V - The Scottish Insurance Commission
Insurance Act in Scotland is administered by the Scottish Insurance
Commissioners, and the Scottish Health Insurance Fund is under the
control and management of the Scottish Commissioners. Insured persons in
Scotland are under the supervision and control of the Scottish Insurance
Commissioners, and insured persons resident in Scotland, even although
members of English, Irish and Welsh Societies, are considered to be
Scottish and under Scottish control. It should be specially noted that
for the very important Insurance purposes relating to valuations,
surpluses, deficiencies and transfers, insured persons resident in
Scotland, irrespective of what Society they are attached to, must be
treated as if they formed a separate Scottish Society.
Amending Act alters this position of affairs. Further reference will be
made to the changes introduced by the new Act in this .respect. In the
meantime, it may be stated that, to put it as succinctly as possible,
Scotland, so far as National Insurance under the National Insurance Act
is concerned, is under Home Rule.
considerable discussion has arisen with regard to the policy of having
separate National Commissions for Insurance purposes, it may be helpful
to examine the case for and against a separate National Commission. It
should be borne in mind that not a word has been alleged against the
capacity or operations of the Scottish Commissioners. The success of the
Scottish Commission is undoubted, and it is generally admitted that
Scotland stands well in the front of National Insurance in every
direction. For various reasons separate treatment of Scotland is
take first of all the geographical position, Scotland differs
considerably from England in several important respects, and such
differences involve administrative variation in treatment. The area of
England amounts to 50,823 square miles. The area of Scotland, with its
islands, is 29,820 square miles, being rather more than half the area of
Around Scotland there are no fewer than 788 islands, of which 600 are
inhabited. The coast line of Scotland is actually 700 miles longer than
the coast line of Englanda much larger country.
Scotland is a much more mountainous country than England. The climate of
Scotland is colder and damper than that of England. The higher parts of
Scotland are more liable to be under snow in winter than are the low
lying parts of the country in England.
Scotland is much more sparsely populated than England. In proportion to
population, England is four times more thickly populated than Scotland.
of communication are not so good in Scotland. In the Islands there are
no railways, and on the mainland there are fewer railways than in
England. The main roads in Scotland are good, but hilly. Many of the
side roads are fair, but many are bad.
are great economic differences in Scotland as compared with England. The
Lowlands of Scotland generally are prosperous, although there are many
special administrative difficulties caused by sparseness of population
and lack of means of communication. In the Highlands and Islands of
Scotland in many parts there exists a combination of adverse influences
which are not equalled in any part of Great Britain and Ireland, partly
because of climate and soil, difficulties of communication, sparseness
of population, great poverty, and specially restricted means of gaining
a livelihood. There is no part of Great Britain which presents to the
administrator so many difficulties of an embarrassing nature. It is
almost impossible to realise that within a days run from London there
exist a lonely people speaking a different language, living in a strange
land, among mountains and islands, trying to extract a precarious and
hard living from a barren soil or an angry sea. It is only on railway
posters that the Highlands of Scotland are painted in enticing colours.
The life behind the picture is our real concern.
it is necessary to remind Englishmen especially that Scotland has been
accustomed to a liberal measure of self government, and that in
Education and Local Government many changes have been introduced and
systems peculiar to Scotland have been successfully instituted and
organised as part of a separate and efficient system of local self
government. Many separate Scottish departments have been set up, and it
is generally admitted they do their work to the satisfaction of the
Scottish people, always bearing in mind the strong preference for
immediate control by a local parliament. This proviso does not apply to
the Insurance Commission, which has its headquarters in Edinburgh and so
is accessible to the Scottish people and responsive to public opinion.
The case for a separate National Commission could be summed up by
stating that Scotland is a separate nation, with many separate
geographical and economic features, with differences in climate, means
of communication, law, language and custom. Briefly, and in tabular
form, here are the considerations which seem to us to make a separate
Commission indispensable :
Convenience and saving of expense to local administrators, insured
persons, and the public generally.
Scotlands different code of law, judicature, and system of local
government necessitates a body in close touch with the genera!
administrative and legal machinery of the country.
The important public health aspects! of National Health Insurance
necessitates harmonious co-operation with the Public Health Authorities,
and this can only bo effectively secured by a Scottish body.
That there should be a Scottish Commission is in line with modern
tendencies. In practically all the comparable spheres of government
separate National Central Authorities have been set up.
Local Government in Scotland is of a much more democratic character than
in England, and local bodies are less likely to work well under a
central administration dominated! by prevailing English ideas.
In administering an Act like the National Insurance Act a tendency
towards bureaucracy is apt to arise. A Scottish Commission through its
close touch and sympathy with subordinate bodies is less likely to
retrograde in this direction.
Geographical and economic conditions in Scotland are so divergent that
only a National Commission can satisfactorily adapt its methods to them.
With separate Commissions it is much easier to allow latitude as regards
regulations necessary to meet the differing circumstances in the two
countries. The position of a body which attempts to make different
Regulations for different parts of the area within its jurisdiction is
less easy to defend against malcontents in both parts, even granting
some difference of circumstances.
The National Health Insurance Scheme is so gigantic that division of
labour and of responsibility is expedient.
The system of medical and pharmaceutical service in Scotland is so
essentially different from' that in England and is also so greatly
affected) by the geographical configuration of the country that the
mediical administration of the Act can be successfully conducted and
supervised only by Scotsmen in close touch with the interests concerned.
The doctors and chemists in Scotland look at matters connected with the
Act in quite n different light from their English colleagues, and their
methods of thought are very dissimilar. A Commission acquainted with
their peculiarities can alone deal satisfactorily with them.
The tuberculosis problem in Scotland is totally different from that in
England, and to grapple with jt a Commission in close touch with the
Scottish Local Government Board and Scottish Local Authorities is
There is no Midwives Act in Scotland, and the administration of
Maternity Benefit has accordingly special characteristics which require
the close supervision of a Commission having personal knowledge of the
The Scottish Poor Law and Public Health Medical Services are under the
supervision of a Scottish Central Body. There is equal need for the
supervision of National Health Insurance by a Scottish Central
The British Medical Association and the Pharmaceutical Standing
Committee found it necessary to recognise the special conditions in
Scotland by setting up independent Committees to deal with Scottish
Insurance questions. The objects of these bodies were severely
practical, and if decentralisation was necessary to deal with their
comparatively small problems, a fortiori
it is necessary in the case of the large problems which have to be
envisaged by the administrators of the National Insurance Act in
The personal knowledge of the people and the problems to be dealt with
possessed by the Scottish Commissioners and their proximity to the scene
of action have often enabled them to overcome difficulties which must
have proved insuperable to a remoter central authority.
may be added that representations in favour of a separate Commission for
Scotland during the recent discussion in Parliament were received from
various sources, notably the National Conference of Scottish Friendly
Societies and bodies representing Chemists.
opposition to a separate national commission arises in the first place
from those who are in favour of centralised government as against local
government. In the debate in the House of Commons during the month of
August, 1913, only one popularly elected Scottish member of Parliament
voted against the continuance of the Scottish Commission. The main
argument is that trouble is caused in certain directions. The directions
are not usually specified and nothing is said about the trouble that
would be caused to the mass of the people by one Commission. Indeed, Mr.
Worthington Evans, the Member for Colchester, was forced to depart from
his plea of one Commission, and his motion actually included the
retention of truncated or delegate commissions in each country. The
complaints as to extra work entailed on a few secretaries is surely a
small matter compared with the convenience and better local management
of a million and a half people. In any case arrangements can be made and
are being made to introduce a six month's card, and in other ways to
simplify procedure and reduce as far as possible the amount of
book-keeping which at present falls on certain officials of some
has been frequently stated, but never proved, that the separate
commissions are expensive, and that money could be saved by
amalgamation. It is assumed by these critics that the staff attached to
each commission could be abolished. The critics have never once examined
the case to see whether inspectors, clerks and accountants could be
abolished or reduced. It will be seen at once that they could not.
Accountants, card sorters, clerks and inspectors would be required for
Scotland irrespective of whatever kind of Commission existed, and the
only difference, so far as expense is concerned, would be that one or
two Commissioners could be dispensed with. On the other hand, the
officials in Edinburgh would have to refer everything to London, with
all the attendant delay and expense that is so irritating a feature of
the Civil Service system to-day. To the vision of the critics there
appears a vast army of officials employed solely because of the separate
Commissions. The National insurance administration is to some extent
fortunate in being able to use other Government Departments, such as the
Post Office and the Customs and Excise, and there is little doubt that
but for this aid there would, especially in the initial stages, have
been a greater number of officials required. It may be news to the
public and to the critics to find that the entire staff of the Scottish
Commission from Commissioners to doorkeepers and including clerks and
inspectors is 221. The whole of the charge for this staff is put on the
Civil Service estimates. In other words, the cost rests on the general
taxpayer. The total charge for staff for 1913-14 is about £30,000, or an
average of about £135 per annum per official.
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