NATIONAL HEALTH INSURANCE (JUVENILE CONTRIBUTORS AND YOUNG PERSONS) BILL.

HL Deb 30 November 1937 vol 107 cc311-8

Order of the Day for the Second Reading read.

VISCOUNT GAGE

My Lords, the national health insurance system of this country is one in which, I think, all parties can feel some pride. It was started some twenty-five years ago, and now provides about eighteen millions of the population with a medical service with a considerable degree of efficiency at a very low cost. The history of the movement records, as might perhaps be expected, a continual process of enlargement and improvement. Most of the great social reforms of this country have grown from comparatively small beginnings, and it has certainly been so with insurance for, as is well known, the Government of the day founded the national health insurance system by enlarging and extending to a very great degree the work that had already been initiated by the private insurance and other mutual aid societies of the kind. And they also endeavoured to co-ordinate the scheme with such other efforts as had been made up to that moment by the Government for dealing with particular classes of the community, and so in this way they preserved the continuity of the work which had already been begun, and they retained within the movement the experience of many of those who had been organising it previously.

All that was of the greatest possible value. But it cannot be denied that such a policy was bound to involve a great deal of complication in administration and to leave certain gaps. It has been the policy of various Governments, and certainly it has been (and is) the policy of this Government to seize every opportunity to strengthen the organisation and render it more comprehensive. Last Session, your Lordships will remember, progress was made in another and different direction by extending the benefits of insurance to black-coated workers and other classes with the particular object of helping them in their old age. The measure I have the honour to present to your Lordships to-day contemplates a step in a somewhat different direction, a direction which has been attracting a great deal of public attention—namely, the providing of better safeguards for the health of the young. Broadly speaking, and with one prominent exception, there exists to-day and is available for all wage-earning classes a fairly continuous chain of State-aided medical services—in the words of my right honourable friend the Minister of Health, "from the cradle to the grave." In infancy there is the infant welfare centre, and on that point your Lordships will remember that the Government recently initiated a campaign to advocate the greater use of the centres. Then there is the village nurse and midwife whose status was materially improved by a measure passed recently and whose work now we hope may be even more effective than it has been in the past. For those at school there is the school medical service, and when the young worker enters industry there is available to him or her the main national health insurance scheme; that is from the age of sixteen until they die.

A break in this chain of medical services occurs unfortunately at the age of adolescence, an age when medical supervision is certainly no less necessary than at any other age—that is to say, from the age of leaving school, fourteen, until the age of entering the national health insurance scheme, which is sixteen. Between these periods these juveniles do not obtain any State-assisted medical service. It has been recognised for a long time that this omission is very unfortunate, and what we propose to do in this Bill is to provide young workers who enter industry at any time between the ages of fourteen and sixteen with the full medical benefits of the national health insurance scheme. We anticipate that about one million boys and girls will be benefited by it in the immediate future, but the number is likely to be decreased when the scheme for raising the school age has been put into operation. Also it is likely to be diminished if the much discussed decline in the birth-rate takes effect. I have said that we intend to make available all the medical benefits of the national health insurance scheme. We do not propose to include the right to cash benefits, for if we did that it would involve the young workers in contributions out of proportion to their wages and we do not believe that there exists a demand for cash benefits on these terms. As it is this scheme will demand only a contribution of twopence from the employee and twopence from the employer, making four-pence in all. I would like to point out that the juvenile worker, once insured, receives these medical benefits whether he remains in employment or not.

For this small payment he gets also another advantage. As I have said, this scheme has been proposed in close collaboration with the approved societies, and it has been arranged with them that when these young entrants come into insurance they should have the opportunity of coming in through these societies and, further, that the date of their entry into insurance should also be the date at which they begin to qualify for those additional benefits which most approved societies are able to give. This is not shown in any clause of the Bill. It is a promise made by the Minister which he will put into effect by Regulations made under the principal Act. In other words, any boy or girl insured under the scheme at the age of, say, fourteen and a half will he able to get dental benefits or ophthalmic benefits at the age of seventeen instead of at the age of eighteen and a half as hitherto. We all know that defective teeth in youth are inclined to contribute to ill health later on in life, and I do not think anyone can doubt that this is a valuable reform. It is indeed one which my right honourable friend would like to carry further, but there are at present certain administrative difficulties in the way, and the matter must stand as it has been arranged at the moment.

There is a third small but none the less important innovation included in this Bill. It will doubtless be appreciated that continuity of treatment is very valuable and important in certain cases of illness. In Clause 6 of the Bill there is a provision whereby the panel doctor can obtain any confidential information he may require from the school doctor with reference to any case that has come to him from school. Thus it is hoped that continuity will be rendered possible. There are various other provisions dealing with machinery and finance, and, in passing, I might explain that Clause 5 is merely intended to deal with a temporary situation which has arisen owing to the fact that some of the approved societies have been canvassing for individual entrants in anticipation of the passing of this Bill. But the three reforms that l have specified—that is to say, the simultaneous entry into employment and into insurance, the advancement of the qualifying period in connection with these additional benefits, and the better provision for the continuity of treatment—are the main features of the Bill.

I know it is very easy to point out that even now there are directions in which our national health insurance system falls short of perfection, but I would ask your Lordships not to underestimate the vast amount of preparatory work that even a small Bill of this kind involves. I would like to emphasise that the great results which have already been obtained have been achieved by continual advances, and that the vital statistics of the country show the value of what has already been done. My right honourable friend will continue in the future to press forward with other similar advances as he has done in the past. I beg to move.

Moved, That the Bill be now read 2^a.—(Viscount Gage.)

LORD STRABOLGI

My Lords, on behalf of my noble friends I do not wish to offer any opposition to this Bill, and I take an early opportunity, I am sure on behalf of all your Lordships, of thanking the noble Viscount for the very clear explanation he has given of this somewhat complicated measure. The only question I wish to ask, before making the very few comments I will venture to offer to your Lordships, is with regard to Clause 6. I should have thought that the medical cards which are kept by the school medical officer should automatically go on to the medical practitioner or the insurance committee. Why should they have to be asked for? There may be some reason, and it would be interesting to know what it is. One would have thought that they would be passed on quite automatically, and that the record of the child's life at school from the medical point of view would be immediately at the disposal of the panel doctor or whoever it might be.

The criticisms that my honourable friends in another place offered, which I shall shortly repeat and which no amount of debate has yet removed, are these. We think that the scheme for these young people should be non-contributory during that short period. I know twopence per week is not very much. I notice that the noble Viscount did not make any explanation in reference to the last words of Clause 2, as to why in the case of young seamen it is only one penny a week. I dare say there is a good explanation, but I should like to hear what it is. We think there should be no contribution at all by any of these young people. Secondly, we think that in addition to medical benefit there should also be some allowance during periods of sickness. After all, these young people are not very subject to maladies and illnesses. They are "good lives" from the medical point of view, and will be, I think, an asset to the Fund. Therefore, when they are ill, I think there should be some sickness benefit paid in cash, as in the case of older contributors, for the relief of their households. Those are the criticisms we make on the details of the Bill. We welcome the principle of the Bill, and we offer no opposition to it.

THE LORD BISHOP OF WINCHESTER

My Lords, in welcoming this Bill I should like to say that it is a small but very important one. It brings under medical supervision something like a million children, and it bridges what has always been, I think, a most unfortunate and almost incomprehensible gap in our system. The State has cared for children and seen that they have had medical supervision, but at the age of fourteen this has stopped, and stopped entirely; then, at the age of sixteen, again the children come under the notice and care of the State through various insurance methods. This has been a gap to which attention has been called time after time. Just at the very period when the growing boy or girl most needs medical supervision and care there has been neglect. This Bill will remove that gap from our system. I welcome also the proposal that the very careful record of the child's health which has been made in the schools should be available afterwards to those who are responsible for carrying out this measure.

I wish the noble Viscount who introduced the Bill had in the very clear statement he made been able to tell us a little more about dental treatment. He pointed out that there still would be a gap between the ages of fourteen and seventeen. Surely that is a very serious matter. Increasingly I think it has been recognised that in later life a great deal of ill-health quite apart from pain, is caused through defective teeth, and that treatment at the age of fifteen and sixteen may save a great deal of serious trouble later on. Although some improvement has been made in that matter, yet between the ages of fourteen and seventeen—I think rather over seventeen—nothing is done for children in this respect. I notice that the Minister in another place gave some hint that through the Regulations he might be able partially to deal with this matter. I did not quite follow how it is proposed to deal with it, and I do not know if the noble Viscount is able to tell us; but it would, I think, be a real strengthening of this most useful Bill if something could be done to deal with this gap which still remains.

VISCOUNT GAGE

My Lords, I am much obliged to your Lordships for the favourable reception that has greeted this Bill. Various questions have been asked which I will do my best to answer. In reply to the noble Lord opposite, who asked why the cards have to be asked for at all, I would point out to him, that so far there has been no continuity of State medical service. There has been this gap, and in consequence it has not been possible to lay down a standard procedure as is now proposed. There will be now no gap, and it will be easy for the medical officer to obtain any information that he requires because there will be this continuous chain.

As for the criticism that this is a contributory scheme—the noble Lord would like to make it a non-contributory one—that is a question of major policy. The noble Lord said he would like this short period to be covered by a non-contributory scheme, but I seem to recall that the Party to which the noble Lord belongs has advocated not only that this but that a good many other schemes should be upon a non-contributory basis. There we are entering an old and very large controversy. We on this side of the House feel that there is something in rendering the worker dependent on something to which he has contributed himself, and not feeling that he is entirely dependent on charity, even though it be the charity of the State. I do not think anyone can say that this is an unreasonably ungenerous scheme when one recollects that even one contribution of twopence—in circumstances which I hope will not often occur—can ensure a juvenile the right to medical benefits extending over a very long period. In regard to the point raised by the noble Lord about seamen, I should like to point out that this is due to the fact that while a seaman is on foreign-going ships medical care is provided at the expense of the shipowner.

Then there were the comments made by the right reverend Prelate. I did try to point out that dental treatment is provided as an additional benefit under the Regulations made by the Minister under the principal Act, and I did try to make clear that the Minister is not himself satisfied about the period of waiting. This matter, however, is one for negotiations between the approved societies and my right honourable friend. He is now engaged in negotiations, and I feel that I cannot say more than has been said. The point is one which my right honourable friend continues to bear in mind, and he hopes to be able to do something to make this period shorter.

On Question, Bill read 2^a, and committed to a Committee of the Whole House.