HC Deb 15 August 1913 vol 56 cc3374-81

"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 three 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 shall be recognised as the local medical committee for that area."

Clause brought up, and read the first time.

Dr. ADDISON

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

Sir P. MAGNUS

This strikes me as being a highly contentious Clause.

The CHAIRMAN

Does the hon. Gentleman desire to move an Amendment?

Sir P. MAGNUS

Yes.

The CHAIRMAN

Then I had better call on another Member first, as there may be an Amendment prior to the one which the hon. Member intends to move.

Sir P. MAGNUS

I only wanted to say that, as it is a highly contentious Clause, it had better be withdrawn altogether.

Dr. ADDISON

I am afraid that the hen. Member for the University of London is under a misapprehension. I should not consider it a highly contentious Clause. I do not want to go into controversial matters, and I will not do so unless the course of the discussion renders it necessary.

Mr. WORTHINGTON-EVANS

Tell us what it means.

Dr. ADDISON

If the hon. Member for Colchester will exercise a little patience I will do my best. Under Regulation 42 it, is provided that in respect of the practitioners' accounts, which are to be rendered quarterly, and before the payment of the balance, the committee shall submit the account to a committee appointed by practitioners on the panel, which committee shall have the power to reduce or disallow any item in the accounts submitted to it. For instance, in Manchester they have a very important committee to which all accounts go—the drug accounts, the accounts for attendance, and so on. During this year I believe they have among other things disallowed a large number of charges for various reasons. This committee serves many other useful purposes, and I think we should recognise it and put it in proper form. It is a committee which Insurance Committees in the future will have to rely upon more and more. There are other questions as well as drugs and accounts with which they have to deal. There are questions relating to mileage and agreements; there are also matters of complaint affecting practitioners on the panel. A committee of this kind can be made very useful, and I believe that throughout the country the arrangements set up in the regulations and under the Act are working quite smoothly. Of course, there are some districts where it is not so, and one of them is London. It is a great drawback to the smooth working of the Act if the Commissioners are not able to rely on the advice and assistance of some such committee on account of the phraseology of the original Act. I am now referring to the last four lines of the proposed new Clause which says, in any area in which within three months of the time of the passing of this Act no local medical man has been recognised under the provisions of Section 62 of the principal Act, a committee elected in the manner hereinbefore provided, shall be recognised as the local medical committee for that area. Section 62 of the principal Act sets out the local medical committee is to be representative of the duly qualified medical practitioners resident in the county or county borough. In the case of London, we have a large number—some thousands—of medical men who are not really in practice, and who are in no way concerned with National Insurance, and never will be. Many of them are University men, men retired from the service, and a large number are consultants and various kinds of specialists. If you are to be tied down to a committee which is to be representative of men resident in the area, great difficulty will necessarily arise. There are over 5,000' men such as I have described in London, and there are about 1,500 practitioners on the panel. It means you may get a committee which does not lend itself to the smooth working of the Act, and, even as in London, may endeavour to frustrate that smooth working. I do not want to open out on the position in London if I can avoid it, but. I have some material which, personally, I should prefer not to give to the com- mittee, but which makes good my contention. At the present time in London there is no local medical committee, and the reason there is none recognised in London is because there has been a great deal of friction fostered, I am afraid, by a number of men who have no special interest in the Act at all. To give an example of the kind of thing which has occurred in London, I will mention one circumstance.

Some time ago, in consequence of the efforts of a good many people who wanted to set up on amicable terms a local medical committee in London, a meeting was arranged, presided over by a gentleman who is generally trusted. This was the proposal which the men who were outside the panel system in London, led by a number of men whom I am afraid nothing will placate, rejected. It was proposed that twenty-nine men on the London Local Medical Committee should be appointed by men on the panel and twenty-nine by the men off the panel, and that fifteen others should be appointed by the men connected with the various hospitals. They actually rejected that as an unreasonable proposal. For my part I rejoice that they did. I think it would be very improper to limit the representation of the men who are doing the hard work and having all the responsibility in London to such a number on a committee of that kind. It meant that those men could not be satisfied with any reasonable proposals. I am quite sure that in the course of time the difficulties will be smoothed away, and that we shall get an amicable adjustment of things. It is necessary that the Insurance Commissioners should have some committee which they can recognise in London for example, and for that reason I suggest that they should be given the power to recognise the practitioners' committee on the local medical committee in such an area if necessary. It is only to enable the Commissioners and the committee to deal with all the intricate medical questions which must arise with a properly constituted committee in every area. I hope that it will not be necessary to recognise such a committee in London—it entirely depends upon the spirit which prevails—and that it will not be necessary under the provisions of this Clause, but if it is required the committee ought to be able to fall back on a committee so set up.

Sir P. MAGNUS

I have no desire to inflict a long speech on the Committee. I only want to point out that this Clause makes a very considerable alteration in Clause 62 of the principal Act. That Clause requires that any local medical committee shall be representative of the duly qualified medical practitioners resident in the county or county borough, and this Amendment proposes absolutely the reverse—to allow a medical committee to consist only of those members who are at the time on the panel. [HON. MEMBERS: "No."] It is so. I admit that there may be cases where it may be necessary? I think it is very doubtful. I should like to see some arrangement made by which such committee can act provisionally until a more fitting committee is appointed. I would suggest as an Amendment to substitute six months for three months, so as to give more time for the possibility of arranging such a committee.

Dr. ADDISON

I will be glad to accept that.

Sir P. MAGNUS

Then I shall be prepared not to oppose the Clause if six months be substituted for three.

Sir H. CRAIK

I entertain a much stronger objection to this Clause than does my hon. Friend the Member for London University, and if that objection is not removed I must consider that the bargain made by the right hon. Gentleman has been broken. By the principal Act the local medical committee is to be representative of the whole medical profession. There has in London been a wide difference of opinion in the medical profession. There are many points of discussion between those who have gone on the panel and those who have conscientiously, and following what they believe to be the right course, refused to come on the panel, and because these differences have not been settled you are to make a local medical committee, which under the principal Act was to be representative of the whole medical profession in the area, constituted from those who have taken one side in the struggle that has occurred in the medical profession. If this is the case it is certainly going very strongly indeed against a very important provision of the principal Act guaranteeing the security of the medical profession. I say, distinctly, that I look upon this as a breach of the understanding that we were not to introduce anything injurious to the medical profession, and unless this will be changed by something the right hon. Gentleman can say I must stand upon my rights and insist upon discussing all the Clauses that we have down on the point.

Mr. MASTERMAN

I would appeal to the hon. Member that this Amendment cannot be injurious to the medical profession. It is to meet a difficulty which was never foreseen when the Act was passing. It is very much to the advantage of the medical profession that there should be some sort of statutory committee, such as the local insurance committee, to consult with them on medical matters. In fact, I think that it was one of the things which those who represented the doctors were most anxious should be put into the original Bill. Now my hon. Friend says that there are certain districts—very few—where there is no local medical committee existing under the conditions laid down in the Statute. He says, "recognise, therefore, a medical committee of those who are actually working the Act." What can be fairer than that? They have the experience and the knowledge connected with the Act. For my part I believe that the intention of Parliament when it passed this Clause was that those who were working the Act should be those who would be electing the local medical committee. My hon. Friend has satisfied the objection of the hon. Member of the University of London by agreeing to accept six months instead of three. I should also like to appeal to him to make another alteration, which I think will go further and perhaps make it entirely non-controversial; that is, that at the end of the Clause to substitute the word "may" for "shall," so that the that portion of the Clause shall read "may be recognised as the local medical committee for that area." If these two alterations be made they will give six months in which, by negotiation, it may be possible to obtain a medical committee of all the doctors, panel and non-panel. But if that is unobtainable we must have a medical committee to negotiate with these insurance committees made out of the panel. Otherwise we will get no committee and the insured persons will suffer.

Mr. GLYN-JONES

I would appeal to the right hon. Gentleman that he should look at this matter from the point of view of the insurance committees for the moment and not as a dispute between doctors. The Insurance Committees are required by regulations to make terms and conditions of contract and submit accounts to the doctors who have entered into the agreements to carry out these services. They are bound to do that, and the regulations as they now stand provide that they shall do so with a committee of the doctors who are on the panel. This Clause does not interfere with the local medical committee at all. It is the representatives of the whole profession that must be consulted by the committee on general matters. But when it comes to particular matters which affect the committees nobody but those who are dealing with the committee have any interest at all in it, and therefore it is necessary, even if there is a local medical committee, that we should have a committee representing the doctors who are on the panel to deal with matters which affect them and them only. The point at the end of this Clause simply says that if there is no local medical committee this local panel committee may be so regarded. What I want to point out to the hon. Member who is speaking for the profession—

Dr. ADDISON

He does not speak for the profession.

Mr. GLYN-JONES

This Clause will enable a local medical committee to be set up in these areas where at present the medical profession in London are without any local medical committee. Though they have not got one, this Clause will give them six months in order to form one, and if in six months they do not form one, then it gives the committee the power to recognise these panel doctors as the committee. It cannot possibly worsen the position of the doctors, and it is certainly absolutely necessary for the purpose of working the Act.

Sir H. CRAIK

The first part of the Clause is not what I object to—the appointment of a committee. What I object to is that this committee would in certain circumstances be recognised as the local medical committee dealing with interests that may appertain to the whole of the profession. I am very sorry to appear to be forcing obstruction, but I am in a very difficult position. If the words "six months" be substituted for "three months," and "may" substituted for "shall." If those in whose interests I am acting are satisfied with that I am ready to withdraw my opposition; but I must reserve the right, if I find that that is not satisfactory, of raising the question again on the Report stage. In these circumstances I will withdraw my opposition.

Mr. HAMILTON

I have received letters from the medical profession in Manchester, where they seem very much upset about this Amendment, which they oppose very keenly.

Mr. MASTERMAN

It does not apply to Manchester.

Mr. HAMILTON

It is in my Division. It is not Manchester, but Cheshire, and sonic of the men there also practise in Manchester. There is a very strong feeling in the district that it is a breach of faith with the profession on the part of the Government.

Mr. MASTERMAN

There is a local medical committee recognised in Cheshire and Manchester, and, indeed, in nine out of ten of the districts concerned.

Clause read a second time.

Amendments made:

Leave out the word "three" ["three months"], and insert instead thereof the word "six."

Leave out the word "shall" ["shall be recognised"], and insert instead thereof the word "may."

Clause, as amended, added to the Bill.