§ Order for Second Reading read.
§ The Secretary of State for Scotland (Mr. T. Johnston)
I beg to move, "That the Bill be now read a Second time."
This Measure is brought forward upon exactly the 29th anniversary of the coming into operation of the National Health Insurance scheme. Some parts of our social insurance are very much older than others and stretch back to a century ago. With all their drawbacks, deficiencies, complexities and overlapping, they constitute a body of legislation of which we might, as a nation, well be proud. I do not often attempt to contrast our social insurance system with systems in other lands, but we are at least as comprehensive in this respect as is anybody else. Nevertheless, there are anomalies and inequalities in our system. People with the same need receive different categories of benefit, and some benefits are barred to large masses of people who are insured with mixed societies, which carry a large volume of the sickness of the country. On the other hand, selected groups, who are well provided for, receive State subsidy on the same basis as do the approved societies which carry the large bulk of the invalidity, while additional benefits which are barred to members of the less fortunate groups, for example, to the miners, can be provided by the selected groups who have surpluses because of their healthy membership. There is an evident contrast between the way in which the wife and children of an unemployed worker are treated, and the way in which they are treated if the breadwinner is sick.
These inequalities, complexities and difficulties are now being examined by an Inter-departmental Committee on Social Insurance and Allied Services, under the chairmanship of Sir William Beveridge, and eight Departments are represented on the inquiry. The terms of reference, which have already been given to the 488 House, provide that the committee is to undertake, with special reference to the inter-relation of the scheme, a survey of the existing national insurance scheme of social insurance and allied services, including workmen's compensation, and is to make recommendations. The Bill must therefore be read against that background. It is only an interim Measure, a stop-gap, designed to meet immediate necessities, but to do so in such a way as will not prejudice whatever conclusions at which this House may arrive after the war emergency is over, regarding the whole future of social insurance. We think the Measure is useful and necessary now. It will bring relief and a measure of happiness to thousands of homes while the committee is laying down the lines for the major Measure, which can be undertaken only when there is time for adequate discussion, free from the stresses and the harassments of war. I take it that there will be general assent in the House on that point.
The explanatory memorandum which accompanies the Bill states three main objects which it is sought to achieve by the Bill. In the first place, we propose an increase of 3s. in the weekly rate of sickness benefit. I trust that hon. Members will know that this is the first increase which has taken place in those benefits for more than 20 years. The benefits were last increased after the last war, and not while the war was in progress. Secondly, for the first time, women receive as large an increase as do men. We do not interfere with what has happened in the past, but the increase now proposed is given to women on the same basis as to men for the first time. Thirdly, the increase in disablement benefit is as big as the increase in sickness benefit. The figures are 40 per cent. for single men, 50 per cent. for single women and 60 per cent. for married women. The Bill provides that there should be a new limit of insurability up to £420 per annum.. The non-manual worker is now insured up to a salary of £250 per annum. but if the Bill receives the approval of Parliament, he will henceforth be insured if his income rises to £420 per annum. We estimate that this increase in insurability will bring in something like 500,000 persons. How many of that number were previously insured and are now earning over £5 a week 489 it is impossible to say. Large numbers of them would be knocked out of health insurance in from 18 to 24 months' time. Therefore the Government, who have consulted many interests on this matter, agreed that it was imperative, unless grave injustice is to be done to the non-manual worker class that the limit of insurability should be raised to £420. The income limit under the Workmen's Compensation Act is to be similarly raised to £420 from its present level of £350, that is to say, to bring in the £8 a week man.
§ Mr. Johnston
We must choose some figure. The changes under the Bill will operate from January next year. My right hon. Friend the Minister of Health explained in the House why the Bill cannot be brought into operation earlier. There is a vast number of cards to be written up and so on, and it has been found impossible to make the Measure operate before 1st January of next year.
The Measure also provides that there will be an increase of 2d. in the premium. At present the premium is 3s. 6d. for men and 2s. 11d. for women. One penny of the 2d. will be paid by the contributor and one penny by the employer. In the Schedule to the Bill we provide that public assistance authorities, who in the past have been prohibited from taking into account the first 7s. 6d. of national insurance benefit, will henceforth be prohibited from taking into account the first 10s. 6d.
§ Mr. Johnston
I would like notice of that question. Perhaps my right hon. Friend the Minister of Health in his reply will answer that point. There are one or two other matters still under consideration. There is, for instance, the question of the doctor's capitation fee. That is being increased, but the amount, plus a mileage grant, is at present under 490 negotiation. These are the main features of this Bill, and so far as the Government are aware, they have met with general assent as making necessary provision for classes and for interests which could not await the conclusions reached by the Beveridge Committee. I take it that the House will not desire any further long explanations. I have stated the essential points of this Measure, but I think I ought not to conclude without saying that in the midst of a world cataclysm in which the democracies are fighting for their very survival, and in which all our institutions of liberty, so painfully built up by many centuries of great effort and sacrifice, are threatened with extinction, it is an indication of the British Government's conviction of ultimate victory that they should ask Parliament to widen and extend our social services. With these words I commend this Measure to the House.
§ Mr. James Griffiths (Llanelly)
I think my hon. Friends in every part of the House will desire me to express our thanks to my right hon. Friend the Secretary of State for Scotland for the brief, simple and lucid explanation of the provisions of this Bill. He referred to the very interesting fact that he had the privilege of introducing this Measure to the House on the 29th anniversary of the coming into operation of the National Insurance Act of 1911, and I, like many others of my generation, well remember that date. I remember too that the right hon. Member for Carnarvon Boroughs (Mr. Lloyd George) was responsible, in a rather hostile House, for bringing in that Measure. My right hon. Friend referred to the fact that the scheme of National Health Insurance has its roots very deep in 19th century life. That is true, and I think that very largely accounts, paradoxically as it may seem, for both the strength and the weakness of British social service. It is strong because it has grown up very deeply embedded in our national life, and for that reason it has withstood many storms, whereas in other countries social service systems grafted on from the top have broken down. At the same time that has given it many weaknesses and has created many anomalies which someday will have to be swept away. If to-day we wish a speedy passage of this Measure to the Statute Book, it is not because we regard it as being either a generous or 491 a comprehensive Measure, and it is against such a background that I wish to make one or two observations on the Bill's provisions.
As to the provisions of the Bill itself, there is first of all the provision by which benefit rates are increased by 3s. I welcome that increase as does every Member of the House; it will bring some measure of relief and increased happiness, and will lessen to some degree the terrible worry and anxiety of many of our people. We welcome, too, the fact that for the first time an increase is made without any sex discrimination at all. The original discrimination is still there, but so far as the increase is concerned, it is an all-round increase. But I think we ought to temper our enthusiasm by the thought that actually and in cold fact this increase of 3s. is not an increase of benefit at all. On the average, it scarcely brings the value of the benefit up to its value in pre-war days, because we have to remember that since 1939, when the war began, there has been a substantial increase in the cost of living, and the 3s. increase does not in every case meet the increase in the cost of living. Frankly, therefore, I do not think we ought to pat ourselves on the back, but rather to temper our congratulations with the thought that we are not actually increasing the real value of the benefits but merely maintaining them at their pre-war value.
However, the Bill is one which we welcome. We know that, in an extension of the social services, a large number of people have to be consulted, and that there has been an agreement between everyone concerned—trade unions, approved societies, the Government—that for the moment this is the amount of increase which every party can be brought to agree upon. There is one increase to which I wish to make specific reference, the most tragic case of all. All of us who are interested in social work and social problems know the problems of unemployment, the problem of insecure old age, and the problem of the invalid, the disabled person. This is the most tragic case of all, the poor person who cannot ascribe his illness to anything specific. There he is with disablement benefit of 7s. 6d. per week. All that we are doing is to raise the benefit of the disabled man 492 from 7s. 6d. to 10s. 6d. That benefit is trifling. No one would claim, and the Minister would be the last to do so, that any person can live on anything like 10s. 6d. per week. It is really a sad commentary upon our whole social system that at the time when a person is struck down by illness and the need for more money is greater, less comes in, but it is a still further reflection, even, upon our social services that the man who loses his livelihood and is unable to ascribe his illness to a particular cause is worst off of all. These benefits do not, as do the other benefits of the other social services, carry with them payments for dependants.
While we welcome this Bill, it is, as my right hon. Friend put it—he claimed no more for it—a stop-gap. I have intimated my view that the 3s. increase only maintains the pre-war value of the benefits. I want to ask the Government to keep their minds open so that, if the cost of living does increase, there should be some arrangement by which these benefits will at least keep their pre-war value. I ask the Government to keep an open mind on that matter. One other feature, one problem to which my right hon. Friend referred, is a very great problem. It is one of the biggest anomalies, I think it is the biggest anomaly in our social services, and one which we cannot allow to survive for very much longer. If we pass legislation here by which we compel persons to pay an equal amount into a system of social insurance, we have an obligation to see that the same payment gets the same benefit. We cannot avoid that as another of our obligations. We cannot pass that on to the approved societies or blame it on to the instructions of these societies. It is not the approved societies, whether trade unions or friendly societies, who have to face this obligation. A trade union has no power to compel a man to pay, it can only induce him to do so, but even in the old friendly societies, in the old trade unions, for equal payment there was equal benefit. It is only now, under this curious structure, that the anomaly has arisen by which many thousands of men and women in this country, who are paying the same benefit, because of the selective character of the administration of approved societies, are receiving very much less additional benefit than do the others.
493 This problem is reaching very serious dimensions indeed. It will be added to now, when we are bringing into insurance—and we all welcome it—a very large new class of people. It is true that these people will have to serve a period of what I might term apprenticeship, or probation, before they are entitled to full additional benefits. Unless we do something to alter the structure of this system, however, we shall find persons who have been completely in insurance since 1911 getting less benefits, in three, four or five years, than people coming in to-day, because these people will be able to join the societies which pay these amounts. I do not like to think that we are pushing that off completely until we get this survey. Many societies have been very hard hit—the small societies; I believe there are about 6,000 of them—which, in the depressed areas, have carried a heavy liability because their membership is composed very largely of people with a very high incidence rate of sickness. There are numbers of these societies, and they are very much handicapped as compared with others. Quite frankly, we have two classes of National Health Insurance, and I hope the Government will find is possible, even within the administration of the Act as it was, and will be amended now, if not to abolish the unequal additional benefits paid by societies, at any rate, to even up somewhat these inequalities. I know that there are hon. Members on this side of the House who will speak about this very strongly indeed in the course of this Debate, much more strongly than I have done, and will press upon the Government that this is a problem to which immediate attention should be given, if possible.
Another provision of the Bill, bringing in people up to an income limit of £420 a year, is something we shall all welcome very much indeed. We shall welcome the fact that the scope of the Workmen's Compensation Act is being increased. That will be a great national asset now and in the days to come. It means that we are bringing the main body of the citizens of this country within the scope of our social insurance system for the first time. I look on it as of very great importance—and it is one of the things in which I have always believed in my own trade union and labour life—to bring about closer relationship between what I might term 494 the black-faced worker and the black-coated worker, bringing them in, altogether. The raising of the income limit will do that. We shall give this Bill its Second Reading and help it on to a speedy passage, not because we think it is generous or comprehensive, but that it is, as my right hon. Friend stated, a stop-gap until the survey is completed. I welcome whole-heartedly the setting-up of this Inter-departmental Committee under the chairmanship of Sir William Beveridge, who has very wide knowledge and experience of this problem.
As for the survey, I hope it will not be left until after the war. This promising of things after the war is beginning to arouse cynical comment. I particularly urge the Government to realise that this is certainly not one of the reforms, or changes, that ought to be left until the end of the war. When the war is over we shall face a colossal problem, such as we have never before faced in this country, the problem of changing over our national life from a war footing and a war economy to a peace footing and a peace economy. It will involve millions of people. Even with everybody making the greatest possible effort, such an enormous transition is bound to be accompanied by difficulties.
We shall not have so much time to build up a peace economy as we have had to build up a war economy. We have built up our Army by calling up the men in classes. Does anyone think that we shall be able to demobilise them by classes, at intervals of three or six months? We have built up our war industry over a period of years. We may have to close it down in a period of months or even of weeks. This will call for the energy and wisdom and statesmanship of everybody. In that period a comprehensive system of social security will be absolutely necessary. We ought to have this system of social security and social insurance completed before the end of the war. It is then that its value will be greatest. Only yesterday I attended a delegate conference of South Wales miners. I and others, including a very distinguished visitor, Admiral Evans of the "Broke," spoke to those men, and appealed to them to produce more coal in this hour of national need. I have spent my life with those men, and for many years I was privileged to preside over their conferences. Something was said by my successor the present President of the 495 South Wales Miners' Federation about the things which are handicapping production. He said that there were two things holding them back. The workmen were thinking of the past, of what they had suffered in the last 20 years, and the employers were thinking of the future. That is not a bad summing up. I have lived with those men, and I could not blame them for thinking of the past. I could see their unasked question to me: "It is all right for you, but when this emergency is over what will you do with us, throw us back to the gutter?" If we could say to the workers of this country that we are passing a comprehensive measure of social reform, something like that which our kinsmen in New Zealand have passed, that would be something to reassure them.
It is not important how a man or a woman loses his or her livelihood. The important thing is that the livelihood is lost. I hope, therefore, that this survey will be pushed forward and completed as quickly as possible. A committee has been set up, and Sir William Beveridge has been released from other tasks, perhaps more directly connected with the prosecution of the war, in order to do this job. That indicates that the Government regard the matter as being important. Let us seek to build up this comprehensive social insurance system, bringing all sides of it together into one compact, well-designed, well-built system. That will give the workers of this country the security to which they are entitled. Insecurity is the dragon of working-class life, and I hope people will not stand for it after this war. In wishing this Measure a speedy passage to the Statute Book, I do so not because of its merits, not because it is generous—it does scant justice to the most needy and deserving section of the community. I regard it merely as a stop-gap, and I hope we shall have that survey very speedily indeed.
§ Mr. Graham White (Birkenhead, East)
The Secretary of State for Scotland pointed out that this Bill was introduced on the 29th anniversary of the National Health Insurance Bill. He made it quite clear that that anniversary was not being celebrated by the introduction of a Bill which made a very substantial addition to the structure the foundation of which was laid 29 years 496 ago. I think the best thing we can do is to pass the Bill into law as speedily as possible. I agree with my hon. Friend the Member for Llanelly (Mr. J. Griffiths) that it would be unfortunate if people were led to think that this House regarded the Bill as an adequate Measure. It is not. It calls attention to the inadequacies of the benefits now being paid. Its provisions are overdue. It is characteristic of the long series of Measures by which we have added to the original structure of social insurance.
It would not be accurate to say that, in connection with social insurance, that we have advanced by leaps and bounds. Somebody has said that we have advanced one step at a time. I think a more accurate description would be to say that we have advanced by fits and starts, whenever some social stress has moved the Legislature or some economic necessity has stirred the Government into activity. It is clear that this Bill must be regarded as a stop-gap, a minor step. There are few things which can be said in this House without contradiction from some quarter, but I do not think that any Member will rise and defend 18s. a week as an adequate sum in sickness benefit for a man with household responsibilities. My right hon. Friend is as aware of these matters as any Member of the House, but no one would rise in his place and make these contentions and defend these proposals. If he did, I believe I am safe in saying that he would receive scant attention and no encouragement from this House. Let the bill be passed as soon as may be, and let us concentrate upon the wider proposals, which, we hope, will follow upon the deliberations of the Beveridge Committee. It is some satisfaction to those of us who have been raising our voices about this matter for many years past to think that at last something is being done to coordinate the haphazard and piecemeal service of social insurances in this country.
My right hon. Friend the Secretary of State for Scotland said that he did not propose to compare our system with that of other countries. I am prepared to say that to-day our system is, on the whole, as good as, if not better than, any other system. There are many marvellous things about our system. One is that it works at all, having regard to the way in which it has been put together, and 497 especially having regard to the fact that there is no common measure of need for the payments made for groups of people for precisely the same purpose. It is a marvellous thing that Parliament and the House of Commons and the people of this country should have tolerated such a tissue of anomalies for so long. When the Inter-Departmental Committee meets it has to have eight different Departments represented in it, and for all these years there has been no single individual or body charged with making a continuous survey of the workings of the system as a whole. Is it not perhaps surprising that it works? I sometimes wonder whether it works because we have such a magnificent and able Civil Service in this country, or whether, on the other hand, our Civil Service is not as capable as it is because of the enormous skill and energy which it has to develop in connection with the administration of these extraordinarily complex and anomalous conditions of our social services. But there it is; we are hoping that there is to be a comprehensive scheme. I hope that, if proposals are not brought to the Statute Book during the war, at least we may have the Measure indicated in outline before the end of the war, as in the case of the Fisher Education Bill, during the last war.
My hon. Friend raised a matter of the very greatest consequence Just now when he said that many people were beginning to look with rather a cynical eye upon proposals which were made and promises which had. not been forthcoming. Not only in this country is attention being given to this matter. Dr. Ley, the German propagandist, has just finished 15 articles in the "Angriff," dealing with the social services of this country. In his last article he said that social services in this country did not exist, and he went on to accuse the right hon. Gentleman the Minister of Labour of building up a whole series of promises to people after the war which we had no intention whatever of carrying out. These are matters of consequence in a very wide field, and it is of great importance that, when we make an increase in unemployment benefit and in National Health Insurance benefit, and when we improve our pensions system by supplementary pensions, we should do our utmost to get these solid facts which are not promises, over by 498 the Ministry of Propaganda, if we have such a body, who should in this effective way answer these charges.
If I may address a word to Sir William Beveridge's Committee, I would say that it is of the utmost consequence, and will possibly be a very live issue in the later stages of this war, to make it clear that in a democracy such as ours the citizens should have as great a system of security as that of any other country or an even better system. There is no more effective propaganda on the Continent or anywhere else than a system which offers security to the people. What use is being made of that propaganda? May I put forward a word with regard to the work of that Committee? There are three things to which it should devote a considerable amount of its time and attention. One is that it should recommend the establishment of some authority to make a continuous survey of the development and working of the social services as a whole, so that, if anomalies exist, they may be brought to light and dealt with in the order of their importance. The second item to which they should pay attention is that every worker who is put out of work by illness, injury or lack of employment should be restored to health, fitness and work as soon as possible, and during that process of restoration his family should not be in want. The same standards of need should apply to all payments made for the same purpose, regardless of the origin of the disability. This is an important task, and if the Committee proceed on these lines they will be able to recommend a series of measures which will lead to the establishment of a basic minimum of subsistence for every citizen as a right in a democratic State. We should pass this Bill as speedily as may be, but I am bound to say that if it had been brought forward as a solution of the many outstanding problems awaiting solution in connection with Health Insurance I would have been obliged to advise my friends to vote against it.
§ Mr. Hewlett (Manchester, Exchange)
My experience of speaking in this House for the first time rather reminds me of the boy who said he liked having toothache, because it was so nice when it was over. I have the honour to represent one of the largest industrial Divisions in this country, the Exchange Division of the 499 City of Manchester, formerly known as the North-West Division of Manchester, which has been represented by some famous Parliamentarians, and I have, therefore, a great duty in front of me to try in some small measure to emulate the examples of those famous men.
I listened with rapt attention to the Minister and was delighted to hear that this Bill is only a stop-gap, because it is most essential that we should have a complete and comprehensive survey of our social services. As has been said by previous speakers, I think it is preposterous that the man who is sick is entitled to 18s. a week, whereas the man who is unemployed is entitled to 20s. a week. This glaring example becomes more definite when we take the case of a married man with four dependent children. According to my calculations, if he is unemployed, he is entitled to 42s. a week, but if he is sick, he is still only entitled to 18s. a week. How can a man live on 18s. a week, or even exist on this sum, particularly when he suffers the disability of being sick? Previous speakers have indicated that they are pleased that this is simply a stop-gap Measure and that we shall be favoured—I hope in the near future—with a complete and comprehensive survey of our social services with more equality of treatment and of benefit.
There are only two points I would like to make, and the first is that I think £420 is rather on the high side, for this reason. In the majority of cases the people who are in receipt of £420 a year will, I think, prefer to go to doctors as private patients rather than as panel patients. Similarly, I feel that there will be a disability to doctors in industrial areas by raising the figure from £250 to £420 a year, inasmuch as few people in the really industrial areas earn more than £420 a year. Therefore doctors in those areas will lose a good number of private patients and be recompensed by a similar number of panel patients, but this will not apply in the same degree in the residential areas where we have a larger percentage of people in receipt of more than £420 per annum.
The other point I want to bring forward for the attention of the Minister is this: As an industrialist and as an employer of labour, I venture to say that 500 the vast majority of workers are prepared to give a good day's work for a good day's pay, but we have what is known as malingerers and those who will make the slightest excuse for not working. I agree, and I state very definitely, that this percentage is very small, but we have to legislate for this percentage just as we have to legislate for Income Tax dodgers and persons of that type. We employers of labour have come to the conclusion that a doctor's certificate for a man who is not too keen on working is not of the value it should be, because this type of person is in the position to use gentlemanly blackmail on the conscientious doctor. If the doctor feels that he is ready for work or should not have a continuance of the certificate, the man makes threats in a veiled manner to the doctor, indicating that he will transfer his patronage to a doctor who would be more generous or sympathetic towards him. These particular points want watching, because we are all anxious that we should have fair play and honest treatment from the workers and employers and, similarly, from the doctors.
The most strict inquiry should be made where any individual is anxious to transfer from one doctor to another unless he is removing from one area to another. A most glaring example was brought to my notice. A young man who was anxious to change his employment brought very great pressure to bear on the assistant to two doctors who were in partnership and eventually received a certificate from this doctor which stated that this man was suffering from defective pulmonary ventilation. When he was later examined it was found that he had no vestige of this disease. The only thing found out about this young man was that he occasionally gave a sigh. This sort of thing shows that a stricter inquiry should be made if an insured person wishes to change his doctor for any reason except that he wishes to move to another district. I thank the House for having listened with patience to the few words I had to say, and it is with great pleasure that I support this Bill.
§ Mr. Buchanan (Glasgow, Gorbals)
In rising to say a few words on this Bill, my first duty is to congratulate the hon. Member for the Exchange Division of Manchester (Mr. Hewlett) on his maiden speech to-day. He cannot expect me to 501 agree with him, but I congratulate him on coming to this House and at least having the courage to state his point of view. I am certain that experience will teach him to modify many of his views, and I hope that the future will make him see the error of his ways. However, as I have said, I congratulate him on his speech, more especially "because it was on a subject which has some human interest and needs some human attention.
The hon. Member has said something about medical certificates. I know something, too, about working folk, and I believe that a man who goes to a doctor to get a certificate which will entitle him to 18s. a week sick pay, when he can get so very much more at work, needs to be examined for something other than the reason for which he goes to the doctor. With regard to the medical profession, as a result of nine years of experience as chairman of a trade union which runs a friendly society and pays sick benefits running into a fairly large amount, I want to say that, generally speaking, we have found that the doctors have carried out their duties in a fairly conscientious fashion. My hon. Friend produced one isolated example, but I could produce other examples of another sort, where possibly the doctors have been too severe. Therefore, I think we may take it that, on the whole, the doctors have carried out their duties fairly well. I notice that the representatives of the Scottish Office have now left the Front Bench; apparently they had not time to spare to wait for me to speak.
§ The Minister of Health (Mr. Ernest Brown)
I am sure the hon. Member will realise that we have to divide up our time, and equally I am sure my right hon. Friend the Secretary of State for Scotland will return when he hears that the hon. Member is speaking.
§ Mr. Buchanan
I want to raise a point which has some significance for Scotland. In opening the Second Reading Debate, the right hon. Gentleman was careful to point out that the Bill raised the disablement exemption under the Poor Law from 7s. 6d. to 10s. 6d. I would remind him that in the past there has been great agitation on this matter. For at least 15 years, 7s. 6d. was exempted under the National Health Insurance Act, but what happened—and 502 this applied in London and Glasgow, two of the biggest cities of the country—was that, although this was the law in respect of National Health Insurance, the Poor Law authorities never accepted that provision, either in London or in Glasgow. The Poor Law authorities claimed that the exemption, although given in regard to National Health Insurance, did not bind them. This situation was not remedied for many years, but ultimately an Amendment was passed by the House which extended the National Health Insurance provision to the Poor Law and made it quite definite that under the Poor Law the 7s. 6d. was exempted. At the present time, the provision under the Poor Law Act is for the exemption of 7s. 6d., and frankly, I am afraid that, unless the Poor Law Act is also amended, the provision concerning 10s. 6d. will not be applicable. I remember a much greater man that I am pleading in the House for the 7s. 6d. to be exempted under the Poor Law, but although the National Health Insurance Act said that it was to be, the Poor Law authorities would not operate the provision because the Poor Law Act did not say so. I ask the right hon. Gentleman to make sure, between now and the Committee stage, that the provision concerning 10s. 6d. will be applied, and to tell us what steps he will take, if necessary, with regard to any authority that does not extend the new provision.
I want now to say a few words about a matter which was raised by ray hon. Friend the Member for Llanelly (Mr. J. Griffiths)—-the question of approved societies and different benefits. My hon. Friend has quite properly raised the whole question of the wide range of difference between the benefits. I agree with him that the raising of the limit to £420 will extend the differentiation. In raising the limit to that amount, we cover a section of the population in which there is, in the main, less sickness than in the poorer-paid section of the community. Everybody knows that poverty has a relation to sickness; that insecurity, low wages and bad housing, things which are usually akin to poverty, make for sickness. In the £420 class of the community, insecurity is not so frequent, and standards of food, clothing and shelter are generally higher, with the consequence that there is not so much sickness.
503 What will happen? These people are to be allowed to enter what may be called the privileged approved society. They will not enter the average collecting society which pays only the minimum benefits. They will be the centre of attraction for the good society, for the society which can offer inducements in the form of higher rates of benefit, and the result will be that those societies which are now offering higher rates of benefit will get more of the better type of members than ever before, and thus will be able to offer still higher benefits. So the process will go on. I want here to congratulate the trade union movement on the fact that the trade union approved societies, in spite of all their difficulties, have constantly taken the view that this differentiation between man and man and woman and woman is something that ought not to be tolerated any longer. The defence has sometimes been made that some of the societies which paid extra benefits were in some way better managed. But take the Prudential Company. Some of us may have made very serious criticisms of them, but no one will say that they are not managed in a first-class manner. Some of the vast collecting societies are unable to pay a penny extra in benefit, but no one will say that they are not extremely well managed. Within the trade union movement there is a difference between the rates of benefit paid by the moulders' approved society and those paid by my own society, that of the pattern makers, which is able to pay extra benefit. Because of the nature of the moulders' work, sickness is on a much higher rate among the moulders. My view is that the time has come when the differentiation ought to be swept aside, and there ought to be equality of treatment.
But there is a much more serious problem than that. It is serious enough for a person to be in a friendly society which is able to pay only the statutory benefit, whereas others are able to pay more, but it is much worse not to be able to get into a friendly society at all. There are numbers of people who cannot get into a friendly society. I would remind the right hon. Gentleman that, at the present time, there are societies which, although they have not passed a formal rule to that effect, 504 have decided by their administration not to accept married women as members. That is happening at the present time. There are to-day poor people who have been unemployed for years, or partly sick for years, and who are now securing employment, and no friendly society will accept them as members. No collecting society will take them and no approved society will take them. It is a shocking thing that on the other side other people who can get into an approved society are guaranteed at least the State benefit, and possibly extra benefit.
I have written to the Secretary of State for Scotland about the case of a man who had been discharged from the Forces, and the only consolation I received was that he could try the Army and Navy Fund, where he might be accepted but where there was no power to compel them to do so. I think this system is shocking. Would anyone tolerate it in unemployment insurance? Would this House of Commons tolerate such a position in unemployment insurance, namely, putting miners and shipbuilders in a different category to their fellow workers? And yet here we say to a man or woman: "You cannot enter here; you are rejected and you shall not be allowed to become a member of an approved society." That is a shocking and indefensible position. I admit that the Minister of Health has his problems in connection with rates of benefit, but surely it could be provided that wherever a person is rejected from an approved society he shall have the right of appeal to the Minister. He ought to have some right of appeal against the decision of an approved society, and the Minister ought to have some right of recommending him to become a member of an approved society. In my view the present position is terrible and calls for redress.
May I say one word about benefits? I am not satisfied in this respect, and I want to make an appeal. It does not even do contributory justice to one section in particular, namely, to women. The present Chancellor of the Exchequer, when he was Minister of Health, introduced a Bill which made a serious attack on the standards of benefit for women. The defence for that Measure was the deplorable state of the funds of certain approved societies owing to bad trade. It was an economy measure, and if hon. Members look up the 505 Debate, they will see the Minister of Health stated that when good times returned he hoped it would be in his power to put the benefits back where they were. Women are not receiving the 3s. increase, and their position is only being partly restored to where it was before they suffered the reduction. The women are entitled at least to have refunded the amount they lost as the result of that economy Bill some years ago.
I should like now to say a word about this comprehensive scheme. I am a little suspicious about comprehensive schemes. I have had a long experience in this House, and my experience has shown that if I get a big comprehensive scheme, I get nothing, because there are so many people involved that by the time it is introduced those who asked for it are all dead. I know it is a fine phrase; it is like planning, getting down to fundamentals, and building brick by brick. They are all fine phrases and catchwords. But what does it mean? It means that to get all these things remedied you have to have a vast committee inquiring here and inquiring there, and there has to be an examination of approved societies, trade unions and employers. While all this is going on I have to wait. I know I can knock holes in National Health Insurance, but the fact remains that I too want something done, and I do not want to wait over long. I do not see the need for making comprehensive inquiries, because the civil servants have all the facts they need. All that is required is a practical approach to the problem by ordinary civil servants.
I welcome the Bill inasmuch as it gives men 3s. a week. I would have welcomed it much more if some account had been taken of the family of a man and some scheme of family allowances had been linked with it. Be that as it may, the Measure shows some improvement on the past, and, as hon. Members have said, no one will vote against the Bill. The Bill will be passed unanimously, but I hope at an early date we shall do two things in connection with National Health Insurance. Firstly, I hope we shall abolish the differentiation between men and "women and the differentiation between friendly society and friendly society, and. secondly, that we shall place no impediment in the way of a poor person becoming a member of an approved society and thereby debarred from common benefits to which his fellows are eligible.
§ Sir Joseph Lamb (Stone)
I want, in the very short time during which I shall occupy the House, to welcome this Bill, but in doing so I welcome it with qualified feelings. While I welcome the Measure as an improvement, I regret very much that we have not a more comprehensive Bill. I use the word "comprehensive"with a certain amount of diffidence after the classification given to it by my hon. Friend the Member for Gorbals (Mr. Buchanan). I think we must have an ideal. The hon. Member for Gorbals contradicted himself in his speech He said he was afraid of comprehensive schemes, and yet he maintained that we had all the materials for a comprehensive Bill, in which I agree with him. The reason why my welcome is qualified is that I am afraid this Bill may delay the more comprehensive Bill which I, for a long time, have advocated—the comprehensive means of giving a measure of security to everyone. I agree with what was said by the hon. Member who spoke from the Opposition Front Bench. I think it is very advisable to put off this larger scheme, because if there is a time when it is likely to be required more even than now, it will be after the war. We shall have very big problems of unemployment and other difficulties, and I believe nothing will give greater security to the vast majority of people than to have a Bill which is really comprehensive. I believe there is no other country in the world which has the same amount of social security that we have, but that does not say that we must be satisfied with what we have. We must always keep these great ideals before us. Consequently I think it would be very much wiser if the Minister were to look upon this as an interim Measure, the forerunner of something on a much larger scale.
We have benefits for sickness, disablement, unemployment, widows and old age, all of them conditions which add to the life of the individual a certain amount of anxiety. I do not know that work has ever killed anyone. It is worry that has killed most people. If you removed from the lives of people that dread of insecurity in the future, you would add very much to their life and happiness. I should like to see, instead of this Measure, a comprehensive Bill; contributory and national, embracing all these various services. I should like to see contributions 507 start either at birth or on first entering into employment. I should like to see a scheme embracing all the social benefits and all individuals. If a man is fortunate enough to be a millionaire and can put up with the inconveniences that that position now brings with it in some cases, he should also be wealthy enough to contribute to the scheme. He has no need to draw the benefits, but I would make it a national obligation to contribute. I believe it should take in every individual, because the larger the scheme the greater security there will be. As our social services improve, the good lives must of necessity be in the majority, and all societies benefit by the good lives. I would not allow a good life to remain out. They should all come in.
This Bill is not what I should desire, but it is something that I appreciate. It is an improvement on what we have at present. I am rather disturbed by the scanty attendance on a Measure of this magnitude. I hope the Minister will not be disheartened by it. I have never seen the House so full as when there is something to object to, so I hope we can take it from the fact that there are so few present that there is total agreement among all parties that the Measure should receive a quick and successful passage.
§ Dr. Edith Summerskill (Fulham, West)
I sympathise whole-heartedly with the hon. Member's disappointment at the inadequacy of the Bill. I find it rather difficult to express my sensations, but I feel a sense of frustration. During the time I have been in the House I have heard successive Ministers of Health asked time after time, month after month, week after week, to revise the national health provisions. I have asked Questions and have received so many evasive replies that I cannot remember how many. During some weeks there have been two or three Questions from different Members asking for some Regulations to be made. At long last we were promised a Bill, and last week we were given this miserable little Measure, which only tinkers with one of the most important matters the Government have to deal with. The Secretary of State for Scotland, in presenting it, made a speech which was in fact an apologia. I have sat patiently listening to my men colleagues accepting that apologia and saying that it is something 508 and that something more will come. But we have waited 20 years. Is the House to be sidetracked once more? The House of Commons, I understand, is a democratic Assembly where the minority and the majority have a right to be heard. We have pleaded, we have agitated, we have cajoled, we have coerced, we have done everything possible to get the Minister of Health to introduce a scheme, and this thing is what we are given. It is another small addition to the hotch-potch of legislation which has been presented by successive Ministers of Health.
Of course, we shall accept this Bill. Would not a starving man accept any crumb? We are dealing with the sick, the unorganised, the helpless and the in articulate. Are they going to say, "We shall not accept 3s. a week?" Of course not. They have suffered for 20 years. The women had their benefits reduced some years ago. The Minister, in his generosity, tells us he is going to make this miserable addition to the existing rates. My hon. Friend the Member for Llanelly (Mr. J. Griffiths) asked, "How can a man live on 10s. 6d. a week?" I ask, "How can the spinster or the widow, living alone, perhaps with an acidulated landlady, live on 15s. a week when she is sick and perhaps bedridden? "This addition to the rates of benefit is ridiculously small and inadequate. I have had it said to me on scores of occasions," Doctor, I cannot afford to be ill. "Although the hon. Member who made his maiden speech talked about withholding certificates, and so on, I know that there may be a minority of people who are naturally idlers. We get in all classes of society, and not only among the workers, those who do not like work and go to the doctor and try and get a certificate. I know also that in our factories and industries there are a number of people who should not be working but who are forced to work because of these inadequate rates.
I was impressed, of course, when the Minister of Health told the House last week that at last he was going to produce the new scale, and I thought that he was looking at me when he said," This is the first time that women have been treated equally with men. "It must be a red-letter day when a bedridden woman is given 3s. equally with a bed-ridden man. I want to ask the Minister whether he has examined the record of this Government 509 as regards the payment of women. Does he not know that the record of every Department, from the A.R.P. service to the Women's Auxiliary services, is a black record in regard to the payment of women during the war? I cannot believe that the Minister would have the gracelessness to suggest that the increased cost of living for a sick woman is less than that for a sick man. Let us examine the Bill carefully. I wonder that the Secretary of State for Scotland and the Minister of Health dare mention the fact that women are being treated equally, because one of the most glaring defects in this Bill is the treatment of women. I am not talking about the benefits or of the wives of men who are sick. I am talking about the wives of all the men who are earning up to £420 a year. The hon. Member for Llanelly said, "We must welcome this Bill because for the first time we have this large section of workers being provided for and their health cared for.'' Has the Minister realised, however, that the wives of all the workers, the women who to-day are queueing and struggling with rations, doing the work of the house and looking after evacuees, have no health provision at all? Yet the Minister has the effrontery to say that women are being treated equally with men.
I am not surprised that last week the herbalists came to the House in force. They are very anxious to have their particular preserves ensured because these housewives who have no health provision represent untold wealth for the herbalists. I am not discriminating between herbalist and herbalist; I only say that for this vast number of women who have been ignored there is no health provision unless they leave home and go out to a job. I am not exaggerating when I say that these women often have to get the cheapest kind of medical advice and they will buy any concoction that is advertised. Investigation after investigation has proved that the out-patient departments of our hospitals are full of those women who have not had proper provision made for their health. I ask the Minister not to come to the House and tell us after all these years waiting that something else is coming. The Medical Planning Commission, consisting of 70 people, is sitting now. Is the Minister going to wait for that Commission to report before he gives us a comprehensive scheme? Will he say 510 that we must wait many years before these people have adequate provision?
With regard to the question of machinery, I do not want to add very much, but it is a question which I understand very well. This Bill is to be administered by the approved societies. We find the most curious anomalies. We find, perhaps, in Lancashire a cotton operative unable to obtain dental treatment because his approved society has run out of dental benefit; or a clerk, attached to another approved society, who needs glasses cannot get them because his approved society has run out of ophthalmic benefit. We are to have exactly the same inequalities as existed before this Bill. We are to have inequalities not only between the sexes, but between trades and even between geographical areas. I realise that the Minister has devoted a good deal of his life to a different kind of work, and I want him to look at the whole field, to think of what is happening in the country, how certain services are administered by the county authorities, certain services by the borough councils, a number by ad hoc boards, a number by insurance committees and a number by insurance doctors. When we come to the health of the children, that is taken out of the hands of the Ministry of Health and administered by the Board of Education. I wish that a new Minister of Health would come along and realise that the health services of the country are in a chaotic condition. We have so often had a Minister come to the House and give us a little bit of jam and say, "Be quiet for a few more years; the millenium is coming." We are now becoming impatient. We want something more. Sometimes I sigh for another change, because I realise that the Minister of Health, if he only knew it, has more power to increase the health and happiness of the people than any other Minister in the Government.
§ Mr. Collindridge (Barnsley)
While my criticisms of the Bill will not be as acute as those of the hon. Member for West Fulham (Dr.Summerskill), I think that the House must feel that her profession outside the House gives her a knowledge of circumstances which not all of us have got. On that account we must pay attention to some of the things that she has said. In the district from which I come 511 there is some appreciation of the three points that are embodied in the Bill, but I cannot say that there is the fullest satisfaction that those points will meet all the problems of National Health Insurance which concern our people. Coming from an industrial district where so many people have to receive health insurance benefit, I am sure that the increase of pay, while small, will be appreciated. I am sure that the extension of insurance to cover individuals with higher incomes will be generally welcome throughout the country. That and the bringing of people with higher incomes into workmen's compensation are good points.
But with all the benefits embodied in the Bill the betterment is not great in view of the times in which we live. A very great many people will still have to be assisted privately or from public funds, and although the burden affects the individual in the first instance, it is also heavily felt by the community. In the town from which I come there is a high public assistance rate by reason of our having to assist people who, when they are sick, receive only health insurance benefit. The rates of the town have been affected and this, together with the lowered purchasing power of the people, gravely affects the trading community. In my own district, where heavy industries and mining are carried on, people are more likely to need health insurance benefits by reason of the nature of their occupation. I was a miner for many years before coming to this House. In the last few years before coming here I was a sedentary worker, a check weigher. Like many of my comrades when I was working at the coal face and ill-health befell us because of the nature of our work, we were compulsorily out of work; but sedentary workers, because their duties are not so arduous, are not so frequently absent from work. We ought to have a more comprehensive scheme of health insurance to balance better the differing requirements of individuals and of districts.
Very often when a person who has been out of insurance gets back into work there is a reluctance on the part of some societies to accept him into membership again, and he is in that way deprived of some of the benefits which he requires. We ought to move along the lines of 512 securing greater equality of benefits, and I believe the people will feel more hope from the promise that a full measure of health insurance is to come than gratification over the meagre benefits which are conferred by this Measure. Though it may be pleaded that there are difficulties in the way of bringing into force a more comprehensive scheme of health insurance for all people, I feel certain that if we took a plebiscite of the people, whether they are at present within health insurance or not, there would be agreement on the necessity for equality of treatment for all who experience foul fate in the shape of illness. In one district on the same day you may have one person falling ill and another meeting with an accident which entitles him to workmen's compensation. Neither of them can help what has happened to him, and yet their treatment is very dissimilar. The other day I heard of a case in my division in which a contributor to health insurance is troubled with that awful complaint diabetes and has succeeded in getting insulin treatment from which he is deriving great benefit. The wife of an insured contributor living nearby also suffers from the same disease but has failed to get insulin treatment through national insurance, and is unable to pay for it herself, and she is therefore left to suffer at least discomfort and to face, perhaps, the likelihood of an earlier death than the insured contributor. We certainly ought to face the question of securing health insurance benefits for all the members of a contributor's family and not for the contributor only. Knowing how acute this question is in our industrial areas I urge that we should have a balancing-up of treatment, cash benefits and other things for those who are similar payees, because it is the height of absurdity that an underground miner who is an insured person and whose eyes have been affected by nystagmus should in some cases be unable to get the requisite optical treatment owing to the fact that, unfortunately, the society to which he belongs is not well enough off to afford him that benefit.
§ Mr. Tinker (Leigh)
I should like the Secretary of State for Scotland and the Minister of Health to explain several things in the Bill. The first Sub-section on page 2 of the Bill gives the Minister power to revoke any scheme under 513 Section 56 of the Insurance Act. It is so long since the Act was passed that it would be well if that matter were cleared up. Clause 5 is entitled "Increased provision for reserve values." I should be glad to have an explanation of that. There is a point in the First Schedule on which I am not clear. It is stated:Provided that, until one hundred and four weeks have elapsed since the entry of an insured person into insurance and one hundred and four weekly contributions have been paid by or in respect of that person, the rate of sickness benefit to which that person shall be entitled shall be, in the case of a man, twelve shillings a week, and, in the case of a woman, ten shillings and sixpence a week.When do they get the first benefit? Is it after they pay one contribution, or have they to pay a number of contributions? I realise that they have to pay 104 contributions before they get the full benefit of the Bill. At the bottom of page ii of the explanatory memorandum it states:The new class of pensioners will, like the existing class, be entitled in certain circumstances to supplementary pensions from the Assistance Board, and there will consequently be a further liability on the Exchequer which it is not possible to estimate.I assume that that means that these people who are now embraced by this extension of National Health Insurance will be entitled to the same kind of benefit under the supplementary scheme as under the old one. Many people will read what we are doing and they will have certain doubts about what it means. An explanation from a Minister is always very widely read outside. People do not take very much notice of what a back bencher may say but a Minister's explanation is always followed as a reliable guide.
We recognise that the Minister has carried out to the full the pledge that he gave us in May. That pledge did not meet what my hon. Friends and myself desired to have, but what he said is, in the main, carried out in the Bill. Naturally, it does not satisfy us, and we are now taking the opportunity to impress upon the Minister some of the points which we hope will be dealt with by the proposed new legislation. I want to draw the attention of the House to one phrase at the end of the Bill, which is all that I desire to see carried out. It is stated: 514This Act may be cited as the National Health Insurance, Contributory Pensions and Workmen's Compensation Act, 1941."I have always understood "National Health Insurance "to mean that everybody should be treated alike, and I cannot understand that term being used unless it has that meaning. In this Measure we call upon everybody to pay equal contributions, but, under the present scheme, people in some difficult occupation or one that is really dangerous do not get the same benefit as other people. That anomaly has been going on for over 20 years. When the first Bill was brought in I imagine the idea was used that if you gave certain societies the government of their own finances, they would be more careful to watch over those finances and would, in that way, enhance the benefit to their members. Anybody who examines the position now will see that that was not the right way to look at the matter.
I belong to the mining profession. A week ago I saw the secretary to an insurance society to find out what was happening there, and he gave me some rather startling figures. Everybody knows that mining is a difficult occupation. Men fall sick more often in that occupation than in any other. The men concerned pay the same contribution as others, but they are on the minimum benefits. A statement was made to me by that society, and I bring it forward for the benefit of the House and of the committee which has been set up. It will let them know why we agitate for an all-in comprehensive scheme. It states that sickness benefit is at present 15s. a week. That is the minimum. Disablement benefit is 7s. 6d. That is both the minimum and the maximum in this society. The above benefits are statutory. There is not a single additional benefit available to the members of this society, and the society Has difficulty in continuing to exist, owing to the very unfavourable sickness experience of the members resulting from the strenuous and exacting nature of their employment. Contributions are at the same rate as for ordinary insured persons, but in other societies, owing to the light sickness benefit, those contributions provide dental treatment, dentures, optical treatment, medical and surgical appliances, and many other additional benefits. Not one of those benefits can be given to the members of this miners' society. The result is that the 515 society has, in recent years, fallen in membership from 17,000 to 11,000. If that decline continues, the society will go out of existence altogether.
It is difficult to understand why, in any National Health Insurance scheme, that sort of thing should obtain. On examination, I think the first insurance scheme was brought in without any such inequality in mind. My hon. Friend the Member for Westhoughton (Mr. Rhys Davies) will no doubt speak in this Debate. I hope he knows my point of view. He belongs to a distributive society which pays its members a very high rate of benefit as well as giving them additional benefits. I know he will agree that that is not because the society is run any more efficiently than the miners' society is run. Both societies are doing their best. The difference is merely because the members of the society belonging to my hon. Friend are not liable to the same rate of sickness, arising out of their work. I do not think the members of any society would object to a pooling arrangement, any money which is paid being put into a common pool so that everybody could get equal benefits from it. I hope that the Beveridge Committee has that point in mind. There are more than 800 societies, and they have much money accumulated, but they ought not to take that fact as a credit to the work of their society. If they were to operate in mining or factory areas, or in the shipping industry, they might be as badly off as the societies are in those areas. I want them to take a broad view of National Health Insurance. Let this scheme be comprehensive and let everybody be embraced by it.
One of my hon. Friends said that he did not want to wait until the termination of the war. I have already prophesied in this House that the war will be all over by the end of January. I want the Beveridge Committee to be ready to say to the people, "We have all helped to win this war, and everybody has thrown his effort into the common lot. This insurance scheme brings everybody into the same rate of benefit." I am prepared to wait for it, but I have never adopted an attitude of throwing anything over. I take what I can by the way, and I am pressing on. Although I am not fully satisfied with what is happening, I shall not oppose the Second Read- 516 ing. I ask the Minister to hurry the Beveridge Committee on, so that everybody can share equally in the benefits of National Health Insurance.
§ Mr. David Adams (Consett)
I can not subscribe to the strictures that have been passed to-day on this particular Measure. As far as I recollect, the pledges given by the Government were detailed, but here in this Measure they are fully honoured, and for that reason, while the criticisms that have been expressed regarding the items which are not included in the Measure have their value, inasmuch as they can serve to advise the Beveridge Committee as to what the feelings of the House are, they are, after all, slightly irrelevant to the present de liberations. I am glad to notice, how ever, the equality of increase as between men and women. Why has this equality been decided upon? Because the Government recognise that there is an equality of need. If they admit that, why do they not equalise the total benefits for sickness and disablement allowances between men and women. In that particular they are acting quite illogically, and although they are on the surface endeavouring to be somewhat repentant, they are retaining a serious disqualification which we hoped to see eliminated.
The hope has been expressed that we might have had in the Measure some statement, or the beginnings of a change, in the direction of family allowances. One could scarcely anticipate that this could be the case at this stage, but we must be certain that an adequate system of insurance, designed to treat all classes and individuals in the State alike, must be in some measure associated with family allowances. I am gratified that the income limit has been raised. That is a very just and a very essential departure. From my experience there is no question that the lack of it has inflicted considerable hardship upon non-manual workers and their families, and we should be glad to know, if the Minister can tell us, how many persons are affected by this change. We notice that the doctors are permitted to increase their charges from 13s. to 14s. 6d. I have no doubt that this is based upon actuarial figures and present-day necessities, and none of us can object to it. Personally, I have had experience as a vice-chairman of a National Health Insurance 517 Committee, and I am glad to testify to the amazingly few cases in which the medical profession have shown any dereliction of duty towards their patients, and I believe that the general spirit in the medical profession is now to recognise these responsibilities perhaps to a greater degree than has been the case in the past.
We are promised, if I may digress a little, a new and comprehensive Measure after the survey which is now in progress is completed, but after the war. I hope the Minister will give us some sort of time-limit as to the introduction of the Measure after the war, or after a certain period of time. No one knows, except the hon. Member for Leigh (Mr. Tinker), when the war is likely to end. Certainly none of the belligerents seem to have the information which he happily possesses; but suppose the war continues for some years, are we to wait for this comprehensive Measure, the benefits of which are urgently desired, for that period of time? I hope the Minister will be able to give us some assurance in that direction. In such a comprehensive Measure there ought, of course, to be equality of benefits for all members of the community, which, of course, we know is not obtainable today. There are certain societies which are unable to give the benefits which others give, with the result that the would-be recipient goes to the local authority.
The local authority with which I am associated is to-day, owing to the failure of the approved societies, supplying spectacles and dentures, and making up for deficiencies, in addition to those very large financial contributions which we are called upon to make in order to make up the amounts requisite for those who are receiving relatively elementary benefits at the present time. It is interesting to note that our latest Ally makes no discrimination with regard to any individual in the State in the matter of benefits, which are of a more universal character than anywhere else among the great nations of the world. That women should be placed in an inferior position to men would be quite unthinkable in that State. Perhaps, therefore, our new association will enable us, in the matter of our health insurance, to follow on the lines which they laid down away back in the year 1920, when their first insurance schemes were introduced. These schemes begin from the age 518 of 16 and provide against any form of disability, for all sections of the community. I am grateful for the present Measure. It will be beneficial, and we welcome it. We regret its limitations, but we look forward with resolution and determination, as well as aspiration, to the new Measure, which we hope will fulfil all the desires and ambitions of those who have spoken to-day.
§ Dr. Morgan (Rochdale)
I have had personal experience of National Health Insurance practice, and I hope the House will bear with me when I ask the Minister to try to have a more humane administration of medical services from the Ministry of Health. I wish to stress the question of the equality of benefits which has been raised, and the unfair discrimination between the sexes, between married women and unmarried women, and the differentiation between one person in one society and another person in another, with the anomaly that the insured person loses additional benefits if he transfers voluntarily from one society to another — although I know that no transfers are allowed during the war. This is, I know, an agreed Measure, and we welcome, of course, the changes incorporated in the Bill, but I hope the House will allow me to say just a few things about National Health Insurance. "National," is not the proper word to apply at all; it is elementary health insurance. The medical service scheme is on the lines of elementary education, with secondary education and university education left out. Numerous anomalies have crept in. The approved society system is wrong, it is rotten, though I welcome the comprehensive survey being made, because it will bring pensions and workmen's compensation and health insurance into one scheme, let us hope, instead of this very complicated present system. The approved society system was one of the blots on the original Act, and vested interests have been allowed to creep into National Health Insurance, which unfortunately, I fear, will take a great deal of eradication even in peace-time. There will be a tremendous fight, sometimes even from the trade unions, approved societies and those in democratic circles, for approved societies as such, even though it is recognised that many approved societies exploit National Health Insurance as a subsidiary for other purposes in connection with insurance. 519 The part I wish to deal with is the medical service. It is unfortunate that there is only a general practitioner system, that there is no hospital arrangement, no arrangements or facilities really for investigation, pathological and biological. The poor general practitioner, working under the most difficult conditions in the world in an environment in which there are disease, bad housing, dietetic ignorance, is put there, and told to sift these cases, and he is given no opportunity of having proper facilities for diagnosis. I was one of those who, after the last war, went, by choice, not from necessity, into National Health Insurance, against all the advice of my professor. I said I thought I could serve the working classes best by going into National Health Insurance. I made a mistake, and I left it disappointed and disillusioned. I was hampered at every stage, not so much by the conditions which I knew existed, not so much by some of the patients who did not understand that I was trying to do my best for them, but by the conditions under which medical services were allowed to be administered by the Ministry of Health.
I can give two examples. When I was in practice in Greenwich my average for prescribing, because of the conditions of my practice, was very small. I knew every patient. I used to represent them on the borough council, and before they came to me I often saw them in the street and talked to them, and told them to come to the surgery. I kept my sickness rate low; it saved me work in the end. But because my average for prescribing was below the average for the doctors of the district I was inspected and visited by an official of the Ministry of Health and practically censured because I could not give an adequate explanation as to why my prescription rate fell down by a certain fraction below the average of the district.
When I moved to another district where I was a candidate, in Camberwell, a seat I represented before I represented Rochdale, my average exceeded the average by a fraction again by a penny or three halfpence. Again, I was visited by a domineering medical official from the Ministry of Health. He, again, challenged me, for hours, by acute cross-questioning, as to why I had allowed my prescription rate to exceed the average, so that I was blamed when my prescription rate was 520 below the average, and blamed when it was above the average. In prescribing for the patient I was simply never thinking about averages or cost, but simply trying to do what was best under the conditions existing for my patients and giving the best treatment possible. I had a hay-fever patient in Greenwich and gave him an order for a 25 c.c. bottle and was challenged by a Ministry of Health Official as to why I had not ordered this in one drop or two drop capsules instead of a 25 c.c. bottle. I pointed out that I had to give a series of doses twice a week and that it was cheaper to do it in the way I had prescribed. He calculated that I had used only 23 c.c. and wanted to know what I had done with the two minims that I could not account for. I had to explain for nearly an hour to this man—he ought to have known—that in giving hypodermic injections one occasionally lost a drop or two.
When I was in Paddington, practising under the National Health Insurance scheme, I had a series of patients with artificial openings for the discharge of waste products. I had five of these patients. Some had malignant growths, others gunshot wounds, and so on. I prescribed cotton wool for these people to use to clear themselves up with. Again, I was visited by a Ministry of Health doctor, who queried whether I had the right to prescribe cotton wool in cases of this kind and asked that I should use tow. This is a thick fibred substance, the sort of material you make mats out of; cotton wool is a thing you put on as wound dressings. I asked him if he would care to use tow for himself under such circumstances, and he replied that that had nothing to do with the question, and that I should have saved the Exchequer money rather than prescribed the use of cotton wool. I told him he could go to Hong Kong and that I would stand any challenge. I was then a Member of Parliament. I told him to go to his Minister, who was then a member of my own party, and that I would do what I could to fight the point. I want to press on the Minister that the way in which he chooses his medical officers is bad. The medical officers are distinctly chosen because they have a certain type of mind and a certain type of outlook. A man with a democratic outlook rarely goes into the Ministry of Health, though I was glad 521 to see recently that they had appointed a Communist into their sacred administration. They are changing a little. They did that before Russia came in; they must have had an inkling of what was going to happen.
Doctors trying to do their best, working the system as well as they can, instead of being helped by officials of the Ministry are really being hamstrung time and time again with wasted mornings, wasted afternoons, because a personal dislike has been taken to a doctor or because his democratic instincts are not liked. Some doctors do not have that difficulty. They put champagne and tea before the regional medical officers. I did not care to do that; therefore I was treated in a certain way. The Minister may say, "You left your practice eight years ago, and that is a long time." But I can give him cases up to 1938, in which doctors have been fined £20 by the Ministry of Health for alleged over-prescribing. One case is that of a Labour candidate, who, I hope, will be in this House after the next election. He has a practice in the East End, where he is doing his best. If ever there was a justifiable case for the Ministry saying that a man was trying to do his job decently, it is that case, in respect of which the Ministry, without allowing me to be present, confirmed the recommendation that the man should be fined for over-prescribing The system is bad. There is no Whitley Council system for the medical men: you have a panel committee; sometimes men are tried by their rivals. I know I should not say that; I am on the B.M.A. Council: there is an esprit de corps in the profession; but that sort of thing does exist. This man was asked, "Do you ever take part in politics?" He said, "Yes, I have been mayor of my borough." Somebody said," Oh, yes. Labour mayors are a penny a piece."
You must take into consideration the difficulties of medical practioners working the service now. They have lost patients through evacuation and through bombing; their practices are ruined; some have mortgaged their practices to the insurance companies and the banks, which opposed the National Health Insurance Act in the first place, but now find that they can make it a good financial investment. These men are keen on giving you a 522 good service, such as it is. I have spent hours on the end of a telephone, trying to get a patient into hospital or to get an investigation done. It is terribly difficult for a man to make a proper diagnosis on general practice. I can tell the right hon. Gentleman—and, no doubt, the Minister of Health has obtained a certain amount of medical knowledge by inoculation by this time—that if one goes to a panel patient at ten o'clock at night to look at a rash on the skin, with the dim lighting, he will scarcely be able to see the rash with the aid of a torch. If it is a case of scarlet fever the patient must go to hospital, yet if you send the patient to hospital by mistake the doctors there say that you are a fool. These general medical practioners are the backbone of any medical service. Even a State medical service would have to have them. I have worked with these men, and know the difficulties that they are up against, the handicaps that they have to get over. I know that in many cases they are finer, better, nobler, harder-worked men than the doctors who live in the hospitals.
It is because they are doing a decent job of work that I ask the Minister to deal with them in a spirit not of bureaucracy, but of decent humanity, giving consideration to the difficulties of their job. While I welcome the Bill, I hope that the Minister will make his survey comprehensive. Already certain facts are known such as the evidence which was given before the National Health Insurance Commission and the Workmen's Compensation Commission, at which evidence was given by the T.U.C., which took us months of hard labour to prepare. You can dovetail these schemes together, giving you a better service with more democracy in it. I believe that the best way to extol a virtue is to practise it. We are fighting for democracy. Let us try to introduce democratic methods, and so help these doctors who are trying to work a service with the best results under the worst conditions.
§ Mr. Evelyn Walkden (Doncaster)
I am glad that the Minister has introduced the Bill in its present form. It is a very simple form. But, while the Bill will receive my warm support, I am disappointed from one angle, about which I believe the Minister spoke long before he held his present very dignified and im- 523 portant office. That is, with reference to cases of tuberculosis and persons who are certified as being what are commonly called by the medical profession T.B. cases. I am sure that the Minister must receive reports about shop-workers and clerks by the thousand. No statistics can convey what is happening in the distributive and clerical professions. To get a true picture, you must be associated with the industry itself, and with the suffering and misfortunes of the T.B. case.
I have seen in recent years people who have been employed by good employers, under reasonably good conditions, who have been certified as suffering from tuberculosis, who have gone to hospitals and convalescent homes, and who, on approaching their employers afterwards, especially if their work involved handling foodstuffs, have been told, "I am sorry, I cannot employ you; you are a T.B. case." So these people find themselves on the human scrapheap. The Bill increases their statutory benefits from 7s. 6d. to 10s. 6d. per week. I would contrast this with the compensation paid to the man in industry. I have been connected with coalminers for the greater part of my life, and I think I have heard all of the many strange terms that are used in different counties. In Lancashire we use the term "compo men." These men are attached to their employers, because the employer has to pay a measure of compensation for the incapacity from which a man suffers. The employer, therefore, knows that if he tells the man that his employment is at an end, the man will sue him, and a considerable sum will have to be paid to the man for the accident.
But here is the misfortune of the shop-worker. He cannot prove to the satisfaction of any tribunal or anybody where he contracted the disease. He knows that he has no evidence except that he suffers from tuberculosis, but he cannot say how it began or how it was aggravated. He knows that once he is certified as suffering from the disease no employer in the distributive trades will give him a job or even look at him, and he cannot claim compensation from an employer. I would ask the Minister one or two other questions in regard to tuberculosis. I have also seen in recent years, especially in the south of England, the sad misfortune of the T.B. case when 524 the sufferer goes to his local authority. He is sent to the after-care committee and receives, I believe, a grant of a few shillings per year. In the case of the town where I happen to reside, they grant, in many cases, £25 per year for after-care. I refer to the Surrey County Council in respect of a borough with a population of something like 80,000 people. But for the rest—the amelioration of hardship, discomfort, and all the other disadvantages you must pass the hat round and collect from the people in the streets and at the four-ale bar. That is the only way in which you can really assist the T.B. victim.
I appeal to the Minister to refer this important subject to the Beveridge Committee to see whether something cannot be done to help these unfortunate victims, especially among the clerical and distributive trades. My hon. Friend the Member for Westhoughton (Mr. Rhys Davies) happens to be connected with a very important society, of which, I am very proud to say, I am a member. They have wealth and are very generous indeed, but because of the Regulations, they have to treat their T.B. cases in exactly the same way as every other society. That hurts those who have to administer the Act very much indeed. Therefore, I appeal to the Minister, if he cannot include provision in this Bill, to re-examine all the Regulations and Acts which have a bearing upon tuberculosis and upon those long standing cases where men and women feel that, although they are cured or are in an improved state of health, they are not ready for the high road of industry. I believe that the Minister could discover ways and means of doing something for them.
§ Mr. Rhys Davies (Westhoughton)
I am sure my right hon. Friend the Secretary of State for Scotland will be more than pleased with the way this Bill which he introduced to-day has been received by the House of Commons. Nearly everybody has said that he welcomes the Bill, but there was a big "but" in each of the speeches delivered. I have that big "but," too. I welcome the Bill, but regard it as just a makeshift; and the right hon. Gentleman admitted so much in introducing the Measure. There is no doubt at all that the Bill is necessary, although it is only a short and puny Measure. It is a 525 Measure which provides that cash benefits may catch up with the increased cost of living; it is not much more than that. In the case of non-manual workers, however —and I should imagine that there will be tens if not hundreds of thousands of them—they will benefit very much by the passing of this Measure. The Bill will do a great deal of good to them apart altogether from an increase in the rates of benefits. In short, this Bill covers Health Insurance benefits and the raising of the income limit for non-manual workers in connection with workmen's compensation and National Health Insurance.
Perhaps the House will forgive me if I utter just one jarring note. Financially, the Bill would not have been necessary at all were it not for the fact that the present Prime Minister, when he was Chancellor of the Exchequer, reduced the State subsidy to the funds of the Health Insurance scheme by over £2,000,000 per annum. You could have given an increase of 3s., 6s., 9s., or even 12s. per week if all that money had been allowed to accumulate since 1926 up to the present. The right hon. Gentleman the Minister of Health must not look quite so furious at me when I say that, because I am sure it is true. He, like me, may not be a very good statistician. The National Health Insurance scheme has come, naturally and rightly, under a great deal of criticism to-day. But it has been very helpful. Criticisms have been levelled against it from time to time both inside and outside the House of Commons, but the one thing we have to remember is that it is still probably the largest, most important and soundest financially of all our schemes; and it is worth while, therefore, that it should be brought under review in the House of Commons by a Debate of this kind. I regard the small grant made by the State towards the National Health Insurance scheme as the most effective subsidy of all towards social amelioration. The subsidy is not very much, but it provides the Government with the right to audit the accounts of the approved societies.
I would like to project my mind into the future of these schemes. Like my hon. Friend, I have no illusions as to what may happen at the end of the war. I do not forget the time when in a financial crisis we were all asked to tighten 526 our belts. I am afraid that at the end of this war there will be no belts to tighten for some people, but I will leave that point there. I understand that the Minister without Portfolio has appointed a committee of very eminent persons to prepare us for a great advance in the field of social security; naturally we are all delighted that that work is going on, and we wish the survey every success.
I have tried to calculate how many persons will be affected under this Bill by the addition of 3s. per week disablement benefit because they will be the most tragic cases of all. There are about 350,000 persons always on disablement benefit of from 10s. a week down to 7s. 6d., or, in the case of women, to 6s. Most of them are likely to be on their sick beds; and it is a very remarkable comment on our democracy that, if you have 350,000 persons completely unorganised and voiceless, nobody takes the slightest notice of them. If, however, you have 350,000 persons in good health, all of them organised, and they have a mentality for politics, they can often get something done, and good luck to them. It is to that 350,000 that I think that this Bill will be most welcome. The increase is only 3s., but that is a lot if you have not very much to live on. Strange enough, nobody has made any reference to the greatest omission of all from this Bill. The three cash benefits under National Health Insurance are sickness, disablement and maternity benefits. There is no word here about maternity benefit, and I would like to know why, because this is quite as important a service as either of the other two.
I would like now to say a word or two about health insurance in general. I hope the House of Commons will never forget this fact—that the main objective of health insurance is not the payment of cash benefits, but the prevention of illness. Quite frankly, since the scheme was established the mass of the people seem to have developed the mentality of believing that this scheme is primarily for the purpose of providing cash benefits. As some hon. Members know, there were provisions under the original Act whereby you could classify the records of certain employments over a given period and said to the employer, "You employ 1,000 persons, and the average rate of sickness among them is far too 527 high. Is there not something wrong with the ventilation or sanitation of your factory? If so, you must remedy all that in order to reduce the sickness rate among your employees."Now all that has disappeared. What I would like to do is to switch the outlook of the people back to the original aim of the scheme—to prevent illness and not merely to pay cash benefits when illness comes along. Let us remember the old adage, "Prevention is better than cure."
My hon. Friend the Member for Rochdale (Dr. Morgan) knows better than most of us that the health of the people of this country has improved enormously during the last two decades. The infantile mortality rate has been halved in the last 30 years; and anybody who cares to study the vital statistics of this country and relate them to National Health Insurance will see the benefit in improved health that has been derived from this scheme. There are, however, two diseases that seem still to baffle the medical profession and the Ministry itself—cancer and rheumatism. Strange as it may seem, once you conquer one fell disease, another seems to emerge.
I welcome very much what is probably the greatest achievement of all in this Bill—the equalisation of the increase in the benefit. It does not equalise benefit; it simply equalises the increase on the original benefits. There is the natural complaint that because an insured contributor pays a given contribution he does not receive the same benefit for that contribution as others. I think the Government will have to face that complaint. I happen to be the secretary of a Society that is regarded by some as being very well-to-do, and I like to think that it is so because I am the secretary, although nobody else believes that. Let me say one thing, with due humility, to the Beveridge Committee on that score. We are told that if you nationalise National Health Insurance and equalise benefits you must automatically abolish the approved society system. But I should have thought that without abolishing approved societies you could' value the whole of the assets and liabilities of all the societies in one unit, instead of valuing 7,000 separate units once every five years, as is the case at present. Additional benefits do not matter for the argument I am now 528 putting forward. This complaint about the differentiation of benefits will persist, and I doubt if there is any alternative except to lay it down that all benefits paid under this scheme shall be statutory. If you add other statutory benefits, as I think you must, to the three main benefits —sickness, disablement and maternity—there are one or two you can add without much difficulty. I think dental benefit ought to be made statutory; it is one of the most beneficial of all benefits.
I cannot speak for my society, but as a politician I am willing to advocate that all benefits under this scheme should be statutory and not dependent on the valuation and surpluses of individual societies. There is another benefit that might be made statutory too. The time has arrived when medical attention ought to be provided for the dependants of insured persons on exactly the same basis as that provided for insured persons. What is the position now? The population of this country is roughly about 44,000,000, of whom 20,000,000 are already within the National Health Insurance scheme. Strange as it may seem, that 20,000,000 of the population have about 20,000,000 dependants. That would cover 40,000,000 out of the 44,000,000 of our population, and so far as I can understand it, that is one of the most necessary steps that can be taken. I am firmly of the opinion that an extension of medical attention for the non-insured population can be more easily provided through the National Health Insurance scheme. The Minister shakes his head. That is exactly what these Scotsmen do. It is strange, by the way, that we have had a Scotsman to introduce the Bill, a Scotsman is to reply and that a Scots lady is sitting next to the Minister. [HON. MEMBERS: "Withdraw"]. Well, politically the Minister of Health is a Scotsman.
§ Sir Robert Tasker (Holborn)
On a point of Order. Is the hon. Member for Westhoughton (Mr. Rhys Davies) addressing you, Mr. Speaker, the Minister or his friends behind him?
§ Mr. Davies
Everybody, I hope. At any rate, I think the hon. Gentleman can hear what I am saying. With regard to raising the income limit from £250 to 529 £420, I would like the Minister, when he replies, to tell us where did the Ministry get: the idea that there ought to be an income limit at all for non-manual workers. To raise this income limit will of course bring tens of thousands of people compulsorily into the scheme. That is all to the good, but with all respect I think the medical profession has something to do with this differentiation between the income limit of manual and non-manual workers under National Health Insurance. I wish the right hon. Gentleman would disclose to us why the Ministry make a difference in this connection. There is no reason in equity or justice for it. With regard to the raising of the income limit for workmen's compensation, as far as I understand statistics, out of every £1 paid by the employers to premium insurance companies to cover workmen's compensation risks, only about 10s. goes into the pockets of injured workmen; the other 10s. goes in profits, doctors' fees, and particularly, in legal fights. I would like workmen's compensation taken clean out of the hands of profit-making insurance companies; and if the Beveridge Committee would be good enough to take a hint, then I would suggest that they could not do a better piece of work than to consider recommending taking workmen's compensation clean out of the hands of profit-making insurance companies.
§ Mr. Davies
Yes: Where a workman meets with an accident and claims compensation, but fails in his claim, he falls on to the funds of the approved society, where there are no legal fees or profit-making possible. I venture the guess that he gets out of Health Insurance premiums paid in respect of him 50 per cent. more than he does in the case of the premium insurance companies. I would urge that that point be borne in mind in future. I should like to show how the Bill will affect an individual by raising the income limit for non-manual workers to £420. I have just come across the case of a member of my own society, who is a clerk. Because his income is over the present limit, he cannot claim workmen's compensation in respect of dermatitis, and we cannot sue for workmen's compensation on his behalf. But once this Bill becomes law, and if he 530 still suffers from that disease, and his income will fall below £420 a year, we maybe able to sue in court on his behalf. That is something in favour of the Bill, and it is only one case; there must be thousands of similar cases' among non-manual workers. Therefore, the Bill does a great deal to a larger number than some people suppose.
There is a mystery about one thing in the Bill on which I would like the right hon. Gentleman to enlighten us. There is an increase from 13s. to 14s. 6d. for medical services. I notice that my hon. Friend the Member for Rochdale listens attentively when I touch on that subject; probably he will know something about it. There is an increase of is. 6d. a year. Who is to get that increase? Is there to be an addition of is. for the panel doctor and 6d. for drugs? It would be interesting to know this, because even in the very excellent report of the actuary, there is nothing to show how the is. 6d. is to be divided. It is amazing how clever Civil servants can be when they come to finance. Hon. Members will notice that in order to meet the liability of these increased benefits, which cannot all be met from increased contributions, there is to be an adjustment in respect of interest on investments. I should like to know whether the adjustment means that the investments will actually earn the interest that is to be credited to the funds to meet the new liability. There is, too, some mystery about the account known as the Central Fund. It would be interesting to know what is to happen on that score; and here let me say that it is my experience that when there Is a will to do anything, finance can bend itself to almost any extent. That is shown clearly in this Bill-There are a few small anomalies in the scheme, and I would like to deal with one of them. It is astonishing what can happen under National Health Insurance-. By ancient custom, non-manual workers are entitled to wages during holidays. Some very clever employers have recently found out that they can get behind the law and the regulations by not stamping the cards of their employees during holidays, although wages are paid. The right hon. Gentleman will probably be familiar with this problem. Will he take the occasion of the passing of this small Bill to provide that no employer shall be allowed 531 to avoid his responsibilities in that direction? If no contributions are paid for each week or fortnight's holiday in respect of all the non-manual workers in the country, the amount of revenue that will be lost to the approved societies may well run into hundreds of thousands of pounds a year, and that, of course, would be detrimental to the scheme.
I come to another point. This Debate has turned more or less to the general problem of social security. This Bill is, of course, only a small contribution towards what we want. The struggle for, and pursuit of, social security has travelled a long way in the lifetime of most of us. My hon. Friend the Member for Llanelly (Mr. J. Griffiths), who comes from the same district as I do, is perhaps able to look back, as I can, to the days when, if a coalminer was injured in the pit, maybe injured for life, all the sustenance he got—and the same applied to the widow of a man killed in the pit—came from collections by way of charity concerts and 6d. each which the colliers gave from their wages at the pithead. Widows, orphans and injured workmen were sustained in that way, because in that district nobody thought they should descend to ask for anything from Poor Law relief. All that has gone. We have seen these social security schemes grow—workmen's compensation, old-age pensions, widows' pensions, orphans' pensions, superannuation and annuity schemes, health and unemployment insurance. They have all emerged during the last half century. For instance, nearly twenty years ago, I moved a Motion in this House in favour of widows' pensions, and, strange though it may seen now, at that time the vast majority of hon. Members voted against the Motion. The argument then was the familiar one that the nation could not afford to give 10s. a week to all the widows in the country. I must pay a tribute to the noble Lady the Member for the Sutton division of Plymouth (Viscountess Astor), who was, I think, the only Tory who voted for my Motion. I say humorously sometimes that she voted for it because she thought that some day she might require such a pension herself. We are to-day faced with a first-class issue. There are 7,000 approved societies and branches which are all valued as separate units every five years. I suggest, although the approved societies have done their 532 duty well, that the system cannot possibly continue on its present basis. That is especially so in view of the references made by my hon. Friend the Member for Gorbals (Mr. Buchanan). Once you provide an approved society with the right to refuse admission, to a married woman, or any persons suffering from some sort of disability, or a person engaged in a certain industry, then you are faced with the fact that this is not a national scheme in the proper sense.
This Committee, set up by the Minister without Portfolio, might consider something else, too. While we are talking about social security, may I say that I wish the Beveridge Committee would have a look at the 1933 Report of the Cohen Committee on industrial assurance, and see what they can make of the recommendations set forth there? It is a very illuminating document indeed. Above all, I hope that Committee will not forget that there ought to be improvements in the provisions for pregnancy and child-birth. I am sure that problem will have been brought to the mind of the Ministry of Health. In conclusion, may I quote what the International Labour Office says in regard to these social and economic security problems? Nowhere has it been better put; the struggle and pursuit for social security among the peoples of all countries is very well painted there.
It declares that—Any lasting civilisation is unthinkable except on a basis of a new economy and social order, in which workers will enjoy, not only a higher standard of living, but also the absolute guarantee of complete economic security.I am sure I can say on behalf of the common folk of this country that they agree to the full with those sentiments; and they trust that those sentiments will be translated into law in due course.
§ The Minister of Health (Mr. Ernest Brown)
My hon. Friend the Member for Westhoughton (Mr. Rhys Davies) always speaks with a very useful balance of idealism and practical wisdom. I am always very glad to hear him wind up a Debate, when I know a good many high-sounding generalisations—the sort of things referred to by my hon. Friend the Member for Gorbals (Mr. Buchanan) —will be brought very close to the actual administration of a well-known society, whose interests he has done so much to 533 promote in the long period since health insurance became a State undertaking. Indeed, my hon. Friend was connected with societies which were in the field before the State took any interest in social insurance. The House will understand that the Debate has fallen into two parts —a few definite clear-cut questions, mostly put by my hon. Friend the Member for Leigh (Mr. Tinker) about actual technical points in the Bill, and the welcome of the Bill, as such, with a big "But. "I think that is a fair analysis of the course of the Debate.
Perhaps I had better answer the practical questions first, and then say a few words about the wider issues which have, rightly, occupied most of the time. It is one of the advantages of our Parliamentary methods of discussion that Second Reading Debates give Members, who have long-cherished ideas and ideals and those who have had long experience, opportunities to set their dreams a-going. Despite the disillusionment referred to more than once in the course of the Debate, these dreams do move, if they are true dreams, nearer and nearer to the business of life, and they can find their way into legislation and administration. I was asked by the hon. Member for Gorbals about workmen's compensation. I will give him the relevant passage, without troubling the House by reading the whole of it. He will find the answer in Part II of the Second Schedule. He will find that it covers both the 1930 English and Scottish Act of 1934. With regard to Scotland, in paragraph (d), it states:(d) under Sub-section (2) of Section forty-eight of the Poor Law Act, 1930, and Subsection (1) of Section eleven of the Poor Law (Scotland) Act, 1934, in granting or affording outdoor relief;shall be the first ten shillings and sixpence instead of the first seven shillings and sixpence of such benefit;So, the answer is that both are covered in this case. There will be no need to revert to the old pre-1934 fight between London and the rest of the country, including Glasgow. In January next, when the Bill comes into operation, all Poor Law authorities will be circulated so that they may be made aware of these changes in the law. With regard to disregard and workmen's compensation, the question, of course, is not the same. The legal provisions regarding the disregard of workmen's compensation in determining Poor 534 Law relief are to be found in the Determinations of Needs Act, 1939. Under that Act one-half of workmen's compensation benefit can be disregarded, and there is, therefore, no need to amend those provisions in this Bill.
As I have said, the hon. member for Leigh put a number of technical points. The first refers to the question of schemes under Clause 1 (2). That refers to schemes which are submitted under Section 56 of the Insurance Act, whereby an approved society may submit a scheme of other benefits for sickness and disablement, providing that such schemes are equivalent in benefit. At the moment only one main society is affected, and that is the railway society. The Sub-section gives power to revoke such a scheme if, by reason of the benefits provided for in this Bill, the benefits provided for in the scheme are no longer equivalent to the value of benefits for which they are substituted. It therefore makes sure that no one who is insured under this scheme shall fail to benefit from any benefits which may accrue in the course of the working of this Measure.
The next question, which is also a technical one, relates to reserve values. It is provided that there should be an average rate of contribution for all insured persons, over the age of 16, no matter at what age they enter National Health Insurance. The contribution is fixed on the basis of normal entry at the age of 16. It is not sufficient to meet the whole liability in respect of persons who enter at a higher age. It is one of the difficulties in discussing these intricate matters, that you cannot get a simple balance-sheet atmosphere, because you are considering not only payments in and out, but potential payments and varied lengths of life. To meet any deficiency, an approved society is credited with a capital sum which varies with the age of the person, whenever that person, over 16, became liable to contribution. We have added about 450,000 to our insured population and, necessarily, when benefits are to be increased we have to make sure that the reserve values are correspondingly increased.
Perhaps the House will be interested to know that to secure the redemption of the present amount of outstanding reserve 535 value, £45,000,000 is the amount required and now we are seeking to add another £18,000,000. It will be seen that the Bill is not quite as puny as my hon. Friend the Member for West Fulham (Dr. Summerskill) described it. We have to provide, as a result, for this contingency, bringing the total amount to £63,000,000. My hon. Friend also put a most interesting question as to the qualifying period. The answer is that with regard to medical benefit there is no waiting period. In regard to sickness benefit, reduced benefit will be payable after 26 weeks and full benefit after 104 weeks in insurance, and in regard to disablement benefit after 104 weeks in insurance. [Interruption.] The hon. Member was asking about new entrants and I have given the precise answer.
If I may turn now to the general Debate, points were directed through us to those who, under the direction of the Minister without Portfolio, are considering the survey of the whole of the insurance and social arrangements. First, of course, it is not because the House has not given attention to National Health Insurance that there have not been bigger changes on the actual sickness and disablement benefit side. I doubt if there is a sphere of the national life, except unemployment insurance, about which there has been more legislation in the past 20 years than National Health Insurance, including—what must not be forgotten—pensions and widows' pensions. The hon. Member for West Fulham was wrong. She said that no woman got any benefit under the Bill unless she went out to work. As some 450,000 new entrants are brought into insurance under the non-manual workers provision, their wives become entitled to old age pensions and widows will get rights under the widows' pensions scheme. The Bill therefore does more for women than the hon. Member understood at first sight from an obviously hurried reading. She and others have said that it does not remove the inequalities which now exist as between men and women, but it does, for the first time, make the increase the same for women as for men, though the level from which they start is the old level.
The hon. Member for Llanelly (Mr. J. Griffiths) put nearly every major point on 536 the Bill, and other speeches have underlined those points, more or less strongly. Let me point out the questions to which the House has suggested that the attention of the Government and of the Committee now operating under the Minister without Portfolio, should be directed. First, the House has had regard to the real value of the benefits concerned. I must say to the hon. Member for Westhoughton, who asked about maternity benefits, that we are conditioned in the present scheme by the actual amount available in terms of the contributions levied. That is the answer to the general statement that we ought to have done a lot more now. We could not have done more now without seriously jeopardising the prospects of the review that is now being undertaken. At the moment employers and employed in all for insurance pay 3s. 6d. a week. Under this Bill they will pay 3s. 8d. a week. Women pay 2S. 11d. If the Bill becomes law they will pay 3s. 1d. It is a very formidable contribution from employers and employed, especially in some industries, and it is for a very wide range of insured persons. My right hon. Friend and I came to the conclusion, when we were striving to meet the real needs that we are meeting by this increase, that we must not make the contributions higher or we might jeopardise the whole future of that big review. Secondly, when we were devoting the money we wanted to put it where it would do the most good, and I think the House has shown by its attitude that it thinks we have chosen rightly in giving the biggest proportion in percentages to the disablement side.
The future of the disabled was described by the hon. Member for Llanelly and the hon. Member for Gorbals as a tragic case. It is, of course. The hardest of all hospital problems, nursing problems, doctors' problems and insurance problems is the case of the chronic sick. It is tragic and it is one of the outstanding cases which must naturally fall within the social services. Of the major points raised, first there is the question of whether dependants' benefits should be grafted on to National Health Insurance for the first time. The question of dependants' benefits was discussed by the Royal Commission in 1926 and it was estimated that it would cost £9,500,000 a year. The House will see that we could 537 not do it in this Bill, and they will understand what it means, potentially, in the range of any survey that is made on this subject. The second point was put by the hon. Member for Rochdale (Dr. Morgan) who said he did not call the National Health Insurance scheme a national scheme but an elementary scheme, and that there was bound to be inequality between people who paid the same rates and got different benefits. The survey that is now being made is not the first survey made on this issue, because the Royal Commission of 1926 had a very full discussion of the matter. It had suggestions to make, and the hon. Member for Westhoughton will know that they did not commend themselves to the approved societies.
A great deal has been said about the approved societies, but the House must not forget 30 years after the start of insurance that voluntary effort was first in the field of social insurance. It may be that at this stage in history the evidence may show that there must be another solution, I express no view about that; it would not be right in view of my right hon. Friend's new committee. The fact is that friendly societies and trade unions were the first in this field, and those who decided to have a national scheme—not in the sense mentioned by my hon. Friend the Member for Rochdale, but a national scheme in which the State took a definite part in contribution and administration— had this choice. They could either scrap the old system and the thousands of branches of the hundreds of societies which had for long periods, some for nearly a century, done voluntary work in helping their members in need; or they could graft the new system on to the old. The new system was grafted on the old and that was recognised by my hon. Friend the Member for Llanelly when he pointed out that troubles arose, not because this thing was made, but because, like Topsy, "it grew." It has grown.
Any committee dealing with this problem will have to take evidence from all those concerned. My hon. Friend the Member for Gorbals was quite right—he has given evidence to too many committees not to know it by experience— when he said that they will have to hear every point of view, because the great 538 majority of approved societies are democratic organisations. They have a democratic right to be heard, and they will be heard in the course of the committee's inquiries. My hon. Friend the Member for East Birkenhead (Mr. White) made three propositions. I will look at them in black and white because they seem—one of them, at any rate—to contain the germs of some of the things that the hon. Member has not been fond of in the realm of unemployment insurance. He spoke about some authority to make a continuous review, but I have heard speeches from him about unemployment insurance in which he did not show much favour for a continuous review committee or a committee not responsible to this House handling that problem. That is why I say that, while not pre-judging, I will look carefully at what he said on those three points. I must say a word of congratulation to the hon. Member for the Exchange Division of Manchester (Mr. Hewlett), who made a very charming maiden speech full of practical knowledge. He found at once that he was now in a Chamber where the hon. Member who followed him, while congratulating him, could say that he had not been persuaded by his persuasive and delightful speech.
The House, I think, is agreed to give this Bill a Second Reading. Some Members appreciate more in it than others, but all are glad that this temporary step has been taken. The real big issues must, of course, await the results of the Committee's work, and Parliament will apply its mind to the results of their inquiry. The hon. Member for Westhoughton put one or two Questions which I should be wrong not to answer. He asked why we had not made an addition to maternity benefit. When we decided what we should do with the money available from the extra 2d. we came to the conclusion that we ought to throw the weight on the side of disablement benefits. We were confirmed in that view because of the need of the disabled and because there has been a tremendous development of maternity and child welfare services apart from National Health Insurance. Since the last increase in maternity benefit from 30s. to 40s. in 1920, the expenditure on maternity and child welfare services has increased from £1,000,000 a year to £3,500,000. About 70 per cent. of children under one year 539 attend infant welfare clinics and 50 per cent. of the women attend ante-natal clinics. We also had regard to the feeling of the Royal Commission of 1926 that any development of this benefit should be in the direction of an increase of the services provided under proper conditions of control. My hon. Friend asked about the provision of the is. 6d. The whole sum is 2s. 6d., is. of which will remain in the benefit funds of the approved societies to fortify them against the various changes of administration. Various charges are included in the remaining is. 6d. The capitation fee has to be increased, there will be an increase of mileage payments to rural doctors, there will be the increased cost of drugs and increased cost of insurance administration because of the war.
My hon. Friend also asked me about contributions during holidays. This is linked with the Question which the House has discussed of holidays with pay, and in advance of whatever new discussions may take place on that subject—they were suspended owing to the outbreak of war—I, cannot say anything more at this stage. With regard to interest, perhaps I may save the time of the House by directing my hon. Friend's attention to paragraph 4 of the Actuary's report on the Bill where he will find a statement on the relation of the 3½ per cent. to the present basis.
This has been a very interesting Debate and has enabled Members to show what wide views they hold. I do not want my hon. Friend the Member for Rochdale to think that I have overlooked the fact that there is more than a cash side to this insurance scheme. There is a medical side, too, and I am sure that one of the things to which the Committee will have to apply its mind, will be the question of how the doctors, the public and the State can get the best, from the point of view of preventive medicine, out of the various provisions that have been made or may be made in future.
§ Question, "That the Bill be now read a Second time," put, and agreed to.
§ Bill read a Second time.
§ Bill committed to a Committee of the Whole House, for the next Sitting Day.— [Mr. Munro.]