§ Order for Second Reading read.
§ 11.18 a.m.
§ The Minister of Health (Mr. Aneurin Bevan)
I beg to move "That the Bill be now read a Second time."
I think the purpose of this Bill will commend itself to hon. Members in all parts of the House. Its justification consists of the fact that before and during the war a number of doctors from abroad came to this country and were unable to practise, because they did not have British qualifications. There were countries with whom we had reciprocal arrangements where the qualifications were regarded as suitable [...] enable doctors to practise in either country if they so wished. There were, however, very few of them—only Belgium, Italy and Japan—and the arrangements have since been cancelled. It is, therefore, necessary, if a doctor who qualified abroad is to practise in this country, that special arrangements should be made. This was done during the war under Defence Regulation 32B of July, 1940. There were a number of territories specified, and the doctors from those territories who lived here were able to practise under restricted conditions.
Independent practice was not permitted because it was considered that it was not reasonable, while our own doctors were called up, that doctors from abroad should be allowed to take their place without any limitation or restriction whatever. The doctors who were placed on the temporary register were allowed to practise in hospitals and as assistants in general practice. That temporary register was closed in February, 1946, under the Emergency Laws (Transitional Provisions) Act, but doctors who were on that register continue to be registered until 31st December of this year. After that they will be unable to practise unless the position is regularised. There is obviously a great deal of anxiety among those doctors about their position, and it was in order to reassure those who are in this position that I obtained permission to print the Bill before the last Recess, in order that they might know what the intentions of the 697 Government were. It is, therefore, necessary that we should get this Bill passed into law by the end of the year; otherwise all these doctors will be unable to practise in this country.
Similar temporary arrangements apply to doctors brought here under the Polish Resettlement Scheme, who arrived after the closing of the temporary register but who may be temporarily registered under the Polish Resettlement Act. This arrangement also will end on 31st December, and some of those doctors may not be here by that date. But I propose to say a word or two about that later. The first purpose of the Bill, therefore, is to regularise the position of those doctors who are on the temporary register, to enable them to practise in this country in exactly the same way as British doctors with ordinary British qualifications. There are, however, some doctors who are not on the register at all, who obtained diplomas abroad and who, for a variety of reasons, have not been able to get themselves on the Register. Obviously, it would be extremely unfair if those doctors were unable to practise, because many of them did very excellent work for us during the war. We therefore have to make provision for them.
There are a number of different groups. There are many American and Canadian doctors who came here with their Forces. There are other individual categories, including Germans, Austrians, Poles and Czechs, of whom there were about 3,500 on the Register when temporary registration ceased. However, from the information I have been able to gather, I do not believe that all of these will want to remain. We estimate that about 1,500 to 2,000 will want to avail themselves of the facilities afforded by the Bill. The Polish doctors who were brought here under the Polish Resettlement Scheme are in a special category, of course. About 200 of them have registered and it is expected that this figure will increase by the end of the year. There are foreign doctors who served overseas with our Forces and who, on demobilisation, have been permitted to enter and remain in the United Kingdom. They were commissioned overseas, and because they were serving abroad they could not become registered in this country, so they are not on the temporary register. They should 698 be allowed to practise if they want to stay.
Then there are doctors who were allowed to come here owing to war circumstances, and who have been unable hitherto to become registered on the strength of their foreign diplomas. These include doctors who were here for some time but who were ineligible for temporary registration because they were not employed on medical work specified in the temporary registration orders, and arrived since temporary registration ceased. They also include graduates of the Polish School of Medicine, Edinburgh, since temporary registration ceased. Then there are unidentified doctors who arrived here owing to war circumstances, but before 4th August. In this respect we are simply regularising the position.
The date, 4th August, is chosen for obvious reasons. We are not here dealing with any change in the permanent law. We are not attempting to say that a doctor qualified abroad can practise in this country without let or hindrance. We are merely dealing with the situation created by the war and by the circumstances immediately before the war. We must, therefore, take a date, and 4th August was chosen because once the intention of the Government became known, and it was realised that we intended to enable doctors qualified abroad in certain circumstances to practise in this country, unless we had fixed a date when the privilege would cease to operate we would have been flooded with doctors whose circumstances would not be known, whose experience we would not be able to trace, but who would be able to qualify and practise in this country. We chose 4th August because that was the date when the intention of the Government became known. Otherwise our position would be quite impossible.
The choice of this date will give rise to hardship in individual instances, but we cannot help it. As I have said, if we did not have a date at all the Medical Register in this country would be entirely upset, because anybody calling himself a doctor abroad would be able to qualify in this country, and unless we had reciprocal arrangements with other countries we would be a receptacle for all kinds of queer people who might have qualified in all kinds of queer circumstances. Therefore, we fixed that date. I am, however, 699 quite conscious that the arbitrary nature of the date may give rise to individual hardship, but it cannot be avoided. There are doctors attached to the Polish Forces who may not be in this country before the end of the year, and, therefore, special arrangements will have to be made to deal with them.
There are also, of course, the pharmacists. They are anxious that there shall be a provision by which pharmacists with experience abroad may be authorised to practise in this country. What the Bill does is to enable the Council of the Pharmaceutical Society to make by-laws, subject to approval of the Privy Council, to register pharmacists with qualifications obtained abroad, either with or without examination and/or training in this country, as they think proper. The existing provision enabling Colonial pharmacists to be registered only on the strength of Colonial diplomas, and that without any examination, is repealed. I do not think there is any difficulty arising there.
There is one other point I would like to make. I have been a little concerned about the position of individual doctors who, for a variety of reasons, were unable to be in this country during the war, who could not get on the temporary register and who may, indeed, not be in this country by the end of the year. I have in mind one or two cases of doctors who were attached to our establishments abroad. It seems to me entirely unfair that those doctors should not be allowed to practise in this country, and I, therefore, propose in the Committee stage, to introduce an Amendment to make it possible for doctors in those restricted categories to be registered in this country. Some of my hon. Friends have been concerned about these cases. I have examined them, and I am satisfied that they have good cause for anxiety, particularly in the case of, I think, an Austrian doctor who was associated with administration and who, because of the restricted character of this Bill, would not be able to practise in this country at all. I propose to make an Amendment to enable that position to be dealt with. I do not believe the mere accident that some doctors were in this country and thus able to be on the permanent register, whereas others who happened to be in 700 Hong Kong or elsewhere could not be registered because they were not here, and, consequently, were unable to get on the temporary register, should be allowed to prejudice the future of the latter class. I am sure hon. Members in all parts of the House will sympathise with the purpose of the Bill.
§ 11.31 a.m.
§ Lieut.-Colonel Elliot (Scottish Universities)
It might be said, with truth, that this is a dignified Bill, and this is a dignified occasion upon which the House is engaged today. It arises out of the circumstances of the war, but it differs from so many other Measures which have arisen out of those war circumstances because it is a Measure of relaxation instead of restriction. It is a good thing that we should be able to embark, even to a small degree, on the lessening of those tight controls over our own personal movements which have had to be introduced since the war. This Bill also recalls, to some extent, the great days when this country was not merely an asylum, but a citadel for those escaping from persecution abroad. It will always be a matter of pride to this House that it should enshrine in the words of a Statute the Polish School of Medicine of the University of Edinburgh; and that we should have been able to give hospitality to men of science and distinction from countries abroad, at a time when their own countries were unable to do it, will always be a matter of very proper congratulation to the people of this country.
The Bill affects a considerable number of persons. As the Minister has said, some 3,500 professional men of high skill were able to exercise their professions in this country, to the great advantage of both ourselves and themselves. The Minister intimated he thought that after the war some 1,500 to 2,000 persons would be covered. These figures alone show the amount of mental uneasiness—and, indeed, possible professional disturbance—which would be caused by any delay in the passage of this Bill. Therefore, we on this side of the House propose to afford every facility to its passage. I understand the Bill has already been considered in another place, where certain Amendments were made, as far as I can see, much to the advantage of the Measure.
I trust, however, that it will be possible to go perhaps a little further along this 701 path, and to extend the arrangements for reciprocity. Some of the arrangements in this Bill are for the relaxation of our rather stringent conditions, even as regards distinguished physicians from the New World, which will be a very great advantage in so far as it will encourage a free flow of scientific and technical men about the world. It will be not merely of great material advantage, but of great spiritual advantage as showing that the currents, long frozen, have begun to thaw, and that the fluid circulation is beginning again. The Minister has pointed out, on more than one occasion, that the whole working of the great health service schemes depend upon an adequate supply of trained personnel, but trained personnel in the case of the junior ranks—if one may so describe the nurses—is, as the Minister knows, a matter of very acute pre-occupation. If it were possible also to allow qualifications overseas in certain other professions to count to some extent towards registration in this county, I am sure that would be greatly to our advantage. I do not think the Bill covers dentists in any way, does it?
§ Lieut.-Colonel Elliot
It does not exactly, except in so far as a certain number of men of professional skill fled from their own countries to this country during the persecutions of the war. In so far as these matters can be regularised, and these men admitted to the register, where they are on the same footing as professional men here, subject to the same tests, and covered by the same code of ethics, it will again be to the advantage both of the people of this country and of themselves. We on this side of the House do not wish to delay the passage of this Bill in any way, and I conclude by saying that we congratulate the Minister on the occasion which this Bill represents.
§ 11.37 a.m.
§ Mr. Somerville Hastings (Barking)
It is an open secret that this Bill arose at the suggestion of the doctors themselves, who felt, I think rightly, that doctors from abroad who served this country so well during the war should be rewarded; and the doctors were ready to give up the exclusive possession of facilities to practise in this country which they had obtained by six years of hard study, to reward these people. I have often heard the 702 medical profession described as one of the liberal professions. I feel that we can now call it not only one of the liberal, but one of the generous professions as well.
I am grateful to the Minister for agreeing with the medical profession, and I hope the medical profession will show reciprocity by agreeing with the Minister in the negotiations now proceeding. I am particularly grateful to the Minister for his statement about the case which I brought to his notice, concerning a doctor who is now a British subject; he was an officer in the medical department at Hong-kong, was taken prisoner by the Japanese, and suffered severely. That man served this country well, and I am grateful to my right hon. Friend for agreeing that he also shall be allowed to register.
There is only one Clause about which I have any doubt, and that is Clause 8 which says:In the case of a person who satisfies the Council"—That is the General Medical Council—that he is or intends to be in the United Kingdom temporarily for the purpose of employment in a medical capacity in a hospital or other institution approved by the Council"—and is well qualified, he shall have a temporary right to practise. This Clause is introduced clearly, and rightly, to allow distinguished physicians and surgeons from Commonwealth and other countries to come here to demonstrate methods of treatment and operation. I, and others, have greatly benefited from that in the past, but the difficulty has been that if one of these individuals treated a patient or performed an operation he would, technically, be breaking the law, and the doctor who gave an anaesthetic and assisted him would also, technically, be breaking the law. Also I welcome this Clause which has the intention of allowing these distinguished foreign and Commonwealth doctors to come to this country in order to demonstrate to us new methods of treatment which they have worked out and practised, and of which we have not as great knowledge as we should like to have.
But other foreign doctors who come to to this country are not so distinguished. They come over for post-graduate study, and we are very glad to have them. Lately there has been a development in this country—the British Post-graduate 703 Federation, a federation of hospitals and medical schools—to help the post-graduate instruction of doctors from abroad. In my early days when I was at this stage of studentship there was nothing of that sort in this country and I had to go to Vienna, Berlin and Heidelberg where I met many individuals from the Dominions and the Colonies who would have preferred to have come to this country. The instruction that is given to these students is by the examination of cases, lectures and operations on the dead subject, and with all that I am in complete agreement.
However, Clause 8 would permit these students to undertake medical work in our hospitals. They would be permitted to take jobs as house surgeons. Some doctors who come to this country are exceedingly well qualified and able men and perhaps just as good as any of the men and women qualified here, but—here I speak from experience as a teacher—some of them do not reach that standard. As I read this Clause they would be permitted to treat patients in a hospital or institution which is approved by the Council; but that, I feel, opens the door a little too wide. I know such doctors would be under the supervision of the physician or surgeon in charge, but they would have considerable responsibility when the physician or surgeon was not present, and they would also have to deal with emergencies. The suggestion is that they should only be allowed to practise in hospital, but I see dangers in that. If they were allowed to undertake private practice or perhaps work under the Executive Council in the new health scheme, their patients would at any rate have some choice, but the patients in the ward of a hospital would be placed under the charge of one of these doctors and have no choice at all.
The Clause requires to be slightly recast. It would be easy if instead of "employment" we said "demonstration and instruction." That would cover the first class of distinguished surgeons and physicians who come to show us new methods, and instead of:… a hospital or other institution approved by the Council …we should say, "a teaching hospital," because there supervision is more complete. I know that according to the Bill the hospital or institution has to be approved by the General Medical Council, 704 but I think we are giving the General Medical Council too much power in this Bill. It may consider too much the needs and desires of the medical profession and not sufficiently the welfare of the people. One can contemplate that to earn dollars or for other reasons we might want to encourage gentlemen from the sunny shores of Sierra Leone or the backwoods of America to come here and practise in hospitals although they might not be as well qualified as most British doctors who undertake work in this country, and many people would consider that most undesirable. This Clause should be tightened up a little so that foreign doctors may work not in any hospital but only in teaching hospitals, and instead of:… employment in a medical capacitythe Clause should read:… demonstration and instruction.What I have said has been on rather minor points but they are important, and I believe that this otherwise first-class Bill might be improved in the few ways I have suggested.
§ 11.45 a.m.
§ Colonel Stoddart-Scott (Pudsey and Otley)
I wish to add my words of welcome to this very satisfactory Measure, which will remove a considerable amount of anxiety and uncertainty from many foreign doctors. My few words of criticism are that it is probably a year or two late, as those people who have been in this country, some for as many as eight or ten years, have had worry and anxiety about their future. This Bill regularises the position of some very highly distinguished refugee doctors who came to this country when they escaped from Nazi oppression at least ten years ago, and it also regularises the position of those foreign doctors who hold British degrees and have every reason to practise here except for the fact that they happen to be of foreign nationality. It also regularises the position of those alien doctors and Commonwealth doctors holding alien degrees who have served this country and the Allied cause and have even served in the Royal Army Medical Corps, and one is delighted that we are doing this very just thing in regularising their position.
Will the Minister tell us if, when they are fully registered, they will have the same facilities as a British doctor with a British degree? Will they be able to 705 practise in any part of the country they wish? Will they have the same professional freedom as a British doctor? It would be good if the Minister could enlarge upon that and make it clear. It would appear from the Bill that the General Medical Council will undertake some sort of screening and will decide from whom registration shall be withheld. Can the Minister tell us whether the General Medical Council will make this decision purely upon medical qualifications or service, or in what way?
I welcome Clause 7 very much because it would appear that the Minister has changed his mind. Should the General Medical Council refuse to allow an individual to earn his livelihood in this country, he will be able to appeal to the Privy Council against that decision. That is a most just, fair and welcome arrangement. It rather contrasts with the arrangements under the National Health Service Act where a British practitioner who is not allowed to practise medicine in the Health Service is, therefore, unable to earn his own livelihood. He does not have the same privilege as this foreign doctor of appealing to such an august and official body. I hope that extending this privilege to a foreign doctor means that the Minister will make the same facilities available to British doctors so that they will be able to earn their own living after the appointed day under the National Health Service Act.
I wish to reinforce a question asked by my right hon. and gallant Friend the Member for the Scottish Universities (Lieut.-Colonel Elliot). What is the position of foreign dentists and foreign doctors? Are we to have another Bill, or are there no foreign dentists and foreign nurses, or what is the position? Do they not require a Bill to legalise their position? I am sure this Bill will be welcomed by the medical profession—in fact I know that it is—because it brings at least 3,000, and possibly 4,000, doctors into a very hard-pressed medical service which will be even more hard-pressed after the appointed day next July. Or should one call it "the expected day" or "the not to be expected day"? I am not quite sure what the position is. This is a Measure which will be welcomed; I am sure it is a most satisfactory Measure, and, therefore, I have very great pleasure in giving it my support.
§ 11.50 a.m.
§ Mrs. Ridealgh (Ilford, North)
I welcome this Bill, and I apologise to the Minister for not being here earlier, because he may have dealt with a point on which I would like to have some information. I would like to know the position of one of my constituents, a person for whom I was able to obtain permission to enter this country last year. She is a German woman doctor who was practising before the war in Germany, and she and her husband, who also was a doctor, had to flee with their children, but were caught in Paris. They were both put into concentration camps. The husband was taken away and she does not know what happened to him. When she was released by the British, the children were brought to this country, but she was not allowed to come here at that time. Eventually, I was able to get permission for her to come here, provided she would do domestic work, which she agreed to do. She has not been practising in this country, although she is a fully qualified doctor, and I would like the Minister to let me know what effect this Bill has upon the position of this constituent of mine.
§ 11.52 a.m.
§ Sir Henry Morris-Jones (Denbigh)
The only contribution that I will make to this Debate which might be regarded as controversial, will be to take up the argument of the hon. Gentleman the Member for Barking (Mr. Hastings), whose contributions to the Debates of this House, especially on questions of public health and medical questions, we always welcome. He advanced the argument, which is an un- assailable argument, that in accepting this Bill the medical profession have shown extreme generosity. I should think they have. Not many professions would welcome the addition of 3,500 non-British doctors to their number; many professions would object. Following this statement, with which I agree, the hon. Gentleman went further and said that because they had shown such generosity, they should show equal generosity in accepting the provisions of another Act, to which we all know many of them thoroughly object. I cannot quite reconcile that argument and that point of view.
I welcome this Bill because, as the right hon. Gentleman the Minister of Health said, the position of many of these temporarily registered men 707 was somewhat difficult. Many of them are old men. Most of them come under Clause 2. If this Bill had not been introduced, after 3rst December they would have had to exercise a choice, and the only choice before them, so far as I can see, would have been to leave this country; to pass the medical examinations for a degree or qualification—which might be very difficult for them—or to enter some other work or profession. I have taken great interest in this matter, because in the first Session during the war, I moved a Motion on this question before the Temporary Registration Regulation was passed. I have come into contact with many of these men, and I know that their position would have been very precarious after 31st December if this Measure had not been introduced.
It is quite true that this country gave asylum and protection to these men, who came here to escape from Nazi oppression, and for other reasons. Indeed, this country has given protection to such people over the centuries, and on the whole I think this country has gained in the process. I am quite sure that in this instance it has gained. After all, many of these men who came here under the temporary registration scheme made very valuable contributions to the national cause at a time when we were very hard pressed. We know there were enormous demands on the medical profession of this country; many had to go into the Forces, and the profession was very attenuated and hard pressed in the civilian areas. These men came to the rescue of this country to a remarkable degree in certain areas at a time which was certainly difficult, and I know many of them have made sacrifices.
I have one case in mind. According to the high principles of my profession we do not advertise, so I will not mention the name of this individual. He had a clinic in Europe, famous throughout the world, and he was making a fabulous income—something in the nature of £20,000 a year. He came to this country in 1939, and accepted a post under the war Emergency Hospitals Scheme at £350 a year. He was afterwards engaged in a very big clinic for miners in this country, where he has done invaluable work in connection with rheumatism. Indeed, he has had some Ministers of the Crown 708 under his treatment. He has certainly made his contribution.
I would draw the attention of the Minister, in particular, to Clause 4. This Clause certainly opens a much wider field. Many will come in under this Clause about whose qualifications—not their academic qualification but their capacity for general practice—we know very little. The standard of efficiency established by the General Medical Council in this country is not only in the interests of the doctors but in the interests of the protection of the public. Those high standards of efficiency, character, and education, enable them to treat the sick efficiently. This Clause will bring in a large number about whose capacity there will be some doubt, and although there is a probationary period under the Clause.—six months, I believe—before they can be granted their qualification, I think the right hon. Gentleman should consider whether some form of examination—an ad hoc examination—should be undertaken to protect the public. Perhaps under this scheme there will be a certain amount of flooding of the profession by medical men whose capacity may be in doubt. I put that suggestion to the Minister, and I hope he will look into it.
With that proviso, I am sure we all agree that the Measure is necessary. I think it should benefit this country, and, incidentally, a large number of people to whom this country gave its protection, in time of danger and many of whom have already been granted naturalisation as British subjects.
§ 11.59 a.m.
§ Mr. Symonds (Cambridge)
Nearly everyone who has spoken so far on this Bill has been a member of the medical profession. I would like to add my welcome to it merely as a layman. I took an interest in the details of this Measure during the Recess, when I was approached by an American woman doctor who was very anxious to know whether its terms would cover her case, which is an interesting case. She came to this country early in the war and worked here under the E.M.S. until 1943, when she had to return to America owing to the serious illness of her father. After that, she tried to get back to this country but was not able to do so. She could get only as far as Jamaica where she served for the rest of the war. In 1945, she was allowed to 709 come back to this country, but only as a student, although she had been practising here, under supervision, during the war. She wanted to stay in this country permanently, and asked for permission to follow her normal profession. That permission was not granted, and for a long time all she was allowed to do was to work as a laboratory assistant in a synthetic resin factory. Instead of doctoring she was making glue.
I took this case up with my right hon. Friend the Home Secretary, and, I am glad to say, he replied that he would be prepared to receive an application from this lady to become a doctor again, within the restrictions which were laid down in the war—that she could practise as an assistant, or in an institution. I hope that by now her application has gone through, and that the glue factory's loss will be Merthyr Tydfil's gain. That case illustrated to me how important it is to clear up satisfactorily these wartime problems. After all, it was in our own interests that we admitted foreign doctors to this country, and it would be a very churlish thing to say now, "Thank you very much; you have served our purpose, and now you can go." I am very glad indeed to hear that we have met their wishes, and I was particularly glad to hear this morning that the medical profession itself has very largely sponsored this Bill.
The Minister, in introducing the Bill, said that no major change is involved in the governing law. By that I understand that the reciprocity provisions of the Medical Act, 1886, still stand. This question is one which needs looking into, because what does reciprocity mean? It means that if there is a reciprocal agreement between this country and another, any and every one of the doctors of that other country could come here to stay. As my right hon. Friend said, there have been three reciprocal agreements with foreign countries—one with Belgium, which expired in 1920, one with Italy, which went on until 1940, and the other with Japan, which went on until 1942. This means that for the whole period between, the two wars, no American or French doctor could come here to set up in practice, but that an unlimited number of Italian and Japanese doctors could, which seems a rather fantastic situation. Clause 8 is, in a sense, the thin end of the wedge. It is a break in the reci- 710 procity arrangement and, under it, distinguished foreign doctors can come here and exercise their skill without involving any British registered doctors in unprofessional conduct if they assist them in any way. Members of the professions are very apt at times to exhort the trade unions of industry to abandon restrictive practices, but as I see it, this reciprocity business is a restrictive practice in itself. The medical profession, having sponsored this Bill, might very well look into this whole question of reciprocity, and see if it can be abandoned.
Everyone realises that we need far more doctors than we have now, and that we shall need many more for many years to come. Surely, a better arrangement than reciprocity would be some alteration in the law so as to enable the Minister, advised, of course, by the General Medical Council, to accept into this country any foreign doctor who is considered suitable. At the moment, as I have said, Americans or Frenchmen cannot be accepted but, given a change in the law, I am sure it would be possible to discriminate and to admit fully qualified acceptable doctors, no matter what their country of origin. Clause 8 makes a small breach in this reciprocity arrangement, and I hope it will be looked at again with a view to ensuring that if a fully qualified doctor wants to come here, and is an acceptable person, there need be no legal bar to prevent his coming.
§ 12.5 p.m.
§ Mr. Linstead (Putney)
Like other Members who have taken part in this Debate, I welcome this Bill both for what it does and because, as has been said, it opens a door, which I think many of us desire to see opened, to the wider recognition of professional qualifications across national boundaries. It is part of a general international and European settlement in which I think it is appropriate that this country, because of its special war record, should be taking the lead. The Bill can also be welcomed because of the contribution which the men who will come on to the medical and pharmaceutical registers will be able to make in the launching of our National Health Service next year. The House may be aware that I have been particularly associated with the pharmaceutical side of the negotiations which have resulted in this Bill, and I can say from my personal experience that the 711 Polish pharmacists who have been trained and examined in this country, in anticipation of this Bill, have been found to be men of exceptionally high professional standing, whom we are very glad indeed to have as recruits to our manpower.
If I have any reservation about this Bill it is about the date, which, I think, has perhaps given a little concern to the Minister, although he has had to accept the situation as it is presented in the Bill. There will be hard cases of men who are on the wrong side of the guillotine when it comes down on 4th August, and I think it is a pity that it has not been found possible for the medical profession to do what the pharmaceutical profession have done in this matter. The pharmacists have said, "We are not going to hedge round this registration with provisos and restrictions of one kind and another; we shall take a broad, general power to bring on to the pharmaceutical register any foreign pharmacist who can satisfy us that his character, personal standing, and professional skill and knowledge are of the right quality." If necessary, that will be done by examination, although in many cases there will not be any examination.
It is in that spirit that a country such as this ought to approach any legislation which is of a liberal character and in keeping with the traditions built up before and during the war. If there is any defect in the Bill, it is that the medical sections of it are rather circumscribed in that way. If it is not too late, I ask the Minister to do something to pick up the doctor who ought to be registered, but w ho will be prevented from being registered by the accident of not arriving in this country before 4th August next year. Otherwise, there will be a few men who will feel bitter because by the accident of date they are not entitled to registration. That is the one flaw in the Bill which, otherwise, I sincerely welcome.
§ 12.10 p.m.
§ Dr. Segal (Preston)
As one who had the privilege of serving for four years overseas during the war, and coming into close contact with many foreign doctors who rendered outstanding service to the Allied cause in the Armed Forces, I would like to associate myself with what has been said about this Bill, and to offer it a genuine and sincere welcome. Many doctors of foreign origin who served in the 712 R.A.M.C. and the R.A.F. medical service during the war were men of outstanding character and qualifications. They were sent to serve in many remote parts of the world, where they rendered first-class service. I recall arriving on a desert landing strip on the far North-East corner of the coast of Arabia, in one of the worst climates of the world, where drinking water had to be brought by ship a distance of over 200 miles, and finding a small R.A.F. unit of 150 men, engaged on maintenance work on our planes travelling across the South Arabian route to India. Here was stationed a doctor who had qualified in Germany, who was himself a first-class surgeon, and who had served for many years on the staff of one of the largest hospitals in Berlin. He was a source not only of tremendous help but of real inspiration to our boys working in this remote and desolate part of the world. His case could be multiplied over and over again.
I came into contact with foreign doctors, serving in the uniform of the R.A.M.C., in the remotest corners of Iraq and Anatolia and on the rugged heights of Kurdistan—men who were really a tremendous acquisition to our war effort. To my mind it is quite unthinkable that now this tremendous effort of the years of war is ended, these men should be cast adrift, and their valuable services denied to us. I cannot conceive that, whatever opposition may come to this Bill from any quarter of the medical profession, it can come from any of the doctors who have had the privilege of serving overseas in the medical services during the war. The more contact we had with these foreign doctors, the more we felt ourselves privileged to know them. The hon. Member for Barking (Mr. Hastings) spoke of the medical profession not only as a liberal profession but also as a generous profession. I am proud to feel that this Bill may render it a still more liberal profession, and even to a greater extent, if possible, a more generous profession.
There is one aspect which I would like to stress. Not only is it a liberal and a generous profession, but it is also an international profession which knows no boundaries in its efforts to bring relief and succour to those in need of medical help. From every point of view, I would like to add my own few words of welcome to 713 this Bill. Of course, it will need some modification in its progress through the Committee stage, and we know that it can be improved to a moderate degree, but its main principles are sound, and, I believe, of great advantage to the people of this country. I think we ought to deny that the doctors have a vested interest in disease. They are at once glad to adopt any new methods and new ideas. I believe that the influx of foreign doctors may be to them a source of new and added strength. Doctors have always been known to subordinate their own personal interests to the interests of their patients—their leisure, comfort, sleep and domestic life—I have no doubt that the new doctors now to be admitted under this Bill will rapidly become absorbed into the fellowship of British medicine, and will not only live up to its high traditions but will make their own distinctive contribution to the progress and welfare of this country. I would like very warmly to welcome the Bill.
§ 12.15 p.m.
§ Mr. Charles Williams (Torquay)
In the first words that I utter on this Bill, I would like to emphasise something which was said by the hon. Member for Preston (Dr. Segal), and other hon. Members who spoke before him. I am glad that in this Debate we have not been confined, as occasionally happens with a specialised Bill of this kind, to speeches entirely by members of the medical profession. Speaking as a layman—and in this House of Commons I think it is essential that we should have all points of view—I welcome the appeal made by more than one Member today that the Bill should be used as an opportunity for widening the whole scope of intercourse between the medical professions. There can be no doubt that in the minds of almost every one, learning, and, perhaps, the greatest learning of all—the science of healing—should be made available to the whole human race. I hope that the position which will be taken up under this Bill, and the fact that we are allowing foreign doctors and doctors from the Dominions to settle here, will immensely widen the international use of knowledge which is required for healing.
When I first picked up the Bill, I was a little doubtful of its origin. After the speeches of yesterday, I rather wondered 714 whether anything good could possibly come from another place, but I realised, when I read the Bill with attention and care, that this is one of the occasions when the other place has performed yet another useful service. May I congratulate the right hon. Gentleman the Minister of Health on the fact that he has now progressed far enough to realise that he also can get good from another place, and I hope that his progress will be continued.
I notice that in this Bill we are dealing with these cases through the General Medical Council, and I would remind the House that, on more than one occasion, I have heard hon. Members, particularly from the other side, saying very unkind things about the General Medical Council. They intimated that the General Medical Council were rather too near what, I believe, in ordinary language, is called the "closed shop." I welcome this opportunity to say that the General Medical Council have given very valuable services to the country. As one who certainly has benefited from the medical profession, I am glad to be able to pay this tribute to doctors as a whole. They are undertaking under this Bill the very difficult work of selecting from this very large class of men, running into some thousands and coming from a very wide area, those who should be accepted here.
I am not showing, in any way, any dissatisfaction with the Bill. I realise the very high standard of the medical profession in this country—and, if I may say so, the Scottish doctors have by no means the lowest standard—but I would ask for some assurance from the Minister that the standard which we expect will be kept up by these men coming from abroad. I feel sure that the British Medical Association will see to that, but, as a mere layman, I think it should be emphasised that in accepting these people from abroad we have a right to know sufficient about their examinations and experience to be able to assure the ordinary person in this country—and this is the thing that I really want—that they will be up to a reasonably high standard. That is a point which has been made before, and I think it is one which should be emphasised.
I would like to ask the Minister about a small point which I think should be made clear. In Clause I, and, indeed, right through the Bill, the word "he" is used. 715 Lawyers would undoubtedly be inclined to think that "he" included both men and women doctors. I think it is essential that we should be told whether the word really means doctors of both sexes. I think it does, but I am not a lawyer. We ought to receive a definite assurance that that is the position under the Bill; that both sexes are included, and that there is going to be no sex bar. I hope the Minister will be able to deal with that point when he replies because, if he does not, I am afraid it might lead to Amendments at another stage of the Bill. I wonder whether the Minister would be kind enough to tell me now whether I am right in assuming that "he" does mean both sexes? I am sorry that the Minister does not seem to know.
§ Mr. Williams
I thought the right hon. Gentleman might just say "Yes," and save himself trouble afterwards. I am only trying to help him.
§ Mr. Williams
I thank the right hon. Gentleman for telling me. Dealing wan lawyers is rather different from dealing with doctors. Doctors do know the difference between "he" and "she," and it is quite possible that doctors may take a more exacting line than lawyers on this. That is why I wanted to make it quite clear at the present time.
There is one other thing on which I would like to congratulate the Minister, and that is on the content of Clause 7. The right hon. Gentleman is really coming on; he is allowing to go into this Bill a proper right of appeal. That is something which is wholly British, and something which is welcomed by everyone in this House. I am glad that he has moved forward, and is progressive in this particular matter. I have never been among those who did not think that he might progress at some time, and I most sincerely congratulate him on that matter. I wish him success with this Bill and success in advancing closer, as indeed, he does in this Bill, towards the general prin- 716 ciple in which I and hon. Members of this side of the House believe—the development of international knowledge for the use and help of the people of the world as a whole.
§ 12.24 p.m.
§ Mr. Skinnard (Harrow, East)
I do not intend to take up the time of the House by attempting a general survey of this very useful Bill, or to emulate the hon. Member for Torquay (Mr. C. Williams) who, under circumstances of exceptional difficulty, has maintained his usual provocative attitude towards the Minister.
§ Mr. C. Williams
If I was in any way provocative, I hope I may be excused. I was only trying to congratulate and praise the Minister.
§ Mr. Skinnard
The hon. Gentleman has the most peculiar way which has yet been observed in this Parliament of attempting to praise Ministers. In my opinion, one small point which he made cannot be considered as having any substance at all. It was his reference to another place as a place of initiative in legislation. Nobody on any side of the House denies that is so. Indeed, in this particular matter, it has been a very great convenience, for which I have no doubt the Minister is amply grateful.
Like the hon. Member for Cambridge (Mr. Symonds) and the hon. Member for Torquay, I am a layman in this matter, but I am glad it is possible for a layman to point out the valuable contribution made by the Pharmaceutical Society in the preparation of this Bill. The National Health Service is not exclusively a matter for doctors; indeed, it has been devised practically entirely from the point of view of the patient. In this Bill, the medical profession has shown an attitude which I am sure all laymen in this House will welcome. In contradistinction to the limitation, in Part I, which was pointed out by the hon. Member for Denbigh (Sir H. Morris-Jones), Part II of the Bill seems to be even more generous. It has not been noted by any hon. Member who has yet spoken that a provision for examination in special cases has been inserted in the pharmaceutical part of the Bill, the omission of which the hon. Member for Denbigh regretted in what I might term the "medical" part of the Bill. The provision for the registration as pharmacists of persons holding qualifications granted 717 outside the United Kingdom is very comprehensive.
I think that provision will be a very great help to His Majesty's Government next year when the National Health Service Act comes into operation, because, while it is true that a great increase is necessary in the number of doctors in this country, it has not so often been pointed out that there is an equal need for a great increase in the number of pharmacists. Indeed, this is one instance where the preponderance of medical Members in this House, as against a comparative absence of pharmacists, rather tends to lay undue emphasis on one side of a great and important partnership. For that reason, I was particularly glad that we had the opportunity today of listening to the hon. Member for Putney (Mr. Linstead) who, if he has fewer professional colleagues in the House to support him, nevertheless showed that the pharmaceutical side of the healing profession is worthily and adequately represented here.
As one who has derived great benefit in the past from the ministrations of foreign-born doctors, and, indeed, of foreign-born chemists, I very sincerely welcome this Bill. As has been stated by other hon. Members, learning knows no national frontiers. Access to knowledge is the right of all who live on this globe, and if this Bill is a demonstration of the determination of this country to admit the international implications of medical learning, then I think that the whole world—not only this House and this country—will judge it a very great and important gesture.
§ 12.29 p.m.
§ Mr. Bevan
I can intervene again only with the permission of hon. Members. Perhaps it would be regarded as discourteous if I did not attempt to reply to some of the points raised. It is always a great difficulty, when a Minister has to introduce a Bill which he hopes will be non-controversial, to know how long, or how short, he should make his speech. If he makes it too short, he will be accused of being perfunctory, while if he makes it too long, he will be accused of being tedious. He is always in trouble, because he knows that if he does not say certain things, hon. Members will point out what he has not said. During this Debate, I recognised that we might, perhaps, have avoided some of the speeches which have 718 been made if I had spoken a little longer, and explained one or two of the Clauses which I did not mention. It may be, however, that that is too optimistic, for, after some Parliamentary experience, I do not think it is possible for any Minister to make a speech which will avoid other speeches.
Some suggestions have been made which I very much welcome. Indeed, I have no reason to be other than very pleased with the reception which has been given to the Measure. I did not spend much time in paying tribute to the work these doctors have done, because I think it is universally appreciated. I know many foreign doctors myself, and it is indeed a fact that the genius of the British people has been refreshed from time to time by freshets from other countries, and the experience during the war has been no exception to that. The medical profession has benefited enormously from the doctors who have had to flee from their countries.
My hon. Friend the Member for Barking (Mr. Hastings) cast a little doubt on the provisions for giving special facilities for temporary medical visitors, and he spoke about post-graduate medical education. I was rather grieved by what he said, because I am an enthusiast about the provision of all the facilities we can possibly provide in this country for postgraduate students from abroad. I believe that if we can provide those facilities, we shall make London and Edinburgh, and Great Britain generally, the medical Mecca of the world. We have not got enough post-graduate facilities now. I have been encouraging the Royal Colleges and the hospitals, by all means that lie in my power, to give facilities for postgraduate education.
It is a great grief to me that we are not able to provide enough facilities for people inside the Commonwealth. It is to me a tragic fact that medical students from India, Africa, Canada, New Zealand and from the Colonies sometimes go to Canada, sometimes to America, because we have not got facilities in London. I shall do my utmost to make it impossible for students to go elsewhere merely because they have not got facilities here, in London. Therefore, I was rather grieved at what I thought was a cold douche on the facilities we are giving in this Bill to post-graduate medical stu- 719 dents. In any case, all that we are really doing is regularising what now exists, because, as some hon. Members have pointed out, it is not lawful for a British doctor to associate with a person who is not on the medical register in this country. All that we are doing in this Bill is to regularise a practice which already exists. These students will be in hospitals, under supervision, and, therefore, there will be protection for the patients in that respect.
I have also been asked a question about doctors who are not on the temporary register, and who are not, at the moment, as it were, identifiable. It is intended under one Clause, I think Clause 4, that these doctors shall be on a temporary register, so that their knowledge and experience can be verified, and then permanently registered if they prove to be satisfactory. It must be remembered that we are not only dealing with the temporary register during the war, we are not only dealing with the Polish Resettlement Act, but also with a number of doctors whom I have mentioned in certain categories, who for a variety of reasons have been here but have not been able to get on the temporary register, and who will still have an opportunity of applying. There will be a provisional registration for them in order that their experience and knowledge may first be tested before they are permanently registered.
I have been asked a question about dentists. Foreign dentists can practise without further provision for registration if their qualifications are acceptable to the General Medical Council. I have been asked about nurses. Nurses with suitable qualifications can practise in this country. There is no need for us to make any special provision in the Bill. I have already answered the question of the hon. Member for Torquay (Mr. C. Williams) about "he" or "she." Fortunately it will not be the doctors who will be considering the Measure. All Acts of Parliament are construed by the courts, and not by any particular profession, and we can look to the courts to have sufficient knowledge to be able to construe "he" and "she," if it is necessary.
§ Mr. C. Williams
The right hon. Gentleman and I are in agreement about the courts, but I think that the General Medi- 720 cal Council comes into this, and I wanted to be quite sure about them. I thank the right hon. Gentleman for helping me on this point.
§ Mr. Bevan
In conclusion, I wish to say a word about the General Medical Council and appeals to the Privy Council. I have been taxed, by two hon. Members opposite with being slightly inconsistent. The fact is that we are here dealing with professional qualifications. That is an entirely different matter from dealing with whether a person in the Health Service as a whole is giving suitable service; it is the difference between whether he is qualified and whether he is a suitable person. Therefore, there is no analogy whatever between this provision and the National Health Service scheme itself.
I do not wish to delay the House any further. I am grateful to hon. Members for the way in which they have received the Bill. May I add my hope that the various references that have been made to the passage of the Bill through the Committee do not mean that the Committee stage will be unduly prolonged. It is absolutely essential that this Bill should be on the Statute Book before the end of the year, or irreparable damage will be done to a large number of reputable persons.
§ Mr. Bevan
I do not believe it is possible for me to reconsider that date because it would be a breach of faith. As has been said, this Bill is an agreed Measure. Of course, the House of Commons is supreme, and can do what it wishes, but it is obvious that once a Bill of this sort is introduced, unless there is a closing date, we may get an influx of people from abroad, whose background we cannot check, and of whose qualifications we know nothing. The whole thing will be difficult to control. We must have a date. I agree at once that the date may cause hardship, but unfortunately it is not possible to avoid it.
§ Question put, and agreed to.721
§ Bill accordingly read a Second time.
§ Bill committed to a Committee of the Whole House for Monday next.—[Mr. Simmons.]