has entered into correspondence with what is known as the Scottish Clerks' Association, an association banded together so far back as 1886, with the object of obtaining for its members various benefits. It must be remembered that clerks are people who are rather above the average class of employed persons; they are very much dependent upon the terms of their engagements, and they run considerable risks in many cases. They banded themselves in this instance into an association which at first did not give them all they wanted. With great trouble and 1287 difficulty they worked this matter out themselves until they had so far improved their rules that they were able to get all they could receive in the way of medical aid of various kinds. By a fixed payment they were to have medical aid, and have it in such a way that each and every one of them, if he so chose, could have the services of his own individual doctor. Their case was represented very strongly through various channels, and they were given distinctly to understand that if they met certain conditions under the Act they would be accepted as an approved society and would obtain Grants-in-Aid, so to speak, which would enable them, under the Insurance Act, to obtain the benefits they were granting to their members previous to the passing of the Act. Under these conditions they withdrew all opposition in this House to the Insurance Act. They followed that up by applying to be accepted as an approved society. To make a long story short, their application was refused, and this after they had obtained a large number of members on the strength that they had been told that they would be accepted as an approved society, and that as an approved society they would be able to grant to their members the same benefits as they were receiving previous to the Act. As soon as the Bill became law they were told they could not be accepted as an approved society unless they altered their scheme altogether, and reduced the benefits. That is only one of the many cases which one might quote if one had time to do so.
Since my name was mentioned as bringing this Motion forward I have been simply inundated with letters, not only from societies such as that to which I have referred, but from individuals all over the country; some of them in my own Constituency, and some in other constituencies, but all of them calling my attention to the way in which the administration of this Act has absolutely failed. I should like to come more closely home and refer to the actual promises that were made. We may say that chiefly what the Government did undertake, that insured persons should receive, was medical attendance and sanatoriam benefit. As regards medical attendance, I think that anybody will agree—I am quite certain that the right hon. Gentleman the Chancellor of the Exchequer, if present, would agree—that one thing you want when you are considering 1288 who is to treat you when you are ill is the doctor of your own choice, and that somebody else's doctor in no sense fills the vacancy. If there was any doubt on that point, I should like to quote from the right hon. Gentleman the Chancellor of the Exchequer, who in this very House, when the Act was in its Committee stage, said:—After all confidence in your doctor is essential. No man who could afford to do otherwise would hare a doctor prescribed for him by any club or society. He wants his own doctor to doctor him: the doctor in whom he has confidence.Again, the right hon. Gentleman said:—An elastic system of this kind (the power of the insured person to make his own arrangement for medical service with a doctor not on the panel) would meet that kind of case. It would enable the doctor to carry on his present practice, it would enable him to get his Bills paid, hecause there would be something to assist the workmen to pay and it would also enable the workmen to secure the services of his present medical adviser even though he refused to act on contract terms.Then we go further. This was not in the House of Commons, but this, Mr. Deputy-Speaker, was in the celebrated speech of the Chancellor in Whitefield's Tabernacle on 14th October, 1911:—What a fine thing it is to get the doctor you want and to get someone else to pay for him. That is the Government Insurance BillI hope Members of the House will bear that in mind. Again, in the Opera House, 13th February, 1912, the right hon. Gentleman said:—Doctors who are not engaged in contract practice need not take it for the future. The only thing that will happen to them will be, that they will charge exactly what they charge now, and they can send in their bills just as they are sending them in now. The only difference will be that there will be a fnnd to help their patients to pay the bill.Again, in the same speech I have referred to at the Tabernacle, the right hon. Gentleman said:—Another thing established by this Bill is this: He (the workman) can have the doctor of his own choice. … So we say to him, 'Go to the doctor you believe in. … What a fine thing it is to get the doctor you want and to get someone else to pay for him.'Again, the right hon. Gentleman said:—Faith is nine points of all healing. So we say, 'Go to the doctor you believe in.' The very sight of some doctors makes you ill. On the other hand, at the mere sight of some men—well, you feel better the moment they come into the room. That is the doctor for you and under the Insurance Act you get him.[HON. MEMBERS: "Hear, hear."] Hon. Members opposite say, "Hear, hear," but I hope they will wait until I finish. The Home Secretary, replying for the right hon. Gentleman, in answer to a question by the hon. Member for the Attercliffe Division, said this:—In making their own arrangements any person desiring to employ a duly quaified herbalist and the 1289 practitioners for whom the hon. Member speaks, will be entitled to receive precisely the same payment as any medical practitioner.So that not only is it promised that they shall have the choice of doctors, but he says that in a case where they do not want a regular practitioner they will be able to call in their own man and to avail of his services. Now what is the result? Here is one case—an insured person under the Act. He says:—I have had my family doctor for the past ten years, who is perfectly willing, for a very nominal sum per annum, to give me the best possible attention. After having filled in numerous forms, and in one instance waited five or six weeks before receiving a reply, and then receiving another form to be filled in by a doctor and myself and returned within forty-eight hours; then another wait, and a curt printed form declining, but giving no reason fur so doing.
§ The FINANCIAL SECRETARY to the TREASURY (Mr. Masterman)
Where was that?
§ Colonel CHALONER
It was the case of a Mr. Zammsky. [Laughter.] I quite understand hon. Members opposite laughing at a man because he has not got a British name, but some hon. Members opposite suffer from the same defect. He is a British elector and has a right to vote under an Act of Parliament, and, therefore, I consider he has a right to be heard. His address is 26, Norwood Road, Bolton, Seacombe, Cheshire. Let us take another case where a man made an application to be allowed to make his own arrangements with a doctor not upon the panel. He duly filled in a form, but he heard nothing about it until 19th February, when he wrote asking if it had received attention. He received a letter, and a few days later a curt refusal to allow him to have his own doctor. As he considered this was a great injustice he decided to put the matter before the right hon. Gentleman the Chancellor of the Exchequer, and he wrote him on 3rd April, when he received an acknowledgment to his letter, and finally he received a letter (No. 4) from the Insurance commissioners, which merely referred him back to the local committee, which they said had absolute power to decide the question upon its merits. In other words, he was distinctly refused what the Act of Parliament says is his right. So much for having the doctor of your own choice, which the right hon. Gentleman told us every insured person was to have. I have now shown, and I could give plenty more cases where those who are insured under the Act are not allowed to have their own doctors and have been actually refused. I should like to show the results that have 1290 accrued in the cases of those who have accepted the panel doctors, and I should think when the House hears them there will not be a feeling of much wonder that insured persons should wish to have what the Act says he should have, the service of a doctor. Here is a case I have seen only to-day from the county of Wiltshire, in which the writer noticed that this matter was going to be brought forward to-day. He writes:—I am sorry to say I have a son eighteen years of age who has developed the disease of consumption. He is discharged from Salisbury Infirmary. Now where is the sanatorium which was promised us? I am sorry to say my son has been a Post Office contributor from the first day. Now after waiting and making all inquiries he has got a bounty of 5s. 2d., and he has been notified that that is the amount standing to his credit after paying the whole time and 7d. per week during the time he has been ill and unable to work. Hoping you will let these facts be known and find someone else to fill Lloyd George's place.
§ Colonel CHALONER
That is what we will have before long. Now, I should like to give a case that happened in my own Constituency, showing the treatment so far as it is received that is meted out to insured persons by certain panel doctors. I do not say I am actually going to condemn the panel doctor. What has happened is merely that the results are bad because you are asking more than a human machine can possibly perform in many cases. Here is the case of Charles Henry Titherington:—My son, a youth of twenty years of age residing with me, is an insured person. On Saturday afternoon last, the 29th March, the boy had been out in the rain and got wet. Later in the evening he developed a chill and was placed in bed. Early on the morning of the 30th (Sunday) he showed signs of getting worse. I came to the conclusion that pneumonia was developing and my wife immediately applied hot poultices to him. I dispatched toy son-in-law to Dr. Dunlop's house with the request to visit the boy. The doctor was not at home at the time, and my son-in-law wrote the name on the memorandum tablet and asked the servant to inform the doctor that the boy was spitting blood, and to request him to come at once. As the doctor did not arrive at tutor, I sent another person, a Miss Kelly. This young lady saw the doctor and informed him of the serious condition of the boy and asked him to come and see him. The doctor asked the young lady whether she was not aware that insured patients were not visited on Sundays.Are we to be told that if a workman's son is dying on a Sunday afternoon that, because it is Sunday, the doctor is not to come to see him? Yet, according to the actual accounts, that is the answer given that insured persons were not visited on Sunday:—The doctor asked her whether she was aware that insured patients were not visited on a Sunday, and requested her to describe the case. She replied that she thought it was a case of pleurisy, and he then said 1291 he would go along and see the boy, but that if it turned out not to be a serious case he would report the matter to the committee. I waited until close on six o'clock for Dr. Dunlop to put in an appearance, and I then sent my two daughters to his house again to ask him to come round. They also saw Dr. Dunlop. He informed them that he had told the last messenger (Miss Kelly) that he was corning round to see the boy. One of my daughters then told the doctor that the boy was very bad indeed, and asked him whether he intended to come round or not; if not, it would be necessary to call in another doctor. He replied, 'I will not come round now; I will come when it suits me.' My daughter then said, 'Very well; we shall have to get someone else.' As a matter of fact, the doctor did not come, and I had to call in another doctor, who reported it was a case of pneumonia.These are serious facts. People are obliged to contribute under this Act for the services of a doctor, and when the man tries to call a doctor in the result is that the doctor declines to come. I could quote other cases where deaths have actually occurred, and I have even got a case where the death of a doctor has occurred because he was so overworked under the Act that it was quite impossible for him to fulfil the whole of his duties, and at last human nature gave way. I have here a letter from a doctor in Dorset, in which he gives examples of the way in which the Act has actually failed where people who have contributed moved from one district to another. Everybody knows the large number of people that come and go. They have been treated by one doctor in a particular district, and when they go into another nobody knows who is liable and nobody knows whether they are entitled to be treated or not. I will not occupy too much time by going into all these cases, as many of us want to speak, and I am particularly anxious not to take up too much time.
I should like to point out that what I have quoted from the Chancellor of the Exchequer is a deliberate and distinct pledge and statement made at the time when by-elections were going on, when this Act was used as a means of obtaining votes in order to win elections. With that object in view, the right hon. Gentleman made the distinct pledge that this Bill was going to give to the insured person, the poor workman, palaces, hospitals, first-class hotels, sanatoria; and he was told that he would be able to choose his own doctor. All those pledges were made definitely and clearly with the distinct object of winning elections, and having made those promises not one of them has been fulfilled. I have proved that they have been broken, and I claim the support of hon. Members below the Gangway, not to con- 1292 demn the Minister or with a party object of proving the Minister was wrong—I could prove that not only on this subject, but on fifty or even five hundred subjects—but to demand for the insured persons, who are working men, and not rich men who can get doctors whenever they want them, who are bound by this Act to contribute to the insurance fund, and having contributed, are bound to accept the terms granted under that Act; I appeal to this House to support this Resolution, in order that we may obtain mere justice for the insured person, and obtain those benefits which were promised when the Bill was passed, which we were led to believe were contained within the four corners of the Bill; and we are now determined by public opinion to force the Government to grant to the insured persons the benefits which were promised when the Bill was passed.
§ Mr. GODFREY LOCKER-LAMPSON
I should very much like to support the Motion which has been so ably proposed by my hon. Friend. It is not so often we get an opportunity of discussing the Insurance Act in this House, and it is really important that the public should realise that a large number of the glib promises made by the Chancellor of the Exchequer two years ago have disappeared in smoke; in fact, the Chancellor of the Exchequer is a past master in the art of making promises, especially when a delicate situation has to be tided over. [An HON. MEMBER: "What about old age pensions?"] When the Chancellor of the Exchequer makes these promises one feels at the time almost a brute to doubt what he says. But what is happening? In many cases, in various directions, insured persons have been denied those benefits which, after all the promises made by the Chancellor of the Exchequer, they have every right to demand as their due. I should like to give three instances of these broken pledges, one of which was dealt with by my hon. Friend. In the first place, the Chancellor of the Exchequer promised the friendly societies and their members a huge release of reserves if his Bill passed into law. At Birmingham, in the year 1911, the right hon. Gentleman told his audience that if friendly society men had been in friendly societies for a period of years they had a credit to their account, and under the Bill he realised that credit and took over the whole burden of the State scheme. The right hon. Gen- 1293 tleman repeated that pledge several times, and he added:—What I want to tell you is this. We are realising the credit which you have created by your thrift, industry, and foresight. We are giving you the full benefit of it, and we are adding something on the top of it.Stripped of its technicalities, that pledge means that if a man was voluntarily insured in a sound friendly society, and then became compulsorily insured, as the Chancellor of the Exchequer said, the insured person would be able to claim a reduction of his voluntary contribution by the amount he would have to pay on the compulsory side of his insurance, and though the voluntary benefits would have to be reduced to the extent the State was taking them over, on the whole they would not be reduced to the whole of that extent, as there would be some benefits to spare on the voluntary side. In the Chancellor of the Exchequer's own words, the promise was:—We are realising the credit mid adding something on the top of it.To put it more plainly, if the member's voluntary contribution was formerly 7d. a week, he would pay 3d. in the future, or 4d. less on the voluntary side of his friendly society, and he would get the full 3d. worth of voluntary benefit, and something added on the top of it on the voluntary side. There is no doubt about this, because the Chancellor of the Exchequer, at Birmingham, quoted an exact instance, and I have here a copy of his speech published by the Liberal Publication Department. He took the instance of a man who had been in a friendly society for a good many years, and who had been paying 8¼d. a week, or 2s. 9d. for a month of four weeks, and he promised his audience that that same man, under the Bill, would only pay 4d. per week, or 1s. 4d. per month of four weeks towards the voluntary side of his insurance, or 4d. less than he had been paying before the Bill passed into law. Of all the promises made by the Chancellor of the Exchequer, no promise facilitated the acceptance of this Bill by the friendly societies in this country more than this one. The friendly societies and their members believed him, and in nearly every case those friendly society men have been deceived. [HON. MEMBERS: "No."] The pledge was merely an emergency promise made in order to serve a temporary purpose, and it came to nothing. I have this on the authority of the greatest actuary I suppose in this country outside the official circle of 1294 actuaries dealing with the Act. In about 90 per cent. of the cases there has been no realisation of reserves at all. Contributions are being paid in full to the voluntary side of the friendly society as well as the compulsory side. I saw a list the other day of 480 friendly societies in a mining district. To take an instance, there was a large branch of the Manchester Unity with 1,700 members, and only two of those members had got reduced contributions and benefit contracts under the voluntary side of their friendly society. Therefore, out of 1,700 members, only two had released reserves.
§ Mr. G. LOCKER-LAMPSON
They were paying the full rate of contributions because they could not get the release of reserves promised by the Chancellor of the Exchequer. This means that £10 of reserves were set free when releases of £8,500 were expected and promised on the basis of that pledge. Another friendly society, the Ancient Order of Gardeners, has a net deficiency of £353,000 and 44,000 members. If it had the release of reserve promised by the Chancellor of the Exchequer, and if every member had been able to reduce his contributions and benefit contract on the basis of that Birmingham speech, the deficiency would have been brought down to £140,000.
§ Mr. MASTERMAN
Does the hon. Gentleman suggest that this is done from any other cause except voluntary agreement with the members themselves?
§ Mr. G. LOCKER-LAMPSON
No. My argument is that this release of reserves was promised in the Birmingham speech to the friendly societies. The friendly society members have not been able to obtain those releases, and therefore they have practically had to go on paying the full rate of contributions to get their benefits. With regard to this society, practically none of the contracts have been reduced, and the deficiency will not be reduced at all. Consequently, all these members will be over insured.
§ Mr. G. LOCKER-LAMPSON
Not at all. I am very glad that hon. Members opposite 1295 should ask these questions, because I want to make myself plain. If this release of reserve had been possible, as was promised by the Chancellor of the Exchequer, it would have been possible to wipe out that deficiency.
Mr. MacCALLUM SCOTT
Has it got a balance to the good—a surplus—or has it got a deficiency? If you have got a deficiency, how can you release a surplus?
§ Mr. G. LOCKER-LAMPSON
I said s—£353,000. Under the Act a great release of reserve was to take place by the fact that the State was going to take over a large portion of the expense, but as this release of reserve has not taken place it has not been able to wipe out that deficiency. That deficiency, as a matter of fact, will not be reduced at all, and the members of that society consequently will be over-insured. In fact, in practice the friendly societies are not in a position to give their members the benefits categorically promised by the Chancellor of the Exchequer in the event of this Bill passing into law. It is not even being done in perfectly sound societies. It cannot be done, and the Chancellor of the Exchequer must have known that. At any rate, he ought to have asked advice and found out about it, and he ought to have said it could not possibly be done in the vast majority of societies to-day. Indeed, in practice it is not done and cannot be done. Friendly societies are even now finding out that they are obliged to limit what reductions of contributions they can give on the voluntary side. They find they have got to limit those reductions to persons under seventy years of age, although the Registrar of Friendly Societies last year issued a table showing the provisional reductions of contributions that could be made without saying a single word about any limit in connection with these reductions. It is a great pity, to say the least of it, that the Chancellor of the Exchequer held out all these hopes. They were hopes which were engineered, somewhat callously I think, owing to his desire to obtain sufficient support for his Bill in the friendly society world when it was passing through the House of Commons. In the second place, a distinct breach of faith has taken place in regard to medical benefit. 1296 On 27th October, 1912, the Chancellor of the Exchequer said:—If the remuneration of the doctors is increased, then where necessary the practitioners should resort to those modern methods of exact diagnosis, the importance of which I am advised is increasingly recognised in the profession.It is perfectly well known in the medical world that these mean pathological and bacteriological investigation. What has happened? Since the speech of the Chancellor of the Exchequer these modern methods without any excuse or explanation have been cut out of medical benefit altogether, although insured persons as taxpayers and as members of friendly societies are paying additional remuneration to the doctors for the purpose. There is no doubt at all about this. On 28th November last year the Chancellor of the Exchequer forwarded a memorandum to the British Medical Association, and in it occurred this sentence:—X-ray diagnosis and pathological or bacteriological investigation would not be services included in medical benefit.The Financial Secretary to the Treasury will remember that, answering a question, he made it quite clear that benefit was excluded. Therefore, a public pledge has again been broken, and insured persons are being deprived of a particular medical benefit, a most valuable and important one, for which they are paying both as taxpayers and insured persons under the Act.
§ Mr. MASTERMAN
I do not think I said that these modern methods would not be resorted to. I said that the obligation was not laid on the doctor, but that where they were available we expected they would use them.
§ Mr. G. LOCKER-LAMPSON
The pledge of the Chancellor of the Exchequer was that where necessary that benefit would be given to the insured person, and he sent a memorandum to the British Medical Association saying that it was not included in medical benefit. That is my point. After all, I do not think it can be too much emphasised that an exact diagnosis is a most vital part of all medical treatment. It lies, in fact, at the root of all medical treatment, as I believe any doctor will agree, and I should have thought that it was just as important for insured persons to have an exact diagnosis as for those richer members of the community who can afford to pay for it, but apparently the Chancellor of the Exchequer and those hon. Members who support 1297 him seem to think otherwise. In my opinion the most unsatisfactory feature in the administration of the Insurance Act at the present moment is the refusal of free choice of doctor to the insured. It is another broken pledge, and to my mind a worse breach of faith even than the two others. The whole history of this question of free choice of doctor has been from beginning to end a flagrant piece of deception. Time after time in this House and in the country the Chancellor of the Exchequer gave his pledged word that insured persons under the Act would get the doctor of their choice. At four or five great meetings in the country he made this promise without any reservation or limitation, and other Ministers in the country reiterated the promise on the platform. The classic instance is the speech of the Chancellor of the Exchequer at Whitefield's Tabernacle, quoted by my hon. Friend. There was not a single word of limitation in that speech at Whitefield's Tabernacle. The Chancellor of the Exchequer did not say to his audience, "The doctor you want, Who has attended to you ever since you were born, and who may be in your sick room at the very time the Act comes into operation may not be on your panel, and in that case you may have to put up with a doctor you have never seen in your life. That is the Insurance Bill." He did not say that, he said exactly the contrary. I have a quotation here—I think it is the only quotation which has not already been made in this House—and it is what was said by the Chancellor of the Exchequer to the Advisory Committee on the 23rd October last year. These were his words:—If any workman does not care to be attended by the whole-time doctor appointed he may choose his own doctor under the Act, and a contribution may he made for the purpose of assisting him in paying his own doctor, so, to that extent, the free choice of a doctor will be safeguarded in the case of a national service.To my mind nothing could be clearer than that pledge. The right hon. Gentleman made the promise over and over again, and everyone knows that it was on the strength of that promise that vast numbers of the people of this country were induced to give their support to the Bill. What has happened in fact? In hardly any case in the country can an insured person get the doctor of his choice if that doctor does not happen to be on the panel. They are even refused permission to have the doctor of their choice if their circumstances are exceptional—if, for instance, they have been attended by the same doctor for a 1298 period of twenty or thirty years, or if they were actually ill at the time the Act came into operation, or at the time they made application to be allowed to choose their own doctor, or if they were actually being attended to by him at that time. I have some information which I have received during the last few hours which comes from different parts of the country, but I will deal with four districts only. They are Warwickshire, Durham, Chatteris and the county of London. In the case of the Warwickshire Insurance Committee, several hundreds of people asked for permission to have as their medical attendant Dr. Nason, of Nuneaton, who supported the request and who received a reply from the insurance committee to the effect it was the intention of the Act that this permission should only be given in exceptional circumstances. That is inaccurate to start with. The insurance committee also wrote to the applicants, stating that their application would be considered after a form of agreement had been signed by them, and the committee in sending the form of agreement added that it must be countersigned across a sixpenny postage stamp by the doctor they proposed to employ. About 250 of Dr. Nason's patients signed the agreement and affixed the stamp. Dr. Nason wrote to the insurance committee and this is what he said. It seems to be a very important factor in this case. His words were:—I am willing, for the sake of my own patients and friends, to accept a strictly limited number, such number to be decided by myself, on the same terms and under the same conditions that apply to persons attended by doctors on the panel, but I am not prepared to join the panel.He ended the letter by asking the insurance committee why his patients should be penalised by having to put a sixpenny postage stamp on the form which they were asked to send in. The committee wrote back:—As to your accepting a limited number of patients, the panels committee has recommended that, subject to provision being made for proper treatment of all insured persons and to the approval of practitioners on the county list, doctors shall, in special cases, be allowed to join the panel for a limited number of insured persons only.And they went on to add:—They (the insured persons) will not receive any contributions unless the doctor complies with the terms of the undertaking—(that is agrees to go on the panel).Further they say:—It is better to spend sixpence, making sure of this beforehand"——1299 The House will note that no intimation was given to these persons that they might be spending their sixpence for nothing—than that they should incur expense only to find that on account of the refusal of the doctor to carry out the conditions the committee could make no contribution towards the cost.As if this was not enough, the Insurance Committee kept the applicants waiting nearly three months, and then sent them the following printed form, without the slightest inquiry into their condition, without any inquiry as to whether their circumstances were exceptional or not. The form was in these terms:—Dear Sir or Madam,—I am directed to inform you that your application to make special arrangements for medical benefit has been considered and is refused. When a practitioner is willing to treat a number of insured persons (as is the doctor whom you wish to attend you) he should do so under the usual agreement with this committee.9.0 P.M.
That means that he should go on the panel. The House, therefore, will see that, though these particular persons wanted a particular doctor as their medical attendant, and though they had paid 6d. in the first instance when they made application, yet after waiting a very long time they were curtly refused permission en bloc, without inquiry into their circumstances, although the circumstances of many of them were exceptional in the highest degree. Some of these persons had been attended by Dr. Nason ever since they were born, some were ill, and actually being attended by him when the Act came into operation, or when they made application to have him as their doctor. The cardinal crime was that Dr. Nason was not on the panel, although he agreed to treat these patients on the same terms and under the same conditions as applied to persons attended by doctors on the panel. [An HON. MEMBER: "Why did he not go on?"] I am not dealing with that; I am dealing with the pledge given by the Chancellor of the Exchequer. The Secretary to the Treasury last Session hinted that doctors outside the panel were not so worthy the confidence of insured persons as doctors on the panel. I believe that to be wholly untrue. I say it is an unworthy insinuation. I may mention that Dr. Nason is a Bachelor of Medicine and Surgery of Edinburgh; also surgeon to the Nuneaton General Hospital and medical officer to the Post Office—all evidence of his high standing in the medical profession and justifying his patients in wishing to have him as their medical attendant.
1300 I have another case from Durham, the case of Dr. Densham, of Stockton-on-Tees, a Bachelor of Medicine and Surgery of Edinburgh and surgeon to the Stockton Hospital. It may surprise the Secretary to the Treasury to hear that, in spite of his medical qualifications, he does not want to go on the panel. His patients have applied to the Durham Insurance Committee for permission to choose him as their doctor, and have been curtly refused without any explanation whatsoever. I should like to ask hon. Members below the Gangway what they think of this case. No fewer than fourteen people have applied. I have their names and addresses here if the right hon. Gentleman wishes to look at them; they have been attended by Dr. Densham since birth in all their sicknesses, and five were actually ill and under treatment by him for critical disorders when the Insurance Act came into operation, and when they applied to have him as their doctor. Surely these cases constitute exceptional circumstances, and surely it is in the interests of the health of those insured persons that they should be able to retain the doctor of their choice. The case from Chatteris is on exactly the same lines. Dr. Nix is not on the panel; five of his patients were ill at the time when the Act came into operation, and were being attended by him when they applied for permission to choose him as their doctor. I have their names and addresses also. I may mention that Dr. Nix is a Bachelor of Medicine and Surgery of Cambridge, medical officer of health to the Chatteris Urban District Council, and house physician to the Brompton Chest Hospital, one of the best known hospitals for consumption.
The same thing is happening in the County of London, for which I will give only one instance. Russell Mott, a bank messenger, has been attended since his birth by the medical officer, Dr. Hildyard Rogers. Dr. Rogers is not on the panel. Although he is a member of the Royal College of Surgeons of London, a Licentiate of the Royal College of Physicians of Edinburgh, and late Assistant Surgeon to the London Ophthalmic Hospital, he has been refused permission to treat these patients under the Insurance Act by the County of London Insurance Committee. The hon. Member for Walworth (Mr. Dawes), who is Chairman of the London Insurance Committee, has written to the secretary of the National Medical Guild to say that Mott's circumstances are not 1301 exceptional, although his doctor has attended him since he was born in all his sickness. A circular has also been sent out by the London Insurance Committee to all applicants for free choice in these words:—Insured persons who have not elected their doctor——that is their panel doctor—by the 31st March, 1913, will be liable to distribution amongst doctors on the panel.I must apologise for having detained the House so long, but I have got a great many more instances here with which I am not going to deal. I have names and addresses from Stafford, Brixton, Wandsworth, Smethwick, and other places. It is the usual state of affairs practically all over the country. I am very glad the Chancellor of the Exchequer has at length put in an appearance. [HON. MEMBERS: "Oh, oh!"] I do not want to say anything offensive or discourteous—[An HON. MEMBER: "Why mention it?"]—but I do feel that when my hon. Friend proposes a Motion of this sort, which is concerned with the pledges given by the Chancellor of the Exchequer, he might have done my hon. Friend the courtesy of being present. I should like to ask the right hon. Gentleman what he really thinks constitutes exceptional circumstances, or is the term "exceptional circumstances" merely one other of those plausible pretexts invented to account for the complete disappearance of the right hon. Gentleman's pledge. As I have shown, many of these patients who have not been allowed to choose their own doctors have been attended by those doctors, ever since they were born, in all their sickness. In these cases it is perfectly evident that a new panel doctor cannot possibly know the peculiarities of their systems or their pathological records so well as the doctor who has always attended them. It is not merely a case of medical attainments and technical knowledge. It is also perfectly evident that the last thing which is good for the patient is that an untried doctor should be thrust upon him, whom he does not want, and whom, perhaps, he greatly dislikes and distrusts. Nothing is more likely to retard the convalescence of a patient and to destroy all confidence in his ultimate recovery. In the Chancellor of the Exchequer's own words, used at Whitefield's Tabernacle:—Faith is nine points of all healing.It is nothing less than a cruel and harsh exercise of bureaucratic power to take 1302 away the doctor a man has always had, whom he trusts, and to foist upon him a stranger who may be antipathetic to him in every way. It would not be dreamt of, except in the case of the poorer classes, and I cannot understand how such a democrat as the right hon. Gentleman can lend himself to it. I have also shown that free choice of doctors is even refused to the insured person when he is actually ill and being attended by his own doctor when the Act came into operation, and when he made the application. Will the right hon. Gentleman maintain that it is wise suddenly to force a new doctor into the sick room, who must necessarily be unacquainted with the history of the disease and all the idiosyncrasies of the patient. These cases form exceptional circumstances, and if free choice is going to be refused generally, surely free choice ought to be allowed where the circumstances are exceptional, such as I have described. The result of refusing free choice of a doctor and of forcing patients upon doctors whom they do not want, is that a vast system of overwork is being established in our great centres of population. Dr. Madden, of 53, Devonshire Street, Islington, has 5,560 patients on his list. Dr. Salter, of Bermondsey, has over 6,000 patients on his list, and Dr. Ainsley Young of Stepney, has very nearly 7,000 persons on his list. How can any doctor possibly deal with such a list, and what can possibly be worse for the health of the community? It is nothing less than a scandal[...] It is entirely due to the refusal to allow insured persons to make their own arrangements with medical practitioners outside the panels. I submit that under the Act, as it is being administered at the present moment in respect of medical benefit, an intolerable course of tyranny is being pursued, and that the promises and pledges made by the Chancellor of the Exchequer have been shamelessly thrown overboard. When he thought it necessary to gain public support for his Bill he was ready to see everybody and promise anything. In those days it was—the doctor you believe in,and—what a fine thing it is to get the doctor you want, and get somebody else to pay for him.But now the Act is passed and public support is no longer required, he wipes his pledges off the slate, and looks on with a cynical indifference at the disappointment of those he has duped and deceived. I do 1303 hope it is not too late, even now, to persuade the Chancellor of the Exchequer to return to his earlier manner, when he saw these things as clearly as anybody else. If the right hon. Gentleman would only believe it, the role of benefactor is much more becoming to him than that of Juggernaut. If, however, the Government refuse to remedy this defect, I believe that it will not only be detrimental to the health of those insured persons they profess to benefit, but that they will lay up against themselves at the next General Election a grievance, a smouldering sense of injustice and injury, that will not be forgotten when they can eventually summon up courage to appeal to the country. For these reasons I have great pleasure in seconding the Motion of my hon. Friend.
§ Mr. DAWES
My excuse for trespassing on the time of the House to-night is that I have a great deal to do in the administration of the Insurance Act in the County of London. Perhaps I may be allowed at once to deal with the point mentioned just now by the hon. Member for Salisbury (Mr. G. Locker-Lampson), who mentioned certain names which appeared in a document marked "Private and confidential," which I have been assured this afternoon has been disclosed to no one, although the figures and nothing else have been given. How the hon. Member got the private and confidential document I do not know, but I will assume that he did not know and did not see that it was marked "Private and confidential" on the outside. I have the document here so marked. He has mentioned three cases. There is the case of Dr. Salter, who has 6,017 insured persons—not insured patients, as stated by the hon. Member—[An HON. MEMBER: "He does not know the difference"]—although that document gives the fact that Dr. Salter has four partners, all of whom are on the panel, and who, by arrangement, have no insured persons to their names, all being put to the name of Dr. Salter.
§ Mr. G. LOCKER-LAMPSON
The numbers I gave are the numbers of the persons of patients on that doctor's own list, and the people who are working with them have separate lists.
§ Mr. DAWES
No, they have not. I was saying, and I repeat, that these four doctors in partnership with Dr. Salter have not got one insured person to their name—any of them. May I say, further, 1304 that four out of these five doctors in that town are among the most highly qualified doctors in London, and four of them are doctors of medicine of the University of London, and it is almost the irony of fate that this gentleman's name should be mentioned, because a fortnight after the Act came into operation I myself asked Dr. Salter if he would take an insured person, and he said, No, his list was full and he and his partners only intended to take a limited number, and he would take no further cases. The inference, of course, is that this man is going on taking patients till he gets 10,000, 12,000, or 15,000. I hope that settles that case. In the case of Dr. W. Ainslie Young, who has got in his own name 6,929 insured persons, there are four partners, all highly qualified men, and, again, not one of those partners other than Dr. Young has got a single insured person in his name, although they are all on the panel. In the case of Dr. Madden, also mentioned by the hon. Member, 53, Devonshire Street, who has 5,560 insured persons, he also has a partner, Dr. Coomber, also on the panel, who has not got a single patient to his name, and the result is that these two gentlemen have about 2,800 insured persons apiece. Dr. Salter's firm works out at 1,204 insured persons per doctor, and Dr. Young's firm works out at 1,732 insured persons per doctor. I put it to the House as to whether it is a fair thing for either a newspaper or the hon. Member to drag respectable names into the House with the view of showing that they are having a great deal too many patients, without apparently taking the slightest trouble to investigate the facts at all and quoting from this private and confidential document.
§ Mr. DAWES
My information was obtained to-day from the clerk of the Insurance Committee, of which I am chairman, and it is official. Is that sufficient for the hon. Member or is it not? I shall be perfectly prepared to show the hon. Member at any time he likes to name, at 5, Chancery Lane, our records showing the figures. Now may I deal with an innuendo which has been put forward just lately by two hon. Members with regard to sanatorium benefit—the hon. Member (Mr. Touche) and the hon. Member (Sir J. D. Rees)? In each case, after asking questions, the hon. Members have asked if it is not a fact that 1305 sanatorium benefit is non-existent in the county of London? I wish to give the House a few facts. The insurance committees, of course, were constituted about the middle of July of last year, and we in the county of London at once set to work to provide sanatorium benefit for such persons as were entitled to it. Of course, you cannot do these things in a moment. We at once, within a fortnight, appointed an expert, Dr. Edward Squire, to advise us on the various cases, as to what they were suitable for and so on, and on 12th September we began to send cases to sanatoria, and between that time and 14th November we had 147 persons in sanatoria in different parts of the country. That is probably a record which, although I do not wish to make comparisons with any other county, compares favourably, at any rate, with sanatorium benefit as administered elsewhere within the country. I only mention this because it is said that sanatorium benefit does not exist in the county of London. Our difficulties on the London Insurance Committee began in the middle of November. Up to that time we had got sanatorium accommodation for approved applicants, but, unfortunately, on 5th October, the vice-chairman of the Metropolitan Asylums Board, Professor Smith, said:—London had at its disposal, practically immediately, a thousand beds for the proper treatment of tuberculous cases in admirable institutions. Large numbers of persons were waiting to be treated, and although they had a thousand beds the Board were precluded from using them owing to the Clause as to the Poor Law authorities.At that time the London Insurance Committee had a very favourable offer of an admirable institution which they wanted. The Insurance Committee unluckily are not able to take institutions in their own name or expend any capital sum upon them. All they can do is to refer the matter to the county councils, or in the case of a borough to the town council. We requested the London County Council to take this matter into consideration. The county council said, "No. The Metropolitan Asylums Board say they can give you a thousand beds immediately. We will make arrangements with them as your agent and you must deal with them." Professor Smith having said they had a thousand beds at practically immediate notice, we were satisfied. In four and a half months the Metropolitan Asylums Board has only been able to provide us with 300 beds altogether. Although the negotiations were completed in the middle of December, we have only at this moment 1306 somewhere about 300 beds, and in the meantime the London County Council refused to move, although they passed some time ago a pious resolution to take over the care of all tuberculous persons within the county, and then the London Insurance Committee gets blamed for the delay. We have done our best, and the present position is this, that we now have under treatment 1,425 people. We have 557 cases in sanatoria, 113 cases in hospitals, 464 persons are receiving domiciliary treatment, 267 are receiving dispensary treatment, and twenty-four are attending hospitals as out-patients. With that I am prepared to leave it to the House to say whether or not sanatorium benefit is non-existent within the County of London.
I wish now to deal with the subject of medical benefit. I have already referred to what the hon. Member (Mr. G. Locker-Lampson) mentioned with regard to these three doctors. No doubt he originally got the statement, or part of it, from an article in the "Daily Mail" of last Monday, headed "Panel Scandal." "Medical benefit under the Insurance Act is to a large extent non-existent," and so On. That purports to be an interview with a member of the London Insurance Committee, and at subsequent meetings we asked that member to substantiate some of these charges. I must ask the House to remember that the number of insured persons in the county of London is 1,430,000—a very large number. The "Daily Mail" article states that large numbers of complaints are being received by the London Insurance Committee of inadequate medical benefit. The total number of complaints amounts to nineteen. The "Daily Mail" article went on to say that these complaints were almost exclusively in regard to doctors who had an excessive number of insured persons on their lists. The actual number of complaints against doctors with more than 2,000 persons on their lists is eight out of these nineteen. Several of these complaints were with respect to such things as declining to give certificates to friendly societies, and so on. I represent a purely industrial constituency with which I have been connected for many years. I have resided within a very short distance of it for twenty-three years. I am in very close touch with the constituency continually, and I have only had three complaints made to me since the medical benefit part of the Act came into operation. But I do not 1307 rely entirely on myself in this matter. In the neighbouring constituency of Lambeth there is a gentleman who has spent all his life practically in the place. He knows the whole life of the district, and I have from time to time, knowing that these visionary complaints were going about, asked him if he had heard any complaints. He has kept very careful watch, and he tells me that there are no more complaints now than there used to be before the Insurance Act came into operation. Bearing in mind that we have 1,430,000 insured persons, the wonder is not that there have been so many complaints, but that there have been so few.
I do not think the Chancellor of the Exchequer and the Financial Secretary to the Treasury have ever claimed that the Act is absolutely perfect. I know very few Acts of Parliament that are perfect, but I say, having regard to the number of persons insured, the complaints are very few. In regard to the free choice of doctors, the "Daily Mail" article apparently desires to restrict the free choice. The hon. and gallant Member for the Abercromby Division of Liverpool (Colonel Chaloner) was eloquent on that subject. The total number of applications for "own arrangements" in the county of London has been 2,900 in all, and of these 293 have been granted. May I say, in answer to the hon. Member for the Salisbury Division (Mr. G. Locker-Lampson), that we have laid down the conditions under which we would grant exceptions? We will grant exception to persons the nature of whose occupation renders it impossible for them to secure the services of a particular doctor; persons who desire a special form of treatment, such as is given by homœopaths and herbalists; persons under treatment for special ailments, including all cases of tuberculosis; women who desire a woman doctor where there is none on the panel within a reasonable distance; and persons who suffer from heart complaints. In these cases we allow an insured person to make his or her own arrangements. A moving picture was put before the House as to those who are not allowed to have the doctors who have been attending to them for years. In the case referred to by the hon. Member, that of a man called Mott, there were no exceptional circumstances which justified the committee in granting an exception. The Secretary to the Treasury will no doubt reply as to the special circumstances in which an insured 1308 person's own doctor ought to be allowed to attend. We are told that there must be special circumstances, and it is in the interest of insured persons that they should have full value for their money, because the moment they contract out they render themselves liable to pay more than they would pay under the Act.
Although it is no business of mine, I would point out that in the case of the 200 odd people referred to the remedy is very simple. Let the doctor come on the panel. Why should he not do so? We have tried to make things in the County of London as easy as possible for the doctor. For instance, the medical officers of hospitals, and so on, who wish to give their services for a limited number of patients are allowed to do so, provided they do not select the lives. I say the Insurance Committee will be taking a grave responsibility if they force on a doctor more patients than he desires to take. It seems to me that, unless there is an excellent reason for not doing so, a doctor should come on the panel. There is no disgrace in it surely. We have some of the most highly qualified men in London on the panel of 1,250. Doctors are coming in every day. We began with 760. May I say in justice to the doctors that they are doing their best to make the Act work in London, and I believe we shall have a considerable accession to the number on the panel. It is for the Secretary to the Treasury to defend the Government, but, speaking as one who has considerable knowledge of London, I can state that the Act is not unpopular. Considering the number of insured persons, the complaints have been infinitesimal, and although, as probably the Chancellor of the Exchequer would agree, there are certain amendments required, the Act is working, in view of the novelty of the whole scheme, with extraordinary smoothness.
§ Mr. ARNOLD WARD
I desire to ask the Chancellor of the Exchequer what is the attitude of the Government towards insured persons with respect to a doctor who is not upon the panel. How do the Government reconcile their attitude with the pledges which the Chancellor of the Exchequer gave? I do not think the right hon. Gentleman was in the House when my hon. Friend read the pledges which he gave at Whitefield's Tabernacle. He said:—He (the working man) can have the doctor of his own choice; so we say to him, 'Go to the doctor you 1309 believe in.' What a fine thing it is to get the doctor you want, and get somebody else to pay for him. That is the Government Insurance Bill.I had the privilege of hearing that speech. I believe I was the only Member of the Opposition who was present at that remarkable meeting, and a very remarkable spectacle it was. There was the right hon. Gentleman standing in a religious edifice with his eyes turned up to heaven, and in that religious edifice he poured forth a flood of violent abuse on the Tories, the rich, the doctors, and the other familiar objects of his platform slander. Certainly it was not an edifying or a Christian or a charitable spectacle, but I am sure that the House will agree that it would be made more uncharitable and more unchristian if the promises, then so solemnly given, are not made good to the insured persons to whom they were made. It is no part of my case to complain that the pledges were not fairly carried out so far as the words of the Act itself are concerned. As far as I have been able to understand the 3rd Sub-section of Section 15 of the Insurance Act, it does provide that insured persons may have a doctor of their own choice. The Sub-section lays down that the regulations made by the Insurance Commissioners shall authorise the insurance committee by which medical benefit is administered to require any insured person whose income exceeds a limit to be fixed by the committee, and to allow any other insured person, in lieu of receiving medical benefit under such agreement as aforesaid, to make their own arrangements for receiving medical attendance and treatment. There is nothing whatever in the words of the Sub-section about special or exceptional circumstances. It is an opportunity to be given to insured persons, and I submit that that is an opportunity which ought not to be unreasonably withheld. But apparently something has happened after the Act was passed to frustrate the insured person from getting the doctor he desires. I will only quote one case, a case which occurred a few days ago in my own Constituency, of a lady who has been for many years the patient of a doctor at Watford. That lady became an insured person, and the doctor did not go upon the panel. I have the correspondence here, which I will be glad to submit to the right hon. Gentleman or to show to any Member of the House. The lady desired to have the advantage of her old doctor's attendance, and wrote to the Hertfordshire insurance committee, asking them to make a contri- 1310 bution to her medical treatment, and received the following reply:—I am directed by the Hertfordshire insurance committee to acknowledge receipt of your letter of the 12th inst., and to state that the insurance committee are not prepared to sanction any arrangement for the medical treatment of insured persons which are alternative to the panel system. I am, therefore, to request that you will present your medical ticket, which is returned herewith, to one of the doctors on the Hertfordshire panel for acceptance.I do not want to criticise the Hertfordshire Insurance Committee in the slightest degree. I am sure it is not their fault; I am sure they have done their very best to administer the Act; but what I submit is that in view of the terms of the Statute they could not possibly have taken up this attitude of refusing to sanction any arrangement outside the panel unless very strong pressure was brought to bear on them by some superior authority. I would like some statement from the Government on that point, and I would like to know whether it is their policy that all arrangements outside the panel are to be absolutely taboo. The last point that I would wish the Chancellor of the Exchequer to answer is as to what has been done towards providing sanatoria. I am not going into the full details of the sanatorium question, but I wish to call the attention of the Chancellor of the Exchequer to the criticism which was passed the other day by Mr. Sidney Webb. In two sentences he summarises his view of the Government. Dealing with sanatoria, he states:Unhappily the Government Departments were found unprepared, and their differences with each other, their delays, and their unresourcefulness, have been maddening. Even now of the £1,500,000 sterling which Parliament voted for the instant establishment of sanatoria in 1911, not a penny has yet been paid over. Up to 31st December last, more than a year after the House of Commons had made the money available, not a single proposal for a new sanatorium has been approved by the Local Government Board and the Treasury.In conclusion, I only desire to ask the right hon. Gentleman whether those criticisms by that great economic authority are accurate, and if not accurate in what respect has he gone wrong, and if they are accurate what is the Government's explanation and what is their defence?
§ Mr. J. H. THOMAS
I think that every Member of this House will welcome the opportunity which we have of discussing this important question. Having listened carefully to the Mover and Seconder of the Motion I am bound to say that I approach the question from an entirely different standpoint, and I really believe that most of the difficulties that are now magnified arise because many Members of this House are entirely ignorant 1311 of the friendly societies and the trade union movement. I speak now as an officer of probably the largest trade union in the world, which at this moment has 100,000 approved members, and I say unhesitatingly that there is no one in connection with this great movement who did not expect many more difficulties than we are even now encountering. Just imagine what it meant for the first time to compel two-thirds of the working population of this country to contribute for insurance against sickness and medical attendance! But I do want to make one particular point with regard to the doctors. I have always felt, and my colleagues on these benches feel, that the Chancellor was too generous with the doctors, and the doctors to-day are taking advantage of it. The hon. Member who moved this Motion cited a case from Wiltshire. I will give a case from Wiltshire which happened this week, where an insured person, a railway man, had made our own society his approved society. He was also by compulsion a member of the railway company's society. The doctor signed a certificate for the approved section and charged him 3s. for signing the certificate for the other club—a most monstrous position, which is taking advantage of and prostituting the whole intention and spirit of the Act. When the hon. Member who moved this Motion talks of the promises of the Chancellor and other Members from this side and their deceit, I think he called it, during the by-elections, I think the least said about by-elections the better, because I am perfectly certain that, whatever Amendment to the Insurance Act may be made, or whatever may be done in substitutions for this Act, the policy that many hon. Gentlemen opposite have pursued, in opposing this Act, has led the workers to believe that they are in favour of a non-contributory scheme. Therefore, if that be the impression that you have conveyed to the minds of the working classes of this country, then we, on these benches, will certainly follow it up to see, if an alteration be made, that it will be one effected in that particular direction.
With regard to the point raised in reference to the reserved values, the hon. Member who seconded the Motion said that the Chancellor's statement in regard to it was not only not true, but that it deceived the members of the friendly societies themselves. I will give you one 1312 illustration why that is so. The Chancellor and everyone else who knew the subject, in talking about reserved values, were assuming that they were talking about a value reserved, and not a deficit. The Great Western Railway Provident Society has a capital of £385,000, and the Company compel the whole of the railway employés to join that fund, and when this Insurance Act came into operation, they decided to make an approved section of that society. The ordinary man in the street and the hon. Member assumed that this £385,000 was then released. [An HON. MEMBER: "No."] That was what the hon. Gentleman actually told the House. There could be no other meaning. Let us be perfectly clear about these reserved values. The hon. Member said distinctly that the Chancellor promised that this reserved money should be set free for the benefit of members. If that was not the point, there was no other meaning in it. I want to point out that this £385,000, instead of being an asset to the society, was actually a liability, because what the Great Western Railway Company did was to immediately take advantage of the Insurance Act to reduce the benefit to the members. They could not have done that if the Insurance Act had not come into operation, and they got out of their liability on the back of the Insurance Act.
We on these benches moved—and I was certainly under the impression that when the Act was passed every workman would be free to join any society—an Amendment which was accepted by the Chancellor of the Exchequer, which was embodied in the Bill, and which everyone thought had that effect. But what have the railway companies done? They have said, "Yes, we will make it a condition that no man must join our approved society, but our approved society will be independent of our other society, and we will make it a condition that they shall join that one." Therefore, the men are in the unfortunate position of either having to pay to two societies or compelled to pay to one they do not believe in. If there is to be any Amendment of this Act—and I hope there will be—the Chancellor of the Exchequer, I trust, will take advantage of the opportunity, and give complete immunity, so far as these men are concerned, and say to them, "Although I am providing free choice for you, I will do it in such a way that your employer will not be able to take advantage of the situation." If I may be 1313 allowed to make a suggestion to the Chancellor, it would be that the approved societies certainly cannot go on with the 3s. 8d. allowance. It is perfectly certain that the administration allowance is not sufficient, and I believe that it could be very largely improved by having half-yearly cards instead of quarterly cards. I believe the half-yearly card would save a tremendous amount of expense. There would be no leakage as far as administering the Act was concerned; it would reduce by half the work now done by the approved society, and I believe that it would go a long way to make the 3s. 8d. meet the case so far as the administration of the Act is concerned.
§ Mr. THOMAS
The difficulty of the lost card is helped by the suggestion, for the reason that at the present time no man can be paid any sick benefit unless his card is produced. It is quite immaterial whether the card is stamped for six months or for three months, the same point is met. The Chancellor of the Exchequer ought certainly to consider whether the sending of the cards themselves should not be franked, and take this expense off the approved societies. The Chancellor of the Exchequer did definitely promise democratic control. He said deliberately that the one object of this Act was to give approved members absolute control. That is not working out in practice, because the workmen who are members of the Insurance Committee elected by their fellows to take special care of their interests, find that the meetings are held in the day time, and they are obliged to lose time from their work; yet the insurance committee not only refuse to pay them for that lost time, but they have actually now said that they will not allow them to be paid out of the administration expenses. It is a most absurd position, and the result is that we have in our own society a number of railway men who have lost time during the past nine months to the amount of over £2 each. They have said: "Very well, we have tried to serve our fellow workmen; we have tried to do our duty; we were elected to the position because we believed in democratic control, but we cannot afford, as working men, to go on meeting this liability." I say that if the object is to keep the control in the hands of approved members, if the object is to allow the workmen to take fair share of respon- 1314 sibility and management under this Act, it is for the Chancellor to say as soon as possible that he will meet this legitimate expenditure, and see that the working men are not out of pocket as the result.
I should also like to emphasise the point that the trade unions are handicapped unfairly as against all other societies in this respect, that, unless the Government are prepared to enforce the Fair-Wages Clause and to apply it to those societies as it applies it to contracts, trade unions which are approved societies, are compelled and are anxious to pay fair wages, while other insurance societies can take on young girls, as they are doing, at half the wages paid by the trade union for the same work. That is not calculated to encourage trade unions to work the Act. I take the advantage of this opportunity to say that there are many administrative improvements which can be made in the Act, and everyone knew perfectly well that they would be required. I say that instead of dealing with this Act in a carping spirit let us realise, instead of driving to the light the few cases of someone dying as the result of the neglect of the doctor, what that means. That is an admission that many thousands died before this Act came into operation without any notice being taken of them, and that fact affords the clearest possible proof that at least this is bringing to light the awful poverty and misery of the people. The Act will enable us for the first time to get the data and statistics to prove the real position of the working classes, and I believe that will enable all sections of the House to deal with the Insurance Act in a way that will be of lasting benefit to the working classes.
§ Mr. MASTERMAN
If every hon. Member who has spoken to-night had dealt with the Insurance Act and the possibilities of improvement in the same fashion as my hon. Friend who has just sat down, then I as one who is in part under my right hon. Friend responsible for the administration of the Act, would have congratulated the House of Commons to-night on two and a-half hours well spent work. My hon. Friend has given us suggestions all of which we will consider and some of which I greatly hope we may be able to embody in legislation, and especially the suggestion of the half-yearly card or any other suggestion reducing administrative expenditure, and the suggestion of in some way or other making it more easy and more practicable either by alteration of 1315 the time of meeting of insurance committees, or by some other arrangement to enable what we desired all through, the working men representatives of the approved societies to attend the insurance committees. But, I must confess, that the bulk of the Debate to-night has been to me a profound disappointment. I thought the time had gone by when we were going to have stuff of that sort. I ventured to appeal in the presence of the hon. Member for Colchester (Mr. Worthington-Evans) at an insurance banquet a few weeks ago, whether it was not possible now to take the administration of the Insurance Act out of party controversy, and to judge it as we judge say, the Home Office, or one of the other offices, when the Estimates conic forward. Instead of that when we have had such curious statements as those given by the hon. Member for Salisbury (Mr. G. Locker-Lampson) and such distressing humour as that of the hon. Member for Watford (Mr. A. Ward), I think I am all the more entitled to ask that this should be treated purely with criticism directed towards benefit, because nine out of ten of the statements made to-night, or the suggestions made to-night, were suggestions, not against my right hon. Friend, not against the Insurance Act, nor even against the action of the Commissioners, who are supposed to be a set of bureaucrats, but they were suggestions and attacks upon the insurance committees, using the discretion which the House gave them, and which committees are representative at least in three-fifths of their members, which is a majority of their members, of the insured persons themselves. The grotesque suggestion is made that the insurance committees, who are appointed from the insured persons and the representatives of the insured persons in this House, are comparatively indifferent to the welfare of the people they represent, and that therefore the only one who can voice the grievances under which insured persons are suffering are hon. Gentlemen opposite.
Let me make one other general remark. I am astonished that anyone who has followed, as I know the hon. Member for Salisbury has followed, so closely the course of the history of this controversy through the autumn and the spring, should be found to be repeating to-night statements which I could quite understand made by those who have no knowledge of 1316 the controversy, such statements as that about the denial of a free choice of doctor to the insured persons. The hon. Member for Salisbury knows as well as we do what happened in the matter. He knows a definite attempt was made to destroy attendance on all insured persons practically except those certain doctors chose to attend. He knows that the only result of that would have been a great majority of the poorest insured persons, and those who most need attendance, would not have received attendance at all, and because we refused, and with the approbation of the House, to allow the breaking down of the very system the House had devised and said no, the only system that can be adopted is that by which every insured person will have the right to have the doctor attend upon him, the hon. Gentleman gets up and says that we are breaking through the letter and the spirit of the Act. Another point he mentioned was that over the great bulk of the country only very few doctors, and those the most obscure and least distinguished, were having anything to do with the Act, and that over the great bulk of the country there was no free choice of doctor—I think he practically said so—because the insured persons, instead of being able to obtain the doctors they wanted, were being shepherded in five or seven thousand into the pens of the inferior practitioners. Has he any knowledge of the actual facts as to the doctors that are going on the panel, and that are working on the panel? They are so willing to continue work on the panel that they re-signed all their contracts this April which they originally made in January, and they have increased their numbers very considerably since January, and are increasing them every day, and that practically now the only place in which any man is deprived of the free choice of doctor, except in those cases of discretion of the insurance committee in individual instances, are three or four obscure villages, or, rather—I must be careful in my language, since one of those towns is represented by an hon. Member on my own side—one town and three or four obscure villages, numbering a total of 27,000 insured persons, out of 14,000,000 insured persons, who are receiving medical attendance.
The number of doctors on the panel on 15th January was 17,790, and on 14th April 18,584, which I have no hesitation in saying represents something between 80 and 90 1317 per cent. of the doctors who are engaged in industrial practice. Even among the total number of doctors, large numbers of whom have no industrial practice at all, fifty-seven insurance committees out of ninety-eight, out of all the practitioners in those districts, huge towns, such as Liverpool, Manchester, Somerset, Salisbury, over 80 per cent. of the practitioners are on the panel—practitioners who are attending, not only rich people, but poor people as well. In a large number of the big towns and counties of England more than 100 per cent. of the doctors are on the panel. I must explain that. That means that not only is every doctor in the town or district on the panel, but that the doctors in the immediate neighbourhood, desiring to obtain practice in those towns, and being so eager to get that practice, are also on the panel. In Buckinghamshire, Derbyshire, Huntingdonshire, Blackburn, Bolton—these are simply some names I have chosen; there are many others—Bootle, Devonport, Dudley, well over 100 per cent. of all the registered practitioners are serving under the ordinary system devised by the Act. Every individual in all those great towns has the freest choice; he can choose any single doctor of all the doctors under the Medical Council. Considering that only three months ago the friendly societies and the Government together, had to fight an organised movement of the medical profession, who desired that the Act should be destroyed, and that not one single doctor should go on the panels, I think the House and all parties might well congratulate the Administration on the present state of affairs. The next point, which was very ably dealt with by the chairman of the London Insurance Committee, is that of overwork. As my hon. Friend said, the keeping down of the number of patients on the list of any one doctor is not always compatible with the free choice of doctor. As I said to the hon. Member for Dulwich—I notice that he has not taken up the challenge tonight—I know of no case in which a large number of persons have chosen one particular doctor because they had no choice of other doctors. The reason why these large numbers have been taken are the reasons given by the hon. Member for Walworth. Somewhat unfairly, as I think, names have been mentioned. I think it is most unfair that we should be discussing individual doctors.
§ Mr. LOCKER-LAMPSON
I cannot say that I actually saw the doctors, but the gentleman who gave me the names said that I was authorised to use them.
§ Mr. MASTERMAN
As names have been mentioned, although the gentleman is a political opponent of our party, I think it is only fair to state the case in regard to Dr. Salter. Bermondsey has never had doctoring at all. It has never been able to afford it. Dr. Salter is perhaps the most popular doctor in any poor district in London. He and his partners have been turning away patients every day for years. I think I am right in saying that before the Act came into operation—that is, before 15th January—more than 5,000 persons in Bermondsey had applied to Dr. Salter and his partners to be placed on their list. There were other doctors around to whom they could have applied, but they desired a free choice of doctor and they got it. Dr. Salter immediately informed the London Insurance Committee that he could not take any more patients. Even now he and his firm, if they could take them, could probably have another 5,000 or 10,000 patients who are willing to take the choice of their services, although knowing the number of patients they already have. Hon. Members must realise this fact when they use these gigantic numbers of persons to frighten people outside. There is no definite number that the Insurance Commission or the Committee or any body in any country in the world, has been able to fix as the number of insured persons to which doctors ought normally to be limited. We found sonic very remarkable figures before the Act came into force when we investigated the question in such places as, for instance, Swindon. In Swindon we found an elaborate system dealing with the railway workers and their wives 1319 and children. There was no complaint. It was an efficient service, contributed to by the people as well as, I think, by the railway company, but of that I am not sure. In that town the average number of persons for each doctor was over 5,000. The system was working successfully, and as far as I know there were no complaints of overwork.
The statistics that we have been able to work out with the friendly societies as to the number of persons converted into the number of patients show that for every thousand persons on a doctor's list, under normal conditions, the doctor would have to deal with eight cases in the surgery and four cases in visiting. That is a day's work. You can work that out in terms of medical work, or in terms of the conditions when the doctor is giving the whole of his time to insured persons, as some doctors are, or when he is taking other practice as well. I do not want to see too large a number of insured persons per doctor. I think it would be better if they were distributed. I cannot lay down a definite number, but I think that if a man was allotted to a doctor who had 5,000 persons on his list that ought to entitle him, if he wishes it, to be transferred to another doctor. But when the patients make no complaint, and are apparently willing to receive the services which these doctors can give, I certainly should not say that a doctor would not be able adequately to deal with 2,000 or 3,000 or 4,000 persons. These special cases largely occur owing to a fact which I shall ask to be allowed to point out before I sit clown. The Committee will be interested to hear that in twenty-five insurance committee areas the practitioners have, on the average, 500 or less insured persons; in fifty areas, they have between 500 and 700; in twenty-eight areas, between 700 and 1,000; in twelve areas, between 1,000 and 1,200; and in only five areas have they 1,200 and over. That shows the very large extent to which that which we desire beyond all things—a general distribution of patients among doctors under the conditions of private practice—has been carried out automatically by the Act and the Regulations. Why in certain cases is there such a temporary heaping up of patients? It is more or less necessary for reasons known to anyone like my hon. Friend the Member for Walworth or myself, who has lived for any long time in the particular labouring districts in which are congregated masses of the poor. It is because these poor have 1320 never received proper doctoring. They have never been able to pay for it. Good doctors who have gone down to these districts have never been able to make a decent living unless they took many more patients than they ought to have taken. The alternative was either for the medical man to have no decent living or the persons not to receive adequate treatment. Just compare two figures—not those given under the Insurance Act—but figures which existed when the Insurance Act came into force. In Shoreditch there were seven qualified medical men, one for every 5,500 persons, or one now for 1,850 insured persons. In Hampstead there was one doctor for every 400 persons. In Bermondsey there was one doctor for every 2,500 persons; in Paddington, one for every 612 persons. For the first time in history the poorer districts are given an equal chance with the richer. For the first time in history the unskilled labourer and the factory girl are able to pay for the doctor. The result will be, and ought to be—there is coming—a very great increase in the number of doctors in these poorer districts. It is a change that all the House should welcome! The best and youngest of our medical men as the best and youngest of our clergy, ought to be found in the East End and the South of London, and now for the first time that you give them a chance of making a living they will go there; and I have no doubt a good many of them will go, and their going will make far more for the good of these districts than the mere fact of the medical attendance of the insured persons. But such tremendous changes in social welfare cannot be accomplished in three months' administration, during part of which we have had to fight the organised medical profession of this country. I am glad to say that is over. But I do not think that we ought to have the criticism such as the Insurance Commissioners have received to-night. The next point raised—and I am very glad to have the opportunity of answering it—though I am surprised and amazed at the statement made by the hon. Gentleman the Member for Salisbury—is as to the administration of Clause 72. The hon. Gentleman said that the Chancellor of the Exchequer promised, if they wished it, that insured persons should have the accumulated reserve which was set free by the Act used for the reduction of their insurance subscriptions, and he said that is not being done. He seemed to suggest that the reserves which had been realised 1321 had been grabbed either by my right hon. Friend or by the Insurance Commissioners.
§ Mr. MASTERMAN
What actually has happened? The hon. Gentleman seemed to be not in the least degree clear that that money was now in the hands of the friendly societies, and is being used by the friendly societies to-day as they want the money to be used. The hon. Gentleman seemed to suggest that there was a check or hamper coming from a central authority to prevent them using the money as they wanted. What are the actual facts? Clause 72 gives the friendly societies a choice in the matter. It says: "You may use your reserves to reduce your contribution, or if you like you may use your reserves to keep up the same benefits which you have already given, just as if the Insurance Act had not passed, and also to get the benefits which the Insurance Act gives." While during the autumn hon. Members opposite poured their vials of wrath upon us for the passing of the Insurance Act, the whole of the insured persons themselves connected with the societies, not only got the insurance of the Insurance Act, but got more insurance still. The vast majority—and this is a remarkable fact—of the friendly societies and their branches, instead of choosing—and the choice was with them—to release the reserves in order to reduce their contribution, or the Government contribution, or both together, said: "No, we will go on paying our own contribution, and getting the same benefits that we have got, and add to it the equal contribution of the Government, and so get full benefits for our contributions." The hon. Member calls that over-insurance. The insured persons do not call it over-insurance; they call it business! And we should have been subject to the severest criticism if we were in any way to exercise any power we possessed in order to alter the very option of self-government we had given to the insurance societies to allow them to get more insurance if they wanted to, on the ground that they had to make one of the two choices freely open to them under the Act, and instead of keeping up their contributions reducing them in order to get less insurance than before. It is amazing the way the class of agricultural labourers whom we were told could not pay 4d. 1322 a week as well as their benefits, in meetings together decided that they would pay the old fourpence per week and the new fourpence to enable them to get the whole benefit, and to add disablement, maternity, and sick pay to that already received; and I am glad, because I think it is well that they should keep up the old elements of their old societies, and that they should join the new societies not merely as compulsory Governmental insured persons, but as voluntary members of the great self-governing friendly societies and trade unions. And that is what the hon. Member reproaches us for. I think I have now dealt with most of the points raised in the Debate, and I have only got to say this.
My hon. Friend the hon. Member for Walworth pointed out how the London insurance committees have interpreted in the widest possible fashion, as I think, the exceptional Clauses of contracting-out which were placed in the Act, and have made arrangements which prevent some doctors from going on to the ordinary panels and joining the great mass of their fellow practitioners by allowing them to come on if they like for a limited number of patients only. I believe every leader of the medical profession will agree with me when I state that the worst possible thing that could happen as a result of this warfare, which I hope is happily over, and which I believe is going to end in free and permanent amicable relationships between the medical men and the insured committee—I state it without fear of contradiction—would be to cleave that profession into halves, one on the panel and the other not, with competition and ostracism in every town between the one and the other, with poison in the minds of the insured persons against a certain class of practitioners, with the unedifying process of recrimination which some months ago was carried on in the public Press, and which I hope, and which the medical profession hope, never will occur again. If we fought for one thing more than another, we fought for unity. We gave the medical profession in the Act what they asked us to give, and in doing so we incurred the enmity of a large section of the insured persons.
We were always willing to meet the medical profession, and there is no bitterness over the fight in the minds of the Insurance Commissioners and the insurance committees in connection with the medical profession. We have given them every 1323 opportunity to make every possible modification in connection with the Insurance Act, so long as the interest of the approved societies as a whole were preserved. The only reason why the choice of patients by any particular doctor has been refused is because the first obligation laid upon the insurance committees was to provide medical attendance for every insured person in their area, and it would be grotesquely unfair, and the system would break down, if a certain doctor in a small provincial town should be allowed to select a particuar class of lives, not caring in the least degree what medical attendance there was for those he did not select. We might then have given a free choice to thirty or forty persons, and we would be left with 200 or 300 with no ability to provide medical attendance for them at all. On the contrary, I would boldly proclaim to-night that the action of my right hon. Friend in the first place, and afterwards the administration of the Insurance Commissioners and the insurance committees has been more than vindicated by the result, and I thank the hon. Member who represent a big trade union for having said so. There is not the slightest reason why the few cases in which free choice of doctor has not been obtained—I doubt if it is a quarter per cent. of the whole population of insured persons—should not be remedied also. Over 99½ per cent. are now obtaining what they desire and what they never had before this Act came into force, because before the passing of the Act scarcely half of the 5,000,000 members of friendly societies had any free choice of doctor, and those 5,000,000 persons have now the free choice of at least twenty-nine out of the thirty doctors in the town, and I think that ought to satisfy them. I have heard practically no complaint against the Insurance Commissioners. The hon. Member opposite brought up a case of neglected treatment of an insured person. I wonder how many thousands of those cases could have been brought up before the Insurance Act was passed. How many thousands of those cases were there in the East End of London who have died without any medical attendance at all. I wonder how many thousands sent for attendance and could not obtain it because they had to pay the doctor before he would attend them. Of course there must be complaints, when half a million persons 1324 are receiving attendance every week from 17,000 doctors. The Act has provided an apparatus for dealing with those complaints, and it is the fullest that can possibly be devised. I do not think those complaints should be read out here as examples of what is going on all over the country when we know that is not the case. We know, from the knowledge obtained in our own constituencies, that medical benefit is being honestly and well administered by the panel doctors, and the complaints should not be brought to this House, but should be addressed to the insurance committees, who have all the machinery for remedying grievances and inquiring into complaints, and after investigation, if necessary, strike off the panel the doctor who does not adequately attend and carry out the contract he has entered into. We have had more doctoring and better doctoring. We have had every promise of the Chancellor of the Exchequer more than adequately fulfilled. We have an Act which every week has shown greater efficiency in administration.
Before I conclude I must pay a compliment to the Insurance Commissioners who have done the most remarkable administrative work which this country has seen for some time in launching a scheme which no other country launched in four times the period. The administration is getting more efficient every week, the insured persons are getting more conscious of the benefits of the Act, and the persons engaged in the administration of the great self-governing societies of this country are more and more finding that the Regulations are those which they can efficiently work under without losing any of their freedom. Every case brought before me by the hon. Member for Derby, and in a still better way in friendly consultation with the Insurance Commission, for loosening or adjusting certain portions of the Bill which can be met by loosening or adjusting, will be met this year by the amending Bill we propose to introduce. I ask once more why on earth, instead of continuing these dismal recriminations, should hon. Gentlemen opposite not take pride in a national achievement and give the talents they possess to making the Act work better, instead of continually attacking those whom they know are working the Act well?
§ Mr. H. W. FORSTER
The right hon. Gentleman—I am glad to see he is well enough to take part in the Debate to-night—concluded his interesting speech by 1325 suggesting that we should give up making these party attacks in connection with the Insurance Act, and devote ourselves to the improvement of the administration of that measure. That is exactly what we are doing to-night. My hon. friend who moved this Motion said that his reason for doing so was not to make an attack on the Chancellor of the Exchequer or on the Government, but to secure that the benefits which the Act gives should be brought to the doors of the insured people through the administration for which the Government was responsible. The Financial Secretary to the Treasury paid a well-deserved tribute to the insurance committee and their staff. He said that this colossal underaking had been launched by these gentlemen within an extraordinarily short space of time. I think that if they had been left a freer hand they would have earned what he has said of them even more fully than they have done. I regret the tone in which the right hon. Gentleman addressed himself to the speech of my hon. Friend the Member for Salisbury (Mr. G. Locker-Lampson). I am bound to say that the speeches of both the Mover and Seconder of this Motion were quiet and restrained, and gave no excuse to the right hon. Gentleman for the heat he displayed. It appeared to me that both my hon. Friends stated their case with reserve and great clearness and lucidity. The right hon. gentleman tells us that the number of doctors on the panels is increasing with comparative rapidity, and that before long we may expect to find that nearly the whole of the medical professions will make a practice of industrial work and will serve on the panels. I am delighted to hear it. Everybody who takes the smallest interest in the administration of the Act, and everybody who has had anything to do with the shaping of any part of it must be glad that there is a prospect of the long and bitter strife between the Government and the doctors being brought to an end. We all rejoice that the number of doctors on the panels is increasing, and I hope that on that account alone it may be possible for the insurance committees, already authorised by the Insurance Commission, although forbidden by the Chancellor of the Exchequer, to allow people to make their own arrangements with greater freedom than they do at the present time. The Chancellor of the Exchequer looks at me with wonder, as much as to say, "What on earth are you talking about? 1326 Where in the world did I forbid the insurance committee to allow people to make their own arrangements?" Has he forgotten the speech which he made to the Advisory Committee? Has he forgotten the promise which he gave to the chairman of the insurance committee? Does he not remember that he said, "Although the Act gives you the power, and although the Insurance Commissioners have given you the authority to allow these people to make their own arrangements, the Government will not allow it?" Those were the words reported in the "Times," "The Government will not allow it." The matter is impressed in my memory, because I wrote a letter to the "Times" the following day hoping that the Chancellor of the Exchequer might take notice of it. He seems to have forgotten his speech.
§ Mr. FORSTER
I am quoting from the published report of the speech of the Chancellor of the Exchequer to the Advisory Committee. I was glad to hear the Secretary to the Treasury say it was desirable there should be some limit to the number of patients on a doctor's list. Considerable indignation has been evinced by the hon. Member for Walworth (Mr. Dawes), and shared by the Secretary to the Treasury, that it should be alleged that certain doctors on the London panel had an undue number of patients on their lists. The Member for Walworth gave what I agree was a very convincing answer when he pointed out that one of the doctors in question (Dr. Salter) has several partners. Surely it would have been very much better for the hon. Member for Walworth, when the question was raised before the London Insurance Committee, and the figures were asked for by a member of that committee, and were published in the proceedings—it would have been better and it would have saved a good deal of misunderstanding if he had said at the time—or if the clerk, who must have known the facts, had said at the time that Dr. Salter had a number of partners and that the insured persons wished to have the services of that doctor and his partners.
§ Mr. FORSTER
Then why did not the chairman of the London Insurance Committee point that fact out at the time? 1327 All this trouble might have been avoided if he had done so, and I cannot see how my hon. Friends exposed themselves in any way to the strictures passed upon them for drawing attention to a matter of this kind—a matter to which the Secretary to the Treasury himself says attention ought to be directed. Of course it may not be possible to lay down any hard-and-fast rule as to the number of patients to be attended by any one doctor, but it is very undesirable from every point of view that doctors should undertake to attend too many. The hon. Gentleman the Member for Derby said he regarded it as a wonder that the Act was working so well, considering that at least two-thirds of the whole population were compelled to subscribe. But the fact that people are compelled to subscribe is really all the greater reason that we should do everything in our power to see that they are given the benefits provided to the fullest possible extent. The Chancellor of the Exchequer may not see it, but really the object of this Motion is to secure that the full benefits which he promised in his speeches are given. That is what we want. We are not taking this action for a joke, and we really hope that the discussion of this matter will induce both the Commissioners and the Government to take it to heart. I do not think I need say anything further with reference to the observations which have been made on the speeches of my hon. Friends. I come to give my own view of the meaning of this Motion, and the reason why it is moved, and to touch upon some of the defects in the administration of the Act under the ægis of the Chancellor of the Exchequer. He will remember that he made many speeches while the Bill was going through the House of Commons, speeches on the platform, speeches to the various bodies who were affected, such as the medical profession, friendly societies, and others, speeches to deputations and speeches in the House of Commons. In all those speeches he was necessarily dealing with the benefits the Bill was going to give. He described the virtues of the Bill, and, no doubt, described them in a very favourable light. I remember that he used to be very angry with anybody who disagreed with the description he gave of the benefits of the Bill. Those speeches form the criterion by which we ought to measure the Act. They declared very fully and frankly what were 1328 the intentions of the Chancellor of the Exchequer when the Bill was going through. We heard over and over again in this House some doubt as to the meaning cleared up by reference to statements that had been made by the Chancellor of the Exchequer. Everyone knows that those speeches were widely read throughout the country, and that people formed their opinion of what the Bill was going to do from the speeches of the Chancellor of the Exchequer. I say that we ought to judge the benefits in relation to the promises or descriptions the Chancellor of the Exchequer gave before the Act came into force.
My hon. Friend who seconded the Motion called attention to the case of the Scottish Clerks' Society, which was organised by the clerks in Scotland, and which has many members in England as well. I am sorry the Secretary to the Treasury did not touch upon that question in his answer. The Chancellor of the Exchequer was not here when my hon. Friend referred to this body and will forgive me if I refer to it briefly and remind him of the correspondence he had with the Scottish Clerks' Society, which arose upon the question of people being empowered to make their own arrangements with the doctors. They have a system by which the members pay a certain subscription and get payment of their doctor's bills. They allow 4s. a visit which is a higher benefit than anything given by the Act. When the Bill was going through, they tried to see the Chancellor of the Exchequer and could not. They correspondend with him and they held from what he wrote that the method of providing benefits adopted by the association was fully conserved and they held and still believe that the Chancellor was also of that opinion, and on receiving his assurance to that effect, the association decided to apply for approval under the Act and the rules of the association were approved. Then they go on:—The conditions laid down the restrictions imposed, and the methods adopted by the insurance committees in different parts of the country have made Sub-section (3) practically inoperative. There is no doubt that this association's successful medical scheme has been sacrificed, not because of the terms of the Act, but of subsequent arrangements and of the unintelligible jealousy with respect to the panel system.I have read that because it shows that the opinion which we hold very strongly, that the insurance committees have been to a certain extent coerced in this matter, is held by other people who have no party bias, and, for all I know, every one of them may belong to the party of the Chancellor 1329 of the Exchequer and not to ours. They look upon this purely as a business proposition, and that is the opinion they have formed. Then they sum up their position in very few words:—Before the Act was passed our members enjoyed the benefit of which the operations of the Act have now deprived them, despite the reply of the Chancellor that those compelled to insure, who desired to make their own arrangements for paying their doctor would be allowed to do so and an allowance made for the same. On the strength of this assurance by the Chancellor 17,00 to 18,000 new members had joined the association in order to obtain this benefit for which they are willing to pay extra as it is better suited to their needs than a capitation service. But they are now being driven back on the system which was abandoned years ago as unsuitable to the requirements of the members and to the nature of their employment.That sums up the situation from their point of view, and it is a situation with which I think the Government ought to deal. I want to refer to one other concrete case, because I think the House will very well remember the position which the Chancellor of the Exchequer took up with reference to medical institutes. He will remember that the Noble Lord (Viscount Wolmer) moved an Amendment for preserving medical institutes which were already in existence. That met with the hearty support of the whole House, and everyone looked forward to these medical institutes continuing to do very useful work. The case of the Cambridge Medical Institute has been brought to my notice—an institute which has been in existence for something like twenty years, and has a membership of something like 5,000 friendly society members, and the insurance committee will not approve them because they do not approve of this system of management. The sub-committee appointed by the insurance committee recommend approval, and the Insurance Commissioners think it ought to be approved, but say that they are powerless to override the views of the insurance committee. The Cambridge Medical Institute has written several times to the insurance committee to ask them in what particulars the Regulations of the Commissioners in respect to management are insufficient, and they say they are ready to do anything they can to fall in with the views of the insurance committee so as to obtain approval. I do not think it is at all satisfactory that the provisions of the Act should be set at naught by the refusal of the insurance committee to give approval to eases of that kind. I cannot expect the right hon. Gentleman to answer as to details of that kind, but I take the opportunity to bring 1330 them forward, because it is better to deal with them viva voce than to take the endless course of carrying on correspondence with the Insurance Commissioners. I think if one can get public opinion brought to bear on the subject, greater attention may be given to it by recalcitrant people.
There is another question of real importance to which I wish to refer. People complain to me rather strongly of the difficulty of getting the medicine which the doctor prescribes. They take the prescription to the chemist, and in some cases the bottle has not arrived for days afterwards. That is a great scandal. What is the use of the doctor prescribing unless the medicine can be got? I hope the Commissioners will give their attention to this matter. The Chancellor of the Exchequer also promised that we might look forward to the prescription of the most expensive drugs. He said that the poor man had never had a chance of getting decent medicine if it was costly, but that now he would be able to get the most expensive drugs as well as the rich. It would absolutely ruin chemists if these most expensive drugs were supplied. I am told, but I believe it is only gossip——[Laughter]—I say at once I believe it is only gossip—I am told that there are two classes of drugs used in making up prescriptions — one of insurance quality and the other of better quality. [An HON. MEMBER: "Not true."] If hon. Gentlemen would look at the thing from a reasonable point of view, they would see that the quickest way to kill gossip was to have it out and cut its throat. I shall be very glad if I have done anything to kill what I believe to be a scandalous attack upon the honesty of those engaged in the business of chemists. I have had to go about the country a great deal of late, and I have found, wherever I have been, that after the meetings I have addressed people have come to me, not from the party point of view, but because they knew that I had something to do with the Act, asking how they can get improvements in regard to medical service. I find wherever I go that there is general dissatisfaction with the quality of the medical service which is given now.
The complaints made to me state that it is worse than that which was given by the old club doctors, and which the right hon. Gentleman painted in dark colours when introducing the Bill. I hope, therefore, that something will be done to improve the quality of the medical service. 1331 I have not done more than touch the fringe of some of the questions that I would like to refer to. We are in a certain difficulty in dealing with this thing. The Government are so secretive about the administration that in spite of the answers which the right hon. Gentleman has to give to questions addressed to him from all quarters of the House we are continually left in the dark as to what is being done. They try to create a public opinion which is favourable by declaring that everything is working smoothly, and it is only from insured persons themselves that you hear a different story. It is no use saying, "Can you give the names?" We can give dozens, hundreds of names. It is not merely a question of names and addresses. It is the general sense of satisfaction or dissatisfaction. The sense of dissatisfaction is widespread. We have not brought this Motion forward merely for the fun of the thing, but in the hope that good will result to the insured people and that benefits will be improved. This Motion reflects the thoughts and opinions of insured people, who formed their opinions of what was going to happen from the statements of the Chancellor of the Exchequer. He is a master of platform oratory, but I think that when
§ he goes on the platform he ought not to forget that he is the Chancellor of the Exchequer. So long as he is Chancellor of the Exchequer he must not blame simple-minded people such as myself if they take what he says as true, and believe that they are entitled to attach the fullest credence to the description he gives of any Bill of which he may be in charge——
§ Colonel CHALONER
rose in his place, and claimed to move, "That the Question be now put," but Mr. SPEAKER withheld his assent, and declined then to put that Question.
§ Mr. FORSTER
People have formed the habit of believing what Chancellors of the Exchequer say, and when they are promised definite benefits by the Chancellor of the Exchequer they were entitled to believe that they were going to get them. The Act empowers these benefits to be given to the fullest possible extent, and it is only because we believe that the administration is at fault that my hon. Friends have moved this Motion.
§ Question put.
§ The House divided: Ayes, 77; Noes, 270.1333
|Division No. 79.]||AYES.||[10.59 p.m.|
|Amery, L. C. M. S.||Gilmour, Captain John||Peto, Basil Edward|
|Baird, John Lawrence||Gordon, Hon. John Edward (Brighton)||Pollock, Ernest Murray|
|Baldwin, Stanley||Grant, J. A.||Randles, Sir John S.|
|Banbury, Sir Frederick George||Guinness, Hon. W. E. (Bury S. Edmunds)||Royds, Edmund|
|Barlow, Montague (Salford, South)||Hall, D. B. (Isle of Wight)||Salter, Arthur Clavell|
|Barnston, Harry||Hall, Frederick (Dulwich)||Sanders, Robert Arthur|
|Barrie, H. T.||Healy, Maurice (Cork)||Sandys, G. J.|
|Beach, Hon. Michael Hugh Hicks||Henderson, Major H. (Berks)||Sassoon, Sir Philip|
|Bennett-Goldney, Francis||Herbert, Hon. A. (Somerset, S.)||Stanier, Beville|
|Bird, Alfred||Hohler, Gerald Fitzroy||Stanley, Hon. G. F. (Preston)|
|Boscawen, Sir Arthur S. T. Griffith-||Hope, Major J. A. (Midlothian)||Steel-Maitland, A. D.|
|Boyton, James||Jardine, Ernest (Somerset, E.)||Stewart, Gershom|
|Bridgeman, William Clive||Jessel, Captain H. M.||Talbot, Lord E.|
|Butcher, John George||Law, Rt. Hon. A. Bonar (Bootle)||Terrell, George (Wilts, N.W.)|
|Campbell, Captain Duncan F. (Ayr, N.)||Lloyd, George Ambrose (Stafford, W.)||Touche, George Alexander|
|Cassel, Felix||Lloyd, George Butler (Shrewsbury)||Valentia, Viscount|
|Cave, George||Long, Rt. Hon. Walter||Walsh, J. (Cork, South)|
|Clyde, J. Avon||Lyttelton, Hon. J. C. (Droitwich)||Ward, A. S. (Herts, Watford)|
|Courthope, George Loyd||Mackinder, Halford J.||Weston, Colonel J. W.|
|Crean, Eugene||M'Calmont, Major Robert C. A.||White, Major G. D. (Lancs., Southport)|
|Dickson, Rt. Hon. C. Scott||M'Neill, Ronald (Kent, St. Augustine's)||Wolmer, Viscount|
|Eyres-Monsell, Bolton M.||Meysey-Thompson, E. C.||Worthington-Evans. L.|
|Fell, Arthur||Morrison-Bell, Capt. E. F. (Ashburton)||Younger, Sir George|
|Fletcher, John Samuel (Hampstead)||Nield, Herbert|
|Forster, Henry William||O'Brien, William (Cork)||TELLERS FOR THE AYES.—Colonel Chaloner and Mr. G. Locker-Lampson.|
|Gibbs, George Abraham||Paget, Almeric Hugh|
|Gilhooly, James||Pease, Herbert Pike (Darlington)|
|Abraham, William (Dublin, Harbour)||Allan, Rt. Hon. Charles P. (Stroud)||Barran, Rowland Hurst (Leeds, N.)|
|Acland, Francis Dyke||Arnold, Sydney||Barton, William|
|Addison, Dr. C.||Baker, H. T. (Accrington)||Beale, Sir William Phipson|
|Agnew, Sir George William||Balfour, Sir Robert (Lanark)||Beauchamp, Sir Edward|
|Ainsworth, John Stirling||Baring, Sir Godfrey (Barnstaple)||Benn, W. W. (T. Hamlets, St. George)|
|Alden, Percy||Barlow, Sir John Emmett (Somerset)||Bentham, G. J.|
|Black, Arthur W.||Hayden, John Patrick||O'Shaughnessy, P. J.|
|Boland, John Pius||Hayward, Evan||O'Sullivan, Timothy|
|Booth, Frederick Handel||Hazleton, Richard||Outhwaite, R. L.|
|Bowerman, Charles W.||Henry, Sir Charles||Palmer, Godfrey Mark|
|Boyle, Daniel (Mayo, North)||Herbert, General Sir Ivor (Mon., S.)||Parker, James (Halifax)|
|Brady, Patrick Joseph||Higham, John Sharp||Parry, Thomas H.|
|Brocklehurst, W. B.||Hinds, John||Pearce, Robert (Staffs, Leek)|
|Brunner, John F. L.||Hogge, James Myles||Pease, Rt. Hon. Joseph (Rotherham)|
|Bryce, J. Annan||Holmes, Daniel Turner||Philipps, Col. Ivor (Southampton)|
|Buckmaster, Stanley O.||Holt, Richard Durning||Phillips, John (Longford, S.)|
|Burke, E. Haviland-||Howard, Hon. Geoffrey||Pointer, Joseph|
|Burns, Rt. Hon. John||Hudson, Walter||Pollard, Sir George H.|
|Burt, Rt. Hon. Thomas||Hughes, Spencer Leigh||Ponsonby, Arthur A. W. H.|
|Buxton, Noel (Norfolk, North)||Isaacs, Rt. Hon. Sir Rufus||Price, C. E. (Edinburgh, Central)|
|Blyes, Sir William Pollard||Jardine, Sir J. (Roxburgh)||Price, Sir R. J. (Norfolk, E.)|
|Carr-Gomm, H. W.||John Edward Thomas||Priestley, Sir Arthur (Grantham)|
|Cawley, Sir Frederick (Prestwich)||Johnson, W.||Priestley, Sir W. E. (Bradford)|
|Cawley, Harold T. (Heywood)||Jones, Edgar (Merthyr Tydvil)||Radford, G. H.|
|Churchill, Rt. Hon. Winston S.||Jones, H. Haydn (Merioneth)||Raffan, Peter Wilson|
|Clancy, John Joseph||Jones, J. Towyn (Carmarthen, East)||Raphael, Sir Herbert H.|
|Clough, William||Jones, Leif Stratten (Notts, Rushcliffe)||Rea, Rt. Hon. Russell (South Shields)|
|Collins, Godfrey P. (Greenock)||Jones, William (Carnarvonshire)||Rea, Walter Russell (Scarborough)|
|Compton-Rickett, Rt. Hon. Sir J.||Jones, W. S. Glyn- (Stepney)||Reddy, Michael|
|Condon, Thomas Joseph||Jowett, Frederick William||Redmond, John E. (Waterford)|
|Cornwall, Sir Edwin A.||Joyce, Michael||Redmond, William Archer (Tyrone, E.)|
|Cory, Sir Clifford John||Keating, Matthew||Rendall, Athelstan|
|Cotton, William Francis||Kellaway, Frederick George||Richardson, Albion (Peckham)|
|Craig, Herbert J. (Tynemouth)||Kelly, Edward||Roberts, Charles H. (Lincoln)|
|Crawshay-Williams, Eliot||Kennedy, Vincent Paul||Roberts, Sir J. H. (Denbighs)|
|Crooks, William||Kilbride, Denis||Robertson, J. M. (Tyneside)|
|Crumley, Patrick||King, J. (Somerset, North)||Robinson, Sidney|
|Cullinan, John||Lambert, Rt. Hon. G. (Devon, S. Moiton)||Roch, Walter F. (Pembroke)|
|Dalziel, Rt. Hon. Sir J. H. (Kirkcaldy)||Lambert, Richard (Wilts, Cricklade)||Roche, Augustine (Louth)|
|Davies, David (Montgomery Co.)||Lardner, James C. R.||Roe, Sir Thomas|
|Davies, Ellis William (Eifion)||Lawson, Sir W. (Cumb'rld, Cockerm'th)||Rowntree, Arnold|
|Davies, Timothy (Lincs., Louth)||Leach, Charles||Runciman, Rt. Hon. Walter|
|Davies, Sir W. Howell (Bristol, S.)||Levy, Sir Maurice||Russell, Rt. Hon. Thomas W.|
|Dawes, J. A.||Lewis, John Herbert||Samuel, Rt. Hon. H. L. (Cleveland)|
|Delany, William||Lough, Rt. Hon. Thomas||Samuel, J. (Stockton-on-Tees)|
|Denman, Hon. Richard Douglas||Low, Sir F. (Norwich)||Scanlan, Thomas|
|Devlin, Joseph||Lundon, Thomas||Scott, A. MacCallum (Glas., Bridgeton)|
|Dewar, Sir J. A.||Lynch, A. A.||Seeiy, Rt. Hon. Colonel J. E. B.|
|Dickinson, W. H.||McGhee, Richard||Sheehy, David|
|Dillon, John||Macnamara, Rt. Hon. Dr. T. J.||Sherwell, Arthur James|
|Donelan, Captain A.||MacNeill, J. G. Swift (Donegal, South)||Shortt, Edward|
|Doris, William||Macpherson, James Ian||Simon, Rt. Hon. Sir John Allsebrook|
|Duffy, William J.||MacVeagh, Jeremiah||Smith, Albert (Lancs., Clitheroe)|
|Duncan, C. (Barrow-in-Furness)||M'Callum, Sir John M.||Smyth, Thomas F. (Leitrim)|
|Duncan, J. Hastings (Yorks, Otley)||M'Laren, Hon. H. D. (Leics.)||Spicer, Rt. Hon. Sir Albert|
|Edwards, Clement (Glamorgan, E.)||M'Laren, Hon. F. W. S. (Lincs., Spalding)||Strauss, Edward A. (Southwark, West)|
|Edwards, Sir Francis (Radnor)||M'Micking, Major Gilbert||Sutton, John E.|
|Edwards, John Hugh (Glamorgan, Mid)||Manfield, Harry||Taylor, Theodore C. (Radcliffe)|
|Elverston, Sir Harold||Marks, Sir George Croydon||Taylor, Thomas (Bolton)|
|Esmonde, Dr. John (Tipperary, N.)||Marshall, Arthur Harold||Thomas, James Henry|
|Esslemont, George Birnie||Martin, Joseph||Thorne, G. R. (Wolverhampton)|
|Falconer, James||Masterman, Rt. Hon. C. F. G.||Toulmin, Sir George|
|Farrell, James Patrick||Meagher, Michael||Trevelyan, Charles Philips|
|Fenwick, Rt. Hon. Charles||Middlebrook, William||Verney, Sir Harry|
|Ferens, Rt. Hon. Thomas Robinson||Millar, James Duncan||Wadsworth, J.|
|Ffrench, Peter||Molloy, Michael||Walsh, Stephen (Lancs., Ince)|
|Field, William||Molteno, Percy Alport||Walton, Sir Joseph|
|Fitzgibbon, John||Mond, Sir Alfred M.||Warner, Sir Thomas Courtenay|
|Flavin, Michael Joseph||Montagu, Hon. E. S.||Wason, Rt. Hon. E. (Clackmannan)|
|France, Gerald Ashburner||Mooney, John J.||Wason, John Cathcart (Orkney)|
|Furness, Stephen||Morrell, Philip||Watt, Henry Anderson|
|George, Rt. Hon. D. Lloyd||Morison, Hector||Webb, H.|
|Gill, A. H.||Morton, Alpheus Cleophas||Wedgwood, J. C.|
|Gladstone, W. G. C.||Muldoon, John||White, J. Dundas (Glasgow, Tradeston)|
|Glanville, H. J.||Munro, R.||White, Patrick (Meath, North)|
|Goddard, Sir Daniel Ford||Munro-Ferguson, Rt. Hon. R. C.||Whitehouse, John Howard|
|Goldstone, Frank||Murphy, Martin J.||Whittaker, Rt. Hon. Sir Thomas P.|
|Greenwood, Granville G. (Peterborough)||Needham, Christopher T.||Whyte, A. F. (Perth)|
|Greig, Colonel J. W.||Norton, Captain Cecil W.||Wiles, Thomas|
|Griffith, Ellis J.||Nugent, Sir Walter Richard||Wilkie, Alexander|
|Guest, Hon. Frederick E. (Dorset, E.)||Nuttall, Harry||Williams, Penry (Middlesbrough)|
|Gwynn, Stephen Lucius (Galway)||O'Brien, Patrick (Kilkenny)||Williamson, Sir Archibald|
|Hackett, John||O'Connor, John (Kildare, N.)||Wilson, Rt. Hon. J. W. (Worcs., N.)|
|Hall, Frederick (Yorks, Normanton)||O'Connor, T. P. (Liverpool)||Wilson, W. T. (Westhoughton)|
|Hancock, J. G.||0'Doherty, Philip||Wing, Thomas|
|Harcourt, Rt. Hon. Lewis (Rosseudale)||O'Donnell, Thomas||Wood, Rt. Hon. T. McKinnon (Glasgow)|
|Harcourt, Robert V. (Montrose)||O'Dowd, John||Young, William (Perth, East)|
|Harmsworth, R. L. (Caithness-shire)||O'Grady, James||Yoxall, Sir James Henry|
|Harvey, T. E. (Leeds, West)||O'Kelly, Edward P. (Wicklow, W.)|
|Harvey, W. E. (Derbyshire, N.E.)||O'Malley, William||TELLERS FOR THE NOES.—Mr. Illingworth and Mr. Gulland.|
|Havelock-Allan, Sir Henry||O'Neill, Dr. Charles (Armagh, S.)|
§ The remaining Orders were read and postponed.