HC Deb 01 January 1913 vol 46 cc483-92

I desire, in the first instance, to express my thanks to the hon. Member for Huddersfield (Mr. Sherwell) for removing the Blocking Motion. which enables me to say a few words with regard to the present position under the Insurance Act. I desire further to express on my own behalf and on behalf of the whole House our great regret that the Chancellor of the Exchequer is unable to be present this evening through indisposition. We were very desirous indeed of securing a statement from him on a very important point, but I understand that the Secretary to the Treasury is authorised to speak on his behalf, and to give a definite reply to a question which at the close of my observations I shall put to him. What I am desirous of knowing is the exact meaning which the Chancellor of the Exchequer attaches to Sub-section (3) of Section 15 of the Insurance Act, and what action he proposes to take with regard to it. In order that the House may see exactly what that Section is, I will read part of it:— The Regulations made by the Insurance Commissioners shall authorise the insurance committee by which medical benefit is administered to require any persons whose income exceeds a limit to be fixed by the Committee, This is the important part:— and to allow any other persons, in lieu of receiving medical benefit under such arrangements as aforesaid, to make their own arrangements for receiving medical attendance and treatment (including medicines and appliances). This matter is one of very great importance to the millions of persons who, I understand, are now insured, and to the thousands of doctors, affecting as it does their position in relation to the Insurance Act. I must remind the House that on the Thursday before we separated, on 19th December, I put this question to the Chancellor of the Exchequer. I asked:— Whether in the event of the doctors refusing to- Accept service under the National Insurance Act on the terms recently offered to them the Government intend as the only alternative open to them to propose a great extension of the system by which the societies employ their own doctors on a whole-time service. The answer which the Chancellor of the Exchequer gave me in writing, because my question was not reached, and I was therefore unable to put any supplemental I question, was:— As practitioners who desire to have their names placed on the first panel lists may make application up to 31st December it will be premature to make any statement of the sort suggested. I think the House will realise that that was no answer whatever to the question I put, and to the question on which the insured people and the doctors required information. That was so much the case that on the following day, the very last day before the short recess which we enjoyed, I sent in another question to the Chancellor of the Exchequer, and I received a letter from the Secretary to the Treasury begging me to postpone the question. The difficulty was that the answer to that question was urgently needed before the great meeting of the representative doctors which was to take place on the next day. What was the answer which the Financial Secretary gave in the letter? Speaking for the Chancellor of the Exchequer, he said:— He is sorry but it would lie impossible for him to make any further statement on this subject during the winter. The Chancellor of the Exchequer happened to be present at the meeting on Friday and I put to him the question to which I have referred, and the answer which the Chancellor then gave me was— I understand that several Members wish to raise this question and discuss it in the afternoon. It is obviously impossible to give an answer to the question in the course of the minute or two at my disposal now. I believe the Chancellor of the Exchequer was genuinely desirous of giving a full answer to the question, but he was pre- vented from doing so by the Blocking Motion on the Paper. So far., therefore, we had no answer whatever to that important question. Now it so happened that only on Monday last my hon. Friend (Mr. Worthington-Evans) asked the following supplemental question dealing with the same matter:— May I ask whether any objection will he made by the Insurance Commissioners to allowing Insurance committees to permit private practitioners in counties to continue for individual patients under Section 15, Sub-section (3). of the Act? and the answer was— I think that would depend entirely upon circumstances. So far, therefore, it will be seen that no attempt has yet been made to give any answer to the important question which I have put down. Indirectly all these questions have reference to a matter on which I have every reason to believe the Chancellor of the Exchequer has always felt very keenly, and that is that there should be a choice of doctors given to every patient. I might quote numerous passages from the many eloquent speeches delivered by the Chancellor of the Exchequer showing how desirous he was at that time that every insured person should have a free choice of doctors, and I need scarcely say that the whole success of this Bill depends upon the insured persons being able to choose their own medical attendants. I do not wish to trouble the House with numerous quotations which I might make from the Chancellor of the Exchequer's speeches, but I cannot refrain from making this one. He said, after having spoken of medical benefit:— Free choice of doctors also will, to some extent. increase the charge. I, personally, have always been in favour of that. After all, confidence in your doctor is essential. No man who can afford to do otherwise would have a doctor prescribed for him by any club or society. He wants his own doctor to doctor him, a doctor in whom he has confidence. According to the answer which the Financial Secretary will be able to give to the question I am about to put to him depends entirely the question whether insured persons will have any opportunity whatever of selecting their own doctors, or whether the doctors who have rushed into the panel as we have been told will be forced upon them. I might ask the Financial Secretary in his reply to state whether in the case of these doctors who have been admitted to the panel any inquiry has been made as to their qualifications, age, experience, or even their character. Owing to the extremely unsatisfactory character of the replies to which I have referred I wrote to the Chancellor of the Exchequer on Monday evening telling him that I proposed on the following day to put to him a question a copy of which I enclosed. I stated in my letter that I thought it only right and proper to give him full notice of the question in order that he might, if necessary, seek the advice of the Law Officers of the Crown with the view to the answer he was proposing to give. From his replies it will be seen that he considered it was very difficult indeed to give a reply in a few words, although I personally should have thought that in one or two minutes a definite answer might have been given. At any rate, I will now ask the Financial Secretary to the Treasury, on behalf of the Chancellor of the Exchequer, to give me a clear and definite reply to the question which I am going to address to him. The question is, whether under Section 15, Sub-section (3), of the National Insurance Act, a local insurance committee is not required to allow any insured person to have the option of making his own arrangements for receiving medical attendance, including medicines and appliances, from the medical practitioner of his own choice? Surely there can be no difficulty in dealing with that question in the course of a verbal reply. As I desire to give the opportunity of speaking to other persons who wish to take part in this discussion I hope the reply given to me by the Secretary to the Treasury will be as brief and concise as possible.

The ATTORNEY-GENERAL (Sir Rufus Isaacs)

I propose to answer the question which was addressed by the hon. Gentleman to my hon. Friend the Secretary to the Treasury.


It was addressed to the Chancellor of the Exchequer.


It was addressed to the Chancellor of the Exchequer originally, but the hon. Gentleman desired him to ascertain the views of the Law Officers. Consequently, I propose to answer the question put to the Secretary to the Treasury now, the Chancellor of the Exchequer being unfortunately indisposed this evening. The answer to the question is very simple. Sub-section (3) of Section 15 of the Act does not require the Insurance Committee to allow such arrangements to be made. What the Sub-section does is to require the Insurance Commissioners to make regulations authorising the insurance committee to allow such arrangements. In other words, what the Insurance Commissioners have to do under these Regulations is to vest discretion in the insurance committee, and the insurance committee can then exercise that discretion subject to Regulations which will be made by the Insurance Commissioners. The insurance committee can then contribute out of the funds which are there for the purpose in order to provide the money necessary for medical benefit. That, I think, is a plain and direct answer to the hon. Gentleman's question. His query, as I followed it, was whether they were not required. My answer is, no. The Insurance Commissioners are required to issue regulations to vest this discretion in the committee, but the committee are certainly not required to allow these arrangements to be made, but simply exercise their discretion in the matter.


I confess I have nothing to complain of in the Attorney-General's interpretation of the Act. He said the Insurance Commissioners were required to make regulations. They have in fact made them, and under them the County Committee have got it in their discretion to give effect to Section 15, Sub-section (3) of the Act. I will only note in passing that the question of my hon. Friend was not merely on the construction of the Act; it was also directed to the administration of the Act by the Government. While the Attorney-General has, in my humble opinion, correctly described the actual legal position under the Act, I shall submit to the House that for purposes which are fairly obvious the name of the Insurance Commissioners has been taken to issue Press notices which are quite contrary not only to the Act itself but to the statement the Attorney-General has made to-night. I am, of course, extremely sorry the Chancellor of the Exchequer is indisposed, but I notice his assistant, the Financial Secretary to the Treasury, is looking in the most robust health, and I could have wished he also had answered this question, because it is not merely a legal question, indeed, it is not primarily a legal question; on the other hand, it is a question of administration.


I am quite prepared to give a reply if I have time.


I will do my best to give the right hon. Gentleman time. It is, in my view, quite desirable the public should understand the matter, because it is not, in my opinion, a doctor's question at all. [HON. MEMBERS: "Hear, hear."] I am very glad there is assent to that observation. It is not, in my view, a doctor's question at all; it is, in fact, this one simple point: Are the insured people to have the free choice of doctor which has been promised them for their money or are they to have that choice limited by the action of the Government?


Limited by the doctors.


Then I start with the assumption that the Government admits that under the Act the Insurance Commissioners are bound to make regulations which do give the insurance committees the right to allow the private individual, the insured person, to choose his own doctor, whether that doctor is on the panel or not. [HON. MEMBERS: "No."] I do not think that the Attorney-General is going to dissent from that. He will admit, I fancy, that Subsection (3) applies to doctors whether they are on the panel or not. That is important. I do not want to speak to the House under a misapprehension. Is that admitted or not—whether doctors are on the panel or not the insurance committees may, if they choose, in their discretion permit of private arrangements?


I have already stated, subject to regulations which the Insurance Commissioners make.

11.0 P.M.


We have got to this stage that private arrangements may be made either with doctors on the panel or doctors not on the panel, subject only to the Insurance Commissioners regulations. [HON-. MEMBERS: "No."] These arrangements may not be made compulsorily, but it is in the discretion of the insurance committees to allow this arrangement, subject to the regulations of the Insurance Commissioners. That simplifies the question very much indeed; for the Insurance Commissioners have made a provision which is contained in regulation 14, the words of which are these:— The committee may allow any insured person in lieu of receiving medical benefits under the arrangements made by the committee, to make his own arrangements for receiving treatment, including medicine and appliances. And in the next regulation it is provided that in such a case a cash payment would be made on account of that form of treatment equivalent to what would have been made had the man been treated by a panel doctor. If there had been the slightest dispute about that I could have referred to the memorandum 136 C and E—which I believe means "Customs" and "Excise," to which is added an explanatory memorandum which clearly sets out, for the purpose of insured persons, that the insured persons may receive medical benefit in one of several ways; first, on the panel system; second, through approved institutions; and, third, by private arrangement. I will read the paragraph relating to private arrangements— The third method by which insured persons may obtain medical benefit is under their own private arrangements. Any insured person can make application to the insurance committee on the appropriate form to be obtained from the committee; to be allowed to make his own arrangements for receiving treatment, and, if allowed will receive a contribution from the committee towards the cost of that treatment. It seems to be quite clear, then, that whether the doctor is on the panel or not, a private arrangement can be made with him, or with the insurance committee—that is, the local county committee. That seems to me to be a matter of extreme importance. There is a large number of doctors who are willing and desirous of treating their old friends and patients. They may be elderly men, who are not prepared to run the risk of going on the panel, because if they go on the panel they may have apportioned to them the residue of patients. [HON. MEMBERS: "No, no."] I would like to refer hon. Members who say, "No," to the Act. Let them read the Act. It is so under the Act. I have not had time to refer to it in detail, but I assert with confidence that under the Act this will happen, that the residue of patients in any county or insurance district who are not allotted to a doctor, who have not chosen a doctor, or who have not, also, been chosen by a doctor, will be apportioned either amongst the doctors on the panel or will otherwise be provided for by whole-time service or in some other way by the Insurance Committee. In one of those ways those patients have got to be dealt with, and the doctor who is willing to treat his own patients is not willing to run the risk—and it is a risk; no one can deny it—of having patients apportioned to him who have been rejected by the whole of the doctors on the panel. That is only one case. There is another case, that of the domestic servants, who in the past have been accustomed to receive treatment from the family doctor. [HON. MEMBERS:"NO, no."] They have had exactly the same treatment, but, if hon. Members like, let them say that is only so in one case in ten that they will be deprived of that class of treatment in future, but that is the risk, because the family doctor may be quite likely not to go on the panel; and unless the doctors not on the panel are also able to be chosen by the insured person, then those domestic servants, however few or however numerous, cannot get the same treatment that they have got in the past. That is a matter of some importance. Hon. Members have some doubt about that. If they were really questioning it I would refer them to the report which appears in the "Times" to-day of exactly the same fear as I am now voicing that was expressed by some doctors who were present at a meeting of doctors yesterday who had agreed to serve on the London panel. It will be found in that report that sortie doctors immediately said that they would withdraw from the panel if they were to run the risk of having persons not chosen by themselves apportioned to them. The real point I want to get at in the short time at my disposal is, firstly, as to the action which has been taken by the Commissioners—or in their name, for at present I am not? satisfied that they themselves have taken it. I believe the Attorney-General has stated the effect of the Regulation correctly, and, if that is the case, how can the right hon. Gentleman the Secretary to the Treasury justify the statement which has been issued to the Press, on the 26th December, which states this—and this is from the "Times' "report of the Insurance Commissioners' Circular?— The point is that in places where a panel of doctors is formed, in accordance with the Act and regulations, it is open to the Insurance Committee of that area, if it chooses, to permit individuals to make their own arrangements for receiving medical attendance and treatment. including medicines and appliances. The Insurance Commissioners have issued to the Press a statement which is absolutely misleading. It is not in places where a panel has been formed, it is in all places, whether a panel has been formed or has not been formed; and the deliberate intention of that statement is to stampede the doctors to make them go on panels from fear of losing their practice, or fear of having to desert their old patients, whom they are perfectly willing to consider and whom they wish to serve in the future. They have been told by the Insurance Commissioners, quite contrary to the view of the Attorney-General, that if the private patient is to be allowed to continue any private arrangement with his doctor, that the doctor has got to be on the panel. I say that is false, and it has been stated in the Press for the very purpose—


If you will give me a moment I will reply.


I have not the slightest doubt the right hon. Gentleman would be to the point when he replied, but he has already had his opportunity, and he will have a further opportunity to-morrow night if he can persuade his hon. Friend the Member for Huddersfield to withdraw his Blocking Motion. [HON. MEMBERS: "Where is your fairness?"] The next Press notice issued by the Insurance Commissioners on 30th December contained an equally in- accurate statement—that individual arrangements can only be made where they are allowed by the Insurance Committee, subject to the approval of the Insurance Commissioners? That statement is absolutely incorrect. There is no question of the approval of the Insurance Commissioners. As the Attorney-General correctly said, the only thing the Insurance Commissioners have to do is to make regulations.


I said that the statement is not incorrect as the hon. Member says, because the Insurance Commissioners must make regulations which provide for the contributions.


The Attorney-General is quite right.

It being half an hour after the conclusion of Government business, Mr. SPEAKER adjourned the House, without Question put.

Adjourned accordingly at Thirteen minutes after Eleven o'clock.