HL Deb 05 May 1870 vol 201 cc253-65

Order of the Day for the Second Reading, read.


In asking your Lordships to give a second reading to the Bill, I will explain the grounds on which I wish to recommend it to the House. I may first mention that there are in the three kingdoms no less than 19 bodies who are empowered after examination to grant licences to persons desiring to practice in medicine, such licences entitling the holders to have their names placed on the Medical Register. The regulations of these different bodies are various, and so also are the qualifications required of those to whom the licences are given. With a view of mitigating the inconveniences obviously attending so many varying examinations, the Act of 1858 established a General Medical Council, and gave it to a certain extent a power of supervision over the licensing bodies. It provided that, if the terms on which licences were granted appeared in any case wholly inadequate, they might represent the fact to the Privy Council, which should thereupon have power to suspend the right of that particular body to grant licences. The Act also enabled two or more of these various bodies to combine for the purpose of holding a joint examination. The power of recommending suspension given to the Medical Council could, it is evident, be exercised only in extreme cases, and, in point of fact, it has never been put into operation, nor has the power of combination been brought into practical operation during the 12 years which have elapsed. The country, consequently, is still suffering from all the inconvenience of having 19 distinct licensing bodies, whose licences indicate very different degrees of qualification, though all equally entitle the holders to admission to the Medical Register. This is unsatisfactory in more ways than one. Some of these bodies examine in medicine only, or in surgery only, yet the persons so licensed in but one branch of the profession are admitted to the Register, and thus become eligible to practice in both, and, in certain cases, to hold public appointments. There is, moreover, a constant temptation for these bodies somewhat to underbid each other in their examinations, and the consequence is, that in many instances the examinations at the present day are of no higher character than they were some years ago. In many cases the standard is higher now than it was some years ago, and I make no charge against any particular institution; but there is considerable variation in the value of the qualifications shown by the licences; and cases have been mentioned to me of persons who, after having been "plucked," to use the ordinary expression, once, or perhaps more than once, by one body, have obtained licences at another institution, and have then flourished them in the face of the institution which had refused them. Confusion and complexity thus arise, and the public have no assurance that the appearance of a name on the Medical Register implies any definite amount of medical knowledge. Your Lordships may think that such a statement requires the corroboration of some professional authority. Now, last year, the General Medical Council appointed a committee to inquire into the question of medical education. It was composed of some of the most distinguished members of the Council, including the President (Dr. Paget), Dr. Christison, and Dr. Aquilla Smith, and it reported that one of the greatest evils of the present system was the inequality of the examinations; that the easy examination of one body tended to depress the standard of all the rest—a circumstance the more injurious that every licence conferred the right to practice; and that an arrangement should be made to have one Examining Board for each division of the kingdom. That report received the sanction of the Council, and the main provision of the Bill is based upon it. On considering how uniformity of examination and equality of qualification could best be secured, it was apparent to my mind that the most complete mode would be a single Examining Board for the whole country. There was, however, as I saw, great difficulty in arranging the practical details of the plan. Such a Board could not sit exclusively in London, for to expect Scotch and Irish students to come up to London, perhaps, for several examinations, would be unreasonable. If, on the other hand, the Board were migratory, the most eminent members of the profession would be excluded from it; for they could not be expected to neglect the scene of their practice in order to hold an examination at various centres; and the expense, moreover, of that plan would be much larger. The alternative, therefore, was the establish- ment of an Examining Board in each kingdom, as recommended by the Committee, under the supervision of the General Medical Council, to which should be given special powers of securing equality in the examinations. How, then, are such Boards to be constituted? One method would be to insert in the Bill a complete scheme for their constitution; another was to confer on some body the power of framing a scheme, to be subject to the approval of a Department of the Government, responsible to Parliament. A good deal might be said in favour of the former course; but the latter seemed more likely to be acceptable to the existing licensing bodies, who have rendered many services to the profession and the public, and are entitled to the greatest consideration consistent with the principle of establishing one Board in each kingdom. The Bill proposes, therefore, that the existing licensing bodies, or the majority of them, in each part of the United Kingdom, shall be at liberty, within a certain time, to propose a scheme for the establishing of a Medical Examining Board, to be submitted to the General Medical Council, and, if approved by it, submitted to the Privy Council for confirmation, their sanction being the final step for giving it validity. If, within that specified time, they are unable to agree on a scheme, the duty will devolve on the General Medical Council, who will then be empowered to draw up a plan and submit it to the approval of the Privy Council. This is quite in accordance with the existing Act, which gives power to these bodies to form such a Board; and after 12 years the time for permissive action is obviously over. I hope, and have every reason to believe, that the licensing bodies will take advantage of this opportunity and will prepare a scheme. The three Boards will act under the general supervision of the Medical Council, and the latter will be directed to take care that there is a uniform standard of examination. Your Lordships will bear in mind that the existing bodies are largely represented on the Medical Council. When the Boards have been established, admission to the Medical Register will be obtained, and obtained alone by persons who have passed their examinations, and obtained their licences to practice in medicine and surgery. Now, I am aware that not a few of the existing corporations would desire that membership in some one of them should be a further condition of registration; but it is unreasonable that persons who must have passed a stringent examination should be subject to any further stipulation. Efficient examinations will be a security to the public that all the persons on the Register possess a certain minimum degree of medical knowledge and experience. The 22nd clause, which I have introduced at the urgent desire of the profession, somewhat extends the existing law as to the penalties to be imposed on persons falsely representing themselves as qualified medical practitioners; but this section is only to be put into operation with the consent of the General Medical Council. There are objections on the part of some of the Universities to some other clauses. Now, I am in communication with the Scotch Universities, with the University of London, and also, through a gentleman who has been good enough to communicate with me, with Cambridge; while a similar feeling exists at Oxford. All I can say is, that it will be my desire to meet, not merely the wishes but the feeling of the Universities, and that I am prepared to modify those clauses. They are not of the essence of the Bill, and I desire to make it as acceptable as possible to the Universities. The noble Marquess (the Marquess of Clanricarde) who has just presented a Petition from the College of Physicians in Ireland does not appear, it seems, as the representative of Dublin University. A copy of the Petition which he has presented was sent to me, and I found that some of its objections went to the root of the Bill, while others are fair questions for consideration. I cannot see that to require in future examinations before one Board as a condition of admission to the Register infringes the privileges of the College of Physicians, for it is simply an extension of previous legislation, with the object of securing adequate qualifications. I am happy to say that the Royal College of Surgeons in Ireland take a different view, for I have received a copy of a resolution adopted by their Board, giving a general approval to the Bill. I have throughout received great assistance and information from the Medical Council, and I am glad to say that they also have by a resolution, passed by 15 to 3, expressed a general approval of the mea- sure, and a hope that it may became law this Session. This shows the prevailing feeling of the profession. I have now stated the main provisions of the Bill; and I think I have sufficiently entered into the subject. I see that the noble Marquess (the Marquess of Clanricarde) has placed a Notice on the Paper, asking for further delay in the progress of the Bill. But, as the Bill has been three weeks before the House, and during that time has, no doubt been well considered, I can see no reason for further postponing the second reading. I believe it will effect a great improvement in admissions to the Register, and will tend to raise the qualifications of medical practitioners. I should regret, therefore, if its progress were delayed so as to endanger its passing during the present Session.

Moved, "That the Bill be now read 2a."—(The Lord President.)


said, no doubt three weeks had intervened since the Bill was ordered to be printed; but that was no long time for the consideration of a measure which affected the medical corporations and practitioners in all the three kingdoms, and required consideration of every one who stood in need of medical aid throughout the land. In the Medical Council itself there had been many discussions, and several amendments had been suggested. Everything showed that the measure was one which required much consideration. He regretted that the measure proposed no change in the election of the Medical Council, for there was a feeling in the profession that the Council ought to be put on a wider basis. The Bill would create I too much of a monopoly, and would shut out practitioners who might have a preference for methods of treatment differing from those which were generally adopted. The principle of uniformity might be carried too far. A tremendous power would be given to the Privy Council; and it was idle to say that there would be responsibility to Parliament, for Parliament could not hold the noble Earl responsible for any error of judgment committed by the Boards. He presumed the Privy Council would be advised by their Medical Officer, who, no doubt, was a distinguished and able man; but this was a life appointment, and during the life- time of any person who filled it various inventions and improvements might occur, which under his direction the Privy Council might ignore or reject. He hoped a postponement would be granted, for the Bill seriously affected the rights and fees of the College of Physicians.


My attention has been called to the provisions of the Bill, more minutely than would otherwise have been the case by the circumstance that, it materially affects the University of Dublin, of which I have the honour to be Chancellor. Your Lordships are perhaps aware that that University possesses a medical school second to none in any part of the country as regards its extent and its standard of merit. Its great object has always been, not as has been intimated of other bodies to lower the standard of medical examination, but to raise it as high as possible. There is one part of the Bill which the University would gladly see passed into a law—that is the clause which provides for uniformity of examination. A great difficulty with which the University has had to contend has arisen from different standards of examination elsewhere, and it would be glad to see a uniform standard effected. I cannot admit the validity of the noble Earl's reason against a single Board for all parts of the country. It is quite true that there would be an inconvenience, if all the Members of the Board of Examiners were obliged to pass from England to Ireland, and from Ireland to Scotland; but there would be little or no inconvenience—it would at any rate be greatly reduced—if the Board were to consist of three or five Members, and if it were provided that at any examination in Scotland one Member representing England and one representing Ireland were present, and if, in like manner, Ireland and Scotland were represented at examinations in London. By that slight admixture it would be possible that the standard of examination would be maintained in uniformity throughout the United Kingdom. But the provisions of the other parts of the Bill seem to be very serious and to be deserving of much attention. The plain English of them all is, that they constitute the Privy Council the licenser for medical degrees throughout the whole country. It is true the majority of the licensing bodies or the Medical Council may prepare a scheme and submit it to the Privy Council, but the Privy Council will be able to modify it; and the scheme which finally becomes law will be the scheme of the Privy Council. So with regard to the examination rules; various bodies may agree upon the rules which they think fit to propose to the Privy Council; and under this Bill the Privy Council keep in their own hands the right of modifying and altering these rules, and the rules, when they become applicable to examinations will be those of the Privy Council. Again, the Board of Examiners is to be appointed by the Privy Council; and the result will be that a Board, under the authority of the Privy Council, is to have the power of granting these licences for practising in medicine and surgery. The consequence may be that any person who has never attended a clinical lecture, who has never heard a lecture on any branch of medicine, who has never walked a hospital or received any instruction in surgery, if he is able to acquire, by the process sometimes called "cramming," certain information, and to pass an examination before this Board, may become competent to practise in medicine and surgery under this degree of licentiate which, is to be conferred by the examining Board. True, there are at present, 19 bodies which confer degrees; but their degrees will be entirely supplanted by this new degree of licentiate in medicine, which may be granted to a person who never matriculated in any University or any College of Surgeons, and I want to know of what use will be the power which is nominally reserved to these bodies of conferring degrees? Although it is quite proper to have an examination of a difficult and high standard before you grant a degree to practise in medicine, I am of opinion that of greater importance, than the capacity of passing an examination, are the training and discipline and the general education which will be acquired by attendance upon lectures and at hospital; and I hope when we come to the clauses that this will be insisted upon. It is proper that, in the public interests, there should be an uniform examination of a high standard, which every person must pass before he receives a degree; but at present the public has the security, not only that such an examination has been passed, but that a person who obtains a degree has matriculated under one of the existing licensing bodies. I only desire to call attention to this, which is an important point, and to express a hope that the noble Earl will allow ample time for the consideration of this subject before the Bill goes into Committee.


said, that having given much attention to this subject, he fully concurred in what had been said as to the importance of having an uniform system; but there was one point which was not clear, and upon which he desired to have some information; and that was the point which had been discussed in a correpondence between the Medical Council and the Queen's University in Ireland. They were at issue upon the nature of the preliminary examination to be passed by a person desiring to practise; and the educational bodies of Ireland were disposed to insist on a higher standard of education than the Medical Council was disposed to grant. It was most desirable to insure some kind of uniformity in the general qualifications of the medical profession; and he, therefore, desired to ask whether, in the proposed regulations which were to be approved of by the Privy Council, there was any idea of including arrangements for a preliminary examination.


This Bill may be shortly described as an attempt on the part of that voracious body—the Privy Council—to eat up all the licensing bodies of the United Kingdom, some of them being Universities. The noble Earl opposite (Earl de Grey and Ripon) says this Bill has been before your Lordships for three weeks. What is the fact? The noble Earl lays this Bill on the Table, and gives us the first hints we get of it on the day that noble Lords separate for the Easter Recess, and on which the members of the Universities separate for their vacation; and about a week after they have returned he comes down to this House and says he has heard of no objections to the Bill from the University of Oxford. It seems to me, from the haste with which the noble Earl is pressing forward this measure, that he is perfectly aware that if the various licensing bodies had time to look at it a little longer, however little they like it, they will like it less. The truth is, this is one of a class of Bills which, owing, I suppose, to the difficulty of getting any legislation through the other House, we have had a good many in recent years; it cuts the knot of difficulties of legislation by enabling the Government to hand over questions of detail to a permanent Department to legislate as it pleases. The mode of doing it is in the Bill concealed by certain provisions, which enable the medical authorities to submit any number of schemes for the approval of the Privy Council; but, after all the pantomime, the Privy Council has power given it to make, alter, modify, or confirm whatever rules it pleases. In fact, the Privy Council is constituted the permanent legislative body. If the Privy Council meant my noble Friend, or the distinguished statesman who serves under him, political differences apart, there are no two men I would sooner intrust with legislative power. But we all know the enormous powers possessed by the permanent officials of the Department—by those who look after the education and the health of the people and the diseases of cattle; they all write under that mythic name, "My Lords," and exercise almost undisputed powers; but I confess I am not prepared to abolish these 19 licensing bodies for the purpose of installing Dr. Simon in their place. I do not dispute the high standing of that officer, but I am not inclined to foster the power possessed by these permanent irresponsible officials at the expense of independent corporations, which have done so much to make England a self-governing and prosperous country. I hope, therefore, we shall have from the noble Earl an assurance that the demand for this enormous legislative power is not to be pressed, and that he will reserve to the Privy Council what alone it has a right to—the power of approval. With respect to the other portions of the Bill, I fear the great danger is it will destroy the independent schools of medicine in this country. In the House of Commons my noble Friend was one of the most ardent worshippers at the shrine of examination; but he would not be willing to have his leg amputed by a man who had done nothing but read about cutting off legs; and, therefore, I say that in the matter of medicine, and still more in that of surgery, it is absolutely childish to be satisfied with your examination. I think the public bodies and the public will be dis- satisfied with this Bill unless it contains provisions which will require those who are allowed by the Government to practice in this country something beyond the mere book learning which only an examination can test. It was understood by many of those who represent the licensing bodies in London that it was intended to allow a second examination to be required by the licensing body, in addition to the minimum examination to be instituted for the whole country. I do not know whether the noble Earl's intentions were rightly understood by those who consulted him on that point; on the point of the powers to be given to the Privy Council, and generally on the point of the concessions the noble Earl is willing to make in Committee, I think he ought to give us clearer explanations than he has done before he asks us to read a second time a Bill so trenchant in its provisions, and of which so slight notice has been given to all concerned.


said, with reference to the short notice of the Bill which, according to the noble Marquess, the two Universities had received, he had no idea but that the Universities should have the fullest opportunity of considering this measure. But it was not the fact that the Universities were unaware of what was going on, because there were on the Medical Council representatives of the Universities who knew, step by step, every proceeding; and the representative of Oxford University, who was perfectly acquainted with what might be called the genesis of the Bill, had rendered valuable assistance in preparing it. The noble Marquess on the cross Benches (the Marquess of Clanricarde) said the Bill entirely omitted to do that which he thought very desirable—namely, to considerably enlarge the Medical Council, and introduce into it the element of election. Now he (Earl de Grey and Ripon) did not think it was desirable to increase the number of the Medical Council; it was already quite large enough; and considering the functions it had to perform, it would not be well to open such a body for the reception of members elected by universal suffrage among the profession. As to the power vested by the Bill in the Privy Council, he was glad to find that his noble Friend (the Marquess of Salisbury) did not object to those clauses of the Bill which gave to the Privy Council the power of simple approval or disapproval of the scheme of the Medical Council; but he was afraid of the powers of modification which were given to the Privy Council. Now, he (Earl de Grey and Ripon) had carefully considered with the draftsman of the Bill whether this portion of the Bill would bear the interpretation put upon it, and would enable the Privy Council in practice to substitute a scheme of their own for that proposed by the Medical Council. There was no wish on his part that the Privy Council should possess powers of this description. But it seemed to him that there were some questions not strictly professional, but affecting the outside public—such, for example, as the fee demanded from candidates for leave to go before the Board of Examiners—as to which the Privy Council should be empowered to interfere, without, however, being compelled to disapprove the scheme en bloc, and thus compel the Medical Council to go through the whole process again. That was the reason why powers of modifying the scheme were given to the Privy Council. But on this part of the Bill Amendments would be proposed in Committee, and he should be glad to place those Amendments on the Table. A complaint had been made that there seemed to be no provision for any examination, of candidates except in books and in theoretical work. Unquestionably, however, that was not the intention of the Bill; and if he held his present Office when a scheme so framed came before him, he should certainly exercise the power of vetoing or modifying which the Bill conferred upon the Privy Council. Clause 10 of the Bill proposed to enact that the General Medical Council should regulate the admission of candidates and the general course of professional studies. It was intended that the Council should prescribe the general attainments in other than scientific branches of candidates, and should also prescribe the course of professional studies, including, of course, the actual study of disease. The Bill referred to knowledge "whether practical or theoretical;" and this expression was adopted in order that the examinations—for his idea was that there would be more than one—should be of a strictly practical character. On this part of the measure it might be a proper subject for consideration whether the Medical Council should not be authorized to accept, as part of the examinations to be conducted by the Examining Board, the examinations at the Universities. There was nothing in the Bill to prevent such a provision. As to the general desire that had been expressed that the time for going into Committee should be somewhat extended, he would only say that, if the Bill were allowed now to pass a second reading, time would be given before it was considered in Committee. For personal reasons he was unable to mention the precise day, but he would place it on the Paper for Tuesday next, with the distinct understanding that the matter would not then be proceeded with, but would be deferred for a considerable time. The modifications he intended to propose should be laid on the Table in ample time before the Committee was finally fixed.


said, that the Council of the University of London approved the Bill, with certain Amendments, which he believed his noble Friend was prepared to introduce.

Motion agreed to.

Bill read 2a accordingly, and committed to a Committee of the Whole House on Tuesday next.