HC Deb 18 July 1950 vol 477 cc2208-16
Mr. Pitman

I beg to move, in page 13, line 40, at the end, to add: Provided that the foregoing subsections shall not apply to any place of instruction under the direction of any body which at any time during the preceding six years has been in receipt of a grant from public funds through the University Grants Committee. This is primarily a university point, secondly a General Medical Council point, but all the way through a point concerning the general public. The general public is vitally interested in the efficiency of training which leads up to qualification. The whole Clause, I understand, arose from the Report of the Goodenough Committee, but I believe that since the report the conditions which that Committee had in mind, and against which its particular recommendation, and this particular Clause was directed, have ceased to be operative. I believe there were certain external degrees awarded by certain universities which were of doubtful qualification value, and the Goodenough Committee and the Minister thought it was desirable to meet those cases by this particular treatment, but I understand that that difficulty has been got over at the University level.

In any case, whether that is the case or not, it is well to consider this Clause and to fight it on the more difficult grounds, namely, that I think it is unwise in any event, and also unnecesary. I believe that the Minister ought to realise that this is wrong in general principle, and unwise because it divides responsibility between the universities and the General Medical Council. At best it blears it, and I maintain that it wholly divides the responsibility of training between the two bodies to the great detriment of both. The Clause says that these visitors should concern themselves with … the sufficiency of the instruction given in the places which they visit and as to any other matters relating to such instruction …. 12 m.

The Clause is drawn in the very widest terms of reference, and I suggest that these visitors will be inspectors. They will be inspecting the qualifications and ability of the staff to teach, the curriculum and hours of teaching and even particular methods in which instruction is given. I think there is an organisational difference between inspection and visiting. By my definition visiting is when the chancellor and governing body invite somebody in to make a report to them. Inspection is when some other body—the General Medical Council or the Privy Council—send somebody to make a report to them, with, admittedly, a copy sent to the chancellor and university governing body concerned.

In this Clause it is clearly an inspection which is taking place, because they are not invited in; they are sent in and make a report to the body sending them, and merely send a copy to the teaching body. We have cut right across the whole principle of the unity of responsibility for the job in hand. Day by day management is under inspection and the responsibility for it, therefore, is shared by the teaching university and by the General Medical Council which does the inspecting.

Let us suppose that university X is doing a bad teaching job in the opinion of the General Medical Council. Remember that university X must have already been recognised, because this does not apply to any new universities, which have to obtain recognition. I think the Minister will agree that the General Medical Council have complete powers of moving in and seeing everything by which they can recognise a new university. Therefore, it must be an existing university already recognised as able to give qualifications.

Already, the Council have power to call for the prescribed courses and in point of practice, since every medical school publishes its own calendar, they have access to the names and qualifications of the teaching staff. They also have the right under previous Acts to visit and supervise examinations to see how the university is conducting its examinations. Finally, through the hospitals' intern year, they have indirectly a new and much more effective method of up-to-the-year judgment the products of a university. Obviously, the General Medical Council will be able to find out from what university intern failures are coming. They are in a position all the way along of judging the quality of university teaching by the products which come from it.

What is the Council's remedy, if they think a university is not teaching properly? They have three remedies at present, and I will deal with them in their order of severity. The most severe remedy is to withdraw recognition of their qualification. Then they can make representations to the University Grants Committee. That is a most effective form of pressure to bring to bear against a teaching university because it puts them on the spot at once. The power of the purse gives a great urge to the need to give very careful consideration to any criticisms which have been made.

Finally, they have the opportunity to make representations direct to the medical school or to the university, which is the ordinary and normal way of doing things in the first instance in this country. The first remedy is to make representations, the next to bring pressure through the University Grants Committee, and the final remedy, and the most severe, is to cut off recognition altogether. I would say that, in general, it is always very much better for any organisation judging the product to be in the position to take all these steps rather than to judge the methods of manufacture by which the product has been achieved.

I want to make it clear that unless the Clause is amended in both of the ways suggested in my Amendments, it will be inevitable for the General Medical Council to assume responsibility for who ought to be the dean of that medical faculty. The position will be that the university will have to say, "If you do not like our dean I suppose we shall have to give way; you are putting in this report and you are taking responsibility for appointments to even the highest posts. Whom do you want us to appoint instead? You will also be responsible, as the General Medical Council, for the views and opinions taught in the course of the three years, or whatever it is, of training. You will also be responsible for the methods of instruction."

I maintain that for the chancellor and senate, or the chancellor and governing body, it is a most dangerous precedent that the employing body. the qualifying professional body, should take responsibility for the day-to-day management of the courses of instruction. Are we to have the electrical and mechanical engineers going into the Cambridge engineering faculty and asking questions about the personnel and inspecting in this way—asking about the curriculum, the hours of work and the methods of instruction? Are the chartered accountants to go into the London School of Economics in this way? Is the Law Society to go into Oxford University's Law School in the same way? Where is the principle to end?

Do the General Medical Council really want to take responsibility in this way? Are they not in a far stronger position if they can say, "You run your own show and we will judge you by the results you turn out"? is it not better for them to say that they want no responsibility for saying that this man is a good teacher and this man is a bad teacher? They would have the power to say, "This school is doing so badly that we have to take one of the three more or less severe sanctions which we can employ against them."

I know that the Privy Council is inserted as a saving clause, but it seems to me that it does not act as a saving clause in any way whatsoever. It merely puts an additional cogwheel into what is otherwise a most simple machine. I think the best method of all is the visiting committee which is invited into the university by the teaching university. That is dealt with by the second of the Amendments in my name and the name of my hon. Friend the Member for Enfield, West (Mr. Iain MacLeod).

Often our universities get visiting doctors from America and overseas, who are invited freely by the universities to make a report to the chancellor and the governing body of that university. If the General Medical Council wanted to see that report they could and would obviously be able to see it. Every university is proud and anxious to do its best to teach the doctors really well so that they can serve the public really well. We would get far further in this Committee if we used that tendency, rather than seeking to divide the responsibility for that job between the General Medical Council and the teaching universities concerned.

Mr. Bevan

I was rather surprised to see this Amendment on the Order Paper, because, as the hon. Member for Bath (Mr. Pitman) himself has pointed out, these words were put into the Bill following the recommendations of the Goodenough Committee. They also received, so far as my knowledge goes, when the previous proposals were being discussed, if not unanimous support from the university authorities, at least no objection from them.

Mr. Pitman

My information is that the universities are very disturbed.

Mr. Bevan

That is not my information at all. My information is that one university, where a new dean had been appointed, raised some objection, but his predecessor had not. His predecessor had been consulted in this matter, and the universities generally are happy about it. In any case, the Committee ought to be happy, inasmuch as it has been accepted now that it is not sufficient for the General Medical Council only to be able to inspect examination, because of the matters and the sort of instruction which is being given throughout the whole of the period. It has been thought wise, therefore, that the General Medical Council should be able to inspect.

It was felt—and this is the point made by the hon. Member—that there would be some clash between the university authorities on the one side and the General Medical Council on the other. That is why the authority of the Privy Council has been invoked. The Privy Council can give directions. If the General Medical Council inspections are vexatious to the university authorities, they can make representations to the Privy Council to alter the directions. I should have thought, therefore, that the university authorities are properly safeguarded, and I hope that the hon. Member will not press his Amendment. We all know that these corporate bodies are exceeding jealous of their powers and their prerogatives.

Sir H. Lucas-Tooth

And rightly so.

Mr. Bevan

Yes, and rightly so; they and the General Medical Council, too, are anxious that they should not have their toes trodden upon. It has been considered that the General Medical Council is interested in this matter. and in order to see that the interests of the Council and the university authorities do not clash it is provided that the Privy Council can be brought in. I should have thought in the circumstances that that was enough. I hope that the hon. Member will not press his Amendment.

12.15 a.m.

Mr. Pickthorn (Carlton)

I dare say this may be all right, but I do not think the case put to us is very convincing. Though I am extremely reluctant to stay out of bed any longer, really something more ought to be said on this subject. The right hon. Gentleman told us about the dean of one university. I do not know to which university he refers, nor, indeed, do I know which universities have deans.

I cannot pretend that I got myself so well advised about this as I should have thought it my duty to do in previous parliaments but certainly, the impression which I have been given, if the right hon. Gentleman can bear to listen to a sentance or two, is that the universities are more than dubious about this. If really his case is to rest, as he seemed to rest it, almost wholly upon the contrary assertion, I think that he owes it to himself, and to the Committee, to make some further inquiry; because I do not believe that it should be taken simply as it has been stated this evening.

If I may say a word about the more general side, I would say that these corporations are not, or I hope that they are not, exceedingly jealous about their powers and privileges. They are no doubt jealous of them, but we here ought to be extremely slow to take them away. There could be a very high degree of independence in the great teaching organs in the old days because they had a high degree of financial independence. It would be out of order, and it is not necessary to my argument, to consider whether the development of the last 50 years, which has caused these corporations to lose their financial independence, is a good thing or a bad thing; but the fact is that that has happened. If it is not desired to give the impression that in the future universities are going to have no sort of genuine independence we ought to be very slow to give new powers to a central organ to inspect teaching.

May I ask the right hon. Gentleman a specific question which is of a very small kind but which, I think, ought to be understood. It is about "a visitor" as mentioned in subsection (3). It is not clear whether the words "a visitor" mean an individual, or whether "a visitor" means one of those visitatorial committees indicated in a previous subsection. I think it obviously ought to mean the same as it meant in the previous subsection, and I imagine that the right hon. Gentleman meant it to mean the visitatorial committee, or whatever it may be called. I think we ought to be certain that the effect of the words would be that, and that they would not mean an individual.

Secondly, to repeat, I should like the Committee to consider whether it ought not to fall over a little backwards in trying to preserve what is left of the independence of the great teaching corporations, in the main universities. I think the Committee ought to consider that, before it gives way on this matter; and more especially before it gives way to this upon the right hon. Gentleman's mere indication that all the universities are perfectly happy except one un-named university, where some dean has been succeeded by some other dean. I do not believe that it is by any intention to be uncandid if the right hon. Gentleman is at all misleading the Committee. But as far as I know, it is not the case that all the universities, except one, are happy about this Clause.

Mr. Bevan

I shall be really happy to be quite candid. This Bill has been gestated for a long time, and I should have thought that if the provisions in the Bill were obnoxious to the university authorities they would have made it clear long ago. I did not want to delay the Committee at this late hour, and that was why my remarks were brief. The Goodenough Committee reported on this matter years ago, and used clear language. They said: We see a need for some central source from which medical schools can obtain advice and guidance. Regular inspection of medical schools should contribute to the maintenance of good standards of training and should prove helpful to the schools. We thought that the General Medical Council, being fully representative of the licensing bodies, and the medical profession, is the proper body to be entrusted with the conduct of these inspections. This was the Goodenough Committee, and they reported long ago. It is important—and I do not try to say anything else—that the universities must always be jealous of their independence. We are seeking to avoid confusion and to see to it that the new authority given to the General Medical Council should not be exercised in a vexatious manner to the universities: and then there is the part which the Privy Council can play. We hope that this will be, in practice, a harmonious way of proceeding. While the General Medical Council has a statutory responsibility to withdraw approval if a school fails to provide proper courses, it has no means, at the moment, of finding out what the courses are like.

Mr. Pickthorn

They have the results.

Mr. Bevan

Yes, they have the results, but that is not deemed to be sufficient and it was thought desirable that there should be these inspections which, we hope, will be joint inspections. With regard to the small point made by the hon. Gentleman, I think that the visits of which we are speaking are the authorised visits.

Mr. Pickthorn

Not an individual member, but the committee as such.

Mr. Bevan

Unless the "visitor" is a visitor in furtherance of an instruction given him by the committee. That may happen.

Mr. Pitman

There is one point and one question which I should like to put and to ask. First, when the Goodenough Committee made their report—that part which the right hon. Gentleman has read to us—were there not external or extramural courses against which that recommendation was directed, but which have now ceased? Secondly, is it not true that so far as his statement, that the universities are happy about it, is concerned, certain evidence can be produced? I will be pleased if he will look into fresh evidence, which, I think, I can collect, supporting the view that there is considerable disturbance at this particular time.

Then there is this specific point that the Privy Council is there to act as "smoother-out" of the difficulties between the universities and others. If I may say so, I think that that concession is just a piece of window-dressing. The right hon. Gentleman is dividing the responsibility for teaching between the chancellor and the governing bodies which are ordinarily responsible for day to day management, and the Council, which will negative day to day matters.

Mr. Bevan

We had optimistically hoped that we might settle this remaining part of the Committee stage in an hour; but we have gone far beyond that already. However, the answer to the hon. Gentleman's last point is that the Privy Council has very specific powers. This is not merely window-dressing. They can say how inspections shall take place. So far as the point about the Goodenough Committee is concerned, the language I have read out is far too wide to apply only to extra-mural teaching. I certainly would inquire between now and the Report stage if the universities are unhappy about it, but I cannot promise now that any substantial alterations can be made to the Clause.

Mr. Pitman

In view of the assurance by the Minister that he would look into the evidence on this point, I beg to ask leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

Clause ordered to stand part of the Bill.

Clauses 21 and 22 ordered to stand part of the Bill.