§ 2.38 p.m.
§ Order of the Day for the Second Reading read.
§ THE LORD PRIVY SEAL (VISCOUNT ADDISON)
My Lords, I venture to invite your Lordships to consider this very important and entirely non-Party Bill. I am sure it will be agreed that it is in accordance with the general rules which we have made as to the character of Bills that are introduced. I may perhaps say, without any egotism, that it presents to me a special personal attraction, seeing that in three months' time from now it will be fifty-nine years since my name was first entered on the medical register. I was then twenty-one years of age. Later on it was my duty to teach for a number of years. The General Medical Council and others connected with the matters dealt with in the Bill have been considering this subject for many years, and there have been careful negotiations concerning it between the different parties. The House will be glad to know that I am assured by the President of the General Medical Council that the Council welcome the Bill and are gratified that time has been 908 found to introduce it. The President has authorised me to say that the Council feel very much indebted to the Departments and other bodies concerned for their co-operation in working out the provisions of the Bill, and that they unreservedly support it. It is a Bill which has been the subject of careful negotiation for many years with different universities, statutory bodies and others concerned.
The Bill has four main purposes. The first is to take measures to improve the standard of medical education and to secure better provision for instruction in the care of patients before a man or a woman is finally admitted to full registration. Then there are proposals relating to the powers and status of the General Medical Council and others in questions affecting discipline and a number of minor matters. One of these, which will not cause your Lordships any surprise, follows from the necessity that has arisen to increase the fee. At the present time, if a man or a woman is registered he or she is at liberty to practise, to sign death certificates and, generally speaking, to discharge all the responsibilities of an experienced member of the profession. I think we shall all agree, whatever be the profession in which we have been trained, that we really begin to learn about it after we have become nominally qualified. This is abundantly true of those who have to deal with human beings in case of real or imaginary sickness.
§ VISCOUNT ADDISON
It is therefore proposed, in this measure, that when a man or a woman passes the final examination of any of the various universities or other bodies competent to grant diplomas or degrees, he or she should be required to have not less than a year's practical experience of the care of patients under adequate and proper direction in a hospital or other approved institution. It may well be that when we reach Committee stage various points will be raised about the length of this interim period, and also about the character of the institutions in which this period should be spent.
In 1942, when Mr. Willink was Minister of Health he appointed a Committee 909 under Sir William Goodenough with this term of reference:Having regard to the statement made by the Minister of Health in the House of Commons on 9th October, 1941, indicating the Government's post-war hospital policy, to inquire into the organisation of Medical Schools, particularly in regard to facilities for clinical teaching and research, and to make recommendations.One of the important recommendations made by this Committee will be found on page 196 of their Report. It is expressed in this way:There has been enthusiastic support among our witnesses, including the representatives of medical students, for the proposal that, in future, entry into independent medical practice should be preceded by a compulsory period of approved and responsible clinical practice under supervision.I believe it is true to say that that suggestion is welcomed by everybody who has first-hand experience of the practice of medicine. Under this Bill therefore, it is proposed that there should be an interim period during which a person shall, if possible, practise under supervision in some hospital or other approved institution.
When I first read this, I remembered painfully that I had to struggle against poverty for several months before I could take up a junior appointment, which in those days, I may say, was unpaid. This was often a tax on those of us who had small means, because in those days there were not sufficient house physician appointments to absorb all the men and women who qualified in a year. Having made careful inquiries, I am assured that at the present moment there are more vacancies in what are called house appointments in England and Wales and Scotland than there are people becoming qualified or passing their final examination every year. So that, on paper, there is no deficiency of posts. But it will be for the General Medical Council to consider what is meant by "an approved institution." It is clearly desirable that if a man is to have practical experience there should be a sufficient number of beds with patients for him to get that experience, and that problem will have to be dealt with carefully.
In view of the possibility that it may not be practicable to bring into force everywhere at any one time the provision for this interim period of training, it is laid down in the Bill that the General 910 Medical Council shall appoint the day on which this provision shall come into operation. It may be that the same day will not be appropriate in every place. For example, I understand that in Northern Ireland at the present time there is an excess of posts available, but that that may not be so in other parts of Great Britain. Power is therefore taken in the Bill for the Council to bring this scheme into operation on an appointed day—that is to say, when there are sufficient posts of a suitable kind to accommodate all the men and women who have passed their qualifying examination. I am sure we shall all agree that a year passed in dealing with patients under adequate supervision will be an immense advantage, not only to the medical practitioners themselves but also to the public who are their patients. It will be a welcome improvement to the scheme of training. In some parts of the Commonwealth—for example, in New South Wales and in South Africa—such a scheme is already in operation, and provision is made in the Bill for reciprocal arrangements between ourselves and the Commonwealth countries concerned in regard to places where training is undertaken. That is an important provision of the Bill. I think it will lead to a great improvement in the standard of training, because at the end of this period it is proposed that the period of provisional registration will come to an end and the men and women will then be fully registered.
It is also provided that the General Medical Council shall be able to visit and inspect medical schools and examine their standard of training. At the present time all that the Council do is to send visitors and inspectors to examinations. I remember, when I was an examiner at my university, having the benefit on one or two occasions of the presence of visitors. The only certainty I had was that they did not know anything like so much about anatomy as I did. However, they were probably there to see that I did my job properly That was the extent of the powers of the examiners; and it remains so now. It is proposed that they shall be entitled to visit medical schools. On that point I have this to say. I feel it will be sensible that there should not be too great a multiplicity of bodies with powers to inspect. Quite properly, the universities must 911 acquaint themselves with the standard of training and the equipment of the teachers, and as to the laboratories; and the University Grants Committee, who make large grants, have the same authority. Therefore, I feel it is reasonable to hope that this new power of inspection and visitation will be co-ordinated and combined with the exercising of the same powers by these other bodies. I am assured that that will be the aim.
Another part of the Bill deals with the important point of the constitution of the General Medical Council. At the moment this body is rather large and, as we all know, the Council have great powers in the matter of discipline when cases are brought before them. If a medical man, on their decision, is struck off the register, it means that he can no longer earn his living by practising that profession. That is a particularly drastic power. It has been represented for many years past that the constitution of the Council might be improved. The result of this Bill, so far as that matter is concerned, is that the improvement takes the form of making the Council larger still—instead of thirty-nine members, as at present, under the provisions of the Bill the Council will have forty-five members. But linked with that is a demand, which has been expressed vigorously, that, in view of the fact that this Council, if a case is proved against anybody, will have power to strike the person off the register, the members elected by medical men shall be greater in number than they are at present. There are now five members nominated by the Crown, and seven elected members. The different universities and other bodies who have power to grant diplomas can each appoint one member, and in all there are twenty-seven of them. Added to that we must now recognise the Royal College of Gynæcology and Obstetricians, which makes the number of members twenty-eight. It is proposed in the Bill that the number of members elected by the medical men themselves shall be increased to nine—six in England and Wales, two in Scotland and one in Ireland.
I dare say that in Committee points will be raised about these numbers. There is no doubt as to the desirability of increasing, to some extent, the number of elected members. The Crown members 912 are increased to eight. At present there is power to appoint only one layman. In view of the great variety of functions of this Council, I think it is right that there should be more than one layman (my noble friend Lord Nathan is at present the only layman on the Council), and it is proposed that there should be power to appoint three. It is clear that a body of thirty-nine was rather cumbrous to deal with the trials of offences, or alleged offences, and a body of forty-five is open to even greater objection. It is therefore proposed that there shall be a specially appointed Disciplinary Committee which, apart from the chairman, will have only nineteen members. This will certainly be more manageable than a large body of thirty-nine. It is also provided that of the nineteen members of that Disciplinary Committee at least six shall be appointed from the elected members of the Council. That means that substantially one-third of the Disciplinary Committee will be medical men who have been elected by their fellows. I feel that that is a fair proportion, and it is certainly a great improvement upon the present procedure.
In addition to having a more manageable and better constituted Disciplinary Committee, there is a further important provision in this Bill. When a medical man is struck off the register at the present time, he has no opportunity of appeal. It is desirable that there should be opportunity to appeal, and that is provided for in the Bill. The question of to whom the appeal should be made was carefully considered, and I am sure there will be general agreement that the proposal that the appeal should be to the Judicial Committee of the Privy Council is both practical and right. It will be the duty of my noble and learned friend the Lord Chancellor to approve certain rules which will be submitted if they have to go to the Privy Council; and it is also provided that an assessor shall be appointed, who will act under rules made by the Lord Chancellor.
In these times of increased costs, it is hardly necessary for me to point out to your Lordships the reasons why the final fee for full registration is raised from five to eleven guineas. The fee for interim provisional registration will remain at five guineas as at present, but when the final interim period is finished and a man or woman is added to the register, with all the authority which that entails, the fee 913 will be increased to eleven guineas. A further welcome proposal in the Bill is that the name of the body, instead of being the General Council of Medical Education and Registration of the United Kingdom (that is a cumbersome name, and the initials have often befogged many of us in the past) will in future be known as the General Medical Council—and "G.M.C." will be fairly easy to remember. It has been known as the General Medical Council, of course, for many years past, and that will now be its statutory description.
Finally, what is to be the position of Parliament with regard to these rules which will be submitted to the Privy Council and which in certain cases will be bound to deal with matters which vitally affect the livelihood and well-being of medical men? It is provided in. Clause 30 of the Bill, with regard to the more important provisions on which rules shall be made, that they shall be subject to annulment in pursuance of a Resolution of either House of Parliament. It may well be that we shall have some discussion later upon the precise form of procedure to be adopted. I have sketched the general outline and the main provisions of the Bill. This is a matter of first-rate importance, not only to the medical profession but to all who look after and care for the health of the people. I beg to move.
§ Moved, That the Bill be now read 2ª.—(Viscount Addison.)
§ 3.0 p.m.
§ LORD LLEWELLIN
My Lords, we are all indebted to the noble Viscount the Leader of the House for having outlined this measure to us in the way he has, and we are all interested to know that it is fifty-nine years since he qualified as a doctor. I am quite certain that, in accordance with Clause 2 (2) (b), "his service while so employed has been satisfactory," entitling him to receive a certificate. We are delighted to have him, with his vast experience, introducing this measure to us to-day. I am told that before the war only about 50 per cent. of the young doctors who qualified went through a hospital before taking up practice, and that during the war, under the arrangements then made—by which doctors had to be apportioned between the Armed Forces and tie civilian population—about 90 per cent. worked in a hospital for at 914 least six months after qualification. The noble Viscount, Lord Addison, has already quoted to us the recommendation of the Goodenough Committee (which was set up in 1942 and which reported in 1944) that they had overwhelming evidence that there should be a compulsory period of practical training in a hospital or in some other approved institution. I think all your Lordships will agree that that is a good thing, and that we shall also agree with the principle which lies behind the first five clauses of this Bill, that at least twelve months is the right time for such practical experience.
It may be that when we have discussed this Bill further we shall find that the twelve months laid down is perhaps a little rigid. We do not want men or women passing their examinations and then kept hanging about before they can practise because there are not enough vacancies for them to co into the appropriate hospital or other approved institution. Twelve months seems to be about the right time because in another profession, that of the Bar, it is customary that either before or after passing the Bar examinations the young barrister goes into Chambers as a pupil, under the guidance of an experienced barrister, before he undertakes cases on his own in the courts. Young solicitors always have to be articled before they can practise as solicitors. Therefore, in the profession of the law, both in the case of barristers and solicitors, a part of their preliminary training is spent in practical work under an experienced lawyer. In those two professions the men may give bad legal advice, but it will affect only a man's or a woman's pocket. The doctor has a far greater responsibility than that: he has the responsibility of giving advice or recommending treatment which affects a man's or a woman's health—and, therefore, their ability to earn any money at all. Indeed, such advice or treatment may affect life itself. Therefore, I believe that these provisions in the first five clauses of this measure are eminently correct.
I noticed that according to this morning's newspapers the noble Lord, Lord Quibell—I am sorry he is not in the House—has been commenting on the number of doctors now employed in hospitals compared with those formerly so engaged. There is probably a lot in what 915 he says, but if these young doctors are I undergoing practical training, I think it is right that they should be there. It is something to be welcomed, and which we must expect once this Bill has become law. The Goodenough Committee reported that as a nation we are justified in taking pride in the reputation of British medical practice and of traditional British methods of medical education. I believe that this part of the Bill will enable us to take even more pride in the future, because during this compulsory practical training we may raise even further our medical standards in this country.
The value of this provision in the Statute must, of course, depend upon the way in which it is carried into effect. There must be sufficient places in suitable training hospitals or other institutions, and the young doctors must be given some measure of responsibility and yet be given sufficient time for consolidating their knowledge and widening their experience. The Goodenough Committee laid stress on provision being made for these young men and women to have free board and lodging and to be paid an appropriate and uniform salary. I hope that that will take place, and that they will not find themselves in the position described to us by the noble Viscount, Lord Addison, who said that when he had to take one of these hospital appointments he had to live entirely on his savings in order to obtain the experience which was necessary for him. I hope that we shall have some assurance that these young men and women will be paid a reasonable and adequate salary, and that in most cases they will be given the board and lodging which they clearly should have.
I now come to Clause 5, which is a new kind of provision in our Statutes. Other parts of the Bill deal with the United Kingdom, with parts of the Commonwealth or Empire, and with foreign-qualified doctors; and then we find a new provision about this area which is suspended 'twixt heaven and earth—the Republic of Ireland. We have a special clause to deal with that particular provision—I refer particularly to Clause 5 (3), which states:In the case of any such person registered by virtue of the said provision of the law of 916 the Republic of Ireland, no fee shall be chargeable for provisional registration.I should like to ask whether that is going to be reciprocal and whether Clause 5 is based on some consultation between the authorities in Southern Ireland and ourselves, or whether it is based only on an idea of what might happen. At the same time I should like the noble Lord who is to reply to glance at Clause 22 (3) (a), because Clause 5 (3) says that in the case of these persons no fees shall be charged for provisional registration. But there is no similar provision in regard to permanent registration: in those cases there is to be a fee not exceeding six guineas for those who come from Southern Ireland. I should like to know from the noble Lord whether, both in the case of provisional registration and full registration, matters are going to be reciprocal between this country and Southern Ireland.
Now I come to Clauses 6 to 11. I quite agree with the noble Viscount, Lord Addison, that it is far better to call this Council, in the Statute Book as well as in practice, the General Medical Council, rather than employ the long list of words which I am not surprised to hear that the noble Viscount himself could not remember on the spur of the moment. For years this body has been called the General Medical Council, and I suggest we had better have it so called on the Statute Book. The directly elected members are, I see, increased in number for England and Wales from five to six, and for Scotland from one to two. That is a step in the right direction. But there are still to be only nine elected members out of a body of forty-seven—which is the total, including the President. I think the elected element might well be larger. Previously it was 17 per cent. of the body, and now it is raised only to 19 per cent. That does not seem to me to be a large enough elected element. I do not think the number of representatives of the bodies that award the diplomas can be cut down; but it may well be that we can add to the number of the elected representatives. Once membership of a body is as large as forty-seven, it does not matter very much if another three or four are added. It is already a fairly large and unwieldy Council if it numbers forty-seven.
I am not sure whether the time has not come to give some representation to Wales. We are giving it to Scotland. 917 After all, Section 6 of the Medical Act of 1858, sot up a branch Council for Wales, as well as branch Councils for England, Scotland and Ireland; but at the present time Wales is still included with England. We ought to consider whether we should not give Wales the same representation as others, or at any rate guarantee that there should be some Welsh representatives. Just as we used to say in other connections, when setting up various Committees, that one or two at least should be women, so we might say here that one or two of the members should be medical practitioners practising in the Principality of Wales.
Clause 10 is more a matter for another place than for your Lordships. It gets over the difficulty of the position of people holding an office of profit under the Crown who happen to serve on this Council. In 1945 a Select Committee of the House of Commons laid down in detail the provisions of a proposed Bill to clarify the whole law in regard to what was and what was not an office of profit under the Crown. I should have thought that this was prima facie the kind of Session where a Bill of this sort, clearing up the whole position, might well be introduced by the Government of the day. It would, of course, be completely non-controversial, and that would be much better than dealing with the matter piecemeal.
The disciplinary provisions, I feel, may need careful scrutiny on the Committee stage. We have to be extremely careful about these matters. The erasure of a doctor's name from the medical register often spells economic ruin, and sometimes social ostracism as well. I very much welcome this much smaller Disciplinary Committee. It is much better thus than for these cases to be tried by the whole of the Medical Council. Certainly, forty-seven would be far too many people to hear cases of this sort. I believe that in other spheres—I do not know whether the noble and learned Viscount on the Woolsack will agree with me or not—nineteen has been found too many. I would much sooner see the smaller panel—a panel composed, say, of the President, and six, or even four, other persons. That would make a tribunal such as is now laid down for quarter sessions—that is to say, about five or seven people. I think we ought to look at this matter during the Committee stage. I am told that, in the case of a 918 solicitor, three persons form a quorum, and that nine persons are appointed to take part in proceedings in which the solicitor's conduct is called into dispute. Something like that would be a great advantage. I very much welcome Clause 15, which states that the Council shall appoint as an assessora barrister, advocate or solicitor of not less than ten years' standing.After all, however eminent many of the members of this Council may be in their medical practice, there, have no doubt been cases where not one of them has known much about the laws of evidence,—what ought to be admitted as evidence, what is mere hearsay or what ought to be excluded. I very much welcome the fact that there will be an assessor to advise them on points of that sort.
I also welcome the right of appeal which is introduced by the present Bill. Of course, it is the Privy Council to whom the appeal goes and they refer it to the Judicial Committee. I was a little doubtful whether the Judicial Committee were the appropriate body. Trials before the Judicial Committee are normally more expensive than those before the High Court, and this is the final appeal. On the other hand, there is the advantage in the Judicial Committee that it will avoid any conflicting differences between the High Court here, the Court of Session in Scotland and the appropriate court in Northern Ireland; so perhaps on balance it may be the right tribunal to which an appeal should go. I am a little doubtful about Clause 16 (2) which lays down that:For the purposes of any inquiry … whether a person has boat guilty of infamous conduct in any professional respect, a finding against him in any matrimonial proceedings in the United Kingdom or the Republic of Ireland, being proceedings in the High Court or the Court of Session or on appeal from a decision in such proceedings, that he has been guilty of adultery with a particular person shall be conclusive of that fact.There are, of course, many other types of unprofessional conduct which may be cited. They were referred to by my noble and learned friend Lord Simon, in giving judgment in the case of the General Medical Council v. Spackman, reported in 1943 Appeal Cases. We are merely picking out here one set of circumstances which shall be conclusive; we are not dealing with other matters. I rather veer to the opinion that, if he wishes, the man 919 ought to be able to bring those matters in issue again when he is being tried, as it were, for his livelihood. But perhaps that is more a Committee point.
I now come to the Interpretation clause, Clause 31, which states:'appointed day' means such day as the Privy Council may by order appoint, and different days may be appointed for the purposes of different provisions of this Act or for the purposes of the application of any such provision to different classes of case.So far as I can make out, under this Bill as it comes before us there are at least six different types of appointed day. What I would like the noble Lord who is to reply to tell me, if he can, is whether the Government have any idea what length of time will elapse after this Bill becomes the law of the land before these different appointed days can come into effect. It would be interesting to know what sort of timetable the Government have in mind in regard to bringing this measure into effective operation. As the noble Viscount the Leader of the House said, this is in no way a controversial measure. While welcoming all its main provisions as right in principle, we shall give the Bill our attention during the Committee stage to see whether as a result of discussions between us certain clauses cannot be improved. Your Lordships can rest assured that, so far as lies in our power, we on these Benches will not enter into such discussions in any controversial spirit but merely to try, as we always do in all parts of this House, to ensure that the measure goes from this House as good as we can possibly make it. With those words, I should like to wish this Bill a successful passage through this House.
§ 3.27 p.m.
§ LORD HORDER
My Lords, in the first place, I should like to join with my noble friend Lord Llewellin in thanking the Leader of the House for his clear exposition of the principles underlying this Bill. Despite his preoccupation with anatomy and politics over a number of years, I think it is still most appropriate that this Bill should be introduced by a member of my own profession. Both in this House and outside, I have been rather a severe critic of the Government, during the last two or three years. I am not contrite. I still think that in some respects the practice of doctoring in this 920 country has been mishandled by the Government. When some of us charged the Government with trying to get control of the doctors in this country, the charge was indignantly denied. "Who could suppose," said the Government apologists, "that any motive underlies the proposed Act, other than the achievement of better doctoring for the community? "Whatever the true answer to this question may be, we find to-day, the teething stage of the Act being over (and "teething" is perhaps not inappropriate in connection with the Act) that the doctors are under control and that not only has the promised betterment in the standard of doctoring not arrived but, in the judgment of many of us, the standard has in fact deteriorated. Vast sums of money have been poured out for the Health Services of the country, and we consider that as yet the country has not received an adequate return.
To-day, however, I am on the side of the Government. I believe that the first five clauses of this Bill do, or should if properly administered, add considerably to the efficiency of doctoring and general practice in Great Britain. The Bill does not improve the conditions of doctoring but it does give the doctor the best chances of being efficient. If we consider for a moment what are the assets of a good doctor, I would say that they are four. I should put first a fitting and cultivated personality, without which nothing can be done; I should put next a thorough training in his profession; I should put third his ability to cream off from science the best that science can offer in the diagnosis and treatment of his patient, and I should put fourth a sense of responsibility. If any one of those assets could be strengthened in the British doctor, I should say it is the fourth. The old apprentice system having died out and there being nothing with which to replace it, immediately after qualification and synchronously with registration the young doctor goes out into practice ill-fitted in respect of the sense of responsibility and judgment (which is born only of experience) and the ability to declare the inherent principle which is in him. If properly administered, the present Bill can render assistance in that respect.
The history of the principle underlying the first five clauses of the Bill has been very clearly put before us by the noble 921 Viscount the Leader of the House, but, as my noble friend Lord Llewe]lin said, it will take some time to implement that principle. Several points call for careful consideration, and I hope I am not trespassing too far if I mention them briefly. First, is it clear that this additional year—the year which the provisionally registered qualified medical men and women have to put in for the sake of perfecting themselves as doctors—is to be added to the present five or (as it may sometimes be) six years of the ordinary curriculum? That is perhaps a position that should be safeguarded, so that the present curriculum is not so modified as to make this very desirable twelve months part of the five or six year period. Another point is, what is to be the status of the qualified but only provisionally registered doctor? I suggest that the provisional registration should entitle him to full responsibility and privileges within the terms of his appointment, such as are accorded to registered medical practitioners in general. The question has arisen, for example, whether he is legally entitled to prescribe dangerous drugs. I submit that that is a point which requires a little consideration and should be made clear. May he sign death certificates? May he certify as to insanity? Together with some others which I propose to raise, I think those are points which can be definitely established in the final drafting of the Bill.
The question of remuneration is mentioned. Should the remuneration of the provisionally registered doctor be the same as the present rates for house appointments? My answer would be that it should be at least at the level of those rates and not below them. When does the remuneration of the provisionally registered but qualified medical man begin? We cannot of course have a number of these provisionally registered men and women sitting about unremunerated, because that would mean that they were being prevented from earning a livelihood. So this point also will require some clarification. The noble Viscount felt that he could reasonably assure us that there was a sufficiency of hospital appointments available for these provisionally registered doctors. I am not certain of that. It is not only a question of how many institutions or hospitals can be approved; it is also a question of the availability of a sufficiency 922 of clinical material. These people are still being trained. Granted, they are being trained in a different but an equally important sense as when they were trained as medical students; but I consider that any approved hospital should be able to provide a minimum of twenty beds or an equivalent number of out-patients—preferably, of course, both in and out-patients—before it is approved. The mere statement that there are so many thousand available posts answers only one of the desiderata, the other, in my judgment, being that there should be a minimum requisite number of beds or of out-patients. It may then be found that there are not sufficient of these posts.
Suppose that that should happen. Would it not be a good thing then that some of these people should be accredited to recognised, approved groups of medical practitioners? If the objection be made: "How can we decide to which group of practices we can safely attach these people? "I would give as a tentative answer: "The Government has already approved health centres." We know that that was a vision; we know that that was an attraction of some magnitude to the doctors before they signed on the dotted line; and now, two years after the appointed day, we know that health centres do not exist, that priority must be given to houses and homes, and so on. This proposal might be an incentive to get on with the health centres, so as to provide some venue in which these qualified, provisionally registered young men and women can work. We must remember that this idolatry of the hospital has gone rather far. These young men and women are not going to be faced with hospital practice; ultimately they are going to be faced with domiciliary practice. If we put them into positions such as are suggested, should they become keen on major surgery and specialist forms of practice we shall defeat our object. Our object is to make them more efficient doctors, not to feed their already avid desire to leave the ranks of general practice and become specialists. Therefore I am merely putting it forward that perhaps the Bill could be so drifted (I believe it says "approved hospitals or approved institutions") that a health centre might be regarded as an institution. I should like that point borne in mind.
923 Then with regard to "specialties," as we term them in our jargon—diseases of children, diseases of the eye, diseases of the skin, and obstetric practice—is experience of these medical or surgical? Here again it may be that in the actual wording of the Bill the medical and surgical spheres could be so expanded as to include these special subjects. They are all-important subjects, and special hospitals where they are taught, and where patients suffering from these particular diseases are treated, would be an admirable field in which to place a number of the provisionally registered men and women. Some other matters that must inevitably crop up in the implementation of this Bill will be dealt with by regulation. May I plead on this occasion that before they are issued such regulations may be discussed with members of my profession? We were promised that in another connection, but the promise has not been fulfilled. It seems to me that it would be lamentable if any administrator attempted to carry out this quite admirable principle without very free consultation with—if I may be egregious for the moment—those of us who do know.
As to the second part of the Bill I have not much to say, but I would offer a few comments. The Bill provides for two more directly elected representatives to serve on the General Medical Council—that is, an increase from seven to nine. I agree entirely with the last speaker, Lord Llewellin. I think that even nine is an insufficient number, and that twelve would be better. I am one of those who hold the view that if you want to keep order in a house you should give some power to the master of the house—though it may be said that the doctor is no longer the master in his own house. With regard to the question of the code of conduct, I would submit that from Hippocrates downwards the doctor has had not only much to say but the major say in what is good and what is not good in his code. Therefore I would plead for rather fuller direct representation on the General Medical Council.
Now as to the question of appeal. Like Lord Llewellin, I was very doubtful whether the appeal suggested—namely, to the Judicial Committee of the Privy Council—was as good as a right of appeal 924 to the High Court. Right of appeal to the High Court allows of a still further appeal to your Lordships' House, whereas appeal to the Judicial Committee of the Privy Council does not so allow. However, I have had the advantage of discussing this point with my noble and learned friend Lord Simon, and I received an assurance from him that this was all right, that it was satisfactory that the appeal should be to the Judicial Committee of the Privy Council. In fact my noble and learned friend rather led me to think that it was the more satisfactory of the two alternatives. Therefore on that point I have nothing more to say. From reading the Bill, I am not clear whether a very useful part of the machinery of the General Medical Council, the penal cases committee, will still function. Perhaps that is for the General Medical Council themselves to decide. But if the committee—which is a sifting committee—is to continue, I hope that it will have a different personnel from the Disciplinary Committee, who have a final say in regard to matters brought before them.
My last comment is in respect of Clauses 16 and 17. I understand that although not bound to do so under the present Medical Act—the Act of 1858–the General Medical Council do, in fact, arrange for what is termed "due inquiry" when a doctor has been convicted of felony or misdemeanour. As I read the present Bill, it would be possible for the Council to proceed to erasure of a doctor's name in these circumstances without a formal inquiry. The defence bodies of the profession, who after all handle 90 per cent. of the cases on the doctors' behalf, tell me that they consider it would be very undesirable that there should be no formal inquiry or that the habit of making an inquiry should be dropped. They therefore contend strongly that Section 20 should be so amended as to provide for this due inquiry to take place in all cases. Questions have arisen as to the total number of members on the Disciplinary Committee and as to what size the quorum should be. As a doctor, and one who has not so far had the misfortune to come before the General Medical Council, I have no views on this point, and I will willingly accept the best available legal advice—and the best legal advice is available—on this point.
925 My Lords, the last time I spoke in your Lordships' House I pleaded with the Government concerning certain disruptive aspects of the National Health Service Bill. The noble Viscount who leads us, when he saw me outside the House, exercising the privilege of a very old friendship, which to me is also a valuable one, said he could not understand how I could talk such rubbish. May I diagnose, by looking at his face to-day, that my stock has risen a little in his estimation, and that there is more sense, therefore, in what I have tried to put before your Lordships? All the same, I would say that in the near future I may still fall from grace in Lord Addison's estimation. But I am not unduly disturbed by the thought that he joined the medical register five years before I did—for the reasons which I gave when I opened these remarks. His preoccupations have been very important and very successful, but for many years they have not been medical.
§ 3.50 p.m.
§ LORD AMULREE
My Lords, I certainly do not wish to take up your Lordships' time, because there is a long list of speakers in front of us and most of the points which I might have made about this Bill have already been made. I should like to join with noble Lords who have spoken in giving a warm welcome to this Bill, because I feel that, whatever be the profession or section of the population to which we belong, we must be pleased to find that some reformation is taking place in the functions and constitution of the General Medical Council which have for a long time been discussed amongst doctors and lawyers.
I should like to take up one or two points. The first is in connection with the period of provisional registration laid down in Clause 2. We have been told that the number of posts that will be available in hospitals will be sufficient to meet the number of qualified students who will be coming along, and I am prepared to accept that assurance; but, like the noble Lord who has just spoken, I would put forward a plea for the possibility of part of the twelve months being spent with an approved panel of general practitioners. The point was raised in Chapter 15 of the Report of the Goodenough Committee, which merely says that the proposal was brought up for con 926 sideration but the Committee did not recommend its adoption because of the serious difficulties that would arise in the choice of suitable practitioners and subsequent supervision of students' work. I cannot see that that is a valid objection, and I wonder whether the noble Lord, when he replies, can give some reason why it is impossible for students to spend part of their time with an approved general practitioner or group of general practitioners. Clause 2 (1) says that it will be possible for part of this time to be spent in an approved institution. I would join with the noble Lord, Lord Horder, in asking whether that means in one of the health centres, no matter what their form is going to be whether one of the newly built centres or a modified one.
And again, what is to be the status of those qualified but not registered practitioners? The question arises whether they can sign death certificates or prescribe dangerous drugs. Suppose they cannot, then there must be some kind of house physician or house surgeon working above them. That will mean that after the twelve months of supervised training they will need to take further jobs as house officers, which will prolong the period before they can go into practice. I should like to be assured that the people doing these jobs will have full status as practitioners and will not be in a sort of semi-responsible post. In regard to the recommendation that hey should spend part of the time with practitioners, even though that may be only experimental for some time or tried out in one or two cases, I think this would improve the status of the general practitioner. There is rather too much emphasis on the importance of the work done by the hospitals. Important work is done by consultants and specialists there, but if students were encouraged to spend part of the year with practitioners it would mean that many of them would be more willing than at present to go into practice. At the present moment, a great proportion of students wish to become consultants—a very laudable desire, but one which is quite incapable of being fulfilled; and it is not until they have tried once or twice to become specialists that they rather reluctantly go into practice. If training under a general practitioner were made an important part of their training, it might draw more people to that side of the 927 profession, and that, I think, would be to the advantage of the profession in general.
I join with noble Lords in welcoming the fact that a practitioner who has been struck off by the General Medical Council will now have the right of appeal. I do not know whether this point is covered by the Bill or not, but I should like the General Medical Council to have the power to give some punishment other than striking off the register. I do not see in the Bill any mention of the power of suspension. Perhaps the Council can arrange this matter themselves. I wondered, however, whether the form of punishment could not be laid down in the Bill, as in other Acts of Parliament. My last point is perhaps purely one for the Committee stage. I wonder whether the words "guilty of infamous conduct in any professional respect" could be changed. I would suggest something simpler, such as "professional misconduct." The words in the Bill sound rather medieval and formidable, and I think that these I suggest are quite as unpleasant and just as damning.
§ 3.58 p.m.
§ LORD WEBB-JOHNSON
My Lords, I do not want to intervene for more than a moment, because most of the points I should have raised have already been dealt with. Speaking in general terms, I think it is unfortunate that Clauses 1 and 2 should be drawn so rigidly as to bind the General Medical Council in certain respects. For example, a minimum period of twelve months is laid down, but twelve months may prove not to be practicable. And it may well be that if the General Medical Council were not so rigidly bound the reforms we all so heartily desire could be introduced at an earlier date. It may be that the Council will find difficulty in finding the requisite number of posts to fill the requirements of the Bill. As an example, I would call your Lordships' attention to Clause 3 (c) where, in the case of a practitioner or qualified man in the Commonwealth, or from a foreign country, the General Medical Council are empowered to accept that he has "otherwise acquired such experience." I should have thought that the same provision might well be applied to our own countrymen.
In regard to the Disciplinary Committee, and the clauses dealing with that 928 question, I should like to support the noble Lord, Lord Llewellin, when he says that he thinks the Committee is too large for a tribunal. It may well be that the panel should be large, but the number selected to sit on any trial should be limited, not by laying down a quorum but by providing that the number sitting should be limited to a more reasonable figure. I also support the noble Lord, Lord Horder, in the view that there should be some sifting committee independent of the tribunal. I am considerably disturbed by the fact that the decision of this tribunal, which may have such serious effects on the individual, spelling practical ruin, can be arrived at by the casting vote of the chairman, in addition to his ordinary vote. I should have thought that it would be wiser to say in the Bill that a conviction carrying such a terrible penalty should depend on a clearly stated majority.
There are other points in regard to the disciplinary side which have disturbed many members of the profession, and some of them have been mentioned today. One is that there is only one charge— it may be beautiful English, but it has an ominous sound—namely, "infamous conduct in a professional respect." I am sure that "professional misconduct" would be the term adopted by other professions. There is a further source of anxiety about this disciplinary procedure — namely, that in practice, if not in fact and in law, there is a verdict either of guilty or that the charge is not proven. Now that witnesses can be put on oath, I should have thought it reasonable that a man who was completely exonerated should be declared not guilty, rather than that the charge was not proven. I would support the noble Lord, Lord Amulree, in suggesting that there might be power to give some other sentence than erasure from the register. I also support those noble Lords—including the noble Lord, Lord Horder—who suggest that even if there is a report on conviction, or a report of something in divorce proceedings which is regarded as "infamous conduct," it should be the duty of the Disciplinary Committee to hold "due inquiry" in spite of those reports. My only anxiety with regard to the appeal is lest the cost of appeal to the Judicial Committee of the Privy Council should be prohibitive. I dare say we shall receive assurances on these points. I am hoping 929 that the noble and learned Viscount on the Woolsack will be a guide and philosopher in steering us on the right path in regard to these legal points on which many men are very disturbed.
Finally, as this is a Medical Bill and not a General Medical Council Bill, we should consider whether there is any important point outside the provisions already drafted which might be included. One point that has been brought to my notice is that while the curriculum is extended by a year, while the training is much more exacting, and while the public are more dependent on scientific guidance in time of illness, yet the maximum penalty for a man masquerading as a qualified practitioner without any grounds for so doing is only £20.
§ 4.4 p.m.
§ THE LORD CHANCELLOR (VISCOUNT JOWITT)
My Lords, it has been suggested that I might say a few words to your Lordships at this stage, though I propose to talk only about the legal provisions and, in particular, the Disciplinary Committee. Let me say, quite frankly, that I regard a committee of nineteen dealing with disciplinary questions as on the large side. I would much rather have had a committee of, say, nine—which is a quorum with its chairman—because I think it is important that you should be able to get the chairman and the committee acting as a body and as a whole. I feel that that becomes difficult with a number such as nineteen. However, this point has been discussed with the General Medical Council, and they are particularly anxious that all interests should be represented. It is for that reason that the number nineteen has been selected. I believe I am correct in saying that at present the committee is the whole body—and I think it now comprises thirty-nine. Nineteen is better than thirty-nine, from my point of view, though I confess that I feel nine would be better than nineteen. That is a matter which we shall certainly consider on the Committee stage, and if we can get agreement on some such lines as those, I personally should welcome the membership of the committee being made only nine.
I am pleased that there has been so little criticism of the provision—for which I must admit I am mainly responsible for an appeal to the Privy Council. I saw the doctors about this matter. They all 930 thought it undesirable that there should be three appeals, one to the High Court in England, one to the Court of Session in Scotland and another to the appropriate Tribunal in Northern Ireland. Each body might lay down its own standards, and they might be differing standards. Everybody thought—and it is obviously the fact—that was most undesirable. Yet the General Medical Council and the Disciplinary Council will, in practice, always meet in London. If they were peripatetic, and sometimes sat in Belfast and sometimes in Edinburgh, it would be easier to provide that appeals from their decisions when sitting in Edinburgh should go to the Court of Session, and so on. But I came across this practical difficulty: that it is extremely difficult to decide what is a Scottish case: and what is an English case. There might be a case of professional misconduct involving, for instance, adultery, when the adultery took place on both sides of the Border. In trying to arrive at a definition it is difficult to define which would be the appropriate tribunal. The Scots are rightly jealous and proud of their system of law—and the more I see of the Scottish system of law the more I realise that they have every reason to be proud of it.
The advantage of going to the Privy Council is that you are there going to a Court which has upon it the most eminent Judges from England, Scotland and Northern Ireland. There may be some criticism, because this is not what we have done for dentists, for pharmacists and for other similar cases. However, in this instance I thought we were justified in doing it. I think it has given the medical profession complete satisfaction and, so far as I can gather, it seems to satisfy your Lordships. The idea that an appeal to the Privy Council is necessarily expensive is wrong. In the first place, the person accused can appear in person, if he so desires; and secondly, in practice, I am assured that the great majority of doctors, if not all, belong to a Medical Defence Union who see them through their difficulties. But even if that is not so, I have no doubt that we shall be able to avoid undue expense failing on a particular person who desires to get his case heard. All these matters are typical Committee points, and your Lordships will not find me unyielding or unreasonable in regard to any of them.
931 I should like to say a word or two about Clause 16, which has not been fully comprehended. Ever since the Medical Act, 1858, the law has been that wherever there has been a conviction, the General Medical Council (as they used to be—the Disciplinary Committee as they are to-day) take that as a fact. They then have to consider simply whether that conviction is of such a grave character that it should involve a man being struck off the register. I feel that that is reasonable. Otherwise, just contemplate what might happen. Suppose there was a doctor convicted of murder, and let us assume that he is reprieved and is sentenced to penal servitude for life. It would be quite intolerable that this Disciplinary Committee should have to try all over again the question of whether he had or had not committed a murder, a question which had been pronounced upon by the appropriate court. They accept the fact of the conviction, therefore, and, of course, in the case I am putting it would be obvious that the man would be unfit to remain on the register. In the case of a lesser crime, under the Act of 1858 they have to accept the fact that the man has been guilty of that crime, and then they have to consider whether that crime is of such gravity as to make it necessary to strike his name off the register.
Divorce has been a difficult question, but in the Spackman case, which was decided by this House in 1943, a principle was laid down which I venture to think was really obvious on the law. The Act of 1858, Section 29, reads as follows:If any registered medical practitioner shall be convicted … of any crime or offence, or shall after due inquiry be judged by the general council to have been guilty of infamous conduct in any professional respect, the General Council may, if they see fit, direct the registrar to erase the name of such medical practitioner from the register".Now in the case of adultery, obviously, under the words of Section 29 of the Act of 1858, they could remove him only after due inquiry. The due inquiry which they had to make, according to the Act, was both as to whether the man had committed adultery and as to whether the person with whom he committed adultery was in such a special relationship to him as a doctor that there was the element of 932 professional misconduct. What we propose here—and this again is a point we can consider on Committee—is this. Where he has been found by the appropriate court to be guilty of adultery, is the Disciplinary Committee to accept that fact? If they do not they are virtually sitting as a court of appeal from the Divorce Division, which is the last thing they want to do and the last thing I think they are fit to do. The fact being granted that he has been guilty of adultery, what they have to consider is whether or not the relationship and the circumstances of the case were such as to make that in any way an act of professional misconduct such as to justify striking a man off the register. I think that is the right way in which to approach the matter, but it is a question which we shall most certainly consider on the Committee stage, if noble Lords so desire.
I believe those are the main points which were raised, and I feel happy to think that upon this part of the Bill there has been general acceptance of the proposals which we make. We shall certainly welcome a discussion on the Committee stage, because we are most anxious to make this Bill as good as we can. The only other point which was raised was whether or not there should be a power to reinstate. I think I am right in saying that at present the only power of punishment that the General Medical Council have is to strike off the register, but what they do in practice from time to time is to postpone judgment. Under our Bill, we are proposing by Clause 19 that where the name of the person has been erased the Committee may, if they think fit, at any time direct the registrar to restore that name to the register. In that way we shall arrive at the result which I think is desired. The Disciplinary Committee will strike him off, and thereafter he can apply to be restored to the register. I have no doubt that in deciding whether or not to do that, the Committee will have regard to the gravity of the offence of which the man was accused and convicted. We arrive at this result in a rather indirect way, but whether or not it might be better to state that there should be a power of postponement for a definite time is one of the matters which we can certainly consider in the Committee stage.
§ VISCOUNT SIMON
Would the Lord Chancellor add one word on another 933 point? I do not wish to make a speech, but it may be that this particular point did not reach his ears. If I understood my noble friends rightly, both Lord Horder and Lord Webb-Johnson made an observation which was addressed to subsection (1) of Clause 16. As I followed it, they said that there ought to be due inquiry before a doctor who had been convicted of an offence was struck off the register. I venture most respectfully to think that the comment is based on a misunderstanding. I think subsection (1) is needed solely because in the interval since the Medical Act of 1858 was passed, there has come into existence the Republic of Ireland; therefore the words which were put in the Medical Act long ago and applied simply to the United Kingdom must apply also if the conviction is a conviction in the Republic of Ireland. Suppose that there has been a conviction. If I understand the position rightly, that does not mean that the Disciplinary Committee will strike off the doctor's name without notice to him, or in his absence. The first step would be that a complaint or information would be given to the President, and he would then direct that there should be proceedings of which the convicted man would, of course, be given notice. It is perfectly true that when he had been given notice, the fact that he had been convicted would be conclusive. That has always been so. But it is not the case that there would not be due inquiry. I believe am correct in saying that both my noble friends mentioned the point, which I think had struck others who had looked at the Bill outside.
§ THE LORD CHANCELLOR
I am grateful to the noble Viscount for raising the point, and I am sorry I did not make it plain. I entirely agree with his reading of the matter. The conviction is conclusive, but that does not mean that the man is automatically struck off the register. Another point has to be considered—whether the conviction is of such gravity as to justify this sentence.
§ THE LORD CHANCELLOR
If you want to act on this, you have to give the man notice and bring him before the Disciplinary Committee. You accept the fact that he was guilty of an offence as 934 found by the court, and then you have to consider, after giving him a chance to make his case, whether the conviction is sufficiently serious. I do not think anything else is possible. That has been the law ever since 1858, and the noble Viscount is quite right in saying that the alteration to Clause 16 (1) is merely to deal with the new situation which has arisen by reason of the fact that there is now a Republic of Ireland. If that is not done, consider what you let yourself in for You have to have a new trial in every case of a criminal offence, which is quite impracticable. You must accept the criminal offence and then ask yourselves: Is there sufficient gravity to justify striking him off? What we are doing in the case of adultery is to put it on the same footing. The Disciplinary Committee will accept the fact, but they will then consider whether the nature and the circumstances in which that adultery was committed are of a character which will require them to take disciplinary action.
§ 4.20 p.m.
§ LORD HADEN-GUEST
My Lords, I venture to enter upon a legal matter and ask a question to clear up a point concerning the method of procedure of the General Medical Council. I understand that it has been the practice in the past for members of the Council to be constituted as a penal eases committee to determine a prima facie case which may come before them. It is suggested that if that is to continue—and it seems the kind of arrangement which would probably continue as a common-sense way of dealing with the situation—anyone who has served on that sifting committee should be precluded from being a member of the Disciplinary Committee which subsequently tries the case. The matter has been mentioned by the noble Lord, Lord Webb-Johnson and, I think, by the noble Lord, Lord Horder. But it is a matter of substance, and I think it would be helpful if w could have it cleared up now; it is a question which certainly will have to be faced before the Committee stage, since, if I am right, it may necessitate an Amendment to Clause 13.
The second point I wish to raise concerns the twelve months' service in a hospital which must now be undertaken by doctors when they have completed their normal studies, been provisionally 935 registered, and are ready to enter on the stern business of medical practice in the ordinary way. They are now to have another twelve months' training before they are fully registered or, perhaps one may say, licensed to practise. They are to have this extra twelve months in a hospital or an approved institution. As a matter of fact, many doctors at the present time already do six months' training, and I believe that a very large number do a year's training. It would be interesting to have information from the noble Lord who is to reply on how many do six months and how many do a year. I have been given estimates of the number of doctors taking a six months' course varying from 50 to 90 per cent. In the war period, of course, practically all doctors on qualification took a twelve months' period. In fact, for general medical practice or for any responsible hospital work, it is extremely desirable that this should be done. The Services, who require continual reinforcements of doctors, strongly prefer men with a year's experience in hospital. With regard to the question of providing the appointments which these men could fill, the information I have leads me to think that there will be enough places to provide appointments for all who require them—that is to say, there are more places needing house appointments than there are doctors wanting to fill them.
Another point—I think it was raised by the noble Lord, Lord Horder—concerns the matter of health centres. Lord Horder suggested that health centres might be the kind of approved institution to which young doctors on qualification should be attached for their year's training before they are given a general licence to practise as and how they please. I would say to the noble Lord that a health centre is not primarily a building; it is primarily a group of doctors working together. And that is what is needed—to get doctors working together in teams. If you get that—and I know that some are in process of formation—the fact that the doctors are working in places which are not well equipped, perhaps with old-fashioned dispensaries and other difficulties of that kind, will not prevent the work they do from being medically very efficient and will not prevent their constituting themselves as in fact a health centre—a building from which health 936 should radiate and in which all doctors should pool their resources to give the best possible service to people in the district. If we are to have such health groups formed, it seems to me very desirable that young doctors should be, as it were, apprenticed to such a group, as an alternative to going into some institution.
It is agreed on all sides that we welcome this Bill. It will improve the standard of medical education and medical practice, and it will improve medical work carried out for the benefit of the public. And this improvement will be brought about by regulations which, if they do not meet the wishes of your Lordships' House or of another place, can be annulled. I think, therefore, that the safety of the public is completely and suitably protected. It seems to me that we should welcome this Bill in every way and do our best on the Committee stage to improve it and to make any small amendments which are required.
§ 4.26 p.m.
§ LORD HACKING
My Lords, I rise to support the Second Reading of this Bill. One great advantage of it, which has already been pointed out by the noble Lord, Lord Horder, is that it is not forced upon an unwilling profession, but in the main is a measure which is agreed between the Government and the existing General Medical Council. I do not know whether the noble Lord, Lord Nathan, is going to address your Lordships. I understand that he is at present a member of the General Medical Council—the only lay member amongst thirty-eight colleagues, all of whom possess a profound knowledge of one branch or more of the medical profession. I occupied for no less than fifteen years, from 1931 to 1946, that same position which is now occupied by Lord Nathan to-day. Even before I was compulsorily retired (I think that is the expression which is used today when the Government have no further use for you) more than four years ago, the question of the reorganisation of the personnel and the function and powers of the General Medical Council was under active discussion and negotiations. The hand which guided these discussions was that of the late President of the General Medical Council, Sir Herbert Eason. For many years he inspired his colleagues on the Council with 937 his enthusiasm for the general welfare and integrity of the profession in which he was such an outstanding figure. He laid well and truly the foundation stone of this Bill, and was the chief builder of the edifice. It is sad that he could not see the completion of his work. I would pay my humble tribute to the memory of this remarkable man, under whom I sat for a period of about ten years.
Credit should also be given to the Registrar of the Council, Mr. Michael Heseltine, for the great part which he played from the very commencement of the discussions until their successful completion some months ago. Officials seldom receive their full share of recognition for the immense amount of work which they undertake so willingly and so efficiently in a task such as this, and it is because of that fact that there is just one other member of the staff of the General Medical Council whose name I should like to record for some excellent work, possibly of a less spectacular kind, but nevertheless of very great importance. I refer to Mr. Heseltine's most able, modest and conscientious assistant, Miss Taylor.
Turning to the Bill, I agree entirely with what the noble Viscount the Leader of the House, and also I think the noble Lord, Lord Llewellin, said: that it is good that the title of the new.body is to be simply the General Medical Council. Long titles are fashionable at the present time. It is a relief to know that, instead of the existing cumbersome title which the Leader of the House found impossible to remember, the new body is to possess this simple name "General Medical Council" by which it has in fact been commonly known for many years. I am particularly interested in the constitution of the proposed new Council. Incidentally, it takes a whole page of the Bill to announce the number of members who are in future to sit upon the new Council, and even then they are only gated by reference to the Medical Acts of 1858 and 1886, and by reference to certain Orders in Council.
I would ask noble Lords who are interested in this form of legislation to look at Clauses 6, 7 and 8 of the Bill. Perhaps the noble Lord, Lord Shepherd, who is to reply to this debate, will let me know how many members there are in fact to be upon the new General 938 Council. The noble Viscount the Leader of the House said forty-five; the noble Lord, Lord Llewellin, said forty-seven. My arithmetic, such as it is, brings the total to forty-five, but there seems to be doubt about the number. I am not surprised, because if one looks for example at Clause 7 (2), one sees the words:So much of subsection (1) of section seven of the Medical Act, 1886, as provides that the Council shall include one person chosen from time to time by each of certain specified bodies shall have effect as if among those bodies then: were included the Royal College of Obstetricians and Gynaecologists.I would ask the noble Lord, Lord Shepherd, how many members on the new Council come under that subsection. I think he will find it not very easy to answer. I do not press aim for an answer now. Perhaps he would prefer to have notice of that question, but I feel sure the total is forty-five. These clauses are extremely involved. As I have said before in another place—I am not sure whether I have said it here—I cannot understand why Parliamentary draftsmen apparently take such a delight in making an Act of Parliament SD difficult for us laymen to understand. It. makes one suspicious that there may be some collusion between these draftsmen and possibly the legal profession. How right was Mr. Gilbert, of Gilbert and Sullivan fame, when he said:Law is but a lottery, all lawyers draw the lot.I wish profoundly that the wording of Acts of Parliament could be a great deal more simple than it is, so that there would be less necessity for the lawyers to draw such a lot.
Clause 6 of this Bill says that there are now to be three lay members among the forty-five who constitute the Council, instead of one lay member out of thirty-nine. After some experience I wonder whether this increase is necessary. The full Council—I draw a distinction between the full Council and the Disciplinary Committee—will deal with the medical standards for registration 71, such as the qualifying examinations, the training and experience in hospitals, The full Council will also control the publication of the British Pharmacopœia. I suspect that these subjects are not understood by lay men, who can make little or no useful contribution 939 to the deliberations when the subjects are before the full Council. At any rate, that used to be the case when I was a member of the Council, for I tried valiantly during my fifteen years of office to become a member of the Pharmacopœia Committee. My application was always resisted by the chairman and other members of that Committee on the grounds that I knew nothing about the subject. I fear that was right: I did know nothing about the subject. Consequently, I was not picked to sit on the Pharmacopœia Committee. The same position, surely, applies to-day. I maintain that the layman is not a fit person to deal with a subject of that kind. He cannot learn it even after several years on the General Medical Council. Therefore I feel it is almost unnecessary to have three laymen instead of, as in the past, one taking part in the deliberations of these subjects.
When we come to the Disciplinary Committee, it is laid down in Clause 13 that only one member out of the total of nineteen need be a layman. Personally, I think that is insufficient, If there are to be three out of forty-five on the full Council, then I suggest that these three should all sit on the Disciplinary Committee. Your Lordships may not remember why a layman was ever appointed to the General Medical Council in the first place. It was to allay public suspicion. There were certain ill-informed and even malicious people who said openly and wrote in the Press that certain doctors had had their names erased from the register because of jealousy on the part of medical members of the General Medical Council. This accusation, was, of course, completely and absolutely untrue, but the fact that the general public, the consumer interest, is adequately represented on the Disciplinary Committee does give confidence to the general public and minimises the risk of an unfair attack being made upon members of an honourable profession. For that reason, I should have liked to see at least two, and if possible three, lay members on this Committee. The noble Lord, Lord Llewellin, said that nineteen was too large a total membership for the Disciplinary Committee. I said that I sat for many years as a member of the General Medical Council, the whole body then consisting of thirty-nine, and that 940 whole body dealt with the disciplinary cases. So far as I could tell, justice was always done. I myself do not think that a Committee of nineteen, with a quorum of nine, is too large a body to deal with these cases.
Clause 14 empowers the Disciplinary Committee to administer oaths and to enforce the attendance of witnesses and the production of documents. That, of course, is very sound. We have suffered a great deal in the past from the fact that we could not put a witness on oath, and especially because we could not compel the attendance of witnesses. The change will be helpful, and justice will be performed with far greater certainty under the new proposals contained in this Bill. In theory, I think that almost every member of your Lordships' House who has spoken has said that it would appear right that there should be an appeal from the decision reached by the Disciplinary Committee to the Judicial Committee of the Privy Council. That there must be the right of appeal is obviously right in theory, and probably this is the best body by which the appeal could be heard. I can only hope that in practice this right of appeal will not be abused.
It has already been pointed out by the noble and learned Viscount the Lord Chancellor that there is only one punishment at present and in the future which the Disciplinary Committee can impose—namely, that of erasure from the register. It follows that on appeal the sentence cannot be increased, so the doctor has everything to gain and nothing to lose by his appeal. This may lead to a large number of appeals having to be heard. A right of appeal is obviously necessary, however, and at the moment I can think of no better method which could be adopted than the one suggested in the Bill. I leave it at that, in the hope that my fears may be found to be groundless. I have nothing further to say on the Second Reading, except again to welcome this Bill and to express the hope that the principle contained in it will be unopposed. I repeat my humble congratulations to all those who have had the wisdom, the industry and the foresight, to bring this measure before your Lordships and before Parliament. I am certain that it will turn out to be a most useful piece of legislation, equally valuable from the point of view of the doctor and, what is just as important, from the point of view of the general 941 public. I wholeheartedly support the Second Reading.
§ 4.42 p.m.
§ LORD STAMP
My Lords,.I do not wish to take up your Lordships' time for more than a few moments, and in addressing your Lordships for the first time I would ask for the customary indulgence of the House. The matter I wish to raise is one to which reference has already been made by the noble Viscount, the Leader of the House; nevertheless, I feel that I should perhaps emphasise it, as I know it is giving rise to some anxiety on the part of the authorities concerned, particularly those of the University of London. It has to do with the authority to Abe given to the General Medical Council to visit and report on medical schools.
As the noble Viscount mentioned, the medical schools of the University of London are visited regularly by the Senate of the University, and in recent years the University Grants Committee has extended its interest in medical schools and proposes to visit them once every five years. The proposed visits by the representatives of the General Medical Council will clearly lead to an increased danger of overlapping and of inconvenience due to multiple inspection and reports. The difficulties are greater in the University of London than in other Universities because of its federal character, with its numerous schools. This makes it necessary for the Senate to carry our regular visits which are not so necessary in other universities. Here, therefore, the schools will have three regular visitations instead of two as elsewhere. This slate of affairs is clearly to be avoided if possible, and it is hoped that some arrangement may be come to whereby the representatives of the interested bodies can visit the schools as a single body. I am very glad to hear that the Government are fully aware of this difficulty, and I hope that a solution satisfacfactory to all concerned will be reached.
§ 4.45 p.m.
§ LORD SHEPHERD
My Lords, it falls to me to express a word of welcome accompanied by pleasure to the speech just made by the noble Lord, Lord Stamp. We are very glad indeed to note the informed interest which he takes in this subject, and we shall be pleased if on future occasions we have not only his 942 presence but his assistance in arriving at proper conclusions. The principal point raised by the noble Lord will be considered by the Minister after this debate is concluded. It is felt that there is something to be said for looking into the danger that might arise from too frequent inspections, and if there is anything we can discuss with the noble Lord on that matter we shall be very glad to do so.
Now may I say a word or two in reply to my noble friend, Lord Webb-Johnson? I am going to be particularly brief, because after the fine speech made by my noble Leader in moving the Second Reading and the assistance we have had from my noble and learned friend the Lord Chancellor, all that remains for me is to deal with the very simple cases. Lord Webb-Johnson said that he thought that Clauses 1 and 2 were too rigidly drawn. I understand his point of view and we will certainly look into the matter raised. But I ought to point put that these two clauses are in accord 'with the Report of the Goodenough Committee. I think the noble Lord will agree that, whether or cot one agrees with the findings of that Committee, one is bound to admit that it consisted of men of great influence and experience in these questions. Moreover, the two clauses have since received the approval of the General Medical Council; so that the Government is fortified in the draft which has been put forward. Nevertheless, we will look into the subject further and perhaps we may have opportunities of further discussion with the noble Lord.
Then the noble Lord, Lord Webb-Johnson, raised the question of the reaching of decisions by the Disciplinary Committee. He rather objected to the casting vote of the chairman being used to pass sentence upon a medical man brought before the committee. I would point out, however, that that has always been the case in the relationship of the General Medical Council to men who have been brought before it because of some mistake or other that they may have committed outside. It has had a long history in practice, and, so far as I know, no doubt has previously been raised upon it. However, we will look into the doubt raised and we will communicate with the noble Lord between now and the Committee stage. The noble Lord, Lord Hacking, raised the question 943 of the strength of the Medical Council under the Bill. The present strength of the Council is thirty-nine and the strength of the Council under the Bill will be forty-five. If the noble Lord has been following the discussion he will have realised that on the Committee stage of the Bill we may be faced with a 'number of Amendments proposing an increase in the strength of the Council.
§ LORD HACKING
What I was a little anxious about was the disagreement between the noble Viscount the Leader of the House and Lord Liewellin. Lord Llewellin said the total was forty-seven and the Leader of the House said it was forty-five. I calculated it at forty-five, and I am glad to hear that I was right and that for once Lord Liewellin was wrong.
§ LORD SHEPHERD
The present strength is thirty-nine and the proposed strength under the Bill is forty-five. That figure will, of course, be subject to any amendment that may be decided upon in your Lordships' House during the Committee stage. One other point was raised in the speech of the noble Lord, Lord Hacking, to which I might give an answer—namely, in regard to the position of laymen upon this particular body. I quite understand that there may be discussions where the layman will find himself almost completely out of the running. Indeed, I myself felt somewhat like that to-day when I listened to noble Lords who have long medical experience. But the General Medical Council is not an instrument elected solely in the interest of the medical profession; it is, indeed, a public institution, and its job is not merely to look after the interests of medical men but to see that justice is done for the public. Therefore it is desirable that there should be laymen upon this body, and the Government believe that in suggesting an extra two they have not gone too far in the matter.
§ LORD HACKING
Would the noble Lord deal with the question relating to the Disciplinary Committee? Does he think that one layman is sufficient when dealing with cases relating to contravention of discipline? Does he think that one layman is sufficient, bearing in mind that he will be guarding the interests of the public?
§ LORD SHEPHERD
I would not like at this juncture, to say "Yea" or "Nays" to that question, but I will give it consideration and perhaps we can deal with it at a later stage.
Now I come to the very helpful speech of the noble Lord, Lord Llewellin. I think that he not only received this Bill very warmly, on behalf of His Majesty's Opposition, but he also dealt in a very understanding way with the matters upon which he touched in his speech. First of all, he raised a question about internes and about the amount of time they are to give to that part of their training. He indicated that he wondered whether we had not been too rigid in fixing a period of twelve months. The Government considered that matter fully, and they realised at once that safeguards would be needed. It will for instance be necessary to make sure, before the appointed day is named, that there will be opportunities for entry upon this section of the work, and the Privy Council, which must name the appointed day, will most assuredly insist that before a man or a woman can become an interne there shall be the necessary room and opportunity. We sincerely trust that the period of twelve months will not be too long for the purpose, and that within that period a man or a woman will have sufficient to keep him or her fully and usefully occupied.
The noble Lord next asked a question about the salaries to be paid to men and women acting as internes during this period of twelve months. It is the opinion of the Government, and it is their intention, that these internes shall occupy house posts, and that the rate for the job shall be paid. I cannot go so far as the noble Lord, Lord Horder, would wish me to go in fixing a rate—that, I think, must be decided elsewhere—but your Lordships may rest assured that in so far as the Government are concerned, and certainly in so far as the General Medical Council are concerned, a suitable salary will be assured for men and women going through this period of work.
In reply to Lord Llewellin's point about the relationship of this Bill with the arrangements in the Irish Republic, I would point out, as I have already mentioned, that, strange though it may seem, the medical profession in Ireland comes somewhat under the jurisdiction of 945 the General Medical Council in this country. Indeed, in the relationship of the two countries medically they are working under an agreement reached in 1927 between the Governments of Great Britain and the Irish Free State. Therefore, when we bring forward measures of this kind and mention facts which relate to Ireland, I think it can be accepted that there has been consultation and agreement. Lord Llewellin raised a point as to the difference between the fee which has to be paid, or which has seemingly to be paid, by a student becoming an interne in this country or in Ireland, and one coming from Ireland under the Bill for interne purposes. The reply to the noble Lord is that on a student receiving a diploma in Ireland following upon examination, and being given temporary registration, the fee of five guineas will be paid in Ireland. So the only distinction is that the live guineas for a student in Ireland is paid in Ireland and not in this country, whereas in this country a student on provisional registration will pay his fee here.
§ LORD LLEWELLIN
What I was rather concerned with was this question. If the student here, after perhaps paying his live guineas here, went over and practised in Southern Ireland, would he be let off his five guineas, as we are letting off Irishmen who come over here? Is the relief to be reciprocal?
§ LORD SHEPHERD
The student who becomes provisionally registered in this country will pay his five guineas in Britain. The student who becomes provisionally registered in Ireland will pay the five guineas in Ireland. The only difference is that one is paid in Ireland and the other is paid in Great Britain. Coming next to the point about the six guineas, which followed the one with which I have just been dealing, the answer is that it will depend on where registration takes place. Presumably, if an Irish student, having obtained his diploma in Ireland, pays his five guineas in Ireland and then comes over here for his interne service, and finally becomes registered in this country, he pays six guineas in this country and not in Ireland. Otherwise, if he becomes registered in Ireland, presumably be will pay his six guineas there.
§ LORD LLEWELLIN
I am afraid that what the noble Lord has just said does 946 not entirely cover my point. By the words of the Bill as I read them, no one is to be allowed to charge a fee to a student who has taken his diploma in Southern Ireland. I am only asking whether there is any assurance from Southern Ireland that similar treatment will be given to our students.
§ LORD SHEPHERD
I understand that there has been complete agreement. However, in view of the fact that the question has been raised in that form, I will endeavour between now and the next stage to obtain further information for the noble Lord.
do not wish to say much more with regard to the point raised by the noble Lord about the numbers to be elected to the General Medical Council. The Bill, as the noble Lord knows, provides for nine. There are proposals which will come up at the Committee stage which will provide for a larger number. I would remind the Hour: that the General Medical Council are not merely a representative body of medical men. They are fulfilling a public function, and they are representative of the training bodies like the universities and the hospitals. It is very important that the representative character of the Council on the practising side should not be unduly great. Between now and the Committee, stage, we may be able to discuss the figures in greater detail.
§ LORD SHEPHERD
I think that I am with the noble Lord, Lord Llewellin, in his view as to the effect on a Member of another place of holding a seat on the General Medical Council. This Bill indicates that a Member of another place can be a member of the Council, but that he must not draw fees or expenses. It will be noticed that if a member of your Lordships' House were appointed to the General 'Medical Council, he would not under this Bill be barred from receiving fees and expenses. That also is a matter which I can look up, and which perhaps we can talk over before the next stage of this Bill is reached. The noble and learned Viscount who sits on the Woolsack has dealt with the question of a quorum so I need not enter further into that.
947 The only other point which calls for reply is the reference made by the noble Lord, Lord Llewellin, to the date of the appointed day. I cannot at the moment state what period will be necessary before the appointed day, in all its aspects, can be fixed. It would be possible, for instance, to fix the appointed day for the Disciplinary Committee quite early. It could come into operation almost forthwith. They would be merely taking over the functions at present exercised by the General Medical Council. But when it comes to the appointed day for the internes, then a good many problems have to be solved, as, for instance, the provision of buildings in which they would work, the residences in which they would reside (because they have to be resident), and the question of notice to the present students. Therefore the appointed day not merely will be variable as between one subject and another; it will be variable in one subject where that may be necessary. For example, the appointed day for an interne in Edinburgh may be an earlier day than for an interne in London. All would depend on the circumstances that make it possible.
§ LORD LLEWELLIN
Does that mean that one section of these young men and women—say those training in Scotland—may have to do this compulsory period before it will be compulsory in England?
§ LORD SHEPHERD
This provision will become compulsory only as and when circumstances permit. As I indicated in my speech earlier, there are points which will determine the appointed day, whether early or late. But any move will be subject to the decision of the Privy Council, acting on the recommendation of the General Medical Council. I think it may be accepted that neither body will lose time in making progress.
I shall deal with only two points raised by the noble Lord, Lord Horder, because the day is getting rather late and the noble Lord is not present. He raised the question of the responsibility of an interne and wanted to know whether he would be able to issue death certificates or deal with drugs. I cannot give a specific reply to that question here. I can merely refer to subsection (3) of Clause 4. There it is contemplated that an interne will be registered only in so far as certain functions can be performed, 948 and no further, and set out in paragraphs (a), (b) and (c) are the lengths to which an interne will have responsibility. In regard to approved hospitals, a matter mentioned by the noble Lord, Lord Horder, I do not think we need fear that the hospitals and institutions secured for the purposes of interne training will be other than suitable and practical. They have to be chosen by the universities and other bodies who are responsible for the granting of diplomas, and I think we can take it that a matter placed in the responsible hands of these bodies will be properly dealt with. I am very much obliged to noble Lords for the kindness they have shown to this Bill, and I hope that as we proceed from stage to stage we may improve the Bill, if that be necessary.
§ On Question, Bill read 2ª, and committed to a Committee of the Whole House.