HC Deb 11 May 1932 vol 265 cc1927-2039

Order for Second Reading read.

The MINISTER of HEALTH (Sir Hilton Young)

I beg to move, "That the Bill be now read a Second time."

The Bill which I rise to introduce to the House is a Bill to ensure the financial stability of our great scheme of National Health Insurance. In some of its aspects this Bill cannot be a pleasure to me to introduce or agreeable to the House. It has nevertheless that strongest of all justifications, that it is absolutely necessary for the protection both of the interests of those who are contributors to the National Health Insurance scheme and of the community as a whole. It is a sheer work of necessity to ensure the financial stability of the scheme. How great are the interests involved? For 20 years now the National Health Insurance scheme has become increasingly interwoven with the social structure of the country, and it is now a most important organ of that social structure.

Let me mention but one or two figures to show how important a feature it is of the society of the nation. There are no fewer than 17,000,000 persons insured under the scheme; it is 17,000,000 persons whose interests we have to ensure and protect to-day. The amount which they contribute in contribution income year by year is no less than £26,000,000. The Exchequer contribution, the sum which the nation pays in to the assistance of the scheme, is £6,500,000 a year; and the measure of the importance of this scheme to those who are contributors and insured will be found in the circumstance that in the course of the last 20 years no less than £434,000,000 has been expended in the form of benefits. It is an organisation of the greatest complexity and, I may say, of the greatest consequence. The organisation by which the scheme is administered is in the hands of no fewer than 7,600 approved societies and branches of societies.

I mention these circumstances in order to demonstrate to the House the importance of the task which lies before us in securing for this scheme absolute finan- cial stability so as to protect the interests of the assured. During the 20 years of the life of the scheme, for the first 10 to 15 years the finances of the scheme saw nothing but prosperity. Large surpluses were earned, and in consequence large additional benefits could be paid. The House knows that additional benefits are those which are paid out of surpluses by the societies that have surpluses, in addition to the statutory benefits which are paid by all societies. Large additional benefits were paid—no less than £21,000,000 in the last 10 years—and owing to those earlier years of prosperity, very large reserves have been accumulated by the societies—no less than £117,000,000. The House will know that for the greater part those reserves are, as it were, earmarked against the positive actuarial liabilities of the societies, so that not the whole of that £117,000,000 is free for additional benefits.

Such was the early history of the scheme, but then, unfortunately, came a change in the nation's circumstances, and with the change in the circumstances of the nation came a change in the circumstances of the scheme. Bad times came, and the finances of the scheme began to show a less prosperous complexion. A threat to the absolute stability of the finances of the scheme was foreshadowed some years ago. It was foreshadowed so clearly that my predecessor—I think it was the right hon. Member for Wakefield (Mr. Greenwood)—was obliged, and quite naturally, to give serious consideration to the financial basis of the scheme. That was some two years ago, and he called for a special report. In that special report we saw the first foreshadowing of what was beginning to be threatening in the circumstances of the scheme, because the principal circumstance that that report brought out was a very startling increase in the sickness experience of married women, which in the years 1921 to 1927 had increased, as regards sickness benefit, by no less than 106 per cent. above expectation and, as regards disablement benefit, by no less than 159 per cent. above expectation.

Now that circumstance foreshadowed what has been found to be, as I will point out later, an essential weakness in the scheme with which we are now called upon to deal. In consequence of this warning, the right hon. Member for Wakefield then issued a circular, in 1931, in which he sought the following remedies, namely, a more careful supervision of claims made and better medical certification in respect of the claims; in other words, a closer scrutiny of claims made against the Insurance Fund.

4.0 p.m.

Unfortunately, those remedies proved neither sufficiently deep nor wide enough to meet the case, and, after that forewarning, there came the severity of depression, and, with the severity of depression in the country as a whole, it became obvious that something was seriously amiss with the finances of National Health Insurance. Things were beginning to be unduly unfavourable on both sides of the account. One side of the account, of course, is contributions—income—and the other side claims, and on both sides of the account things were beginning to move against the stability of the finances of the scheme with an increasing menace. Claims were increasing, and particularly in respect of the women's claims, and, as regards the women's claims, particularly with respect to the claims of married women. On the other side of the account, that is the contribution income, which provides the funds out of which the claims are met, a new menace appeared. This second menace was entirely due to the growth of unemployment. Owing to that, contributors were constantly falling into arrears with their contributions, and the income from contributions was consequently falling off. And so as I say, on both sides of the account increasing difficulties were threatening the stability of the scheme.

After those forewarnings at the beginning of this year the blow falls in the form of the Actuary's Report upon the scheme for the third valuation period. The House is aware that at the end of each period of years there is a special valuation of the assets and liabilities of the societies by the Government Actuary, who evaluates what they have, what the potential claims upon them in insurance are, what surplus they have of the one over the other, and, on the basis of that surplus, after a proper subtracting for reserves, fixes the amount which can be spent in additional benefits. On this third valuation, as we expected, the blow falls. The situation it revealed I can summarise in a single phrase. It is this: The valuation shows that we have now arrived at a point at which the health insurance scheme is living upon its accumulations. What is the measure of that? A full account of this will be found in the Government Actuary's Report, to which I invite the attention of the House in order to get a full view of the situation, but I will give the essential position in one figure, which will be readily intelligible to the House.

During the period from the first to the second valuation, that is, during the period of prosperity, the surplus assets of the approved societies grew by no less than £25,000,000. Now for the contrast. During the period of the second to the third valuation the surplus had increased by £12,500,000 only, that is, half the previous increase, and, what is more unfortunate, that increase is not a substantial one. It is an illusory one, because it is due, as to about half of it, to interest upon funds previously accumulated, upon which they must now be drawing, and is due, as to the second part of it, to non-recurring margins. The increase of surplus assets at the last period is, therefore, an illusory one, and what I have to tell the House to-day is that, as things stand at present, the rate of increase in the surplus assets of the approved societies and of the scheme as a whole, is, in substance, nil. We have arrived, therefore, at a point at which, without an increase of surplus assets, the future holds nothing but the necessity of living upon accumulations.

That state of affairs finds its expression, of course, in the reaction upon the additional benefits. The additional benefits, as I have pointed out to the House, are those which societies pay out of their surplus assets. They are the measure of the elbow room, the margin, and now we see the inevitable effect upon these additional benefits of this decrease in the surplus assets. The contrast is a strong one. After the second valuation no less than 95 per cent. of the approved societies and branches could, and did, give additional benefits. Now see the change. After the third valuation additional benefits have had to be reduced for 6,250,000 out of 17,000,000, and, more unfortunately still, in respect of no less than 4,250,000 contributors the additional benefits have had to be discontinued altogether. That is the measure of the degree in which the prosperity and the stability of the funds of the scheme are placed, and—most menacing feature of all—no fewer than 418 societies and branches find themselves not only in a position not to give additional benefits, but actually with a deficiency; that is, if they did not fall back upon central aid, they would not be in a position to pay the very minimum of statutory benefits which the scheme requires. Do I go too far in saying that this outlook is now a critical one? I will quote the words of the Government Actuary himself in reporting upon the state of affairs. He says: Existing surpluses provide only a temporary bulwark, and serious deficiencies are in prospect. What does that mean? Let me earnestly ask for the attention of the House to what is really the principal evil which we have to try to remedy. I will put it in this way: If we went on as we are going with National Health Insurance, at the end of the next valuation period there would be widespread deficiencies among the approved societies. They would be unable to pay the statutory benefits which the scheme requires. The deficiencies would be so great that the resources of the scheme would be unable to meet them, the scheme would be insolvent and would break down. We have a clear indication that, unless we take prompt action, we shall be confronted at the end of the next valuation period with a breakdown of the scheme of National Health Insurance.

This scheme has been, in a way, the pride of our social organisation. We have boasted of its financial aspects as an example to the world. We now have, as I say, the threat that if its finances are allowed to continue as at the present time, it will break down, and we must draw the obvious conclusion that prompt action is absolutely necessary. It must be based, I think the House will agree, upon two principles. First of all, we must secure the solvency of the scheme. We must protect it from the least threat of that breakdown at the end of the next period to which I have referred. In the second place, we must maintain the other foundation stone of the scheme, which is that it is a contributory scheme, that is, a scheme based upon the principle that people get what they pay for. It is that contributory element which we shall look upon as having to be absolutely preserved and fortified in anything we do.

We now set out to seek the proper remedy for the threatened danger which I have described, and, in order to do so, we must look a little more closely at the actual causes of the threatened breakdown. As I have said, the first cause is the increase in the sickness experience, and that is particularly the case in regard to the women's claims, and, as regards women's claims, it is particularly in respect of the married women. It comes from women in contrast to men, and it comes from married women in contrast to unmarried women. What is the measure of the breakdown in respect of the married women? During the last valuation period the sickness and disablement benefit paid to women was nearly £4,000,000 in excess of the actuarial provision; that is, after every allowance has been made for a reasonable increase to be normally expected, it was found that the claims for women during the period was £4,000,000 in excess of the expectation. I ask the House to notice this feature particularly. The excess was greatest at the end of the period —the last year of the valuation. The report by the Government Actuary shows that during the years 1928-30, after the valuation, the average expenditure on sickness and disablement benefits of women exclusive of the State grant, exceeded the provision made for it by no less than £850,000 a year.

So that we have in the unexpected increase in the claims on behalf of women, a serious feature, and we must notice a most serious element in that great feature which is still increasing at the present time. This increase over expectation has got worse and worse. I would mention only one fact which, I think, will carry immediate conviction to the House as to how much the burden comes from married women's claims in contrast with unmarried women's claims. The average yearly loss per head on married women is 3½ times greater than it is with respect to unmarried women. So now we have traced down the increase in claims to its true origin.

I turn to the question of remedy. How can we put this right when the burden is in excess of expectation? Something must be done. Only two things can be done. You must either increase the contributions or you must decrease the benefits. There is no other course which any man can devise to make the two ends meet. Let me consider for a moment the possibility of raising the contributions. In order to make both ends meet by raising the contributions, we should have to increase them for all women from 8½d. to 10d. The result of that would be that we should have to make the woman's contribution to the scheme higher than the man's contribution. At first sight that appears to be a stark impossibility. Let me suggest two other considerations. In the course of the recent past we have had to increase other contributions. We had to increase Unemployment Insurance contributions in October, 1931, by as much as 5d. In the not too remote future the finances of the National Insurance pension scheme will require an increase in contributions for women of 1d. With the increase of contributions for unemployment and pensions there is the strongest possible reason against making further increases in contributions for National Health Insurance; and, when we look round at the general conditions of the nation and at the industrial depression, when we consider the remedies which are appropriate for our national disorders, the House will come to the conclusion that it is frankly impossible to place any fresh burden in the form of increased contributions upon either the employer or the employed.

I now turn to the alternative of a decrease in the benefits. The House is already acquainted from the White Paper with the nature of the decreases which I propose. There are one or two points that deserve special consideration. Discrimination is made between married and unmarried women. It would be unfair to call upon unmarried women to bear the burden incurred owing to the increase of claims by married women. The unmarried women in the scheme are to married women as four to one. There is, too, a difference between the economic position of the married woman and that of the unmarried woman. The married woman is in a position of greater security. She has no strong deterrent to going out of work for a time and on to the fund for she is a partner in a firm, the other member of which is, generally speaking, in a position to earn a living for the family if she is for a time out of work. Such a consideration as that makes it not only essential but just to make a distinction as between married and unmarried women. Even after reductions in benefits, they will still be above the pre-war level. They will still be substantial benefits.

As a result of this adjustment, we shall return to what I think is a due proportion between sickness benefit and disablement benefit, which is the benefit which follows after the first period of sickness is over. It is always looked upon as a good rule that disablement benefit should be half sickness benefit, and we are now re-establishing that just proportion. Undoubtedly, the benefits are not as great as they have been or as we should like them to be, but what is the intention of National Health Insurance? After all, it is only to provide an assured minimum; it makes no pretence of being able to provide maintenance. It is only an assured minimum which is supplemented in many cases by voluntary insurance from a friendly society or a trade union. It is of the greatest importance to restore the stability of our national scheme and to bring it into due relation with the voluntary schemes which are still being provided. By the adjustments which I propose not a single penny is taken from the fund. All the money that was there before is still there; it is simply a matter of adjustment to make sure that the money goes round and that the scheme does not break down.

There is another menace to the scheme on the other side of the account; that menace is wrapped up with the question of arrears. The cause of the difficulty is the system established in 1928. I can summarise it by saying that the system established in that year turns out to be too big a burden for the finances of the scheme to bear. The system was that all arrears of contribution because of unemployment were totally excused. The burden that was thrown upon the funds of the societies in the then state of unemployment was about £700,000 a year. Of that, £500,000 was met out of the central fund by an adjustment of the unclaimed stamps account. Only £200,000 was thrown upon the finances of the approved societies. But now see the disastrous change. With unemployment in its present condition of severity, the burden which this method of excusing all arrears throws upon the finances of the fund is no less than £2,500,000 a year. Of that, £2,000,000 has to be borne by the societies, and the funds available from the unclaimed stamps account are failing. That burden of £2,000,000 upon the funds of the societies is too heavy to be borne, and the societies cannot continue it without being driven down into deficiencies and practically into insolvency. It is urgently necessary that an intervention should be made in order to relieve them from this burden, which has proved intolerable.

I come to the proposals to deal with this grave emergency. The proposal is that arrears due to unemployment shall be excused to the extent of one-half, the remaining one-half, less an allowance of two contributions, to be met by the insured person if he wishes to cover himself for full benefits. This proposal will result in a scheme of arrears very much as before 1928. Arrears are to be excused in any case during the weeks of notified incapacity. I take powers, if there is any improvement in the unemployment position, to give more generous treatment by the excusal of more than one half of the arrears due to unemployment. In approaching this question, I have tried to do what is necessary to make things safe, but not to do anything more than is necessary in the hope of things improving, and to take power to put things back into a better state of affairs than they were before if and when the general finances of the scheme enable me to do so. The result of the scheme with regard to arrears is that it will reduce the burden on societies by one half, that is by £1,000,000 a year; £1,000,000 a year will still be borne by the societies, and the other £1,000,00 will fall upon the contributors. This scheme has been submitted to my consultative council, and they agree that it is the legitimate and right way of dealing with the matter.

There is a further protection which I propose to give to the finances of the approved societies. It is not right that, owing to this burden of arrears due to unemployment, the finances of any society should be driven into a deficiency. I therefore propose that, if any society finds itself in danger of a deficiency owing to the burden due to arrears, it shall receive a grant of the balance necessary to avoid a deficiency from the resources of the fund, and it shall receive that grant in priority to any claim upon its reserves. The consequence of that will be to spread the burden of avoiding deficiencies due to arrears over the central finances of the scheme. These two proposals in respect of benefits and contributions do not wholly satisfy the actuarial demands. I have not gone so far as the most rigid standard of actuarial requirements goes, but I am entitled, as hon. Members will see by reference to the report of the Government Actuary, to count on an improvement in respect of claims owing to that improvement in administration which was inaugurated by the right hon. Gentleman the Member for Wakefield. I am told that it is not unreasonable to count on an improvement of 10 per cent. in respect of claims owing to the improvement in administration.

4.30 p.m.

If that be so, we shall by these two Measures, as far as it is reasonable to foresee, assure the financial solvency of the finances of our health insurance schemes. I do not mean to say that there is not an element of uncertainty. I have not gone so far as to make absolutely certain, but I have felt it right in the present condition of the nation's finances to stretch a point and to take a risk, so long as it is not an unreasonable risk, while avoiding going further at the moment than is necessary for the recovery of the general prosperity of the nation. I turn from the question of the finances of the health insurance scheme to another and equally critical, and perhaps even more difficult, aspect of health insurance, and that is the prolongation in insurance of the unemployed who, because of the failure of their contributions, would otherwise go out of insurance altogether, losing all their insurance rights, their rights to sickness benefit, medical benefit, and lastly, and worst, losing their rights to the widows' and old age pensions at 65. I approach that matter on the basis of what I have already described to the House. If the House will adopt the measures outlined they will have restored the solvency and the stability of National Health Insurance, and that will give us an opportunity of dealing with this question of prolongation in a manner which will make possible every allowance to avoid hardship to the unemployed who otherwise would be out of insurance.

What is the state of affairs? At the end of this year we shall be confronted with a crisis. Unless we do something some 80,000 men and women will pass completely out of insurance owing to unemployment. They will be losing all their insurance rights, including, as I have said before, the right most appreciated and valued of all, the right to widows' and old age pensions. How are we to deal with those 80,000 persons, and the other persons in future years, who will thus go out of insurance? I suggest that we should deal with the problem with two objects in mind. First, we must not do anything which will have the effect of inflicting any mortal injury upon the contributory principle. We have seen the effect of that upon unemployment insurance. We know the infinity of difficulties we got into owing to not firmly gripping the essential principle of contributions in unemployment insurance, and I am sure the House will support the Government in their determination that health insurance is not to go down the slippery slope into the disaster which has attended unemployment insurance. I think we should also approach it from this point of view, that the loss of insurance rights, and particularly pension rights, is a bitter hardship to the unemployed, and if, without sacrifice of the contributory principle and without sacrifice of the essential solvency of our scheme, we can manage to maintain at least some of those rights for those who are losing them on account of unemployment, and for no other reason, we ought to do so. I shall approach the matter in that spirit.

We ought to take advantage of the stability which we shall gain from the passage of the first provisions in this Bill frankly to temporise as regards those of the unemployed who otherwise would lose their rights through no fault of their own. We ought to give them the benefit of the doubt, and see whether we cannot establish a period during which it will be possible to retain them in insurance, at least as regards some of their rights, in order, in a word, to give the national situation the opportunity of redeeming itself. I do not think it is essential to allow the rights harshly to be cut off at the end of the year, and, since it is not essential for the solvency of the scheme, we ought to allow them to continue, in so far as financial considerations will allow, in order to see whether things do not pull round, to see whether, in the course of time, the improvement in employment will not allow many of them to get back into work and so save their rights.

How far is it possible to go in that respect? I propose to go just so far as is possible while providing for the maintenance of solvency and of the contributory principle. The House will realise that substantial concessions have been given to the unemployed under the existing law. Everybody whose contributions ceased owing to unemployment and who would otherwise go out of insurance gets these concessions: First of all, he gets an average period of 21 months' free insurance at full rates, and in addition to that he gets, after his 21 months, a free year of insurance for all purposes but at half rates as regards pecuniary benefits. So already he has 21 months plus one year, that is a 33 months' bonus period, as it were. The House will realise that it is a real bonus. I will not detain the House with arguments on the subject, because they are too technical, but under our flat-rate insurance scheme there is no surrender value to anyone going out of insurance. He gets the full value of his contributions as long as he is in insurance, but when he goes out of insurance he has got no value left such as one has in an insurance made by personal contract. Therefore, the whole of the period of 21 months and one year's free insurance is bonus.

On looking at what can be done to keep the unemployed in insurance, consistent with the solvency of the scheme, I find that it is possible to make further concessions, which are these: Nobody at the end of this year, because of mere unemployment, shall go out of insurance; then the cash benefits shall cease, because they cannot be maintained and yet make the scheme financially sound; but after the end of this year—that is, for the following year, 1933—we will give him another free year of medical benefits. The House will know that from the point of view of social welfare the medical benefits are the more important, because they are necessary to maintain the health and, in that way, the employability of the man. The House will ask now, How is this to be financed with the finances of the scheme in the condition which has been described? It can be done by a very slight stretching of what I would call the capital account of the scheme. The cost can be met by the adjustment of the transfer values which will be debited to societies when members cease to be insured for health insurance benefits. That means that for one occasion, and for one occasion only—because I cannot repeat it in future years—I can, by a slight adjustment of the transfer value, get the £50,000 I want to give that additional year of medical benefit.


Does this proposal entitle insured people to the additional benefits? There is a special Clause in regard to additional benefits.


I must verify the facts. The point I wish to emphasise is that that is a slight stretching of the capital account, which I cannot repeat in future years. At the end of the medical benefit year 1933 I still do something to preserve the most valued of all rights, the widows' and old age pensions rights. I. am establishing a period of prolongation to give things an opportunity of pulling round, in the hope that they will so much recover that those still subjected to these misfortunes will get an opportunity of further employment. I propose to give another year, 1934, of continued pension rights, and after that another year of continued pension rights, to the end of 1935. So there will be two years of additional pensions lights at the end of the additional year of medical benefit. The House will ask why I end at 1935. The reason is that there is then due, under the Statutes, a general actuarial review of all the conditions and circumstances of National Health Insurance. That will give whoever is in charge at the time an opportunity of reviewing the situation and seeing what it is as regards prolongation. The point is that that period is sufficient to allow for recovery, and I can do it without any infringement of the new-found stability which will be gained from the first part of the scheme.

What will be the general effect of all this? The effect as regards prolongation is that under the National Health Insurance scheme the unemployed man and woman will have got at least 5½ years' free insurance without contribution, and for pensions' insurance the average unemployed man or woman will have 10 years' insurance for only 2½ years' contributions. I do not think the House will come to any other conclusion than that this is a generous method of dealing with prolongation. If the House will accept from me the assurance that it is compatible with the solvency of the scheme, subject to the adoption of the remedies proposed in the first part of the Bill, I think the House will have no hesitation in coming to the conclusion that we succeed in reconciling the two essentials: solvency and protecting the unemployed who are suffering, through no fault of their own, undue deprivations and undue hardships.

The House will next ask, What will be the state of affairs at the end of this period of prolongation, this waiting period? At the end we shall revert to the existing law, with certain exceptions which I will now specify. There will be no further special years of prolongation of the sort I propose for the transitional period. We shall go back to the present system, the system of an average of 21 months' free insurance for all persons after their contributions cease, and on the top of that one year of free insurance; and the only proposal I have to make is that it will be possible, in view of our present foundations for the finances of the scheme, to continue anew, as part of the permanent concessions made to the unemployed at the end of the one year of free insurance, one further year of the prolongation of the pensions rights as part of the permanent scheme. The House will see that throughout I have laid particular stress upon this preservation to the unemployed of their pension rights, because I am confident that it is that right which is most valued, and the loss of which, owing to unemployment, is looked upon as the most bitter form of hardship.

There is one other form of concession which, I think, it is appropriate to make to alleviate the evils of unemployment. Beyond what I propose to do it is impossible, whilst maintaining the contributory basis of the scheme, to continue in insurance one who does not make his contributions owing to the loss of his employment; but there is something else which can be done, and that is to make it easier for him to get back into insurance. If he has been, so to speak, a good fellow, and made his contributions while he is in employment, and he suffers from the great evil of unemployment, and in spite of every concession we have made has finally gone out of insurance, he is entitled to every consideration in order to get back. What I propose is to see again what I can skim off the scheme in the way of financial accommodation in order to make it easier for the unemployed man to get back. This is the hard detailed expression of the principle which I have put in more general words. Now he cannot get back his pension rights until he has 104 fresh contributions, and that means two years. I propose to reduce that period to 26 weeks, and I think I can do that within the finances of the scheme. I think that will be a big concession of much importance.

I propose not only to make it easier for that man to get back in respect of his pension rights, but I propose to make it easier for him to get back his qualification for Health Insurance. Take the case of the man who has lost his rights owing to prolonged unemployment. Under my proposal, he will, up to the end of 1936, if he becomes employed, retain his rights to full rates of benefit after 26 weeks' employment and the payment of 26 contributions. That is a very great advantage to him compared with the present state of affairs, which is that with the ordinary re-entrant into Health Insurance he can only get sickness benefit at reduced rates after the payment of 26 contributions. Then he would have to wait for maternity benefit until he had made 42 contributions, and he would not get disablement benefit until after 104 weeks and until he had made 104 contributions. I think the concession which I propose is a fair thing to do, and if it can be done within the finances of the scheme I think it ought to be done.

There are one or two other minor concessions which I want to recommend to the House that are embodied in this Bill. They can be made without casting an undue financial burden on the scheme, and they will meet cases of special hardship. I think we ought to take this opportunity to take advantage of remedying what experience has shown are individual cases of special hardship. One of these cases is when a man is sick at the end of his period of insurance, where he only gets an extension of four weeks. I think if we can stretch that period a bit we ought to do so in order to give the sick man a chance of getting back into insurance. If they are sick at the time of going out of insurance, I propose to extend their insurance to the end of the half-year.

Take next the case of a man who happens to be just getting back to work and coming into insurance. In the first place, I make the following proposal in the Bill. In order to re-qualify for a fresh free period of insurance, I propose to wind up the old system under which only one or two contributions were necessary to re-qualify, because I do not think that that was practical. I now propose that eight weeks in two successive half-years will be required to get fresh free periods. I think a proposal of that kind is necessary for the success of the scheme. In the next place suppose that a man gets into work at the end of the time that he would otherwise be out of insurance. I propose an extension of insurance to the end of the half-year which will give him an opportunity to have the new contributions so as to re-qualify him for his insurance. I think that proposal will do much to meet an individual grievance.

I propose one alteration which, although it may meet a minor point, is of some importance. Hon. Members know that if a man arrives at the age of 60, after that, if he is out of work, he is still in insurance for pension rights up to the age of 65, and he continues in insurance up to 65 in order to secure the old age pension. A man over 60 has not much chance of getting a job, and without the present system he would lose his pension rights. I find that the finance of the scheme under this Bill will allow me to make the age 58¼ instead of 60, so that anybody who arrives at 58¼ becoming unemployed will continue in insurance until he has reached 65 if he remains unemployed. That completes the account which I desire to give of the main principles of this Bill, and the justification for these proposals.

There is one other circumstance which is extremely relevant to this Bill. Our National Health Insurance scheme is administered by the approved societies, and they are not only responsible, in the first place, for its administration, but they feel the full effects of any weakening of its financial stability. They are really in the front line trenches, and I feel that any action which I propose to take, if it is taken without the sympathy and agreement of the great approved societies, is likely to be taken in vain. Let me tell the House that I have been approached by a deputation representing those societies and they have pressed me to take some such action as that which I have proposed in this Bill. I do not think I am going too far when I say that, perhaps with the exception of some minor adjustment, the provisions of this Bill have the support and approval of the approved societies.


I understand that there are three main sections dealt with under this Bill. Of course, I am aware that there may be one or two dissentients, but I want to know if all these three types of societies have agreed to this legislation.


I appreciate the hon. Member's question, and I am pleased to say that the scheme proposed in the Bill has the approval of all the three types of societies. It could not be otherwise, for, unless we take such action as we now propose, those societies would be threatened with a financial position of the utmost gravity, and nobody responsible for the administration of those societies could consent to continue the existing situation unless the Government were prepared to act by such action as we have proposed in this Bill. I notice that a Motion for the rejection of this Measure has been put down by hon. Members opposite, and I shall be interested to hear by what arguments they are going to support that Motion. I do not think hon. Members opposite can deny the gravity of the position which I have placed before the House. I am sure that they cannot question that there is a situation existing with which it is urgently necessary to deal, and no solution of this problem on general lines other than that which I have placed before the House is possible. I believe that what I have suggested is the only method by which it is possible to reconcile the two things which I have described, the solvency of the scheme and its protection from disaster.

The maintenance of the contributory principle permits the Bill to follow along the path which we all have conspicuously before our eyes. On the other hand, I believe in my heart that the new stability which will be given to insurance by this Measure will be of the utmost use in mitigating the hardships which affect the unemployed. I started my remarks by saying that I have not a pleasant task before me. No task is pleasant which is confronted with difficulties like those with which the nation is faced to-day. The proposals I have made are in accord with the genius of our race. We should not wait for things to go from bad to worse before we put out a hand to stop the downward course. I feel sure that the House will be prepared to take the necessary measures, but I hope that I shall not be blamed for making every allowance for the hope which we all have that things will not always be as bad as they are, and that we can legitimately make allowance for the hope that things will be better and that they will be completely restored in the future.


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."

5.0 p.m.

In moving this Amendment, which is supported by several of my hon. Friends on this side, my first obvious duty is to congratulate the right hon. Gentleman on his very lucid statement on a very technical subject. I agree entirely with him that this is a Bill to secure the financial stability of the National Health Insurance scheme, but I am afraid I shall be compelled to be a little critical of one or two of his observations on that issue. Indeed, it would be a very strange Bill if it found agreement in every quarter of the House, and, therefore, I am sure that the right hon. Gentleman will not be offended if I direct two or three criticisms against his Bill on points which do not find favour on this side of the House.

The right hon. Gentleman said that we have now reached the point when the schemes is living on its past, and he pointed out that there was a serious reduction in the surplus on the third valuation as compared with that shown on the second, the surplus being, in fact, reduced by one-half. I would ask the House to bear that very important statement in mind. I agree with the right hon. Gentleman that we must secure the solvency of this scheme. He also remarked that under this Bill the Government are not taking a penny piece from the funds of the societies. I wish that he could have said that in 1926. I am under the impression that he was a party to taking money from those funds in 1926. But before I dwell on that burning question within the approved society world, I want to make one point clear, because it is very important that we should understand where we are on this issue. I am sure I am right in saying that there is no section of the community that is not anxious to see this scheme continue to be based on insurance and actuarial principles. In fact, its success for the future depends, in my view, entirely on that fundamental basis, and any criticism that we may offer on this Measure will, therefore, fall within the confines of those principles. This is the only national social fund left to us in this country that is now based on insurance principles, and I want very much to see those principles maintained. I do not think that anyone in the House, and least of all anyone connected with the administration of National Health Insurance, will ever want at any time any means or income test to be applied to the recipients of health insurance benefits.

I should like to offer one or two observations on the history of the National Health Insurance, because I think we ought, as the preachers do, to take a historical sketch before we criticise the details of the Bill. I see that the Parliamentary Secretary is rather glad that I should say something about the preacher and the historical sketch, because it will show him that I know what I am talking about. It is important to remember, in connection with the history of this scheme, that, if the original contract entered into by the State, the employers and the insured population had been carried out up to date, we should not be faced with this problem of finance at all to-day. The scheme, however, has been saddled from time to time with obligations that its founders never intended it to carry, and I make bold to say that no private insurance company would ever have allowed liabilities to be placed upon its funds in the way in which Conservative Governments have placed obligations upon these funds. I am proud to stand here and say that no Labour Government at any time has thrust added responsibilities upon this fund, or reduced any of the contributions of the State to it.

The whole trouble about the financial stability of this scheme came, and it received its first blow, when the Chancellor of the Exchequer in a Conservative regime—the right hon. Gentleman the Member for Epping (Mr. Churchill)—reduced the State grant to the National Health Insurance Fund by £2,750,000 per annum. Ever since that time, the financial foundations of the scheme have been somewhat shaky. Not only did the right hon. Gentleman do that, but he added to the liabilities of the fund in respect of medical benefit costs by nearly £2,000,000 per annum; and up to date the funds of these societies have suffered, as a result of the reduction in State subsidy, of new obligations, and of loss of interest that would otherwise have accrued, to the extent of very nearly £30,000,000. The Minister of Health has pointed out to-day that the surplus on the third valuation was only £12,500,000 as compared with £25,000,000 on the second valuation. I am sure I am right in saying that, if the original contracts had been carried out by the State, and the usual subsidy to these funds had been continued, the surplus on the third valuation would have been equal to that on the second. The surplus on the third valuation was very largely destroyed by the reduction of the State subsidy.

Of course, in addition to all that, unemployment has taken its toll on the funds. The average number of contributions has declined with the economic depression that has fallen upon the insured population. As a direct result of that economic depression, the scheme has been saddled with certain liabilities that it was never intended to carry; and I do not like at any time to see responsibilities thrown by the State upon this or any other in- surance scheme that ought to be borne by other services of the State. It is a remarkable tribute, therefore, to the soundness of the scheme that it has been able to withstand all these liabilities and reductions of subsidy. In spite of all that has been said about the scheme, it is still, as it now stands, the safest and soundest social insurance scheme in the world. We cannot get ninepence for fourpence out of it now; it is about sixpence for a "tanner" at the present time. Nevertheless, the scheme has been very useful to a large number of persons in this country who have suffered prolonged sickness.

Were it not for the fact that the Ministry induced most of the approved societies to separate, for valuation purposes, the funds of the men from those of the women, I am positive that those societies would never have had reason to complain of the heavy claims of married women; they would not have been brought to light to the same extent. [Interruption.] Perhaps I should say rather that the problem would never have arisen in this acute form. If we are to extend this process, as I imagine it is intended to do, and not only to separate the men from the women for valuation purposes, but to separate married women from single women, we shall in the end reach the stage when each of the 17,000,000 insured persons will have a separate ledger account. As an administrator, I am rather inclined to the view that this scheme ought to be carried on in its original form, that is to say, that the liability ought to be shared out over all the membership, men and women alike, and that, if a tightening up of administration is required in respect of any section of the membership, some of the financial reforms which the right hon. Gentleman is suggesting to-day ought to be carried out, within the principles of insurance, but by administrative action.

I am quite sincere in my opinion that the Ministry of Health could, on the financial points of this Bill, have found a way of doing all that they desire in respect of the married women without reducing their benefits. The right hon. Gentleman said that only two courses are open to us—either to increase the contributions or reduce the benefits. I do not think he need accept either of those two alternatives. I cannot believe that married women in 1930, 1931 and 1932 suffered more from ill-health than they did in 1920 and 1921, when their experience on sickness benefit was very much less. I cannot conceive, after 20 years of panel medical service in this country, with such a large number of medical men giving attention to the boys and girls who were growing up—so far as I know, the most universal medical attention in any country in the world— that the really genuine claims of women have increased to such a great extent between 1920 and 1930.

I am satisfied that a large proportion of the increase in the sickness claims of married women comes from the loose certification of the panel practitioners. The number of medical men in this country is, I believe, growing in proportion to the number of the population; that is to say, there were so many doctors in this country per 10,000 of the population, and the proportion has increased each year. They must all have a livelihood; I do not dispute that; but I am sure that the medical practitioner to-day is not adopting the same attitude towards panel practice as he used to adopt when he was employed by the old friendly societies. Further, if the panel doctor of 1932 did his work as conscientiously as he did for the friendly societies 20 years ago, we should not be faced with this problem of reducing the benefits of married women to-day. The Ministry of Health has been so dissatisfied with some panel practitioners that it has set up what is called a regional medical service, which actually takes an oversight of the work of the panel practitioner, and approved societies that are dissatisfied with the certification of the ordinary panel practitioner send thousands of cases annually for second medical opinion. Were it not for the work of the regional medical officer, the percentage of this increase would not be 100 but I should imagine it might easily reach 200 on the experience of some approved societies.

The Ministry of Health has done a great deal already in dealing with this problem. They know as well as the administrators of approved societies that the situation regarding certification is still very unsatisfactory. What should be done? In my view, the medical practitioners who are dealing with National Health Insurance ought to be employed by the State. I see no way out of securing a proper certification unless you get a State medical service. The right hon. Gentleman may say that is a very Socialistic proposal, but I am sure that some day a Minister, of whatever political colour the Government may be, will be faced with the problem of appointing State medical officers to deal with this problem of certification, because when the right hon. Gentleman has done all that he is proposing to do in this Bill to-day, unless the question of certification is dealt with properly we shall still be in the same financial position later on.


Is the hon. Gentleman suggesting that the medical profession are passing people for benefit who are not suffering from illness?


The real fact is that the average panel doctor is doing his work well, but there are certain cases of practitioners who are known to be granting medical certificates when they ought not to be granting them.


What is the motive?


May I suggest to the hon. Gentleman that, if you did away with the opportunity that is allowed to patients to transfer from one practitioner to another, you would prevent the granting of these easy certificates. I could give instances where one doctor is canvassing patients and endeavouring to induce them to get them away from a rival round the corner by promising to grant certificates.


The hon. Member has answered my hon. Friend the Member for Shettleston (Mr. McGovern). That is exactly what we say. The Ministry of Health has all this information in its hands. This problem of the medical profession is not a new one. Those who administer the scheme know, too, of the extravagant claims of some dentists, opticians and surgical instrument makers. All these claims are happily scrutinised very carefully at the central offices of the approved societies. To come back to the question of the married women, we are not satisfied that the benefits should be reduced at all. The right hon. Gentleman said that, because contributions were declining, consequent upon unemployment, and claims for sickness were heavy, you must reduce the benefits. The actuary's statement in the report on the third valuation, not in regard to women but to men, says: Friendly societies without branches contain 10 cases of men insured alone, in which there is an aggregate deficiency of £288,673. There is no proposal in this Bill to reduce the statutory benefit for men. The complaint I make is that there are some segregated approved societies covering certain sections of the workpeople in quite as serious a financial position as women's societies. I would not be a bit surprised if financially the drain upon the funds of some men's societies is as heavy as the drain of the married women upon theirs, and it is unfair to draw a distinction between these persons because the woman is a married woman. If you segregate a section of men who are unemployed for a long period, and their claims are heavy, you may find the same condition appertaining to the men alone as to the married women when segregated. Those who administer approved societies have never been satisfied that all the married women who are in membership are insurable propositions. A great deal of this problem would be avoided if membership of approved societies in respect of married women was confined to women in regular employment. I think a number of women have slipped into insurance because they are casual workers, and they are very difficult to supervise, even for membership purposes, let alone scrutinising their claims for sickness benefit.

There is another aspect of the problem too. When a woman gets married, I think she ought to be transferred to a class of her own, and be dealt with in that class throughout marriage. When you have done those two things, it seems to me that you should avoid a reduction in benefit because you avoid these very grave liabilities that come from the two categories that I 'have mentioned. There are societies of women membership only, and they are, of course, feeling very severely the effects of these claims. But the economic depression has more to do with the problem than anything else I have mentioned. When there is very little money to buy food, the married woman is probably the first to suffer in the home. She is willing to make a sacrifice for the sake of her children, and when she is sick she naturally very easily secures a certificate and claims benefit. But I have yet to learn that the Ministry of Health has ever been able to determine one issue for us. A woman gets married and declares that she is going back to work and, consequently, remains in insurance on her own statement that she is eligible for employment. I do not know what this Bill intends to do in those cases, but it seems to me that the right hon. Gentleman ought to bear in mind that a better definition of the declaration as to whether a woman on marriage is going back to work or not is essential. We have never had a proper definition yet. We on this side are afraid that, once we begin to emphasise the difference between the several sections of the insured population, we shall arrive at the stage when we might as well keep a separate ledger account for each person. But, if that were the case, it would no longer be a social insurance scheme. It would be a contributory scheme; you would merely get back all that you paid in minus administrative expenses. I wonder, however, whether, when the right hon. Gentleman was considering these proposals, he ever turned to the recommendations of the May Committee on the subject. That Committee was condemned in several of its recommendations, but I am not so sure that it was not very much more generous to the insured population in its recommendations on this subject than the right hon. Gentleman is to-day. Perhaps he will look up the recommendations of the Committee in that respect.

The right hon. Gentleman has included a provision in the Bill to safeguard the title of persons who have suffered from a long period of unemployment to the pension at 65. I do not know, after all, that it will carry them all to the point that they will secure their pension. The State has saved a great deal of money by the institution of contributory pensions. We shall soon reach the stage, I should imagine, that very few people will be entitled to claim the original Old Age Pension at 70 years of age. Most of the industrial population will obtain the con- tributory pension at 66. As the number of Old Age Pensions under the original scheme at 70 is declining, the amount paid under the contributory scheme from 65 upwards is increasing, and consequently the State has already gained financially on the transaction. There is, therefore, very much greater reason why the State should say that all persons who are unemployed for a long period should be guaranteed entirely for their contributory pension at 65 whether they are employed or not. It seems to me that it is only a human duty on behalf of the State to carry out that principle.

To sum up our attitude on this side, we stand unhesitatingly for the continuance of the application to this scheme of actuarial and insurance premiums. We are satisfied, however, that, were it not for the reduction of the State grant by the Act of 1926, we should not be subjected to the difficulties that we are now faced with.


indicated dissent.

5.30 p.m.


I shall be very glad if the right hon. Gentleman's deputy will tell the House if it is not a fact that that Act has caused a saving to the Government, up to date, of not less than £25,000,000, including interest accruing. The right hon. Gentleman does not shake his head now, and I am sure I am right. We are of the opinion that there are certain cases which ought to be left out of the scheme as uninsurable, and that if they were eliminated from the scheme it would be possible to maintain the same rate of benefits for married and for single women. The distinction which the right hon. Gentleman has drawn between the single woman and the married woman is very unfortunate in respect of the decrease in benefit.

I am sorry that hon. Gentlemen on my left seem to think that I am a little too critical of the medical profession, but I have said it more than once in this House and I repeat it, that better and more accurate medical certification in connection with the scheme would go a long way to obviate the reduction of benefits. I am absolutely satisfied of that fact, and I should be surprised if any approved society in the land disagreed with such a statement.


I want to know—and I want his evidence for it—whether the hon. Member is suggesting that people who are contributors to the insurance scheme, and the doctors are co-operating in a fraud upon the State. That is a very serious statement to make, and it ought to be backed up by facts.


I have never used the word "fraud" at all. If hon. Gentlemen want proof they can get it from any insurance committee in the land, and if they want figures I am prepared to get a return showing how many medical practitioners are brought before insurance committees for giving certificates which are not in fact genuine.


It is only human nature.


Here it is said that we have married women who are engaged in a fraudulent practice. That is the first part of the statement. The second part is that medical men, men of one of our learned professions, are out to defraud the State. Taking those two examples we have to go on the assumption that the whole community is a fraud. Unless the evidence is overpowering we are not inclined to believe that the mothers and the doctors of the nation are engaged in a fraudulent conspiracy.


I have never charged any of them with fraudulent conspiracy, and the hon. Gentleman is not entitled to put those words into my mouth. What I said—and I repeat it—is that some medical practitioners have issued certificates when they ought not to have been issued, and everybody connected with National Health Insurance, and everybody at the Ministry of Health, knows it to be true. Finally, we are very anxious about the suggestion which I have made this afternoon that the scheme should still be carried on by better administration, better 'medical certification, and by the elimination of what I term uninsurable classes from the scheme. I think that by adopting the suggestions which I have made it will still be possible—because the amount is not very great compared with the whole —to save the married women and the single women from any reduction in benefit.


I should like to offer my congratulations to the Minister upon the very clear and lucid manner in which he has explained a somewhat intricate Bill. Those of us who have taken the trouble during the last two or three days to try and find out exactly the implications of many of the provisions of the Bill realise that, after all, the Bill is not such a complicated Measure and appreciate its proposals. Having heard the proposals, I think that those of us who have been associated with National Health Insurance administration for a large number of years will agree that the Bill is on the whole a fair and complete attempt to deal with certain difficulties which have arisen in the administration.

I propose mainly to confine myself to the portion of the Bill which deals with a reduction in the benefits to married women. It is really the portion of the Bill which is of greatest interest to all who are associated with approved societies. For some time we have been apprehensive as to the situation. We realised that the various demands upon the funds of approved societies were such that at no distant date we should be facing almost the bankruptcy of the scheme, and when the third valuation was published we saw that our fears were well founded. Most of us agree with the importance of maintaining the scheme on an insurance basis, and I am glad to hear from the hon. Member for Westhoughton (Mr. R. Davies) that he and those who are associated with him adopt the same view. Presumably, if that means anything, it is that the State should not be called upon to find anything further in the way of funds in order to relieve the scheme from any of its existing liabilities.

Notice taken that 40 Members were not present; House counted, and 40 Members being present


During the past year the various publications devoted to the interests of approved societies have devoted a considerable amount of space to the serious situation which has been created owing to the large sickness incidence of married women members. We have heard a statement from the Minister as to the position as a whole and as to the large amount involved. I was interested to notice in one of the insurance gazettes two or three weks ago a report dealing with one of the smaller approved societies with three classes of members— men, single women and widows, and married women. Perhaps from a small case of this kind it is very much easier for us to visualise what is taking place. In this particular approved society there were 31,200 men, and the sickness benefit paid in respect of them during the previous year amounted to £18,858, which was equivalent to 12s. 1d. in respect of each member. In the case of single women and widows the number in the society was 15,200, and the benefits paid in respect of those members amounted to £10,142, or at the rate of 13s. 4d. per member. There were 7,100 married women, and the sickness and disability benefit amounted to £10,000, very nearly as much as the amount paid in respect of double the number of single women and widows, or an average of £l 8s. 2d. for each married woman member.

Incidents of that kind—I am certain that similar instances could be multiplied —show that there is a problem to be faced and that unless it is faced it will gradually lead to the insolvency of the whole scheme. Even societies which administer women's benefit only have realised this fact. If my hon. and learned Friend the Member for Argyllshire (Mr. Macquisten) had been present at the moment I should have liked him to listen to what has been said by the secretary of a large Scottish women's friendly society which has had to face this position. That society recommended, in the first instance, a reduction of benefits.

I should like to impress upon the Government—the point has been mentioned by the hon. Member for West-houghton—that you have to deal with married women in a very different way from that in which you deal with other persons who are in the insurance scheme. The recommendation of the society was that all women on marriage should be placed in a separate class with the right to certain benefits, or alternatively that a woman on marriage should go out of insurance and that a certain sum of money should be paid to her. I believe that the same sort of situation arose in the Irish Free State. Similar difficulties were found there with regard to married women who were in insurance and the Irish Free State Legislature decided that on marriage the women in insurance should be paid a certain sum and that all her claims upon the insurance fund should cease. There may be difficulties in that connection, but at any rate it is one way—perhaps the easiest way—of solving a very difficult problem. Afterwards, if a married woman bona fide resumed employment, she was entitled to be treated as a re-entrant into insurance. The third recommendation made by the Scottish Women's Friendly Society is very much on the same lines as that suggested by my right hon. Friend, namely, that employed married women working less than 30 hours per week should be treated as exempt from insurance. That is that you should regard a woman who only works for a comparatively limited number of hours per week as entitled to be left out of insurance. In that case certain provisions will have to be made so that the employers should not escape liability for contributing to the Insurance Fund.

Some of those who are associated with the administration of National Health Insurance approved societies feel that the Bill does not go far enough, and that the whole position is not going to be safeguarded by the provisions of the Bill. Therefore, on the Committee stage, it is proposed to put down an Amendment of a somewhat lengthy character. I will not read the Amendment, but the operative part is that it contemplates that all insured women who marry shall automatically be transferred to a special class as from the date of marriage and become entitled to the benefits of that class, whether or not they continue in employment; and that those who cease employment will ultimately pass out of insurance in the same manner as at present; whereas those who continue in employment will requalify for full insurance by shorter waiting periods than at present. That is briefly the essence of the new Clause which it is proposed to put down for consideration on the Committee stage.

I am satisfied, just as the hon. Member for Westhoughton is satisfied, that legislation alone is not going to clear up the grievances of which we have to complain. Very strong, stern administrative action will be required. In this connection per- haps a few sentences which appear in the very valuable report for last year of the Chief Medical Officer of Health of the Ministry of Health might be read, as they put the position very much more clearly than I can do. Sir George Newman says: The experience of 1930 has again emphasised that the health insurance scheme cannot be maintained, still less can it expand, unless it is administered on strictly economic and actuarial lines. If the doctor or the insured person ignore that fact nothing but difficulty will emerge, or if they ask from the scheme more than it can reasonably yield nothing but disappointment will result. For instance, if a doctor furnishes certificates incorrectly or unreasonably extending the period of incapacity, or prescribes excessively, or prescribes something akin to "public assistance" to the patient on request, he may be performing a service of charity or even indirectly of medical aid, but he is rendering a direct disservice to the whole system of health insurance. If, on the other hand, the insured person demands from the system advantages in benefit, privilege or relief quite outside the contractual rights under the Act, or if he asks for aid on economic rather than medical grounds he may indeed be asking for something which is beneficial to his health, but he is making a demand, however reasonable in itself, which makes an insurance system a mere method of financial relief and uses the doctor as a relieving officer instead of a physician. I think that quotation puts the position very succinctly.

I disagree with the attack which has been made upon the panel practitioners by the hon. Member for Westhoughton. For over 20 years I have sat as chairman of the Insurance Committee for my county. My hon. Friend said that there are constant complaints before every committee as to irregular certification. I cannot at the present time remember 1 single case of a complaint by an approved society against a medical man in my county as regards irregular certification. We have had certain complaints. We had to recommend that the services of one medical man on the panel should be dispensed with and the Ministry of Health through the Commissioners held an inquiry, which upheld our recommendation. On the whole, however, I believe that the great mass of the medical practitioners on the panel endeavour to administer the Act in the most straightforward manner in the interests of their patients.


That is exactly what I said, but I pointed out that if 2 per cent. did not do the right thing, it was damaging to the funds of the societies.


I cannot agree that that was the line that my hon. Friend took. He made a bitter attack upon the medical profession. So bitter was his attack that certain of his friends opposite resented it. They could not believe that the medical profession could be described in the way that it was described. An hon. Member behind me intervened and said that he knew of cases where medical men in order to increase their practice had certified cases of sickness where they were not justified in doing so, and had gone round to induce patients to go to them. I am satisfied that if complaints of that kind were reported to the British Medical Council, immediate action would be taken. I think I am right in saying that in one or two cases action has been taken and the offending doctor has been removed from the Register and from the list of panel practitioners. But I do not wish it to be understood that the medical profession could not have done more than they have done in connection with certification. It is a very easy thing for a medical man to err on the wrong side. He may think that a patient should have a week or two longer than is absolutely essential. I know that there is a certain number of cases of that character. The difficulty of the medical man is very much greater in the case of women, particularly of married women, than in the case of the ordinary worker.

During the past few months an attempt has been made by insurance committees, with the concurrence of the Ministry of Health, to arrange for conferences of medical men, representatives of insurance committees and representatives of friendly societies, and I am satisfied that those conferences have resulted in a vast amount of good. They have enabled medical men on the one hand, and the representatives of the approved societies on the other, to appreciate the point of view of the medical man or the approved society, as the case may be. About five weeks ago a conference of that character was held in my county. There was a large attendance of medical men and members of approved societies, and the chief medical officer for the Welsh Board of Health attended. The medical men, naturally, listened to him as a member of their profession, and I feel certain that if there has been any ground of complaint in the past so far as my county is concerned, those complaints will be largely removed in the future.

In regard to the question of certification and excessive claims upon societies, I am not satisfied that the societies have done all that they could. I think that the system of sick visiting which is in vogue in a great part of the country is of very little value to the societies. The Minister in his statement referred to the fact that there are 17,000 approved societies in Great Britain.




7,000. What does that mean? It means that in the area of almost every insurance committee you have hundreds of societies. When you go to any industrial town, you find on door after door a different society with its name up. That makes it essential that if the scheme is to be operated in such a way that there is not an undue charge upon the funds, there should be sick visitors. One knows that there is a certain amount of malingering and that the medical man cannot always detect malingering. Anyone who had to do with recruiting for the Army during the War will appreciate the difficulty that the medical men have. They had to take cases from board to board before they could be satisfied whether or not a man was malingering.

It is only by constant vigilance that you can get off the books of the approved societies persons who are malingering. The temptation is greater in regard to the married woman, and the difficulty of finding out if she is a malingerer is greater than in the case of a man. I suggest that the Ministry should endeavour to get the approved societies to do away with the existing method of sick visiting and that instead of the sick visiting taking place in respect of A, B and C society, with an indefinite number of sick visitors in each area, there should be a number of visitors in the first instance appointed by and responsible to the Ministry of Health. I am certain that if a system of that kind were introduced and the sick visitors were regarded as perfectly independent of local approved societies and responsible to the Ministry of Health, we should find very soon a large reduction in the incidence of sickness in various parts of the country.

6.0 p.m.

There is only one other point to which I would refer in regard to the statement of the Minister. We must all feel grateful for the Amendments which he proposes to move in regard to unemployed persons not losing their pension rights. When the Pensions Bill of 1929 was introduced, one was flooded with complaints of cases where persons who had been in insurance up to a certain point and had suffered from unemployment had gone out of insurance, and a very large number were accordingly unable to enjoy the rights which they would otherwise have enjoyed under the Acts of 1925 and 1929. There will be considerable satisfaction throughout the country that the Minister has taken this step to secure that unemployed persons shall have their pension rights ensured for a further period. When the Division takes place, I shall have no hesitation in supporting the Government.


I cannot agree with the hon. Member for Flint (Mr. Llewellyn-Jones) in his observations in regard to approved societies. His solution for the difficulty may be quite right from the medical point of view, but to talk about setting up a State service of sick visitors on the remuneration given to approved societies is absolutely nonsensical. A small saving might be made, but a great deal would have to be paid out by societies, who have not got the money, for such a service. There is one observation I want to make in regard to the continuation of those who are unemployed on the funds of approved societies. It appears that this provision is the result of consultations which have taken place between approved societies and the Government. I was not aware that there had been any such consultations until the Minister of Health made his statement this afternoon. It appears that they are not to be entitled to additional benefits. It is no use hiding facts.


I do not know why there should be this misunderstanding. What I said with regard to the approval of approved societies referred to that part of the Bill which concerns approved societies, and is the part which relates to the benefits of married women. It does not affect the finances of societies at all.


As I understand it, those who have been accepted as members of an approved society are entitled to certain benefits when they have complied with the regulations concerning contributions, and, that being so, this is truly a National Insurance scheme. One would have thought that, with an experience of 19 or 20 years, we should by this time thoroughly understand the position. What do we find to-day? The Minister of Health in a National Government says that this will certainly prove to be an insolvent scheme, and that as far as the allocation of surpluses is concerned, they are getting to the diminishing point. The first valuation showed a big surplus. The second valuation showed a 50 per cent. reduction, and now we are coming to an allocation which is smaller, and which makes the Minister think that it is absolutely necessary to deal with the claims of married women. One would have thought that it would not have taken 20 years for the administrators of the scheme and for those in charge of approved societies to find out the actual position, inasmuch as they already knew the liability on the society of married women. I want to pay a tribute to the Actuarial Department. I am convinced that there could be no better body of men to deal with the affairs of approved societies than the National Health Insurance Actuarial Department. They have all the material and information, which they place at the disposal of the Minister and approved societies.

I suppose that this is one of those problems which Governments must face. One would naturally have thought that in dealing with the case of married women there could be no saving; and it is unlikely that any body of sick visitors will be able to supervise what doctors themselves are not able to deal with. Medical certification has certainly a lot to do, from the point of approved societies, in regard to this matter. A married woman bona fide entitled to go back to work is entitled to benefit. When a woman is married she naturally feels that she should stay at home if the income of the house is sufficient to keep her. But she may have to go to work and when you ask a married woman whether she intends to return to work she knows that if she says "No," she will be put out of insurance. She accordingly, of course, says "Yes, I shall return to work." Those who administer the Act have no power to say that they must get off the funds of the society because they are unemployed. The society is not able to put these people out, and, therefore, they have to bear responsibility. It is a remarkable thing that a married woman about to return to work can go on practically the whole of her life drawing benefit from an approved society when periods of sickness occur. Disablement benefit continues all along the line. Approved societies have not the power to deal with these difficulties, and they have been overburdened.

I do not think that the Ministry have really gone into the causes of this position in regard to approved societies. I admit that the solvency of approved societies is essential for National Health Insurance. In order to give the benefits it must be a solvent body, but the State is a third party to the scheme and owes a duty not only to approved societies but to every approved member. You are going to make a farce of the whole position in the case of a person who fills up a form, joins an approved society in a state of health and, being a worker—because no one but a worker can fill up the form—makes a payment. In this Bill the Government are applying for powers which they have already got. The Act of 1912, which has not yet been repealed, gives the Government exactly the same powers which they are asking from the House to-day. It is already Laid down that a society composed of male and female members can be separately or jointly valued. If it is a joint valuation, the surplus of deficit is defined on the two; if it is a separate valuation, you have a surplus on the men's side and a deficit on the women's. Any society that may have a deficit can take the women's side as being deficient: and the Government have the power either to raise contributions or decrease benefits. If that is so, I want to know why the Government are coming to this House and ask- ing for special provision to be made in regard to married women; why we should be asked to pass something which is more stringent than the original Act? One would have thought that the Government would have asked for a repeal of the Act of 1912 and then introduced a new National Health Insurance scheme. At the moment the Government are dealing with a matter in a patchwork fashion.

In the deficiency account there is one society, which I will not mention, which has a deficiency of £9,803. The National Glassblowers' Society has a deficiency of £7,219, the Weavers' Society a deficiency of £63,332, the West Riding Miners Association a deficiency of £10,190, the Lancashire and Cheshire Miners Society a deficiency of £17,969, the Northumberland and Durham Society a deficiency of £248,459, the Durham Miners' Society a deficiency of £107,967, the Scottish Miners' Society a deficiency of £5,504, and £6,637. These figures indicate that in those areas where there is impoverishment of the people and a great amount of unemployment, there is a great drain on the insurance account. That naturally follows in our great mining areas and industrial centres where poverty is rampant and where there is unemployment and malnutrition; where medical men are required to attend the wives and children of those who are unemployed. Of necessity, in those great areas you have this reflex on your insurance accounts. That was bound to follow. If you have prosperity you have well-fed children, but if you have unemployment you must have malnutrition, anaemic cases and all the other things that follow from poverty.

We have had a scheme that was prosperous, with £25,000,000 for allocation in the fifth year on the first valuation, then £12,500,000, and now a deficiency. Now we are told that economies are necessary. We are told that we must make the scheme solvent upon actuarial calculation. It may be that the means test and other things have no bearing on this matter. If you talk of national schemes designed for the welfare and health of the people it is necessary to pause and consider well before bringing about actuarial solvency, when the present conditions show so much poverty, starvation and misery in the industrial centres of the country. I am just as anxious as the Minister to have a National Health Insurance scheme which is perfectly all right. I have administered the Act from July, 1912, up to the present time, and I say that all Governments have done a great amount of good through the benefits that the Act has given to the people. I know of no scheme of national service that appeals more to all parties or goes more deeply into the life of the nation than this Health Insurance scheme.

We have in power a great National party. I call it great, because it has the power of doing great good or great evil. The Amendment asks the Government to stay their hands for six months. It is a right and proper Amendment. The Government have the facts of the actuarial position in their possession. Why should they not give an opportunity to the scheme to regulate itself by an increase of employment? In dealing with the unemployed and the sick, can the Government find no other solution than to make an attack on the rights of married women by a reduction of benefit? That method will only create greater evils. It may be that some approved societies are anxious, from the point of view of valuation, to have a surplus. The society to which I belong has a surplus, but I would much prefer to see it with no surplus if that would ensure the service for which National Health Insurance was established. When all is said and done the question of national health is superior to the administration of approved societies. The health of the people is of first importance.

If the Government want to make the scheme solvent there is one way, which has not been mentioned so far, in which it can be done. At the age of 14 to 16 boys and girls start work and enter the competitive field. At the age of 16 they become insured. They are then often turned adrift, and their places are taken by younger people of 14 to 15 years of age. In considering the question of solvency, have the Government thought of the other end of the scale? They talk of provision for old age. What attention are they giving to young age? I ask the Government to remember that thousands and hundreds of thousands of children from 14 to 16 are leaving school every year, and because they have to contribute to the insurance fund at 16 they are often discharged from their workshop. The scheme should be made solvent by bringing in the younger people to make good the defects of those who through no fault of their own break down in health. The scheme was never brought into existence for the healthy ones. It was brought into existence to repair those who were unhealthy and to keep in repair those who are healthy.

Lieut.-Colonel FREMANTLE

To prevent them getting unhealthy.


It may be preventive work, but what we are dealing with in this Bill is a proposal that lower benefit should be paid to those who are ill, and those who are not ill are to pay for the benefits of those who are ill. This is a scheme of National Health Insurance. What is the nation doing? Will there be any benefit to the nation by persisting in this Bill and saying that married women must now be ostracised? Is there any supporter of the National Government who dare go to his electorate and say, "We had a mandate to deal with the married women"? I know there is audacity in the National Government. They claim many things, but they will not claim that they have authority from the people to deal with married women in this way. Good times, we are told, are likely to come from Lausanne and the balancing of the Budget. Moreover, the Liberals may leave the Government and make the position better. I suggest that it would be a wise thing to wait a little while. We have been waiting ever since the defeat of the Labour Government and we keep on waiting. There would be no harm in the Government accepting the Amendment and waiting a little longer.


Some of the later speeches this afternoon have wandered rather wide of the subject-matter which we have been asked to discuss. The hon. Member who has just spoken said he had very grave doubts whether any hon. Member could say that he had a mandate to deal with married women. I do not suppose that any hon. Member wants to say that. He would be an unwise person who attempted to say it. But we have this mandate: that every member of the National party had a mandate to come back to this House and endeavour as far as he could to see that the national finances were placed on a sound footing. We are to-day dealing with a very important part of the social services of this country. The Government have financed and kept solvent this scheme. They have a right to say, "We have doubts as to the financial condition of this scheme, and we propose to put before you certain things which we think will place the scheme on a much sounder footing."

The House might well offer its sincere congratulations to the Minister for the Bill and for the excellent and clear way which he has explained it. But let me add that, but for the excellent Memorandum issued and but for the very clear statement of the Minister, I defy the uninitiated to understand what the Bill is about, and even those who are initiated may be left wondering whether they are dreaming or have passed to another world. What is the Bill? What are the Government endeavouring to put right? There are two points which have caused great concern in the minds not only of the Government but of those who have to deal with the question of National Health Insurance. One is the great problem of unemployment as it has affected contributions, and the other is the unfortunate position in which the sickness fund of the women's section, and particularly the married women's section, has been placed. I have here the report by the Government Actuary on the Third Valuation of the Assets and Liabilities of Approved Societies, and this is what he says: Certain features in the present situation must, however, evoke anxiety. The claims for sickness and disablement which, on the whole, have been light between 1915 and 1921, have subsequently risen to a level which, in the case of men (regarding the system as a whole) precludes the expectation of any large amount of further surplus from savings in this direction, and in the case of women results in a loss of such dimensions as to call imperatively for measures of reconstruction. He wound up: The present position is that while full benefits are being paid to the great mass of the insured whose normal occupation is employment, less than 90 per cent. of the contributions required to support these benefits are being collected. I ask the House to take notice of that. Such a position is wholly incompatible with the maintenance of the soundness of an insurance organisation. It may be endured for a time, especially by societies which under more prosperous conditions have accumulated surpluses, but even here a limit must be put to the burden. I heard with great satisfaction the observation of the hon. Member for West-houghton (Mr. Rhys Davies) that the members of his party strongly believed in the principle of insurance. That is 'a conversion—


Hear, hear.

6.30 p.m.


As my hon. Friend the Member for Bridgeton (Mr. Maxton) agrees, that is a conversion from the view which they held in the not very far distant past. I have heard them pressing for prolongations when there was no principle of insurance involved, but only a giving of something beyond what contributions would provide. It is a very good thing to know that they have returned to saner paths of finance in regard to National Health Insurance. The Minister has told us in connection with Clause 1 of the Bill of the unfortunate condition of the employed people. For three years now the insured people who are unemployed have been in a state of grave anxiety, towards the end of each year, as to what was going to happen to them in the succeeding year. In my view it is much better to know the worst than to go on from year to year not knowing what is going to happen next. The Minister has endeavoured here to deal very generously with the position of the unemployed people.

Reference has been made to the Act of 1928 which conferred the extended period of insurance. The Minister now says that, instead of bringing down the guillotine immediately, he will give the people concerned ample notice. He introduces his Bill and the insurance of these people is to be carried on during 1932. In 1933 there is to be another year of insurance, with certain limited benefits and thereafter, until the actuary has an opportunity of considering the position of the Widows', Orphans' and Old Age Pensions Scheme, these people will have the knowledge that, with regard to Old Age Pensions, their position is to be safeguarded. Other matters are dealt with in the Bill which I believe although they may not be very costly to the scheme are very important. The real burden of this question of unemployment was this. What were the societies to do? It was not a case of the Government coming forward and offering grants. It was quite evident that in the present state of the national finances anything more by way of grants-in-aid was not to be expected. The societies had to put their house in order and they had to look after their own concerns before they could be generous to other people.

Last night the Financial Secretary to the Treasury complimented the House and the country on the fact that our great social insurance schemes were in a state of solvency. He referred to the unemployment insurance scheme although that can hardly be said to be in a state of solvency because it has been necessary to borrow to put it on a proper footing. At all events the Financial Secretary meant that the people who were concerned with unemployment insurance knew that they would get their benefits when those benefits were payable, and he included also within the scope of his remarks the great national health insurance scheme. If there is one thing on which the approved societies of this country pride themselves, it is that this scheme, without any State aid; has maintained itself up to this moment in the proud position of solvency.

An hon. Member has dragged in the King Charles' head of the excellent position in which the societies would to-day find themselves had it not been for the Economy Act. For my part, I was in favour of the Economy Act, much as it cut against health insurance, and it has been clearly proved since, that it would have been a wise thing had there been a little more economy in the days that have gone by and if before we launched out upon these remarkable schemes of generosity we had first considered carefully whether the country would be able to pay and to continue to pay. As a matter of fact if the Economy Act had not been introduced when it was introduced it is clear that it would be necessary in order to meet the emergencies of to-day. The question which the societies had to consider with regard to the unemployed person was this burden of £2,000,000 a year and there is a distinct generosity now, going even beyond the bounds of insurance principles, when the societies undertake to bear a burden of £1,000,000 in respect of their members who have been unfortunate.

The hon. Member for the Scotland Division of Liverpool (Mr. Logan) seemed to imagine that the health insurance scheme had been brought into existence for the benefit of the sick. It was brought into being for the benefit of the sick and also for the benefit of those who are well. It is true that the people who have the fortune to enjoy good health have to pay for those who experience long runs of sickness. On the other hand those who do pay and who do not fall on the fund in the early years, have a right, to expect, as the years go by, that when sickness does overtake them they shall be able to claim the benefits which they were promised when they first came into insurance. If we reach a state of insolvency in connection with the scheme, then it may be that persons who have paid in the past will find, in the absence of arrangements such as those adumbrated by the Minister, that they will not receive the statutory benefits which they were led to expect.

What is the other point which is troubling hon. Members? It is the question of the position of women and particularly married women in relation to health insurance. In the last Debate in the House on this subject, we had the evidence of the Department and the report of the Government Actuary as to the sickness experience of this country. We also had the allegations, which have been repeated to-day, perhaps with rather greater vehemence, by the hon. Member for Westhoughton against the medical profession. I have spoken in the past with regard to medical men and health insurance but I am not prepared to say that bad medical service is so widespread as to make the difference between the expected sickness experience and the actual. In the main I believe that the doctors render excellent service. The Actuary has said in a very pronounced way with regard to the married women that although he suggests either an increase in contribution or a reduction in benefits a satisfactory state of things is only possible on the assumption that there is going to be the greatest care with regard to supervision and certification. He says further that there must be a reduction of about 20 per cent. in sickness experience to maintain the benefits exist- ing at the present time, and with regard to the suggested reduction in benefits these are only possible provided there is a reduction of at least 10 per cent. in the sickness experience. Therefore it is a matter for co-operation between all parties concerned in this great question of health insurance. The Minister referred to the fact that the proposals which had been put forward in the Bill or those mainly affecting the societies had been approved by the great body of the societies. That is the case, and the hon. Member for Bridgeton can take it from me that the deputation representative of all types of societies which went before the Minister and without any dissent, expressed their firm conviction that the present position of affairs must be met in the way in which the Minister has met it.


Will my hon. Friend make clear this point? Did the various groups which were associated with that deputation meet in advance and come to a considered decision before those representations were made?


First of all the secretaries of the various groups were communicated with and asked to send delegates to a meeting at which the general question was discussed. They were then sent back to their respective groups to take instructions and return to a further meeting and they then nominated delegates to go to the Minister. I do not think there is any body which is more representative than that of which I have the honour to be chairman, the Consultative Council to the Ministry of Health. That body is representative of all types of societies and not merely the large groups, and there was unanimity when the matter was put to the Council with regard to the measures which are proposed in this Bill. I hope that the Minister, having taken the advice which was tendered to him, not only in the interests of the societies but in the interests of the insured persons, will take the advice which was also tendered to him and which will be tendered to him again in the form of a new Clause which is to be submitted on the Committee stage.

The deputation to which I have referred put four points before the Minister. First, that the question of women's insurance should be reviewed; second, that there should be no increase in contributions; third, that benefits should be related to contributions even though restriction and reduction of benefits might prove to be involved, and, fourth, that there should be differentiation between single women and married women. That proposal will be put before the House in the form of a new Clause to extend the differentiation between married women and single women. I hope that there will be no confusion of mind as to what is intended. The widow is classed as a single woman, and I hope that there will be no sentimental talk about the widow with many children having to go out to work. We are dealing here with a proposition which is entirely different, namely, the treatment of the married women under this insurance scheme as opposed to the single women.

The incidence of sickness in the case of married women, is so vastly different from that in the case of single women, that you are bound, in justice to the single women, to see that their funds are not depleted to the extent to which they are being depleted by married women to-day. Single women ought to get, under the insurance principle, that return for their contributions to which they are rightly entitled. As I view the matter, there is no hardship involved to the married woman. The married woman when she enters into that state takes on an entirely different condition and status. Presumably she hopes that her future life will be one of dependence upon somebody else and not upon her own labours. Of course she may be disappointed and I have heard it suggested that if there is to be any grant or any other form of assistance given to the married women to prevent their benefits being reduced that assistance ought to come from the man's fund because the men are responsible for the unfortunate position in which the married woman finds herself, and if it were not for the men there would not be any married women. But that is hardly a matter which we can deal with by legislation.

The proposal to which I have referred is that the married woman shall enter into a new insured class just as she has entered into a new condition of life and that, if she is going to enter into employment she shall prove that, not as in the past by merely saying, "I propose to continue in insurance and I will do a few weeks work and so on," but she has to prove actually that she is continuing in employment. There is a provision in the new Clause for a further period of requalification—that she should be at least 26 weeks in work before she can say, "I am a person who has entered into insurance once again as an employed person." That does not go as far as I would like. I would prefer a qualifying period of 104 contributions for sickness benefit and 42 for maternity benefit. In either case, during the qualifying period, provision would be made for payment of certain benefits provided out of the contributions of the previous insurance. The Minister has expressed himself as grateful for the advice and assistance given by the society. I hope he will accept my statement that it is with the deepest sincerity and regard for the well-being of the scheme that they put forward this particular proposal. I do not think that I need labour the question beyond that. I agree with the main principles of the Bill, the two points which the Minister has endeavoured to meet—the question of unemployment in its relation to sickness insurance and the question of the position of women—and if he will crown his good work by accepting the new Clause which I hope to put forward, I believe that he will go forward as the Minister who, among many amendments of the Insurance Act of 1912, carried through a Bill which will stand as an immemorial example of good legislation.


I want to deal only with those portions of the Bill which affect the women. The right hon. Gentleman the Minister laid down two propositions. One was that the solvency of the insurance scheme must be safeguarded, and the other was that the contributory nature of the scheme must be safeguarded, in the sense that benefits must go to those who deserve them and who pay for them. I accept both those propositions, but the application of them seems to me to depend on what you mean by the word "contributor." I listened very carefully to the speech of the right hon. Gentleman, but, as far as I could judge, he took completely for granted, and did not argue, what seems to me the real point at issue in this Bill, and that is the question of whether it is fair to segregate the women, first of all, and within the women the married women, and to make them bear the whole burden of the difficulty caused by their excessive sickness claims. I should not have the slightest objection, as a matter of justice, to segregating the women from the men in the matter of insurance if that principle was carried out over the whole field of insurance. But although the Minister is only responsible for health insurance, we in the House of Commons are concerned with other insurance as part of a system of State insurance, and I think there ought to be some natural relation between the principles that apply in the case of health insurance and those that apply in other forms of insurance.

The suggestion is that the high rate of sickness incurred by women in general and married women in particular requires that these particular classes shall meet the deficiency by having their benefits cut down, but that kind of principle is not applied in other forms of insurance, and the attitude of the State both when acting in defence of its own funds and when acting in defence of its male beneficiaries seems to be on the principle of "Heads we win"—meaning by "we" the State and the men—" and tails you lose"—meaning by "you" the women. Take the question of the Widows, Orphans, and Old Age Pensions Contributory Insurance Act. I remember well, though I was not in the House at the time of the first Act, the discussions which took place with regard to it, and it was repeatedly stated, in the discussions on that Measure, that the contribution asked from women was really greater than was necessary to pay for the benefits which they would individually receive in their own right. The justification put forward was that in their capacity as future probable widows, mothers of fatherless children, and recipients of pensions as wives of insured men, they would benefit indirectly by the Bill and, therefore, ought to bear a part of the burden. Does not that principle apply equally to the present Bill? If the sickness of married women is heavy, it is largely because of their motherhood. Sir George Newman, principal medical officer of the Ministry of Health, wrote: An incalculable amount of unreported and often untreated injury and ill-health arises from pregnancy and labour … 3,000 mothers a year die, and tens of thousands of young mothers are unnecessarily damaged or invalided every year. I am not making an appeal to sentiment in recording that fact. I am merely recording it because it has a real bearing on the question of whether you can segregate the women's claims. I note with satisfaction that only a few days ago the cotton unions held a meeting about this Bill and that they caused a test to be carried out among their married women members, which showed that out of 5,724 weeks of incapacity incurred by that group of married women members, no fewer than 3,625 weeks were due to childbirth, and they went on to make the proposal that that should be covered partly by segregating the married women, but also by a general contribution from the men towards their support. That seems to me a just proposal.

Take again the question of unemployment insurance. Here, so far as I know, it has never been suggested—certainly it has never been conceded—that the charges incurred for men and women beneficiaries should be pooled separately and that the women should bear only that portion of them which is actuarially attributable to women's claims. Supposing that principle were adopted in unemployment insurance, what would be the result? Women pay a lower rate of contribution, and they get a relatively lower rate of benefit, but in addition they draw that benefit on the average for a far smaller number of weeks in proportion to their contribution than the men. That has been so from the very beginning of unemployment insurance until now. Thus, from November, 1920, till April, 1927, for every day's benefit claimed by a woman, more than one week's contribution was paid, but for every day's benefit claimed by a man, only half a contribution was paid. If we take the later figures laid before the Royal Commission on Unemployment Insurance, we see that in January, 1929, 13.8 per cent. of men insured in industry were drawing benefit, as against 8.5 per cent. of women; in July, 1931, 23.8 per cent. of men insured in industry were drawing benefit, as against 19.5 per cent. of women; in December, 1931, 23.2 per cent. of men were drawing benefit, as against 15 per cent. of women; and in January of this year, after two months' experience of the Anomalies Act, 25.1 per cent. of men were drawing benefit, as against 15.4 per cent. of women, a discrepancy of 10 per cent.

It is clear from those figures that if men and women were pooled separately in unemployment insurance, women would probably be able to claim very much higher rates of benefit relative to their contributions than men. I have made that comparison between the treatment of women under this Bill and that accorded to them under the other two principal forms of State insurance for the purpose of showing how unfair and illogical it is to treat women as a special class of contributors who must pay for their own insurance when the cost of their insurance is heavier than that incurred for men, while continuing to pool the two sexes together whenever that pooling is for the benefit of men or alternatively to save State funds.

Women are not the only class that has an abnormal sickness rate. In the actuary's report regarding this Bill, it is pointed out that coal miners have a specially heavy sickness rate, and also it is pointed out that Welshmen have an exceptionally heavy sickness rate. I think that two hon. Members who have advocated the segregating of married women are Welshmen. I wonder how they would like it if Welshmen were to be segregated for the calculation of their benefit because they have an exceptionally heavy sickness rate.


May I interrupt the hon. Lady in order to avoid a misconception? There are no provisions in this Bill for the segregation of married women at all.


Not perhaps for the segregation of married women, but there is a provision in the Bill for the cutting down of the benefit of married women and the disablement benefit of single women also because they have 'an excessive sickness rate. They are treated as a separate class, and that is all that I mean. Apart from the question of the anomaly in the different kinds of treatment accorded to the two sexes, this Bill has another defect. One of the features of the present Bill and also about the recent Unemployment Insurance (Anomalies) Act which has been most resented by women is the implication which is being drawn by the general public that women in general, and married women in particular, are malingerers who willingly sponge on the State, or on their fellow-contributors, to a greater extent than do men. I think the figures that I have just given about the much smaller proportion of women's claims in unemployment insurance to men's, and the much smaller number of weeks for which they claim, do not at all bear out the theory that they sponge more readily than the men.

At the same time, I am not going to deny that there is a real difficulty here. The married woman has undeniably a greater temptation to malinger than the married man. I think there is some confusion, because hon. Members have spoken as if sickness was a clearly defined thing. The fact is that sickness is a relative thing. Many married women know, when they go out to work, that their work is badly needed at home, and if they are feeling slightly ill, they may deem it better policy to give up their work and claim on the fund, so that they may remain at home with the children. They are not actually working at home, but the value of their supervisory services at home, plus their sickness pay, is better worth their while than to continue at work. A man in similar circumstances, if he was slightly ill, would not be able to stay at home. He would know that he would be merely a nuisance at home, and that his money could not be spared, and he is driven to go to work, even though it may be greatly to the detriment of his own health.

I am not sure that in many cases it really does pay in the long run for a sick contributor to hold out too long before applying for sickness pay, but I admit that there is a certain greater risk of malingering in the sense of too eagerly going on the fund on the part of married women. But that ought to be met by stricter administration, and, what is more, it is being so met, and, as was pointed out in the report, special steps are being already taken to tighten up the administration, and are having some effect. Malingering is certainly not the sole cause of the higher sickness rate.

There is one other factor, to which I have already alluded, and that is the sickness which follows on pregnancy and arises out of labour, but, in addition to that, there is the fact that often a married woman goes out to work because she knows that her husband is unemployed or suffering from short-time or lower wages, and the double strain of working and carrying on the duties at home of cook, housemaid, washerwoman, and general servant is a very heavy strain on her health. Then again, when the woman is carrying this double strain, she is very likely getting a smaller share of the family food than anybody else. Every social worker knows that in hard times, when there is unemployment or when money is short, the woman, because she is the housewife, comes off worst. Mr. Rowntree writes in his book, "Poverty": Extraordinary expenditure, such as the purchase of a piece of furniture, is met by reducing the sum spent on food. As a rule, in such cases, it is the wife and sometimes the children who have to forgo a portion of their food—the importance of maintaining the strength of the wage-earner is recognised, and he obtains his ordinary share. Speaking of the excessive sickness of married women, the secretary of the National Association of Trade Union Approved Societies said last year: If food is short in the home, the man does not go without. The wife feeds the brute because he is earning the money. Then she feeds the kiddies. If there is any left, she has it, but often mother says she is not hungry. That happens because as the person who provides the food she has to see that the rest of the family get their share first.

7.0 p.m.

These three factors, the effects of pregnancy and labour, the double strain of earning and of housework, and the traditional self-sacrifice of the housewife, very largely account for this excessive sickness. The question is whether they justify the separation of the married women's claims and the expediency of cutting down their benefit. It is a well-known maxim that the most economical method of treating sickness is to cure sickness. It is difficult to see in what way, except on the principle of taking a hair of the dog that bit you, it is going to help the married women with debilitated health through insufficient food not to give them enough to eat. Married women are getting tired of these attacks on their pocket and on their repute. All the attacks of the last six months have hit the married woman heavily. Six months ago her unemployment pay was cut down. Now her sickness pay is to be cut down. If she is the wife of an unemployed man, she has had her dependant's allowance reduced.

I often wondered why the Government were so ready to attack the married woman. The Debate to-day furnishes the reason. It is because in the economic structure the married woman inhabits a No Man's Land. The economists used to talk of the Economic Man, who responded solely to economic considerations. If there is an Economic Woman, she must be a spinster because no Economic Woman of the working class would be such a fool as to get married. The married woman of the working class always gets the worst of it every way. If she decides when she marries to give up her job and look after her home and children, she is entering one of the most dangerous occupations in the world. She does not get a penny of wages and is expected to live on what her husband can spare her out of an income which is no larger than that of a bachelor, but out of which she has to keep her husband and children. If she retains her job, everybody looks at her askance. Her employer looks at her as one who may be irregular in her work, the trade union looks at her as a potential blackleg, and the spinster often asks why there should be two incomes coming into the same house. The Government, watching these things with one eye on their finances and the other on the electorate, think that married women are fair game. I do not mean that the present Bill is fair on the spinster, because she too is to receive less disablement benefit, although she already has to contribute to old age pensions and widows' pensions from which she derives no benefit either in her own capacity or if she becomes the wife of a man who is not insured. Her wages are low because she has no family to keep, but under the means test she has to contribute to the upkeep of any member of the family who is unemployed. Now, with her debilitated state of health, if she is driven to claim disablement pay, her miserable 7s. 6d. a week is to be cut down by 1s. 6d.

I ask the Government to consider whether there is not some way, which is fairer and more consistent with the other forms of State insurance, of meeting the acknowledged difficulty. We recognise that the gap has to be bridged in some way or other, but is there no other way? I do not claim to be an expert on insurance, but I know that in the report of the Royal Commission on Health Insurance in 1926 it was definitely suggested that some scheme should be adopted of pooling a certain amount of the surplus enjoyed by the more prosperous societies in order to meet the claims on the less fortunate. It was suggested that in a universal compulsory scheme of insurance, towards which a substantial contribution was made from the resources of the State, some element of mutual aid should be included by which the more fortunate members of the insurance community should contribute out of their abundance to the needs of the less happily placed. The Royal Commission declared: These considerations …. would incline us to view with favour the introduction of a measure of partial equalisation of benefits so limited in its operation as to preserve the incentives to sound and economical administration …. but at the same time going considerably beyond the restricted scheme of pooling which was introduced, so far as Societies actually in deficiency are concerned, by the establishment of the Central Fund. Does the Minister say that the means adopted in this Bill is the only possible means of meeting this deficiency? Might it not still be possible to meet it by some form of pooling the surpluses of those societies, a very substantial number, which still have such large disposable resources that they are able to give substantial additional benefits, such as dental benefits and convalescent benefits? Is it not right that, in a State system of insurance contributed to by the State, the principle of equality should be carried at least far enough to assure that the rates of benefit necessary for subsistence should be paid to everybody before any group of fortunate contributors are allowed to enjoy additional benefits? I believe there is a strong ease for such a method of dealing with the matter. I do not believe it is beyond the power of the Minister of Health to devise such a method if he wished to do so. He told us that the means he has devised meets with the approval of the great majority of approved societies. I do not doubt that the great majority of approved societies approve it, because they have a substantial surplus which they can use to make themselves more attractive to their contributors by giving every kind of additional benefit. Naturally they want to retain those surpluses, and do not want to share them with the less fortunate. But it does not follow that the State, as a substantial contributor to the scheme, should not say that the underlying principle is, "Bear ye one another's burdens," or that that principle must be carried to such an extent that the burdens of the poorest section of the community, the section most liable to sickness, shall be borne by the men of the community as well as by the women of the community, and that the whole burden shall not be placed on the shoulders of the unfortunate married woman or of her still more unfortunate sister, the single woman who is disabled. I shall have no hesitation in opposing the Bill as long as it remains in its present form.


I have no hesitation in associating myself with the opposition to this Bill and the Amendment for its rejection, although the hon. Member, who moved the rejection, did not make out a very convincing case. He seemed to have some difficulty in reconciling his two interests, one as spokesman for the official Opposition and the other as the responsible head of a great approved society. I hope that the right hon. Member for Wakefield (Mr. Greenwood), if he is going to take part in this Debate, will let us hear somewhat more decisively and distinctly the voice of the official Opposition in its antagonism to this Measure. The hon. Member for West-houghton (Mr. R. Davies) intimated that he stood by the insurance principle, so far as health insurance is concerned, and also by the principle of a National Health service under entirely national control. It is some time since I was a member of the party above the Gangway, and I did not know of the alterations in its policy which he revealed to-day. I understood that the Labour party stood completely for a National Health service completely under national ownership and national control, and I was surprised to hear that the Labour Opposition now stood for the insurance principle.

I also wish to raise another point with the hon. Member. He made the suggestion that there was much malingering, particularly among married women. I use the word "suggestion" and I am not trying to quote his words. He left the impression that, in his view, there was a sort of tacit conspiracy between the panel doctors and the married women to get more out of the National Health Insurance funds than these contributors were entitled to. I hope that that is not an unfair representation of what the hon. Member said. I challenged that statement at the time he made it, and said that it should not be made unless there was some evidence to support it. He said that the evidence in support of it was that a person called the regional medical officer was reviewing claims and that that regional medical officer was passing a great number of people as fit for work who had been passed by the panel practitioners as unfit for work and in need of benefit. Does that prove the panel doctor was wrong? I have just been discussing with the Minister of Labour the case of a constituent of mine, who has been off work and on sick benefit. His panel doctor says that he is unfit to return to work, but that panel doctor's opinion has been reviewed by a regional medical officer who declares that the man is fit for work. The man has not got a job and, when he signed off his sickness benefit, he went to the Employment Exchange. The Employment Exchange reviewed his case and decided that he was not fit for work and on that ground not entitled to any benefit. The Health Insurance authorities refuse the man benefit because their medical officer declared him fit for work, while the unemployment insurance authorities refuse him benefit because he is unfit for work.

Lieut.-Colonel FREMANTLE

What right have the Employment Exchange officials to say that he was unfit for work? Had they medical advice or were they acting on their own lay opinion?


As a matter of fact, in this case they had medical advice. But my knowledge of the case is that to the layman this person is, obviously, unfit to go back to work.


Some people look very ill and are yet very vigorous.


Yes, and some people look very fit who are not fit for work. Here we have a case of a regional medical officer, on whose evidence my hon. Friend supports the malingering charge, and it may be that, as we have had experience in the Ministry of Pensions, the local medical practitioner is the honest witness, the human witness, and that the other man is merely the hack of a Government Department who is endeavouring to serve his master by saving the funds of the Department. I am afraid for a portion of this Debate that none of the women Members of the House were going to be present. The Debate had proceeded for a considerable time before any one of the women Members deigned to grace the Chamber with their presence on a matter in which indubitably the women are again being made first to shoulder the burden of responsibility for the necessary economies to make this fund solvent.

I want the Minister to consider whether the problem of solvency should be allowed to take first importance in his mind. I can understand the Chancellor of the Exchequer or the President of the Board of Trade or the heads of Departments, such as the Government Actuary, who are concerned with finance, trade, industry or commerce, being primarily concerned about the balance-sheet aspect, but this National Health Insurance scheme, of which the Minister of Health is in charge, has for its main purpose the maintenance of the general health of the community. It has been a matter of some slight satisfaction to all of us that, in the difficult times through which the people of the country have been passing, the vital statistics of the country have been on the whole showing an upward tendency, although the one figure in our vital and health statistics that does not show an improvement, and has not shown an improvement for a long period, and is one of the most obstinate problems, is the figure of the maternal death-rate at childbirth. I should like the Minister also to have that in his mind when he picks out the married woman as the special instrument for achieving a solvent balance-sheet.

The point which I want to make to him primarily is this. Is it in his opinion, and in the opinion of the House generally, sound national economy to risk a serious deterioration in the health of the nation? Up to last year the criminal statistics of this country were also showing a steady diminution. The number of persons sent to long terms of imprisonment were steadily going down. All of us know the outcry that has been raised in this Parliament about the increase of serious crime. I do not say that it is post hoc propter hoc, but it is a fact that since the anomalies Act the cut in unemployment insurance, and the application of the means test, the criminal statistics have begun to show an upward tendency. It would be poor economy if, as the result of the economy on the health services, the health of the nation should show a steady deterioration.

A criticism which I would make of the Bill is that the Minister admits quite frankly that it is hand-to-mouth legislation; a number of the proposals are mere improvisations. He does not pretend that they are anything more than an attempt to tide over a period of crisis which he still seems to believe is passing. I want to suggest to him that the real danger of insolvency to this fund does not lie in the extravagant demands of the married or unmarried woman upon the fund, but upon the possibility that the investments in which the funds of the health insurance scheme are placed will not be able to face up to a valuation one, two or three years hence. That is the really serious danger, and you are not going to save this nation from its difficulties by knocking a couple of shillings off a married woman's benefit. You will only get out of your difficulties if you can devise ways and means to show how the hundreds of millions of pounds that are the basis of this fund's solvency are to continue to show a reasonable return over the years that lie in front of it. I do not believe that you will be able by anything that has been done yet by this Government, or by anything that is in contemplation, to save the industrial and financial machinery of this country from complete collapse.

The fact that the Minister himself does not speak with any degree of confidence and makes only temporary arrangements in this matter is an admission on his part that the Government have no great confidence in the resuscitative qualities of their policy as it has been applied so far to our industrial and commercial problems. The sick married woman, the totally incapacitated married woman, is to be asked to maintain herself in her total incapacity on a weekly payment of 5s. It is again another contribution from the poorest section of the poor, and the sick poor at that, to maintain the stability of our great nation with its great history. We are asking our sick women to shoulder this added burden in order to save this indefinite, impersonal entity, the nation, from collapse. The sick married women are to be shoved out into the front line trench. After them will come the aged persons, the 65-years-of-age people. The Minister said something about the aged people and the widows' pension rights for a period of 10 years. The Minister shakes his head. Am I right in my assumption?


I am anxious to help the hon. Member, but I do not in the least know what he is referring to.


Tht right hon. Gentleman will see in the OFFICIAL REPORT, if he takes the trouble to read his own speeches, which I do not advise him to do, that he said that with regard to the rights for old age pension there was a guaranteed period of 10 years insurance for, I think he said, 2½ years contributions. That might have created a wrong impression, but I understood quite clearly that the old age pension is not to be guaranteed beyond 1935. Am I right in that assumption, namely, that only up to 1935 the old people in this country have any assurance that their old age pension is to be available?


What the hon. Member is saying has no relation to any provision in the Bill. The existing law stands as regards the relation between old age pension rights and contributions, and the proposal is to extend to those who would otherwise come out of insurance their pension rights for two additional years—1934 and 1935.

7.30 p.m.


But after that they go out, failing a great fundamental change in the whole insurance system. Am I right in concluding that up to 1935 the old age pensioner who is unemployed is maintained in his rights to his old age pension, but that after that, so far as the law of the land is concerned, and so far as his knowledge of it is concerned, he is in complete uncertainty. He is left in complete doubt as to whether he is to receive the old age pension or not. I presume that that is a correct description of the position. You are shoving the married woman out into the trench, then the single woman to a lesser extent, and then the aged persons. All those who are now between 66 and 60 are to be left in complete doubt as to whether after 1935 they will be in a position to draw the old age pension, or, if the husband dies, whether the widow and orphans will be able to draw the allowances which are now provided for them. The Minister sits there with a very strong hand. He has a very strong majority behind him. He has a certain statement by his immediate predecessor showing that something was necessarily required in the way of economies in this Fund. He has, as he has explained, got behind him the support of all the approved societies, but I want him to consider whether on high national grounds all that he will get out of this will justify the very heavy risk that he is taking. Since he is quite uncertain of what the future may hold for this nation, quite uncertain what our financial position will be 12 months hence, since the Chancellor of the Exchequer has indicated that further drastic economies in our national expenditure will have to be imposed, could not the right hon. Gentleman, as Minister of Health, say "I agree that further great economies will have to be made,"—that is the outlook of the present Government, that the nation is going to be saved by reducing everybody to destitution—"but the aged, the sick, the widows and the orphans will be left to the very last"? Can he not say that, until we are right in the middle of the catastrophe, the mothers of the nation, the aged people, the widows and orphans, the sick people, the future mothers will suffer no cut in the meagre, miserable allowances secured to them by legislation so far?

This great National Government came in nine months ago, with a great flourish of trumpets, to do wonderful things in five minutes, but already it is shifting its ground. Now Ministers say it will be a long slow process. Last September, and in the General Election, it was going to be done by a wave of the magic wand —when they got on the job! [Interrup- tion.] I see a young Member who was more cautious, but I am talking of the experienced politicians! They said, "If only we can get on to the job, on to the Treasury. Bench, in a few months you will see the rising tide of prosperity." Now, nine months afterwards, they tell us that it has not worked, that there is no rising tide of prosperity. Things are worse financially and industrially than they were nine months ago, so bad that the sick people have to be refused the comforts that their few shillings buy them on their sick bed, and the aged people, or the people approaching the age of 65, have to spend their latter years with the feeling of uncertainty that at 65 the meagre 10s. which they have been looking forward to will no longer be available. I ask the Minister of Health if that is worth while. Is it good business? Is it high statesmanship? I ask him whether he will not walk back into the Cabinet and say: "Here, take my resignation. Get somebody else to run a show like this. I will not do it."


The hon. Member for Bridgeton (Mr. Maxton) loves to make our flesh creep, and I think he has succeeded.


Oh no, I do not.


He did it quite effectively, but those who speak like that always overlook the fundamental fact that it is something to have safeguarded 5s., in preference to running the risk of having nought, which would be the inevitable result of a succession of years of a Labour Government's administration. [Interruption.] If the hon. Member treats us to 20 minutes of platform stuff, surely I am entitled to reply in the same vein! That is what the trouble was about last year. But I am not going to pursue that point, though I am quite capable of doing it. It is inevitable that all the Bills which come before this Parliament should have a financial background, what the hon. Member described as "the balance-sheet mind." He pokes fun at that; be does not think there can be such a thing. This House, which was elected at a time of grave national crisis, must weigh up that consideration very carefully when any Measure comes before it. In any Bill there must be a balancing of advantages and disadvantages, and the House has to make up its mind.

Before I comment on the Bill I think one word should be said to express the indebtedness of the House for the careful estimates which the Government Actuary's Department have made. To be sure, their estimates generally turn out to be wrong, through circumstances which could not possibly be foreseen, but we are always grateful for the reports they submit on the facts which they have got. The Financial Secretary to the Treasury last night pointed out that the actuarial calculations on Unemployment Insurance at the time of the Blanesburgh Committee are some 2,000,000 out, as compared with the position to-day. That was no fault of the calculators. There is also the most glaring difference between what has actually happened and what was forecast, on good authority, in regard to the price of corn in the Tithe Act of 1925. Therefore, whilst we are grateful for the work of the Actuary's Department, we must not be too confident that even now the calculations on which these alterations are based will turn out to be correct. The actuaries have very little to go upon. A nation-wide scheme of compulsory insurance is a very different proposition from the ordinary kind of insurance, in which the companies can distinguish between the probably good and the probably bad people from the insurance point of view.

The Chancellor of the Exchequer and the Financial Secretary to the Treasury have repeatedly stressed the point, during the Debates on the Finance Bill, that it is up to this House, when a Bill comes Before it, to try to disentangle its possible financial repercussions. It is too late to do so afterwards. When the Budget of 1935 or 1941, or whatever year it may be, comes along, it is too late for the House to complain of the bill then presented, because the answer will always be, "The House of Commons, in its wisdom, passed such legislation, and now we are merely asking you to provide the ways and means." When we find the unemployment position is so different from what people had expected it to be, even so recently as 1928, the Minister of Health is confronted with the problem of whether he should reduce benefits or raise contributions, on the assumption, which he rightly makes, that the great bulk of the people want to keep the fund solvent. They are all the more keenly anxious to keep it solvent on account of the tragic experience of the insolvency of the Unemployment Insurance Fund. If, when we started on the slippery slope of giving unemployment benefits which were not in the original contract without making adequate provision therefor, we could have foreseen that in the end it would have meant those dreadful hardships to which the hon. Member has referred, and which are vaguely described by the words "means test," people would probably have taken a very different view of that legislation. That is the warning which the right hon. Gentleman has put before the House.

If we look at the Bill it will be found that there are really two fundamental principles. Whereas, in the first part, dealing with health insurance—the married women's case, and all the rest of it—he has appealed to the "head" of this House, and told us we have to keep the scheme on a solvent basis, in regard to the second part, dealing with the concessions put forward with a view to keeping the unemployed in benefit, so that they may qualify for pensions, the appeal is completely ad misericordiam, because there are no financial provisions for that in the Bill. The first part of the Bill is, roughly speaking, a self-balancing affair. There are certain contributions and certain benefits, and, as it is found that the benefits do not fit the contributions, of the two alternatives he has chosen to reduce the benefits. That is a mathematical arrangement. As to the other arrangement, I am surprised to find hon. Gentlemen proposing to vote against it, because, looking back to the Debates in 1925, it is exactly what they have always been pleading for. Their theory then was, and may be still, so far as I know, that we should not have a contributory system for widows and old age pensions. In a way that is the effect of the concessions. The right hon. Gentleman has told us that now an unemployed man will, after the age of 58½, be automatically kept in mythical insurance, so that he can get his pension at 65, though no contributions have been paid.


That is a very limited period.


Well, from 58¼ to 65 years is a goodish time. The hon. Member may call it "limited," but it is a great deal better than nothing. [Interruption.]


He is not an old man at 58.


No, at 58 very few people like to call themselves old.


If I understood the Minister aright, this only applies up to 1935.


No, no. Under the present law a man who reaches the age of 60 and who is unemployed is, if he has been insured for 10 years, kept in insurance for all the benefits. That provision is not interfered with by this Bill, except in so far as it makes the position better for the insured person by lowering the age from 60 to 58¼ years; and the picture of the old man with white locks which has been given to us is entirely fanciful.


Do I understand that all the provisions that are at present safeguarded to the aged people by the Prolongation of Insurance Act now go by the board, and that the provision for 1935 takes its place?


Now my hon. Friend is putting an entirely different point. He is not painting the same picture. The picture he painted was a picture of old people dropping out and losing their insurance completely.


If unemployed.


That is not so. I repeat that the present law, the permanent part of this scheme, now lays it down that if an unemployed person has been insured for 10 years and, when he reaches the age of 60, is unemployed, his rights are safeguarded. What this Bill does is to make a concession in favour of that man by lowering the age of 60 to 58¼ years. Then there are a certain number of people who are under the prolongation Act. It after 1935 they are not 58¼ or have not 10 years insurance to their credit when they become unemployed, they will cease to be insured after 2¾ years' continuous unemployment.


I am much obliged to the hon. Member for eliciting that clear statement from the Front Bench. So far as old age pensions are concerned, it means a concession of 1¾ years on the present advantages which the unemployed person enjoys. May I bring the House back to the financial question? I was alluding to the second part of this Bill which deals with the insurance scheme and the old age pensions which seemed to me to be an appeal ad misericordiam. If I want a witness to that statement, I can only refer the House to what the Minister said on this point. He stated that you must temporise and give the national situation a chance of improving. That has been echoed in one form or another very frequently from the Front Bench, and certainly the Government, of which Miss Bondfield was a member, surpassed anything in that respect of which the Minister of Health could be capable. That is a little disquieting, because it shows that there is a risk that we may, in future, look back upon this Bill as something which this House ought not to have passed. Take the Actuary's Report. He takes a period of 2½ years only in the 10 years and makes his estimate on the basis of 80,000 persons. The Actuary goes on to say: The pension contributions so paid would amount to less than £400,000, while the payments to widows of men in respect of whom they have paid will eventually exceed £2,500,000. The Actuary further states: The pensions system is so constituted financially that the concessions under this head will impose, ultimately, some charge upon the Exchequer though its amount cannot be assessed in the absence of means of estimating the number of cases that will arise. The trouble of our social legislation is that we have merely looked at a period of five or 10 years, but this House should consider sometimes the potential expenditure under these proposals. I hope the House will fully realise what it is doing, because the same problem arises in connection with other Departments. The Service Estimates show the amount that has to be found every year under those estimates for pay and pensions in the non-effective Votes. The same problem arises in every one of our great social services, and the potential amount which will be required in future years seems to have been lost sight of by this House. The Minister of Health is squaring one account in one part of this Measure, but in another part he is opening the door a little wider. I should like the Government to have accepted an instruction dividing the Bill into two parts, one dealing with the widows', orphans', and old age pensions' side of this question. A division of that kind would have given us a better opportunity of reviewing the problem. If the House gives this Bill a Second Reading, at least let hon. Members do it with their eyes open. While recognising the hardships referred to by the hon. Member for the English Universities (Miss Rathbone) in relation to married women, and the people who are going to have their benefit cut, in spite of all that it is the same old problem that has worried everyone connected with the crisis, and that is to see whether under the changes which are being brought about all round anything at all in our social scheme can be saved from the wreck.


I rise to say a word or two from the point of view of Scotland, but, before doing so, I would like to congratulate my hon. and gallant Friend the Member for Gainsborough (Captain Crookshank) on the clearness with which he has put before the House the vital question of national economy. I accept the hon. and gallant Member's statement that the great mass of the provisions of this Bill are based upon the balance-sheet mind. With regard to the prolongation of pension rights to the end of 1935, I think it is only right to say that on the best estimate that could be made the possible financial expense in that direction will be very slight. In this connection, we have to consider the vast importance to men and women who may for a long period have paid Health Insurance contributions and then for a small period have been unable to do so. This is a very important advantage to them in their old age. Even my hon. and gallant Friend the Member for Gainsborough with his strict balance-sheet mind would agree with me when I say it is well to dilute the head a little with the heart. This is a matter of arrears, and that is a point to which we ought to give consideration.

I know, and my colleagues from Scotland know, that the proportion of unemployment is heavier in Scotland than in the United Kingdom, for the simple reason that we are more dependent upon the heavy industries, and it is those industries which carry the chief burden of unemployment. It is not surprising that many Scottish Members have received deputations from friendly societies urging them to do all that is possible to help them to face their problem of arrears. I think, however, that we may be satisfied that in this Bill we have faced the problem of arrears which presses so heavily upon Scottish societies, and that under the proposals of the Bill that problem will have been solved to a considerable extent. The excusal of arrears is placing on approved societies a burden of over £2,000,000 a year, and of that £2,000,000 they are going to be relieved of the burden of £1,000,000 per annum. With regard to the £2,000,000 liability which the societies incur, only £1,000,000 will be met forthwith, and the second £1,000,000 will be met at the next valuation period, when any deficiency which the societies may have incurred will be met by the central fund. Therefore, the approved societies have the knowledge that with regard to one-half it is being dealt with forthwith, and they will be relieved of the burden of the other half at the next valuation. I think that should bring some satisfaction to those approved societies which are so heavily pressed owing to the large number of members who are suffering from unemployment.

8.0 p.m.

The Debate so far has dealt very largely with the reduction in benefit to married women, and various points have been raised as to who is at fault in this matter. It has been admitted that the claims of married women are enormously high. They have risen very much, and they are still rising. On that thorny topic, I do not think that I need to enter, but I would just like to say to the House that it so happens that investigations which have been made in Scotland will, I think, very soon enable those interested in this question to satisfy themselves to a large extent as to who is at fault. The Scottish Department has attempted to solve this problem, and their report will enable hon. Members to see what has happened since June, 1930, in relation to sickness and insured persons in Scotland, and the report will tabulate the number of certificates given by various medical men. That will furnish a double check as to how far in certain districts certain complaints and ailments are prevalent, and the kind of proportions in which medical men give certificates. I think that that will furnish a very real addition to our knowledge of the question of insurance medical benefit. The only other comment that I would like to make on that matter is that the investigation which I have very briefly described affords an interesting example of the benefit of having a separate insurance administration in Scotland. To have undertaken this investigation in England would clearly have been a very large and expensive task, but the Scottish Department of Health, administering a smaller area and a smaller number of persons, has been able to undertake this highly scientific and detailed examination, which I think will be valuable to all who are interested in the question of health insurance far beyond the confines of Scotland.


Will the results of that investigation be made available to Members of the House shortly?


The first report, I think for the year from the 1st July, 1930, to the 30th June, 1931, will shortly be published, and will be available, not only to Members of the House, but to the public generally.


Does it cover the whole of Scotland?


I understand that it does.


Does it cover all insured persons, or does it cover male and female alone, or married and single alone? Is there to be any differentiation, or will it cover all who are in National Health Insurance, irrespective of their calling or the part of Scotland in which they live?


It is universal and comprehensive. It covers, not merely special cases, but all insured persons.


Are the persons who are carrying out this investigation Government inspectors presently employed in the Department, and are they all men, or do they include a proportion of women? Are they in any way specially selected, or are they members of the normal staff of the Scottish Board of Health who have been transferred for the time being to this duty from other duties? Seeing that the work of the doctors is going to be corrected or altered on the basis of this investigation, it is important that we should have some knowledge as to the persons who are conducting the inquiry.


I understand that the investigation has been, and will continue to be, conducted by the ordinary staff of the Department of Health, which includes, as the hon. Member knows, a medical staff. It is largely a clerical matter, consisting of the checking and tabulation of written records.


The report will be a publication of the Department?


Yes. I should like to add, to what I have said on this matter from the Scottish point of view, that, from the general point of view, I am satisfied that we have found, for the extremely difficult insurance problem with which we are concerned, solutions which clearly have commended themselves to the approved societies, which will commend themselves, I think, to any reasonable persons who have made themselves acquainted with the problem, and which I think I may say, judging from the Debate as far as it has gone, have commended themselves to the House as a whole. I am satisfied that in National Health Insurance, as in every other department of national life, my hon. and gallant Friend the Member for Gainsborough is right when he says that one form of mind above all is absolutely vital at the moment, and that is the mind which not only appreciates, but determines to pursue, the difference between solvency and insolvency.

Lieut.-Colonel FREMANTLE

I am much interested in the scheme which has just been propounded by my hon. Friend the Under-secretary of State for Scotland—a kind of sleuth-hound, Sherlock Holmes scheme for the investigation of the crimes or otherwise of the medical profession in this matter. Of all those who are concerned with the question of the health of the people generally, none would wish more strongly than the medical men themselves that this inquiry should be successful in running down any real negligence on the part of the panel practitioner. No one can be a friend of the medical profession, or of the panel practitioners in particular, who in any way supports any suggestion of laxity on their part—

Notice taken that 40 Members were not present; House counted, and, 40 Members being present

Lieut.-Colonel FREMANTLE

My hon. Friend the Member for Bridgeton (Mr. Maxton)—I call him my hon. Friend because he attacks the Opposition, as I always do when it is necessary—made, in his attack on this Bill, some very interesting remarks on the general subject; but the unfortunate thing is that he always finds it necessary to twist his original thoughts, which are useful, round to the Communism or Socialism which he advocates outwardly, and, consequently, the latter part of his speech was not worthy of him or of the subject. In the earlier part of his speech I found a great deal with which I could agree, because he represents the side that sees realism, and recognises that these matters have to be considered in their human aspect. He mentioned a particular case in which the panel doctor, with his human appeal, was apparently, in his estimation, right, but in which the regional medical officer, bound, as he said, by the dictates and rules of the master whom he serves, was bound to consider only the financial aspect. Therefore, the hon. Member concluded that the panel doctor was right and the regional medical officer was wrong.

Let us see where that leads us. If the regional medical officer, because he serves the Government and the insurance scheme, is bound to consider finance only, and not humanity, what becomes of the hon. Member's whole structure of Communism and Socialism, of the State scheme that is entirely bound under the State, when these officers will all be like the regional medical officers, when they will all be officials holding public offices? Does the hon. Member think that they will not be primarily bound by finance? Why should that not be so? Why should they suddenly become human? The hon. Member will say, because, under the Communistic, Socialistic system that he advocates, all will be well, and all people will be angels. If that foe his argument, we may leave the bringing in of such a system to the Greek Kalends, because we know that it is not practical politics.

It is true that the panel doctor often knows, and the regional medical officer, who comes in from outside, does not know, the real human side of the case, and that is what we have to consider in this difficulty about certification. If these matters are to be judged by bureaucratic methods—by methods, which quite rightly are being explored by the Scottish Office, of tabulating columns and percentages—if one doctor who certifies 50 per cent. more patients than another is to be adjudged wrong—it will reduce the whole thing to ridicule. You cannot judge human action by percentages. Material facts can perhaps be so judged, but we are dealing here, not with material facts, but with human judgment, and that is the difficulty of getting at the real truth on this subject of certification.

I agree with the hon. Member for the English Universities (Miss Rathbone), who suggested that this difference in certification for sickness benefit could not all be attributed to malingering, but that, nevertheless, some must be attributed to it. I do not like the use of the word "malingering," because it leads us astray. I do not like the use of the phrase "false certification," because it leads us astray. The great majority of people, whether they are beneficiaries or officials, do not deliberately break the law or cheat, but they are human, and the result is that, on the one hand, they naturally take benefits as they come to them in the ordinary kind of way, while, on the other hand, the doctor hates signing certificates, and signs them as a matter of course, not meaning to deceive anyone or to betray anything, but in the hurry of his ordinary practice and because he hates signing these things. The medical profession are probably the most un-businesslike people in the world in their general practice, because their general practice has such a compelling human appeal that they cannot be businesslike in their ordinary arrangements, and, when they have time to be businesslike, they suffer from never having learned the habit of being businesslike. It is natural to them to do what they can for their patients, and to do what their patients wish them to do; and it is natural that if the patient comes to his doctor and says, "Sign me again, doctor," he signs. I agree that he is not fulfilling his contract under the insurance system, and that an insurance system would break down if that practice were followed generally. I am only saying that it is a natural tendency, and the reason why it involves going against the rules is that the whole National Health Insurance system is against the rules. When you have anything systematised, you are bound to have difficulties. I do not mean to say that you must not have rules, but you must expect that they will break down when it comes to a narrow line. They will not follow the straight line that the law wishes them to do. There must be a swerve one way or the other, and those carrying out the scheme are more swayed by the human appeal than by the head, or by the head than by the human appeal. You must have rules and you must try to get them carried out, and you have to make up your minds whether it shall be a general beneficial system of charity, such as is advocated by the hon. Member for Bridgeton and many others, or whether it shall be a definite insurance system.


When did I ever suggest a general system of charity for anything? I listened very quietly while the hon. and gallant Gentleman misrepresented my Socialist and Communist views, but now when he is talking of me as a charity monger I am entering my dissent.

Lieut.-Colonel FREMANTLE

The whole implication of the hon. Member and his policy is that it should definitely be the care of the State as a whole, regardless of contributions, and I say that is charity. The House and the country generally have decided that this should be an insurance system. We have to keep it a watertight and a financially sound system; otherwise, it will break down on the very lines which have been so well put forward by my hon. and gallant Friend the Member for Gainsborough (Captain Crookshank) and be involved in the general ruin. We must make this watertight and sound if we are to carry it on as an insurance system, and we have to see that the systems of public health and public assistance shall be improved wherever we can. The question is in what way we can make it sound. The figures show an increase in certification up to 1927, but I was rather surprised that the Minister did not also remark that the figures since then show a definite improvement. He rather left the impression that there had been this constant increase in certification for sickness and disablement benefit among the women. As a matter of fact, in the last three years there has been a considerable improvement, as is shown in paragraph 9 of the White Paper. Disablement and sickness are practically stationary at a level slightly above that reached in 1927 for unmarried women while those for married women have substantially increased. If that is the case, there has been an improvement.

The Minister is banking on having a 10 per cent. improvement during the next few years. I have the figures here for the, society with which I am proud to be associated in the work of honorary arbitrator, the Hearts of Oak Society, and their figures for the last three years certainly do not show that there is likely to be a 10 per cent. improvement. There has been an improvement on some lines, but on others it is very slight. The figures for women's sickness in 1930 were £70 benefit per 100 members, and in 1931, £66. Disablement benefit was reduced for all women from £52 to £49, with different figures for spinsters as opposed to married women—married women very much more. There was not very much reduction, and that reduction really corresponded to the reduction in the scale of benefits. I am very much afraid that the 10 per cent. reduction on which these estimates were framed will not be sufficient, and that is why I hope we may be able to get support for the Amendment that has been adumbrated by the hon. Member for Flint (Mr. Llewellyn-Jones). It is a natural, a reasonable and a right suggestion in accordance with his diagnosis of the trouble. Women, when they are married, try, wherever they can, to retain benefit so long as they remain in the same class. The suggestion in the Amendment is that they shall go into a separate class—class K—until they are definitely disabled, and then they go back to class E and get their benefit. I believe that is a human, natural way of meeting the point, and you will get a further reduction in sickness and disablement without any real hardship.

I have been asked also to support an Amendment put forward by the National Association of Insurance Committees to prolong medical benefit along with the prolongation of pension rights. Obviously, we should all wish to see that if possible, but it depends on finance. I understand from my society that it would not be practicable to make that further concession of medical benefit for another two years, but I hope that it will be properly looked into and that we shall see about it in Committee. As the right hon. Gentleman the Member for Epping (Mr. Churchill) said the other day, what is the use of a National Government if it does not do the unpopular things which require doing and which the ordinary party Government is unable to do? In any sense in which it reduces benefits, this must be an unpopular thing to do, but, if it is the right thing to do, let us do it and not hesitate. I am certain we shall gain credit and confidence for the National Government if we do the right thing to help to make the scheme sound. So much depends on this because the health of the people depends on it. The whole system was badly conceived, and largely politically conceived, and there is a great deal wrong with it. It is more directed to benefit than to treatment and prevention of sickness. It has failed a great deal from that point of view, on which it was so much advocated by the right hon. Gentleman the Member for Carnarvon Boroughs (Mr. Lloyd George). But we have to make the most of it, and we have made a great deal of it. There is a great deal of good in it which can be preserved and enlarged. I object strongly to the hon. Member for Bridge-ton saying, as he did, that the health of the people is deteriorating. It is not, and he knows it is not. It is extraordinary how the health of the people has been improving despite all the difficulties of the past years, and we have to see that this improvement and the benefits continue. They can only do so if we keep to sound financial lines.


I rise to address this enthusiastic House of 13 Members—




And I am wondering where the other 602 are. A scheme is being put before the House which ought to have the consideration of all concerned. I am rather inclined to think that, if the contributors to this scheme could see how they are being dealt with and could see the interest that is taken in a Bill which affects 17,000,000 insured persons, their interest and their support of this House, with its traditions and its great National Government, would go by the board. I am interested in the scheme which has been presented. We are dealing with a Bill proposed by the Ministry of Health. I have always understood that the term "Ministry of Health" meant that they were primarily interested in the general well-being of the health of the community, and especially of its insured persons. But the whole case which is being made out here to-day for reducing the benefits to insured persons who are ill is that they have to balance the Budget in connection with the Insurance Fund.

We have been told that we must put the insurance scheme upon a sound, actuarial basis. Since I came to this House two years ago I have heard, in season and out of season, the words "placing the fund, or the insurance, either unemployment or health, upon a sound, actuarial basis." I understand that the lesson which we have to learn from the piling up of a huge deficit upon the unemployment side is that we must be very careful with the Health Insurance Fund and must draw in the reins and cut down benefits at the outset. The people who are affected by the Bill are not ill because they desire to be ill. They are ill because of certain diseases which affect the human being. People do not wish either to lie in bed, or to malinger upon the fund for the sake of the scanty amount which they receive as a result of being ill. I believe that in London I could go carrying packages at the railway stations for a couple of hours during the day and almost obtain as much as is paid out of the Insurance Fund to any individual for a week.

Here we have a problem, where, as the national position, industrially and economically, becomes worse, we have to go round to all the poorest sections of the community and say, "The fund is insolvent, and because this old system of ours will not work as we should like it to work, you who are at the bottom of the social ladder are to be the very first to be attacked and have your standards reduced." If the system gradually goes into a state of collapse and creeping paralysis passes over industry, are we always going to the fellow at the bottom and say, "Another bob is to be lopped off you"? We do not think about going to the men at the top. We always go to the poor man at the bottom who cannot get a decent meal or a suit of clothes, or who is being ejected from his house, and ask him to make the sacrifices. We are told that there are two or three ways of making the fund solvent—increasing the contributions, or decreasing the benefit, or the State making up the difference. Why should not the State make up the deficit in order to give to the people the allowances they are entitled to receive? If I understand humanity and morality, it is that the strong should keep the weak, and not that the weak should always be bearing burdens which should be borne by those at the top and be going further down into the depths of poverty and distress.

8.30 p.m.

On the other hand, it has been said in effect that there has been a conspiracy between the medical profession and those who have been drawing from the Insurance Fund so that the latter should get something out of the fund to which they were not entitled. If that were true—I do not believe that it is true—it would mean that the nearer the present system of society came to collapse and the greater the economic difficulties, the more those at the bottom would be driven to attempt other methods in order to safeguard their loaf of bread, or margarine or poor standard of life. It would mean that your system, as it gradually approached collapse, would throw up people with a criminal mind and intention, and you would be driving them to other than honest methods in order to get a livelihood. I think that that is a very fair statement of what is meant when any person says that those people are attempting to get benefits to which they are not entitled.

To suggest that the medical profession in this country are going to certify people as being ill when they are not ill is one of the gravest charges that could be made on the Floor of this House. There has not been any evidence submitted in the House to-day to show that such a condition of things exists. If I made across the Floor of the House a charge of dishonesty against any hon. Member in the House, I should be asked to withdraw, and, I suppose, rightly so, according to the ordinary decencies of the House. But hon. Members are permitted continually in this House to attack millions of human beings outside who cannot be here to defend themselves, and to charge what I believe to be an honoured profession with dishonest tactics and methods in dealing with a great State fund. I believe that when the suggestion was made here that the medical profession and a large number of insured persons were engaged in a conspiracy to defraud the State or the fund, it was done with a deliberate intention. That is what I read into it.

We were told by the Minister that a circular was sent out by the late Minister of Health suggesting that there should be a more careful examination and certification of those who were applying for benefit, and, realising that there was likely to be a charge made that the Ministry of Health under the late Labour Government were equally responsible for suggesting the cutting off of people from benefit, an attempt was made to attack the insured persons and the medical profession in order to defend the Ministry in the late Labour Government. That is my reading of the situation. I resent it entirely. I have been in contact with hundreds of human beings who were ill and drawing from the fund, and I can say that the amount they received from the fund was insufficient to meet their ordinary needs, and they were compelled to go to the ordinary Poor Law in order to get the balance made up, enabling them to keep their home and have the ordinary securities of life. Meagre as is the amount which is given at the moment, it is suggested that there shall be a further cutting down of the miserable pittance at a time when we are told that there is a great national emergency.

I listened to the right hon. Member for Epping (Mr. Churchill) last week. I think he said that he was never satisfied that there was such a national emergency as the Government made out. He said that he thought it was greatly exaggerated, and I do not think the emergency exists yet. Nevertheless, the plea has been continually put forward that there is an emergency and that we have to economise under this Bill. It is also suggested that we must economise all round. I do not possess the great governing capacity or the great brain power that is claimed for the Government bench but I could suggest numerous methods of dealing with this national emergency, if there is an emergency in existence, so that the standards of life of the poor people shall be safeguarded and we shall not disturb the social system upon which this nation and the world is built.

I came into the House last night during the tariff Debate on the Finance Bill. The House was packed with hon. Members. They were all, as they put it in Australia "looking for their share of the cut." They were all gathered round like wolves, looking for their share of the swag that was going to ensue from the tariffs. But when we are dealing with 17,000,000 insured persons, we get a miserable House of something like 12 or 13 persons. If we had ordinary rules governing this House it would be in order to adjourn the House completely, because people are not paying any attention or taking any interest in the Bill. I am not satisfied as a Socialist that there is any need for a contributory scheme. I believe that the medical profession ought to be run by the State and that when a person is ill, after having given service to the State, that person should be treated as any citizen ought to be treated who has ordinary needs. People need food, clothing and shelter and they should get that from society, just as a Cabinet Member gets it or as any person in society gets it, who does a great deal less service than the ordinary man whose position we are discussing in connection with this scheme.

We are told that there are periodical valuations, that we find out how things are going on and then we decide what benefits are to be paid. The Minister told us that we have paid out £434,000,000 in 10 years, that it has been distributed through 7,600 approved societies and that for the first 10 years surpluses were made. In addition, £21,000,000 were paid out in benefit during those 10 years. I expect that the additional benefits were given in the shape of teeth and spectacles by the different societies. Some societies paid a little higher than others and competed for the insured person, just as one hon. Member suggested that doctors compete. He suggested that doctors were going round tapping at the doors and looking for insured people to go to them, and in that way stealing from other medical men in the area. I can hardly believe that such a state of things exists, that the honoured medical profession are going round tapping at doors and looking for persons to insure with them. I suppose the next thing that will be said will be that they are paying people to go out and canvass for them and giving them a dividend on the number of persons they get; a sort of payment by results.

We are told that these valuations have been made from time to time and that fairly good surpluses were shown. I think the Government Actuary said: Existing surpluses provide a temporary bulwark and serious deficiencies must be looked for. I am prepared to accept the view that that is the state of things and that serious deficiencies must be looked for. We are told that we should make this a contributory scheme and that people should only get that which they pay for. It would not be so bad in life if everybody got exactly what they pay for. A large number of the supporters of the National Government would go hungry to bed at night if that system prevailed. It is further said that the payment of better benefits was a method of reducing the surplus, that 6,250,000 received decreased benefit and that 1,250,000 were cut off altogether.

We are told that the health of the community is becoming better. If the health of the community is becoming better, the insolvency of the fund must be due to some other factor than that which has been stated. The hon. Member for the Scotland Division of Liverpool (Mr. Logan) said that it was in the distressed areas where the greatest decrease took place in contributions, and that that was one of the main factors contributing to the insolvency of the fund. One can readily understand that in the depressed areas, mining, cotton and shipbuilding, where there is so much unemployment and where the unemployment is steadily on the increase a very large sum of money will have been denied to the fund. If there is so much unemployment, surely the people who are ill are not responsible. I suggest seriously that the Minister of Health should not be discussing only the solvency or insolvency of the fund. The fund might be solvent and people not getting that to which they are entitled. The fund might be insolvent and the health of the people might be requiring greater protection than it is getting.

We may have to change the name of the Department of Health for Scotland and the Department of Health for England. Instead of a Ministry of Health we may have to call it a Ministry of Death. If we are continually reducing the standards of life of the people we are bound to have serious results. We do hot escape the result of a policy of that description. It simply means throwing on to the local rates in the form of ill-health the people who are not being properly treated. It means sending them into institutions where, as is the case in an institution in Glasgow, it costs three guineas a week from national and local funds to keep a patient. Yet we are grudging paying a few shillings to people. They cannot be maintained on a few shillings. We are always hearing the threadbare argument about putting the fund on a proper actuarial basis. We are putting people on their backs and into their graves as a means of putting the fund on to a proper actuarial basis. If the fund is insolvent through unemployment I could conceive the scheme not paying more than 2s. 6d. a week to people who are ill. If not more than 2s. 6d. per week could be paid, are hon. Members going to suggest that people should be cut down to that standard in order to make the fund solvent?

I am sick to death of hearing of the insolvency and bankruptcy of these various funds. Hon. Members are always trying to make the outside public believe that something else is responsible rather than a decaying system of society which is continually throwing up these problems. Hon. Members may disagree, but any intelligent person will realise that we are dealing with the effects of a bankrupt capitalist system, and things may become a great deal worse. They are always buoying themselves up with the old story that the tide will turn. I have heard this said since 1918, by every so-called great statesman in the land. They are always telling us about the bright light appearing over the hill, the depression passing away, the dawn of a new era, the old ship of State coming safely into harbour, and prosperity around the corner. All these statements have been made over and over again, and when they ask for still further sacrifices from the common people the tale is always spun that it will be all right when days are more prosperous. There will be no prosperous days under the present order. It is going to inflict great sufferings on the people, and in the end will throw up worse problems than those which we have to face now.

We entirely disagree with the present method of dealing with National Health. We think that every human being has a right to be treated if he is ill; that he has every right to be catered for by the State. The great medical profession, instead of haggling, should be under the control of the State. Every person should be able to send for a medical man when he is ill without considering the cost; perhaps dying because he cannot afford the amount. The condition of the people is very bad at the moment and the worry of unemployment and the hardships of the home are bound to increase the number of married women who will come under the scope of the Bill. In connection with lunacy we were told that seven cases out of 10 of people mentally deranged since the War were due to economic causes; and the same is true of the women who are coming under this scheme. It is a question of household worry, of making ends meet, the insufficiency of food. We protest against their being made the butt of attacks in this House. We are here to defend people who are suffering because of a system of society which is entirely out of date and which outrages all common decency. The sooner a complete collapse comes the better. We shall welcome it, because it will open an opportunity for the people to receive common justice.


The Minister of Health did not state in his opening speech that he had actuarial sanction for that part of the Bill which deals with the insured person who continues in insurance, in the matter of old age pensions and other benefit, a part of the Bill with which I entirely agree, but I assume that he had in fact actuarial sanction for this part as well as for that relating to married and single women. If that is so I can tell hon. Members that they cannot have a better or more reliable adviser than Sir Alfred Watson, and I readily accept the Bill as it stands. Except on one small matter. It seems to me an insecure basis to tell any approved society that if they run into bankruptcy, by reason of the unemployment of their members, they have a call on a general reserve fund in preference to their own reserve. A more extravagant form of management I cannot possibly imagine. I was a little surprised that the hon. Member for the English Universities (Miss Rathbone) justified the proposal that the claims of married women should not be altered on the ground that men should bear them. From the beginning of national insurance the contributions paid by women have been on a different scale to those of men, and so have the scale of benefits paid to each. As it has been discovered that the contributions do not bear a fair proportion to the benefits paid to married women it is obvious, if it is to be an insurance scheme, that either the contributions or the benefits must be altered.

The point upon which I desire to address the House, however, is this. There has been no mention by anyone, from the Minister downwards, of the administration of approved societies. I am by no means satisfied that the present position might not have been avoided or the financial position of approved societies put right by better administration. I speak now as a rural Member with the experience I have as the chief officer of a rural society, whose members for the most part are lowly paid people. We pay the very best benefits that are paid by any society in the country. We pay a cash benefit, a medical benefit of 22s. 6d., a disablement benefit of 11s. 3d., a maternity benefit of £2 15s. We pay the whole of the eye doctor's bill, and the whole of the dental bill, whatever appliances are ordered. We pay the whole cost of any surgical or medical appliances which may be ordered, and the full cost, including railway fares, of any member who has to go to a hospital or convalescent home. We pay a number of other smaller benefits which I will not mention and, in addition, we return the whole of the contributions except one-half-penny per week.

In fact we do better than the right hon. Member for Carnarvon Boroughs (Mr. Lloyd George), for instead of giving 9d. for 4d. we provide 9d. for ½d. I will not mention the name of the society because I do not want to advertise it, but if by careful administration these results can be brought about in a truly rural district, how is it that all over the industrial areas of the country the position is different? How is it that we are told by the Minister that unless something is done the whole system of National Health Insurance will be bankrupt, and that to-day not only have the extra benefits disappeared, but that even there is difficulty in paying the smaller benefits? I would have liked to have heard something from the Minister or from some official source as to how the big societies are being administered when the results are so different from what is taking place in the case of rural districts. I wonder whether any information is in the possession of the Ministry showing what has been the effect of paying benefit for the first three days. One hears rumours and stories, how members of approved societies in town wish to take a holiday, a long week-end of four or five days, and a complacent doctor—I hardly dare mention a doctor—does not take very much trouble, and the members go on benefit for these week-ends. That is the story that we hear. I wonder very much whether that benefit, which I always mistrusted, has not been abused, and whether there has not been laxity in this administration.


This is a matter of interest to the medical profession. Will the hon. and learned Gentleman translate the stories of what he hears into how he hears it and from whom? The medical profession will then be greatly indebted to him.


I only hear it. Numbers of people tell me so, but otherwise I am not prepared to justify it. I was asking for information, whether there were any statistics upon it. I wish also to ask whether it would not be advis- able to alter the system of the relationship of the panel doctor and his insured patients. At present, I understand, no notice has to be given of any change. Can a doctor be more secured in his position by having a two months' or three months' or four months' notice given by the patient before the patient changes his doctor?


The patient has to give notice now.


I understand not.


Very brief notice.

9.0 p.m.


The doctor is put into an impossible position, where his duty conflicts with his interest. No judicial officer is allowed to be placed in such a position in the administration of justice. What happens now is that the panel doctor is the medical man of the head of a family, and he has, as a rule, the wife and children of the family as his private patients. He is presented with an application to sign a certificate that a panel patient is ill and wants to go away. He is put in the position that if he refuses he runs the risk of at once having an application made, in the heat of the moment, for a change of the patient's medical adviser, and if that takes place the dotcor loses the whole household as his patients. That is a position which is not fair to the doctor and not fair to the system, and it ought to be altered. On broad public grounds, making no suggestion that the doctor does not try to do his best in a very difficult position, I say it is a position in which he ought not to be placed.

I welcome this Bill in so far as it is necessary, because no one recognises more than I do title enormous advantage to society of many of the benefits conferred by National Health Insurance. I have taken an active part in their administration ever since the Act was passed, and I shall be only too glad to see them on a perfectly solvent basis, and to see everyone in the position that my society is in, of being able to give every additional benefit that the Act provides.


The hon. Member for Shettleston (Mr. McGovern) commented on the fact that there were only 13 Members present during his speech. I said that they were unlucky, and the longer he spoke the more certain I was that my remark was well founded. I have listened to the speeches on this Bill with great interest. I want to take exception to one phrase that the Minister used, and that was his reference to "increased contributions." I always understood that a contribution was a voluntary payment. These are not contributions to this fund; they are compulsory exactions; they are levies, like taxes. It is a misuse of language to call them contributions. What the insured person has to pay, what is deducted from his wages willy nilly, is not a contribution. That is what is at the bottom of the failure of the National Health Insurance Act. I get very tired when I hear Members of this House, medical or otherwise, talk about the great National Health Insurance Act. There is no more unpopular Act amongst the mass of the people, and no one more heartily dislikes it than they do. No statesman could make himself more popular than by reducing the whole thing to ashes and doing away with it. But there are the vested interests that have grown up, numerous officials who make a living out of it, and the vast mass of doctors who have been reduced from a profession to becoming tax collectors, a brotherhood of Zaccheus. They do nothing but collect and fill up forms, and are insulted by committees of laymen, and surcharged if they give patients medicines that are a little expensive.

The whole thing is bound to be unsound because it is founded on the essential fallacy that if you have £5 a week or less you are such a fool that you cannot look after your health by consulting a doctor, and you are too dishonest to pay him. That is the basis of the National Health Insurance Act. That is the fallacy on which it is founded. We all know people who have £5 an hour but who are very foolish, unscrupulous and nasty persons and we know others who have 30s. a week and who are very intelligent and are people of the highest character. Imagine what feeling there would be on our side if the Government said to everybody who was paying Income Tax on a large salary, "We propose to deduct £200 or £300 a year from you in order to pay your doctor and you will take one from a panel." Why, there would be a Fascist revolution against it at once. Yet we inflict that sort of thing on the poor working man under this National Health Insurance Act. This scheme was made in Germany because Bismarck wanted to placate Lassale the Socialist and he held the old Greek conception of Aristotle, the basis of a slave civilisation, namely, that mankind were divided into two classes, namely, those who thought and ruled and those who had no right to say anything but had to take whatever was given to them.

It may have suited the servile Germans. But the whole thing is totally antipathetic to the spirit of our people. It is against all the ideas of liberty-loving British people. You cannot found a moral system on a compulsory basis. People naturally make up their minds when they are compelled to pay their money that they are going to get their money back if possible. They say, "We were never consulted about paying our money and we want to get it out." People do not understand insurance, especially the women. A great many of them are like the woman who was left a little house property and was told that she ought to insure it against fire. She asked the agent, "Does it make any difference if you set fire to it yourself?" The agent said, "Of course it does; you will be put in gaol for that." Whereupon she said, "Then I will not insure; I knew there was some trick in it." That is the position of the women in regard to this insurance and it is the married women who are getting the most money out of it, because they are the most artful. That is why they are married. But even the women who have been left on the shelf are more artful than the men and are getting more out of the scheme than the men. It is all farcical in the extreme.

The hon. Member for Westhoughton (Mr. Rhys Davies) found fault with the medical profession but he had not the courage to boldly affirm what he knew to foe the facts. Then we had the hon. Member for Bridgeton. (Mr. Maxton) and the hon. Member for Shettleston defending the medical profession. As I have already said, the medical profession has been largely degraded by the position into which its members have been put by this abominable Act. A different breed of men has come into the profession and doctors themselves or most of them will tell you how they detest it. A doctor friend of mine in Edinburgh told me that he was getting £1,500 a year for a few working men waiting in his consulting room in the evenings. He said he got £75 a quarter from people who were too indignant to nominate a doctor and whom he therefore did not attend, and he felt as if he was getting money under false pretences. I asked him why he did not "chuck it" and his reply was that if he did, some other fellow would get it; that it helped to pay for his car and household expenses and enabled him to build up a West End practice on the backs of the poor. That is what the National Health Insurance Act is doing. Another medical friend of mine who had a practice in the slums said to me when I was denouncing the Act nearly 20 years ago, "Do not be too hard on it. Formerly I could not make £300 a year; now I am making £1,500 a year." I said "Yes, out of the poorest of the poor. You ought to be ashamed of yourself."

It is all nonsense to talk about the Act protecting the people's health. An hon. Member sitting below me, who belongs to the medical profession I take it, judging by the indignation which he displayed in reference to a remark by the hon. and learned Member for East Grin-stead (Sir H. Cautley), asked for instances. I will give him instances. To begin with a substantial percentage of doctors practically wiped their boots on the panel patients when it was impossible for the patient to change his doctor. When the patients got some liberty and got the chance of changing their doctor, there was the inevitable result of competition for patients. I do not blame the doctors. They are only human beings, a little lower than the angels, just like ourselves, and if I were put in the position of having to compete with other doctors to get 10s. a year each from several thousand people, I would naturally look after myself, though I might curse the Government which had put me in that position.

I remember the case of a man who came to my own house to do some upholstering. He was a man who worked singlehanded. I always employ such a man because I have no use for your combines and big shops. I know that the free man working for himself will do a conscientious job. He was complaining bitterly to me of all the contributions which he had paid into the National Health Insurance scheme as an employé to a big firm and said that they were all lost. He said, "I called on a doctor the other day, and he was very rude to me. He could not pass me out quickly enough, and almost pushed me out of the door. I asked him what I owed him, and he said, 'Are you not one of my panel patients?' I said 'No,' and he said, 'I beg your pardon,' and shook me by the hand and dragged me back and examined me carefully." That is the result of the National Health Insurance Act. If I were being paid 10s. a year by several thousand people for giving them legal advice, they would get it, but it would be very quickly given. I would not spend much time in going through law reports. I would be too busy looking after the other clients who could afford to pay me guineas. I make that frank confession, and I say that that is what every man in this House would do, and the man who says he would not do so is the man that I would be most careful to watch.


The hon. and learned Member knows that he has made a speech here in praise of those who act as "Poor man's lawyers" in Glasgow, and I think he himself has given poor people legal advice without any payment at all.


Yes, but when we won our cases, we got damages from the other side. There was always a sporting chance. But I will give another instance to my medical friend below me to show how this system is bound to have a demoralising effect. In a certain district a member of the education authority told me that the school cleaner, who was a man, had had a letter from a doctor newly settled there, suggesting that he should give up that post and arrange to have his wife appointed in his place. He also wrote to this member of the school committee asking him to arrange (hat the man's wife should take the job, and the reason given was because the wife was a very delicate woman and the doctor could give her a certificate enabling her frequently to go on to the National Health Insurance. These are actual cases, and, with weak human nature, it is inevitable that such cases should arise. When patients have the right to change their doctor, pretty well as they choose, that kind of thing is inevitable.

It is not so long ago since a letter appeared in the "Daily Telegraph" from a young practitioner describing how he had bought a country practise with a number of panel patients. In one little village there were 12 panel patients. On the first day he was there a man called on him to get a "line" to enable him to draw on the fund. It struck him that there was not much wrong with the man. He came to the conclusion that the man was perfectly well or at any rate as well as any of us are, because I suppose most of us are not perfectly well. He did not think the man was ill enough to give him a "line," so he sent him to the referee doctor, who still maintains some of his independence, which the panel doctor has lost. The referee doctor confirmed that the man was not entitled to a "line," and the result was that the panel doctor lost 10 out of his 12 panel patients in that village within a week. There could not be any other result; it was inevitable.

This is not a National Health Insurance Bill at all. The British working man is satisfied of this, that all your so-called social services are costing 5s. or 10s. a week out of his pocket, money that he could spend much better for himself. After the first few years the whole of the beneficiaries are completely forgotten, and the thing is run almost entirely for the benefit of those who are administering it. All this sort of legislation is based on the false principle that the British working man is a pauper and that you need to bribe him to get his vote, which all the politicians have done.

My view is that the British working man is a gentleman, that he hates all these eleemosynary services and wishes to get rid of them, and the politician who will get his vote is the man who will have the courage to do it for him and clean up these matters. The ordinary man-in-the-street does not understand what the politicians mean. A woman wrote to me a little while ago, saying: "I do not understand what you politicians mean. Why should a woman get money for burying her husband whom she may have worried into his grave? There is no. reason why, unless she is in dire need. Here am I, a poor, lone, delicate spinster, who has never had the joys of matrimony in any shape or form, and Mrs. Brown next door, a big, strong woman with four strong sons and four lodgers, gets a pension! Are you politicians all mad?" I wrote back and said that they all were, except myself.

The hon. Member for Westhoughton said that the panel doctors are not satisfactory, but he went one worse, and said that therefore we must have a State medical service and State doctors. God help the patients if we do that! Panel doctors may chastise with whips, but State doctors would chastise with scorpions. They would be like Income Tax collectors, and do you think it is possible to make medical men out of such people? Do you think they would have that rare and delicate relationship which there used to be between the family doctor and the poorest of the poor? I knew a doctor in a country area who is a splendid fellow. In fact, I got him to come to London, because he was too good for the district he was in, but he would never render a bill to anyone. He took what they gave him. I had to send him a case of whiskey and a box of cigars at Christmastime to clear my conscience, because his bills to me were so ridiculously modest. All that sort of thing has been killed out by the commercialising of a noble profession. There was never a worse turn done than the passing of the Act of 1911. It was a quack Measure, introduced by a quack politician, and unfortunately it is still quacking on.


I have listened with the greatest disappointment to the speech of the hon. and learned Member for Argyll (Mr. Macquisten). I have sat and watched him for the past two hours waiting to catch Mr. Speaker's eye, and I thought he was going to make a great pronouncement. As the leader of the new party, holding strong views on the Supreme Court (New Procedure) Rules, 1932, I thought he was going to back up the hon. Member for Bridgeton (Mr. Maxton) and the hon. Member for Shettleston (Mr. McGovern), but he delivered a speech that ought to have been delivered when the National Health Insur- ance Act, 1911, was passing through this House. Most of what he said would have been very appropriate then, but is hardly appropriate to-day. My complaint against the hon. and learned Member is that his speech had very little to do with the Bill now before the House. He delights us with his stories, but he charms us mostly by his irrelevance, and we have had a typical speech from him this evening.

The problem with which we are faced to-day is part of a very much larger problem than appears in the Bill. It is part of the general problem of poverty. If we lived in the kind of society that the hon. and learned Member visualises, where everybody does what he likes and sends cases of whiskey and boxes of cigars to his friends at Christmas time, and nobody charges anything for services rendered, it might be possible to do without a scheme of this kind. But because, as a matter of fact, poverty does afflict the people of this country, we have tried to deal with it in various ways, and the National Health Insurance scheme happens to be one of the ways which we have devised to deal with the problem of poverty. The National Health Insurance Act, 1911, when it reached the Statute Book was perhaps the most unworkable Statute ever passed by Parliament, due very largely to conflicts between vested interests and to the desire of the Prime Minister to get a Bill of some kind.

It has been made to work, very largely by the genius of the Civil Service, who have administered what left the Houses of Parliament as a quite impossible piece of legislation, and we have now for 20 years made national health insurance a scheme which can be carried out. It has worked in normal times, but now the trouble is that we are not living in normal times—the fact that there are so many hon. Members sitting opposite is proof of that—and the National Health Insurance scheme is breaking down now, not because of inherent weaknesses in the scheme, but for two other reasons. In the first place, I think its foundations are being shattered because of the aftereffects of the War. I have not time to go into that, but it is clear that since the War changes have taken place, and the National Health Insurance scheme has not escaped the effects of those changes. In the second place, it is breaking down because of a long period of trade depression. The National Health Insurance scheme was never devised to deal with a period of more than a decade of serious unemployment.

The Minister this evening said that the blow had fallen this year, but the truth is, of course, that the blow has been falling for several years. This is not a new crisis. The crisis through which we are passing is one which has been with us for many years, and the present Government exists because there is a crisis, a crisis which is exceptional in its character, a crisis which resulted in welding together the most diverse political forces. So serious was this crisis, that political considerations had to be set aside. Then, in the face of this great world crisis, the National Health Insurance scheme is the one on which the blow falls. Why should this scheme have to bear the burden of a crisis of this kind? It was never devised—no scheme ever is—to be able to meet exceptional circumstances. Legislation is passed, for the most part, to deal with normal situations. We are to-day in an abnormal situation, so abnormal that now that I am back in this House I can realise how abnormal it is when I see hon. Members opposite. You cannot expect a piece of legislation, passed in ampler and more leisurely days than this, to weather the storm of a post-War period and expect it to come through unscathed. When the right hon. Gentleman says the blow has fallen this year, I say the situation has been developing through a long period of trade depression, and that because of the urgency of the crisis of last year it has fallen to the present Government to deal with it on lines which are most unfair to insured persons.

I am not going to deny the existence of the problem which has brought this Bill before the House. After all, there are documents which were published during my term of office in which we pointed out the facts of the situation. There is no denying the fact that sickness claims have increased among women within recent years. Nobody could get up in this House and say that that was not the case, but it is not so easy to ascertain the reasons. I know there are people, such as the hon. and learned Member for Argyll, who think otherwise. I am sorry the hon. and learned Member has left his place. He comes from a part of Britain where, I thought, they had a high opinion of human nature, but what he said seemed to lead one to believe that the people with whom he associates are not people who are nice. I think that it is very difficult to ascribe reasons for this increase in the claims among married women. I am satisfied of this, however, that the long drawn-out trade depression is one of the most important reasons, because it is clear that where there is unemployment, and where the family income is restricted and less money is going into the home, there is likely to be more sickness. It is true, also, that if anybody goes short when income is reduced, it is the housewife herself, and it would not therefore be surprising if during a period of this kind—a period of 10 years of abnormally high unemployment—the claims for benefit among women, and especially married women, did increase.

Lieut-Colonel FREMANTLE

Does the right hon. Gentleman really think there is any sign of increased sickness on which to base his argument?


I think it has been admitted as a factor in this situation.

Lieut-Colonel FREMANTLE

Not the death rate.

9.30 p.m.


There is all the difference in the world between the death rate and the sickness rate, but I have not finished yet with this question of unemployment. In a family where the wage-earner is unemployed, it is not surprising, if the woman who is sick, and who would have carried on if the father had been working, did go to the panel doctor. Further, I put as a very important factor in the decrease of claims among women the results of the propaganda which has been going on in recent years and in which the hon. and gallant Member for St. Albans (Lieut.-Colonel Fremantle) has himself taken part. We have been preaching now for a generation that prevention is better than cure, and that early treatment is better than late treatment. We have been urging pople to go to the doctor as soon as there is anything wrong with them in order that they might avoid more serious consequences later on. It is undoubtedly true to-day—and it is a Very good thing from the national point of view—that people are going to the doctor when they would not have done so in the old days, or are going earlier than they would otherwise have done.

Coming to the third cause, it may be, as a result of one of the unfortunate effects of the aftermath of the War, that there may be laxity. That laxity is not confined to any class of the community. It is undoubtedly there. I was astonished to hear hon. Members below the Gangway getting up in defence of the doctors this afternoon. Their case has been argued with tremendous enthusiasm, but with very little knowledge of the subject. They act as though they were friends of every class but their own. The hon. Member for Westhoughton (Mr. R. Davies) never made any general charge either against the doctors or against the married women, but it is undoubtedly true that in every scheme you will get people who will, as far as they can, exploit the opportunities that are open to them. That is not a new thing. I am not suggesting that doctors are acting dishonestly or that married women are trying improperly to obtain benefits under the National Health Insurance scheme, but it is undoubtedly true that there are cases of lax certification by doctors and a desire on the part of insured persons to get something to which they are not entitled. So far as I am concerned—I said it when I was on that side of the House, and I say it again here—I could not myself ever agree to persons obtaining benefits unfairly under any scheme.

What is the solution which the right hon. Gentleman put forward? He has told us, as a justification for what he has done, that the approved societies have approved his policy. Naturally they want their problem dealt with, and it is a serious problem from their point of view, but, of course, they know the kind of Government we have got to-day. They know the attitude that this Government will take towards this problem, and, as long as their problem is settled, they do not mind. That is perfectly natural and perfectly proper. But they knew perfectly well when they were faced with the position this year that there was little point in going to this Government and expecting any financial relief. I do not think, therefore, that the right hon. Gentleman can claim that he has the whole-hearted support of the approved societies. He has got what I suppose he expected to get, their approval to proposals which would meet their immediate difficulties.

The Minister asked what the appropriate remedy was. He said that we must either increase contributions or decrease benefits; there was no other way. He said that increased contributions were out of the question, and he accepted reduced benefits. There is no case whatever for penalising either married or single women. If it be true that there are married women who are improperely obtaining benefits, it is no way to deal with them to make an all round cut in the benefits to married women. If it be true that there is a problem regarding single women, it is not a fair way to deal with them by cutting the disablement benefit of single women as a class. Nor is there any case for depriving the unemployed of their pension rights. The right hon. Gentleman has admitted the case. He knows in his heart that the National Health Insurance scheme has a value to working people which it never had before because of the pensions which are attached to it. I have often worried myself about the reduced rates of benefit for unemployed persons; it does not save them from the Poor Law. I do not attach too much importance to that, however; what I do attach importance to is that the unemployed person should have his rights to pension or the rights of his widow to a pension safeguarded. I hope that the House will realise that the public would wish that to be so.

We have now had for two or three years this long-drawn-out process of slow murder: they are not to be thrown off now, but they are to be thrown off in time. The House should recognise that that is not in accordance with public opinion. In 1929 I was able to prolong it by regulations and in 1930 by legislation. It was prolonged again last year by legislation. It is quite clear that the unemployed, because of their unemployment, ought never to be deprived of security in old age or of a measure of security for their widows. The Minister has more or less admitted the case in the rather timid provision that he has made. I do not believe that the reduced benefits are justified. A good deal might have been done by administrative action. I was not the author of the National Health Insurance scheme. If I had had to deal with it, it would have been a far different scheme because I do not believe that the present scheme is the way in. which to deal with the problem of public health. The point is that the scheme is there; it is embedded in our national life, and we must take it for what it is worth. So far as I am concerned, I should be prepared to see it properly administered. Let it be administered properly. If there are people anywhere who are obtaining benefits to which they are not entitled under the scheme—I am not saying that they are not entitled to help from the community in other ways—let them be turned out of the scheme, though that does not in any way absolve the community from its responsibility.

Something is being done. Something was inaugurated during my period of office to deal with the problem. Indeed, a reduction of sickness claims is being anticipated because of the improved administration which we inaugurated when the late Government were in office. For his recognition of that, I make my acknowledgments to the right hon. Gentleman. But there is another way. Reference has been made to the right hon. Gentleman the Member for Epping, who is the great robber of hen roosts since the War, because of the raid that he made on the fund and the reduction which followed in the State contribution to National Health Insurance. I do not say that had that £2,750,000 still continued to be paid in, it would have obviated the present situation, but I do say, though I have my own views as to how that money might be used, that if the Government are faced with the serious decision, in a time like this of prolonged unemployment, of reducing benefits in one class of insured persons, they might at least have got from the Treasury some of that £2,750,000 a year which was filched from the fund by the right hon. Member for Epping (Mr. Churchill). It is along those lines that I think the Government should have gone.

The Minister spoke about a financial adjustment and said that there will be just as much money in the scheme as before, but that it is a matter of bookkeeping. It is all right for the fund, but it is not all right for a considerable number of insured persons who are not "swinging the lead," but who are going to be deprived of benefit to which hitherto they have been entitled. Whatever you can do by book-keeping, you can never avoid having to pay the bill, and if you cut down the benefits of these women, if their ailments are not dealt with, and if they are driven on to the local rates—and the half-crown might make all the difference—you take it off the back of the national Exchequer. The nation, however, has not saved anything. Indeed, it might be argued that nationally there is a considerable loss. I suggest that it would be wiser for the Government to say, "We will try and make this a scheme which is Being fairly used by the people who are entitled to benefit, but we will find, if it is necessary, a little further assistance rather than inflict this new insult on the people who are down and out."

This must stand in the same category as the reduction of unemployment insurance benefit. If we were really hard pressed as a nation I should not complain of a reduction of benefits all round. I have never thought we should be worse off if we were all poor together; but the trouble is that we are not all poor together; and it is a little mean for a great nation like this, even if it passing through a time of economic difficulty, to filch half-a-crown from the pockets of married women, honest industrial workers, in a time of sickness. It does not seem to me that that is consonant with the dignity of this House. This House has done some very bad things in its time—I have witnessed some of them myself, as a victim—but I thought that it rose to a very high level for a short time yesterday when the Lord President of the Council and my right hon. Friend the Member for Bow and Bromley (Mr. Lansbury) put aside everything but simple human interest. There was no spark of party politics for 10 minutes yesterday afternoon. It would be good if the House could pay as much attention, with the same human interest, to the people who will be smitten by this Bill. I am satisfied that the Government will not do a good day's work for itself in pressing this solution of the present difficulty. After all, it is a very small difficulty, relatively, and if the Government cannot meet these minor difficulties in any better way than by a further impoverishment of the poor, what hope is there that they will surmount the larger difficulties?

My own view is that this Government cannot surmount the larger difficulties, and to-day they are showing their pettiness of mind in dealing with what is a relatively small national problem in this very petty and narrow way. We shall vote against the Second Reading of this Bill, because we regard it as a further offence, as a further insult, as another instance of the unfairness of this Government. We can utilise our national resources to help national institutions which provide incomes for the well-to-do, we can even mobilise credit to the extent of £150,000,000 for that purpose, but when it comes to a mere handful of people who, in the hour of sickness, look to the community to help them, then they are to be deprived of something which they have enjoyed. I am sorry this Bill has been introduced. My hon. Friends and I will vote against it with a clear conscience. We know we cannot defeat the Bill; but I must utter this word of warning—the Government will be sorry that they ever introduced it.


This has been a remarkable Debate. In my time in the House I do not recall a more remarkable one. We have to answer an Amendment for the rejection of this Bill. My trouble in replying to the Debate is to find the reasons why there should have been such an Amendment. I think it is fair to say that the only Member who made a speech relevant to the rejection of this Bill or any insurance Bill of any kind was my hon. and learned Friend the Member for Argyllshire (Mr. Macquisten). When I looked at the Order Paper and saw the six names attached to the Amendment I wondered whether, on paper, Wakefield and Gorbals had met together and Bridgeton and Westhoughton had kissed each other. On the Paper three hon. Members from above the Gangway and three from below the Gangway have joined together in an Amendment for the rejection of the Bill, but those who have followed the Debate will have noticed that there is no agreement as to the reasons for so drastic a course. Members will not have overlooked the fact that this is no reasoned Amendment; it is a bald negative. No reasons are set down for careful consideration, as careful consideration as has been given by the Minister and the Government to the Bill; it is a bald negation. I thought the hon. Member for the Scotland Division of Liverpool (Mr. Logan) showed great innocence. He seemed to think, being an administrator of an approved society, and rather anxious about the society, that the Amendment would not kill the Bill but only put it off for six months. I can disabuse him of that idea. The Amendment is the Parliamentary form not for putting off the Bill for six months but for killing the Bill, or any Bill like it, in this Session of Parliament.

We are glad to see the right hon. Member for Wakefield (Mr. Greenwood) back and to hear him speaking on these proposals, but what does he say? He says that there is a case in that the facts are grave, and he rightly says that he himself took steps, by the issue of a. memorandum to medical men and a circular to approved societies, to see whether certification could not be tightened up. He refers the whole problem to three things—to the trade depression, to the propaganda in favour of an earlier application to medical men in times of sickness, and, thirdly, and very tentatively, to laxity. But his trouble is this, that when he comes down to his real argument it is the same plea as is put up from below the Gangway, though not in the same terms. In the last parallel he drew, the parallel between the moving episode yesterday and the Bill to-day, surely he cannot be ignorant of the fact that yesterday was an occasion on which pure sentiment was the real medium, and the only possible medium, for the expression of any man's feelings or any public body's feelings about a great event. It is true that sentiment enters into this problem, but sentiment is not the only thing, and, moreover, there are opposing sentiments concerning this problem. The sentiments expressed are based on two opposing conceptions. I do not seek to underestimate sentiment, and I will say a word or two in a moment about the speech of the hon. Member for Bridgeton (Mr. Maxton). I have always agreed with Wendell Phillips that sentiment is the toughest thing in the world, and that nothing else is iron, but there are spheres in which sentiment can affect nothing. There are cases where sentiment can effect nothing, and, on the other hand, there are occasions when sentiment may have a directly opposite effect. To vote against this Bill is to act on a sentiment that is based upon profusion. The sentiment of those who are supporting this Bill is based on the principle of frugality. We feel just as keenly as hon. Members opposite the fact that these cuts have to be made in benefits to sick women. The only difference between the supporters of the Government and hon. Members opposite is that they prefer to ignore the facts and we prefer to face them. That is the difference between the two sides of the House on this issue. The right hon. Gentleman opposite talks about filching money, but we have not filched any money. That is a word which might pass on the platform outside without notice, but it ought not to pass when it conies from the Front Opposition Bench.


I was referring to the right hon. Member for Epping (Mr. Churchill).


I certainly took what the right hon. Gentleman said in that light, but it is agreed now that we are not filching money. The essence of the whole problem is the matter of frugality. The hon. Member for Bridgeton (Mr. Max-ton), in his wonderful way, played his sentimental violoncello and then painted the picture of the old man, but he has never applied his mind to the Bill, and when he is tackled in terms of cold, practical fact, he has to look away from his fanciful picture of the old man and drop the tune. The hon. Member talks about solvency as if it were some form of abstraction. If it were, we should not need to be standing here defending this. Bill. Solvency is not an abstraction, but it is an essential condition of being able to pay not only these benefits, but any benefits at all. I can assure the hon. and gallant Member for Gainsborough (Captain Crookshank) that the main point which he raised was seriously considered by the Government. The Government in making these changes had to do it so as best to guard the pension Tights of these poor people as far as possible, consistently with a sound scheme, and that we have done.

10.0 p.m.

In the whole course of this Debate there have been very few commentaries. The hon. Member for Mitcham (Mr. Meller), the hon. Member for Flint (Mr. Llewellyn-Jones) and the hon. and gallant Member for St. Albans (Lieut.-Colonel Fremantle) raised the question of a special class for married women. That is, of course, a case which can be presented during the Committee stage of the Bill, and then everything that is to be said in favour of it or against it will be heard with great care by the Minister of Health when the case is put. Some hon. Members who have spoken have rather misunderstood the scale of the problem, and I would like to point out that our powers are very limited and the Central Fund is also a very limited fund. I would like to remind hon. Members that since the pension fund became part of National Insurance, there have not been so many unclaimed stamps and the fund is much smaller. That is my reply to the criticisms of the hon. Member for the Scotland Division of Liverpool (Mr. Logan).


The Minister of Health has still the power to do what I stated that he could do. He could either make the people contribute more or reduce the benefit under the Act which the Government are operating now without this Bill.


At any rate, the solution which was put forward by the hon. Member for the Scotland Division was no solution at all. Now I turn to the hon. Member for Westhoughton (Mr. E. Davies), who stood for a sound insurance system. If he had not done so, I have here a speech made by him which would have made the point clear, because not only the hon. Member, but the society for which he has done such good service, stand for the contributory principle of insurance. I suggest that there could be no clearer proof of the lack of a case against this Bill than the fact that the hon. Member opposite spent three-quarters of his speech dealing with what was done in 1926. [Interruption.] I would refer the right hon. Gentleman the Member for Wakefield to what I said in 1930 in regard to the prolongation of insurance. In 1926 the general financial position of the country was causing serious alarm, but at that time the National Insurance Fund was in a position of abounding prosperity. In the previous year the Government had introduced the Widows' and Orphans' Old Age Pensions Contributory Act, and they relieved societies of the cost of benefit to persons between 65 and 70 years of age, and such persons became entitled to old age pensions.

If hon. Members argue on one side of this case, we must argue on the other. The case is surprising when we consider the problem of which the hon. Member for Westhoughton reminded us. The hon. Member was addressing his mind to the problem of women, but surely he would not claim that any large part of the effect with which we are trying to grapple in this Bill is due to the Measure of 1926. In the case of men, the reduction of the State payment was from two-ninths to one-seventh, and to one-fifth in the case of women. In the case of men, the reduction of the State grant was substantial, and events showed that it was justified, because, as regards men, notwithstanding the reduction, the position of the scheme is still not unsatisfactory; while the reduction of the State grant under the Economy Act in the case of women was trifling—only from two-ninths to two-tenths, that is to say, one forty-fifth, or slightly over 2 per cent. Let us compare this with the position which now faces us as regards excess of expenditure over receipts. Paragraph 9 of the Actuary's Report on the present Bill states that, for the years 1926 to 1930, as regards the percentage of weeks of sickness to the valuation provision, the actuarial position was as follows:

Unmarried Women
Sickness Benefit 110
Disablement Benefit 123
Married Women
Sickness Benefit 112
Disablement Benefit 190
On these figures, it is obviously absurd to say that the present position is due to the reduction of 2 per cent. in the case of women made by the Economy Act. Putting it in terms of money, the annual expenditure on women's benefits, cash and medical, at the present time, is about £12,000,000 a year. If the Economy Act of 1926 had not been passed, the Ex- chequer would have found a further amount of one forty-fifth of this sum, that is to say, £250,000 a year.

I now want to deal with the major topic that has occupied the attention of the House, namely, the reduction in the case of women, and especially of married women. Charges have been flung, not across the House, but across the Gangway. I do not wish to join in recriminations about doctors, societies or patients. There is no Member of this House who has had any experience in the working of approved societies of any kind who does not know that the most subtle and difficult of all approved societies' problems is the decision as to when a married woman is or is not sick. It is not only a difficulty for the doctor; it is a difficulty for the approved society. I have in mind now a small approved society whose Secretary has been the Secretary first of a voluntary insurance scheme, and then of a mixed scheme, for 54 years. He has seen the whole of its membership grow up under his regime, and, if anyone knows the character of individual members, and is in a position to say whether there is malingering or not, it is he. He tells me that, of all the hard problems to solve, whether in a voluntary or in a State scheme, the problem of deciding when a married woman is sick is the hardest. It is a very serious problem. His visitors go and pay the sick pay, they make inquiries and reports, the town is a small one, and people's movements are known; but, with all these advantages, which do not occur in the case of many large societies in the great cities and in London, it is still very difficult to decide whether there is laxity or not with regard to certification in the case of married women.

One fact is certain—and this is the answer to the hon. Member for the English Universities (Miss Rathbone)— and that is that, however you construe the results of the last valuation and the Actuary's report of 1930 to the right hon. Gentleman the Member for Wake-field, the actuarial risk in the case of married women under an insurance scheme is out of all proportion either to the risk in the case of men on the one hand or in the case of single women on the other. It is because that risk, whatever may be its cause, has assumed such great proportions, that my right hon. Friend has felt it right to face the problem in the way that he has, and to say, regretfully, that there is only one thing to be done, and that is to tackle the question of what is the risk, in terms of solvency of the scheme, in the case of married women; and I think the only answer, in these times, must be the one that he has given. Any suggestion as to increasing the contributions of 4,000,000 single women in order that 1,000,000 married women may take a risk that is four times as large, only needs to be mentioned to be brushed aside as irrelevant. The right hon. Gentleman talked lightly about this small claim upon the Treasury, and brushed aside the crisis as though the taxpayer in this country at the moment were not taxed, not merely up to the hilt, but above the hilt. The right hon. Gentleman smiles, but I would say to him that, as long as he smiles in that way when thoughtful men talk about serious problems, the people of this country will never trust him or his friends. I think I have covered all the points that have been raised, and, in conclusion, I would say that in my judgment, while for divers reasons hon. and right hon. Gentlemen opposite have put their names to an Amendment for the rejection of this Bill, I have never heard a weaker case against a Bill than has been made this evening, and I ask the House to give the Bill an overwhelming majority.


I rise to offer a few comments on the Bill which it is now proposed that we should pass. In the first place, I do not think that the hon. Gentleman has met the point that my hon. Friend the Member for Bridgeton (Mr. Maxton) raised. I would remind the hon. Gentleman that, since he asked people to state facts, he ought to have tried to meet my hon. Friend by supplying the facts, but, as far as I could gather, he did not do so. I regret that I was not present to hear the Minister's speech in introducing the Bill, because I take some interest in this matter from the point of view both of unemployment and of the approved societies. I am myself the chairman of an approved society, and am also concerned with the unemployment aspect of the matter. Although I have heard most of the Debate, I have heard very few speakers cover the real points with which this Bill deals. I was amazed at the attitude of the right hon. Gentleman the Member for Wakefield (Mr. Greenwood). He said that many of these people were entitled to be treated as sick persons but were not entitled to be treated as insured persons. He would have no compunction in removing them from the purview of the Insurance Fund. Where would he put them? There is only one place where they can be put, and that is on the Poor Law. Am I to understand that the right hon. Gentleman who is at the moment leading the Labour party would transfer people who are in need of sickness benefit, because they are not covered by an insurance basis, on to the Poor Law?

I agree that the Bill is shockingly bad, but the right hon. Gentleman's record is not one to be proud of. He introduced a Bill to prolong insurance, but he only did it at the eleventh hour of the eleventh day, when Parliament was almost closing down. My colleagues and I say frankly that this is not insurance. You talk of insolvency. There would be insolvency if the fund was run on an insurance basis. I am surprised that this point has never been raised. Take two trades, patten making and moulding. Both unions cater for their approved members. Both are capably served by officials. The moulders' union is in debt. The moulder makes the same contribution, but the patten makers' society has a surplus and gives additional benefit. The moulders' calling is dangerous and you must inevitably have sickness, while the patten maker is comparatively free. Where is the insurance principle?

Go further and take the clerks who deal on the stock exchange. They have practically no sickness at all. Local Government employés have relatively no sickness. They form approved societies which have huge surpluses. This is not insurance, because you have men and women paying equal amounts but receiving different returns in the shape of benefits. If you intended to make your fund solvent, I could understand the Government with a balance-sheet mind— a frugal mind—saying, "We are going to put all approved members on an equal footing. We are going to tackle the whole problem from beginning to end, to deal with the problem of the moulder and the kindred tradesman, and to deal with the problem of the female worker." But the hon. Gentleman did not tell us in regard to the female worker that there are higher rates of sickness among women in certain callings as compared with other callings. The sickness rate in certain female callings is high, and it is low in others. I could have understood the Government dealing with the problem as a whole. They do not do that. Their only justification for dealing with the matter is that they find themselves faced with financial difficulties, and they pick out two classes. I confess that the Labour party can have little complaint against them for picking out the married women. After all, they are leaving married women with 5s. and 8s., but under the late Labour Government's Anomalies Act they were left with nothing, so that the women are at least that much better off.

The main point regarding the Bill has not to do with married women but with the man who, after long years of unemployment, is going to drop out of insurance. He is to be given a year and nine months on the average, and in addition another year. In that additional year, if he is to retain his full benefits, he must have 26 weeks of contributions. Take, again, the case of the man who has been unemployed for some considerable time. That man, even if he has not worked a day for six years, and is 50 years of age, is safeguarded at the present time, if the card has been stamped, in respect of the old age pension, medical service, and sickness benefit on a reduced scale. Now, that man is to lose his sickness benefits. In addition, after the lapse of a year, he will lose his medical connection. Then he will have to go on for another two years for old age pension purposes.

Let hon. Members note three outstanding facts. In the first place, the man loses his health money. That money is exempt for Poor Law purposes. A person who is on sickness benefit and on the Poor Law gets that sickness benefit at the present time in addition to his Poor Law benefit—7s. 6d. It is also exempted by almost every local authority for transitional benefit payments under the means test. Now, it is proposed to take from that sick man the 7s. 6d. which is safeguarded for Poor Law purposes and for the means test, because for those purposes the sick man is treated a little out of the ordinary. He is being treated worse than the married woman and worse than the single woman. Not having done enough to him, it is proposed to take from him his doctor in the following year.

The Under-Secretary of State for Scotland said that there were men with long years of contributions to their credit. I know of men 50 years of age who paid into this fund up to four or five years ago, who were never one day unemployed, and yet from those men it is proposed to take away every right, by degrees. There will be taken away their sick benefit, their doctor and every right down to pensions. The Parliamentary Secretary tried to reply to the hon. Member for Bridgeton (Mr. Maxton). He made a slight improvement by reducing the age from 60 to 58¼. The man of 58 years of age who has passed out cannot get back again unless he puts in 26 payments under the insurance scheme. Let hon. Members think of the time in which we are living. Let them think of mining areas. How is a man of 57 or 55 years of age going to fulfil that condition? The Parliamentary Secretary spoke about men being young at 58. They are young in age, but our trouble is to get the employers to believe that they are young. These men are old for employment purposes, and you are setting an impossible task to a man of 55 to be sure of the putting in six months' contributions in order to get back into the scheme.

10.30 p.m.

This Bill attacks the married woman and the single woman, and it even attacks the man in fairly steady work. If that man has 28 weeks' employment and 24 weeks idle he is credited for his 24 weeks if his card is franked, but under this Bill he is only to be credited with half of those weeks. He must now find arrears of contributions amounting to 1s. per week for 12 or 13 weeks. I do not want to be in any way insulting to the hon. Member for Leith (Mr. E. Brown), but I would like him to remember that we are applying our minds to these things—


My remark was justified because an attack was made upon us that we are robbing old men of benefits. I said that the hon. Member who made that statement had not applied his mind to the Bill.


The hon. Member, however, has not replied to the point. The Act of 1920 brought large numbers of men into insurance. These are the men who have been for 10 years in insurance, and who cannot now come within this Bill. Therefore large sections of the old ment are going to be kept out. The Bill affects married women and single women, the man who is at work, and the man who has been out of work for a long time. It makes it difficult for old people to retain their pensions, and widows are in danger. It attacks every one of these classes, and the only excuse of the Government is the solvency of an insurance fund, which is not an insurance fund. If it was an insurance fund every member would contribute the same amount for the same benefits, and under the same conditions. This fund makes all contribute the same for different ranges of benefits. That is not insurance. It allows approved societies to make different regulations and adopt different methods. If the Government want to make it an insurance fund they should bring in a Bill based on the principle of equal payments, equal benefits. But because we are faced with a financial system which is going bankrupt the Government is attacking these people and has singled out married women.

It is not an unpopular thing to attack the married women. There are many working people, no doubt, who will support the Government in this attack. It is not unpopular to pick out single women who are in industry. But this has nothing whatever to do with insurance and the question of solvency. If it is wrong for married women to continue in industry, from the point of view of employment, let us be quite open and say that they are barred from industry. Let us say straight out that the country can only afford to employ its male adult population and single women, but cannot employ its married women. That is the logical position, but it is not right to allow married women to enter into industry and then because they have done something that is legal to subject them to vindictive and cruel treatment because you think it is a popular policy.

This is a bad Bill. We may be called sentimental. I have heard terrible sentimentality about the Empire. Why should not we be sentimental about the sick and the needy? This is an unwarranted attack on these people, and the only excuse for it is the saving of money. I disagreed with everything that was said by the hon. and gallant Member for Gainsborough (Captain Crookshank), except one thing. He said that this House was apt to pass Measures without taking the long view, that we made commitments and did not look ahead far enough. We pass here proposals for saving millions, but we do not count the cost 20 years ahead in the social havoc that they cause. The Government, of course, will put this Bill through, but all they will have to their credit in the future will be a wastage of poor humanity, and those people will soon see through the falseness and the hollowness of this National Government.


I would ask indulgence for a few minutes simply because I have heard a most corrosive contribution to the Debate, and if taken seriously it might lead administrators into difficulties and politicians into trouble—lead to the use of my professon as the goat of Israel, so that they might tie their sins upon its horns and push it into the wilderness. We have heard from the hon. and learned Member for Argyll (Mr. Macquisten) that doctors accept their money as if that money were obtained under false pretences. That is a form of words often used in His Majesty's courts in criminal procedure, and I think it is no help to clear thought or any aid to Debate to suggest that there is a profession that could have attached to it so criminal a label and so vile a libel. We are told, on the authority of that hon. and learned Gentleman, that a new breed of men has come to my profession. I would assure him that the men who are entering my profession now are born of women, as they ever have been. They are handed to the care of the pedagogues, as has always been the custom of this country. They proceed to the ancient universities, where they study athletics and the humane arts, and they are entered into the hospitals to be taught the same traditions of medicine as existed before the National Health Insurance Act was ever thought of.

At the head of my profession are ancient and learned men who are quite unaware that the sons of women given to them are of a lesser or inferior breed. But the hon. and learned Member's contribution has been fortified by evidence, the evidence of men who have found no employment in organised trade, the evidence of workmen who have not been even checked by foremen, men loose upon the labour market, unattached craftsmen. I suggest to the hon. and learned Member that the word "evidence" in my profession consists of a careful observation made by a competent observer, accurately recorded and truly reported. But the hon. and learned Member has left upon my mind the impression that, in his profession of the law, evidence is any old story repeated by any old gossip that the courts in their inscrutable wisdom may listen to. I tremble to think of what his brethren in the legal profession must think of the evidence which the hon. and learned Member has offered on the state of the law and the practice of the law in the ancient and venerable city of Edinburgh.

We are told that the cases of poor people are handled, not with a passion for justice, not to punish the wrongdoer, but as a sport, with the hope of getting damages out of the troubles of His Majesty's lieges. It is the most degrading admission I have ever heard. But I still believe that lawyers are moved by a passion for justice just as the clergy are moved by a passion for goodness, and I do not believe that the law is pursued either as a sport or as a means of getting damages in cases where the poorest people are concerned.

I am troubled, however, to think that it should be suggested to this House that a member of my profession ought to be perfectly content to maintain his family on a salary of £300 a year; that he should live until death calls him, in a miasma of disease and in the midst of the direst poverty on such a sum and that on the other hand if he takes service under the panel and receives £l,500 a year, he ought to be troubled in his conscience and refuse to work. It has been a blessing to the profession that, thanks to the Health Insurance Act, doctors can now bring up their sons to that profession which they love and hand on from father to son its great traditions of service. We are told by the hon. and learned Member that the National Health Insurance Act passed by this House after long debate has produced but one fruit, namely, that doctors will shake the hands of the patients who offer to pay them and neglect the others. I would offer as a serious contribution to this Debate the submission that the Act has brought into the profession a wider selection of keen minds anxious to maintain the public health.

I was a little disturbed when the ex-Minister of Health said that the success of the National Health Insurance Act had been due to the genius of the Civil Service. I always think that when you attribute genius to administrators you are confessing to an inferiority complex. To complete the statement of the right hon. Gentleman I would say that the Act has worked well because it has received the co-operation of an intelligent and learned profession. Acting through the British Medical Association, my profession has worked cordially with Governments of all colours for the people's health and because of that cooperation the fruits of this Act have been good. The British Medical Association will celebrate the centenary of its foundation, this year, in London, under the presidency of Lord Dawson and hours will be devoted by the keenest minds to the discussion of public health problems. We have seen members of my profession drawn into public life because, through this Act, they have been interested in public health administration. We have not segregated ourselves entirely in the atmosphere of the sick room. Owing to this Act which has been so much derided, our medical research, through the medium of the Medical Research Council, has been placed on a footing which is the admiration of Europe. Through that they have been able, with the co-operation of our large voluntary hospitals, to bring every modern device of science and the help of specialists to the home of every one of His Majesty's subjects. I apologise for delaying the House from important business, but a corrosive acid should have some antidote.

Question put, "That the word 'now' stand part of the Question."

The House divided: Ayes, 245; Noes, 43.

Division No. 173.] AYES. [3.42 p.m.
Acland-Troyte, Lieut.-Colonel Beaumont, M. W. (Bucks., Aylesbury) Brown, Ernest (Leith)
Adams, Samuel Vyvyan T. (Leeds, W.) Beaumont, Hon. R.E.B. (Portsm'th, C.) Brown, Brig.-Gen. H. C.(Berks., Newb'y)
Agnew, Lieut.-Com. P. G. Belt, Sir Alfred L. Browne, Captain A. C.
Allen, Lt.-Col. J. Sandeman (B'k'nh'd) Benn, Sir Arthur Shirley Buchan, John
Anstruther-Gray, W. J. Bernays, Robert Buchan-Hepburn, P. G. T.
Applin, Lieut.-Col. Reginald V. K. Birchall, Major Sir John Dearman Burnett, John George
Apsley, Lord Blaker, Sir Reginald Cadogan, Hon. Edward
Astor, Maj. Hn. John J.(Kent, Dover) Borodale, Viscount Caine, G. R. Hall-
Atholl, Duchess of Bowater, Col. Sir T. Vansittart Campbell, Edward Taswell (Bromley)
Baillie, Sir Adrian W. M. Bowyer, Capt. Sir George E. W. Caporn, Arthur Cecil
Baldwin, Rt. Hon. Stanley Boyce, H. Leslie Carver, Major William H.
Baldwin-Webb, Colonel J. Bracken, Brendan Cautley, Sir Henry S.
Balniel, Lord Braithwaite, J. G. (Hillsborough) Cayzer, Sir Charles (Chester, City)
Barclay-Harvey, C. M. Brocklebank, C. E. R. Cayzer, Maj. Sir H. R. (Prtsmth., S.)
Barton, Capt. Basil Kelsey Brown, Col. D. C. (Nith'I'd, Hexham) Cazalet, Thelma (Islington, E.)
Cazalet, Capt. V. A. (Chippenham) Hunter, Dr. Joseph (Dumfries) Ralkes, Henry V. A. M.
Chalmers, John Rutherford Hunter, Capt. M. J. (Brigg) Ramsay, Alexander (W. Bromwich)
Chapman, Col. R.(Houghton-le-Spring) Hutchison, W. D. (Essex, Romford) Ramsay, Capt. A. H. M. (Midlothian)
Choriton, Alan Ernest Leofric Inskip, Rt. Hon. Sir Thomas W. H. Ramsay, T. B. W. (Western Isles)
Christie, James Archibald Jamieson, Douglas Ramsbotham, Herwald
Churchill, Rt. Hon. Winston Spencer Johnstone, Harcourt (S. Shields) Rathbone, Eleanor
Clayton, Or. George C. Jones, Henry Haydn (Merioneth) Reed, Arthur C. (Exeter)
Cochrane, Commander Hon. A. D. Jones, Lewis (Swansea, West) Reid, Capt. A. Cunningham-
Colman, N. C. D. Ker, J. Campbell Reid, David D. (County Down)
Colville, John Kerr, Hamilton W. Reid, William Allan (Derby)
Cook, Thomas A. Kimball, Lawrence Reynolds, Col. Sir James Philip
Cooke, Douglas Kirkpatrick, William M. Roberts, Aled (Wrexham)
Cooper, A. Duff Knatchbull, Captain Hon. M. H. R. Roberts, Sir Samuel (Ecclesall)
Copeland, Ida Knox, Sir Alfred Robinson, John Roland
Cowan, D. M. Lambert, Rt. Hon. George Rosbotham, S. T.
Craddock, Sir Reginald Henry Latham, Sir Herbert Paul Ross, Ronald D.
Cranborne, Viscount Law, Sir Alfred Ross Taylor, Walter (Woodbridge)
Croft, Brigadier-General Sir H. Law, Richard K. (Hull, S.W.) Ruggles-Brise, Colonel E. A.
Crooke, J. Smedley Leech, Dr. J. W. Runclman, Rt. Hon. Walter
Crookshank, Col. C. de Windt (Bootle) Lees-Jones, John Runge, Norah Cecil
Crookshank, Capt. H. C. (Gainsb'ro) Leighton, Major B. E. P. Russell, Albert (Kirkcaldy)
Crossley, A. C. Levy, Thomas Russell, Alexander West (Tynemouth)
Cruddas, Lieut.-Colonel Bernard Liddall, Walter S. Russell, Hamer Field (Sheffield, B'tside)
Culverwell, Cyril Tom Lister, Rt. Hon. Sir Philip Cunliffe- Rutherford, Sir John Hugo
Curry, A. C. Llewellyn-Jones, Frederick Salmon, Major Isidore
Dalkeith, Earl of Lloyd, Geoffrey Salt, Edward W.
Davison, Sir William Henry Locker-Lampson, Rt. Hn. G. (Wd.G'n) Samuel, Sir Arthur Michael (F'nham)
Denman, Hon. R. D. Lockwood, Capt. J. H. (Shipley) Samuel, Rt. Hon. Sir H. (Darwen)
Denville, Alfred Loder, Captain J. de Vere Scone, Lord
Despencer-Robertson, Major J. A. F. Lovat-Fraser, James Alexander Shaw, Helen B. (Lanark, Bothwell)
Doran, Edward Lumley, Captain Lawrence R. Shaw, Captain William T. (Forfar)
Drewe, Cedric Lyons, Abraham Montagu Shepperson, Sir Ernest W.
Duckworth, George A. V. MacAndrew, Lieut.-Col. C. G.(Partick) Simmonds, Oliver Edwin
Dugdale, Captain Thomas Lionel MacAndrew, Capt. J. O. (Ayr) Simon. Rt. Hon. Sir John
Duggan, Hubert John McConnell, Sir Joseph Sinclair, Maj. Rt. Hn. Sir A.(C'thness)
Duncan, James A. L. (Kensington, N.) MacDonald, Malcolm (Bassetlaw) Skelton, Archibald Noel
Dunglass, Lord Macdonald, Capt. P. D. (I. of W.) Slater, John
Edmondson, Major A. J. McEwen, Captain J. H. F. Smiles, Lieut.-Col. Sir Walter D.
Ednam, Viscount McKeag, William Smith, Louis W. (Sheffield, Hallam)
Elliot, Major Rt. Hon. Walter E. McKie, John Hamilton Smith, R. W.(Ab'rd'n & Kinc'dine, C.)
Elliston, Captain George Sampson Maclay, Hon. Joseph Paton Somervell, Donald Bradley
Elmley, Viscount McLean, Major Alan Somerville, Annesley A. (Windsor)
Emmott, Charles E. G. C. Maclean, Rt. Hn. Sir D. (Corn'll N.) Soper, Richard
Entwistle, Cyril Fullard McLean, Dr. W. H. (Tradeston) Sotheron-Estcourt, Captain T. E.
Erskine, Lord (Weston-super-Mare) Macpherson, Rt. Hon. James I. Spears, Brigadier-General Edward L.
Essenhigh, Reginald Clare Macquisten, Frederick Alexander Spencer, Captain Richard A.
Everard, W. Lindsay Mallalieu, Edward Lancelot Spender-Clay, Rt. Hon. Herbert H.
Foot, Isaac (Cornwall, Bodmin) Mander, Geoffrey le M. Stanley Hon. O. F. G. (Westmorland)
Fraser, Captain Ian Manningham-Buller, Lt.-Col. Sir M. Steel-Maitland, Rt. Hon. Sir Arthur
Fremantle, Lieut.-Colonel Francis E. Margesson, Capt. Henry David R. Stevenson, James
Fuller, Captain A. G. Marsden, Commander Arthur Stones, James
Ganzoni, Sir John Martin, Thomas B. Strauss, Edward A.
Glimour, Lt.-Col. Rt. Hon. Sir John Mayhew, Lieut.-Colonel John Stuart, Hon. J. (Moray and Nairn)
Gledhill, Gilbert Millar, Sir James Duncan Sueter, Rear-Admiral Murray F.
Glossop, C. W. H. Mills, Sir Frederick (Leyton, E.) Sugden, Sir Wilfrid Hart
Goldie, Noel B. Mills, Major J. D. (New Forest) Summersby, Charles H.
Goodman, Colonel Albert W. Milne, Charles Sutcliffe, Harold
Gower, Sir Robert Milne, John Sydney Wardlaw- Taylor, Vice-Admiral E.A.(P'dd'gt'n, S.)
Graham, Fergus (Cumberland, N.) Mitchell, Harold P.(Br'tf'd & Chisw'k) Thomas, Rt. Hon. J. H. (Derby)
Grattan-Doyle, Sir Nicholas Mitchell, Sir W. Lane (Streatham) Thompson. Luke
Graves, Marjorie Molson, A. Hugh Elsdale Todd, Capt. A. J. K. (B'wick-on-T.)
Gretton, Colonel Rt. Hon. John Moore, Lt.-Col. Thomas C. R. (Ayr) Todd, A. L. S. (Kingswinford)
Grimston, R. V. Moore-Brabazon, Lieut.-Col. J. T. C. Train, John
Guest, Capt. Rt. Hon. F. E. Moreing, Adrian C Tryon, Rt. Hon. George Clement
Guinness, Thomas L. E. B. Morrison, William Shephard Vaughan-Morgan, Sir Kenyon
Gunston, Captain D. W. Moss, Captain H. J. Wallace, Captain D. E. (Hornsey)
Guy, J. C. Morrison Muirhead, Major A. J. Wallace, John (Dunfermline)
Hacking, Rt. Hon. Douglas H. Munro, Patrick Ward, Lt.-Col. Sir A. L. (Hull)
Hamilton, Sir George (Ilford) Nation, Brigadier-General J. J. H. Ward, Irene Mary Bewick (Wallsend)
Hanley, Dennis A. Nicholson, Godfrey (Morpeth) Waterhouse, Captain Charles
Hannon, Patrick Joseph Henry Nicholson Rt. Hn. W G (Petersf'ld) Wedderburn, Henry James Scrymgeour-
Harris, Sir Percy Normand, Wilfrid Guild Wells, Sydney Richard
Hartland, George A. North, Captain Edward T. Weymouth, Viscount
Harvey, Major S. E. (Devon, Totnes) Nunn William White, Henry Graham
Headlam, Lieut.-Col. Cuthbert M. Oman, Sir Charles William C. Williams, Herbert G. (Croydon, S.)
Heilgers, Captain F. F. A. Ormsby-Gore, Rt. Hon. William G. A. Wills, Wilfrid D.
Henderson, Sir Vivian L. (Cheimsford) Palmer, Francis Noel Wilson, Clyde T. (West Toxteth)
Heneage, Lieut.-Colonel Arthur P. Pearson, William G. Windsor-Clive. Lieut.-Colonel George
Hoare, Lt.-Col. Rt. Hon. Sir S. J. G. Peat, Charles, U. Womersley, Walter James
Holdsworth, Herbert Petherick, M. Wood, Rt. Hon. Sir H. Kingsley
Hore-Belisha, Leslie Peto, Sir Basil E. (Devon, Barnstaple) Wood, Sir Murdoch McKenzie (Banff)
Hornby, Frank Peto, Geoffrey K. (W'verh'pt'n, Bilston) Worthington, Dr. John V.
Horsbrugh, Florence Pike, Cecil F. Young, Rt. Hon. Sir Hilton (S'v'noaks)
Howard, Tom Forrest Powell, Lieut.-Col. Evelyn G. H.
Hudson Capt, A. U.M. (Hackney, N.) Procter, Major Henry Adam TELLERS FOR THE AYES.—
Hume, Sir George Hopwood Pybus, Percy John Sir Frederick Thomson and Sir
George Penny
Attlee, Clement Richard Halt, F. (York, W.R., Normanton) Maxton, James
Batey, Joseph Hall, George H. (Merthyr Tydvil) Owen, Major Goronwy
Bevan, Aneurin (Ebbw Vale) Hicks, Ernest George Parkinson, John Allen
Brown, C. W. E. (Notts., Mansfield) Hirst, George Henry Price, Gabriel
Cape, Thomas Jones, Morgan (Caerphilly) Salter, Dr. Alfred
Cocks, Frederick Seymour Kirk wood, David Thorne, William James
Cove, William G. Lansbury, Rt. Hon. George Tinker, John Joseph
Daggar George Leonard, William Williams, Edward John (Ogmore)
Davies, Rhys John (Westhoughton) Logan, David Gilbert Williams, Thomas (York, Don Valley)
Edwards, Charles Lunn, William
George, Major G. Lloyd (Pembroke) Macdonald, Gordon (Ince) TELLERS FOR THE NOES.—
Greenwood, Rt. Hon. Arthur McEntee, Valentine, L. Mr. Groves and Mr. Duncan
Grenfell, David Rees (Glamorgan) McGovern, John Graham.
Grundy, Thomas W. Maclean, Neil (Glasgow, Govan)
Division No. 174.] AYES. [10.45 p.m.
Acland-Troyte, Lieut.-Colonel Goldie, Noel B. North, Captain Edward T.
Agnew, Lieut.-Com. P. G. Goodman, Colonel Albert W. O'Donovan, Dr. William James
Aitchison, Rt. Hon. Craigle M. Gower, Sir Robert Ormsby-Gore, Rt. Hon. William G. A.
Allen, Sir J. Sandeman (L'pool, W.) Graham, Fergus (Cumberland, N.) Palmer, Francis Noel
Allen, Lt.-Col. J. Sandeman (B'k'nh'd.) Grattan-Doyle, Sir Nicholas Pearson, William G.
Anstruther-Gray, W. J. Graves, Marjorie Peat, Charles U.
Atholl, Duchess of Greene, William P. C. Petherick, M.
Baldwin-Webb, Colonel J. Grimston, R. V. Peto, Sir Basil E. (Devon, Barnstaple)
Balfour, George (Hampstead) Guinness, Thomas L. E. B. Peto, Geoffrey K.(W'verh'pt'n, Bliston)
Balniel, Lord Gunston, Captain D. W. Pickering, Ernest H.
Barclay-Harvey, C. M. Guy, J. C. Morrison Pike, Cecil F.
Barton, Capt. Basil Kelsey Hanley, Dennis A. Powell, Lieut. Col. Evelyn G. H.
Beauchamp, Sir Brograve Campbell Hannon, Patrick Joseph Henry Procter, Major Henry Adam
Beaumont, M. W. (Bucks., Aylesbury) Harris, Sir Percy Pybus, Percy John
Beaumont, Hon. R.E.B. (Portsm'th, C.) Headlam, Lieut.-Col. Cuthbert M. Ralkes, Henry V. A. M.
Birchall, Major Sir John Dearman Heilgers, Captain F. F. A. Ramsay, Alexander (W. Bromwich)
Bird, Ernest Roy (Yorks., Skipton) Heneage, Lieut.-Colonel Arthur P. Ramsay, Capt. A. H. M. (Midlothian)
Blindell, James Hills. Major Rt. Hon. John Waller Ramsay, T. B. W. (Western Isles)
Borodale, Viscount Holdsworth, Herbert Ramsbotham, Herwald
Bossom, A. C. Hope, Capt. Arthur O J. (Aston) Ramsden, E.
Bower, Lieut.-Com. Robert Tatton Hope, Sydney (Chester, Stalybridge) Reed, Arthur C. (Exeter)
Bowyer, Capt. Sir George E. W. Hopkinson, Austin Reid, William Allan (Derby)
Boyce, H. Leslie Hornby, Frank Remer, John R.
Braithwaite, J. G. (Hillsborough) Horsbrugh, Florence Renwick, Major Gustav A.
Brocklebank, C. E. R. Howard, Tom Forrest Reynolds, Col. Sir James Philip
Brown, Col. D. C. (N'th'l'd., Hexham) Hudson, Capt. A. U. M. (Hackney, N.) Ropner, Colonel L.
Brown, Ernest (Leith) Hume, Sir George Hopwood Rosbotham, S. T.
Brown, Brig,-Gen. H.C.(Berks., Newb'y) Hunter, Dr. Joseph (Dumfries) Ross, Ronald D.
Browne, Captain A. C. Hunter, Capt. M. J (Bring) Ross Taylor, Walter (Woodbridge)
Buchan-Hepburn, p. G. T. Hutchison, W. D. (Essex, Romford) Ruggles-Brise, Colonel E. A.
Burghley, Lord Jamieson, Douglas Runge, Norah Cecil
Burnett, John George Johnstone, Harcourt (S. Shields) Russell, Hamer Field (Sheffield, B'tside)
Campbell, Rear-Adml. G. (Burnley) Jones, Sir G. W. H. (Stoke New'gton) Salmon, Major Isidore
Caporn, Arthur Cecil Jones, Henry Haydn (Merioneth) Salt, Edward W.
Carver, Major William H. Jones, Lewis (Swansea, West) Samuel, Samuel (W'dsworth, Putney)
Cassels, James Dale Kerr, Hamilton W. Scone, Lord
Cautley, Sir Henry S. Kimball, Lawrence Selley, Harry R.
Cayzer, Maj. Sir H. R. (Prtsmth., S.) Knatchbull, Captain Hon. M. H. R. Shakespeare, Geoffrey H.
Cazalet, Thelma (Islington, E.) Knox, Sir Alfred Shaw, Helen B. (Lanark, Bothwell)
Chalmers, John Rutherford Law, Richard K. (Hull, S.W.) Shaw, Captain William T. (Forfar)
Chapman, Col. R.(Houghton-le-Spring) Leckie, J. A. Simmonds, Oliver Edwin
Chapman, Sir Samuel (Edinburgh, S.) Leech, Dr. J. W. Sinclair, Maj. Rt. Hn. Sir A.(C'thness)
Choriton, Alan Ernest Leofric Leighton, Major B. E. P. Sinclair, Col. T. (Queen's Unv., Belfast)
Clarry, Reginald George Liddall Walter S. Skelton, Archibald Noel
Clayton Dr. George C. Llewellyn-Jones Frederick Smiles, Lieut.-Col. Sir Walter D.
Cobb, Sir Cyril Lovat-Fraser, James Alexander Smith, Sir Jonah W. (Barrow-in-F.)
Cochrane, Commander Hon. A. D. Lyons, Abraham Montagu Smith, R. W.(Ab'rd'n & Kinc'dine, C.)
Colvllie, John Mabane, William Somerville, Annesley A. (Windsor)
Conant, R. J. E. MacAndrew, Lieut.-Col. C. G.(Partick) Soper, Richard
Cook, Thomas A. MacAndrew, Capt. J. O. (Ayr) Sotheron-Estcourt, Captain T. E.
Cooke, Douglas McConnell, Sir Joseph Southby, Commander Archibald R. J.
Copeland, Ida McCorquodale, M. S. Spencer, Captain Richard A.
Cowan, D. M. McEwen, Captain J. H. F. Stanley, Lord (Lancaster, Fylde)
Cranborne, Viscount McKie, John Hamilton Stanley, Hon. O. F. G. (Westmorland)
Craven-Ellis, William Maclay, Hon. Joseph Paton Stevenson, James
Crooke, J. Smedley Maclean, Rt. Hon. Sir D. (Corn'll N.) Stones, James
Crookshank, Capt. H. c. (Gainsb'ro) McLean, Dr. W. H. (Tradeston) Storey, Samuel
Cruddas, Lieut.-Colonel Bernard Macquisten, Frederick Alexander Stourton, Hon. John J.
Davies, Edward C. (Montgomery) Maitland, Adam Strickland, Captain W. F.
Davies, Maj. Geo. F.(Somerset, Yeovil) Mallalieu, Edward Lancelot Stuart, Hon. J. (Moray and Nairn)
Dickie, John P. Mander, Geoffrey le M. Sutcliffe, Harold
Donner, P. W. Manningham-Buller, Lt.-Col Sir M. Tate, Mavis Constance
Drewe, Cedric Margesson, Capt. Henry David R. Taylor, Vice-Admiral E.A.(P'dd'gt'n, S.)
Duggan, Hubert John Marsden, Commander Arthur Thomas, Rt. Hon. J. H. (Derby)
Duncan, James A. L. (Kensington, N.) Martin, Thomas B. Thomas, James P. L. (Hereford)
Dunglass, Lord Meller, Richard James Thompson, Luke
Eastwood, John Francis Mills, Sir Frederick (Leyton, E.) Titchfield, Major the Marquess of
Edmondson, Major A. J. Mills, Major J. D. (New Forest) Todd, Capt. A. J. K. (B'wick-on-T.)
Elliot, Major Rt. Hon. Walter E. Milne, Charles Todd, A. L. S. (Kingswinford)
Ellis, Robert Geoffrey Milne, John Sydney Wardlaw- Train, John
Elliston, Captain George Sampson Mitchell, Harold P.(Br'tf'd & Chisw'k) Tryon, Rt. Hon. George Clement
Elmley, Viscount Mitcheson G. G. Wallace, Captain D. E. (Hornsey)
Emrys-Evans P. V. Molson, A. Hugh Elsdale Ward, Irene Mary Bewick (Wallsend)
Entwistle, Cyril Fullard Morgan, Robert H. Whiteside, Borras Noel H.
Essenhigh, Reginald Clare Morris, Rhys Hopkin (Cardigan) Windsor-Clive, Lieut.-Colonel George
Fermoy, Lord Morrison, William Shephard Womersley, Walter James
Fox, Sir Gifford Muirhead, Major A. J. Wood, Sir Murdoch McKenzie (Banff)
Fremantle, Lieut.-Colonel Francis E. Munro, Patrick Worthington, Dr. John V.
Ganzonl, Sir John Nail, Sir Joseph Young, Rt. Hon. Sir Hilton (S'v'noaks)
Gilmour, Lt.-Col. Rt. Hon. Sir John Nathan, Major H. L.
Gledhill, Gilbert Nation, Brigadier-General J. J. H. TELLERS FOR THE AYES.—
Glossop, C. W. H. Nicholson, Godfrey (Morpeth) Lieut.-Colonel Sir A. Lambert Ward
Gluckstein, Louis Halle Normand, Wilfrid Guild and Lord Erskine.
Adams, D. M. (Poplar, South) Griffiths, T. (Monmouth, Pontypool) McGovern, John
Attlee, Clement Richard Grundy, Thomas, W. Maclean, Neil (Glasgow, Govan)
Batey, Joseph Hall, F. (York, W.H., Normanton) Maxton, James
Bevan, Aneurin (Ebbw Vale) Hall, George H. (Merthyr Tydvil) Parkinson, John Allen
Brown, C. W. E. (Notts., Mansfield) Hicks, Ernest George Price, Gabriel
Buchanan, George Hirst, George Henry Rathbone, Eleanor
Cape, Thomas Jones, Morgan (Caerphilly) Salter, Dr. Alfred
Cocks, Frederick Seymour Kirkwood, David Thorne, William James
Cove, William G. Lansbury, Rt. Hon. George Tinker, John Joseph
Cripps, Sir Stafford Lawson, John James Williams, Edward John (Ogmore)
Daggar, Georgs Leonard, William Williams, Thomas (York, Don Valley)
Davies, Rhys John (Westhoughton) Logan, David Gilbert Young, Ernest J. (Middlesbrough, E.)
Edwards, Charles Lunn, William
Greenwood, Rt. Hon. Arthur Macdonald, Gordon (Ince) Mr. Groves and Mr. Duncan
Grenfell, David Rees (Glamorgan) McEntee, Valentine L. Graham.

Bill read the Third time, and passed, with Amendments.

Bill committed to a Committee of the whole House for To-morrow.-[Sir Hilton Young.]

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