§ Mr. GINNELLasked the Chancellor of the Exchequer (1) whether he is aware of the loss, danger to life, and complaints prevalent in important towns and populous districts in Ireland owing to the unwillingness of Poor Law guardians to give relief to sick poor who are entitled to sickness benefit under the Insurance Act, and to the difficulty the sick poor have in travelling to the official certifier, who usually resides remote from populous places; whether any provision has been, or will be, made to make sickness benefit retrospective to the beginning of the illness or to recoup out of the insurance fund guardians who, on the advice of the medical attendant, give prompt relief in cases subsequently certified valid; (2) what amount Ireland contributes annually to the common fund under the National Insurance Act, as compared with the other portions of the United Kingdom; on that basis, what is the amount of Ireland's equivalent for certification; what amount is paid in Ireland for certification, exclusive of travelling expenses; what is the reason for not paying the £91,000 which he promised for this purpose, and which the Irish doctors consented to accept; whether the balance is being applied to any other Irish purpose; (3) what independent medical approval, if any, the Irish Insurance Commissioners have for allowing insured poor persons seriously ill to be improperly disturbed by a certifier who, not being the medical attendant, is unacquainted with the cases, and for the Commissioners' more recent attempt to have laymen appointed to visit cases which they have no qualification for judging and from some of which they may convey infection; whether, before allowing those two practices to proceed further, he will have them considered by the highest medical and surgical authorities in Ireland; and (4) by what authority and on what grounds of justification the Local Government Board for Ireland, while refusing to allow a workhouse doctor to act as locum tenens for another in an adjoining district, yet do allow such a doctor to act as certifier under the National Insurance Act for half a county; how this is reconciled with efficient discharge of his proper duty and with that prompt certification available to the sick in their own homes in Great Britain; whether a 826W person, apparently well when such a remote certifier takes his weekly drive, can on becoming ill get promptly certified otherwise than by travelling, in some cases twenty miles, in his sickness, which maybe contagious, to the certifier, while his medical attendant is not empowered to certify; and whether the Local Government Board or Insurance Commissioners have any independent medical approval of this practice?
§ Mr. MONTAGUTaking the hon. Member's questions in order, I may say that I shall be glad to make inquiry into any case which is brought to my notice where undue delay or difficulty has been experienced in obtaining a certificate to support a claim for sickness benefit. That part of the hon. Member's question which relates to the granting of Poor Law relief does not fall within my province; but as regards claims for sickness benefit, the doctors who are giving certificates under the National Insurance Acts have arranged convenient places in their districts at which insured persons may attend for examination, and in any case where an insured person is prevented by distance or by his physical condition from leaving his own home, he must be visited by the doctor in his own home. It is the duty of approved societies to scrutinise all claims for sickness benefit, and where the necessary conditions are fulfilled to their satisfaction, benefit is payable from the fourth day of incapacity for work. There is no provision in the National Insurance Acts for making repayments to the Poor Law authorities in the circumstances stated in the last part of the question, and I may remind the hon. Member that under Section 109 of the Act of 1911, any benefit received under the Act is not to be taken into account in granting outdoor relief except in as far as the benefit exceeds 5s. a week.
As regards the second question, the annual amount derived from the contributions of employers and employed persons in Ireland is approximately £724,000. These contributions are paid into the Irish National Health Insurance Fund, set up under Section 81 (2) of the Act of 1911, and not into a common fund as stated in the question. As regards the basis on which Grants have been made to facilitate the provision of medical certificates in Ireland, my right hon. Friend the Chancellor of the Exchequer stated in reply to my hon. Friend the Member for Waterford City, Waterford, on the 14th August, 1913, that 827W he was satisfied that a Grant of £50,000 was insufficient to cover the cost of satisfactory arrangements for this purpose, and undertook to ask Parliament to increase the Grant up to a maximum limit of 2s. 6d. per insured person per annum. This latter Grant is equivalent to a sum of £97,100 per annum, and the estimates provide that payments out of the account under this head shall be subject to conditions determined by a scheme made by the Irish Insurance Commissioners, with the approval of the Treasury. Pending the approval of such a scheme, expenditure may be incurred for the purpose of certification in Ireland to an annual amount not exceeding £50,000 voted for this purpose. The present annual expenditure is about £44,000, the remuneration paid being inclusive of travelling expenses.
As regards the third question, I am informed that doctors who visit insured persons desirous of obtaining medical certificates are instructed to exercise every care in visiting persons who are seriously ill, and are not permitted to interfere with the treatment prescribed by the doctor in attendance. If I correctly understand the second part of the question to refer to the appointment of sick visitors by approved societies, I may say that a system under which such visitors are appointed is of much value to approved societies in exercising a proper supervision over claims for sickness benefit. As regards the third part of the question, the Irish Insurance Commissioners or myself are, of course, happy at anytime to receive suggestions for the improvement of the existing system of certification. As regards the last question, I am informed that any work in this connection is only undertaken by Poor Law medical officers on the distinct understanding that it will not interfere with the proper performance of their other duties. The details of the actual arrangements which are made in order to overcome, as far as possible, the peculiar difficulties existing in Ireland, are perhaps sufficiently described in the reply to the hon. Member's first question.