HC Deb 18 April 1921 vol 140 cc1673-6

Resolution reported, That it is expedient to make provision for the payment, in the first instance, out of moneys provided by Parliament of any expenses incurred by the Minister of Health in arranging for the treatment of tuberculosis under any Act of the present Session, to make further provision with respect to arrangements by local authorities for the treatment of tuberculosis, subject, however, to power being conferred on the Minister to recover any amounts so paid from local authorities failing to make such arrangements.

Motion made, and Question proposed, "That this House doth agree with the Committee in the said Resolution."


Before we pass from the financial side of the Tuberculosis Bill I should like to ask if the Minister can assure the local authorities that they will not be put into a worse position by the passing of the Bill and the Financial Resolution than they are at the present time. There is nothing in the Bill itself except the imposition of certain duties. Under the Financial Resolution money is asked for to allow the Minister to pay for the expenses he may incur in putting into force the provisions of the Act where the local authorities fail to do it. Therefore I think that this is an opportunity of inquiring to what extent are the local authorities protected so that the Ministry will not have to act under this provision. Under the Insurance Act, which lapses at the end of this month, certain amounts are provided for tuberculosis treatment, and the Minister suggested that a block amount be provided for the local authorities in lieu of that sum. What is the position in regard to this amount in future years? If the amount had remained as under the Insurance Act it would have increased each year. In the White Paper and under this Bill that amount will be a block grant. Therefore, as things stand at present, as far as we have information, the local authorities, instead of getting an increasing amount each year, will apparently only get the amount they would have got in the year 1920. Therefore to that extent they are losers. This Bill makes provision for the sharing of the extra expense between the Treasury and the ratepayers; but then they are the losers, because, if the existing arrangements had been continued, they would have got the whole of the cost of treatment of tuberculosis cases under the Insurance Act, whereas under the increased charge they will only get half. I would like to know if the Minister can satisfy local authorities that they will not in the future be in a worse position than under the existing arrangement?


Under the provisions set forth in the White Paper, the local authorities are likely to be considerably worse off financially. The original financial condition under which the insurance committees worked was that they received Is. 3d. per insured member for the treatment of tuberculosis. Subsequently 6d. per member was deducted from that, and paid to the medical profession for domiciliary treatment, leaving the insurance committees with 9d. per member. That 9d. has not been used in institutional treatment. Considerable sums of money have been paid to insured persons entering sanatoria for the purpose of purchasing clothing, and so on, before they entered those institutions. Considerable incidental expenditure has also been incurred in other directions, and the £300,000 which is mentioned as the "block grant" by no means represents what the sum would be if 9d. per member were the basis upon which it was calculated. If the present financial conditions are acted upon, the whole of the insured persons in the country ought to be numbered and 9d. per head ought to be calculated. If that were done, it would come to a figure, in my opinion, considerably larger than the figure set forth in the White Paper, leaving out of account all the progressive expenditure which has been mentioned by the hon. Member (Mr. Thomson). The financial conditions, before they are passed by this House, need much closer investigation, or the local authorities will be in a worse financial position in dealing with this question even than under the régime of the insurance committees.

The MINISTER of HEALTH (Sir Alfred Mond)

I do not think that either of the speeches we have just heard is in any way relevant to the Financial Resolution, the Report of which we are now dealing. The Financial Resolution deals merely with the case of the council of any county or borough which fails to make adequate arrangements, and it does not deal with the question of the finance of local authorities in regard to tuberculosis. I stated on the Second Reading that it is a mistake to speak of £300,000 as a block grant. There is no block grant. The £300,000 is the estimated amount which would have been received for the year 1920 on the contributions from the Insurance Committees. The calculation has yet to be made, and if it is larger than £300,000 the larger amount will be paid. As it will not be a block grant but an annual Vote it is obvious that it will be open to the House of Commons year by year if there is any loss by local authorities—which I do not foresee—to deal with the matter. Clearly it does not arise on the Financial Resolution, which deals entirely with a specific case involving a total expenditure of only a few thousands a year.