CLAUSE 9.—(Extension of Powers of Commissioners to Make Regulations.) (Hansard, 15 August 1913)

§ Mr. GWYNNE
I do not think that it is very much good in going into this question of the Advisory Committee all over again, as I have expressed my opinion about it.

§ The CHAIRMAN
This Amendment is not in order, as it deals with medical benefit and treatment. As I understand, Clause 9 does not affect medical attendance and treatment which the hon. Member seeks to protect, and therefore it is unnecessary. Perhaps I should hardly say it is out of order, but if the hon. Member wishes to move it, he may then be told that it does not affect the matter.

Mr. BATHURST
I am bound to accept from you that you think that this Amend- 3030 ment is out of order, but this Clause refers to the Schedule, and the Schedule deals with regulations of a certain kind issued in specified circumstances. What I and some of my Friends seek to do by this Amendment is to secure that those regulations shall not in any way limit medical benefit. I do not know what reason there is for suggesting that that is out of order.

§ The CHAIRMAN
I did not say that it was out of order, but that it seems to be unnecessary.

§ Mr. MASTERMAN
The hon. Gentleman is moving something which is consequential to a, later Amendment. That is the real difficulty. He is moving to provide that such regulations shall not have a certain effect, and that is really consequential to the Amendment which he has got down next. I think if it is in order that it would be better to move the substantial Amendment, and if that was carried, we could easily put the other thing right.

Mr. BATHURST
I want to be sure that I have got it one way or the other. I was going, in submitting this Amendment, to refer to the two Amendments standing in my name. It does not matter for my purpose in what form it comes up for consideration.

§ The CHAIRMAN
That meets my point. The Committee can take the discussion on the two Amendments together if the hon. Member will formally move this first.

Mr. BATHURST
Very well I will formally move after the word "Act" to insert the words "provided that such regulations have not the effect of limiting medical attendance and treatment."
What I want to raise here is what is a serious grievance all over the country. I am not here to represent the doctors. They are perfectly well able to look after themselves. The Act provides definitely that among other benefits, in fact the first benefit specified in the Act as a result of contributions by the employer and the employés, is medical treatment and attendance. That is in no way limited except in the case of the confinement of the woman referred to in Sub-section (6) of the same Section, but further in Section 15 we have this definite statement with regard to the meaning of the medical benefit:— The regulations made by the Insurance Commissioners shall provide for 3031 the arrangements made being subject to the approval of the Insurance Commissioners and being such as to secure that insured persons shall, save as hereinafter provided, receive adequate medical attendance. Subsequently to that, the Commissioners by their regulations have cut down the interpretation of medical benefit as expressed in the Act to mean the ordinary medical attendance and treatment in respect of ordinary ailments which require no specific treatment and no specialist knowledge. This is operating as a serious injustice in many of the industrial districts. I can speak especially for South Wales, where the doctors have been in the habit of providing, for less remuneration than they are receiving now, such medical treatment as will cover all ordinary cases that did not require treatment in a special institution such as a county infirmary. There are many cases of this sort. There may be cases affecting the nose or the ear or the throat or the eyes, or even the teeth, and many ailments of this character are being treated now by doctors as being outside the scope of the work which they are paid to undertake. Thereby a serious injustice is being done to these men, and they are being told—and this is my main complaint—by many of these medical practitioners, that these are not matters which come within the scope of their work, but that if the insured persons require attendance they must go to the assistant of the doctor, who has some specialist knowledge in respect of these complaints, and having gone there, they will have to pay a special fee outside the ordinary insurance payment to secure attendance for such cases.
In effect it is a serious evasion of the intention of this Act as originally framed, and it is one of those cases in which the interpretation of the Commissioners by regulation is cutting down the scope of the Act to the detriment of the insured persons. The sole object of this Amendment is to secure that the words which appear in Section 15 of the principal Act shall be given effect to, namely, that in every case the regulations shall secure to the insured person medical attendance without any qualifications whatever. That ought to cover all cases that require simple treatment, and do not require special treatment in special institutions, and especially such cases as defects of the teeth and. many minor ailments 3032 connected with other organs of the body to which I have referred. I beg to move.

§ The CHAIRMAN
The hon. Member is understood to be moving this first Amendment as part of the second Amendment on the wider subject.

§ Mr. C. BATHURST
What I want to secure is with reference to any regulations of the Commissioners that they shall not, as in the past, be operative to cut down the intention of the principal Act.

§ Mr. MASTERMAN
This Amendment, if I may say so with the utmost respect, is meaningless. No regulations could have the effect of limiting medical attendance and treatment if that medical attendance and treatment is designed by the principal Act. Whatever regulations the Commissioners make, if they are outside or contrary to the provisions of the original Act they are ultra vires, and they can be challenged, and, as far as I know, no regulations have in any degree attempted to make that condition. The point which the hon. Gentleman raises as to what should be regarded as medical attendance, and treatment is really a different point. I could not possibly accept words like these, because it would suggest that regulations might override the original Act.

§ Mr. GOULDING
In rising to support the Amendment I really think the right hon. Gentleman (Mr. Masterman) is riding off too quickly.

§ Mr. MASTERMAN
I am willing to discuss the other point.

§ Mr. GOULDING
It is the case that a different interpretation has been put into the regulations than that which exists as to what adequate medical attendance and treatment should be. The regulations state such services as may be given by a practitioner of ordinary professional competence and skill. That is a mitigation and whittling down of the original Act. I am told of a case of a servant girl whose eyes were badly inflamed, causing great danger as regards the permanent cure of the eyes, and the ordinary panel doctor declined to deal with this case and said it was outside of his scope. I maintain that is not carrying out the distinct terms of the sentence in the principal Act, and I hope my hon. Friend will insist on pressing his Amendment which would really go to strengthen the hands of the Commissioners in seeing that the Act as originally passed in this House shall be fully endorsed and given effect to.

§ Mr. C. BATHURST
May I draw attention to one observation of the right hon. Gentleman which, with all respect, I do not think is quite correct. This Clause specifically provides that the Commissioners may make such regulations and consequential provisions as appear necessary for modifying, as well as adapting, the provisions of the principal Act to the provisions of the regulations. That gives specific power to modify the provisions of the Act, and it is against that I am declaiming.

§ Mr. MASTERMAN
Only as regards things in the Schedule, and I do not think medical benefit is in the Schedule.

§ Mr. C. BATHURST
It may be included too.

§ Mr. THOMAS
We are all in hearty agreement with the Amendment proposed by the hon. Member. The position in this case is identical with the position yesterday, where a concession was given to the doctors at the expense of the insured person. When the Act was going through the House there was a no suggestion made when the discussion took place on medical treatment that there would be such limitations as have been now introduced, and we look upon it was a perfect scandal to find some of the cases which the doctors have refused to treat under the Act. For this reason, whilst I am not quite sure whether this is the right place to introduce it yet if the effect is to broaden the situation, and make perfectly clear the meaning of the original Act that those cases should be treated, then we certainly will go to a division, as we hope the hon. Member will, and support him.

§ Sir. P. MAGNUS
In Section 8, Sub section (8) of the principal Act, the first Subsection says:— Medical treatment and attendance, including the provision of proper and sufficient medicines, and such medical and surgical appliances as may be prescribed by regulations to be made by the Insurance Commissioners (in this Act called 'Medical Benefit'). If I am not mistake those regulations were published before the medical practitioners entered into any undertaking with the Government for giving medical benefit. They are, therefore, bound by the regulations which were published by the Commissioners, and under those regulations under the words quoted by my hon. Friend, it was distinctly understood by the medical practitioners 3034 that they should only be asked to treat such cases as came within the knowledge and general practice of the ordinary practitioner. I am not quoting the words exactly, but that is the effect of them. All other matters, it was provided, should be referred to other medical practitioners or experts in the particular complaint for which the patient sought the assistance of the medical man. It very frequently happens that it would be far easier for a medical practitioner to give treatment on a subject which he does not thoroughly understand than to refer the patient to an expert, who would be able to give valuable advice, but in any circumstances, having regard to the agreement, which after very considerable consultation and difficulties was finally arrived at between the medical men and the Commissioners, it would be quite impossible to expect them to do more than they undertook to do in accordance with the regulations which were published and submitted to them prior to that agreement being entered into. Therefore, there is an absolute contract at the present moment between the Commissioners, the Government and the medical men as regards the kind of treatment which is included in the words "Medical benefit," and any attempt which is being made by my hon. Friend to alter that would be simply a breach of agreement which would bring all the old difficulties which existed between the doctors and the Commissioners once again before the public.

§ The CHAIRMAN
I think the discussion is rather drifting away from the Amendment on to the whole Clause. I am to some extent in the hands of the Committee if they like to take the discussion on the Clause as a whole now instead of on the question that it stand part. Practically all the Amendments, except this one, are out of order, but the matter might be regularised by taking the discussion on the question that the Clause stand part.

§ Mr. THOMAS
We want a vote.

§ The CHAIRMAN
Then I must keep to the Amendment. Speeches have already been made quite wide of the Amendment, and referring to matters which are not included in the regulations in the Schedule.

§ Mr. ALDEN
I submit that this is not the proper place to discuss this question. It is an important question, and I shall support the hon. Member in discussing it now, unless the Government can give us an assurance that there will be a proper opportunity afterwards to raise this whole question 3035 because it is a very big question and ought to be adequately discussed at some considerable length. If the Government can give us that assurance I would suggest to the hon. Member to withdraw his Amendment and let us get on to the Clause.

§ Mr. MASTERMAN
The hon. Member has recognised quite frankly that, there being nothing dealing with medical attendance and treatment in the Schedule, there is really no need to pass this.

§ Mr. C. BATHURST
I have not recognised that at all.

§ Mr. MASTERMAN
But it is so. Therefore the Amendment is not really any Amendment except to protect something that may be done in the future, and that can always, if required, be put in on the Report stage. As to the general question, I agree that it is a very important one. I want it discussed. I have got a good deal I want to say about it, but surely, this Amendment, referring to something that is not in the Schedule is the worst possible place to have that discussion.

§ The CHAIRMAN
I pointed out it was not within the scope of the Schedule.

§ Mr. C. BATHURST
Can the Government give us any assurance that this matter is going subsequently to be dealt with. This Schedule deals with certain regulations which may refer amongst other things to medical benefit. It is perfectly true that the Schedule does not specifically refer to medical benefits, but the regulations drafted under the Schedule may do so. Before withdrawing this Amendment I should like to know whether the right hon. Gentleman means to give us any opportunity of discussing this hereafter, and of considering a Clause to be put down with that special object, because our position is in fact, that the regulations now put forward are ultra vies of the original Act. We want to be quite certain that hereafter, regulations shall not be issued having the same effect.

§ Mr. MASTERMAN
It is the Chairman who is to rule ns to order, but we certainly shall do anything we can do in order to enable the question to be discussed fully.

§ Mr. GOULDING
I do hope my hon. Friend will insist upon going to a Division. We are really going to get into tremendous confusion if every single difficulty is to be postponed to some later period. I want some one of these difficulties to be dealt 3036 with now. When we go downstairs it will be open to the right hon. Gentleman to show that what has been put in might be improved, but we all feel that injustice is being done, and a wrong interpretation placed on the Act in regard to this matter, and I hope we shall see it put right.

§ Mr. RAMSAY MACDONALD
We feel very keenly as to the conduct of the doctors in a very considerable number of directions in connection with the administration of this Act, and we are determined that that condition will be raised, agreement or no agreement, but what I feel about withdrawing is this: that if the Government desires that we should discuss this question before the Report stage, it would be a mistake to divide now, because obviously we could not then raise the same question. If we are only going to have a discussion on the Report stage downstairs; then we might just as well divide now.

§ The CHAIRMAN
I understood that it was desired that the discussion should range wider than it could possibly do on the Amendment before the Committee. By continuing the discussion before the Committee even with the help of the Chair limiting the discussion as far as possible, it world yet range so far as to prevent it being brought upon the wider basis on a new Clause afterwards. It was in the interests of Members on both sides who wished to raise the question that it was pointed out that it should not be raised on this narrow issue as to the making of regulations.

§ Mr. FORSTER
I hope my hon. Friend will not press this Amendment to a Division, because it will not really secure the object he has in view. If this Amendment is carried the Clause will run The Insurance Commissioners may make regulations with respect to all or any of the matters specified in the Schedule of this Act, and then will come the saving words of my hon. Friend. What are the matters with regard to which regulations can be made? The regulations relate not to medical benefit and other benefits, but only to the dissolution or the amalgamation of approved societies. It does not touch the general question, and neither the hon. Member opposite nor my hon. Friend will attain his object if we divide now.

§ The CHAIRMAN
I would point out, from the new Clause point of view, that the 3037 hon. Member already has an Amendment on the Paper which will certainly be prejudiced by a longer discussion now.

§ Mr. C. BATHURST
I ask leave to withdraw the Amendment on the understanding that I shall put down a Clause to deal with the subject.

§ Sir W. BYLES
I would ask my right hon. Friend to tell the Committee a little more definitely when we shall have an opportunity of discussing this question. It is really thought a great deal of, not only by Members opposite, and by Members of the Labour party, but by many individual Members of the Committee. If we could know when and on what Amendment the discussion might come on, I should be quite satisfied to concur in the withdrawal of this Amendment.

§ Mr. MASTERMAN
The discussion will come on a new Clause, and the sooner we get the Bill—the great majority of the small Clauses I think are uncontroversial—the sooner the hon. Gentleman will be able to get his teeth into the new Clause.

§ The CHAIRMAN
The next Amendment dealing with maternity benefit should come as a new Clause.

§ Mr. BATHURST
Do I understand that it is out of order at this point?

§ The CHAIRMAN
Yes. It has reference to the payment of money to the wife rather than to the husband, and I think it would come better as a Clause by itself. This is a regulation Clause. The same remark applies to the similar Amendment in the name of the hon. Member for Worcester (Mr. Goulding). With regard to the Amendment standing in the name of the hon. Member for Wallsall (Mr. Cooper) [providing that certain approved societies should not hold their meetings on licensed premises]—if it is a permissive Clause it is already covered by the Act; if it is compulsory it would be out of order at this point.

§ Mr. CASSEL
I have not had time to put down an Amendment, but I think, when I point out the defect in the Clause, the Government will probably consider the point before Report. In regard to these regulations there is no proviso similar to that in regard to regulations under the principal Act, namely, that on an Address being presented 3038 to the Crown by either House of Parliament within a certain time the regulations shall be annulled. On the question of interpretation, it does not seem to me at all clear that Section 65 of the original Act would apply to this Clause. I am quite aware of Clause 13, but I do not think that that applies in connection with this point, because you are not here superseding or amending any provisions of the principal Act; you are giving to the Insurance Commissioners a new and additional power of making regulations with regard to other matters. If the right hon. Gentleman will consider before the Report stage whether the proviso referred to applies to this Clause, and if it does not, will favourably consider an Amendment in that sense, it will meet my point.

§ Mr. MASTERMAN
There is no intention of doing anything in connection with these regulations different from what is done under the original Act. I will look into the point and, if necessary, have words brought up on Report.