NATIONAL HEALTH INSURANCE (REGULATIONS). (Hansard, 3 August 1925)

§ Mr. HARNEY
I beg to move, That an humble Address be presented to His Majesty praying that the National Health Insurance (Medical Benefit) Amendment Regulations (No. 2), 1925, which was presented to Parliament on the 6th day of July last, may be annulled. Although the application I make is that the whole of the Regulation be annulled, really it is only directed towards one part of it. Under the National Health Act the country was divided into areas, each administered for medical benefit purposes by a committee made up of representatives of insured persons, representatives of approved societies and medical representatives. Subordinate to that body there was a sub-committee in each area whose function was to hear and conciliate or decide with reference to grievances that might be alleged by patients against the conduct of panel doctors. It was important that such a sub-committee should have on it a representative of the medical men, because otherwise there would be a chance that the panel doctor would be victimised. It was equally necessary that they should have on it representatives of the insured, because otherwise the doctor might be whitewashed. It was of all things essential that neither party should have a controlling voice on the committee because if you gave a controlling voice to the doctor it was only natural to suppose that esprit de corps would always protect a member of the profession. Similarly, of course, if you gave control to the insured, it was quite likely that the general prejudice that prevails against doctors would get too much sway. 1124 The position was met 13 years ago by composing these sub-committees of six. Three of them were representatives, from the insurance committee itself, of the insured, three of them were from an outside body sleeted by the panel doctors and stood for the medical side, and the chairman was elected by a majority of votes.
Although it is quite natural to expect that a medical man would rather reluctantly accept a committee composed partly of laymen that was to sit in judgment upon the doings of some of the fraternity, the system worked exceedingly well for 13 years, and it was not until very recently that any difficulty arose. The difficulty arises because of the new Regulation which I am asking the House to annul. It arose in London because the medical members of this subcommittee were not agreeably disposed towards a chairman who had been there seven years, and who had given the utmost satisfaction to the other members, because in their view he did not lean as much in their favour as they wished and three of them stopped away and rendered abortive the whole proceedings of the sub-committee. Under those circumstances it was necessary that something should be done. The Minister of Health, of course, acted properly, but, by reason of some misunderstanding, the only side that was heard before this new Regulation was framed was the medical side, the very one that should have least heeded under the circumstances.
The effect of the new Regulation is this. It does three things. In the first place, it says that the chairman in future shall be elected not by a majority but unanimously. The next thing it says is that if there be default in the finding of a chairman, or the proper election of a chairman, then the Superintending, Insurance Committee is to be skipped over and the whole power is to pass directly to the Minister. [HON. MEMBERS: "Hear, hear!"] Hon. Members say "Hear, hear!" Surely it is contrary to every principle of local government that a body which has the administration of the medical benefits of this insurance scheme, and is the responsible body that has to do with the giving of the penalty imposed upon doctors who do not act properly, when a difficulty arises in the constitution of the sub-committee, they should not be given a voice in appointing the chair- 1125 man. I do not think that needs any argument to show its unfairness. The last thing I wish to comment upon in regard to what this Regulation does is that the Minister may, passing over the responsible body, without giving them a chance of being heard, himself appoint a chairman, who need not even be a member of the committee, an entire outsider. He will be a member of the committee on appointment and can sit at the meetings of the committee and take part in the debates, but without a vote.
I am glad to understand that the right hon. Gentleman is not indisposed to meet me as far as he reasonably can. Speaking for those I represent, I would say that we are not wedded to any particular form, provided the right hon. Gentleman makes some sort of a suggestion which will leave the appointment of the chairman as it always was and should be with the majority and not left in the power of one recalcitrant doctor to say, "Because I object you shall not appoint so and so as chairman, and because I object the committee shall not have power." It is indefensible that an obstructive power of that sort should be put into the hands of any single person. If the majority rule is brought back, and before the matter goes to the Minister to make the appointment, an opportunity shall be given to the committee of itself having a say in the control of its own subordinate body, and in the appointment of the chairman, and in regard to a few other matters of minor importance, then, if the right hon. Gentleman is prepared to meet me in those respects, I should be glad to fall in with any suggestion which he makes tending in that direction.

§ Sir GEORGE HUME
I beg to second the Motion.
We are aware that the right hon. Gentleman knows a great deal about local government and would be opposed to anything which would in any way have the effect of undermining the powers of local authorities; but one cannot help looking with a considerable amount of jealousy at this suggestion of the central authority impinging upon the prerogative of the local authorities. It does not seem to me that the Regulation, as framed, is likely to serve the purpose. It is all very well that the Minister should appoint the chairman, but it is quite possible that the chairman so appointed 1126 will not satisfy one side of the committee and that you will have a strike again, such as you have had in the past. It is necessary that something more drastic than that should be done, or if that be not done, then the whole district committee, the local committee, should have power to appoint the chairman in the first place, and if a deadlock occurs after that then we might have recourse to the powers of the Minister. I do urge upon him to reconsider this from a local government point of view, and to see if it is not possible to find some means other than those suggested in this particular order.

§ Mr. CAMPBELL
I endorse everything which has been said by the other two speakers. I merely intervene because I happen to have been a member of the London Insurance Committee and the chairman of the Pharmaceutical Committee at the time this incident occurred. I know the circumstances of the case, and I hope sincerely that the Minister of Health will see his way to meet what has been proposed.

§ The MINISTER of HEALTH (Mr. Neville Chamberlain)
The House does not want to be kept waiting longer at this hour, but if I do not go into the details of the incidents which have given rise to this Regulation, I must not be taken as accepting the account which has been given of what took place by the hon. and learned Member for South Shields (Mr. Harney). It is not accurate in several respects. Bearing that in mind, I think it better to come to the business under discussion at once. The reason for the Regulation was that a state of affairs had arisen in which this particular sub-committee had ceased to function in London. That was a state of affairs which could not be allowed to continue in fairness to the patient. Therefore it became necessary to find some means of re-starting the machinery which had broken down. The object of the Regulation was not in any way to interfere with local government or to give the Minister arbitrary powers, powers such as no Minister would desire if he could avoid it. But it was to find a way out of the impasse into which the committee had got.
I have been going into this question with the parties to the dispute, and I am prepared to withdraw the article in this particular Regulation and to sub- 1127 stitute for it another provision which would be as follows: That the chairman of the medical sub-committee should, in the first instance, be appointed by a majority of the votes of the sub-committee. If he cannot be appointed because the two sides of the committee are voting in opposite ways, the committee being divided in equal numbers so that no majority can be obtained, or if the committee fails to function by reason of the fact that the chairman appointed is unacceptable to some of the members of the committee and they do what has been done in this case, and decline to function, then the matter is referred to the insurance committee itself, and the insurance committee will then appoint the chairman, and they should have power to appoint a chairman who would not necessarily be a member of the committee, but if he were an outside person he would then have to be co-opted a member of the committee if he were accepted as chairman of the sub-committee.
But we must contemplate the possibility that the sub-committee may not accept him as chairman, and again declines to function. In that case I should propose that the insurance committee should make representations to the Minister, and the Minister himself, after consultation with the committee and with the panel committee, so that he might be sure that he had the views of both sides, should himself then appoint a chairman, who again might be somebody outside the committee, but who in that case would have to be co-opted. Those are the main 1128 proposals. There is just one other point. I conceive that it is just possible that a deadlock might arise over some other point than the acceptability of the chairman, and I would safeguard against the possibility of that kind by providing that, if the committee were unable to function on account of some other reason than the fact that the chairman was not acceptable to the members, then the insurance committee should have the power to put before the Minister a scheme for the reconstruction of the medical services sub-committee, and the Minister would have power to approve it or to modify it. The proposal is one which goes as far as I can go, and perhaps the hon. and learned Member will be prepared to withdraw his Motion.

§ Mr. HARNEY
In the circumstances, I beg to ask leave to withdraw the Motion.

§ Dr. SALTER
Speaking on behalf of the doctors concerned, particularly those on the London panel, I would state that the compromise suggested will be entirely acceptable.