HL Deb 02 July 1958 vol 210 cc515-22

6.34 p.m.

Order of the Day for the Second Reading read.

LORD COHEN OF BIRKENHEAD My Lords, I hope that even at this late hour your Lordships will permit me to sketch very briefly the background to this Medical Act, 1956 (Amendment) Bill which I have the privilege of commending to your Lordships and which your Lordships will know has already passed through all its stages in another place without a dissentient voice. I should remind your Lordships that the Medical Act, 1956, was a consolidating measure and therefore it could not alter in substance the provisions of the Medical Act, 1950, the anomalies and injustices of which this Amending Bill seeks to repair. The anomalies have become unmasked as a result of several years' experience of the working of the Act. They could not have been foreseen, and if they could I fear that part of the blame lies on the noble Lord. Lord Nathan, and myself, for we both represent the Crown on the General Medical Council.

Your Lordships will also know that in the British Isles for exactly 100 years there has been maintained a Medical Register. That Register was designed, not as is sometimes thought for the protection of the medical profession but for the protection of the public. It incorporates the names of all those who have been shown to possess the requisite knowledge and skill for the efficient practice of medicine, surgery and midwifery, and by the Medical Act. 1858, which gave birth to the Medical Register, there was brought into being the General Medical Council which is responsible for maintaining the Register.

The functions of the General Medical Council are primarily educational, although I know that in the minds of the laity their functions appear to be primarily disciplinary against the medical profession. In pursuance of its statutory responsibilities, the General Medical Council has appointed visitors and inpectors of examinations of our University medical schools and of the Examining Boards of the Royal Colleges, the Society of Apothecaries and Apothecaries Hall of Ireland, which are known as Licensing and has from time to time issued recommendations about the form and content of the medical curriculum.

In 1943, the General Medical Council decided that the time was ripe to consider the provision of additional postgraduate experience before a qualified person was registered as a medical practitioner, thus entitling him to independent medical practice. Effect was given to this proposal in the Medical Act, 1950, which introduced as part of the required medical experience before full registration a year's residence as a house surgeon or house physician, or both—it specified the requirements which must be satisfied—in an approved hospital. The Medical Act, 1950, came into being and the appointed day was January 1, 1953. That was the day which the Privy Council assigned to the incoming of the "intern year" as it was called, on the advice of the General Medical Council.

I must tell your Lordships two further historical facts. In 1886 there was passed another Medical Act which enabled the General Medical Council to recognize, for the purposes of registration in this country, Commonwealth (then Colonial) and foreign degrees and diplomas which the General Medical Council felt satisfied the criteria of proficiency demanded of those who were registered in this country. Registration here was decided on the basis of reciprocity: that is to say, if we recognised the degrees and diplomas of other countries, they should recognise our degrees and diplomas for practice in their territory. On that basis of reciprocity we have over the years recognised many other qualifications. We recognise the qualifications of four of the States of Australia and six of the Provinces of Canada; we recognise qualifications in India, where nineteen of the medical schools now grant recognised registrable qualifications, and qualifications of Ceylon, Hong Kong, Pakistan, New Zealand, Singapore, Malaya, Malta and South Africa. We recognised most recently Uganda. We now recognise the qualifications of one foreign country only, Burma, though before the war we recognised the qualifications of both Italy and Japan. The second historical fact is this. Under the Medical Act of 1950, Commonwealth and foreign practitioners who have a recognised qualification need not carry out a year's internship in this country, provided that they can show that they have had "not less extensive experience" than is required by the year's internship in this country.

The purposes of the present amending Bill are threefold. Two of them refer to points I have already mentioned and the third is an entirely separate point. The first is on Clause 1, which seeks to remove certain anomalies and injustices which have arisen in the case of certain doctors who are seeking full registration. The second clause seeks to simplify the procedure of what is known as provisional registration. As soon as a doctor is qualified, he can seek, under conditions of which I will speak a little later, provisional registration, which entitles him to serve in a hospital and to carry out all the activities which are necessary for work in that hospital, but does not entitle him to independent practice—medical work, that is to say, outside hospital. The third clause simply seeks to remove an unnecessary provision about certain fees, allowances and expenses which are payable to members of the General Medical Council and to its branch councils.

Under Clause 1 there is an attempt made to seek to remove the disqualification of two groups of practitioners who are now debarred from applying for full registration. The first group are those who qualified—that is to say, who received a degree or diploma—in this country before January 1, 1953, and who would, if they had then sent in an application and the requisite fee, have been registered on the medical register, but who for certain reasons failed to do so, sonic of them because they went abroad immediately in the Armed Forces or as medical missionaries. They now return to this country, but before they can be fully registered, whatever experience they may have had between the date on which they qualified and the date they return to this country and apply for full registration cannot be taken into account. In other words, they have an absolute disability, inasmuch as any experience, however extensive, however adequate, or however acceptable it might be to the General Medical Council, cannot under Section 15 of the Act be recognised.

But it is not only an absolute injustice; it is a relative injustice, because if the doctor had received his registrable quali- fication in the Republic of Ireland he is exempt from this provision under subsection (3) of Section 7 of the 1956 Act; and a Commonwealth or foreign practitioner who has a qualification which is non-registrable but which is recognised as providing a sufficient basis for accepting that the qualified person possesses the requisite knowledge and skill for the efficient practice of medicine, surgery, and midwifery, need not serve a year's internship if he can show that in the period between his non-registrable qualification and registrable qualification he has had an experience which is "not less extensive" than that required from those who possess British qualifications.

The amending Clause 1 (a) will enable practitioners who qualified before January 1, 1953, with a British qualification, but who failed to register, to fall into line with Irish practitioners, Commonwealth and foreign practitioners, and they will be able to be fully registered on providing evidence that they have an experience which is not less extensive than that required under Section 15 of the Medical Act, 1956. I might say that each individual case of a Commonwealth and foreign practitioner is, and, if this Bill becomes law, of those who qualified before January 1, 1953, will be, considered by a Committee of the General Medical Council which was appointed some years ago, which is maintained and which studies with great care the individual applications in relation to the experience which they certify. Clause 1 (a) will in fact ensure that those who receive British qualifications are not labouring under a disadvantage compared with their Irish, Commonwealth and foreign professional brethren. The number of doctors who will be affected by Clause 1 (a) is very small and, clearly, the number will, as time passes, decrease.

Clause 1 (b) refers to those doctors who hold qualifications granted outside the United Kingdom and the Republic of Ireland which are of acceptable standards but which are not registrable in this country. If they later acquire a registrable qualification in the British Isles no account can he taken of any experience they, might have had between the date of the non-registrable qualification and the registrable qualification. Let me give you two examples which have been brought directly to our notice. A Hungarian refugee doctor of the highest qualifications which the General Medical Council would be prepared to recognise, on merit as acceptable, with many years' hospital experience, comes to this country; he is allowed by temporary registration to practise in a hospital in this country. He then receives a British qualification, but any experience he has had, however extensive, does not permit him to dispense with the intern year.

In the same way, a Munich doctor who had received the degree of Doctor of Medicine came to this country and was temporarily registered and for four years held hospital posts, some senior, in this country. He received then a British qualification, but the four years' experience that he had had in hospitals was not allowed to count towards his intern year. This is, of course, the more anomalous because under the Medical Act, 1956, Section 22 (2) (b), it is possible to register Commonwealth and foreign doctors who have recognised but non-registrable qualifications on the basis of work done which is not less extensive than that which Section 15 of the Act requires. The amending Clause 1 (b) will give the person the right to full registration on obtaining his British qualification if this experience between his non-registrable and registrable qualification satisfies the General Medical Council that it has been not less extensive than that required in this country.

As I said, Clause 2 seeks to simplify the procedure for provisional registration, which at present is complicated, cumbersome and involved. The young doctor who is qualified and receives his degree or diploma must, before he is provisionally registered, apply to a hospital for employment. The hospital must be approved by the licensing body—his medical school or his examining board. He must receive a certificate of selection of employment from the hospital authority which selected him and this, together with evidence of his qualifications, is sent up to the General Medical Council.

The certificate of selection of employment of the licensing body must be signed by a fully competent and authorised person of the licensing body and this leads to some delay. Indeed, since the General Medical Council has to scrutinise some of the signatures, and has to verify some of the qualifications, there may in some cases be a few weeks' delay between provisional registration and the date at which application was made, which means that however keen a young doctor may be, or however keen the hospital may be to have his services, he cannot legally carry out his duties in a hospital. We know quite well that these provisions are sometimes disregarded, and the result is that young doctors in hospital may not have their provisional registration although they hold a house appointment. This procedure applies to about 2,500 qualified doctors each year, and when you consider the number of certifying authorities and individuals involved you will realise that there is considerable complication and much time is wasted. Here again, the Republic of Ireland, by their 1950 Act, introduced the direct method of application for the provisional registration which meant that as soon as a young doctor received his qualifying degree or diploma he applied to the Medical Council for registration as a provisionally registered practitioner, and it was granted. That system has been quite satisfactory; no difficulties have arisen, and the safeguard which was originally thought to be covered by our method has, in fact, been found unnecessary.

Amending Clause 2 provides that the present requirement for production of a certificate of selection of employment before provisional registration shall cease to have effect and I should like to assure your Lordships that the deletion of this requirement will be very warmly greeted by those who are charged with the task of implementing the provisions of registration.

Clause 3 refers to the fees, expenses and allowances which are paid to members of the General Medical Council and of its branch councils. These fees are determined by the General Medical Council but require Treasury approval. Treasury scrutiny might have been appropriate nearly a century ago, when the funds of the General Medical Council were not provided wholly, as they are to-day, by the registration fees of practitioners. No public money is now involved but the Medical Act, 1956, under paragraph 7 (1) of the First Schedule, perpetuates the need for Treasury approval. It is the more anomalous because the Dentists Act, a much more recent Act which established the General Dental Council, contains no provision for Treasury approval of fees paid to members of the General Dental Council. Moreover, the Opticians Bill, which is at present awaiting Royal Assent, has no such proviso in relation to the General Optical Council. Clause 3 provides that Treasury approval is no longer required for the payment of fees, expenses and allowances to members of the General Medical Council and its branch councils. I would assure your Lordships that all interested parties have been consulted in these matters and all concur in the provisions which the amending Bill seeks to establish. I beg to move.

Moved, That the Bill be now read 2a.—(Lord Cohen of Birkenhead.)

6.56 p.m.


My Lords, as I also am a member of the General Medical Council—although a lay member, in contradistinction to the noble Lord who has just spoken, with all the authority of a medical man of his standing—I feel that I must support him in what he has said and associate myself with the full and careful explanation of the Bill which he has given to your Lordships' House. I therefore, for conformity, stand before your Lordships' House in association with this amending Bill.


My Lords, in view of the extremely detailed and careful exposition of the Bill given to us by the noble Lord, Lord Cohen of Birken- head, all I need do on behalf of Her Majesty's Government is to support this Bill.

On Question, Bill read 2a, and committed to a Committee of the Whole House.