HC Deb 13 May 1941 vol 371 cc1158-78

Motion made, and Question proposed, "That this House do now adjourn" — [Mr. Munro.]

Sir Henry Morris-Jones (Denbigh)

I gave notice a week or two ago that I would, with your permission, Mr. Speaker, bring before the House on the Adjournment the question of the treatment by the Government of alien and Allied doctors in this country in relation to the whole question of our man-power and the way it is being used. There has been a good deal of chaos and muddle in dealing with this question. It will generally be recognised that the economical use of our man-power and woman-power in the war is a vital matter. The strain upon the medical man-power and woman-power is greater because of the demands of the Services, and the very character of this war imposes also an additional strain on the medical personnel in civilian life. That there has been a scarcity of medical men and women is admitted, although I am bound to say that this scarcity has been aggravated by the maldistribution of medical personnel and, in some categories, the maladministration which now exists." The Government recognised the principle that foreign medical men should be used, to meet the scarcity, by passing a Regulation in January last whereby such medical men could be admitted to the British Medical Register and become qualified to serve professionally in hospitals and under the Emergency Medical Service. Indeed, this decision has been confirmed by the recommendation of the committee set up by the present Minister or his predecessor— the committee known as the Robinson Committee which has been inquiring into the position of medical men here.

Recommendation 5 of this Committee States that the employment of alien practitioners, admitted to the Register, in civil hospitals and—be it noted—in the Services should be further extended. It is very difficult for a Member of the House who is not a member of the Government to get the exact figures but I have the approximate figures which, I think, are nearly accurate. In January last there were 1,400 alien doctors in this country—and here I use the term "alien" in its comprehensive sense. About 750 were German, Austrian and Italian; 250 were Czechs; about 350 were Poles and a number were Norwegian and French. Although that Regulation was passed in January, when it was admitted by the Ministry of Health that these medical men should be utilised, as far as my information goes, out of that 1,400, roughly only 100 foreign doctors have found employment in this country. 'What is the cause of this dilatoriness in dealing with what is generally admitted to be, an urgent problem?

There may be, no doubt, a little lack of good will in the medical profession itself. Probably the members of no profession want to see a foreign element coming in and taking part in work which belongs to them, as it were, and has belonged to them for ages. I think this lack of good will may have slightly expressed itself, too, in the Central Medical War Committee which is dealing with this problem. Although this body is not a British Medical Association Committee, it has a majority representation from the Association and I think it is largely regarded as such. It may be also that our hospitals in this country have shown a little ill-will but my information is that that is very small. If it had been put to them that alien doctors were ready to offer their services, I feel sure that the hospital authorities of this country would have been only too glad to utilise them. Where, therefore, does the fault lie? It lies, of course, like a lot of other things in connection with this war, with the multiplicity of Departments. I am sure the House will not think that I am over-critical. I am most anxious to help the war effort in any way I can and if I say anything critical it is meant to be con- structive. We all want to beat the Nazis and to be sure that every branch of Government and its organisation is alive and cleaving its way through small difficulties in order to arrive at satisfactory conclusions.

As I have said, there is this multiplicity of Departments. These is the Ministry of Health, the British Red Cross, the Army, including the R.A.M.C., the Polish Consulate, the Polish Military Headquarters, the Czech Ministry of Social Welfare, the Czech military authorities, the Czech Refugee Trust Fund, the Central Committee for Refugees, the Parliamentary Refugees' Committee and a host of other committees and persons. The Central Medical Committee has an inadequate staff to deal with the matter. I am told that there is only one official to deal with this question at the moment. Last, but not least, there is serious delay at the Aliens Department of the Home Office which is causing a hold-up. This Department is the very crux of the matter. It is the bottle-neck, as I hope to show. If my simple calculation is correct it will take three years to absorb these alien doctors at the present rate of absorption. There are cases in which hospitals in this country have appointed these medical men to posts. These hospitals have been unable to get other medical assistance and have appointed alien doctors. Sometimes it has taken two months to get sanction from the Home Office to do this.

I do not want to detain the House but there has been no opportunity of making this case before and I would like to refer shortly to the procedure, in order to illustrate this aspect of the problem. The applicant, first, applies to the hospital the authorities of which interview him. If they like him, they have to send for his references. His referees send back particulars about his character and the hospital appoints him. That is the first step. The next thing the hospital authorities have to do is to communicate with the Central Medical War Committee which sends back two forms to the hospital and two others to the applicant. The hospital and the applicant send back these forms and the Central Committee approves.

What happens next? The Central Medical War Committee sends the applicant to the Aliens Department of the Home Office. Then the delay starts. The Aliens Department begins again to send out reference forms. Last Saturday I received from the Aliens Department a reference form to be filled up in connection with a medical man who has been waiting for a job for two months, and who is wanted by a hospital. When the Aliens Department gives its "O.K" to the man, the form is returned again to the Central Medical War Committee, and that Committee sends it to the General Medical Council for final confirmation. I believe I am right in saying that the General Medical Council does not sit every day, but once a week. Eventually the form goes back from the General Medical Council to the Central Medical War Committee, which communicates with the hospital, and finally the hospital communicates with the applicant. I ask hon. Members whether that is the way for a great nation like ours to carry on its affairs? For generations we have shown the world how to organise. If there is an earthquake in China, our people go there and do magnificent work. The British are the best organisers. If there is a famine in India, we do magnificent work. Can we not deal with alien doctors in this country in a proper way? We admit the necessity of using their services. Cannot we deal with this matter in a proper way instead of having all this tomfoolery, which is a disgrace?

Dr. Russell Thomas (Southampton)

May I ask my hon. Friend whether, when the Central Medical War Committee send out these forms for the Home Office, they also send some other secret document with the form? Are they merely the channel by which the forms are sent, or do they comment on the matter to the Home Office; and also, when they send the forms back to the General Medical Council, do they again comment on the position of the alien? May I also ask whether the Central Medical War Committee is not merely an organ of the British Medical Association?

Sir H. Morris-Jones

It is rather difficult to answer those questions. I have not seen any evidence that the Central Medical War Committee question the bona fides or the loyalty of these applicants. I think they allow the Aliens Department of the Home Office to deal with that.I have given the House an illustration of the number of forms that have to be filled up. I was told the other day that there is some further delay now because the supply of forms has run out at the Central Medical War Council. Is it to be wondered that, with circumstances of this sort, these alien doctors, many of whom have been in this country for many years, feel rather bitter, rather disappointed, and rather sore? I could give some very remarkable examples regarding some of these men. The man for whom I filled up a form last Saturday is an Austrian. He had a very good clinic at Hamburg in Germany. He was in this country before the war at a spa in North Wales, where he did quite good work on diet. He was arrested, and put in a camp at the time of the crisis after Dunkirk. Later he went into a pioneer battalion, and he contracted tuberculosis, and was sent to a sanatorium. He got better. At the sanatorium they liked him very much and were very anxious that he should go on their staff, as they were short-staffed.

Another case of which I know is that of a Czechoslovak doctor. He came to this country in April, 1939, and addressed a very big medical conference in London. He is a man of international fame and is a great authority on his subject. While attending the conference in London, he was informed that Hitler had marched into Prague, and that an employè whom he had formerly dismissed for dishonesty had been made Nazi leader in the area. He very wisely thought that it would not be very good for him to go back. This individual has been offering his services to the British authorities since the beginning of the war. He is known all over the world, and among his referees in this country are men like Lord Horder, Sir John Weir, Sir William Wilcox and Lord Dawson; and men and women of renown in this country in all classes of society and in all spheres of life have been patients of his before he came to this country. This man was making about £20,000 a year once He is a man with a brilliant mind. In addition to his medical and scientific attainments, he is a man of great political and economic acumen, and on several occasions he has sent me suggestions which I have passed to the Government, some of them having been acknowledged with gratitude by the Government. This man has now been kept waiting seven weeks for a £200 a year job on the East Coast.

Why do we not make use of these brains? We are fighting the most diabolical, most organised and most scientific men the world has ever known or conceived of. Cannot we make use of these alien doctors? At this juncture, when these men have been applying since the beginning of the war, it is announced that we are to take 1,000 American doctors into the Royal Army Medical Corps. I should be the last to say a word against that. I am a great believer in an Anglo-American union. I give it my most hearty co-operation, and will do everything I can to help it, because I believe that the only hope for the future is in that direction. But do not let us shout from the housetops about asking 1,000 American doctors to come here, and then do an injustice to those who have been here for so long and those who have had to leave their homes. The Czechoslovaks are very fine men; they offered to fight and were persuaded by us not to fight, and they came over to England. There are many Poles and Austrians as well.

By the way, we always speak of them as aliens, and they rather object to that term. Why not restrict that term to police use? If we refer to their forces, we speak of the Allied Forces—the Czechoslovak Allied Forces and the Polish Allied Forces; but if we refer to them as individuals, we call them aliens. Some of them who have been here a very long time rather dislike the term. They hate the Nazis far more than some British people do, and they are prepared to do anything they can to help us in this war. We are asking 1,000 American doctors to come here. May I give a warning to the hon. Lady the Parliamentary Secretary, which I hope she will pass on to the Minister of Health? These American doctors will come here with great enthusiasm for a crusade. They will come here with different traditions and a different upbringing. They will be unable to understand the obtuseness of the English official mind. Do not let us discourage them by putting them in the R.A.M.C. to clean instruments for a few hours a day. Let us see that their skill is made use of in the best possible way, and let there be liaison officers and staff officers to ensure that these fine men who come from across the water will be given an opportunity to develop their talents in a way which will most help our medical man-power.

The question of alien doctors touches the whole question of our medical manpower. I, like other hon. Members, receive a great deal of correspondence on this subject. Our medical man-power is very badly distributed at the present time. In the rural areas it is often impossible to find a medical man to attend even a confinement case. I had a letter from South Wales the other day which showed that there was only one firm of doctors to deal with a population of 10,000, which no doubt has now been swollen to 18,000. I do not see why I should not mention the town; it is Milford Haven. This firm of doctors has to treat the whole of that population, and now they are threatening to call up a junior partner. In a neighbouring town the medical personnel has not been diminished at all. The Royal Army Medical Corps—I happen to be an honorary officer, and to have served in that Corps during the last war—which I believe to be a very fine Corps, seem, owing to the peculiar character of this war, to have an avaricious appetite for medical personnel, although there is not much work for them to do. The public are uneasy when they find they cannot get medical attention in a civil area. Some civil areas have been denuded, and doctors have left fine practices to spend their time with the Royal Army Medical Corps cleaning instruments. [AN HON. MEMBER: "The hon. Member was, I understand, about to say something most interesting about a town next door to Milford Haven"] I may unintentionally have been incorrect in regard to that particular town, but I have had instances where in various counties of England medical personnel has been so depleted that the population has been denuded of medical attention, whereas in other towns, five or 10 miles away, not a single man has been called up. The civil population are at a loss to understand this disparity.

I think that the Central Medical War Committee have done very valuable work in this war, but the whole question has now got beyond them. The Minister of Health ought to take the matter into his own hands. He should review the whole question of the utilisation and distribution of medical men and women. Let him appoint committees in each county, or in each county borough of over 250,000. Let that committee be comprised of a representative of the British Medical Association, which is a very large body and to which the majority of medical practitioners belong, a responsible public man from the county, known for his eminence, fair play and fair dealing, and representatives of the trade unions and employers. Let that body consider the question of medical man-power for that particular county. I implore my hon. Friend, who represents the Ministry of Health, and the Under-Secretary of State to the Home Office, to recognise the principle and, indeed, the need of utilising alien and allied doctors to help our war effort. Let us get them on the Register doing the job. In the second place, let there be a review on a wide basis of the whole question of the distribution and employment of our medical men and women.

Sir Francis Fremantle (St. Albans)

I do not wish to stand for long between my hon. Friend the Member for Denbigh (Sir H. Morris-Jones) and the reply of the Parliamentary Secretary. I should, however, like to say one or two words as the only Member of this House who is a member of the Central Medical War Committee, a body which does not seem to meet entirely with the approval of my hon. Friend. I want to make one or two corrections. I should like to say most cordially that the Central Medical War Committee welcome this discussion. They welcome criticism and they are glad it has come, because, in the first place, some of the criticisms may be justified and we may help to correct things of which we are conscious, or sometimes unconscious. In the second place, most of the criticisms will be found unjustified, and we are very glad to give an explanation. One point still requires to be made, that the Central Medical War Committee is not the British Medical Association. When the Government had to consider a body to carry out this work for the whole profession, they naturally took the advice of the British Medical Association, which includes 40,000 registered medical practitioners—practically the whole of the medical profession. It may be 80 per cent. or 90 per cent. Anyhow, it is far and away the nearest approach to the whole medical profession. When the British Medical Association said they would help to establish a committee which would represent the whole profession, without any undue balance to the British Medical Association, with their staff and apparatus and organisation, to help in the national cause, surely the Government were very sensible in accepting that offer on condition that those points were made clear. So what happened? The Central Medical War Committee was set up, by agreement with independent bodies like the Royal Colleges of Physicians and Surgeons, and direct representation was given to those outside bodies. I think the Central Medical War Committee is probably the most representative body of the medical profession that you could get.

In the second place it is obviously a great deal better for something of this sort to be dealt with by the profession as a whole, with its intimate knowledge of the individuals concerned, whom they can therefore deal with and whose difficulties they understand, than to be taken over by a Government Department which is not only already very much overworked but which would also largely be in the hands of a great number of persons who would not equally be intimate with the whole work of the profession, and very likely some of whom would not be medical men themselves. The Central Medical War Committee has official observers appointed by the Ministries of Health, Education and Labour and by each of the Fighting Services, who attend regularly and are a very useful addition to the committee, and they keep a link with the whole of the Government machinery. I do not believe you could get a better body than that to carry on the work, because you have it directly related to the machinery of government, and undoubtedly the two observers from the Ministry of Health, one a layman and the other a medical man, are extremely valuable too.

Then we come to the specific difficulty of the alien doctors. We are as conscious of this difficulty as anyone else can be. We are as keen on using these people as my hon. Friend because the most gruelling part of the pathetic and tragic work that we have to do, especially with the Services Sub-committee, of which I am a member, is to take over from civil life medical men who are already fully employed, leaving their practice to a large extent depleted, in order to satisfy the demands of the public services. It is not clear from my hon. Friend's remarks whether he considers that the public services should or should not have the establishment made up to the full. The estab- Iishment is laid down as the result of experience, and probably they cannot have less. He will probably agree that it is necessary that they should be ready for action at any time—that is, that our job is to fill the requirements of this service.

Dr. Russell Thomas

I do not think the hon. Member for Denbigh (Sir H. Morris-Jones) attacked the Central Medical War Committee. He asked where the delay was in the appointment of alien doctors to take part in the medical welfare of the country. He suggested that it was the Home Office. I suggested that possibly it was the Central Medical War Committee, because they got forms sent, which were then sent to the Home Office. Then they go back to the Central Medical War Committee and to the General Medical Council, which is also practically representative of the British Medical Association, and therefore another vested interest.

Sir F. Fremantle

I will leave the Parliamentary Secretary to explain that. The hon. Member for Denbigh himself said that there was some lack of good will in the Central Medical War Committee. We are the same body as we were two years ago when we started the work. I do not think there is any lack of good will—certainly not consciously. However, I am clear that the actual machinery is there and is the best in the circumstances. I would go a stage further with regard to the question of organisation. My hon. Friend suggests that the Ministry of Health should take over the whole of the work and appoint local committees. Local committees already exist. In fact, it is the fundamental basis of the work of the Central War Committee, who are in the centre and cannot undertake the distribution of these men ourselves, so there was appointed in each area a local medical war committee, consisting of a certain number of representative and highly responsible medical men, and some women too, to give up their time to this very unpleasant work of deciding among their own colleagues whom they would root out from their practice and compel to serve. They come up to the Central Committee on appeal, and we are an appeal board, and we have to go through some very pathetic cases. I went through 40 on Friday and shall have probably another 40 on Friday week. We do it on the advice of the local medical war committees. For heaven's sake, do not let us substitute for them any other committees to be set up by Whitehall.

Now I come to the question of how we are dealing with the alien doctors. I inquired specially on the subject on Friday in order to refresh my mind. We cannot do much more on the Central Committee than pass the thing on, but you must have one centre to which people should be able to direct these alien doctors in order to get their case put forward, and this medical association makes itself responsible for being a kind of centre to collect applications from alien doctors, or those concerned with them, to pass them on to the proper authority and, on the other hand, to receive applications from employing authorities in order to be able to employ them. I have been keenly interested in individual alien doctors and do my best for them, but it is not so easy as it might seem to employ them. In the first place, most of them cannot talk English, or, if they do, it is broken English. Therefore it is very difficult for them to understand the ways of the English medical profession and still more to understand English patients in order to prescribe for them; it is difficult for them to use the organisation to which they are to be appointed and to understand the conditions and the circumstances in which they have to recommend the application of their advice to their patients.

Therefore you come down the list and say, '' Let them be employed in research or laboratory work." I agree, but there are very few openings in that kind of work. It is not simply getting a man. You must have a laboratory for him to work in, and he has to work with those already employed there. Every now and then there are vacancies, but not frequently. You have to get the exact man to fit into the job, and you have to get the head of the laboratory to agree to accept a man who does not talk good English and can hardly be understood and will have difficulties in various ways. They are being fitted in. I do not think they can be fitted in at a much greater rate, but if anything can be done to simplify the machinery and to be sure that you can get them useful employment, it should be done. I hope that will be the result of the Debate, and I shall be interested to hear the reply of the Parliamentary Secretary and to see if anything further can be done in this direction.

Dr. A. V. Hill (Cambridge University)

We have been unexpectedly fortunate so far during the war in the matter of our public health. An instructive broadsheet has been issued recently by P. E. P. on "Health in War-time," and the reasons for this good fortune are there analysed to some degree. They probably depend firstly on our much greater knowledge of food and of the protective elements in it and on the greater efficiency as compared with the last war in its distribution, and secondly on a better knowledge of disease, its treatment and its spread. The broadsheet also discusses the extent of the troubles we had during the last war of which the most extreme example was the influenza epidemic of 1918, when 112,000 people died, as compared with the preceding year, when only 10,000 died of that disease. There is obviously a chance that in this war troubles of that kind again will come upon us. We must not assume that our present good fortune will necessarily continue. There is no doubt that already Britain's medical resources are taxed to the utmost. In ordinary times, perhaps, we may have enough doctors as we are organised, that is, for dealing with disease only, with a limited public health service and with the limitation of the fees that ordinary people can pay for medical treatment. We should not have, even in ordinary times, more than one-half to two-thirds of the doctors wanted if, for example, the families of insured men were to be treated as the insured men themselves are treated, and if health were to be regarded as the essential thing instead of merely the treatment of disease which has already in many cases become incurable.

In war-time, even more than in peace, we have to think ahead, to think of health and to take thought for to-morrow, not merely to treat disease when it has already occurred. For example, as an illustration of the way in which disease can be anticipated, we know that 3,000 deaths from diphtheria and 60,000 cases annually could be abolished if only we could think ahead, if the Government and the people were not so complacent about the situation and if doctors were available to carry out the necessary immunisation. But if we are to avoid disease, if we are to treat the wounds of war and disease resulting from fatigue, from temporary food deficiencies, from abnormal conditions due to enemy action resulting, for example, in the cutting of water supplies and drainage, if we are to provide the Fighting Services, our ships, the Royal Air Force, the units of the Army at home, and more particularly in the tropics where there are new dangers to meet, then far more doctors are required. For this reason we can only welcome with gratitude the promise of the United States to send us 1,000 doctors to help us. This promise shows the degree of realisation by the United Stales of our need. In view of this realisation it seems to me appalling that we should have 1,300 doctors from Europe unemployed of the 1,400 available. The hon. Member for Denbigh (Sir H. Morris-Jones) has spoken of muddle and complacency and of the bottle necks of the Central Medical War Committee and the security Departments. He also mentioned the bottle neck, as one may call it, in the information which ought to have reached those who can employ these doctors, that they are available if they will only ask for them.

The story that our people will not accept them and that the hospitals do not want them seems to me nonsense. Many of these doctors speak English well enough. I would like to give an example of the way in which a foreign doctor fitted into a British community. He came from Germany and had done research in this country before Hitler arrived. When Hitler arrived he came to England again to seek refuge here. He obtained a British medical qualification and took a practice among the miners in South Wales. A great affection developed between him and them, so much so that, although he had fought in the line against them in the last war they made him a vice-president of the local branch of the British Legion and his wife vice-president of the women's branch. He remarked to me humorously that he thought they must have loved him because he was not an Englishman. He fortunately has been able to be naturalised, because he spent some time in England before; he has had no trouble and he is in active work. Another man less fortunate joined the emergency medical service at the beginning of the war. He was interned last summer and let out again later on but remained unemployed for many months. After much agitation on his behalf it was only after a question from the hon. Member for the Combined English Universities (Miss Rathbone) that he was taken back into a job. We are told that people will not like these foreign doctors. What about the Poles? The statement seems to me to be pure nonsense. Wherever they have gone the Polish troops, airmen and sailors have been liked. It is said that they cannot speak English well enough, but I gather that in Scotland, at least, they are learning very well the variety of English that is spoken there. If the troops and the sailors can, why not the doctors?

Dr. Russell Thomas

Has not my hon. Friend found in his experiece that the most prosperous doctor in an industrial town is generally a dark gentleman who can hardly speak any English but gathers a large amount of magical sentiment around him?

Dr. Hill

I cannot speak from experience about that, but I can well believe the truth of what the hon. Member says. We are told again that our Czech colleagues here cannot be used because they cannot speak English. Many of them do in fact speak English well and have great professional knowledge and skill. It seems to me again to be pure nonsense that these men cannot be used. We are told that German Jews cannot be used because people have a prejudice against them. My friend who went to South Wales and was beloved by the coalminers was himself a Jew. The people who raise these objections are often disguising their own prejudices by referring them to the common people. The ordinary people of this country reckon a man by his human qualities as the coalminers in South Wales did. If a man understands them, is friendly with them, and can serve them, they will like and appreciate him.

It is the usual story of complacency and unwillingness to take responsibility leading to failure. In some quarters vested interests will attempt to stop foreigners from competing, as is said, with our own people. The old traditional government of the medical profession, or, as it should be termed, the calling of medicine, by wealthy consultants is already doomed; we must realise that the public health, and not the interests of consultants in Harley Street, or even the supposed interests of busy practitioners who are paid by the job and not by the day, are at stake. We must examine the objections that are made to the use of reliable aliens with the same scepticism that we do Hitler's reasons for the arrival here of Rudolf Hess last Saturday. Actually little objection to the employment of alien doctors is openly voiced by the medical profession, and practically no objection by our people. The people are courageous, patient, broad-minded, friendly and reasonable. They, like the Welsh coalminers, realise who are their friends, who are competent and who can be of service to them.

May I give an illustration of a woman doctor who is at present unemployed? This woman is pure German; in the German phrase, she is an Aryan. She was one of the most distinguished children's doctors in Germany. In 1933 she came to England, not to escape persecution but having realised earlier than many Members of this House the nature of the Nazi tyranny. She was employed in a well-known health centre. She took a British medical degree some years ago, but now she is forbidden to practise. Why? She is only anxious to serve this country. I understand that the Central Medical War Committee have applied at last to the Security Department for the necessary permit for her. Whether she will get it I do not know, but I am sure of her reliability.

We are told that there is no demand for the services of such people. The demand could easily enough be made obvious if the possibility of employing them were advertised. In one borough of which I know an attempt was made to find a suitable candidate for a vacancy in one of the medical services. Finally no appointment at all was made, because only one man applied, and he was described by his referee as "all right when he is not drunk." A lady, who interviewed him as a member of the appointing committee, tells me that she regards that testimonial as a gross exaggeration. When such a situation exists, when it is impossible to get British doctors for the essential needs of the population, how can it be said that there is no demand for these thoroughly competent and reliable aliens who are with us? In America the words "appeasement" and "appeaser" are now the worst form of abuse. I believe that here the word "complacency" is rapidly becoming an even worse form of abuse, which may, perhaps, soon become an un parliamentary expression. In spite of that, I would venture to say that this most deadly crime has been and still is dogging our footsteps, and I hope that this Debate may ensure that the importance of the subject is realised and that adequate steps may be, taken to meet the need.

The Parliamentary Secretary to the Ministry of Health (Miss Horsbrugh)

I certainly think this Debate will have proved of use if it can be made clear that the Ministry of Health and those interested in the health of our people do not view the situation with complacency. The lion. Member who opened the Debate told us what he considered to be the procedure if a doctor of alien or Allied nationality wishes to be employed in one of the hospitals; of this country. I think it has not been fully understood that the original arrangement was to have been that the Central Medical War Committee were to act as a clearing house, that the name should be registered there and that from that committee the hospitals would be able to go. the names of doctors available. I would remind the hon. Member for Cambridge University (Dr. Hill) that this has nothing to do with specialists, wealthy or otherwise, in Harley Street, but that the employing authorities of the hospitals are in many cases the local authority. Some of these employing authorities have got into touch first with the committee, or the alien doctor has first got into touch with them, and in these latter cases application has then had to be made to the Central Medical War Committee, so that the name of this doctor who wishes to be put on the register of the General Medical Council can then go forward.

There are two things of which we all want to make certain, I think. One is that the doctor has skill and that his training has been what he professes it to be. If he is to go into the hospitals it is natural that one must check those things. The second point we have to check is that he is loyal to this country. As I have listened to the Debate the two points which have come up have been, first, has the machine worked too slowly, and, secondly, is it the right machine to check the two points which I have mentioned? It was in January of this year that the Regulation was made permitting alien doctors to serve in these hospitals. The original Regulation of last year applied to American and Canadian doctors, and the Regulation of January this year added a long list of Allied countries whose citizens would be welcome to serve in our hospitals. The arrangement has been working for about four months. The hon. Member for Denbigh (Sir H. Morris-Jones) said there were about 1,400, and he thought only about 100 had been employed. I am not saying the number is satisfactory, because I think the machine has got into action too slowly. It is not as bad as that. I think the number is 1,350 and now 200 or 250 are being employed.

Sir H. Morris-Jones

I am sorry to interrupt the hon. Lady, but I should like to be quite accurate about the figures. She has told the House that 250 have actually procured employment; does she mean that 250 names have been sent to the Central Medical War Committee, which is an entirely different matter?

Miss Horsbrugh

No, I have the figures for the hon. Gentleman as near as I can get them, and they show that 59 obtained employment at a hospital first and that then their credentials were checked. Then 333 names have been sent in to the Security Department, and arrangements were then made for 224 of that number. Then 126 were registered with the Council, and we think that they are in employment, while 98 remain in the pool that has now been created. Their bona fides have been examined and they are awaiting employment.

Sir H. Morris-Jones

The hon. Lady was not strictly accurate. I am sure she did not intend to mislead the House when she gave the number of those who had actually secured employment. My 100 was not far off the mark, after all, compared with 126.

Miss Horsbrugh

If the hon. Member was listening he heard the two figures 59 and 126. I said—and I have been very honest about it—there were 59 that actually secured employment themselves and then their cases went back to the Central War Committee to have their registrations taken up. A further 98 have now gone through. The exact number of the 98 who are in employment I cannot say definitely at the moment. My hon. Friend shakes his head, but if he has statistics which are more up to date I shall be interested to hear them. The statistics which he gave to us in a letter were sent some weeks ago. That being so, the hon. Gentleman and I disagree over 20 or 25. The main scheme has been slow, as I have said, but we have increased the pace and the numbers now coming through from the Home Office Department are at the rate of about 100 a week. The thing is now getting into its stride.

The other point was as to the number of doctors and the possibility of employment. A great many of them are specialists as the hon. Gentleman knows, and it is not always possible to employ in their own speciality those who are specialists. My hon. Friend referred to one case of a doctor who he said was of international reputation and an outstanding person. It is not impossible in many cases to employ these people where there is a deep need, such as we have at present, in some of the junior positions in a hospital. That is where we want them to-day probably more than anywhere else in the junior posts in the hospitals. Some of these people would not be suitable for such posts. Others are doing part-time work or continuing various studies, and are not able to give their whole time. But I want it to be quite clearly understood that we are anxious that they should be employed, if we have checked up their bona fides both as regards the laws of this country and as regards their training. We are anxious that the hospitals should employ them. We have not only sent circulars to the hospitals on the subject, but the hospital officers are and have been getting in touch with the hospital and suggesting that they should employ these doctors, and informing them that a list can be sent by the Central War Committee giving their qualifications.

The hon. Gentleman referred to the 1,000 doctors who, we are glad to know, are coming from the United States. He pointed out that they were particularly for the Services and said he hoped that they would not be used on cleaning instruments or doing other work of no importance. One thins; we have learned from this war and I suppose it has been learnt at other times—is the difficulty of regulating both the supply and the demand for doctors and nurses. I remember some time ago discussing the number of nurses to be kept at the hospitals, when we were told that we were keeping too many nurses there and they were not getting sufficient work. Then came Dunkirk, and instead of the nurses or doctors not having enough to do, there was a rush of work. I think we are all agreed on the difficulty of ensuring sufficient R.A.M.C. personnel for the Services while not having too many standing by. If we knew the exact course of the war, if we knew the exact part of the world to which the Army would be going, and if we could see ahead, it would be very much easier to distribute the right number.

Dr. Russell Thomas

While the Army is in this country, is it not quite clear that, when they are stationed at a certain town, the local doctors can quite as well attend them as the ordinary R.A.M.C. lieutenant?

Miss Horsbrugh

Certainly, and my right hon. Friend has considered that. If the troops are in a particular town at a given time and have no R.A.M.C. doctors, they have to be attended by the local doctors, but at any moment they may leave the district and have no one to attend them. I think more can be done in co-operation between the practitioners in a certain area and the troops stationed there so that there should not be too many, but we have to face the difficulty that changes may be made and the personnel of the R.A.M.C. must be sufficient to provide for them when they have to move. Several hon. Gentleman have said that, after all, the majority of the foreign doctors can speak English. I do not think that is necessarily so. A great many of them cannot, and one of the difficulties we might have to face would be the difficulty of language if the foreign doctors were used as we hope to use the American doctors. Those who do not speak English as well as others find it far easier to work in one of the hospitals, where they are working with other doctors who can assist them.

The hon. Gentleman also spoke of the arrangements of the Central Medical War Committee and the distribution of doctors throughout the country. He suggested that local committees should be set up to deal with local conditions. As my hon. Friend the Member for St. Albans (Sir F. Fremantle) pointed out, that is exactly what has been done. Perhaps the hon. Gentleman the Member for Denbigh thinks that other people ought to be co-opted on to these local committees. That has already been considered, but his main suggestion was to have local committees to deal with the local subject of the necessary medical personnel to remain in their particular district.

Sir F. Fremantle

And also to arrange for the practices of those who are called up to be looked after by those remaining in the district. That is a very essential part of the scheme.

Miss Horsbrugh

The point is that the local committee should see how many doctors are required to carry on the work in the district. If one or two leave to join the Forces, the people in the neighbourhood must be looked after properly by those doctors who are left. I hope that I have been able in these few moments to convince my hon. Friend as to the difficulty of the problem, and to convince him that the trouble is not complacency, but perhaps a machine that has worked too slowly. I have listened to the criticisms— or shall I say, to the suggestions? —and I have not heard any suggestion as to how we could have a better organisation to deal with these doctors My hon. Friend complained that papers went backwards and forwards. The doctor has first to get the employment, and then to have it checked up. Nobody has suggested that there should not be this double check. We must check up to find out that the doctors have had sufficient training. It must be remembered also that we have various areas, protected areas and others, about which there are particular difficulties; and that the doctors going into these hospitals are looking after both military and civilian casualties and sick. It is said that we have been too slow in checking up, through my right hon. Friend, as to the loyalty and credentials of these doctors. It has been slow, perhaps.

Sir H. Morris-Jones

Very slow.

Miss Horsbrugh

My hon. Friend says, Very slow." Now that we have done over 450 cases, and they are coming through at the rate of 100 a week, it is not too slow. But suppose that there had been one, or two, or three, mistakes, and that these people had not been all that they appeared to be, and that they had been put into the hospitals among the soldiers and civilians to-day. Is it not a great deal better to be slightly slow than to make a mistake as to a doctor's skill or his loyalty to this country?

Sir H. Morris-Jones

My hon. Friend will agree that both she and I are anxious to make this matter clear, so she will perhaps pardon my interruption. Why should it be necessary now for the Aliens Department of the Home Office to renew their inquiries into these particular cases as they come up week by week, when they have had a dossier in respect of each of these doctors in this country for at least 20 months, and probably for two years? Is it not an almost invariable rule that the amount of sabotage in the medical profession is infinitesimal? Why should an applicant have to wait two months in order to get his dossier through the Home Office, after having secured an appointment?

Miss Horsbrugh

I should very much like to know of any cases of doctors who, having secured their appointments, have had to wait for two months. I do not think that the hon. Member will find that there are many, as the Regulations came into effect only in January. As to whether it is necessary to go into these cases so minutely, I believe that it is. In these hospitals there are military, airmen and civilians. I have sometimes thought that if any of us wished to go to any other country, to obtain information which would be of the greatest use to our country in a war, there would be nowhere better to go than to a hospital. Go into a hospital ward, listen to the conversations, and I think you will obtain more information about what is going on in the country than you would get anywhere else. There is no other way, I believe, in which you ought to be more careful than in dealing with the subject of hospitals. It might have been slow. We would like to see it quicker, but there is no hon. Gentleman in this House who does not want it to be thorough. I hope that the number will be 100 a week, perhaps increased to 150, but, if I make too many promises, the hon. Member for Denbigh will say that I was incorrect. At any rate, I have proved that we are not complacent. We believe that there are opportunities for these doctors and that we shall be able to employ them, but we need to employ them with safety both for the health of the patients and for the war effort.