HL Deb 25 February 1879 vol 243 cc1722-7

, in presenting a Bill to amend the Medical Act, 1858, said, it was not necessary that he should enter at any length upon the previous legislation with regard to medical education, as he did so last Session; but he might remind their Lordships that the object of the Bill he then submitted to their Lordships, and which he had now the honour of laying on the Table, was to amend the Act of 1858, which, though it contained a great number of valuable enactments and provided for the granting of certificates by Conjoint Boards to practise in medicine and surgery in England, Ireland, and Scotland, yet contained no compulsory provision for that purpose. The Conjoint Examination Board had, in reality, never come into action. No stops had been taken by Scotland or Ireland for the formation of a Conjoint Board, though in England some progress had been made in that direction. The matter remained unaltered until the year 1870; but in the latter year the noble Marquess opposite (the Marquess of Ripon), who preceded him in the Privy Council, introduced a measure in that House for the purpose of amending the Medical Act of 1858. That measure provided that the establishment of a Conjoint Board should be compulsory instead of permissive, and that a certificate to be given by the Board to an applicant should qualify him to enter the Medical Profession. That Bill was discussed and carried through all its stages in their Lordships' House; but in the other House of Parliament it failed to pass, in consequence of the Medical Association having objected to the constitution of the Medical Council. The Medical Association desired that there should be a representation on the Medical Council of the whole Medical Profession. The opposition which was instituted against his noble Friend's Bill in the other House of Parliament was successful; and from that time until last year, he (the Duke of Richmond) thought he was right in saying no medical legislation on the part of the Government had been attempted. But, occupying the place which his noble Friend recently occupied, he (the Marquess of Ripon) could well understand that he had the subject constantly before him. He had consultations with various persons qualified to judge of the question of medical education; and, in consequence, he had come to the conclusion to deal with the question last year. He accordingly introduced a measure in their Lordships' House. In that Bill, so far as England was concerned, the principle of a Conjoint Board was approved of; but as regarded Scotland and Ireland, the establishment of such a Board was allowed to be optional, instead of being made obligatory, or, in other words, the medical authorities were only to adopt the provisions of the Act if they should see fit. Having since then considered all the arguments which bad been brought forward against the optional character of the Bill in that respect, he was of opinion that to leave the setting up of a Conjoint Board optional would not be consistent with reason. Therefore, in the Bill he should lay on the Table, the establishment of a Conjoint Board in each division of the Kingdom was made compulsory. Some of the most distinguished medical men in this country had manifested a desire for the establishment of a Conjoint Board, and he was himself convinced that if a measure were passed of an optional character an attempt to set up a Conjoint Board would fail. The English Committee for settling a Conjoint Board had held more than 50 meetings. In that Committee the College of Surgeons was represented by Sir James Paget and Mr. John Marshall; the University of Oxford by Dr. Henry W. Acland and Dr. George Rolleston; the University of Cambridge by Dr. G. E. Paget and Dr. G. M. Humphry; the University of Durham by Dr. G. H. Philipson and Dr. George G. Heath; the University of London by Dr. Richard Quain and Dr. W. B. Carpenter; the College of Physicians by Dr. James Risdon Bennett and Dr. Henry Pitman; and the Society of Apothecaries by Mr. E. Cradford and Mr. George Corfe. This Committee had given the fullest consideration to the subject, and they were strongly in favour of the change he now proposed; and he trusted that the same reasons which had induced him to propose a compulsory measure would also have weight with the Medical Bodies of Ireland and Scotland. The Bill provided that where a Medical Corporation refused to admit a student to their body, he having produced a certificate of having passed the examination of the Conjoint Board, the student should be entitled to go to the Registrar for the purpose of having his name inserted in the register as of right. This provision had become the more necessary since they compelled the Conjoint Board to examine female students; if, therefore, women were refused admittance to the Corporation, they would, under this provision, having passed the examination of the Conjoint Board, be entitled to be placed directly on the register. With regard to the penalties on unregistered practitioners, and kindred matters, these being practically the same as those in the Bill of last year, he did not think it was at all necessary that he should trouble their Lordships by going into details of the clauses. He might, indeed, now conclude all he had to say upon the Bill, if it were not for one subject, to which he had already lightly alluded, and that was the constitution of the Medical Council. He was sure his noble Friend (the Marquess of Ripon) would excuse him for saying that that was the rock on which shipwreck was made in 1870; and it was with a view to avoid a similar disaster that he proposed to touch the subject in a different way now. The Medical Council consisted of the representatives of the 19 various licensing bodies. There were six nominees of the Crown and a President appointed by the Council. He should like to read the names of the Council—The President, Dr. Acland; Crown nominees, Dr. Quain, Sir William Gull, Mr. John Simon, Mr. Teale, Dr. Fergus, and Dr. Hudson; representative members, Dr. Pitman, Sir James Paget, Mr. Bradford, Dr. Pyle, Dr. Storrar, Dr. Haldane, Dr. Orr, Dr. Wood, Professor Turner, Dr. Pettigrew, Dr. Aquilla Smith, Dr. Leet, Dr. S. Haughton, Sir Dominic Corrigan, Dr. Rolleston, and Mr. R. Macnamara. This was a very eminent body of men; and be might now say that no objection had reached him as to the qualifications of the Crown nominees. Certainly, in those he had recommended to the Crown, he had been actuated only by a desire to select the best men he could find in the Profession for the purpose, and from his knowledge of those appointed by his Predecessors in Office, he was confident that they were actuated by the same feeling. He was equally certain that those elective bodies had the same object in view, and would select men who were most competent and who would carry out their duties in the most efficient manner. He was sure he might say that his noble Friend opposite (the Marquess of Ripon) would corroborate his statement, that all those gentlemen had performed their duties faithfully and well. The Council had been in action for 20 years, and he thought all would agree that they had deserved well of their country. Of course, the argument of the eminence of those gentlemen, or reference to the manner in which they had performed their duties, did not weigh with those who thought there ought to be a representative Council, and those who desired to have votes in the representation and who desired to have the Council very much altered in its character. There were several schemes for the amendment of the Council brought forward by various bodies. One scheme was that there should be representatives of the whole Profession upon the Council. To enable them to do this some would increase the number of the Council. He did not adhere to that view, because he thought the Council was already sufficiently large. There was another proposal—that the bodies now sending representatives to the Council should have their number curtailed in order to make room for the representation of the Medical Profession at large. There was another proposal—that the number of persons nominated by the Crown should be diminished with the like object. All these were questions which seemed to him not unworthy of consideration; but they involved a very wide inquiry, and he certainly did not feel himself justified in including the matter in the Bill without further information than he possessed at the present time. It was, therefore, the intention of the Government to suggest that there should be a Committee of the other House appointed to inquire into the matter; and at the end of that inquiry, when that Committee should have reported, the Government would be able to see whether any, and, if so, what alteration in the Council was required. It did not seem desirable to endanger this Bill, which contained many valuable features, by interfering with this subject of the Medical Council. This measure could not be considered a Party measure in any particular sense, and he looked forward to receiving from his noble Friend opposite (the Marquess of Ripon)—than whom no one was more competent to give advice, because he had great experience in dealing with this subject—his valuable assistance in achieving what was the object of all—the maintenance of a high standard of professional reputation. He did not despair of the solution of what seemed to be a very difficult question, if the subject were, as he could not doubt it would be, fairly considered by their Lordships. He begged to present the Bill, and to move that it be read a first time.

Bill to amend the Medical Act, 1858Presented (The LORD PRESIDENT).


said, he had paid close attention to the statement of his noble Friend the Lord President, and should be happy to give him all the assistance in his power in passing the Bill. As his noble Friend was well aware, he was strongly impressed with the conviction that the most urgent reform in respect of medical affairs in this country in the interest of the public was the establishment of a single Medical Body for the three divisions of the United Kingdom, through which, and through which alone, persons should be able to get their names on the register. He understood his noble Friend intended to adopt that principle, instead of leaving it optional to the various Medical Bodies in England, Scotland, and Ireland to establish one Conjoint Board of Examination in each country. That he held to be the first object of medical reform at the present time; and he, for one, should approach the consideration of the Bill with every desire to give assistance to his noble Friend in passing it. It seemed to him that something might be said in favour of those provisions, which were inserted in the Bill of last year at his suggestion, but were modified in this Bill; but he should be ready to lay aside his own opinions on minor points, and he only hoped and trusted that others would do the same. With respect to the other part of the statement of his noble Friend, he was not surprised he had thought it wise to make a concession on the subject of the composition of the General Medical Council. He could fully bear his testimony to the correctness of the statement with regard to the ability of the members of that Council, their high standing and reputation, and the excellent manner in which they had discharged their duties. But there was no doubt there did exist, and had existed many years, a large amount of opinion in the Medical Profession that the Profession, as a Profession, ought to have a more direct share of representation on that Council. He did not desire to express an opinion on it at the present moment, except that when one saw a great body of the Profession entertain that opinion, it was quite fair and right that the subject should be investigated by an impartial inquiry before a Parliamentary Committee. All he trusted was that his noble Friend on one side, and those who were the cause of the failure of his own Bill of 1870 on the other, would take care that a question altogether distinct from the main object of the Bill should not produce a failure of the present measure. If the Committee, after considering the subject, should report that a change in the Medical Council was desirable, he hoped it would be carefully considered; but that no side interests of any kind would be allowed to interfere with the success of the Bill. He hoped there would be no delay with the second reading, as he thought it important the Bill should be speedily taken to the other House and considered there.

Bill read 1ª; and to be read 2ª on Tuesday the 11th of March next. (No. 16.)