HC Deb 03 July 1919 vol 117 cc1243-60

Order for Second Reading read.

The PARLIAMENTARY SECRETARY to the MINISTRY of HEALTH (Major Astor)

I beg to move That the Bill be now read a second time. The House earlier this afternoon considered probably the most important Bill it will have before it at any time in its history. The Bill which I am now asking the House to give a Second Reading to is probably one of the smallest it will have to deal with this Session. But though it is a small Bill it is a necessary—in fact it is an essential—Bill to prevent a real injustice being done. This is not in any way an attempt to amend the Insurance Act of 1911. The whole object of the Bill is to maintain as far as possible the status quo. Hon. Members are aware of the change that has taken place in money values, and because of that change a large number of people who in 1911 were earning round about £160 are now earning something like £250. The original Act, which, as the House will remember, made insurance compulsory for non-manual workers with a low income, would, unless this Amendment were made, drive out of insurance very nearly 1,000,000 insured persons. That is to say, that unless the House passes this Bill, as from 30th June last a number, which is estimated at from at least 500,000 and probably 1,000,000 insured persons will be driven out of insurance and lose the advantage of all the contributions they have made at different times. I want to emphasise the fact that the whole object of the Bill is to maintain the status quo—that is to say, to continue in insurance the people who have contributed to it to carry out the intentions of Parliament in 1911.

I know very well that there are hon. Members who even now are not converted to the advantages of the original Act, but this is not the time to discuss that. We are not trying to improve or to patch up the original Act. In drafting this Bill, we have given every attention to maintaining the status quo as far as we are able to, and we were guided in selecting the figure of £250 instead of £160 by the award of the Conciliation and Arbitration Board for Government employés. That is the figure which they selected, and the Government felt that they would be wise to take that figure. If the Government had attempted to change £160 in order to meet the in- creased cost of living, they would probably have selected a higher figure, and I hope hon. Members will appreciate that if we had based our figure on the cost of living, probably the figure in the Bill would be over £250. I am certain there is no hon. Member or group here who would want in any way to inflict any hardship on the insured persons concerned, and it would be a real hardship if, having contributed over a considerable period towards insurance, anything up to a million persons were to lose the benefit of their contributions, and that would happen as from 30th June last unless this small Bill were passed. The Bill itself refers to Sub-section (g) of the second part of the First Schedule of the 1911 Act, where the excepted person from insurance is one who is employed otherwise than by way of manual labour at a rate of remuneration exceeding in value £160 a year. It is the duty of every employer to see that his employés, if they are non-manual workers and earning not more than £160, are treated as insured persons. Owing to war bonuses and other reasons, the remuneration of these people has increased. Employers have been in doubt as to whether or not to treat their employ£s who were insured before at a rate of remuneration under £160 as insured persons when their remuneration went up. I am now talking of non-manual workers. We got them to carry on. We did not know when the point first arose how long the War would continue, whether the bonuses would continue, or whether the rates of wages would continue at the high level, but it has now become essential to pass a Bill to regularise the situation.

There is a considerable difficulty in ascertaining and defining exactly what is the difference between a manual and a non-manual worker, and there are cases I could quote in which a man sometimes is a manual worker and at other times is a non-manual worker. A ticket collector, if he punches tickets only, I believe, is a non-manual worker, but if he helps to move a brake occasionally during the day he becomes a manual worker, and it is therefore exceptionally difficult to define exactly whether a man is a manual or a non-manual worker, and it is therefore the more necessary to pass this small Bill. A large number of influential deputations speaking on behalf of insured persons have been received. Only the other day I was asked, in the same way as a little previously the Leader of the House was asked, to receive a most influential deputation to put the case of injustice in which these million people would be placed unless the Bill were passed. I told them that the Bill would be coming this week before Parliament, and I am perfectly certain hon. Members have only to appreciate the intention of the Government to maintain thestatus quo to realise that a real injustice would be done unless it were passed. There are a certain number of people who in 1914 were non-manual workers and taking a little over £160 whose incomes are now not gone up above £250. To that extent, and as far as they are concerned, new people would be brought into insurance under this Bill. As far as we are able to tell, that number is practically negligible, and if I had to give the House a figure i should estimate it at something like twenty or thirty thousand, whereas if the Bill were not passed about a million people would be affected. As far as we are able to ascertain, more people, owing to the increased rate of remuneration, will be leaving insurance than will be brought in, and as far as we are able to estimate, the total number of people insured after the passing of this Act will if anything be rather less than it would have been according to the original intention of the Act of 1911.

I want to say one thing affecting the medical aspect. I know my hon. Friends here representing the medical profession want to know why the Bill is now introduced, and they will also probably want to know what their position is going to be in the near future. I know that they have doubts, some of them, as to the need for passing this Bill at this particular moment, and I have tried to explain to them, as I have tried to explain to deputations, that as far as insurance is concerned the date of 30th June is. crucial, that it was essential to get this passed now, and that we could not postpone the Bill because of that date, which is due to a medical contract. My hon. Friends know that during the War the doctors have received a war bonus. They know that at the present moment and for some time past the Department have been discussing with representatives of the medical profession the rates of remuneration for the future, and that at once raises the whole problem of the nature of the services to be rendered in return for the remuneration. I do not want to go into that, because that particular point is not raised here to-day, but I merely want to tell the House that the whole subject is being carefully considered by the Department in consultation with the people concerned. As a matter of fact, if this Bill were not passed, a large number of medical men who deal with insured persons would lose their patients, their clientele. I hope that, as soon as they appreciate and realise that, none of those outside will wish to oppose the measure.

I have received deputations from medical men. There was one point which was raised, and that was the bringing into insurance of that very limited class to which I referred just now, some 20,000 or 30,000 people, so far as we are able to estimate, who will for the first time be brought into insurance. I told the deputation that we did not want to bring these people into insurance, but that we found it administratively impossible to exclude them, for reasons with which I will not trouble the House at the present moment. We tried to frame a Clause which would exempt them. We were not able to do so. I asked my hon. Friends to do the same, and I want to repeat now what I said then, that if in Committee they are able to put down an Amendment which carries out their intention, which carries out what we would like to include in the Bill, we will be prepared to accept it. But we can only put into the Bill provisions which can be administered, and that is the only qualification which I make. [An HON. MEMBER: "Re-draft the Bill."] It is no good redrafting the whole Bill. We 'have drafted a Bill in order to carry out the intentions I have been trying to explain to the House, and it is the only way, so far as our draftsmen are able to see, that we can do it. If my hon. Friend can produce an Amendment in Committee which remedies the exceedingly small point which he has in his mind, then I say we would be prepared to accept it. I want to ask the House to give this Bill a Second Reading to prevent a real injustice being done to a large section of the community, and to maintain, as far as possible, the status quo; that is to say, to carry out the intention of Parliament when it originally passed the Act in 1911.

Major FARQUHARSON

I quite agree with the hon. and gallant Gentleman that there exists at the present moment a necessity for some such Bill, and I am quite sure that the whole community, with the medical profession as well, will agree that people who are now insured persons, and nave been for some time insured persons should not lapse their insurance benefits because of the altered values of money. The primary object, I take it, the one essential and final object of this Bill is simply to prevent individual persons lapsing from insured benefits. From that point of view I am heartily in support of the Bill, but I have to find fault with both the text and with the effect of this Bill. The text is so framed that the annual income is taken as a basis for determining that certain people shall now be in insurance who have not been in insurance before; in other words, the insurance limit, which was fixed by Statute some years ago at £160, is now, by a stroke of the pen, to be put up to £250, and thereby a large number of entrants into insurance benefits are legalised by Statute. I have not the slightest objection to everybody and anybody obtaining insurance benefits, but remember the position we are in now was standardised and fixed by Statute. The doctors made certain definite binding contracts that they would attend people whose incomes did not exceed £160. Those contracts are now in existence, and are passed in review at the end of each year. Why does the Government now, by a simple Statute, absolutely destroy the sanctity of a contract which exists between the Government through its agents, the Insurance Commissioners, and the medical profession? This Bill has been brought in without the smallest consideration on the part of the medical profession. The medical profession does not desire to exclude people from medical insurance, but it does-desire that where those services are part of something which the Government are-bartering for something else, they must be considered. The medical profession has-a right to stand upon the sanctity of a contract, and to demand that that contract shall not be violated and destroyed, and that they shall not be penalised for the benefit of any section of the community. It is all very well for the Government to come down here with altruistic feelings towards the insured persons, but the whole history of the relations of the Government to the medical profession since the Insurance Act came into force has been one series of incessant instances of nothing else than betrayal and of depriving them of every penny they can. I am goaded into this by what the hon. Gentleman said with regard to the war bonuses. I had no desire to make reference to the financial aspect of this, but he told the House that the doctors were evidently making themselves rich on the war bonus.

Major ASTOR dissented.

Major FARQUHARSON

That was the inference. Let me say that bonuses were only given to the poorest of the poor of the profession and on condition that they tabulated income from all sources. Is there now an occupation in the whole of this country which has had to submit to the ignominy to which this occupation has submitted in the last Government? We had for years and years been allowed 2s. 6d. for notifying an infectious disease. In 1916 some officious person said, "We will exploit the medical profession and save a lot of money to the State; we will strike out this miserable 2s. 6d. for giving a professional opinion upon a professional document and sending it to an official, and will make it Is. "I say that is an outrageous attitude to take up towards an honourable profession which deserves well of this country, and has served it well throughout the War and puts up with a great deal more than it deserves to put up with. I will just take this question from the point of view of the panel practitioner. The Government has contracted with him at the present time to do certain definite things under certain definite rules. This has been departed from. I do not wish to make odious comparisons, but there is an historic phrase called "A Scrap of Paper." Why should the Government regard a contract of service with an honourable profession as very much like that miserable, historic scrap of paper? I think it is most deplorable—most odious. Take the case of a non-panel practitioner—the middle-class non-panel practitioner attending people for small fees. By this Clause all these non-manual workers, such as clerks, will be compelled to be insured. The hon. Gentleman estimated that the number would be very few, but I defy him to give us the means whereby he has arrived at these figures. It is the merest conjecture. The number may be very large or it may be very small, but, on the one hand, the Government is destroying a contract of service with the panel practitioners, and, on the other, destroying a great many practices of men working hard for a miserable livelihood.

I do not want to elaborate the point, but I do beg at this time, when great schemes of medical service are coming before the country, that this is a most inopportune time to tamper with a contract of service. There are great schemes before the country, and the Government should postpone this Bill until those schemes are matured, when the whole question of the unified medical service, insured persons, and dependants comes up. Instead, they adopt this policy of pin-pricking and grinding down and sweating of the medical profession. I appeal to the Government to accept some modification of this Bill which will enable at least a postponement of new entrants into insurance, and for the whole scheme of medical insurance to be considered. When great schemes are before the country and the Ministry of Health is just coming in, the Government does not want a. sweated and disloyal medical profession. The profession, I am sure, is absolutely desirous of shouldering its responsibilities, to convert a C3 population into an A1 population, and will do so if treated squarely. But it is not just for the Government to adopt this attitude; it is not wise, and I tell this House that if this policy is continued towards the medical profession by the Government, one and all, the great majority of honourable thinking men, having to fight for their living, will inevitably drift into the ranks of trade unionism. [Hon. Members: "You are now!"] I do appeal to the Government. It is not asking for much. It is something which could easily be done but for the inflexibility of this Bill. This Bill has been, cunningly drafted so as to be incapable of modification, and so drafted that, when modification is applied to it, it becomes an administrative impossibility. Whichever way you approach this Bill you get up against difficulties for which there is no possible remedy. I suggest that the whole thing should be redrafted. If the Bill simply confined itself to the purpose for which it was brought into existence, namely, to secure that no person shall lapse from insurance to which he is now entitled, that meets the whole situation. But there is an oblique result, a sort of sideway sequence in this Bill, opening the door to a great many people coming in. I assure the hon. Member you cannot estimate the numbers which will be enabled to come into benefits at the expense partly of the medical profession. The medical profession does not wish this question to be approached in this way. It is part and parcel of a far greater question, and I do appeal to the Government to be both just and wise, if they cannot be generous, to the medical profession.

Captain ORMSBY-GORE

I beg to move, to leave out from the word "That" to the end of the Question, and to add instead thereof the words, this House declines to proceed with a measure which increases the number of persons compelled to make contributions towards the funds administered by the National Health Insurance Commissioners without guaranteeing acceptable medical service to all insured persons and without establishing the principle of free choice both by patient and medical practitioner. I hesitated to rise before to move this Amendment standing in my name on the Paper, lest I should have narrowed down the area of discussion, but I think it is clear from the speech of my hon. Friend who has just sat down that what I had in mind is very much what he has in mind, but approached from different points of view. He has approached it from the point of view of the medical practitioner, and I do think that in the preparation of this Bill it is fair to say that sufficient attention has not been paid to the point of view of panel doctors and also of non-panel doctors. I approach it from the point of view of a very considerable body of men in my Constituency who, at the last election, when I was thinking of quite other things, recalled to my mind the Insurance Act, and revealed to me that the administration of the Insurance Act in my Constituency was far from satisfactory, and that if a Bill were to be passed such as is now proposed, that grievance, which I think is a just grievance, would not merely not be redressed, but would be aggravated, and the area of the grievance widened. What is the fact? The fact is that the intention of Parliament in the original Act, Clause 15, Sub-section (3), has not been carried out. That is to say, the National Health Insurance Commissioners, and the Committees set up under that Act, have not provided acceptable medical service to insured persons where those insured persons are either unwilling or unable to make use of the services of the panel doctors. In my Constituency, a very considerable proportion of the working men have formed an association. They are all poor men—a good many of them Post Office servants. They all go and consult the doctors who are not on the panel. Efforts have been made to get the doctors on the panel; those efforts Have failed. Under these circumstances, under the original Act, it is really the duty of the Insurance Commissioners, under Section 15, Sub-section (3), to provide something in lieu of medical benefit under such arrangements as the panel system. It is perfectly clear, from the Regulations issued on the 10th of January, 1914, Part II., No. 14, Sub-section (6), that this should be so. Let me read the provision: The Insurance Committee may allow insured persons resident in the county, whether individually or collectively, in lieu of receiving medical benefit under the arrangements made by the Committee, to make their own arrangements for receiving such treatment. What is the result? The result is that in the town of Stafford a few panel doctors have far more patients than they can pay attention to, and the remainder of the doctors get nothing from the Insurance Committee or the Insurance Fund. Still, they are dealing with over 700 insured persons, and these have to pay twice over. It is perfectly clear that is a, grievance which has to be redressed. It was the intention of Parliament, when the original Act was passed, that such a grievance should not be possible. I do say we cannot and ought not to extend the principle of insured persons unless the hon. and gallant Member in charge of the Bill is prepared to carry out the original intention of Parliament as expressed by the Act of 1911. I hope my hon. Friend will not think I am in any way hostile, either to the principle of insurance or anything like it, because I remember being rather gibbeted at the time as being one of the five Conservative Members—I think he was one of the others—who voted for the Bill on the Third Reading, whereas a considerable number of our colleagues either voted against it or abstained from voting. He will realise that it is not in any hostile spirit that I have moved this Motion. I do so simply because there has been a breakdown. Unless the grievance which has been created is removed from this Act by the Government, I think it will be very bad, and will increase the grievance both for the doctors and for a large number of insured persons. Instead of being to the credit of the Government, this matter will be to their discredit.

I quite realise that owing to the rise in wages we have to do something. When that principle is invoked, I would remind hon. Members that if the insured persons are to be considered with respect to wages the doctors ought to be considered too. Prices have gone up to them in just the same way as they have to the insured persons. It is only fair that their case should be further investigated. I hope that when I bring to the attention of hon. Members the fact that in my Constituency about 700 insured persons have banded together to form a Protest League against the way he is administering this Act, he will examine into their grievance, and if legislation is necessary he will accept an Amendment to this Bill so that their grievance may be removed. Thus insurance may work its way, as I hope it will, for the benefit of the health of the people.

Captain ELLIOT

I beg to second the Amendment.

The Amendment is one I am not entirely in favour of, in view of the statement as to the people making contributions. Not all the people who will come under this Act will be compelled to contribute, because, so far as I can see from the Clause, a certain number of people will be entitled to get a certificate of exemption. They, therefore, would not come under the Act. However, the broad principle remains that but for this Act a million people will drop out of insurance. A small number of people—I think 25,000—will be enabled to get certificates, and consequently will not need to come under the insurance. The main point I wish to make is simply this, that the insurance services just now, from a medical point of view, are not satisfactory. I think it is an unsound scheme, an unsound idea, to carry out an extension of this scheme just now. If there is a grievance, we ought to do our best to remove it when and where we get a chance. Here we have the chance to remove an undoubted grievance of the people of this country being compelled to make contributions towards medical benefits which are not satisfactory and which are not carrying out the original intentions of the Insurance Act. Great services under the Insurance Act axe still being given for charity as they were before. The services of consultants, surgeons, and so on, are being rendered as they were rendered before. I do not think that is a fitting way for service to the sick of this country to be rendered. I would draw the attention of hon. Members opposite to that point.

The only other point is that it seems to me very important—I do not know if the Chancellor of the Exchequer has heard of this extraordinary departure—but when Labour Members go to ask for a further increase in the exemption limit for the income Tax it seems to me they will have an unanswerable case that the Government recognise the facts by a statutory declaration that £250 now is equivalent to £160 before the War. I do not know whether this has been done with the consent of the whole of the Government, but an Act that establishes that principle and an Act which affects, as the Under-Secretary himself said, over 1,000,000 people, is not the harmless, simple, innocuous, trivial little Act which he wished us to believe when he moved the Second Beading of the Bill.

Lieut. - Commander KENWORTHY

I hope this Amendment will not be pressed. I might oppose it on one or two grounds. The first is that, undoubtedly, in most parts of the country, though possibly not in Stafford—the town so ably represented by my hon. and gallant Friend who moved the Amendment—but in other parts of the country, the Insurance Act is giving satisfaction to the insured. This devoted service has proceeded in the face of many difficulties, and largely-thinned ranks owing to the War, of the medical fraternity. The class which is being particularly hard-hit at the present time is the non-manual worker with a low income. This is intended to benefit him, or will include him in his benefit. Anything we can do to help the struggling shopkeeper, or the clerk at the present time with an income of £250 a year, or round about that figure, the better. The only criticism I am here to make will be that it is not put up, say, to £300, because living is more than doubled in price. There-is also a most acceptable point in the Bill which the Government has introduced, and I must congratulate the Government upon their courage in having recognised that a man earning £250 a year is a poor man, that he needs the help of insurance. This is a most valuable concession. I hope my hon. and gallant friend in charge of this Bill will particularly bring it to the notice of the Chancellor of Exchequer. For that reason alone I hope the Members associated with us on this side of the House will support the Second Reading. I was interested in the indignation of my hon. Friend opposite, the Member for one of the Divisions of Leeds, where he told the Government of the hardships of the medical practitioner at the present time and threatened that the doctors would form a trade union. They are in a trade union.

HON. MEMBERS

No!

Lieut.-Commander KENWORTHY

Yes, in the most and exclusive union in the country.

HON. MEMBERS

No, no!

Captain ELLIOT

But they do not strike!

Lieut.-Commander KENWORTHY

They have threatened to strike in the past.

Captain ELLIOT

Your unions do not only threaten.

Lieut.-Commander KENWORTHY

I do not belong to any trade union. We all know that doctors "ought to be remunerated much better on account of the same increased cost of living which makes this Bill necessary. I am sure hon. Members on this side of the House are only too glad to support any motion the Minister of Health, which I think I may now call him, will bring in to increase the fees chargeable by panel doctors, for I think it was recognised that they have a hard case, and that it should be done. But let us get this through first, and I am sure the medical fraternity will have the good wishes of the Government very quickly when their case comes up.

7.0 P.M.

Sir P. MAGNUS

There are many points in this Amendment with which I find myself in agreement. I do not, however, think it will be advisable that the Amendment should be carried at the present time. It seems to me, however, necessary that something of this sort should be passed now. Therefore I certainly shall support the Second Reading of the Bill. I think the Minister in charge, when it goes to Committee, ought to be prepared to consider very favourably certain Amendments, some of which may be of a drastic character. The Bill is founded on the assumption, and it really is only an assumption, that £250 now is, and will remain permanently, the equivalent of £160 before the War. That is by no means certain, and it is a question which requires very careful consideration. Of course, it might also be said that, if an employed person's salary has increased from £160 to £250, that might be considered as a reason for his being exempted from the Insurance Act, and for his being able to pay a doctor the charges which he might make, because it is certainly not to be supposed that the doctor's income has increased in the pro- portion of £300 to £160. I should also like to draw attention to the fact that, when the original Bill was passing through the House in 1911, there was a strong effort on the part of nearly the whole of the medical men to make the limit £104, and the £160 was only carried by the strength, of the Government majority. All these questions, therefore, require to be very carefully considered. Then it has been pointed out, and it is acknowledged by the Under-Secretary for Health, that if this Bill is carried as it now stands it is certain that a considerable number of persons—he said 25,000—who do not wish to be insured will be compelled to come under the Act, and can only be kept out of its provisions by making a claim to the right of exemption, which probably is a difficult process. For all these very strong reasons, I think the Bill ought to be very carefully considered in Committee. I should like to emphasise what has been already mentioned, namely, that the minimum limit of income exempting anyone from Income Tax still remains at £160. I think there ought to be some close connection between that limit and the limit for insurance. I say again that, whilst I am prepared to support the Second Reading of this Bill, I think that very important and drastic changes should, be made in it.

Lieut.-Colonel Sir A. WARREN

I profoundly hope that this Motion will not be persisted in, not only for the reasons which have already been advanced, but because of a position which is causing the greatest possible difficulty, and in a sense chaos, so far as the administration of national health insurance is concerned. It will be within the recollection of the House that the measure provided for ail manual workers, and also for those not engaged as manual workers within a limit of income of £l60. The House is bound to recognise, as all reasonable men recognise, that the economic value of money has changed, and that £160 in 1911 is practically not worth £80 to-day. Therefore, there has been an earnest desire that the income limit should be altered. What is the effect upon the approved societies of this country? Whilst much can be said regarding the doctors, I would have the House bear in mind the important part that the approved societies have played in the administration of national health insurance. They have not always been able to make their voice heard; they have not been able to combine in a trade union, and have not always been threatening the Government and the Commissioners as to what action they would take unless they got constant increases in pay. They have, [however, played a valuable and most important part, and this House is indebted to them for the manner in which they tackled this question of national health insurance in. early days, and brought within its operation, within a very measurable distance of time, the millions of persons who were supposed to come in under the Act. The conditions in respect of wages in the case of those men and women who are not manually employed have altered, and at the moment the approved societies are confronted with the fact that a very large number of their members, according to the Act of 1911, are now outside the Act, and what to do with them has almost passed their comprehension, because it is open to those persons now, with their present income, to remain outside the Act, unless at the speediest moment this short Bill is passed increasing the income limit. Not only has chaos been caused by the alteration, so far as regards the determination of what people were really to be insured, but it has had the effect that a large number of per-eons for the time being have fallen out of insurance, and consequently the approved societies have been depleted of an exceedingly meagre administration allowance. I hope that within the near future the House will hear something on the question of bow the approved societies of the country have struggled during these last eight or nine years. Whilst demands have been conceded in other directions, the allowance which was provided for them under the Act of 1911 has been gradually whittled away, and they have been administering this great piece of machinery at a starvation rate. I hope, therefore, that the Motion will be withdrawn. It is of paramount importance that at the earliest moment those persons who come within the meaning of this Act should realise that the change in the economic conditions brings the income limit up to £250. The approved societies of the country will be profoundly grateful to this House for dealing with this question at the earliest possible moment, because it will remove some of their difficulties, and enable them to go on working with smoothness and with the success that has characterised them up to the present. In the hope that the Motion will be withdrawn, I will refrain from dealing in detail with one or two matters mentioned here, particularly as to the principle of free choice both by the patient and by the medical practitioner. I do not know that that is seriously in question. I have not learned from my experience—and the House will pardon my saying that I have had some little experience of this matter-that there has been any want of freedom of choice on the part of the patient, or that there has been any great want of freedom so far as the medical practitioner is concerned. But that is by the way. You will be acknowledging the service of approved societies, you will be removing a difficulty, and you will be assisting in the administration of national health insurance if this Motion is withdrawn, and the Bill as now presented is allowed to pass.

At this point a woman in the Strangers Gallery rose and protested against the sending of troops to Russia. She was removed by an attendant, and, other strangers having also interrupted, Mr. SPEAKER ordered the gallery to be cleared.

Mr. TYSON WILSON

I hope the Motion will be withdrawn. Many of the doctors have benefited by this Act. I am inclined to think that if a ballot were taken of the doctors of the country they would vote in favour of continuing the Bill. I say without hesitation that many of the working classes have benefited by the Act, and I also say that many doctors have benefited. Some of them are better off now than ever they were before. I think we ought to give the Bill an opportunity of going to Committee, where it may be amended and made a better Bill than it is at the present time.

Lord HUGH CECIL

I did not catch, in the speech of the hon. and gallant Gentleman in charge of the Bill, any statement as to its bearing on the general financial question. I hope he will be able to tell us whether it will involve any great increase in the burden on the national finances which arises out of national health insurance. It is, of course, obvious that, while the Government may by legislation interfere whenever an economic change in the value of money has any particular effect on this or that body of the community, they do not and cannot interfere with the constantly growing burden of those with small fixed incomes. The effect is to create great injustice. There is gradually growing up a process, at which legislation which adds to national expenditure constantly aims, whereby persons with small fixed Incomes constantly feel a greater burden. They have to pay, like everyone else, the increased cost of living, and they have to meet a gathering weight of taxation. On the other hand, they get nothing out of these numerous advantages given to other classes of the community. I think the House ought, apart from the direct bearing of this Bill, to have constantly in mind that it is most undesirable that we should always be adding to the financial burdens of the country. Constructively it works a great injustice on those who have suffered from the change in the value of money.

Major ASTOR

I will reply first to the question of the Noble Lord. The whole object is to maintain the status quo, and to prevent a million people losing the advantages of the contribution. We do not believe there will be any more people under insurance after the passing of this Bill, and we do not believe there will be any additional charge on the Exchequer. I hope very much that my hon. and gallant Friend will not press his Motion. I think he will find on reading it that it is already met. The new persons who will be brought in will have the right of claiming a certificate of exemption, and so I think his whole point is met. I listened with great care and attention to what he said about a certain number of insured persons in his constituency. That, however, appears to be not a matter of legislation, but of the administration of the Insurance Act. I can assure him that my right hon. Friend the Minister for Health and I will go into it very carefully and see whether anything can be done to meet their wishes. I do not say that it can be; it is a matter of administration; but we will go into it very carefully. I think my hon. and gallant Friend will be the first to agree that, because there is a grievance among a certain number of his constituents, it will create a far greater grievance to drive a million people out of the benefits of insurance. I do not want to repeat what I have already said, but the Government would not have brought in this Bill if it had not been urgently necessary. We were up against the fact that unless this Bill is passed nearly 1,000,000 people will lose the benefits from insurance to which they have contributed. The Government would not have brought in this measure under any other circumstances. I welcome this opportunity of paying a tribute to the splendid services which the medical profession has rendered to the wounded in France and England during the War. We all realise that, and we realise, also, the extent to which we can count upon the medical profession in the future in. the administration of the Ministry of Health. With that brief explanation, I hope the House will now give the Bill a Second Beading.

Captain ORMSBY-GORE

After the fair way in which the hon. and gallant Gentleman has met me and his promise to look into the case, and the fact that this Bill is absolutely urgent and necessary in the interests of a large number of insured persons, I ask leave to withdraw my Amendment, and I hope this measure will go to a Committee, where we shall have an opportunity of amending it if necessary.

Amendment, by leave, withdrawn.

Bill accordingly read a second time, and committed to a Standing Committee.