TREATMENT OF TUBERCULOSIS (SPECIAL GRANTS). (Hansard, 27 February 1919)

§ Major ASTOR
It may assist the Committee if I explain that there is only a very narrow point to be raised on this Vote. The money is really only a Grant in aid of rates. There is no expenditure for the treatment of ex-soldiers. That is paid through the Ministry of Pensions and through the Insurance Fund. This is merely a Grant-in-Aid for additional treatment.

§ Sir K. WOOD
The deficiency in the insurance funds for tuberculosis, especially in the case of discharged soldiers, is causing a great deal of anxiety to insurance committees and approved societies up and down the country. During the last fee, the Association of Trade Union Societies recently met and passed a very strong resolution with reference to the deficiency in the sanatorium funds. Other associations have met almost as recently, and the matter is of very great importance because a large number of persons are not obtaining the treatment for which they paid. I should like to ask my hon. Friend whether this £25,000 is capable of meeting any of the difficulties which I have indicated. There are several insurance committees which at present have considerable deficiences in their funds. For instance, in Leeds and Lancashire, owing to the deficiency in the sanatorium fund, many insured persons have died whilst they have been waiting for beds which have not been able to be obtained, partly on the ground of want of funds and partly owing to lack of accommodation. I should like my hon. Friend to tell me whether any part of this £25,000 would be available for making up that deficiency. There are other cases, particularly in Liverpool, where discharged soldiers and sailors have been recommended treatment in sanatoria, and again, owing to lack of funds, they have had to return to their homes, which are actually on the scheduled list of houses which are unfit for occupation. I want to know whether any part of this £25,000 is available for making up that deficiency. Again, there are the cases of the insurance committees of Staffordshire and of Bath, where no provision at all is being made for ad- 2051 vanced cases. In fact, all over the country there are complaints of the absence of Parliamentary provision in respect of treatment for the most difficult of all these cases—namely, the advanced cases; and I should like my hon. and gallant Friend to tell me whether any portion of this £25,000 is available for that purpose also. There is also the important case of London, which I know my hon. and gallant Friend has given some attention to, where for the last four years there have been hundreds of insured persons waiting for treatment owing to lack of funds, and I want to know again whether there is any portion of this sum going to the London Insurance Committee in order to meet what I call a very grave scandal. All these people have been compelled to insure under the Act. They have been recommended for treatment, and have not obtained the treatment to which they are entitled. Is it not possible by some means or other for part of this sum, at any rate, to be available for that purpose? Not only in London, but all over the country, the insurance funds have been wholly deficient in respect of what is known as domiciliary treatment, and hundreds of people have been refused any treatment whatever for which they have paid, owing to lack of insurance funds, and for that purpose I should like to know whether this sum will also be sufficient and available for all these cases.

The CHAIRMAN
Most of these points are a matter for the main Vote of the year, but the Parliamentary Secretary will, no doubt, explain them again.

§ Mr. HOGGE
I was astonished to hear the Parliamentary Secretary explain that this £25,000 is only for Grants towards the rates. The Estimate does not say so. It distinctly says the reason for coming to the House for this Supplementary Estimate is due to the fact that the amount allocated to the Local Government Board has proved to be insufficient owing to the additional treatment in residential institutions which has been given, and the higher cost of such treatment. As a matter of fact the treatment of tuberculosis, so far as the discharged soldier is concerned, has been transferred from the Ministry of Pensions to the Local Government Board. That is a departure in policy which the House has never approved, just as the same departure was made in regard to the training of dis- 2052 charged men in transferring it to the Ministry of Labour. If the Local Government Board has had that function passed over to it, we are surely entitled to know, when they come for extra money in order to secure additional treatment and to meet the higher cost of that treatment, what they are paying with regard to those men who are now placed under their care since they came to the House for their original Estimate. We all know the deep interest the hon. and gallant Gentleman takes in this question, and we know that the oversight of these men is in very capable hands. We should like to know what provision the Local Government Board is doing for these men and whether they are able to deal with them, because last year there were long waiting lists of men, 40,000 or 50,000, suffering from tuberculosis who had been discharged from the Army without getting adequate, treatment. Before we part from this Vote the House is entitled to get that information.

§ Major ASTOR
This money is limited to Grants in aid of the rates, in respect of the treatment in sanatoria during the past year, and also the treatment of tuberculosis under what is called the Hobhouse Grant. It only refers to expenditure during the past twelve months and up to the end of March. Therefore, it does not deal with next year, and it does not refer to the treatment of ex-soldiers. As the Committee knows, the cost of living and the cost of treatment, and, in fact, the cost of everything, has gone up during the War, and it is not necessary for me to explain that. This additional £25,000 for which we are asking means that an additional £50,000 have been spent, because every £1paid out of the public Exchequer is supplemented by £1 out of the local rates. In regard to the points raised by my hon. Friend (Sir Kingsley Wood), there is, so far as the Treasuryis concerned, no limit to the amount of money which is available; and, in so far as it has not been possible for people to get treatment through inadequacy of institutions, it is not due to any inadequacy of funds as provided by the Treasury. As he knows perfectly well, when sanatorium benefit is extended, or where it is necessary to provide for the treatment of the population as a whole, that is done under the Hobhouse Grant, partly out of the rates and partly out of the Treasury, and there is no limit placed on that. Therefore, if treatment has not been available for any member of 2053 the community requiring it, it is not owing to lack of Treasury money. I say, quite frankly, that it is to a certain extent due to lack of institutional facilities.

Sir K.WOOD
Such arrangement as the hon. Gentleman indicates is in existence in London, and, as he knows perfectly well, the London Insurance Committee have constantly applied to the Insurance Commission because of deficiency in funds and the absence of a complete scheme for London.

§ Major ASTOR
I know the point which my hon. Friend raises, and as he knows, we are going into that. I do not think that arises on this Vote, which is an additional grant to the Estimate originally made by the Department to meet expenditure for the year which comes to an end in March. I want to be quite frank with the Committee. I do not come here to say that I am satisfied with the provision which is now available for the treatment of consumption or tuberculosis generally. But we are not here discussing the future. Neither my right hon. Friend the President of the Local Government Board nor I say that in our opinion the provision of residential accommodation is adequate. At the present moment we are doing all we can to develop it, and if it had not been for the discussion yesterday on the Ministry of Health we should have had a discussion on farm colonies, a very necessary development especially applicable to ex-soldiers. But I do not want to be drawn into a discussion which would be ruled out of order. That raises a big question of policy as regards the future. I am particularly anxious not to embark upon that, because I know perfectly well that you, Mr. Whitley, would quite rightly rule me out of order. As regards this particular sum I think it is very gratifying that in spite of the War, in spite of difficulties due to the War, in spite of the fact that the War Office required institutions for the treatment of wounded soldiers, in spite of the fact that there was all round a reduction of staff both of the Local Government Board and of the local authorities, in spite of the fact that the Treasury limited their loans very strictly and rigidly during the War, and in spite of the fact that it was difficult to get additional buildings put up during the War, we come to this Committee to-day and ask for additional money to meet the additional treatment in residential institutions—that is to say, that our 2054 predecessors at the Local Government Board and the local authorities have in fact been able to provide more residential treatment than was originally estimated by the Department, and to that extent the position is more satisfactory than it was hoped would be the case. But I hope the Committee will not think that we look upon the present provision as being adequate. The Committee may be assured that we are going into the question very fully both as regards its effect upon the civilian population and its effect upon the ex-soldiers who, as hon. Members know, are now under our care.

§ Lieutenant-Colonel RAW
Does the Estimate include the treatment of ex-soldiers and ex-sailors for the past year? I am sure the Committee is very grateful for the hon. Member's sympathetic consideration for soldiers and sailors and we shall be glad if he would tell us whether he thinks the institutional accommodation for the treatment of tuberculosis is sufficient or adequate, because I know, as a matter of fact, that hundreds of people are at the present time in workhouses in this country simply because there is no other accommodation available. I am sure no Committee of this House would wish this to happen in the case of discharged sailors and soldiers.

§ Sir K. WOOD
Will the hon. Gentleman say if he has any knowledge of the number of discharged soldiers and sailors who have been refused treatment owing to lack of funds during the year?

§ Major ASTOR
I thought I had made it clear to the Committee that this money does not at all refer and was not used for the treatment of ex-soldiers and sailors. It is purely money for the extension of sanatoria benefit, and ex-soldiers have not been treated in this manner and through this machinery in the past. The money provided for the purpose has come partly out of the Ministry of Pensions and partly out of Treasury Grants. As regards the other point raised, I have already said, and I say again quite frankly on behalf of my right hon. Friend and myself, that we sincerely trust that during the coming twelve months there will be a great deal more accommodation available. That is the best answer to all questions as to whether we consider the present provision adequate or not.