of which £1788, 15s. 8d. was contributed from the special drug fund to meet deficits of five committees. £10,155, 4s. 8d. of the expenditure was paid in fees to the doctors who dispensed.

The epidemic of influenza in the early months of 1922 is mainly responsible for the large increase shown in the following table in the number of forms as compared with 1921. The extra expenditure involved was, however, partly counterbalanced by the reduction in the price of drugs. The frequency of prescriptions for 1922 is the highest since 1918.

The sum provided in 1923 for payment to doctors under agreement with insurance committees outside of the Highlands and Islands in respect of liability to travel to insured persons residing in the rural parts of their districts of practice was maintained at the amount (£55,000) which had been determined to be necessary for each of the preceding years 1920-1922.

1924.

In considering the amount which it is necessary to provide for mileage, regard has to be taken not only of the costs of locomotion but of the allowance to be made for time occupied in travelling to patients beyond a certain distance from the practitioner. Apart from the fall in costs of motoring, the revision of the capitation fee for 1924 afforded another reason for re-opening the question of the amount to be provided for mileage for that year.

A careful investigation was made of the reduction in the cost of running various types of motor cars, and the data was used in the negotiations with the Scottish Committee of the British Medical Association, which resulted in the sum of £46,000 being provided in respect of mileage allowances and grants required for improvements in the medical service of certain necessitous districts in the Lowlands. The amount estimated as required for the latter is £3500.

The agreement arrived at is to have effect for one year.

As regards the distribution of the mileage fund among doctors, we consulted the Approved Societies' Consultative Council, the Scottish Association of Insurance Committees and the Scottish Committee of the British Medical Association. The Consultative Council recommended a reversion to the practice which obtained prior to 1920, namely, that mileage should be paid only in respect of persons living beyond 3 miles from a doctor, and that the payments

should be reckoned from the nearest doctor and not from the doctor of choice. The recommendation was not wholly acceptable to the insurance committees and was strongly opposed by the Scottish Committee of the British Medical Association. As an outcome of the discussions on the matter the existing arrangements have been continued with the modification that insurance committees in consultation with panel committees have been allowed to depart from the general practice where circumstances seemed to make that course advisable. Generally, we have allowed insurance committees in consultation with panel committees a somewhat wider discretion in the distribution of their mileage funds for 1924. We have also arranged that the doctors who participate in the mileage allowances will keep a daily record of visits and travelling throughout the first seven months of 1924.

NECESSITOUS DISTRICTS-LOWLANDS.

The assistance provided in necessitous districts of the Lowlands followed generally the line which we have had occasion to take in former years. Certain small adjustments were made in respect of difficulty of access and footpath mileage.

We have been impressed with the importance of medical practitioners keeping in touch with the latest developments in the science of medicine, and resolved as an experiment to afford certain practitioners living in the more remote districts the opportunity of taking a post-graduate course of study in general medicine. Of the doctors whom we approached three were able to attend a course arranged by the University of Edinburgh. In expressing their recognition of the facilities which were afforded they reported that the instruction had been of the greatest benefit to them.

The purposes for which payments were made from the sum provided under this heading were:—

Cases.
38

...

...

12

...

11

8

26

13

Difficulty of access

Footpath miles

Post-graduate study

still remaining

Liability to Insurance, Collection of Contributions and Special Classes of Insured Persons.

QUESTIONS REGARDING LIABILITY TO INSURANCE.

In continuation of the policy followed in previous years, questions which arose in regard to the liability of particular employees or classes of employee to be insured were with few exceptions disposed of satisfactorily by administrative action. We have given judicial decisions in five cases in which the facts could not otherwise be properly established or in which the parties were not prepared to

accept an informal ruling. Formal hearings were held in three of these and decisions given as follows:

Case.

(i.) Boatmen licensed by the Clyde Navigation Trust to perform certain work in connection with the mooring of ships.

(ii.) Persons employed by a firm of publishers to canvass for orders.

(iii.) Men recruited by an estate owner from an employment exchange and engaged in drainage work on the estate, which was organised as a relief work and subsidised by the Board of Agriculture.

Decision.

That the boatmen were employed by the shipowners within the meaning of the National Health Insurance Acts.

That the canvassers were employed by the firm within the meaning of the Acts. That the men in question were employed by the estate owner within the meaning of the Acts.

The Society of Accountants in Edinburgh appealed from one of our decisions relative to the insurability of an apprentice receiving regular payments from his employer which the latter was under no contractual obligation to make. The practice of the employer, however, was to make such payments. The Lord Ordinary (Lord Constable) refused the appeal and upheld our decision that the apprentice in question was in receipt of money payments in the sense of the Act and was therefore insurable. The case was one of general interest as it affected the position under the Acts of a considerable number of apprentices employed by chartered accountants and other professional employers. In one case where there was no understanding between the employer and his apprentice that money payments would be made but where, in point of fact, payments, indefinite in amount, were made at irregular and long intervals during the year, we had already decided that the apprentice was not employed within the meaning of the National Health Insurance Acts.

The cases of doubtful insurability which were dealt with administratively covered a wide range of occupations and forms of contract, and the questions involved turned mainly on whether or not particular employees or classes of employee were employed under contract of service or by way of manual labour. In order to satisfy ourselves of the true circumstances in cases of doubt or of conflicting evidence we have frequently arranged for local inquiry to be made by our outdoor staff to elicit the information necessary to enable us to reach an opinion.

We have also found it profitable to consult representative industrial bodies when doubt arose in cases affecting classes of employment which might be suitable for general treatment. As a result of the general arrangement made with the entertainments industry to regulate the insurance of persons employed in places of public entertainment, to which reference was made in our last Report, we have noted a marked diminution in the number of

inquiries addressed to us in regard to the position of employees in this class. During 1923 we reached a similar general understanding in regard to the insurance of butchers' charge hands in Glasgow and district.

At the date of this Report we are considering, in conjunction with the Ministry of Health-(1) the possibility of formulating for the guidance of employers concerned a code of simple working rules applicable to the question of the insurability of marine officers and engineers; and (2) the adoption of uniform standards of value. applicable to emoluments in kind provided to these classes of employee. Both these matters have been a frequent source of difficulty in the past.

Unemployment Insurance Acts, 1920-1923.

The Ministry of Labour continue to refer to us, under the liaison arrangements mentioned in previous Reports, doubtful questions of liability to unemployment insurance where, as is ordinarily the case, the question is common to health and unemployment insurance and liability under one scheme carries with it liability under the other. Such cases are treated by us in the same way as the questions of liability to health insurance referred to in the preceding paragraphs. Administrative rulings given by us for health insurance are accepted by the Ministry of Labour as governing the position under unemployment insurance. Uniformity of treatment is thus secured and duplication of action by the two Departments avoided.

The duties involved in the supervision and enforcement, where necessary, of payment of contributions under the Unemployment Insurance Acts continues to be carried out by our inspectorate under the instructions of the Ministry of Labour. In the exercise of their duties during the year the inspectorate recovered on behalf of the Ministry arrears of contributions to the value of £19,770 which would otherwise have been lost to the Unemployment Insurance Fund.

Certificates of Exception under paragraphs (b) and (c) of Part II. of the First Schedule to the National Insurance Act, 1911. The only new certificate issued during the year was granted to the Aberdeen Parish Council in respect of employees to whom the Council had applied the provisions of the Local Government and other Officers' Superannuation Act, 1922.

COLLECTION OF CONTRIBUTIONS.

While, generally speaking, there has been an improvement in the collection of contributions, there still exists a certain amount of neglect and evasion. Constant and energetic inspection, however, is ordinarily sufficient to keep this in check and prosecution has been found necessary in only 91 cases.

The dislocation of normal industrial conditions due to continued trade depression has again tended as in recent years to cause a large volume of irregularity and, in particular, difficulties in the collection of contributions from small employers. The mass of inspectorial

work has been of the ordinary kind which has been frequently described in previous annual reports, and need not be referred to in detail here.

Special attention was given to certain types of employment in which doubt more frequently arises whether the employed persons are within the Acts, or in which for other reasons there is greater danger of evasion. Among these may be mentioned casual and seasonal labour of all kinds, employees in picture houses and icecream shops, navigating officers and engineers in the mercantile marine, commission agents and persons paid by the piece, such as road metal breakers, drainers, etc. While the number of employees concerned in such groups is relatively small, the time that has to be expended on them by the inspectorate is disproportionately large, and frequently involves close investigation into contractual and other conditions in doubtful cases. The larger businesses are, on the whole, quite satisfactory.

The following statistics give a general idea of the scope of the outdoor staff's activities during the year in the enforcement of the National Health Insurance Collection of Contributions Regulations:

It is estimated that the total number of employers in Scotland having employees insurable under the National Health Insurance Acts is 156,300, and that the total number of employees so insurable is 1,619,000. The inspectorate's surveys during the year covered 18,776 of the employers and 198,600 of the employed persons, and disclosed 3433 irregularities by employers which affected 17,235 insured persons. Fully one-fifth of these irregularities were serious. The value of arrears of contributions secured by inspectorial action which would otherwise have been lost to the National Health Insurance Funds was £6036.

During the year 85 prosecutions were instituted against employers for non-payment of health insurance contributions or failure to return stamped cards to employees. In 83 cases convictions were obtained and 2 cases are still outstanding. Fines ranging from £30 downwards were imposed.

One exempt person who had persistently refused to surrender his exemption cards timeously was prosecuted for failing to surrender his card timeously for the 1/23 period. He was convicted and fined £5.

Two insured persons were each fined £1 for failing to produce their cards to their employer, while another was fined 5s. for affixing cancelled stamps to a card.

One case under the Stamp Duties Management Act, 1891, relating to the fraudulent removal of national health insurance stamps from an insured person's card and the fraudulent affixing of cancelled national health insurance stamps to the arrears cards of three insured persons was reported to the Crown Office. A prosecution was instituted and the accused, an approved society agent, was fined £5. An insured person was fined 5s. for defacing a card and another 10s. for destroying three cards.

Outworkers-Unit System of Payment of Contributions.

The number of employers of outworkers who were paying health insurance contributions on the unit system at 31st December, 1923,