CARD INDEX.

(9) Your Committee have given some consideration to the subject of the Card Index in relation to National Health Insurance. The necessity for such an index arises from the mobility of the insured population. In the absence of such an index a reduplication would be inevitable, and it would be impossible to assess fairly the remuneration of the panel doctors. The question naturally arises whether it would not be possible to save public funds by an amalgamation of the card indices of persons insured for health and persons insured for unemployment. Health Insurance covers about sixteen million and Unemployment Insurance about twelve million persons.

(10) A Committee under the Chairmanship of Sir Alfred Watson was appointed in January, 1922, to consider inter alia this question of amalgamation, but that Committee has not yet reported thereon, and pending its Report your Committee are unable to express an opinion on a highly technical problem, but they deem it their duty to report to the House of Commons that the question is one which calls for the attention of the House.

HOUSING GRANTS.

(11) The estimate for Housing Grants for the current year amounts to £8,050,000, being a decrease of over £500,000 on last year's estimates. The decrease appears to be due partly to the fact that the work of building houses has taken longer than was anticipated, and partly to the fact that the figure of £8,627,500 for last year was admittedly an over-estimate.

(12) Your Committee would remind the House that the Geddes Committee strongly recommended that the liabilities of the State should be curtailed by promoting a policy of sale. That policy has not been carried out, mainly because the Ministry of Health deem it undesirable to put pressure upon the local authorities. The Ministry of Health are reluctant to exert such pressure in view of the fact that in their opinion the local authorities could not now obtain the capitalised value of the unsubsidised rents of occupied houses.

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THE SELECT COMMITTEE ON ESTIMATES have made further progress in the matters to them referred, and have agreed to the following THIRD REPORT.

MINISTRY OF PENSIONS.

1. Your Committee have investigated the Estimates of the Ministry of Pensions, and have examined Sir George Chrystal, K.C.B. (Permanent Secretary), Mr. R. J. Coles, C.B.E. (Financial Assistant Secretary), and Mr. E. H. Hodgson, C.B. (Principal Assistant Secretary).

2. The Ministry of Pensions was established by an Act of 1916, in pursuance of which an Order in Council was issued transferring to the Minister of Pensions as from the 15th February, 1917, the powers and duties of the Admiralty, the Chelsea Commissioners and the War Office in regard to the administration of pensions to officers, nurses and men in respect of disablement, and to their widows, children and other dependants in respect of death. The Act further provided that the powers and duties of the Statutory Committee of the Royal Patriotic Fund Corporation should be exercised by the Minister of Pensions. This Statutory Committee was dissolved in 1917, and its powers and duties were transferred in part to the Minister of Pensions and in part to a new Committee appointed by the Minister of Pensions and called the Special Grants Committee. Chief among the functions so transferred to the Minister of Pensions was the duty of making provision for medical treatment and for training. In 1919, however, the responsibility for training was transferred to the Minister of Labour, except in so far as it was deemed necessary to provide training in conjunction with treatment under medical supervision. The duties of the Minister of Pensions were further limited to provide for the transfer or re-transfer to the Service Departments of matters in connection with pensions for disablement in times of peace. Since that date the two main functions of the Ministry of Pensions have been: (1) The award and payment of compensation in respect of disablement or death arising as the result of service in the Great War or in any former war; and (2) The provision of medical and surgical treatment for disabilities so incurred. The Ministry continues to be responsible not only for Northern but for Southern Ireland.

3. The organisation of the Department is three-fold, namely, Local, Regional, and Headquarters. The Area Offices discharge

the executive functions formerly performed by the Local War Pensions Committees; the latter are now purely advisory bodies. Members of these advisory Committees receive travelling expenses and compensation for loss of time. The large majority of cases are dealt with by the Regional Offices, which are in effect the executive of the Ministry.

4. The Estimates for the current year, 1924-25, amount to £66,947,180. This compares with an Estimate of £73,655,246 for 1923-24, and with a nett expenditure of £106,366,500 for the year 1920-21, when the peak was reached. The main causes for the decline from the highest point, apart from the deaths of pensioners, are the recoveries of pensioners under medical treatment, the re-marriage of widows, and the growing-up of the children; but the Ministry claim credit, and, in the opinion of your Committee, justifiably, for progressive reductions in expenditure wherever these have been possible without interfering with the interest of the pensioner. The capital value of present war pensions liabilities is estimated at about £900,000,000, as compared with about £1,400,000,000 in 1921.

5. The present staff of the Ministry is just over 18,000, as compared with 32,045 in 1920-21, and the cost of staff has been reduced to £2,337,000 as compared with £4,252,188 for the peak year. The percentage cost of administrative expenditure is about 453 per cent., as compared with 59 per cent. for the peak year, 1920-21. This diminution in the percentage of administrative costs, attained without impairing the efficiency of the medical or non-medical services of the Ministry, is in our judgment highly creditable to the organisation of the Department, and we are gratified to learn that we may expect further economies in the near future.

6. The estimated appropriations-in-aid for the year 1924-25 amount to £66,000, as compared with the actual appropriations-inaid for 1923-24 of £125,000. This diminution is due partly to the fact that sales of hospitals and equipment cannot be looked for on a large scale in future, and partly to the gradual abandonment of the policy of making recoverable advances for pensions, a policy admitted to be objectionable.

7. The Ministry have given careful consideration to the question of treatment allowances, and in particular to the possibility of instituting differential rates for different localities. At present treatment allowances do not vary according to localities, with the result that in certain Counties where wages are low the treatment allowance is considerably in excess of what the patient could earn in health. There are obvious objections to this, but it is held that owing to the wording of the Warrant the treatment allowance is interlocked with the pensions scale, and, after very careful consideration of the matter it was decided that it would be impossible to separate the two scales without a breach of faith.

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8. In regard to hospital treatment the policy of the Ministry is to rely mainly upon Ministry of Pensions hospitals. The question of utilising, on the one hand, military and naval hospitals, and, on the other, ordinary civil hospitals has we understand been carefully considered, but, in our opinion, insufficiently. There are at present 36 Ministry hospitals, with just over 8,000 beds, of which 10 or 15 per cent. are unoccupied. It is believed that there are a considerable number of beds unoccupied in the military hospitals, some of which are in districts also served by Ministry of Pensions hospitals, and we recommend that the question of utilising them for patients under the Ministry of Pensions be further and immediately reconsidered.

OFFICE OF WORKS.

1. Your Committee also investigated the Estimates of the Office of Works, and examined Sir Lionel Earle, K.C.B., K.C.V.O., C.M.G. (Secretary), Mr. J. A. W. Buchanan, C.B.E. (Controller of Accounts) and Mr. James Eggar, C.B.E. and Mr. W. Leitch (Assistant Secretaries).

2. The work of this Department consists, broadly speaking, of (1) the erection of any new buildings required for the Civil Services; (2) the maintenance, repair, alteration, &c., of existing public buildings and of the Royal Palaces, and the maintenance of the Royal Parks; (3) the administration and maintenance of the Osborne Convalescent Home for Naval and Military officers; and (4) the administration of a number of deposit and non-Voted services, i.e., works carried out on repayment terms for other Departments. There is a constant tendency to throw additional work upon this Department.

3. The normal total expenditure of this Department is in an exceptional degree dependent on rates of wages and prices of materials, but receipts have in recent years been largely swollen by the disposal of stores and furniture; thus, in the year 1923-24, receipts amounted to £877,124, as compared with £52,382 in the year 1913-14. A sum of £11,500 a year is at present received for the letting of chairs in the Royal Parks.

4. The nett Estimates for the present year are £4,815,000, as compared with £5,583,620 for 1923-24. These figures compare with £2,484,894 for the last pre-war year, and with nearly £11,000,000 for the year 1921-22, when the peak was reached. The administrative staff was 1,683 on the 1st April, 1924, which compares with 770 for the 1st August, 1914, and with 1,853 for the peak year. The cost of the administrative staff for 1923-24 was £567,907, compared with £149,660 for the year 1913-14,

and, what is more remarkable, the percentage cost of the staff for last year was 8.5 on the total expenditure, as compared with 5.9 for 1913-14; but the Office points out that the figures are not fairly comparable, and that the percentage cost has been increased (1) by the employment, in accordance with the settled policy of successive Governments, of partially-trained men; and (2) by the fact that the work is in many ways more complex than before the war. Your Committee were informed that one of the main reasons for the increase in the percentage cost of staff and expenditure generally was the enlistment of men through the Joint Substitution Board who are not up to the full standard of efficiency as compared with the pre-war staff. This is a direct consequence of the war, and while the problem of employing, as far as possible, ex-service men in Government Departments must be sympathetically dealt with, the consequences to the Public Service are likely to continue, and possibly to become accentuated. To the extent that the efficiency of the Department is lowered, so, in the same measure, is the cost of administration increased. This lower standard is naturally more apparent among the lower grades in the service than in the higher grades.

5. The rental expenditure for the current year is estimated at £365,500, which compares with £409,230 for last year, and with £459,900 for the year 1922-23. Maintenance, repairs and unemployment relief works show a reduction to about £384,000, as compared with £412,000 for 1923-24. The Office of Works has, so far as possible, adopted the recommendation of the Geddes Committee that resort should be had to hired accommodation for Employment Exchanges rather than to the erection of temporary buildings, and your Committee are informed that there are practically no permanent buildings being erected at present for Employment Exchanges.

RE-VOTES.

6. Your Committee have paid considerable attention to the question of re-Votes in relation to current Estimates. The total amount of re-Votes in the 1924-25 Estimates for the Civil Service and Revenue Departments amounts to no less a sum than £1,690,574, of which the grants for compensation for damage by enemy action account for £500,000, payments under the Coal Mines Emergency Act £500,000, and Revenue Buildings £151,409. The reason for these exceptionally large re-Votes are (1) The Coal Mines Department were not able to settle accounts in 1923-24 to the full extent of their Vote (£1,500,000); and (2) The disappointment of the expectation that the Royal Commission on Compensation for Enemy Damage would report for payments to be made in the year 1923-24. The re-Vote for the Office of Works, however, can hardly be regarded as exceptional having regard to past experience. The Estimates for which this