NATIONAL HEALTH INSURANCE BILL. (Hansard, 17 May 1920)

§ THE PARLIAMENTARY SECRETARY OF THE MINISTRY OF HEALTH (VISCOUNT ASTOR)
My Lords, I must apologise 340 for asking that this Bill should be passed before the Whitsuntide recess. I have been expecting it to come up from the House of Commons for several weeks now. Its arrival has not been delayed owing to its being a highly controversial or contentious Bill, but owing to the congestion in the other House where they have been obliged to deal with the Home Rule Bill and with the Budget. This Bill passed through the Committee stage in one day in the House of Commons. That will show your Lordships that its slowness in coming here was not due to any serious opposition. As my noble friend Lord Crawford said just now, it is vital that the Bill should pass before the end of this week. The Department have to send out something like 20,000,000 cards to be filled in, registered, given numbers, distributed amongst approved societies, and sent all over the country early in June. Those cards ought to be despatched by the end of this week. The next payment is due early in July, and it is as much as the approved societies will be able to do to get the cards properly filled in and distributed among their members during the next few weeks. In addition to that, we have to get something like 200,000,000 stamps ready and distributed.
The Bill does, roughly, four things. First of all, it increases the benefits paid under the National Health Insurance Act to meet the altered value of money; secondly, it states the amount to be paid to the doctors out of the funds of approved societies; thirdly, it in part provides for new machinery for dealing with tuberculosis; and, lastly, there are certain comparatively minor changes to rectify measures which have been found necessary through our experience of administration, and to bring the benefits and the procedure under this Bill more into line with the Unemployment Insurance Bill which will be coming up later from the other House. We propose to increase the sickness benefit for men by 5s. and for women by 4s. 6d., making the total sickness benefits payable to men at 15s., and to women at 12s.; disablement benefit will be increased by 2s. Gd. for both men and women, and maternity benefit will be increased by 10s. These sums were originally settled in order that there should be proper relation between the benefits paid under health insurance and the benefits proposed under unemployment insurance. The funds will be provided by increasing the employer's contribution by 2d. and the contribution of 341 the insured person by 1d. There will be an additional Treasury grant, to the Women's Equalisation Fund of £70,000, and the additional money payable out of the Exchequer amounts to £1,772,000, making the total Exchequer grant up to £6,942,000.
Then for the first time we put into a Health Insurance Act the amount payable to doctors out of the funds of approved societies; this amount is to be 9s. 6d. Hitherto the actual sum payable by approved societies out of their funds has not been stated in the Act of Parliament. We then propose to take out of insurance sanatorium benefit. We propose in future that treatment for tuberculosis should be provided by the larger public health authorities. At present the position is very anomalous. Insured persons have to pay for their treatment if they get tuberculosis, while non-insured persons, who very often are better off financially than the insured persons, are in a position, where the local authority provides adequate schemes for treatment for its citizens, to get free treatment for tubercle—that is to say, at present insured persons have to pay for their treatment, whereas non-insured persons are in a position to get free treatment. If it had not been for the war I am perfectly certain that this would have had to be remedied several years ago. This particular proposal, I should tell your Lordships, will not affect Ireland. It only affects this country. We do not propose to touch Ireland because of the near advent of the Home Rule Bill.
My right hon. friend the Minister of Health will shortly be introducing a Bill dealing with tubercle. All we are doing at present is to take the sanatorium benefit out of the Insurance Act. This means that about £500,000, which hitherto was earmarked for sanatorium benefit, will be available for the general pool for meeting the other benefits. Domiciliary treatment for tubercle will be provided by the doctors as part of medical benefit. It might interest your Lordships to know that there are at the moment seventeen thousand beds in institutions in England and Wales. We are negotiating for about eight thousand additional beds. I hope, therefore, that in the near future we shall have a more Comprehensive and adequate provision for institutional treatment for tubercle throughout the country.
The only other changes of importance affect, first of all, the men in His Majesty's 342 Forces. Up to now 1½d. a week has been deducted from their pay, so that when they are discharged from the Forces they might go straight into the approved societies and draw the benefits. We propose in future that there should be no deduction from their pay. Next, we have a clause safeguarding disabled discharged men undergoing treatment who occasionally find themselves prejudiced when their training is through and they want to join an approved society and get its benefits. We have a clause remedying this, so that they will not be prejudiced in future. There are other minor amendments, but, unless your Lordships ask me to do so, I do not propose to go further into the contents of this Bill. Should your Lordships desire it I can, of course, go into the whole Bill in greater detail. It is a perfectly straightforward measure. As I said at the outset, it got through Committee stage in the other House in one day, and it would have been with your Lordships long before this had it not been for the congestion there owing to the time which had to be given to the Home Rule Bill and the Budget. I trust that your Lordships will assist us in getting this Bill passed this week.

§ LORD STRACHIE
My Lords, I should like to ask the noble Viscount a question. He told us of the circumstances—as to which I cannot agree with him—which had prevented the Government from bringing this Bill before us except at short notice and in such extraordinary conditions that when the Second Reading is moved we have not the Bill before us. I have to ask him, therefore, whether the Bill makes any changes as regards the treatment of the friendly societies or approved societies, or is their position exactly the same as under the original Bill.

§ VISCOUNT ASTOR
I think the Bill has been circulated to your Lordships in the form in which it passed the House of Commons. It was explained on Thursday that this would be done, and I understand the Bill was circulated on Saturday morning. The position of friendly societies is not materially amended. They get slightly increased grants for administration, but the general scheme of insurance remains as it was.

§ LORD STRACHIE
They are not prejudiced in any way?

§ VISCOUNT ASTOR
No.

§ LORD ASKWITH
I should like to ask a question on a matter which I do not understand. I have read the Bill, and it seems to me most admirable. But I do not quite understand why the sanatorium benefit is being taken out of the Bill. What becomes of the support for sanatoria?

§ VISCOUNT ASTOR
The treatment for consumptive and other tuberculous persons will in future be provided by the public health authorities. It will be paid for partly out of the rates and partly out of Exchequer grants. As the noble Lord probably knows, at the present moment insured persons have a certain amount deducted every week for treatment, in case they get consumption. We do away with that. Our intention is that the population at large should be provided for and that treatment should be available for all, irrespective of whether they are insured or not. That treatment will be paid for partly out of the rates and partly out of Treasury grants.