§ Order for Second Reading read.
§ The MINISTER of HEALTH (Sir Alfred Mond)
I beg to move, "That the Bill be now read a Second time."
This Bill originates in one of the recommendations of the Geddes Committee who, when reporting on National Health Insurance, recommended that certain supplementary special grants, which had been paid in the past by the Exchequer, and which were in addition to the statutory grant under the National Insurance Act should be discontinued, and that the amount of these special grants should, in future, be defrayed out of Insurance Funds. The total amount of these special grants was approximately £2,150,000 per annum, made up in the following way: £1,700,000, the State contribution towards the cost of medical benefit in excess of the statutory proportion of two-ninths; £100,000, the expenditure incurred by the Ministry of Health on behalf of approved societies and insurance committees for 1278 the Regional Medical Officers and the Index Clearance Branch; and £350,000, the amount of the State grant to the Women's Equalisation Fund, which was set up in order to assist approved societies in meeting claims due to extra sickness among married women members. The total therefore under these three different heads amounts to £2,150,000. When it was considered how this money should be found, the Geddes Committee recommended that it should be found by increasing the contributions in respect of insured persons by one penny per week—a halfpenny by the employer, and a halfpenny by the insured person. In the present time, when, owing to our exceptional unemployment distress we have had to raise the contributions both of employers and employed for unemployment insurance to figures very far in excess of what was originally contemplated or what should be necessary under normal circumstances—with these contributions for existing national health insurance forming the really serious burden on industry that they do—although I was prepared to put forward and have drafted a Bill to carry out the recommendations of the Committee I felt strongly, and so did others connected with national health insurance, that if some temporary measure could be found to avoid an increase in contributions it would be a very good thing and would solve a very difficult problem.
In consequence of this feeling, a meeting was held of the consultative council of approved societies, which is fully representative of all types of societies—the trade unions, the friendly societies, and other great societies like the Prudential and similar organisations dealing with National Health Insurance matters—and several conferences followed, and they came to the unanimous conclusion that, while in the interests of national economy the State should no longer be called upon to find these special grants, some other scheme should be devised rather than one which involves increasing the contributions. The council, therefore, on behalf of the approved societies, submitted an alternative scheme, and this is the scheme which is embodied in the Bill. It has been endorsed by the societies generally.
§ Sir A. MOND
Clause 1. The proposed increase of contribution has for the moment been abandoned, and the present Bill provides that the total cost of the special Exchequer grant, apart from the women's equalisation fund—of which I shall say something a little later—shall, as from 1st April, 1922, be a charge on the benefit funds of the societies during the continuance of the present contract with the medical profession. The House is probably aware that the contract with the medical profession as to their remuneration for national health insurance services varies from time to time. I made a renewed contract some time ago with the representatives of the medical profession on a reduced scale, which will continue to 31st December, 1923, when, of course, it will be subject to review in the light of the conditions then prevailing. On the question whether a proposal to take the money required during that period and provide these grants from the societies is actuarily Bound and such as either to impoverish or embarass the approved societies to the extent of imperilling the financial position—which, I am glad to say, we have succeeded in building up in the national health insurance scheme, and which, of course, it must be always our desire to protect at all costs for the benefit and certainty of all insured in this scheme—
§ Sir A. MOND
From the benefit funds. I will come to the matter in a moment. The further to satisfy ourselves on this point I asked the Government Actuary, Sir Alfred Watson, very carefully to go into this whole question. He did so. He made a report to me as Chairman of the National Health Insurance Joint Committee, and this has been circulated as a White Paper. Sir Alfred Watson, in his report, points out thatIn addition to nearly £8,000,000 in surpluses amongst the societies in Great Britain which was carried forward at the last valuation, over £6,000,000 in Contingencies Funds has been accumulated by the societies and was transferred almost intact to the benefit funds of the societies on tat January, 1919.This was the surplus fund of the societies available in excess of their liability for benefits, and this includes the additional benefits made after the last valuation— 1280 a total sum of £14,000,000. These are very imposing sums, and I am glad to realise that the finance of the National Health Insurance Fund has been so conducted as to allow large funds to be accumulated. In view of these accumulated funds, the Government Actuary advises that the extra charge imposed by the Bill upon the funds of the societies can be safely borne subject to the time limit mentioned in the Bill, that is December, 1923. I am not prepared to go further than that statement. I want to make it quite clear that the Bill will not in any way affect the operations of the schemes of additional benefits which have been recently declared by the societies and branches. This is money surplus to those claims, and there is no question of any of the claims being diminished.
When this proposal was put forward by such an important and representative body as the consultative council of approved societies I was entitled, in fact, I should have been very foolish not to accept what was, in fact, a very generous proposal, as I recognise it, on their part. They felt as strongly as I did that to levy an additional contribution upon employers and employed for such purposes at the present time would be a most injudicious thing to do. Their advice on a subject of this kind I should be the last person lightly to disregard. The financial stability of the scheme, I think, stands beyond all question. I do not think there is any doubt whatever as to the financial stability of the proposal. Even with these amounts, the surplus will still stand well over £12,000,000 over the actuarial liabilities of the approved societies. There has been some little misunderstanding about the procedure that has been adopted. Two alternative suggestions were made that the money should come, not out of this fund, but out of reserve values.
§ Sir A. MOND
Yes, reserve values, and I would point out the very serious objection to taking it out of the sinking fund. I will go into that with my hon. Friend if he thinks it worth while, because that point was considered. Under the present proposal the money which will be paid for these medical benefits and coming from the funds of the approved societies will Toe treated in the general account in the same way as 1281 any other benefit payment. That is to say, they will automatically carry with them the two-ninths of State grant, which will be created when the time comes and be placed to the surplus value. If the whole financial burden were placed on, the sinking fund the following result would happen. The societies would lose the State grant of about £800,000 or £900,000 which they are keeping under this Bill. There would be no money towards the redemption of the sinking fund until the end of next year, and the fund would default in payment of interest, and there would be a shortage of nearly £1,000,000 in the sum required for interest payments. If the present sinking fund fails to be redeemed in 1953, if this further liability of over £3,000,000 were placed upon it, and this sum is not found, the interest will amount in 1953 to over £9,000,000 in addition to the amount required for redemption; which will mean the postponement of the redemption of the sinking fund for many years after 1953. These reasons, I think, are conclusive against those who have made that suggestion, and some of whom have discussed with me at considerable length. It was these reasons which led the Consultative Council, who, after all, are the experts in this matter, to put forward the proposals which they put forward instead of putting forward proposals for dealing with the matter from the sinking fund.
In dealing with the general aspect of this question, I think I should say a word on the subject which naturally arises in connection with this Bill. I am given to understand that there is a certain amount of apprehension existing in the minds of the medical profession that the present Bill may make some change, or enable it to be made, in the arrangements for the control of the medical benefit. I have already said, in answer to questions in the House, that there is no word in this Bill which modifies the existing statutory provision for the control of medical benefit, and I take this opportunity of formally repeating that statement. Having regard to the provision in this Bill for contributions in relief of State expenditure from the surplus funds of approved societies, I think that it is no more than fair and reasonable to-day that I shall give the societies an opportunity of expressing their views before any new 1282 terms of service are made with the panel practitioners on the expiry of the existing contract of service. But the responsibility for accepting those contracts rests and will continue to rest with the Minister of Health.
A question has been raised as to the possible implications in the words "subject to such conditions as may be prescribed in Clause 1, Sub-section (1,a) of the Bill." These words are intended solely to provide for the detailed conditions which may arise in the field of administration. They are certainly not to be used in any way inconsistent with the principle which I have just been enunciating. This deals with the first section of the expenditure, namely, the State contribution towards the cost of medical benefit. There is the further point which I was dealing with, namely, the expenditure of £100,000 incurred by the Ministry of Health on behalf of the approved societies for the regional medical officers and Index Clearance Branch. I do not think that anybody can cavil at this, because the medical officers who are appointed do really save time and a very large amount of money, by getting people off the books who would otherwise be there costing a large amount of money. I do not think any objection can be taken to that. Then I come to the question of the Women's Equalisation Fund (Clause 2). We started originally with the idea that to take women into the approved societies the same as men was a very dangerous thing and would lose a great deal of money, and that therefore an Exchequer grant would be necessary. The Exchequer grant of £350,000 to this fund disappeared in January last, but there is a surplus of something like £2,000,000 to enable any deficiency to be met which might arise under this heading. Clause 1, Sub-section (1), deals with the question of payment by approved societies to insurance committees of an increased contribution in respect of the cost of medical benefit and administration expenses. Sub-section (2) of the same Clause provides for the whole of the payments being made out of the Insurance Fund.
§ Sir F. BANBURY
I do not quite understand Sub-section (2) of Clause 1 because it says that these sums are to be payable "From moneys provided by Parliament." I want to know how much will be provided by Parliament.
§ Sir A. MOND
The amount is two-ninths. When the Act was originally passed, the State contribution was two-ninths. Then in 1918, to meet the expenses of the doctors, a special Exchequer allowance was made for medical services, and we are now doing away with this special grant amounting to £1,700,000, and also the special Exchequer grant to women.
§ Major FARQUHARSON
There was a considerable reduction made recently in medical treatment which will certainly have some bearing on the figures now before the House.
§ Sir A. MOND
That has already been discounted. My hon. Friend is aware, I am sure, that the medical fees are still very much higher than in the time of the 1918 Act. I am pleased to say that I have got the medical profession to reduce their fees somewhat, but it still leaves necessary the figures with which we are dealing under this Bill. When we get to a more stabilised condition, I hope we shall be able to get more to the normal state of things under which this Act was originally framed. Clause 2 deals with the Abolition of Women's Equalisation Fund, and Clause 3 deals with another point which hon. Members will recollect came up last year under the Geddes Report. Owing to the very large amount of unemployment from which we have been suffering for the last two years, we have had some difficulties in regard to members of approved societies getting into arrears under their Health Insurance, and getting into a position where they would drop out of benefit. Hon. Members will recollect that question was raised last year and was dealt with temporarily at that time.
Under the financial scheme of the Insurance Act an insured person's benefits varied according to the number of contributions he had paid, and if he had less than 26 contributions credited to him, he was not entitled to any cash benefits for the following benefit year. A considerable number of persons are in that position, and as a consequence would not be entitled to any cash benefits during the next year. That is a serious matter which has been confronting approved societies, and we have been trying to find some way of meeting the difficulty. Fortunately we have been able to find a method of deal- 1284 ing with this problem. The Act of 1918 deals with the question of unclaimed contributions, and these have been constantly growing, and now amount to a very large sum of money. We are now taking power under Clause 3, up to the 31st December, 1922, to vary the provisions of the 1918 Act as regards the disposal of such contributions, to enable us to make such payments to approved societies as will enable them to pay cash benefits to those who would otherwise not be entitled to them owing to loss of employment.
§ Sir A. MOND
Those who have fallen into arrears and have not paid contributions for 26 weeks will be able to receive cash benefits tinder some scheme which will have to be arranged, although it will not be full benefit. That fund, which now amounts to something like 12,000,000, has accumulated through people not sending in their stamped cards, and we thought there could be no better purpose to devote this money to than dealing with this very serious condition of things, and helping those who have not been able to pay up their 26 contributions, and they will now be entitled to receive cash benefits during the next year.
§ Sir A. MOND
Yes. Under the Act they were entitled to medical benefits, but not to cash benefits. This measure will enable them to receive cash benefits as well as medical benefits, and I think it is very important that such provision will be made for them, and it is for that reason that we have introduced Clause 3 into the Bill. With regard to the main provisions of the Bill, I hope that they will be treated by the House as being generally agreed between those representing the great mass of insured persons who are responsible for the funds of approved societies and my advisers and myself. It is very important and urgent that this Bill should pass into law as early as possible. It will effect very considerable economies, and I wish to fully acknowledge the noble hearted way in which the representatives of approved societies have come to my assistance in this matter, for they have acted with a gene- 1285 rosity for which I wish to thank them. I think their appreciation of the position of natonal finance does credit to their wide outlook upon national affairs.
§ Mr. THOMAS
I am sure that the latter part of the right hon. Gentleman's speech will be duly noted by the approved societies, but it is necessary, after all, whilst congratulating the right hon. Gentleman upon sticking very rigidly to his brief of what is a very difficult and technical point, to bring the House back to the facts of the case, because the passing of this Bill is a clear violation of Government pledges to approved members. Curiously enough, when the Geddes Committee considered this matter, I do not know of any approved society, or anyone responsible for the administration of the Act, who was called before them to give an opinion. It may be a good thing to have such confidence in this Committee, and to feel that they would give an impartial judgment, but I think the right hon. Gentleman would be the last person to claim that they knew anything about the Act and its administration, and they have arrived at definite conclusions without even consulting anybody connected with the administration. That is the first point.
The Minister of Health came down to the House of Commons immediately following the Geddes Report, and presented a Bill to give effect to that Report by an increased contribution. I asked whether the Consultative Committee of which he has now spoken in such high terms of congratulation had been consulted, and whether they know anything whatever about the introduction of the Bill, and he replied that they did not. Without consulting anybody the Minister of Health acts on their Report, brings in a Bill and does not consult those responsible for the administration of the Act. The right hon. Gentleman has repeated this afternoon that he has not consulted those who are the best judges of the situation. The right hon. Gentleman read to us this afternoon a quotation from Sir Alfred Watson. He told us that as the Minister responsible he wanted to ascertain the actuarial situation, and he had consulted Sir Alfred Watson on the matter, and he read to us a letter from Sir Alfred which says, of course, that the approved societies can stand it and that there is plenty of money to deal with this ques- 1286 tion. Sir Alfred Watson wrote to the Geddes Committee on this very point immediately their proposals were made, and he said:I should not be justified in advising that the funds of Approved Societies can bear this extra burden without an increase of contributions.This Bill does not provide for an increased contribution. Sir Alfred Watson says in the letter which was read to us this afternoon that the societies can bear the burden. Three months ago he said he would not be justified in advising that they could bear it without an increased contribution. The surplus of each society is the property of the members of that society. It cannot be assumed from this fact that there is any general redundancy of contributions of which advantage might be taken. To resort to this surplus in order to meet a new general charge would therefore only be possible if a partial pooling of the funds were to be adopted. But this would mean a fundamental change in the system of National Health Insurance. It would impose a serious burden on particular classes of assured persons, and it would be very difficult to justify. Sir Alfred Watson months ago said to the Geddes Committee, "This is my considered judgment," but this afternoon we have the Minister quoting from a letter in which he says, in substance, "I am perfectly sure that this is not only sound but that it can be financially upheld."
§ Sir A. MOND
I said that in the letter which Sir Alfred Watson wrote to me guarded himself by limiting the application of his statements to December, 1923. He did not say it as applying to a permanent settlement.
§ Mr. THOMAS
I am dealing with the facts as I find them. Why did the right hon. Gentleman a few weeks ago introduce a Bill to increase the contribution I He based it on Sir Alfred Watson's opinion, and if Sir Alfred is to be quoted in one connection, we are entitled to quote him in another. The fact of the matter is, that this Bill violates every pledge that was made to the insured person; it is "a robbing of the hen roost," of which we have heard so much in late years. When the National Health Insurance Act was passed through this House, everyone supported it, and everyone agreed that there ought to be an 1287 advantage to the society which administered its affairs soundly and economically. It was pointed out from all quarters of the House that it would be a bad thing unless there was some inducement for societies to administer their funds economically and to stop all abuses. In order to meet that, provision was made in the Act that the society that showed a surplus at the end of the valuation period could use that surplus for the particular and exclusive advantage of its members. I want to ask the right hon. Gentleman where is this money to come from?
§ Mr. THOMAS
Yes, but the Minister knows there are three funds, and there is not a word in the Bill as to where this money is to come from. Let me ask him which of the three funds it is to come from? Is it to come from the aggregate surplus of the societies? Is it to come from the disposable surplus, or is it to come from the non-disposable surplus, which amounts to nearly £8,000,000? As a matter of fact, I believe it is to be taken from the last named. I do not think the Minister himself really knows, but it is important that we should know. It is no good talking about it coming from the surplus when there are three different surpluses.
§ Sir A. MOND
It is to come from the aggregate surplus. That is shown in Sir Alfred Watson's circular.
§ Mr. THOMAS
The aggregate surplus amounts to £16,850,000. There is a disposable surplus of £9,000,000 which the administrators of the societies are to deal with, and then, in addition, there is a sum of £9,000,000 which the societies are always told is not disposable, and must not be used. We have always been told it is kept for safety. It is what is called "a safety valve." Is the money coming from that fund, because if it is, then clearly it is a violation of all the pledges and promises made to the members of the societies. My right hon. Friend says there is a fundamental objection to taking it from the reserve fund. When did the Government discover that objection? It is a new theory. One would assume from what the right hon. Gentleman says that he has gone carefully into this matter, and that the proposal was so funda- 1288 mentally wrong that he turned it down. But that was what he himself did in 1916. He then actually took the reserve to make up a deficiency, and I put it to the House that that could be done again. We do not for one moment suggest that the agreement between the doctors and the approved societies should be broken. Well, I will not call it an agreement, it is an arrangement. We wanted an agreement. It is the existing condition under which the doctors serve, and no one suggests that that should be broken. But while this Bill is limited in its application to 1923, we want an assurance that, in 1923, when we come to review the situation, those who have paid the piper shall at least have an opportunity of calling the tune. In other words, whilst the existing agreement with the doctors is to continue until 1923, we want that, when that time comes, the approved societies shall themselves have a voice in determining the new arrangement, whatever it may be, between the doctors and the insured people.
§ Major FARQUHARSON
Does the right hon. Gentleman mean a voice independent of the voice of the Minister of Health?
§ Mr. THOMAS
No. The approved societies find the bulk of the money today. Prior to the passing of this Act the panel doctor in making his arrangement with the Hearts of Oak or any other society made the arrangement directly with those who were paying. Today that is not so and the insured member and the approved society have very little voice in the matter. We feel we are not only entitled to have a voice, but that we are also entitled to say something definite at that period. The difficulty we are in to-day is this. The Government committed themselves to accepting a certain proposal. I agree entirely with what my right hon. Friend says that it would not only be a mistake but it would be madness to increase the contribution to-day, for the burden that both the employers and the workpeople are bearing is so heavy that any attempt to increase it at this moment would be fatal. Are the Government themselves taking the right course in breaking what, after all, was a definite promise to these people? It may be true that the sum of £2,000,000 is involved. That is a great amount of money, and it is well worth 1289 making every effort to save it. But in the end if you create in the minds of the people of the country an idea that the word of the Government cannot be depended upon, that the Government cannot be trusted, and that, when it suits it, it violates its own pledges, promises and laws at the end you will lose far more than £2,000,000.
What is more the Minister in charge ought to feel proud of the care exercised by the approved societies. He knows perfectly well that large numbers of these officials work unstintedly, some at low salaries and others voluntarily, in order to build up a strong position for their own society. They feel proud of being able to go to their members and say: "We, by our careful administration, have succeeded in saving so much." That is something which ought to be encouraged and it is something which this House ought to be very chary of interfering with. The effect of this Bill is going to dishearten these people. It is going to create a feeling that they ought not to make an effort such as they have made in the past. I do not think it would be wise to divide against this Bill, but it will have to be carefully considered in Committee and we must secure a definite guarantee about our position in 1923. Above all, the source from which this fund is to be taken must be clearly laid down. As I have said, I feel unable to vote against the Second reading of the Bill, but I reserve to myself the right to go into more details in Committee. I cannot but deplore the fact that once more we have an illustration of lavish promises made not in 1918 only, but in 1912 and 1914 to the members of the approved societies now being ruthlessly broken by the Bill which we are asked to support.
§ 7.0 P.M.
§ Lieut.-Colonel Sir A. WARREN
I am obliged to the Minister in charge of the Bill for the complimentary remarks he made in the course of his speech, in which he recognised the indebtedness under which he laboured to the approved societies and to the members of the Consultative Council for the services they had rendered him in a very difficult situation. I hope that during the progress of this Measure, and before the final settlement that may be arrived at, he will have regard to what he has already said and be prepared to keep certain pledges that have 1290 been made and which have a direct bearing upon this matter. Speaking on behalf of the approved societies, I have to say that when the Geddes Committee's Report came before us we were very much concerned. May I remind the House of what the Geddes Committee actually said upon this matter? They recommended that the Exchequer should be relieved of the special grants, amounting to about £1,760,000 per annum, toward the cost of medical benefit in excess of the statutory proportion of two-ninths, and of the cost of the regional medical officers so far as it was not already met from the Approved Societies Fund. That is the origin of the Bill before us this afternoon and the Minister of Health, in considering that, as has already been observed, came down to the House with a proposal to increase the contribution in relation to National Health Insurance by ½d. per week from the employer and ½d. per week from the employee. We strongly felt that that was a mistaken course; that in the present economic conditions with a great volume of unemployment, and knowing that still in the country there were elements of resentment against National Health Insurance—I would have the Minister realise that it is not regarded with abounding satisfaction—knowing as we did, from our experience, the feeling that would be engendered, we were strongly moved in the direction of urging that that proposal should be withdrawn. The right hon. Member for Derby (Mr. Thomas), who has just spoken, asked if there were not another way than that suggested under this Bill. He asked if it were not possible to meet the situation by extending the sinking fund for a further period. I am not going to vote against this Measure, nor am I going to advise the House to do so.
I want the House to realise that we have endeavoured to exhaust every reasonable means before we have come to the point we have reached to-day. We urged that there should be an extension of the period of the maturity of the sinking fund. I am bound to say that, after going into the matter and having careful expert advice, we had to realise, after all was said and done, that probably these societies would materially suffer by extending this redemption even beyond the period it now has to run. Therefore, while we were opposed to the 1d., and 1291 while we had to realise that it was a mistake to deal with the reserve values, yet in a spirit of loyalty, and in a desire to assist the Government, we were prepared to consider alternative proposals. The Minister of Health has said kind words regarding the approved societies. The approved societies to-day are prepared to agree to a suggestion with regard to a certain benefit under the Act in respect to which they have very considerable feeling. If there has been one benefit more than another, under the National Health Insurance, which has caused us consternation and feeling, and which has created difficulty, it is, and I say it with great respect, the administration of the medical benefit. We are asked to shoulder a burden of £1,760,000 per annum in relation to a benefit which we think ought to be materially improved. I wish to say, and I do not want to be taken as speaking harshly, that if that benefit cannot be improved, and if it is going to continue in the future as it has been in the past, we should be glad to be rid of it altogether and to make other arrangements to safeguard the rights of our members and to obtain medical benefits for them.
We are asked to consent to £1,760,000 per annum coming from the unappropriated surpluses under the National Health Insurance. I do not 'believe that it will do hurt or harm to any individual insured person. The appropriable surpluses under the last valuation have been ascertained, and the additional benefits, whether in money or kind, are now being administered throughout the country. As we have heard, there is still in the Fund a vast sum of money, unappropriated surpluses which, under the advice of the Actuary, and quite correctly so, are kept for the purpose of safeguarding the Fund. The proposal is that the money coming from that source, together with that from the abolition of the Women's Equalisation Fund, shall be appropriated to meet the amount of which the Government will be relieved up till the end of 1923. With that we are in agreement, on one consideration. The Minister of Health has already promised that at the end of 1923, when it is proposed to enter into new agreements with the medical profession, that the approved societies of the country shall be consulted. I do not regard that as a very extortionate demand. It seems 1292 to me an exceedingly reasonable thing to ask. I would not even go so far as the right hon. Member for Derby and say that he who pays the piper should decide the tune. I would ask, however, that we should come into some reasonable connection with the medical profession, a connection that hitherto we have never had. Instead, we have always been kept at arm's length, and our friends of the medical profession would have nothing whatever to do with us.
I want to ask the Minister to-day again to reaffirm his decision, having once announced it. I ask that, with a view to obtaining the Second Reading of the Bill, he should say in this House that that is his determination, because already the medical profession in the country are taking exception to it. At an interview which took place not long back with the right hon. Gentleman's chief advisers there was an attempt made to get that promise withdrawn. I hold in my hand an extract from some of the remarks made at that meeting by the secretary of the British Medical Association, in the course of which he said:Ministers may come and Ministers go, but we know from what we have seen of the approved societies that if you give them an inch they will take an ell, and we are not prepared to give them that inch.That is a remarkable statement to make. If that is true, I say it quite deliberately, the approved societies could have said something very much stronger, and something very much more pungent regarding the medical profession. Whenever have they given us an inch? Whenever have they given us a fragment of a fraction of any period of measurement? Yet the charge is made that we are taking an ell in respect of matters over which we had no control.
That is the only one thing on behalf of the approved societies that I ask. It is that the Minister shall again say, when the arrangements are come to at the end of 1923, that we shall be taken into consultation. Unless we have that deliberate promise, and unless that promise is kept, I want whoever may be in charge of the Ministry of Health at that time to appreciate the fact that the approved societies will put up the strongest fight of their lives to ensure that not one farthing more shall be taken from their funds. As one who, in a humble position, has the opportunity of 1293 advising them, I should advise that not another farthing of the money they have won for themselves should be paid. After all, from whence have these surpluses come? They have not come from the medical profession, nor have they fallen from the ethereal blue. They are the result of the careful administration and of the hard, honest, and thorough work of thousands of officials throughout the country who have had to operate this Act, smothered, as they have been during the last few years, under an avalanche of regulations which might well have sent mad the sanest men in this country. The fund is the result of their careful and deliberate work. It may be a hen-roost, and at the moment it may be raided, and we are prepared, in the exigencies of the situation, to allow it to be so raided; but we will see that in the future there shall be no raiding, because if it is a question of raiding surpluses, then we can, if we care to do so, take measures and means whereby no surpluses shall arise.
There is another point that I hope the Minister will consider, and I say it with great respect. I want his Consultative Council to obtain the greatest possible confidence throughout the country. I have met certain bodies in this country who feel they are not properly represented, and I trust that the right hon. Gentleman will turn his attention in that direction. I hope he will see that the interests, whether agricultural, industrial, or whatever they may be, are properly represented on the Consultative Council, because so much depends upon the advice of that body. The right hon. Member for Derby said that the approved societies have not been consulted. We have not made any clamorous demand to be consulted, because we have been prepared to leave the settlement of this case in the hands of the Consultative Council. Let us see to it, however, that it is a strong and representative Council, and one in which there is unbounded confidence. Then many of the difficulties in the future will be removed.
§ Mr. CAUTLEY
I desire to induce the House, as far as I can, to consider very carefully where it is being led by the Minister of Health. The House will recollect that the Insurance Act was based on a most careful actuarial valuation. A system was set up which, in effect, constituted a contract made by 1294 the State with every insured person and employer, who became bound to contribute to the Insurance Fund. The terms of this contract were laid down, and one of those terms was that the surplus of the benefit fund, which might accrue after paying expenses, should belong solely to the individual society in respect of which it accrued. That is the principle of the Insurance Act, which is a contract in the strictest sense of the word. It seems that in 1918 the doctors required to be paid further fees. The Government at that time respected that contract, and by an Exchequer grant they provided the necessary money to pay the increased cost of the medical service.
Since 1918, and up to the present time, the present Minister of Health has succeeded in reducing to sonic degree the medical fees of the doctors who work this insurance. Allowing for that diminution of the fees there remains a total sum amounting to 2s. 6d. per member of every approved society in the country which, in the ordinary course, would be found by the Exchequer grant. The Minister now asks the House for a reversal of that policy. He asks the House to agree to disregard the contract that he made with every insured person. He means to raid the benefit fund of every society, and not only the surpluses, but to raid those societies which have no surplus, and to require from them a further payment of 2s. 6d. per member per year, which was never taken into account when the original actuarial valuation was made which was the basis of the original Insurance Act. I say that to do any such thing would be wrong in principle, and will tend to cause the insolvency of the societies. It may be the first step towards that insolvency. It cannot be done rightly, and it is a very dangerous course to pursue. The Government are doing it, no doubt, with a view to economy, and Sir Alfred Watson made a Report to the Geddes Committee, during their investigation, as to whether any economy could be effected in the administration or working of the Insurance Act. I did not hear all that was said by the right hon. Gentleman the Member for Derby (Mr. Thomas), but, if he referred to that Report, I hope the House will forgive me if I read six sentences from what Sir Alfred Watson then wrote. The first sentence which I will read is this: 1295I should not be justified in advising that the funds of Approved Societies could bear this extra burden without increase of contributions.That bears out the first point. I made, that the actuarial valuation was so carefully considered at the time that it was impossible that it could stand any extra charge upon it. The Minister of Health will, no doubt, retort, "Oh, but the working of the Act shows that it can." I disagree with that suggestion entirely. I would ask the House to recollect that during the years up to the time when the valuation was made on 31st December, 1918, everyone was employed, we had constant increases in wages, and people were better fed and better clothed, and lived under better conditions, than had ever been known in this country—a state of things which, as far as I can see, is economically unlikely to occur again for some time. If the insurance scheme was to be solvent and prosperous, it was certain of being solvent and prosperous during those years. As has already been mentioned, the Minister knows this. He is as far-seeing a man as any in this House, and he brought in, on Sir Alfred Watson's suggestion, a scheme by which he was to save this money by providing that the contributors—employers and employed—should each pay an increased contribution. There was, however, a great outcry at that, and rightly so, because under the conditions of life now, and considering the increased contributions in respect of unemployment benefit, it is practically impossible that insured people should pay a larger contribution; but the right hon. Gentleman knows perfectly well in his heart that that is the only way in which it could be done without breaking the contract with the insured persons. The next sentence which I will read from Sir Alfred Watson's report is this:The surplus of each society is the property of the members of that society.That bears out my statement that it is part of the contract that any surplus belongs to the individual society, and that was the basis of the Act, the object being to insure careful and economical administration, so that every advantage so gained would go to the benefit not of the whole of the insured people of the country, but of that particular society which had made the economy. The next sentence is: 1296It cannot be assumed from this fact that there is any general redundancy in the contributions of which advantage might be takenThat was written when the Geddes Committee was sitting last year, and after Sir Alfred Watson had had before him the results of all the valuations of all the societies in the country which he himself had been instrumental in making on the 31st December, 1918. The fourth sentence is this:Resort to surpluses to meet a new general charge"—and this is a case in point—could only, therefore, be possible if a partial pooling of funds were adopted.The Act does not provide for any partial pooling, or any pooling at all, and it is contrary to Sir Alfred Watson's own advice that the Minister is bringing forward this proposal. It is not putting a charge on to the extra surplus, if I may use the expression, nor on the surplus at all. The whole of the surpluses shown by the valuations made under the direction of Sir Alfred Watson have been divided into two parts, the disposable surplus and the surplus to be kept in hand. The disposable surplus is being used for benefits, the other is being kept in hand, and the Minister suggested that it was only on this extra surplus that this charge is coming. That is not so at all. The Bill says that every member of every society, whether there is any surplus or whether the society is working at a loss, as some of them have been, would have to pay this extra charge of 2s. 6d, a member. Then. Sir Alfred Watson goes on to say:This would amount to a fundamental change in the system of National Health Insurance.The last sentence I will quote is this:It would impose a serious burden on particular classes of insured persons, and would be difficult to justify.These sentences are dead against the proposal which the Minister now makes. How does the right hon. Gentleman attempt to justify it? He attempts to justify it by saying that the Advisory Committee of Approved Societies have approved of it. But who are they? They are the nominees of the right hon. Gentleman himself.
§ Mr. CAUTLEY
Of course, I admit that they are chosen by the approved societies, but they are nominated by the right hon. Gentleman. What I said was that they are the nominees of the right hon. Gentleman.
§ Mr. CAUTLEY
I sit on that side of the House which some people say is not democratic, but, whatever the hon. Member opposite may say, I object to nominated members, and I do say that, if the Minister is going to put forward this Bill as having the approval of the approved societies it ought to be the approval of all the approved societies iii this country, who ought to have some right of representation and some power of saying what they think of this Bill. I am not speaking for the large societies. I have ventured to speak here rather more on behalf, so far as I can, of the small rural societies in this country. When the Act of 1911 was passed, I was instrumental in forming the small societies in my own county into a county association. I have seen the practical working of the Act, and, so far as the agricultural districts are concerned, the results of our valuation come out extremely well. Our surpluses, however, are relatively small, and the great difficulty that we have is that of competition from the large societies, like the Prudential and others, who pay agents, which we cannot do, who come running about all over our rural districts. One of the real advantages that we have is that we are enabled to pay better benefits from the contributions than most of these societies in the large towns can do. Therefore, having regard to the smallness of our individual societies, this is going to be a most oppressive burden on all of these small societies, and, so far as our county association is concerned, owing to the smallness of our societies and the fact that we have to meet this competition of the larger societies, it will take away a great deal of the advantages that we possess. It is mainly, however, on the larger ground that I say that this proposal is not justified for any reason that the Minister has given. I am not satisfied that this money cannot be raised by some prolongation of the redemption period of the reserve values formed when the original Insurance Act was passed. 1298 If the Minister can tell me that this is a question which can be thrashed out in Committee, I shall not take the step of voting against the Bill, because I should like him to find this money, but without injustice to the existing societies. If he cannot tell me that this matter can be raised in Committee and thoroughly threshed out to the satisfaction of the Committee, I shall feel bound to vote against the Bill.
§ Major MACKENZIE WOOD
I beg to move to leave out the word "now," and, at the end of the Question, to add the words "upon this day six months."
This Bill raises questions of very great importance, and I hope they will receive the careful examination of the House. It is for that reason that I have put down this Amendment. The Bill is important because, on the face of it, it transfers from the Exchequer to the approved societies a liability to pay something like £3,500,000. It has an importance, however, beyond that. It is important because it illustrates, to some extent, the Government's whole method of dealing with approved society finance, and it is also of importance in a further sense, because, in my opinion, it raises the whole question of the future of the doctors in their relationship to the approved societies. That has to be considered now, and I hope it will be considered by the House, and that we shall have some statement from the right hon. Gentleman before this Bill is allowed to go very much further. The right hon. Gentleman, in recommending the Bill to the House, has practically told us that it is an agreed Bill, and that we need not waste very much time in considering it. That is practically the effect of much that lie has said, and, in my opinion, it is typical of many of the methods to which we have become accustomed from the present Government. They meet interests outside, they make a deal with them, and then they come down to the House and ask the House to register that deal; and they seem to think that we are trenching upon someone else's preserves if we venture to criticise or to ask that the Government or their representatives shall explain the Bill which is thus put forward. I hope the House will insist on a full and careful examination and explanation of every Clause of this Bill, and 1299 also of the other questions which, to some extent, lie outside the Bill, but which are bound up with it.
I agree practically with what has been said by the hon. and learned Gentleman who preceded me, but I want the House again to consider what the right hon. Baronet has said. He says the Bill is agreed because it has been approved by a certain body which is called the Consultative Council. The members of this Consultative Council are men appointed by the right hon. Baronet, creatures, without disrespect to him or to them, of his own, who may not be re-appointed, and probably would not be re-appointed if he did not think they were good members of that Council. But, apart altogether from that, he said they represented the approved societies, and indeed he said this scheme was approved by the Council on behalf of the societies. I think there are something like 24 to 30 members in this Council, and there are thousands of approved societies. How can the right hon. Baronet say that a body consisting of 30 people, nominated by him, not representative of the societies at all, not even appointed or approved by the societies, can commit thousands of approved societies all over the country? It is a physical impossibility, and he has no right to say this is a Bill which is approved and agreed to by the approved societies. They have not been consulted. The right hon. Baronet gave the House to understand that they had been consulted. I think the recommendations of the Geddes Committee were published, and three days afterwards this Consultative Council met and considered the question of this Bill, and made their recommendations. How was it possible for a body of that kind to give a decision which could be at all representative of the approved societies? They had no time to consider it. They had no time to consult the societies of which they themselves were members, and it was quite impossible for them to give any decision which could in any way be said to reflect the opinion of the societies behind them. Even supposing this Council were able to give a decision which would be binding on the whole of the societies of the country, from my information I think the right hon. Baronet was quite wrong in saying that even this non-representative Council assented to the Bill.
§ Sir A. MOND
The Consultative Council assented to the Bill. Schemes were considered and proposed by them. They had a number of meetings, and after they had come to their decision I met the full Council and had a two-and-a-half hours' discussion on the subject.
§ Major WOOD
I have been in communication with many people who are directly interested in this question, and my information is that this scheme did not originate from this Council at all, but that the right hon. Baronet informed the Council that the Government were determined to make them swallow the matter.
§ Sir A. MOND
The hon. and gallant Gentleman must allow that I know more about what happened than his peculiar sources of information. That statement is absolutely without the slightest foundation. I introduced a Bill into the House for increased contributions—the only method I can see at that time of carrying out the proposals of the Geddes Committee. The Consultative Council met, and after a series of meetings reported to me that they objected to the increase of contribution and they proposed this scheme. After they had come to that conclusion I met them myself and had a considerable discussion of the matter, and they unanimously asked me to accept this scheme. I should never have dreamt for a moment of forcing a scheme of this kind upon the approved societies.
§ Major WOOD
I do riot think that explanation makes any difference to my argument. My point is that the right hon. Baronet gave it to be understood that the Government had made up their minds that this burden of £3,500,000 was to be transferred from the Exchequer to the approved societies. The approved societies, therefore, had to swallow it, and all the right hon. Baronet did was to give them an option of electing in what form they would take their medicine. I think if he will consider it I am not misrepresenting him. Certainly I do not desire to do so. It is the last thing I should like to do. That is the submission I make as to what really happened, and what the approved societies have said was that of the two schemes the one embodied in the Bill is the less evil. Of course, if they could have their way they would have neither. If the right hon. Baronet says, "We have 1301 made up our minds to do this," naturally it is not for the approved societies to say they will not agree to it, when they know that if they do not agree to it they will be landed in something else which will be even worse. They have simply agreed to this scheme as being not so bad as the one which was originally put forward by the right hon. Baronet. If the hon. and learned Gentleman who preceded me had not read that paragraph from Sir Alfred Watson's letter to the Geddes Committee I would have done so, and I should like every hon. Member who desires to get in small compass the arguments against the Bill to read the paragraph in the letter, because that is practically the whole case against the Bill. The right hon. Baronet never alluded to the first letter from Sir Alfred Watson, and made no attempt to explain the inconsistencies which, in my opinion, exist between that letter and the subsequent memorandum which was sent out as a White Paper along with this Bill.
The Actuary in the memorandum agreed to this Bill—and it was a very half-hearted blessing in my opinion—on the definite understanding that it was going to be limited in its amount and temporary in its operation. It inaugurates a new scheme which must lead to something else, and if we are going to approve of this we ought to know what is to be behind it. The Bill proposes to make a raid upon certain funds. A short time ago, after the last valuation of the assets of the societies, the Actuary said he would not allow societies to pay out all the surplus which they had accumulated. He allowed them to pay out a certain amount, but beyond that he said it would not be safe to go. How is it that if it was not safe to go further a few months ago it is now safe to go very much further and to make an inroad to the extent of £3,500,000 on these funds? I gather that the Government put forward the view that it is possible and it is fair to raid the surplus funds because they have been to a large extent created by the War. I agree that the surplus funds of the societies are perhaps larger to-day than they would have been if there had not been a war, but on the other hand the War has created many liabilities on these societies which have to be met. Thousands of insured persons have returned to their ordinary work very much impaired in health and they 1302 are a very much heavier burden on the societies than ever they were before. They are going to come back continually on the societies as the result of their war experience and of the bad health which they now enjoy, and that will go a long way to cut into these surpluses which the war may have helped to accumulate.
But there is another question. Last year the right hon. Baronet introduced, and the House passed, at his instigation, the Prolongation of Insurance Act, and that put upon the societies the obligation to find a great deal of money for benefits to members who have really fallen into arrear and would have fallen out of benefit altogether. These were extra benefits which were not contemplated by the actuaries when they drafted the scheme behind the Insurance Act. These are two additional burdens which have come directly as the result of the War, and will in time more than take away any surplus which may have been heaped up as the result of the War. These funds of the approved societies are moneys which, in the case of a large part of the working-class community, are their last stay and practically their only protection against days of illness, and to take away that money which belongs to them and has been accumulated by them on the faith of the pledges given by the right hon. Baronet and his predecessors, is to try to help the general taxpayer at the expense of the poorest classes of the community. No one suggests for a moment that this Insurance Scheme should not be self-supporting. I do not think any approved society suggests that the Exchequer should have to beat this 2s. 6d., but the Exchequer definitely, of their volition, accepted this burden without consulting in any way the societies. The societies believe that a very bad bargain was made, and if it had been left to them there would have been no 2s. 6d. to pay at all. But the right hon. Baronet made a bad bargain. Now he finds that the finances of the country are in a bad state, and he desires to put off on to other shoulders the result of this very bad bargain which he has made.
One of the objections which I take to the method adopted by the right hon. Baronet is this. He tells us that he has made an agreement with an outside body. We never know what may have passed between him and that body. We never 1303 know on the basis of what consideration this body may have agreed to the proposal which he made or the proposal which was put before them. As I understand it, the consultative council gave the somewhat qualified agreement that they did give on the expressed understanding and undertaking by the right hon. Gentleman that when the present agreement runs out at the end of next year the approved societies will be consulted with regard to any new agreement. The doctors, so far as I know, repudiate that. They say that the right hon. Gentleman can make any agreement he likes with the approved societies, but they as doctors will have nothing to do with negotiations with approved societies. Which is it? I hope the right hon. Gentleman will give us more information about this very important point. It may not seem of as much importance to-day as it will latterly, but it is a very great question of vital interest, not merely to doctors but the whole of the approved societies of the country. I hope we shall have a great deal more light thrown upon this subject before the Bill is allowed to pass.
I have no objection to Clauses 2 and 3, but I have some objection to Clause 4, and I am sorry that the right hon. Gentleman did not think it necessary to mention that Clause. In Clause 4 there is a discrimination made in favour of England and against Scotland and Wales in regard to the amount of money which is going to be paid. In England the amount is 2s. 6d., in Scotland 2s. 11d., and in Wales 3s. 1d. What is the reason for that distinction? Many people will be inclined to support the Bill merely because they consider it is a question of economy. There is no economy in this Bill in the sense that it means that we are going to spend one penny less. This £3,500,000 is going to be spent. Real economy means lack of spending, the fact that you are not to spend the same money that you were spending before. There is no economy of that kind involved in this Bill. The money is going to be spent as it was before. The only difference is that the right hon. Gentleman is going to move it from the Exchequer. It is no more economy than it would be for the Chancellor of the Exchequer to come down and say that certain charges which previously 1304 had been placed on the national Exchequer were in future to be placed on the local rates. That is a complete analogy of what is being done in this case.
There is another point of a somewhat different nature, and it is a very important point. Under this Bill, the Government are going to postpone certain charges which fall in the present financial year and the next year to a date beyond the next valuation. Why should the right hon. Gentleman ask us to approve of the postponing of payment of debts which are incurred in the present financial year? We heard a great deal about the payment of debt and the postponing of obligations when we were discussing the Budget. Here is a case where the Government definitely and deliberately ask the House of Commons to postpone the payment of nearly £1,000,000 to a few years hence, although the whole of the money is going to be spent and the liability incurred in this year and next year. That will increase the burdens on the Chancellor of the Exchequer a few years hence, and, if one can judge things aright, the Chancellor of the Exchequer of that day will have trouble enough without having trouble created for him by the present Government. It would be a mistake for the House to approve of the Bill at this stage, and that is why I move its rejection.
§ Mr. RHYS DAVIES
I beg to second the Amendment.
The House will recall that 10 years ago a distinguished Member of this House stood at the Treasury box and preached the gospel of 9d. for 4d. To-night, 10 years later, a Minister of Health reduces the 9d. for 4d. and inclines to the view that approved societies should now come to the bare economic financial status of 4d. for 4d. That is the tendency of this Measure. A great deal has been said about the consultative council. I do not wish to be as harsh on the consultative council as some hon. Members, but I do say that the right hon. Gentleman, when he saw the consultative council, put to them only two alternatives—the Government had decided on the first already—that either the approved societies were to find an increase of 1d. contribution per week, or this Bill must be passed. That was after the Government had decided to relieve the Treasury to the extent of £1,750,000. The principle of this Measure 1305 is exactly the same principle as the proposal of the Government to deal with the superannuation of teachers. It is the principle of taking pence from the insured population of this country. It means raiding funds which are provided for sickness, maternity, dental and optical treatment, and the Government takes, that money, the money of the poorest population of the country.
§ Mr. DAVIES
This House accepted that liability when it passed the first Insurance Act. When it passed that Act, with its Amendments, it adopted this philosophy, that the sickness of a workman was not of necessity to be a liability on the workman himself, but that the employer, the industry, and the State must come to the aid of the person insured. Now the right hon. Gentleman in this Bill violates that principle.
§ Mr. DAVIES
I think the right hon. Gentleman will have to confess that the consultative council as it now stands cannot possibly represent the views of the approved societies of the country. I do not say that that is the fault of the Minister—I think the council was there before the Ministry of Health was established—but I do think that the Minister ought to take steps and try to secure a democratic representation on that consultative council. It will astonish the House when I say that I hardly think that a single member of the consultative council is insured under the State health scheme. Consequently, they cannot represent the views of the insured population. If the consultative council is drawn from the approved societies, what are the approved societies? The biggest approved society in this country is the Prudential Approved Society. If a managing director of the Prudential Approved Society is on the consultative council, surely he cannot represent the insured population of the country. How could he? He cannot represent their point of view. He is not insured. He does not mix amongst them. All he does is to help pass resolutions 1306 once a month in the management committee of the approved society.
A great deal has been said about the Actuary's report. This is not the first time the Government has ignored an Actuary's report. The Government take no heed of actuaries' reports. If they decide upon a certain issue, as they have done in this Bill, they will flout anybody and anything. The Actuary has given later figures than the quotations already given, and he has pointed out a very significant fact which ought to be borne in mind by the Minister and the House. The approved societies were valued to the end of the year 1918, and it was then found that they were in a good way financially, but since the approved societies were valued to the end of 1918, sickness benefit has increased by at least 50 per cent. in all the approved societies, owing to lack of food and decent shelter for our people, consequent upon unemployment. I can imagine that when the next valuation takes place at the end of 1923 all the money, and more, that the Minister is now proposing to take from the funds of the approved societies will be required in order to make good the financial position at the end of that valuation period. The Actuary hints at that problem.
Whatever the opinion of other hon. Members may be, I hope that the House will divide on this Bill. The insured population of this country are not affected as intimately by these proposals as were the teachers. The teachers were affected intimately because there was a proposal to take 5 per cent. off their wages; but this fund which the Government is raiding in this Bill is too far removed and too technical for the average insured person to understand exactly what the Minister is doing. Something has been said about the doctors. The doctors are represented in this House. They have taken up rather a strange attitude towards the approved societies in dealing with this Bill. The doctors, so far as my knowledge goes, are the only people in this country who are paid wages, and who are not employed by anybody. They decline to be employed by anybody.
§ Major FARQUHARSON
Every panel practitioner has to enter into a very definite contract of service. Surely that is a contract of employment?
§ 8.0 P.M.
§ Mr. DAVIES
When a person is employed he can be dismissed, but the doctors cannot. The doctors under State insurance draw their salaries, and certainly they ought to be well paid. But I do say this, that the panel system under the State insurance scheme is a failure. It could be proved that prior to the advent of this system the doctors for less money gave to the same patients whom they are now treating better service than they are giving now for more money. I trust that when the doctors come to negotiate again the Minister will take heed of the fact that approved societies are determined, as they are the people responsible for finding the money to pay for medical attention, to have a say in dealing with the doctors in this connection. I know the attitude which the doctors have taken up, but that attitude has got to be altered, if doctors are to continue to treat the members of approved societies.
The Minister, in bringing in this Bill, shelters himself behind the decision of the Consultative Council. That is a cowardly thing to do. The Government, by bringing this Bill before the House, is inflicting an indirect penalty on the insured population of this country. The insured population are the people who work, and only the people who work. The non-manual worker, who is in receipt of wages beyond £250 per year, does not contribute under the State Insurance Scheme It is the worker who contributes under this scheme. For 10 years he has been compelled to contribute, and he has built up a surplus on the understanding that it would be available for additional benefits for him by way of optical, dental, and hospital treatment, and other things that go to make up the new Jerusalem of the distinguished Welshman to whom I referred a few moments ago. But this new Jerusalem is now to be destroyed by the Ministry of Health. The Ministry of Death would be a more appropriate title for the present Ministry, owing to the way in which it is proceeding now. Whatever may be done this evening I trust that there will be in power some day a Government who will take a different attitude with regard to the health of the people. During the War the Government were responsible for maiming and bruising thousands of the folk who are expecting to receive 1308 money in future by way of additional benefit. I protest in the name of a large number of insured people in this country against the provisions of this Bill, and I have much pleasure in seconding the Amendment.
§ Dr. FARQUHARSON
It has been said by the hon. Member for Westhoughton (Mr. Rhys Davies) that doctors are represented in this House. I would remind him that there is no such thing as vocational representation, and while I happen to be a doctor my representation is that of an ordinary constituency. I make this statement, not in any sense as a rebuke of the hon. Gentleman's remark, but in order to make my position clear in the observations which I am about to make. Nothing has given me greater regret this afternoon than to notice the ease and the avidity with which certain Members chose to attack the medical profession. Not only it is the individual members of the medical profession whom they seek to attack, but they seek to attack the whole medical profession. [HON. MEMBERS: "No!"] If approved societies simply desired to improve the medical service by getting rid of black sheep in the medical profession they would find no more hearty co-workers than the great rank and file of the panel practitioners in this country. The medical profession are very desirous of improving the medical service. The medical profession recently agreed voluntarily to a very considerable diminution in their remuneration, amounting, I think, to about £1,250,000. That is a very large sum of money which the doctors are giving up voluntarily.
Let no hon. Member forget that the doctors are a very important part in the mechanism of the administration of the National Health Insurance. I submit that one of the causes of the splendid surplus which many societies now possess is, to a very considerable extent, to be found in the most effective work done by the medical profession under the Act. One hon. Member uttered what I may describe as a threat, that if they do not get the doctors by the throat by the end of 1923 and make them do exactly as the right hon. Gentleman the Member for Derby (Mr. Thomas) said they did in the old days, the approved societies would take this money and keep it. But those were the old days. There was no State element and no employer element. Now the 1309 approved societies say, "We shall sweep away the right of the State and the right of the employer and we shall dictate terms to the doctor." I wish to express gratitude to the Minister of Health for what he has said. There has been undoubtedly an uneasy feeling in the medical profession and I suggest to the House rightly so, because not so many years ago doctors were slogging along at 1s. 6d. or 2s. 6d. per annum, attending individuals year in and year out for these sums. Does the House want a return to these conditions? I think not. I thank the right hon. Gentleman on behalf of the medical profession for his attitude in reference to those fears of being put again under the heel—it was nothing more or less—of the clubs.
I once was a club doctor myself, and I can assure the House that no harder work was ever done for a more miserable pittance than was done in those days. If the approved societies wish to return to those conditions, and to force the medical profession into that position, it will be a fight to a finish. The insured person will suffer. To the glory of the profession, doctors will never refuse to attend the person who is ailing or sick, whether they get something or nothing. Rut are these men to be treated harshly? I have no mandate to speak for the profession, but I believe that they will hear with great gratitude the frank statement of the Minister of Health that they will not have to meet that point of view. And I have not the slightest doubt that when the time comes to recast the figure, it will be done in a fair, straightforward manner. The medical profession will not object to approved societies having access to the Minister. Why should they object? The Consultative Council, under the Ministry of Health Act, have no right of access of their own initiative to the Minister. The right hon. Gentleman this afternoon has decided a point of great importance in constitutional procedure. He told us in effect that the Consultative Council, representing approved societies, have the initiative of access to him. I hope that in time to come the Conultative Council representing the doctors will also be granted the same degree of access. I am content with the promise given by the right hon. Gentleman this afternoon. The profession wish to dictate to no one. I hope that hon. Members will cease attacking the medical profession on the ground 1310 that their ranks contain a few black sheep, of which the profession are anxious to get rid. Let this purely financial transaction be decided on its merits without making an attack on the profession which has served the country so well.
§ Mr. HURD
I would ask the right hon. Gentleman to give special attention to the rural aspect of this question. There is a strong feeling in rural areas that they are not so well looked after as they might be. I have received to-day representations on this point from the body that specially represents the working farmer. I have not time to develop the point except to make this suggestion. Would it be possible for the right hon. Gentleman when reconstituting his consultative council, as he proposes to do, to give the rural societies more adequate and more direct representation, so that their views may be more fully represented than is now possible?
§ Mr. HURD
The fact remains that throughout the rural areas there is a strong feeling that their special case is not properly put before the consultative council. When the right hon. Gentleman is reconstituting that body I would ask him to give special attention to that particular aspect of the case.
§ Mr. G. LOCKER-LAMPSON
I desire to refer to one or two financial considerations. During this Debate many hon. Members seemed to take it for granted that the whole of this 2s. 6d. special grant was coming out of the funds of the approved society. I think that the speeches made have tended to convey that. That is not the case. We had several plans. We have first had the plan of the Geddes Committee. Under that plan there was to be an extra contribution paid for this 2s. 6d. and the State were not to contribute, as in the case of other contributions, the two-ninths from the Exchequer. That was refused by the approved societies, whether rightly or wrongly I cannot say. Then we had the second plan.
§ It being a Quarter-past Eight of the Clock, further Proceeding was postponed, without Question put, pursuant to Standing Order No. 4.