§ 26. Sir J. D. REESasked the Chancellor of the Exchequer whether he has instructed the insurance committee not to allow people to make their own arrangements for medical treatment because the Government will not allow it; and, if so, by what authority he urges the insurance committee to contravene the provisions of the Act to which they they owe their existence?
§ The CHANCELLOR of the EXCHEQUER (Mr. Lloyd George)I do not know to which of the 235 insurance committees the hon. Member refers, but in any case the answer to the first part of the question is in the negative; but I may 1865 again point out, with regard to the suggestion contained in the second part of the question, that an insurance committee is not required by the Act to allow insured persons to make their own arrangements for medical treatment.
§ Sir J. D. REESMay I ask the right hon. Gentleman if he did not say they were so entitled?
§ Mr. LLOYD GEORGEI certainly did not. If I did the Act provides that they are not to be allowed.
§ 27. Sir J. D. REESasked the Chancellor of the Exchequer whether he has informed the secretaries of the National Insurance Medical Practitioners' Association that priority will be given to the doctors on the panels if whole-time appointments are necessary; and, if so, by what authority he offered this preference to doctors who accepted his views in preference to those who stood by the British Medical Association?
§ Mr. LLOYD GEORGEI would refer the hon. Member to the answer given by my right hon. Friend the Financial Secretary to the Treasury on the 1st January and to my letter, dated 18th December, 1912, which has been laid on the Table of the House.
§ Sir J. D. REESWill this form a precedent for using public funds for breaking great industrial and other non-professional strikes?
§ Mr. LLOYD GEORGEIt has nothing whatever to do with that. We simply propose this course because doctors refuse to place their services at the disposal of the State.
§ 28. Sir J. D. REESasked whether the Insurance Commissioners have approved of the action of the Middlesex Insurance Committee in agreeing that the sum pay able in respect of insured persons who have not before 31st March selected a practitioner on the panels will be divided amongst the practitioners on the panels; and if the Government has sanctioned offering those practitioners who accept its terms additions and emoluments at the expense of those who, maintaining their pledge, decline to accept such conditions?
§ Mr. LLOYD GEORGESection 15 (2) (d) of the National Insurance Act and the regulations made by the Commissioners expressly provide for the distribution amongst the practitioners on the panel of 1866 insured persons who after due notice have failed to select a doctor and the distribution is to be carried out so far as practicable under arrangements made by the practitioners on the panel themselves. These practitioners are responsible for the medical treatment, if required, of such insured persons, and all money available to the Committee for the medical treatment of insured persons obtaining treatment from the panel will be distributed among these practitioners in accordance with the regulations.
Mr. WORTHINGTON-EVANSCan the right hon. Gentleman say whether a doctor who has gone on the panel can refuse to take his quota of the distributed insured persons?
§ Mr. LLOYD GEORGEThe hon. Gentleman knows perfectly well there are special provisions in the Act dealing with cases of that kind.
Mr. WORTHINGTON-EVANSCan a doctor, once he has gone on the panel, refuse to take persons distributed by the committee amongst the doctors on the panel?
§ Mr. LLOYD GEORGEAs a matter of fact that has nothing to do with the question. The hon. Gentleman knows perfectly well he can refuse, in the first instance, but there are provisions dealing with those who have not been already distributed among the doctors.
Mr. WORTHINGTON-EVANSDid not the right hon. Gentleman, in answering my hon. Friend's question, say that those persons were to be distributed according to arrangements made with the doctors. I ask can a doctor refuse to treat those patients who are distributed—may I have an answer?
§ Mr. GWYNNEAre we to take it that although a doctor on a panel may refuse to attend a patient that same patient may be allotted to him by the committee?
§ Mr. LLOYD GEORGENo, I did not say that. If I did not make myself intelligible I will answer again. I said there were special provisions in the Act for distributing those who had been refused by all the doctors, but it is a very improbable contingency that every doctor on the panel will refuse the patient.
§ 29. Sir J. D. REESasked the Chancellor of the Exchequer whether he organised or expressed his intention of 1867 organising a service of State-paid doctors ready to proceed to any area in order to break; down the opposition of the medical profession to working on the panel system?
§ Mr. LLOYD GEORGEIn any area where the panel may be found to be inadequate the duty is laid upon the Commissioners of making alternative arrangements in conjunction with the insurance committee for the medical treatment of insured persons; and of such alternative arrangements that of a salaried service appears to be the one most acceptable to the insured persons themselves.
§ Sir J. D. REESMay I ask whether this forms a precedent for breaking down industrial and non-professional strikes?
§ Mr. LLOYD GEORGEThe answer is a specific answer to the question, which is whether a State service is to be organised in those cases. I say that it is the duty of the Commissioners to see that adequate medical provision is made. There are two or three alternatives, and the one which is popular with insured persons is salaried service.
Mr. WORTHINGTON-EVANSMay I ask, where a State service is organised and put into force in a district, will insured persons have free choice of doctors?
§ Mr. LLOYD GEORGEInasmuch as the insured person is fully represented upon the insurance committee which will be making the arrangements, I take it he would look after his own interest.
Mr. WORTHINGTON-EVANSHas the right hon. Gentleman altered his mind since October last, when he stated that in such a case a person would be entitled to free choice of his own medical man?
§ Mr. LLOYD GEORGEI fail to see in what respect my answer differs from the answer I gave before.