HL Deb 26 April 1883 vol 278 cc1119-30

Clause 9 (Establishment of Medical Boards).

LORD CARLINGFORD (LORD PRESIDENT of the COUNCIL)

said, he desired to submit an Amendment to the House relating to the English Medical Board. When the Bill was discussed on the last occasion, in Committee, he threw out a suggestion which was not very well received, especially by the noble Marquess opposite (the Marquess of Salisbury). He now made another proposal to the House—that the number of representatives given by the Bill, as it stood, to the five Universities of England should not be altered; but that the two great Medical Colleges, the Royal College of Physicians and the Royal College of Surgeons, should receive an addition of two members, being one for each. He had found great difficulty in understanding the enormous and vital importance that appeared to be attached by the medical authorities of the three countries to the exact numbers which they should have a right to return to those Medical Boards. He did not believe that the interests and views of one sot of those bodies would be supreme and exclusive, merely because that set of authorities happened to have a majority, perhaps of one, on the Conjoint Board, because he considered that that Board would do its duty; nor did he believe that the interests and views of the other set of authorities would be sacrificed, merely because they happened to be in a minority, perhaps of one. However, after having given the best consideration in his power to the whole matter, he had come to the conclusion that there was sufficient reason for increasing by two, the number of representatives returned by the two principal Medical Corporations. Nothing could be of more importance, or more wholesome, than the influence of the Universities, and the Government desired that that influence should not suffer under this proposal. On the other hand, it was evident that, in this country, the lion's share of the duty of examining and licensing candidates for the Medical Profession fell to those two Corporations. That view had been pressed upon him in the strongest possible way by some of the most eminent—he might say the most illustrious—members of the Profession; it was the view of the Royal Commission presided over by his noble Friend behind him (the Earl of Camperdown); and there could be no doubt that the part played by the two great Medical Corporations in respect to the examinations and licensing of candidates was out of all proportion greater than that by the Universities. He was glad to find that one of the Universities, the University of London, which examined the largest number of candidates, was satisfied with the proposal he had made; and he hoped that that might be the case with the others, especially those of Oxford and Cambridge. It was well, he thought, to remember that, while the high educational influence of the Universities was most important and essential, and would be exercised by the large number of members who would be returned by them to the Conjoint Board, yet the object of the Board was not to provide the highest possible standard for examination or education, inasmuch as it would have nothing to do with the honours of the Medical Profession, but would only be concerned with maintaining a sufficient standard, and a minimum qualification, for all the young men who were to be admitted to the right of practice; and the two great Medical Corporations, with their immense experience on that subject, should have the right, he thought, of full representation on the Medical Board for England.

Moved, in page 3, line 30, to leave out ("three") and insert ("four").—(The Lord President.)

THE MARQUESS OF SALISBURY

said, that, in his opinion, the noble Lord the Lord President of the Council would have made his task much easier, and also that of the Universities, if he had arrived at this decision at an earlier period, and given those Bodies interested some Notice of what he was going to do. As the Amendment had only been put upon the Paper on the previous day, there had been no opportunity of ascertaining the opinion of the Universities; but, at the same time, as he understood the proposal, he was bound to say that in the absence of any information that they objected to it, he did not feel inclined to oppose it, at least at present. He should, however, have preferred that more consideration could have been given to the proposal, instead of its being thrown with that explosive suddenness on the House. With regard to the Apothecaries' Company, he might be allowed to say that its standard was not very high; while, with reference to Victoria University—though, no doubt, it had splendid prospects—it was still a baby, and it was a strange thing to give it equal privileges with those of the more ancient Universities. There was only one other point he would venture to protest against, and that was the attempt made by the noble Lord to enact by Act of Parliament that 10 and 7 should make 15. He (the Marquess of Salisbury) thought that was outside the power of Parliament altogether. Notwithstanding the additions which had been made to the Board the number of 15 still remained in the Bill.

THE EARL OF CAMPERDOWN

said, he was glad to hear that the noble Marquess opposite (the Marquess of Salisbury) did not intend to oppose the Motion. The Commission were certainly of opinion that it was desirable to give due representation to the Royal Colleges of Physicians and Surgeons in England, as they had taken a far more prominent part than the corresponding Bodies in other divisions of the Kingdom. If a victim was to be offered up, he thought it should be the Apothecaries' Society of England. He was bound in fairness to state that that Society had no stronger claim to existence, in his opinion, and in that of the Commission generally, than the corresponding Society in Ireland which had already been disfranchised as far as the matter under discussion was concerned.

VISCOUNT POWERSCOURT

said, that the noble Lord the Lord President had said that the two Colleges of Surgeons and Physicians in England had the lion's share of the work; but he (Viscount Powerscourt) did not know that the two Colleges in Ireland had not a lion's share also. He thought it rather a misfortune that the representation of the two Colleges in England and Ireland should not be equal, or that the Government could not elect a Chairman themselves, who should have a casting vote.

Amendment agreed to; word inserted accordingly.

LORD CARLINGFORD (LORD PRESIDENT of the COUNCIL)

said, he would admit the fairness of the criticism of the noble Marquess opposite (the Marquess of Salisbury) as to the matter of the 15. He would, therefore, propose in page 3, line 21, to leave out the word "fifteen," and insert the word "seventeen."

Amendment agreed to; word inserted accordingly.

THE EARL OF GALLOWAY,

in moving the first of the four Amendments standing in his name, said, that they were practically one; but he wished to remind their Lordships that they were to the effect that the Medical Corporations of Scotland should have a majority of one over the Universities. The present representation was three to the Corporations, and two to the Universities; but it was now proposed by the Bill that the Universities should have eight members of the Board and the Medical Corporations three, and the latter Bodies thought their claims were being sacrificed. He thought, after what had fallen from the Lord President of the Council as to the Medical Corporations in England, their Lordships would not think it a very monstrous proposition if he suggested that the representation of the Universities of Scotland should be so constituted that there would only be a majority of one. His proposal was not to increase the number of members, but to add to the Corporations by substracting from the Universities. There was some difficulty in choosing which of the Corporations ought to get the advantage; but it had been deemed wise to add one to the Medical Corporations of Glasgow, and another to the College of Physicians in Edinburgh. It had been suggested to him that the University of St. Andrews bad no claim whatever to be represented, and that Aberdeen University would be quite sufficiently represented by one member.

Moved, in page 4, line 5, to leave out ("Two") and insert ("One").—(The Earl of Galloway.)

THE DUKE OF RICHMOND AND GORDON

said, he totally disagreed with this Amendment, on the ground that the University of Aberdeen was justly entitled to two members. He could not understand who could have told his noble Friend (the Earl of Galloway) that Aberdeen ought not to have two members; but it was evidently someone who had not been at sufficient pains to inform himself as to the facts. He should strongly object to the representation of that University being altered.

LORD BALFOUR

said, he hoped that the Amendment would not be accepted. He thought the representation of the Universities and the Corporations, as it was provided by the Bill as it stood, could be defended on several grounds. It had been recommended by the Report of the Royal Commission that the Universities of Scotland should have preponderating representations in the Board in Scotland, on this ground, among others—that the Universities were teaching bodies, as well as merely examining bodies; while the Medical Corporations did nothing more for the medical students than examine them. Again, there had been complaints made against the action of some examining bodies in Scotland— it was not for him to say whether these charges were well or ill-founded—but if any charge had been made and brought home of improperly admitting students, it had certainly not been against the Universities, but at the door of the Corporations. As regarded the University of St. Andrew's, it seemed at present to be thought fair game for anyone to have a kick at. Their Lordships had heard something of another scheme by which it was threatened to be improved out of existence altogether. That made him all the more anxious that no change to its detriment should be introduced into this measure. He trusted the Amendment would not be accepted.

LORD CARLINGFORD (LORD PRESIDENT of the COUNCIL)

said, he had nothing to add to his previous declaration on the subject. He could not admit for a moment that the Scotch Medical Corporations were, in any way, on a par, as regarded the part they played in medical education and examination, with the great Medical Corporations in this country.

Amendment negatived.

THE EARL OF GALLOWAY

said, he would not move the remaining Amendments.

Amendments (by leave of the House) withdrawn.

On the Motion of The LORD PRESIDENT, the following Amendments made: —In page 3, line 31, leave out ("three") and insert ("four"); in page 5, line 12, after ("Council") insert ("or of the Privy Council"); and in line 19, leave out ("are") and insert ("or the Privy Council are or is").

Clause, as amended, agreed to.

Clause 10 (Medical Board to regulate examinations subject to control of Medical Council and Privy Council).

On the Motion of The Lord BALFOUR, Amendment made in page 6, line 9, after ("examinations") by inserting ("in medicine, surgery, and midwifery").

Clause, as amended, agreed to.

Clause 20 (Medical Board to visit schools and examinations).

On the Motion of the LORD PRESIDENT, the following Amendment made:— In page 11, line 25, add at end of clause as a separate paragraph— ("Any revocation or alteration of a scheme in pursuance of this section shall not be of any validity until it has been approved by the Medical Council and confirmed by the Privy Council.")

Clause, as amended, agreed to.

Clause 25 (Power of Her Majesty in Council to define colonies and countries to which this part of the Act applies).

On the Motion of The LORD PRESIDENT, the following Amendment made:— In page 14, line 5, insert as a separate paragraph at end of clause— ("Her Majesty may from time to time revoke and renew any Order made in pursuance of this section; and on the revocation of such Order as respects any British possession or foreign country, such possession or foreign country shall cease to be a possession or country to which this part of this Act applies, without prejudice nevertheless to the right of any persons whose names have been already entered on the register.")

Clause, as amended, agreed to.

Clause 26 (Medical titles).

LORD ABERDARE,

in moving, as an Amendment, to insert again the words struck out on a former occasion, making it lawful for any registered medical practitioner to use after his name the title of licentiate in medicine, surgery, and midwifery, or any letters indicative of such title, said, he regretted that he had not had an opportunity of discussing this matter with his noble Friend the Lord President. On the face of it nothing could be more modest than his proposal, which provided that those who had passed their examination and re- ceived a licence from the Board should be entitled to bear the title of "licentiate in surgery, medicine, and midwifery." He had great difficulty in understanding the manner in which this question of titles had been treated. He thought the great Medical Corporations had already sufficient forms, and that those who did not desire to enter them should be allowed to use the title of licentiate. The Amendment would apply to women as well as men, and it seemed so reasonable that he could scarcely think it would be opposed.

Moved, in page 14, line 19, at end of clause, to add— ("And it shall be lawful for any registered medical practitioner who has passed a final examination as in this Act mentioned, if he thinks fit to do so, to use after his name the title of licentiate in medicine, surgery, and midwifery, or any letters indicative of such title.")—(The Lord Aberdare.)

THE EARL OF CAMPERDOWN

said, he regretted that he must object to the suggestion of his noble Friend (Lord Aberdare), because, either under Statute or Charter, there were already 62 or 63 medical titles, and he hoped that they were not going to add another to the list by Statute. The object of the new Board was not to confer titles; but to insure that there should be sufficient skill on the part of the person who was licensed; whereas the adoption of the Amendment would have the effect of diminishing the securities afforded by the Bill, with regard to the qualifications of those who assumed the title of licentiate. Besides, it would be open to anyone who had the licence to call themselves licentiate if they chose. In addition to that, the great Medical Corporations felt very acutely in this matter, and thought that the creation of another new title would interfere with and depreciate the value of those which they were now able to confer.

EARL CAIRNS

said, he trusted the Amendment would not be accepted. The degrees of medicine were valuable titles —as valuable as any that were conferred. They were titles of honour, and it was right that certain bodies should have the power of examining and granting those degrees. He did not understand what object there was in trying, by this Bill, to interfere with the Corporations which now had power to confer medical titles.

LORD CARLINGFORD (LORD PRESIDENT of the COUNCIL)

said, that although he was responsible for the insertion of the original clause, yet he saw good reasons for omitting the words in question; and, therefore, he was not prepared to accept the Amendment. Upon consideration, he thought it better not to create by the Bill a new statutory title which would rival the titles of the medical authorities. It must be remembered that the Bill proposed to utilize and adopt the existing medical licensing authorities. Nothing, he thought, ought to be done without the strongest necessity to interfere with those Bodies.

Amendment negatived.

Clause agreed to.

Clause 27 (Penalty on misuser of medical titles).

On the Motion of The LORD PRESIDENT, the following Amendments made:—In page 14, line 25, leave out ("aforesaid") and insert ("said appointed"); line 26, leave out ("for gain"); line 28, after ("surgery") insert ("for gain"); page 15, line 3, leave out ("aforesaid") and insert ("said appointed"); line 15, leave out ("aforesaid") and insert ("said appointed"); line 16, leave out ("for gain"); line 18, after ("surgery") insert ("for gain").

Clause 36 (Expenses of Act, and funds to meet such expenses).

LORD CARLINGFORD (LORD PRESIDENT of the COUNCIL),

in moving the following Amendment:—In page 21, line 10, after ("Act") insert— ("And subject to the payment of the foregoing expenses in this Act described as the administrative expenses of each board,") said he did so for the purpose of distinguishing between the fees necessary for the administrative expenses and those which would go to meet other expenses, such as museums, libraries, &c. He agreed that the students coming up from any University should only be liable to contribute to the administrative expenses.

Amendment agreed to; words inserted accordingly.

On the Motion of The LORD PRESIDENT, the following Amendment made:—In page 21, line 32, after ("such Council") insert ("or any Committee of the Council").

LORD CARLINGFORD (LORD PRESIDENT of the COUNCIL),

in moving the following Amendment:—In page 22, line 24, insert as an indented paragraph— ("In estimating the amount of the fees to be charged by each medical board for its final examination, a distinction shall be made between so much of the fee as is leviable for the purpose of supplying funds for defraying the administrative expenses of the board and so much as is leviable for the purpose of defraying the expenses of the maintenance of museums and libraries; and the fees to be paid by University graduates or persons holding University certificates of having passed the examinations at their University qualifying for admission to the final examination of the board shall not exceed the portion of the fee leviable as aforesaid for the purpose of supplying funds for the administrative expenses of the board,") said, he also proposed to amend the Amendment, by substituting for the word ("persons"), in line 8, the word ("undergraduates").

THE EARL OF MILLTOWN

said, that "undergraduate" was a vague expression, which merely meant that a gentleman had passed his preliminary examination at a University. He proposed that "graduate in arts" should be the term substituted.

THE EARL OF CAMPERDOWN

said, he considered that the Amendment as it would stand did not propose to give any unfair advantage to University undergraduates.

Amendment, as amended, agreed to.

Clause, as amended, agreed to.

Clause 40 (Legal status of Medical Board and Medical Council).

On the Motion of The LORD PRESIDENT, the following Amendments made: —In page 23, line 22, leave out ("or of a committee of a medical board"); lines 27 and 28, leave out ("or of a committee of a medical board"); lines 34 and 35, leave out ("or of a committee of a medical board"); page 24, lines 4 and 5, leave out ("or of any committee of a medical board").

Clause, as amended, agreed to.

Clause 41 (Approval and confirmation of schemes).

On the Motion of The LORD PRESIDENT, the following Amendment made: —In page 25, line 34, insert at end of clause as a separate paragraph.— ("Any revocation or alteration of or addition to a scheme is included under the word 'scheme' in this section.")

Clause, as amended, agreed to.

Clause 51 (Time of election of Medical Board).

On the Motion of The LORD PRESIDENT, the following Amendment made: —In page 30, line 22, leave out from the word ("in"), and insert— ("Following, that is to say, if it be an authority which before the passing of this Act returned a member to the General Medical Council, then in manner in which such authority was accustomed to return a member to such Council, but if it be not such an authority as lastly hereinbefore mentioned, it shall return a member or members to a medical board in manner directed by the Privy Council.")

Clause, as amended, agreed to.

Clause 53 (Rules for final examination).

On the Motion of The LORD PRESIDENT, the following Amendments made: —In page 32,line 30,leave out ("May") and insert ("August"); line 32, leave out ("its division") and insert ("the part of the United Kingdom to which such board belongs"); line 33, leave out ("its division") and insert ("the part of the United Kingdom to which such board belongs"); line 38, after ("schemes") insert ("comes or"); page 33, line 1, leave out ("September") and insert ("January"); line 2, leave out ("four") and insert ("five"); line 4, leave out ("on or"); line 5, leave out ("November") and insert ("March"), and leave out ("four") and insert ("five"); line 12, leave out ("March") and insert ("September").

Clause, as amended, agreed to.

Clause 54 (Continuation of old system of registration to the appointed day).

On the Motion of The LORD PRESIDENT, the following Amendment made: —In page 33, line 29, after ("same") insert ("before or").

Clause, as amended, agreed to.

Clause 55 (Transfer of funds of Branch Councils to Medical Boards).

THE EARL OF CAMPERDOWN

said, it was necessary that some provision should be made for enabling the Medical Boards to defray necessary expenses in the interim before a medical fund could be formed. He therefore proposed, as an Amendment, to add the following Provisoes at end of clause:— ("Provided that the Medical Council shall, out of such funds (that is, the funds received from the branch councils), advance to each medical board such monies as shall be required to defray the expenses necessarily incurred before a medical fund can be formed. ("Provided also, that the Medical Council shall, when making such advances, be satisfied as to the terms and other conditions of repayment by the several medical boards.") The object of the second Proviso was to prevent the Medical Board from being unnecessarily extravagant.

LORD CARLINGFORD (LORD PRESIDENT of the COUNCIL)

said, that the Amendment was a very proper one, and he would, therefore, accept it.

Amendment agreed to; Provisoes added accordingly.

Clause, as amended, agreed to.

Clause 71 (Definitions).

On the Motion of The LORD PRESIDENT, the following Amendments made: —In page 37, line 24, leave out ("January") and insert ("June"); and in line 26, leave out ("January") and insert ("June").

Clause, as amended, agreed to.