§ "Section 12 of the principal Act is hereby repealed."
§ Clause brought up, and read the first time.
Mr. WORTHINGTON-EVANSOn a point of Order. Before you call that Clause, will you kindly say why some of the new Clauses bearing a star which were put down yesterday, have come in before other Clauses that have been down for some days? Mr. Duncan Millar has one down which is starred and comes in before a large number of others that were down earlier.
§ Sir P. MAGNUSMay I point out that those stars have been retained with 3211 respect to Clauses put down on Wednesday or Thursday last week. Two or three of the Amendments which I put down on Wednesday or Thursday retain the star.
§ The CHAIRMANIf the hon. Members will refer to page 70 of yesterday's Order Paper, they will see that the Amendment referred to by the hon. Member who has just spoken is on the Paper and has been for some time.
§ Motion made and Question proposed, "That the Clause be read a second time."
§ Mr. CHARLES BATHURSTI desire to move, that Section 12 of the principal Act be repealed, and perhaps I may be allowed to remind the Committee what are the provisions of this Section. It relates to the mode in which sickness, disablement, or maternity benefits shall be applied in the event of the person who is entitled to it being an inmate of any workhouse, hospital, asylum, convalescent home or infirmary supported by any public authority, or by a charity or voluntary subscriptions, or of a sanatorium or similar institution approved under the Act; and it makes provision that in such event the sum which would otherwise have been payable on account of the benefit referred to shall either be paid for the maintenance of the dependants of the person so accommodated, or if he is a member of an approved society and is an inmate of a sanatorium shall be paid to the Insurance Committee as being the authority which controls sanatorium benefits; or alternatively if an inmate of a hospital or similar institution shall, if an agreement has been made between the society or Committee with the hospital or similar institution, be paid towards the maintenance of such person in such institution. If there is any part of the sum remaining unapplied it may, if the committee or the society think fit, be applied to the provision of surgical appliances. I do not know that I need deal with the rest of the Section, which refers to the case of the married woman, and also to the possibility of defraying the expenses of the conveyance of a consumptive person to the sanatorium. But what I desire to say about this Section is that it is practically a dead letter at the present time, and where it is not a dead letter there is no uniformity whatever in its administration as between the various societies and Insurance Committees referred to in the Section. As far 3212 as the societies themselves are concerned, it simply imposes upon them the necessity of finding some plausible excuse for paying sickness benefit in such a way that it will ultimately reach the sick person, and only the sick person.
It is perfectly clear that it is not desirable to retain upon the Statute Book a Section of an Act which every effort is being made to evade, and which, in fact, is being successfully evaded. I desire, without suggesting what should be the alternative, to move the omission altogether from the Statute Book of this particular Section, upon which I think we shall all be agreed, at any rate all those who know anything about the approved societies. Without entering upon the much more difficult task of suggesting what shall be the alternative process, upon which it is quite possible we shall not be agreed, I want to say further in support of this Amendment that it is entirely contrary to the old practice of the voluntary societies. They always gave their full sickness benefit to their members when in hospital, and they evidently desire to continue that practice. At the present time there is no reason in logic or justice why that sickness benefit should not pass into the hands of the employed contributor. If the hospital represents an equivalent to anything, it is mainly the equivalent of the medical benefit, and not the equivalent of the sickness benefit. Furthermore, you are placing even the hospitals in a very difficult position by this Section, because you make provision for an arrangment being made as between the societies and hospitals that this sum shall, in part at any rate, go towards defraying the cost of the maintenance of these persons in the hospitals. Why, Sir, hospitals are very much in the position of the doctors at the present time. They are supported very largely by the voluntary contributions of the workmen themselves. In South Wales, with which I am best acquainted, they are supported almost exclusively by the contributions of working men, and the hospitals are not going to enter into any arrangement with the societies which might act to the detriment of their working class supporters, upon whose contributions they largely depend for the maintenance of their institutions. This Section imposes upon them a delicate, difficult, and, as I suggest, in many cases a wholly impossible task. I should like to suggest that we frankly accept the inevitable position, and decide upon the alternative Amendment that is going to 3213 be proposed that sickness benefit shall be paid in all cases to the employed contributor after he leaves the hospital.
§ The FINANCIAL SECRETARY to the TREASURY (Mr. Masterman)If he has no dependents.
§ Mr. BATHURSTI should have mentioned that. Of course, if he has dependents, it is right that it should be applied to their maintenance when he himself is not in a position to earn money to support them. If he has no dependents, let it be paid out to the individual himself as soon as he leaves the hospital. I suggest that an arrangement such as that would meet the approval of Members in all parts of the House, and will certainly meet with the approval of the majority of the approved societies, and still more, with the approval of the working classes. I beg to move that this Section 12 of the principal Act be repealed. I venture to express to the right hon. Gentleman that the issues shall not be confused by suggesting any Amendment to this proposal. Let us get rid of our old love before we take on the new. Let us get rid of what we agree is undesirable before we enter upon the consideration of an alternative upon which, possibly, we shall not so easily agree.
§ Mr. GOULDINGI rise to support the Amendment moved by my hon. Friend. He has stated very clearly and specifically what is the grievance which we desire to remove. Everyone is agreed that the present position is mischievous and chaotic. There is no uniformity. Relief is given in an indirect way to evade the Act; often given to meet arrears of rent; and frequently given in the way of food and comfort; one society doing this in one direction, and another society interpreting the Act in a very rigorous form. The Section as it stands gives no security at all to the approved societies, while at the same time it creates a great deal of difficulty. I have put down upon the Paper the full Section as it exists to-day with these Amendments moved into it, so that the Committee can see exactly how it is proposed to meet the difficulty. It is on page 778 of the Amendment Paper. It has one omission. In line (d), 29, of course, there should be the words "if such person having no dependents." That is, of course, really the whole purport of the rectification that we desire to make. Last night the right hon. Gentleman was good enough to talk to me about this 3214 Clause, and he expressed his willingness to accept the Amendment moved by my hon. Friend, and to substitute part of the Amendments that I desired to move which appear upon the Paper. While he was perfectly willing to accept the Amendment as set out in Sub-section (c) on page 778, he was not prepared to accept Subsection (d), which gives power to pay a portion of this money to the individual, and the balance to the hospital or infirmary. The right hon. Gentleman, having given his consent to accept (c), I said I would be satisfied with that so far as I myself was concerned, and would be prepared to vote with the Government when they came forward with Section (d). I am making this clear so that there shall be no mistake. I have spoken to some of my hon. Friends upon the matter, and they say that they lay a great deal of importance upon Section (d), and that they cannot join with me in excluding that Section. They want power to be given to the approved society, where there are no dependents, to divide the sum that is due between the hospital and the insured person. The right hon. Gentleman has been good enough to hand me another Amendment. I do not see how I can move that Amendment by reason of the pledge I gave, but when my own Amendment comes on, I shall move it as it is, and I shall certainly abide by the promise I gave. I cannot for the moment, see why we cannot get this Debate on the substitution of the Section as amended. I do not see that the deletion of Section (d) in the least prevents the giving of effect to the rest of the Amendment in the Section, which the Government say they are good enough to accept. Everyone is agreed that the present position is chaotic, and that there must be uniformity, and I do hope there will be give and take in this matter, so that we may get rid of a thing which everyone agrees is unsatisfactory.
§ Mr. MASTERMANThe hon. Gentleman, the Member for Worcester, has very fairly expressed what is the present state of affairs with regard to this question. I do not think we ought to get rid of the whole of Section 12, in order merely to meet one particular point. In regard to that particular point, I am anxious to meet it. The matter has been put very lucidly by the hon. Gentleman the Member for Wilton. I hope we can move an Amendment meeting this particular point to his Amendment. The later Clause which the hon. Gentleman, the Member for Worcester, has on the Paper, on page 3215 777, really first abolishes Section 12, then re-enacts four-fifths of that Section, and makes one or two alterations in two Sub-sections. I agree that may be useful for clearness and lucidity, but it is a great mistake to send a Bill down to the House of Commons with such enormous alterations to which Amendments may be moved in the House. Really, there is only one tiny point which can be met by an Amendment to the Clause. What is that point? As far as insured persons, who have dependents, are concerned, nothing arises in connection with this Clause. As far as I know, the sick pay is paid to the dependents of the insured persons when they are in institutions. What happens in the case of insured persons who have no dependents? As the Clause stands at present, it is left optional to the societies to use the money which would have been their sick pay, if they had not gone into a hospital, for any purpose which is for their benefit. It is doubtful if they can pay over any of the money in cash. As the hon. Gentleman the Member for Wilton has said, there has been a good deal of difficulty in connection with this Clause.
I may say that the actuarial calculations on which the Bill was framed assumed that, in every case, the man or woman without dependents would receive full sick pay in some form or other, and I agree with the hon. Gentleman, the Member for Wilton, that the time has come when we might clearly state in the Act that the man or woman without dependents shall receive full sick pay in some form or other. I do not want entirely to take away the discretion from the societies. I am not sure that it is always advisable to take a man, for instance, who has been in the hospital for a large number of weeks, and give him a lump sum of £5 or £10 at the end; but I do think he ought to have either in cash, or in kind, the full amount of his contribution, and I have an Amendment to the Amendment to omit the Clause, which I think the hon. Gentleman the Member for Wilton will accept, which will have the effect of securing to the insured person all the sick pay that he requires. Of course there may be an argument that some of it should go to the hospitals. Well, if he wishes to pay it to the hospital, and if the hospital is willing to have it, it can be paid under this Clause to the hospital, but I should be very chary of making any kind of arrangement by which the hospital should secure all the 3216 money. That would really raise the whole question of the voluntary hospitals in the least favourable form to the hospitals themselves. They have not taken paying patients from among the poor, and I have had no request from them that they could take paying patients from among the poor. If they do begin to take part of the sick pay in the hospitals, I think the result will be a very great decrease in their subscriptions from other sources, because their boast has been that they have not made the poor pay, and, as a consequence, they have in the past received enormous voluntary subscriptions. Take the case of a woman earning say 15s. per week; she meets with an accident in the street and is taken to hospital. There ought to be no pressure put on her in that hospital to sign away her sick pay. Probably she has a room, the rent of which is getting into arrears, and, if she does not pay up those arrears, her furniture may be thrown into the street. Perhaps, after spending some time in hospital, she may require a week at the seaside, and she would need her sick pay for that purpose. I think this Amendment ought to meet both possibilities—the making arrangement with the hospital, and also the view put forward by the hon. Gentleman. I propose, later on, to move an Amendment of the Clause to leave out certain words, and to insert the following words:—
Section 12 of the principal Act shall have effect as though the first provision of Sub-section (2) of that Section were omitted therefrom, and that 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, and if the society or committee administering the benefit thinks fit, be applied in the provision of any surgical appliances required by 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.It is the last four words that really make the change in the Act. Instead of the option being left to the society to absorb 3217 the money which this man would otherwise have had in sick pay in the general funds of the society, it is to be paid to him in a lump sum after leaving the institution or in instalments, as the society thinks fit. I hope that that is quite clear. As a general condition I may say that these conditions do not vary the conditions laid dawn in the Act. Any approved society may make arrangements with a hospital if they think fit so that a certain number of their patients will be received during the year in return for the endowment of a certain number of beds set aside for that purpose. That was the original idea adopted by many societies, by which the hospital problem was expected to be settled in specific cases.
§ Mr. GOULDINGI understood that the right hon. Gentleman was going to move this, because he said it was a misfortune to rule out the whole of Section 12, and to substitute anything for it would really be introducing new business. But he is really putting down an entirely new Clause, no doubt with the object of giving effect to the objects we have in view. His Clause, however, is not in the hands of a single Member, and surely that is not calculated to expedite business. It would be much better to amend the scheme in any directions that may be deemed desirable.
§ Mr. MASTERMANIf the hen. Member will look to the Clause he has put down on pages 777 and 778, it occupies a whole page of the Paper, he will see it re-enacts forty or fifty lines of Section 12 without any change at all. I am only-proposing that the first proviso of Section 12. I am amending four lines instead of first ruling out something like sixty lines and then ruling in fifty-six lines.
§ Sir P. MAGNUSAre you not amending Sub-section 1?
§ The CHAIRMANI may point out that it is not possible to move this until we get into consideration of the Clause itself. Therefore, hon. Members are quite at liberty to discuss the whole question.
Mr. WORTHINGTON-EVANSI think my hon. Friend has taken a business-like course in putting down exactly what he proposes to the Committee so that hon. Members can see it. But the Government, following their usual practice of rush and scurry, have produced a long and utterly and absolutely unintelligible Amendment. I take leave to say that no Member of the Committee can understand 3218 what the right hon. Gentleman is going to propose. The right hon. Gentleman himself had the greatest difficulty in reading it and he could not make sense of it apparently without interjecting large number of comments. It was extremely difficult to follow, and I do not believe any Member of the Committee could tell what referred to the Amendment and what was mere comment. I undertake to say that nobody, unless they had seen the draft beforehand, could say what it was the right hon. Gentleman was proposing. I ask the Committee to come to, a decision upon a simple point, whether or not Clause 12 should be omitted from the Bill, and then, afterwards, we can come to a decision, if desired, as to what shall be put in its place. The hon. Member for the Wilton Division (Mr. C. Bathurst) made out a very good case for omitting Clause 12 altogether, even if the Committee cannot agree upon what should be put in its place. Let us see what it is that the Clause does. It is doubtful under it whether you can pay in cash any benefit to any insured person who is not dependent so long as that insured person is in hospital. It is doubtful. Some societies are doing it and are taking the risk. There is a certain form of competition which has sprung up between societies on this point. Some societies are, I say, paying and taking the chance; other societies are not paying. Clearly there ought to be one rule for all societies. If you omit Clause 12, and do not put anything in its place, you have one rule for all societies, namely, that the sick pay will be given when an insured person is in hospital. If we do nothing more, if we cannot agree upon anything else, we shall have remedied a real grievance that exists under this Clause.
Let me point out to what extent that grievance exists. A case was brought to, my knowledge a little while ago, and asked the Secretary to the Treasury a question upon it in the House. A hospital porter, who was an insured person employed in his ordinary occupation as porter in a hospital, was taken ill, and was invited by the hospital to go into one of its wards during the time he was ill. He could not get any sick pay at all during the time he was in hospital. If he had not been in a ward, if he had been looked after in some other way, it is at least doubtful whether he was entitled to sick pay. At any rate he did not get it while he was in the ward. Then there is another 3219 case to which my attention was drawn. A girl, an insured person, was in the Nelson Hospital paying 5s. weekly as the paying patient. She was sick for nine weeks, and she got one week's sickness benefit out of the nine, because during the other eight weeks she was in the hospital, paying 5s. weekly for maintenance. The right hon. Gentleman said that hospitals did not make these charges. I do not know if many do so, but here at any rate is one case to which my attention has been called. Why on earth should not that girl, during the time she was actually paying for her maintenance in hospital, have received her 7s. 6d.? She wanted it; she was not a dependent, but nevertheless she was actually paying 5s. weekly. If we omit Clause 12 and do not complicate the position by considering what we are going to put in its place, we shall meet these two grievances.
This applies not only to hospitals, but also to convalescent homes, and there the case becomes still more urgent, because it may be well that an insured persons may be insured not only under the Act, but on the voluntary side of his society. On the voluntary side he will be paid sick benefit while in hospital or in a convalescent home. It seems to me it is highly desirable that a man should be allowed to have his sick benefit so as to enable him to go into a convalescent home. He should be allowed, if he chooses, to pay for going into that convalescent home out of his sick benefit. I do not want him to be in the position of signing away his sick benefit. I do not want the hospitals to be allowed to make it a condition of their treating patients that they should sign away their benefits. After all there are, among insured persons, persons of very different classes. Some are quite willing to pay for their maintenance at a convalescent home, and it is unfair you should deprive them of their ability to pay during the time they are in the home. Therefore, I urge that the Committee should support the Amendment of my hon. Friend, which will omit Clause 12, because under that, whatever else happens, you do remove a great grievance under this Act, and you do not create any other grievances that are worth speaking of. After that, it may be well to consider, if anybody is able to understand it, the Amendment moved by the Secretary to the Treasury. I infinitely prefer the Clause down in the name of the hon. Member for Worcester for the reason that it is in print 3220 and we can see what we are voting on, whereas the proposal of the Secretary to the Treasury is not on the Paper and we do not know exactly what we are voting about.
§ Mr. J. H. THOMASI think the Committee generally agree with the intentions of both the Mover of the Motion on the Paper and of the Motion standing in the name of the hon. Member for Worcestershire. But so far as I am concerned I should strongly oppose the suggestion of nomination or any kind of pressure whatever. It is all very well for the hon. Member to say that it is optional. It will be optional if the Amendment of the right hon. Gentleman is carried, and it is paid in a lump sum, and surely if a man has any desire to pay the hospital, he can far better do it when he has a lump sum free, than if pressure is brought to bear upon him when he is in hospital. There is a further point. Do not let us forget that while nominally a man is maintained in the hospital there are ninny luxuries that the sick pay enables him to enjoy which otherwise he would not get. Therefore, it having been agreed to remove this difficulty, which the majority of the societies are now doing, is there any necessity for deleting this Clause and then re-enacting four-fifths of it, when it is met by the Amendment of the right hon. Gentleman? If it is not so met, then surely as we all know and agree with the object aimed at, it will be easy on the Report stage to insert necessary words without wasting further time at the present moment.
§ Mr. HARRY LAWSONI wish to address myself to the merits of the case from the hospital point of view. I have had a great deal to do with hospitals, and I must say that the Government have never, either in this House or here, properly appreciated the position of the great hospitals. Two years ago there was a strong protest made in the House of Commons on behalf of the hospitals, and everything which was then said by those who spoke for the hospitals at that time has since turned out to be absolutely true. The Financial Secretary does not seem to appreciate what has happened with regard to the great hospitals. Of course, a broad line must be drawn between provincial hospitals and the great London hospitals. In the case of the provincial hospitals 60 per cent. or 70 per cent. of the cost of maintenance is furnished by the working classes by means of collections at factories and workshops, but in London, where we 3221 have the great schools as well as the hospitals, the schools from which practitioners go out with the trained capacity which makes them useful to the community elsewhere, only 10 per cent. or 12 per cent. of the cost of maintenance is paid by working people, and the rest collies out of the voluntary contributions and subscriptions of the well-to-do. What has happened as a result of the Insurance Act is that there has been additional work imposed upon the hospitals in the more serious cases. There has been a slight falling off in the outpatients' departments, but the more costly part of hospital work has grown both in cost and in extent. The subscriptions have fallen off. Letters are received every day by hospital secretaries from employers of labour saying that as they pay insurance they cannot continue their subscriptions, or cannot continue them to the same amount. The quinquennial subscription list of the great hospital with which I am connected, the London Hospital, has been very much smaller than was ever known before. That is only an example. The Financial Secretary says it would be a great mistake for hospitals to accept payment for the services they render out of the Insurance money of the working people.
§ Mr. MASTERMANI did not say that. "Imposed" was the word I used.
§ Mr. HARRY LAWSONAnyhow, the right hon. Gentleman seems to wish to make it a little more difficult than before for hospitals to obtain from the Insurance money any subscription which would to some extent at least cover the cost of treatment.
§ Mr. MASTERMANNo.
§ Mr. HARRY LAWSONThat is certainly what I want to guard against very strongly. I am not quite satisfied as to what the effect of the Amendment will be. This treatment is becoming much more costly to hospitals. I do not know where the money is to come from, unless you are prepared to face it from the Insurance point of view. That has not been done. It seems to me as if the Committee were going to take a backward step in that regard. I do not believe in the danger of compulsion on the part of the hospital authorities, but I am bound to say that I do think that if a workman receives a lump sum after he has had the highest form of special treatment in a great hospital, he 3222 ought to be under an obligation to pay part of it over to the hospital. I think it is a monstrous thing for him or anybody else to think that they can get everything for nothing. In the provincial hospitals the men are paying. In London they are not. In London it is entirely a matter of chance in regard to the workingman except what is collected by the Hospital Saturday Fund. I view with disfavour any Amendment which will make the case of the hospitals more difficult. I do not want to see a rate in aid for the great hospitals. I think it would be a great misfortune from every point of view. The Committee must take care if they are not going to decrease the amount which goes to the hospitals at present. Under Section 12 the Insurance Committee can make a payment if it thinks fit. If that power is taken away and the money is handed over to a man as he quits the hospital—no doubt there are very hard cases and no doubt comforts are required at home, and there is no superfluity of them—at any rate it is a strong order to deprive the hospital of this assistance.
§ Mr. MASTERMANWe do not propose to touch that power, which will only be taken away if we delete Section 12 altogether. If we do not delete Section 12, but accept my Amendment, that power remains as in the original Act.
§ Mr. HARRY LAWSONI should have preferred to see it strengthened. I am not afraid of the word "compulsion." I do not say it should be used. What I want is to make it more a normal matter for the money to be paid to the hospital which has given the special treatment. I warn the Committee that if, because they want to hand over—it is a very pleasant thing to do—a lump sum to the workman on his leaving any hospital, they are going to decrease the resources of the great London hospitals, which really advance the science of therapeutics, upon which the health of the country depends, they are doing a great dis-service to the working classes. I look with concern upon any Amendment which makes it easier for a man to keep the money and not to give the hospital any return for the work they have done for him.
§ Mr. BOOTHCan the Government tell us whether any societies have used this Section and made contributions to the hospital under it.
§ Mr. MASTERMANI cannot tell. I know a number of the old friendly societies used to do so. I have a question in the House to-day about it, in reply to which I say I have no knowledge on the subject. I believe there are some who do it.
§ Mr. HARRY LAWSONThere is not a word in the Insurance Commissioners' Report about it.
§ Mr. MASTERMANThe Insurance Commissioners would not know without sending out a circular to 23,000 approved societies and branches.
§ Mr. FORSTERThe question whether we should delete Section 12 seems to be one of convenience more than anything else. It is recommended by my hon. Friends as being a convenient method of leading up to new proposals they wish to substitute for the provisions of Section 12 which axe now in the Act. The thing which really matters is what we do in the way of amendment to Section 12. I feel very strongly that what has fallen from my hon. Friend (Mr. Harry Lawson) is well worth consideration by the Committee. The Secretary to the Treasury said it would he a great mistake if the voluntary hospitals imposed charges upon insured patients. None of us want them to impose charges. What we want is that there should be some opportunity given to an insured patient to contribute towards the funds of the hospital while he is in the hospital. I do not think the suggested Amendment of the Secretary to the Treasury enlarges the powers which are contained in Section 12 as it stands. So far as I understand it, the power given in Section 12 is given to a society to contribute towards the cost of maintenance in the hospital where an arrangement is made beforehand between the society and the hospital. The case I want to cover—and I believe it is a fairly common case—is this; an insured person is really seriously ill and goes into the hospital, where he gets the best treatment. Unless he is a member of the society which has an existing agreement with the hospital, there is no power to make any contribution towards the funds. The Financial Secretary says "Granted, but under the proposal I make, when that man comes out of the hospital he will, provided he has no dependants, have an accumulated sum, perhaps £5 or £10, out of which, in gratitude to the hospital, he may be able to make a contribution." Look at the 3224 position. The man comes out, he has had his treatment, he comes into the enjoyment of a lump sum or a sum paid in instalments. Anybody in that situation will be able to find his own personal uses for the money. The balance is weighted heavily against the hospital in such circumstances. I know there will be many men who in gratitude for the services they have received will no doubt make some contribution, but I want the opportunity to be given to the insured patient to make the contribution while he is receiving the treatment. I cannot see why such a enlargement of the provision could not be made. I do not believe in the danger suggested by the hon. Member for Derby (Mr. J. H. Thomas). I believe it would be a useful thing, and I am certain that if the insured patients had an opportunity of doing it, many of them would avail themselves of it.
§ Mr. JONATHAN SAMUELWould you exempt the contributor?
§ Mr. G. H. ROBERTSThe suggestion of endeavouring to impose a payment on a patient while in hospital should not be carried out. It would inevitably destroy the voluntary character of our hospitals if, by any device whatever, you place the responsibility on the patient by any form of direct or indirect pressure to make that payment. It would inevitably give rise to a demand that the hospitals should be brought under public control. You have to recognise that if you seek to press a man to make any payment just at the time of treatment or at the point of discharge you would not achieve the object you have in view, viz., bringing support to the hospital funds. I know of many cases where men have had hospital treatment which has created a life-long gratitude, through which they have devoted themselves to the work of raising contributions for the maintenance of that hospital. That is a point which ought to be borne in mind, so far as my experience has gone, the working man who receives benefit in the hospital is invariably the man who displays his gratitude. By this means you get much more voluntary support for your hospitals than you would if you set up any device to compel him under any form of pressure to make a payment.
§ Mr. MASTERMANPerhaps the Committee would now be willing to come to a decision on the matter.
§ Mr. BATHURSTI should like to make my own comment upon your Amendment if I may do so. I have now, so far as I can, digested the Amendment suggested by the right hon. Gentleman, intricate though it is, and presented to us rather at the last moment. So far as I can see, the part of the Section to which we mainly object, is left in. No part is excised by this Amendment until we come to the proviso at the end of Sub-section (2). That brings in the whole of paragraphs (a) (b) and (c) of Subsection (2). It is paragraph (c) to which I particularly object, and which I suggest is causing a great deal of difficulty and lack of uniformity, and, in many cases, is being evaded and will continue to be evaded. If the first proviso is cut out and the whole of this is left in and the Amendment is tacked on to the end of the three paragraphs, what will be the effect in fact of this somewhat cumbrous scheme, which will then take the place of what the Section of the Act provides? First of all, the dependants will have a prior claim. About that there is no division whatever between us. If there are no dependants and there is an agreement, either as to the whole or a part of the fund, the result of such an agreement would be that it would be handed over either in whole or in part towards the maintenance of the sick person in the hospital. That is the position which is anomalous and has caused great difficulty in the past. Failing that being carried out, if the society, under the right hon. Gentleman's Amendment, thinks fit, a portion, at any rate, may be applied towards surgical appliances. This is the expression to which I take the greatest exception—
Or otherwise for his benefit.What does that mean? It is going to be left to the society or the Insurance Committee, as the case may be, to decide what is for his benefit otherwise than what the previous paragraphs provide. How are we going to decide that? I say quite candidly that as a member of an Insurance Committee I should not like to have to consider what is otherwise for his benefit, failing the dependants and failing payment for maintenance in the hospital and the provision of surgical appliances. Only then and not till then can any payment of the money be made to himself. That is what we all desire should be done in nine cases out of ten. That is what the societies have been trying to do, that is what the societies will try to continue to do, whatever machinery you now incorporate by way of substitution in this Section. 3226 We ought frankly to accept the position, and we ought to say that the sick person shall be entitled to his sickness benefit, and sickness benefit is the equivalent of wages. The sick person shall be entitled to his sickness benefit as he was under the voluntary system, whether he is in hospital or not, and leave it to him, as it ought to be left, to provide, out of the money he will receive after he leaves the hospital, for his keep in the hospital, as nine self-respecting men out of ten do to-clay.
§ Mr. HARRY LAWSONThat is not so.
§ Mr. BATHURSTIt may not be in London where the hospitals depend largely on the contributions of rich men. In the provinces, especially in industrial districts, they depend almost exclusively, at any rate to the extent of a majority of their funds, upon the insured persons themselves. What will happen? If it is going to be the custom that this money, which is really the equivalent of their wages, shall be applied as a matter of course towards the cost of their maintenance, it will follow that these men will not regard it as a moral obligation any more to contribute voluntarily to the support of their hospitals, and the hospitals themselves will suffer. There is another word to which I take exception, and that is the word "shall." The right hon. Gentleman proposes that any sum which, but for the provisions of this Section, would have been paid to the person on account of sickness or other benefit, shall be applied, if the society thinks fit, for surgical appliances or otherwise for his benefit. I think that ought to be permissive, if you are going to have the provision at all, and if it is not permissive the last words mean nothing, because you say definitely they shall be applied in this particular way, and then you go on to say that if it is not so expended it shall be paid in cash to the individual himself. You cannot have it both ways. If you are going to make it, mandatory that it shall be paid in a particular direction there is an end of it. You cannot have an alternative to that. So far as that is concerned, the Amendment is not sense. May I appeal to the right hon. Gentleman to cancel this Section, of which we disapprove, at once and get rid of it, and then consider which of these alternatives shall take its place. I am quite sure, if you are going to leave the whole of this cumbrous provision, with the still more cumbrous Amendment tacked on to it, as the future machinery 3227 for the working of this benefit, you are going to make confusion worse confounded, and you are going to bring no solace either to the friendly societies or to the working classes who support the hospitals.
§ Mr. MASTERMANI have a very great desire to meet the hon. Gentleman, but I think he will see that the course he suggests is a very unusual and a very unwise one. I have no power to express an opinion, but I am not quite sure, if we now delete Section 12, how far it would be in order to re-enact practically nine-tenths of the Section afterwards in the Act. There is only one point in the controversy before the Committee. If you delete the whole of the Section you delete many provisions which no one has any desire to delete at all, and you would only have to laboriously re-enact them again, and the Bill would have a very strange appearance when it went down to the House. As to the point raised by the hon. Gentleman (Mr. Forster), he does not object to our new Clause, but he wants something more in connection with hospitals. I do not want to tear up the arrangement at present on the experience which we have had of only six months working, and we ought, at least, to let the friendly societies go on for a little longer working the Act under the conditions of this proviso in relation to the hospitals before we re-open the whole hospital problem, which will be a very big problem if re-opened. But I can assure the hon. Member (Mr. Harry Lawson), that so far as this Amendment doing any injury to the hospitals, in so far as it has any effect at all it will benefit them, because what is the result? As the law stands at present, the funds of the insured person who is in the hospital—the sick benefit—may go entirely back into the general pool, and not a penny may be paid to him or to the hospital. The Section now asserts that the money shall go in his interest or to him, and in so far as the money goes to him instead of to the general pool of the insured person, the point raised by the hon. Member (Mr. G. Roberts) comes in, and he now will have the opportunity, which he would not have but for this Amendment, of directly contributing to the hospital which has cured him. Therefore, so far as it has any influence, it makes for the benefit of the hospital, but benefit on the voluntary system instead of an imposed system. As to the words objected to by the hon. Member 3228 (Mr. Bathurst), "or otherwise this benefit shall," in the original Act, it occurs in the original Act in many places. Friendly societies have always had this discretion, and they have had the discretion in connection with maternity benefit, and I do not want to take it away unless it is abused. Everyone knows why it is given them.
§ Mr. MASTERMANSuppose a man wants to pay his rent or to have a bath-chair, or any other of these necessities. It has always been done by friendly societies. Why should you take the power away now they have become approved societies? As for the word "shall," I am assured by my advisers that, as read, it offers a real choice. "Shall, if the society or Committee think fit, be applied, or, if it is not so applied, shall be paid in cash." If that is not a good point I will promise to put it right on Report. I therefore ask the Committee now if they are in general agreement with the Government, first, to read the Clause a second time, and then to read my Amendment into the Clause, and then to vote for the Clause. If my Amendment is not carried I should vote against the Clause as a whole.
§ Mr. BOOTHOn a point of Order. Are you, Sir, going to put an important Amendment like this which we have not seen? We do not know what we are talking about. I shall be obliged, unless there are some copies circulated, to ask your leave later to move the adjournment. I cannot take any responsibility.
§ Mr. GLYN-JONESI want to put one short point on the general question which has not been put before. Anything which we do which would provide for payment in the hospitals will give rise to difficulties with the medical profession. A committee that I know of has made arrangements with a hospital in London which deals with consumption. They have arranged to pay for insured persons in that hospital the cost of maintenance. That went on for a month or two, and then that hospital came to this committee and said: "We want you to increase your payment to the hospital, because the medical staff of the hospital, who formerly gave their services free, say that now we are being paid for our patients, they, as medical men, claim a right to payment." That is an important consideration, which we shall have to settle with the medical 3229 profession if we do anything which will provide that patients in the general hospitals pay for the treatment they receive there. I only instance what happened at this hospital which has come within my own notice as member of a committee, where the medical profession have now made a fresh demand for payment for their services if inmates are paid for in any way by the Insurance Committee or society.
Mr. MacCALLUM SCOTTI would ask the right hon. Gentleman whether he could not arrange this so that before voting on his Amendments we may have them on the Paper. I am quite willing to support him in rejecting the Amendment on the Paper now, but before voting on the Amendments which have been suggested by him I should like, and I think the majority of the Committee would like, to have an opportunity of seeing them on the Paper. Could he not simply ask us to reject this Amendment now and promise to put down his own Amendments on the Paper on Report.
§ Mr. MASTERMANThe substance of my Amendment has been on the Paper for many days. It is Sub-section (c) in the Amendment of the hon. Member (Mr. Goulding).
§ Mr. MASTERMANI cannot accept it in its present form, but I have given it in the form in which the Government are prepared to accept it.
§ Mr. MASTERMANThe substance is the same. If it had not been, I should have had some difficulty on pressing hon. Gentlemen, but as it has been on the Paper for their consideration for many days I think I have a right to invite them to accept the Government Amendment.
§ Mr. RUPERT GWYNNEAs far as I can read it from the manuscript Amendment, the right hon. Gentleman proposes that some of the money might be used for providing surgical appliances as the committee administering the Act should think right, but that committee would not have an opportunity of coming to a decision until the man had left the hospital. We have been told already that the man is not to have the control of the money until after he has been discharged from the 3230 hospital. Therefore, how would the hospital authorities know whether they were going to get the money for surgical appliances?
§ Mr. MASTERMANThe proviso that we take out is this. Section 12, Sub-section (1), provides that any part of such sum which is not so applied as aforesaid, may, if the society or committee thinks fit, be applied in the provision of any surgical appliances required by the insured person or otherwise for his benefit. The only changes we make are the changes on the Paper. The whole sum shall be applied for his benefit. We leave the surgical appliances or otherwise, and we say if it is not applied for that it shall be given him in a lump sum when he leaves the hospital.
§ Mr. GWYNNEThe right hon. Gentleman seems to think that because a thing appears in the original Act it has a sort of cachet, a passport for sensibility, and that it is sufficient for him to give that as a reason. That is the very reason, so far as many of us are concerned, for opposing it and wanting to know further details about it. It emphasises the reason why the hon. Member (Mr. C. Bathurst) is right in omitting this Section, because it is a very foolish Sub-section altogether.
§ Question, "That the Clause be read a second time," put, and agreed to.
§ Mr. MASTERMANI beg to move to, leave out the words "is hereby repealed" and to insert instead thereof the words "shall have effect as though the first proviso of Sub-section (2) of that Section were omitted therefrom, and that 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, shall, 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 not so extended, 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. HARRY LAWSONMay I move, by way of addition, an Amendment to the 3231 proposed Amendment? The words which I propose to add are part of an Amendment of which the hon. Member for Worcester (Mr. Goulding) has given notice.
§ The CHAIRMANI have had other Amendments handed in, and I must know the line in the proposed Amendment where the hon. Member wishes his Amendment to be made. I think the Committee should
| Division No. 12.] | AYES. | |
| Astor, Mr. | Clay, Captain | Locker-Lampson, Mr. Godfrey |
| Baker, Sir Randolf | Forster, Mr. | Magnus, Sir Philip |
| Bathurst, Mr. Charles | Gwynne, Mr. Rupert | Parkes, Mr. |
| Bentinck, Lord Henry Cavendish- | Hamilton, Mr. | Rolleston, Sir John |
| Boyle, Mr. William | Lawson, Mr. Harry | Worthington-Evans, Mr. |
| NOES. | ||
| Addison, Dr. | Esmonde, Dr. | Millar, Mr. Duncan |
| Alden, Mr. | Harcourt, Mr. Robert | Money, Mr. Chiozza |
| Beck, Mr. | Harvey, Mr. Edmund | O'Grady, Mr. |
| Booth, Mr. | Jones, Mr. Glyn- | Roberts, Mr. Charles |
| Boyle, Mr. Daniel | Jones, Mr. Haydn | Roberts, Mr. George |
| Bowerman, Mr. | Keating, Mr. | Samuel, Mr. Jonathan |
| Buxton, Mr. Noel | Lardner, Mr. | Scott, Mr. MacCallum |
| Byles, Sir William | Macdonald, Mr. Ramsay | Thomas, Mr. |
| Carr-Gomm, Mr. | Macnamara, Dr. | Warner, Sir Courtenay |
| Dickinson, Mr. | Masterman, Mr. | Wing, Mr. |
§ Question proposed, "That those words be there inserted."
§ Mr. C. BATHURSTI desire to move to leave out the word "shall" ["shall if the society or committee administering the benefit"] and to insert instead thereof the word "may." I want to make it permissible for approved societies to apply this money, if they choose, in the way of paying it in a lump sum to the person when he leaves a hospital, and not making it a mandatory obligation upon them to find some kind of benefit to which it shall be applied in his interest.
§ Mr. MASTERMANI think the Amendment does make the wording of the Clause more clear, and I shall be glad to accept it.
§ Amendment put, and agreed to.
§ Mr. BATHURSTI beg to move to leave out the words "or otherwise for his benefit." I wish to make it perfectly clear that discretion will not lie with a society to find some other benefit, but that it shall pay the money in a lump sum on discharging the person.
§ Mr. MASTERMANI would ask the hon. Gentleman not to press this Amendment. He knows there are certain cases where it is undesirable that the money should be given in a lump sum to the
§ take a general Division on the proposed Amendment, and see whether it is going to be made. Hon. Members would then have an opportunity of altering the words of the Amendment when positive words are put.
§ Question put, "That the words 'is hereby repealed' stand part of the proposed Clause."
§ The Committee divided: Ayes, 15; Noes, 30.
§ person. It has been the custom ever since friendly societies existed to have the right of exercising that discretion. I think it would be a great mistake to press the Amendment.
§ Mr. BATHURSTI do not desire to press the Amendment.
§ Amendment, by leave, withdrawn.
§ Mr. HARRY LAWSONI beg to move at the end of the proposed Clause to add the words, "or if such person has no dependent, and gives authority in writing to the approved society of which he is a member, it shall be lawful for such approved society to pay the whole or part of such benefit towards the maintenance of such person in the hospital, asylum, convalescent home, or infirmary." The House of Commons is famous for clumsy drafting, but I think that to-day it establishes a record. May I ask whether it would be possible to add my Amendment in the way proposed?
§ The PARLIAMENTARY SECRETARY to the BOARD of ADMIRALTY (Dr. Macnamara)If you put in the words "has no dependents" after the words "if such person" it would better express what you wish.
§ Mr. HARRY LAWSONI have put in the words "has no dependent."
§ Mr. MASTERMANThis has been quite fully debated, and we can now make up our minds upon it. The scheme of the Act is clear that the money is payable to the person. In addition to that we have given the right to insured persons to contribute towards the hospital in return for services received. What is now suggested by the hon. Gentleman would mean, I think, that insured persons would be compelled, or in a majority of cases compelled, to sign a form giving away his sick benefit.
§ Mr. HARRY LAWSONindicated dissent
§ Mr. MASTERMANIn some cases there would be action of that kind. I do not wish to say anything offensive, but I think that in a number of cases convalescents would have to fill up a form saying that they would give the money of their sick pay to the hospital, and it is in order to protect the individual member against such pressure that I ask the Committee to reject the Amendment.
Mr. MacCALLUM SCOTTMay I ask whether everything which is proposed to be done by the Amendment could not be done under the words as they stand at present in the right hon. Gentleman's own Amenclinent1 A society has power to apply all this money for the benefit of a member, and therefore, even if a member signed a form giving it to a hospital, the society has power to do that already, because that is applying the money for the benefit of the member.
§ Mr. MASTERMANHe has to do it by agreement beforehand, or pay it out of the lump sum at the close.
Mr. MacCALLUM SCOTTHe has power to do it by agreement beforehand, but if it is not done by agreement beforehand, then I submit that the society has still power to do it, if requested, for the benefit of the member.
§ Mr. BOOTHI want to protest in the name of many of these people, not always very well educated, who read these Acts, particularly this one, and who cannot understand it. This sentence, as proposed by the Government, is 166 words long, and is read in connection with fifty-two more words, which makes a total of 218 words in one sentence.
§ Mr. BATHURSTI would appeal to my hon. Friend not to press this Amendment because with all candour it does not make sense.
§ Mr. HARRY LAWSONThat is a general charge against the whole Clause.
§ Mr. BATHURSTI hope that the hon. Member will not be sensitive about charges. If read in connection with paragraph (c) it partially contradicts it, and so far as it does not contradict it, it makes it anomalous.
§ Mr. HARRY LAWSONI will not press it.
§ Amendment, by leave, withdrawn.
§ Mr. GOULDINGI hope that what the Government have done will give effect to the object which we all have in view. But I still am pretty clear in my own mind that the Sections as down on the printed Paper are far more clear and specific, and far easier to be understood outside. I doubt very much whether, when this comes to be interpreted with its 166 words, there will be any understanding conveyed to those who have to interpret the Act outside.
Mr. WORTHINGTON-EVANSI must make a protest against what has been done. I do not believe that anybody now knows what words there are in the Clause which we are asked to agree to. We have heard them read out, I quite agree, but it is a very different thing struggling after the Chairman, however slowly he reads it out, and seeing the thing in print in the Paper, when we are trying to move Amendments, and we do not even know which line it is in. It is in line 5 if the writing is small, but it is in line 15 in the Amendment of my hon. Friend. It is not treating the Committee fairly. The Government have no ground for complaint that this Committee has not, up to to-day, done its work in a businesslike way, and they are the first to come down in the most unbusinesslike fashion that I have ever seen and throw this thing at us and then say, "It is all right. It is not all that is on the Paper, but it is as much as we are going to give you." If they had taken the Amendment on the Paper we could have had it in print and have amended it to produce a result that would have been the same as this, though I confess that I do not at this moment know what we are asked to vote on. I do know this, however, that a uniform practice is to be made in future for approved societies, and if they, do not expend the sick benefit in one or other of these ways provided for, then at any rate the insured person is to 3235 have it. That being the main object of the Amendment which we have moved I am not going to vote against this Clause standing part, but I cannot let it pass without protest because I think that the fashion in which this has been put into the Bill is extremely dangerous, and, if it is applied any longer, I assure the right hon. Gentleman that he is not facilitating the work of the Committee.
§ Mr. MASTERMANI am only trying to meet the hon. Gentleman in every way. Clauses are on the Paper. I first see whether we can meet those Clauses. When I see that we can meet the essentials of them, I have to go to my draftsmen and take their expert advice as to how they can best 132 brought about, and inserted in the Bill. The only alternative would be to refuse the Clause on the Paper altogether. Nor am I able to put it down as a Government Clause, because hon. Gentlemen want to move their own Amendments and have shown very great jealousy when we have tried to work under a different system. The hon. Member for Worcester was informed of this last night, and he agreed with me that the Amendment meets the substance of his Amendment. In those conditions I have to ask the Committee to accept somewhat complicated Amendments solely in order to meet the wishes of hon. Members as they arise.
§ Mr. FORSTERI think that the difficulty which has arisen may be unavoidable, but it really is occasioned by the fact that we are necessarily called upon to sit day after day, and there is so little time for consultation between the various sittings of the Committee, that I am afraid bomb-shells will be continued to be exploded either on one side or other of the Committee until we have finished our work. I do not want to say anything unkind of the right hon. Gentleman. I think he is doing his best in circumstances that we all find difficult, but I think that my hon. Friend had some very substantial ground for protest, because I think the Committee generally feel that the Amendment, that was put before us to-day for the first time was complicated and it was very difficult for all of us to fathom precisely what it meant.
§ Sir COURTENAY WARNERI think that it is not realised by many hon. Members that this sort of thing has happened before. I remember quite well during the passing of the Workman's Compensation Act that the Member for West Birmingham used to read corrections to new Clauses and corrections 3236 to Amendments in exactly the same way as that in which they have been read to-day, and it is a precedent that is often observed not only in Committee here but in Committee of the Whole House, though it is regrettable I know.
§ Mr. HARRY LAWSONI think that the speech of the hon. Baronet requires an answer to this extent, that I do not recollect any case where for ten days together the Grand Committee has been asked to sit day after day in the way in which we are sitting now. It was not asked to do so in the case of the unemployment section of the Insurance Act, because I was a member of the Committee. If the Government does this thing it must expect to get this hopeless, faulty, bad drafting and the impossible positions into which we are plunged.
§ Question; "That those words be added to the proposed Clause" put, and agreed to.
§ Clause, as amended, added to the Bill.