§ 2.54 p.m.
§ Order of the Day for the Second Reading read.
§ LORD HENDERSON
My Lords, in the explanatory memorandum accompanying this Bill its object was described as to dispose finally of the various wartime problems associated with the admission to the British Medical Register of doctors not possessing British qualifications. This is a good general description of its primary purpose. It deals also with pharmacists qualified abroad. In the years before the war the refugees from countries on the Continent of Europe who came here to escape Nazi oppression included, as one would expect, a considerable number of doctors. Many of these have been able to acquire British qualifications and thus obtain admission to the British Medical Register. With these the Bill is not concerned. Those of them who have also been naturalized are as free to practise here as their British-born colleagues. Except that they may be precluded from practising in certain areas, those who have not acquired British nationality have also the same freedom.
The Bill is concerned with doctors who do not possess British qualifications. It is many years since Parliament considered the position of such doctors. It was in the Medical Act of 1886 that it was laid down that admission to the Medical Register of doctors holding only diplomas obtained abroad should be conditional upon the existence of reciprocal arrangements under which similar facilities were 556 granted by the country in which the practitioner qualified. Insistence upon reciprocity was no doubt designed to safeguard the interests of the medical profession in this country, but in effect it meant that few foreign doctors were able to gain admission to our Register on the strength of their foreign diplomas. The only foreign countries with which reciprocal arrangements were ever made were Belgium, Italy and Japan, and these were cancelled respectively in 1920, 1940 and 1942. The position is different with regard to doctors who have qualified in the Dominions and other Commonwealth territories, where reciprocal arrangements exist in many cases.
This was the legal position which faced us when the war came and doctors from all parts of the world were finding their way to this country. It would have been folly to waste these resources in medical man-power and it was soon realized that some temporary amendment of the law was called for. The amendment was effected in July, 1940, by Defence Regulation 32B, which gave powers to the General Medical Council to register practitioners qualified to practise outside the United Kingdom in territories to be specified by Order. Under successive Orders the arrangements became geographically of very wide application, and by the time temporary registration ceased nationals of as many as twenty-six foreign countries had been temporarily registered by virtue of foreign diplomas.
To ensure that the services of foreign doctors should be made available where they were most needed, the Orders made registration conditional upon the practitioner taking specified kinds of employment—namely, service with British or Allied Forces, employment in approved hospitals and institutions or other approved services and as assistants in general practice. Independent practice was not permitted—this could not have been justified when so many of our own doctors were absent on military service and it would also have been doubtful wisdom to allow foreign doctors, unfamiliar with our standards and methods and about whose professional conduct nothing could be known, to practise free from any form of supervision. The help we got from these doctors was substantial. A large proportion served with His Majesty's Forces or those of the Allies, 557 and many gave valuable service in hospitals, the public health services of local authorities and as assistants in general practice. In all these fields we were severely depleted by withdrawals for our Forces, and our plight would have been much worse without these doctors who included many men of high professional distinction.
When the various emergency measures came tinder review at the end of 1945 we had to decide what to do about these temporary registration arrangements. The decision, embodied in the Emergency Laws (Transitional Provisions) Act, 1946, was that there should be no further grant of temporary registration after February, 1946, but doctors already registered should remain so until the end of 1947. We now have to decide what is to happen after that. In the Government's opinion, we cannot, in fairness, say to these people that if they stay here they cannot remain on the British Medical Register. So it is proposed in this Bill to make it possible for those remaining in this country who have given good service, whether in the Forces or in civilian life, to secure permanent registration. That is the major purpose of the Bill.
It contains, also, provisions with regard to certain doctors not holding British diplomas who are not at present on the temporary register (I will refer to them later), but those already temporarily registered are numerically much the largest group. When temporary registration ceased there were about 3,500 on the register. This figure included many American and Canadian doctors who came here with their Forces. Of the others, Germans, Austrians, Poles and Czechs are the largest individual categories. Most of the temporarily registered doctors have returned to their own countries and it is estimated that not more than 1,500 to 2,000 will be here to avail themselves of the Bill. It may be much less. Among them will be a number of Polish doctors who have come to this country under the Government's Polish resettlement scheme. As temporary registration under the old provisions had ceased by the time they arrived, special provision had to be made in the Polish Resettlement Act for their registration by the General Medical Council. The registration under that Act is temporary, too, being due to cease also at the end of 1947, and the position of these Polish 558 doctors after that has also to be settled in this Bill.
Apart from doctors already on the temporary register, the Bill makes provision for certain other groups who are at present not registered at all. The first group consists of foreign doctors who have served overseas in our Forces and who have now been permitted to enter and remain in the United Kingdom. They were commissioned overseas and as they were serving abroad there was no occasion for their registration in this country. These are men who have given us useful war service and, having allowed them to settle here, we cannot equitably refuse them permission to practise their profession. The other group comprises doctors who have been allowed to enter or stay here owing to war circumstances, and have hitherto been unable to secure registration on the strength of their foreign diplomas. Some of them have been in the country some time but were ineligible for temporary registration because they were not employed in any of the various forms of medical work specified in the Temporary Registration Orders. They may nevertheless have given the country useful service in medical research or otherwise. Some may have arrived since temporary registration ceased. In this group will also be graduates of the Polish School of Medicine, Edinburgh, who in the absence of some provision in this Hill would be ineligible for permanent registration.
The doctors in this group differ from those in the other categories covered by the Bill in that we shall know nothing of their work in ordinary medical practice. It is proposed that their registration should be provisional, in the first instance; and during this provisional period they will be required to work in hospitals and other institutions where they will be under supervision, so that we shall be able to get useful reports on their work to enable the General Medical Council to judge of their suitability for permanent registration. We propose to limit the operation of this provision to doctors who were in the country when the Bill was introduced. The Bill is meant primarily to clear up the aftermath of war and, with that in mind, I think we have gone as far as we reasonably can, if we make this provision available only to doctors already in the country. No one could say that either in the Bill or in 559 our war-time measures we have treated foreign doctors ungenerously, but, except in one limited respect to which I will refer in a moment, this Bill does not attempt to make any permanent change in the law, and, that being so, we must obviously put some limit to the relaxation of the ordinary procedure. The Government think that the line drawn in the Bill is a reasonable one. Any question of permanently modifying the present law, which makes the registration of foreign doctors dependent on reciprocity, would be beyond the present intention of this Bill.
The one provision in Part I of the Bill which will be permanent is Clause 8. The purpose of that Clause 1s not self-evident. Its intention is to regularize the position of doctors from abroad who visit this country for limited periods for the purpose of doing professional work in hospitals, normally teaching hospitals, either as teachers or as post-graduate students. Eminent doctors from abroad have long been welcomed by teaching hospitals in this country because of the advantage of personal demonstrations by them of their special skill in their particular field of medicine, surgery or midwifery. Many of these visitors are not eligible for registration under the Act of 1886. Technically it is a professional offence for a registered practitioner to co-operate in professional work with an unregistered person, and it is obviously undesirable that there should be any doubt as to the propriety of cooperating with one of these distinguished visitors. These practitioners are also at present subject to the professional disabilities applying to unregistered persons—among them inability to give statutory certificates and to possess or supply dangerous drugs.
A second group who will be covered by this clause are doctors qualified abroad who come to this country to continue their professional education in temporary appointments at hospitals, usually teaching hospitals. Some of those coming from Commonwealth and Empire territories outside the British Isles may not be registered because the countries in which they qualified are not covered by reciprocal arrangements. The desirable practice of exchanging doctors with the Dominions, to the advantage of post-graduate education on both sides, is made difficult by the 560 absence of registration. It is quite true that these things have gone on in the past but, even if no legal difficulties have arisen, the risk has been there and we think it should be removed, especially as in the near future hospitals will become a State responsibility and it is clearly desirable that there should be no question about the legal position of doctors coming here for the purposes I have mentioned. The registration under this provision will be temporary, for the duration of the appointment, and will apply only in respect of the appointment. The General Medical Council are the authority responsible for medical registration and the Bill gives them the necessary powers in regard to the doctors concerned. The Council are the guardians of the standards of medical education in this country, and we can safely leave to them the task, which may be by no means an easy one, of assessing the value of the great variety of medical diplomas held by applicants under the Bill.
In Part II of the Bill we are proposing, with the blessing and indeed at the request of representatives of the pharmaceutical profession, a change in the law as to the registration of pharmacists holding qualifications obtained abroad. In making this change we are at the same time providing for those foreign qualified pharmacists who obtained temporary registration under the Defence Regulations in the same way as the temporarily registered doctors. In their case also, under the Emergency Laws (Transitional Provisions) Act, temporary registration is due to cease at the end of 1947. The change proposed is in the form of a provision enabling the Council of the Pharmaceutical Society, under by-laws (which are subject to the approval of the Privy Council), to register any pharmacist holding a qualification obtained outside the United Kingdom with or without examination and with or without training in this country as they think proper. This supersedes the present provision in the Pharmacy Act, 1908, which enables the Council to register only Colonial pharmacists on the strength of their Colonial diplomas—and that without any examination.
The Bill was introduced in August in another place so that members and outside organizations and persons interested should have time to study it and offer any 561 criticisms before it came to be discussed. The Department has heard little in the way of criticism except on points of detail, and where it appeared desirable the necessary amendments have been made in the revised draft of the Bill. I am hopeful that this will be regarded as a non-controversial measure, doing justice to the individuals who will benefit by it, and of advantage to the country in the addition it makes to our resources in medical man-power. I beg to move.
§ Moved, That the Bill be now read 2a.—(Lord Henderson.)
§ LORD AMWELL
My Lords, if I may ask the noble Lord a question, can he say whether there is any sensible or substantial differences in the diploma qualifications of medical men and pharmacists so far as the Dominions and foreign countries are concerned?
§ LORD HENDERSON
I am sorry I cannot answer that without notice. That is a matter to be decided by the appropriate councils; on the one hand, by the General Medical Council and on the other by the Pharmaceutical Committee.
§ 3.13 p.m.
§ LORD LLEWELLIN
My Lords, on behalf of those who sit on these Benches, I welcome this Bill. I welcome it because it is a good Bill and also, if your Lordships will allow me to say so, for the timing of its introduction. I am given to understand that the fate of this House is being discussed in another place, and I read in Hansard some comments made upon us there yesterday. Certain things were said about us as a revising Chamber, some complimentary and some not so complimentary, it is clear to me that the Government are attacking our powers and many of their supporters would like to get rid of us altogether. When all this is happening not so far down the corridor, it can only be gratifying to members of your Lordships' House to find that three measures have been introduced into this House before going to another place. It is our duty, therefore, to scrutinize these measures carefully, because if we look back over the last two years, we find that very few of our Amendments to Bills have come back to us from another place, compared with the number of Amendments which they have been good enough to accept at our hands.
562 Coming to the Bill itself, I welcome it because, as the noble Lord said, it does give justice to men who have been of considerable assistance to us in the medical services during our difficult years. I remember well that in the days when the demands for medical officers for the Forces were "colossal," to use the only word that applies, and the number of doctors for our civilian population was being cut down, it always seemed odd to me that we needed many more doctors per head to look after the fit young men passed into the Services than for the older people and the children in civilian life. It was different, of course, when the men went into battle areas where there were high casualty rates, but some of us could not understand why it was necessary at a time when most of the Army was in these islands. Be that as it may, the doctors who came to us from abroad, whether they came from Germany and Nazism or with the Polish Forces or from other parts of Europe, were of the greatest assistance to us. I do not know that we are doing this only out of fairness to them, because I believe that we are not overflush with doctors in this country at the present time, and we welcome the continuation of the medical care and treatment that these men are giving.
As I understand it, Clause 2 gives permanent registration to medical practitioners who are already on the temporary register. That is how it is described in the Explanatory Memorandum. I would like to ask the noble Lord, who has as usual introduced this Bill with great care and courtesy, how that squares with subsection (5) of Clause 1, which says that this direction to put them on the register ' shall not be given except in the case of a person who is resident in the United Kingdom otherwise than for a temporary purpose." I should like the noble Lord at some stage in the discussion to say why it is necessary to have that subsection at all. If there is provision, as it says in the Memorandum, to put practitioners on the permanent register, it does not seem to me much good if you are going to put on only those temporarily in this country, which is the principle of Clause 1 (5). I may be wrong, but perhaps the wording might be looked at, since it might convey that impression to others than myself. I think that comment applies not only to those 563 dealt with under Clause 2, because Clause 1 is the governing clause.
Another comment I would make is on Clause 3, dealing with persons who have served in a medical capacity in His Majesty's Forces overseas. When one looks at the definition of "medical capacity," one finds that "'medical capacity' means 'the capacity of a practitioner of medicine, surgery, or midwifery'." I am not at all sure that these words do not want looking at, although, of course, one can read them in conjunction with Clause 9 (2). Then we come to Clause 4. I know that considerable satisfaction is felt in the medical profession at the alteration which the Government have made, since the Bill was first introduced, by putting in the date as before August 4, 1947. They know that they are dealing with people who will not rush over, after the introduction of the Bill, to get into this category, but with people who are already here and with whom we want to deal. In regard to all those categories of persons, if I may say so, I think the provisions are quite right.
When I come to Clause 8, I approve even more, because I think it is highly important that where we get these extremely able and eminent men over here—there are some in this country at the present time; there is one working at Guy's Hospital who comes from the United States—we should do everything possible to welcome them, and not leave the least impression that anybody who works with them is being unprofessional. I wonder myself whether in Clause 8, as in Clause 4 (2), we ought not to have the words "in a medical capacity in a hospital," and then to add "or other institution for the time being approved." The noble Lord will see my point. Some of these people may be working in institutions which are not technically hospitals, and if you insert the words in one clause of a Bill it is important not to leave them out in the other. Although "hospital" might have a wide context if these other institutions were not mentioned in the clause, it has a narrow context seeing that they are mentioned, and quite properly, in Clause 4. Here I may say that I think it is a very wise provision to require that people who go on a professional register should be in some hospital or institution, where you can get reports on them and 564 the General Medical Council can investigate before they put them on to the permanent registry.
The only other point I would make is this. I welcome equally, the position as to the pharmacists. There, it is true, it is done in rather a different way, but pharmacists are people we should welcome equally with the doctors. In fact, we really ought to welcome those who have been doing this work for us for the work they have already done. I notice, however, that in all references to doctors, quite properly, we insist that the General Medical Council shall be of the opinion that they are men of good character. There is nothing of that sort with regard to the pharmacists. From my own personal point of view, I must say that I should like a man who has such extensive dealings with poisons necessarily to be equally a man of good character. Perhaps we shall see that there is provision so that the Pharmaceutical Society can look into the characters of these men, as under these provisions they look into their qualifications.
Those are not really points for this stage of the Bill, but it is often convenient on Second Reading to indicate matters that may come up when the Bill comes before us in Committee. As I say, we welcome this Bill, It is, as the noble Lord said, giving a fair deal to men who helped us in the critical times of great shortage of medical staff, and it is also helping the health services of this country by putting them on our register and keeping them here to do the good work which they have done in the past.
§ 3.26 p.m.
§ LORD HARLECH
My Lords, I would also like to say a few words in regard to this Bill. I remember a bitter experience which I once had when I was at the Colonial Office of being asked to preside, and in fact presiding, at an International Conference in Paris to deal with the tsetse problem in Africa. We there had entomologists and doctors from all the Colonial Powers in Africa. We were faced with the position that the Belgian doctor, under the old reciprocal arrangements, could come and give us a hand in the British territories, and we could help the Belgian doctor in his territory, but the French and the Portuguese were unable to assist. As a matter of fact, the Portuguese gentleman was one of the most eminent 565 men in that field of research, with very wide experience in Africa. Equally with our hosts, the French, there were no reciprocal arrangements for the recognition of qualifications and degrees. However, we let it pass, and we had a very useful Conference.
The other experience I would like to mention in connexion with this Bill is that when I went to South Africa in the war I found practising in Swaziland, under one of the special temporary licences granted during the war, a very eminent Viennese physician. Having been in a very high position in the Vienna University, he had once in his life personally attended Dr. Dollfuss, which meant that he had to fly for his life from the Nazis. As there were no reciprocal arrangements with Austria for their degrees and qualifications to be recognized by us, he was not allowed to practise in South Africa. However, when the war came along he was allowed to practise in British territory under the wartime registration, and he had a huge clientele which visited him in Swaziland, where he was allowed to practise, from the Union of South Africa.
Why is this a good Bill? Because it is seeking to break down this idea that all the doctors from one country shall be recognized and allowed to practise in this country, and that none of the doctors from certain other countries shall be recognized. The mutual recognition ought to be personal. Certainly in this country—and I hope it will in others—it should depend on whether a man is properly qualified. Is it not ridiculous that the great Vienna School of Medicine was not recognized, and that every Japanese doctor, including any little quack from Nagasaki, should be recognized because he was a Japanese? Really the state of the law before the war was quite ridiculous, and the war broke it down. I hope to see the day come when there will be more interchange of medical experience, medical research workers, and medical practice between all countries in the world. Therefore, in so far as this is a new principle in that direction, I welcome it.
Really, to think that all Italians, Belgians and Japanese could practise in this country, and that nobody from the great Viennese School of Medicine was allowed to practise here, was ridiculous. That 566 was the law before the war and it is being broken down. I hope it will be further broken down and that the mutual arrangement and permissibility of practice shall be personal in the individual case. That is the only safe way and the only right way in which to administer this international interchange of men whom we and all countries want for the advancement of human health and happiness and the cure and conquest of disease.
§ 3.31 p.m.
§ LORD ALTRINCHAM
My Lords, I have one comment to add to what has fallen from the noble Lord, Lord Llewellin, and the noble Lord who has just spoken. I welcome this Bill most warmly, and not least I welcome the provision which deals with doctors and pharmacists from the Dominions. I is in regard to this provision that I would say just one word. It is only a matter of terminology, but it is an important matter of terminology. If the noble Lord who introduced the Bill will look at Clause 8 (1) at the bottom of page 5, he will see that those who are to be given temporary recognition in this country must hold either a Colonial or a foreign diploma. Subsection (3) of the same clause lays down that they are to be registered as Colonial or foreign practitioners. It may be that in the opinion of our Parliamentary draftsmen the words "Colonial" and "foreign" cover the Dominions. They are covered by the Statute of Westminster, but all I can say is that it is an improper description and it is high time that it was altered. I can quite conceive a sensitive person from any of the Dominions feeling very great resentment in finding that he has to qualify either as a Colonial or a foreign practitioner, and that the existence of such a thing as a Dominion is apparently not recognized in Bills passed through this Parliament at the end of 1947. I ask the noble Lord to look into that. It applies also to pharmacists, and although probably the terminology is correct I think it is improper, and I hope the noble Lord will amend it.
§ 3.33 p.m.
§ LORD HENDERSON
My Lords, I am grateful for the reception which your Lordships have given to this Bill this afternoon. A number of points have been raised, which the noble Lord, Lord 567 Llewellin, quite rightly said are points for Committee, and I will have them looked into. There are two, however, to which I would refer at this moment. They are with regard to subsection (5) of Clause 1. I must confess that I myself had difficulty in reading this subsection when I first came to the Bill. In point of fact I read into it the very reverse of the meaning given to it by the noble Lord. It seems to have a good deal of unnecessary language but it refers to people who are to be permanently in this country. In view of the difficulty both he and I had of understanding the language I will see whether it is necessary to have it in this particular form or whether it cannot be better drafted.
As regards the word "Colonial," I particularly noted that and I had grave doubts about it. I may be wrong, but I think it is used in the sense of meaning people coming from Colonial territories and not from the Dominions. With the Dominions we have reciprocal arrangements and, therefore, they are covered apart from the Bill. In any case any such disagreeable terminology should be removed, and I will see that it is dealt with. If I may leave it there I will see that the points are looked into.
My Lords, may I ask whether during the Committee stage the noble Lord will arm himself with such information as will enable him to give information about the position of British doctors in any particular foreign country? There are British communities abroad all over the world who like to be treated by their own doctors and they are prepared to pay for it. But in many cases I understand that the rules and regulations are such as to make that virtually impossible. We are altering our rules and regulations and perhaps the noble Lord will be prepared on Committee stage to answer any questions about individual countries.
§ LORD HENDERSON
I will certainly do my best to come prepared to cover all the countries in the world. I think it would be better, if the noble Lord has one or two countries in mind, that I should get the precise details of those countries. It is rather a large request for me to bring data about every country.
§ LORD HARLECH
So far as I can recollect, the only British doctor who practised in Oporto was not allowed to go on practising there because we refused to recognize any Portuguese qualification.
§ On Question, Bill read 2a, and committed to a Committee of the Whole House.