§ Mr. T. M. HEALYIn addressing you, Mr. Speaker, when addressing the House, we fulfil a mere formality, but on the present occasion I am going to make an appeal to you in a different capacity in reference to this Bill, and that will be that you should use the Act passed to reform the House of Lords in such a way as will preserve the liberties of the House of Commons. You, Sir, have a function in reference to this Bill which none of your predecessors ever had or ever could have exercised, and the way you will exercise that function concerns every Member of 996 this House and concerns the preservation of its ancient constitution, and also, I venture to think, concerns the honest working of the financial system under which we live. You have to give a certificate, if this Bill is to pass into law without the sanction of another place, that it is a Money Bill. I say that as regards the sum of £1,800,000 of Supply in this Bill that this Bill no more deserves the name of a Money Bill than a forged note of the Bank of England deserves the name of a money transaction. I say that this Bill is a forged note so far as its provisions affecting the Insurance Act are concerned. I say it is grossly and abominably illegal. and I arraign the Minister and through him the Cabinet, because I assume that what was done in this case was done on corporate Ministerial responsibility. I arraign the Minister and the Cabinet of being guilty of one of the greatest acts of illegality ever practised by a responsible Government, and I say that because the Chancellor of the Exchequer, after the passing of this Bill. made an appeal to those who were opposed to it, as I was—I am happy to say I voted against the Third Reading of the measure—now that the Bill was law that it was our duty to obey it. As far as I am concerned, to every extent in my power I have done so, and never certainly made any protest against its enactment once it passed in this House, and the Chancellor of the Exchequer was especially emphatic in appealing to the public in reference to the agitation which existed as to providing stamps and so forth, and he was most eloquent in appealing to the public that they should obey the law. It is now the law of the land, and it is the duty of every 4.0 P.M. good citizen to obey that law. If any person fails to put the necessary stamps upon the documents connected with insurance the right hon. Gentleman immediately has him prosecuted at Petty Sessions, and many persons have been sent to prison for refusing to obey this law. Who is the principal lawbreaker in connection with this measure Why the right hon. Gentleman who has appealed to the law of the land, because what has happened is, that while the entire Statute is governed by Section 3 which provides that Parliament has only to find two-ninths of the contribution, this Bill has been introduced for the purpose of enabling the right hon. Gentleman to repeal the Third Section by implication, and to do it without the knowledge of the House of Commons, and in this way sneak and 997 smuggle this Bill through the House without letting us know what the Bill is for, and when it has been passed unawares by this House we are told afterwards that we have thereby repealed the Third Section of the Act of 1911. In this matter the right hon. Gentleman has taken the most desperate gambler's course that has ever been taken by a Chancellor of the Exchequer. If everybody knew, as the right hon. Gentleman knew and must have known, that in regard to every contract made either with a doctor or anybody else before this Bill could pass into law he had no power to make any fresh contract, I should like to know in what position the persons were placed with whom those contracts purported to have been made. Until this Bill comes into law there is no more power to expend a single shilling beyond the two-ninths contribution than there is to take the money out of the pockets of private individuals.
What was the excuse made last night by the Financial Secretary to the Treasury? He said that this had often been done before and that he had armfuls of precedents, but he did not quote one. I do not think any precedent can be found, because no precedent exists for the repeal of the Statute by means of an Appropriation Act. The right hon. Gentleman stated that I had no knowledge of Treasury technicalities. I do not profess to possess that knowledge, because it is not my business or duty and I am paid no salary for understanding them. I come here as an ordinary individual to take up such Papers as the Government afford me. I am not supplied with information from the place behind Mr. Speaker's chair. I am not supplied with a prompter's box, in connection with which one may also remark that in previous Parliaments you would sometimes see an official sitting under the gallery where occasionally a furtive visit was paid by Ministers to consult him on some matter. That was done perhaps once in a night or once a week, but under the prompter's box system this Government have established a system of associating us directly with the officials whom they bring down in a group. We know it has always been asserted that it is beyond the power of the First Commissioner of Works even to take down the grille in the Ladies Gallery, but this Government has changed the whole method of the House of Commons, and I say that the ordinary Member who has not such assistance need have no shame and feel no particular sensitiveness if he is 998 charged with being without that knowledge which the receipt of £5,000 a year and the assistance of half a dozen secretaries is supposed to confer.
The right hon. Gentleman says he has precedents. Will he oblige us by reading them? He said last night that this Grant is not made under any special Section of the Insurance Act. Am I correctly translating the observations of the right hon. Gentleman? If this Grant is not made under any special Section of the Insurance Act, what is the meaning of this provision in the Bill: "For Grants-in-Aid of National Health Insurance in addition to the sums payable under Section 3." In other words, whereas Section 3 provides that the whole of the expenses shall be found under that Section, including the expenses of administration, you now ask us for three months of the year alone for a sum of £1,800,000 outside the provisions of Section 3. How, then, can the right hon. Gentleman say that this is voted under the general provisions of the Act when, by his own enactments, he states that it is granted outside the provisions of Section 3, in addition to the sums payable under Section 3. If you have power to raise money outside the provisions of Section 3, as you claim to have, what is the Section that gives you that power? If this system of legislation is going to be continued in this House it must be continued not in the Appropriation Bill for the present Session, because we are only dealing with three months, and if for three months you want £1,800,000 for provisions outside of Section 3, what will you want for twelve months? If you have no extra legislative authority beyond What this confers, will it not be necessary that in every Appropriation Bill for all future time you will have to make provision for enabling money to be raised in addition to the provisions of Section 3? Therefore I say that this Bill is a repeal of the provisions of Section 3, and I respectfully submit to you, Mr. Speaker, that you should not give to this Bill your certificate under the Parliament Act certifying that it is a Money Bill. This is not a Money Bill, but a Bill to repeal the provisions of the Insurance Act. There is no means by which a Member of this House can ascertain what certificates the Chair has given under the provisions of the Parliament Act, but no doubt the Chair will find time to place sonic memorial upon the journals of this House or its Library which will enable hon. Members interested in these questions to ascertain what is the view 999 of Mr. Speaker with regard to the provisions of the Parliament Act. I can quite conceive that a certificate might be given under Section 3 by the Chair.
The right hon. Gentleman told us that this Estimate was presented to the House by the Chancellor of the Exchequer in his Budget of 1911. He then stated that he would be able to give the doctors 4s. and he based his Act upon that figure. The doctors, through their trade union, as everybody else does, raised their price, which they were fully entitled to do, and I do not complain whether they got 8s. or 28s., because that is not the point of my complaint. My complaint is that contracts should not be illegally made either with doctors or anybody else. If the doctors are to get more money, let us have it stated in the Statute. Great care was taken last year with regard to the miners. The Prime Minister, in a pledge with which we all sympathise, because it was made under great and strong pressure, refused to put a minimum wage into the Miners' Bill. The minimum wage the doctors were to get in 1911, according to the view of the Government, was 4s., but owing to the operation of the doctors' trade union they have screwed up that wage to more than double that amount, and their insistence has thrown this Bill out of gear. That being so, I maintain that the two-ninths is now as dead as Queen Anne, because it is absurd to contend that this ninepence for four-pence, or this two-ninths as against seven-ninths, has not now gone the way of many other Ministerial professions. The two-ninths is dead, and the ninepence for four-pence is dead, because they have been killed by the doctors' agitation, and that being so, do not let the Government through the instrumentality of a Finance Bill, or by means of an Appropriation Act, hoodwink the House of Commons, because no statement was made when this Bill was introduced that it was intended as a supplementary measure to the finance of the Insurance Act. The Government are trying to throw dust in our eyes by the suggestion of Supplementary Estimates. True, we have beaten the doctors on one field of battle, but they have beaten us on another field. They have rendered the profession of two-ninths, and the nine-pence for fourpence, practically obsolete. Having done that, I ask, was it ever contemplated by Parliament at any time in its history that when such an Act was passed under such conditions, and had 1000 practically been repealed by the Minister of Finance, that Minister should then try to smuggle through an Estimate for the purpose of covering over his own glaring blunders.
The right hon. Gentleman certainly enjoys an opportunity and a position and a faculty which no other Minister has. Supposing the Secretary to the Navy in a time of peace without warlike necessity and without threat and peril to these shores increased the Vote for "Dreadnoughts" from two capital ships to ten and then said, "I did it because I wanted to increase and enhance my popularity in the country," what would this House say? His object would be good; everybody would approve of his action as regards defence, but would anyone say he could subtract himself from the authority of this House and order ships according to his whim when Parliament had not sanctioned them? Let us take another illustration. Supposing the staff connected with any Government Office had been limited by Statute to a certain proportion, what would this House say if, without being told that invasion of the Statute was being made, an attempt were perpetrated under the cloak and cover of an Appropriation Bill to double or treble that staff contrary to Parliamentary authority? I respectfully say to you, Sir, that you should not give a. certificate simpliciter under this Bill, and I say it for this reason. If you withhold your certificate, Ministers will regularise their procedure, but, if you grant your certificate, you will have associated the Chair with the conduct of the Chancellor of the Exchequer. He will be able to boast not merely that he has had the sanction of this House in Committee and not merely that you had put it in a formal manner from the Chair, but that you had afterwards certified that this was a Finance Bill. We are now told these Finance Bills are so elastic that you can entirely change prior Statutes by means of the system of Votes in Supply, and my suggestion is that you should give a certificate of fact, and that you should not be tied merely to certifying that this is a Finance Bill. It is a Finance Bill coupled with the repeal of the Insurance Act, and I respectfully ask that you should certify accordingly. Your certificate under the Section is this:—
"There shall be endorsed on every Money Bill when it is sent up to the House of Lords and when it is presented to His Majesty for Assent, the certificate 1001 of the Speaker of the House of Commons, signed by him, that it is a Money Bill."
It is a Money Bill, but it is not a Money Bill in the sense of any Bill that has ever yet passed this House. It is a Money Bill with a hump to it; it is a Money Bill which repeals the provisions of the other Act, and it has been introduced by the Minister who alone controls this Department. No other Minister, no matter who he may be, would be allowed to bring in a measure without having the rampart of the Treasury to cross. We have heard of appeals from Philip drunk to Philip sober, but here the appeal is from the Chancellor of the Exchequer to the Chancellor of the Exchequer. Every other Minister, no matter what he wants, has to go hat in hand to the Treasury, but he apparently can launch programmes of his own, independent of his colleagues. We have found this in the Single Tax campaign. We do not know whether Estimates have yet been presented or are to be presented for the expenses of these inquiries for throwing all taxation upon the land. [HON. MEMBERS: "Oh, oh!"] We do not know it. Nobody would have believed in December last when the right, hon. Gentleman was arguing with the doctors that he was going to go outside the two-ninths proportion. Nobody would have believed it was contended he could do it, but he has done it. Therefore, on these grounds I respectfully ask you not merely to certify simpliciter if you feel bound to give such certificate, but to give your certificate in such a form as would in future protect the House of Commons from outrages upon the Constitution which has always regulated the finances of this House.
§ Mr. SPEAKERIt would perhaps be convenient if I now made a reply to the hon. and learned Gentleman. The hon. and learned Gentleman has read Section 1, Sub-section (3), of the Parliament Act:—
"There shall be endorsed on every Money Bill when it is sent up to the House of Lords and when it is presented to His Majesty for assent the certificate of the Speaker of the House of Commons—"
and so on. Then Sub-section (2) describes what a Money Bill is:—
"A Money Bill means a public Bill which in the opinion of the Speaker of the House of Commons contained only provisions dealing with all or any of the following subjects, namely—"
1002 I leave out the unimportant words—
"the Appropriation ….. of public money."
Therefore, if in my judgment this Bill contains only the appropriation of public money, I shall be compelled to certify it is a Money Bill. The hon. and learned Gentleman will not expect me now to make an answer, and I can only say I will carefully consider everything he has said this evening before I give my certificate on the Bill. I do not think it is open to me to give anything but the certificate in the form set out in the Parliament Act. I can either give that certificate or none at all. It would not be competent for me to give a qualified certificate.
§ Mr. AUSTEN CHAMBERLAINI am sure the House will await with great interest the decision which you will have to take at a later stage of this Bill as to whether you should endorse it as a Money Bill or not. I do not rise to submit any further considerations to you on that subject, but to renew an appeal, this time to the Prime Minister, which I made last night, in the unfortunate absence of the Chancellor of the Exchequer, to the Financial Secretary, and to which he did not think it necessary to respond in the course of that Debate.
§ The FINANCIAL SECRETARY to the TREASURY (Mr. Masterman)I had no opportunity.
§ Mr. AUSTEN CHAMBERLAINI suggested that the House would have been willing to hear the right hon. Gentleman if he had been willing to make use of the opportunity. If he thought it not right to do so, I have no right to complain, but I take the opportunity of the Prime Minister being here to address to him a question which I should more naturally have addressed to the Chancellor of the Exchequer, but which is really one of sufficient consequence to justify me in putting it personally to one of the Treasury Ministers. Parliament, in the Insurance Act, specifically laid down in respect of certain expenses that they should be borne as to seven-ninths by the employer or employed and as to two-ninths by the Treasury. This Estimate is an additional Grant from the Treasury towards those expenses, and by making this additional Grant you destroy the proportions laid down by Statute. This Grant being paid, Section 3 of the Insurance Act is of no effect as regards the proportions of the payments. The amount to be raised from the employer 1003 and from the employed still remains fixed by that Statute, but the amount contributed by the State, instead of being two—ninths, becomes a considerably larger proportion of the total or enhanced sum. I do not challenge the additional payment to the doctors. I rise only for the purpose of challenging the procedure by which the Government seeks to give effect to it. By means of a Vote in Supply, followed by an appropriation in the Appropriation Bill, the Government are reversing the expressed statutory provisions of Section 3 of the Insurance Act, and that is not a light matter.
When the Insurance Act was under discussion in Committee this proportion of seven-ninths and two-ninths was settled early in order to prevent the House of Commons requiring any larger contribution from the State funds. We complained again and again that the Chancellor's very insistence on fixing the contributions in those proportions prevented us from making the best use even of the particular sum which he was willing to allot. He admitted that was so, but he insisted upon fixing that proportion because at the same time it fixed the total contribution and protected him against any claims from other people. Accordingly, he fixed it by Statute and as early as the Third Section, and now, having done that to bind the House of Commons, he, in defiance of the Statute and without legislative authority, reverses the decision which he forced on the House of Commons. I can recall only two precedents, and only one before their own time, for the course which the Government are taking. I shall not dwell upon the one they made themselves, because a manufacturer may not plead his own past misdeeds in palliation of a repetition of them. The only other precedent I know is the attempt of Mr. Gladstone's Government in the early eighties to pay certain resident magistrates in Ireland at a higher rate than the Statute provided. It was alluded to last night by the hon. and learned Gentleman (Mr. T. M. Healy). The history of that precedent is instructive and conclusive. It was done, I think, two years running; and it was twice condemned by the Public Accounts Committee in very strong language. The Treasury itself concurred in the condemnation passed by the Public Accounts Committee. Mr. Gladstone made an effort to secure legislative sanction for the course he pro- 1004 posed, and, failing through opposition and for want of time to get his legislative sanction, he abandoned the attempt; he abandoned the infringement of the Statute. That being the only precedent before the time of the present Government for such a course of action as this, and the case being as bad as I have shown it to be—I think it is very bad when the Chancellor of the Exchequer deliberately imposes this limitation on the House in the discussion on the Insurance Bill and then as deliberately breaks the law which he himself induced the House to pass—I repeat my appeal to the Prime Minister. My appeal is not that, at this period of a Session such as this, they should find time to regularise their action, but I ask that they should admit that this is not a precedent to be followed, and that they should underake that in the next Session, before a similar Vote conies round, they shall have presented to Parliament, and passed through Parliament, a law, it may be simply a one-Clause Act, varying Section 3 in such a sense as to authorise this payment. They should make their action regular to prevent this from being brought up as a precedent. I think it is a bad precedent. I am fully confident it is not a precedent that would be allowed in the case of any other Department than the Treasury. It is only because the Chancellor is at once—what shall I say?
§ Mr. T. M. HEALYPooh Bah.
§ Mr. AUSTEN CHAMBERLAINMy comparison was not quite so strong as that. It was the case of two persons rolled into one. It is only because the Minister who wants to spend is the same Minister who has to guard the financial proprieties that this course is allowed in this case. I do not think it is a course that should be allowed, and I hope the Prime Minister will make the course which the Government have pursued regular in the future, if not in the present, and by taking such a step prevent their present action being brought up as a precedent.
§ The PRIME MINISTER (Mr. Asquith)I very much regret the absence of my right hon. Friend the Chancellor of the Exchequer for a reason of which the House is aware. He could deal with it much more fully than I could possibly do now, bat I gladly respond to the appeal the right hon. Gentleman has made. I listened with a good deal of regret to some parts of the speech of the hon. and learned Gentleman below the Gangway (Mr. T. M. Healy). I do not think it was quite 1005 necessary to impart so much heat into the matter as he did.
§ Mr. T. M. HEALYThe right hon. Gentleman was not here on Friday.
§ The PRIME MINISTERI am rather sorry that he adopted so remarkably controversial a tone in the discussion of what, after all, is a serious point of constitutional practice. He arraigned the whole of us on this bench in somewhat strong language. I do not think that language of that kind is altogether warranted by the circumstances of the case. I do not go into the question, which is entirely one for the Chair, whether or not under the provisions of the Parliament Act, this Bill falls within the category of a Money Bill. We are at present discussing the Second Reading. Now I may state my own view as an old Chancellor of the Exchequer in these matters, and I believe one of the strictest purists in the House of Commons. I take, and have always taken, a very serious view of the importance of following custom and rules in our procedure. I do not think it is desirable, on the contrary I think it is very undesirable, that the Appropriation Act should be resorted to in a manner which was suggested by the hon. and learned Member so as to override the provisions of an Act of Parliament. He used the expression "subterfuge." I do not know what he meant by that. The Supplementary Estimate is presented to the House of Commons, which has the fullest opportunity of discussing it in Committee, and again upon Report, and again on the Second Reading of the Appropriation Bill. To represent this as a subterranean action, to speak of an imperious Minister overriding the authority of Parliament for some purpose of his own is not to make a statement which is in accordance with the facts. The House of Commons has complete control over the whole matter. If it pleased, it could have rejected the Supplementary Estimate or reduced it. To say that this Estimate in any way impairs the authority of the House of Commons over the finance of the year is really not to represent but to caricature the facts of the situation. Let us see what the facts are. I turn to the Schedule in which this particular Vote is put down, Class 8. How is it described? It is described as a Vote for—
"Grants-in-Aid to the National Health Insurance in addition to the sums payable under Section 3 of the National Health Insurance Act, 1911."
1006 Therefore it is described in the Estimate as an addition to the Grant which is made under Section 3 of the National Insurance Act, and there can be no suggestion of any concealment from the House. The very form of the Estimate negatives that. It says it is an addition to the sum which the Statute of 1911 provides. It cannot be said that the House is in any way taken by surprise, or that the contribution here suggested is not properly described as a contribution outside of and in addition to that which is provided by the Act itself. Any argument based upon the suggestion of some subterranean method is completely negatived by the form of the Estimate itself. At the same time I quite agree that when an Act of Parliament prescribes that a particular charge should be made in a particular way, whether it be in certain definite proportions as between individuals and the State, or whether it be in certain definite proportions as between the central and local authorities, whichever of those forms an Act of Parliament prescribes, it is not desirable, unless for special reasons to increase these proportions, or that, without very special need, the proportions so fixed should be altered by the Appropriation Act. But it has been done over and over again for special reasons. The right hon. Gentleman has referred to one case, a case which, I understand, was one which occurred under Mr. Gladstone's Government, and there was no more severe authority than Mr. Gladstone in those matters.
§ Mr. T. M. HEALYHe abandoned it.
§ The PRIME MINISTERIf the hon. and learned Member will allow me, that was a case of a Grant in excess for the resident magistrates beyond the limit which have been imposed by Statute, and the Public Accounts Committee in their report upon that used this expression:—
Your Committee are not prepared to say that such payments in excess of a limit imposed by one Act are invalid if made after a vote in Parliament and the passing of the Appropriation Act. It is not perhaps quite correct to say that the Appropriation Act overrides the limits imposed by the preceding Act.' It only admits that special reasons have arisen which justify an addition to those limits. Should those masons cease, the limits imposed by the former Act would remain unaffected by the temporary addition to those limits.The reasons for the criticism which are there made by the Public Accounts Committee apply exactly to and, I think, cover the present case. They did not censure it. They carefully guarded themselves. They refrained expressly from censuring it. I will not say they approved it, but they 1007 guarded their condemnation by the limitations to which I have referred.
§ Mr. AUSTEN CHAMBERLAINSurely the right hon. Gentleman has not read the report. I know they declared that it was not invalid. But they declined to approve of it in quite unmistakeable terms.
§ The PRIME MINISTERThey admitted that, for the temporary purpose.
§ Mr. BONAR LAWIt was out and out condemnation.
§ The PRIME MINISTERIf anybody has got the report they may quote it. I have got here those words, and I am sure they are accurate.
Your Committee arc of opinion that should the services continue to be paid by vote of Parliament, the existing Statute should be repealed.With that I quite agree. Well, now, take another case, which is a more remarkable case. It went on for forty years, and it also arose out of Irish expenditure. That was a Vote for the law charges for criminal prosecutions in Ireland. It was a case in which by Statute the local authority were made liable for the expenditure, and yet, notwithstanding that statutory imposition of the liability upon the local authority, the House of Commons year after year voted money out of Imperial funds, and it was included in an Appropriation Act of the year. Upon that the Committee said:—Your Committee, after hearing the evidence of the Comptroller and Auditor-General and of the representative of the Treasury, are of opinion that while it is undoubtedly within the discretion of Parliament to override the provisions of an existing Statute by a Vote in Supply confirmed by the Appropriation Act, it is desirable in the interests of financial regularity and constitutional consistency that such a procedure should he resorted to as rarely as possible, and only to meet a temporary emergency. In cases where such an emergency arises and there are reasons against the amendment Or repeal of the Statute governing the case, your Committee recommend that the fact that the proposed Vote overrides an existing Statute should be clearly stated on the face of the Estimate with the reason for adopting that course. so that no doubt can exist on the deliberate intention of Parliament. The exceptional nature of the Vote should also be indicated in the Appropriation Act.That is a case which applies to the present case exactly, but I do not want to fortify myself by authority. I could cite other cases to show that this has been done in certain circumstances, but in my own opinion the true rule is the rule laid down by the Public Accounts Committee. It is this. I think it really consists of three branches. In the first place, it ought not to be a surprise. The House of Commons should be clearly informed of what the 1008 character of the Vote is and what its relations to the Statute are. That condition is complied with by the very form of the present Estimate. Next, it should be a Vote necessitated, as I think it is admitted on all hands, excepting perhaps by the hon. and learned Member below the Gangway—the Vote in the present case is—by temporary emergency or by absolute necessity.
§ Mr. AUSTEN CHAMBERLAINIt is very important that we should follow the right hon. Gentleman, but I am afraid I do not quite understand him. Does he mean that this additional Supplementary Estimate is a purely temporary measure?
§ The PRIME MINISTERNo, I quite agree. But what we are voting upon on this occasion is a temporary matter. If he will allow me to finish, he will see that in the third place, as I was going to say, if it is a matter which is not merely temporary but permanent, it should be regularised by Statute. When I say by Statute, I mean by Statute—otherwise and in addition to, the Appropriation Bill. I think that fairly represents the facts. I accept these propositions and I make that reply to the appeal of the right hon. Gentleman. I do think that even the hon. and learned Gentleman might agree that it would not be right to oppose this Grant-in-Aid on this occasion. On my part, I agree that it ought to be, and that in this case it shall be, by legislation expressly authorised in the future. I am speaking of it in substance. I think it ought to be. I take that view as strongly as anybody on either side of the House. May I appeal to the hon. and learned Member, if not to mitigate the rigour of his criticism, to assume that there was a necessity for the moment to make a Grant of this kind? The Government have not acted contrary to all precedent. They have not in any way concealed the matter from the House. They are now prepared to regularise by permanent legislation in future the course they propose.
§ Mr. H. LAWSONWhen?
§ Mr. T. M. HEALYIn future I will not criticise the Government as a whole in this matter; I will confine my strictures to the Chancellor of the Exchequer.
§ The PRIME MINISTERThe Government as a whole are responsible.
§ Mr. BONAR LAWThe right hon. Gentleman, in the closing words of his speech, has really admitted everything for 1009 which we have been contending. We have felt from the first that this was not a case where we should oppose the Vote, because we admit that the arrangement, having been made with the doctors, it is necessary for the House of Commons to implement it. Therefore we have no desire to oppose the Vote. I could very easily go over the past history of the Insurance Act, but it is only necessary for me to say, in my opinion, and I think in the opinion of the majority of the House, that as the Insurance Act rested entirely on medical benefits, it was clearly the duty of the Government, before the Insurance Bill left the House of Commons, to have made arrangements by which, from the beginning, they could have been carried out. I do not wish to go into that, because it does not arise on this question. Our whole point was that if the system which has been adopted now was going to become a regular system, the practical result would be that whenever money was required the Government of the day could alter Acts as they pleased by coming to the House of Commons and getting it legalised by an Appropriation Act. That seemed to us to be the end of all financial control. I should like to point out to the right hon. Gentleman that if, when the question was first raised, the Chancellor of the Exchequer had made the speech he has just made, the difficulty would never have arisen, because we should have recognised the necessity, under existing conditions, of the position the right hon. Gentleman has taken up. But what happened? When the point was raised, the Chancellor of the Exchequer, instead of recognising that it was an irregularity and saying that the Government meant to redress it at the earliest possible moment, said there were hundreds of precedents, and that this was a quite proper proceeding. That was his answer to the hon. and learned Gentleman the Member for North-East Cork (Mr. T. M. Healy).
§ Mr. MASTERMANIn justice to my right hon. Friend, who is not present, I must say that this specific point was not raised until last night. [Hex. MEMBERS: "Yes, it was."? The point raised by the hen. and learned Gentleman on Friday was a totally different point; it was whether we could give any money by Grants in an Estimate without a Statute behind it. That point my right hon. Friend answered.
§ Mr. T. M. HEALYHe never answered anything except by insults.
Mr. MASTER MANIt was only last night that the right hon. Gentleman (Mr. Austen Chamberlain) made a definite challenge to me on the point. Until then no one had the least idea that this point was going to be raised.
§ Mr. BONAR LAWI really cannot understand the interruption of the right hon. Gentleman. I did not hear but I have read the Friday's statement of the hon. and learned Member for North-East Cork. The meaning of his statement was perfectly plain to me, as was the speech of my right hon. Friend, and I heard the speech of the hon. and learned Gentleman last night, and it is impossible for the right hon. Gentleman to say that that speech did not raise it.
§ Mr. MASTERMANThat was a perfectly clear and categorical challenge to me, asking whether I could promise legislation. I was not in a position to promise legislation.
§ Mr. BONAR LAWThe right hon. Gentleman will not understand what I said He said he did not understand that the speech of the hon. and learned Member for North-East Cork had raised this point. I listened to it. My right hon. Friend pointed out that the real point. in the speech of the hon. and learned Member had not been touched upon by the right hon. Gentleman in his reply. I do not think there is anyone who has read Friday's Debate, or who was present last night, who doubts that the Government did not intend to take the course which the Prime Minister now says they intend to take. If they did intend to take it apart altogether from the speeches of the hon. and learned Member for North-East Cork or my right hon. Friend, why should they not have made it plain to the House? The importance of the matter has been recognised but not exaggerated by the right hon. Gentleman, and I do say that no one in this House can doubt that this is another instance of a method of procedure to which we have become so accustomed, when the Chancellor of the Exchequer, having satisfied himself that his motives are good, and that what he means to do is for the benefit of the community, does not care twopence what method he takes, so long as he can carry it into effect. That is the criticism I make on this transaction. I am very glad for the sake of the regularity of our financial proceedings, which is the basis of the 1011 whole government of this country, that the right hon. Gentleman has recognised the seriousness of this matter, and has promised to put it right by means of an appropriate Statute.
§ Mr. BUTCHERTo anyone who, like myself, was in the House on Friday and heard the speech of the Chancellor of the Exchequer on the subject, and who heard the speech of the Secretary to the Treasury last night, the speech of the Prime Minister to-day has come as a very welcome change. The Chancellor of the Exchequer and the Secretary to the Treasury maintained that their action in going forward with this Vote in the form they did was an absolutely normal and regular thing, for which there was no occasion to apologise, and they declared that there was nothing exceptional about it. Does not the Secretary to the Treasury now think it would have been better if he had qualified that speech? It would have been a little more informing on his part if he had told us that this was an entirely exceptional Vote, which would have to be regularised by legislation hereafter. When he was challenged as to whether legislation would not be necessary next Session, he made absolutely no reply. He did not even say he would consult his colleagues about it, but scouted the whole idea. It is gratifying that the Prime Minister has admitted that this is an entirely exceptional Vote, and that next Session legislation will have to be brought in to regularise the proceeding. I desire to call attention to a passage in Sir Erskine May's book, in which he defines the objects and purposes of an Appropriation Bill. He says:—
No grant of Supply is effected by the Bill; its provisions are solely administrative; the sole object of the Bill is to ensure the application of the Grants made by Parliament to the objects defined by the Resolutions of the Committee of Supply.It is now admitted that Grants of this sort in violation of a Statute cannot properly be made without legislation, except as mere temporary expedients, which have to be regularised hereafter by legislation. If this Vote had been allowed to go unchallenged, and the Appropriation Bill had been passed in this form without any protest, this House would have created a most dangerous precedent. The thanks of this House are due, in the interests of financial regularity and purity, to the hon. and learned Member for North-East Cork, who introduced this subject on more than one occasion, and who has elicited from 1012 the Prime Minister a most important statement as to the practice of this House.
§ Mr. PRINGLEThe Leader of the Opposition has stated that everybody understood what was intended by the hon. and learned Gentleman the Member for North-East Cork on Friday, and that the point which the hon. and learned Member raised was subsequently developed and amplified in the speeches he made last night and this afternoon. In these circumstances it is strange that the hon. and learned Gentleman who has just spoken did not so understand the hon. and learned Member for North-East Cork on Friday, because if he will look at his speech made in the Debate on Friday, the hon. and learned Member for York (Mr. Butcher) will see that, in addition to this Grant to the doctors, he made another demand upon the Chancellor of the Exchequer. He asked not only that £1,800,000 should be given for extra medical benefits, but that there should be an additional Grant for the benefit of men over sixty-five years of age who were not provided with medical benefit under the Act.
§ Mr. BUTCHERI never referred to this question at all, because I regarded it as disposed of. I suggested that there should be some medical benefits given to old men over sixty-five who were not insured.
§ Mr. PRINGLEI do not know in what way the hon. and learned Gentleman thought the question was disposed of.
§ Mr. BUTCHERBy a very rude answer on the part of the Chancellor of the Exchequer.
§ Mr. PRINGLEThat is a reply which is worthy of a Chancery barrister. The hon. and learned Gentleman has said that he thought the question was disposed of by a rude reply from the Chancellor of the Exchequer. If he thought it was disposed of, it could only have been by a full and conclusive answer, otherwise it would have been open to the hon. and learned Gentleman to pursue it further.
§ Mr. SPEAKERThe hon. Gentleman is not entitled to interpose with questions in an argument; he should await his proper turn.
§ Mr. PRINGLEI think the hon. Gentleman (Mr. Peto) was intervening for the 1013 protection of the hon. and learned Member for York with another red-herring. Returning to the position of the Opposition in this matter, it is evident that the hon. and learned Member for York, who is one of the most acute Gentlemen sitting opposite, either did not appreciate the point raised by the hon. and learned Member for North-East Cork or that he thought that the Chancellor of the Exchequer had completely disposed of that point by his speech on Friday, because subsequently to the Chancellor of the Exchequer's reply, the hon. and learned Member for York invited the Chancellor of the Exchequer to do exactly the same thing again, and to make a further Grant in the teeth of the National Insurance Act, because there is no provision in that Act for any Grant for medical benefit for men ever sixty-five years of age. The hon. and learned Gentleman holding, as he now does, that the Chancellor of the Exchequer was committing a gross constitutional outrage, rose and invited him to commit a further constitutional outrage. The express question was raised by the Chairman whether it would be in order to do that in a Supplementary Estimate, and the hon. and learned Gentleman said that it could be done. He said:—
No legislation is necessary."—[OFPICIAT. REPORT, 7th February, col. 339.]5.0 P.M.That was the extra 2s. 6d., which is a further constitutional outrage. In these circumstances, I think we are entitled to claim that the Opposition all along have not appreciated this point, and that it is only due to the acuteness and ingenuity of the hon. and learned Member for North-East Cork that we have secured this point. I frankly admit that I am glad he has succeeded in making this point, because I think everyone who wishes to see these matters regularised must be glad that one who is possessed of the erudition of the hon. and learned Gentleman should put that erudition at the service of the House, and so maintain its traditions for financial regularity.
§ Mr. CASSELI do not think it is really necessary to reply at length to the speech we have just heard. If all that the hon. Member wishes to do is to pay a tribute to the hon. and learned Gentleman for having called attention to the point and having successfully established that an irregularity was being practised, all Members of the Opposition will join with him in saying that the credit for that rests with the hon. and learned Gentleman. I will 1014 not say there are not Members on this side of the House who had not seen that there was this irregularity, but the merit of having pointed it out and of having shown conclusively to the occupants of the Government Bench that they were bound to accede to his argument rests with the hon. and learned Gentleman. If the hon. Member thinks he has made any score off the Opposition for having stated that, he is as welcome to it as he is to the taunt and sneer which he threw out against a member of his own profession. I will leave the hon. Member with that and come to certain important matters which arise with regard to the merits of this Grant. This is a Grant-in-Aid of 2s. 6d., intended as an addition to the 6s. originally contemplated for medical benefits, and in considering whether we ought to oppose the Bill under which that Grant is to be made we are bound to look at the conditions which the Government, through the insurance committees, is making with the doctors. At Question time to-day I raised a point of very great general importance, and that is whether the result of keeping these records in the form in which the doctors are required to keep them is not to have, in two Government offices, a complete record, which can be identified, of the diseases from which every insured person in the Kingdom is suffering. I agree that the result of the forms is that you have a record in two offices instead of one, but I think, by comparing the documents in the two offices, you are able to identify the persons and to say for certain what are the diseases from which they are suffering. I think the Government themselves recognise that it is undesirable that that should be the case.
For instance, in a Court of Law, if you call for the production of the documents in the two offices, you could perfectly well establish what particular disease, even if only a cold or a minor disease, any workman in the country suffers from. The Government have issued to the doctors a form of day-book, in which there is perforation, and one part, I understand, goes to the Insurance Commission and the other to the insurance committee. The Insurance Commission keeps a record of the diseases, and the insurance committee gets a record of the names of the persons who are suffering from the diseases. If you put the two documents together it is perfectly easy to take any doctor's records for a month and to identify the persons. You could do it from the numbers on the pages of the day-book, and by comparing the 1015 total of the number of attendances and visits with the total number of attendances and visits in each of the two columns you could perfectly well fit these two things together in such a way that you could identify them. Supposing in future, in a case which arises in a Court of Law, the production is asked for of documents which have been sent in to both these offices by particular doctors would privilege be claimed in the same way as it is claimed in the case of the Income Tax? That is a very grave and important question, because to have everyone's disease recorded in a public office in such a form that it can be established is, I think, something which this House did not intend to give its assent to, and I do not think the Government themselves intended to do it. It should be possible to alter the way in which the forms are kept so that this would be impossible, and I invite the right hon. Gentleman and the Insurance Commissioners to see whether sonic method cannot be devised under which this undesirable result does not follow. I observe, moreover, that when the right hon. Gentleman wants to refer to the fact as to whether a person is suffering from a particular disease, or when it commences, he does not seem to have the least difficulty, and the chairmen of insurance committees who have spoken in this House have admitted as much. The hon. Member (Mr. Glyn-Jones) said that from these records he had been able in a certain case to obtain them.
§ Mr. MASTERMANWill the hon. Member give me an example of this particular charge? I do not understand it.
§ Mr. CASSELI think it was in the Enfield case where the complete diagnosis of a disease was stated in this House.
§ Mr. GLYN-JONESAll I was able to say from the records was the number of visits which have been paid by the doctor to the patient arid the number of times the patient had been to the house. What I said about diagnosis came from the report of the inquest.
§ Mr. CASSELThe hon. Member told us on Friday that the doctor at first had not been able to diagnose what form of tuberculosis it was.
§ Mr. GLYN-JONESThat information I got from the coroner's depositions taken at the inquest.
§ Mr. CASSELI understood the hon. Member to be giving us the facts from the record. If he did not do that, I withdraw what I said in regard to that case.
§ Mr. MASTERMANThere is a withdrawal due to me also, because there is rather a serious charge.
§ Mr. CASSELSo far as the right hon. Gentleman is concerned, he has produced all the details with regard to certain cases of tuberculosis in the House.
§ Mr. MASTERMANReally, if this went out that I was giving in the House of Commons the result of these records, it would be disastrous in connection with the Insurance Act. I have never given any information from any doctor's records in connection with this matter at all, and under these circumstances, as the hon. and learned Gentleman cannot give an example, I will ask him to be good enough to withdraw the statement.
§ Mr. CASSELThe cases I had in mind were certain cases which had been given with regard to persons suffering from tuberculosis.
§ Mr. CHARLES DUNCANSanatorium benefit.
§ Mr. CASSELAs far as sanatorium treatment is concerned, full details have been stated. I quite agree that where a case has already been raised by a Member of the House, the right hon. Gentleman is justified in making a reply to it.
§ Mr. MASTERMANOn my assertion that no kind of information has ever been given to this House in any way in connection with the official record, will the hon. Gentleman then be good enough to withdraw the statement?
§ Mr. CASSELIf the right hon. Gentleman gives me an assurance that he has not made any statement in the House on the official records I certainly accept it. I did not desire to make any charge against him, but what I maintain is that it is perfectly possible to obtain full details from these records. I want him to tell us whether he will so alter it that in future it will not be possible to do so, and I should like him to tell us whether they will claim privilege for the production in a Court of Law of these records which are identifiable. I think it is a point to which the public will attach very great importance, whether it be in one Government office or in two, that the records of the disease from 1017 which every person is suffering remains recorded for all time.
Let me pass from that to another point in connection with sanatorium benefit. The Government are now giving 6d. to the doctors for each person who is undergoing some domiciliary treatment, and that will be paid out of the 1s. 3d. which is paid to the insurance committee for administering that particular benefit. That only leaves 9d. a head for sanatorium treatment, apart from the payments made to the doctors, and that will be wholly insufficient for giving the benefit which has been promised under the Act.
§ Mr. MASTERMANOn a point of Order. There is no provision in the Supplementary Estimate for 9d. for sanatorium benefit at all or for anything connected with sanatorium benefit. I am always willing to give answers if it is in order, but I am sure the hon. and learned Gentleman is out of order.
§ Mr. CASSELOn the point of Order. This Estimate is in order to enable the contract which has been made with the doctors to be carried out. The schedule to the contract provides that the doctor must undertake domiciliary treatment. of insured persons recommended for sanatorium benefits.
Arid it shall be undertaken by the practitioners by whom they are attended. For that purpose the practitioners shall receive remuneration out of a fund equivalent to a sum of per annum in respect of each person entitled to receive treatment from them.We are considering whether 2s. 6d. extra shall be paid for medical attendance, and in considering whether we ought to give our sanction to that,, we are bound to consider whether the form of contract which every doctor is asked to sign is such a form of contract as will lead to the proper administration of the Act.
§ Mr. SPEAKERThe arrangements with respect to sanatorium benefits have been made already, is not that so?
§ Mr. CASSELUnder the contracts which are now being made with the doctors there is a provision that they shall receive 6d. That provision is made for the first time in the very contracts which are under consideration.
§ Mr. MASTERMANThe point arose in Committee, and I had to take the same point of Order. The money set apart for sanatorium benefit in the Act includes sanatorium benefit, domiciliary and institutional. That money is paid to the doctors. It has nothing whatever to do 1018 with this extra Grant of half-a-crown for medical benefit or for sanatorium benefit, and no farthing of this money goes to sanatorium benefit.
§ Mr. CASSELI put the point because the money is asked in order to implement these contracts made with the doctors. Therefore, I submit we are entitled to consider whether these are proper contracts to enter into, having regard to the fact that you are taking away 6d. which was intended for sanatorium benefit.
§ Mr. SPEAKERThere is nothing for sanatorium benefit in the Supplementary Estimate.
§ Mr. CASSELI wish to ask information on another point, and that is in connection with persons who move from place to place—casual labourers, or persons who reside in one place and carry on their business in another. Supposing a person resides outside London and works in London—[An HON. MEMBER: "A waiter."] Yes, a waiter, for example; he may reside in the suburbs and carry on his work in London. Supposing he falls ill where he carries on his business, how does he get his medical benefit? I raised this point while the Bill was under consideration, and the Chancellor of the Exchequer dismissed it with a wave of his hand, stating that it was a minor detail which need not be considered when dealing with an Act of Parliament. In fact, he seemed to indicate that it was absurd on my part to have raised the point. We have now to consider it in connection with the working of the Act. Take those persons who are continually travelling, and who may be only a week, or a fortnight, or a month in one place at a time. Let us assume that an insured person in that position has put himself on the books of the doctor where he resides, but he has an accident where he is actually at work. What doctor does he go to? I will assume that he calls in the medical practitioner who is as near as possible to the place where the accident happens. That practitioner says to him, "I will treat you if you pay me my ordinary fees as an ordinary patient." He cannot call upon that doctor to treat him under the Act if he is not on his list. If he has to pay for treatment, can he recover insurance money from the Commissioners? I think that is a point on which many people are in considerable anxiety and wish to be enlightened as to the real position. I hope the right hon. Gentleman will not consider 1019 it a minor and unimportant detail, for I can assure him that it is a matter which vitally affects thousands of people in this country.
Another question arises with respect to insurance committees and special arrangements. Insurance committees at present are all constituted illegally. When I say illegally I mean that they are only constituted under the power conferred upon the Commissioners under Section 78 of the Act. I think the right hon. Gentleman will agree with me that they are not constituted as provided for under the Act. They are at present the nominees of the Insurance Commissioners. I should like to ask what steps are being taken to get these committees regularly constituted. It seems to me to be very important that these committees should be left a little more discretion themselves. I think the Chancellor of the Exchequer and the Financial Secretary to the Treasury are taking upon them authority which they never were intended to possess. The insurance committees were intended to exercise their discretion as to whether they would allow special arrangements as they thought fit, and not according to orders given them from headquarters. In connection with these special arrangements certain insurance committees are throwing difficulties in the way of an insured person obtaining the rights which Parliament in tended them to have. I could give the right hon. Gentleman a whole sheaf of cases where persons from childhood have been attended by a doctor who knows their constitution; they have faith in him, and they wish to continue with that doctor. That doctor has not gone on the panel, and insurance committees are not allowing the insured persons to make arrangements to go to that doctor and to have their proper share of the contribution. That is a very important matter to a very large number of people. I think this action on the part of the insurance committees is largely owing to the attitude taken up by the Chancellor of the Exchequer. The insurance Committees are taking a line, which they would not take if they were really representative of the insured persons rather than, as at present, of the Insurance Commissioners, and if they were allowed a little more latitude, and on the contrary, I believe they would be ready to allow these arrangements to be made.
I will state what happened in my own case. I was anxious that my servants 1020 should continue with the doctor they have always had, and who is my own doctor. I should have been perfectly willing to pay any difference between the contribution they received and the doctor's charges, whatever they might be. I would sooner that they had my doctor than any panel doctor. On my advice they all wrote to the London Insurance Committee. [Laughter.] Hon. Gentlemen opposite seem to consider that as a matter for merriment. The servants wanted to be allowed to make their own arrangements which, under the circumstances, I thought was the best thing for them. They wrote three weeks ago, and none of them have received the courtesy of a reply. I should have thought in a case of that kind it was intended by the provision in the Act that they should have been able to go to a doctor not on the panel and to receive their contribution. I hope the right hon. Gentleman will take steps to disabuse the insurance committees of the idea that this Section is not to be exercised in such cases. I cannot help thinking this is part of the policy to force doctors on to the panel. The Government are sacrificing the insured for the purpose of forcing doctors to go on the panel. It is done simply in order that the panel doctors may get these cases. I say that the way in which the doctors have been treated by the Government in this matter is simply scandalous. They have been bullied in a way and, treated in a manner in which no great learned profession ought to be treated. Threats have been levelled against them by the Government that they would do things which, in my judgment, they have no power to do. The interests of the insured themselves have been sacrificed with the same object. The doctors are resisting from perfectly legitimate motives. They are entitled, whether right or wrong, to carry on their professional work in the way they think best in the interests of their patients. They do not, complain now of the remuneration paid to them, but they think it is in the interest of their profession and in the interest of the patients that they should be free from lay control. They think they should not be bound to give so much of their time as they are required to do in making out all those records, and filling up all those forms which are quite unnecessary.
You go to this great profession and say, "unless you enter into arid accept a particular form of contract, verbatim et 1021 literatim, unless you agree to take the patients you accept and also a portion of the residue of those no other doctor will take, unless you agree to keep your books in the precise form sent to you, write your prescriptions in the way indicated in the forms sent to you, and make them out in triplicate, we shall see that the business goes to others." That is practically what the Government say to them. I quite admit that some of the requirements, from the Government point of view, may not be unreasonable for them to put forward, but it is inconsistent with any sentiment of liberty that a great profession should be treated in the way they are treated by the Government, and that they should have threats levelled against them. We find approved societies refusing to accept certificates of doctors who are not on the panel. I have a letter here from the secretary to the Order of Foresters written to a member of the lodge, in which he says:—
I cannot pay your husband's insurance sick pay unless I get a proper health insurance certificate front a doctor who is on the panel. I dare not do it.That is to say, if a certificate were given by Sir Frederick Treves, Professor Cheyne, or any of the greatest physicians in the Kingdom, who do not choose to go on the panel, even that would not be accepted as sufficient for paying sick benefit. [HON. MEMBERS: "Hear, hear."] I observe that hon. Members below the Gangway cheer that statement, and approve of that way of dealing with the matter. I understand that they will use their influence with the societies with which they are connected in favour of that course being followed. I say that is treating the doctors in a way it was never intended they should be treated. It is practically saying to them that sinless they come on the panel you are going to do all in your power to prevent them from carrying on their business or earning a livelihood at all. I think some explanation is necessary in regard to this matter. I should like the right hon. Gentleman to say whether that course of action on the part of approved societies in refusing to accept the certificate of a doctor who is not on the panel meets with the approval of the Insurance Commissioners. I think if the right hon. Gentleman gave us an authoritative statement on that matter it would help very largely to set it at rest one way or the other. Some societies seem to be bonâ fide under the impression that they are not entitled to accept any certificate except that of a doctor on the panel. I have raised these points for the 1022 purpose of settling some difficulties which have arisen in actual practice, and which affect a very large number of people.
§ Mr. WEDGWOODI do not propose to join in the criticism of the Insurance Act in which the hon. and learned Member has indulged. Whatever shortcomings there may be in the working of the Act in its early days, we ought on both sides of the House to be sincerely grateful to the right hon. Gentleman who has been conducting the Act for the Government in this House. No Minister whom I have come across is more open to receive advice or to give help wherever asked, and it is a great pity that for purely partisan purposes he has been day after day for the last year and a half made the object of attack for every little detail that has gone wrong in the working of the Act. Details are bound to go wrong in the early stages of its working, and it is only experience that can put them right. I do not think the right hon. Gentleman or his Department can be blamed for want of receptivity in the matter. They have an extremely difficult task to perform, and everyone who has had practical experience of working on the insurance committees in the country, or who is trying to solve the problems put before him by his Constituents, can say that the Department in very difficult circumstances, working an entirely new branch of Government work, have carried out their duties under the Insurance Act as satisfactorily as anyone could ever expect they would have done. I do not want to deal with the Insurance Act or with that portion of the Appropriation Bill, but I wish to call the attention of heads of various Departments to some items of which we complain, with a view to a possible future remedy of defects and, to a certain extent, of extravagance.
The first point is in connection with the printing and sales of Government publications. On page 7 of the Supplementary Estimate additional money is voted for printing Government publications, and in a per contra account there is profit on sales made. I feel certain that this part of the work of the Government Stationery Department is not carried out on the most businesslike lines. When a Blue Book is published the Stationery Department estimate the number of copies that will be sold, and the cost of printing the Blue Book. Then they divide the cost of printing by the number of copies they think they will sell, and the quotient is the price 1023 charged for the Blue Book. But in many cases there is a very large demand which they did not anticipate, and the very method of estimating the price of these Blue Books is one which tends to restrict the circulation of Government information. I would say it is advisable to sell these Blue Books below cost price and let them get through the country into people's hands so that people may see the information collected with so much trouble and expense by Government Departments. The expense of printing a Blue Book is a mere flea bite compared with the expense of holding a Departmental Committee, and still more a Royal Commission. There are certain Reports of Committees, and there is evidence taken before Committees, as for instance the Committee now sitting on Imperial and Local Taxation, for which there is an abnormal demand, but it is almost impossible for the ordinary man to buy these reports owing to the prices put upon them by the Stationery Department. If the price was lower, the sale would be far greater, and in many cases by merely reducing the price of those publications a wide sale would be got and higher profits earned for the Stationery Department. Coming to the Public Record Office, the Government, I think quite rightly, appointed a Royal Commission to go into the question. The Commission issued its first report—
§ Mr. MASTERMANI am sorry to raise a point of Order after the introductory words of the hon. Member's speech, but my duty to the House compels me to point out that there is no Vote in this for anything connected with the Public Record Office.
§ Mr. SPEAKERIf that is SO—and I am bound to assume that the right hon. Gentleman knows for what purposes this money is required—the hon. Member would not be entitled to go into it.
§ Mr. WEDGWOODI think the right hon. Gentleman is probably incorrectly informed in this matter. The Public Record Office of course do sell those publications, patent rolls, close rolls, and a great many other publications, at what I consider to be the exorbitant price of 15s.
§ Mr. SPEAKERThe right hon. Gentleman has just said that those publications are not publications referred to in this Estimate for which the money is required.
§ Mr. WEDGWOODThey must be. I will pass from that point, but I will raise 1024 it on the Adjournment or on some more suitable occasion later on. The next point to which I wish to refer is in connection with the Vote for Office of Works and Public Buildings, Class 2 on page 8 of the Supplementary Estimates. There we are voting an additional £600 for incidental expenses. We are merely told that the original provision has proved insufficient, and that a Supplementary Vote of £600 is required. I know one of the additional reasons why this Vote is required was in connection with the evidence taken by the Estimates Committee this year. The Estimates Committee went into the question of the expenditure of the Office of Works and Public Buildings, and took very valuable evidence. The Report has been published, but I do not think it possible for this House to get full value for the work of the Estimates Committee any more than it is possible for them to get full value for the work of the Public Accounts Committee unless there is on the Report of those Committees a full debate in order to bring before the attention of the Members of the Ministry and the offices of the Minister particularly concerned the shortcomings of any sort of the office for which he is concerned. The hon. Baronet the Member for Swansea and the hon. Baronet the Member for the City of London, sat on that Committee day after day for about four months. A great deal of valuable work is embodied in their report, and I submit that if there is an additional charge upon the Office of Works to take up the time of Members of this House in that way is a waste of public money, unless at the same time we have a debate on the subject and some general improvement in the methods.
§ Mr. SPEAKERI think that that is rather too far-fetched to appeal to me.
§ Mr. WEDGWOODPerhaps I may refer to the question of the Public Trustee which is raised on page 12. We are voting an additional sum of £1,000 a year for salaries in connection with the investments of the funds by the Trustee. I have personally so much confidence in the Public Trustee that I have made him my own trustee. But I do think that in the interests of the credit of the country it is necessary that some sort of check should be kept by the Treasury over the investments of the enormous funds which the Public Trustee has now in his control, and which will undoubtedly grow very rapidly as the years go on, and as people become 1025 accustomed to using the Public Trustee as the best possible trustee for all wills and settlements. The Public Trustee has a very wide range of security in which he can invest, and I would not for one moment suggest any restriction in the range of securities, but I do think we should look ahead a little and consider whether there ought not to be some careful supervision by Treasury officials of the manner in which those sums are invested. They have at the Treasury various clerks, who superintend each particular spending Department, whose business it is to cut down expenditure and to see that there is no waste going on in that spending Department. We submit that this public trustee business is growing to such an extent that it would be well if there were in the Treasury some official whose business it should be to supervise the investment of this money. I do not want to suggest at this moment that the Public Trustee is not in a position to invest these great sums of money, but I do think that public confidence in the office and in the finance of the Public Trustee would be increased, and ought to be increased, by the appointment of some such official at the Treasury as will act as a sort of check or guarantee of good faith for the benefit of the public.
As this business of the Public Trustee has grown to this extent, so that year by year we have increased Estimates and increased Supplementary Estimates as well, which pay for themselves—because they come out of the fees, as the business is self-supporting—I think that the Government should consider the extension of the principle to Scotland as well as to England. I desire now to refer to the question of Somaliland. On page 15 we have the Supplemental Estimates for the Colonial Office. We ought to congratulate the Minister in charge of the Colonies on the very small Supplemental Estimate that there is this year for the Colonies. We have been accustomed to having Supplemental Grants-in-Aid on a very large scale for African Colonies. We have been accustomed to having little wars and expeditions, the Estimates for which did not work out, and to putting our hands in our pockets in the month of February in order to finance gross extravagances very often on the part of our Colonial administration. But in recent years there is a welcome reduction on the amount demanded from this country for the upkeep of our great possessions over the seas. The only item of this year is the Somaliland Grant. I think it is important that we 1026 should consider whether this Grant is advisable and whether the Colonial Office should not be urged to see that in future Somaliland becomes like our other Equatorial posssessions, a self-supporting item. Everyone knows that we have tried a variety of policies in Somaliland. We have annexed the whole country, we have cleared out of the country, we have had wars, and we have gone backwards and forwards, shilly-shallying, though I think the shilly-shallying occurred more under the Foreign Office, and has not been so great recently under the Colonial Office. About eighteen months ago we left our advanced positions in Somali, after due consideration, and we definitely said that it was not worth while spending British money on defending these arid wastes in the hinterland of Somaliland. We went back to the coast towns, and there was a considerable attack made on that policy, principally by the hon. and gallant Gentleman opposite, and some others. They made, I think, a very good case out, that in the interests of protecting the native tribes who had trusted themselves to our control, who had been called "friendlies," and who had thereby incurred the wrath and vengeance of the mad Mullah, we were wrong in deserting them.
A good case could be made out either way. We took friendlies with us, in retiring, who wished to come; we supplied others with guns to fight their enemies; and I think the Government, in the circumstances, were justified in retiring from those advanced posts. What is the change which has now led to this enormous increase of expenditure? Are we again going back to the waste spots of Somaliland, to protect friendlies from the mad Mullah, and to arm friendlies, with the result that fresh tribal wars may be started? What is the object of this fresh expenditure? It does seem to me that we ought to be more definite in our policy, whether it be the Colonial Office or the Foreign Office which is in charge of this particular policy. The House ought to be informed, where a change of policy is to take place, on what grounds it has to take place; and we ought to know whether we may expect to spend these large sums of money on these desert Colonies or whether we should spend them in colonising our own country. And it is to colonising our own country that I wish to turn my attention. I should like to say one or two words on the Votes for additional assistance to fisheries and agriculture in this country. I do not say a single 1027 word of criticism as to the additional money provided for fisheries. I think the money that has been spent on steam motor boats for trawlers is an admirable departure on the part of the President of the Board of Agriculture—one that will probably revivify the fishing industry as well as supply us with cheap fish. I do not see that there is any possibility in the circumstances of the money found by the taxpayer going into the pockets of any vested interests. I think that the money is well spent, and probably has already led to a great extension of the fishing industry. I would only offer this hint of criticism, and that is to suggest that all fisheries and all fishing districts should be treated alike in this matter—that there should be no special preference for the Scotch fisheries, and that the Northumberland and South Coast fisheries should also receive assistance in the way of motor boats to get the trawlers to sea and to get their cargoes landed.
It would be most undesirable if those valuable aids to one of our oldest industries were to cause jealousy between the various districts of the country. I think that those Members who are interested in the fishing districts ought to see that their parts of the country get their fair share of the money given to assist the-fishing industry. I want to criticise the action of the President of the Board of Agriculture in spending so much money on subsidising agriculture. I maintain that all industries in this country should stand on their own legs, and that none should be favoured above any other. My Constituents, and the constituents of all hon. Members, are interested in getting assistance for their own particular industries. They all like special legislation, they all like assistance for co-operation, and they all like that assistance should be provided for agriculture. Last year there was a Grant for breeding light horses, and there has been a Grant for the breeding of heavy horses, and these Grants, I think, could be far more valuably employed in horse breeding, which seems to me the worst side of agricultural development. The hon. Member for the Wilton Division (Mr. C. Bathurst) has ably expounded to this House that the tendency of agriculture in recent years is to get away from large grazing and pasture lands and to get back to the use of the plough and intensive cultivation. But here you are devoting money to a further development of the great grazing farms, a form of agri 1028 culture which is certainly out of date, which employs very few hands upon the land, and which is thereby just that kind of agriculture which leads to overcrowding of the towns and lamentable increase of emigration to Australia and elsewhere. I have no doubt that the President of the Board of Agriculture in devoting money to co-operation and education feels that he is thereby laying the foundation of and developing that side of agriculture which it is perhaps more advisable to develop than any other, and that is the cultivation of small farms—intensive cultivation, French gardening, and all that form of agriculture. I partly agree with him—
§ Mr. SPEAKERThe hon. Member must keep to the question before the House. I have already twice told the hon. Gentleman to do so.
§ Mr. WEDGWOODI was referring to the £7,500 for assistance to intensive agriculture, co-operation and education.
§ Mr. SPEAKERA general discussion of intensive cultivation would not be in order.
§ Mr. WEDGWOODWhat I want to suggest with regard to particular agriculture is that it is a pity to spend this money on the development of co-operation or any form of small cultivation in agriculture unless you have got your foundation upon which to build; that the important thing is to first of all get the people upon the land whom you are going to educate—
§ Mr. SPEAKERThat has nothing whatever to do with this matter. I must ask the hon. Gentleman to resume his seat for continued irrelevance.
§ Mr. MASTERMANAs I understand there are Members in the House who wish me to deal with the subject for which I am directly responsible in connection with the work of my right hon. Friend, and I think it will be for the general convenience if I deal at this moment with the special subject connected with my own Department of the Treasury, and with the insurance question as well.
§ Mr. G. LOCKER-LAMPSONMay I be allowed to ask one question before the right hon. Gentleman proceeds?
§ Mr. HAMERSLEYI have also a question to ask.
§ Mr. MASTERMANI have begun my speech, and I am afraid I cannot give way. Perhaps on the Third Reading of the Appropriation Bill, or on the Motion for the 1029 Adjournment, hon. Members can raise any practical points, but so far, in dealing with the insurance questions, I am in order. I may say one word as a kind of personal explanation in regard to the Debate on the general question of these Grants-in-Aid, at the beginning of to-day's discussion, in which I interrupted the right hon. Gentleman opposite in order to make a personal explanation which I do not think was quite clear. What I wanted to say was this, in justice to the Chancellor of the Exchequer as well as to myself: There was a long discussion on a technical point of procedure in connection with this Grant-in-Aid last Friday. The special point as to possible future legislation was never put then, either by any Gentleman on the Front bench, or later on by the hon. Member for North-East Cork (Mr. T. M. Healy). The Member for North-East Cork last night indulged in a very lengthy speech, and a kind of broth of invective against myself and the Chancellor of the Exchequer, and we certainly never understood that the particular point of discussion this afternoon was put by him, and the first opportunity for replying on that particular point arose when the right hon. Member for East Worcestershire (Mr. Austen Chamberlain) put it and was replied to by the Prime Minister this afternoon. I want to make it clear that there was never any suggestion by the Government of not giving an answer to a specific question, nor has the policy of the Government in the least degree varied during the course of the discussion on the Supplementary Estimates. We believe we were right, in the circumstances, in taking the Grant in the form of a Grant-in-Aid, and we never suggested that there should be a permanent Vote year by year, or a Grant-in-Aid under the Insurance Act to the extent of £2,000,000. If we had been asked: Do you intend later on at the proper time to produce legislation embodying the provision of this Grant within the Insurance Act itself, I should have given an affirmative answer to that effect.
6.0 P.M.
As to the specific point raised by the hon. and learned Gentleman the Member for West St. Pancras (Mr. Cassel) I am very sorry that he considered it his duty this afternoon to instil into the minds of those who will read his speech the idea that the medical records demanded in connection with the Insurance Act are demanded under such conditions that publicity may be given to the particular diseases of particular individuals. I believe that suggestion if it were spread about would have a 1030 profoundly adverse influence upon the working of the Act. It would not only be a violation of specific and definite promises made when the Act was passed, but it would be a violation of specific and definite promises made by me again and again from the Front Bench in the administration of the Act. In face of those promises, the hon. and learned Gentleman rises in the House and announces that I have given, from medical records sent in to the Insurance Commissioners, statements as to the diseases of insured persons. It is true the hon. and learned Gentleman withdrew the statement when convinced that it was not so, but he did not so very graciously, and, perhaps, he will be more emphatic in his withdrawal when I tell him that not one single one of those records has reached the Insurance Commissioners, so that even if he wanted to obtain the information as to the specific diseases of specific persons, we could not do so as there is no record in the Insurance Commission by which I could obtain it, and no doctor has sent it in. "Oh," but he says, that "if the second part sent to the insurance committee was collated with the part sent to the Insurance Commission, then," in spite of the promise we made that no attempt would be made to do so, "it might be possible to find out from the two parts collated together the disease on one form attributable to an insured person on another form." I state definitely that even if that were desired it would be absolutely impossible to produce that result. There are at present 300,000 of these medical tables in operation. The medical daybooks consist of twenty sheets apiece, and the particulars are on the forms which are sent in with the record of the disease for something like thirty persons. In order to produce the result which the hon. and learned Gentleman suggests, out of 300,000 forms sent in, you would have to collate one number with one sheet, and you would have to hunt through the sheets in order to find a possibility against which you have 300,000 chances to one. I should have thought if that was ever to be done in any single case we would want a Grant-in-Aid of more than £2,000,000 for a clerical staff to do it in the one solitary case. The forms which are now issued do not contain that number at all. The portion of the form which is sent in for statistical purposes to the insurance committee which shows the list of the diseases, has no number at all upon it. Those are 1031 all sent in, and I know of no kind of ingenuity, human or otherwise, with those sheets sent in to the extent of 300,000 of records of diseases, by which that record could be collated with the lists which are necessary for the insurance committees.
§ Mr. CASSELI assumed there were numbers on the forms. The right hon. Gentleman says the numbers are dropped. If the numbers are there, and the name of the doctor sent in is known, is it not possible, then, that they could be collated? I do not wish to suggest that that would be done intentionally, and I certainly did not wish to do so. What I wished to suggest was, assuming production were asked in a Court of law, would privilege apply?
§ Mr. MASTERMANI submit, even with the numbers and the names, there are 300,000 chances to one against striking the right number on one sheet with the right number on the other sheet; but with no numbers at all, the chances against it are just about the chances of the number of insured persons, that is about 14,000,000 persons. In any case, I think it is unfortunate, after the definite statements made both as to the nature of the forms and as to the policy, that any suggestion should be made that through the Insurance Act the private nature of diseases of persons should at some future time be able to be brought out against them. It has been stated outside, but this was the first time I think I heard it stated in this House. The next point raised by the hon. and learned Gentleman was the question of medical benefit for those who move from place to place. The question is a perfectly simple one in connection with movement of residence. As I have replied over and over again, full arrangements are made with the local insurance committee for dealing with changes of residence, even if those changes are of a temporary character. So long as notice is given to the insurance committee into whose district the insured person is moving the risk of medical attendance for him will be taken by the committee into whose district he is moving so long as he is in that district, and the portion of the amount that is paid for medical attendance will be credited in proportion to the risks which are taken by the different insurance committees in whose areas he may be in residence from time to time.
The hon. and learned Gentleman put another point which up to now has 1032 never been met by trade anions and friendly societies in connection with the normal system of industrial insurance. He says, supposing a man works in any place and lives in another place, and changes from day to day, or during the day, how can he be sure, suppose for instance he comes into the City of London and lives, say, at Enfield, if he is taken ill in London that he will be able to obtain a free doctor, having already chosen an Enfield doctor on the panel? I agree that is a position of great difficulty, but I do tot think it is insuperable. That has neven been done by the friendly societies. The man in the friendly society chooses the doctor of his residence, and has to go to the doctor of the district in which he lives, the friendly society doctor. But it is perfectly possible, if this becomes a real case which it is necessary to meet, for the insurance committees of ally area to make arrangements in order to meet such cases. It is perfectly possible for them to distribute the payment given to the doctors in different areas in which men are part of the time in one area, and part of the time in another, in proportion to the risks taken by the different bodies, so that there may be a doctor taking the risk for the man in the district where the man works in proportion to the amount of the year in which he is at that particular place, and another doctor taking the risk of medical attendance in the district in which the man resides. I am not sure that that could be done in all cases, but it is certainly a possibility before the insurance committee where this transformation takes place on anything like a large scale.
It is perfectly possible again, if you have a district like the London Insurance Committee where a large number of persons are in the city during a certain number of hours in their day's work, for the London Insurance Committee, in agreement with the panel doctors in London, to agree that special amount shall be paid to doctors with surgeries in the City of London specially to meet the cases which may arise during the hours of a man's work in the city. That could be done by arrangement between the panel doctor and the insurance committee. On the other hand, it is well for me to point out the policy which has been adopted by the hospitals in this country. After all in nine cases out of ten sudden cases which demand medical attendance, or accident cases under the conditions of a man's work, are cases which go to hospital, and for 1033 which the public subscribe to hospitals. In all the policy which has been adopted by the hospitals they always openly declared as an integral part of their policy that under no circumstances will they refuse treatment to an insured person when any ease of urgency is shown. I think under those three possibilities insured persons who happen to get those urgency cases of illness during hours of work will have no difficulty in getting the attendance they desire. The next point the hon. and learned Gentleman made was as to the question of the constitution of the insurance committees. He said they were illegal; he explained afterwards what he meant. Of course they are just as legal as any other part of the Act, and constituted under the Act as completely as any other part of the Act. He stated that the only legal insurance committees which could be constituted were committees elected by the insured person. That, of course, is not the Act. The Act, in Section 59, lays down conditions under which committees should be constituted. In no place does it state that the committee shall be elected by the insured person; the only statement regarding election is that two members of the committee shall be elected in manner provided by the Commissioners to represent the medical practitioners in any area, and the election on those committees of medical practitioners is proceeding at the present time, and will be completed in a very few days. What is stated in connection with the insurance committees is that three-fifths shall be appointed in the manner prescribed by the Commissioners so as to secure representation of the insured person resident in the district which the committee supervise.
The hon. and learned Gentleman is perfectly incorrect when he states that those committees are the result of casual or chance appointment by the Commissioners of certain persons whom they have selected to represent insured persons. What the Commissioners have done has been to ask all the societies and trade unions of insured persons in the districts to appoint men who may rightly represent them in those districts, and it is those men who have been appointed by the Commissioners, and no casual or chance selection by the Commissioners themselves. The hon. and learned Gentleman asks when the fully constituted insurance committees will be arranged for. I hope the medical members will be appointed in a very few 1034 days. They would have been appointed long ago but for the policy adopted, for better or for worse, by the British Medical Association last summer, and encouraged, I am sorry to say, by men who could expect no public interest to gain by their encouragement of such a policy by the British Medical Association. It is a somewhat squalid story, and I do not want to enter into it on this occasion, but one is delighted to realise that now in every district in the country that the doctors of the country, following the advice of their own wisest leaders, are freely agreeing to come in to elect members on the medical committees, and I hope that is only a symbol of the increasing sympathy and friendliness with which the insurance committee and the doctors in every district are settling down to work the Insurance Act. The hon. and learned Gentleman also asks me about the certificates of doctors on the panel, and requests me to make a definite statement that every friendly society or every approved society must accept as evidence of specific disease the certificate of any doctor, whether he is on the panel or not.
§ Mr. CASSELI did not say that. What I asked was whether the certificates of other doctors on the panel would be refused?
§ Mr. MASTERMANI have answered that question again and again by question and answer. The sole duty of the representatives of the approved societies is to satisfy themselves, either by certificate or by any other means they choose to adopt, that the insured person is suffering from a specific disease which entitles him under the Act to sick pay. They are not obliged to accept a certificate at all; they can refuse the certificate of the doctor on the panel and they can refuse the certificate of a doctor who is not on the panel. They can adopt what method they think right to see whether the man really comes under the Act. The insured person, on the other hand, if he has reason to believe that he is suffering from a specific disease under the Act, and has a right to sick pay, and if he thinks the approved society representatives have refused proper evidence of his having this disease and this right, has redress in his hands in an appeal to the Commissioners, and the Commissioners have to prove not a question as to what doctor gave the certificate, but whether as a matter of fact the insured person was suffering from this specific disease within 1035 the meaning of the Act. They have to give a judicial decision. Speaking with the responsibility of one concerned with the working of the Act, I cannot recommend without any hesitation members of approved societies all over the country promiscuously to accept certificates of non-panel doctors, and for this reason, which has been very strongly put before me by leading members of friendly societies. They say that the doctors who come on the panel have done so with the definite intention of working the Act. They have come on the panel not only with the intention of working the Act, but with a two-fold limitation upon the amount of sick pay that they will grant under their certificates. First of all, there is the limitation of being on the panel, and therefore in touch through their local medical committee with the insurance committee; so that if there is any challenge as to their giving certificates too freely, it can be investigated by a mixed committee of doctors and representatives of the approved societies. In the second place, there is the limitation imposed by the fact that if they are giving certificates for sick pay too liberally or when certificates ought not to be given, they will also be under the obligation of giving very liberal visits to the persons who are supposed to be ill, and as they have no wish to multiply their attendances the tendency will be to deal only with real cases.
Take the case of a doctor who does not wish to go on the panel. I am not suggesting that this is probable amongst 20,000 doctors, or even amongst 500 or fifty doctors. I take it as a case which makes it impossible for me to lay down a general rule. Take the case of a doctor who does not wish to go on the panel, but who wishes to get a working-class practice, and who is quite content to use the easy giving of certificates in order to get a working-class practice. It is worth the while of hundreds of men to pay a doctor 1s., 2s. 6d., or 5s. a week for medical attendance if they can get from him certificates for 10s. per week sick pay, which certificates another doctor would not give. There is no check upon him; he is not on the panel; he is not on the local medical committee, and his action can never be reviewed by a mixed tribunal representing the approved societies and the medical men of the district. It is because there is a possibility of that being done, which possibility is very real to the minds of approved societies, that I think approved 1036 societies in cases are justified in saying. "No, we will not accept without any right to make any kind of investigation as a certificate for sick pay a piece of paper handed to us over the counter from a doctor who has not put himself on the panel and does not wish to work the Insurance Act."
The last point of the hon. Member was in connection with persons making their own arrangements. The hon. Gentleman gave us the sad and pitiful case of his own servants. We always intended, and still intend, that the insurance committees, if they wish to do so, when they have assured adequate medical attendance for all insured persons within their areas, should permit, under certain conditions, arrangements in connection with doctors who may not be on the panel. Take one prominent example, for instance, that of nurses in hospitals. I believe that the London Insurance Committee has granted or is granting a general exemption under Section 15 (3), allowing nurses at hospitals to make their own arrangements with doctors at the hospitals, who are not, and do not want to be on the panel, and do not wish to attend insured persons outside the hospitals. Similarly conditions might be laid down with regard to allowing doctors to go on the panel to attend only a limited number of persons. This practice in the working of any insurance committee must be qualified by one dominant consideration, namely, the duty of the insurance committee, in conjunction with the doctors on the panel, to see that every insured person within their area receives adequate medical attendance. I have had a number of questions put to me by Members of Parliament, and that is why I am taking up rather more time than I should otherwise have done in connection with this particular subject, which is one of great importance. Members of Parliament have been approached, as I have been, for example, by the medical man who attends me. He says. "I do riot want a large industrial practice; it is no advantage to me to have a thousand or two thousand insured patients. I have plenty of paying patients at the present time. But I am quite willing to go on attending, say, the servants in the houses where I have been attending up till now, and I am quite willing to attend them at the ordinary insurance rate. It seems to me, and it seems to them, rather hard if they do not want to be attended by another doctor, and if I am willing to attend them, that they should be forced to be attended by 1037 another doctor just because I do not want to have a thousand, two thousand, or five thousand panel patients." I think that is a fair statement of the case.
I have been in consultation with the chairman of the London Insurance Committee on the subject, and he says, as we say, as Commissioners in conjunction with the insurance committee, that there is no kind of objection to these cases being met by insurance committees permitting doctors to go on the panel in order to attend a limited number of cases, so long as that is done in conjunction with an agreement with, the doctors en the panel, and so long as the system can be interwoven with a system whereby adequate medical attendance can be given to every insured person within the area. I have not the slightest doubt that that will be done. What the insurance committees have had to face was not a problem of that sort at all. What they have had to face, especially in London, was a definite, deliberate, and avowed attempt to break the Act to pieces, an attempt dismally encouraged by some persons connected with the party of the hon. Gentleman opposite, by using the special exemption Clause—
§ Mr. FORSTERBy whom?
§ Mr. MASTERMANBy some prominent newspapers which give consistent support, to hon. Gentlemen opposite, very largely endorsed and supported by the continual pressure which I have had to face for several months— something like fifty questions to answer every day—to try and compel us to give way in order to allow people to use Section 15 (3), not to make special arrangements, but to break down the whole system devised by the National Insurance Act. I think the hon. Gentleman himself has engaged in that campaign, and it is with profound regret that I have found him changing from the policy which he adopted at the beginning. I maintain, therefore, that the insurance committees, when confronted with this avowed and organised conspiracy, were perfectly justified in saying, "Until we have assured medical attendance for all the insured persons in our areas, if possible, by the panel system, if not by some other system, we will not have the Act broken up by our own arrangements." The great bulk of applications for own arrangements which have come in to the insurance committees with which I have been in contact have not been bonâ-fide applications at all. They have come in on forms all in the 1038 same handwriting, evidently the result of a canvass, and probably the result of a canvass in which complete misapprehensions have been created in the minds of insured persons as to the real meaning of the Act. On the other hand, peace being restored, as I believe it is, the doctors, as I believe they will be found if only they are left alone, working the Act with ever-increasing enthusiasm, and, in friendly conjunction between the insurance committees and the panel doctors, arrangements being made to meet the needs of all the insured persons in the area, I see no reason at all why in certain special cases the use of Section 15 (3) should not be allowed where special circumstances are made out for it; or, what I think is better, if in friendly agreement with the doctors on the panel arrangements under some such conditions as those laid down in this Debate are made with doctors engaged normally in another class of practice, but who are willing to come on the panel for a limited number of patients who wish to have those doctors and no others, so that, at any rate, all the insured persons in the area are covered, those arrangements may be worked in amity and harmony.
§ Mr. FORSTERI should not have intervened in this Debate had it not been for the personal references which the right hon. Gentleman made to myself.
§ Mr. MASTERMANI was interrupted by the hon. Gentleman.
§ Mr. FORSTERI was asking for information. I do not object to the personal references, as I have nothing to be ashamed of and nothing to be afraid of in the action I have taken either in this House or outside in connection with the Insurance Act. I have been animated all through by one consideration alone. From the time the measure was introduced, during its passage through the House, and now that it is in actual operation, I have looked upon it essentially as a matter of business. and I look upon it as a matter of business now. I say that you are bound, treating it, as you ought to treat it, as a matter of business, to see that you get full value for the contributions which you are taking from the people. The right hon. Gentleman spoke rather sharply about my having assisted the Press which is generally asociated with the party to which I belong, and of having assisted my hon. Friends—I do not know whether he referred to the hon. Member for Colchester (Mr. Worthington-Evans)—
§ Mr. MASTERMANI referred to the constant pressure of twenty or thirty questions a day put by a number of Members opposite.
§ Sir H. CRAIKWhy should they not put questions?
§ Mr. FORSTERLet us understand the charge that we have to meet. If the right hon. Gentleman says that that is not the charge, and that we are entitled to ask questions, what is the gravamen of his complaint?
§ Mr. MASTERMANI do not want to Enter into a personal controversy. Perhaps it would have been better if I had not responded to the hon. Gentleman's interruption. What I was saying was that attempts were made day after day in this House, by the use of Section 15 (3), to break down the arrangement made by the Commissioners and the insurance committees, in order that the whole system of the Insurance Act for the provision of medical benefit might be broken down.
§ Mr. FORSTERI will endeavour to pursue the topic with an absence of heat and with perfect good temper. I think the right hon. Gentleman is under a complete delusion as to the motives which my hon. Friends and I have had in advocating the right of insured persons to make their own arrangements. It is not because we wish to break down the machinery of the Act. It is not because we found fault with all the arrangements which the Insurance Commissioners and the insurance committees have made. My object, and I believe the object of my hon. Friends, was to give the insured persons in practice the right which was promised to them by the Chancellor of the Exchequer, by the Lord Advocate in speeches in the country, and by other Ministers on the Treasury Bench, including the Chief Secretary for Ireland—the right, that is to say, of choosing their own doctors, whether the doctors were on the panel or not, and to make their own private arrangements—
§ Mr. J. M. HENDERSONHow can they?
§ Mr. FORSTERThe right promised to them not only by Members of the Government, but the right given to them by the Act. It is only, as we think, owing to the intolerable and unjustifiable pressure which has been brought to bear upon the Insurance Commissioners and the insurance committees by the Government that 1040 that right has been denied. The right hon. Gentleman does us less than justice when he attacks our motives. He is entitled to attack our actions, but he is not entitled to attribute to us motives we have never entertained.
§ Mr. HAMERSLEYThere is one point to which I would like to call the attention of the right hon. Gentleman, and that is the question of the secrecy which he says, and I believe honestly, should be observed as to the diseases that people may have who come under the Insurance Act benefit. The Commissioners have issued a certificate to be given by the doctors when the insured person applies for sick benefit. That certificate has never been alluded to, so far as I am aware, this evening. It is, I think, No. C, 29, and it was issued after 14th January, when the right hon. Gentleman made a statement as to the necessity of secrecy. If the right hon. Gentleman gives his attention to the matter he will find that it is absolutely impossible for a doctor to give that certificate without disclosing the nature of the disease of the insured person. Beyond that, this certificate goes before the committee, or the friendly society, who, it appears, in sonic cases are insisting, whether the doctor is on the panel or not, and refuses a certificate, to have further reasons for allowing insured persons to receive benefit. If it is desirable that the doctor should observe secrecy, I would ask the right hon. Gentleman to instruct the Commissioners as soon as possible to alter that certificate, so as not to necessitate the doctors giving reasons for the sickness. At present the doctor has not only to say that the man is ill, but to give the reasons for it. I have been spoken to by several doctors who have refused—and I think quite properly—to give the reasons asked for in order to maintain secrecy. Unless the right hon. Gentleman alters that certificate, or form, he will be not only not carrying out what he wishes to carry out, but he will be doing a great deal of harm, not only to the working of the Act, but to insured persons.