NATIONAL HEALTH INSURANCE (COST OF MEDICAL BENEFIT) BILL.

TUESDAY, 8th APRIL, 1924.

1439

The Committee consisted of the following Members:

Mr. Short (Chairman)

Ainsworth, Captain (Bury)

Alstead, Mr. (Altrincham)

Astor, Major (Dover)

Barclay, Mr. (Manchester, Exchange)

Beckett, Sir Gervase (Leeds, N.)

Blundell, Mr. (Lancaster, Ormskirk)

Bramsdon, Sir Thomas (Portsmouth, Central)

*Cautley, Sir Henry (East Grinstead)

Cayzer, Sir Charles (Chester, City)

*Chapple, Dr. (Dumfries)

Clarry, Mr. (Newport)

Courthope, Lieut.-Colonel (Rye)

Croft, Lieut.-Colonel, Sir Henry (Bournemouth)

Darbishire, Mr. (Wilts., Westbury)

Davies, Major G. (Yeovil)

Edmonson, Major (Oxford, Banbury)

Edwards, Mr. G. (Norfolk, S.)

*Falconer, Mr. (Forfar)

*Fremantle, Lieut.-Colonel (St. Albans)

*Greenwood, Mr. A. (Nelson and Colne)

Grenfell Mr. D. (Glamorgan, Gower)

Hamilton, Sir R. (Orkney and Shetland)

Harbison, Mr. (Fermanagh and Tyrone)

Harbord, Mr. (Gt. Yarmouth)

Hartington, Marquess of (Derbyshire, W.)

*Harvey, Mr. Edmund (Dewsbury)

Hastings, Mr. Somerville (Reading)

Herbert, Captain Sidney (Scarborough)

*Hohler, Sir Gerald (Rochester, Gillingham)

*Howard, Mr. D. (Cumberland, N.)

Jones, Mr. Leif (Cornwall, Camborne)

*Joynson-Hicks, Sir W. (Twickenham)

Kirkwood, Mr. (Dumbarton Burghs)

Lee, Mr. (Derby, N.-E.)

Leigh, Sir John (Wandworth, Clapham)

Makins, Brig.-General (Chester, Knutsford)

Mansel, Sir Courtenay (Penryn and Falmouth)

*Masterman (Manchester, Rusholme)

Mills, Mr. (Dartford)

Montague, Mr. (Islington, E.)

Morrison-Bell, Sir Clive (Devon, Honiton)

Morse, Mr. (Bridgwater)

Murrell, Mr. (Weston-super-Mare)

O'Neill, Mr. J. (Lancaster)

Oliver, Mr. G. (Ilkeston)

Perring, Mr. (Paddington, N.)

*Perry, Mr. (Kettering)

Philipson, Mrs. (Berwick-upon-Tweed)

Purcell, Mr. (Coventry)

Raffan, Mr. (Edinburgh, N.)

Rawson, Mr. Cooper (Brighton)

*Raynes, Mr. (Derby)

Ropner, Major (Durham, Sedgefield)

Shepperson, Mr. (Leominster)

Sherwood, Mr. (Wakefield)

Stephen, Mr. (Glasgow, Camlachie)

Stuart, Lord Colum Crichton- (Northwich)

Tillett, Mr. (Salford, N.)

Viant, Mr. (Willesden, W.)

Welsh, Mr. (Lanark, Coatbrige)

*Wheatley, Mr. (Glasgow, Shettlestone)

*Williams, Mr. J. (Carmarthen, Llanelly)

Williams, Lieut.-Colonel T. (Kennington)

*Wood, Sir Kingsley (Woolwich, W.)

Woodwark, Lieut.-Colonel (King's Lynn)

* Added in respect of the National Health Insurance (Cost of Medical Benefit) Bill.

Mr. THROCKMORTON. Committee Clerks.

Mr. DENT. Committee Clerks.

1440
1441 STANDING COMMITTEE C Tuesday, 8th April, 1924.

[Mr. SHORT in the Chair.]

NATIONAL HEALTH INSURANCE (COST OF MEDICAL BENEFIT) BILL.
[OFFICIAL REPORT.] CLAUSE 1.
—(Provision as to cost of medical benefit and administration expenses.)

1.—(1) There shall in respect of each year during which this Act continues in force be paid:—

  • to insurance committees in England on account of the cost, and the expenses of the administration, of medical benefit, by way of addition to the sums payable under Sub-section (1) of Section seven of the National Health Insurance Act, 1920, and, subject to such conditions as may be prescribed, a sum at such yearly rate as may be prescribed, but not exceeding two shillings and twopence three farthings per year, in respect of each of the total number of the persons in respect of whom payments are made under the said Section seven (in this Act referred to as "the total number of persons for the purposes of the said Section seven"); and
  • to the Minister of Health, on account of the expenses incurred by him in connection with the administration of benefits, a sum at such yearly rate as may be prescribed, but not exceeding three half-pence per year, in respect of each of the total number of persons for the purposes of the said Section seven.
  • (2) Such part of the sums to be paid as aforesaid as is not defrayed in pursuance of Section three of the National Health Insurance Act, 1911, out of moneys provided by Parliament (hereinafter referred to as "the balance") shall in each year be provided as follows, that is to say:—

  • there shall be paid by each approved society an amount representing a charge at the rate of seven-ninths of twopence in respect of each of the total number of persons in respect of whom payments are made by the society under the said Section seven;
  • 1442
  • there shall be paid out of the moneys in the Central Fund representing sums carried to that fund under Section twenty-nine of the National Health Insurance Act, 1918 (which provides for the disposal of sums unclaimed in the Stamp Sales Account), as amended by this Act, an amount representing a charge at the rate of seven-ninths of one shilling and eightpence farthing in respect of each of the total number of persons for the purposes of the said Section seven:
  • the residue of the balance shall be paid out of the sums standing to the credit of the Income Account of the National Health Insurance Fund (Investment) Account in the books of the National Debt Commissioners kept in accordance with the regulations made by the Treasury under Sub-section (3) of Section fifty-four of the National Insurance Act, 1911.
  • (3) There shall in respect of every member of an approved society who has attained the age of seventy years in respect of every year during which this Act continues in force be paid to the Reserve Suspense Fund out of moneys in the Central Fund representing sums carried to that Fund as aforesaid and out of the Income Account mentioned in paragraph (c) of the last preceding Sub-section, amounts at the like rates at which payments are to be made out of the said Fund and the said Account under paragraph (b) and paragraph (c) respectively of the said Sub-section.

    Mr. MASTERMAN: I beg to move, in Sub-section (2), to leave out paragraph (a). I wish to raise a point which my right hon. Friend the Minister can explain. He will remember that in the debate on the Second Reading practically the only exception that was taken to the Bill was on the question of the contribution of 2d. per member from the approved societies to certain services, and that it was with some difficulty that he managed to get a unanimous vote in favour of the Second Reading, owing to the protest of a certain number of members, especially those who stood for the small insurance societies, that this seemed to be a violation of the pledge that no money would be taken from approved societies towards the additional cost of medical benefits. Since then we have had the pleasure of receiving a very interesting and admirable memorandum on National Health Insurance which gives us the figures which were not before us on the Second Reading. The services, for which this levy of 2d. per head of insured members of all the approved societies is made, are 1443 described as services for retaining medical referees and for the making of a medical register. When my hon. Friend the Under-Secretary was replying to a question put by, I think, the hon. Member for Kettering (Mr. Perry), as to who have paid for these services up till now, the reply was that the cost has fallen on the Department. The cost of the Department is paid out of moneys provided by Parliament, and I would like an explanation as to why we should transfer from moneys provided by Parliament to the approved societies the cost of these services, and why the general taxpayer should be relieved of this cost and the approved societies asked to take it on. I realise that the Consultative Council and the Emergency Committee have agreed to this proposal, and I do not want to interfere with an agreed Bill. On the other hand, I do not think that the small societies are sufficiently represented on the Consultative Committee, and it was from the small societies, and especially from some of the small Scottish societies, that the protest came in the House of Commons. The first thing which I would ask is that if we are to carry on these services at practically the same amount of expenditure—and that is not exactly given in the memorandum—why are we transferring these services from the Exchequer to the approved societies? Is it, on the other hand, suggested that more is going to be spent on these services than has hitherto been spent on them by the Exchequer? Is there any development of expenditure that is not given in the memorandum? It would be more justifiable if the right hon. Gentleman could tell us that this is a development of expenditure which has to be met from some source, and to which the approved societies have agreed, and that it is not merely the transference of the amount, some £116,000, from the approved societies to the Exchequer. If we eliminate these words would the cost be borne automatically by moneys provided by the Government out of the Exchequer, or, if that were impossible, could the cost be transferred to moneys obtained through the working of paragraph (b) of this Sub-section? If it be a matter of breaking faith with the approved societies, I should prefer this 2d. levy to be eliminated, and the 1444 extra money required put on the unclaimed stamps account in the central fund. We are taking from that fund £1,266,000, and the addition of £118,000 would not bankrupt it. Thus, by transferring it from paragraph (a) to paragraph (b) we should be able to keep the universally given promise that no additional levy in connection with medical benefit should be laid upon the approved societies without doing anyone an injustice. I disagree entirely with the argument which was advanced on Second Reading that the unclaimed stamps account is money obtained from the approved societies. Therefore, if either the Exchequer would continue to shoulder this burden, or if it could be transferred to the unclaimed stamps account it would give considerable gratification to a large number, especially to the representatives of the small approved societies, though I think that the best method would be to allow the Treasury to continue the cost of this service as apparently they have done until now.

    The MINISTER of HEALTH (Mr. Wheatley): Perhaps it might expedite our business if I gave now a few words of explanation on the points raised. With regard to the representative character of the council with whom I came to an agreement and the Emergency Committee, I find that while the members of the council are not representatives of societies they are prominently connected with societies representing over 13,000,000 of the total 15,000,000 insured persons, and so we may take it that they speak with a great deal of authority. Some of them, at any rate, are connected with the small societies. Not only are they representative numerically of the insured people, but they are representative of the different sections of the insured people.

    Mr. MASTERMAN: Would it be fair to ask if they were unanimous in their decision?

    Mr. WHEATLEY: Yes. I understand that at the Scottish meeting one member expressed doubts about the wisdom of the proposal, but he did not vote against the words when they were put to that meeting, and they were carried unanimously. At the conference which I had with the representatives of England and Wales there was not merely unanimity, but they were most cordial in their offer of the 1445 2d. to me. A very strong point in my favour is that this offer comes from the societies themselves. Had I gone to the societies and proposed it, and used my persuasive powers to get them to agree to it, I might have been criticised for having done so. But the offer, like everything else in the Bill, is not to be credited at all to my ingenuity or any other qualities which I may have, but to the good will of the approved societies. The right hon. Member for Rusholme (Mr. Masterman) thinks that I am imposing upon the societies, or that they are imposing on themselves in a suicidal manner, something which was formally borne by the Treasury. The facts are that for the past 21 months—my predecessors in office are more familiar with it than I am—ending on the 31st December, this 2d. was borne by the approved societies. It is not a fresh burden which I am putting on them. They bore it up till the 31st December, but, as the agreement under which they were working terminated on the 31st December, we are merely renewing this part of it under this Bill at their suggestion and with their support. The right hon. Gentleman asked on what fund it would fall if we did not get it from this source. If he turns to paragraph (c) he will see that it would be paid out of the balance of the National Health Insurance Fund Investment Account, and that it would fall on the residue of that account. I hope that he will not press his Amendment, but will agree with me that in the circumstances—as they have been paying it up to the termination of the contract, which made this Bill necessary, and as they propose to continue to pay it—we ought to agree to it. It is only for services rendered. It is not a contribution to anything that is being done here. It must be remembered that it is a maximum figure. We are merely taking the actual cost of the original medical officers who served the societies, and of keeping the central index of insured persons. If the cost be less than 2d. we shall take less than 2d. We allow 2d., and we put in 2d. as a maximum figure in the Bill.

    Sir WILLIAM JOYNSON-HICKS: I concur in what the Minister of Health has said. I do not wish to raise again the debatable point as to the allocation of the money by the approved societies. The point about which I was most anxious in connection with this offer was that no 1446 extra charge should be placed on the Treasury. That was the view which I took when I was Minister of Health, and I congratulate the present Minister of Health on being able to produce a Bill which does not put fresh expenditure on the Treasury. I had thought from my experience of the approved societies that the Minister of Health must have been extraordinarily persuasive with them, but he has told us that, on the contrary, they were very kind to him and proposed themselves this excellent way of getting out of the difficulty. In my brief experience at the Ministry of Health there was always money in the extraordinarily large funds of this great Health Insurance organisation, which could be picked up for small items of this kind.

    Sir KINGSLEY WOOD: Except when you wanted to increase the administration expenses.

    Sir W. JOYNSON-HICKS: I am not sure that it is desirable to do that. The White Paper tells us that this will probably sweep away the whole of the stamp fund at the end of three years. That stamp fund will no longer be raidable on behalf of any further expenditure. May I make a suggestion? It is really like producing rabbits out of a hat. If the right hon. Gentleman takes the Government actuary by the neck and gives him a little shake, I am sure that he will find that Sir Alfred Watson will be able to produce a few more millions out of that large reserve which I know there is in these funds. With regard to the Amendment, I would like to say a word which will be of comfort to the Minister of Health. I do not think that he need be alarmed by the action of the right hon. Gentleman who moved this Amendment. Perhaps, on the whole, after the very admirable fighting speech which the right hon. Gentleman has made, he will be found not voting in the Division if one be taken. I really hope that on this particular morning the right hon. Gentleman will find himself able, in accordance with his conscience, not to vote against the Government on this Amendment. May I congratulate the Minister of Health on having produced a Bill which everybody can understand? It is a great thing in Parliamentary matters, as the Minister will realise, to produce a Bill which all Members of the House, of Commons can understand. When the Government do 1447 produce a Bill which all can understand the Minister will see at once how pleased we are to allow it to pass into law.

    Sir K. WOOD: I want to say a word or two, because the approved societies have just asked me to state exactly what their position is with reference to this Amendment. I share, of course, the views of the last speaker, that although the right hon. Gentleman has moved this Amendment, we shall probably hear nothing more about it, so far as he is concerned. But the Societies say this: That the 2d. in question, in the first place, has nothing whatever to do with the remuneration of the doctors. They want to make that quite clear from their point of view. They say that until the last few years the societies engaged their own medical referees and paid them out of their administration fund, which in its turn is maintained by a transfer from their benefit fund. They also state that until recently they paid from their administration fund, which is derived from their benefit fund, the cost of notifying insurance committees of changes in and additions to their membership, so as to enable the number of persons entitled to medical benefit to be calculated. The suggestion now is, as stated in the Bill, that instead of taking the money direct from the administration fund and then replenishing the latter from the benefit fund, the 2d. shall be taken direct from the benefit fund of the society. I hope, therefore, that members will see that in no way are they being asked to deviate from the pledge which many of them gave. And for this reason: that the societies concur in the suggestion which the right hon. Gentleman has made. It is true, as the Minister has said, that the societies cordially accepted the suggestion. I remember very well the Minister going to a meeting of societies and saying that he did not come to them as a thief but as a beggar. In that spirit they received him and did what they could for him. We see the result in this Bill. My right hon. Friend (Sir W. Joynson-Hicks), in the House, and to-day again, has talked about the large reserves and the big funds of these societies. There ought not to be any misapprehension as regards that, because if there are big funds and large reserves a good many of us want them to go in additional benefits under this Act 1448 We do not regard this scheme as by any means complete until all the additional benefits mentioned in the schedule of the original Act are brought fully into play. Therefore, this money is not to be regarded as a sort of fund to be constantly raided for all sorts of people and things. This Clause is a temporary matter. The whole idea of the arrangement that has been made is that it will operate for only the short period mentioned in the Bill, and the societies have agreed, mainly on the understanding that a Royal Commission will be set up to go into the matter and put the whole thing on a permanent basis. No one can regard the present proposals as anything but temporary. Before we pass this Bill this morning, I want the Minister to say exactly what is happening so far as this Royal Commission is concerned. Several questions have been asked in the House as to the terms of reference and as to the personnel. My right hon. Friend has been engaged for some time in settling the terms of reference. We ought to know to-day exactly what the position is. We are very anxious that the Commission shall be not only a representative commission, but one which will have the confidence of the country.

    Mr. STEPHEN: On a point of Order. Is the hon. Member in Order in discussing the Royal Commission in connection with this Amendment?

    The CHAIRMAN: I think that the hon. Member was concluding his speech.

    Sir K. WOOD: I was concluding. Perhaps the Minister will tell us exactly what stage has been reached in the matter.

    Mr. PERRY: I am glad that the point has been raised this morning in regard to this twopence per member, or sixpence per member, because this is one of the few Acts of Parliament under which persons insured have no right of appeal to the courts. It has been decided time and time again that when a dispute arises between a member and his or her approved society he or she have no right of appeal to the courts. The rules of each society provide a means whereby disputes can be settled. That brings in the important work done by medical referees. It has been rightly pointed out that, prior to this 21 months, of which the Minister speaks, medical 1449 referees were paid by approved societies, and were a very necessary safeguard. When I was an inspector at the Ministry of Health, I had to deal with the abnormal sickness benefit prevailing in certain parts of North-East Lancashire during the early stages of the Act. People were ill for very long periods, and it took them a long time to get better, and the Act was threatened with bankruptcy. Some of my friends who are now in the Ministry will remember the experiences we had in Lancashire, particularly during the years 1913 and 1914. I want to emphasise the point that medical referees have performed a very important function. What the Minister said this morning, in regard to the payment for 21 months up to 31st December, 1923, being made by approved societies, does not quite fit the statement made in the House the other day, that till now that payment had been made by the State. I agree that there was a purely temporary arrangement to get over a difficulty, but the fact remains that for 21 months, up to 31st December last, this money was provided by the approved societies. I would like to have a little further information as to how far this conference of approved societies represents the smaller approved societies. I know that practically half the insured persons in the country are members of one approved society. I say, frankly, that at the inception of the Act, if it had not been for that particular kind of approved society, the Act would have broken down entirely. That is my opniion. The trade unions and friendly societies were not prepared for the Act at first. That is past history. My point is this. A great deal of the success of the Act is due to the personal touch that one gets in the smaller approved societies, particularly in the village areas, where they may be grouped according to counties or in trade organisations. But I know that a payment of sixpence a member over three years is going to make a very material difference to these small societies, as to whether they have a surplus or a deficiency when their next valuation takes place. I believe that the surplus was about £17,000,000 at the first valuation, and that surplus should be much greater at the next valuation. But it comes back to the small societies, that they will have to bear this additional 1450 burden of sixpence per member, spread over three years. I would like it to be made clear whether it is correct that the State will not have to bear any additional burden. Surely, the State will have to provide the usual two-ninths? So that, after all, there will be an additional burden on the State, so far as that particular point is concerned.

    Mr. MASTERMAN: £26,000.

    Mr. PERRY: I do not agree with the right hon. Member for Twickenham (Sir W. Joynson-Hicks), who said that at the end of three years the unclaimed stamps fund will be gone altogether. I suppose that the same practice is still going on in the National Health Insurance administration that went on when I was an officer in the department. It is this: That while the employer carries out his function of stamping the card and you put a charge upon industry and upon the worker, there are thousands of these cards which are never handed in to approved societies. In the mercantile marine, particularly, you have a very large number of such cases. You can go into any lodging house in any of our port towns to-day, and I will guarantee that you will find hundreds of pounds' worth of insurance stamps affixed to cards, some cancelled, but many not cancelled. It would be interesting some time to ascertain how much trafficking takes place in uncancelled insurance stamps. There is another class, the casual labour class, who get their cards stamped; the employer carries out his function. These cards are never forwarded to approved societies. What happens in practice is this:

    Mr. TILLETT: That is how the poor sailor gets robbed.

    Mr. PERRY: I agree. The poor man falls ill. He claims benefit from his society. He is told that he is not entitled to benefit. He goes to the medical inspector and asks for the complaint to be investigated. We used to try to trace the man's history, and we found that he had left cards at one place and at another place. The same principle applies not only to the mercantile marine, but to casual labour in the dock towns.

    Mr. EDMUND HARVEY: Would this not be in order on the next Clause?

    1451

    Mr. PERRY: The money has to come out of a fund which the right hon. Member for Twickenham says will be gone in three years.

    Sir W. JOYNSON-HICKS: I was quoting from the fourth paragraph on page 4 of the White Paper issued by the Minister of Health.

    Mr. PERRY: I supposed if it was in order for the right hon. Gentleman to quote it, then it might not be out of order for me to deal with it.

    Mr. MASTERMAN: We all desire to get the Bill this morning if we can and that subject would be more relevant on Sub-section (2). I should like to say that after the explanation which has been given I am quite prepared to ask leave to withdraw the Amendment. I am not greatly moved by the cheerful gibes of my right hon. Friend the Member for Twickenham (Sir W. Joynson-Hicks). I have the honour of representing a party which always withdraws an Amendment when a satisfactory answer has been given by the Minister in charge, and in this case, I think the answer is satisfactory, in so far as it contradicts the statement which was made—I attach no blame for that statement because it was made in great haste—by the Parliamentary Secretary in answer to a question downstairs. If the statement made to-day could have been made then, I think much of the opposition that was shown downstairs would have been removed. Now the Minister tells us that this is not a fresh charge on the approved societies. It is not money which has hitherto fallen on the department but is merely the legalising in some fashion, of a charge which the societies have already been bearing. That removes nine-tenths of our objection. As to the consultative council, which I first had the honour of setting up, I agree that this is the Minister's great organ of communication with the approved societies. I agree with the hon. Member who has just spoken on another point. I am not sure that it is entirely representative of all the smaller societies, but it is a most important part of the work of the Insurance Acts. If this is not an increase on the approved societies, if it is merely a technical matter which happens to be placed here as an increase but which they are already paying, and if they are 1452 willing to continue this service, then I will ask the leave of the Committee to withdraw the Amendment.

    Mr. BLUNDELL: I am perhaps biased in thinking that the smaller societies are adequately represented on the consultative council, as I am one of those who try to represent them, but, at any rate, the particular approved societies with which I am connected, namely, the rural societies, are adequately represented in point of numbers if not in point of quality as we have three representatives on the council. I may tell the right hon. Gentleman the member for Rusholme (Mr. Masterman) that we are very much better represented now than we were when he was in office. The Minister referred to the cordiality with which he was received by the consultative council, and I desire to endorse what he said, but I think I should not be breaking confidence or misrepresenting my colleagues if I said that there was more cordiality over the twopence than over all the rest of his Bill put together. I think the right hon. Member for Rusholme is guarding against a blow that has not been threatened. There is a great deal more to be said against the one and eightpence farthing and the sixpence than against the twopence, but out of a desire to see this matter settled the consultative council put their conscience into their pocket, as far as they could, in order to meet the Minister of Health halfway. I should like to impress upon the Minister that these proposals are a bargain. The consultative council and the approved societies have kept their part of the bargain, and we are very anxious to know when the right hon. Gentleman is going to set about performing his part of the bargain to set up a Royal Commission. We wish to know when he is going to set it up, what the terms of reference are to be, and, if he cannot tell us the personnel, at any rate can he tell us whether it is going to be a Commission of an impartial character or whether interested—

    Mr. STEPHEN: On a point of Order. I object to the hon. Member discussing this matter.

    The CHAIRMAN: That is a matter which should be dealt with on the Floor of the House, and I hope the hon. Member will not press it.

    1453

    Mr. PERRY: Is the hon. Member for Ormskirk (Mr. Blundell) interested in the West Lancashire rural societies?

    Mr. BLUNDELL: Yes.

    Mr. PERRY: I guessed so.

    Mr. BLUNDELL: I bow to your ruling, Sir, but I did raise this matter on the Floor of the House, and I am sorry to say that the Minister took no notice whatever of my remarks.

    Amendment, by leave, withdrawn.

    Mr. HARVEY: I beg to move in Sub-section (2), to leave out paragraph (b). I move the omission of this paragraph in order to call attention to the point which has been raised with such intimate knowledge by the hon. Member for Kettering (Mr. Perry). On the occasion of the Second Reading, I referred to the fact that this money is being taken from a fund which is largely contributed to by people who get no benefit from the way in which it is being used, particularly casual labourers, and people who are not members of approved societies and who unfortunately do not get proper use of the means intended to be given them by the Act. Most of them in so far as they come under the advantages of the Act at all are Post Office contributors. It is very convenient for the Government and for the approved societies that this fund should be available to be made use of in this way and the object it is to serve is a very laudable one with which we have great sympathy, but it is very important we should get from the Government a definite statement that whatever use is made of this fund during the three years, there is not going to be for the benefit of members of approved societies any permanent raiding of a fund which is largely provided by casual labourers and others. They have no one to speak for them and no organisation, and it is only when the matter is raised as it has been by the hon. Member for Kettering that there is an opportunity for considering their case. The Minister should make it quite clear that the Government are going to look after the interests of these people. Every Government is in danger of giving a too literal interpretation of the Gospel text "to him that hath shall be given," and this is certainly an instance. It is being taken from those who have not, and there is very little reserve left for their benefit. 1454 We have not had a clear statement as to the amount which remains. This money has been taken from the Unclaimed Stamps Fund, but there will ultimately remain a sum which should be reserved for the benefit of the persons I have indicated and the Post Office contributors. We require a clear statement of the Government's view on this point.

    Mr. TILLETT: May I add my appeal to the claim made by the Mover of the Amendment as to the difficulties suffered by the casual labourer. The more casual his labour, the more casual his habitation and the more handicapped he is in life. He is the creature of circumstance. He is manufactured by our industrial system and civilisation, and, if there are any means whatever of assisting him, of attending to him in periods of illness, of preventing him from being a burden on the State in any respect, they should be adopted. I do not wish to argue the point, because I am sure that we shall receive a sympathetic reply.

    Mr. WHEATLEY: If this Amendment were accepted, it would destroy the Bill as it stands.

    Mr. HARVEY: It is not moved with that object, but in order to get a statement from the Government.

    Mr. WHEATLEY: I am quite sure it was not the hon. Member's object to destroy the Bill, but, as the Bill is drafted, it would throw a burden on paragraph (c), which has to bear any balance that remains, and paragraph (c) would not, in itself, be sufficiently strong to bear the burden, and so ultimately it would be thrown on to the societies. I assure the Committee there is no danger of any section of insured people suffering by the scheme of finance which is proposed here. We have gone into the matter very carefully, and after making all essential reserves—indeed, generous reserves—we have plenty of money for the purpose proposed. I need not remind hon. Members of the figures given in the memorandum. We have millions of money, and the claims on the central fund which has all this money, during the period of its existence, have not, I believe, exceeded from £20,000 to £30,000, though I am not going to vouch for the figure.

    Mr. MASTERMAN: Can the right hon. Gentleman give us anything more definite as to the number of millions?

    1455

    Mr. WHEATLEY: I think you will find two figures in the memorandum as to the amount in the fund. There is one figure of £1,500,000 and another figure of £2,500,000. I am sure I shall have no difficulty in assuring the Committee and the two hon. Members who have just spoken on behalf of the poorer section, whose interests we are all anxious to conserve, that they are running no risk at all under the scheme of finance in this Bill, and I appeal to the Mover of the Amendment not to press it and to let us, if possible, get through an unamended Bill.

    Mr. HARVEY: I do not wish to obstruct the Bill, and I ask leave to withdraw Amendment.

    Amendment, by leave, withdrawn.

    Motion made and Question proposed, "That the Clause stand part of the Bill."

    Sir W. JOYNSON-HICKS: I should like a ruling as to when it will be possible to ask for information regarding the Royal Commission. This question might be put on the Motion, "That the Clause stand part of the Bill," or the matter might be raised on Clause 6 by an Amendment to alter the date on which the Measure comes into operation, or it might also be raised on the Motion, "That the Bill be reported to the House." There is no question of obstruction, but, if a ruling were given now, it would be convenient.

    The CHAIRMAN: I had already decided that if it was desired to press this matter, I should ask hon. Members to raise it on the Motion "That the Bill be reported to the House."

    Question put, and agreed to.

    Clause ordered to stand part of the Bill.

    Clauses 2 (Payment into Central Fund), 3 (Application of part of sums unclaimed in stamp sales account towards cancellation of arrears), 4 (Payment out of Central Fund for purpose of health insurance in Northern Ireland, 5 (Application to Scotland, Ireland and Wales), and 6 (Short title, construction and operation), ordered to stand part of the Bill.

    Motion made and Question proposed, "That the Bill, without Amendment, be reported to the House."

    Sir K. WOOD: I now desire to put some questions to the Minister to which I am sure he will be willing to reply. What 1456 position has he arrived at in connection with the setting up of the Royal Commission; what are the terms of reference, and can he indicate anything as to the personnel of the Commission?

    Mr. WHEATLEY: I can only say to the Members of the Committee that negotiations are very well advanced. We have submitted the terms of reference, I believe, to the approved societies and doctors who are agreed on them. We have to submit them to another body before it would be proper to report them to the public, and but for that, I would give the Committee the terms of reference to-day. They are going to present no difficulty. Regarding the personnel of the Commission, on which I have been invited to give an explanation, I am sure the hon. Member will appreciate that that is not a matter on which I alone am the determining agent, and I have to negotiate with the people who are interested, and to get the authority of my Government on a matter such as that, but there again I do tot anticipate any difficulty, and we hope to have the Royal Commission established without very much delay.

    Sir K. WOOD: Does the right hon. Gentleman propose to include representatives of the various interests affected?

    Mr. WHEATLEY: The hon. Member is now raising a point which is one on which I could very easily slip, so I beg of him not to press it.

    Mr. PERRY: May I make an appeal to the right hon. Gentleman in regard to the terms of reference? I hope they will be wide enough to include the whole question as to whether the present method of carrying on national health insurance is the most advisable—I mean, really, by the stamping of insurance cards. First of all, it imposes a heavy tax upon the employers, with regard to additional staff to carry out the Act, and my own experience has been that they are loyally carrying it out. It imposes an additional tax upon industry, and while I agree with all that has been said, that the National Health Insurance Act is one of the finest Acts that has ever been put on the Statute Book of this country, I am not prepared to admit that the stamping of a card is the last word in regard to methods of carrying out national health insurance, and I hope the right hon. 1457 Gentleman will take that into consideration when drawing up his terms of reference.

    Sir W. JOYNSON-HICKS: I wish very earnestly to ask the Minister of Health, in considering the personnel of the Royal Commission, that he should make it an impartial body. I think it would really be very detrimental to getting at the truth if he were to endeavour to put representatives of different organisations, societies, and so forth on the Commission, because by so doing he would split the Commission up into rival bodies, which would become, not judges, but advocates. He knows that I was endeavouring myself to secure a very impartial Royal Commission, and I had received—there is no secret about it—the assent of a very well-known man, not of my own political persuasion, to act as Chairman, a man whom, I am sure, the whole of the House of Commons would have been delighted to welcome. I cannot mention his name now, but I have given it to the Minister, and I want to ask him whether he will consider very carefully indeed before putting anybody connected with different societies on this Commission, so as to have a really impartial Commission, which would receive, I am sure, the support of the whole of the House of Commons and the confidence of the country.

    Mr. FALCONER: I would like to say that the feature of the personnel of the Royal Commission which seems to me to be most essential is that you should have on it men who have a real knowledge of health insurance matters. There is a great danger that you will get people who are most excellent members of the community as a jury, to give a judgment upon national health insurance matters, but who have no real knowledge of the particular matters with which they have to deal, and having regard to the complicated nature of the arrangements in connection with national health insurance, first and last, I think it is almost a hopeless task for a person who has not some knowledge of it to appreciate all the different questions which are bound to come up. I agree that the Chairman ought to be a man who is outside any possible interest in connection with any societies or others, but if you can get persons who are not connected with any society, yet who 1458 really do know about insurance matters, I should say: "By all means, get them," but if you cannot get such persons—and I doubt whether you can, because it re only those who have to do with the working of the societies who are capable of understanding the bearings of the different questions—then I think you ought to have on the Commission carefully selected men, familiar with the working of the societies, who will be able at any rate to appreciate the different points and, if necessary, state their view in a minority report. After all, the great thing is that the House of Commons should have before it the different views, and that itself should be able to judge what is the right course to follow. A Royal Commission composed of people with no real knowledge of the working of the Act would pronounce a judgment upon the question which would carry weight practically with no-one connected with insurance.

    Mr. TILLETT: I do not want to cause any discord in this matter, but I hope the Minister will not consent to make a Commission of experts. The curse of all Governments is the committee of experts, who generally understand least about their business. If the right hon. Gentleman will get an ordinary, decent, common-place sort of Commission, he will get on with it, because the expert is a person who generally leaves his heart behind him, thinking his brain is the only material necessity.

    Mr. MASTERMAN: My right hon. Friend has been appealed to from totally different directions, and I am rather inclined to agree with the hon. Member for North Salford (Mr. Tillett) in desiring a judicial rather than an expert Commission, and I would suggest that the experts might be asked to give evidence before that Commission. But I have a third appeal to make, and that is that the right hon. Gentleman should put on the Commission men who are able to give much time to the work, in order that the report should be in the hands of the House of Commons in a very short space of time. I do not think I am out of order in stating, what everyone in this connection knows, that all the political parties in the State are now very much interested, not merely in health insurance, but in much larger schemes, in which health insurance 1459 shall be embodied, and a demand has gone out that another Royal Commission shall be appointed to consider the general question of security and how the various kinds of insurance shall be extended and amplified. If we have to wait for two years before the Health Insurance Commission reports, and then to wait for another couple of years before this new Insurance Commission reports, most of us will have perished before we see the scheme carried into operation. I am not trying to lecture the Minister, but if he will only put men on the Commission who can give a very considerable amount of time to the work, and instruct them, as far as he is able to instruct them, to report as speedily as possible, we shall be able to get on to the larger question which is interesting nearly everyone in the country.

    Lieut.-Colonel FREMANTLE: The question of the position of the doctors has not been raised. I am not qualified to speak for them, but I am in touch with them, and I believe that their position is this, that they would not wish to be on an expert Commission if it were decided that the Commission should not be composed of experts, but what they would object to very strongly, if the Commission were supposed to be a non-expert Commission, would be that it should contain direct representatives of approved societies, but no representatives of the panel doctors. What they hope is that in either case they will be perfectly fairly dealt with, and have the position considered judicially. If so, they have per- 1460 fect confidence that the justice of their case, when it comes into conflict with other persons, will be fairly considered.

    Mr. WHEATLEY: I am afraid I cannot promise the right hon. Member for Rusholme (Mr. Masterman) that this Commission, however you may select it and however assiduously it may attend to its work, will get through it in a very short time. I have already sufficient evidence to justify me in saying that the question it has to consider is a very complicated one, and will take more time than we should like. We are all anxious to have it report with all possible speed, but the right hon. Gentleman himself knows how indefinite that qualification is.

    Mr. MASTERMAN: I quite agree.

    Mr. WHEATLEY: The various view's that have been expressed indicate the value of caution. I have had the opinions of three or four different sections of the Committee in regard to the kind of Commission that should be set up. I will give due weight to all these considerations—and they are due considerable weight from the sources from which they emanate—but again I want to ask the Committee to recognise the storm that will break about my ears immediately I have appointed the Commission, no matter which course I may take. I will do my best.

    Question put, and agreed to.

    Bill, without Amendment, ordered to be reported to the House.

    Committee rose at Five minutes before Twelve o'Clock.

    1461

    THE FOLLOWING MEMBERS ATTENDED THE COMMITTEE:

    Mr. Short (Chairman)

    Ainsworth, Captain

    Alstead, Mr.

    Astor, Major

    Barclay, Mr.

    Beckett, Sir Gervase

    Blundell, Mr.

    Cayzer, Sir Charles

    Courthope, Lieut.-Colonel

    Croft, Lieut.-Colonel, Sir Henry

    Davies, Major George

    Edmondson, Major

    Falconer, Mr.

    Fremantle, Lieut.-Colonel

    Greenwood, Mr. Arthur

    Grenfell, Mr. David

    Hamilton, Sir Robert

    Harbord, Mr.

    Hartington, Marquess of

    Harvey, Mr. Edmund

    Herbert, Captain, Sidney

    Howard, Mr. Donald

    Jones, Mr. Leif

    Joynson-Hicks, Sir William

    Kirkwood, Mr.

    Lee, Mr. Frank

    Makins, Brigadier-General

    Mansel, Sir Courtenay

    Masterman, Mr.

    Montague, Mr.

    Morrison-Bell, Sir Clive

    Oliver, Mr. George

    Perry, Mr.

    Purcell, Mr.

    Raffan, Mr.

    Raynes, Mr. William

    Shepperson, Mr.

    Sherwood, Mr.

    Stephen, Mr.

    Stuart, Lord Colum Crichton-

    Tillett, Mr.

    Viant, Mr.

    Welsh, Mr.

    Wheatley, Mr.

    Williams, Lieut.-Colonel, T. S. B.

    Wood, Sir Kingsley

    Woodwark, Lieut.-Colonel

    1462