§ "Notwithstanding anything in any Act, it shall be lawful for the managers of the Metropolitan Asylums district, with the sanction of the Local Government Board, to enter into agreements with any county council or, with the consent of the county council, with any authority in a county for the reception of persons suffering from tuberculosis or any such other disease as the Local Government Board, with the approval of the Treasury, may appoint under Section eight of the principal Act, into hospitals provided by the managers, and for this purpose the managers shall not be deemed to be a Poor Law authority. Any such agreements may provide that the cost of the treatment of the patients so received, or some Hart thereof, shall be borne otherwise than as provided by
3458§ may prescribe the time within which, and the conditions under which arrears may be paid up.'"
§ Question put, "That the words proposed to be left out stand part of the, Clause.
§ Mr. CHIOZZA MONEYI object.
§ The CHAIRMANThe Committee have already accepted the first line, and therefore it would read nonsense. The hon. Member can withdraw his opposition now and vote against the Question, "That the Clause stand part of the Bill."
§ Mr. CHIOZZA MONEYThe Question was put rather quickly, and I did not fully understand it, or I should have objected. I must take the opportunity now.
§ The Committee divided: Ayes, 1; Noes, 28.
§ Section eighty of the Public Health (London) Act, 1891."
§ Clause brought up, and read the first time.
§ Mr. DAWESThis Clause is in my name, but it is not the Clause which I put down in the names of the hon. Member for Hoxton (Dr. Addison), the hon. Member for North St. Pancras (Mr. W. H. Dickinson), and the hon. Member for Plymouth (Mr. Astor). I do not know how the Clause got here in this form. The Clause I put down had the very important words "insured persons" in the fourth line of the Clause. I think the word "insured" came after the words "reception of."
§ Mr. CASSELThe Clause is also in my name.
§ The CHAIRMANI was waiting for someone to move it. I understood it was going to be moved in that form.
§ Mr. CASSELI agreed to the Clause with the hon. Member for North St. Pancras in the form in which it is on the Paper.
§ Mr. CASSELI beg to move, "That the Clause be read a second time."
In some way or other it appears on the Paper in its present form. So far as I am concerned, I am not responsible for the form in which it appears on the Paper except to this extent, that I told the hon. Member I had agreed to it. If there is any misunderstanding I am willing to insert words to meet the hon. Member's objection, subject to one consideration to which I should like to ask his attention. Regarding its particular form, to which the hon. Member objects, I do not think it really was my fault. I do not think the Committee will be sorry that this is the last Clause to which the right hon. Gentleman (Mr. Masterman) has given his imprimatur. The object of the Clause is simply to enable the London County Council to make arrangements with the Metropolitan Asylums Board and to regularise and give legal sanction to what is in fact being done. The difficulty has arisen owing to the fact that sanatorium benefits can only be provided by authorities other than Poor Law authorities. Section 64 of the original Act dealt with that matter, and I think the position of the Metropolitan Asylums Board was overlooked at the time. That body is technically a Poor Law authority, but so far as the provision of hospitals is concerned it receives non-paupers. Out of 7,000 or 8,000 patients, 96 per cent. are non-paupers, and, in fact, the Metropolitan Asylums Board at the instance of the Local Government Board, and at the request of the Insurance Committee for London and the London County Council is actually doing this work. It has thrown itself into the breach and, according to everybody's statement, is doing the work well. All that we ask is that it should have regular legal sanction for doing it within the four corners of the law.
I think some opposition to this Clause arose from misunderstanding. It was thought that the London County Council were not willing to become the general authority for the treatment of tuberculosis in London. May I assure hon. Members that that is not the case. The county 3460 council, as their minutes shows, are perfectly willing to become the general authority for London and wish to be able to avail themselves of the existing accommodation which the Metropolitan Asylums Board provides. This Clause does not allow the Insurance Committee to contract direct with the Board. It necessitates a circuitous method through the London County Council, and as a matter of compromise I gave way on that. As to whether the word "insured" is to be inserted, I suggest to the Member for Walworth that it should come after the words "reception of" I am willing to accept that form. I do not want to be under a suspicion of having brought forward a Clause in a form which was not fully agreed to. I should like to have the words "insured persons, or their dependents" for this reason: Supposing the London County Council decided to treat dependents as well as insured persons, the facilities of the Metropolitan Asylums Board would be open to them in that case, if they chose to avail of them. They might or they might not think it the best thing to do, but, at least, they might have the opportunity, and it might have an effect upon them, when they were deciding the question of treating dependents, if they knew that the existing accommodation would be available for both insured persons and dependents; whereas, if they had not the power, they might not be willing. I think we may safely trust a matter of that kind to the discretion of those who are responsible for the government of London. If the hon. Member insists upon it, I shall only press the words "insured persons," but I should like the word "dependents" as well.
§ Mr. CASSELThen I will move it as it stands on the Paper, and leave my hon. Friend to amend it.
§ Question, "That the Clause be read a second time," put, and agreed to.
§ Mr. DAWESI beg to move to insert the word "insured" before the word "persons" ["reception of persons suffering from tuberculosis"] and in the same line to insert the words "or their dependents" after the word "persons."
§ Mr. ASTORMy name is down to this Amendment, but I only go as far as the inclusion of insured persons.
§ The CHAIRMANI will put the words separately.
§ Question, "That the word 'insured' be there inserted," put, and agreed to.
§ Question proposed, "That the words 'and their dependents' be there inserted."
§ Mr. DAWESI should like, in view of what tile hon. Member who moved the Clause said with regard to the London County Council, to state that there is no supreme desire at present on the part of that council to act as the central authority for London. I happen to be on the Public Health Committee, and after deliberations extending over five months we have got to this—that the existing institutions be utilised.
§ Mr. CASSELIs it in order to raise a debate on the whole policy of the London County Council? If so, I should have to make a reply.
§ The CHAIRMANOn the question of the desirability of such discussions I think we are all agreed. I did not hear anything which was out of order. If the question is a simple one, would it not be better if the Committee did not open out these other questions?
§ Mr. DAWESI am afraid I cannot. I happen to be a member of the committee, and I know more about the matter than my hon. Friend.
§ Mr. ASTORI do not wish to delay the Committee, but I feel that we are going beyond insured persons when we are discussing dependents. We have to legalise the present position and to make it possible for the Metropolitan Asylums Board to treat insured persons. If you go further, and include dependents, you are not amending the Insurance Act, but really amending the Public Health Acts of London, and opening a very large question—the question as to whether we should have seperate authorities for the treatment of a variey of cases. The point is whether it is possible by additional capital expenditure to increase the development of the present hospitals belonging to the Metropolitan Asylums Board so as to make them into sanatoria. I do not wish the Committee to imagine that I am protesting against the administration of the Metropolitan Asylums Board. But what I would suggest to the Committee and to the right hon. Gentleman in charge of this Bill is 3462 that he should stick to amending the Insurance Act, and not to include persons who are not insured persons, or else we should stray into amending every Public Health Act connected with London.
§ Mr. MASTERMANI hope an agreement will be come to by all parties. I do not think that by including dependents in this fashion we are straying into matters of public health outside the Insurance Act, because, as hon. Gentlemen well know, dependents are includable—if I may use that term—in the National Insurance Act, and in many cases are being treated under that Act.
§ Mr. HARRY LAWSONI cannot find myself in agreement with the hon. Member for Plymouth, for I am always anxious to deal with things as they are and making the best of them. There is not the least doubt if you leave out dependents, you fetter the authority to which you wish to give this discretion and power to make the best of the Act. By Clause 17 dependents are brought within the scope of the National Insurance Act. Clearly there should be an understanding between the county council and the Metropolitan Asylums Board—something that would be a workable scheme, and it will be a great mistake to fetter the hands of the local authority when we are endeavouring to remove the stigma of pauperism. Let us do what we can to enlarge and confirm the powers of local authority.
§ Mr. CASSELI do not wish to raise the question, but I must say that this is the only new Clause I have moved. What I said was that the London County Council were willing to become the central authority. I absolutely deny the allegation which the hon. Member has made against the county council, but I do not think that this is the proper place to enter into a discussion.
§ Mr. ASTORMy point in opposing dependents was that uninsured persons would be more likely to receive treatment if that term be not included. No money is being taken for dependents, and if you include dependents the third class of non-insured persons are less likely to receive payment in the near future than if you leave dependents out.
§ Question, "That those words be there inserted," put, and agreed to.
§ Clause, as amended, added to the Bill.
3463§ The CHAIRMANAs to further Amendments, I shall only call upon those Members who are present.
§ Mr. MASTERMANI understood that the general agreement was that the Clauses which were not starred by the Government should be withdrawn.
§ The CHAIRMANAs Chairman, I must pass them over as not moved.
§ Mr. FORSTERThe suggestion was that, after the Government had come to the end of the Clauses for which they took the responsibility, we should then pass to the Schedules and complete the Bill. If we once begin to pick and choose Amendments we cannot deny the same opportunity to Gentlemen opposite, and we cannot ask them to abide by the arrangement reached yesterday. I wish to say nothing further at this moment. The whole position is one of extreme difficulty, and one which is very distasteful to a great many members of the Committee.
§ The CHAIRMANI believe there are precedents for going through the Schedule, if that is the general wish of the Committee.
Mr. BATHURSTIt is difficult for those members of the Committee who feel that they are trustees for certain bodies of persons outside this Committee to calmly agree that the particular Amendment which we intended to bring forward in their interests should be sacrificed. But having said that, I would like to add that I am not going to take up the time of the Committee by an Amendment which will not be accepted. So that in the massacre which is now about to take place, one at least of my treasured bantlings is about to be sacrificed.
Mr. HALLMy Clauses have not been deemed worthy of consideration, but, having entered my protest, I do not wish to sit down without saying that it is a great pity that important alterations such as we have on the Paper have not had a chance of being considered. If the Government had brought forward their Amending Bill earlier, many important Amendments might have been discussed for the general benefit.
§ Mr. RAMSAY MACDONALDI understood that the Clause in the name of my Friend the hon. Member for Leeds was to be starred—the Clause dealing with taking insurance books in pawn.
§ Mr. MASTERMANIf that was understood I am afraid it was omitted by accident. I suppose the hon. Gentleman will have an opportunity of moving it on Report. If that is so, I express my regret to the hon. Gentleman for Leeds.