§ Section twelve of the principal Act shall have effect as though the first proviso to 1547 Sub-section (2) of that Section were omitted therefrom, and any sum which, but for the provisions of that Section, would have been payable to any person on account of sickness, disablement, or maternity benefit, if and so far as it is not paid or applied in accordance with the provisions of that Section while the person to or in respect of whom it would have been payable is an inmate of any workhouse, hospital, asylum, convalescent home, or infirmary, may, if the society or committee administering the benefit thinks fit, be applied in the provision of any surgical appliances required for the person or otherwise for his benefit after he ceases to be an inmate, or, if it is not so expended, shall be paid in cash to the person after leaving the institution, in a lump sum or in instalments as the society or committee thinks fit.
§ Mr. C. BATHURST
I beg to move to leave out the words "or otherwise for his benefit after he ceases to be an inmate."
The House will remember that the object of this Clause is to alter the destination of the money which is payable in respect of the provision of surgical appliances required for a patient while he is in a hospital or other similar institution. As regards sickness and disablement benefit payable in respect of such persons, an attempt has been made in most cases to secure that the money shall ultimately reach the hands of the insured person although he is in the hospital. The old friendly society practice was that the money should pass into the patient's hands, and the only alteration being made in this Clause, so far as Section 12 of the principal Act is concerned, is that after the whole machinery of this Clause has failed, then, and then only, shall the money pass into the hands of the patient in the hospital or other institution. I want to secure that where the insured person has no dependants, and where there has been no agreement that a payment shall be made for his maintainence in the hospital, that the money shall pass into the hands of the insured person. Surely that is a proper course to take after he has made his insurance contributions with the object of receiving sick benefit at the time of his illness, and if, as a matter of fact, a hospital or other institution supported by voluntary contributions makes provision for him while within its walls, there seems no reason whatever why the man himself, after leaving the hospital, should not receive the money in full or by instalments, 1548 as is proposed by this Clause. The words I want to leave out provide for the society applying the money for his benefit after he ceases to be an inmate. I think the man himself best knows what is for his own benefit, and, therefore, I think it ought to. be left to him to receive the money without any further interference with him after he has left the hospital.
§ Mr. MASTERMAN
We had a discussion on this Amendment in Committee, and I thought I had satisfied the hon. Member as to the necessity of these words. The same words are used in respect of maternity benefit, which provide that it may be paid in cash or otherwise. We are only meeting what has always been in the power of friendly societies, namely, the possibility in certain cases of administering the money for his benefit instead of paying it to him in cash. The hon. Member for Wilton, I am sure, will realise that such cases might arise when a man is recovering from sickness, and when he might be tempted by being paid in a lump sum of £5 to use it in a way which would not be to his own interests. Friendly societies have always had this discretion, and I hope the hon. Member will not press his Amendment.
§ Mr. C. BATHURST
In these circumstances, I do not desire to press my Amendment, and ask leave to withdraw it.
§ Amendment, by leave, withdrawn.
§ Mr. NEWMAN
I beg to move, to leave out the words "if it is not so expended, shall be paid in cash to the person after leaving the institution, in a lump sum or in instalments as the society or committee thinks fit," and to insert instead thereof the words "may be paid to such hospital, asylum, convalescent home, or infirmary of which such person may be an inmate." My Amendment is a perfectly simple and obvious one, and it deals with the hardship which has been felt by the hospitals ever since the principal Act became law This hardship has been borne in silence for some time, and I think this is a matter which the House ought to take cognisance of. I was rather struck when discussing adequate medical service by an illustration given by the hon. Member for Wilton, who spoke of Wiltshire and South Wales where there was a case of two medical men on the panel, one of them a specialist in diseases relating to the ear- 1549 eye, and throat, and the other was a heart specialist. The hon. Member told us that when a patient requiring special treatment applied to the ear and throat specialist he was referred to the other doctor for heart affections, and the heart specialist referred ear and throat cases back to his colleague for special treatment. That may be all right in Wiltshire and South Wales, but it does not happen in Middlesex or in London.
What happens is this: A patient goes to a panel doctor, and he is told on examination, "I cannot treat you, because you want a specialist form of treatment," and probably the doctor advises him not to go to a specialist, but to go to one of the small hospitals in Middlesex, or one of the large hospitals in London. The practice of people coming to panel doctors, and being advised to go to the hospitals for special treatment is becoming a very serious matter for the hospitals. Clause 14 gives power to the society or committee to pay to the insured person on leaving the hospital a lump sum in medical benefit. A very eminent legal gentleman in my own Division who acts as legal adviser to a hospital in which I am interested, told me that it was illegal at the present time for societies to pay over medical benefit in a lump sum, but if this Amending Bill becomes law that practice will be legalised. Unless under Section 12, Sub-section (2), paragraph (c) of the principal Act, the society or committee makes a definite arrangement with the hospital, no part of the medical benefit can be paid to the hospital which treated this man, and that the hospitals consider is a great grievance. We have got to take human nature as we find it, and I am sorry to say that in the district of which I speak it is the exception, and not the rule, for the societies to give any contribution at all to the hospitals which have taken their cases.
Then, again, private subscriptions have fallen off. A man who sent one of his dependents to a hospital formerly felt in duty bound to pay something to that hospital, and a great many people gave subscriptions; but now, if they are employers of labour and have to pay on behalf of their employés, they say, "why should I send my two guineas, my five guineas, or my ten guineas to the hospital as well?" The result is that subscriptions from the employer class are falling off. I cannot say exactly what the working classes are doing, but I should imagine 1550 that they are doing their level best to keep their subscriptions up. I have been told by more than one general hospital that the subscriptions from the comparatively well-to-do are decreasing. It is also perfectly obvious that now we have got 14,500,000 insured people more people go to hospitals and have operations which, if the Act had not been passed, they would never have dreamed of undergoing. That, of course, means that there is a great deal more work thrown upon the hospitals. In the course of the last fortnight representatives of eight cottage hospitals in the Northern part of Middlesex had a conference, and the committee of management of the Great Northern Central Hospital which caters for Islington also, met and passed a resolution and interviewed me. As the result of those two consultations, I have put down this Amendment. I would like to give one or two examples why I think that the House ought to adopt this Amendment. Take, first of all, the ordinary case of a domestic servant who is an insured person. She is taken ill, and sees a panel doctor who tells her that she wants medical treatment, which he is not able to give her, and he advises her to go to the hospital. She goes to the hospital and stays there perhaps for four weeks, and then she comes out. She has had her wages all the time that she has been in the hospital, and she gets in a lump sum the medical benefit, 7s. 6d. per week, to which she is entitled. She might, and I dare say would, pay some of that back to the hospital, but we have got to take human nature as it is, and there is a temptation to that girl to use the money to buy something for herself. Again, the employer who in the ordinary case would have contributed perhaps two or three guineas to the hospital says, "I pay my 3d. per week for this girl, why should I give anything to the hospital as well?"
Take another case which came to my notice the other day. A young man earning 22s. per week went into the hospital and stayed there five weeks. When he came out he was met on the doorstep by the agent of the society with which he was insured and had passed over to him the sum of £3 10s. I am sorry to say that young man went off without subscribing anything at all. These may be exceptional cases, but there they are, and it is to meet them that I ask the House to accept my Amendment and to put it in the power of the hospital to get something in return for what they have spent on 1551 these insured people. After all, 10s. or 7s. 6d. is only a comparatively small sum. They cannot treat a person even in a cottage hospital for less than 25s. per week. I know that the Financial Secretary to the Treasury has every sympathy with the work of our great hospitals and with the work which they have done in trying to make the Act a success. He has said so over and over again. We all sympathise with them, but unfortunately sympathy, unless it is backed by something else, does not pay the half-yearly bills of these establishments, and we have therefore got to do something practical. I know exactly what the Financial Secretary will say. He will say, "Do not let us do it now; do not raise this awkward question at this time." We have got to face it sooner or later, and I say, "Let us face it now." I may be told that next year we shall have had much more experience to deal with it, but I say that every year it will get worse, and every year the hospitals will be inclined to drive a harder bargain. I, therefore, suggest that it would be well now to give the hospitals the powers which I propose in my Amendment.
§ Mr. MASTERMAN
This is a matter which we discussed in Committee, and I certainly think that no one at this moment wishes to deal with the question of the hospitals as a whole. It is a narrow Amendment, and I will tell the hon. Gentleman why I think that it is undesirable that we should accept it. I would very much deprecate a discussion on the general position of hospitals and their future on such a narrow Amendment. Their future will not be settled by this Amendment, and personally I think that those who are deeply interested in the hospitals as well as those who desire considerable changes would greatly prefer that the whole subject should not come up at this time. The Amendment proposes to put a compulsion upon the insured person who has been in the hospital to pay over to them his sick benefit. I do not think that it is a fair compulsion to put upon insured persons.
§ Mr. MASTERMAN
But it would be a compulsion on the insured person, and I 1552 believe that the hospitals themselves would rather have the contributions they receive as voluntary contributions. We allow full power to the insured person to give any sum he pleases to the hospital out of his sick pay in accordance with what the hospital has done for him, and surely that is a good deal better way than compulsion. I believe that the Committee upstairs was very much influenced by a speech made by the hon. Member for Derby (Mr. Thomas), who gave us case after case in which persons having received good treatment from hospitals became friends of those hospitals for life. It is quite true that human nature is as it is, but it is very often a good deal better than it is supposed to be, and I am quite sure that we had better maintain the voluntary principle and see whether those who can afford it will not out of gratitude for the treatment they receive contribute something towards the hospitals out of the lump sum they get as medical benefit.
§ Mr. FORSTER
The Amendment of my hon. Friend does not interfere with the voluntary character of the Bill. It proposes that such "a sum may be paid to the hospital"; it does not say that it shall be paid. It does not make it compulsory on either the society or the individual.
§ Mr. MASTERMAN
If the society decides that it shall be paid, the individual would have no choice in the matter.
§ Mr. FORSTER
That is quite true, but it is a power the societies have already got under the Act. They have the power of entering into arrangements with the hospitals for payment to the hospitals of, at any rate, some portion of the sickness benefit of their members who have no dependants. This would merely extend that power. I do not know that my hon. Friend will think it necessary to press the Amendment to a Division, but it will not interfere in any shape or form with the voluntary character of the Bill.
§ Mr. J. SAMUEL
Unfortunately most of the Amendments on the hospital question are moved with regard to London, but that which affects London would be a serious injury in other parts of the country. If this Amendment were accepted, it would give great offence to a very large number of working men, especially in the North of England, who contribute not only towards the maintenance of hospitals but also towards convalescent homes and other 1553 such institutions. The money, in fact, is stopped from their wages. We know that in London there is no such contribution exacted or asked for from working men. I think, therefore, that the proper thing would be to try and introduce some such contributions in London, rather than to adopt an Amendment like this, which would give power to a committee or a society, if they thought fit, to deduct a subscription from the benefit to which the man who had gone to the hospital for treatment was entitled. I have just been reading the report of the committee of the hospital in the town I represent. A part of the report deals with this very question, and it reads as follows:—Oar past year's experience shows that this institution was not affected adversely—indeed, rather to the contrary—for the subscriptions and contributions show ran increase compared with the previous year.7.0 P.M.
That is so where working men contribute towards the upkeep of the hospitals. They dealt last year with 5,387 outpatients, and, although the workmen there contribute their 4d. per week to the insurance fund, and also to a convalescent home, and to Dr. Barnardo's Homes, they raised £327 for the hospital more than they did in the year before. This indicates that working men do not object to paying this money, and where they do pay it I think that it would be a mistake to give any power to a society to deduct from their benefit the cost or any portion of the cost of their upkeep in the hospital. I hope the hon. Member will not press this Amendment to a Division, but will leave the matter open until we have had a little more experience with regard to London. The present system undoubtedly, in many cases, does bring greater attachment to the hospitals on the part of working men, who work all the harder towards their upkeep.
§ Mr. POLLOCK
I should be sorry to think that the observations of the last speaker in re1gard to the working men in London were accurate. I think if he made further inquiries he would find that considerable contributions are made by working men to the London hospitals, and that there are many sources—associations and societies—through which they make their contributions. The hon. Member cannot know London as well as he knows his own town; if he did he would find that my statement is well founded.
§ Mr. J. SAMUEL
I was speaking more of deductions from wages and systematic contributions week by week.
§ Mr. POLLOCK
That may be the case, but in the wider sense in which the hon. Member appeared to speak, I do not think it would be true so far as the working men of London are concerned. This Amendment seems to be very much misunderstood. There already is power in the committees to use this sum in certain ways; they may apply it to the provision of surgical appliances or otherwise for the benefit of the insured person, and if it is for his benefit it can be paid to him. That is one way of making use of the money. But the rest of the Clause goes on to say that if it is not so expended for his benefit, then it can be paid to him in a lump sum on leaving the hospital. The purpose of the Amendment is not to try and force a contribution from the working man and the committee will still have the power of using this money for his benefit, by making a payment to him should they think it right to do so. But this power to make contributions to hospitals might be a very useful one to place in the hands of the committee. At present their hands are tied, their powers are limited in a particular direction, inasmuch as they can make make no contribution at all to these institutions. If this Amendment were accepted the Committee would have a larger range of choice, and it would give them the opportunity of making payments to institutions which certainly deserve some sort of reward. If the Committee find the exercise of this power is objected to they can still employ the money for the insured person's benefit in one of the ways already laid down, and one of those ways obviously would be to pay it, to him. This proposal I think is a good one.
§ Mr. THOMAS
I hope the hon. Member will withdraw the Amendment. There was a long debate on this point in Committee upstairs. In the first place, the hon. Member must be aware that it is undesirable for any insured person to have to go before any committee with a view to explaining his financial difficulties. Perhaps that point has not occurred to the hon. Member. If you give a power to the committees to pay the money to the hospital or some other institution while the insured person is in that hospital or institution they must before they can come to any decision have inquiries made as to the position of the particular individual. Take the case of a young man with no dependents. He lives in lodgings. While he is in hospital his lodgings must be paid for. He may also have other 1555 other difficulties. It is obvious there are thousands of young men in London who live in lodgings and who, while they are in hospital, have to pay for their lodgings week by week. There is, therefore, a continuous charge upon them. They may, too, have other debts which must be met out of the sick pay which comes to them in a hoop when they come out of hospital. Then there is this further point. They may find it necessary, after leaving hospital, to go to a convalescent home. This money would enable them to do that; but if discretion is to be given to the committee to pay the sick benefits over to a hospital it will be necessary to drag the man before the committee in order that he may explain his circumstances. There are hundreds of working men who are so gratified at the treatment they have received in hospital that when they come out they start funds among themselves and organise concerts for the benefit of the institution, and in a hundred and one ways they show their appreciation of what has been done for them in the hospital. I hope that that spirit will continue. If you give the money to the man in a lump sum, he is just as likely to make a contribution to the hospital. For this reason, I would urge that this matter should be left to the insured person and that no definite obligation should be put on the approved society.
I, too, hope my hon. Friend will not press this matter to a Division. If he does so I shall have to vote against him, and as one very much interested in hospitals I will give my reasons for the attitude I am taking up. I do not think this proposal will be good for the insured person, and I am quite sure it will be very bad for the hospital. It will not be good for the insured person, because if he knows he is liable to have his sick pay compulsorily taken from him and paid to the hospital, when he is told by the doctor he must go to a hospital because he cannot get proper treatment at home, he will be very disinclined to act upon that advice. I have always thought it was a great blot on this Act that hospital treatment was not included in the medical benefits, and I hope that some day, and that very shortly, the cases of the hospitals will be taken into consideration by this House. It is quite clear something should be done for some of them. They have had a lot of extra work put upon them since this Act came into operation, 1556 and in many cases their subscriptions have largely fallen off. Where ought the money to come from? Not from the pockets of individual patients who happen to be ill, but from the contributions of all insured persons through insurance committees, or from some Government contribution. The principle of insurance is that all should pay towards the sick benefit of those who fall ill, and if insured persons have hospital treatment the payment for that treatment should not come out of their pockets only. If that is insisted on, then it is not in accordance with the principles of insurance. The hon. Member who moved the Amendment said it was designed to meet exceptional cases, but as I read the Amendment, it is of a most general and sweeping character. I am quite sure that the hospitals, or at any rate a large majority of-them, would not desire that their funds should be supplemented by compulsory contributions from sick people. If they are to receive support at all in the way of contributions they should be general. contributions from all insured persons, and they should come out of general funds. For these reasons I ask my hon. Friend not to press this matter to a Division With regard to one other point—the suggestion that a man when he leaves the hospital and receives his sick benefit in a lump sum may abuse it by getting drunk. I venture to say that, in the vast majority of cases, this is the time above all others when the man wants money in a lump sum in order to enable him to make a start. He may have to pay for his lodging, he may have to go to a convalescent home, or, having been out of work for some time, he may have to seek fresh employment, and under such circumstances a lump sum of money would, of course, be most useful to him.
§ Mr. MAN FIELD
I also would appeal to the hon. Member not to press this Amendment to a Division. All those who are interested in hospitals have had this question under consideration for some time, and I do not think it would be at all in the interests of hospitals and kindred institutions that such a proposal as this should be introduced into this Act. I can endorse all that has been said by the last speaker as to the attitude which working men have taken up in regard to hospitals, and especially those who have received insurance benefit. There is no doubt also that the sum of money paid as sick benefit is of the greatest use to a man on leaving 1557 hospital, and in most cases it certainly is not misapplied. I do appeal to the hon. Member not to press his Amendment to a Division.
§ Amendment, by leave, withdrawn.
§ Amendment made: At the end of the Clause add,
§ "and Where any sum which apart from Section twelve of the principal Act would have been payable on account of sickness has been paid or applied under that Section as amended by this Section, it shall be treated as a payment in respect of sickness benefit for the purpose of determining the rate and duration of that benefit."
§ "(2) Proviso (ii) to Sub-section (2) of Section twelve of the principal Act shall have effect as if for the words 'both on account of sickness or disablement benefit and on account of maternity benefit' there were substituted the words 'both on account of maternity benefit payable in lieu of sickness or disablement benefit and on account of maternity benefit not so payable,' and for the words which would otherwise be payable on account of maternity benefit' there were substituted the words which would otherwise be payable on account of such last-mentioned maternity benefit.'"—[Mr. Masterman.]