§ 25 Mr. TOUCHEasked the Secretary to the Treasury (1) what is the position, under the National Insurance Act, of doctors' dispensers who have dispensed for many years, but had ceased to be doctors' dispensers and were running drug stores for a period of years prior to the passing of the Act; are they debarred from dispensing in future unless they have a registered chemist on the premises; (2) what is the position, under the National Insurance Act, of a man of many years' practical experience, but an unregistered chemist, who has dispensed for public in stitutions and doctors, but who was not a doctor's dispenser or an institution dis- 964 penser during the three years mentioned in Section 15 of the Act, but was for that period dispensing doctors' prescriptions behind a chemist's counter; is he debarred from dispensing insurance medical prescriptions under the Act; (3) if his attention has been called to the case of J. P., who was brought up in the business of a chemist and has known no other calling, who has passed the preliminary examination recognised by the Pharmaceutical Society, served four years' indentured apprenticeship with a fully qualified chemist, has had a twelve months' course at a college of pharmacy in Manchester, has held the positions of branch manager and assistant for several years, and has done the dispensing at one of the shops of a well-known firm of chemists, has now embarked the whole of his capital in purchasing a business, and has dispensed a great number of physicians' prescriptions during the three years prior to the passing of the Act, but has not dispensed solely for a doctor during that time, and is therefore debarred from dispensing medicines under the National Insurance Act; and will he say whether, in pursuance of the pledge given on 2nd August, 1911, the necessary steps will be taken to allow this man and others similarly situated to dispense under the Act; and (4) if he is aware that hundreds of capable dispensers and chemists, many of whom have served apprenticeships to registered chemists and who know no other calling, have reason to fear that they are disqualified from dispensing medicines under the National Insurance Act; and will he say what steps he proposes to take to secure to them this right?
99. Mr. FRED HALLasked if, under the National Insurance Act, doctors' dispensers can be placed upon the panels; if so, what, if any, conditions are enforced in dealing with applications; and whether men who have been dispensing for the last thirty years, but do not happen to have been working with doctors latterly are excluded, while men who have combined such duties as the grooming of horses and cleaning-out of stables with occasional elementary dispensing work are admitted?
§ The FINANCIAL SECRETARY to the TREASURY (Mr. Masterman)The Act gives effect to the pledge given on 2nd August, 1911, that no persons should become disqualified for dispensing medicines through the passing of the Act. The conditions under which persons are allowed to arrange with insurance 965 committees to supply medicines requiring dispensing, to dispense medicines for other persons and firms who are supplying them, and to supply drugs not requiring dispensing, are laid down in explicit terms in Section 15 (5) of the National Insurance Act, and the Commissioners have no power by regulation to vary that Section.
§ Mr. TOUCHEIs the right hon. Gentle-aware that since I asked a single question on this subject I have received heaps of letters from people who say—
§ Mr. SPEAKERIt is impossible for the right hon. Gentleman to answer as to the letters the hon. Member has received.
§ Mr. MASTERMANI have replied. The conditions are laid down fully in the Act. I will send the hon. Gentleman a copy of it.
Mr. WORTHINGTON-EVANSTs the right hon. Gentleman not aware that the Chancellor of the Exchequer gave a pledge to the House that no one who was then qualified to dispense should be deprived of his living under the Insurance Act, and is he not aware that owing to the actual words in which that pledge was carried out a large number of dispensers are deprived of their living, because they are not now allowed to dispense under the Act?
§ Mr. MASTERMANNo qualified dispenser is deprived of his living under the Act, and not only that, but a large number who are not qualified get special qualifications under particular Clauses of the Act.
Mr. WORTHINGTON-EVANSHas the right hon. Gentleman looked into the facts stated in the question? Is he aware that men who have been dispensing for twenty years are now deprived of their living under the Act?
§ Mr. TOUCHEI do not understand the effect of the right hon. Gentleman's reply to Question No. 31. Will he tell me if a man who has been a dispenser for doctors for ten years and who was running a drug store at the time of the passing of the Act is now in a worse position under the Act than a man who has been a doctor's dispenser for the three years preceding the passing of the Act?
§ Mr. MASTERMANI think if the hon. Gentleman will be good enough to look at 966 the Sections to which I have referred him he will see that he has got a full answer.
§ 28. Mr. NEWMANasked if the yearly remuneration or allowance due to a medical practitioner under any regulation made by the Insurance Commission in respect of any insured person who may apply and be accepted by him to be entered on his list, is held to date from the I01h January, from the date on which the medical practitioner agrees to accept such insured person, or from the date on which he first professionally is required to attend on such person?
§ Mr. MASTERMANThe payment is due in respect of the period commencing 15th January or whatever later date the doctor joined the panel.
§ Mr. NEWMANDoes it make any difference to the funds of friendly societies or approved societies or to the insurance company, when he comes on the doctor's panel? Is it to their advantage or disadvantage that an insured person fails to put his name on the panel?
§ Mr. MASTERMANThe doctor is paid from the time he takes responsibility. He is not paid before that time.
§ 29. Mr. NEWMANasked the Secretary to the Treasury whether he is aware that a majority of insured persons have failed to take steps to be placed on the list of any approved medical practitioner on the panel in their district, and that their failure to do so will be attended with discomfort and danger to themselves in the event of sudden illness or other emergency and inconvenience to the medical practitioners on the panel; and whether the Insurance Commissioners will direct the local committees to notify insured per sons of the obligation imposed on them to forthwith apply to be placed on the list of a medical practitioner on their local panel?
§ Mr. MASTERMANI have no information to suggest that insured persons are not taking the necessary steps to select a doctor from the panel who will attend them in case of illness. Indeed, all the evidence in my possession shows that not only the sick, but persons in good health have come with quite unexpected alacrity to have their names registered by panel doctors to be their patients in the event of possible future illness.
§ 30. Mr. JOHN WARDasked how the Insurance Commissioners propose to allocate to the rural districts where they temporarily reside the medical contribution of an insured workman who changes his place of abode on an average of four or five times in a quarter; and will the approved society have to notify the change of residence each time to the local insurance committees, or will it be sufficient to notify only that local insurance committee where the approved member resides at the beginning of each quarter?
§ Mr. MASTERMANArrangements for the necessary notifications and adjustments of contributions in the special class of cases referred to by my hon. Friend are now being completed, and I will communicate with him at the earliest possible date.
§ 34. Major GASTRELLasked the Secretary to the Treasury whether his attention has been called to the circumstances of the death of Frederick Richard Townsend, an insured person under the National Insurance Act, and to the verdict of the jury who inquired into the cause of death, when the jury referred to the scandalous amount of clerical work required of a panel doctor, and the coroner in summing up said that the man's life ought to have been saved if the doctor, owing to his work, had not been prevented from examining the case; and what steps will be taken for limiting the number of insured persons any one doctor may agree to treat?
§ Mr. MASTERMANI am informed that the London Insurance Committee are conducting an inquiry into the allegations made at the inquest in the case referred to that the amount of work imposed upon the doctor in attendance upon the patient by the Insurance Act, the regulations made thereunder, and the arrangements of the insurance committee were such as to preclude the doctor from a proper examination of or attendance upon his patients. Until this inquiry is completed, it would be improper for me to make any statement on the subject.
§ Major GASTRELLWill compensation be paid to the relatives of this man owing to the neglect of this doctor to carry out his obligations under the Insurance Act?
§ Mr. MASTERMANI cannot say that. It is a more or less judicial inquiry, and I think that it would be very unfair to the doctor himself if I made any statement until I get the Report.
§ Sir C. KINLOCH-COOKEWill the right hon. Gentleman make any observations in regard to the death of a domestic servant which occurred in somewhat similar circumstances?
§ Mr. MASTERMANI do not like to make any observations unless I have some facts to warrant them.
§ Sir C. KINLOCH-COOKEShe is dead.
§ Major GASTRELLIs the right hon. Gentleman aware that claimants are kept waiting daily for two hours in the streets of London while seeking to gain admission to the doctor, and will he endeavour to provide some temporary shelter for such persons until the necessary number of doctors to attend on the insured sick persons is secured?
§ Mr. MASTERMANI am not aware of any such facts. There are far more doctors on the London panel than are necessary to meet existing needs.
§ Sir J. D. REESHow many lives will have to be sacrificed before the Government mitigates the severity of this Act?
§ Mr. MASTERMANI know of no lives being sacrificed. I know of a number of lives that probably Will be saved.
§ 38. Sir J. D. REESasked the Secretary to the Treasury whether he is aware that, though the Rochdale Insurance Committee has been in existence for several weeks and medical benefit has actually been in operation for upwards of one week, the Commissioners have not yet issued the Regulations necessary for the due election of the medical members of the Insurance Committee; and, if so, what explanation he can give of an omission so unsatisfactory to the medical profession?
§ Mr. MASTERMANWhen the Rochdale Insurance Committee was constituted, like the other insurance committees, in May last, the British Medical Association was invited to obtain from the medical profession throughout the country the names of medical practitioners suitable for appointment as representing the profession in each area, in the same way as central organisations representing approved societies obtained names of their representatives throughout the country. The Association declined this offer, and, in the ordinary course, no new appointments would be made until new committees are appointed. The Commissioners have, however, decided to allow representation on 969 the present committees, and are arranging for the election at the earliest possible date of direct representatives of the profession on the various committees, and also for the appointment of medical members of the committees by the county and county borough councils and the Insurance Commissioners.
§ 43. Sir J. D. REESasked the Secretary to the Treasury whether he is aware that Dr. Guinness, of 30, Walbrook, E.C., whose name appears on Panel C, London, is not known or found by insured persons at that address; that doctors who reside in the suburbs and have no surgeries in the City are likewise entered on London panels; and whether the Government have satisfied themselves as to the efficacy of panels so constituted?
§ Mr. MASTERMANI am informed by the London Insurance Committee that the practitioner referred to sent in his name, with the address stated, for inclusion in the first list of the London panel, but that since that list was published he has left England. A revised list, which will include over 300 additional names of practitioners who have applied to be put on the London panel since the publication of the first, will be issued this week, and will omit the name of the practitioner referred to as he is no longer available.
§ 44 and 57. Mr. TOUCHEasked (1) what course an insured person ought to pursue when he has incurred expense by obtaining treatment from a doctor not on the list, and has failed to receive any reply to repeated applications to the insurance committee for permission to contract out, and is so placed that it is a matter of urgency to him to ascertain how far the expenses he has incurred and may incur will be met by the insurance committee; and is the Government aware that many insured persons in London are in this position; (2) whether an insured person under the National Insurance Act is acting in accordance with the instructions printed at the foot of the medical ticket issued by the Insurance Commissioners if he returns that ticket to the insurance committee with his application for permission to contract out, or should he only forward it when he has actually incurred the expense towards which he is claiming a contribution?
§ Mr. MASTERMANThe National Insurance Act contemplates that permission to an insured person to make his own arrangements and receive a contribution 970 towards the cost from the insurance committee will only be given in special circumstances. Insured persons are, therefore, not entitled to assume that their own applications can be granted, and if in these circumstances they choose to incur expense by obtaining treatment from a doctor not on the panel they must be prepared to take the risk of receiving no contribution if their application cannot be acceded to. The medical ticket should be retained by the insured person until the insurance committee have directed him to forward it to them.
§ Sir C. KINLOCH-COOKEIs not that in direct conflict with what the Chancellor of the Exchequer said the other day?
§ Mr. MASTERMANNo. It is a direct carrying out of the Act which was passed twelve months ago.
§ 91. Mr. ORDE-POWLETTasked the Chancellor of the Exchequer whether he is aware that an official of an assurance company is advising insured persons to select one particular doctor; that it was only after repeated inquiries that he admitted that they could choose for themselves; whether such a proceeding is in accordance with the regulations of the Insurance Com missioners; and whether he has sanctioned such a practice?
§ Mr. MASTERMANIf a case were substantiated of an insured person being deliberately misled into thinking his choice of a doctor on the panel was in any way fettered the Commissioners would take a serious view of such conduct, and would take the appropriate action with regard to all persons found to be responsible for it.
§ 92. Mr. BRIDGEMANasked whether, in the case of a practitioner on the panel supplying his own drugs, Regulation 47 only assures to him a capitation fee of three-seventeenths of the amount avail able for medical benefit; and if, under these circumstances, the total capitation fee may not exceed 8s. 6d.?
§ Mr. MASTERMANThe medical practitioners, in the circumstances stated, would receive three-seventeenths in respect of drugs, and fourteen-seventeenths in respect of medical attendance and treatment, making a total capitation fee of 8s. 6d. In addition, each would receive his proportionate share of the sum, equal to 6d. per head per annum, of all insured 971 persons entitled to obtain medical attendance from practitioners on the panel in respect of the domiciliary treatment of insured persons suffering from tuberculosis, making a total of 9s. in all.
§ Mr. BRIDGEMANWill the proportion of the drug suspense fund referred to in the right hon. Gentleman's answer be certain to amount to sixpence?
§ Mr. MASTERMANI understand that agreements are being made on that basis.