DR. VICTORIA TERRELL (Hansard, 15 May 1968)

§ Sir Cyril Black (Wimbledon)
I am glad of this opportunity to raise in the House the case of my constituent, Dr. Victoria Terrell Dr. Terrell obtained her medical qualification at Warsaw, a qualification which is, I believe, well regarded in medical circles throughout the world. She was of Polish nationality and, on coming to this country, obtained a certificate of temporary registration as a medical practitioner. She worked for a period at St. Lawrence's Hospital, Cater-ham, Surrey, specialising in clinical work among mentally deficient children. She served there in all for about two years and, according to my information, her service was entirely satisfactory to the hospital authorities and the hospital was sorry when she left.
Dr. Terrell gave up her post at the hospital because she married my constituent, Mr. Christopher Terrell, and in due course gave birth to a child. During the latter stages of her pregnancy, and while the baby was young, she found it necessary to give up work temporarily and attend to her responsibilities as a wife and mother.
After her marriage, Dr. Terrell became a naturalised British citizen with the intention of living permanently in this country in my constituency. About a year ago she wished to return to medical work and at that time her old post at St. Lawrence's Hospital was unfilled. I understand that the hospital was both willing and anxious to re-engage her, she having for them the advantage of experience and qualifications for the work. The hospital was unable at that time to obtain the services of another doctor.
Unhappily, Dr. Terrell was unable to return to her old post because the Genera Medical Council was either unable or unwilling to grant her another certificate of temporary registration, the reason, I understand, being that the Council considered that now that she had become a naturalised British subject and 1362 was married to a British subject it was reasonable to assume that she would be permanently resident in this country. While the Council was willing before these events to grant her temporary registration, in the new circumstances in which she was placed it was not willing to do so.
Dr. Terrell, who is anxious to resume medical practice in this country, is now taking a medical course at Dublin, but I submit that, inasmuch as the course that she is taking is merely in her case going over ground that she has already covered in her original medical course at Warsaw, she is being subjected to delay and expanse unnecessarily by having to go through this further medical course.
It is relevant to notice that, if Dr. Terrell had been trained in a Commonwealth country with a reciprocity agreement with the United Kingdom, on coming here she would have been automatically eligible to practise, even though she might have been unable to speak, write or understand a word of English. The fact is, as I submit, that her Warsaw qualification is at least equal to many of the acceptable medical qualifications in Commonwealth countries. Dr. Terrell at least has the additional advantage over some doctors from Commonwealth countries that she can speak, write and understand English.
I understand that Dr. Terrell's case is by no means unique, although it is somewhat exceptional, there being other foreign doctors in the country suffering from similar disadvantages; so that the importance of this debate extends over a wider field than to one individual only.
The case of Dr. Terrell has received over the last 12 months extensive coverage in both the medical and the national Press. The position in which Dr. Terrell is placed has, I think it is not unfair to say, been adversely criticised in every medical and national paper which has reported the circumstances of the case.
The restrictions to which Dr. Terrell and other similarly situated doctors are subject would be understandable and intelligible if in this country there was a sufficiency of doctors or too many doctors, but I think that it will be common ground on both sides of the House 1363 that there is in this country a considerable shortage of doctors and that there are most appalling shortages in many other parts of the world, including particularly the continents of Africa and Asia.

§ Mr. Speaker
Order. I am not without sympathy with the point that the hon. Gentleman is advancing. Is the restriction to which he refers a matter of law or of administration? If it is one of law, he cannot pursue it on this Adjournment debate.

§ Sir C. Black
I appreciate that point, Sir. I gave careful consideration to it.
I must admit immediately that I am not an expert in these matters, which are subject to some doubt and difficulty; but I gather that the position is that the Minister has certain powers of representation in these cases and that it is not beyond his power to intervene if he felt it right to do so. That is what I am asking him to do. I was trying to be, and I will continue to be, as careful as possible not to impinge on the legislative side, upon which I appreciate that I must not touch.
The medical profession itself appears to be concerned about, and even dissatisfied with, the present position operating both in Dr. Terrell's case and in other cases. A commentator in the authoritative medical journal, the Lancet, said of Dr. Terrell's case as long ago as 19th August, 1967: The publicity given last week to the case of Mrs. Terrell illustrates the distinction which is made between graduates from the Commonwealth and those from other countries.… The manoeuvre of temporary registration is an unhappy one, born of post-war politics, and based on the palpably irrelevant consideration of duration of stay. Surely it is ludicrous that when a doctor declares an intention to remain in Great Britain the reward is a decree of unfitness to practise here? If there is any justification at all for two different kinds of registration, they must be related to fitness to practise supervised on the one hand and unsupervised on the other. If supervision is required, registration should clearly require that the doctor embarks on a recognised course of supplementary training, and it should be for a strictly limited period which is determined by educational factors alone. Only today I have received a letter from Dr. Derek Stevenson, Secretary of the British Medical Association. He says: 1364 Your constituent, Mr. Christopher Terrell, has been to see me and has told me that you are to initiate an adjournment debate in the House of Commons on the registration of foreign-qualified doctors, such as Mrs. Terrell. This is a complicated subject, on which it is not wise to dogmatise. I will, however, say this: in the present shortage of medical manpower in this country, I should hope that ways and means could be found to retain the services of doctors who have worked satisfactorily on the Temporary Medical Register for some time. This is a viewpoint which I have already expressed, and will continue to express to the General Medical Council and to the Ministry of Health. I have tried to raise this matter in no controversial or censorious spirit. I am concerned, as I think the House will be, with only one matter—the apparent failure to make the best use of available medical manpower. I hope that the Minister will feel able in this and similar cases to confer with the General Medical Council with a view to its being able to deal exceptionally with exceptional cases like this. I hope that the Minister, who, I think, is not unsympathetic to this case, will use his good offices to get Dr. Terrell and other similarly situated back to work, where their services are so much required.

§ The Parliamentary Secretary to the Ministry of Health (Mr. Julian Snow)
I very much appreciate the way in which the hon. Member for Wimbledon (Sir C. Black) has spoken about this case. I am not unacquainted with the details of this history. In raising the question of Mrs. Terrell's registration as a medical practitioner and the recognition of medical qualifications granted abroad, the hon. Gentleman has served his constituent well.
This debate gives us an opportunity of debating a matter about which there has been considerable misunderstanding and it would be to the general advantage that the misunderstanding should be cleared up.
I shall start with a short explanation of the provisions of the Medical Act, 1956. The first point I must make is that under that Act the responsibility for registration lies wholly with the General Medical Council, and the Council is an independent body. The Act assigns certain functions, mostly of a judicial nature, to the Privy Council, but it does not make the General Medical 1365 Council responsible to my right hon. Friend or to any other Minister.
It would not, therefore, be right for me to discuss whether Mrs. Terrell should or could be granted some form of registration, since that is a matter in which the Minister of Health has no standing. But I can help to dispel some of the misapprehensions that have arisen about the question. I certainly do not want to appear to be slamming the door in the hon. Gentleman's face.
To understand what is involved, it is helpful to look first at the requirements for qualifying in this country. The prospective doctor is required to undergo undergraduate medical training lasting at least five years. This is followed by the pre-registration year, during which the graduate may practise only in resident posts in approved hospitals. At the end of that year, he can obtain full registration and be entitled to practise on his own responsibility in whatever way he wishes.
Let us turn now to the position of doctors who qualify abroad. May I say that I believe that the greater flexibility we have in accepting medical qualifications of approved standards, the better. Doctors with certain recognised Commonwealth or foreign qualifications can obtain registration in this country on the strength of the qualification granted abroad. Similar conditions apply to such graduates as to British graduates: the primary qualification in itself entitles them to provisional registration and they must satisfy the General Medical Council that they also have the experience required under the Act to obtain full registration. The provisions relating to experience are rather more flexible than for a graduate in this country to take account of different varieties of experience which graduates may have obtained.
A doctor who has qualified abroad, irrespective of the country of qualification, can obtain temporary registration under Section 25 of the Act, provided his qualification is acceptable and he is or intends to be in the United Kingdom temporarily for the purpose of practising medicine in a hospital or other institution approved by the General Medical Council. This is a limited form of registration and was introduced under 1366 the Medical Practitioners and Pharmacists Act, 1947, to regularise the position of doctors from abroad who visit this country for limited periods either as teachers or as postgraduate students.
I will turn now to what I know of Mrs. Terrell's own situation. If I refer to her as "Mrs." Terrell, the hon. Gentleman will understand that I am in no way discounting the fact that she is a qualified doctor from Warsaw. Mrs. Terrell qualified in Warsaw in 1961. Although the known facts of her career are incomplete it appears that she was a "student of paediatrics" at the Medical Academy in Warsaw and took her final examination at the end of her fifth year, followed by a 40-week internship to obtain her Lekarz diploma. She then would apparently immediately specialise in paediatrics for a period of 18 months.
I understand that Mrs. Terrell is now studying for a British primary qualification. According to my information, although I have not had written confirmation, she has apparently passed some of the examinations, but still has medicine and surgery to complete. When she has her primary qualification she will be able to apply for provisional registration, the first step to full registration under the Act. I certainly wish Mrs. Terrell well on her course. I know that she has domestic problems in relation to children and that it is not an easy thing for her to carry out.
Mrs. Terrell came to this country in February, 1963, and first applied for temporary registration in April, 1964. She was at that time not married. Further certificates of temporary registration were granted to her in June, 1964, and May, 1965, and on that last occasion the General Medical Council reminded her that they only have power to grant temporary registration to persons who satisfy the Council that they are only in this country temporarily.
The Council heard no more from Mrs. Terrell until Mr. Terrell, in November, 1966, took up with them the question of his wife's obtaining permanent registration in this country. On her marriage to Mr. Terrell, however, she ceased to be temporarily resident in this country and the General Medical Council consequently had no power to continue her temporary registration: her qualification, 1367 moreover, was such that they were not able to grant her provisional or full registration to enable her to continue her work.
During the period that Mrs. Terrell held a temporary registration, she was working with mentally subnormal children at St. Lawrence's Hospital, at Caterham, and there is no doubt that she made a valuable contribution to the work of the National Health Service in that position. There was a great deal of Press criticism, not always well informed, of the position and of the Council during last summer, but the Lancet in its issue of 2nd December, 1967, published an article which set out the facts about the statutory system of temporary registration at some length, and a leader which recognised—and this is an essential point—that the General Medical Council were bound by the powers granted to them by Parliament in the action they took. The leader accepted that change could only be brought about if the powers themselves were amended by legislation. Like the hon. Gentleman I am restricted in what I may say about that subject, because of the rules of Order in this House.
Except for graduates of countries with reciprocal arrangements, doctors who qualify abroad must obtain a British primary medical qualification to obtain provisional or full registration as distinct from temporary registration. The Press criticism concentrated, wrongly I think, on attacking the provisions restricting the grant of registration under Section 18 to countries with reciprocal arrangements. The real problem is to devise a method of granting registrations to doctors from abroad where the content of the training leading to their qualification cannot be known in detail, but without putting the doctors to unnecessary trouble and at the same time without putting patients to the risk of being treated by doctors less thoroughly trained than those who qualify in this country.
One further point I should make is that graduates from abroad do not necessarily have to complete five or six years' training to obtain a British qualification. In 1966, only 25 out of 106 candidates were required by the English and Scottish Conjoint Boards and Apothecaries Society of London to obtain further hospital experience. I 1368 should add that the General Medical Council is discussing with the bodies most directly concerned ways and means of pooling information and of co-ordinating the policies and practices.
My right hon. Friend in answer to a Question by the hon. Member for Wood Green (Mrs. Joyce Butler) on 4th December, said that he was in touch with the General Medical Council about the position of doctors who had qualified abroad. It is not a matter which lies wholly within the competence of my hon. Friend and he has, therefore, been considering carefully with other Ministers the information and suggestions put to him. There are also innumerable complexities in trying to arrive at a just solution. I have mentioned one, namely, the difficulty of assessing the quality of training. This is obviously linked to the way in which British graduates are trained and to the methods used in assessing their progress and granting qualifications.
However, the Royal Commission on Medical Education has now published a report which makes far-reaching proposals for revising medical education and granting qualifications in this country. My right hon. Friend and other Ministers concerned are already considering the recommendations of the Royal Commission and the recognition of qualifications granted abroad will no doubt form part of the study. Because of these considerations, a permanent solution cannot be looked for immediately. I am a little sorry to say that, because it sounds as though one important difficulty is being raised against dealing with cases such as that of Mrs. Terrell, but it is a genuine new factor which has entered into the situation.
I hope that I shall not be ruled out of order if I remark that there nevertheless appear to be some amendments to the Medical Act which could be made immediately independently of and without prejudicing the consideration of the long-term solution, and that the Government propose to introduce legislation making certain relatively small changes when the opportunity occurs.

§ Mr. Speaker
Order. I would hope that hon. Members realise that if they are raising a matter on the Adjournment they can raise a matter only of administration, not of changing the law. This is what I suspected earlier.

§ Mr. Snow
Yes, Mr. Speaker. I was not attempting to evade a rule that I fully understand, but to reciprocate in saying that we were not adopting a sterile and stagnant attitude in this matter, and that we were very conscious of the fact that something needs to be done to reform the situation.
I hope that the hon. Gentleman will consider that I have been as forthcoming 1370 as I can in the circumstances. It is very much in the public interest that this matter has been ventilated and an opportunity afforded for removing some of the misunderstandings which have occurred and been voiced in the House.