THE NATIONAL INSURANCE BILL IN ITS RELATION TO THE VOLUNTARY

HOSPITAL SYSTEM.

[To THB EDITOR OF TILL " SFECTITOR."] SIR,—It is the fact, and it is quite excusable, that your-corre- spondent, Mr. H. W. Burleigh (Spectator, December 9th), has evidently not seen the amendments to the Insurance Bill as it exists to-day. The quotations are apparently taken from the Bill as introduced, though the numbers of the clauses he gives are not those contained in that Bill, or in the Bill as it left the House of Commons. The numbers of the three clauses quoted should be 8, 16, and 63 respectively, and they differ materially from the wording given by your correspondent. It will be seen that the whole of them relate to sana- torium benefit or the erection of sanatoria, and have in fact nothing to do with hospital benefit, which is quite another matter. I thought that Mr. Burleigh might have in his mind the representations made to the Chancellor by the Royal College of Physicians, to the effect that sana- torium benefit to be of use should be provided, under proper conditions, for insured persons who need convalescent care, whether they suffer from tuberculosis or from other diseases. The Chancellor expressed himself favourably inclined to the suggestion of the Royal College of Physicians; but the Bill, as it stands at present, as I am advised, does not provide for the class of patients in hospitals suffering from accidents or disease, or in operations, who may need sanatorium care. The clauses in question do not, therefore, affect voluntary hospitals by providing accommodation which will relieve them from the duty of hospital care which they at present afford. In fact, the Insurance Bill "does create a large number of insured persons needing hospital treatment without providing a single bed for their accommodation, and unless such accommodation is provided by the Bill either the voluntary hospitals must be greatly abused or the insured sick must suffer cruelty."

In these circumstances you may be willing to give space to enable me to set forth a ready and relatively inexpensive means of providing hospital benefit. The suggested amend- ments, drawn by counsel who have had much to do with the Bill from the commencement, should illustrate the error into which your correspondent has fallen by confusing sanatorium with institutional benefit. Counsel's amendments prove to demonstration that the Bill as it stands does not provide a single hospital bed for the accommodation of the insured. These amendments, too, would make provision for hospital

treatment upon a basis which would enable the cost of such provision to be reduced to a minimum by agreement, through the Insurance Commissioners, with each voluntary hospital on a pro rata basis, plus ten per cent. to cover the payment for

the medical and surgical treatment of each case. There is no reason why these amendments should not be made in the Bill by the House of Lords ; and if they were introduced there I have reason to hope they might be accepted by the Govern-

ment. Should the House of Lords not reject the Bill altogether, but endeavour to improve it, they would, I hope, consider the further question of ivreased hospital accommodation. Believing as I do that the solution of our hospital problem

lies in an adaptation of the Continental system whereby each hospital is organized in departments, (a) for cases sent in by the Government or municipalities, which pay the actual cost of the treatment given to the patients ; (b) provision for those patients who can pay a portion, though not the whole of the actual coat of treatment ; (e) those who can pay the whole cost of their treatment ; and (d) those who can pay the whole cost of their treatment and accommodation when in the hos- pital, together with the medical fees and charges, I found, as the arrangements made by the medical profession with the working classes in Birmingham prove, that it is possible

to arrange with the medical staff or consultants, in connexion with our hospitals, for reduced fees in the case of artisans, workers, and others whose means are strictly limited. I further

find that a number of hospitals have sites available in con- nexion with their present establishments, whereon pavilions can be readily erected at a minimum cost, where patients of one or all of the four classes already referred to can be treated under the best conditions, also at a minimum cost. I know some such hospital authorities would be willing to grant sites for the erection of pavilions thereon and to undertake

their administration upon terms to be mutually agreed. It is practical, therefore, to provide any further hospital accom- modation which may be required at a minimum cost, pro-

viding the capital sum needed to defray the outlay on the erection of the new buildings or pavilions for the treatment

of patients is forthcoming. To enable this point to be met my suggestion is that a new sub-section shall be added to Clause 63, being sub-Section 5, as follows :—

" In order to provide such additional accommodation in any hospital, convalescent home, or infirmary approved by the Local Government Board as may be required for the purposes of institu- tional benefit under this Act, the Local Government Board may from time to time, with the consent of the Treasury, make loans to such hospital, convalescent home, or infirmary, at such rate of interest, not being less than 3 per cent. per annum, as may be arranged; but every such loan shall be made repayable by means of a sinking fund in not more than . . . years, and all sums payable in respect of the interest and sinking fund on any such loan shall constitute a first charge upon any sums payable to the hospital. convalescent home, or infirmary in respect of any institutional benefit under this Act, and also upon any sums paid or payable to the hospital, convalescent home, or infirmary by or in respect of any individual receiving treatment in any building erected wholly or partly out of moneys provided under this sub-section."

This suggestion is calculated to win the support of all practical men, for it would enable the Government, without further addition to the Budget or any increase of the National Debt, to effect this invaluable reform and benefit all classes of the community, in regard to the treatment of illness and accident, who might henceforth need hospital care, either for

payment, or as insured persons, or as poorer members of the

community receiving free hospital benefit.—I am, Sir, dra., The Lodge, Porehester Square, W. MENET BURDETT.