REPORT. (Hansard, 4 July 1870)

§ THE EARL OF LICHFIELD
said, he felt that an apology was due from him, for venturing at this late stage of the Bill to introduce an Amendment of considerable importance; but he believed he should be justified in doing so, even at a very short notice, if it should appear that the object of the Amendment was to carry out an almost unanimous feeling of the medical profession. In asking for such a representation on the General Medical Council as his Amendment would give them, the profession were not seeking to advance their own interests, but were actuated by a desire to promote the interests of the public. It appeared to him that they were indebted to the profession for the Bill introduced in 1858, and also for the Bill now before their Lordships. He had heard several objections made to the direct representation asked for by the profession. It was said that the medical body was represented indirectly, if not directly, on the Medical Council. Now, if it had no direct voice in the constitution of the Colleges and Universities—and it was only necessary to look into the pages of the medical calendars to see that it had not—it could not have an indirect representation on the Medical Council. It was urged also that a direct representation of the profession on the Council would not be worth the trouble and expense which it would involve; but he believed that the registration of the whole profession, established by the Act of 1858, rendered the carrying out of the object of his Amendment a very easy matter. Another objection was that the addition of eight members to the Council would make it too unwieldy. This was a matter of detail, and the difficulty might be met by linking together some 1348 more of the Colleges. A Petition emanating from some 4,000 members of the profession, a memorial presented to the President of the Council, and meetings held at Oxford, Leeds, Edinburgh, and Dublin, all went to show how strong was the opinion of the profession in favour of direct representation. Even at a meeting of the General Council held to consider the clauses of this Bill, a resolution was brought forward by one of the nominees of the Government strongly recommending a larger representation, though an indirect representation. A long discussion ensued, and a decided feeling was manifested by the Council in favour of a better representation of the medical profession. He was certain their Lordships would not desire to pass a measure which would not be acceptable to the profession at large, and therefore he proposed to insert a new clause, to the effect that the General Medical Council after the passing of that Act should always contain four representatives elected by the registered members of the medical profession residing in England and Wales, two representatives elected by the registered members of the profession in Scotland, and also two elected by the profession in Ireland. Although he did not wish to pledge himself as to that being the exact number or proportion of representatives of the profession who ought to sit in the General Medical Council, yet he thought their Lordships should not allow the Bill in its present shape to leave the House without at least giving to that which was really the desire of the medical profession generally a fair consideration.

EARL DE GREY AND RIPON
said, he concluded from the concluding observations of the noble Earl, and from the nature of his clause itself, that it was not his intention now to press his Amendment on their Lordships for adoption. The noble Earl's object, no doubt, was simply to raise a discussion on the 1349 question whether such a change as he suggested was desirable, and whether this was the best time to carry it into effect. It was clear that the clause could not be admitted into the Bill, inasmuch as no machinery was provided for the election of the proposed representatives of the medical profession. Although the noble Earl might think it an exceedingly easy matter to have persons elected by the universal suffrage of the medical profession, yet that could not be done by simply enacting that it should be done, without supplying any machinery for carrying it practically into effect. The noble Earl had spoken as if there could be no question that the General Medical Council should be representative of the medical profession; but whether a body ought to be representative or not depended very much on the functions it had to discharge. In his view the functions of the General Medical Council might be rather called executive than properly representative. He was aware that many members of the profession desired to impose on the Council duties which would be more likely to be properly performed by a body largely containing a representative element; but he strongly doubted the advisability of that extension of its functions, and—speaking generally and with due reserve—he did not think it would be expedient to extend the functions of the Council in a greater degree than was proposed under the Bill. With regard to the number of members on the Council, he was inclined to think it was too large rather than not large enough, and that the proposed addition of eight members would be a serious hindrance to the proper transaction of its business—which was not that of a debating society, but should be confined as much as possible to duties of an executive description. He believed, however, that the Council was fully representative of the intelligence of the medical profession. It contained not only several most eminent members of the existing corporations, but also six members appointed by the Crown, who might be taken not merely from the profession but from the general body of the public, whose interests were concerned in the matter as well as those of the profession. The principal duty of the Council under the Bill would be to conduct the examinations by which persons were to be admitted to the medical pro- 1350 fession. It had another duty to perform as regarded those already in the profession—namely, that of striking practitioners off the register for proved offences; but that was a function of a strictly judicial character, to be exercised in a strictly judicial spirit, and it hardly formed a ground for giving to the body which exercised it more of a representative character. With these views, he should be ready to give his very careful consideration to any complete scheme which the noble Earl might propose on that subject. Had his noble Friend proposed his Amendment at an earlier stage of the Bill, he should have given it his careful consideration; but he owned it did not appear to him that this was the right moment when such a change should be made, nor did he think it a change from which the public or the profession in reality would derive advantage. He, therefore, ventured to suggest that the noble Earl should not press his clause on that occasion, but that the Bill, which had a distinct object quite separate from that aimed at by the clause, should be allowed to pass.

THE MARQUESS OF CLANRICARDE
regretted that the noble Earl the President of the Council had refused his assent to this clause. Notwithstanding the objections taken to it by that noble Earl, he thought there ought to be an element representative of the medical profession in the Council, and that without it the Council would be neither so authoritative nor so popular as it deserved to be. The only tangible objection urged by the noble Earl to the clause seemed to be its insufficiency in respect of the machinery for electing representatives; but such machinery could very easily be devised. As it stood, the Bill would not give satisfaction either to the public or to the profession, and it ought not to be sent down by their Lordships in its present shape to the other House. Unless the measure underwent material amendment he should, therefore, feel it his duty to move its rejection on the third reading.

EARL GREY
admitted that without the required machinery it would be idle to insert the clause, and that at that late stage it might be difficult to add to the Bill the provisions necessary to give effect to this proposal. He also thought the President of the Council was right in objecting to make the Council too 1351 numerous. But he regretted that in effecting what was, he believed, a valuable reform in respect to the medical profession, some means had not been devised by which, without rendering the Council too unwieldy, the medical profession at large, as distinguished from the medical corporations, should be enabled to make its voice heard in the deliberations of that body.

§ THE MARQUESS OF SALISBURY
wished to say a word, lest there might be an appearance of unanimity on this subject which did not really exist. He had no doubt that if the Amendment had been proposed when their Lordships had met to discuss the Bill at the usual stage, the proposition to apply the elective principle to a body which had such functions to discharge as would fall to the Medical Council to discharge, would not have been received with much favour. The experiment of electing an executive body by a profession widely dispersed having no means of communication or of forming a public opinion except through the medium of newspapers, was something so new—not having been applied to any other body in this country—that he should regard it with great suspicion. He had not heard that any of the more eminent members of the medical profession were anxious for the proposed change. His own opinion was that they were content with the present constitution of the Medical Council, and that they would look upon this change as tending to introduce political controversy where peace now existed.

EARL DE GREY AND RIPON
said, the noble Marquess (the Marquess of Clanricarde) was mistaken in supposing that the number of entrances to the profession would be increased by the Bill in its present shape, and that the controlling power of the Government was weakened. The fact was under the Bill there would be only a triple door of entrance—namely, the examination of the conjoint Board in the three divisions of the country. All that the 18th clause permitted was, that the existing Universities might give their degrees to whom they liked; but such degrees would confer no right to be placed on the registry, and if the holders of them called themselves by these titles for the purpose of practising, they would be liable, under the 21st clause, to very heavy penalties. There would, therefore, be but this triple 1352 door instead of the 19 distinct and separate entrances which now existed. He hoped his noble Friend would not pursue the course of opposing the Bill on the third reading, as he had intimated. His noble Friend did not object to the constitution of the Medical Council in Committee, where all his objections might have been fully and fairly discussed, and, therefore, he trusted he would not attempt to stop the measure at its last stage.

§ THE EARL OF LICHFIELD
said, his object had been gained when he heard his noble Friend's statement that if the Amendment had been brought forward at an earlier stage he would have taken the subject into consideration. He would not, therefore, press the Amendment. As to the remark of the noble Marquess opposite (the Marquess of Salisbury) that the leading members of the profession were not in favour of the clause, he begged to say that there was a strong feeling on the part of the leading members of the profession—even of those who were nominees of the Government, and sitting in the General Council—that the Council would not exercise the influence which it ought to possess owing to the fact of its not sufficiently representing the profession at large.