MEDICAL BILL [Lords]

HC Deb 18 June 1969 vol 785 cc645-68

10.30 a.m.

The Under-Secretary of State for the Department of Health and Social Security (Mr. Julian Snow)

I beg to move, That the Chairman do now report to the House that the Committee recommend that the Medical Bill [Lords] ought to be read a Second time. This Bill can be briefly described as a modification of the financial and disciplinary powers of the General Medical Council. Before embarking on a brief description of the main provisions of the Bill, I should like to explain why the Bill does not include any provision for vocational registration and why it contains nothing in a very definite form about testing for command of English. I shall be making observations about this aspect later on.

Vocational registration, whereby a doctor, on satisfactory completion of specified period of training in a specialty, could become a registered practitioner in that specialty, was a recommendation of the Royal Commission on Medical Education. The Royal Commission saw this as complementary to its recommendations for postgraduate professional training and envisaged that the General Medical Council would act as the registration body for vocational registration.

Legislation will be required to allow the General Medical Council to implement the Royal Commission's recommendations on vocational registration, and this raises a number of complex issues which necessarily take time to explore. Moreover, it cannot properly be considered apart from the other recommendations of the Royal Commission relating to postgraduate medical education which the Government are still examining. I know that some Members are anxious for a further Government statement on these important issues and I hope that it will not be necessary to delay such a statement too long. In the meantime the provisions of this Bill are urgently needed, and I can assure hon. Members that they will in no way prejudice any future action on the recommendations of the Royal Commission, including the question of vocational registration.

I should like to make an observation on a slightly broader issue which, strictly speaking, does not come into the Bill, but is a useful background note to show the Committee that we are very conscious of a problem which is in the minds of many people. I refer to the training and promotion prospects of junior hospital doctors, which have been sources of discontent in the profession for some time, and were recognised as direct causes of emigration in the Report of the Working Party on the Responsibilities of the Consultant Grade.

The Report of the Working Party, which was established by the then Minister of Health and the Secretary of State for Scotland in July last year, has recently been distributed to all National Health Service hospital doctors and dentists in and above the grade of registrar. The Working Party drew attention to the fact that junior hospital doctors are spending far longer than should be necessary in the hospital training grades with very varying degrees of supervision. The Working Party suggested that such a situation is conducive to frustration and some disillusionment in the profession and is an important factor in the migration of skilled doctors.

Discussions between the Health Departments and the profession have already begun on the basis of this Report, and also the Report of the Joint Consultants Committee's sub-committee on the hospital staffing structure. Neither the Health Departments nor the profession are yet committed to any of the recommendations in these Reports, but we are hopeful that these discussions will lead to agreement upon an improved career structure for hospital doctors which will make the prospect of practice in this country more attractive.

I turn now to the criticisms that have been made that National Health Service authorities are employing doctors from overseas who may not be able to speak English well enough to communicate effectively with their patients.

Whilst I join my right hon. Friend the Secretary of State in paying tribute to the very good service provided by the great majority of doctors from overseas, the Government are nevertheless concerned that there should be no continuing justification for such criticism. It may be helpful if I say why provision for language testing has not been introduced into this Bill and why command of English is not made a condition of registration.

The Government have carefully considered this course, and the conclusion has been reached that the objections to it would outweigh the advantages. It is certainly the case that the institution of an examination system would give rise to difficult practical problems for the General Medical Council, but an even more substantial objection is that such an isolated test of linguistic competence does not, in our view, meet the requirements. What is wanted is a means of assessing the general capacity of an overseas doctor to practise in a clinical situation. A doctor may be able to get away with doing his weekend shopping and communicating with his friends, but his English may not be adequate for his practice as a doctor.

The present voluntary attachment scheme provides overseas doctors with an introduction to clinical practice in this country and at the same time enables their clinical competence and knowledge of the English language to be tested, under supervision. The Government have decided that the extension and strengthening of this scheme is the preferable course, and consultations with the interests concerned, including Commonwealth countries, have already begun with this end in view. It is not possible to say when these consultations will be completed, but we are pushing ahead with them so that any changes decided upon can be introduced quickly.

I should not like the Committee to be left in any doubt that we are seized of the importance of this matter and are taking steps to deal with it. But we have a Commonwealth part to play in the matter, which must not be ignored when considering the major responsibility to our patients in this country.

Turning now to the Bill itself, its main purpose is to enable the General Medical Council to require an annual fee to be paid by a doctor for the retention of his name on the Medical Register. Unlike most professional bodies, the Council cannot at present charge an annual retention fee, and so far its income has been derived from the fees paid by doctors on initial registration. The initial registration fees are at present £9 for provisional registration and a further £12 for full registration, which are considerable sums for a young doctor in his first 12 or 18 months of practice to pay and we do not want to increase them. Even so, they have not provided the Council with a sufficient or dependable income. The Council's expenditure has trebled since 1960 and will continue to rise. Its annual deficit is now considerable and it badly needs a means of increasing its income and placing itself on some more flexible basis.

Clause 5 is an attempt to remedy this situation by empowering the Council to charge an annual fee for the retention of a doctor's name on the Register, in addition to an initial fee for registration. Its scheme would require the approval of the Privy Council. Although introduction of annual fees is intended to provide the Council with an assured income, it will, incidentally, enable it to reduce the initial fees payable on provisional and full registration. Anyone who failed to pay the annual retention fee could, subject to certain safeguards, be removed from the Register under the new powers.

The main purpose of the remainder of Clauses 1 to 10 is to simplify the registration procedure and make consequential changes in the administration of the General Council. Levying of an annual fee makes it desirable for the control of medical registration to be centralised, and Clause 1 therefore provides for the local registers kept by the three Branch Councils, that is to say, the Councils for England and Wales, for Scotland and for the whole of Ireland, to be abolished, and for registration to be effected by a single Register maintained by the Council, to be called the Register of Medical Practitioners.

I was not proposing going into the detail of these Clauses, but I should perhaps mention Clause 3, which provides for the Register to contain the names of all fully and provisionally registered practitioners but not those of temporarily registered practitioners. It will consist of two lists, the Principal List and the Overseas List, the latter containing the names of practitioners residing overseas who choose to appear on that list. A separate register will be kept of practitioners who are temporarily registered.

Clause 9 provides for some changes in the arrangements for publishing The Medical Register". In Clauses 11 and 18 there are some sensible amendments of the Council's power to recognise qualifications for registration.

After satisfactory completion of the requisite period of hospital experience, the provisionally registered doctor becomes eligible for full registration.

Temporary registration, as the Medical Act, 1956, now stands, is granted to overseas doctors who are in the United Kingdom temporarily and whose qualifications, although recognised by the General Council, were not obtained in countries covered by reciprocal arrangements.

I should like to draw attention at this paint to the provisions of Clause 12 which substitutes a new Section 25 for the existing Section of the Medical Act, 1956. As I have indicated, at present a person can obtain temporary registration only, amongst other conditions, if he is or intends to be in the United Kingdom temporarily". This provision has aroused some criticism, particularly in those few cases where it has prevented a doctor already practising in this country from continuing to practise if he or she can no longer be said to be "temporarily resident in the United Kingdom". The limitation in the 1956 Act serves no useful purpose, and prevents a few doctors who wish to do so, and are otherwise qualified to do so, from practising in this country.

Clause 12, therefore, removes the present limitation on temporary registration being granted only to persons who are temporarily resident in this country.

Before going any further I should perhaps define a few terms to which I have already referred and to which I shall be referring again. These are the terms "provisional", "full" and "temporary" registration.

Provisional registration enables a newly-qualified doctor to gain the requisite experience for full registration through employment in approved hospitals. It is available to overseas doctors who have obtained recognised qualifications in countries with which there are reciprocal arrangements for the registration of qualifications. As, no doubt, we shall be coming back to that aspect later on, I would draw particular attention to those reciprocal arrangements.

At this point I should like to pay tribute to the hon. Member for Wimbledon (Sir C. Black) who, on behalf of his constituent Mr. Christopher Terrell, highlighted the defect in Section 25 of the 1956 Act. Hon. Members may recall that this was raised on the Adjournment on 15th May last year, when the hon. Member for Wimbledon drew attention to the way in which tying temporary registration to temporary residence had prevented Mr. Terrell's wife from practising medicine in this country when, on her marriage, she became a permanent resident. In parenthesis, I should tell the Committee that Mr. and Mrs. Terrell are personal friends of mine, which did not make my reply in that Adjournment debate particularly easy. On her marriage, Mrs. Terrell was no longer able to have temporary registration.

In the Adjournment debate last May I said that the proposals by the Royal Commission on Medical Education for revising medical education and granting qualifications in this country were being considered and that the recognition of qualifications granted abroad would no doubt form part of the study. I said then that there were some amendments of the Medical Act which could be made independently of and without prejudicing consideration of the long-term solution.

These amendments appear as Clause 12 of the Bill and we have thus taken the first suitable legislative opportunity which presented itself to rectify the anomaly to which the hon. Member for Wimbledon drew attention. I think I should point out, however, that although it will be possible to continue temporary registration for successive periods it will still be limited to employment in hospitals approved for the purpose by the General Medical Council; and the Council may give a direction that approval to temporary registration is limited not only to specified hospitals but also to a grade or post, or both, within a hospital.

The General Medical Council has a duty to safeguard the public and it considers that this restriction on the type of employment undertaken on temporary registration ensures that a doctor can be employed only on work suitable to his training and experience. It is not always easy to get hold of the necessary information about training or experience. The Council can satisfy itself as to the basic medical qualifications granted by the countries with which we have reciprocal arrangements, but no such detailed and consistently reliable sources of information are available to the Council with regard to the standards of qualifications and experience of many of the applicants for temporary registration, coming as they do from about 60 different countries.

Some people have argued that temporary registration is unnecessarily restrictive, in particular because the temporarily registered doctor who qualified in a country with which the United Kingdom has no reciprocal arrangements must secure a British qualification through examination before he can obtain full registration. However, I understand that although the General Medical Council is not unsympathetic to the possibility of a temporarily registered doctor being able to move eventually to full registration the ways and means of doing so will require considerable discussion with the professional bodies concerned. All I can say at present is that the Government are prepared to discuss this with the General Medical Council when we are ready. The G.M.C. is fully conversant with the problem.

Before leaving temporary registration, I should mention that since this form of registration will, under Clause 12, be able to run for an indeterminate period, Clause 16 makes certain extensions to the powers of the Disciplinary Committee in relation to temporarily registered practitioners.

I turn now to Clauses 13 to 16 which amend the General Medical Council's disciplinary powers. At present, when a doctor has been convicted of a criminal offence or has been guilty of "serious professional misconduct"—which is the from the Bill proposes should replace the existing and somewhat archaic expression "infamous conduct in any professional respect"—the only power open to the Disciplinary Committee of the Council is to erase or strike his name off the Medical Register. In some cases judgment is postponed for up to 12 months, but this has not been found to be an entirely satisfactory alternative.

The most important change introduced by Clause 13 is the addition of suspension from the Register, subject to the same safeguards by way of appeal, as an alternative to erasure. The effect of suspension is that though the doctor's name remains on the Register, the suspension will be recorded there while it lasts, and he will be treated as though unregistered for the period of suspension. The Disciplinary Committee will be able to watch the progress of a suspended practitioner and, where appropriate, remove his suspension without delay. Alternatively, it can extend suspension or strike him off.

This brings me to the provision in the Bill for closing the loophole in existing legislation revealed in the notorious case of Dr. Petro. Where the Disciplinary Committee decides to erase or suspend a doctor from the Register, Clause 15 will enable it to suspend a doctor's registration with immediate effect rather than from the end of the appeal period or, if an appeal is lodged, from the date of its dismissal. The intention of this new power is to enable the Disciplinary Committee, when the public interests demands, to prevent a doctor from practising during the appeal period and while an appeal is being determined. This, as the Petro case showed, can be quite a protracted process. The General Medical Council directed that Dr. Petro's name be erased from the Register on 31st May, 1968, but, mainly because Dr. Petro appealed, erasure could not be put into effect until 30th October, five months later. This power of immediate suspension, together with the amendment in Clause 14(1) to the requirement for giving notice to a doctor of the Disciplinary Committee's decision, will, we believe, effectively close this loophole.

I hope that I have now put a little flesh on the bones of the Explanatory Memorandum by developing the main provisions of the Bill. Hon. Members will see that its object is to provide some very necessary powers for stabilising the finances of the General Medical Council, and that it introduces some useful improvements in the Council's disciplinary and registration procedures. The General Medical Council itself agrees with the proposals in the Bill and the medical profession broadly accepts them. I hope that the Bill will receive a wholly general welcome and as speedy a passage through the House as possible. If I have in certain cases been unable to give a specific timetable for certain reforms it is because my Department must act in concert with those who are vested by law with professional responsibilities, such as the G.M.C.

10.53 a.m.

Mr. Maurice Macmillan (Farnham)

Yesterday it was nurses, today doctors—both Bills which have been described as relatively minor in the sense that they are narrow in their coverage, but, as the hon. Gentleman's speech made clear, important in the range of their activity, rather as might be said of the elastic in a pair of pants—narrow in relation to the whole but necessary for them to function properly. No one has yet said that this is an innocuous Bill, perhaps because no one has criticised it at all, or else only in a very limited way, in another place. I do not have any criticisms. I have one or two points to make, giving notice to the Under-Secretary of the line we think we will take in Committee, doing what is the job of the Opposition, to point out the facts and to put some ideas forward, especially in such a case as this where the main provisions have been drawn between the Government and the professions concerned, where Parliament has an especial duty as a watchdog in the public interest, which has to be considered as much as the interests of the profession concerned.

I am very grateful for some of the background points which the Minister has given. I had thought that I should be able to say that his speech reminded me of Sherlock Holmes's dog. The Committee will recall that what was significant about that animal was what it did in the night—and it did not do anything. I had thought that I would have been able to say that what was significant about the Minister's speech was its omissions, but he has not made the omissions I thought he would. We would have liked a little more on the wider issue.

The reasons for the retention fee being introduced are that the costs of the G.M.C. have risen threefold since 1960. I reckon that to be a rise of 25 per cent. a year, and they are still rising. This is not taxpayers' money, but in view of the importance of its work perhaps we could at some stage develop some ideas of the range and future work of the G.M.C. Lord Cohen of Birkenhead referred in another place to the level of the proposed fee of £2 or £3. As he said, this is a matter for the G.M.C. with the approval of the Privy Council. Perhaps at some stage the Government will give us some idea of the balance between the initial fee and the retention fee, and the sort of level at which the retention fee is likely to be.

Although there is no public money directly involved, the G.M.C. is a matter of considerable public interest. If I may so without impertinence, I thought that Lady Serota, in another place, made a slight mistake when she said that this was no direct concern, except in one instance, of the general public. The instance to which she referred was the new protection of immediate suspension. This puts the G.M.C. in the same class as the Jockey Club, exercising strong disciplinary powers upon members of the profession. There is considerable public interest in this, and particularly in the career structure.

I was not altogether convinced, either by reading the arguments in another place, or by listening to the Under-Secretary this morning, of the reasons why vocational registration cannot be included in this Bill. I cannot understand why it cannot be considered apart from the other Royal Commission recommendations. I accept that we need to wait for the method of training, the numbers of people to be trained, and the details of the postgraduate training, but I do not see that this implies that we have no coherent idea of the nature of the qualifications, the range of their coverage, and the sorts of methods employed for training and career structure for the future.

I was very grateful, as I am sure the Committee was, for what the Minister said about career structures, and the problems of junior doctors in particular. There are one or two points that I should like to make now, and perhaps the Minister will consider them for some later stage. It seems that there is a growing concern to get the work of the general practitioner more closely integrated with the hospital service to prevent the growing division between general practice and hospital doctoring. This question of the vocational register and postgraduate training is, therefore, of the utmost importance both to the staffing structure and to the pursuing of this end.

There is also the point, which we might hear about in this context, of the need, and the difficulties which that need imposes, for some junior hospital doctors to move around to get the qualifications they require. If a junior hospital doctor remains too long in one post he may find, when he applies for promotion, that others who have moved around more than he have acquired more qualifications. When we consider the question of the vocational register perhaps that aspect will be kept in mind.

This is a two-part problem. There is the whole question of the structure of the hospital service itself, and the status and rôle of the doctors in it. We have to consider the difficulty that there would be in promoting more registrars to consultants if that implied that they were also to have the full team which all existing consultants have, and the probability, therefore, that some consultants would be consultants in status and qualifications but would have to accept that they would be acting on their own and not necessarily with the full apparatus which every one now has. Again, there is the whole question of the rôle of a general practitioner in a hospital.

Apart from the question of the doctor—and this is where I regret that the Bill does not go further—there is closely linked the whole question of training, and this question, as the Minister has admitted, is closely linked with the question of a vocational register. I think that we shall return to this in more detail in Committee.

I turn, now, to the second of the points which I feared the Minister would not raise—I am grateful to him for doing so—namely, the registration of foreign doctors. I am not wholly convinced by the Minister's arguments. I agree that they were reasonably truncated for this Second Reading debate, and no doubt we shall be able to go into the whole question in a great deal more detail in Committee. This is a very big and difficult problem. There is not only the question of language, but that of the medical training and experience of some foreign and Commonwealth doctors. It is so varied from what they meet in United Kingdom practice that it is difficult for them to overcome the problem.

This is not a question of colour, although, regrettably, it may in some cases be treated as such. Not least of the difficulties arises with non-English speaking doctors from southern Europe, who have come to this country in increasing numbers during the last five years. It is a big problem, because large numbers of these doctors arrive here every year. I think I am right in saying that more than half the junior staff are immigrant doctors, and that, whether we like it or not, for the next ten years we shall have to rely to a great extent on doctors coming to this country from abroad.

As we have got on to that aspect at this stage I think I ought to emphasise how necessary it is to improve the arrangements, to be fair to the immigrant doctors themselves. So often when something goes wrong the blame is spread among other immigrant doctors whose qualifications and mastery of the English language are complete and adequate. That spread is, regrettably, that much easier when immigrant doctors can be identified by colour, than in other cases.

One must emphasise that this is a limited problem, but it is an important one. To say that a doctor may have difficulty in this country does not necessarily imply that he is a bad doctor. Sometimes his medical experience is different from the rôle that he is asked to fulfil. Very often it is, perhaps, a mistake on the part of the employer in appointing a particular person to a particular post, rather than a fault on the part of the employee.

The Under-Secretary of State referred to the voluntary attachment scheme, and to the discussions which are continuing with the Commonwealth. I hope that the hon. Gentleman will not make the mistake which Governments sometimes make of thinking that in a matter of this kind it is sufficient to get agreement between the interested parties, the G.M.C., the B.M.A., and the Commonwealth countries, to bring in regulations. Parliament is concerned, and people are concerned. The great problem which we have to face is that these regulations cannot be amended. I am anxious, therefore, to get as much as possible into the terms of the Bill, and to leave as little as possible, and only that which is properly left, to subsequent negotiation and settlement. I think that the same considerations apply to temporary registration.

Turning to the detail of the Bill, I hope that on Clause 3 the Government will let the House know as soon as possible about the discussions they are having with the profession on the employment of overseas doctors. The wider range of qualifications which can now be included in the Register under Clause 11 will be very welcome to all concerned, and I should like to go on record as thanking the Minister for, and congratulating the Government on, correcting that tiresome anomaly in the way that they have done in Clause 12.

We shall have a great deal more to say, and rightly so, on Clause 13 and the provision for suspension in lieu of striking off the Register. I must mention in passing a slight feeling of nostalgia that the splendidly archaic language has been modernised, but, of course, it is right that that should be so. I hope that the position of single-handed doctors in general practice, the whole question of suspension, of seniority payments, and so on, will be carefully considered.

If suspension is intended to have a much less severe effect on a doctor's life than erasure, we must be careful to limit the consequences of suspension and not let the consequential effects make the penalty more severe than is intended. That applies particularly in the case of immediate suspension. If the Council is to have these powers—and I do not doubt that it should—it is very important that any appeal should be dealt with as speedily as possible, otherwise it may be that a sentence, as it were, intended to be a suspension for 12 months will extend beyond that period because of delays, and if the appeal is successful the doctor will be penalised unnecessarily, and even if it fails he will be penalised to a greater extent than was originally intended.

I was a little worried about Clause 19 and the provision for getting for the G.M.C. statistical information from doctors. If it is intended to allow the Council to request information from doctors for statistical purposes, I do not see what this is doing in the Bill at all. It seems to me that a body of this nature does not need the authorisation of a Statute to request information from those who are registered with it. If, on the other hand, the intention is to empower, directly or indirectly, the Council to demand information about patients from doctors, I do not think that this should happen at all. I do not believe that to be the intention, but perhaps we can come to that in due course.

I hope that I, too, may digress a little into the background, as the Minister did, and say that the changes wrought in this Bill, and the intentions of the Government and the Council with regard to training, postgraduate training, and a vocational register, make it extremely important that the composition of the Council should be as broadly based as possible, and I hope that the majority will, therefore, be elected from the profession. I hope, too, that the Ministry, as what one might call the supervising employer, in the sense that all hospital doctors are indirectly employed by the State, will do what it can to see that junior hospital doctors are given enough time to play a rôle in this organisation.

In another place Lord Newton said that this is the latest but, I imagine, not the last of a long list of Statutes"—[OFFICIAL REPORT, House of Lords, 6th May, 1969; Vol. 301, c. 1166.] on this subject, and Lord Cohen of Birkenhead, in his admirable speech, said this is, as it were, the first of a series of Bills"—[OFFICIAL REPORT, House of Lords, 6th May, 1969; Vol. 301, c. 1174.] to be presented to another place. I hope, therefore, that in Committee we can ensure that, as the latest, but not the last, or as the first of a new series, the Bill does everything it can to improve the arrangements for the registration of doctors and to aid the work of the General Medical Council.

11. 12 a.m.

Colonel Sir Tufton Beamish (Lewes)

I think that this is a useful Bill, and, as my hon. Friend the Member for Farnham (Mr. Maurice Macmillan) said, it received a warm welcome in another place. The debate on it there was very interesting.

I recognise that there is a need to modify the financial and disciplinary powers of the Council, which is broadly what the Bill sets out to do, but it affects the livelihood and careers of every doctor in the country, and anyone who is to practice in future, and, for that matter, every patient and every potential patient: in short, everybody. Therefore, while it may seem superficially to be of a fairly routine character, I think that we are obliged to look at it very carefully indeed. I recognise that, on the whole, the Bill is not controversial, but my hon. Friend raised a number of important points, and I should like to underline one or two of them.

I propose to deal, first, with the question of command of the English language. I confess that I am worried about this. I was not at all convinced by what the Minister said. He told us that command of the English language for normal purposes is not by any means the same as it is for clinical purposes, but this is why I am worried. I do not think that to hold that view leads one to the conclusion that nothing should be done about it. I take the view that something should be done, and quickly. From a clinical or medical point of view command of the English language is very important. There is a lot of public anxiety about this, and we would be wrong not to recognise it. I hope that in Committee we shall consider this again and get some further assurance from the Government. I am sure it would be wrong to imagine that the public is not interested in the ability of doctors in the Health Service to speak English adequately to carry out their professional duties. There has been much in the Press about this. We have to take careful note of it. I hope that we shall do so and that we shall have some reassurance.

The General Medical Council is in some financial difficulties, and there is an obvious need to make it solvent, while at the same time seeing that it maintains its independence from the Government. This independence is very important as a part of professional status. The provisions of Clause 5 will mean that the medical profession must provide the wherewithal for the General Medical Council to do its job while maintaining its independence. The Clause is non-controversial, but it is important.

I have been in touch with the British Medical Association with reference to Clause 13. There have been second thoughts on the part of the B.M.A. In the past it was very doubtful about these powers of suspension in the form proposed. Now, I understand, it has changed its views and is willing to accept a Clause of this character.

Mr. Snow

This is a very important point. There are consultations going on at present, and I hope to be able to be a little more explicit about this in Committee.

Sir T. Beamish

I am grateful to the Under-Secretary and I appreciate that intervention. As he knows, the B.M.A. has serious doubts about the practical effects of this new power. This is a matter we shall have to consider very carefully in Committee.

As was mentioned by my hon. Friend the Member for Farnham, there is a direct relationship between the length of practice in the National Health Service and seniority and superannuation payments. A suspension could have as severe an effect as erasure from the Register. As suspension is entirely different from erasure, the Committee will want to make sure that a clear distinction is made between the effect it can have on a doctor's superannuation and on his seniority rights. I understand the B.M.A. is not happy about the side effects of the Clause. One suggestion has been put forward for suspension for a lesser period than a year, with a view to making clear the difference. I am sure the Under- Secretary will agree that this is important.

Also arising from the Clause, the B.M.A. has serious doubts, I understand, about the appeal machinery, and it has good grounds for them. The Privy Council, which is the appellate body, is very slow moving, and long delays can take place in the hearing of appeals. Would it be possible to ensure that appeals are heard more quickly, or is there the alternative idea that the High Court should be the appellate body? The Under-Secretary will know more about these ideas of the B.M.A., and I hope that we may have more information about them.

I have strong feelings about Clause 19 which empowers the Council to obtain information from registered practitioners for statistical purposes. That it needs a certain amount of information in well-defined fields goes without saying, but I would need much convincing that it requires information outside those fields. I should like to know for what purpose it is needed other than the purpose of registration by the General Medical Council. This is something we have to look at very carefully, because inevitably there is a view, of which we must take account, that the seeking from doctors of information outside limited fields for specific purposes by the General Medical Council could easily interfere with the confidential character, which is so important, of the doctor-patient relationship.

None of the things I have mentioned is of a party political character. It is nice to get away from party controversy for a time. All members of the Committee will share my view that a great many people are asking questions of a great many other people in these days. We want the minimum interference with our private lives. I should want some convincing that this is the right Bill to introduce these powers, and that they are really needed now. I realise, of course, that the answering of any questions would, presumably, be voluntary. I may not have studied the matter with sufficient care, but I do not think there would be any compulsion on doctors to reply to questions which they thought went beyond what was necessary. Even so, asking unnecessary questions, although there is no compulsion to reply, is something which should be avoided if possible. This aspect of the Clause must be looked at extremely carefully.

We look forward to the Committee stage of the Bill.

11.22 a.m.

Mrs. Jill Knight (Birmingham, Edgbaston)

When I started to endeavour to brief myself about this Bill I thought it rather strange that apparently a law had to be passed in Parliament before the General Medical Council could alter the fees for people applying for registration. However, I learn that the General Medical Council expects that, if no change is made, the cumulative deficit by the end of 1971 will be about £200,000. That is an extremely large sum, bearing in mind the amounts of money which the G.M.C. has to find for various purposes. I very much support what was said by my hon. Friend the Member for Farnham (Mr. Maurice Macmillan) and by the Under-Secretary. I am anxious that, by reason of what we are doing in this Bill, no hardship should be caused to those called upon to meet the extra fees.

I recognise that we do not know what the extra fee will be. In another place it was suggested that it would be merely £2 or £3 per annum. That may seem a small sum. Nevertheless, I wonder if anything could be done for junior hospital doctors who, I believe, have to pay out of their salaries for such things as stethoscopes, white coats, and so on. If they apply for another post in a hospital the actual application for the job can be extremely costly under present procedural rules. I want to be assured that this provision will not mean more pinpricks for the junior hospital doctor.

I join my hon. and gallant Friend the Member for Lewes (Sir T. Beamish) in expressing concern about knowledge of the English language. I listened carefully to what the Under-Secretary said. He said, "We are taking steps in this matter." It is important that the public should be able to expect that those steps will not be faltering ones, because there is great concern about this matter. I should have thought it a simple basic qualification for practising medicine that a doctor should be able to understand clearly not only the precise words used by his patients but their nuances. Often, these are, for strangers to our country, difficult to understand. I therefore hope that the steps which are taken will be swift and will deal with the problem properly.

Sir. T. Beamish

I think my figures are correct and that more than half the doctors below consultant level in the National Health Service hospitals are foreigners. That is a remarkable number and shows the importance of this question. I do not think many people realise how many foreign doctors are practising here, and how dependent we are on them.

Mrs. Knight

That adds weight to what has been said. I am sure the Under-Secretary is apprised of the problem. I do not for a moment suggest that lie does not agree about its seriousness.

I was interested in the change to be made in the wording which the Disciplinary Committee has to use: "infamous" has become "serious". It is a comment on our times that what used to be "infamous" conduct is now "serious" conduct. I merely make that comment. I do not oppose the change. But it is an interesting one.

On Clause 13, I agree with what the Under-Secretary said about Dr. Petro and prescribing of drugs. It is most important that the appeal mechanism should be good. As my hon. and gallant Friend said, there is an appreciable delay when a doctor appeals. Power is provided in the Bill for immediate suspension. There is need not only to be able to suspend at once but to appeal quickly. This is most important. Under the Bill a doctor, having appealed against an extension of suspension, might serve the whole additional period of suspension before the appeal is dealt with by the Privy Council.

As the Clause stands it allows the General Medical Council to act on an offence which a doctor committed before he was even on the register. It does not seem quite right that offences committed prior to registration should be brought to the notice of the Disciplinary Committee in cases where doctors train and qualify in Britain.

On Clause 17 I ask whether the election procedure of the G.M.C. is to differ substantially from the present procedure, and, if so, in what way.

I, too, am somewhat anxious about Clause 19. This question of requesting information from doctors for statistical purposes is a delicate one. I have in mind another Measure in respect of which the giving of information to a doctor, knowing that it might be handed over, has had a salutary effect on the patient. I agree with my hon. Friend the Member for Farnham that the provisions of the Clause should be contained in a subsequent Bill dealing with vocational registration. There is opposition from the B.M.A. to this provision, and the Association wrote to me saying: The Council does not see any place in the Bill for powers which in any case are voluntary to obtain statistical information other than for purposes of compiling the register. I support the Bill, and I am glad that our discussion today has been on a nonparty basis.

11.32 a.m.

Mr. Snow

With permission, I will address the Committee a second time.

The hon. Member for Farnham (Mr. Maurice Macmillan) raised a number of useful points, and I think he will agree that they could be more usefully discussed at a later stage.

The hon. Lady the Member for Birmingham, Edgbaston (Mrs. Knight) and others were concerned about the information which will be required by the G.M.C. It may be more helpful if this point, too, is discussed at length at a later date, in Committee. The intention is to provide the G.M.C. with information which it would like to have to make better informed decisions. Although this is not a compulsory power to demand information, we can discuss the matter later. I feel that it is a reasonable request and should be incorporated in the Bill. I assure hon. Members that there is no question of compulsion.

I assure the Committee that we regard the language problem as an important and urgent matter. There are many problems which do not immediately appear to be involved in this issue; for example, even where we have reciprocal arrangements with countries in which the studies in the medical schools are conducted in the English language we frequently find that the people who qualify from such schools still really do not understand colloquial or idiomatic English. We are seized of the urgency of the matter and I hope, at a later date, to give the Committee more information.

The question of the appeals structure was raised and the hon. Lady the Member for Birmingham, Edgbaston made a good point when she said that we should, as I will do later on, clarify the appeals structure in relation to immediate suspension. I agree that the matter needs to be discussed.

I was relieved to learn that the hon. Member for Farnham had done his homework on the question of vocational registration, since I had studied the matter and had wondered whether my efforts had been necessary. It is not possible to incorporate this item in the Bill because it cannot be done in isolation from the findings of the Royal Commission on Medical Education. The consultations at all levels in the profession are of such a technical nature that it is not possible to have this ready in time. I am somewhat perturbed that the document, "The Responsibilities of the Consultant Grade", may not be available to all hon. Members of the Committee. I will try to have more copies available.

I have taken note of what has been said about the timing of the appeal procedures and about delays which may ensue on appeal to the Privy Council. I will elaborate on this and other matters when we discuss the Measure in Committee. Hon. Members may ask why this issue has not been decided previously. Negotiations between the Government and the professions are always somewhat slow, and we must keep in mind the person who really matters in all this, and that is the patient. I therefore ask hon. Members to bear with me for the time being; and I hope to give more detailed information as we proceed.

There does not appear to have been very much controversy over the Bill and I therefore hope that hon. Members will give it a Second Reading.

Question put and agreed to.

Ordered, That the Chairman do now report to the House that the Committee recommend that the Medical Bill [Lords] ought to be read a Second time.

Committee rose at twenty-three minutes to Twelve o'clock.

THE FOLLOWING MEMBERS ATTENDED THE COMMITTEE:
Probert, Mr. (Chairman)	Macmillan, Mr. Maurice
Armstrong, Mr.	Millan, Mr.
Beamish, Sir T.	Rhys Williams, Sir B.
Evans, Mr. Fred	Royle, Mr. A.
Fletcher, Mr. Ted	Ryan, Mr.
Knight, Mrs.	Snow, Mr.