NATIONAL HEALTH INSURANCE BILL. (Hansard, 18 May 1920)

§ THE MARQUESS OF SALISBURY
Since my noble friend addressed your Lordships yesterday I have made myself acquainted, very superficially, with the tenor of tins Bill. It is a Bill of very considerable importance, and it was only in the hands of most of your Lordships for the first time yesterday, because I presume you were not in London on Sunday. It is a Bill of 21 clauses, most of them clauses of legislation by reference. I dwell upon that very specially, because it is of great importance from your Lordships' point of view. This House is above all things a House for revision of legislation. It has to see that all legislation is properly framed and properly enacted, and there is no such difficult legislation as legislation by reference. It requires special scrutiny to see that none of the references conceal legislation which your Lordships would wish to criticise.
385 Besides the legislation by reference, there are one or two proposals of an obviously very important character. There is, first of all, the question of the tubercular provision to which my noble friend opposite referred in his Second Reading speech yesterday, but he did not explain what the policy of the Government was in reference to the treatment of tubercular disease. The effect of the provisions of the Bill is to strike out the old sanatorium provisions from the principal Act—so at least I understand—and my noble friend said the Government intended to legislate in another manner on this subject. It would have been probably convenient if he had been able to tell us what the policy of the Government was upon this very important subject. If the Government come to Parliament and say, "We propose that you should abolish all your present provision for tubercular treatment, we have a better idea," then it would seem to me to be suitable that they should tell us what that better idea is before we consent to dispense with what we have got. We would rather know exactly where we stand. That appears to be a very important matter which was omitted.
Moreover, there are some important provisions in Clauses 10 and 11 of the Bill. I am not going to dwell upon them at any length. I only want to refer to them with a view of suggesting to your Lordships a course which I think ought to be pursued. The appeal to the County Court on questions of fact as to whether a man is employed or not are profoundly modified; in fact, the County Court jurisdiction is entirely cut out of the principal Act. My noble friend opposite did not mention that yesterday, but said there were other proposals in the Bill which he would not go into. Surely these are rather important provisions. To cut out the jurisdiction of the County Court altogether is an important matter, although, as far as I can make out, the protection of the High Court remains. Nevertheless there is a general exaltation which is typical of all the legislation which is now presented to us of the bureaucratic authority of the Minister as against the impartial jurisdiction of a Court of Justice. That is the kind of procedure and the kind of policy to which we have become in a melancholy way familiar in recent years. This appears to me of great importance.
Now the Bill comes before your Lordships at this period of the session. What 386 protection have the people of this country that legislation is going to be properly done? It is not only that your Lordships' House is treated with this disrespect. Just see how this Bill was treated in the House of Commons. I specially desire your Lordships' attention to this. The Second Reading was taken the same night as the Army Estimates, beginning at about midnight and getting through at about 3 a.m. Then the Bill was sent upstairs and was passed through the Standing Committee in one day. You would have thought that upon a Health Insurance Bill you would have had all the great medical authorities of the House put upon the Standing Committee. Not at all. There was only one medical member on the Standing Committee. It was all hurried through in one day—all this legislation by reference. Any of your Lordships can see the tremendous modifications it makes in the principal Act—all sorts of additions to the pecuniary burden thrown upon the country, and thrown upon the employer. All these things are hurried through in one day upstairs. Then there was the Report stage and the Third Reading. That came on in the all-night sitting, between midnight and 6 a.m. in a very small House. That is the legislation which has come up to your Lordships' House.
An appeal is then made to us to get the Bill through, without consideration at all, before the Whitsuntide holidays. Is it possible to treat Parliament with greater contempt? The real truth is that the departmental Ministers do not really care a bit how Parliament is treated—neither the House of Commons nor the House of Lords. Get the Bill, get a little more power to the Minister—that is what they want, and let Parliament go and look after itself. I do really think that this is a scandalous state of things and I earnestly hope that your Lordships will not submit to it. I do not mean to say that I shall persist in the course which I am going to suggest to your Lordships, because the Government may be able to persuade us that that would not be wise. But, in order to bring the point to a head, I beg to move that the debate be now adjourned.

§ VISCOUNT ASTOR
My Lords, I sincerely trust that the noble Marquess will not persist in his Motion. As I explained 387 yesterday, it is very urgent that this Bill should get through during this week. We have to send out by the end of this week something like 20,000,000 cards to be filled in, registered, given numbers to, and distributed among approved societies. Unless those cards are sent out before the Whitsuntide Recess it is quite impossible for the approved societies to be ready by July 5, when the contribution for the next half year begins. In addition to that, if we do not get this Bill through all its stages before Whitsuntide a serious additional burden will be put upon the Treasury.
Those are two practical reasons why I trust your Lordships will enable this Bill to get through. As I explained yesterday, I have been expecting its arrival for some weeks. My right hon. friend the Minister of Health has been trying, as far as he was able, to get it passed through the House of Commons. The noble Marquess said it was passed through some of its stages at a late hour of the night or the early hours of the morning. That is a good illustration of the sort of pressure under which, I understand, the House of Commons has been working during the last few days. We were not able to get time during the afternoon or the early hours of the evening. We expected on two occasions that we should be able to take the Bill, but unfortunately urgent and important discussions in connection with finance, the Budget, and Home Rule made it impossible for the Leader of the House to give the Minister of Health the time which he wanted. He had nothing to conceal, nor did he in any way want to burke discussion on the Bill. I entirely agree with the noble Marquess that this is an exceedingly unpleasant Bill to have to study. It is legislation by reference in every Clause. Having had to try and study it and master it, I entirely agree with him that it is a very unsatisfactory Bill as far as the draughtsmanship goes in that respect.
There were two points raised by the noble Marquess, one about Clause 10, dealing with the determination of questions as to unemployment, and the other about the clause Which takes out the appeal to the County Court and merely gives an appeal to the High Court. The latter clause was put in in order to simplify the procedure. It was felt that, so long as the right of appeal existed to the High Court, it would simplify matters not to have the intervening stage. 388 No exception was taken to that, and I understand that that would be a matter of considerable simplification in getting uniform decisions, and also in expediting such appeals as may have to be made. As regards the other clause, Clause 10 is framed, as one or two other clauses in the Bill have been framed, to bring it into conformity with the other Bill dealing with unemployment insurance which is coming up, and deals with the determination as to whether a particular individual is an employed person (and so an insured person) or not.
I am very glad that the noble Marquess raised the larger question of the policy of the Government as regards tubercle. I have been interested in the administration of this disease for many years now, and I tried yesterday very briefly to explain why it is that we are taking sanatorium benefit out of the Insurance Act. At the present moment the position is quite anomalous. Insured persons have to pay for treatment, non-insured persons who are very often better off financially get free treatment. Treatment is provided through the local authorities, either by agreement with insurance committees who hand over their funds in order to make an agreement for the treatment of the insured persons for whom they are responsible, or else local authorities may themselves provide treatment for noninsured persons, getting a Treasury Grant to the extent of 50 per cent. of maintenance for the provision of treatment. If this is passed all that happens is that the local authorities will provide for the population at large.
We propose in another Bill that there shall be provisions enabling the local authorities to provide what are popularly known as village centres, where men may have training where they may be continuously employed. We find unfortunately that a certain number of men are treated for tubercle and are apparently cured; then, because they return to the conditions under which they lived before they contracted the disease, they relapse. All those who have been interested in the treatment of tuberculosis will probably have followed the very satisfactory results obtained at Papworth. We want to make it possible for the larger local authorities to provide village centres as part of the organisation for the treatment of consumption; so that all that will happen 389 until the other Bill is passed is that the population at large will be provided for by the public health authorities. There will be a Treasury grant to relieve the rate-payers of a part of the cost of providing treatment—that is to say, that the insured persons will be on exactly the same footing as the non-insured persons; so that you will remove the anomaly which you now have of people who are less well off having to pay for treatment, whereas very frequently people who are better off get free treatment. That is the position in which the insured person will be. The provision of institutional treatment is proceeding. I gave the figures yesterday, though I have not them by me now; but as far as I recollect there are 17,000 beds in institutions at the moment and we are considering the approval of 7,000 or 8,000 additional beds. There has been the same difficulty in providing beds, as, there has been in providing every form of institution, since the Armistice; but the number of beds available is being increased with considerable rapidity by and through the larger local authorities. We want to simplify administration and to put the whole responsibility upon the public health authorities. Our policy is based upon simplification and unification.
I hope that I have answered the questions put by the noble Marquess. I earnestly hope that your Lordships will enable us to get this Bill through this week, or the Treasury will be put to large expenditure which otherwise would not be incurred; and also it would be quite impossible for the approved societies to get the 20,000,000 cards properly filled in if this Bill is not passed until after Whitsuntide.

§ THE MARQUESS OF SALISBURY
My Lords, the appeal which the noble Viscount has made to us is certainly of a persuasive kind. I think your Lordships will be anxious, if possible, not to put the Treasury to any greater expense than otherwise would be the case, and, as we plead every day for greater economy, it would, perhaps, be more consistent with our general attitude not to involve the country in greater expense. There is no doubt also that my noble friend who has just sat down has very fully responded to my request to know what the policy of the Government was with respect to the treatment of tuberculosis; though for my own part, and I think this applies also to the other House, I would rather have seen the new proposals 390 before we get rid of the old so that we should know exactly where we stood. However, I do not want to press the point any further, having regard to what the noble Viscount has said, and we shall perhaps be content to allow this Bill to go through before Whitsuntide. I hope, however, that the proceedings of this evening will have convinced His Majesty's Government that they can no longer count upon the House of Lords passing Bills at the last moment without proper consideration, and that on a future occasion we shall find that His Majesty's Government have made arrangements by which the proper revising obligation of Your Lordships' House can be efficiently performed.