§ 13. Sir J. D. REESasked whether the Chancellor of the Exchequer gave a pledge to the secretary to the Medical Association Alliance that the friendly societies should not be deprived of the right to administer their medical benefits?
§ Mr. MASTERMANSection 15 (4) provides for the administration of medical benefit through existing systems and institutions tinder conditions there defined. Promises have been made that such institutions as the Friendly Societies' Medical Alliance should be entitled to apply for approval subject to such conditions as may be required, and this right is secured by the Sub-section referred to.
§ 29. Mr. CASSELasked whether it is proposed to close the panels of doctors in any areas at a fixed time; and, if so, how in such cases the right of every duly qualified practitioner to have his name placed on the panel will be secured?
§ Mr. MASTERMANThe right of a duly qualified practitioner to have his name on a panel is conditional upon an adequate medical service having been arranged in his area on the normal panel system. Where a panel cannot be formed the Insurance Commissioners may under the proviso in Section 15 (2) authorise the insurance committee to make such other arrangements as the Commissioners may approve, or may themselves make such arrangements as they think fit.
§ Mr. CASSELIs the right hon. Gentleman aware that Clause 15, Sub-section 802 (2), specifically provides for the right of every duly qualified practitioner to go on the panel, and that in the case where no panel is formed Parliament has expressly secured them that right?
§ Mr. MASTERMANCertainly. But I said that when the Commissioners after examination found there was no adequate panel. In that case it is evident there is no panel formed.
§ Mr. CASSELHas the right hon. Gentleman considered the question whether in the case where there is no panel at all the Commissioners are not bound under the Act to admit every duly qualified practitioner?
§ Mr. MASTERMANWhere they have not declared the panel to be inadequate there is a right for every practitioner to go on.
§ Mr. FORSTERUnder what Section have they power to close a panel?
§ Mr. MASTERMANUnder Clause 15, Sub-section (2), the Commissioners have power where there is no adequate panel to make any other arrangements they think fit; declaring that the panel is inadequate, they can make what arrangements are suitable for the locality.
§ Mr. FORSTERBut under what Section of the Act?
§ Mr. MASTERMANThey can suspend the normal panel system, and devise a system which may be known as the "close panel."
§ Mr. FORSTERUnder what Section?
§ Mr. MASTERMANClause 15, Sub-section (2).
§ Mr. CASSELDoes not that apply only where there is no panel at all?
§ Mr. MASTERMANNo, it applies where the panel is declared to be inadequate.
§ 47. Mr. CASSELasked what is the reason why arrangements for providing medical benefit which, according to statements made by the Chancellor of the Exchequer, will involve an additional charge upon public funds of more than one and a half millions a year, are not to be submitted to this House for its consideration before binding contracts have been entered into?
§ The PRIME MINISTERNo agreement with the doctors, involving the expenditure of public money outside that provided by the National Insurance Act will be entered into without the sanction of Parliament.
§ Mr. CASSELIs the right hon. Gentleman aware that the arrangement now proposed to be entered into contemplates the payment of 8s. 6d. per head for attendance and drugs; that when the Bill was before Parliament it was contemplated that the payment would be only 6s. 6d. per head; that this increase will involve additional expenditure of moneys by Parliament, and that if the arrangement is once entered into Parliament will not be absolutely free in giving its decision?
§ The PRIME MINISTERThe hon. and learned Gentleman is quite wrong. Parliament will be absolutely free. The agreement was only entered into for three months, and the sum already provided is quite adequate for that purpose.
§ Mr. CASSELIs the right hon. Gentleman aware that if the arrangement is made for three months it practically carries with it an agreement for a longer time; and what is the reason why this House is prevented from discussing this matter?
§ The PRIME MINISTERThere will be free discussion. No arrangement has been or will be entered into except within the limits the House has already decided.
Mr. WORTHINGTON-EVANSIs it not the case if the 8s. 6d. is paid during the first three months, there will be a deficiency during the other periods of three months, unless Parliament does grant an extra sum?
§ The PRIME MINISTERParliament will have a full opportunity for determining that question when it arises.
§ 60. Mr. NEWMANasked whether it is intended that whole-time sanitary and medical appointments in the gift of the Government are in the future to be reserved for candidates who have signified their intention of accepting service under the terms of the National Insurance Act as on 31st December, 1912?
63. Mr. FRED HALLasked the Chancellor of the Exchequer if, with a view to securing the adhesion of members of the medical profession, he has undertaken that those doctors who agree to work under the National Insurance Act shall 804 receive priority in filling medical appointments under the Act; how many such appointments will have to be created in order to attract a sufficient number of doctors; and whether he is in a position to give an undertaking which removes staff appointments from the control of the Insurance Commissioners or insurance committees under whom any such appointments will be held?
§ The CHANCELLOR of the EXCHEQUER (Mr. Lloyd George)These questions apparently refer to a letter which I issued with the concurrence of the Insurance Commissioners, and which has been laid on the Table of the House, promising priority of consideration in connection with whole-time appointments to doctors who had gone on the panels. Duly qualified practitioners have a statutory right to be included in the panels in their areas if such panels are formed. Those who are deprived of this right through the refusal of other doctors to come on panels must of necessity receive priority of consideration in connection with any substituted system; as any not appointed would be excluded, by a choice which is not their own, from any opportunity of working under the National Insurance Act. The number of salaried appointments made will depend upon the number of doctors required to provide medical attendance and treatment in those areas, if any, in which sufficient doctors have not accepted service under the ordinary panel system; but I would add that there are very few areas where the possibility of such arrangements being needed exists.
§ Sir PHILIP MAGNUSMay I ask the right hon. Gentleman whether priority of consideration will be given quite independently of the qualifications of the doctors?
§ Mr. LLOYD GEORGENo. Certainly the qualifications will be taken into account.
§ Mr. LLOYD GEORGENo, I cannot give an undertaking of that kind.
Mr. FRED HALLWill the right hon. Gentleman say when he will be in a position to reply to that part of the question?
§ Mr. LLOYD GEORGEI am in a position now, and I cannot give a guarantee that the Insurance Commissioners will not exercise some control in the matter.
§ 61. Mr. NEWMANasked the Chancellor of the Exchequer whether his attention has been called to an advertisement of the Bradford Insurance Committee asking for medical men to work the National Insurance Act at salaries of from £500 to £700; and whether, under the terms of service at present specified by the National Insurance Act, he can state how many insured persons it would be necessary for a medical practitioner to have on his list to assure for himself an income of £500?
§ Mr. MASTERMANI have seen the advertisement referred to in the first part of the question. A doctor not doing his own dispensing would cam £500 a year in respect of 1,429 insured persons, or, if the cost of drugs did not exceed 1s. 6d. a head, in respect of 1,333 persons. A doctor in a country district who did his own dispensing would earn the same sum in respect of 1,111 persons.
§ Mr. NEWMANIs it not a fact that the Chancellor of the Exchequer adumbrated a scheme for Bradford giving for its 100,000 insured persons fifty doctors?
§ Mr. MASTERMANCertainly. In that case each one would look after the general health of 2,000 insured persons, and he is quite capable of doing so.
§ 65. Mr. NEWMANasked the Chancellor of the Exchequer whether he has asked for and received assurance from adequate professional sources that 2,000 employed contributors can be adequately attended by a medical practitioner on a panel who will, in addition, be allowed to take private practice among the families of such insured contributors?
§ Mr. MASTERMANAs I stated in answer to the hon. Member for Wolverhampton West on the 19th December last, it would be impracticable to fix 2,000 or any other figure as the maximum number of insured persons to be attended by a practitioner on the panel, as the number must necessarily vary according to the circumstances of each particular case. I am assured by adequate professional advice that, certainly in urban areas, a doctor will be able to be properly responsible for 2,000 persons (the majority of whom arc, of course, not ill in any given year), without being debarred from any private practice he may obtain among the families of the insured, and this advice is confirmed by the experience of insurance schemes both here and abroad. It will be 806 the duty of the insurance committee in each district to see that the arrangements are such as to secure that the insured persons in their district receive adequate medical attendance and treatment.
§ Sir HENRY CRAIKMay I ask if the average number of 2,000 has been reached as the result of experience, and whether, as a matter of fact, it is not something like 800 or 900?
§ Mr. MASTERMANI will give the figures if the hon. Gentleman will put a question on the Paper.
Mr. LAWSONAre we to understand that any maximum number of insured persons will be fixed by the insurance committees?
§ Mr. MASTERMANI think the insurance committees will deal with the circumstances of each particular case as it arises.
§ 66. Mr. NEWMANasked whether, in the case of a salaried service being established by a local insurance committee and consisting of ordinary medical practitioners, nurses, specialists, and superintendent, such insurance committee will be empowered out of public or other funds to establish and equip a hospital to receive for treatment insured persons who may be refused admission by any hospital supported by voluntary contribution?
§ Mr. MASTERMANI have no reason to believe that voluntary hospitals will refuse to treat cases of a kind which are out side medical benefit. The exact scope of a special medical service which might be arranged as an alternative to the ordinary-panel system would be decided with reference to the requirements of the area affected.
§ Mr. NEWMANSupposing the local hospitals refuse to treat these insured people, what will happen?
§ Mr. MASTERMANThen, I think we must deal with each case as it arises.
§ 67. Dr. CHAPPLEasked the Chancellor of the Exchequer whether, in view of the statement made at a meeting of doctors in Stirlingshire, where the conditions imposed by the Insurance Commissioners have been accepted, that doctors attending insured persons requiring an anæsthetic will have to pay the fee for the anæsthetist, and of the very prevalent idea that this is the case, he will make a statement on the subject?
§ Mr. MASTERMANThe conditions under which payment is made in such cases are explained in detail in the memorandum of 3rd December, which is reprinted in Cd. 6520 (page 26), of which I am sending a copy to my hon. Friend.
§ 68. Dr. CHAPPLEasked the Chancellor of the Exchequer whether, in view of the statement made by the chairman at Wednesday's conference with the London doctors to the effect that no patient will be forced on any doctor, and in view of Section 15, Sub-section (2) (d) of the National Insurance Act, he is prepared to state what arrangement has been made in this respect?
§ Mr. MASTERMANAny doctor on the panel has a preliminary right of refusing any particular insured person who applies to be placed on his list. It will be the duty of the Insurance Committee to make such arrangements as are suitable for medical benefit for any patients who are thus refused by the doctor of their first choice; and these arrangements must be as far as practicable in agreement with the doctors themselves. Insurance Committees may ask the doctors in any district to agree each to accept a proportion of insured persons who may be refused attendance by the doctors of their first choice, or the insured person may be invited to make another choice of a doctor willing to accept him, or some other arrangement may be made by the committee for his medical attendance and treatment.
§ Dr. CHAPPLEIs it not the case that a number of insured persons might be rejected by all the doctors on the panel? What will be done with those who have been rejected? Does this Sub-section not contemplate that they should be distributed among the doctors?
§ Mr. MASTERMANThe Insurance Committee has made the arrangement suggested by my hon. Friend, and if a panel system is still in that district and kept in operation then it will be necessary to provide a doctor on the panel who would undertake the treatment of those patients.
69. Mr. WORTHINGTON-EVANSasked whether the following statement, contained in the official explanatory statement as to medical benefit issued by the Insurance Commissioners to the doctors about the 16th December last, that it will at any time be possible for a doctor to in- 808 dicate his willingness to act on a panel, but unless indicated by the 31st December the name will not be included in the first list, represents the policy of the Government; whether any warning has been given to doctors that the panel may be closed against new names for one, or two, or three years; and whether such closing is authorised by any, and which, of the existing regulations under the National Insurance Act?
§ Mr. MASTERMANThe answer to all three parts of the question is in the affirmative, with the reservation that the right of a practitioner to be included upon a panel is conditional upon a panel being formed in his area. My right hon. Friend the Chancellor of the Exchequer announced so long ago as the 23rd October that if no adequate panel can be formed in any area arrangements would be made for suspending the normal panel system, and that it would then be the duty of the Insurance Commissioners under the proviso to Section 15 of the Act to provide medical benefit by authorising the Insurance Committees to make other arrangements, or by themselves making such other arrangements as they think fit, as an alternative to the suspension of medical benefit. The regulations issued by the Commissioners are subject to the exercise by them of the powers reserved in the proviso to Section 15 (2).
Mr. WORTHINGTON-EVANSCan the Insurance Commissioners close the panel for one, two, or three years against the doctors who do not first go on the panel?
§ Mr. MASTERMANIf a panel is declared by the Insurance Commissioners to be adequate, and so long as it is adequate other doctors may have their names added to the panel. If the Insurance Commissioners declare the panel inadequate, then they can make any arrangements they think fit for the medical treatment of insured persons.
§ Mr. RUPERT GWYNNEWas the Chancellor of the Exchequer asked by the Insurance Commissioners to make arrangements that doctors should be kept off the panel for one, two, or three years?
§ Mr. MASTERMANI cannot add anything to the answer I have already given the hon. Gentleman. Every action taken in the matter has been taken by the Insurance Commissioners in conjunction with the Government.
§ Mr. GWYNNEHad the Chancellor of the Exchequer their sanction when he made that statement?
§ Mr. LLOYD GEORGECertainly.
§ Mr. GWYNNEAnd was it definitely sanctioned by the Insurance Commissioners?
§ Mr. LLOYD GEORGECertainly.
§ 70. Mr. NEWMANasked whether, in the case where a panel of medical practitioners is closed though incomplete by the Insurance Commissioners, and leave given to practitioners on such panel to engage assistants to complete the panel, on whom will devolve the duty of examining into the professional capabilities of such assistants; and whether any provison will be made securing to them a minimum salary?
§ Mr. MASTERMANThe insurance committees will be responsible for securing that the service in their areas is adequate if the normal panel system is in operation, or if the panel system is suspended, and they are authorised to make such arrangements as they think fit, subject to the approval of the Commissioners. If in the latter case the service were partly provided through partners and assistants of the original practitioners, it would therefore be the duty of the insurance committees to take any necessary steps to secure that the service provided by such persons is satisfactory.
§ Mr. NEWMANWho will actually examine the doctor's qualifications—the insurance committee?
§ Mr. MASTERMANIf the work is entrusted to the insurance committee, it will be done by them with the approval of the Insurance Commissioners, or the Commissioners may, if they like, themselves make the arrangements.
§ Mr. HARRY LAWSONWho is to determine the standard of capacity?
§ Mr. MASTERMANI think I have already answered that—if it is entrusted to the committee, the committee, and if the Commissioners do it themselves then the Commissioners.