HC Deb 31 January 1958 vol 581 cc773-82

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

4.0 p.m.

Dr. Donald Johnson (Carlisle)

I raise this matter on the Adjournment with two objectives in mind, and I apologise to my hon. Friend the Parliamentary Secretary to the Ministry of Health for bothering him to be in the House at this inconvenient time, though I feel that I have two good reasons for doing so.

My first reason is a personal one, in the injustice which my constituent, Mr. John Smith, of 40, Greystone Road, Carlisle, has suffered through a decision under the National Health Service (Medical Auxiliaries) Regulations, 1954. The second is to try to deal with certain general principles which I feel are involved. My constituent is one of the victims, if I may put it that way, of the juggernaut of progress, in this case of administrative progress. This progress is the result of an entirely praiseworthy effort by medical ancillaries and auxiliaries to regularise themselves by organising their various professions and setting up professional standards. This started with the dentists about twenty-five years ago. It has gone on from there, from the ancillaries to the auxiliaries such as physiotherapists and chiropodists.

My constituent is an extremely reputable professional man who has been practising in Carlisle as a chiropodist for over twenty-two years, but this situation has arisen through the introduction of the Medical Auxiliary Regulations, 1954. With a view ultimately to providing a chiropody service under the National Health Act, a preliminary step was taken to attempt to regularise the profession of chiropodist. As was natural, certain standards were laid down for these to be included in the Ministry's list.

These standards were fourfold. Anybody who wished to be included had either to be employed in the National Health Service at 31st March, 1954, or must have held at that time one of the qualifications listed in a schedule to the Regulations. Thirdly, he had to take a course of training and pass an examination approved by the Minister. Fourthly there was a clause, which has been aptly described as a safety valve, for those whom the Minister felt to be people suitably qualified by training and experience, but who had failed to qualify under any of the other three heads.

My constituent, through no fault of his own, failed to satisfy the first three main qualifications. At the time he qualified, about twenty-five years ago, he had taken what he describes to me as the finest training available at that time at the National School of Chiropody, in Upper Street, Islington, and he finished first, equal with another student, in the final examination. As time went on, and the profession of chiropody started to organise itself, the National School, unfortunately for Mr. Smith, was dissolved. It seems that it was not one of those schools incorporated into what became known as the Society of Chiropodists.

Nevertheless, and this is the nature of his outstanding qualifications, he was elected by his old school to serve on the first council of the new Society. I understand that he served on that council for two to three years, until the travelling distance between Carlisle and London became too much for him, and he had to give up his membership of the council for that reason.

As I have said, Mr. Smith has quite unusual and outstanding qualifications which, one would think, would qualify him, under my right hon. Friend's escape clause, clause 4, for approval on his list of chiropodists. To check these, I asked Mr. Smith to obtain personal recommendations, and this he did without the least difficulty. He produced letters of recommendation from members of the medical profession with whom he had worked for between ten and twenty years, and one of them, in particular, said that over a period of ten to fifteen years he knew of no complaint whatsoever having been made of Mr. Smith's professional services. He produced a recommendation from the Federation of Women's Institutes which he had served as a lecturer locally in Cumberland. He produced others from prominent citizens in Carlisle, some of whom he has attended in his practice. All of them, without exception, are the most excellent recommendations and qualifications which, one would think, would entitle my right hon. Friend to approve him on his list under that escape clause, clause 4.

I have, as my hon. Friend knows, submitted these recommendations to my right hon. Friend, but, despite that, Mr. Smith has been turned down. I submit primarily that a refusal of this character is a departure from the liberal spirit which animates our professions. I appreciate that my right hon. Friend, in assisting to regularise a profession, has to have in mind certain qualifications, that he has to be careful whom he takes on, and that he must, above all, insist that those who are entering the profession fulfil certain requirements. None the less, as I understand, it has always been the custom for those who are reputable people and who have earned their living in a profession to be allowed to work out their days in it. One can almost say that Mr. Smith is in the evening of his really quite distinguished career, and I should have thought that the custom would have applied to him.

We can look to what happened originally under the Dentists Act, 1921. There was at that time a large number of unregistered dentists practising. They were allowed to work out their time without acquiring additional qualifications. Of course, here the circumstances are slightly different. The relevant regulations were framed with a view to chiropodists coming into the Health Service when circumstances allowed it. None the less, my constituent has had an injustice done to him by this decision.

I should not be bothering my hon. Friend with this debate, however, if there were not more tangible reasons. Mr. Smith is suffering definite hardship because the Council of Social Service in Carlisle has—with the entirely praiseworthy motive of providing chiropody services for elderly people—drawn up its own list of chiropodists, and has refused to include Mr. Smith on that list, on account of the Minister's decision.

That, in turn, means that Mr. Smith is losing his elderly patients, because they are unable to come to him at the reduced fees which are arranged through the Council of Social Service in Carlisle. He is losing his practice, and many patients who have been with him for years. He is thereby suffering a tangible hardship.

After a lengthy correspondence, in which we covered the points that I have raised, in his final refusal to me my right hon. Friend said: I am very conscious of the undertaking given when the Regulations were introduced, that they would not be used to lower the standard of the profession. I think I have said enough to prove that he would not be lowering the standard in any way by accepting Mr. Smith. My right hon. Friend then went on to say: You will appreciate that the qualifications required by the National Council for Social Service are a matter for the Council, and I have no jurisdiction over them. If Mr. Smith feels aggrieved by their decision, his proper course would no doubt be to make representations to the Council. My right hon. Friend thereby washes his hands of this situation. But I submit to my hon. Friend that he and his right hon. Friend do not know their own strength. They remind me of a heavyweight boxer who gives a man a slight tap and is surprised when he falls over and down the stairs.

In its letter to Mr. Smith, the Old People's Welfare Council says: With reference to our recent correspondence, my Executive Committee has requested me to inform you that if the representations being made by Dr. Donald Johnson on your behalf are successful, and you become qualified within the meaning of the Regulations, your application for inclusion in our Chiropody Scheme will again be considered, but in the meantime we are acting strictly on the basis of the Regulations laid down by the National Health Service (Medical Auxiliaries) Regulations, 1954. The ball therefore goes to and fro. My right hon. Friend passes it to the Council and the Council passes it back to him.

I hope that my hon. Friend will change his mind about this matter, but if he cannot do that, I hope that he will at least give a quite definite ruling and confirm what his right hon. Friend has said in his letter, namely, that the Council for Social Service must take responsibility for refusing to accept Mr. Smith. Then, at least, my constituent will know where he is and we can take the matter elsewhere, knowing exactly where we are from a public point of view. I would thank my hon. Friend the Parliamentary Secretary for attending the debate and, though I dispute his decision, for the great trouble that has been taken in this case.

4 16 p.m.

The Parliamentary Secretary to the Ministry of Health (Mr. Richard Thompson)

I must pay a tribute to the assiduity of my hon. Friend the Member for Carlisle (Dr. D. Johnson) in this matter. I believe that he has risen from a bed of sickness today to press still further this matter about which we have had correspondence. I am not too sure that what I have to say will be satisfactory to my hon. Friend, but at any rate he will have the satisfaction of feeling that he has done everything that lay in his power to put things right for his constituent.

This is an argument partly about the powers of my right hon. Friend the Minister of Health under Regulation 3 (4), to which my hon. Friend referred, and partly about the local refusal of employment to Mr. Smith by the Council of Social Service in Carlisle. My hon. Friend would not expect me to go now into the wider question of registration of medical auxiliaries. Indeed, if I did I should probably incur your displeasure, Mr. Speaker, because it is a matter which would require legislation.

On the question of the provisions under the Regulations, my hon. Friend was right. Perhaps I might summarise them. The Regulations provide that persons in post on 31st March, 1954, might continue to be employed in the National Health Service; secondly, that persons who held certain prescribed qualifications on that date might similarly be employed, but, for the future it would be necessary to qualify either by taking a course of training and examination approved by the Minister or—and this is where my hon. Friend's case comes in—by gaining admission to the list kept by the Minister under Regulation 3 (4) of persons who are not qualified under the other provisions but who satisfy the Minister that their training and experience are adequate for employment in the National Health Service.

These Regulations were introduced in order to ensure the maintenance of satisfactory standards among medical auxiliaries qualifying for employment in the National Health Service. It is important to remember that when the Regulations were discussed in this House on 23rd February, 1954, misgivings were expressed by several hon. Members about the danger of Regulation 3 (4), which affects this case, being used by the Minister to lower the standards of medical auxiliaries qualified in that way. My right hon. Friend the Minister of Labour, who was then Minister of Health, gave an undertaking that the general standard would not be lowered by any widespread use of Regulation 3 (4) which, he promised, would be used only for the exceptional cases which did not quite fit into the other Regulations.

This policy has been followed by all my right hon. Friend's successors. As our present attitude stems from what my right hon. Friend said in the House at that time, perhaps I might be allowed to quote what he said, which was: I understand the worries that people may have, but I do not think there is the slightest risk that the Minister will accept standards in this field that are too low. Quite frankly it … the Regulation we are discussing— is a safety valve. It is obviously possible to conceive of cases of people who because they have been living abroad or for other reasons, have not been able to obtain the particular qualifications that are suggested in the earlier Regulations, but who might yet be fully worthy of inclusion in the list. If such a list comes into being it will indeed be very small; there is no suggestion that it should be used other than as a means of ensuring that unfairness is not caused in the most exceptional cases that might well arise."—[OFFICIAL REPORT, 23rd February, 1954; Vol. 524, c. 343.] Later my right hon. Friend said: it is not intended in any way that this list shall become an umbrella—if a list can become an umbrella …"— or a safety valve, or, as my hon. Friend said, an escape clause, but we know what is meant— for those people who cannot qualify under any other Act. It is only for the very rarest case that it is possible to imagine that somebody would be entitled to submit their names to me either independently or through an Association and to have it put on the list."—[OFFICIAL REPORT, 23rd February, 1954; Vol. 524, c. 357.] It is in this spirit that the Minister, in consultation with his expert advisers, has examined Mr. Smith's application for inclusion on the list and has reviewed the matter on a number of occasions following representations made by my hon. Friend. He has felt bound to maintain that decision, namely, that Mr. Smith's training and experience were not adequate to justify his inclusion on the list as a fully-qualified chiropodist for National Health Service purposes. My hon. Friend will note that the Regulation says, "training and experience," not "training or experience." It was clearly not envisaged that length of service by itself in any one of the medical auxiliary professions would qualify a person for employment in the National Health Service. If that had been intended, a paragraph to that effect would no doubt have been included in the Regulations.

The 1954 Regulations provide the statutory control for employment in the National Health Service, and when a person is admitted to the Regulation 3 (4) list as a chiropodist, he is qualified to take any chiropody post in the National Health Service, namely, including the hospital service. In the case of Mr. J. Smith, the Minister's advisers therefore had to consider whether his training and experience were adequate to warrant his employment over the full range of chiropody services, including, of course, employment in a hospital department where he would be working to the instructions of a consultant orthopaedic surgeon. On the evidence available so far, the Minister has concluded that Mr. Smith is lacking in the particular experience needed to fit him for employment in a hospital department of this kind.

My hon. Friend will recall that in his correspondence with me in his letter of 4th December last year, he agreed that Mr. Smith had not had any experience of hospital practice, although he had been in practice for a great number of years. The actual details of the syllabus of Mr. Smith's training twenty-two years ago are not now available. The training was followed by private practice and Ministry of Pensions clinic work in Carlisle. That kind of experience is not considered adequate by the standards required for National Health Service employment and the Minister does not consider that he would be justified in making an exception in this case bearing in mind the statements made and undertakings given in the House when the Regulations were debated. If any new evidence about Mr. Smith's training—

Mr. W. R. Williams (Manchester, Openshaw)

Is there a shortage of chiropodists in the National Health Service?

Mr. Thompson

I think we can always do with more, but we have to consider very carefully the original undertaking quite freely given by a predecessor of my right hon. and learned Friend that he would not, so to speak, water down the standards by anything approaching an indiscriminate admission of people to this section of the Regulations.

If any new evidence about Mr. Smith's training and experience is produced subsequently, my right hon. and learned Friend will certainly be glad to review the matter again, but as it stands now he sees no alternative but to stand by the decision already announced. In so doing, he has no other intention except to administer the Regulations in the spirit in which they were presented to the House in 1954.

I said that this argument fell into two parts. The second is the question of Mr. Smith's difficulties by reason of the decision of the Council of Social Service in Carlisle which makes it impossible for him to be employed by that Council. The Council has made it a condition of employment for chiropodists in its scheme for old people that the chiropodist should be qualified under the National Health Service Regulations, and the only way in which Mr. Smith can qualify is under Regulation 3 (4).

My hon. Friend felt, I believe, that we were rather playing cat and mouse with Mr. Smith by saying, "It is up to the Council of Social Service to employ Mr. Smith if it wants to," and then the Council telling Mr. Smith that if only the Ministry would take certain steps it could so employ him. That was certainly not our intention. Indeed, the National Health Service Regulations are not being misused by us in being applied in this way. Employers outside the National Health Service, such as this body, are entitled to lay down any qualifications they wish for the chiropodist then intend to employ, and it is not a matter over which my right hon. and learned Friend has any jurisdiction at all.

If, however, an application is received for inclusion in the list under Regulation 3 (4) the Minister is clearly obliged to consider whether the applicant is qualified for employment in the National Health Service. It is not his business to consider whether the applicant is qualified for employment elsewhere, and of course the requirements laid down by the Council of Social Service are its own business. They are a matter for discussion between Mr. Smith and the Council. If the Council makes these requirements before it is prepared to recruit chiropodists, we cannot require it to change its rules, nor can we take any steps in the matter at all. All we can say is that, having given the matter the most careful attention—and my right hon. and learned Friend has taken good care of that—we do not feel that at present, at any rate, we can admit Mr. Smith under Regulation 3 (4). If that has the effect that the Council of Social Service in Carlisle cannot employ him, I can say only that it is a matter between the Council and Mr. Smith, because we cannot compel the Council to act in a particular way in matters of this kind.

I regret that I have not been able to give my hon. Friend, who has been so pertinacious in this matter, a more satisfactory reply from the point of view of his constituent, but I hope he will feel satisfied that at any rate this matter has not gone by default and that it has been looked at as sympathetically as it possibly could be within the context of the Regulations which we are bound to administer.

Dr. Johnson

May I ask a short question? It may be tedious for me to ask my hon. Friend to repeat this, but will he make it clear that it is not his intention or that of his right hon. and learned Friend to lay down any standards at all for the Council of Social Service? I should like that point made quite clear.

Mr. Thompson

We cannot require the Council of Social Service to lay down any particular standards in a matter of this kind. I am glad to give my hon. Friend that assurance.

Question put and agreed to.

Adjourned accordingly at half-past Four o'clock.