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Scotland Insured
Chapter V - The Scottish Insurance Commission

The 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.

The 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.

As 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 imperative.

To 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 England.

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 England—a 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.

Means 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.

There 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 day’s 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.

Again 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 :—

(a) Convenience and saving of expense to local administrators, insured persons, and the public generally.

(b) Scotland’s 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.

(c) 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.

(d) 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.

(e) 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.

(f) 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.

(g) Geographical and economic conditions in Scotland are so divergent that only a National Commission can satisfactorily adapt its methods to them.

(h) 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.

(i) The National Health Insurance Scheme is so gigantic that division of labour and of responsibility is expedient.

(j) 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.

(k) 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.

(l) 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 required.

(m) 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 conditions.

(n) 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 Authority.

(o) 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 Scotland.

(p) 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.

It 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.

The 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 Societies.

It 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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