§ Motion made and Question proposed, 2. "That a sum, not exceeding £148,709, be granted to His Majesty, to complete the sum necessary to defray the Charge which will come in course of payment during the year ending on the 31st day of March, 1917, for the Salaries and Expenses of the National Health Insurance Joint Committee (including sundry Grants-in-Aid)." [NOTE.—£60,000 has been voted on account.]
§ Mr. CHARLES ROBERTS (Comptroller of the Household)On these Estimates for National Health Insurance I should like to begin by pointing out that this Department, like all other Departments of civil administration, is at the present time conditioned by the one dominant fact of the War. It affects us in the insurance work in three ways. In the first place, it is obvious that we cannot get funds in the shape of Exchequer Grants for new services and fresh developments that might have been contemplated in normal times. On the other hand, the Estimates which are before us to-day show that there are still very considerable sums contributed by the Exchequer, and it is with there I have to deal. Secondly, the War affects us, as it affects all employers, by reason of the depletion of staff joined with the complication of problems and additional work which war brings in its train. As this point has been brought to notice and attention called to it, I should like to give at once the extent to which the Department has been depleted by the claims of the War. In the first place, it suffered more than most Departments. Our staff was organised only a little while ago, and it happens to be a very young Department, as only 19 per cent, of it was above military age. Some of the older Departments have, I believe, as much as 50 per cent, of their staff above military age. 44 Therefore they could afford a more sweeping loss of the men ox military age and under. But of the total male staff of 1,424 in the English Commission 50 per cent, has been released for war service either through enlistments or else they have been transferred to other Departments—Admiralty, War Office, Munitions War Trade Department, Prisoners of War Bureau, and so on. Two-thirds of the men of military age have been released for war service, and I think those proportions hold good in the other Commissions, certainly in Scotland, and I rather think in Wales the proportion is even higher. We have got on as well as we could without those officials. We have, of course, drawn largely upon woman's labour to help us through. In the English Commission we now employ 1,331 women in the Department. I hope the Committee will realise from those figures that we are doing our utmost as and when it is possible to release for war services all those who arc not indispensable for carrying on work of national importance.
The same cause depletes the staffs of the approved societies through whose agency, of course, we work, and they have taken a somewhat different point of view from that taken by some hon. Members in this House. Some hon. Members have thought perhaps that we have not been ready enough to release the staff for military work, but the approved societies, on the contrary, have been rather inclined to complain that we have not taken sufficient steps to assist the members of their staffs whom they regard as indispensable for their work. Some steps have been taken, and I should like to make it quite plain that we have applied one consistent rule both to our own staff and to the staffs of the approved societies. We have made no general exemptions. Each case has been taken on its merits. If a man could fairly be regarded as indispensable for carrying on work of national importance, steps have been taken to keep him in his present employment, but not otherwise. Meanwhile the War has brought new problems. There is naturally a considerable amount of extra work, rearrangement of normal work to secure economies, rearrangement of staff, and so on. There is additional work in connection with the Army and Navy Fund. We have carefully to watch the administration of benefits to soldiers who have been invalided. We 45 have to deal with the supervision of the medical attendance for the dependants of soldiers. A great deal of work has been put into the task of co-ordinating a sufficiency of doctors for both civilian and Army needs. The shifting of the industrial population brings its own difficulties, such, for instance, as the increase of the number of women entering into insurance and extra deposit contributors. Besides that there has been the safeguarding of the national supply of drugs, as to which the Government has charged the Department with special powers. Under all the circumstances I would invite the Committee to pay what I think is a well-deserved tribute to the staff, which, under circumstances of great difficulty and sometimes of great strain, has been carrying on its work and doing it as best it can. I do not pretend to say that we can maintain the same standard of efficiency as we could in normal times. Inevitably there must be a scaling down of efficiency. But there is a limit beyond which efficient administration must not be allowed to sink, and I do not believe that that point has been crossed. If hon. Members occasionally have not received from me attention quite as prompt as I should have desired, I hope they will make excuses and realise that it is more difficult than in normal times.
Thirdly, I ought again to remind the Committee that war conditions make it impossible to deal administratively with a number of questions which are too controversial to touch at the present time. For instance, it has often been suggested in the course of the last twelve months that something might be done with regard to sanatorium treatment or with questions connected with the payment of doctors. I am sure the Committee, when they come to think of it, will feel that when the whole of the medical profession is being mobilised for the needs of the Army it is out of the question to attempt to revise or consider in any way the terms of the agreement which was originally framed. All that must wait until peace gives us a return to normal conditions. When some of our critics are good enough to suggest schemes which will save untold labour and unnumbered millions, I welcome such suggestions with all my heart; but what would interest me more would be schemes of that kind having the additional merit that they would receive universal acceptance. Meanwhile I frankly admit that during the War period we must have a deliberate policy of marking time. That is not, as it is called, 46 a policy of drift. We have to recognise the conditions under which the work has to be carried on. I do not think that the Act and it administration will suffer from this period during which administration settles down into routine. If it were possible for administration to tear up the Act by its roots, to overhaul the methods which are now growing familiar, I am sure I should be greeted with groans of protest from overworked officials up and down the country, who find it all they can do at the present time to carry on. What they ask for is simplification, a smoothing down of processes. We must always bear in mind the fact that a great part of the work in the country has to be conducted by part-time officials and by men who have not had the highest training, though they know their work thoroughly well, and what they ask for, especially at this time, is as much simplification as they can obtain. I am glad to say that some steps have been taken in that direction, and I am looking to the Committee presided over by Sir Gerald Ryan, about which I will speak in a minute, for many suggestions when their task is completed.
Meanwhile, I am glad to think that some tidying up of our Regulations has now been carried through. Originally it was impossible to act except piecemeal. Especially in the hurry of the start you had to issue regulations and orders to deal with emergencies as they arose. They covered hundreds of pages, and were no doubt difficult to keep pace with. I am glad to think that the process of consolidating those Regulations, at all events, so far as the English Commission is concerned, is now practically complete. They are consolidated into codes under certain heads—for instance, Approved Societies, Navy and Army, Collection of Contributions, and so on. There are some gaps. The medical benefit Regulations have to be left until after peace returns, and there are some individual Regulations dealing with special points which cannot very well be grouped. I should like to mention one small improvement, which has been sanctioned by Parliament, in forming these codes of Regulations. We have inserted in them, with the assent of Parliament, a printing clause, as it is called, under which any amendments of the Regulations that may be made will be made in such a form that they can be inserted into the code, or the code made to give effect to them in such a way that any future amendments will be at once, or, at all events, after a 47 short interval, automatically put into the code. So these codes will be there, growing or modifying themselves as may be; but we shall not get the same litter of Regulations that we have had in the past. The officials also have had a handbook published this year as a book of reference to guide them through some of the mazes of the Act. I hope within the course of a few weeks to get a volume published which will give us the Act, Orders, and Regulations in one volume, which, I think, will help to put the Act upon a proper basis. I do not mean there have been no new developments in the course of the present year. I am glad to think that in Ireland a belated and long overdue system of medical certification has come into force since 1st January. The chemists of England and Wales have been able to arrive at an agreement with us under which the very bad and unbusiness-like habit of discounting their bills has been abolished, and prompt payment, in full, of their bills is assured. I must admit that there are one or two outstanding points in that agreement, but I hope we shall be able to settle them. I think that, on the whole, the present position of affairs is well understood by the Committee. We have had a period of rather unusual quiet. At times during the present year I have thought that the stream of national insurance, after the noisy and brawling rapids of its early days, was being smoothed down into the calm of an uneventful backwater. I have, however, few illusions as to the future. I dare say we shall again get the familiar ruffled surface and the usual disagreeable snags.
I now turn to a question which I am sure the Committee will want some information upon—that of the economical administration of the Act. If the Committee will look at the Votes for the Joint Committee —the four Commissions—and the Vote for the Audit—which is not administered by us, but by the Treasury —they will find this result: The Grants, as stated in the Appropriation Act of two years ago, 1914, were just under £7,700,000. The same Grants in the Appropriation Act of last year, 1915, were £7,195,000. The Estimates for 1916–17 are £6,305,000—that is to say, as compared with two years ago, the Estimates show a reduction of £1,380,000. As compared with last year there is a reduction of £890,000. I hope that the look of these figures will be satisfactory to the economists. I am afraid, 48 however, that they will require a good deal of explanation before the economists will be satisfied that they have arrived at the bottom of the matter. Anyone who> looks even cursorily and superficially at these Estimates will see that it is not very easy to compare this year's Estimates with last year's. When, for instance, they find that the Vote for medical and sanatoria benefits is three-quarters of a million up, and the Votes for sickness, disablement, and maternity benefits are £1,200,000 down, it is obvious that there are here bookkeeping changes calling for explanation. It will probably save time if I try to explain them now—though I must apologise to the Committee in view of the matter being technical. There are two main changes which have affected our accounts. The first is that sums paid to insurance committees—that is to say, medical and sanatoria benefits, and expenses connected therewith, had, under the Act of 1911, to be paid at the beginning of the calendar year. This was modified by the Act of 1913, which gave power to frame regulations under which payment could be made from time to time; in fact, generally month by month. Thus, two years ago sums were taken for the full calendar year—for the twelve months up to 31st December, 1915. In the Estimates for 1915–16 we only, therefore, required to have one quarter's moneys provided for these services, up to 31st March, 1916. This year we are taking the full financial year's Grants, up to 31st March, 1917. That is one of the grounds why the figures this, year are not very easily conparable with the figures of last year.
There is another complication. Originally it was the rule that we should only charge against the Vote —or give as the final figure in the year's accounts—sums as they were audited, not as they were issued to the societies. This has been changed. Now we can charge against the Vote, and include in the year's figures the sums which are actually issued from time to-time to the societies. These sums, which come from Grants-in-Aid, have afterwards, of course, to be audited, and any excess or diminution is put right according to the audit in subsequent accounts. The result of all of this is that this year we are taking twelve months' full provision. Last year, so far as the insurance committees were concerned, we only took one quarter's; and so far as the approved societies were concerned, we took, as it happened, fourteen months' provision. At the same time 49 there was a considerable revote in last year's figures, necessitated on account of moneys surrendered in the year previous. I cannot satisfy myself, therefore* that I have succeeded in doing what last year the Committee asked me to do—secure that the accounts should be presented in such a form that one year's accounts could clearly be comparable to that of another; but I do think that this year's accounts are in much more satisfactory order to serve as a basis of comparison for future years. Even there I must guard myself on one point. So far as moneys paid to insurance committees and approved societies are concerned, we have got in the present years' accounts a normal twelve months' provision. The War, however, comes in again and complicates the matter, when you have to deal with doctors' half-crowns; those are not a normal figure for an ordinary year—and we cannot see what variations there may be next year.
Then as the result of these changes, in the first place, we have got the accounts in such a form that they will really serve as a basis for comparison in the future. The other point, on which I think the Committee may congratulate itself, is that in a time of great financial pressure we have been able to present our claim against the Exchequer in such a form that it is £1,380,000 less than it was two years ago. And the sum, which I have shown to be reduced this year as compared with last year, does contain some very real economies. There is a substantial reduction of expenditure. On the one hand we have postponed new services. With regret —but if economy were to be made somewhere, you had to cut down in some direction or other—health lectures, nursing schemas, referee consultants, and one or two other new services have had to be postponed until the War is over. We have saved £145,000 on that. We have depleted balances in funds fed by Grants-in-Aid. For instance, as an illustration of that, last year we took £100,000 to enable approved societies to assist their members in paying penalty arrears. This year we are going to restrict that service to the cases of discharged seamen, marines and soldiers alone. The state of trade renders it unnecessary to use the Grant in full, and it causes an immense amount of complicated book-keeping, so that though the approved societies may lose in money they save in trouble, and I hope, therefore, they will not mind. We are taking this year a mere Token-Vote of £100, and using the balance 50 left in that fund to meet the restricted service. In some ways the War itself lessens expenditure. Of course there is a large transfer going on from the class of employed contributors to the New Armies, offset by the new entrants, women and others, who are coming into employment. The State, does not lessen its liability for benefits that would have been paid if the insured person had not gone into the Army, except in reference to what are known as the doctors' half-crowns, the money which is given under sub-head (k) As it happens, there will be fewer half-crowns granted this year, and there is a; real saving thus produced by the War itself. Another illustration is the fact that the State will have to pay a lessened contribution on account of low-wage contributors. With the rise in wages there will be fewer low-wage contributors, and that is a change which, I am sure, we shall all regard as satisfactory.
Turning once more to the domain of minor economies, I only refer to these as illustrations. They are rather difficult to single out. Though I think the Committee does feel that the money which is being spent on national health insurance is money well spent for good social purposes, yet it needs to be assured that the money spent is being carefully scrutinised, and I believe the various Commissioners are doing their best. They have overhauled their routine expenditure in such a way that I can assure the Committee a very real regard has been paid to the demands of economy during the present year.
§ Sir P. MAGNUSWill there not be less State liability, owing to the War, on medical benefit?
§ Mr. ROBERTSI think not, except in so far as the doctors' half-crowns are concerned.
§ Sir P. MAGNUSNot beyond that?
§ Mr. ROBERTSNo. May I give three illustrations? In the first place, sums borne on other Votes amounted: to£393,017. That has now been reduced by £56,633, partly on account of office accommodation in Wales, and partly by revaluation of work done by Customs and Excise. Travelling expenses, which were heavy, are down this year by £9,450. The four National Commissions cost, I think, in all about £25,000. There are eighteen gentlemen on the various Commissions who draw" between them £21,100, but there are two vacancies which, in accordance with the 51 recommendations of the Committee on Public Retrenchment, have not been filled, and thereby a saving of £2,000 has been effected. On the other hand, I am quite sure the Committee, when they think of it, will not expect any large saving on salaries this year, considering the fact that half our staff has gone, that we have of necessity to pay their salaries, less any sums coming back by way of military pay, and we have to pay in many cases the cost of substitutes. I think the Committee will agree that if there is ever any chance of reducing staff or diminishing salaries they certainly will not expect to find it this year.
§ Mr. LEIF JONESWill the hon. Gentleman tell the Committee what part of the salaries is paid for service no longer rendered to the Insurance Committee, but payment for men who have joined the Army, and do not do work under the Insurance Committee?
§ Mr. ROBERTSI can get that worked out, but I am afraid I have not the figures before me. Of course, I must remind the Committee, the main lines of expenditure are fixed by statute. The benefits are fixed by statute. The proportion of the estimated cost of those benefits which falls upon the State is also fixed by statute. The economies that may be made by administration are not negligible, and attention is being paid to them, but they are restricted in scope. I wish to say a word or two on the question of financial soundness of the Act, and in reference to that I should like to refer to the recently-published Report of Sir Gerald Ryan's Committee. I can only refer to that Committee, I am sure. Mr. Whitley, under strict limits of order. Clearly I cannot refer to it in so far as it recommends legislation, but I apprehend I am in order in alluding to the Report for the light it throws on the present financial soundness of the Act as shown in the administration up to date, and also, I imagine, on the question of whether any flaws which have been discovered by that Committee are to be properly met by legislation of whatever kind, or by a simple and facile recourse to Exchequer Grants. I am quite certain that I may be allowed to pay my tribute of thanks to the labours of this Committee— a very large and representative body, fully equipped with intimate knowledge, the working of approved societies, and with technical and actuarial advice. It has been 52 a rather prolonged inquiry, but I am sure no one will grudge the time which it has bestowed in the endeavour to probe what has been discussed on party platforms, what has been the subject of a good many discussions in this House, but what has never received the prolonged scientific and impartial inquiry which it has now obtained. The main defects which the Committee have brought to light have been already stated frankly to the House of Commons long ago. For instance, on 4th May, 1914, the present Minister of Munitions, then Chancellor of the Exchequer, made a statement in which he spoke of the deficiencies which might arise from mismanagement and malingering. Those he sharply distinguished from the
cases where well-managed societies attracted an unusual proportion of bad lives, or were limited to classes subject to special sickness and disability, and, above all, the working of the Act revealed an appalling amount of sickness among married women, especially under certain conditions, a fact which was quite unknown before the Act."—[OFFICILAL REPORT, 4th May, 1914. col. 82, Vol. LXII.]4.0.p.m.In other words, he laid stress on the two main points, which, I think, are brought out by the Committee—the risk of segregation, that is, the possibility of persons of under-average health, or exposed to special risks, being grouped together in a single society; and, secondly, the excessive sickness which has been found to prevail among women. What the Ryan Committee have done is to measure and appraise as far as possible before the valuation is carried through the position under the Act, and if the Committee will allow me I should like to draw attention to what has been found. If you are an expert in approved society finance you would think in terms of so many pence or decimal points of pence per member per week. It is not a form of calculation which is very familiar to me, but I have translated it into something more intelligible. Take the case of the 10,000,000 men insured under the Act. The provision made for sickness benefit and for maternity benefit in 1913 was just under ½ per cent, more than was required; in 1914 it was I per cent, less than what was required. In 1915 there were the abnormal conditions of the War, greater opportunities for employment, high wages, and other circumstances which we cannot reckon upon under ordinary circumstances, but under those abnormal conditions the provision made for sickness benefit and maternity benefit was 8 per cent, above what was required—that is to 53 say, in terms of money in 1915 it was just over £500,000 more than was needed. So far the Act is in no bad condition, and I am bound to say that that result does do great credit to the actuaries who laid the original estimate before us. Of course, that is for all men taken together; it does not mean that every society, however badly managed, is in that fortunate position, and consequently it does not take into account the risk of segregation which does apply among men's societies as well as among the women's societies. That, however, is the position.
The case of the 4,000,000 insured women is not so satisfactory. In 1914 the provision made for sickness and maternity benefit was £675,000 short, but in 1915, under the abnormal conditions, in round figures that shortage was reduced to £170,000, and that is the measure of the shortages of the provision made in the case of the women. The men were up by £500,000 and the women were down by £170,000. The Committee will remember that the- total income of the Act from all sources is £25,000,000. I have paid my compliments to the actuaries for their work in reference to the men, but their work in reference to the women is not nearly so satisfactory; still, before you blame them or the Government for listening to their advice, I think you must remember what the actual conditions of actuarial science are. In the case of the men actuaries can tell you what fraction of a penny per week is necessary to safeguard the population against the sickness which they anticipate will come some twenty or thirty years hence; but they are acting on a firm statistical basis before they make their prophecy, and then they trust to the law of averages; so in cases where you have not that groundwork it is impossible for them to make more than a conjecture. In the case of the women, in 1911 there was no such statistical basis to go upon. It is true that some facts were alluded to in the actuarial report, but they were imperfect; though they appeared to point to a rate of sickness similar to that of the men. Some precautions were taken and the actuaries proposed that there should be a margin of 31 per cent, above the figures shown; that is, they assumed that the women would have 31 per cent, more sickness than men, but the House of Commons during the stages of the Bill reduced the margin to 24 per cent. It has been proved, especially in the case of married women, that the excess is even higher than 54 that, but before this House blames the Government for that I would ask hon. Members to recollect what the conditions were in 1911. In that year an agitation was raging in the country which, I think, would have seized hold of any proposal to differentiate between men and women as a gross injustice. There were no facts available to justify such a differentiation which the actuaries could point to; if in spite of this the Government had decided to treat the women with far less liberality and generosity than the men, and if such a proposal had been brought down to the House of Commons, I do not think it would have survived an afternoon's discussion. That, I think, is the defence on that point. The other point on which apprehension has been expressed in reference to the soundness of the Act is the effect of the War on its finances. On that point I might refer to what the Committee has said. It does not think that there are sufficient data yet for measuring the ultimate effect of the War. There is no immediate bad effect, as the Committee knows, but there may be in the future, and no doubt prudent men would make their calculations and allow for extra risks. The result of the War will depend upon a balancing of forces operating in different directions. On the one hand you may have the benefit of improved physical training and physical exercise during the War to set oft against the strain of war service. Then you have got the release of reserves by premature death, and you have the opportunity of getting a much higher rate of interest than was anticipated, and you also have the present low rate of sickness. You have also to take into account not the direct results of the War which are immediately traceable to war strain—those, no doubt, must be borne by the country as a whole— but what is feared also is that at a later stage, some years hence, there may be" an upward curve of ill-health due to a lowering of stamina which could not directly be traced to the War, but which might be indirectly due to it. On the other hand, the Committee does not think that there is any ground for taking more than precautions, and that there is no real unsoundness to be found in the Act as a result of that. My submission to the Committee on the basis of this prolonged investigation is that the problem is really a manageable one. There is no justification for scare-mongering and no ground whatever for lurid pictures of impending doom and disaster such as we hear of 55 sometimes. I might warn the scaremongerers that sometimes their policy tends to fulfil its own prophecy by preventing persons from taking the proper precautions which would obviate the results that they apprehend. I think the pessimists ought to be pleased that their complaints have received this prolonged and thorough investigation. For the rest I think the problem is well within the range of statesmanship, to say the least of it. How it is to be done I cannot say to-day, because I am prevented from doing so by the limits of order. The Committee does assume that one Grant of £135,000 a year, representing the Grant-in-Aid to meet excessive sickness of women which was voted by the House in 1914–15, will be continued. Apart from that it is quite idle and unpatriotic to expect in future any further Government Grants in the present condition of national finance.
§ Mr. ROBERTSThat condition was explicitly laid down in the terms of reference under which this Committee was appointed; but in answer to a plea that nevertheless the State should come to the rescue with moneys from the Exchequer, I should just like to quote a Treasury letter which, I think, disposes of that contention. The Lords of the Treasury say:
They advisably excluded the possibility of relieving valuation deficiencies of approved societies by Exchequer Grants from the terms of reference under which the Committee was appointed. The present financial position of the country necessarily precludes such a course, which moreover is, in their opinion, not warranted either by the principles of the Act or the necessities of the situation.I think we may take that as a fixed point in our calculations. Both the Retrenchment Committee and the Public Accounts Committee gave their warnings against any facile recourse to the Exchequer for such Grants, and the anticipation that such Grants are now available may be finally dismissed from considertation. I hope that is a decision in which the Committee will be prepared to concur.
§ Mr. ROBERTSThe Committee also mention the question of valuation which, under the Act, was to begin about a year ago. We were unable to begin the process of valuation at that period, because it would have involved keeping a considerable staff doing sums in the office instead of fighting for their country in the field, 56 and I do not think we were justified in taking that course. The Committee has now shown reason why the valuation should be begun at the quinquennial period. The duty of fixing the date is placed upon the Joint Committee, which has not yet had time to consider the matter, but no doubt they will not fail to pay attention to the recommendation of such an important Committee. I think, to prevent misconception, I must assure the Committee that there is no intention whatever of shelving indefinitely the beginning of I the process of valuation. That process of valuation is an indispensable part, is an essential part, of the system under which the work of insurance is done by approved societies. There is every intention to carry it through, and the societies can be assured that it will undoubtedly be undertaken.
§ Mr. ROBERTSI said that the Joint Committee has not yet considered the point of the date, and I really cannot say more at the present time. There is one other point on which I should like to say a few words and to comfort some apprehensions which have been expressed as to the possible drying up of sanatorium benefit. These apprehensions are sometimes put in a very exaggerated form. There has been some diminution of income for this purpose due to enlistment, but anybody who really knows the work which has been going on in the country since the Act came into force must realise that there has been a very considerable progress shown in counties and county boroughs in tackling this great evil of tuberculosis. It is to a large extent, I admit, outside the Act, but one of the Votes down for to-day is for the Hobhouse Grant, and therefore I am in order in referring to it. That is administered, of course, by the Local Government Board, except so far as the Welsh Commission is concerned. With the money which has been available both through the Insurance Act and by means of what is known as the Hobhouse Grant, the country has been covered with a network of hospitals, sanatoria, and dispensaries, and in connection with that, by voluntary effort and otherwise, there have been Tuberculosis Schools and Care Committees set up. I do not consider that process is complete. The counties and county boroughs in a considerable number of cases have fairly comprehensive schemes, 57 but the work, of course, was largely, though not entirely, suspended by the War. The Committee may be interested to know that in this Vote, Vote 9, you have an addition of £40,000 this year. It is the one sub-head which has really gone up. I do not think anybody will object to it.
Of course, we are concerned from' the point of view of the Insurance Commission, not in the question of the provision of buildings—that is Local Government Board work—but in the question of the treatment of persons, and taking the year 1914, for which alone I have the full information, I can give some indications of the measure of the advance. The applications for treatment that year increased by 6 per cent., the persons treated increased 17 per cent., the cases treated in residential institutions increased 69 per cent., and the cases treated in dispensaries increased 232 per "cent. I have not yet got complete information for 1915, and it is-quite impossible at the present time to press insurance committees to give information in detail, because one has to realise the difficulties under which they are carrying on their work; but such partial information as I have received points in this direction. The dispensary treatment, which went up by 232 per cent, in 1914, went up in 1915 by a very large percentage. I would sooner not give figures. The treatment in residential institutions dropped by a small percentage—a percentage not greater than the reduction in the insured population during the year. Meanwhile, I can assure those who think that the sanatorium benefit is no longer available, that there is accommodation in different parts of the country. I am told that in Scotland they have had no difficulty in finding room for all the tuberculous soldiers reported to them, and there are vacancies in some of the institutions for the civilian population in addition.
I ought to say just one word about the the tuberculous soldiers, who have been treated with special attention. We have had 3,250 cases mentioned to us by the War Office. We have an arrangement under a special Grant for which we arc taking money this year by which we can get treatment of priority for these tuberculous soldiers, and I believe treatment has been offered in residential institutions for all those whose -cases have been mentioned to us. I quite 58 admit that we have not as large a fund as I should like to have, and as I am sure the Committee would like to have at its disposal, The fund is a limited one, and the need, unfortunately, is not limited. I do not know how great it may be. Still, under the Insurance Act we have found, since it has been in force, the sum of £2,800,000. It has been spent in an attack on tuberculosis by means of sanatorium benefit, and, so far from that fund drying up, insurance committees in 1916–17 will have an income of £760,000, including a Grant of £35,000 for tuberculous soldiers, so that the income for that year will be a considerable sum. When the War is over I shall hope to see —it would amply repay the country—a still larger expenditure of money in eradicating, as far as we can, tuberculosis from the country; but let no one because he wants more deny the value of what is being done with the very considerable funds which are at our disposal.
I need only add one other word about the operations of the Act, and I will put it in statistical form, because it is easy to translate the figures into what they really moan in the form of benefits. We have now got invested a sum of £23,000,000. That fund is piling up to meet the anticipated sickness which the present population will have to face, it may be, ten, twenty, or thirty years hence. That money at the present time is being invested in sums of £200,000 a month. That is going into War Loan and other Government securities. That is not bad altogether for a so-called bankrupt Act. Meanwhile in 1915, to take merely one side of the Act, the good work which is being done through the approved societies—I leave out of sight the work of medical benefit and sanatorium benefit-men and women received a sum of £6,300,000 in sickness benefit, £1,300,000 in maternity benefit and £840,000 in disablement benefit. Anyone with a very slight effort of imagination can easily see what is the value of these sums coming week after week in small numbers of shillings into the homes of the people who get them. It only requires a very slight effort of imagination to realise what the absence of these sums would mean, and I think all of us may be glad to think that before the deluge of the present war swept everything before it this system of national health insurance was built up as a permanent dyke and defence against social misery and distress.
§ Mr. CURRIEWhen one reflects on the great difficulty under which the hon. Gentleman and his Department have laboured during the past year, I think the Committee will feel inclined to congratulate him in several respects on his having been able to make the statement which he has just made. It is quite true that the accounts reach us this year in a form which makes comparison a little difficult. I will only say that the new accounts are in a better form than the old ones. I am quite sure that such criticisms as have been levelled at the hon. Gentleman on the ground that he has not released a sufficient number of his staff for service In the field are not well taken. I do not believe that the hon. Gentleman has made any such mistake. The promise to codify the Regulations will be a great relief to many associated with the working of the Act, and I hope they will be ready in the course of a few weeks. Finally, I would congratulate him on having been able to secure certain economies. They are not so large as they might be, but we are glad to have them for what they are worth, and the hon. Gentleman is entitled to point to them as the practical result of his efforts to secure economy. In some other respects the statement was not quite so satisfactory; but I wish to assure him that none of the observations I have to offer are made in an unduly controversial spirit, because I agree with him that scaremongering in connection with this Act is really wrong, most unjustifiable, and, it may be, extremely mischievous.
I quite understand the Department's view that we should adopt at the present time a policy of deliberately marking time, but, if that is to be the policy, I confess that I was rather surprised the hon. Gentleman did not say anything when he was referring to the Report of the new Investigation Committee regarding their suggestion that the scheme which they outlined should be adopted for a fixed period of ten years. It is quite true that the hon. Gentleman remembered that he was debarred from entering into matters of legislation pure and simple, but at the same time I should have been glad if he had been able to give us his view whether a policy of marking time was consistent with the adoption of a partially remodelled scheme for a fixed period of ten years. For myself, I should rather doubt it. I was interested to hear the hon. Gentleman say that he had got rid of many illusions, and also to hear 60 him admit that he realised there were breakers ahead of him. Unfortunately, that is the case. He himself referred to the Investigation Committee's Report, and, whilst he is entitled to take some encouragement from some of the things which appear in it, he scarcely laid sufficient weight upon some of the serious remarks which are made in that report. The Report just issued by Sir Gerald Ryan and his colleagues appears on the face of it to be an interim report. The second report will mainly deal with administration, and perhaps only incidentally with finance. I agree that the hon. Gentleman is entitled to wait for the second Report before giving his view on the whole matter, but at the same time it is very serious to see the Committee making, in the seventeenth paragraph, the remark that "bankruptcy in the strict sense of the word cannot overtake the scheme." Admitted; but what kind of bankruptcy is J it that Sir Gerald Ryan has in view when he says that "bankruptcy in the strict sense of the word cannot overtake the scheme?" Sir Gerald Ryan and his Committee, to a certain extent, go on to explain what they mean, but at the same time I think it very serious that the state of affairs should be such that the Committee should make such a remark at all.
Another thing pointed out by the Investigation Committee was that, although in many ways it is a flat-rate system, it is not what is normally called the flat-rate system; it has certain peculiarities which are bound to destroy it. The hon. Gentleman, when dealing with the actuaries, seemed inclined to place upon them a certain limited amount of blame because things had not turned out quite so fortunately as a few years ago the Chancellor of the Exchequer thought they would. My complaint is rather that the advice which they gave was not followed or only followed in a very partial way. It is not the fact that the actuaries are to blame for the undue risk which was taken by the Government in regard to segregation. Neither do I think that they are to blame for the risk run in connection with women's societies. It is true that the House of Commons was foolish at the time it dealt with these questions. The actuaries' margin was 30 per cent., and they reduced it to 24 per cent. I do not think the actuaries ever led the Government to believe that if they, adopted even the 30 per cent, margin they would be proof against trouble, and in 61 placing such implicit faith on either the 24 per cent, or the 30 per cent, margin the House of Commons of the day, I think, committed an unpardonable mistake.
In addition to the Report of the Investigation Committee, which I agree is a very valuable and suggestive document, I should like to draw attention to certain very severe strictures made on the administration of the Act by the Public Accounts Committee. I see that in Clauses 11 and 12 they refer to certain sums, amounting to nearly £9,000,000, spent upon purposes which they describe as out with the framework of the Act and spent without proper authority. It is true that the House subsequently ratified that expenditure, but I think the Committee are well within reason when they say they view any such proceeding with anxiety. I should like to have same explanation of how that came to be done, either by the National Health Insurance Commissioners or by anyone else. Again, if the hon. Gentleman will turn to paragraphs 13 and 14 of the same Report, he will sec a reference to expenditure which is described by the Public Accounts Committee as considerable, and in certain important respects as improper and irregular. Again I ask, what is the explanation, of that? In paragraph 16, dealing with irregular transactions, the Committee goes on to suggest that individuals who are parties to such transactions should be surcharged. This principle is well admitted in other connections, but I think the irregularities which the Committee have censured must have been rather serious when they go so far as to make this suggestion. In another paragraph they refer to certain proceedings of such a serious nature that severe action will be necessary in future, and they suggest that the Government Grant should be withheld.
§ Mr. ROBERTSDo not these refer to irregular payments by the approved societies, and not to payments made by the Commissioners?
§ Mr. CURRIEAt any rate, the sum of £9,000,000 was a Government Grant, and was not a payment made by the approved societies. Perhaps the other cases have arisen in connection with those societies. Nevertheless, I think it well worth while drawing the attention of the Committee to the matter. The language in both of these Reports is really very serious, and I 62 the hon. Gentleman seems to have taken less notice of it than he might very well have done. I think the criticism remains in the mind of the average working man and working woman, who, after all, are the people most concerned, as they are the people who most directly pay the money into the scheme, that the proportion of the money they get back in hard cash—not by way of provision for the reserve funds and so on, but the proportion that comes back to them in hard cash—is on the low side. I know that industrial insurance of any kind cannot be worked without a fairly heavy expenditure. That is a commonplace. But I still suggest there is room for a larger proportion of the money which contributors pay being made available for them here and now. I admit the thing would not be easy, but then the feeling is so widely prevalent among contributors that the proportion is too low—last year it was 13s. 4d. in every £ contributed, and this year we have not had the figures given us by the hon. Gentleman—
§ Mr. CURRIEAnother point on which, I think, contributors would be well warranted in asking for information is this: These reports refer to the risk of the societies becoming if not insolvent at all events involved. The position of certain of the women's societies is not in dispute. They are admitted to be in bad straits. If this House is to force anyone to contribute to any society it should be willing to submit evidence to the parties so coerced that the society is in a satisfactory condition. I wish to make a suggestion which I think is not impracticable, although I admit its application would cause a certain amount of trouble. We all know that under the Companies Acts if a certain proportion of the shareholders feel that a company is drifting into an unsatisfactory state they are entitled to petition the Board of Trade for an investigation. In the 1911 Act it was contemplated that if a society drifted unexpectedly into a state of suspected insolvency, an anticipatory investigation might take place. My suggestion is that if a man is coerced to pay his pennies every week into a society, clearly he ought not to be forced to pay them into an insolvent society; and if a reasonable proportion of the contributors, say 20 per cent., petition the Commissioners for an investigation into the affairs of their particular society so that they may feel sure 63 that they are not being forced to contribute to an insolvent society, then such an investigation should take place with all convenient speed.
I am not one of those who have argued that no benefits hare accrued to the contributors under this Act. On the contrary, I admit that the large sums which are paid week by week are much appreciated in the homes in which they are distributed. It would be idle to deny it, and I think the Act has familiarised the working-class public with the great benefits of insurance. But that does not alter the fact that the benefits given are on the small side. Like the hon. Gentleman who has just spoken I regret I cannot deal with one or two suggestions whereby a better scheme might be brought about. To do so, however, would be out of order. The hon. Gentleman referred to the language of actuaries as being so much black magic, and I confess that a contributor who reads in Sir Gerald Ryan's Committee's Report that "the general financial equipoise may be regarded as a diagonal of forces" is apt rather to be "bamboozled." If the hon. Gentleman will accept the suggestion that specially petitioned-for investigations shall be held into the affairs of a society it will go far to take away from the average contributor the feeling that he is unable to got his full rights; I am certain that that feeling exists in the mind of a large number of contributors just now, but the feeling which once existed against the Act because it was thought it was unduly coercive—and that in a sphere of morals where coercion is seldom profitable—may in the future become much modified. We do not know what the level of industrial wages will be after the War is over. Many of us hope it will be very much higher than it was twenty or thirty years ago, and if it should be, then the feeling that the Act is unduly coercive may become greatly modified.
My original feeling was that the Act was so grossly coercive that it was bound to defeat itself. But if the level of wages for the future should be higher than it was ten, twenty, or thirty years ago, the force of contention will require a great deal of consideration. The arguments against compulsion have been greatly weakened in many minds by compulsion being applied so freely and so wisely in many other directions. I do not object to compulsion if it is imposed upon the people by the people themselves, after full consideration. That 64 was not the nature of my original objection to the coercive features of this Act. I wish—I know it would be a difficult point to deal with—that the Committee could have given it some further enlightenment on these points. One of the great difficulties underlying the successful working of this Act is that, whereas under the old societies every man was willing to act as a watchdog for his neighbour's interest as well as for his own, at present so many members are not only unwilling to consider themselves as watchdogs but are tempted to take up the attitude of demanding their pound of flesh out of the Act. It is an instance. I suggest that financial problems, if probed a little deeper, often turn out to be no financial problems at all; lurking under them is a moral or psychological problem, and I would suggest that running coterminously with ' Sir Gerald Ryan's Committee's investigation there should be another investigation conducted by expert actuaries and medical men which would deal with this moral tilt in people's minds, and which would throw a vast deal of light on the administration of the Act Can the hon. Gentleman hold out any hope that an investigation of this kind will be added to those which are being carried out in other directions?
§ Mr. JONATHAN SAMUELI was glad to hear what the hon. Member who has just sat down said, because I believe that when he fought his constituency he was a very strong opponent of the Act and today he has partly confessed that he was wrong at the time.
§ Mr. CURRIEThe hon. Gentleman must not misrepresent me. I did nothing of the sort.
§ Mr. J. SAMUELAt any rate, I am very glad to find that the criticisms of the hon. Member are not so severe to-day as they were formerly. As I see that he is about to join a new unofficial committee which is to investigate the working of the Act, I suppose we shall have some more interesting revelations when that committee makes its report. I was very glad to listen to the statement of the hon. Member for Lincoln (Mr. C. Roberts), who is in charge of the Insurance Department, because, like the hon. Member opposite (Mr. Currie), I read the Report of the Ryan Committee, and certainly became very much alarmed at some of its aspects, with which I shall deal shortly. I am glad to find that the Insurance Commissioners since they 65 started work have invested something like £28,000,000. That is a very large sum indeed for so short a period. I am given to understand that they are now investing at the rate of £200,000 per month, which works out at about 9 per cent, of their total income. On the whole, that is satisfactory and ought to give a little reassurance to the public, because after the recent discussions in this House and the Report of the Ryan Committee there has been a certain amount of alarm among insurance experts—I have heard them discuss the matter very fully—and a feeling that the finance of the Insurance Act is unsound and that things are bad. By his statement to-day the hon. Member will have reassured those who are insured persons that they will be able to draw their benefits and that at the same time the Commissioners will be able to invest money. Whether the proportion of benefits is high enough it is not for me to judge, but the facts are very satisfactory indeed for the third or fourth year of the working of the Act. Those of us who are interested in insurance companies know that it takes a very long time to bring an insurance company to fruition, and if insurance companies or societies were able to invest money as fast as is being done under this scheme their shareholders and members would be greatly satisfied with their work. The hon. Member (Mr. Currie) shakes his head. I do not know whether he is interested in insurance work, but I can assure him that it takes a very long time to bring to fruition the work of an insurance company, especially the industrial part of it.
I do not know whether the hon. Member for Lincoln explained one or two matters which certainly seemed to be very alarming. On page 2 of the Estimates I find that the total reduction in the Estimates for 1916–17 amounts to no less than £939,753. That is a very large reduction, and some explanation ought to be given why it is possible that it can be effected. Is it partly due to the reduction in the number of insured persons? I find there are fewer men insured than formerly. On page 8 I find there is a reduction of no less than £1,197,000 in respect of sickness, disablement, and maternity benefits. No explanation of that has been given. It appears to be a very large reduction. For 1915–16 the total of those benefits amounted to £3,147,000. This year the sum is £1,949,000, showing a reduction of £1,197,000. Against that there is a large 66 increase which will give satisfaction to the hon. Member for Pontefract (Mr. Booth), because he has raised the point more than once, in the sanatorium benefit and Grants-in-Aid. There is an increase there of £754,300. Taking the whole, there is a net increase of £244,000, because I find that the increase in the sanatorium benefit reduces to a great extent the very large decrease in sickness, disablement, and maternity benefits. We ought to receive some explanation of this large variation in the Estimates for this year in comparison with those for last year. That has not been given, but I hope to hear it from the hon. Member for Lincoln when he replies.
With regard to the Ryan Report, I have road it very carefully, and also the Minority Report. Both Reports are very able, but they are in direct contradiction one of the other. Although the Ryan Report is excellent in many ways, it is defective in other directions I shall attempt to point out. If they had been dealt with the Report would have given Members of the House of Commons a clearer conception of the work of the approved societies and the Insurance Act. I would say one word with regard to the attack made upon the actuaries. In this Report the actuaries come out exceedingly well. The Report shows with regard to men the actuaries estimated that the expenditure for benefits would work out at about 3d. per week per insured member. It has worked out at 2¾d., so that there has been a saving of ¼d. per week per member in regard to male insured persons. That is a splendid tribute to the work of the actuaries, considering that they really had no basis upon which to work, and considering the vast number of new men who were brought into this insurance scheme. In stead of the actuaries being attacked, so far as the men are concerned they ought to be complimented upon the efficiency of their work in advising the Government as they did at the time. There are very few actuaries in insurance work who could claim equal credit with them. With regard to women, I should like to confirm what was said by the hon. Member for Lincoln. Everybody knows that there is a very striking difference now in the benefits paid to women—
§ Mr. CURRIEWill the hon. Member explain who it was that attacked the actuaries? I do not think anybody really attacked them.
§ Mr. SAMUELI did not say that you attacked the actuaries.
§ Mr. CURRIEWho has attacked them?
§ Mr. SAMUELIt has often been said in my hearing that the actuaries were all wrong in their estimates.
§ Mr. CURRIEI never heard it.
§ Mr. SAMUELI heard it stated outside the House only last week.
§ Mr. CURRIENot in the House.
§ Mr. SAMUELIf it was not so stated I do not think the Committee would have investigated that part of the matter so thoroughly. In regard to women, everybody knows—in fact, the Report says so—that their benefits were extended during the passage of the Act in 1911. They were again extended under the Act of 1913, and the Report clearly shows that there is an excess of about a penny per week in the cost of benefits to married women for sickness and maternity over those paid to single women. No actuary could have estimated the probable cost of maternity and sickness benefit to married women, especially when Parliament went beyond what the actuaries expected would be the benefits when they made their estimate. On that ground alone the actuaries ought to be exonerated. Parliament really rushed into a great many things while the Bill was passing through this House. Especially was that the case in 1913. If anybody will read the speeches made on the Second Reading of that Bill they will see that that is the case. The hon. Member who is now Financial Secretary to the War Office then stated that the Chancellor of the Exchequer had conceded what had been demanded from the Front Opposition Bench in 1913, which he would not have looked at when the Bill was going through in 1911. We all know that the Chancellor of the Exchequer over and over again had to fight against making concessions with regard to benefits beyond those for which the actuaries had estimated. If there is any fault so far as the women are concerned we Members of the House of Commons should shoulder the responsibility, because it was we who extended the benefits. I do not think anyone grudged those benefits being extended at the time.
5.0 p.m.
Coming back to the Report of the Ryan Committee I find in it one great defect in regard to the Appendix. The Appendix to the Report is of no value to us who were not members of that Committee, because 68 it simply gives the expenditure for sickness, maternity and disablement benefits. The Insurance Commissioners should prepare what insurance companies are bound to prepare every year to the Board of Trade, namely, a statement at the end of the financial year showing, first, the total incomes from all sources, secondly, the administrative cost, which is a very important matter; and, thirdly, the total amount of money paid in sickness, maternity and disablement benefits. Then they should give us the net expenditure as against the net income. If we had these figures presented to Parliament in the same way as insurance companies are bound under the Acts of Parliament under which they work to supply Parliament with every detail of their income and expenditure, Parliament would be able to be guided by the Commissioners infinitely better than we are now under these reports.
§ Mr. SAMUELI do not think that. The Commissioners are more or less new to their work, and it takes a considerable amount of time to acquire knowledge of this work, but if a statement of that nature, or a complete balance sheet was presented to Parliament, so that the insured persons could see exactly so far as the aggregate of the work is concerned, we should have a clear conception of what the Act was doing. I should like to say this further: It is unwise for anyone to say that any approved society is insolvent. That is a very grave error, and I quite agree with my hon. Friend (Mr. Roberts) that you can bring about the collapse of a very large number of these approved societies if you begin to alarm the public with the suggestion that they are more or less insolvent. I can say from my experience as an insurance man that no one can tell what is the position of an insurance company or collecting society until you have a valuation. You may assume that it is not doing well, you can assume that it is insolvent, but until you have a valuation in which you take into consideration all the assets of the company with its liabilities, no one can tell whether the company is insolvent or not, and therefore I would advise any Member of Parliament, or any person outside—I have heard a good deal of criticism—to wait until that valuation takes place.
§ Mr. SAMUELNo, it is not. How does the hon. Member know what is the position of the society?
§ Mr. CURRIEBecause the Ryan Report tells you. He says:
It is clear, bearing in mind the general scheme of the Act, that a number of societies would, under the existing law, inevitably find themselves in deficiency on valuation.Is that not plain?
§ Mr. SAMUELThat is an assumption. That is not proof.
§ Mr. CURRIEIt is a good enough assumption for Sir Gerald Ryan.
§ Mr. SAMUELI have read that part of it. There is no evidence there. Neither Sir Gerald Ryan nor any other member of the Committee can tell the House of Commons or the public that any society is insolvent until the valuation takes place. I should have waited until these valuations are prepared. I do not say some of the societies are not insolvent. I should not like to make the statement one way or the other.
Mr. RUTHERFORDIt is quite true that you cannot tell exactly to what extent a society is insolvent until you make out that balance sheet which the hon. Member has referred to, but it is clear from the incomings and the outgoings, and from how much the reserve is, that a considerable number of these societies are insolvent. The hon. Member is wrong in saying that as a matter of general principle you cannot say a society is insolvent until you get out the balance sheet. Of course you can.
§ Mr. SAMUELHow is anyone to know what is the income and the expenditure of a society unless he is a member of the managing committee? Therefore it is unfair to attack any approved society by name. I dare say there is a large number of societies which are more reckless than others. They are bound to be penalised for that. Some are exceedingly careful with regard to the payment of benefits. I have conversed with some very active men on some of these approved societies, and they have assured me that they are doing exceedingly well. They give a great deal of attention to the administrative work, with the result that they are going to receive the benefits arising from that work. Another society may take in anyone and may be reckless in the payment of 70 benefits with a view to trying to pull in other members. You must wait until you have the result of that work at the end of a certain period.
§ Mr. SAMUELIt may be too late with regard to some societies, but I should not like to allege that any society is in that state. I should like to come to one point with regard to the Ryan Report which I thought my hon. Friend (Mr. Roberts) would have attempted to deal with. It assumes that unless the Government will authorise the taking of £1,800,000 a year from the Saving Fund, which amounts to £4,500,000 a year, and reducing that to £2,700,000, these approved societies will not be able to manage their business. There is nothing in my hon. Friend's statement which traverses that point.
§ Mr. ROBERTSThe reason I did not touch upon that was that it could not be done except by legislation, and therefore it is out of order.
§ Mr. SAMUELIt could be done in this way. I do not propose that you should legislate, but I think my hon. Friend or the Insurance Commissioners ought to traverse that point.
§ Mr. SAMUELThey suggest that the Commissioners could take take from the Saving Fund £1,800,000 a year. That is a very large sum. They propose then to extend the redemption period for six years. That may be right or wrong, but if the approved societies are in the position that they are bound to obtain this £1,800,000 a year to form a certain contingent fund which they have set forth in the report with very great clearness, and if these funds are not set aside out of the £1,800,000, they allege that matters will be serious with the approved societies. In that case the Government spokesman on behalf of the Commissioners ought to reassure the public upon that point.
§ Mr. SAMUELTake the first case. Take the case of maternity benefit and sickness benefit for married women. They definitely allege in the Report that they must set aside something like £280,000 a year from the £1,800,000 to form a fund. They also suggest that the Government 71 should continue their £135,000, which would make a fund of £415,000, for the purpose of paying and meeting this excess maternity and sickness benefit. If that is the case, why have we not some answer from the Government that this fund is not needed. Again, they propose to form a men's special reserve fund amounting to £250,000. That is for the purpose of meeting the case of men who have come back from the War suffering in health and who, they estimate, will fall upon the approved societies. They cannot ask the Government for an extra grant to meet this, neither did they suggest extra contributions from the married women, or from the men, therefore they say "we must put aside out of this £1,800,000, £250,000 to meet this contingency." Again, they want a contingency fund amounting to £710,000 a year for men and £280,000 for women, amounting altogether to £990,000 out of this £1.800,000.
The CHAIRMANSurely all these matters the hon. Member is now referring to would require legislation. I do not think they could be done by administrative action.
§ Mr. SAMUELI called attention to that for the simple reason that the Report from this point of view is creating a certain amount of unrest, and I am asking the representative of the Government to consider this point with a view of reassuring the public that there is no necessity to create these funds.
§ Mr. SAMUELWhat use are the Commissioners? If the hon. Member says the Commissioners are not in a position to advise the Government on these points, the sooner we change the Commissioners the better, and put the hon. Member or someone else in their place. "Really, to me they are very important indeed. I have heard so much criticism about the effect of this Report from that point of view in the insurance world that you begin to think that many of these approved societies are wrong. The men on this Committee are more or less all members of approved societies, some of them belonging to the largest approved societies in the country.
§ Mr. SAMUELYes, and Government Departments with an actuary upon the Committee, I dare say.
Mr. RUTHERFORDOn a point of Order. All the suggestions the hon. Member is making would involve passing Acts of Parliament. None of these things could be done without legislation. We must take the Act as we find it. I do not know whether it is in order to deal with these matters, which cannot be dealt with except by legislation.
The CHAIRMANThe hon. Member is perfectly right so far as I recollect the Act. These matters would require legislation.
§ Mr. SAMUELI do not intend to pursue the point. I have made my point. I thought there might be power within the powers of the Commissioners to set so much of the sinking fund aside for this purpose, otherwise these men would not have made the suggestion. I thought there might be power within the powers of the Commissioners to do that without legislation. I think it is incumbent upon the Commissioners, in view of the points set forth in this Report, whether they require legislation or otherwise, to state definitely to the public whether these funds are required or not, so that the public can understand, and so that they may know whether the approved societies are able to carry on their work without j taking this large sum of money from the sinking fund each year to sustain and help them in their work.
§ Mr. BOOTHI should think it must be clear to my hon. Friend (Mr. J. Samuel) that this expert Committee of all the talents would never dream of suggesting that the sinking fund should be raided to the extent of £1,800,000 per annum unless it was needed. You do not raid a sinking fund to that amount of money for an Act that is insolvent for an Act that shows a surplus, for a scheme that can confer extra benefits. We all know—and I wish the right hon. Baronet the Member for the City (Sir F. Banbury) were in his place— that the current doctrine in this House is that it is the last resort of a Chancellor of the Exchequer in desperation when he raids the Sinking Fund. The House has never tolerated in connection with our national finance the raiding of the National Sinking Fund except in a time of great emergency such as a war. What is the 73 position? The Insurance Commission is under the Treasury; it is not a Department by itself. That is one of the troubles of the position. The Insurance Commission is a Department of the Treasury, and surely a body of men under the control of our Treasury would not bring in this idea of raiding the sinking fund unless they were in desperate straits. As to asking them not to raid the fund, and to withdraw their words, and withdraw their figures, I only wish that could be done. But the position will not allow them to do it. It has taken a year to drag this admission out of the Government, but at last they cannot deny that an inroad must be made upon the sinking fund to preserve the finances. The hon. Member (Mr. C. Roberts) who speaks on behalf of the Government seems to think that when any of us point out these things we want to attack the Act. That is not so. We want to save the Act from its enemies and its incompetent administrators. How could it be a pleasure to me to attack the Act? The hon. Member (Mr. C. Roberts) did not do one-hundreth part of the work that I endeavoured to do in the country to get this Act satisfactorily started. Therefore, how can it be suggested that I have the faintest bit of pleasure in pointing out anything that is wrong in the Act? It is because this is an Act to which this House gave so much time and attention, which raised such hopes among the people, and which deals with the lives of 14,000,000 of our workers, that I emphasise the importance of these matters, and wish the Act to be beyond all question sound financially.
It is no answer to say that the Act is conferring huge benefits. Of course it is. What a scandal it would be if we took compulsorily a portion of the wages of all these classes of workers, including charwomen, and exacted contributions from the employers, and from the State, if the Act had not done a great deal of good Of course it has. It has saved hundreds and thousands of homes, but that is not the point. It could do that and still have much wider gaps than it has in the way of efficiency. I hope we have done with that. The remarks that have been made in public as a rule, and in this House, and in articles, have been with the object of getting the Government to see the truth of the position and not to alarm the insured people. When I drew attention to the matter earlier it was in order that the Government should realise where they were. But they did not. They would not 74 admit anything in all their public utterances. They have the Press Bureau, and they send to editors of newspapers. It is all a myth that the Civil servants of this country do not appear in any public statements. They keep putting statements about time after time from the Department, and they are very easily traced by any of us who are connected with the working of this Act. What does it all mean? As a sincere friend of the Act it has convinced me that they had not realised the position. A frank statement a year ago that they did know and realise that the woman's position under the Act is unsound would have saved them probably twelve months' worry. They never admitted it, though it was explained by those familiar with the daily and weekly routine of the Act, and they have had to have a Committee to show them the facts. I know of no statement anywhere that the men's side of the Act is unsound, and I challenge anyone to produce such a statement. I have always taken care in my utterances in the Press and elsewhere to say that the men's side was sound. In an article which I wrote, and which has just been published in a London weekly newspaper, at the request of that paper, and which was written solely in order to further the interests of the Act—I took no money for it—I stated plainly that the men's side of the Act was sound. Of course, that reflects well upon the two actuaries who framed the figures, and it is very satisfactory to all of us who are connected with the working of the Act throughout the country. That has been freely admitted from the beginning.
My complaint is that when the suggestion has been made from time to time that the woman's side is not sound like the men's side, we have had an answer from the Front Bench dealing with the general position of the Act. It has never been admitted before to-day by the Government in this House. I think I am entitled to say that those hon. Members who search the pages of the OFFICIAL REPORT will find that one voice was raised before the women's Clauses left the purview of this House, when the original Bill was under consideration, and I then said that I was not satisfied with the finances. I thought them unsound. My voice was the only one raised at that time. I followed up my protest with a letter to the "Times," so that I should not be committed, as one who was working to get a successful Act passed, to the view that the women's figures would turn out sound. After I had 75 sent that letter to the "Times" I had a great deal of correspondence from women's suffrage societies and other organisations who wanted to know what I meant. I frankly told them that I did not think the figures on the women's side were sound. I remained quiet for years afterwards, until it was only too obvious to anyone who was connected with the working of the Act that something was going wrong. It is not the case, as the hon. Member for Stockton (Mr. J. Samuel) suggests, that it is in doubt. Some of these women's societies have been paying double and treble the benefits that any actuary would say were sound. He says we must wait until the valuation to know the exact position, but the people administering the Act, as well as the Commissioners, know that some of these societies, for considerable periods, have been paying aways benefits out of all proportion to their resources.
The reason why I am drawing attention to these matters is that I want to fix the responsibility upon the community. I am not ashamed of the fact that I spring from the humblest ranks of Lancashire mill-workers on both sides, and anything which affects the welfare of married women workers in the cotton mills conies right home to me on account of my experience. It is not right that societies composed largely of married women should go en year after year showing these statistics without the Government and the country realising it. It cannot be put right by actuaries, and it cannot be put right by Grants-in-Aid. It can only be put right by the community. These married women have no right to live in hovels, trying to get well, and to keep off the insurance funds under such conditions. I have always made it plain why I want the facts revealed in regard to married women, and that is that I want the position to be put right. Raiding the sinking fund will not put it right. By that means you hide the position from the majority of the people of this country. I do not want it to be hidden. Let us have the naked truth. The hon. Member for Lincoln says, "Do not do that; it will cause alarm among these people." A little bit of mental unrest for these poor overworked women is nothing compared with the duty of the community to put the social conditions right. In nearly every speech I made on this subject I made one prophecy in regard to social legislation, and that was that we could divide our ideas into two historical periods—the right 76 hon. Member for Kirkcaldy (Sir H. Dalziel) will remember me doing that in the famous Adam Smith Hall in his constituency—one before the Insurance Act was passed, and one after. I said that after the Insurance Act came into operation there would be a period in which knowledge would be revealed to us which was not revealed before, and it would alter our views about social reform. That was my statement in 1911 and 1912 all over the country. That is my position now. I want us to know the worst and to face it, not merely to put figures in the Insurance Act right, but I want the community to realise the position so that our social progress may be led in the right direction. I have no doubt the hon. Member for Lincoln has given a great deal of patience and time to this Act. I would suggest that if he followed up cases in London, without taking any railway journeys, he could find out how some of these women are living. He could find out cases like one which I will call to his attention. My wife went down to the East End to see one of these sickness cases, and found the room exceedingly stuffy. She insisted on having the window open. The sick woman asked her not to open the window. My wife asked her how she could expect to get well when she was living in such an atmosphere. Upon opening the window a most awful stench came into the room, because just underneath the window, in the yard, was a refuse tip for butchers' offal. It is all very well to say that you can put the Insurance Act right, or put the insurance scheme of women's societies right, by some actuarial method, but you cannot put that kind of thing right by such methods. The community must know the facts, and see that such things are put right. The Insurance Act did not cause such conditions, and is not responsible for them; it only reveals them, and it is our duty, as Members of Parliament, to see these things are not perpetuated in the back streets and slums of every town. That is why I welcome now a little more plain speaking on behalf of the Government, such as we have had. Such a scene does not reflect upon the author of the Act, and it does not reflect upon the House or upon the actuaries. Such a scene reflects upon the whole community, and until we remedy the possibility of such scenes as that we shall have deficiencies in some of the women's societies.
I join issue with the hon. Member for Lincoln on one point. He says it is unpatriotic for anyone at this time to 77 suggest that there should be any State Grant. I say that is a cruel and hard doctrine which we will not take from that bench. Here is an Act where the calculations made by the Government have proved to be wrong. The figures in the Act with regard to the men were right, but the figures with regard to the women, and the calculations, have proved to be on a wrong basis. The Government were responsible for the Insurance Act. These women were not considered. They have no votes. They were not called together. They were driven compulsorily—I quite agree for their own benefit—under the Act. It is the duty of the State, if deficiencies have occurred owing to their own error, to put that error right. The least they can do when they ask those women in future to go on a financial basis is at any rate to say, "We will wipe out the arrears." No nation which is spending £5,000,000 a day on a war, even at a time like this, would begrudge a few hundred thousand pounds per annum in order to put these women's funds right when the State has made an error in its calculations. I do not agree with the reference by the Treasury to this Committee. I do not blame the hon. Member for that. It may be that this Committee can do useful work inside its reference. It may make a contribution to the problem which will be useful so far as it goes, but it will only be a very small contribution. I do not know what view the Labour party will take, but there is not one member of that party who would dare go down to the unions and say, "As it has been proved that the men's contributions were sound and the women's contributions were unsound, you are to have a joint sinking fund in order to put it right."
Therefore I raise my protest at once against this, and I will resist it to the utmost of my power, and I believe that I shall be backed by the overwhelming numbers of the insured persons of this country, both men and women, in saying that we will not have the men's sinking fund raised in order to put right the women's calculation. Nor do I think that the women should be put in that invidious position. They have a perfect right to look to the State. The State has passed Acts of Parliament regulating their occupation. Therefore the women, without any derogation of dignity or loss of self-respect, can ask the State to put the scheme right. I want to say quite plainly, and quite apart from my interest in the 78 Insurance Act as such, that on grounds of public policy I am bound to oppose such an idea as raising the sinking fund of the men in order to put the women's societies right. The Government have never come to any decision. The hon. Member for Lincoln read some Regulation from the Treasury, but we know that that means Treasury clerks. The Government are not committed to this Bill, and I challenge the hon. Member for Lincoln to say that he has got the authority of the Cabinet for appealing to this House that we must not consider any State grant to women's societies. He has not the support of the country, and he cannot get it, or the support of this House either.
Why did not the hon. Member for Lincoln tell us something of the working of the Insurance Commission? How many members are there on the English Commission1! One has died, another has resigned, one spends a great deal of time on deputations, and another seems to be going about to meetings. The English Commission never had a very strong hold on the insured workers of this country, and such as it was has been greatly weakened. I would like an explanation on another point. Why has not the hon. Member called the Advisory Committee together? He made no reference to it, though he knew very well that if I spoke I should raise it. The Advisory Committee is the only body on which the employers of labour have the right to offer an opinion. The employers of labour provide threepence per head per week, and they have no voice in controlling the approved societies. They were given representation upon the Advisory Committee. Never in the history of the world have employers of labour provided such large sums as they have for such a purpose. Probably more than half of the reserves of which the hon. Member boasts as being invested—£28,000,000—has been subscribed by the employers who are not given any representation upon the Commission or upon the approved societies. The one body on which they were given representation was the Advisory Committee, and various great organisations of employers have had their chairman and so on put on that Committee. The hon. Member has never called that Committee together since he was appointed. He came straight from the Indian Department, and one would have thought that the necessity of provision for consumptive patients and the difficulties with regard 79 to doctors, and so on, would have caused him to call the Advisory Committee together. He has not done so.
What is the explanation? It is highly important that employers of labour should be carried along with the workers in the successful administration of this Act. Some of them have criticised it, and I have had to answer their criticisms in debate. I have gone to meetings of employers from time to time in different parts of the country as well as to meetings of trade unionists, trying to reconcile them to the Act, and the point I always made with the employers was that they would have representation upon this Advisory Committee. I suggested to the hon. Member for Lincoln a year ago, when he was appointed, that he should call it together, but he made some remark about expenses, yet there has just been set up a Committee which is sitting from day to day and which, of course, involves a great deal more expense. It is the duty of the hon. Member for Lincoln to carry out the Act which this House passed. This House intended that the Advisory Committee should meet. He has not called it together. He is incurring a great responsibility in following the advice of his permanent officials who, of course, do not want these meetings, and not merely the employers, but the public in this country will not be satisfied if the Advisory Committee is suppressed without the leave of this House. It is quite time the Advisory Committee had regular meetings and that the employers upon it had some responsibility for administration and were encouraged to give their views and were shown that they would be acceptable.
What would be the position as to valuation? Employers in some cases will see societies in which their own workpeople are insured going down, and they have been contributing what the State asked without a murmur and without being allowed to have any representation upon the approved societies, and they will see the spectacle of those grave financial difficulties, which probably might have been avoided if they had been allowed to come in and help by giving advice. I am perfectly certain that large firms will be very seriously concerned if they find that considerable numbers of their workpeople are in societies which prove to be insolvent to the extent of having their benefits reduced. They keep on making the same 80 contributions as other employers whose employés may be in a society which is strong. The employers are not told on the insurance cards in what societies their employés are. So scrupulous was the House in preventing them from finding out this, that they have not the right to ask their workpeople, and they do not ask them. I want the Government to realise the serious position in which they will be in in giving an account to the employers, after they were denied the right to know in what society their workpeople were, if they find that the society is in this position. These questions should be taken into consideration in some statesmanlike spirit. A committee with a small reference, looking at actuarial calculations, is far too limited to deal with a problem of this kind which can be dealt with in one place only—that is upon the floor of this House. There is no Commission or Committee or form of discussion to compare with open criticism of these points in this House, because Members of Parliament will not take merely a standpoint with the approved societies but must take the broad view of the welfare of the whole community.
It is all very well for my hon. Friend to take some credit for the appointment of the Ryan Committee. I have no doubt that he is going to meet my criticism of not calling together the organisation foreshadowed in the Act, the Advisory Committee, by the statement that there has been appointed this Committee. It was not appointed by the Commission at all. Any inquiry that I suggested was pooh-poohed by the hon. Member and his board of officials. At the very time when I was asking for it in this House and from Ministers, and before the Retrenchment Committee which did me the honour of calling me before it and giving me a most patient hearing, the officials of the Department were openly boasting in the usual way that Booth would not get his Committee. That was the kind of talk that was going on at Wellington House behind the hon. Member's back. I do not know whether any of it reached his ears or not, but it came from a good many quarters to me. Who was it that appointed this Committee? The hon. Member ought to have told the House that it was the direct result of the Retrenchment Committee which was going round the Government Departments, and when it came to the Insurance Department so convinced was it of the need of vast economies that the conclusion 81 was arrived at that a Special Committee should be appointed to investigate it, and this Interim Report, which I will not discuss in view of the limits of order—my hon. Friend who was stopped rather skilfully got in a number of points. I cannot hope to emulate his feat, not being so agile in Parliamentary finessing—but if I cannot discuss that Report I think I may say that that Interim Report was produced before they heard a single word of evidence, and any idea that this Report is a guide for this House is a proposition which I hope will never be broached from the Front Bench.
With regard to the position of some of the societies and the suggestion that it is unfair to say that they are insolvent, as the hon. Member for Liverpool has pointed that out I will content myself with endorsing his views. But the Ryan Committee had ample evidence that some of the societies were insolvent. I could give twenty names. That would be unfair, and I would never dream of doing it, but it will be found that some of the societies which have really the most faithful officers, who are doing their best to grapple with the difficulties which they encounter, may have had a bad time. It would be unfair to point them out before some solution has been found to meet their case, and it may be, when all the facts are known, that a way out of their difficulties may be suggested. It is not the society which is best managed which will always be shown to be in the best circumstances. For instance, take the Stock Exchange Clerks' Society, where all the members are young, where there is no maternity benefit, where other benefits are merely nominal, and where no large reserve is required. Nearly all these young men, as they grow older, will pass into higher positions and higher wages; they do not expect to remain on a low scale of pay, and they are always looking forward to higher posts. But how can you compare the position of a society such as that with the position of a society which is composed of married women, as is the case in North-East Lancashire and in some of the districts of the West Riding? You could not expect to have the same result in the case of such a society as that to which I refer as is obtained in a society like that of the Stock Exchange Clerks'. It is not that one society is badly managed compared with the other, but it is because the operations of the clerks' society are not in any way comparable to those of the society of which married women are members. There are huge distinctions between 82 the different societies, and it is for the State to grapple with them in a broad and liberal spirit, and we must not be told that in no circumstances will the State deal with these women's societies.
The hon. Member for Lincoln (Mr. Roberts) stated that stocktaking would not be postponed indefinitely. That was a most remarkable statement— that the valuation of these insurance societies will not be postponed indefinitely. I do not know that I should go to the experts of approved societies or the experts of insurance companies when considering drastic legislation from the public standpoint, and I venture to suggest that the sanatorium position has been left by the hon. Member in a state just as unsatisfactory as it was before. He gave us the figures for 1914, and why does he not give us the same information for 1915? A great many of us have that information, but the hon. Gentleman has never applied to me for any information.
§ Mr. ROBERTSI could give information from fifty insurance committees, but complete figures are not yet collected. I would point out that I have been very careful to avoid putting any pressure upon the insurance committees, and I have extended to them every consideration, because I know that they are being very hard pressed at the present time, and that they are doing their best.
§ Mr. BOOTHThey are very hard pressed, but by whom? By the Department piling up expenses upon them last year to get out all kinds of particulars that had never been asked for before. The hon. Member and his Department actually suggested to these committees that girls should be got at learners' wages, and that when they became competent and asked for a proper wage, they were to be discharged, and new learners taken on. That is the kind of thing they got from the hon. Gentleman's Department in order to relieve the situation during the War. I did not want to make that point, and, if I may say so, I do not make it now. I know that the hon. Gentleman is in a very difficult position, but it is one of the unfortunate occurrences connected with the establishment of a Coalition Government that we have all this chopping and changing, which nobody can understand or explain. The hon. Member has left the Himalayas and the Ganges to become the Comptroller of the Household, and nobody more sincerely rejoices that he has left his place on 83 the Back Benches for a seat on the Front Bench. But take the one point of sanatorium benefit. We have the fact that clerks of insurance committees are in communication with clerks of workhouses, and with guardians, to take insured consumptives. Can the hon. Gentle man deny that? Of course he cannot, because it is being done. I venture to say, as a member of the London Insurance Committee, that the public of this country would never tolerate that sanatorium cases should in any circumstances whatever be sent to the workhouses. But that is going on, with the connivance of the Department, and they cannot deny what I say, for I know the facts. I would point out that people cannot be sent to the workhouse except under the law of Settlement, and the insurance societies and the sanitary and health authorities would have to work under the law of Settlement. It was never intended by this House that insurance clerks should have communication with the clerks of workhouses, and, whether cases are chronic or not, or whether or not patients cannot do well in a first-class public sanatorium, I submit that it is a scandal that there should be this communication with workhouse clerks, and things like that cannot go on without bringing about difficulties for those who administer the Act, as well as all kinds of criticism either in this House or in the Press.
The hon. Member referred to certain county boroughs in which there was provision made for consumptives. The county borough which is doing best is Bradford. I will not say that there are not others as good, but I mention Bradford because I am acquainted with the men who are on; its town council and on its insurance committee. In that town they are doing this work out of the rates. The position is this, that this county borough makes provision for consumptives out of the rates, and thus the insured person is paying twice. That is all the difference. If that is intended, as the hon. Member seems inclined that it shall be, it is only shifting the responsibility from the insurance committees to the local authorities, who will make both insured an uninsured persons pay. I am rather astonished that the hon. Member refers to the work of the county boroughs as a matter for which the Department deserves praise. As a matter of fact, the hon. Member's Department has not shown that keen enthusiasm 84 for the Act which should have been exhibited. The House will remember questions which I put with regard to consumptives in London, and the hon. Gentleman's reply that the number of consumptives was falling; but I would point out that the number was falling because of on the approach of winter the patients did not like open-air treatment, and therefore a number withdrew their names, only to come up again in the spring and in the warm weather. The Department knew that part of the answer well enough. Surely the only answer which could be satisfactory would be that the number of consumptives had declined because people were getting accommodation.
6.0 p.m.
What is taking place in London with regard to the consumptives? I have always understood that, roughly, the population of London is about equal to that of the whole of Scotland. In London we have a widely diversified population of workers; there are the rich and poor, both north and south of the river; there are people huddled together near the docks in the East End, and people with a great deal of room round their houses in Kensington. The duty is imposed in this large place of providing sanatorium accommodation for consumptives, but they cannot give it. They have a long waiting list, and are not in a position to deal with it. The hon. Member knows that well enough. What the hon. Member and his Department are trying to force is this: that the London County Council should step in and do what the county council is doing at Bradford. That is no answer to the insured persons. I care not what the majority is at Spring Gardens for that is not the point. It does not solve an insurance problem to say that another authority could step in and do it out of the rates. I think it would be the easiest thing in the world for the hon. Member with his persuasive eloquence, his commanding figure, and a very good cause, to get up in this House and ask for money to put, at any rate, the sanatorium question beyond all doubt. I think that such an appeal would meet with no opposition from any part of the House except the Treasury. I am perfectly certain no group of any kind, either party or nonparty, would get up in this House and oppose a Treasury grant for the consumptive side of the Act. If the hon. Member and his Department do not take any notice of anything else I say, I wish 85 they would take notice of this question of the treatment of consumptives and sanatorium benefit. I think it could easily be put right and with great gladness by this House. The hon. Member in his statement talked about the proportion of insured persons in the Army. It is not consumptives who are fighting our battles in Flanders, and it is not French consumptives who are defending Verdun. It is no answer to us to point out the proportion of consumptives to insured workers who are now in this country. The consumptives who are on the waiting list with very few exceptions were left behind, and that is our trouble. The healthiest lives were taken from the approved societies and sent to the War. Many are coming back shattered and liable to disease, and thus coming on the funds. That is not a point to blame anybody about. It does not reflect on the author of the Act or on the Insurance Commissioners, except in so far as they hide and deny it. Is it any discredit to anyone that a healthy man should go out to the War and come back and be more liable to make claims on the approved societies? The sum of money required to deal with this is very small compared with the vast sums which are being spent. Some of the men never got to the front at all. They were taken out of their working occupations and given open air life, and broke down in training. Then they have no proper place for them in the first class sanatoria.
I do not care whether anybody is vexed or pleased at these statements, and I do not say that I am, but why these facts, should not be stated I do not know. The hon. Member's Department seem to think that they are a sort of regiment or battalion in some trench, and that anybody who comes along and criticises is turning a quick-firing gun upon them, and is an enemy. That is not the conception they ought to have of their duty towards employers, members of the societies, and public-spirited, social reformers who want to come and rally round and help them, and then if they want more money from the State, they will have interest and enthusiasm behind them in making their demands. The amount involved is so trifling as compared with our national expenditure, that I do again appeal to the hon. Member to at any rate make his mark on the Government by using his influence to put this Act, which has been temporarily put under his charge, right.
Mr. RUTHERFORDI approach this subject from an entirely opposite point of view from that of the hon. Member who has just spoken. He was one of those who looked upon this Act as being a benefit to the State, and as being right on its general lines, while I was one of the few who ventured to think the opposite. I considered it was very doubtful whether the contributions would secure anything like the benefits promised, and I also felt the strongest possible objection to the general principle of compulsion. We are not here, however, to discuss matters of that kind. Some of the subjects referred to by the hon. Member for Stockton (Mr. J. Samuel) could not be carried out without legislation, and all that we are entitled to do is to refer to the administration of the Act as we have it. I do agree with the hon. Member that if we are to look at the subject intelligently we ought to have a proper balance shoot. A mere statement of the Bums we are asked to grant without giving the corresponding figures, which are inextricably mixed up with the others, prevents any final opinion as to the general working. The Votes we have before us, 2, 3, 4, 5, 6, 8, and 9 merited, I think, a little bit of extra explanation at the hands of the hon. Member. We find, without the slightest explanation from him, that there are most extraordinary and almost inexplicable differences with regard to the amounts of expenditure in the past and those we are now asked to vote.
§ Mr. ROBERTSI will give an explanation of any single figure the hon. Member asks for, but I really did not know which particular figure the Committee would like.
Mr. RUTHERFORDI am grateful to the hon. Member because I quite understand that he would hesitate to embark upon any explanation about particular figures unless it was asked for. In some of the cases the differences are enormous. Take the subject of sickness benefit for women. For 1915–16, for this purpose, a sum of £150,000 seems to have been voted, and this year we are asked for the same purpose for a Vote of £100, and we are calmly told there is a decrease in this item of £149,900. If I understand anything upon this subject it is that it is exactly upon the sickness benefit for women that the greater portion of our present apprehensions have arisen. I see one or two other very startling alterations in the 87 amounts that are being asked for. I draw attention to the administration in Scotland which appears on page 3, where it appears that some gentlemen are drawing enormous sums of money for travelling and other expenses. You cannot go over these Estimates without seeing that in many cases the amount asked for to-day is quite out of all comparison with that voted last year. For instance, on page 13, the amount for medical and sanatorium benefit, Grants-in-Aid, voted last year, was £14,950, and this year for the same purpose we are asked for £59,000, or an increase of £44,050. The curious part of this item is that whilst this increase arises in Wales we have in England exactly the opposite. There arc a number of curious items like that, and under those circumstances it would obviously be impossible for any of us to set to work and really make any effective criticism of the items in this Vote.
We are asked to-day to pass a Vote in a lump sum of a very considerable amount. I think we ought to be grateful to the Government for putting this Vote down at all, because that does give us the opportunity of saying something about it. Upon the general principle, what one would like to say is this: A certain period has now expired, and some of us are very much relieved to find out that substantially with regard to the men the figures appear to be approximately correct, and come out in practice as being reasonably satisfactory. I think that that is a very excellent thing to have found out by experience of two or three years. With I regard to the women it is satisfactory at all events to have found out that the amount that is short is not greater, but I confess in the country and amongst the constituents of all of us there is a very strong feeling that they would like to know what is the attitude of the State generally towards this whole subject. Are societies going to be allowed to become insolvent? One member of the Government makes a speech that the Government is not responsible, and of course we knew this. It would require an Act of Parliament to make the Government distinctly responsible, and therefore I presume that the question of responsibility is not one which we can substantially discuss here to-day. I do say, however, that after the experience we have had of the Act, that there ought to be some assurance given to the people all over the country who are paying their 88 subscriptions and to the employers who are paying in immense sums, and some authoritative description given as to what the Government intend to do generally with regard to this important matter.
I take the view personally that having embarked upon it the Government must see it through. There is a duty to every person who has paid his 2d. or 3d., even if only for a few weeks, to see that those benefits which were distinctly promised in Acts of Parliament are carried out. I join with the hon. Member who last spoke in sincerely regretting that the Department has not seen its way to look for a Grant in connection with the sanatoria. There are parts of the country, including London, where that subject is at present in a disgraceful condition. We recollect a Minister of the Crown thumping at that Table opposite and pointing out the great benefits that were going to be received and which people are not receiving. Why is it that the work has greatly slackened off, because there was an enthusiastic start made on this subject, and now it has almost died away? I think one or two of these items show that it is deliberately not the intention now of the Government to go on grappling with this sanatorium question in the way in which they ought. I think it is a great scandal that those benefits should have been promised, that subscriptions should even now have been taken upon the footing of the benefit being furnished, when the Department could not furnish it, and are not furnishing it, and when they have undoubtedly at all events put off their intention of furnishing it for some time. There are a number of other very important questions surrounding the administration of this Act. I do not think we are quite in a position to deal with them. The accounts do not cover them, many of the points would trench upon the question of legislation, and a very considerable number of the important items that have excited our attention and our anxiety also were left entirely untouched by the hon. Member who introduced this Vote. All I can say is that I listened with the greatest pleasure and satisfaction to the observations of the lion. Member for Pontefract. I doubt it, but I trust a considerable portion of those observations will be preserved, and that some of us who do not know anything like so much about the details of these matters will be able to read his speech. It was an exceedingly valuable contribution to the position of this matter to-day, and I 89 was glad I was able to be here to listen to it. I trust that the attitude which was taken up at the conclusion of the hon. Member's speech will not be persevered with. It practically came to this: "We have not taken any stock. We have put it off. I beg to assure you that we have not forgotten it, oh no! but at all events we have not fixed a date. It will be done. You shall have a valuation some day." It is the same thing with regard to the sanatoria and a lot of other things. I wanted to have asked the hon. Member why he spends some hundreds of thousands of pounds on drugs one year, and is not going to spend £50 in the next year? I suppose, however, these are things which happen in the case of accounts presented in this fashion, and all I can say, in conclusion, is that I trust when this subject does come forward again the Government will not shelter themselves behind the War—that they will not say, "We cannot administer this Act properly, cannot take stock of our position, and cannot give money for sanatoria and drugs, and so on, because of the War." The War is no answer to statutory obligations undertaken to poor people who are paying their money. We have had a few years' experience of this Act now. It is the duty of the Government to learn lessons from facts ascertained, to come here at the earliest possible moment after they have found out what the facts are, and honestly and frankly admit what are the true circumstances, what the way of dealing with them ought to be, and to ask the House to help them to put this matter right in the interests of the people who are paying these sums.
§ The FINANCIAL SECRETARY to the TREASURY (Mr. Montagu)I have not the slightest intention of intervening for the purpose of answering any of the criticisms of the administration of the Act, which, of course, I leave to my hon. Friend the Member for Lincoln (Mr. C. Roberts) to deal with in his reply. My sole object is to deal with one or two of the points made with reference to the Treasury in the speech of the hon. Member for Pontefract (Mr. Booth). Let me just say that I hope he will not think that I dissent from the whole of his remarks upon the subject. Much of what he said I heartily endorse. The history with which he began of his own valuable contributions to the passage of the Insurance Bill, and the working of the Insurance Act, is all public knowledge. Hon. Members who talk of their own work 90 are sometimes greeted with suspicion, because it is thought they may be attempting to overestimate their own services, but when the hon. Member deals with this subject he is to be congratulated that the material on which he has to make his speech is so splendid and so well known that it admits of candid and truthful treatment by him. I also want to say that I am in perfect agreement with the remarks he made as to the value of the Insurance Act as a means of measuring the social problems with which we have to deal, and I for one look forward with confidence to the setting up of great machinery in more favourable times, when by experience of the Insurance Act we shall have the mechanism for dealing with problems of health and social welfare worthy of this great country in the twentieth century.
I am concerned now to defend the appointment of Sir Gerald Ryan's Committee by the Treasury, and the letters which the hon. Member for Pontefract seemed to think were written by irresponsible Treasury clerks acting on their own initiative and without consulting any member of the Government, or any Minister. His conception of a public office is really the most remarkable one I can conceive. Does he have clerks in his own office writing letters, setting up inquiries, pledging the money of the firm; and acting without reference to those who employ them, or to those responsible1? The hon. Member must know that all these things have been done by the heads of the Departments concerned, irrespective of the name which may appear at the bottom of a particular letter. With regard to this Committee, I am perfectly certain that we shall all, particularly this House, profit by the splendid work they have done, and the careful and scientific inquiry they have made into the financial provisions of this Bill. The Committee arose in this way: The Chancellor of the Exchequer was asked to receive a deputation of representatives of the great insurance bodies. He could not do so, and I had the honour to receive them at the Treasury on his behalf. They made two requests. The first was that the vacancies on the Insurance Commission should be filled up. I was compelled to refuse this request, repeating the decision announced on behalf of the Government by the present Minister of Munitions last year, not owing to a departure of policy, but to the fact that we did not feel justified in making new appointments to these highly paid offices 91 during the War. I am sorry to have to offend the hon. Gentleman opposite (Mr. Rutherford) by mentioning the War, but we cannot exclude it from our conclusions, and when a large number of activities are suspended there is no real reason for making appointments to offices which it has been felt ought to be left in suspense when there is no immediate necessity for filling them. I believe I am right in saying that these very representatives agreed with the arguments I put forward, regretted the conclusion I came to, but postponed their demand to another occasion. The second point they put forward was for the appointment of a Committee of this kind. To that request I agreed, and in due course the Lords Commissioners of His Majesty's Treasury appointed, by Treasury Minute, which was, I think, approved by no less a person than the First Lord, through so humble, a person as their Lordships' Financial Secretary, this Committee, and invited these representative gentlemen to sit on this Committee, not in the dark, but with the terms of reference before them. We did not feel justified in making, and did not think there should be, any Grant of public money in the middle of this War, and so we appointed this Committee with those terms of reference. I do not know whether my hon. Friend (Mr. C. Roberts) has received, I have never had, any complaints about the terms of reference. All these representative gentlemen were good enough to accept the offer made to them. They agreed to sit on the Committee, and set themselves to do the work. Then suddenly, long afterwards, we hear that this Committee is unsatisfactory, that it ought to have had wider terms of reference, and that, therefore, we ought to view with distrust the very narrow terms of reference. I am bound to confess that that is a little hard on those who appointed them. They were appointed in response to a request, and, having drawn up the terms of reference, we are suddenly criticised because of something which must have occurred, but of the explanation of which I am wholly ignorant and which I am unable to understand, and are told that the whole procedure is unsatisfactory.
All I have to say further is this. Under the Insurance Act, it is true, the Treasury is responsible for the work of the Insurance Act and the Department over which my hon. Friend the Member for Lincoln presides, and on whose behalf he opened 92 the Debate this afternoon. It is true that his Department is not independent in the same sense that all Departments are. It is true in theory, but I am most thankful to say that it is not true in practice. If it were, I should not be able to sit on this bench and hear so often the statement, the truism, that the Treasury ought not to be a spending Department. It is not. Long ago, many years ago, when Mr. Masterman left the Treasury, the work of the Insurance Department was wholly divorced in practice from the work of the Treasury. Suggestions, estimates, and requests are submitted in the usual course by the Department at Wellington House to the Treasury, and are scrutinised by the Treasury in exactly the same way as if they were dealing with Home Office, or any other estimates. That happened as soon as Mr. Masterman left the Treasury, but it has been growing and perfected, and I do earnestly hope, speaking for myself and not for the Government or the present head, that the time will come when we shall be able to translate that practice into the terms of a Statute, so that there will be no further misunderstanding. As regards the appointment of this Committee having been done by Treasury Minute, it was not done, as the hon. Member for Pontefract suggests, over the head of my hon. Friend the Member for Lincoln.
§ Mr. BOOTHMy right hon. Friend misinterprets what I said. I never suggested that. It was his statement in this House, when he asked the Committee not to consider any Grant from the State. I know how the Committee was appointed, but may I also correct him on another point? My criticism has not occurred only now. I wrote to the chairman of the Committee, challenging the terms of reference, and offering to give evidence, but the chairman declined.
§ Mr. MONTAGUI apologise to my hon. Friend. I thought I heard him say something about the Committee being appointed over the head of my hon. Friend the Member for Lincoln.
§ Mr. MONTAGUI can say that it was appointed with his concurrence; I think in his presence, and at his suggestion. With regard to what the Committee have recommended, the Report has been received and will be dealt with in the usual way. It will be sent by the Lords of the Treasury to the hon. Member for Lincoln 93 and his Department for their recommendations, and, having then made their recommendations, the Treasury will suggest, as they would in regard to the Home Office or any other Department, what action will be sanctioned with regard to expenditure by that Department. The moment has not arrived when either the hon. Member for Lincoln or anyone else can make a statement as to those recommendations. The appointment of the Committee was perfectly proper, and it was essential if we are to proceed to the stocktaking to which the hon. Member attaches so much importance. The Committee has on it representatives of the various societies as well as of the Commissions and deserves our thanks for the excellent work the members have done.
§ Mr. PROTHEROThe point I wish to speak upon is a very small one; it relates to the position of societies, without branches, which are federated in an association. As I should probably come under the ruling of the Chairman in what I should like to say, I shall approach the matter very carefully. There are certain sections in the Ryan Report which deal with societies of the character to which I refer, and these sections have given great alarm to the federations of rural societies without branches. We are afraid that the very large administrative powers of the Commissioners may enable them to carry out those recommendations without legislation. For that reason I am anxious to put before the Committee the real value of these small rural societies formed out of the old village clubs. I speak as the chairman of a federation of about 100 of these societies, numbering about 6,500 members, partly women and partly men. The old village clubs were, many of them, extremely well managed, with the closest possible supervision of sickness benefits, and with administrative expenses which were absolutely reduced to a minimum. The lives in these rural societies were mostly healthy; therefore, from an insurance point of view, they were good, and the doctors gave them generous treatment. They had these two main drawbacks: each society was too small in size to stand the strain of any excessive sickness, and they were also run on the dividing-out principle, instead of the proper principle of reserve. The first principle works very well so long as there is a constant supply of young men. When that supply fails the older men are left in the lurch. When the Insurance Act came in I thought I saw 94 the opportunity of preserving these village clubs under the Act, and I formed this Federation of Rural Societies. I may add that the rules which I drafted for it were adopted by the Insurance Commissioners and now form part of their model rules. I can, therefore, claim in this particular branch of business to know of what I speak. The two reasons why I wanted to preserve the village clubs were these: First of all, they were of very great use in village society. They pulled the villages together. They gave them a common interest and common obligations. They relieved the monotony of village life by widening the horizon, because the villagers were keen in their management. They were also a training ground in business, a school, as it were, in the management of affairs, and they were an education in the wider duties of citizenship. They had, and still have, a very strong moral influence. To be a member of a village club, or of an approved society which has taken its place, was a blue ribbon in the village. That was one reason why I wanted to preserve them. The other reason was this: I agree with the hon. Member (Mr. Currie) that if you have a flat rate you ought to have prohibited the formation of these village societies. The Act is inconsistent with itself in this respect. But this formation of the federation of rural societies mitigated one of the great hardships of the Insurance Act. The agricultural labourer is the poorest paid man who is insured. Yet he is made to pay, as a flat rate, a sum which is out of proportion to his earnings as compared with the artisan. Every labourer earning 16s. cash has to pay 4d., and that means a great deal more to him than to> the artisan who pays it out of 35s. Not only does he pay more in proportion, but actually he pays more.
§ Mr. BOOTHDoes not the agricultural labourer also receive more in proportion? Is not the 10s. per week worth a great deal more to him than to the artisan?
§ Mr. PROTHEROThat is partially true, but if the hon. Member will allow me to go on I will endeavour to show that the benefits are not benefits which the agricultural labourer would prefer to have, and are not the benefits which are best for him. As I was going on to say, not only does he pay more in proportion, but actually he pays more. The Act proceeds on the assumption—the hon. Member for Pontefract will correct me if I am wrong, 95 because I recognise in the admirable speech I heard from him to-day how full and complete is his information on the subject—that every insured person will pay forty-eight payments in the year—that is to say, it allows for every person having four weeks' sickness. The agricultural labourer, being more healthy, from sixteen up to sixty, pays in all probability fifty-two contributions. The townsman pays forty-four, and the agricultural labourer is brought in to redress the balance. He not only pays in more, but he also gets less out in the way of sickness benefit, while sanatorium benefit affects him less than it does the townsman. The real value to him would be an arrangement which would allow him at the age of sixty or sixty-five to get some sort of benefit to tide him over the time before he comes to the old age pension, and at the time when with the agricultural labourer rheumatism begins to tell and a man becomes more or less incapable of working. Therefore I say you have the agricultural labourer exploited under the flat rate for the benefit of the townsman. Pie pays in in proportion a greater amount than does the townsman. He pays in actually a greater amount and he takes out less, and the benefits secured to him are not the benefits which are the best for the agricultural labourer.
I was not a Member of the House at the time the Act was passed, but I did my best outside the House to try to get the agricultural labourer treated by himself, as the Insurance Act is conducted in Germany. However, Parliament thought fit to take the other course, and I dare say they were right, for there were many arguments on both sides. The moment, however, I found the Act was departing from the flat rate by allowing societies to be formed which discriminated between healthy and unhealthy lives, between occupations which were healthy and those which were unhealthy or dangerous, I saw my opportunity of getting the agricultural labourer the benefit of his more healthy life. Therefore, as I say, this federation was formed, and it became the model of many other federations. In the Ryan Report, Sections 65 to 71, there are recommendations made which can be carried out by administration and not by legislation, and which may break up these federations. What I am anxious to get from the hon. Member for Lincoln is a promise that no administrative measures 96 will be taken to destroy these rural federations—because there are several of them besides the one which I represent— without coming to Parliament for the power to do it. My own federation has been a success. The expenditure upon the men is very considerably below the estimated expenditure on which the Act was based. The expenditure for the women also is well below the mark, and below the expected expenditure on which the Insurance Act was founded. As to the cost of administration, I think—again speaking subject to correction—that the insurance calculations allowed 3s. 5d. for administrative expenses, and we are doing it for 2s. 4d. We have, therefore, a margin on all the principal items of expenditure, which, leaving out the prospect of a sufficient surplus, should help to make up any deficiency in any federation. On no financial grounds can there be any justification for disturbing the federations. I therefore reiterate toy appeal to the hon. Member for Lincoln that he will not, without corning to Parliament, break up the federations which are doing useful work, and which still maintain in the great number of villages —some hundred villages in the country districts—all the good results of the old village clubs, with the condition of financial stability—that he will not break up federations of this kind without coming to Parliament for the powers to do it— that he will not exercise administrative action for the purpose.
§ Mr. HASLAMThe most important statement made by the hon. Member for Lincoln this afternoon undoubtedly was that the finances of the Insurance Act are safe—that is to say, that on the men's side there is a surplus, whilst certainly on the women's side there is a small deficit. My object in rising is to call attention to the probable reason why there is a deficit in connection with women's employment insurance. I think a great deal is due to overstrain and overwork in factories. I suggest strongly that the Insurance Commissioners should make representations to the Minister of Munitions with a view to preventing a large amount of the overtime now being worked in munition factories. One must not forget that a great many of these women are young. They are at the strongest part of their lives, when they can, perhaps, for a certain time endure great strain; but this strain will tell upon them in later years, and the result will 97 be that the finances of the Insurance Act will be very detrimentally affected thereby. I would also say further that, from my own experience, I know as a matter of fact that working for long hours, especially working overtime, results in the long run in less production, and I am convinced to-day that if overtime among women in national munition factories were absolutely prohibited the result would be not only lessened sickness, but also a largely increased production of munitions. I hope, therefore, that this aspect of the question will receive very careful consideration. A short time ago we had the Report of the Committee on the Health of Munition Workers. They reported most conclusively that overtime was a most objectionable feature among workpeople, especially among women. The reason for overtime usually is that the employers get greater production and the workpeople increased wages. Both are wrong. In the long run, by preventing overtime, not only will production be increased, but wages also. Considered, therefore, from the Insurance Act point of view, from the point of view of the health of the workers, and also from the point of view of the finances of the State, I do trust that the hon. Member will give this very important matter his most careful attention.
Mr. DENNISSI rise to express my personal thanks to the hon. Member for Pon-tefract for the able and courageous way he has spoken out in the matter. Incidentally, it has saved me a great deal of ground; otherwise I should have thought it my duty to go further. As it is, J have very little to say. I listened to the speech of the hon. Member for Lincoln with very great interest and great expectation. I hoped that we should have a sort of rough-and-ready statement, at all events, as to what were the contributions under the Act and the amount of benefits received, giving a comparison between this year 1916 and the previous years, to see whether the Act was really working satisfactorily. I hoped we should have something in the nature of a National Insurance balance sheet and a promise or statement that the valuation, without which that could not be complete, would be forthcoming at an early period. I ventured to interject an observation in the hon. Member's speech, and asked him when that would be likely to be forthcoming, but we did not get even the answer that it would be in three years or the duration of the War, but that it was postponed indefinitely.
§ Mr. ROBERTSMost certainly not. That was the one thing which I was most anxious to assure the Committee would not take place. There is no indefinite postponement of any kind, whether with financial adjustment or without financial adjustment. The process of valuation will assuredly take place, and the Committee and the approved societies, and anybody else interested, must take that as an absolute fact.
Mr. DENNISSI am very much obliged for that statement. I wish the hon. Member would complete it by stating when it is likely that will be done. Has it been commenced?
§ Mr. ROBERTSThe actual fixing is not done by myself, but by the Joint Committee of which I am Chairman. The Report of the Ryan Committee has only been out, I believe, ten days or a week. The Joint Committee has not happened to meet since that Report was out, and it is clearly impossible for me, in advance of a meeting of that kind, to make any statement on a matter where discretion lies with the Joint Committee and not with myself.
Mr. DENNISSI understood the hon. Member to say that it would be inadvisable for it to go on during the War, because you would not have the necessary assistance or the necessary staff for the purpose. That is why I interjected the question whether it was postponed until later. However, I think I am right in saying the hon. Member's answer was indefinite, and it is still indefinite; but I am very glad to hear that the Committee over which he presides will probably consider it shortly, and then they will have the expression of opinion of Members of this House that we think, as far as our constituents are concerned, at all events, that it is necessary it should be done, and done speedily. A suggestion was made by the hon. Member in the course of his speech that, instead of being triennial, these valuations should be quinquennial, and we have just reached now the fifth year. I hope he does not mean that it will be postponed, or is likely at all to be postponed, until ten years have elapsed, when the second complete quinquennial period will have come round. If so, I am quite sure there will be disappointment. I took out figures some time ago from which it was clear that the actual benefits in 1913 came out to a shade under 4½d. in value as compared with 9d. 99 I think the hon. Member will remember he took an interest in the election in which I was returned at Oldham. In the discussion of the Insurance Bill it was prophesied by myself that, instead of being 9d. for 4d. it would be 4d. for 9d., and I think I said it might be 5d. It has turned out to be just under 4½d. How do the people insured stand? What sort of value do they get for their money? That does not appear anywhere in the statement made by the hon. Member, nor can it really appear until we have a proper valuation and a proper national balance sheet. Of course, under those circumstances people will go about the country saying what I said at the commencement of the Act, that people are not getting value for their money and are not likely to. If that is not true, please disprove it as soon as you can, because I was one of those who sit on this side who voted for the Second Reading of the National Insurance Bill, and I have always wanted it to be a success.
Mr. DENNISSI forget what the Division was on; I thought it was on the Second Beading. Then I found, in listening to the hon. Member, that he had altered the basis of the figures this year. He did it on the ground that it was better for future comparison, he said, but it makes it absolutely impossible and useless for any comparison with the present, and I have no basis on which to see what is the position with regard to national insurance this year as compared with last year. I must confess that that is a disappointment; but I do ask the hon. Gentleman to do this, and I threaten him that if he does not I will put questions to him in the House which will have the same effect. I want to know whether he could not issue a White Paper in which he could put in a comparative form figures of this year compared with the previous year. It is only the few years from 1911 to 1916. If he could do that, then the reproach of his having altered the basis of the figures which makes it impossible for us to compare the present with the past will be removed.
100 There are only two other matters to which I want to refer. One is the statement in the Ryan Report that bankruptcy cannot exist in an approved society. That is in one sense true. The reason is that if a society has a deficit, you must either reduce the benefit or raise the contribution, and the fact that there are a very large number of societies which are insolvent is clear from the Report, because I find it stated on page 10, much to my disappointment:
But it is clear that, bearing in mind the general scheme of the Acts, a number of societies would, under the existing law—I suppose Sir Gerald Ryan means under the existing benefits and contributions—inevitably find themselves in deficiency on valuation, probably in some instances to a serious extent. The flat rate of contribution in their particular case has been obviously insufficient, and because of the heavy pressure of current claims they cannot have accumulated funds in correspondence with the normal growth of their liabilities.Then he considers the remedies. In another statement on page 28, in which he talks about a certain society in which this sort of thing would not apply, he suggests that the scheme that he proposed here is framed "in order to bring about the financial soundness of the National Health Insurance system." It seems to imply that the National Health Insurance system is financially unsound. This is very vague and very unsatisfactory, and I hope the hon. Member, when he replies, will explain that to some extent, if he can, so that the public mind may be relieved. I quite agree with the hon. Member for Pontefract and other Members who have spoken, that under no circumstances should the recommendations in that Report be adopted to make up the deficiencies in women's societies by trenching on the men's societies' reserve funds by postponing the period for another six years. It is the duty of the State, in my opinion, to make up any deficiency at present, and to make such a scheme as would ensure that there should be no bankruptcy or unsoundness in the future.7.0 P.M.
One word with regard to sanatoria. There was a sum of £1,600,000 set apart for building sanatoria, and I want to know how much of that money has been spent. I know it is an awkward question. I have asked it several times, and have never got a satisfactory answer. Consumption is a notifiable disease under the Public Health Act, and the borough councils and district councils, urban and rural, are bound, if there is an infectious disease, which consumption is now by Statute declared to 101 be, to provide hospital accommodation and isolation. Any doctor who attends a patient suffering from consumption must within twenty-four hours notify it to the local authorities of the borough council. In this matter I accuse the Insurance Commissioners of using that provision in order to evade their liabilities under the Insurance Act, and they are trying to get borough councils and district councils to build sanatoria and pay the expenses of their upkeep in order to relieve the funds of the National Insurance Scheme from the payment of those liabilities which the Act was brought into force to fulfil. In regard to the £1,600,000 which the State was to contribute towards building sanatoria, the State was to advance for every building 60 per cent, and the local authority was to pay 40 per cent, out of the rates, and beyond a certain fixed sum the expenses of running the sanatoria were to be defrayed out of the rates. Consequently the unfortunate person who is insured under the Act has not only to pay his contribution under the Insurance Act, but he has also to contribute both as a ratepayer and a taxpayer for the building of sanatoria. I regard this as a deliberate attempt on the part of the Insurance Commissioners to throw the whole burden on the borough council and the district councils by taking advantage of the fact that consumption is a notifiable disease, and that is the position as I understand it.
There are several other small matters I wish to raise. One is that when an insured contributor goes into a sanatorium his sick benefit ceases. Upon entering such an institution he is very often in receipt of sick benefit, but when he goes into a sanatorium he no longer gets that benefit. The result is that in many cases which have come under my own observation from my Constituency when a person is sent to one of these institutions his sick benefit ceases, his family are left without means, and when he comes out of the sanatorium he is absolutely without any money to start work afresh. In many cases these men have not even suitable clothes to go to work in, and no tools, and they have to be relieved by members of the local insurance committee out of their private pockets. My Constituency consists mostly of working people, and the number of cases of that kind among them are very considerable. I want to know whether it would not be possible without legislation to have the practice so altered that when 102 a man goes into a sanatorium his sick benefit should accumulate until he comes out, and then he would have a fund to start life again? If that is not done, what happens in many cases, when a man comes out of a sanatorium, the good that has been done him is thrown away because he falls back into ill-health through not having proper employment and proper food and accommodation. At the present time the money saved in this way by the Insurance Commissioners goes into the General Purposes Fund, and is used for the relief of administration expenses. Is it not possible, instead of that money going in that way, to make some small economy in administration expenses, and let that money go to the insured person? With regard to the payment of doctors' fees I have had many complaints from my Constituents, and I sent one of the worst cases to the hon. Member, and in that case the doctor was seriously in want of money and more than inconvenienced by the delay in the payment of his fees. I hope the hon. Member will be able to assure us that an improvement has been made in that matter and that in future doctors will be paid more punctually. With reference to the case which I put before the hon. Member the other day, I understood that there was a deficiency in the fund which is available for the payment to chemists for drugs, but if that is not so I will not pursue the matter. The hon. Gentleman has already told us that the doctors are going to lose a great many half-crowns in consequence of the War.
§ Mr. DUNCAN MILLARI wish to congratulate the hon. Gentleman on his statement to-day, more especially after we have heard so many disquieting rumours as to the state of the insurance funds. I am sure his statement will have a good effect in the country. I desire to put to the hon. Member a question on one point, which is of special importance, and that is the treatment of soldiers and sailors suffering from tubercular disease. I understand that something like 3,250 soldiers and sailors are already being provided for, and it appears to me that we should have some indication given to us as to the extent of the demands which are likely to be placed upon the Insurance Commissioners in regard to this special form of treatment. I am afraid we must anticipate that there will be a considerable number of men who will require to be dealt with in the future. I do not know whether the hon. Member 103 can indicate how far these cases have arisen in connection with trench warfare, or how far he anticipates provision will have to be made in future. It appears to me that it is very necessary that not only should provision be made for the men who are now being treated, but sufficient arrangements should be made for those who may yet require to be dealt with in the immediate future, and these men should not only be treated in the ordinary way but some provision should be made for their convalescent treatment as well, in order that it may be possible in convalescent homes to teach them certain branches of work which will keep them in the open air and eventually lead to their complete restoration to health. I understand that provision has been made for the men affected, but I should like to know whether the hon. Gentleman is in a position to state what accommodation is available for future cases.
We have to remember that besides soldiers and sailors there is a large civilian population to be dealt with, and providing for soldiers and sailors causes displacement of other patients in some of these institutions. I should like an assurance from the hon. Member that every effort will be made to secure the use of buildings which are suitable for that form of treatment where they can be had from the local authorities. I might give an illustration in connection with a large sanatorium scheme which has recently been provided by the County Council of Lanarkshire which is not yet complete, but which could easily be completed during the next month or two if sufficient labour was provided for the purpose. I hope the Insurance Commissioners will be able to secure that such facilities shall be placed at their disposal to enable them to deal with the treatment of future cases, and that in the case of such a scheme as I have mentioned in Lanarkshire some arrangement will be made to use those buildings by completing them in order that they may be made use of in connection with this form of treatment. The ease of the soldiers and sailors is one which, of course, raises a new question since the War arose, but it is one the value of which cannot be overestimated, and I am sure the country will be glad to learn that adequate arrangements have been made for the future treatment of all those soldiers and sailors who may come home suffering from tubercular disease.
§ Mr. ROBERTSI need hardly assure the Committee that I have listened with great interest to the criticisms which Hon. Members have been good enough to pass upon the administration of the Insurance Act, and I will promise that I will give very careful attention to what has been said by hon. Members. I am afraid that I cannot reply to every single point which has been raised, and if I do not refer to some of them I hope hon. Members will not think that I have forgotten them. May I clear oft' in the first place a few small matters, which, although they are not small in importance, I can deal with briefly? The hon. Member for Monmouth Boroughs (Mr. Lewis Haslam) raised a point about fatigue, in munition factories and excessive sickness. I do not know how far his argument is helped by the fact that in 1915, since the-women came more largely into the munition factories, there has been much less: sickness. Fortunately we have a little money, which is being used for the most valuable of all purposes, that is medical research, and I can assure the hon. Member that this particular point of fatigue is being inquired into, and we hope to gain valuable scientific information which, I think, will be of use not merely at the present moment but later on. The hon. Member for Oxford University (Mr. Prothero) asked me to consider the case of certain small societies, to whose merits he paid a most handsome panegyric. I may remind the hon. Member that I have not the power to act in that matter without legislation, and therefore he may rest content that, for the present, at any rater I can do nothing to interfere with those societies. I should have to come to this House for sanction. I will now deal with the points made by the hon. Member for Stockton (Mr. J. Samuel), and the hon. Member for Liverpool (Mr. Watson Rutherford), in reference to the figures, some of which I did not give an explanation of sufficiently satisfactory to them. The real explanation is that owning to the two changes in book-keeping, which I referred to, we are taking twelve months of provision for the full twelve months of the financial year, both in the case of Grants to the Insurance Committees and Grants to approved societies. Last year we only took one quarter's provision for money payable to insurance committees, and we also took fourteen months' provision for sums payable to approved societies. And in the accounts for 1915–16 there was a large sum re-voted which really belonged 105 to the expenditure of the previous year. Therefore, when my hon. Friend (Mr. J. Samuel) asks me why medical and sanatorium benefits have gone up apparently by £725,000, and sickness, disablement, and maternity benefits under the English Commission have gone down by £1,200,000, I can tell him that both those are really book-keeping charges. There is some real economy. The sum of £754,000 payable to insurance committees for medical and sanatorium benefits contrasts with only one quarter's provision last year, as against a full twelve months' provision this year. There are some other transfers of lesser importance.
§ Mr. J. SAMUELThen it is not correct to say that the expenditure on sanatorium benefit last year amounted to £280,900?
§ Mr. ROBERTSIt is perfectly correct. In 1915–16 we took that amount, and the House sanctioned it. It was for one quarter's work. In the case of the next Vote for sickness, disablement, and maternity benefit, Grants-in-Aid, there is a drop of £1,200,000. That is for fourteen months last year, as against twelve months this year. There was also a sum re-voted last year which really belongs to the year 1914–15. There is a surrender in one year and a re-voting in the next. That re-voting belongs to a system of book-keeping of which I am glad to say we have now got clear.
§ Mr. SAMUELMay we take it for granted that £1,949,000 is the amount you require this year for sickness, disablement, and maternity benefit?
§ Mr. ROBERTSYes, I think the hon. Member may take it that is the total amount provided for the current year. The hon. Member for Liverpool (Mr. W. Rutherford) asked me why I am only-taking £100, in place of £150,000 last year, as Grant to meet excessive sickness among women. That fund is fed by Grants-in-Aid, and as a matter of fact we have got not £150,000, but £500,000, or the balance of £500,000 in hand, and we are merely taking a Token Vote this year to continue the Grant. If legislation follows as the result of the Ryan Committee, we may take whatever is required in future years. The hon. Member for Leith Burghs (Mr. Currie) drew attention to some strictures passed by the Public Accounts Committee. I thought that was a somewhat serious point, and I should like to draw attention to it. The Public Accounts Committee 106 complained that certain additional Grants not originally provided for under the Act of 1911 were not in their opinion in the early years of the Act sufficiently provided for. They received no Parliamentary sanction other than that of the Appropriation Act itself. I suppose that was irregular, but, as the Public Accounts Committee says, "the position has now been regularised by the passing of the Act of 1913," and I should have thought that the hon. Member might have been satisfied with that judgment of the Public Accounts Committee on that point.
§ Mr. CURRIEMy question was as to the future.
§ Mr. ROBERTSOf course, it is also regularised for the future by the Act of 1913. All that the Public Accounts Committee said was that we ought to be cautious in using these powers to give additional Grants. Several hon. Members —the hon. Member for Oldham (Mr. Denniss), the hon. Member for Pontefract (Mr. Booth), and I think one other—might pay attention to that recommendation. It cautions the House against having facile recourse to these Exchequer Grants and warns us that we ought to pay attention to the principles on which the Act was originally founded. The hon. Member also referred to the question of irregular expenditure. It is not irregular expenditure by the Commissioners but by the approved societies. The Public Accounts Committee referred to small sums which are paid irregularly as is almost inevitable where millions of money are doled out in weekly grants of small amounts. They are irregularities not in the sense that there is any moral turpitude about them, but they are contrary to regulation. Of course, if there were any improper perversion of money we should undoubtedly deal with it, but the Committee are only referring to the method of dealing with irregular expenditure of that kind. They propose the power of surcharge where such irregular payments have taken place, but it is clearly not in order for me to discuss the matter, because it would require legislation.
I will not deal with the speech of the hon. Member for Pontefract (Mr. Booth) at any very great length. I quite understand that the strictures which he is occasionally ready to level against our administration are intended for my moral good, and for my proper discipline. I accept them in that spirit, and all I would ask him to do if he 107 were here would be to level his criticisms against me and not against my officials. My officials are not in a position to answer him, and I am responsible for their acts. So far as his criticisms were urged against me, I think, reading through the lines of his speech, I saw that what he really wanted to do was to encourage me along a path which he thought I was reluctant to travel, and if there was a trifle of overemphasis in some of his criticisms, well, perhaps, I understand that too.
There is an old quarrel between us which I need not go into at any length, as to my non-summoning of the Advisory Committee. The Advisory Committe was set up for one specific purpose. It was set up to give advice to the Insurance Commissioners in connection with the making and alteration of Regulations under this part of the Act. It was not a general advisory body. As a matter of fact, during the, last year there have been very few Regulations I made, except Regulations for the purpose of consolidation. Am I to go to the expense, in a year when economy is being pressed upon us on all hands, of getting gentlemen from all parts of the Kingdom at a cost of no less than £600 for one meeting to give us advice, for instance, as to the consolidation of Regulations? Last year the Committee was pressing me on the grounds of economy. This year some hon. Members, deserting all that, are anxious to induce me to go to the Treasury to get further Exchequer Grants. For my part, I think it is our duty at the present time— I am not saying anything as to the future —to make as little demands upon the Exchequer as possible and to administer this Act with all the economy which is really necessary under the circumstances of the time. I wish the hon. Member for Pontefract had been here, because I should have liked a further explanation as to his statement that the Commission has been in some collusion with clerks and with insurance committees to get tuberculous patients into workhouses.
§ Mr. ROBERTSOr with boards of guardians to get tuberculous patients into workhouses. Tire position is this: Patients who are recommended for insurance treatment can only be placed in approved institutions, in institutions approved by the Local Government Hoard for the purpose. 108 I do not know what wild maresnest the hon. Member has got hold of, but I know nothing whatever of any such transaction as that to which he refers.
Mr. DENNISSI really do not know, but I think he meant that tuberculosis was a notifiable disease, and if a poor person had it the workhouse might have to take him in.
§ Mr. ROBERTSThe hon. Member for Oldham has not quite stated the position of insurance patients under the sanatorium benefit. After all, we have to administer the Act. The Act provides us with a very admirable but limited fund for the purpose of granting sanatorium benefit. It does not give to everybody who is tuberculous an unqualified right to sanatorium treatment in the sense of residential treatment. That is explicitly limited under the Act, and it is no use critics of the Act claiming that everyone has a right in set terms under the Act itself; only those persons whom the insurance committees recommend have got a claim to sanatorium benefit.
§ Mr. ROBERTSIt is not always understood, nor do I think it is quite understood that we have not imposed upon us the obligation of building sanatoria. When the Act was started there was a Grant for the erection of sanatoria. That has got nothing whatever to do with me; it is the work of the Local Government Board. I am afraid I have not got the facts, but perhaps a member of the Local Government Board will give them to the hon. Member. Of course, it is for the public health authority to deal with the non-insured population and the Exchequer is ready to come to their assistance with a 50 per cent. Grant. That is for the benefit of the non-insured population, but the insured population can combine to use it; when it is suggested there is not sufficient provision for the whole population I would point out that the local authorities have not availed themselves of their powers to the extent to which they might have done. I can assure the Committee nothing would give me greater pleasure than to press on the completion of the network of provisions which has been made to a large extent throughout the country. In the case of tuberculous soldiers in Scotland, I have been assured by the Scottish Commission in the last few days that they have been 109 able to make provision for all the tuberculous soldiers with whom they have had to deal in Scotland, and there is in some institutions a reasonable amount of accommodation still available, so that the claims of the tuberculous soldiers have not, in Scotland at any rate, prevented the proper claims of civilians being attended to. We are taking this year a sum of £35,000 to deal with tuberculous cases, and I think that will be sufficient for the purpose without trenching on the sums available for the rest of the population.
§ Mr. MILLARIs that sum being voted for the provision of additional accommodation purely?
§ Mr. ROBERTSIt will be expended through the insurance committees to secure accommodation in residential institutions for tuberculous soldiers. There is every desire on the part of everyone to press on with this work of providing the necessary accommodation. Of course we must have regard to the financial necessities of the present time. The work is growing, but when the financial conditions of the country arc more promising than at the present moment I hope that the work which has been done will be rendered complete. No one could be more anxious to press it forward than I am.
§ Question put, and agreed to.