HC Deb 06 August 1913 vol 56 cc1647-53

Where it is made the duty of an insurance committee under the provisions of this Act or of the principal Act, or of regulations made thereunder, to ascertain, in respect of any matter affecting the administration of medical benefit in the area, the opinions and wishes of the medical practitioners who have entered into agreements with the insurance committee for the attendance and treatment of insured persons whose medical benefit is administered by the committee, they shall do so through a committee appointed by such practitioners in accordance with regulations made by the Insurance Commissioners, and such committee shall perform such duties and shall exercise such powers as may be determined by the Insurance Commissioners, and in any area in which within six months of the time of the passing of this Act no local medical committee has been recognised under the provisions of Section 62 of the principal Act, a committee elected in the manner hereinbefore provided may be recognised as the local medical committee for that area.


I beg to move, after the word "Commissioners" ["by the Insurance Commissioners, and such"], to insert the words, "provided that such practitioners shall be entitled to appoint the medical committee for their area as the committee."

It will be seen that Clause 30 really con-consists of two parts, the second beginning with the words, "and in any area." Now, when this Clause was being considered in Committee, the Secretary of the Treasury was good enough to accept an Amendment which I proposed with regard to the second part of this Clause, and I have, therefore, no alteration to suggest in that part; but the first part is of a very different character. It proposes to set up a new committee to be appointed by what I may call the panel doctors, and it does seem unnecessary that that should be done in an area in which there already exists a local medical committee. The Amendment that I am proposing is that where the panel doctors—that is to say, the doctors who have come to an agreement with the Com- missioners—are satisfied that the existing local medical committee can be trusted to discharge the duties which are to be entrusted to them by this Clause, they should be entitled to propose that the local medical committee should be the committee to be appointed under this Clause. It only gives permission to the panel doctors to recognise this particular committee instead of a new committee.

I need scarcely point out that the object of the Amendment is to simplify the procedure under this Clause. Already the Act is sufficiently complicated and anything we can do to prevent the appointment of additional committees where other committees already exist which are capable of doing the work properly is, I submit, undesirable. The local medical committee is much more important than the committee which it is proposed to appoint would be, because it represents the whole of the medical practitioners in a particular area, whereas the Committee proposed to be set up under the Clause will only represent practitioners who happen at the time to be on the panel. I cannot help thinking that if the panel practitioners are themselves satisfied that their interests can be entrusted to the local medical committee, they might at least be allowed to appoint that Committee in place of the one suggested in the Clause. I did not think the matter was sufficiently considered in Committee upstairs and I therefore thought it desirable in the interests of simplifying the Act to bring the subject before the notice of the House on the present occasion.


I beg to second the Amendment.


I hope the hon. Gentleman will not think it necessary to press the Amendment. This was an agreed Clause in Committee after we had made considerable concessions to the hon. Gentleman and to the hon. Gentleman the Member for Glasgow and Aberdeen Universities (Sir Henry Craik) who have a special right to speak for the medical profession.


That only referred to the second part.


If an alteration were made in Clause 30 it would also involve an alteration in the scheme laid down in Clause 31. May I point out that there is not in the Clause a suggestion that there should be any rival to the local medical committee in connection with any medical question, but the suggestion is that the panel doctors themselves should be allowed to have a committee which can agree with a similar committee appointed by the chemists on the panel as to arrangements for checking the chemists' fees and other matters. May I, as an example, remind the House of the case of Manchester, where they are not working exactly on the panel system. There a local medical committee of the panel doctors is essential, because they are engaged on the work of checking the bills of each other and of the chemists. It is for the sake of the work which the panel doctors have to do that this has been proposed and I thought it was agreed to unanimously by the Committee upstairs.

Question, "That those words be there inserted," put, and negatived.


I beg to move to leave out the words "and such committee shall perform such duties and shall exercise such powers as may be determined by the Insurance Commissioners, and in any area in which within six months of the time of the passing of this Act no local medical committee has been recognised under the provisions of Section sixty-two of the principal Act, a committee elected in the manner herein-before provided may be recognised as the local medical committee for that area."

The right hon. Gentleman has first stated that this Clause was wanted in order that there may be a committee of panel doctors able to check the bills of panel doctors, to deal with the druggists.' accounts, and to look into various other items which affect the panel doctors. There is, I admit, some force in his argument that there ought to be a committee of panel doctors for that purpose. My Amendment will leave the committee of panel doctors for the purpose for which the right hon. Gentleman says he wants it, but by striking out the words which I propose to omit the House will prevent the committee being used for the purposes of the local medical committee under Section 62 of the principal Act. Section 62, I may remind the House, provides for the creation of a local medical committee, which is to be representative of the medical practitioners residing in the area, whether they are on the panel or not. That committee was particularly designed to embrace all classes of medical practitioners, as it was intended to be a com mittee to advise the Commissioners and the Insurance Committees on all affairs relating to the public health of the country so far as they were touched by the National Insurance Act. Upon that committee in many cases now, where it has been formed, are the medical officers of health, and it is highly desirable that they should be on the committee, so that they may be able to keep in close touch with the other practitioners in the neighbourhood.

On that committee are to be found also the consultants now attached to various hospitals throughout the country. It is highly desirable that they, too, should be represented on the local medical committee, because to the hospitals the insured people owe a great deal of the health treatment that they may be expected to obtain. The result of my Amendment would be to leave the proposed committee in the shape the right hon. Gentleman wants it, namely, a committee representative of the panel practitioners, but it would prevent that committee being used for any purpose other than those for which it is intended. It could not be used, that is, say, as a local medical committee, which ought to be constituted in a totally different way. If the Amendment is agreed to—and I have a faint hope that the right hon. Gentleman may accept it—it will, I think, meet both cases in a very fair way.


I beg to second the Amendment.


This question was argued in Committee upstairs when the hon. Gentleman was present. In the Standing Committee two persons who have a special right to speak for the doctors, and whose opinions I value greatly—the Member for London University and the Member for Glasgow and Aberdeen Universities—both at first took exception to the Clause, but I think they were convinced by the arguments which were advanced that it was essential in cases where there was no local medical committee that some committee of this sort should, in the interests of the insured persons, be taken into consultation by the Insurance Committee. On my agreeing to extend the time which must elapse before committees of panel practitioners may be formed from three to six months and substituting the word "may" for "shall" the hon. Gentlemen to whom I have referred said that they were satisfied with the com promise and withdrew their objection. In these circumstances I feel that I must ask the House to stand by the decision of the Committee upstairs which went closely into the subject.


I think the account given by the right hon. Gentleman of the proceedings in the Committee upstairs on this point was substantially accurate, but I should like to say that I was not the least satisfied with the alterations made in the latter part of the Clause. I did not press the matter at the time, because we were working in the Committee under such extraordinarily high pressure, and it, was really impossible to do so without prolonging the proceedings of the Committee to an undue length, but I did look forward to raising an objection on the Report stage. I entirely agree with the right hon. Gentleman that it is desirable that there should be a committee of panel doctors in order that the Insurance Committee may consult them on various questions, but I do not at all agree that to this new committee of panel doctors there should be entrusted any of the interests of the local medical committee. It is true that the right hon. Gentleman endeavoured to meet the point by extending the period during which the local medical committee might still be formed for another three months. I look forward to the time when there will be established a local medical committee for every area, and if you are going by means of altering part of this Clause to allow the

committee of panel practitioners to be substituted for the local medical committee, then you will shut the door against the formation of any local medical committee which is not established within the next six months. I should regret that as a great pity, and I hope the right hon. Gentleman will accept the Amendment.


I do not know whether the hon. Gentleman realises that if this Amendment were accepted all this Clause would do would be to give the Insurance Committee power to ascertain the opinion and wishes of the medical practitioners on the panel. In that case the very duties that the Insurance Committee would wish the committee of panel doctors to do, they could not do under the Clause as it would then stand. All the Insurance Committee could do, as I have pointed out, would be to ascertain the wishes of the panel practitioners. There are matters contained in regulations which really make it the duty of the committee of practitioners on the panel to check accounts. I hope the right hon. Gentleman will not accept the Amendment, because I feel quite certain that there are very useful functions which this committee and this committee alone can perform, and there need be, in carrying them out, no encroaching on any of the functions and duties of the local medical committee.

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

The House divided: Ayes, 173; Noes, 34.

Division No. 265.] AYES. [12.55 a.m.
Abraham, William (Dublin, Harbour) Condon, Thomas Joseph Griffith, Ellis Jones
Acland, Francis Dyke Cornwall, Sir Edwin A. Guest, Hon. Frederick E. (Dorset, E.)
Addison, Dr. Christopher Crumley, Patrick Gwynn, Stephen Lucius (Galway)
Allen, Rt. Hon. Charles P. (Stroud) Cullinan, John Hackett, John
Baker, Harold T. (Accrington) Davies, David (Montgomery Co.) Hall, Frederick (Yorks, Normanton)
Barnes, George N. Davies, Ellis William (Eifion) Hancock, John George
Barran, Sir J. (Hawick Burghs) Davies, Sir W. Howell (Bristol, S.) Harcourt, Robert V. (Montrose)
Beck, Arthur Cecil Dawes, James Arthur Harmsworth, R. L. (Caithness-shire)
Benn, W. W. (T. Hamlets, St. George) Delany, William Harvey, A. G. C. (Rochdale)
Bentham, George Jackson Devlin, Joseph Harvey, T. E. (Leeds, West)
Boland, John Pius Doris, William Hayden, John Patrick
Booth, Frederick Handel Duffy, William J. Hayward, Evan
Bowerman, Charles W. Duncan, C. (Barrow-in-Furness) Hazleton, Richard
Boyle, Daniel (Mayo, North) Edwards, Clement (Glamorgan, E.) Higham, John Sharp
Brady, Patrick Joseph Edwards, John Hugh (Glamorgan, Mid) Hobhouse, Rt. Hon. Charles E. H.
Brunner, John F. L. Esmonde, Dr. John (Tipperary, N.) Hogge, James Myles
Bryce, J. Annan Esmonde, Sir Thomas (Wexford, N.) Howard, Hon. Geoffrey
Burke, E. Haviland- Falconer, James Hughes, Spencer Leigh
Burns, Rt. Hon. John Fenwick, Rt. Hon. Charles Isaacs, Rt. Hon. Sir Rufus
Buxton, Rt. Hon. Sydney C. (Poplar) Ferens, Rt. Hon. Thomas Robinson John, Edward Thomas
Carr-Gomm, H. W. Ffrench, Peter Jones, Rt. Hon. Sir D. Brynmor (Swansea)
Cawley, Harold T. (Lancs., Heywood) Field, William Jones, H. Haydn (Merioneth)
Chancellor, Henry George Fiennes, Hon. Eustace Edward Jones, J. Towyn (Carmarthen, East)
Chapple, Dr. William Allen Fitzgibbon, John Jones, William (Carnarvonshire)
Clancy, John Joseph Flavin, Michael Joseph Jones, William S. Glyn- (Stepney)
Clough, William Gill, A. H. Jowett, Frederick William
Clynes, John R. Gladstone, W. G. C. Joyce, Michael
Collins, Godfrey P. (Greenock) Goldstone, Frank Keating, Matthew
Kilbride, Denis O'Brien, Patrick (Kilkenny) Scott, A MacCallum (Glas., Bridgeton)
King, Joseph O'Connor, John (Kildare, N.) Seely, Rt. Hon. Colonel J. E. B.
Lambert, Rt. Hon. G. (Devon, S. Molton) O'Doherty, Philip Sheehy, David
Lambert, Richard (Wilts, Cricklade) O'Donnell, Thomas Shortt, Edward
Lardner, James C. R. O'Dowd, John Simon, Rt. Hon. Sir John Allsebrook
Lawson, Sir W. (Cumb'rld, Cockerm'th) O'Grady, James Smith, Albert (Lancs., Clitheroe)
Lewis, Rt. Hon. John Herbert O'Kelly, Edward P. (Wicklow, W.) Smyth, Thomas F. (Leitrim, S.)
Lundon, Thomas O'Malley, William Sutton, John E.
Lyell, Charles Henry O'Neill, Dr. Charles (Armagh, S.) Taylor, Theodore C. (Radcliffe)
Lynch, A. A. O'Shaughnessy, P. J. Taylor, Thomas (Bolton)
Macdonald, J. Ramsay (Leicestesr) O'Shee, James John Tennant, Harold John
Macnamara, Rt. Hon. Dr. T. J. O'Sullivan, Timothy Thorne, G. R. (Wolverhampton)
Macpherson, James Ian Parker, James (Halifax) Toulmin, Sir George
MacVeagh, Jeremiah Pearce, Robert (Staffs, Leek) Ure, Rt. Hon. Alexander
M'Callum, Sir John M. Pease, Rt. Hon. Joseph A. (Rotherham) Wadsworth, J.
M'Curdy, Charles Albert Phillips, John (Longford, S.) Ward, John (Stake-upon-Trent)
McGhee, Richard Pointer, Joseph Waring, Walter
M'Laren, Hon. H. D. (Leics.) Ponsonby, Arthur A. W. H. Warner, Sir Thomas Courtenay T.
Manfield, Harry Price, C. E. (Edinburgh, Central) Webb, H.
Markham, Sir Basil Pringle, William M. R. Wedgwood, Josiah C.
Marshall, Arthur Harold Radford, G. H. White, J. Dundas (Glasgow, Tradeston)
Masterman, Rt. Hon. C. F. G. Reddy, Michael White, Patrick (Meath, North)
Meagher, Michael Redmond, John E. (Waterford) Whyte, A. F. (Perth)
Meehan, Francis E. (Leitrim, N.) Redmond, William (Clare, E.) Williamson, Sir Archibald
Meehan, Patrick J. (Queen's Co., Leix) Redmond, William Archer (Tyrone, E.) Wilson, Rt. Hon. J. W. (Worcs., N.)
Millar, James Duncan Richardson, Thomas (Whitehaven) Wilson, W. T. (Westhoughton)
Molloy, Michael Roberts, Charles H. (Lincoln) Wing, Thomas Edward
Muldoon, John Roberts, George H. (Norwich) Wood, Rt. Hon. T. McKinnon (Glasgow)
Munro, Robert Robertson, John M. (Tyneside)
Murphy, Martin J. Rowlands, James
Neilson, Francis Samuel, Rt. Hon. H. L. (Cleveland) TELLERS FOR THE AYES.—Mr. Illingworth and Mr. Gulland.
Nolan, Joseph Samuel, J. (Stockton-on-Tees)
Norman, Sir Henry Scanlan, Thomas
Baird, J. L. Henderson, Major H. (Barks, Abingdon) Pease, Herbert Pike (Darlington)
Burn, Colonel C. R. Hope, Major J. A. (Midlothian) Samuel, Samuel (Wandsworth)
Campbell, Captain Duncan F. (Ayr, N.) Horne, E. (Surrey, Guildford) Sanders, Robert Arthur
Cassel, Felix Ingleby, Holcombe Stanley, Hon. G. F. (Preston)
Cator, John Lewisham, Viscount Stewart, Gershom
Cecil, Lord R. (Herts, Hitchin) Lloyd, George Butler (Shrewsbury) Talbot, Lord Edmund
Dalrymple, Viscount Locker-Lampson, G. (Salisbury) Terrell, Henry (Gloucester)
Dickson, Rt. Hon. C. Scott Locker-Lampson, O. (Ramsey) Tullibardine, Marquess of
Forster, Henry William M'Neill, Ronald (Kent, St. Augustine's)
Gibbs, G. A. Magnus, Sir Philip
Gilmour, Captain John Morrison-Bell, Major A. C. (Honiton) TELLERS FOR THE NOES.—Mr. Worthington-Evans and Mr. Gold smith.
Hall, Frederick (Dulwich) Mount, William Arthur
Hamilton, C. G. C. (Ches., Altrincham) Parkes, Ebenezer

Question put, and agreed to.