is 
el 
MAJORITY REPORT. 
person, and we are informed that so far there has been no case 
in which the penalty has been imposed. 
643. After careful consideration of all the evidence before us 
we think that this method of providing medical attention and 
treatment is an anomalous feature in a scheme of which the 
cardinal principle is a contract between Insurance Committees 
on the one hand and individual independent doctors on the other, 
and that it introduces lay control over professional men in an 
undesirable form. On the other hand we consider it necessary 
to have regard to the recognition by Parliament of these insti- 
tutions at the time when the scheme was introduced, and to the 
fact that there is no evidence of failure sufficient to justify a 
recommendation on our part that the recognition of the insti- 
tutions for the purposes specified should now be withdrawn. The 
original Act, it will have been noted, restricted recognition to 
those institutions then in existence, clearly designing that this 
method of providing Medical Benefit should be exceptional and 
should be regarded as an unavoidable inheritance from the past. 
We do not consider either that that uecision should be reversed, 
or that power should now be given to recognise further mstitu- 
tions beyond a small group of a special type, to which we refer in 
paragraph 648 below. On the question of the control over the 
salaried doctors in the institutions, we feel that that must neces- 
sarily continue to be exercised by their employers who are the 
committees of the institutions, though at the same time we think 
that no rule of an institution should purport to debar a member 
of the institution from carrying an appeal as to his medical 
treatment to the Insurance Committee in the area. 
644. Our attention has been directed to the peculiar position 
of the medical institutions in South Wales specially set up under 
Section 24 (3) of the 1924 Act for the provision of medical treat- 
ment and attendance to persons who are allowed to make their 
own arrangements for Medical Benefit. 
645. A distinction is to be drawn between those medical 
institutions which were in existence before the date of the passing 
of the original Act and which have been approved under Sec- 
tion 15 (4) of that Act (Section 24 (4) of the 1924 Act), and those 
new institutions which, although they are not entitled to recogni- 
tion under Section 24 (4), are set up for the provision of medical 
benefit under what is known as ** collective own arrangements 
allowed by Insurance Committees under Section 24 (3). In these 
cases the Insurance Committees in effect allow insured persons 
to make their own arrangements to receive medical benefit 
through an institution which is debarred from recognition as such 
under the Act. With regard to the latter type of institution, the 
British Medical Association, in their evidence, objected to the 
fact that they were under lay control, and stated (Q. 15,222) 
that * their influence has been very detrimental indeed to the