This morning, Mr. Speaker, I have no lengthy statement to make with regard to the business of the House. On behalf of the hon. the Prime Minister I just want to wish hon. members a very pleasant rest.

When the House meets again on 14 April, that week will be devoted to the Second Reading debate on the Appropriation Bill.

Mr. Speaker, when the House adjourned yesterday, I was in the process of sketching the events that took place after I read in the Press about the so-called 52,2% increase in the tariffs of doctors and dentists and the public reaction that followed it. I then made a public request to the Medical and Dental Council to reconsider this matter and following that, I took the only legal alternative by addressing a written request to the President of the Council in terms of section 8(2) of the Act asking him to convene a special meeting of the council with a view to reconsidering the fees that the council had determined and to determine new fees. The ordinary meeting of the council took place on 15 October 1979, and on this occasion I addressed the council by invitation. At this meeting, the council decided to accept the fees on which it had already decided, and that they would be implemented as from 1 November 1979, or as soon as possible after that. Under pressure from members of the council to convene a special meeting in order to implement my request, the council met on 17 October 1979.

The request that I addressed to the council to reconsider its decision, was made on the basis of legal advice from the State Legal Advisers, to the effect that the council was in fact in a position to implement my request. However, the council obtained a conflicting legal opinion and on the basis of that the following decisions were made—

1. 1. That in view of the legal opinion contained in document Council 55/October 1979, this council is not in a position to consider any representations until the medical and dental tariffs have been promulgated in the Government Gazette in compliance with all the statutory requirements;
2. 2. That the tariffs committees be instructed to convene as soon as possible after the promulgation of the tariffs in the Government Gazette to consider the tariffs of medical and dental fees;
3. 3. That the registrar be charged in consultation with the chairmen of the tariffs committees to give effect to paragraph 2; and
4. 4. That the tariffs committees report to council at its next meeting in April 1980.

The public was up in arms about the decisions of the council and the Government was powerless to take any further steps in this regard at that stage.

I have now briefly stated the factual course of events. At this stage I do not want to comment on the merits of the fees which the council determined, because I have already done so to the council. I want to limit myself to the legal aspects of this matter only.

If practitioners are dissatisfied with fees determined in terms of the present dispensation, they simply give notice in terms of section 29 of the Medical Schemes Act that they are not prepared to provide services at the tariff of fees, and in that case they stipulate their own fees. This is to the detriment of a member of a medical scheme, because in such a case he is obliged to pay the difference. Whenever fees have been modified in the past, this was followed by a public reaction, the most vehement of which occurred on the occasion of the latest determination of fees. This in turn places the professions concerned in the unenviable position of having to motivate their fees in public. We cannot carry on like this. The whole dispensation of the provision of health services is being adversely affected. As a result of the increase in costs, it may happen that patients who need care, simply cannot afford it. On the other hand, the practitioners cannot be expected to practice their professions under these conditions. These conditions cannot but lead to the undermining of the professions in the Republic and to damage the relationship between practitioner and patient. The determination of fees for members of medical schemes is a small aspect of health service in general, but it is interwoven with all the facets insofar as costs for the patient are concerned. That is why the Government thought fit to have health services in their entirety investigated by a commission with a view to placing the costs for the patient on a fixed basis. In the meantime, however, since the council has decided that the fees that it determined, should be reconsidered and that there were no legal provisions with regard to the periods within which fees could be considered or modified, I am of the opinion that as far as this matter is concerned, the Act should be amended as indicated in clauses 8 and 9(c). The question of contracting in and contracting out has been included in the Medical Scheme Amendment Bill.

Nevertheless, I want to state two matters very clearly, so that there will be no misunderstanding. Medical schemes developed in order to keep the cost of medical services within the means of members. If such schemes had not developed, a considerable number of members of the present medical schemes would have been dependent on the State for services because they would simply not have been able to afford it themselves. This would have resulted in a socialization of services, and the Government has repeatedly expressed its opposition to such a system, through my predecessors and myself. However, medical schemes function within the capabilities of their members and we must guard against the cost aspect becoming so out of control that people can no longer afford to belong to a medical scheme.

Therefore, I want to stress once again that it is not the policy of the Government to create a socialized health service. Nor am I seeking confrontation with any profession or with the medical schemes. Nor do I intend to play off various aspects against a profession or medical scheme. I am simply seeking harmony in the health set-up, so that the man in the street can be satisfied with his obligations and the practitioner can be satisfied that he is receiving a fair dispensation. During two interviews with each of the executive committees of the council, the Federal Council of the Medical Association and the Dental Association, I held an in-depth discussion with the professions on this whole matter. I think we understand one another better now and that we now have a mutual understanding and appreciation for one another’s standpoints.

At the moment the Act provides for full registration of psychologists who come from outside South Africa and have obtained their qualifications there if there is an agreement of mutual recognition of qualifications between South Africa and such a country. There are not always registering bodies for psychology abroad nor any such agreements. Consequently the Professional Board for Psychologists recommended that this provision be deleted. The necessary power for the board to register a person if he has an acceptable qualification, still stands. Clause 1 deals with this aspect.

The present provisions concerning the institution of control over a supplementary health service profession, are cumbrous and long-winded. Amongst other things the provisions call for the Minister, if he is satisfied that there are enough qualified persons to serve the residents in an area, to declare such an area a prescribed area in which only registered persons who belong to the relevant profession, may practise. As matters stand at present, professions will not be able to be controlled within the foreseeable future due to a shortage of manpower. If an area is declared a prescribed area, we are faced with the problem of established rights of unqualified persons and the same time this problem continues in those areas that have not been declared prescribed areas, since nothing prevents newcomers starting to practise in such areas. In view of this, amendments are made in clauses 3, 4 and 5 to eliminate the problems. This will result in established interests being protected and complete control being established over a group without new, unqualified people being able to practise such a profession legally.

The remaining provisions of the Bill have been introduced at the request of the council with a view to eliminating deficiencies. The Bill has been published for information and comment in the Gazette.

Mr. Speaker, ever since 1967, when the Medical Schemes Act was first passed by Parliament, there has been a long and very unsatisfactory search for a method or scheme by which medical tariffs could be determined on the one side by the medical profession and on the other side to the satisfaction of the public who have to meet those medical fees. I am afraid that it has not been possible ever since that time to find a formula or a system which could satisfy both sides and which at any time operated satisfactorily. In fact, confrontation has more often been the characteristic of the systems which have been attempted than co-operation between the various parties concerned. This has been most unfortunate, because it has at times resulted in a most unedifying spectacle with regard to a profession which should normally have the respect of everybody concerned. It has been an unfortunate public confrontation and has been most undignified. I believe that some time or other we are going to have to find a system which will avoid such an unfortunate situation. I am not so sure that we have been able to achieve that through the latest compromise.

If we go through the history very briefly, we see that in terms of the Act of 1967 that there was always a hope expressed that the professions on the one side and the medical schemes on the other side would, by negotiations between them, be able to reach accord with regard to medical tariffs. However, that hope proved to be an idle one, because very soon problems arose and it soon became clear that the two sides could not reach agreement. The result was that the Act was amended. It has always been a case of amending the Act in the hope that the problem has been solved, further problems then arising and further amendments then having to be made to the Act. Then it was decided that commissions would be appointed to decide upon the remuneration of the medical profession. Such a commission, in order to make it an independent commission, would be under the chairmanship of a judge. It was hoped that that would solve the problem. This system operated for many years, but once again, unfortunately, problems arose, problems which the hon. the Minister has in fact referred to, with regard to the way in which and the times at which a determination of tariffs should be made. Once again there were changes brought in and once again problems were experienced.

There was then the problem experienced, which I think the hon. the Minister has also referred to in his Second Reading speech, with regard to the fact that on the commission there were two laymen, viz. the judge on the one hand, who is a legal personage, and a representative of the medical schemes on the other hand, who is a commercial personage. These two laymen had to assess the relative merits, the relative values, of the services rendered by the medical profession. With justification, I think, the medical profession made representations to the effect that they did not think that laymen, people outside of their profession, should decide on the relative value of the services rendered. Once again these problems led to a change, which was that in future the profession would decide on the relative merits of the services they render and that the commission would decide on the fees to be charged after the relative values had been determined by the members of the profession themselves.

Once again problems arose. Problems were experienced in respect of the availability of a judge. Dissatisfaction continued with the tariffs and once again it was decided that a change should be made. The whole problem was then handed to the Medical and Dental Council which was charged with the responsibility of determining what the tariffs or fees should be. At the time—and I think the hon. the Minister pointed this out as well—there were in fact very strong reservations both from the side of the medical profession, who were not sure that this system would work satisfactorily, and from the side of the medical schemes, who were also unhappy with the system that had been decided upon. There were certain indications given of compromises that would be reached. In fact, it was decided that the medical schemes could be represented on a tariffs committee of the Medical and Dental Council in order to give them the opportunity of expressing their point of view at the time when tariffs are decided upon. There was also talk of representatives of the Human Sciences Research Council or of the Bureau for Economic Research being called in in order to assess the background to medical tariffs in order to give specialized and expert advice to the Medical Council at the time of the determination of tariffs. For some or other reason this did not in fact take place. Perhaps the hon. the Minister can in his reply answer the question, to which we have not yet had an answer, why the medical schemes were for some or other reason not fully involved in the tariffs committees and why the Human Sciences Research Council or the Bureau of Economic Research were not involved either, although either one of those bodies could have been seen by both the public and the profession as independent entities which could have been trusted to give an objective view of what the background and the basis for the determination of fees should be. Although there was an indication that they would be involved, in actual fact for some reason or other they did not become involved.

So the situation arose where one day we read in the newspapers that medical fees were going to go up by over 50%. Naturally there was an immediate and sustained public outcry and reaction. Unfortunately perhaps, the Minister, who was a new Minister, immediately rushed in where angels fear to tread. Certainly as far as the Press was concerned, it appeared that he had made threats that he was going to take action to see to it that the medical profession did not increase the fees to that extent and did not behave in what he believed to be the wrong way. I say that it was very unfortunate that a public and very undignified confrontation resulted at that time. I think it was very unfortunate because it angered and alienated members of the medical profession as a whole and resulted, I think, in their becoming unco-operative at that particular stage. So what we had, in a very delicate and unfortunate situation, was that instead of a process of co-operation and negotiation, a peaceful, quiet and dignified process which could have led to a satisfactory compromise, there was unfortunately a most undignified confrontation which resulted in the polarization of various positions, a situation which, in fact, delayed the reaching of an agreement. I think that was most unfortunate, and I think the hon. the Minister must bear part of the blame for the confrontation that resulted. After all he, as the representative of the Government, should always be the person who takes the lead in bringing about co-operation when something like this arises.

I do not want to cover the full spectrum of what happened. The hon. the Minister did, however, meet with the Medical Association on numerous occasions. Various draft Bills have been prepared by the department and recently amendments have appeared on the Order Paper, amendments which the hon. the Minister intends to include in the Bill at this stage. We have now apparently reached a compromise between the medical profession on the one hand and the hon. the Minister on the other. The details we can talk about very briefly. By and large the Medical Council will still be responsible for the determination of a tariff of fees, but those tariffs of fees will not become applicable until approved by the hon. the Minister and published in the Government Gazette. The hon. the Minister will also have something like three months in which to inform the Medical Council of his response to the fees it has proposed. If he does not agree with those fees he “may”, according to the amendment, resubmit them to the Medical Council for reconsideration. We believe, however, that the provision should not stipulate “may”. The hon. the Minister should change the word “may” to “shall”, so that it is mandatory for the Minister to refer the proposals back to the Medical Council if he does not agree. The Medical Council is then given six months in which to reconsider the fees and once again submit proposals to the hon. the Minister. Then, if the hon. the Minister still does not agree, he can make a determination of tariffs. Then there is a little bit of arrogance included in the amendment in the sense that after the hon. the Minister has determined the tariffs, the tariffs will be published and applied and be deemed to be the determination of the Medical Council, despite the fact that it is clearly not the Medical Council’s determination, being in fact the determination of the hon. the Minister. Quite honestly I cannot see how the hon. the Minister can include that particular aspect of the amendment, because I think it is most arrogant and misleading. I therefore think it would be most unfortunate indeed if he were to do so.

I think we must talk a little bit about a number of very important factors that must always be borne in mind when we are dealing with a profession such as the medical profession and a matter relating to the determination of tariffs of fees involving people’s incomes and their standard of living, in other words the remuneration that people receive for the services they render.

In the first place I think it is important to point out that South Africa has a society that is peculiar from many points of view, but particularly from the economic point of view. Our society is not a very rich society. If one looks at the per capita income of South Africa’s people, one sees that we are not one of the world’s richest societies. South Africa is not at the top of the list. Despite the fact that South Africa is a very rich country, having very extensive mineral and other resources, despite the fact that we have a sound economy and that we have peace and stability, ours is not a very rich society if one takes the average South African citizen into consideration. We are a society made up of very poor groups and a small very rich group. We are, in fact, in many ways a Third World society—the vast majority of our population is a Third World society—and superimposed upon the Third World society, the society of “have-nots”, the poor group, is a small Western capitalist-type society of “haves”, people who are very rich. This creates tremendous problems, particularly from the point of view of providing services to the people, whether those services are medical, housing or education.

The hon. the Minister has said that he is opposed to, and that we do not have, a system of social medicine in South Africa. I want to differ with him on that. South Africa, in fact, has a system of social medicine which is, compared with that of Third World countries, a very good system rendering better services than that of most Third World countries. These services are rendered to the Third World portion of the South African society, to those people who cannot afford medical services. They are given a system of social medical service of which we can, in many respects, be proud if we look at the standard of the service, the standard of the people who render the service and the equipment involved. Of course there are many problems, such as the shortage of hospital beds, about which we shall talk later when the hon. the Minister’s Vote is discussed. We have a system of social medicine for a very large sector of our community which cannot afford other medicine.

In South Africa we also have very rich people. To them it does not matter what the medical fees are, because they can afford anything. Those people do not avail themselves of social medicine and do not even avail themselves of the medical aid schemes to cover their medical costs. They are a very small group, however, and we need not refer to them.

There is also other groups, the lower-income and the middle-income groups, the majority of which are covered by medical aid schemes. There is, however, also a percentage amongst them who are not covered by medical aid schemes. This is so because in South Africa we unfortunately do not have a requirement which compels all people to be covered by medical aid schemes. I think that is unfortunate because there is a percentage of people in South Africa who will land up with very severe problems when they need medical service but do not have the financial means to avail themselves of such services. It very often happens when they reach a stage in life when it is too late to make other provisions. Those people then go without medical services simply because they cannot afford it Even in respect of those people who are covered by medical aid, we find that some of them go without medical services because the medical aid system is such that it does not meet the full costs of medical services. It actually happens that many, many people, despite the fact that they are covered by a medical scheme, do not avail themselves of medical services simply because they cannot afford the additional costs which are involved. This is also an unfortunate situation that we have in South Africa.

The point is that we have to appreciate that we have a complex society, with different sectors living at vastly differing economic levels in the country. This complicates the job of the Government in providing services for those people. It in fact suggests that different systems may have to operate side by side within the country. What is most important, however, is that it is nevertheless the responsibility of the Government to see to it that all the people of the country will have access to adequate medical services in order to ensure a healthy population, and thereby to ensure the prosperity and security of the country.

It is also important that something be said about the medical profession because with all the problems we have discussed, problems that have arisen from 1967 onwards, the medical profession has had in many respects a very sound case to put to the hon. the Minister. Their position has displayed certain distinct characteristics. Many years ago—20 or 30 years ago—the local village doctor, the local general practitioner, was a person at the very top of the pyramid of that particular society. He ranked with the local magistrate, the local police sergeant, the local “dom-inee” and the leaders of the community, the people to whom the entire community turned for help, for assistance and for advice. He was considered to be among those at the very pinnacle. In other words, the medical doctor had a very high status in the South African society. Ever since then, however, there has been a steady decline in the status of medical men—doctors, dentists and other medical people. There has been a steady decline in the status of South Africa’s doctors, and associated with that steady decline in that status of the doctors—and we must remember that status has to do with the approach, the attitude, the way in which the public sees these people—there has also been a steady decline in the financial rewards and remuneration received by these people for the services they render.

I do not want to refer now to medical specialists who earn extremely high salaries, but rather to general practitioners. General practitioners in particular, despite the hours they work, despite the irregularity of their hours, despite the tremendous problems with which they have to contend, are people whose incomes when compared with other professions, for example that of business people, of people in the financial world, have just not kept pace. Therefore they have a very good case in respect of this specific facet.

It is, of course, not only income that we are talking about. We are also talking about the status of doctors in its entirety, the recognition which they get in society and in the system. We are talking about the way in which they are seen, the way in which they are accepted, the way in which they are recognized by South African society and by the system. Because of the decline in the status of doctors in particular, but also those serving in all other supplementary health services—and here we can also talk about the nursing profession—South Africa has in fact suffered a loss of a vast amount of talent in the medical field. I think it is most unfortunate that this has been the case. I think it is a particular responsibility of the hon. the Minister and of the Government to take steps in order to prevent this from continuing.

These people are often lost to South Africa permanently. I should like to take the opportunity of making an appeal to doctors and medical people who want to leave South Africa. Obviously, anybody who wants to leave can leave. That is part and parcel of the democratic system. If a person wants to leave the country to settle somewhere else, in an attempt to improve his position, that is entirely his own business and he is entitled to do so. Otherwise South Africa would not have been where it is today. We are where we are today because of the talent that has come to us from other countries in the world. I should like, however, to make an appeal to these people and to tell them that I believe they have a greater responsibility to South Africa. Medical people are people who are dedicated to the rendering of services to humanity. In South Africa, in particular, the opportunity of serving humanity is far greater than for instance in the USA. All these people have benefited from being in South Africa. From the very day of their birth they have benefited from being in South Africa. They have received their school and university education in this country. Here they have been given the opportunity of achieving an exceedingly high standard of training and a very valuable qualification. They have achieved all this simply as a result of the fact that they have been South Africans, that they have been born and bred in this country. Every taxpayer in this country, from the very lowest to the very highest, even the underdeveloped and deprived people we have spoken about, have in one way or another contributed to the education of these particular doctors. I should like to make an appeal to these people and to tell them that I believe they have a responsibility to remain in South Africa despite the problems they encounter, in order to make a contribution to our society as a whole, and particularly to serving and uplifting the deprived people we have spoken about.

Doctors are people who are used to making independent decisions. They also feel that they would like to make independent decisions when it comes to the fees they should be paid. Particular categories of doctors have to spend tremendously large sums of money on equipment and material. In this regard I particularly think of radiologists and dentists. Their equipment costs them a great deal of money. If one were to look at the way in which inflation has affected the cost of this equipment, one would be absolutely surprised. Certain dentists have mentioned to me that the cost of their equipment has increased three-fold in three years. We are not talking about hundreds of rands, but about tens of thousands of rands they have to pay for some of the equipment they use. If one compares the tariffs of the medical profession with those of other professions, one sees that the tariffs of the medical profession are not as high as some people seem to think.

I believe that particularly the people in the supplementary health services, people like radiologists, are the ones who are very deprived indeed when it comes to the remuneration for the very high standard of the services which they render after very many years of study.

We must also realize that it is in the interest of South Africa and of the public for these high standards of medicine in South Africa to be maintained.

Taking all these things into consideration, particularly the fact that the Medical Association and its representatives have, after long negotiation with the hon. the Minister—I want to emphasize this—indicated to us that they have accepted the compromise they have reached with the hon. the Minister, we have decided to support this Bill under those circumstances. In doing so we want to point out to the hon. the Minister very specifically that we shall support this Bill now and wish him well in the application of it, but that we shall very carefully monitor the position from now on. We shall keep a very careful eye on the hon. the Minister to ascertain whether he ensures that members of the medical profession at all times receive adequate remuneration for the services, that that remuneration takes into consideration all the characteristics of the services they render, and that he will also see to it that at all times these people’s incomes and standards of living keep pace with the rapid inflation with which South Africa has to contend.

We shall also ask the hon. the Minister to make extraordinary efforts to see to it that the status of the medical profession is improved so that once again these people can enjoy the status to which they are entitled and which will place them at the right level of South African society, to see to it that steps are taken to retain the medical talent that we need in South Africa, to see to it that steps are taken to ensure that adequate training in the medical field is provided for all the citizens of South Africa, and to see to it that the manpower situation in the medical field is stabilized and is satisfactory. Above all else we shall be very careful to see to it that the hon. the Minister does not apply the very wide powers, now given to him in terms of this proposed legislation, in an authoritarian or arrogant manner, because that we will not tolerate.

The medical profession is one of the highest and most important professions in South Africa. It makes one of the most significant contributions to the well-being of our society and our people. Its members must be treated according to their status and should not at any time be subjected to any type of authoritarianism exercised by the Government. We know the hon. the Minister is entitled to take these powers, and we cannot stop him. In fact the hon. the Minister has these powers, and he can use them either to the benefit of South Africa, and in particular the medical profession, or to further bedevil relationships between the profession and the people.

We look forward to the report of the commission which the Minister has appointed to go into all the medical services in South Africa, particularly with the view to providing a formula which will provide for the satisfactory determination of tariffs for the medical profession in the future. The then Minister appointed Mr. Haak as the chairman of that commission. I do not know why he did it. Maybe he thought Mr. Haak would be of particular service to the dentists in view of his specialized knowledge of the ivory trade, but subsequently Mr. Haak was removed as the chairman of that commission. Somebody else is to be appointed now. The point is that we now have an opportunity, and I hope that this opportunity will be utilized successfully, of once again comprehensively examining the full spectrum of medical services in South Africa, of once again hearing the representations and the evidence of all interested parties, and I hope that an agreement will be reached between the professions, the medical schemes representing the public, the Minister and every other interested party, an agreement which will provide for a system whereby medical fees can once and for all be satisfactorily dealt with.

With the exception of the two aspects which I have mentioned and which we shall also be dealing with by way of amendments in the Committee Stage, we give our support to this legislation, and we should also like the hon. the Minister to take notice of the conditions under which we give him that support. We wish him well with this legislation and we hope it will give rise to a situation which is satisfactory to both the medical profession and to the public.

Mr. Speaker, the hon. member for Bryanston dealt fairly extensively with the history of the aspect of health services and the medical schemes. I do not have any fault to find with this. It simply emphasizes for me the extremely important matter that we are dealing with here. However, I have serious problems with the criticism that he expressed towards the hon. the Minister. I feel this is quite unjustified, and during the course of my speech I shall show why I think so. The hon. member also alleged that the drop in the status of medical practitioners can be connected to their income. I disagree with him entirely. We need only consider that, in comparison with the past, the clergyman, the teacher and the magistrate have also experienced a drop in status which had nothing whatsoever to do with their income, but with the completely altered conditions in which we are living. The hon. member accused the hon. the Minister of a degree of arrogance which he showed in the legislation under discussion. If we are to speak of arrogance, then I accuse the hon. member of arrogance if he thinks that he can speak on behalf of the medical profession in this House.

Now I come to the important amendment that is being moved here, the one in clause 8, which amends section 53A of the principal Act and which concerns the statutory tariff of fees which is now being determined by the S.A. Medical and Dental Council and which, according to the amendment that is being moved, cannot come into force before the Minister has approved it and it has been published by the registrar and the Gazette. Then we also have the proposed paragraph (b) which provides for a maximum tariff, subject to the provisions of section 29(1) of the Medical Schemes Act. This means that the status quo is being maintained in respect of the right to contract in or out, with the provisos laid down in the Medical Schemes Act. The whole process of determining the statutory tariff by five successive remuneration commissions has actually been an unfortunate one, in the sense that it was a continual source of tension between the State, or rather the remuneration commission, on the one hand and the medical schemes and the medical professions on the other, as the hon. the Minister also explained in his speech.

I want to look at this matter from both sides, from two different points of view. Firstly, I want to look at it from the viewpoint of the medical practitioners themselves. During the years 1974 and 1978 in particular, as a result of tremendous increases in the cost of living and the cost of maintaining a practice, a considerable backlog arose in regard to the statutory tariff. Nevertheless, I think we must concede that today, particularly considering the background of the considerable adjustments which the tariff committee of the Medical Council thought fit to make in terms of its directive which it received in 1978 under this very section. At the time, before the amendment in 1978, and after the decision of the Fifth Remuneration Commission, an authoritative economist, Prof. J. Lombard, declared the following—

He goes on in his commentary to mention the peaceful, voluntary atmosphere which prevailed in this regard before 1977; in other words, before the advent of the medical schemes.

In 1978 it was calculated that the percentage of the total consumer expenditure on medical and dental services was only approximately 1,5%. The Fifth Remuneration Commission granted an increase of 9,2%, whilst it was calculated that the average costs of maintaining a practice had increased by approximately 42% over the previous three years. At present the unit value of the tariff of fees has increased from 80c to R1,10 which, in monetary terms, represents an increase of 37,5%, whilst the overall increase of 52,45% is the result of the increase of certain units in regard to certain procedures.

If one reads the report of the tariffs committee of the Medical Council, one must concede in all fairness that this committee did in fact make a thorough study of the available information, and that, amongst other things, they tried to draw a comparison between the earnings of a medical practitioner employed by the Government on a full-time basis, with all his fringe benefits including pension schemes, paid leave and other benefits for which the private medical practitioner has to pay for himself. I do not want to comment on the question of whether the committee used all the available information, or on the accuracy of their calculations. There were economists who questioned their calculations and were given prominent publicity in the Press. However, there were also other economists who proved the contrary with figures. Of course, anything can be proved with figures and statistics. It depends on what one wants to prove or what one’s point of departure is. I shall leave the matter at that.

I simply want to allege, in spite of the whole controversy, no one denies the medical practitioner a decent income. This is their due, otherwise we would not have had the quality of medical services that we do have in our country today. On the other hand, we must also understand the position of the hon. the Minister of Health. He has been entrusted with the welfare of all the residents of South Africa when it comes to health. Health is a strategic sphere of our community. That is why it is also the task of the hon. the Minister to ensure that our health services remain within the means of the majority of the citizens of this country. That is why the hon. the Minister is in a position to judge the increase in tariffs against the background of the prevailing economic climate in this country, and also because he is provided with information by the Economic Advisory Council for instance, whose advice the hon. the Minister must also take into account. On the other hand, the hon. the Minister is also faced with considerable opposition from medical schemes and the public. Since this is the case, I do not object to the hon. the Minister’s powers. I am sure that the vast majority of the members of the medical profession will agree with me that the hon. the Minister should have the final say on the statutory tariff, particularly if one reads this against the background of the amendment which the hon. the Minister is moving in clause 9 of the Bill, viz. that the hon. the Minister’s final decision will be subject to referral back to the Medical Council for reconsideration by the council after consultation with the professional association concerned. This reflects a disposition of helpfulness and goodwill on the part of the hon. the Minister, because it means that the hon. the Minister is prepared to negotiate with the interest groups in order to arrive at consensus on the matter. This is important, because we cannot allow a situation of conflict and enmity to arise between the medical profession and the State in this country. If something like this were to happen, there would be only one party who would lose, viz. the patient. I want to congratulate the hon. the Minister in this regard on the great deal of diplomacy that he displayed when, after all the fuss and bother and the public debating following the publication of the draft legislation and after discussions with the interested parties, he made his statement here in the House on 15 February. I just want briefly to elucidate the two most important aspects that he dealt with. He announced (Hansard, 1980, col. 770)—

The second important aspect is that—

This did in fact bring about a great deal of calm and peace, which was very necessary at the time, because attempts can so easily be made to turn our health service into a political football. This must be avoided and rejected with the contempt that it deserves, because after all, we know what happened in other countries where this did in fact happen. There was of necessity a socialization of services with a concomitant drop in the quality of the service and an astronomical increase in cost. We simply have to take a look at what happened in Britain. Now I see in the latest edition of the Medical Journal that, believe it or not, there is a medical practitioner who is advocating that the medical practitioners should organize themselves into a trade union outside the professional association. This medical practitioner says that the British Medical Association was registered as a trade union as early as in 1971. I want to tell the medical practitioners in our country that they must not allow themselves to be misled by a school of thought like this, because if this should happen, if the private medical practitioners in our country were to think of organizing themselves into a trade union, they are going to be responsible for greater State control having to be imposed on health services in our country.

In conclusion, I want to express the wish that we are going to arrive at a satisfactory, workable situation through this amending Bill, because if this does not happen, in my opinion there is only one alternative and this is that we shall have to think seriously of breaking the three-sided relationship that has been in existence for 13 years between the medical practitioner, his patient and the medical scheme and we shall have to do so at the point of contact between the medical practitioner and the medical scheme. In other words, the medical scheme will have to develop along the lines of health insurance or indemnity. This would be the only solution. We cannot deny that, apart from other factors, the intervention of a third party—the medical scheme—between the doctor and his patient, gave rise to abuse on the part of some patients as well as some medical practitioners. After all, we have heard of medical practitioners who try to increase their earnings by providing excessive services, too many visits and consultations, unnecessary series of injections, premature reference to specialists because there is no time to examine a patient properly and unnecessarily long series of special examinations, and are encouraged to do so because there is no direct quid pro quo on the part of the patient. On the other hand we have also heard of patients who make excessive demands on medical services, who visit the medical practitioner for slight indispositions and summon him to their homes for imaginary complaints simply because they do not have to make a direct financial contribution. This may perhaps also explain why the medical profession has built up a considerable resistance to making house calls over the years.

That is why I think that the statement which the hon. the Minister made yesterday that a commission of inquiry is going to investigate the entire broad spectrum of the costs of health services, should be welcomed on all sides. Since the proposed amendments in the legislation give full effect to the announcement that the hon. the Minister made on 15 February this year, it is my privilege and my pleasure to grant my support to the Bill.

Mr. Speaker, in considering the implications of the provisions of this amending Bill, I believe that the legislature should exercise the greatest degree of objectivity. The question of medical tariffs and fees to be paid is a highly emotive one, both for the patient and for the medical or dental practitioner.

Before going on to the specific aspects of this Bill which are of the greatest interest and referring to the hon. the Minister’s Second Reading speech, I should like to just comment on one or two of the aspects the hon. member for Pietersburg raised here today. I should like to congratulate him on the objective way in which he went about discussing this very emotive issue. Although I congratulate him on that, it does not necessarily mean that I agree with the conclusions he came to. I think he went to a lot of trouble to examine the problem from both sides, i.e. what the effect is going to be on the medical profession and the supplementary health services and what the possible effect is going to be on the patient. I believe that one should look at this amending Bill in that spirit of objectivity.

The hon. member for Pietersburg has indicated that he believes that the new powers the Minister will be taking unto himself in terms of the provisions which will only come up in the Medical Schemes Bill, will only refer to the determination of tariffs. I regret that we in this party do not agree with that interpretation. However, I shall come back to that shortly. I should like to deal just briefly with the other two aspects which are covered by this amending Bill.

The first concerns the exclusion of the reference to psychologists in certain provisions as set out in clause 1. I believe that this is an improvement and that the question of prescribed qualifications from overseas, as it is currently included in the legislation, is now being satisfactorily amended in order to allow greater discretion to the Professional Board of Psychology to determine what qualifications it is going to accept. I am, however, rather intrigued to know when the hon. the Minister, as he indicated in his Second Reading speech, actually received representations from the board to amend this particular provision. The time factor would be of interest to me. I ask this specifically because the whole question of psychologists, their registration and the exercise of their profession, in terms of the 1974 Act seems to be going through a very difficult period of time at present.

The other aspect in this Bill with which we agree and have no difficulty is the question of the prescribed areas in which supplementary health services may be exercised. As the hon. the Minister himself has indicated in his Second Reading speech, there are difficulties in the transitional stage when one goes from formally qualified people to what was the traditional practice in certain areas. Although the Minister is empowered in terms of this legislation to prescribe areas, it is obvious from his statements that this is going to be done in an objective and practical manner so that the public will not suffer in the transitional stage between an open and a prescribed area. In that regard we have very little difficulty with the Bill.

Then we come to the major problem, the gravamen, the crux of the matter, as far as the Bill is concerned. The hon. the Minister, the hon. member for Bryanston and the hon. member for Pietersburg gave very eloquent and detailed descriptions of the difficulties that have occurred in regard to the vexed question of finding an acceptable tariff, a tariff which will be acceptable to patients, medical aid schemes, the Government and the practitioners. This has had a long and tortuous history and yet I believe we have again fallen into the trap of judging the system of deriving tariffs by judging whether the tariffs are acceptable to all parties. I think that the amending legislation introduced in 1978, legislation by which this House established tariff committees under the auspices of the S.A. Medical and Dental Council, was the right move. We in this party implicitly believe that the people most involved in a profession should determine their tariff of fees. I do not believe that it is the task of external bodies to determine a tariff of fees for any profession. The hon. member for Bryanston concurred with the hon. the Minister is suggesting that bodies such as the Human Sciences Research Council should be utilized to determine fees. We would rather like to see them as the providers of information to the existing tariff committee, which can then use this information in determining the fees.

That is what we said.

I think, however, that the implications go further. If one brings bodies outside the profession into the formal structure, in order to determine the fees, i.e. if the hon. the Minister is to be influenced by an opinion furnished by an institution outside the medical profession, I think we are embarking on a very different and a difficult course.

Let me now refer to the statements the hon. the Minister has been making during the past six months. From the draft Bill submitted by the hon. the Minister for consideration on 12 December 1979, it was clear to me and to the majority of members of the medical, dental and supplementary health service professions that the hon. the Minister was going to get his teeth into the question of tariff establishment for the medical and dental professions.

Although the hon. the Minister realized the difficulties that draft Bill had given rise to as far as the medical fraternity was concerned, he nevertheless spelt out, in the no-confidence debate on Friday, 15 February, how he had possibly changed his attitude in the face of the uproar that was caused by that draft Bill. Let me refer hon. members to the very carefully worded statement on 15 February. If one reads that statement one sees that what actually happened was that the hon. the Minister had not really changed his attitude or his structure in regard to the determination of tariffs. I quote (Hansard 1980, col. 770)—

That is not, however, the way things have turned out in practice, because one must read the Medical, Dental and Supplementary Health Service Professions Amendment Bill in conjunction with the Medical Schemes Amendment Bill. Having done this one would see what the hon. the Minister’s intention is. What has actually happened in practice is that the hon. the Minister has told us that he would only become concerned with the determination of the maximum fees as far as medical aid schemes are concerned. By implication we welcomed that when the hon. the Minister made the statement, because it implies that if a medical practitioner or dentist decides to be contracted in, he would be able to charge that particular tariff, which could be done in agreement with the hon. the Minister. The medical, dental and supplementary health service professions fully expected, however, that the option to contract out would be left untampered with. When we examine these two Bills, however, we find that the hon. the Minister now wants to take unto himself, by regulation, the power to prevent doctors from contracting out. That is not, however, the spirit in which we read and welcomed the explanation given to the House by the hon. the Minister on 15 February. What has happened is that we have now entered upon a completely new dispensation in South Africa, and I am going to come back to that aspect. I want to stress to the hon. the Minister, however, that if we tamper with the medical and dental professions by adopting an authoritarian approach to their tariffs, and if it is going to be the sole prerogative of the hon. the Minister to determine what tariffs are acceptable, he is likely to destroy, or at least seriously damage, the very fabric of one of the finest medical services anywhere in the world. I think that the hon. the Minister will agree that to build up a medical and dental service such as we have in South Africa is the envy of every country in Africa and many countries in Europe. If the Minister takes this power, one can understand what is likely to happen. The hon. the Minister, in terms of the amendment contained in the last clause of the Bill, says that he will negotiate and try to find consensus with the S.A. Medical and Dental Council. If, after six months, they do not reach consensus, the Minister will then have the power to determine that the tariff approved of by the Minister is the tariff which is going to apply, although it may not necessarily have been agreed to by the S.A. Medical and Dental Council’s tariff committee. If we then find that the medical fraternity, the ones in private practices, are dissatisfied with the tariff which the Minister has approved of, the Minister can, in terms of the powers which he is going to take unto himself in the Medical Schemes Amendment Bill, prevent doctors from opting out or contracting out. They will, in other words, be forced to charge the fees of the medical aid schemes. When this happens, we have reached the turning point in the medical services of South Africa.

If we reach the point where the Minister can, by regulation, take unto himself the power to stop doctors from opting out, thus forcing them to charge the medical aid tariffs, we shall have furthered the process of a nationalized health scheme in South Africa. The hon. the Minister said very clearly in his Second Reading speech that he does not desire the establishment of a socialized or nationalized health service, but if he does take unto himself the power to stop dental and medical practitioners from contracting out, he is in fact aiding and abetting a nationalized medical service. The only difference between the nationalized medical service of England and that of South Africa would then be that the Minister will not be employing the doctors as the Government does in Britain. They will be self-employed, nationalized medical practitioners.

Then we have reached a position which will seriously damage the very fabric of our excellent medical and dental services. The hon. member for Bryanston has mentioned the number of medical practitioners who have left South Africa. It is a fact that during the last three years we have lost 5% of our medical and dental practitioners. The cost to South Africa is very considerable. It is well-known that it costs more than R30 000 of taxpayers’ money to train a single doctor in South Africa. It would therefore be a tremendous pity if the quantity of doctors available to South Africa were to diminish, but it would be all the more serious if, at the same time, the quality of the service were to deteriorate to such an extent that we would find that the patient, whose interests we are trying to protect with this Bill, was detrimentally affected. That is where the problem lies.

I do not believe that we should only criticize the hon. the Minister for what he intends doing and on what the likely effect is going to be on the medical profession and the patient, but that it is also encumbent upon the legislature and every hon. member to suggest to the hon. the Minister what the alternatives could be. Let me come back to the argument I advanced earlier on. Every time there is disagreement between the medical aid schemes and the doctors about the tariff of fees, we are told that the system does not work. Then the system gets changed. We bring in new commissions headed by a judge or a non-medical man, and we bring in tariff committees. Every time there is disagreement on the tariff, the system is blamed. This is not at all the truth of the matter. The problem is that the system is being judged by whether the tariff is acceptable or not, and the tariff is normally acceptable to neither the medical aid schemes nor the profession itself. Perhaps the system is working very well and has, for the past eight years, been telling South Africa that there is something seriously wrong with the level of the tariff. That is the problem. The system has repeatedly shown us that it is the tariff that is unacceptable, and not necessarily the system. I am sure that to start tampering with the system again would not produce a satisfactory solution to this problem of acceptability of the tariffs by patients, medical aid schemes and the doctors.

What would the alternative proposal to this be? First of all we believe that the commission which the hon. the Minister has appointed to investigate the tariffs is to be welcomed, provided—and this is my appeal to the hon. the Minister—he ensures that the chairman of the committee is a medico-legally trained man. They are there. They are available in South Africa. They are as objective as the next man, as objective as the hon. the Minister. I believe that a medico-legally trained man is the right man to carry out that particular investigation. Possibly, in that investigation, we will find an equitable base line of tariffs which doctors can charge, rather than to attempt to change the whole system and move away from the 1978 legislation which produced the present tariff committee under the S.A. Medical and Dental Council. What is the alternative to this? I believe, as so many of the medical and dental professions’ people in South Africa believe, that if one wants to find acceptable tariffs, one must provide patients with an alternative service. We have that in South Africa already. We have alternative services available to those patients who are not prepared to pay a private practitioner’s fee and to those people who believe it is too high or that the quality of service is not good enough. Every province of South Africa runs some of the finest medical services in the world at very, very reasonable costs.

The latest figure I received from the Cape Provincial Council indicates that on merit—of course merit comes into it—one can have the finest cardiac surgery, heart or liver transplants or whatever one likes, for less than R50. One can visit any provincial hospital and get the finest treatment in the world. If one is poverty-stricken, and cannot afford to pay at all for medical and dental services, one can get them ex gratia as well. One can get all this for free.

Those patients who prefer to go to a private practitioner, or those patients who feel that the tariffs are not too high, will go to a private practitioner and not to a provincial hospital. They will do so for their own particular reasons. If there are other people who believe that the tariffs are too high, they are welcome to visit an equally good facility, i.e. any provincial hospital.

The hon. the Minister has said that his fear is that people will stream to the provincial hospitals, that doctors will become State-employed and that we will then, in fact, have a national health service. If the hon. the Minister takes the power to stop doctors from contracting out, he will in fact create a national health service in any case. Then the patients will not have the alternative choice, if they can afford it, of going to a private practitioner. Therefore we in the NRP do not feel that the answer lies in bringing in restrictive mechanisms in the determination of the tariffs. We believe that if there are sound and adequate alternatives available to a patient—which there are in South Africa—it will not be necessary to tamper with the system as it is at the moment.

I should like to point out to the hon. the Minister that the statement which created such a tremendous amount of trouble with the public was the statement that medical tariffs had increase by 52,45%. That rather shocked the public. It would probably shock anybody. When one quotes percentages one must realize what is actually happening to the actual base-line figure. I am sure hon. members will agree that an increase of 52% on a basic charge of R6,60, to bring it to slightly over R9,00, is not exorbitant for a visit to a private practitioner at his surgery. What one has to determine is: 52% of what? It is not just 52%. It must be 52% of something.

The public are shell-shocked. They are price-shocked by increases. Everybody is shocked. Everybody was shocked at the increase in the price of petrol announced by the Government last year. Of course we are all shocked at price increases. There was a tremendous outcry against this, but it was absolutely essential for those administered prices to be increased. Of course, the Government did not adopt the attitude that because of that tremendous outcry they were going to do away with the increase in the price of petrol. It was a necessity, an absolute necessity. I personally believe that the interests of the public are paramount, but so are the interests of the medical profession. Therefore, when statements are made such as that about a 52,45% increase, it should be fully explained to the public on what that increase is based. There should always be a base line.

If one employs an electrician or a plumber today—and one certainly will not get them out at 2 a.m.—to come to one’s house to install a tap, as I recently had to do at my home in Durban, the installation of that tap, which does not take more than 20 minutes to complete, can cost one, as in my case, R35. It cost me R35, and there was no outcry.

You must do it yourself.

The hon. member for Bellville says I should have done it myself. I am so busy, however, looking after the interests of the public against those of the NP that I do not have time to do things like that myself. [Interjections.] I am trying to stem the flow here, not the flow in my bathroom. Then, of course, I also believe in leaving every job to the experts concerned. We must determine whether the absolute level of tariffs and the proposed increases are exorbitant. Looking at the cost increases and the devaluation of money, I do not believe there is a single member of the public who can say that the doctors and the dentists are not due for a substantial increase. The problem has been that they have held back substantial increases.

I believe that an objective look must be taken at these tariffs, that a committee under a competent medico-legal man must investigate the matter and that we must have a look at the tariffs and not at the system, because if we could arrange to find an acceptable base line of tariffs, it would be easy for the medical profession to follow a formula, on which they can agree, of adjustment according to the cost of living index and the input costs, and then there can be gradual increases every year.

The medical fraternity actually held down their tariff of fees, but when they could no longer make ends meet because of their costs and because they, like everyone else, wanted a return on the capital they invested, there was a big hue and cry.

In summary I therefore want to make a recommendation to the hon. the Minister. By all means have this commission investigate tariffs under the chairmanship of a medicolegal man. I should also like to tell him, however, that we find the last clause of the Bill, in particular, totally unacceptable, because we believe it will result in the destruction of the quality of the medical services in South Africa and will probably reduce the number of medical and dental practitioners. If this happens, we will not have looked after the interests of the patient, something which is of paramount importance. On behalf of the NRP it is therefore my pleasure to move the following amendment—

Mr. Speaker, I have appreciation for many of the standpoints that have just been advanced here by the hon. member for Durban North. I am also gratified that he specifically pointed out that the hon. the Minister had been objective in his handling of matters relating to the medical profession. I also want to assure him that there is no desire on this side of the House to develop medical services along the lines of a national health service. We should oppose that vigorously.

What struck me about the speech by the hon. member for Bryanston was that not only did he have a negative attitude towards the hon. the Minister’s activities and actions since becoming Minister of Health, but—and this is even more serious—he also questioned the integrity of the Medical and Dental Council by his negative remarks on the new initiatives that have been making greater progress during the past few weeks under the leadership of the hon. the Minister and the Council.

I wonder whether people are aware that fewer than 1%, fewer than 300, of the approximately 14 000 medical practitioners in this country, about 50% to 55% of whom belong to the Medical Association, objected in writing to this amending Bill. I believe that it is very important to us and the general public to know that overall there is a great deal of unanimity among the medical profession as to the direction and course being adopted by the hon. the Minister. I shall come back to that presently.

It is of the utmost importance for us to take note this morning that the S.A. Medical and Dental Council is of cardinal importance in the implementation of this legislation. There are specific agreements between the Republic and other countries in order to regulate certain matters, for example—the hon. the Minister referred to this in his Second Reading speech—the recognition and the registration of medical practitioners and dentists. What is also of great importance is the fact that in terms of clause 1, provision is made for the registration of medical practitioners and dentists, i.e. provision is made for the registration of these professions, but as far as the psychological professions are concerned, no provision has been made, for the simple reason that there are no agreements in existence between the Republic and other countries. The same applies to related health service professions as well. The Professional Board—it is important that we should note this—requested that this be arranged in this way, because there is virtually no control over the training of people at this level abroad. I could point out that parapsychological practices and activities have increased tremendously during the past few years and have sprung up like mushrooms. The public must be protected against these para-psychological activities.

However, the path is always open, as far as supplementary health service professions are concerned—it is as well that this has also been mentioned here this morning—to apply to the council for registration, and each case will in any event be dealt with on its merits. Of the utmost importance in this sense is the fact that as soon as these requirements have been met, those professions will be closed professions to any person from outside. To these medical and related professions this is very important, because immediate protection is being afforded the practitioners of these professions. If there are at present unregistered persons who are already practising, for example foreigners, and who, according to their record, have acted correctly in the ethical sense, they may still apply to the Board for limited registration and continue with their practices. More than 30 different professions fall under this category, for example optometrists and many others. The fact is that the registered practitioners of many health service professions have to compete with unregistered persons and the council and the Government most definitely cannot allow this. What is at issue here is the protection of excellent professionals in many fine professions.

I want to conclude by coming back to what we could call the tariff clause, clause 8, which has been referred to a great deal this morning. The amendment contained in this clause is probably one of the most important because it affects one of the most sensitive issues. It not only concerns the tariffs of medical practitioners and dentists; it concerns far more. What is at issue here is the weal and woe of people, and it is they whom I wish to emphasize this morning. On the one hand you have the practitioner who earns his living by practising his profession, who, owing to the pledge and the honour of his profession alleviates endless suffering and pain in many peoples’ lives, but on the other hand we have the patient who comes and stands before the practitioner as a fellow human being in distress and says to him: “See me and recognize my dignity: My pain, my illness is secondary. See me as a fellow human being with human dignity.” At present a congress of general practitioners is in progress in Cape Town. I read in Die Burger of 28 March 1980 that a foreigner said, inter alia—

Hereby I want to confirm that the human being in distress wants to be seen and recognized as a person with human dignity. When this happens, the tariff is no longer the most important issue in the doctor-patient relationship for either the practitioner or the patient. But because the materialism and the technocracy of the 20th century have caught up with us, a great deal of the earlier idealism has had to make way for the materialism of today. Today I want to advocate the renewal of this spirit in the practitioner as well as the patient, and I do so for the sake of both. When I say that, I am interpreting not the feelings of an outsider, but the feelings of the most eminent figures in the sphere of medical science, who, as professional people, make this appeal to the medical practitioners and the patients.

I think it is fitting to pay tribute this morning to people such as Prof. Van den Berg of the Netherlands, Victor Frankl of Vienna, Paul Tournier of Switzerland and Von Weizäcker of Germany, but also to the A. G. Vissers, the Louis Leipoldts, Karel Bremers and the Hennie Snymans of the RSA, our own people, and through them, to the thousands of unsung general practitioners who are the soul of the profession in our country.

Finally, as far as this clause is concerned, I believe that it is fair. I believe in its fairness, and I believe that it will satisfy not only the profession, but also the Government and the public. No reflection is being cast on any profession. It is only a question of certain attitudes, for example that of the hon. member for Bryanston. I am convinced that most of the 14 000 medical practitioners will be satisfied with the Bill and that the most important component in this structure, viz. the patient, will be well served by it. The medical profession and the patient in need ought to be raised above the materialism of our time and the coldness of technocracy. Therefore, with these words it is a privilege for me to support the proposed amendments to the Act and to congratulate the hon. the Minister for having succeeded in bringing the three components together to negotiate, and on having done a tremendous amount of work behind the scenes to obtain the goodwill and co-operation of these professions.

Mr. Speaker, we have listened with great interest to the hon. member for Brits, a member of the medical profession. We were particularly interested in the figures that were given with regard to the objections that have been made by the medical profession. I think this has got something to do with the attitude of this side of the House towards the Bill. We would have preferred not to have had this discussion in the House at all, and I think if the hon. the Minister of Health did not take the steps that he has taken, the Bill would not have been before us. I think the medical profession, which has had control over this since Union in 1910, should have been left where they were and not now in 1980 have this legislation hanging over them affecting their right to make a decision themselves concerning their tariffs.

Concerning this question of tariffs, I listened with great interest to the hon. member for Pietersburg. Quite frankly, the hon. member did take an objective view, but I think he in fact justified the tariff increases of 52,4% that the Medical Council actually proposed at the time. The hon. member said that certain economists backed it whilst others did not. Speaking purely as a layman, I must say the 52,4% sounded a lot when it was announced by the council. My immediate reaction was that they could perhaps have spread it over a year or two so that the public would more readily accept it. I agree with a lot that has been said. I think we all have the experience that in so far as a plumber, an electrician or someone to fix one’s garage door or refrigerator is concerned in that one will pay a jolly side more for that compared to what a doctor charges to attend to a sick patient in his house. So much for the question of the tariffs. We all hold the medical profession in the highest esteem. Their status, as the hon. member for Bryanston has said, should be maintained at a high level. We regard the medical profession as a responsible body, and we are prepared to trust the profession with our lives and those of our families. Therefore it boils down to a question of whether we can trust them to make a decision concerning their own tariffs. I mention this in passing. We should not frighten the medical profession out of this country. There was an exodus, but I think the situation is not so bad at present. I know of a young recently qualified doctor who has been looking for a job for the past three months, but he cannot find one with any medical hospital or institution. Therefore I do not think that the situation is as bad as it was. The dispute with regard to the protection of members of the public, a dispute between them and the Medical Council, is now in the hands of the hon. the Minister. Our attitude to this dispute is very simple. We feel that since we have such confidence in the Medical Council, which controls the medical profession so well in regard to all aspects of medicine and dentistry when it comes to discipline and general conduct—which I may say is of the highest order—if they have negotiated with the hon. the Minister and are prepared to accept the compromise, I think we would be placed in a difficult position if we were to say that we do not have confidence in the Medical Council which has accepted this compromise. Had we opposed the Bill at this stage, we would in fact be in the position of not accepting the decision of the Medical Council. That is the position in which we find ourselves at the moment.

That is wrong reasoning.

I think the hon. member for Durban North devoted a lot of his time to a discussion of the next Bill which is to come before the House. I will not get myself into the same difficulty by discussing the right to opt in or out of a medical scheme, because we will deal with that adequately when the relevant Bill is discussed.

In so far as the system is concerned, section 53A of the principal Act makes it perfectly clear how the tariff of fees is to be arranged after the amending legislation comes into operation. The principle is therefore not a subject for discussion under this Bill. If it were we might well have had certain views on the system as such. We are now discussing the right of the hon. the Minister, in terms of the amendment on the Order Paper to control the tariff of fees which the Medical Council has decided on, and we must therefore confine ourselves to that particular argument. In those circumstances the wording of the amendment of the hon. member for Durban North is a little bit difficult to understand. His amendment states that the Bill drastically changes the effects of a determination relating to professional fees. I think he means that the hon. the Minister’s right to have a say in the tariff is being queried. I am afraid that the wording of the amendment does not quite have that meaning, but I think I know what the hon. member intends by his amendment However, in view of the stand we have taken on this Bill, I am afraid that we cannot support this amendment.

Do not try to think. The smoke will come out of your ears.

I think it is pertinent to discuss the hon. the Minister’s statement in so far as the areas of medical services for the public in South Africa are concerned, and the hon. member for Durban North quite rightly touched on this. We are arguing here very much in respect of medical services for Whites, because they are involved in medical schemes to a large extent, unlike the Blacks and the Coloureds.

We are not arguing about medical services for Whites. We are arguing about one single tariff.

But I think that the participants of medical schemes are mostly Whites. There is a small category of people in South Africa who go to private doctors for medical attention because they can afford what private doctors charge. Secondly, we have the medical schemes. As I have indicated, a large number of people are involved in them. Thirdly, we have the hospital services. I side with the hon. member for Durban North in that regard. If the hon. the Minister is worried, as I think he ought to be, with regard to general services to the great majority of people in South Africa who cannot afford the first two categories of services I have mentioned, I think he should bring his influence to bear on the Administrators of the provinces in respect of hospital services for the general public. In that respect there are the free patients, the patients who pay in part and the patients who pay in full. I think it is time that the means test applied for hospital services should be reviewed in the light of the economic situation prevailing in this country today with a view to opening the doors wider to admit more people. I agree with the hon. member for Durban North that the hospital services available at the majority of our hospitals in South Africa under the control of the provincial administrations are very good. I think we should encourage these services as much as possible.

I want to return to the question of tariffs. I think there are two sides to the argument concerning the determination of tariffs. I hope the hon. the Minister will bear this in mind. If the tariffs are too low, a lot of doctors will obviously opt out of the medical schemes. They will take advantage of their legal right to opt out and charge their own fees. As a result the medical schemes themselves may suffer to a certain extent and they will not have the medical profession to assist them. On the other hand, if a realistic tariff is laid down, one will find that fewer doctors will opt out. They will remain contracted in at the tariffs that have been agreed to, so that members of medical schemes will continue to consult them and obtain medical services from them. We must therefore be careful not to make the tariffs counterproductive to either the medical profession or the satisfactory continuation of the medical schemes. We must find that balance. I believe that if the tariffs are attractive, a lot of the doctors will not contract out. Why should they? If they are happy with the tariffs, they will remain contracted in and thus the medical scheme will be satisfactorily maintained.

I think that all in all I have explained our point of view. I want to ask the hon. the Minister in his reply to help us by just clarifying one thing. I should like to know whether the tariffs, which have formed the subject of so much discussion, have been gazetted. If not, would they fall within the ambit of the legislation now being proposed in the sense that they will have to be submitted to the Minister for a period of three months? In terms of the Minister’s amendment, there will then be six months left in which to revise the tariffs. For the rest, I think the hon. member for Bryanston has stated our point of view very adequately, and we stand by it.

Mr. Speaker, one of the issues which in my opinion gave rise indirectly to the formulation of clause 8 of this amending Bill, is really as old as man himself. In fact, even one of the oldest known books, the Bible, gives prominence to this issue. Allow me just to quote from Mark 5, verses 25 to 27. I do not quote this to bring the medical profession into discredit. I have a high regard for the medical profession, as I shall indicate later. I quote—

Here, then, was a patient who had lost all her possessions in the process of paying for medical services rendered, but who had nevertheless remained ill. This was a patient who urgently needed medical treatment but could simply no longer afford it. I think that in order to prevent a similar situation proverbially—and I emphasize “proverbially”— clause 8 of this Bill stipulates that a tariff of fees for medical services rendered has to be submitted to the hon. the Minister for approval before it is published as a law of the Medes and Persians in the Gazette.

An objection being advanced against the principle contained in clause 8 is that we are really moving in the direction of the socialization of medicine. Limited tariff control— and I do want to mention this—in the sense of a limited say for the hon. the Minister, with, in extreme cases, the determining of a tariff of fees, does not necessarily lead to socialization of the medical profession. Surely the socialization of the medical profession entails that the profession as a whole is administered with Government money. However, there is no question of that here.

It is not being denied that such a say will involve an element of Government intervention, but what is emphatically denied is that such an element must necessarily be generalized to the concept of socialization. In fact, the hon. the Minister went out of his way to prevent the socialization of the medical profession in South Africa. Recently he spelled it out clearly to the dentists that if the State had to provide for emergency services to the private sector, some of these emergency clientele would not flow back to private enterprises, and that was the very thing which he, as Minister, wanted to prevent. Taking everything into consideration, it would thus seem wrong simply to shoot down a provision because it contains just an element of socialization.

I should like to refer to what was said by the hon. member for Bryanston. It is true that our system of provincial hospitals contains a strong element of socialization as well, but no one would advocate that we should do away with the system because of this element. I think one should rather weigh the merits of the case, and I think that the merit lies in the fact that now, for the first time, the consumer of medical services also has a say in the determining of the tariff of fees as such. In this regard I think that we should also just take cognizance of what Sigerist said in his article: “Die beroep van die geneesheer deur die eeue.” He says that there is one lesson one should learn from history and that is that a medical practitioner’s position in society is not determined by himself, but also, indeed, by the society he serves.

I find merit in another aspect of this clause as well. The merit lies in the fact that the hon. the Minister is preventing the national economy from being disrupted. It is nothing new that tariffs of fees are being determined by the State. In the code of Hummurabi, drawn up 2 000 years before Christ, we also find such a provision. I do not think the intention behind this provision should be seen as the impoverishment of the medical practitioner. At the beginning of this year the Human Sciences Research Council published figures that perhaps indicate that the financial position of medical practitioners is not as rosy as was originally supposed. I should just like to quote a few figures published in this report. It is alleged that a specialist at the age of 50 years earns R30 050 per annum. For a general practitioner the amount is R24 010, for an engineer it is R23 250, for a managing director R22 500, for a dentist R20 810 and for an architect, R18 960. This has nothing to do with the legislation, but I think that Parliament should take cognizance of the fact that clergymen are not even mentioned in these tariffs. However, let me now come back to the medical practitioner himself. This council’s report rightly points out, too, that 34% of the income of general practitioners is earned outside normal working hours. Moreover, medical practitioners write off thousands of rands in bad debts every year, and I believe they deserve the gratitude and appreciation of every South African for the work they are doing in the Republic.

The hon. member for Bryanston said that these people were experiencing a loss of status. However, I am not so sure of that. In the USA a credibility list was drawn up by the Louis Harris Bureau. According to this list medical practitioners occupy the top position. They are followed by refuse removers, journalists, politicians and clergymen. I think that the position here in South Africa would be approximately the same, except that the position of the politicians would be a lot lower down, owing to the statements made by the Opposition. [Interjections.]

I have almost finished. I just want to emphasize that I believe that we should support this Bill. We are happy that those medical practitioners who do good work should have a higher tariff, as long as this does not disrupt the national economy or give rise to socialization.

Mr. Speaker, I found the contributions which hon. members made very interesting. I listened to them attentively. Hon. members of the Opposition would probably have noticed that I only made an interjection at one point. This was of course because I was exercising very strict self-discipline. What I want to say, I shall rather say now. I did not want to interrupt hon. speakers while they were talking. I hope that I shall also be granted that privilege.

To start with I should like to associate myself with what the hon. member for Randfontein said. Hon. members might perhaps have wondered how a trained clergyman could participate in a debate of this nature, but I wish to point out that the person who is closest to the medical practitioner in his overall profession is in fact the clergyman. If a medical practitioner does not have the support of a clergyman in his general practice, if he does not emphasize his strong faith, he cannot act as a medical practitioner. After all, the medical practitioner deals with very difficult problems every day. Every day he has to deal with suffering and death, with difficult tidings which frequently have to be broken to the next-of-kin. Thus one can say that the medical practitioner frequently has to take the place of the clergyman himself. Therefore I thank the hon. member for Randfontein very sincerely for his participation in the debate. He is of course a member of the study group on medical matters. I think him cordially for his sturdy contribution to the debate. Without the clergyman the medical practitioner cannot be a medical practitioner.

But the hon. member for Randfontein also raised many other interesting points. Right at the outset I want to clarify one matter again. Neither I, nor the Government, nor a single hon. member of the NP is interested in a total socialized system of medical aid in South Africa. What we do have is a hybrid system. I think the hon. member for Bryanston referred to this. At our provincial hospitals everyone is treated, whether they are White, Brown or Black. I do not wish to refer to colour again. This matter has nothing whatsoever to do with colour. Unfortunately the hon. member for Hillbrow dragged the colour issue into this matter. But it has nothing to do with colour. No one who needs a service, even if he is so poor that he possesses nothing—even if he has less than nothing—is turned away when he goes to a provincial hospital for help.

In comparison with medical services in the rest of the world, every patient at a provincial hospital receives a better service even than every White person in Europe, in Russia or wherever he may find himself. Our Black people in South Africa are extremely privileged. For a very small charge they can receive the best service in the world anywhere in this country. Our medical services are second to none in the world. This I ascertained after examining the position for myself. Moreover I know this to be a fact because I read up on this matter myself.

The entire system of medical schemes revolves around the contributions made by hon. members. This is every member’s own money which is paid into the medical scheme. That money goes to the medical practitioner. The State does not receive even a percentage of that money. The State has nothing to do with it. If I should therefore, at any stage, have the right to try to keep tariffs in check, not to control tariffs or determine them, even though the hon. member for Hillbrow says I will be watched … I welcome it if people keep an eye on me. It keeps one on one’s toes. In the meantime it also gives other people something to do. [Interjections.] Since we do have the medical schemes on the one hand, and the medical practitioners who receive the money on the other, surely it is clear that the Government does not enter the picture at all. Since the Minister will merely, by way of a statutory amendment, have the right to ensure that the tariffs are at least fair to the medical practitioner and the patient, we are in this process in fact dissociating ourselves from a socialized system. The moment when the medical practitioner’s tariffs for his services are so high that he prices himself out of his practice, as it were, there is a greater flow of patients to provincial hospitals. That is what the hon. member for Hillbrow advocated. This will be the beginning of a larger number of people who will begin to receive socialized medicine, because the State pays for those services. In the Cape, for example, the total expenditure on medical services last year was R250 million, of which we recovered only R8 million from tariffs. If that is not a socialized system, there is no such thing anywhere in the world. It cannot be any worse, and if one maintains an equilibrium between the scheme on the one hand and the doctor with his price increases on the other, I am certain that what the hon. member for Randfontein said must certainly be the last of this old story of the socialization of medicine, because it is only being used to frighten the doctor. The doctors are not always conversant with all these things, because they have work to do.

I also want to thank the hon. member for another interesting point which he raised in regard to what the incomes of various people are, and I do not wish to use the debate today to discuss in any way the incomes earned from various practises. The HSRC made the inquiry to which the hon. member for Randfontein referred. Occupying the first four positions are accountance in the first position, and in the second, third and fourth positions the medical practitioners, the specialists, the general practitioners and dentists. Surely we cannot then be dealing with a profession which can plead poverty.

But that is not the end of the matter, the end of the matter is what their total expenses, the expenses connected with practices, etc., are. The hon. member for Durban North and the hon. member for Bryanston mentioned radiological expenses and machines that had to be purchased. It is not my task to see how a person is compensated for that; it is the task of the profession. The profession establishes a number of units which a person receives for certain work. He may establish units for a certain radiological examination, but it must be borne in mind that the machine cost R500 000. However there is something else which must be borne in mind, viz. that after the machine has been in use for one or two years, it has been paid off. What happens then? The machine then operates at an overall profit.

I know what I am talking about Only yesterday I paid an account for a radiological examination. My share was R32. The total amount just for one type of examination—but it was a highly specialized examination, namely a brain scan which one of the members of my family had to undergo—was R160 according to the tariff of the medical scheme, of which I had to pay R32. The tariffs which are determined, in other words the units, are determined by the profession itself. If the people who determine the tariffs think that the radiologist is receiving too little for his examinations they must state that he should receive more units. Actually I can only agree with the hon. member for Bryanston.

†He gets these lucid moments and I want to congratulate that hon. member. I agree with him where he said that the whole object of this commission and of the attempt that I am making through this Bill and the determination of fees in the future, should be one of the easiest and most simple things in the world. One does not need a whole commission every time, which will sit for days, weeks and months on end and call on every economist in the country to help to solve the problem. At the end they get twice as many opinions as there are economists. What one needs, is a basis of units already determined by the profession. That is their job. I have told them that on three or four occasions. They should not look to me. They put these same points to me and asked what about the general practitioner, the specialist and the ear, nose and throat surgeon.

*I don’t mind in the least what they do. They must fight it out among themselves, and I want to tell you that it will be no ordinary fight, because when doctors fight, they really fight. Hon. members will see that they will fight in those cases. However, it is their business. They must determine the units, and then we arrive at a tariff price per unit. When the commission has finished sitting, it can recommend anything. The hon. member for Hillbrow asked me whether I could just tell him what was stated in the Gazette. It has been in the Gazette since 1 November 1979, and it was published there by the Medical Council itself.

These tariffs and fees are already operative. It is obvious to me that the hon. member did not fall sick since 1 November. He has not had anything to do with the new tariffs yet. There are a few things which are being completely ignored. I think the hon. member for Pietersburg made an exceptional contribution as a member of the profession. He said that one was dealing with tariffs and the State on the one hand and the medical practitioners on the other, and then tried to bring the two together. That is what I have been trying to do over a period of six or seven months. I fell head first into this whole situation. I did not ask for this situation. But it is very clear to me that something certainly has to be done so that we can restore calm. We must reconcile the medical schemes on the one hand with the doctors on the other. They have been trying to reach a settlement for the last thirteen years, and to reach consensus with one another on preferential tariffs. I think that is the aspect which the Opposition is to a certain extent ignoring.

†We are talking about preferential tariffs and not total medical tariffs. We are only talking about preferential tariffs. South Africa is the only place in the world where a doctor, if he is contracted in, can be completely certain, by law, that he is going to receive payment.

*South Africa is the only place in the world where a doctor, if he is contracted in, is certain, by law, that he will receive payment. Nowhere in the world can any person in any profession claim, under the same circumstances, that he will have his money in his pocket if he is contracted in. If we correlate these two aspects we must realize that we have to give a little on the one hand and take a little on the other. If I were to open a practise tomorrow, I would contract in, as surely as I am standing here, and I shall remain contracted in because it facilitates bookkeeping. One receives one’s cheques directly from the medical schemes after one has sent out one’s accounts.

But that does not mean that health services have been socialized. On the one hand one is giving the patient a guarantee that if, as 80% of our White population are, he is a member of a medical scheme and pays the required amount every month, he need not be burdened by the payment of medical expenses the day something drastic happens to him or his children fall ill.

Now that I have pointed out these few aspects, I want to return to the basic question around which this entire matter revolves. I have sketched the history of the matter, and I do not wish to go into it again. The entire matter revolves around a dispute which arose, and which in my opinion was a justified one. As Minister of Health I could not simply allow the matter to continue. I have an obligation to the Government and a special obligation to the general public of South Africa. Surely if I think the tariffs are too high, I must say so. Surely I am not such a duffer as to say nothing when I think they are too high. If people wish to hold it against me for saying so, there is nothing I can do about it.

†I do not think it was necessary that the hon. member for Bryanston should say that I as the Minister was acting in an undignified and arrogant way.

*I just wish to quote a short extract from a letter which I received from the Medical Association of South Africa on 13 March 1980, in which they thanked me for the last interview which I had had with them—

Does that sound as if I am an arrogant Minister who kicks the doctors round a table? Does it? This is what the medical practitioners themselves told me. I have great appreciation for what they wrote, because we went through a great deal together. That is how one learns to know people better.

[Inaudible.]

When the hon. member grimaces like that, it looks as though he is also going through a difficult spell.

There are just a few other points I wish to emphasize further. I have no problem with this Bill. All I am trying to do in this case is to prevent the same situation from ever arising again. The Press kicked up a fuss and there was no cartoon in which a doctor was not being lampooned. Once one begins to heap scorn on and laugh at the profession, one denigrates it completely and impairs its status. The status which any professional man enjoys in the eyes of a patient, is not the status which he gains because of his wealth, but because of his conduct towards the patient.

Mr. Speaker, when business was suspended I was gathering up the threads and putting the finishing touches to the discussion of this particular legislation. I want to thank the hon. member for Brits for his potent contribution. It is a privilege to listen to the hon. member for Brits. He discussed the related professions here, a subject which was not touched upon very often by other hon. members, but which he can discuss as an expert. I want to thank him for the way in which he dealt with the other parts of the Bill, those parts which deal with other matters besides the tariffs. There was something else which the hon. member did which was exceptional. He made a plea for the reinstatement of goodwill between the physician and the patient. I think that is very important. I hope that in future I myself, and the legislation, in conjunction with all the associations, for example the Dental Association and the Medical Association, will contribute to our being able to restore this relationship.

I think the basis which is being made an integral part of the legislation is that we should now separate the scheme and the medical practitioner. There is no longer negotiation between the two and no squabbling over what the preferential tariff should be. In the course of such negotiations the relationship between the patient and the physician could perhaps be harmed because there is a constant argument over the tariffs. I am certain that the plea which he put forward was a very important one and this legislation will consequently ensure that we are able to do this.

I also want to thank him for the last part of his speech in which he referred to my having succeeded, as Minister, in bringing together the three components dealt with in this Bill around a conference table so that we could discuss matters. I went out of my way to do so. The letter which I quoted briefly to hon. members before the lunch break pointed out very clearly that I had gone out of my way to accommodate these people. We understand one another very well now. At one stage I held talks for up to two hours at a stretch with each of the associations and the council, and I repeated this again at the request of the council.

By consensus?

Yes. I shall come to the hon. member in a moment. I am not finished with the debate. The hon. member also moved an amendment which I have to deal with.

In the talks which we held, we reached a consensus. The hon. member for Hillbrow could be labouring under the misconception that the medical and dental council accepted all these things. I do not think they have accepted everything. They did accept certain things, but they are not very happy that the Minister has to give his final approval as far as the tariffs are concerned. I think the hon. member for Hillbrow is making a fatal error in saying that we should leave this matter alone. He said it is the profession which has to pay the tariffs. Surely the Medical and Dental council does not represent the profession. It is a statutory body and if one analyses it, one finds that it consists, inter alia, of quite a number of persons who are laymen and who are not medical practitioners or dentists. There are a few who are full-time employees and there are others who are part-time employees. Consequently the statutory board does not represent the professions. It was felt at the time that it would be best if the council would do this, because they could receive representations from the two associations, the two bodies on whom they are able to impose disciplinary measures.

I said earlier that I did not want to go into the details of what happened over this whole period, the hon. member asked me whether we did in fact reach a consensus. I am not going to quote the whole letter which was handed to me prior to the meeting to hon. members, because that would make my reply too long, but the last sentence reads—

Then the letter deals with the period during which accounts may be submitted before they have to be settled. We shall deal with the question of contracting out in a moment. The other question is that I agreed that provision should be made in section 53A(4) for a maximum period of six months in which the tariff of fees shall be approved and published. I added the additional point, with which they were very satisfied, viz. that I shall state within three months whether I accept the tariff. Consequently I cannot toss it into a drawer somewhere, and forget about it for a few years.

The last point they made was that I had agreed to the amendment of section 61(2) to provide that any tariff of fees determined in accordance with the stipulations of section 53A by the Medical and Dental Council which were not acceptable to the Minister, shall be referred back to the council provided—and this was the point on which they placed great emphasis—that the council should take up the matter with the association. They were concerned at the possibility that the council and I might become involved in a struggle and that the associations would have to stand on the sidelines and watch the fight, while the tariffs were not increased. That is why I added the provision in section 61 that if an argument should develop between us, I could announce an increased tariff in any case while we are in the process of arguing. I want to make it clear that the legislation is not intended to give me an opportunity to muzzle the medical practitioners. It is merely intended to create orderliness in the determination and the implementation of tariffs. I wish to make the hon. members for Hillbrow and Durban North aware of this. The amendment moved by the hon. member for Durban North falls away completely. If only he will understand this.

†Great minds think alike and it is a rare occasion when the hon. member for Hillbrow and I find ourselves in that position.

Very rare for both of you.

The hon. member for Durban North agrees with everything but then he states in his amendment—I cannot quite understand the hon. member’s attitude—

This does not affect the determination at all. The council still determines them. It uses its tariff committees. The only difference is that, when the council has decided upon a fee, the Minister will be handed the information, and if he agrees, the fee will be published immediately.

[Inaudible.]

That is not the determining of fees. That is the bringing into effect of the determination of fees. I want to appeal to the hon. member rather to withdraw his amendment.

*Do not let the amendment remain on the books. People will subsequently, when they see the amendment, laugh at the hon. member.

There is one more thing I want to point out to the hon. member, but I shall discuss this later during the discussion of the next Bill.

†That concerns the question of contracting in and out. The hon. member for Hillbrow, I think, has already made the point that that is not really relevant to this Bill. The hon. member for Durban North asked when representations were received from the Professional Board of Psychologists regarding the amendment to the Act. It was recommended by the board to the Medical Council sometime last year. The Board of Psychologists falls under the Medical Council. As far as I can remember, the department received the recommendation in about May 1979, i.e. early last year. All the recommendations embodied in the other clauses, which have not been discussed and do not seem to be any real problem, were actually received by way of the council. So we are putting them into effect because they had problems with certain aspects of the particular provisions.

There is one thing I would like to ask the hon. member for Durban North, and other members. I want to ask that the hon. members stop comparing doctors with plumbers. I think we are very sensitive about this whole issue. The number of jokes going around about the doctor and the plumber are getting a bit superfluous. The hon. member complained about his tap but for all practical reasons he could have fixed it himself, but the hon. member could not take his own appendix out. That makes the medical profession a monopolistic profession. Anybody can try to fix an electric light—if one wants to bring electricians in as well—and one can fix one’s own tap. [Interjections.] The hon. member for Bryanston raised another point by asking whether I should not alter the provision of the particular clause to read “shall” instead of “may”. If I am left with no option it may be that the publication of the tariffs in the Gazette may be overdue and it is better that I perhaps published a raised tariff than a reduced one in the meantime. If I am bound by the clause that says that I shall do it then I cannot publish the new tariffs in the Gazette.

But there will be a tariff in operation.

Yes, but the reason for publishing a new tariff would be that the old one is absolute. I obviously hope that the Medical Council will not come forward with a new tariff while the old one is still very effective. If a new tariff does come, but there is only a difference in respect of how much it should be raised, one does not want to have a long dissertation with the council. If it is stipulated that I must first refer it back to the council, then I cannot publish a tariff in the Gazette in the meantime.

*I want to thank all the hon. members who participated in the debate for their contributions. We have debated important legislation which I hope will ensure in future that we restore order in respect of medical tariffs, and that we are also able in this way to eliminate the dispute between the patient, the medical practitioner and the medical schemes in future.

Mr. Speaker, I move—

In the medical scheme set-up there is a tripartite contractual relationship, viz. the relationship between the member and the practitioner, the relationship between the member and the scheme, and the relationship between the scheme and the practitioner who is prepared to render services at the tariffs of fees laid down for members of medical schemes. The member and the practitioner derive benefit from the relationship in that the member is to a great extent assured against medical expenses, and the practitioner’s payment for services is guaranteed. However, the tripartite relationship creates serious problems in regard to the mechanism that has to be created to determine the fees that would satisfy most practitioners and members of medical schemes. Various alternative methods for determining the tariffs have been adopted in the past. I do not wish to go into that any further at this stage, as the matter will be investigated by a commission.

The fact of the matter is that at present we have the situation that a person who renders services may decide whether or not he wishes to render services at the tariff of fees laid down. If such person does render services at the fees which have been determined, the member receives full benefits from the medical scheme. If the person does not render services at the tariff of fees laid down, the member’s benefits decrease to 40% and even less of the account for the services. The question which immediately arises is whether it is worthwhile for such a member to remain a member of the medical scheme, particularly in the case where a member only avails himself of services sporadically. This aspect affects the young person in particular. A point could therefore be reached where it would no longer pay such a person to be a member of a medical scheme, and such a state of affairs could cause the entire medical scheme set-up to collapse.

If that were to happen, the State would have to provide services to people who cannot afford them for I doubt whether, under the present circumstances, many of these services would be within the financial means of persons with an average income unless they were contributors to a medical scheme.

The income of medical schemes consists of member’s contributions and interest on investments. Reserve funds are limited to 50% of the annual income from member’s contributions and these are compulsory to protect the interests of members in case a medical scheme were to be liquidated, and also to ensure the payment of accounts of contracted-in providers of services in such an event. In the case of employee’s schemes, the member is subsidized by the employer. The amount of member’s contributions determined in such a case depends upon the ability of the employee and the employer to pay and in the nature of things, they are limited. Consequently, the source of income of a medical scheme has a restrictive effect. So I wish to sound a serious warning that medical schemes are not geese that lay only golden eggs.

The medical profession, in particular, has levelled serious criticism and accusations at medical schemes in the past. With the appointment of the Commission of Inquiry into Health Services, every opportunity is now being afforded of proving claims and of rectifying shortcomings, and undesirable practices, if any. If people do not avail themselves of this opportunity to the full, nobody must be blamed if such criticism and accusations are ignored after the inquiry has been completed.

The question of contracting in and contracting out is a sore point with the professions. Certain practitioners charge the tariffs determined for members of medical schemes, but avail themselves of the right to contract out because they take pride in their independence as professional people and do not wish to be bound by stipulations made outside the profession to limit the exercise of their professional activities. Others, again, avail themselves of this right because they are of the opinion that the remuneration is insufficient.

As far as this matter is concerned, there are certain factors with particular disciplines, with the dental profession and at private hospitals, that do play a role. For that reason the provision on contracting in and contracting out has not been repealed. The Medical Association of South Africa has stated that as far as the financial aspects are concerned, there is no longer any reason for doctors to contract out. For the above-mentioned reasons the association is of the opinion, however, that it is not in the public interest that the right of contracting out should now be abolished.

The association and also the S.A. Medical and Dental Council have requested, however, that members of the profession should be afforded an opportunity of taking action themselves against any exploitation of the right of contracting out and to discipline practitioners with regard to malpractices in the application of the tariff of fees. The association has further indicated that it would be satisfied, if the efforts of the profession were to be unsuccessful and if it were to become necessary in the public interest, if the right of contracting out could be revoked by way of regulation. Provision is now being made for that in clause 1(b) of the Bill.

The rendering of services at tariffs specified in the tariff of fees only affects practitioners in private practice. The matter is clearly stated in clause 1(a).

As in the case of the professions in the Medical, Dental and Supplementary Health Service Professions Amendment Bill, I am of the opinion that it is also in the public interest that the Minister should be empowered to control the tariffs for private hospitals. The necessary amendment has been included in clause 2.

If a practitioner has been contracted in, the payment of his fees is guaranteed. In the present set-up, however, there is an unduly long time lapse before payment takes place, for the most part owing to the negligence on the part of the member. This causes difficulties between the practitioners and the schemes. I think this area of friction could be removed if the practitioner who has been contracted in could be given the right to send his account directly to the scheme. Various schemes have already adopted this method without any problems. Provision has been made for this in clause 3. To obviate possible malpractices, provision is also being made for control measures to be introduced by way of regulations.

It could happen that a practitioner would like to benefit a patient by charging a lower fee than is specified in the tariff of fees. With schemes where there are no 100% benefits and a member has to pay a surcharge when settling an account, the member does not receive the full benefit of the abatement, since he still has to pay a surcharge on the reduced account. Provision is now being made, with the proposed insertion of subsection 32(4) by clause 3, for the full benefit to accrue to the member. In this regard I wish to point out that the member would not be entitled to the payment to him by the scheme of any balance of the abatement after his obligation with regard to a surcharge has been discharged.

Clause 4 merely contains an essential consequential amendment as a result of the provisions of clause 1(b).

With these provisions, and those contained in the Medical, Dental and Supplementary Health Service Professions Amendment Bill,

I have tried to create powers that could prevent a repetition of the 1979 situation with regard to medical practitioners’ and dentists’ fees. I am striving for equity for all, so that harmony may be established between patient and medical practitioner or dentist, between patient and scheme, and between scheme and medical practitioner or dentist. Illness is an emotional matter and if the doctor-patient relationship were to be disturbed by a continual haggling over fees, it would not benefit anybody. However, the member of the scheme should not have to fear the expenses involved should he or his family fall ill.

This Bill has also been published for information and comment in the Gazette.

Mr. Speaker, there is a close relationship between the provisions of this Bill and the Bill with which we have just dealt. In fact, the relationship is so close that the hon. member for Durban North, when he dealt with that Bill, made a speech which was far more appropriate to the Bill now under consideration. [Interjections.]

You make your own speech.

The hon. the Minister has indicated that the interests of the public are once more involved in that the existence of the medical aid scheme is very important indeed and would obviously be very detrimentally affected if a large number of doctors contracted out of serving patients and dependants of people who are members of such scheme. As the medical schemes have been established in the interests of the public to ensure that people, who are members of the scheme, and their dependants should be able to avail themselves of medical services, it is very important that those schemes should be protected in such a way that they can continue in a viable form.

If it should happen that doctors, because they are unhappy with the tariff of fees that exists in respect of medical schemes, should contract out in large numbers, it would in the first place affect the viability of the scheme and the schemes would then not be able to operate. As a result thereof the interests of the public would be affected. I say this in the first instance.

The second point is that if the provisions of the Bill of which the Second Reading has been approved a few minutes ago should now prove to be successful and if, as a result of the mechanisms which have been decided upon in terms of that Bill, tariffs of fees were to be determined from time to time in such a way that they met with the requirements of the medical profession—in other words that they would satisfy their need for proper and effective remuneration for the services they render—then, under such circumstances, the need for doctors to contract out would fall away. In fact, the hon. the Minister indicated this and the Medical Association also indicated to us that they are of the opinion that if this new system could be effectively introduced and carried out, the need to contract out would no longer exist. The free and independent right to contract out would then not be as necessary as they previously thought it was. They also indicated that provided they were given the opportunity of dealing with this problem within their own ranks in consultation with the Medical Association, the Medical Council and the associations which represent all the other supplementary health services, the dentists and so on, who are all part and parcel of this process, they would be prepared to accept that the Minister be empowered with the right provided for in the Bill to have a final decision as to whether practitioners should contract out or not. This is, in other words, exactly the same as in the previous case where the Medical Association on behalf of its members has accepted the situation as it stands and as it has resulted because of the negotiations with the hon. the Minister, that provided they have the opportunity of dealing with the problem within their own ranks, the Minister should have the right, when agreement cannot be reached, to deal with the matter by way of regulation.

I am not particularly happy that it should happen by way of regulation. I think it would have been an improvement if a provision such as that were to be the subject of a further amendment which would be introduced in this House if necessary. It has been indicated by the hon. the Minister that he needs that provision and that that provision would only be used if it became absolutely necessary to protect the public, the various medical schemes, and, in fact, the medical profession as a whole.

Once again, we support this provision, but with the very strict proviso that the hon. the Minister will at all times apply this provision, if its application becomes necessary, with circumspection and in the interests of the public and the medical profession, and that he will, under no circumstances, compromise the interests of the medical profession by the provisions of this particular amendment.

Mr. Speaker, it is necessary that a few questions should be raised in connection with medical schemes. The first is why it was necessary that the schemes should also have insisted on a tariff increase of 52%. I am asking this particularly since some of them have vigorously criticized the 52% increase of doctors, dentists and other health professions. It is interesting to note that only 40% of the total money received by medical schemes in respect of health services have been paid in respect of services rendered by doctors. So, this increase in medical fees could not have been the only factor causing members’ subscriptions to be increased by 52% as well.

I see no reason—and I am putting it very strongly—why there should be more than 250 different schemes in a young country such as South Africa. Medical schemes will have to rationalize. That is one of the matters which this new commission would have to look into, because the interests of the public must be protected. There should be considerably fewer schemes so that each scheme would have enough members to ensure a wide distribution of the risk. The fewer schemes there are, the fewer limitations there would be on members to keep the costs down. Small schemes are simply not able to cope with two or three major upsets, and consequently it is always the public that suffers.

I request that the following matters should also receive urgent attention. These are: the sharp increase in members’ subscriptions over the past few years, the immense increase in claims, the immensely higher administrative costs connected with these medical schemes, etc. What is happening to the profits? That is not disclosed anywhere. We have to remember that these schemes were originally introduced to protect the person who is a member of such a scheme, and that they were not geared to becoming vast business undertakings.

I wish to conclude with this statement: The system of medical schemes has succeeded in more or less commercializing medical services, increasing costs, and lowering the standard of medicines. The doctor-patient relationship has been jeopardized, medicine has become dehumanized, the status of the doctor has been lowered in the process, and to a certain extent a socialization of services has set in. For that reason I am supporting this legislation, and particularly the intentions of the hon. the Minister of instituting a penetrating inquiry into this set-up by way of his commission.

Mr. Speaker, I believe we have now come to the amending Bill which will make it quite clear to hon. members, particularly the hon. member for Bryanston, why we have made continuous reference to the principle contained in this particular Bill. I think the hon. member should well have been alerted, by my referring to it so closely, to the fact that all was not quite what it appears to be. In fact, in chemistry every Std. VI pupil will be able to tell about a very interesting experiment known as the titration process. That is when one has two separate chemicals—both may be quite clear liquids—that are put together, and the moment they are mixed the colour of the whole compound changes. Sometimes when one puts two apparently inert chemicals together, one gets a quite effervescent effect, as the hon. the Minister should know because he is medically trained, he should know what happens when one puts two such apparently innocuous chemicals together.

We have the same sort of situation here. The problem area related to the system which is going to be changed in terms of this amending Bill lies very much in clause 1 which seeks to amend section 5 of the Act. That is the real problem, the essence of our complaint against this amending Bill. Before coming back to that very important aspect, however, there are some of the other clauses—and we will obviously be discussing them during the Committee Stage—about which we are interested in finding out from the hon. the Minister certain details about why it was necessary to bring these particular stipulations into the amending Bill. I refer in particular to clause 3, which seeks to amend section 38 of the principal Act.

In the proposed new section 32(1)(b) reference is made to the necessity for medical aid schemes to receive their accounts directly from the doctor concerned. The hon. the Minister did mention that in many instances this happened. It will be interesting, however, to know whether the difficulties which produced the necessity for this amendment can, in fact, be spelt out in concrete terms. What precisely were the difficulties? Were the doctors not receiving the correct payment? Were they receiving late payment? Were the medical aid schemes actually suffering as a result of the problems, was the patient suffering or were all three suffering?

I say this specifically because if one looks at the proposed new section 32(3), where an extension is being granted from 30 days to six weeks for the payment of accounts, one gets the feeling that what has happened here is that there has been a bottleneck in the processing of medical aid accounts. It is quite interesting to note why a situation like this should arise when in this computerized age one would have expected an improvement in the cycle of payment and not an extension. I was interested to hear from the hon. the Minister that this was in fact requested, or at least supported, by the various medical associations. I am referring now to this request for a change in the time period in which an account must be paid. I wonder whether cognizance has been taken of the possible cash-flow difficulties which will arise for medical practitioners as a result of this clause.

We have no particular difficulty with clause 4 of the Bill, which seeks to amend section 41 of the principal Act. We find this quite acceptable. I should like to come now to clause 1 of the Bill which seeks to amend section 29 of the Medical Schemes Act, 1967. This refers to the right of the Minister to determine by regulation whether a practitioner may contract out or not. I find the argument of both the hon. the Minister and the hon. member for Bryanston on behalf of the official Opposition quite mind-defying. It really goes beyond reason. [Interjections.] It really does. The rationale is that the hon. the Minister, in terms of his amendment to the previous Bill, finds that he cannot find accord with the tariff committees. Then, after a six-month’s process, or rather what could be a three months’ process because he has three months in which to put it in his drawer—if they do not agree, the hon. the Minister, by decree, will determine what will then be the medical aid scheme tariffs. If this is unacceptable to the majority of the doctors contracted in …

You are on the wrong Bill again.

The hon. member for Bryanston is actually in the wrong time-space. [Interjections.] He is well ahead of himself. [Interjections.] If the majority of medical practitioners, doctors and dentists, find the tariff of fees, determined by decree by the hon. the Minister, to be unacceptable, the hon. the Minister fears, as does the hon. member for Bryanston, that the majority of them will then contract out, and he finds this an unacceptable situation. Therefore the proposed remedy is that the hon. the Minister must now have the power, by regulation, to force those people back into accepting the tariff of fees. How does one solve a problem by covering it up? It is like an ulcer. The hon. the Minister, who has been a medical practitioner, knows that if one just neglects a sore and one does not get down to the root cause, it can cause the demise of the patient or certainly a tremendous amount of discomfort. The remedy which has been proposed for this problem, is to cover it up and to force the doctors by regulation into again accepting the medical aid tariffs. How is that going to affect the number of doctors available in South Africa and the quality of the service? If they were not men of such integrity and who honoured such high ethics, I believe it could have had a disastrous short-term effect. However, because they are dedicated people, they obviously will not allow medical services to deteriorate. It will, however, certainly affect the intake of new doctors and those people who are offered opportunities overseas. I cannot understand how the hon. the Minister thinks he is going to solve the root cause of the problem purely by saying that by decree one must now accept the medical aid tariffs. That is going to produce more problems than we have at the moment.

I should like to restate what I said this morning, viz. that the problem does not lie with the system whereby the medical aid schemes, the tariff committees and the hon. the Minister agree on tariffs, but with the actual quantitative figures of the tariffs. That is the problem and that is why we welcome the appointment of the commission which is going to investigate the whole problem of equitable tariffs, so that once and for all parties concerned can reach agreement and consensus and then work out a formula for allowing those tariffs to be increased according to the cost-of-living index or whatever. However, I cannot understand how the hon. the Minister can introduce this amending Bill which in principle changes the very structure of the interaction between patient and doctor, and therefore we shall obviously be moving an amendment to negate this.

Furthermore I am very interested in the terminology the hon. the Minister has been using today. He has said that he is not interested in seeing medicine becoming socialized. I take it that by that he means that the provincial administrations and the State organizations have to provide the medical services. However, what is of tremendous concern to me, in particular in relation to this Bill, which contains the obnoxious clause, is that here we have started a process of nationalizing medical services in South Africa. The hon. the Minister will deny that, but I want to point out to him that he has transgressed the golden rule. For the first time the Government is putting its foot across that thin red line in that a Minister is taking into himself the powers of the council. That is what is happening. If a Minister is going to operate by decree in this fashion, what is the use of having something like the S.A. Medical and Dental Council? Why have a council if the hon. the Minister is going to make all the decisions, in particular the critical and difficult decisions which are of paramount importance to the whole of South Africa? It seems to me that if everybody, including the Opposition, agree to this amending Bill, we can expect that very shortly the hon. the Minister and his department will want to take over all the functions of the S.A. Medical and Dental Council. We in this party cannot tolerate a situation in which functions which have proven themselves over the years to be in the interests of the public and of the profession should now be threatened by the actions of the hon. the Minister. It is one of those situations in which, once one crosses a particular line, one has broken the principle. This will happen when the decision of a Minister supercedes the decision of a controlling professional body. On that basis and in conjunction with the motivation I have given this morning, I consequently want to move the following amendment—

Mr. Speaker, my time is much more limited than the time that has elapsed since the legislation received attention during the ’sixties, and for that reason I shall not devote too much attention to all the questions the hon. member for Durban North has raised here. I just think the hon. member should clearly accept one thing, and that is that in spite of what has been written and said, the medical profession consists of a group of very responsible people, and so the situation which he foresees, would not arise. In spite of everything that has been written and said, we are dealing with a very, very responsible group of people in the medical profession, and a situation such as the one he foresees, would not arise. It has taken many years’ effort to accomplish what we have. We have come a long way. It has repeatedly been stated that it has been a long and arduous task, and that has indeed been the case. It has ultimately taken shape in the form of this streamlined amending Bill we have before us today.

One object that has been achieved, is to have brought us to the point where the cost of medical treatment and healing is within the means of our people. If we look at the legal draftsmen’s final product that is before us, it is very obvious that very good care is being taken of the interests of all the parties involved with one another here, viz. those of the people who render medical services, the medical scheme, the patient, and also the Minister. The responsibility of the Minister to the State and the general public is self-evident.

I also wish to avail myself of this opportunity, on behalf of the medical profession and also as a person who was, until recently, in the medical profession, of expressing sincere thanks to the hon. the Minister for acting as he has done in the recent past. It is no wonder that a remarkable letter from the chairman of the Medical Council and of the Medical Association of South Africa, addressed to the hon. the Minister, has appeared in a newspaper. In this letter he states, inter alia, that a climate should not again be created which would disturb the good relations prevailing between the Minister of Health and the profession at present. I therefore think that this side of the House, too, should compliment the hon. the Minister, who has acted in this way in the recent past. Since we see in the Press every day that confrontation and all that that involves, is being propagated, I wish to express the hope that a little more use will be made of the word “peace” and that the striving after good things that are accomplished when people find one another, will also be propagated.

It is very obvious from the amendment now before us that the rights of the professions involved are by no means being infringed upon and that there need be no fears on that score. It is with gratitude that we note that the legislation provides at present that in exceptional cases the professional man can indeed contract out, otherwise he might have felt that his autonomy as a professional man was being encroached upon unjustly. I think the hon. the Minister can count on the responsible action of members of the profession and their representative organizations. I also happen to know that on the part of the profession there is great appreciation for the fact that it has repeatedly been stated that the hon. the Minister and the Government are averse to the idea of private control over medical practice being superseded by State control.

There are a few matters which are relevant in my opinion. I think it is very important for us to know that there are several things, such as the increased cost of medicines, that have contributed to the situation in which we find ourselves today. On behalf of this side of the House I just wish to state that we shall do everything in our power to play our part in making this set-up a happy one and, ultimately, in ensuring that we have a healthy body for a healthy spirit for the fine things in our country.

Mr. Speaker, I will be very brief. I shall just make two specific points.

Is that possible?

We support the Bill because we have confidence in the members of the Medical Association, and if they have agreed, by way of compromise or otherwise, to this situation, we will not show a lack of confidence in the association by opposing what they have agreed to. [Interjections.] It is as simple as all that. In the second place we welcome the fact that the hon. the Minister has appointed this commission of inquiry. Our submission is very simple.

You are so right.

If the Medical Association, or any other association connected with the medical and dental professions, is dissatisfied with the system that now pertains, it has the opportunity to submit evidence to the commission of inquiry which can then make recommendations to change the whole system by which tariffs are now adjusted, viz. the system which allows the hon. the Minister a say in the determination of tariffs and the question of opting in or opting out. The commission of inquiry can then, on the full evidence taken, make a finding. I take it the hon. the Minister will then issue a White Paper which we can then discuss. For those reasons we regret that we cannot accept the amendment moved by the hon. member for Durban North. [Interjections.]

Mr. Speaker, I wish to thank the speakers who have participated in the debate, for their contributions. It seems to me that medical Bills like the Bill we are dealing with bring out the best in the hon. member for Hillbrow. I have no doubt about that. [Interjections.]

I wish to thank the hon. gentlemen sincerely, but I must just discuss one or two points very briefly. The hon. member for Bryanston made the point that if the tariffs are acceptable to the doctors and to everybody else, obviously everybody will be happy and the doctors will stay contracted in. That is what one must aim at, but one does not want to be in the same position that one was in a while ago when there was total chaos in the sense that the Minister had no final say. When I say that, it is not that I want the Minister to have final say, but rather that I want to create order and a better climate between the patient, the schemes and the doctors in the middle. The hon. member also mentioned that he was not happy about regulations. There are six to seven months between parliamentary sessions, and a problem can arise such as that raised by the hon. member for Durban North, a very real problem indeed. It has happened before. If there is any alteration between the Minister and the association the association can, as it did once before, tell all their doctors to contract out. Then one has the same problem, because what use is there in having doctors contract in if everybody is going to contract out. One would just get raised tariffs and fees. There must be some built-in mechanism.

*The hon. member for Hillbrow made the same point, namely that the medical profession had accepted this. The hon. member is like Don Quixote tilting at the windmill. It has been accepted by the profession. The way in which the Bill now makes provision for contracting out, is in accordance with proposals made at the time of our discussions on 14 February 1980. We met twice and this proposal was a combined one from both sides. We accepted this by mutual consent and I wrote it into the Bill. They have stated in writing that they thank me and have said that this has been done as we agreed. Now the hon. member is speaking out against this.

I cannot accept the amendment by the hon. member for Durban Point. As I have told the hon. member for Hillbrow, I have to act in accordance with the proposals put to me and through me to the associations. They are accepting the position as it is now, because in the statement I issued I stated clearly that they should put their own house in order. They now have every opportunity to do so. They can now put their proposals to the commission, and I think we shall now obtain the necessary order.

I wish to thank the hon. member for Brits for his contribution. He raised a few interesting points. There are many schemes, and many administrative problems in respect of profits, etc., and I think these are matters which the commission will have to scrutinize. I also wish to thank the hon. member for Rustenburg for the way in which he thanked me for what I did. I appreciate this very, very much because at one stage I was experiencing a great deal of difficulty with this situation. However, if one gets recognition for the fact that one has done one’s best, it certainly means a great deal.

I repeat that I cannot accept the amendment moved by the hon. member for Durban North. I am sure that all the amendments that are now being effected, are going to set better administrative processes in motion. There were no direct requests from the medical practitioners or from the medical schemes to rectify any of these provisions, but it did appear from the discussions that a medical practitioner should, for example, have the opportunity of sending the first account directly to the medical scheme because at holiday resorts, for example, people come and go. The doctor then has to send accounts after the person involved for months at an end before he can send them to the medical scheme. In certain cases there has also been duplication. In my view, all the clauses in the Bill are an interim improvement in the administrative process until such time as the commission can convene to solve the difficulties.

Mr. Speaker, I move—

I should like to explain briefly to hon. members the reasons for the proposed amendments. As hon. members have probably noticed, the Bill involves only two principles: Firstly, the employment of members of the Force for service outside the Republic, and secondly, a further regulation of the requirements for qualification as a member of the Police Reserve.

As far as the first aspect is concerned, clause 1 contains a readjustment of an existing principle. A similar principle is already contained in regulation 4(5) of the regulations of the S.A. Police, which, for the sake of clarity, I shall quote here—

This regulation has existed for years, but unfortunately, according to the State law advisers, it now appears that there are doubts about its legality. In order to rectify the situation, the provision is being inserted into the Act in order to put its legality beyond all doubt.

It happens from time to time that a friendly neighbouring State, for example, requests assistance from the S.A. Police on Government level, and they help each other, as good neighbours do.

However, this provision should not be confused with section 7 of the Police Act, 1958, authorizing the State President to utilize the Force or part thereof inside or outside the Republic in its defence. Action in terms of that provision takes place only during a war or some other emergency in defence of the Republic.

Mr. Speaker, as far as the second principle is concerned. I have to concede, unfortunately, that section 34A of the Police Act has had to be amended every year since 1975, with the exception of 1978. The reasons for the amendments concerned were accepted in a responsible way by hon. members during those years and I want to trust that in this case too I can rely on the support of hon. members.

The effect of the proposed amendments is that a person who joined the Force in a permanent capacity on or after 1 January 1980 will have to serve at least 48 months to qualify for becoming a member of the Police Reserve. In addition, the service obligations of such members of the Reserve are extended to a maximum of 240 days, which may be served over a period of eight years.

By way of illustration I should just like to mention that these proposed amendments have resulted from the recommendations of an inter-departmental committee consisting of members of the S.A. Police and of the S.A. Defence Force, who had to consider disparities that existed between members of the Permanent Force, national servicemen and the police.

The proposed amendments serve to eliminate the differences that existed, and it is hoped that in this way, the services of members will be retained for the Force for at least four years after their enrolment.

Mr. Speaker, as the hon. the Minister has pointed out, this Bill deals with two basic issues. In the first instance it gives power to the Commissioner of Police with the approval of the Minister to authorize any member of the Force to serve outside the Republic in the exercise of police functions. Secondly, it lays down new conditions of service in the Police Reserve for those members of the Force who were members on 1 January 1980 and who, having served in a permanent capacity for at least 48 months, leave the Force for one reason or another. On the basis that the first issue is a requirement, as the hon. the Minister has stated, relating to the normal operation of the Police Force in the exercise of its functions as laid down in the Act, and that the second is the requirement to bring the Police Reservists into line with requirements relating to other forms of national service, we in these benches will support the Second Reading of this Bill.

There are, however, certain matters in respect of which we require some response from the hon. the Minister. There seems to be some doubt as to the circumstances and authority in respect of which members of the Force have in the past been required to serve beyond the borders of the Republic. I understand that the Police regulations—and the hon. the Minister has told us this again this afternoon—do in fact contain authority, or have contained authority, for the Commissioner to require members of the Force to serve outside the Republic, although the Act itself does not, save for section 7 of the Act, which lays down that the State President in a state of emergency or in a state of war may require the Force itself or any part of it to serve outside South Africa. That is part of the principal Act and it would not be competent for us to debate the principle involved during the discussion on this amending Bill. There certainly have been many instances in the past over the years where members of the Police Force have been required to serve outside of the Republic. One thinks immediately of the situation in Rhodesia in the late ’sixties and the early ’seventies when there was certainly a S.A. Police presence in Rhodesia. At the time there were reports that members of the police were in Rhodesia at the request of the then Prime Minister of Rhodesia, Mr. Ian Smith. There were also reports that the South African Prime Minister at the time, Mr. Vorster, had referred to the suggestion that the Force was there because there was infiltration of terrorists from elsewhere in Rhodesia with South Africa as their target. This was then given as justification for the presence of the S.A. Police in Rhodesia at that time.

I should like to ask the hon. the Minister to tell us what the authority was for that situation at the time, because legislation is now being introduced to allow the Commissioner, with the approval of the Minister, to authorize members of the S.A. Police Force to go outside, and that certainly was not the position at the time. Was it in terms of section 7 of the Act—I have already referred to this section—in terms of which the State President in a state of emergency or in a situation of war could decree that members of the S.A. Police should serve outside the boundaries of the Republic?

The Rhodesian situation is the one instance which one recalls, but clearly through the years there have been many instances of individual S.A. Police members being required to perform services outside the Republic. One thinks of matters relating to the extradition of people from other countries. One thinks of the pursuit of normal criminal investigations involving people who may have left the country. Presumably in these circumstances there have been negotiations— I imagine this would be the normal course— between the authorities of this country and the authorities in the foreign countries concerned to regularize the situation where members of the S.A. Police Force have gone beyond the Republic in the performance of their duties.

In this Bill we are asked to give authority to the Commissioner, with the approval of the Minister, to require a member of the Force to perform service outside the Republic. It seems to me that there is a clear distinction between what we are asked to do in this Bill and what is authorized in the Act itself in section 7, the section which empowers the State President to require in certain circumstances the Force or part of it to perform service outside the Republic. In this instance we are dealing with the Commissioner who may, with the approval of the Minister, require a member of the Force to do this. Subsection (6), the addition of which to section 6 is sought in terms of clause 1, lays down—

I think this is very important and as one reads the Bill it is clearly—I have no doubt that the hon. the Minister can give us reassurance on this point—in circumstances where the Commissioner deems it necessary for the purpose of the performance of the functions of the S.A. Police that this authority will be given.

What are the functions of the S.A. Police? Section 5 of the Act lays down four functions. In the first instance their function is the preservation of internal security; in the second instance, the maintenance of law and order; in the third instance, the investigation of any offence; and in the fourth instance, the prevention of crime. These are functions which clearly form part of the normal duty of the Police Force and if in the performance of these functions it is necessary for the Commissioner to require members of the Force to go outside the Republic, this would appear to be a reasonable requirement.

It goes without saying that we would expect the Commissioner, and for that matter the Minister, to exercise this authority with the greatest degree of circumspection. Clearly the Force itself has a tremendous responsibility, particularly at the present time, within the Republic where its resources are very often stretched to the limit. We do not see it as part of its function to operate as an arm of any other agency beyond our borders and beyond the scope of the functions as laid down in the principal Act. I think one must make this very clear.

The point must also be made that if in the performance of their functions in respect of the Act or the amending legislation which we are now debating, they are required to perform service outside the Republic, it is of course vitally important that when they do so, they do so with the knowledge and approval of the authorities in the foreign countries concerned. I am sure the hon. the Minister will appreciate the very sensitive and delicate nature of the situation where a member of the Police Force of South Africa is required to operate in another country. One would certainly not like to see a situation that the S.A. Police Force or South Africa itself is in any way compromised as a result of these activities. One would therefore hope that there would be a very close co-operation with the Governments and the authorities of the countries concerned in situations where the South African Police are required to serve outside South Africa.

With regard to the second issue raised in this legislation, the need to extend the period of service which may be required in the Police Reserve, I want to say that it is, of course, very regrettable that this should be necessary as it does impose a considerable increased burden on those who are affected. However, it has unfortunately become part of the pattern of life in South Africa, and at this stage we regard this as a precautionary step to augment police strength in the event of the resources of the Force becoming further strained in the preservation of law and order in future circumstances in South Africa. We therefore see it as a precautionary step and we trust that the hon. the Minister, in particular, will in the exercising of authority in terms of section 34A(3) of the Act, which relates to the call-up of police reserves, have due regard for the disruption that such call-ups cause in the lives of those concerned, and we trust further that he will not use this authority unless it is absolutely necessary and that he will restrict the frequency and duration of such periods of service to a bare necessity. With these observations, we will support the Second Reading of this measure.

Mr. Speaker, I have already heard such tortuous reasons for supporting a Bill. The hon. member for Musgrave has given every sort of reason in the world for not supporting the Bill, and then went ahead and supported it. He talked about the first issue in the Bill, which is the provision regarding the operation of our Police Force outside the borders of the Republic, and then he went into a long diatribe about what happened in Rhodesia. I submit quite frankly that that was trying to bolt the stable door after the horse has gone over the hill, through the dip and up the next hill.

And ended up in Mooi River.

Perhaps in Musgrave, I do not know. I was given to understand that the regulations were contained in Regulation No. 45. It appears that that regulation is now considered to be ultra vires and we understand that it is for that reason that the hon. the Minister has brought this amendment before this House today. Without any equivocation whatsoever, we agree wholeheartedly with what he has done. It has legalized these things, has dotted the “i”s and crossed the “t”s, which is what is required in the interests of good legislation.

The second provision in the Bill concerns Police Reservists. One should at all times remember that our national servicemen are being seconded to the Police Reserve as well. They are seconded to the Force and they then ultimately take up posts in the Police Reserve, and again I cannot quite follow the logic of the argument of the hon. member for Musgrave. However, he has his reasons for it, and all I wish to say is that although it is something that is possibly a hardship for some, this is indeed a way of life in our country and we must accept it. We will support the measure which the hon. the Minister has introduced.

We have absolutely no objection whatsoever to this Bill and we will support all stages in this House this afternoon.

Mr. Speaker, I thank the hon. members of the Opposition for their support of this Bill. It is, as the hon. member for Umhlanga has said, only these two particular points that are involved, and there is nothing else to discuss in the Bill. As far as the hon. member for Musgrave is concerned, I should like to assure that hon. member that members of the Police Reserve Force are only called up when it is, of course, necessary, in the interests of the Force, and with due regard to their own personal circumstances as far as possible. I have had practically no, or very few, complaints in this regard, because the responsible, police officers go out of their way to try to accommodate the members when they call them up for duty during July or December, or whatever the period may be. As far as the first point made by the hon. member is concerned, I am not sure myself under what authority police were called to perform duty in Rhodesia during the 1960s. It seems to me it was in terms of the relevant regulation I have quoted. If so, it was quite a legal call-up. It may also have been in terms of section 7 of the Act. Unfortunately I cannot take the matter any further. In fact, on this particular point I am not well enough informed to take the matter any further. Whichever of the two it was, in my view both were legal and in order.

I also wish to assure the hon. member that it is my policy not to allow the police to become involved in any way whatsoever without my personal consent in any other country, be it Transkei, Venda or Bophuthatswana, where we have previously been actively involved in assisting their own Police Forces in training, organization and administration. I shall only allow the S.A. Police Force to become involved in another country upon the explicit request of the Government or the authorities of that particular country. We do not send our men out of choice, but only upon a request from another country. The hon. member may rest assured of that. What is more, even before this Bill was drafted, when I first became the responsible Minister, I laid down as policy that notwithstanding the provisions of the regulations, every such posting must be authorized by me personally. That happens in every instance. It has been done in the past, and will now become the legal position once this Bill becomes law.

I believe I have covered all the different points made by the hon. member for Musgrave.

Mr. Speaker, there are only one or two aspects I should like to refer to in respect of this particular clause. There was one particular point raised by this side of the House during Second Reading on 12 February this year. We then asked whether this would not lead to the possibility of authority over an area being taken away from one local authority to be given to another. When we raised this point the hon. the Deputy Minister said it was nonsense, it could not happen. In his reply the hon. the Deputy Minister said (Hansard, 12 February 1980, col. 579)—

He then went on to say it could not happen, that the problem was purely restricted to Natal.

Now, we have in front of us an amendment which actually confirms the point we made during Second Reading. We said it could be transferred from one local authority to another. The amendment before us now actually deals with the very point that was raised during Second Reading and repudiated by the hon. the Deputy Minister at the time. We believe he should explain to us why this has been brought about. I quote from the amended clause as it stands now—

Do I understand the hon. the Deputy Minister therefore to be saying that if a particular local authority takes over from a previous local authority, the new local authority can then impose its decision on the earlier local authority? We have no objection to this because we foresaw it. I think, however, that the hon. the Deputy Minister must explain, in greater detail, exactly how this will work and what the impact of this is going to be on the first-mentioned local authority.

Mr. Speaker, I stand by the reply I gave the hon. member for Sea Point. However, I wish to tell him by way of explanation that there is no land in this country that does not fall under the jurisdiction of some authority or other. We are concerned here with a matter which affects Natal. In this case the area falls outside the area of jurisdiction of the local authority. Therefore it falls under the jurisdiction of the Provincial Administration of Natal. The hon. member rightly asked what was involved here, and I have specifically made inquiries concerning the matter. It was then explained to me that in Natal so-called service boards exist. The Natalians will be able to tell me what their correct name is.

Development and Services Boards.

These bodies fall under the Provincial Administration of Natal. They exercise certain rights within the scope of the jurisdiction of the Natal Provincial Administration. They also have the right to decide what type of structures may be erected outside the area of a local authority. This applies in particular to the small places where there are no local authorities. They perform a certain function. Although the law advisers have told me …

[Inaudible.]

There is unfortunately a whole long reply I have to give hon. members. The law advisers told me that the case of Mr. Pyper, the hon. member for Durban Central, will in fact not create a problem. While I have some time at my disposal, I wish to read something to him. I submitted the amendment to the department, and they told me the following—

The provincial authorities have the right, within their area of jurisdiction, to use any body or person to exercise that jurisdiction on their behalf. These Development and Services Boards exist in the small areas around the big cities and the larger towns in Natal. They are used by the Provincial Administration and they also obtain the right to decide what type of structures people may erect there. Because we do not wish to abrogate those vested rights obtained by people, and also by those bodies that receive their powers from a higher body, we have decided to write it into the Act as the hon. member requested.

Mr. Speaker, I move—

Section 20(3) of the Constitution of the Republic of South Africa, 1961, provides that a Minister may not hold office for more than three months without being or becoming a member of the Senate or the House of Assembly.

This provision therefore entails, inter alia—

1. (a) That a Minister who is not a member of one of the two Houses and who wants to become a member of the House of Assembly must fight an election within a period of three months after he has been appointed, while at the same time he has to find his feet in the new post. Under the present circumstances in which the task of a Minister is so much more demanding than has perhaps been the case at any other period in the past, it can also happen as a result of this that a Minister has to give attention to different matters at two different places, and this, of course, is not always possible.
2. (b) that if this period of three months falls partly or wholly within a parliamentary session, it is not always possible for such a person, after his appointment as Minister, to be available for the House of Assembly or the Senate when his presence is required, because he is concerned with his election as a member of the House of Assembly;
3. (c) that it may be required of a sitting member of the Senate or the House of Assembly, during the session of the Senate or the House of Assembly, as the case may be, to vacate his seat for the purposes of the election of the new Minister as a member of the Senate or the House of Assembly, because the national interest requires it. Such circumstances could result in financial and personal embarrassment to such a member and to the new Minister and other persons as well;
4. (d) that the appointment as Minister of a person who is not a member of the Senate or the House of Assembly may have to be delayed because such a vacancy is not available in either of the two Houses or will not become available within a reasonable period. Such a delay could, at the least, have an adverse effect on the implementation of important plans and projects.

In the light of these considerations it is proposed in clause 1 of the Bill that the provision in question be amended to enable a Minister to hold office for a period of 12 months without having to be or become a member of the Senate or House of Assembly.

†Section 54(4) of the Constitution Act provides that a Minister, or someone who holds the office of deputy to the Minister, who is a member of the Senate or the House of Assembly, has the right to sit and to speak in both Houses, but he shall only vote where he is a member. This provision entails that a Minister who is not a member of any of the two Houses, is therefore not entitled to take a seat and to speak in any one of the two Houses. Such a Minister is therefore prevented from taking part in debates and to be questioned in the Senate or House of Assembly on matters for which he bears the responsibility as Minister.

It is, to my mind, in this time in which we are living, not desirable that a Minister, not being a member of the Senate or the House of Assembly, should sit in the gallery and be debarred from debates dealing with matters which are his responsibility as Minister. Good government demands that he must be subjected to questioning in any one of the two Houses and that he be enabled to perform his duties in all respects. It is therefore proposed in clause 2 that the provision concerned be amended so that a Minister who is not a member of the Senate or House of Assembly may sit and speak in any one of the two Houses, but with this important qualification that he may not vote in any one of the two Houses.

In this regard I wish to draw your attention to the provisions of section 78 of the Constitution Act in pursuance of which the Administrator and every other member of the Executive Committee of a province who is not a member of the provincial council has the right to take part in the proceedings of the council but does not have the right to vote. The principles contained in the proposals of this Bill are therefore not new.

*The proposal embodied in clause 3 of the Bill will have the effect that a Minister who is not a member of the Senate or the House of Assembly will obtain the same powers and privileges as a “member”. This proposed amendment is clearly desirable if he may sit and take part in debates, because it could lead to major injustice if a Minister who was not a member of either of the two Houses but was allowed to sit and to speak in the Senate or House of Assembly, did not enjoy the same protection as a member.

During the Committee Stage I shall move an amendment to clause 1 of the Bill. The amendment appears on the Order Paper of 4 March 1980, and its purpose is to provide that if a person has been a Minister without being a member of the Senate or the House of Assembly, he may not be reappointed as Minister being such a member. The Act is now being improved, since as section 20(3) reads at present, a Minister can be appointed ad infinitum with only a day’s interruption at the end of each period.

Mr. Speaker, firstly, on behalf of the entire House I should like to thank the hon. the Minister for finding a moment to be here this afternoon timeously to propose his Bill. We nearly missed that very erudite Second Reading speech. The Bill has been on the Order Paper for some weeks now, which has given us time to study it, and hon. members will be delighted to hear that we intend arguing this Bill at length. However, I am sure that hon. members will be even more delighted to hear that we intend doing that after the recess. Therefore I move—

Mr. Speaker, I move—