ROYAL ASSENT. (Hansard, 14 February 1913)

§ Mr. MASTERMAN
I was dealing with the case of persons over sixty-five who do not become insured persons under the Act, and who were insured in friendly societies. It is pointed out very strongly that if those persons who expected medical benefits for their lives are deprived of it now it would be a very hard case. My answer to that is twofold. The position is, if they have been accumulating funds in accumulating societies up to that age, that as the funds are released for those societies by the passing of this Act, I think that those societies ought to make arrangements for the continuance of the medical benefit, and I think that members of societies should be very careful that in the allocation of those funds special attention should be called to the interests of old members. The old members are not in a majority, and there may be a tendency in certain cases to think more of the interests of the great mass under that age than of the few who are above it, but I think that the first charge on any funds which are liberated should be those old persons. The second point is this. The hon. 1457 Member for Shropshire called attention to the Clause in the Act, which says that insurance committees must arrange for the attendance of these persons over sixty-five at a rate not less than the general rate for insured persons. That was specially brought in for the protection of persons of that age who might find the doctors charging an extra amount. The difficulty has not arisen in connection with that particular Clause. There is no difficulty, and I think there will be no difficulty; in securing attendance on persons who are over sixty-five, who are not insured, at the rate for which insured persons are attended. But what has happened is that owing to the extra Grant which the Government has given the price for the attendance of insured persons has very much increased. It has increased in country districts from an average of 4s. up to now to an average of 9s., or more than twice as much. I think it is rather unfair if doctors receiving 9s. a year capitation fee for patients for whom they were receiving only 4s. a year before the Act passed—which is more than doubling their income in respect of those insured person—also turn round on persons who are not insured and who are over sixty-five and say, "Because we are receiving 9s. a year—"

§ Mr. CASSEL
I do not think the doctors receive 9s.

§ Mr. MASTERMAN
Yes, I was taking the case of a doctor in a country district who does his own dispensing and therefore receives his full 9s. just for exactly the same service which he used to give for 4s. In the town districts also there would be a very considerable increase. If doctors are doing this—and I am sorry to say they have been encouraged to do it in certain quarters—it would mean that it in a certain club a doctor had been attending 300 persons, members of the club, at 4s. a head and had been doing it for the last twenty years, he would say, "I am now receiving for 280 of those persons who are insured persons 9s. a head, and therefore I refuse to attend the other twenty for 4s. a head." That is how the whole difficulty has arisen. I very strongly hope that as the Act comes to be understood the doctors will choose the better course, realising that this is a small and rapidly diminishing number of people who cannot live many years, and that they will say, "Because my income has been built up from a friendly 1458 society, and has been extended under the Insurance Act, I will at least attend these old people for the same price which they paid before."

§ Mr. BRIDGEMAN
What about the extra half-crown?

§ Mr. MASTERMAN
We could not give the extra half-crown except for those who come under the Insurance Act. I am making inquiries into this matter, and 1 very much hope that the result will show that a majority of doctors working under the Act are willing to accept the old figure for these people. A question was raised by two hon. Members for Scotland which is a very big question in the Highland ccunties—that is the question of mileage in some difficult districts, where many insured persons are living many miles from the nearest doctor. We all recognise that we have to meet that question. We promised to meet it and we are meeting it I hope in the Grant which is being voted in the Appropriation Act to-day. It includes a Grant of £40,000 for special mileage in Great Britain outside the Highlands and a separate Grant of £10,000 for dealing with this special problem of the Highlands and Islands. We have described that special Grant of £50,000 mileage as a Grant not for the ordinary population. We think that the 9s. given to the ordinary country doctor should be enough to cover that in the ordinary closely-populated village life of England. We desire that the scheme shall be elaborated in conjunction with the insurance committees, whereby this £50,000 shall be distributed in mileage in just those cases brought up by the two hon. Gentlemen who represent the Lowlands of Scotland. Where there is not a practice that can be taken in the ordinary round, as in closely-populated districts, but where the doctors may have to go four, five or seven miles in order to attend one or two insured persons, we ask the insurance committees to report how far those conditions present themselves within their areas, and from their reports, in conjunction with the Scottish, English, and Welsh Insurance Commissioners we will devise a scheme for the distribution of that £50,000 in a way that will as far as possible meet cases of hardship that may arise in mountainous or moorland, or plain districts, or any district where the population is widely scattered.

§ Sir JOHN JARDINE
May I ask the right hon. Gentleman if that will take effect from the present time?

§ Mr. MASTERMAN
When the scheme is completed the money will be paid as from the commencement of the Act.

§ Mr. FREDERICK WHYTE
Is any of the money taken for wider purposes, such as the amalgamation of the various medical services, which is really a bigger and more important question?

§ Mr. MASTERMAN
All the money taken under this Bill is intended for medical attendance on insured persons, but under circumstances of special difficulty this money is advanced for the commencement of a general scheme, and the Highlands and Islands, with their special difficulties, will be dovetailed into that general scheme. As to the question of certificates, it must not be understood that I have no wish not to deal with that subject, but I can only repeat again what I have again and again repeated in this House. The question of sick pay under the Act is entirely a question for the managing body of the approved society, subject to this one reservation, that if the approved society has refused sick pay to the insured person and that insured person thinks he has the right to sick pay, being ill from a specific disease, he can then appeal to the Insurance Commissioners, who will then judicially adjudicate on the question of fact whether the injured person is suffering from that specific disease, and whether the insured person had a right to sick pay under the rules of the society which he has joined. The Insurance Commissioners have nothing whatever to do with the sick except dealing with that specific point. If the hon. Gentleman would like to see the reason why I said that we considered it unwise for the managing bodies of approved societies promiscuously to announce that they would receive certificates from any doctor, panel or non-panel, he will see it in the report of the debate on the subject a few days ago. I do not wish to repeat the arguments then used; they are fully set out, and the hon. Member can see whether those arguments are valid or not. The last point raised by the hon. Member for St. Pancras (Mr. Cassel), who made what I can only freely acknowledge was a most handsome withdrawal of the charge that I thought he was bringing against me the other day. I do not wish to raise any personal question, but I do not think that the hon. Gentleman intended to bring the charge at all, though he perhaps did not quite realise how the effect of his remarks might mean a prac- 1460 tical breach of faith in the relationship between the Insurance Commissioners and myself on the one hand and the insured person on the other. If the slightest suggestion is made that I have at the Home Office Insurance Department a full account of all diseases to which insured persons have been subject, and that if a Member asked a question I could turn to a diary of the diseases of unfortunate persons, I cannot imagine anything which would cause greater resentment against the National Insurance Act.
It is because, not only have I no wish to do so, not only I freely refuse to do so, but also even if I could do so, there is no conceivable power under which I could do so, because the record does not exist and never will exist. Perhaps I spoke with some heat in repudiating what I thought was the charge, but I am glad the hon. Gentleman raised the question in order that I might make a full statement, and I think he agrees with me that, under the old system, and even under the new system, in which no numbers are given on the counterfoil, no clerk or Minister could ever find out the name of the insured person or the disease from which he suffered. I am afraid I cannot deal with the question of the outworkers which was raised by the hon. Member for Nottingham, because there is no Vote under the Appropriation Act dealing with the subject. We are watching very carefully the operations of the Act in view of the difficulties and conditions in connection with special circumstances of that particular kind. This is the end of a long and exhausting Session in dealing with the Insurance Act, and I should like to express my gratitude to those Members who all through the year's violent controversies have given every possible assistance in the difficult work of administering and carrying out the operations of an Act so gigantic and so novel in many respects as this Insurance Act, and may I congratulate all of them on finding, as they are finding to-day, that they are working on the winning side.