§ Question again proposed, "That the Bill be now read a Second time."
§ 6.52 p.m.
§ Sir R. MELLER
There is only one other point to which I want to draw attention. The Minister rightly touched upon the increased contribution which must be paid in respect of the pension scheme as from 1st January, 1936. That is a statutory obligation. It is not some thing introduced in this Bill, but I have no doubt that the insured person will be very surprised when he finds that in 1936 an increased contribution has to be paid. I hope that some method will be devised whereby the insured person will know some time in advance the reason why this extra charge is being made. But I venture to hope for something more, having regard to the improved conditions to which reference has been made by the Minister, namely, the increased contributions which have been received, showing that the improvement in employment in this country, if that improvement has gone on, as I believe it has, will have its reflection in the contributions to wards the unemployment scheme. Under that 2112 scheme a committee was set up to consider from time to time the finances of the scheme and to suggest benefits which might be conferred as a result of the improvement in the contributions. We cannot expect a reduction in the statutory contribution which will be demanded in 1936 and subsequent years for pensions, but I hope that the Minister will endeavour to persuade his colleague at the Ministry of Labour, if some distribution is to be made for the benefit of the insured person, that possibly a reduction in the unemployment contribution may be made as a set-off to the increase which is to be made in the health insurance pension contribution. The Bill has received much commendation this afternoon, and I would once more congratulate the Minister. I believe that I am voicing the views of those who have worked in the approved society world and of the insured when I say that at last an opportunity has been found of getting out of the difficulty into which many of them have found themselves through no fault of their own.
§ 6.54 p.m.
§ Mr. JANNER
The Minister has on this occasion certainly proposed a Bill which will meet with commendation, I believe, from all parts of the House, although there will be people who will have some criticism to offer in that the Bill does not go far enough, or objections of that nature. I am sorry that we have not had a larger House in dealing with this Measure. It is very interesting to recall at this time what happened some years ago. Just as we are celebrating the Jubilee of our Gracious King we may well turn our attention for a moment to the original National Health Insurance Bill of 1911.I should like to quote one passage from the speech that was made by the right hon. Gentleman the Member for Carnarvon Boroughs (Mr. Lloyd George) at that time. He said:Here we are in the year of the crowning of the King. We have got men from all parts of this great Empire coming not merely to celebrate the present splendour of the Empire, but also to take counsel together as to the best means of promoting its future welfare. I think that now would be a very opportune moment for us in the Homeland to carry through a Measure that will relieve untold misery in myriads of homes-misery that is undeserved; that will help to prevent a good deal of wretched ness, and which will arm the nation to fight until it conquers the pestilence that 2113 walketh in darkness and the destruction that wasteth at noonday'."—[0FFICIAL REPORT, 4th May, 1911; col. 644, Vol. 25.]There is no doubt that the claim made at that time by the right hon. Gentleman has to a considerable extent turned out to be justified and to-day we are undoubtedly dealing with an advance which will redound to the credit of the Minister himself and to those who have taken up the matter. Indeed, we know that other nations have sent representatives to tins country in order to study our national health insurance schemes, and they have taken strong views back to their respective countries in order to introduce similar measures the re. I happen to be vice-president of a large organisation, consisting of some 50,000 members. It is an association of friendly societies. I have examined the Bill carefully, and have consulted with officers who have been administering national health insurance and pension matters in some of the constituent societies. I am bound to say that in the main it is agreed that this will mark a distinct improvement as far as health insurance and contributory pensions are concerned. The anxiety which has hung over the heads of people who have been unemployed will undoubtedly be dispelled in many cases. People who are unemployed and who are watching for their pension rights to be retained will find themselves in the position of knowing that a pension will be there for the m.
It is rather important that we should consider the principles of health insurance and pensions in their relationship to the people who come with in their provisions respectively. It has not been pointed out yet that the pension is an annuity for which a person pays by instalments and that in respect of his payment he does not get any return until the pension itself is received; it should have a surrender value. In consequence he is insuring himself or making provision for his widow or orphan child against the day when he will no longer be with the m, and it is essential that the pension side of the scheme should be dealt with on a basis which excludes forfeiture by reason of un employment. On the other hand, the provision of health and disablement benefits is different. This is like a fire insurance or a similar insurance—one that exists in order to give insurance to the person as and when a contingency arises 2114 and in respect of which payments are being made for specific periods. Both these items have been dealt with by the Bill.
I have a number of criticisms to offer. The Minister would be well advised to take into consideration some of the points raised this afternoon, and some of the points which I now propose to raise in criticism of the details of the Bill. We have heard it explained, and I think rightly, that the complications that arise from legislation by reference are so enormous that they confuse the whole issue in many cases and make it impossible for people to understand what a Bill really means. Someone has said that the person who understands insurance measures will undoubtedly find in this Bill much that is of advantage to the insured persons. But the person who does not understand those measures will find it terribly difficult to acquaint him self with the new suggestions. I do not say that this is any fault on the part of the Minister. It is very difficult to get complicated matters of this sort put into simple language, but because yon now have a Bill entirely dependent for its sense upon reference to so many other Acts very few people can really under stand it. I would ask the Minister to consider whether he should not at the earliest possible moment have whatever is passed in this Measure consolidated with the other Acts, so that there may be a clear and distinct Act providing for all the contingencies that arise in respect of national health insurance and contributory pensions.
With regard to the Measure itself, I should like to stress the importance of the point raised as to maternity benefit. I think it would be granting an import ant concession which would not cost a tremendous amount of money. It is of infinite importance that a person who has, unfortunately, fallen out of insurance benefit, should not have the fear that his wife will not have maternity benefit avail able as and when the occasion arises. The n there is the question of extended benefits. We have heard that there is a considerable amount of anxiety about insured people being unable to obtain the right kind of specialist, medical and surgical advice, and that specialist treatment and diagnostic advice are not available for the insured person. In 1926 a large 2115 amount of money was diverted from the fund which was available for the purpose of supplying insurance benefits to those who come with in the provisions of the Acts. I am sorry that it has not been found possible to give back a larger portion of that sum in order to provide the additional benefits that could thus be provided for people who are in insurance. The point has been overlooked to o, that the health insurance funds are no longer yielding the same amount of interest as they did before. The interest received on the funds in future will not be as great as it is and the amount that will be avail able for the purpose of giving additional benefits will not be as great. In these circumstances the Exchequer might very well be called upon to contribute a larger amount to wards providing the new health insurance burdens.
There are a number of other points I intended to raise which I will not touch upon, because they have been already amply dealt with by other Members. But there are one or two other matters that I should like to bring to the notice of the Minister. Perhaps we may have an explanation of these at a later stage. Members will see that Clause 3 (2) provides:Where on the 31st day of December in any year an insured person is an inmate of an institution, any sum which but for the provisions of this section would have been payable to him shall, in so far as it exceeds fifty pounds, or in the case of a per son who was an inmate of an institution on the seventh day of January, 1929, such sum as may be prescribed, be paid to the Central Fund.And it is further provided:and where under this section any payment is made to the Central Fund so much thereof as is derived from moneys provided by Parliament shall be repaid to the Exchequer.In my view this is not a fair manner of dealing with these sums. The State itself is taking back all it has paid to wards these amounts, but it is putting into the Central Fund the sums which have been obtained from various approved societies. That is my interpretation of the section. In my view, the approved societies, having them selves contributed these funds, should have the benefit of the return of the money instead of it being placed in the central fund. I should like to know 2116 whether in the course of the Committee stage of the Bill the right hon. Gentle man will see his way to amend that, which seems to me an unreasonable pro vision so far as the approved societies are concerned. I do not think any of us will deny the advance which is being made by this Bill, and I hope it will not be utilised for any ulterior motive, and that attacks will not be made upon it from the point of view of trying to present out of all proportion those matters which require remedying vis-à-vis the important measures that the Bill is introducing. I hope the House will give the Bill a Second Reading unanimously, and that some of the matters to which attention has been directed may be remedied in Committee.
§ 7.10 p.m.
§ Mr. BANFIELD
We have listened to a great number of speeches most of which lauded this Measure in remarkably complimentary terms. I think it is possible to make far to o much of this Bill; and I am afraid that supporters of the Government who describe this as a comprehensive and magnificent Measure, and so on, will find when they face their supporters, a great deal of dissatisfaction with it. After all, this Bill deals with a matter which, of necessity, could not be let alone. It would have been unthinkable on the part of any Government to have left 200,000 people in the year 1936 in a position in which their pension rights would be sacrificed. This Bill does not even as sure to all unemployed persons their pension rights. The ideal provision, and the one which would have appealed to many people, would be that no insured person should lose his title to health or pensions benefits solely because of unemployment. This Measure falls very far short of that ideal. Even so far as the 200,000 people with whom the Measure deals are concerned, the Government actuary states that 20,000 among them will probably not come back into insurance and will, as a matter of fact, lose their pension rights.
Further, it must be remembered that a person of between four and 10 years' insurance record, with 160 contributions, is entitled under the Bill to 1 years of free insurance on becoming unemployed. Thereafter, for a further 12 months, he is entitled to pension only—at which 2117 point he passes out of insurance if Still unemployed. The proportion of people who may be left out may be 5 per cent. Or 10 per cent., it may be 20,000 or rather less, but I suggest to the Minister that there is nothing that causes more unrest and more trouble than that nine people should come under a Bill of this sort and that one person should be left out. The amount of money involved is comparatively small, and the amount of unrest, the amount of disgust as it were, and the amount of worry, trouble and agitation caused by leaving anyone out of a Measure of this sort is scarcely com parable with the amount of money involved.
We have heard from various hon. members what a great, glorious comprehensive and beautiful Bill this is, but the fact remains that it is a comparatively small Bill, limited in character and dealing with a very pressing evil which could not be left untouched any longer than the end of 1935.More than anything else I want to complain of the limited character of the Bill.
It is well to point out precisely what the Bill does not do. It does not restore the cuts in women's benefits imposed in the 1932 Act; nor does it continue the full prolongation provision; nor does it relieve approved societies of the burden of the shortage of contribution so as to enable the conservation of funds necessary for additional benefits. It may be that the societies have agreed to find the £700,000 a year. May be they feel that this is the very best thing that can be done, but the fact remains that the taking of this money from the societies leaves them with a less surplus and with less money for additional benefits, and will tend ultimately to some reduction in those additional benefits. The Bill makes no attempt whatever to deal with the bigger issues involved in national health insurance and pensions. There is the question of the lowering of the age of entry into health insurance. We recently lowered the age of entry so far as unemployment insurance is concerned, and I am still very unconvinced by the arguments put forward why the entry for national health insurance could not have been brought down to the age of 14 at the same time that the unemployment insurance age was lowered.
Another very important point is that there are hundreds of thousands of 2118 people who have been looking to the Government to raise the income limit of insurability. That is a point that ought to be dealt with, and it might have been dealt with in this Bill. I have heard hon. Members complain that shopkeepers have a particular claim to be brought under national health and pension schemes. There are hundreds of thousands, possibly millions, of people who would only be to o pleased to be brought under this scheme, who in their health may have earned more than 2250 a year, but in the days when their strength declines or when their hair becomes grey are just as liable to unemployment and hard times as the manual wage-worker. If the Government were really going to do something big in the way of national health insurance they might consider that point. I have heard over and over again this class of people above the £250 a year limit, the small shopkeeper and professional people declare that they could never see any reason why they were not given the opportunity to contribute to old age pensions and national health insurance.
There is one point which, obviously, must be dealt with, and that is the question of maternity benefit. I was hoping that we should get a Bill which would deal with the whole question of maternity services under the national health insurance scheme. It is wrong to say to the unemployed man: "You have had a bad time and have been out of work for years, but we are taking steps so that at the age of 65 we will pay you 10s.a week pension as the ne plus ultra of what may be done, but if your wife has a child during that period we shall not allow you anything for the expense of bringing that child into the world, and your wife must go to the Poor Law institution and you must go to the parish." That is not defensible. If the figures were got out I believe that it would be found that the majority of the approved societies could afford to pay that extra benefit, even in present conditions.
Finally, there is a point on which I have always felt sore, and that is that no provision is made so that people paying equal contributions are entitled to receive equal benefit. The whole system of national health insurance as at present administered by the approved societies requires overhauling and should have attention. Something has been said about 2119 the technicalities of the Bill. I defy the vast majority of lawyers to say that they understand what the Bill is about, and I am satisfied that the ordinary layman cannot possibly understand it. We who are connected with the approved societies manage to plough our way through this sort of thing and find out what it means. We make a guess sometimes at the things we are required to do, and we are able eventually to find some way of dealing with the situation, but for the ordinary rank-and-file member of the approved societies, it is impossible for him to know where he stands under the National Health Insurance Acts.
My complaint against the Bill is that it is of such a limited character. I agree that as far as it goes it removes what would have been a glaring injustice. I do not think the Government could have done anything less than they have done. In bringing in the Bill they have been compelled by the force of circumstances and by the feeling that would have been aroused in the country if they had not brought it in at this time to safeguard in some measure the pension rights of unemployed men. I am very sorry that the unemployed man is to receive no cash benefits in the case of sickness or maternity. Possibly he is hoping that he will not live to the age of 65 in the circumstances in which he finds himself. We may perhaps have new ideas in the future in the Ministry of Health, and when that time comes I hope that the Ministry will settle down and give us a comprehensive scheme of national health insurance and old age pensions. It is impossible to think that this is the last word in this kind of legislation. Does anyone believe that the question of old age pensions can be left where it is, and that 10s.a week to keep body and soul together is always going to be paid out to old people?
§ Mr. BANFIELD
I am sorry. It has been said that the Bill settles for some time this particular question. I would point out to the Minister that the Bill is not the last word in these matters, and that other Bills will have to be brought in. I trust that, limited as the Bill is, the point about maternity benefit will be dealt with in the Com- 2120 mittee stage, and that we may get some satisfaction in regard to it.
§ 7.23 p.m.
§ Mrs. TATE
It is not often that I find myself in agreement with anything that the hon. Member for Wednesbury (Mr. Banfield) says, but there is a good deal to be said for him when he states that the whole matter of national health insurance might well be overhauled. When the Minister opened the Debate this afternoon he reminded us that the claims of women on the Fund had been greater than had been anticipated, and therefore their sickness benefits were cut down in 1932.We cannot regard the Bill before us as merely dealing with national health. Had it not been for the improvement in national employment, we should not have had the benefits that are put before us now. Therefore, you cannot separate the two things. I recollect very well that in 1932 an Amendment was brought for ward, nominally in the names of the hon. Member for South Croydon (Mr. H. Williams) and the hon. Member for St. Albans (Sir F. Fremantle) who, I think, were really Government spokesmen. That Amendment was to ensure that should a woman marry she would have to reinstate herself before she would be allowed to be regarded as an employed insured person by having to work for 26 weeks. During that interim period she was to go into Class K, which would have meant that if she fell sick after marriage with out having done 26 weeks' work she would have drawn, not 12 weeks, but six weeks' sickness benefit. I think that I am correct in that statement.
I have a lively recollection of the approved societies and the friendly societies sending for the women Members of this House to go into the Lobby and saying to them: "Support this magnify cent Amendment for the sake of the women, because if you do not do so our funds will be ruined." Thank God, the women Members did not support that Amendment. I think it was because of the opposition of the women Members that the Amendment had to be with drawn. In view of the fact that the Amendment was with drawn it is interesting to note that the Minister said this afternoon that owing to the cuts that were made in women's benefit the fund is now all right as regards women. I 2121 hope that in future when gloomy prognostications are made as to what will happen if one does not support some particular amendment which is based on wholly unjust foundations, it will be remembered what was said in respect of that particular amendment. It is a curious and an unsatisfactory state of affairs that when it comes to health insurance, seeing that the claims of women are greater than the claims of men, the funds are always kept separate, but when it comes to unemployment insurance, where the claims of women are very much less than the claims of men, the funds are put together. It is un satisfactory that no attempt has ever been made by the Minister of Health and the Minister of Labour to see that these two funds were put on a proper basis, so that they could be compared, and one could know exactly how the fund stood as regards men and women, because whenever it comes to the question of health insurance the amount which women draw out is always stressed.
I wish the Minister could find some way of doing what has been suggested by many hon. Members this afternoon, and that is to grant maternity benefit. We have been to ld of the claims that women make on the fund. I cannot help thinking that that might almost in itself be regarded as an insurance. Perhaps the claims of women on the Health Insurance Fund would be less severe if they could know that during a very anxious period in their lives they were still going to draw their maternity benefit, and probably that would help the health of the rising generation. I do not wish to keep the Committee to o long, but I hope that the Minister will pay very serious consideration to the points that I have raised.
§ 7.28 p.m.
§ Mr. KENNETH LINDSAY
I rise to speak on behalf of my particular wing of the National Government in support of the Measure. It looks as if the Bill will go through with out a Division, and I note that only a week ago another great Measure went through with out a Division. I merely mention that fact in passing, because I think it is due to the workman like way in which the Minister of Health and the Parliamentary Secretary have devised these two Statutes. No doubt hon. Members opposite will say that the 2122 Government in this Measure are making good what should have been done before. At any rate, they are passing Measures which meet with universal acceptance. It is interesting to note also that Measures dealing with social services if they are really fair Measures meet with general approval, that there is no real opposition to them in the country and that there is no real party division at the moment on this question. I very much doubt whether any Measure which is fairly presented and which the state of the national finances will allow will be voted on on purely party lines in the future.
This is a Bill to make national health insurance square with unemployment. As the Minister pointed out, it depends on the state of trade, because this Bill is the logical result of an insurance which is based on wages. If the wages are absent, and? the wages have been absent, you have to bolster up the system in some way or other. In the past free cover has been given by stages, and it has made the finances of the Insurance Fund and of the approved societies impossible. It has also prevented a great many extended benefits being given by approved societies. Attention has already been called to the maternity ser vices, and it is worth while noting that when the special commissioners were looking round for services which needed special aid they quickly turned to the maternity and some of the health ser vices in the depressed areas. I only mention this because in insurance we are running the risk of basing our health and unemployment systems on the de pressed areas rather than on the country as a whole—and it is a question whether we should not base it on the country as a whole and make special provision for these areas. I notice that, according to the Actuary's Report, there are 200,000 persons who are in arrears. I should like to ask the Parliamentary Secretary to give us some information about these 200,000 persons. Apparently they have not paid anything for three and a-half years. They are not able-bodied unemployed in the old insurance sense. I take it that they will be found largely in the worst areas—I have some in my own constituency—but it will be interesting to know a little more about the make-up of this 200,000. 2123 If we are to keep these great insurance systems going they must rest on two planks. One is that the numbers of the unemployed must not exceed a certain figure. It is impossible to keep an insurance system going if you have 2,000,000 or more unemployed; in that case the insurance system would inevitably come on the dole. Secondly, there must be a public and basic provision for those who do not come with in the industrial class. In order to achieve the first my belief is that means must be found for taking out of employment a residue of the old workers. Unless by some miracle the tide of prosperity turns quickly you will never be able in the coming years to cater for these old people by an ordinary insurance system. Insurance is a purely arbitrary thing, but there is a limit to the way in which you can utilize benefits or have a sort of insurance with in insurance as contained in the new arrears fund. I think that the retirement of a certain number of the older members and workers is not only good in itself but would help to keep these insurance systems on a sound financial basis.
Nearly all the criticisms of the Opposition have been in regard to things which are not in the Bill or because some things have been done a little to o late; there has been no real criticism of the actual provisions of the Bill. With regard to the second point, in Scotland, due to the initiative of the Secretary of State, a very important commission has been sitting for the last two years to consider the whole health services of Scotland. The re are gaps—and this applies equally to England—between one and five and between fourteen and sixteen, and there is the whole field of the dependants who are not yet looked after. If we are thinking of the positive health services for the future obviously this Bill is only a stop gap in building up that new structure. I do not wish to pour coldwater upon it, because it is a practical Bill, and, while it is a stop gap, it has with in it all the elements of permanency in so far as it touches the extension of pensions and health insurance.
There are other things in the health services of the country which sooner or later—I hope soon—will have to be tackled. The re are many thousands of people in Scotland who are going to be thankful for this Measure. I know many 2124 in Ayrshire and in the West of Scotland who will come with in the category of the 2,000, but we look forward, thanks to the energy that is now being put into the consideration of this problem, since the reports have been received, by the Secretary of State, to the time when he will be able to put a new stone in this great health structure. There are big gaps existing, and until the structure is complete it is doubtful whether we can say that we are getting full value for our money. I learned some things on these questions from the right hon. Member for Wakefield (Mr. Greenwood), and it came to me as a shock a few years ago when he said, in effect, that there was no limit to the money which could be found for social services. The more one looks at social services to-day the more chances there are of improving and harmonising them. We have a great national health insurance system and also a public tradition, through our local authorities, and sooner or later we shall have to harmonise them and fill in the gaps which now exist right through our social services. If we do that, we can get value for our money, a positive health policy for the country. I congratulate the Minister of Health and the Parliamentary Secretary for a practical piece of work which has met with universal approval in the House.
§ 7.38 p.m.
§ Mr. LOGAN
I want to say to the Minister that I do not think he will find any approved society agent or. Official who will not be delighted with the Bill. I say that from the point of view of an administrator of health insurance; the Bill will give some relief to those people who are engaged in approved society work. The question which appears to me to be of paramount importance is not the question of equalisation in regard to the affairs of approved societies. The Minister must be aware of the difficulties which approved societies them selves create on the question of centralisation of the fund. When we think of the rise and fall of contributions and the solvency of the fund, we naturally think at once of one huge organisation, but, if we look round the country, we find that there are many approved societies with different rates, different methods and different benefits. We have a diversity of things. All the great approved societies having different 2125 methods on the question of solvency, the point arises whether there can be a better distribution in regard to national unemployment.
There is no doubt that the Department are up against a great problem. In the first place, approved societies have certain benefits and preferential rates given to them in collecting their units, and I should like to remind hon. Members who take part in these discussions that some of the anomalies which exist in this Bill exist simply because the question of centralization cannot be achieved. The various societies in the country are Dot prepared to centralise. Anyone who has any knowledge knows that the last Labour Government on the question of prolongation of insurance, gave to the members established on the books of approved societies first the opportunity to put forward evidence of incapacity—which was equivalent to payment—and, secondly, the opportunity to bring for ward evidence of franks to the Employment Exchange, or evidence supported by an authority like a Justice of the Peace or an employer that they were actually looking for work, and this was accepted by the audit department and the approved societies as evidence in regard to the question of arrears. As unemployment increased approved societies who had to meet their ordinary disbursements week by week, were likely to become insolvent, because the unemployed, not being able to contribute stamps could only send into the societies franks, or alternative evidence that they were looking for a job. When unemployment went up into the neighbour hood of 2,750,000 it was utterly impossible for approved societies to come out on valuation with anything of a surplus at the disposal of members. The Government were then confronted with the problem that they must meet the depression which had developed in various areas. They were compelled to see what action they could adopt to remove the difficulties, and they have presented the Bill saying that there must be a pooling system, to which one-and three-quarters will be contributed by the societies and one-and-three-quarters by the State, or three-and-a-half altogether, which will be credited to the whole of the approved societies in regard to the franking of these particular cards. 2126 There is one remarkable point that must be remembered. This is a contribution which, as far as 50 per cent. Is concerned, is to be borne by the approved societies. What State contribution is that when it is to be paid by the society? What is the State doing when that contribution must come out of current revenue account of the year from the members who contribute the money? as regards that 50 per cent. We need not thank the Government. The n we are to ld that there is to be money from the Army and Navy Fund. The Government are making good from the point of view of those who go out of employment as on 31st December, 1935, and receive benefit on 1st January, 1936. It has been stated to-day that the Government are now going to place all these people again into insurance, but the Minister knows that that is not so, and knows that he is not going to do anything of the kind. What he is going to do is to place in insurance those who have been continuously 10 years in insurance.
I want to compliment the Minister. I am not one of those who is not pleased when a constructive policy is brought for ward. I have worked the Act since 1912 and I am convinced that there is some thing to commend this Bill to the people. But the Minister must not for a moment think that now the Bill is produced the Government can say to the Labour party, "This is a presentation to the public of something which you never gave." Although this is a Bill which will be very acceptable to the people, it is not a Bill which gives the same benefits as the prolongation Act of the Labour party gave to the depressed classes. I agree with the Minister that from the point of view of actuarial solvency that could not be continued any longer. It cannot be disputed that what the Government are giving here is not on a par with the benefits, paid up to 1932, which the Labour party, whether wisely or unwisely, gave to the unemployed. The fact is that from 1912 onward every person who was kept on a book in insurance and was able to bring alternative evidence or franked cards, was entitled, riot to what this Bill entitles him to, that is classification only for pension benefits, but was entitled to maternity benefit, 'sickness benefit, disablement benefit and all the additional benefits that any society could give to any paying contributor. 2127 A few hon. Members with out a thorough knowledge of the subject have spoken as though we on the Labour benches had denied to the people benefits which this Bill is to confer upon the m. I do not think the Minister wishes to convey that impression. If that impression has been created, I want the House to understand what the Bill means. It means that if a person has 160 contributions to his credit —he could have paid 208 contributions—and has been a member for any period from four to nine and a-half years, even though he has contributions to his credit he can go? out of insurance and get nothing any more. When the Minister was speaking to-day I wished to interrupt him because what he said was in correct. The right hon. Gentleman said that in these cases with which we were going to deal, that is up to 10 years, the benefits could be carried on. I would like the right hon. Gentleman to say clearly that that is not so. This Bill does not say that. The Bill is only to apply to those who have been 10 years continuously insurance. I do not mean 10 years continuous contributions. I go so far as to say that that is a valuable concession. I know I am giving bouquets which might be used against me. Many approved societies were anxious that a number of contributions should be mentioned. The Ministry have not stated any figure, but have accepted "from the date of entry, 10 years," which is a wonderful concession to all insured members of approved societies.
The question of maternity benefit has been referred to. In my administration of the Act I know of no greater benefit for the public good than the maternity benefit. Provided a person has been 10 years continuously in insurance and a society is able to give additional benefit, I do not know why it should be argued that the giving of maternity benefit is a grievance. Societies that are able to give additional benefits need not worry their heads about maternity benefit. If they have the money they can pay it out under "Want and distress." What I want to draw attention to most is something that is a misnomer in the Bill. We have heard that, from the point of view c, f money, we must not add to the burden. As far as that is concerned, I do not know 2128 that there is anything that it is not possible to bring into the Bill. Let me mention two important points. First, there is the question of boys starting work at 14 years of age. If we want the Act to be solvent, we must rise to the occasion and see that those from 14 to 16 are insured and contribute to the Fund. With my knowledge of an industrial area, I say it would be a great protection if the State were to bring insurance into operation at the school-leaving age. Every boy entering a workshop becomes a competitor in the labour market. In a city like Liverpool one finds 200,300 and even 400 lads at a time being thrown on the street simply because insurance contributions must be paid when they reach 16 years of age. If those boys had to pay contributions from the moment that they left school, they would not be thrown on the streets at the age of 16.
I consider that the Bill is defective from the point of view of the additional benefits, from the point of view of solvency, from the point of view of making it more workable for the societies, and I consider that steps should have been taken to include contributions at the school leaving age. I will call attention to another point. When one looks around one finds many workers who are receiving over the insurance limit in the way of income. In certain parts of the country it may be £6, £7, or £8 a week. They are not outside insurance. Those people who work in factories or in machine shops or who do puddling are able to be insured. But there are clerical staffs, office men, who get over £250 a year and are in constant jobs. The re might be an office with 80 or 100 on its staff, and in a great city like London you could multiply that number by thousands. If these people were insured, you would bring into insurance men whose cards were fully stamped, men who were in constant employment 50 weeks a year. How can you make things solvent if you look only into the casual markets of the country How can you expect to be able, with out financial assistance, to carry the burden of a great Measure such as this? Bring in the boy and the girl at school-leaving age and save the wastage that takes place in the factory when they are discharged at 16. Give an opportunity to clerks, brain workers, who are getting over £250 a year, to pay their contributions and 2129 enable them to come in under this Bill. If you do that the new sources of revenue will reduce very much the liabilities of society.
There is one other point. If you bring in a Measure of this kind, is it going to be labour saving and will the societies be enabled from a clerical point of view to save their time? Instead of the people going to the employment exchanges, they will be able to get their cards franked, and there will be no necessity for the societies to go through their books and to send to the lagging ones information that they can come and have their benefit. This will save thousands of pounds to the approved societies and enable legitimate members, and unemployed members, to get the benefit of the Act and the additional benefit which otherwise they would not be able to get. I think on the whole that the Bill is as good as we can expect to get in the present conditions, but I hope that the Government will not crow that they are giving something different from what any Government placed in a similar position would have been bound to give. I would like to see the aid. Coming in borne by the State. The nation ought to bear the whole burden of unemployment.
With regard to the aid. For each frank, the Minister did not make it patent to the House that they had an obligation placed on them by their own act, on account of the Prolongation Act being dissolved. The re would have been 200,000 put out of insurance on 31st December, 1935. It followed that these 200,000 people would no longer be able to get medical benefits. They would no longer have their panel doctors and the panel doctors would no longer be able to collect from the approved societies the annual amount of money allowed them in regard to those on their panel. An agitation went on up and down the country in regard to the 200,000 who were likely to be thrown on Poor Law administration. Public assistance committees were being requisitioned to make new appointments of medical officers. They were already overburdened with work, and the panel patient found that his medical practitioner was about to be taken away from him and placed in another category. This has been a big burden on approved societies. You have had a saving as far 2130 as the State is concerned, and I am convinced that you have no right to charge the approved societies with a medical service you would have been compelled to give under the public assistance committees. That being so, I am at a loss to understand where the great benefit comes in as regards the approved society. The approved society is not get ting any benefit from what was an act of your own doing.
A few days ago I put a question to the Minister, and I was to ld that the number of franks was 81,000,000 for men and 17,000,000 for women for the insurance year of 1933.Therefore, we have the startling figure of about 98,000,000 franks during an insurance year, which will mean 98,000,000 three pence half pennies will go into a pooling arrangement. It is a big amount. It is a big job with which the Department has to deal. They will have a very much easier job in connection with the making up of the books of the various societies. I must certainly congratulate the Minister in straightening out the many difficulties in the old Act, and I would like to see it made simpler still, with economy and efficiency in administration. I am convinced that when the next quinquennial valuation comes the approved societies will be in a much better and more flourishing condition with less red tape in regard to administration. I think the Minister is to be complimented, and I speak as one with a full knowledge of the Act. We are right in putting for ward our suggestions, but no suggestion has been put forward from this side of the House which is a condemnation of the Bill. We welcome it for what it gives us. We hope that more will follow, and we trust that you will have God speed and good will in the working of your Act.
§ 8.10 p.m.
§ Mr. MAITLAND
The hon. Gentleman who has just sat down is always fair in his intervention in our debates, but in his speech to-day the validity and force of two statements will be found to be destroyed, because one was founded on a misapprehension of what the Minister said, and, in the second instance, he followed up a statement with a flat contradiction. In the first case in which he referred to the Minister I think that the hon. Member, when he reads the OFFICIAL REPORT to-morrow, will find that the 2131 Minister did not say what he quoted. The se were the actual words of the Minister:Subject to certain qualifications, which I will refer to in a moment, no one will be put out of getting insurance because of unemployment.I think my hon. Friend could not have heard his qualifying statement because later on in his speech the Minister went on to refer to those qualifications.
§ Mr. MAITLAND
I was quite sure that with the fairness that is characteristic of him the hon. Gentleman would at once wish to with draw his statement that the statement made by the Minister was in correct. With regard to his second statement, I hope he will be equally willing to make a further withdrawal. He said quite frankly that what was pro posed in this Bill was not so good as what the Labour Government had introduced when they were in office, but he destroyed the validity of that a few seconds later by saying that he admitted that that could not go on. That is what the hon. Gentleman said, and it is no use assuming that something which he suggests is better is in fact better than this Act offers, when in almost the same sentence he said what the Labour party offered could not be carried on.
§ Mr. LOGAN
I do not mind making one confession, but when it comes to a double dose it is a bit thick. What I wished to imply was that the benefit that the Labour party gave in the Prolongation Act was a benefit which entitled the members to all the benefits of an approved society, and that the benefit given under this Act does not enable them to get anything else except pro vision for old age. That being so, I then contrasted it and said that could not go on, but bearing in mind I am speaking from the point of view of the National Government.
§ Mr. MAITLAND
We shall see. Per haps it may take us a long time before we do see, but when the hon. Gentleman ventures into the realms of prophecy I will not attempt to follow him any 2132 further. We have had a most interesting discussion, and, when the Minister opened the Debate by explaining the provisions of the Bill, he did a service to the House, because wherever we may sit we must all find a great difficulty in following a Bill which very largely is legislation by reference. Any complaints about legislation by reference would always find a very sympathetic response from the average private Member. But because of the very elaborate exposition of the Minister, and because of the memorandum which has accompanied the Bill, it is possible for the average Member to obtain a clear idea of what the proposals of the Government are and, like other Members who have spoken, I would like to congratulate the Government on the proposals they have submitted. I do not suggest that it is an ideal Bill. I have been long enough in the House never to expect an ideal Bill, but I do suggest that the main purposes of the Bill are purposes which we can all support whole-heartedly. It does not profess and is not intended to be in the nature of a complete overhaul of our system of national health insurance.
I think the Minister again did the House a service when, in introducing the Measure, he referred in very general terms to the construction of our great system of national health insurance and. Also reminded us that no fewer than 18,000,000 of our people are affected by our various schemes of national insurance. The astronomical figures given by the hon. Member for Mitcham (Sir R. Meller) as to what has been accomplished in these vast schemes are sufficiently astonishing as to give one reason for pro found gratitude that under a system which has stood the stress of the last 20 years we have been able to do so much for that section of the community who, through various circumstances, have unfortunately had to suffer. It is rather in that sense that I approach this Measure. I look upon it in the light of what it purports to do. Whether hon. Members of the Opposition are satisfied or not with the extent of the provision which the Government are making, I think they will agree that in seeking to improve the position of those people who have suffered from pro longed unemployment the Government at any rate are doing something which we can admire and appreciate. As to whether 2133 they have done enough or not, that question of course always offers a fair basis of criticism but in ray judgment the Government have done a humane service, not only in bringing with in these provisions, the 200,000 people who are said to be directly affected but also in having preserved these rights for the people who will be affected in the future should bad times continue.
I can understand and sympathise with the view that this Bill ought to be ex tended so as to include maternity benefit. The hon. Member for Gorbals (Mr. Buchanan) always speaks on this subject with a sincerity and knowledge which command respect, and I am sure the Minister will take particular note of what he said. He suggested that, in certain respects, the Bill would put a section of the community in a position inferior to that which they occupy to -day. If that be so, then I am certain that the spirit which has actuated the Government in the production of this Bill will lead them to remedy such a defect. It is suggested that perhaps 10,000 people out of these 200,000 will be left outside insurance. I submit that if there are only 10,000 in that position, steps should be taken to secure, as far as humanly possible, their legal rights with regard to insurance, pensions, and medical benefits.
We became so accustomed, during the War, to talking about thousands and millions that we ceased to appreciate the value of the individual human being. It ought to be the cause of the utmost concern if even one citizen of this country is in distress and how much more ought we to be concerned if 10,000 of the poorest of our people are suffering as the result of an administrative act. The re fore I say that if only this percentage of the 200,000 are left out of the provisions of the Bill, the Ministry ought to take such steps as they can to bring them with in the purview of some administrative arrangement which will secure to them these benefits. I know that such a proposal would come, in another form, under our social services. We can always rejoice at the fact that, at a time when other nations besides ourselves have been undergoing great troubles, it has been possible for us to do so much for the poorest of our people and I would like to ensure that these people should have these benefits as a matter of right, be cause that is what Britishers prize most. 2134 If we can make provision for 190,000 I would like to see it extended to the whole 200,000.
In considering the great insurance Measures which have been in operation in this country now for a quarter of a century, it is not out of place to invite Members of the Opposition to reflect upon this aspect of the question. They have spoken, with sincerity, on the subject of national pensions, and they have also spoken many times about the shorter hours which are, they claim, made possible by economic conditions, the advance of mechanical science and the like. I would ask them in the interests of the workers to consider the question of a shorter working life rather than of shorter working hours. I think if they did so they would be on surer ground. I suggest that in any reconsideration of our insurance system we would do well to take into serious account the possibility, not so much of shorter hours because that gives rise to other problems connected with the use of leisure, but the possibility of putting into operation a great national system of insurance which would make the age of retirement earlier than it is to -day. I believe that such a scheme would be a real contribution to the solution of some of our economic problems. I appreciate however that that is a much wider measure than is covered by the scope of the present Bill and perhaps it is only by forbearance that I am allowed to refer to it incidentally. I conclude by congratulating the Government on the present Measure, which, with in its scope, is intended to assist directly a poor section of our people, and I join with the hon. Member for the Scotland Division of Liverpool in saying that as far as they go in these and similar efforts I wish the Government Godspeed.
§ 8.21 p.m.
§ Mr. BATEY
I am not going to criticise the speech to which we have just listened. I admire the way in which the hon. Member praised the Government and thanked them for this Bill. I only say that I wish he had gone a step further and asked why the Bill was necessary. Had he gone into that question, I feel sure that he would not have had words of praise but rather words of blame for the Government. We must keep in mind the fact that this Bill only partly undoes a great wrong which the 2135 Government did to the unemployed in 1932. This Government have committed two great wrongs on the unemployed and in the distressed areas those wrongs have been felt more severely than elsewhere. In 1932 thy took away from thousands of unemployed, medical benefits, and maternity benefits, and endangered their old age pensions. That was one wrong. The other was the imposition of the means test but it would not be in order to discuss that to -night. I am glad to find that there is a death-bed repentance on the part of the Minister of Health for the wrongs which have been done to the unemployed. If rumour and news paper reports are correct this is probably the last occasion on which the right hon. Gentleman will stand at that Box as Minister of Health and I am glad to think that, even at this late hour, he is showing his repentance by taking the step indicated in the Bill. But I wonder why the Government have brought in this Bill at the present time. It is just over a year ago on 1st May, 1934, that I put a question to the Parliamentary Secretary in these terms:Whether he will introduce legislation to amend the National Health Insurance Act, 1932, so as to restore medical benefit and old age pension benefits at 65 years of age to unemployed workmen.That question was answered by the Parliamentary Secretary, who said:this matter was fully debated during the passage of the National Health Insurance Act, 1932, and again in November last, and nothing has since transpired to call for the reopening of the question.Then one put a supplementary question to him, and his answer was more startling still. This was the supplementary question:Is the Parliamentary Secretary aware that this question was put down to the Prime Minister, as, in view of the Budget surplus which has been achieved since the subject was discussed in 1932, I want to know whether the Government will reconsider this matter with a view to righting this wrong to so many of the unemployed?The Parliamentary Secretary's answer was this:the Budget surplus has nothing to do with making national health insurance non contributory."—[OFFICIAL REPORT, 1st May, 1934; col. 155, Vol. 289.]The Budget surplus last year had nothing to do with it, but to-day we are told by the Minister of Health that it is the prosperity of the nation, which is 2136 revealed in the Budget, that makes this Bill possible. If it is possible to do it to -day, it was possible for the Government to do it last year, and one must come to the conclusion that the Government are doing it to-day because a general election is in the air and they know that if they went to the country with this great wrong being done to the unemployed, it would not be well for the m. One can only come to the conclusion, seeing that the Government have put off to this last minute the bringing forward of this Bill, that it is being introduced to-day with an eye on the general election and to put them selves right with the people of this country before the election takes place. I am glad that the Minister of Health said to-day that this Bill was possible through the prosperity of the nation. After what the Chancellor of the Exchequer said, when delivering his Budget speech, about there being no lees than £50,000,000 savings in trustee and Post Office savings banks, we are entitled to-night not to be merely satisfied with this Bill, but to say that because of the prosperity of the country and because of the way in which the Government boast of that prosperity, we should expect the Government to have gone much further than they have done.
The Minister talked about the improvements in the Bill for those who fall into unemployment, and he said that 5 per cent. Of the unemployed would fail in obtaining these benefits. I want to ask why any one should fail. My opinion is that the Government ought not to have come with a Bill like this, although I confess we cannot vote against it. Some one has described it as a simple Bill, but I do not regard it as simple. I have read it two or three times, and I confess that there are things in it that I cannot yet understand. It is not a simple Bill. The Government ought to have come to this House with a one-Clause Bill repealing the 1932 Act and putting us back into the position that we were in prior to that Act. That would have been a simple Bill, and then we should have known where we were. If the country is so prosperous, then the country can stand putting as back to where we were prior to the 1932 Act.
The right hon. Gentleman says we have put the unemployed, so far as medical benefit and pension rights are concerned, 2137 right. One thinks of the men who, one believes, ought to be able to claim maternity benefit. Apart from all that we are losing under this Bill that we had under the prolongation Acts, and in spite of all this, we ought really to have had maternity benefit, because that means so much to a man when his wife is con fined and he has been out of work for years and years. I come from a district, the North-East coast, where the Civil Lord, in his report last June, said there were no fewer than 63, 046 persons unemployed who had been unemployed for more than two years. This is the class of people who will feel the loss of maternity benefit. When the Government are restoring medical benefit and pension rights, the unemployed, in my opinion, have a strong claim, an immense claim, for the restoration of maternity benefit also. One thinks that there will be thousands and thousands of men on the North-East coast who will feel the loss of that benefit, and I am hoping that, while the Minister was so strong to-day on the point that there would be no cash benefits, be will not take his stand the re, but that before the Bill gets through the Committee stage he will seriously consider doing something to re store at least maternity benefit, because it would mean so much to so many thou sands of men who have been unemployed, not for a few months, but for years.
I have two questions that I would like to ask the Minister, and the first is: Does the Bill restore medical benefit to all those who had it or would have had it but for the 1932 Act? I think we ought to have that question answered. Secondly, I want to as k, will all the unemployed be entitled to pensions who would have been entitled to pensions but for the 1932 Act?
Sir H. YOUNG
I think there must be some misconception the re. Nobody has lost any pension rights at all under the 1932 Act.
§ Mr. BATEY
I agree that nobody has lost any pension rights, but there was the danger: of their losing those rights. It is really the first of those two questions to which one would like an answer when the proper time comes. This Bill has a special interest for some of us who come from the distressed areas, because if the Minister looks through the figures of the unemployed, he will find it stated in the 2138 Ministry of Labour Report for 1934, which has just been issued, that the bulk of the unemployed who have been out of work more than 12 months is concentrated in the north-east district, where there are 109, 635. In Wales there are 65,000, in Scotland 66,000, and in the north-western district 68, 000. In London, the south eastern district, the south-western district and the midland district put together, there are only 56, 000. This question, therefore, has a special interest for those of us who are in the north east district. We have not only men there who have been unemployed for 12 months and two years, but men who have been unemployed for years and years and have no prospect of work. I am anxious to know whether those men who have been unemployed for a long time will be able to claim medical benefit and keep their pension rights. Because they have been so long unemployed in the distressed areas, large numbers of men have ceased to register at the Employment Exchange and many have even ceased to get their cards franked. They have lost unemployment benefit and have been forced to go on poor relief.
I was looking up yesterday the number of men who were refused benefit by the courts of referees last year, and I found that the number was no fewer than 402, 510. Where men have been cut off benefit, the tendency in the north of England is for them not to go to the Employment Exchange to register. They say that it is no use registering as they have been refused benefit. What is the position of those men who have lost heart, whose benefit has been stopped, who feel that it is no longer any use going to register? Will they be allowed to be make a fresh start and get their cards franked I Will they be allowed the privilege of putting themselves right so as to be able to claim medical benefit and pension rights? I consider that the introduction of this Bill would have been a golden opportunity for the Government to go further than they have gone. We heard the hon. Member for Sunderland (Sir L. Thompson) speaking as though the working-classes should be content that the Government were spending about £500,000,000 on social services. The Government are spending no such sum. As a matter of fact, they are spending this year immensely more for past wars and 2139 preparing for future wars than they are spending on social services. The working-classes, and especially those who are unemployed, are entitled to ask the Government and to expect, when the country is prosperous, a greater share of the money spent by the Government than they are getting at the present time. I hope that the Minister will not be satisfied with this Bill as he has presented it. Let him put the unemployed back to where they were prior to 1932, and, if possible, give to the working-classes greater benefits than they obtain at the present time.
§ 8.42 p.m.
§ Sir FRANCIS FREMANTLE
The speech of the hon. Member for Spennymoor (Mr. Batey), who always interests us, was full of fallacies in order to substantiate the position of not agreeing with the Bill. His first fallacy was to think that in an insurance scheme and a business measure such as this you can put in all sorts of other benefits such as he—and I too—would like to have included. He wants maternity benefit for everybody and other benefits of all sorts for an increased body of uninsured persons.
Whatever the extra benefits, it is a question of what the fund can afford. The hon. Member spoke of the country as being in a, state of great prosperity. He has lost sight of what the Chancellor of the Exchequer said when he stated that we were on the turn of prosperity. Everyone knows, and the hon. Member knows perfectly well, that the position of the whole world is such that we cannot depend from year to year on the future. We do not know what next year is going to bring. If we did, we could go ahead. Nobody can say that the position of this country a year hence will be as prosperous as it is to-day, or that we shall be able to increase these benefits beyond a certain measure. Such benefits as this Bill does introduce are a hazard banking on the fact that we are probably going to move along the road to prosperity, but we must be careful in the steps that we take. The other fallacy, 2140 which has run through so many speeches, is that the Government ought to do more because any other government would have done more and that the last Labour Government would have done more. The last Labour Government put the country in a position in which they could not have done it, and it is only because the present Government came in and saved the country that they are in a position to bring in this Measure.
It has been suggested from this side that it is only a kind of automatic cockatoo call to praise our own side. I have taken precaution, therefore, of getting the opinions of those who are most concerned with the work of the approved societies, who have great experience and responsible positions, and who certainly do not belong to my political party. Here is one opinion:this Bill is warmly welcomed by the approved societies.Here is another:Great credit is due to the Government for the new Measure.Another says of the Bill that it is.a new charter of security for our working people which will bring comfort and peace of mind to hundreds of thousands..
They are private letters and I do not care to say who the individuals are, but one of them is a man who is one of the main bulwarks of approved society work. Another letter says:This is the most beneficient application of the principles of insurance with in my experience.A great tribute is due to the Government Actuary for his wonderful work. He has drawn up a report on five years' working, which was presented to us this year, and the results of that work are to be seen in this Measure. Honest critics of the Bill will recognise that it could not be introduced earlier, because we were waiting for the report of the Actuary, and for the statistics from 1925 to 1932 on the working of the insurance system. The hon. Member for Govan (Mr. N. Maclean) spoke of the Government having "robbed the till," and we are familiar with that phrase and the arguments based on it, but the House ought to realise what expenditure the 2141 Government have let themselves in for in respect of the contributory old age pensions Acts. From the report of the Actuary, who has prepared estimates covering 30 years, we see that the total annual expenditure will go up from£43,000,000 this year to £62,000,000 in 30 years' time, and that the Exchequer contribution is £13,000,000 at the present time and in 30 years' time will be £25,000,000.Those are big figures, and in face of them it is absurd to talk of the Government having "robbed the till." As part of the whole economy scheme the Government had to make a few small reductions, but they are very slight in comparison with these enormous commitments which they have undertaken. We are going ahead steadily with the collective services and are helping the community in many directions, but it should be understood that there is a limit.
The hon. Member for Flintshire (Mr. Llewellyn-Jones) and one or two others raised the difficulties created by legislation by reference. I think we all remember the valiant and courageous effort of the Minister of Health to avoid legislation by reference in the Housing and town Planning Act. All those who were concerned with it in. Committee will re call that the result was to produce a crop of Amendments which were not in the least necessary or germane to the Bill and which prolonged the discussions on it, and in the end made it a more complicated Measure than if we had proceeded by the old system of legislation by reference. It seems almost a revolutionary suggestion, but would it not be possible to consider the question of printing the Bills with the references attached to them either as footnotes or appendices. That would save us from having to come into the House with large armfuls of reference books. No doubt it is useful for the hon. Member for Gorbals (Mr. Buchanan) to have two large books on which to rest his elbows but it would be more useful to have the references printed in the Bill. This is a point which might be referred to the Committee which is charged with the duty of looking after our publications, of which I am a Member, which has not met this Session. Perhaps I misheard the Minister of Health, but I understood him to say that this country was a pioneer in this insurance business. I had vivid recollections 2142 of going to see the Museum of the work men's insurance system at Charlotten burg, outside Berlin, as far back as 1905.
§ Mr. BUCHANAN
The Minister only said that we were pioneers in widows' pensions. The hon. Member must be fair even to his own Government.
§ Sir F. FREMANTLE
Anyhow, we have gone ahead, and we have done so on democratic lines, which ought to fill us with confidence when we think of the position in Germany and other Continental countries. The Bill also has the great advantage of producing a more uniform, sensible and businesslike system of administration. In the past there have been great variations in administration in the different approved societies. A certain amount of variation is all very well, but differences in the interpretation of the test of unemployment and the contributions' test gave rise to much difficulty in administration and to consider able hardships. Now we are laying down clearly a definition of the unemployment test which should produce uniformity.
The Bill also sets up reasonable conditions under which the insurance status can be maintained. That is a movement in the right direction. One thing I should like to know, however, is why it is that under the interesting system by which a fund is to be provided for paying off arrears instead of the arrears being constantly debited to the insurance we pare off the penny contribution one-third of a penny in the case of a male contributor and one-ninth of a penny in the case of a female contributor. The re is a difference of 300 per cent. between the two. I have discussed this point with a number of people, and I cannot see that that justly represents the differences in the burdens of the two sexes upon the Fund. Further, I should like to know why short-term insured persons, those who have been insured for not less than four years, have to show only 160 contributions with in the four years, and why such large allowance is made for their not being franked at the employment exchanges during un employment. It is all very well to say that you must allow them to miss an occasional week when they are unemployed if it occurs by inadvertence, but it is encouraging slackness to allow such a large number of weeks to be missed. I should think the unemployed might now 2143 be expected to appear at the employment exchanges at least once every week to get their frank, as is required. The re must be very few weeks in which they cannot manage it. People are beginning to understand the system which is in vogue and there should not be so large an allowance for weeks to be missed. Attendance at employment exchanges should be a more regular and certain feature.
I join with those who wish that it were possible to provide further maternity benefit, but again this is a question of expense, as it is with other benefits, including medical benefit. I wonder whether the Minister has it in his mind to bring in during the autumn, and in the last Session of this Parliament, that Maternity Bill of which we have heard so much, and whether it would be possible in that Measure to make maternity provision for all the insured people. The re is also a general feeling in regard to ordinary medical benefit—I 'am not speaking now of the cash benefit—that it is a. Hardship that the insured person should have to leave the doctor of his choice, who is used to him and to whom he is used, and go to the public assistance doctor, and then later on go back to his own doctor. Now that we are accustomed to the panel doctor and public assistance system, some arrangement ought to be made which will apply equally to insured and non-insured persons as regards medical benefit and treatment, and I hope that there will be such an arrangement before very long. That can hardly be brought into the Bill. What is brought in carries us a stage further in the right direction, and I hope that the Bill will receive the unanimous support of the House.
§ 8.59 p.m.
§ Mr. CLEARY
The Bill brings us face to face once more with the difficulties of the depressed areas. I represent one of those areas, in which the full effects of prolonged unemployment and loss of insurance benefits have been felt. In addition to the detrimental effects upon the persons concerned, an additional responsibility has been placed upon the unfortunate distressed areas of the country.
I want to raise only one point, in the hope that it will be dealt with this evening, at least by a. Promise of consideration. It refers to dental benefit. 2144 Representations have been made on the subject to me by approved societies in Liverpool. I understand that the societies are compelled to grant at least 50 per cent. of the cost of dental treatment, but they feel that although, after the valuation, they may have a surplus to devote to additional benefits, it may not be sufficient, especially in the depressed areas, to allow them to offer that 50 per cent., and they wish to ask the Minister if they could be permitted to submit schemes whereby they could grant dental treatment allowances to insured persons on a scale lower than 50 per cent. It may be suggested that such a proposal would lead to abuses, but that can hardly be so. No approved society worthy of the name would wish deliberately to reduce its own benefits, if it had resources at its disposal. The re is the further safeguard that any society wishing to grant less than 50 per cent. Would be compelled to submit its scheme to the Minister and his department. In considering the request of the society, the Minister would take into consideration all the relevant facts, and he would have a full knowledge of the resources and surplus at the disposal of the society.
At the moment the societies have to grant 50 per cent. Or nothing. Dental treatment is not a luxury in these days, but is one of the ordinary essentials of health, and, although no society should offer less than 50 per cent. if it is in a position to give the full rate, it is better that some less assistance should be given, if the full 50 per cent. cannot be offered by societies which have been badly hit by the conditions prevailing in industrial areas which are the cinderellas of the National Government's prosperity complex. Relaxation would not merely benefit the society but would help insured persons to get the dental benefit which is imperative to their health. It would be a great step if the Minister would take notice of this point—I can hardly expect a complete answer this evening—and would promise to take it into consideration.
I would emphasise the plea which has been made by my hon. Friend the Member for the Scotland Division of Liverpool (Mr. Logan), who hoped that the time was not far distant when the clerical and professional classes would be included in the insurance system. In the depressed areas it is those classes who 2145 have not the ordinary standby upon which many other classes of the community can to some extent rely, and who would be very grateful for such a change. I trust that the Minister will note the two points I have raised, and, will make some remark, particularly upon the former point.
§ 9.5 p.m.
§ Sir JOHN WITHERS
I rise to sup port the Bill, and to say that I should be pleased to support a very considerable extension of the principle embodied in it. A person like myself who is not mixed up intimately with insurance matters finds it very difficult to go into detail, and I feel strongly that a consolidation Bill should be brought in to help the ordinary person who wishes to know something about the subject. Two important points in connection with the Bill are that the arrears are now to tally obliterated—they were half obliterated before—and that, as I understand, some 200,000 persons will be retained with in benefit. That in itself is a very great thing. I would also very strongly urge the Minister to consider, if possible, in the future, if not in this Bill, improving the maternity benefit. I think everyone who has spoken in the Debate has referred to the maternity benefit. It is a matter of very great importance, not only for the husband, but also for the wife and for the little child that is born.
Another matter to which I should like to refer is a little delicate, namely, the attitude taken up by the Noble Lady the Member for the Sutton Division of Plymouth (Viscountess Astor) in her criticism of the Labour Opposition. The Noble Lady said that the Measures of the Government in these social matters were not strong enough, because, as I understood her, the Labour Opposition were not strong enough to urge the Government on; and there was also very considerable criticism of their attitude and powers. I wish to dissociate myself, as would, I am sure, most of the Members on my side of the House, from any such criticism. It has been to me and my associates a source of very great wonder that so small a body of men as the Labour party should have kept their flag—whichIdo not in the least follow or admire—jolly well flying. It is wonderful to think that so few people should have made themselves specialists in the number of intricate matters that have been 2146 brought forward during this Parliament. I heartily congratulate the m, and wish to dissociate myself and the Members of my party from any of the criticisms made by the Noble Lady, who, I am sure, must have made them by some inadvertence, and with out having really thought much about the matter.
§ 9.9 p.m.
§ Mr. CLARKE
I rise to make an appeal to the Minister on one point, and that is that an additional Clause should be inserted in the Bill to provide for the insurance of boys and girls between the ages of 14 and 16. I have set down four reasons for this, which, with the permission of the House, I should like to give. The first is that there is at present no organised provision for the medical treatment of boys and girls between the ages of 14 and 16.Secondly, this is a critical period of growth, when neglect may cause irreparable damage. Boys and girls are subject to considerable strain when they first enter employment. Thirdly the examinations by certifying surgeons under the Factory Acts are confined to a section of the juvenile population, and are merely designed to prevent boys and girls with health defects from entering industrial employment; there is no provision for remedying any of the defects discovered. Fourthly, unemployed boys and girls joining junior instruction centres and classes may be treated by school medical officers, and it seems anomalous that the unemployed in this respect should be provided for while the employed are not. This tragedy of juvenile unemployment is so serious that one feels that some special provision should be made in these cases, and I am sure it would be for the future benefit of the citizenship of our country.
§ 9.12 p.m.
§ Dr. O'DONOVAN
The hon. Member the Wavertree Division of Liverpool (Mr. Cleary) will, I hope, excuse me if I quote his opening remarks in which he stated that this Bill brought us face to face with depressed areas. I take it that he will not mind if I amend his statement to express the wider view that this Bill brings us face to face with the care of the health of the British people, of whom those in the depressed areas are a fraction, but not a dominating consideration. This Bill is entitled:Amendment of National Health Insurance Act, 1924.2147 We have had in this Debate many references to employment and unemployment, and even to means tests; we have had references to actuaries and praise of actuaries; indeed, this is a Bill which deals with many millions of pounds. But, th ereferences in the Bill and in the Debate to the care of the people's health have ben singularly slight, and in no sense deep.
The first matter to which I should like to refer is an aspect of the approved societies as regards the care of the health of the people. We entrust a great deal of the financial help of the sick to the approved societies; but such societies, once they have the millions of the public in their custody, husband those millions with a care that has the full approval of the British Treasury, but is often a source of grave disquiet to the doctors and to the sick throughout the country.
Ordinarily a medical certificate is given in good faith to a sick person, but the impish ingenuity of the skilled advisers of the approved societies can see many outlets for the unwary disbursement of public money through medical certificates written in good faith but with out lawyer-like skill; and, while those difficulties are being cleared up by leisurely correspondence, the sick person often waits weeks for the financial assistance that is so pressingly necessary to him. I would like to point out also that, when the sickness becomes a matter of litigation, so that the approved societies and the insurance companies, both having skilled professional advisers, are set in opposition to one another, the needy sick per son may wait weeks and months for any assistance from either side until the eminent lawyers and specialists, with the help of the judiciary, have come to some conclusion, and then only are his needs met. I should say in passing that it is occasionally possible for the two sides to come to some temporary compromise as to which shall pay in the interim, but I notice in my work, and many of my brothers also notice, that, when this House wishes to help the sick instantly, the skilled professional advisers of approved societies, carrying out their very proper work of the custody of their funds, put a very high barrier between the poor sick man and the money that he might have. 2148 Ithink it is quite fair and proper at this stage to point out how much trust this House puts in the medical profession. On page 4 of the Bill will be found references to.specific disease or bodily or mental disablement.The action taken in such cases depends upon accurate medical certification. On page 5 there is a reference to.satisfactory evidence of his incapacity,and behind the production of that satisfactory evidence is the expenditure of very large sum of public money; yet I think it is quite correct to say that the men who have the first custody of those large sums of public money are perhaps the most overworked of all the professional men in this country. Their day's work starts quite often at half-past eight in the morning. They finish a heavy surgery by half-past nine at night, and after that come night calls; and through out that day's work, in addition to their ordinary professional care of sick people, they have to give the most minute attention to certification and to the observance of complex regulations which are showered upon them with the best of intentions, but which, collected, make a full volume year by year. This work of certification cannot be escaped once we are responsible to the State for this Fund, but it does, I think, need some pointed observation in this House that all the actuarial calculations which have been referred to so approvingly would be rendered nugatory unless the actuaries could depend year by year upon consistent and accurate medical certification. The fact that this generally approved Bill depends so much upon the actuary, and the fact that the actuary depends so much upon medical certification—these two concomitant observations lead one to state fairly to the House that medical certification is pretty accurate and very reliable.
We have been to ld that it would be advisable for additional benefits to be granted. It has been suggested that these additional benefits might be maternal benefits and dental benefits, but, if I may I would put in a prior plea before the se, that specialist advice be made more available through the Ministry of Health for panel doctors up and down the country. It is not dignified or proper that this service should depend for its ultimate efficiency upon the free 2149 advice of consultants up and down the country. The more the panel system is approved and extended, and the more medical benefits are extended among the poor people, the more patients will be found to need specialist advice. The out patients of all the great hospitals are being more and more crowded by patients sent to them in pursuit of their proper aims by doctors whose work is safeguarded and increased by this amending Bill. Before we consider dental benefit we might turn our minds to the extension of maternity benefit. I refer to this matter because the Chancellor of the Exchequer recently referred in his Budget speech to the fall in the birth-rate as a possible menace to future prosperity and stability of this country, and if more can be done to encourage motherhood it can not be done more speedily and more simply than through the operation of this amending Bill.
There is one other matter to which I would like to refer. If the age groups of population in this country are to change greatly, the actuarial provisions for ex tended benefit will be rendered very shaky. If we are to have, therefore, through a fall in the birth-rate an in creasing aged population, then our figures to -night are based upon a shifting basis. I should very much like to hear from the Minister if the change in the birth-rate and the change in the age groups of the population, which are referred to repeatedly in specialist papers on this matter, are constantly and frequently under review by his actuarial advisers.
This is a big Bill. It covers the expenditure of millions of pounds. sit touches the lives, the happiness and the health of millions of poor people, and I am sure, therefore, that the country will welcome the attention which the Minister and his expert advisers have given to the matter. One must confess that this Bill could not have been produced by the wisdom of Parliament. We in the House have many and diverse occupations and few of us are familiar with every aspect of the difficulties of insurance benefits, but we feel that all these difficulties have been collated during the past few years and that they have been sifted and arranged from their disorder especially for our benefit. In thanking the Minister for bringing in this much awaited 2150 amending Bill, I think that it will not be out of place for a medical man who knows what specialism is to add a word of tribute and thanks to the specialist advisers of the Minister, those in the employment exchanges, and those in his own office who have made our work here possible to-night.
§ 9.20 p.m.
§ Mr. RHYS DAVIES
It is not the first time that I have had the privilege of listening to Debates in this House on national health insurance, and I must congratulate the Minister on the way he managed the many technicalities of this very intricate Bill. I was not moved, however, by some of the statements made by supporters of the Government about the magnitude of the Measure. One could imagine in listening to some of the laudatory remarks, especially the speech of the hon. Gentleman the Member for Sunderland (Sir L. Thompson), that the pillars of the Empire were shaking in their sockets because this Bill came before the House to -day. Some hon. Gentlemen would have us believe that this is a more important occasion than when the right hon. Gentle man the Member for Carnarvon Boroughs (Mr. Lloyd George) introduced his scheme for the first time in 1911.On looking round these empty benches to -night, however, this Bill does not seem to be quite as important as the events which culminated at that time.
Before I proceed any further on these lines, it is only right to say that the main features of the Bill are very accept able; there is no doubt about that. It is no use gainsaying it. They are acceptable in the main because we on these benches have agitated for the m. It is not long since I stood at this Box to open a Debate on two problems, maternal mortality and the condition of these 200,000 men, and we were not very hopeful from the reply of the Minister that day of anything being done at all for these unemployed people.
I am really driven to the belief that this Bill has very much greater significance than merely restoring the insurance and pensions rights of 200,000 unemployed people. I have an impression that the sound of the general election is somewhere in the air. Indeed, the Noble Lady the Member for the Sutton Division of Plymouth 2151 (Viscountess Astor) would have the Government give greater publicity to this Measure and the manner it has been brought before us to -day. We shall, I suppose, see this Bill and its contents blazoned upon the hoardings of the country, but I must pay tribute to the wisdom of those who are behind this advertising campaign that these great posters do not appear in my particular constituency; they have not the slightest meaning in a division like mine. There is not a word of truth in any of the statements on these posters in relation to the distressed areas of this country. I was diverted to that subject by the hon. Gentleman who smiles at me. Let me say, therefore, that we welcome the main provisions of this Bill, as I have already indicated. It is a great relief for the unemployed man to feel that he is not going to lose his pension, the one thing that would indeed have disheartened him more than anything else. He was afraid, up to the coming of this Bill, that when he reached a given age he might lose his old age contributory pension. That, of course, would have been a very terrible thing for him.
I am not so sure that it is possible in any circumstances for the employed man to know what it means to be in the position of the unemployed. Unfortunately, I have seen this actually happen: a man may have been unemployed for many months and he may know exactly what it means to stiffer prolonged unemployment, but when he gets a job even he forgets the very conditions from which he has emerged. I say, therefore, that it takes some mental effort to understand the heart-breaking situation of men who were left out in the cold until the introduction of this Bill. The Government have come to the penitent form for the second time this year. I am now a greater believer in political democracy than ever, because this is the second occasion that public opinion has roused itself to such an extent as to move even this stupid Government—and it is a stupid Government: you never know who is the Prime Minister to start with —to change its mind. That is saying a lot.
Let me say a word or two about medical certification. The hon. Member who referred to this subject should call at the Ministry of Health, where he will find a report on medical certification, 2152 which would show him that if approved societies paid benefits on medical certification alone they would require a Bill many times as big as this to get them over their financial difficulties.
I should like now to refer to the speech made by the Minister when he introduced the Bill. He used some strange arguments which I could not follow. Never since I have been here have I heard such camouflaged oratory as I have listened to in this Debate. The right hon. Gentleman said that the Bill was introduced because of improvement in trade and employment, as if those things affected the health insured population and had such a great influence on the finances of the scheme. The n he claimed that the contributions of the insured population under this scheme have increased between 1932 and 1934. I have yet to learn that there has been any year since 1912 when the total contributions have not increased—because the insured population has increased, anyhow. Even if unemployment figures in our statistics, I cannot conceive that this scheme will ever show that there is not a greater number of persons in health insurance than there was in the previous year. That follows almost automatically. Consequently, I could not very well understand the argument of the right hon. Gentle man. I noticed hat in his speech he was always anxious about protecting the finances of the scheme; and supporters of the Government have since been thanking the Government for what they are doing to -day. Were it not for what the Government did in 1932, they would not be doing this to -day.
I will venture to tell the House what the true position is. It is just as if a man stole a shilling from me and expected me to thank him for bringing three pence of it back. That is exactly the position. As has been said over and over again, the Tory party in this country must take responsibility for shaking the foundations of the finances of the scheme. The re can be no argument about that. Does any hon. Member in this House think for a, moment that this Bill or the 1932 Act would have been necessary were it not for the fact that £2, 750,000 per annum was taken from this scheme under the Economy Act of 1926 7 Would any hon. Member dispute that? the Government, having the n 2153 taken £2, 750,000 per annum out of the scheme, now want us to thank them profusely for putting back just one-fourth of that amount.
The right hon. Gentleman will pardon me if I am a little critical of one or two things in the Bill itself; I have never yet known a Measure about which we could agree on everything contained in it. I should refer, to o, to the very common statement made that our social services are now costing the State £500,000,000 per annum, and that this Bill is an addition to that cost. Hon. Gentlemen who make that statement must always bear in mind that our social services are, on the financial side, built up in a large measure by contributions from employers and employed. It is never correct to say that these schemes are "costing the country" so much; they cost the workman something in almost every case. I have heard people say: "See how much we pay away from the Treasury to wards unemployment, health insurance and contributory pensions benefits." they do not take into account that the State in the main only contributes one-third of the total of these benefits.
I have indicated already that I did not like the way in which this Bill was regarded as comprehensive, generous, and as a mighty piece of social reform. I detect trumpets for the next general election whenever I hear these adjectives coming from hon. Members who sup port the Government. Something was said about agreements with the approved societies. I will tell the House what sort of agreement the approved societies always make with the Government. The societies are to ld by the Minister of Health that he has been able to get £750,000 per annum for this scheme out of the Treasury and that now the approved societies must agree how that money shall be used. That is all the agreement the approved societies are asked to enter into. What else can they do? It is wrong, there fore, to say in all these cases—as was said in 1932—that the approved societies have agreed to it all. In fact, we know that the same argument was applied when the 22,750,000 was taken annually out of the scheme. The approved societies were said to have agreed the n; but the only agreement they came to was that if the Chancellor of the Exchequer was 2154 going to take £2,750,000 he should appropriate it in a certain way. The money was to be taken whether they agreed or not. I therefore object to that argument being employed in this connection.
I, to o, want to pay a tribute to the Civil Service. They are in the same position as the approved societies; they have got to cut the coat according to the cloth. In my view, the civil servants have cut a decent coat out of a pretty rotten bit of cloth on this occasion.
We are setting up an Unemployment Arrears Fund and we are to ld to-day that the Treasury will contribute to that fund£750,000 per annum. It sounds a lot if you say it with a particular modulation of the voice and with a little sing song behind it. If I were a Wagner I would write it in grand opera; it would sound better still. The Government give away millions of pounds in wheat subsidy, beet sugar subidy, Austrian loans and so forth, and then expect us to be very thankful for what they are doing for these poor unemployed people in this Bill. How are they doing it 7 It is very cleverly done. First of all, there is to be a fund established of £1,500,000 per annum to help these un employed people to secure their pension rights, medical benefit and cash benefits in some cases. I understand that £130,000 of that will go to the medical profession. I have an impression that the medical profession, had something to do with securing medical benefit for the unemployed. The re never was a stronger trade union established than that of the medical profession, except maybe the legal profession.
It is a very clever way in which the Treasury are going to deal with the first year in connection with the new fund. The right hon. Gentleman said that they were going to take £701, 000 out of the surplus of the Army, Navy and Air Force Fund. They are doing that because the men in the forces never pay contributions to the fund. Consequently, as the employer pays the whole of the contribution the employer is entitled to raid the surplus. In reply to that argument, let me say that these men joined the forces under a contract of service, and if they knew that the surplus created out of this money was being filched in this way I am not sure that they would be as satisfied as the 2155 right hon. Gentleman thinks they are. The argument used is: "Do not worry about our appropriating this surplus because the men in the forces will still be entitled to additional benefits similar to those paid to the civil population by the approved societies." That is a very neat way of putting it. What is happening I the right hon. Gentleman and his Department know full well that the main purpose of the whole scheme is to put a levy on the contributions pay able by the civil population. That will automatically reduce the capacity of the approved societies to pay additional benefits. It stands to reason that that will happen once you adopt this scheme, about which I am not complaining [Laughter.] Hon. Members laugh. I am not complaining, but I cannot under stand that kind of argument coming from the Front Bench. Once you adopt this scheme you automatically reduce the surpluses available in the approved societies for paying additional benefits. It is no use, when you have reduced the additional benefits to the civil population, telling the men in His Majesty's Forces: "We shall secure for you the same additional benefits, on the average, that are available to the civil population".
Those of us who are in the administration of approved societies will take some convincing about some of the arguments we have heard to -day. Let me quote the case of one society which al ready provides four additional benefits at a cost of £2, 300 per annum. The levy on contributions under the Bill for this society will be £2, 800 per annum. The levy swallows up more than the cost of four additional benefits at one stroke. What is the use, there fore, of saying to the men in His Majesty's Forces that they will get the same additional benefits that are paid in this particular society, when that society may not be able to pay any 'additional benefits at all? In spite of all that I have no hesitation in saying that the time has arrived when well-to-do societies ought to help the weaker ones, and I happen to be connected with what is called a fairly fortunate society.
I should like to call 'attention to one particular Clause in the Bill, and I want to deal with it rather delicately. The point has already been raised by the hon. 2156 Member for the Scotland Division of Liverpool (Mr. Logan), who knows great deal about this business. The re are 500,000 voluntary contributors in this scheme. Most of them are non-manual workers, whose income has been increased beyond the rate of £250 per annum. They are fairly well off among the working class in receiving £4 16s. 2d.a week, and although I am not speaking particularly on their behalf, there is one thing in equity which ought to be said about the m. They pay out of their own pockets the combined contribution of employer and employed. In some cases they will be unemployed. They have been induced to become voluntary contributors by Members of Parliament, at the instance of the Minister of Health. They have been to ld that if they wanted they could come in as voluntary contributors, and they did so with out knowing that this Bill would be produced. They have lost their medical benefits, because the medical profession have to ld them long ago that they are capable of paying for their own medical attention. They cannot get medical attention through panel practice.
I have never been able to understand why the Government do not include the non-manual worker, irrespective of his income, in the same category as the manual worker. What is happening to these people? Not only have they lost their panel doctor, not only do they have to pay the combined contribution of employer and employed, but they are going to have to pay a levy with the rest in order to establish an unemployment arrears fund, from which they will not benefit. Although they have to pay the full combined contribution, when they themselves are unemployed they will not be able to benefit from the unemployment arrears fund. The basis and foundation of the assurance principle is that you do not call for contributions from any person unless he is entitled at some time to benefits in common with the rest of his fellows. The hon. Member for Mitcham (Sir R. Meller) shakes his head.
§ Sir R. MELLER
The hon. Member is dealing with the case where a man makes a selection as against a group of persons who are compulsorily insured. He usually comes in at a very much later age and has had the advantage of a flat 2157 rate of contribution, whereas if his contribution were based upon age at entry the contribution would be very much heavier than under the present scheme.
Mr. DAVI ES
The re is a good deal in that point, if these men were not unemployed after they have become voluntary contributors. A large number of them have entered into business, they have taken little shops and after a short period the business has been lost and they find themselves un employed, and yet they are called upon to pay a levy, although some of them may be in a worse position than the ordinary unemployed. The re is something wrong in such a case. Having induced some of these unemployed to become voluntary contributors, on the assumption that this Bill would not be introduced—and six months ago no one believed that it would be introduced—I am sure that the Minister does not want them to be in a worse position than they would have been if they had never become voluntary contributors. I understand that there is one society with 80,000 insured members, 60,000 of whom are voluntary contributors. Consequently, the problem is really one which requires some attention.
Let me turn to what the actuary has said about the amount of the weekly levy, and put the position as I see it. The actuary has made a suggestion that the levy should be based on so much from the man's contribution and so much from the woman's. An hon. Member asked why the difference—one third and one-ninth? Unless I am mistaken the reason is that a woman leaves insurance on marriage, whereas a man hardly ever leaves. He does not go out on getting married; indeed, that is all the more reason for remaining. But there is nothing in the Bill to prove what the hon. Member said. I should like to know whether the levy is going to be based on the suggestion of the actuary.
There is another point upon which I hope I shall secure the agreement of hon. Members in all parties. Every child in this country is examined by a doctor Four times on the average during his elementary school career. The vast majority of them never see a doctor again after they enter employment until they reach 16 years of age, when they come into this scheme. How many of the se 2158 children are left out of health insurance? For every argument you can give for including boys and girls from 14 to 16 with in the unemployment insurance scheme, there are a dozen in favour of including them with in this scheme. How many are the re? they were included in unemployment insurance for the first time in September last year, and 499,000 boys and 400,000 girls, 899,000 altogether, between 14 and 16 years of age were registered under the unemployment insurance scheme by last March. I am sorry to say—I thought it would have been otherwise—that children are still being dismissed from their jobs by some unscrupulous employers merely because they come into health insurance at 16, the employer arguing that the cost of the contribution upsets his budget. I trust that the Government will be able to do something to take that excuse away from such an employer altogether. Let us, therefore, include these boys and girls in health insurance.
Then there is the question of the test of 10 years which has been mentioned by several hon. Members. It seems to me that the test is a little to o rigid. I know some of the arguments against another test, that the approved societies may not be able to trace membership further back than 10 years, but I think most approved societies are able to trace their membership at least for 17 years. They can test their membership not only for benefit purposes but for contribution purposes as well much further back than 10 years. I would also urge the point which has been referred to already, in connection with the loss of cash benefits in certain of these cases. I was much tickled, shall I say, with the new provision whereby the benefits beyond £50 of an insured person who is in an institution are to be transferred to the Central Fund, and that the Central Fund is going to be used for the purposes of equalising the finances of the scheme. Most of these people will be in lunatic asylums. All approved societies have a proportion of them. If you accept the fact, as it seems to me to be a fact, that all approved societies will have about the same proportion of members in this category, then what is the use of taking this money from the approved societies into the Central Fund of the Ministry of Health and then sharing it out again among the same 2159 approved societies. It would be much better to let each approved society retain the money in order to extend their additional benefits, if they have a surplus. I do not think I am putting it too strong when I say that this provision is devised in order to compel lunatics to secure the benefit rights of sane persons. That may be a rather strong thing to say, but it seems to me that it comes to that in the end.
There is one small point of administration at which I should like the Minister to look. Approved societies are not quite satisfied with the case of a person surrendering medical certificates for three days only, he only becomes entitled to benefit on the fourth day un less there is an additional cash benefit payable. A man can fall ill for three days, six or seven times, but if these three days fall with in a given period, he may pass through the scheme with out receiving any sickness benefit at all. Those three days should be regarded as a waiting period, and he should be paid benefit on the first day of his second illness. It would not cost much. The re is one further important point. Am I right in assuming that about 20,000 unemployed persons will not be covered by this scheme at all? I am under the impression that this figure has been given, and I think officially. It would be well, there fore, if we were to ld what type of person is not covered in spite of all these pro visions. Am I right in assuming that it will be the young fellow of 25 years, who enters insurance at 16 years, with nine years, but who has not ten years continuous insurance? We are not quite satisfied on that score.
Then there is the other point which has been stressed, the loss of maternity benefit in some of these cases. On that score the Bill does, indeed, put some of the unemployed in a worse position than they were before its introduction. It may be but a small number, but there they are. Let me put one pertinent question, to which I should like a reply, in connection with the pensions scheme. How comes it that the contributions of women for pension purposes are increased by one penny per week while the employers' contribution remains stationary? It has been the practice up to now that when 2160 the contribution of the insured person has been increased there has been a pro rata increase in the employer's contribution as well.
The Bill is long overdue. Let me give the case of a Lancashire approved society—and approved societies, unfortunately, are not national organisations. Some of them are based on counties, some on districts, some on towns, some on religious denominations, some on crafts and some on industries. Take the case of a Lancashire society, where the unemployment rate in one year not long ago was 19 weeks on the average per member throughout the year, and in another society it was only about three weeks on the average. The old scheme is unfair on that score.
I would pay a compliment to the Minis try in one respect, and that is on Clause 7,the provision to cover border-line eases which were thought to have been covered by the Act of 1932.I refer particularly to slaughtermen in abattoirs, who were thought to be covered already. I ask whether the Minister cannot see his way clear at this stage to deal with one other matter. We are in the difficulty, in a Bill of this kind, that we cannot table Amendments that will increase the charge upon the Exchequer. I am going to appeal to the Minister to deal with one or two other things. Some friendly societies have branches, and each branch is a separate unit in itself. But we have this anomaly: You have a branch of a society, say, in Norfolk, a rich branch with plenty of surplus on valuation. You have a branch of the same society in Durham or Glasgow or Cardiff, but it is in deficiency, and, lo and behold, as the law stands now there is no means of allowing the rich branch of the same society, with its surplus, to come to the aid of the poor one. We have made an attempt on more than one occasion to secure redress in this matter. I am hoping that the Minister may be able to do something on that score in this Bill.
Whatever our criticism of the acts of Governments may be, this scheme stands out as the most effectively ad ministered social insurance scheme in history. In travelling abroad I have taken a little interest in finding out what is done in other countries. Whatever our criticisms of Governments or schemes or 2161 institutions may be, I am proud to think that this scheme stands pre-eminent among all schemes of the kind in the world. I do hope that after the passage of this Bill, whatever Government may be in power, that some administration some day will take a very much deeper interest in this problem of health insurance and pensions, and will try at any rate to do one thing—to extend its operations and to widen its scope so that we may achieve some of the noble aims of its originators in 1911.
§ 9.59 p.m.
§ Mr. SHAKESPEARE
Although this is a very complicated and very technical subject, we have had a great number of interesting and valuable views expressed on it. Personally I do not remember a day, with a Health Insurance Bill under discussion, when the Government received so many bouquets, and I start therefore by thanking several hon. Members for their appreciation of the purpose of this Bill. The hon. Member for Sunderland (Sir L. Thompson), the hon. Member for Mitcham (Sir R. Meller), who have deep knowledge of the subject, made most interesting contributions; and I must include also the hon. Member for the Scotland Division of Liverpool(Mr. Logan), and the hon. Member for Westhoughton (Mr. Rhys Davies).The hon. Member for West houghton started by welcoming the Bill, but finished by saying it was long over due, and he introduced in the middle a lot of irrelevant facts based on claims that cannot be sustained. The interesting thing to know, however, is that all those Members of the House who have had experience of approved society work, bless the Bill. Indeed we claim that it is a humane, just and practical Measure.
The hon. Member for Westhoughton said that the Bill would not have been possible but for the Act of 1932.We have never pretended that the Act of 1932 was a popular Measure. The National Government were not returned to do popular things; they were returned to rescue the country from the deplorable financial condition into which it had lapsed, and among our essays we passed that Act, which did in fact restore the solvency of the health and pensions insurance scheme. But it was always understood that when things improved —not in relation to a general election— 2162 when the Government Actuary reported on the scherna—the Government Actuary does not report in relation to a general election—steps would be taken to review the situation in the light of the improved situation. It is true that the finances of approved societies do depend on the contribution income. It is no good saying that more people come into approved societies year after year, for if we look up the figures for 1930, 1931 and 1932, in spite of the increased membership of approved societies the fact that unemployment increased in those times meant that the finances were straitened and the contribution income decreased every year.
I will deal with some of the main points that the hon. Member raised, but let me, in passing, refer to one thing which he called a flaw. He said that the voluntary contributor was put in the same category as the employed contributor, that a levy was being put on him for the purposes of the Unemployment Arrears Fund, and that in spite of that fact he did not get the same benefit as the employed contributor. That is true. But then the hon. Member for Mitcham, who has a far greater knowledge of this question than I have, pointed out the reason for it. The great bulk of these voluntary contributors came under the Act of 1926, and they came in, not at the age of 16, but at various ages in middle life. Had they been asked to pay a contribution in accordance with the benefits or the risks they might have paid 3s., 5s.and even 7s., whereas they were admitted at a flat rate spread over a number of years. But what has been the consequence of that? High reserve values have been created in respect of these voluntary contributors and these reserve values have to be redeemed by levies on contributions over the whole field of insurance, including employed contributors. To that extent members of approved societies have had to wait, and will have to wait, much longer for additional benefits, owing to the fact that a part of their contributions instead of going some day to additional benefits goes to redeem the high reserve values of the voluntary contributors. It is very technical.
§ Mr. RHYS DAVIES
Is it not possible that you will have in the scheme as many employed as voluntary contributors who joined at a late age?
§ Mr. SHAKESPEARE
That may be, but that is another point. The point is this If you wish to treat voluntary contributors as a class by themselves in logic it will be plain that they must be admitted at different rates of contribution and you will have a graded scheme as you had in 1912. The hon. Member raised the question of the gap in insurance between 14 and 16, and here one is in sympathy with him. I think there is a demand for medical benefit. I think that we should all like to see that gap removed, but we have not the finances to do it at the moment and we must leave something for posterity. Several hon. Gentlemen raised the question of the complicated nature of the Bill, and my right hon. Friend authorises me to say that it is our intention to consolidate these Health Insurance Acts as soon as possible. That will be to the benefit of everybody.
Now we come to the big question of the 200,000 who but for this Bill would have fallen out of all pension rights at the end of December of this year. The hon. Member for Govan (Mr. N. Maclean) challenged the assertion of the Minister that all but 5 per cent. of these would qualify for the 10 years' test, because he thought that the average would be higher in the distressed areas.
§ Mr. N. MACLEAN
If I may correct the hon. Gentleman and also the Minister I neither maintained nor insinuated that the average for the distressed areas would be higher. What I actually said was that the numbers in the distressed areas would be higher than in some other areas.
§ Mr. SHAKESPEARE
I am sorry if I misinterpreted what the hon. Member said, but I do not think that it is true, for this reason: In the distressed areas there has been prolonged unemployment and the age of the unemployed is higher. As we have framed our 10 years' test not on work, nor on contributions but on insurance the chances are that there will be a greater percentage of unemployed men who have satisfied the 10 years' test in the distressed areas than elsewhere. The hon. Member for Kilmarnock (Mr. K. Lindsay) asked who the 200,000 were. As far as we know, 180,000 of them ore men and 20,000 women. Everyone of them must have ceased work 2164 before 31st December, 1932, and the bulk of them form the hard core of unemployment who have been kept in by successive prolongation Acts. The bulk of them have paid nothing in recent years either to health or pensions insurance. They are men in middle age or even older. The great bulk of them must be over 30. The re are very few young men among them. In so far as a very small part of the 200,000 do not satisfy the 10 years' test the chances are that they are the young men, under 30, who have left the field of insurance. We are satisfied that we have done substantial justice to a very real grievance among these 200,000 people. It has been pointed out by the hon. Member for Gorbals (Mr. Buchanan) that it is hard for men who have been used to family life to have to go else where. All except a fraction—young men who have gone elsewhere—are men who were turned out of work at the age of 50, and whose pension rights might be affected unless something were done. It is the man who has done some work since the War but who has been unemployed for many years who is kept in. That is the man whose full pension rights have been safeguarded. I am sure that all of us in all parties are glad that the finances are so improved that we are able to do it. The re are one or two doubts as to the 10 years' test but we are satisfied that on the whole it is a very fair test. We do not say: has a man been 10 years in insurance when he ceased work? We say: has he been 10 years in insurance? It is the widest test he could have. All but the young will satisfy that test.
The hon. Member for Birkenhead (Mr. White) raised the question of Clause 7 and asked whether certain casual workers would qualify. I do not know as he did not give me enough information to go on. But there are certain hard cases which the Clause is designed to cover. I am thinking of a footballer who was deemed to be in insurance, contributed, received benefit and then suddenly as the result of a high court decision was held to be no longer an insured person. All that we do is to validate the past.
the hon. Member for Gorbals made several interesting criticisms, as he always does on questions of insurance, and he stated that we were not so generous under this Bill as we were under the 1932 Act in one particular point. It 2165 may be that if you look at just one corner of the whole field you do not get a right conception of the whole. Let us take the case of two men who fall out of employment and qualify for insurance under the 1932 Act and under this Bill and see who is most fairly treated. First forget this Bill and take the old case. A man fell out of insurance; he had his 21 months as a start and cash benefits. He might have been subject to arrears. Then he had an extended year. The chances were, in the ordinary case of an unemployed man, that although he had his free insurance period, 21 months plus an extended year, he received no cash benefits. If he had been unemployed for 21 months it was very rarely that any cash benefit was payable because the right to benefit was governed by previous contributions. In point of fact, that concession was not worth very much to him as the hon. Member for Mitcham has pointed out. What are we doing, under this Bill? If a man falls out of work now, whatever his contributions, he starts off by getting 21 months full cash benefit. If he was unemployed for the whole of the previous contribution year and paid nothing, he still gets his full cash benefit for 21 months. After that, he gets a full year's pension cover if he has the four years insurance qualification. If he has the 10 years insurance qualification, as the great bulk will have except those young people to whom I have referred, he will be entitled to medical benefit year by year and covered for pensions for the rest of his life, even though he remains unemployed and does not pay anything further. Taking the large and wide view, I suggest that under this Bill we are treating the man inafar more generous way than was possible under the 1932 Act.
§ Mr. SHAKESPEARE
He will get the full cash benefit. The hon. Member for Spennymoor (Mr. Batey) asked what would happen if a man had not franked his card. There is always provision for supplying alternative evidence.
§ Mr. SHAKESPEARE
The re is no change in practice. If he has not his card franked he can get corroborative evidence that he has been looking for work. There has not been much trouble with regard to this question among the approved societies. The hon. Member for Wavertree (Mr. Cleary) raised a point about 50 per cent. dental benefit. That matter does not come with in the scope of the Bill. It is a matter for a recommendation to the Minister by the consultative council and, as far as I know, the consultative council have always been against it. To sum up.
§ Mr. BUCHANAN
Before the hon. Gentleman leaves the details will he answer the point raised by the hon. Member for Westhoughton (Mr. R. Davies) and myself as to the position of the voluntary contributor—the man who, not knowing that this Measure was going to be introduced, chose to become a voluntary contributor and is now in a worse position?
§ Mr. SHAKESPEARE
I meant to deal with that point, which I may explain briefly to the House. A part of the 200,000, that "hard core" who had exhausted their free insurance period and extended period and were only kept insured for pension until the end of this year, may have decided that they were finished with pensions and that they had better become voluntary contributors, so that whatever happened some form of pension would be preserved to them. In the Bill all the se, or 95 per cent. of the m, with out the exercise of any such caution on their part are safeguarded. The hon. Member suggested that a man ought not to be penalised for his caution in this respect. Although I cannot give any definite pledge, we will look at that point sympathetically to see whether, somehow or other, we can ensure that these per sons are not ranked as ordinary voluntary contributors, but that they will come in for the benefits of this Bill.
Let me sum up. In future, after the 1st January, 1936, any person who falls out of work will get 21 months' full cash benefit, and if he has been four years in insurance and has paid 160 contributions he gets the extra year of full pension rights. If, as the bulk 2167 will be, they are men who have been continuously employed for many years and they satisfy the 10 years test, then they are entitled to medical benefit and have their pension rights safeguarded year after year subject to proof of unemployment. As regards arrears they all go, and they go as it were retrospectively. The House will appreciate that if a man falls out of employment next year and starts his 21 months' full cash period, but for this Bill his sickness benefit next calendar year would be governed by contributions as from last July, 1934. This Bill means that such a man—and there are hundreds and thousands—will get full cash benefit what ever his contributions in the year 1934-35. Indeed, some 5,000,000 persons, as my right hon. Friend pointed out, who would have expected a reduction in sickness benefit next year owing to their unemployment experience in the previous contribution year, will under this Bill be entitled to the full cash benefit.
Finally, we have made it easy for the man in his free insurance period, that is, the 21 months, or in his extended period, to requalify. If in the free period of 21 months he does eight weeks' work in two consecutive half-years, he requalifies for another free period as soon as he becomes unemployed. In the extended period when a man, perhaps year after year subject to unemployment, is kept in full pension, he can requalify for all benefits, that is, full cash benefits and so forth, by 26 weeks' work. When one considers that the new entrant has to wait until, he has paid 104 contributions for disablement benefit, the House will see how generous these provisions are and how we have done our best to secure a title to the full benefit of insurance.
I will conclude by repeating what my right hon. Friend said and in congratulating the societies on their far-sighted ness and their willingness to share each other's burdens in this matter, because it is the more fortunate societies that will contribute most and the less fortunate societies, those whose finances have been straitened by unemployment among their members, who will contribute least and gain most. Therefore, it is a real sharing, and the approved societies ought to be congratulated on their vision. I venture to think that this Bill will long be remembered, not only as a popular 2168 Measure, but as a humane and practical Measure. Indeed I have noted with pleasure that a very experienced man in the insurance world referred to this Bill as the charter of the unemployed, and I should like the House to think of that when it comes to pass the Second Reading of this Bill.
§ Question, "That the Bill be now read a Second time," put, and agreed to.
§ Bill accordingly read a Second time.
§ Bill committeed to a Committee of the Whole House for Monday, 17th June[Sir G. Penny.]