This tendency is defended on the ground that the numbers are so large as to make it necessary to clear the wards daily. There is force in this argument so long, and only so long, as the adjoining Unions fail to require a full measure of detention in their wards, and it is hoped that in this respect, at any rate, the efforts of the Vagrancy Committees may be successful in securing improvement.

It is feared that the importance of the activities of Vagrancy Committees as co-ordinating bodies is not sufficiently appreciated by the Guardians. On the 20th July, 1921, the Department issued circular letters drawing the attention of all Boards of Guardians in areas for which no Vagrancy Committees were in existence to the urgent importance of establishing such Committees, and pressing upon Boards of Guardians not participating in schemes established for their areas the arguments in favour of participation. As a result of this action a Committee has been established for the County of Kent, but Committees are still required in some counties.

A deputation from the National Association of Vagrancy Committees, received on the 8th June by the Parliamentary Secretary, Lord Onslow, advocated the compulsory establishment of Vagrancy Committees and compulsory membership of such Committees, extended powers of detention, and the institution of labour colonies for the treatment of hardened cases.

Attention may be drawn to the possibility, through the agency of the Vagrancy Committee and its pooling arrangements, of offering without undue cost to the particular Union a permanent refuge in the institution to aged and infirm tramps, and of similarly taking permanent charge of children brought to the casual wards.

ASSISTANCE TO DESTITUTE ALIENS AND OTHER
SPECIAL CLASSES.

On the expiration of the first quarter of the year under review, in respect of which, as was intimated in last year's Report, the Committee were authorised to continue payments to families of Russians who left the country to join the Russian Forces, the Treasury consented to give the Committee full discretion, subject to audit, as to the rates of relief and the expenses to be incurred in connection with repatriation, on the understanding that the total liability of the Government under these two heads, as from the 30th June, would not exceed £20,000 for relief and £5,000 for repatriation.

With a view to enabling the Committee dealing with the cases of British refugees from Russia to provide for the final settlement of a comparatively small number of cases of acute hardship, the Treasury consented to the extension of the sum of £3,000 to which reference was made in last year's Report by a further sum of £500.

Sums awarded by the Treasury as ex gratia compensation for personal injury due to enemy action and resulting in death or permanent disablement have, as was explained in the 48th Annual Report of the Local Government Board, hitherto been paid out of the Department's Vote, and the services of the Department have been utilised by the Treasury for the purpose of investigating the circumstances and state of health of applicants. This arrangement has now been terminated, and any future applications will be transmitted to the Reparations Claims Department of the Board of Trade.

The total number of applications which have been received since September 1917, when the Government inaugurated the scheme, is 757, comprising 333 cases of distress due to the death of persons upon whom the applicants were dependent, and 424 cases in which permanent injury produced distress owing to loss of actual or prospective earning capacity. Awards have been made in respect of 233 of the applications in respect of death, and 214 of the applications in respect of injury, accounting for 447 of the total number of applications. The total amount charged to the Department's Votes since the inauguration of the scheme is £59,787 18s. 5d., comprising £39,589 17s. 3d. in respect of death and £20,198 1s. 2d. in respect of injury. Payments are still being made in 47 cases of death and 107 cases of injury.

DEPARTMENTAL PROCEDURE.

Following the action taken in the previous years in the direction of the decentralisation of Poor Law administration, a careful review has been made of the returns and applications required in various connections from the Poor Law Authorities. In a number of cases emergency arrangements for the reduction of the work involved had been made during the War, and had proved of practical advantage, and in these cases and in certain other directions permanent modifications of procedure have been made or suggested. For details reference may be made to the circular letter (Circular 223) in which the decisions made were communicated to the Guardians. These decisions, and others of a similar kind, have been effective in reducing the work of the Department, and making it possible, in spite of a considerable reduction. in staff, to deal with the additional work resulting from the high level. of pauperism.

In several directions such economies have resulted from the consideration of suggestions made by individual Boards of Guardians, and though the field for economy of this kind without further legislation appears to have been materially restricted, the Department will readily consider any further suggestions placed before them. The need for additional inspection owing to the great increase in out-relief during the year was partly met by the appointment of two members of the existing staff to share the work of two of the General Inspectors. On the retirement of Dr. Fuller after a long period of devoted service his duties were divided between a number of Medical Officers already on the staff.

REGULATIONS.

Consideration has been given to the question of the revision and consolidation of the regulations made by the Minister and his predecessors, and appreciable progress has been made. It is intended that an opportunity shall be afforded to the Poor Law Associations of considering drafts of the revised regulations, and it is hoped that one or more sections may shortly be issued for this purpose. In particular, the draft of a general infirmary order is in an advanced stage of preparation, and in view of the progress made it has been decided to postpone action on an application for the issue of a special order on this subject to the Stoke-upon-Trent Union. Such special Orders were in the earlier part of the year issued in respect of infirmaries belonging to the Ashton-under-Lyne, West Ham and West Derby Unions.

(6478)

E

By a General Order, entitled the Powers of Boards of Guardians Order, 1921, provision was made to enable the Guardians to deal without reference to the Department with a number of matters in which the approval of individual applications had previously been

necessary.

Proceedings under the Unemployed Workmen Act, 1905.

GENERAL.

The Unemployed Workmen Act, 1905, was again extended by the Expiring Laws Continuance Act, 1921, but, in view of the decision to afford Government assistance in the provision of relief works by way of such grants as those made to Town and District Councils by the Unemployment Grants Committee, money has not been available for grants to the Distress Committees. In a few instances Committees are known to have taken action on a voluntary basis. Thus the Reading Committee has acted as agent for the Guardians in supervising work upon which unemployed persons were engaged, and the Leicester Committee has co-operated with the Guardians for the provision of a work scheme for persons in receipt of relief. Reference has already been made to the scheme promoted by the Central (Unemployed) Body for London for the utilisation of their farm colony at Hollesley Bay, for the reception and training of able-bodied persons chargeable to the several Metropolitan Unions. A similar scheme has been brought into operation by the West Ham Committee, who possess a farm colony at South Ockendon, and are maintaining some forty able-bodied men who are chargeable to the West Ham Union.

Old Age Pensions.

ISSUE OF REVISED REGULATIONS.

On the 13th January, 1922, copies of Consolidated Regulations, made under section 10 of the Old Age Pensions Act, 1908, were circulated to Local Pension Committees and Sub-Committees. The Regulations differ only in points of detail from the provisional Regulations of 1911 and 1920, which they supersede and revoke.

APPEALS.

During the year ended 31st March, 1922, 8,325 appeals were received against decisions of Pension Committees and Sub-Committees, 8,722 appeals were decided and 341 appeals were withdrawn or otherwise disposed of. The appeals received included 916 appeals on cases in which a pension was claimed, or was being received, under the Blind Persons Act, 1920.

NUMBER OF PENSIONERS.

The number of pensions payable on Friday, the 31st March, 1922, was as follows:

making together 761,958. This total includes 9,107 pensions awarded under the Blind Persons Act, 1920, distributed thus:

The total number of pensions payable in the United Kingdom on the same date was 1,029,367-366,255 to men and 663,112 to women-and included 14,222 pensions awarded under the Blind Persons Act, 1920. Of the total number of pensions payable, 958,909, or 93.2 per cent., were at the maximum rate of 10s. a week.

As compared with the 25th March, 1921, the number of pensioners in England shows an increase of 3.8 per cent., in Wales an increase of 3.4 per cent., and in the United Kingdom an increase of 2.7 per cent. Excluding pensions awarded under the Blind Persons Act, 1920, the figures show the following increases in the number of pensioners as compared with the previous year, viz., England 3.7 per cent., Wales 3.1 per cent., and the United Kingdom 2-4 per cent.

IV. NATIONAL HEALTH INSURANCE.

Medical Benefit.

RECONSTITUTION OF INSURANCE COMMITTEES.

The local administration of this service is in the hands of Insurance Committees, which up to October last consisted of from 40 to 80 members. In the interests of economy the size of the Committees was reduced during the year, and they now consist of from 20 to 40 members. New Committees with the reduced membership were constituted as from the 1st November last, and will hold office for three years. Two new Committees, the constitution of which had been deferred during the war, were established for the County Boroughs of Darlington and East Ham.

SCOPE OF MEDICAL BENEFIT.

The treatment which an insurance practitioner is required to give is defined as “such treatment as is of a kind which can consistently with the best interests of the patient be properly undertaken by a general practitioner of ordinary professional competence and skill." Machinery is provided for determining whether a particular service comes within this definition. (See last year's Report, page 39.)

During the year 31 cases in all were reported to the Department. In 22 cases the Local Medical and Insurance Committees were in agreement, the decision in seventeen of these cases being that the service was not, and in five that it was, within the definition quoted above.

None of these cases was deemed of sufficient importance to necessitate an opinion of referees.

Of the remaining nine cases, six were automatically referred to referees, as the Local Medical and Insurance Committees disagreed. Of these six cases, four were found to be within, and two to be not within, the definition.

E 2

Three cases were referred to referees under the discretionary powers contained in the Regulations notwithstanding the fact that the Local Medical Committee and the Insurance Committee were in agreement. In two of these cases the referees decided that the service was not, and in one case that it was, within the scope of the definition.

COST AND EXTENT OF THE SERVICE.

The total cost of the medical benefit for the insured for the year 1921 was, for England, about £8,250,000, of which about £6,885,000 was paid to the doctors, and the remainder spent on drugs and appliances, apart from a small sum expended on the treatment of persons who get their benefit from approved medical institutes or under special arrangements. The total insured population entitled to treatment is about 12,500,000. As explained in a previous Report, the sum carried to the medical pool out of which the doctors are paid is now fixed on an actuarial basis, and was calculated for the year 1921 on a capitation fee of 11s. As the result of negotiations with representatives of the doctors the capitation fee was reduced to 9s. 6d. as from the 1st January, 1922, and this fee will remain operative for two years.

In addition to the sums distributed to doctors out of the general medical pool, a sum of about £250,000 for supplementing the income of rural practitioners on account of mileage in 1921 was granted out of moneys provided by Parliament.

The sources from which these sums were derived, and the machinery employed for their distribution, were, in 1921, similar to those described with reference to the year 1920 in the previous Report.

DRUGS FOR INSURED PERSONS.

The yearly cost at present of drugs and appliances supplied to insured persons is about £1,250,000. The chemists receive a payment per prescription for services rendered and establishment charges-the payment for different classes of prescriptions varying in accordance with a scale—and in addition the actual cost of the ingredients in the prescription as set out in the Drug Tariff, the table of drug prices being revised month by month. The payment made to chemists during 1921 represented an average (apart from the price of ingredients) of about 5d. for each prescription. In view of the prevailing economic conditions an all-round reduction of 1d. in the payment per prescription has now been made, to take effect as from the 1st May, 1922.

The Act provides that insured persons should have proper and sufficient medicines. Reference was made in last year's Report to the fact that the criticism is sometimes made that insured persons do not get the "proper and sufficient medicines" to which they are entitled because doctors, it is said, hesitate to provide expensive medicines which they think necessary, as the regulations provide for surcharging doctors for excessive prescribing. It appears desirable to repeat that no insurance practitioner can be penalised in any way as a result of his prescribing particular drugs or appliances unless it is found after an investigation that by reason of the character or quantity of the drugs or appliances so ordered or supplied the cost is in excess of what may