HC Deb 05 August 1913 vol 56 cc1296-303

"If the Insurance Commissioners are satisfied that the insured persons or any considerable proportion of them within an area, or part of an area, are not receiving satisfactory medical treatment under the panel system the Commissioners may authorise the insurance committee to make, or may themselves make, such other arrangements as will secure to insured persons within the area, or part, such better medical service as is practicable having regard to the funds available for the purpose, or arrangements whereunder insured persons within the area, or part of the area, may be required to make their own arrangements for receiving medical attendance and treatment, including medicines and appliances, and whereunder the insurance committee or the Insurance Commissioners undertake to pay the cost of such medical attendance and treatment upon such scale as they may determine with the approval of the Commissioners so calculated that the medical attendance and treatment so secured shall be of a quality not inferior to that provided under the panel system."

Clause brought up, and read the first time.

Mr. RAMSAY MACDONALD

I beg to move, "That the Clause be read a second time."

This is an attempt to amend the arrangements which can be made under the panel system. It is really unnecessary to say very much in support of the new Clause, because the very wording of it is its justification. The idea is that where the Commissioners or the insurance committee are of opinion that insured persons are not receiving satisfactory medical treatment under the panel system the Commissioners may authorise the insurance committee to make special arrangements which will ensure a better medical service being given to insured persons. First of all, the service must be better than that which is enjoyed for the time being under the panel system, and the limit put upon it is that it must be practicable, having regard to the funds available for the purpose. That is the first part of the Clause. It is unnecessary at the present moment to go into the question of the panel system. Everybody who has had experience of the administration of the principal Act has, I think, come to the conclusion that some fresh power should be given to enable insurance committees to deal with the deficiencies in the working of the panel system. We have not, as a House of Commons, had enough experience to say precisely what form the new arrangements should take, and my proposal is that the insurance committee should suggest arrangements and that the Commissioners should approve of them. This is not an attempt to supersede the panel system. My intention is simply to arm the authorities with powers to give that medical attendance which is promised to insured persons under the principal Act and to enable them to overcome unnecessary and unreasonable difficulties that the working of the panel system presents to-day. The second part of the new Clause enables the committee to cause other arrangements to be made so that insured persons may receive certain monetary payment if medical attendance cannot be provided owing to any breaking down of the arrangements that are made. Again, I want to safeguard the rights of insured persons, and the final words of the new Clause read:— The medical attendance and treatment so secured shall be of a quality not inferior to that provided under the panel system. Everybody who has had experience of the working of the Act knows that it has broken down or threatens to break down, not all round, but only in certain special districts, and the purpose of my Clause is to arm the authorities with powers to meet the difficulty.

Mr. G. H. ROBERTS

I beg to Second the Motion.

Mr. MASTERMAN

This Clause was discussed to a considerable extent in the Committee upstairs, and I know that it found sympathy, because sympathy was expressed with it by all parties in the Committee. It was rather late in the proceedings of the Committee, and the hon. Gentleman the Member for Sevenoaks (Mr. Forster), who is leading the party opposite, asked that it might be deferred to the Report stage for reconsideration. My hon. Friend therefore withdrew the Clause, and we did not come to a division upon it. I hope that now those hon. Gentleman who saw good in the Clause will be able to see their way to support it, and that we may place it in the Act. The Clause, as my hon. Friend has said, does not touch the ordinary panel system at all. We have got 18,000 doctors working on the panel system, and so long as it works satisfactorily we do not, at this stage, at all events, propose to make any alteration in the system. We are appointing a Committee to gather information, and we shall be more prepared to deal with any change, if any change is needed, after that information has been obtained by that committee. This Clause is to enable arrangements to be made where there is no satisfactory panel system. We are obliged to give medical benefit to the persons concerned, and I think that it is necessary in the interests of the insured persons that we should be in a position to give that medical benefit if there is no satisfactory panel. Two examples occur to my mind. One was raised by the hon. Gentleman the Member for Mile End (Mr. Harry Lawson), and was strongly supported by him. There are certain districts in East and South London where at present, owing to the persistent under-doctoring of the people for many years, although all the doctors are on the panel, or nearly all, yet we cannot give medical attendance sufficient for the people. We hope in time, as the hon. Gentleman said in Committee, that doctors will drift into those areas and, come on the ordinary panel system. It may be necessary to attract some doctors to those areas by some sort of support, and I think I can say that in many of those areas the doctors who are being overworked would welcome some such alteration as this. Another question which is very uppermost in the minds of people at present is that of seaside resorts where there is a sudden influx of people who demand treatment as insured persons. There, I think, it is quite likely that some arrangement will have to be made to supplement the panel system to meet this sudden influx of insured persons. There may also be a necessity for dealing with those cases where the insured persons are few in number, and where it cannot be arranged under the ordinary panel system. I want it to be clearly understood that, in accepting this Clause. I do not wish to accept anything which interferes with the panel system so long as it is satisfactory. This is an alternative and supplementary method of procedure to be adopted in cases where, for one reason or another, insured persons are not able at present to get satisfactory treatment.

Mr. FORSTER

It is true that in the Standing Committee I expressed the opinion that it would be wiser that the consideration of this Clause should be postponed until we reached the Report stage, because, working as we were in Committee, it was quite impossible to give adequate consideration to it, owing to the limited time at our disposal. The right hon. Gentleman has said that the Commissioners have no intention of interfering with the ordinary panel system except in cases where it has broken down, or where it has not been satisfactorily established. But it does not want this new Clause to empower the Commissioners to take any such step as they may think desirable, in any case where the panel system is not working satisfactorily, because the provisions of Section 15 cover the case completely. As the right hon. Gentleman knows the Section very well, it is hardly necessary for me to remind him what it proposes, but I may tell the House that Section 15 already provides that, where the Insurance Commissioners are not. satisfied with the panel system in any area, they may dispense with the adoption of such system, they may authorise the insurance committee to make any such arrangement as the Commissioners may approve, or the Commissioners may themselves make such arrangements as they think fit, or they may suspend the right to the medical benefit altogether. As far as that difficulty is concerned, therefore, there is ample power in the Commissioners at the present moment, and to that extent this new Clause is not needed.

There is one provision in the new Clause I do not like at all, and that is the provision that where such other arrangements—arrangements other than the panel system—may be made so as to secure better medical service, such better medical service is to have regard to the funds available for the purpose. I do not quite know what that means. Under the provisions of Section 15, where the ordinary panel system is not in working order, but where the Commissioners authorise insurance committees to allow people to make their own arrangements, then the individual insured person gets full value of his contribution which would be applicable to the provision of medical benefit. There is nothing in Section 15 of the Act limiting the amount that may be given to each contributor to such funds as may be available for the purpose, and it seems to me, if we pass this Clause in its present form, we shall be giving, either to the Commis- sioners or to some other people, the power of setting a limit to the amount which may be restored to the individual contributor as being his proportion of the amount available for the provision of medical benefit. I do not like that. I learn with regret that the Government have consented to incorporate this Clause in the Bill, and, in view of what I have said with reference to the ample powers which at present reside in the Commissioners, I do not think the Clause is necessary, and I shall vote against it.

Mr. HARRY LAWSON

I agree with the hon. Member that this is a clumsy and unworkmanlike method of altering the Clause in the original Act. But I cannot agree with my hon. Friend in thinking that it makes no change. The panel system, especially in parts of London, to a large extent has broken down, owing to the paucity of doctors and the under-doctoring of the people, and if the great hospitals had not kept their doors open to all the sick poor who went there, there would have been far greater hardship. There has been a considerable amount of hardship and suffering in the administration of the Act so far. The point which I should like my hon. Friend to consider is this, that in the original Act you can only deal with the area of administration. Now the area of administration for the purpose of the Insurance Act is the county area. The point I wish to make is that in the original Act they could only deal with the area of administration, which is the county area. London is an administrative county. At the same time there are whole districts of an area in which the conditions are peculiar and unlike those of any other part of that area. There is an enormous variety of conditions of life, and later on it may be not only possible but necessary to regulate the medical panel in special quarters of London, and to give it that which is not necessary in other parts of London. For that reason I think the proper mode of dealing with this would have been to amend the proviso of the principal Act. To introduce a new Clause merely for that purpose adds confusion to confusion. I am bound to say I think the right hon. Gentleman, probably through want of time in the interval between the Committee stage upstairs and the Report stage here, has not been able to suggest such Amendments in drafting as to make an Act an Act which may be understood of the people. He did promise consideration to the question of printing at length the Clauses repealed, but one disadvantage we are under here is that the new Clause introduced is merely an amendment of the original Act, and the object aimed at by the Clause could have been better secured by an amendment of that Act. As I think it is necessary the Commissioners should be free to deal with parts of an administrative area, I shall not feel at liberty to vote against this Clause. But I do feel deeply the unnecessary suffering which is being inflicted on working people in the East End, and in the South of London, and even though it be a clumsy way of effecting the object aimed at, I cannot withhold my support.

Mr. WORTHINGTON-EVANS

I hope the Secretary to the Treasury will give some assistance to the Committee in this matter. It is desirable there should be an amendment of Section 15 of the original Act, so as to add to the word "area" the words "part of an area." That especially applies to large places like London, because a part of London may require to be dealt with in a different way to the rest of London. If the amendment were confined to that, I should be perfectly prepared to support it, but, as it is not, and as it goes a great deal further, I feel, like my hon. Friend the Member for Sevenoaks (Mr. Forster), it is extremely difficult to support the Clause as it appears on the Paper. Let me tell the House why. Under the original Act the Insurance Commissioners, or the insurance committee, can allow anyone for whom they cannot supply medical attendance on the panel system to provide their own medical attendance. If they do that, they must give them a sum equal to the cost of the benefit—that is, a Sum of 8s. 6d. or 9s., including the grant. Under this Amendment they have the same power, but no greater power, and they get it not by giving a man 8s. 6d. or 9s., but by giving him some sum prescribed upon a scale which the Insurance Commissioners may determine. But that sum is obviously smaller than the 8s. 6d. or 9s., or it would not be necessary to bring this Amendment in. If it is the sum provided by the original Act, why is this new Clause brought in to amend the original Act? If it is only because it is desired to extend the power from an area to part of an area, then a simple Amendment of the original Act, by inserting the words "part of an area," would carry out the object of the Clause, and would also meet the views of the hon. Member for Mile End. But that is not the intention. There is something more at the back which neither the Mover nor the Secretary to the Treasury have explained. There seems to be some desire to set up some other system. Suppose, for example, a whole-time system was set up in part of an area, and the salaries which were paid to the whole-time officers took up a large part of the fund available for medical benefit in that area. Suppose then insured people who objected to being doctored by whole-time men and wanted a free choice of doctors, desired to make their own arrangements. The answers of the insurance committee would be, "We have set up whole-time men, the only money available for medical benefit has been absorbed in payment of the salaries of the whole-time men, and, if you do not choose to get your medical benefit from those men, you can only have a proportion of what is left." That would work out at 2s. 6d. or 3s. per head, a sum quite inadequate to give medical benefit to those who do not choose to come in under the whole-time scheme. I believe that is at the back of this Amendment. If so, it should be stated to the House. If it is not at the back of the Amendment, then the point can be met in the way suggested by my hon. Friend the Member for Mile End by adding the words "or part of an area" to the word "area" in the Section of the principal Act.

Question, "That the Clause be read a second time," put, and agreed to.

Clause added to the Bill.

Mr. SPEAKER

The next Clause standing in the name of the hon. Member for Perth (Mr. Whyte) dealing with pooling arrangements for centralised societies should come as an Amendment to Clause 15, and that in the name of the hon. Member for the Wilton Division (Mr. C. Bathurst) (Exemption from Employer's Contribution) to Clause 5. The new Clause (Punishment of Husband Depriving Wife of any Benefit) is an Amendment to Clause 32, while the proposed new Clause of the hon. Member for the Eifion Division (Pooling Arrangements for Centralised Societies) comes as an Amendment to Clause 16. The Clause of the hon. Member for the Wilton Division (Increase of Women Members on Insurance Committees) comes as an Amendment to Clause 28, and the Clause (Limitations of Patients on Doctor's Panel) is an Amendment to Clause 10). The Clause of the hon. Member for Stoke-on-Trent (Appointment of Commission for the United Kingdom) is an Amendment to Clause 27, and the Clause (Definition of "Incapable of Work") is an Amendment to Clause 12. The next new Clause on the paper (Definition of "Confinement" and "Confined") is an Amendment to Clause 13, and the new Clause (Provision to Avoid Transfers Within an International Society) is an Amendment to Clause 15. The proposed new Clause of the hon. Member for Mile End with regard to benefits to aliens is out of order, as it imposes a charge, while that regarding outdoor relief for Scotland should come as an Amendment to Clause 39.