NATIONAL HEALTH SERVICE (SCOTLAND)

HC Deb 09 February 1948 vol 447 cc161-75

10.23 p.m.

The Joint Under-Secretary of State for Scotland (Mr. J. J. Robertson)

I beg to Move: That the Draft National Health Service (Scotland) (Superannuation) Regulations, 1948, proposed to be made by the Secretary of State for Scotland under subsection (1) of Section 66 of the National Health Service (Scotland) Act, 1947, a copy of which Regulations was presented on 10th January, be approved. The purpose of these regulations, necessarily complicated as they are, is to set up a comprehensive superannuation scheme for all persons employed in the National Health Service in Scotland. They correspond to, and, except on a very few minor points, make the same provision as the superannuation regulations which have already been approved by Parliament for the English Health Service. I am sure, therefore, that at this late hour the House will not wish me to deal with them in minute detail. Like the English regulations, these draft Scottish regulations provide for all the employees and practitioners in the new service superannuation benefits on a contributory basis, consisting of retiring and incapacity pensions, short service gratuities, death gratuities and injury allowances, and also include a provision for widows' pensions. They contain special provisions to ensure that the existing superannuation rights of the 60,000 persons who will become subject to the regulations on the appointed day will be fully preserved, and that everybody being transferred into the new Service will be at least as well off as he or she was before the transfer.

Those hospital officers who have at present no pension rights at all will be able to count, for qualification purposes in the new scheme, all their previous hospital services. This is a substantial benefit to those officers, because it will mean that such an officer may immediately become eligible for the benefits of the scheme, some of which have minimum amounts such as the incapacity pension, which is normally one quarter of the officer's remuneration, or the death gratuity, which is a minimum of one year's service salary. A unique feature of these regulations is the extent to which they preserve the pensions rights of persons who, after the appointed day, move from the Health Service into other types of public service, or from other types of public service into the Health Service. These arrangements for interchangeability will provide a greater measure of mobility for the Health Service staffs than has ever before been practicable in any public service superannuation scheme in Scotland. They will, at the same time, serve the best interests of the new service in helping to secure wider experience amongst the staffs.

As I have said, all these provisions have already been approved by the House in the regulations for the English Health Service. The Scottish regulations have been discussed in draft with some 40 representative bodies. While on one or two points we have not been able to go as far as we have been asked, nevertheless we have had a fairly high degree of support for the proposals now made. I should like to say, in conclusion, that this is a most comprehensive, most fair, and, indeed, the best superannuation service that any Government has introduced for Scottish interests. It will be administered by the Secretary of State, and it is our hope and intention that it should provide a sound background to the National Health Service in Scotland and a substantial feeling of security on the part of all those who will serve in that great service.

10.30 p.m.

Mr. Charles Williams (Torquay)

I should like to ask the Joint Under-Secretary of State one question before he resumes his seat. He will have noticed on page 77 the rates as they apply to males. For instance, in the under 30 group the sums are £11 3s. and £5 11s. For the females under 30, the amounts are £9 14s. and £4. Will the hon. Gentleman tell me precisely why there is this difference between the males and females, and how the figures were worked out? It does not quite seem to be in accordance with some of the views put forward by, for instance, the Parliamentary Secretary to the Ministry of Food. Is there a disagreement in the Government about that matter?

10.31 p.m.

Mr. J. S. C. Reid (Glasgow, Hillhead)

As the hon. Gentleman the Joint-Under Secretary of State has said, these regulations follow pretty closely the English regulations. There was a debate on the English regulations in which a large number of points were raised, and I do not think that the House would appreciate my raising these points again now. I have no doubt they have been studied by the Department, and I trust they will continue to be studied in so far as they have not received effect. There are, however, one or two points which were either not mentioned or not, I think, fully discussed in the English debate, and I would like shortly to deal with them.

In the first place, the Joint Under-Secretary of State has rightly said that there is a large measure here of interchangeability. This point was raised in the English debate and I would like to hear from the right hon. Gentleman in his reply just how far we have got. I am thinking, in particular, of four classes of medical men—the general practitioner, the teacher in the University, the full-time Government servant and the full-time municipal servant. Is there full interchangeability so far as pensions are concerned between all these four classes? I am not sure that there is. If there is not, can that be achieved administratively within a reasonably short time? It may be that there are difficulties for the moment, but I should like an assurance from the right hon. Gentleman, if there is not already full interchangeability, that this will be brought in as soon as may be.

I welcome the statement of the Joint Under-Secretary of State, if I understood it aright, that all officers in voluntary hospitals and the like who have had a reasonable expectation of a pension at the end of their service, although they had no legal right to get one, will have the full period of their service before being transferred to the new scheme calculated for the purpose of pension. I understood him to say that, and if he said it, then I think the position is satisfactory. I understand that with regard to those who already have retired, ex gratia payments will be made, continuing the pension which they enjoy as a matter of grace from the existing hospital authorities and accordingly, if that is so, the position of all those who were in some doubt is adequately safeguarded.

I would like to say a little about the general provisions for pensions for the general practitioner. Of course, this is a novel scheme. It is not, as are most pensions, calculated on the earnings over the last few years of a man's career. If the value of the pound remains steady, I can see that the scheme in the regulations is a fair one, but I hope the Government will realise, as I am sure those chiefly concerned realise, that here is another instance where the whole plans, good plans though they may be, will be brought to nought unless we can keep a steady level of prices over a man's whole professional career. If a man had come in on this type of pension 40 years ago, he would not have been very well off today. No doubt that is the fault of circumstances over which none of us has any control; but it is well to bear in mind that a scheme of this sort is subject to unforeseen changes of that kind. The same applies to payments on goodwill.

I would like to have an answer to one practical question which has been put to me. I do not know what the answer is, or whether it was given in the English debate. I refer to incapacity. No one, of course, gets any benefits at all for five years after coming into the scheme. Certainly after ten years and I think after five, a doctor who becomes totally incapacitated gets these benefits. Who determines whether the man is finally and totally incapacitated? Supposing, contrary to everybody's expectations, he feels well enough to try again, what happens? Has he got to give up all rights he has acquired, or will he be allowed to try again to see if he is fit enough; and if he breaks down, can he revert to his allowance? There is a practical point there. It may be that the right hon. Gentleman has not got the answer. I hope that the draft is wide enough to cover it, but obviously there ought to be some definition of who settles, and how he settles, whether there is total incapacity; and there ought also to be provision to cover the situation in which a man thinks he is partly recovered and then finds that he has been too optimistic.

But the main point I wish to raise, and the last one, is the position of the doctor who is, let us say for the purposes of illustration, 56 years of age. I understand that a doctor has to work ten years under the scheme in order to get a pension, and the difference between retiring at the end of nine years and ten years is extremely large. If you retire at the end of nine years, you merely get your contributions back. If you retire at the end of ten years you get your pension. I understand that you can take a pension at 60, and you must take it at 65, though you are allowed to go on working after 65 and you can draw your pension as well.

Surely a man ought to be allowed to go on working after 65 in order to complete his qualifying period of ten years, as a man who has done ten years before he is 65 ought to be allowed to go on working and get his pension as well as earnings. I can see no reason why a man who started at 56 and goes on working should never be allowed to get a pension at all, even if he goes on to be seventy. Unless I am wrongly informed the scheme is so drawn. Though you carry on working after the age of 65, you can never qualify for pension. That seems to be a loophole which is quite unjustifiable, and would ask the right hon. Gentleman to look into the matter if he has not already done so, and see if he cannot make it clear that a doctor who finishes ten years' service, no matter at what age he finishes, will be entitled to a pension based on those ten years' service. I do not think this is covered. If it is, I am very glad to hear it; but I do not think that it is covered by the regulations as they stand. I think it ought to be covered, and I think it is a distinct flaw in the scheme if it is not.

Other points have been suggested to me, but they have either been covered already in the English Debate, or else do not appear to me to be of sufficient importance for me to detain the House at this time of night. Therefore, I would say that I think these regulations have been reasonably drafted on the whole. There are, of course, rough places which will have to be worked out in practice, and I hope the right hon. Gentleman will not feel himself precluded by the Treasury from putting things right if any unforeseen illogicalities or technicalities result.

10.41 p.m.

Dr. Morgan (Rochdale)

I do not want to detain the House long, but there are three points that I would put to the Minister. I wish to ask the right hon. Gentleman, first, about any prospective changes in the definition or interpretation of the words "mental health officer." The Secretary of State for Scotland knows that in England a new interpretation has been put on the term "mental health officer," by which many of these officers are precluded now from getting the full advantages of the Superannua- tion Regulations in England. I want to make sure that the right hon. Gentleman will not give a different interpretation to the term which will affect the superannuation of any of the men who would have been included had the term not been restricted in any way in its new interpretation. The second point is that, if possible, we should have an assurance from the right hon. Gentleman that employees in mental institutions will still have the right of opting to retire, as they are allowed to do by previous legislation, and will not be compelled to accept new terms under the new Superannuation Regulations.

The third point is with regard to the mental employees in the Royal Institutions in Scotland. After a long correspondence, the Secretary of State for Scotland and his predecessor have been kind enough to grant us all we want from the point of view of the option of those men to remain in their old schemes if they can prove that their conditions would deteriorate by their being compelled to go into the new scheme. I ask for an assurance from the right hon. Gentleman with regard not only to the one at Dumfries, which he has given me, but with regard to certain of the other institutions. In his answer to me, the right hon. Gentleman said that, provided the institutions could prove that they have had an established, permanent, definite, voluntary superannuation scheme by which these men were getting a certain payment definitely upon retirement after a certain number of years' service, then he would allow them to opt to remain in such a scheme. At the time of the correspondence, the right hon. Gentleman was not sure whether all the other Royal Institutions in Scotland had such schemes. He was not sure, for example, whether the Royal Institutions in Perthshire or Stirling had such schemes. I do not think he was sure about the Morningside Institution, at Edinburgh, or the Royal Institution in Glasgow.

I hope the House will understand that all I want to do is to make sure that while those at the Royal Crichton are acknowledged to have an excellent scheme, employees at other mental institutions, who have had voluntary superannuation schemes giving them very good pensions upon retirement, will have the option of proving that by going into the new scheme, their superannuation rights in the old schemes may be jeopardised. I am quite sure the Secretary of State for Scotland, having granted this in the case of Dumfries and the Royal Crichton, will look into this matter as regards the other institutions. All that the employees in these institutions have asked me to do is to see that the position in Scotland in this matter is not jeopardised as it was in regard to the English regulations, which were allowed to slip through without any provision being made for the employees to exercise an option.

10.45 p.m.

Sir William Darling (Edinburgh, South)

This is a very lengthy and complicated book of regulations. While it has been discussed under English law, there are certain matters which we have had no opportunity to raise and which I would like to raise, and I hope the Secretary of State will help me regarding two items. Under Part II—"Medical and Dental Practitioners: Application of regulations with modifications," many doctors have found in the past that life insurance is the only way in which they could make adequate provision for their future. The Clause does offer preferential rates with many insurance companies which, in the main, are satisfactory policy holders. The paragraph to which I refer deals with these circumstances. It says: (m) where any person holding a contract or policy of insurance with any of the Life Assurance Companies becomes a practitioner on the appointed day, then, if he so requests the Executive Council in writing within three months after the appointed day, the Secretary of State may agree that the practitioner shall not, so long as he continues to be a practitioner, become subject to any provisions of these regulations except this provision, and in that event the Secretary of State shall, subject to such terms and conditions as the Secretary of State may determine, pay to him as a contribution towards the maintenance of the contract or policy an amount equal to eight per cent. of his remuneration as a practitioner as defined in paragraph (2) of this regulation. We have heard in the Debate that the basic salary of a doctor will be £300 a year—probably more—but that certainly will be the basis. If I understand this paragraph correctly, eight per cent. of this remuneration of a practitioner will be £24. If the doctor has taken out, as many doctors do, a very substantial insurance policy, £24 a year will not be very much towards its maintenance. It may be that the young man, contributing heavily for an insurance policy, may find himself faced with the maintenance of this valuable asset, which if taken out within the last 3 years has no value at all as a surrender value. Doctors are often prudent and careful men, and they recognise that a life insurance policy is perhaps the best way, in their circumstances, of saving money. It is the only way in which they can make adequate preparation for their retirement or for their families in the event of their untimely death. This paragraph does not seem to me to be very helpful to a doctor, and it may be many of them have taken, at the low premium which would obtain in the earlier years of their lives, a very substantial insurance policy. I am of the opinion that the Secretary of State should be prepared to reconsider this and to use his power to help doctors who may be placed in these circumstances.

The scheme will be subject to actuarial investigation periodically. Most insurance companies believe in actuarial valuations at least once a year, some quinquennially, but not "periodically," and I suggest that in the interests of those who subscribe to the superannuation scheme it would be more comforting for them to know that an investigation took place more frequently and more exactly than merely "periodically." I would like to see a greater degree of precision, and I am sure that what I am suggesting is in accordance with the practice of the best insurance companies and actuarial practice. On these two points alone, I should like to have some reply. I have no doubt there are many other hon. Members who would like to put points forward. I have not been able to discover what is being done for opticians under this regulation. I have heard from opticians who say that they do not know where they are. I have not read the Schedule with the same care, but neither in the index nor the pages have I found any reference to them, but I understand that opticians will no doubt come within the scope of this pension.

10.50 p.m.

Colonel Gomme-Duncan (Perth and Kinross, Perth)

I want to associate myself with the hon. Member for Rochdale (Dr. Morgan) so far as I could understand him, and I am sure he will forgive me for saying that, because he did say he hoped the House had understod what he had said. I ask for some assurance about superannuation with reference to the various Royal Institutions in Scotland, apart from the ones he specifically mentioned. I wanted to ask the Secretary of State this question before, but he would not let me; it is a simple, straightforward question, and it is concerned with Regulation 6.—Contributions. There it says: For the purpose of defraying the cost of the superannuation benefits provided by these regulations, …. certain amounts will be paid by the officer for this purpose, and under sub-paragraph (a) it is stated that, an amount to be paid by the officer equal to six per cent. of the amount of his remuneration for the time being; and a little farther down, it says, … in the case of an officer whose employment is by way of manual labour, five per cent. shall be substituted for six per cent.… I would like to have a little explanation of why a manual worker should be saved one per cent. There may very well be a good reason why this provision has been made, but I must say that it is by no means apparent to me, nor, I suggest, to any other hon. Member. It is not certain that any person employed in manual labour is less well paid than any other.

10.52 p.m.

Mr. McKie (Galloway)

I should like to refer to the point made by my right hon. and learned Friend the Member for Hillhead (Mr. J. S. C. Reid), namely, the arbitrary procedure so far as what I may term the sixty-five years of age limit in this regulation is concerned. This has been referred to specifically by my right hon. and learned Friend. He has put to the House the serious position and inconvenience and hardship that will be caused to many men of fifty-six years and upwards as a result of this scheme, and I hope that we shall hear something from the Secretary of State by way of clarification and assurance on this point. I would like to say that, in rural constituencies, such as mine, there may well be—I sincerely hope that there will not be, but there may—cases of hardship and inconvenience. If the Secretary of State is not in a position tonight to clear up this matter, I hope he may be able to do so in the future.

I can think of many cases in my own division of men of fifty-six years of age and upwards who for many years have gallantly and nobly carried on their duties and who now are in a deep state of anxiety about things in general, and we want them to know quite clearly that they need have no particular fears about this superannuation scheme. I think that it bodes nothing but good for the medical profession in general. I am thinking, in passing, about the case in my own constituency which concerns probably the oldest medical practitioner in Scotland; he is eighty-five or eighty-six years of age, and has been in practice for more than sixty years. We do not want anybody like that to be prejudiced nor those two or three decades younger, because there is an arbitrary limit of sixty-five years.

The hon. Member for Rochdale (Dr. Morgan) instanced the very good superannuation scheme of the Crichton Royal Institution, which is in the division just adjacent to my own, and which is represented by my hon. Friend the Member for Dumfries (Mr. N. Macpherson). I have known it for many years—not as an inmate—and I have known a good many people who worked there. They are not to be prejudiced in any way by the passing of this Bill. The same benefits which the Crichton Royal Institution has had for so many years will no doubt be held out to them, too.

Those, then, are the two points which I hope the right hon. Gentleman will do his best to clarify. I hope that in the very near future he may be able to remove any doubts and allay any fears in our minds. I feel that the medical profession in Scotland may take some little consolation tonight from the passage of this Motion immediately after the ruthless turning down of their pleas in our Amendment to the Motion moved by the Minister of Health this afternoon.

10.56 p.m.

The Secretary of State for Scotland (Mr. Woodburn)

I am very pleased to have the assurance that some doctors are coming into the scheme. After the previous Debate, I had begun to doubt whether any scheme at all would be needed and therefore it is a great comfort to me that some hon. Gentlemen opposite are convinced there will be a scheme.

Interchangeability is assured and part of that is effected by the Bill presented last week. I am not quite sure whether a person who interchanges and who is not entitled to superannuation, nor has qualified for superannuation, would count his previous service in this connection. He certainly will be superannuated immediately. He may come out differently from an officer who has to wait 10 years, but I would not be quite certain of that point. That is my impression. So far as pensions for the general practitioner are concerned, the right hon. and learned Gentleman stated this quite correctly. Normally 55 would be the oldest age for qualifying for a pension at 65, but there is provision that in special cases where circumstances are suitable, practitioners may carry on beyond 65, and so complete the 10 years. In that case they would be entitled to a pension in the normal way. If that were not the case, and a practitioner came in at 57 and had only eight years to complete, he would, of course, get his contributions returned with compound interest, and he would get the value of his practice in the normal way. Let us keep in mind that if the Act did not come in, he would still finish about 65, with nothing but the capital value of the practice, and that is being given now in addition.

What is being given now is in no other superannuation scheme. If he dies his widow gets one-third of his pension, and he has the right—given to very few people—of diverting part of his pension to dependents. I should say that there are very few superannuation schemes that can compare with the benefits offered in this scheme. I am not sure I can give all the details the right hon. and learned Gentleman asked for, but I do promise to look into the points he has raised, and if there is any point not covered in what I have said, I will certainly let him know about it.

The hon. Member for Rochdale (Dr. Morgan) raised the question of the Royal Crichton Institution and the others. That has been covered and I think the assurance given to the Royal Crichton can be extended to others similarly placed. If there is any doubt about that, I will let the hon. Gentleman know, but that is my advice at the moment. As far as I know what we have done has been accepted by the Confederation of Health Service Employees, and they are quite satisfied. With regard to the point of the hon. Member for South Edinburgh (Sir W. Darling), the question of the remuneration of a doctor takes two forms. The £300 is the basic salary, which was objected to in the previous Debate today as being one of the things which the doctors do not want. The total remuneration is basic salary plus a capitation fee.

Sir W. Darling

What is the minimum likely to be?

Mr. Woodburn

£3,000, which will be subject to deduction for practice expenses. The doctor only pays six per cent. of his remuneration. It will be six per cent. of his net remuneration, and of course the eight per cent. will be paid on the same sum. It is true that a young doctor who only had £300 would be paid on the same basis. He would get his contribution to his insurance premium on the same basis, but the hon. Gentleman is taking a most unusual case of a young doctor taking out a policy to mature at 65. His premium will be much less than an older doctor taking out a similar policy, and I would like to see a real case presented rather than a hypothetical one. I think that the general principles laid down are quite just and fair even to young doctors.

Sir W. Darling

Will the right hon. Gentleman deal with a real case if I give it to him?

Mr. Woodburn

Certainly, we will look into any case. The hon. and gallant Member for Perth (Colonel Gomme-Duncan) is concerned about the manual worker. It is a principle that when one gets a manual worker on a steady wage in these institutions, naturally the proportion taken is always less than is taken from people with higher progressive salaries. One might argue that things are changing very rapidly, and sometimes manual workers are getting more; but here we are working on an actuarial contribution basis.

Colonel Gomme-Duncan

Supposing there are definite cases? Supposing, to take an example, there is a junior on the clerical side who is getting less than the man in charge of boilers, who is sometimes comparatively highly paid? Would they be adjusted accordingly?

Mr. Woodburn

The difference there is that the boilerman, the manual worker, would never change his wage, while the junior clerk's salary would progress. Therefore, the liability from the point of view of the community is going to be far different, and from the actuarial basis one has to take this into account.

Mr. C. Williams

The right hon. Gentleman says that the manual worker will never change. Does that mean a new Government policy, and that no manual worker's wage will ever change?

Mr. Woodburn

There are certain occupations where a man starts as an apprentice and rises to a journeyman. There is usually a wage for the job, and the man remains in the same grade whatever his wage. A boilerman is always a boiler-man, whatever his wage, while a junior clerk may become manager of the institution. If a man remains a boilerman all his life, the calculation must be made on a different actuarial basis than for a junior clerk who may rise to a manager's salary. Therefore, clearly the actuarial calculation is arranged on a different basis.

Mr. Williams

Surely, that only applies providing the wage does not go up. Supposing the wage doubles or trebles, the whole argument falls.

Mr. Woodburn

judging from what has happened in the past, if the wage of a manual worker doubles or trebles his contribution doubles or trebles, and his pension goes up, too, and the whole thing works out actuarially. The hon. Gentleman had better argue this with the actuaries. I did not frame the scheme, and we have to accept our learned assistants' advice in these matters. I think that covers all the points on which I am able to give detailed information. If there are points which I have not touched upon, I shall be very glad to take some other opportunity of clearing them up with hon. Members.

Mr. Williams

I did ask the hon. Gentleman who moved this Motion a question about the table at the end, and I was hoping to have an answer. It is a point on which I happen to want an answer. I am sure by now there must be a full answer available. On page 77 you have a male getting a higher rate than a female at the beginning, and then in a mysterious way, about the age of 36, the female goes ahead of the male. What is worrying me is why this happens at all, why they do not have a uniform rate, and how it is that the age of 36 is chosen for the change.

Mr. J. J. Robertson

I hope the hon. Gentleman does not think I intended any discourtesy to him. The answer is that this is based on an actuarial calculation of the different expectation of life.

Mr. Williams

rose—

Mr. Deputy-Speaker (Major Milner)

The hon. Gentleman is not entitled to make half-a-dozen Speeches.

Mr. Williams

Of course, Mr. Deputy-Speaker, if you rule that my question to the Minister is a speech, I naturally give way, although on both occasions I tried to get it in before he sat down. I do think that when I ask questions of this sort I am entitled to something more than to be merely told this is just an actuarial matter. There is a very great change in the middle of this table.

Mr. Woodburn

I think the best answer is that given to the question which someone once put, "Do men live longer than women?", and somebody said, "It only seems longer."

Sir W. Darling

On a point of Order, I did put questions to the right hon. Gentleman which he has not answered.

Mr. Deputy-Speaker

It is not within the province of the Chair to compel a Minister to answer every question. I understood the right hon. Gentleman to say that those questions he had not answered, he would look into and, if necessary, communicate with the hon. Members concerned.

Dr. Morgan

May I remind the right hon. Gentleman of two questions I asked him? One was about the possible variation in the interpretation of the term "mental health officer;" and the other was about the employees under the scheme, and retirement at the age prescribed in the previous legislation rather than at the age now arranged. Even if I cannot have an answer now, if my right hon. Friend will look into the matter and give me a reply another time, I shall be much obliged.

Resolved: That the Draft National Health Service (Scotland) (Superannuation) Regulations, 1948, proposed to be made by the Secretary of State for Scotland under subsection (1) of Section 66 of the National Health Service (Scotland) Act, 1947, a copy of which-Regulations was presented on 20th January, be approved.