§ 4.58 p.m.
§ Order of the Day for the Second Reading read:
LORD ST. OSWALD
My Lords, I am sure that the whole House will be disappointed at missing a speech by my noble and learned friend Lord Hailsham, but he returned, not exhausted but somewhat extended, by his American visit, and I am here to-day in his place.
This is a short though fairly complex Bill, devised and presented for the benefit of seven separate professions, the patients they serve and those members of the medical profession whose work they supplement. The seven professions are: chiropodists, dietitians, medical laboratory technicians, occupational therapists, physiotherapists, radiographers and remedial gymnasts. They are all highly skilled and highly trained professions requiring the protection and status that this Bill is designed to give them. I should explain that, as first presented to another place, the Bill included eight professions: the seven I have named, with the addition of the speech therapists. It is quite possible that, one day, eight professions will again be included in these provisions—eight, or even more, up to the limit of twelve, for which allowance is made in the Bill. But during the passage of this Bill through another place, the speech therapists, for reasons which they clearly explained, voluntarily withdrew from its provisions.
The main object of the Bill is the registration, training and discipline of the members of these seven professions on the broad lines of earlier legislation of the same nature, such as the Medical Acts, the Dentists Acts, the Nurses Acts and the Opticians Act of last year. It will be necessary to give some history of this particular piece of legislation, but I shall try to keep this as short as possible. In doing so, I shall forfeit some opportunity of explaining the time taken to bring it before Parliament. If your Lordships have any questions upon this point or upon any other, it may be for the convenience of the House if I say a few words, by leave, at the end of this debate.
The introduction of the present statutory registration scheme has been an ob 56 ject of Government policy for a good many years. Its history can be said to begin in 1949, when a series of eight Committees were set up under the chairmanship of Mr. Zachary Cope (now Sir Zachary Cope) to consider the supply and demand, training and qualifications, of certain medical auxiliaries employed by the National Health Service. The Reports were published in 1951 and recommended a unified system of statutory registration for medical auxiliaries. The formula put forward was a Registration Council representing doctors, medical auxiliaries and others in approximately equal numbers, with advisory committees to the various medical auxiliaries concerned. That was in 1951.
As a first stage, and pending the formulation of such a registration scheme, the 1954 Regulations were made which at present govern the qualifications of medical auxiliaries for employment in the National Health Service. These Regulations cover the eight professions, including speech therapists. When they were introduced and adopted in Parliament the then Minister for Health, now my right honourable friend the Colonial Secretary, made it clear that they were intended only as a temporary measure. The Regulations, which are now in force, provide that hospital authorities and local health authorities may employ medical auxiliaries only when they satisfy one of a series of qualifications. This list of qualifications I do not propose to inflict upon your Lordships at present, though, of course, I am ready to answer any question upon them if any noble Lord should so wish.
By way of emphasising the temporary nature of these 1954 Regulations, a Working Party was set up by the Health Ministers in the same year to find out what measure of agreement could be reached among the medical auxiliaries themselves as to what form statutory registration should take. The Working Party produced a Report in the form of a draft scheme for statutory registration for eight classes of medical auxiliaries. This scheme provided for the establishment of registration boards, on which the medical auxiliaries would be in the majority, for each of the eight professions, and for a co-ordinating Council, consisting of eight medical auxiliaries, eight doctors and seven others, which 57 would have power to veto the board's proposals but not power to direct a board what it should do. The aim here was to provide a measure of self-government for the medical auxiliaries, and the main emphasis was placed on the registration boards, which would be controlled by the medical auxiliaries themselves, assisted by medical and other expert members.
A long period of negotiation followed between the Minister and representatives of the medical auxiliaries and of the medical profession to see whether title details of the scheme could be agreed. Discussion centred, as it has done ever since, on the proposed membership of the registration boards, land the powers of the co-ordinating Council. The medical profession wanted equality of numbers between the doctors and the medical auxiliaries on the registration boards, and also wished the co-ordinating Council to have overriding powers over the registration boards. The medical auxiliaries were not prepared to accept either of these amendments, as they saw in them the defeat of their object of self-government.
In the first half of 1958, a measure of agreement between the eight professions and the Joint Consultants' Committee appeared to have been reached, and the revised scheme was discussed at a conference in July of that year between representatives of all the medical auxiliaries concerned and of the same Committee. The scheme as it stood provided for each registration board to have a majority of only one medical auxiliary in its membership and the co-ordinating Council to have only powers of veto over the registration boards. These provisions were accepted by the representatives of the medical profession, so long as provision was made for any disputes between the boards and the Council to be referred to an independent arbitrator, assisted by expert assessors appointed by both sides. The medical auxiliaries accepted this proposal. Subsequently, however, the British Medical Association were unable to endorse the agreement reached at the conference and returned to the line that the scheme would be acceptable to the medical profession only if eitherthe numbers of doctors on each registration board remained equal to the numbers of medi 58 cal auxiliaries, or the co-ordinating council were given over-riding powers over the Boards.When these suggestions were put to the medical auxiliary bodies, they rejected them almost unanimously.
My Lords, in that relatively short description is contained the explanation of why it bas taken so long to bring this Bill before Parliament. Your Lordships will appreciate the difficulties of reaching agreement between the seven professions, upon what they deemed an essential measure of independence, and the doctors, upon their demand for what they considered adequate representation. The doctor's interest in all this is very plain. When a consultant calls for treatment by one of these professions for a patient, that patient remains the doctor's responsibility, and clearly a conscientious doctor must be perfectly assured of the qualifications of his fellow professional before doing so. The present provisions represent a nice balance between the seven professions and the medical profession under whose general direction they work. I hope that the imaginations of noble Lords will enable them to understand why this commendable outcome has taken the time it has. Much is owed to the Cope Committee's Working Party, who did a great deal of hard work to provide the basis of the Bill.
The present Bill provides machinery for registering members of seven professions, and for regulating their professional education and conduct. It also provides for the setting up of one registration board for each of the seven professions concerned and of a Council which will be responsible for the co-ordinating and supervising of activities of the boards. The Council will consist of 21 members—7 representatives of the supplementary professions, 7 medical practitioners, and 7 laymen, including the Chairman. On all the boards, the supplementary professions have a majority of one, and their insistence upon this seems reasonable in view of the intimate concern of the members with the affairs of their professions and their members. The minority consists of doctors, experts in professional education and such additional specialists as are appropriate to the individual board.
The functions of the Council are co-ordination and supervision, and are described in subsections (2) and (3) of 59 Clause 1. Its work of co-ordination will be especially important in view of the number of professions covered by the Bill. It will also provide a central secretariat and will deal centrally with financial matters. The general tasks of the boards will be the promoting of high standards of professional education and professional conduct among members of the professions concerned. To this end they will have the functions of preparing and maintaining registers, of making rules dealing with a number of matters related to the registers, and of preparing and approving courses of training.
When this Bill becomes law, the professions concerned will cease to be subject to the National Health Service (Medical Auxiliaries) Regulations, 1954, to which I have referred, and the intention of my right honourable friend the then Minister of Health will be carried out. His words during the debate on these regulations were:I regard it as highly undesirable that the Minister of Health should concern himself with qualifications in this sort of field unless it were inevitable. This is only a temporary measure and must be considered as such".Perhaps I should say a word about the speech therapists. Until the Report stage in another place, they were included in the Bill, together with the seven other professions. But shortly after its introduction they indicated that, even though they had been concerned in all earlier discussions, they were not happy about the detailed proposals contained in the Bill and that the profession as a whole wished to withdraw from it. It was the view of my right honourable friend that they had nothing to lose by remaining in the Bill and a good deal to gain, and he made very considerable efforts to persuade them to reconsider their decision. In this he was unsuccessful, and they were therefore excluded from the Bill, by Government Amendment at the Report stage. My right honourable friend did not, and does not, accept the view that the speech therapists are not a profession supplementary to medicine; but, for the time being at least, they have gone their own way. If at some future date, they should reconsider, it will be open to them to apply to contract in.
Noble Lords may notice that the rôle proposed for the Privy Council is some 60 what larger than that assigned to it in other similar measures. There are two main reasons for this. The first is that, as I have emphasised, the Bill is concerned not only with the supplementary professions but also with the medical profession and their special relationship and interest in the courses of treatment involved. The second is that the Bill covers seven professions—it could even be regarded as covering the ground of seven separate Bills, and it establishes seven boards, together with a Council, to co-ordinate and supervise their work. As I have recorded, the main points of difficulty have been the composition of the boards and the relative powers of the boards and the Council. As the medical profession had repeatedly pressed for either equality of representation on the boards or for overriding powers to be given to the Council, neither of which was acceptable to the supplementary professions, the Government decided that the proper solution would be to leave the supplementary professions in a majority of one on each board, the Council with powers of general supervision, but for the avoidance of possible deadlocks (to which the medical profession attach considerable importance) to leave decisions on certain matters (such as courses of training and qualifications) subject to the final approval of the Privy Council. The Privy Council already has wide experience in exercising such powers in other registration schemes and so is well acquainted with the kind of problem involved.
My Lords, with one exception I think I can pass fairly rapidly over the detailed clauses and Schedules of the Bill after this general review. Perhaps I should deal with the exception, first of all—it occurs in the Second Schedule. This Schedule deals with the constitution of investigating and disciplinary committees and their procedures, including the appointment of legal assessors. Most of this is in common form, but this month produced a new development with the publication of the Report of the Committee of my noble and learned friend Lord Simonds, and I think I must take up a few minutes of your Lordships' time in explaining the position here.
Paragraph 2 of this Second Schedule, as originally drafted, empowered disciplinary committees to administer oaths, and also conferred express powers for 61 the parties to proceedings before a committee to obtain writs of subpoena. At the Committee stage in another place a Government Amendment was moved and accepted removing these express powers to secure the issue of writs of subpœna. This resulted from the Government's decision to set up a Committee under the chairmanship of my noble and learned friend Lord Simondsto consider to what extent and subject to what condition, subpoenas (or in Scotland citations) should be issuable to secure the attendance of witnesses and the production of documents before disciplinary tribunals; and in particular to consider whether subpœnas should be issuable to secure the production before such tribunals of evidence obtained by police officers in the course of criminal investigations".It is quite clear how the appointment of this Committee affected the Second Schedule as originally drafted, but in seeking to remove the express powers initially conferred, my right honourable and learned friend surmised that the recommendations of the Simonds Report might require them to be put back. In fact, the recommendations of my noble and learned friend, Lord Simonds, published some days ago, are entirely explicit on this point. The Committee says in paragraph 15 of the Report:We therefore recommend that express statutory power to secure the issue of writs of subpoena should be conferred on those statutory disciplinary tribunals that do not now possess it. We further recommend that if Parliament sees fit to create additional disciplinary bodies in the future they should also have the power for the reasons we have given".Consequently it is proposed that at the Committee stage of this Bill, which is set for Tuesday, June 28, an Amendment will be moved by my noble and learned friend Lord Hailsham to restore to this Schedule the express powers for the issue of writs of subpœna, which were struck out at the Committee stage in another place, shortly after the appointment of Lord Simonds's Committee. I trust that this will be agreeable to your Lordships, but since my noble and learned friend himself is, I am happy to say, going to speak later in this debate, the House will no doubt know a great deal more of this matter within some minutes than I should be capable of explaining in the entire afternoon.
That is the only complication that I am aware of in the Bill as set out, and 62 for that reason I have thought it better to bring it forward, out of its proper order, before proceeding to the list of clauses. Clause 1 deals with the establishment of the boards and the Council. Clause 2 deals with the establishment and maintenance of registers by these boards and places a duty upon each board to prepare and maintain a register, and also to have that register primed, published, and put on sale to members of the public. It also enables the Council, with the consent of the Privy Council, to make rules governing registration fees. Clause 3 describes the qualifications entitling a person to be registered. Clause 4 lays down the procedure for the approval of courses and training, qualifications and training institutions.
Clause 5 provides for the supervision by boards of approved institutions and of examinations leading to the approved qualifications. Clause 6 lays down titles which may be used by persons registered and penalties for improper use of those titles. Clause 7 describes penalties for fraudulently securing or trying to secure entry of a name on a register, and Clauses 8 and 9 define the disciplinary machinery for removal of names from the register and for the hearing of appeals against removal. Clause 10 provides machinery for extending, restricting or modifying the application of the Act to supplementary professions in the future. This clause was altered in another place, and an Affirmative Resolution of both Houses is now required to effect such changes, whether additions or removals. Clause 11 empowers the Privy Council to take action in default of the Council or of a registration board, and Clause 12 lays down certain procedures to be followed by the Privy Council in exercising those powers under the Act.
The First Schedule deals with the constitution of the Council, the constitution of the boards, and with supplementary provisions relating to the Council and to the boards. The Second Schedule deals with the constitution of investigating and disciplinary committees to be set up under Clause 8 and with the procedure of the disciplinary committees. I have already referred to the Amendment by the Government which will affect Paragraph 2 of this Second Schedule, but I might 63 make a reference to another recommendation of Lord Simonds's Committee, in Paragraph 45 of the Report, which reads:Any disciplinary tribunal should have available to it legal advice not only for assistance in the conduct of its hearings generally, but for its guidance in ruling on the submissibility of evidence and of schemes of privilege".Paragraph 4 of this Second Schedule already provides that a legal assessor should be present at all proceedings before disciplinary committees.
My Lords, I hope that I have covered the purposes of this Bill. If at the beginning, and despite my promise, I laboured the gestatory stages at greater length than might have seemed necessary, it was with the object of emphasising how delicate the negotiations have been and how reluctantly certain concessions have sometimes been made. The Government think that in these provisions is contained a just and workable formula for all concerned. The exact work undertaken by these professions is, as I have said, skilled and highly trained. It is also extremely varied as between one profession and another, and if questioned I can satisfy the curiosity of noble Lords upon the various natures of this work as I have fairly recently satisfied my own. The numbers involved are not large, but their work is vitally important and of benefit to a large proportion of the public. Although still regarding myself as possessing an abnormal degree of rude health, I find that I have already benefited from the ministrations, seen or unseen, of the chiropodist, the medical laboratory technician, the physiotherapist and the radiographer. There is no doubt that I should benefit also from the ministrations of the dietician, the occupational therapist the remedial gymnast, and most of all, as no doubt your Lordships will now be ready to bear witness, of the speech therapist. It is therefore in a personal, as well as a public, note that I ask your Lordships to give this Bill a Second Reading.
§ Moved, That the Bill be now read 2a.—(Lord St. Oswald.)
§ 5.20 p.m.
§ LORD TAYLOR
My Lords, the noble Lord, Lord St. Oswald, has moved this Bill with his usual eloquence and clarity, although at times I thought he had rather a tongue-twisting brief. We, too, 64 welcome this Bill, as it was welcomed in another place. It was fifteen years ago that I had to give a Fabian Lecture on "the Professional Man in the Socialist State." I may say that I was doing it only because the noble Lord, Lord Shawcross, had to go to Nuremberg at the time. To-day we are adding seven new professions, if not to a Socialist State, at least to the socialised sector of our society, for most of the members of these professions will be working for most of their time within the National Health Service. As the noble Lord, Lord St. Oswald, has said, it would have been eight professions but for the decision of the speech therapists to opt out of the provisions of this Bill. They decided, I think, that they were closer to education than to medicine, and I suspect that they were not uninfluenced by the fact that they thought they would do better under the Whitley Council for Education than under the Whitley Council for Health. We all regret this, but they may be right, for the professions covered by this Bill are, I am sorry to say, very poorly paid.
The Bill not only creates seven new professions but leaves the door open for the creation of more by Affirmative Resolution. We wonder why it is up to twelve? Is there any mystic reason for the figure twelve? Are there going to be only twelve supplementary professions to medicine in due course? Would it not be better to omit this limitation, for who can say what will be the nature of medical advance in the years ahead? There may well be a growth in supplementary professions out of all recognition and out of all our beliefs nowadays. So I hope this limit will go, as it seems an unnecessary restriction.
The Bill does, however, raise the question of what are the criteria of a "profession," because here we are creating seven new professions—and we can admit more under the Bill—without really thinking what we are doing. The boundaries between trades, professions and occupations are a little blurred. I looked it up, and the earliest use of the word profession "I could find was the following:Joseph, the spouse of Mary, was by profession a carpenter.The four classical professions are the Church, the Law, Medicine and the Army. We speak, perhaps a little loosely, 65 of "the theatrical profession". But one would suggest that the essence of a profession is responsibility. The membership of a profession should guarantee to the public the reasonable competence of the individual concerned. This is achieved partly by the individual maintaining his competence and professional traditions, and partly by the profession collectively supervising the training, examination and subsequent conduct of its members.
It implies a proper body of knowledge—a corpus of knowledge—which can be taught, and in which competence can be assessed. It implies, too, that there should be no free market in the service offered to the public, but that the fees charged shall be reasonable and not more than reasonable. It implies, moreover, that there shall be no individual advertising to obtain clients or patients. Finally, it implies that the occupation itself is something of real and generally accepted value to society. In future, claims to admission for professional status will certainly grow. One has watched with great interest the endeavours of the advertising agents to persuade us that they are a profession, though they certainly do not hesitate to advertise themselves; and I should say that they are not yet a profession.
As the noble Lord, Lord St. Oswald, has said, this Bill had a long gestation. Sir Zachary Cope did a very good job, and I would pay tribute also to Mr. J. E. Pater, of the Ministry of Health, who chaired the Working Party which had a very difficult time indeed. This had one good effect, for it changed the collective title from "Medical Auxiliaries" to "Professions Supplementary to Medicine", which is a much better way of describing these excellent people. Most of these professions come into operation at the request of a registered medical practitioner, but the public can approach sonic of them direct—for example, the chiropodists. In the past, doctors have been in some doubt about their responsibility for the work done for their patients by these medical auxiliaries. We think that under this Bill the position is now quite clear—at least we hope it is.
In another place, Miss Edith Pitt, speaking for the Minister, said [OFFICIAL REPORT, Commons, Vol. 614 (No. 28), col. 939] that in future doctors will not take responsibility nor be held respon 66 sible for work done by these new professions. This is very important indeed, particularly with regard to one of these professions. The activities of these workers are mainly concerned with people who are not in any great danger as to life or limb, but there is one group of people who are handling an exceedingly lethal weapon—I refer to the radiographers, whether doing therapeutic radiography or diagnostic radiography. We make, and have been making in this House, very stringent regulations for the control of radio-active substances, but the danger from radiology is far greater than the danger from radio-active substances. I think it should be clearly recognised that under this Bill we are transferring, so far as I can see, the doctors' responsibility to the radiographer when the radiographer is doing his job.
The Faculty of Radiologists—that is, the doctors who specialise in this subject—have been a little worried about this, and my old friend Professor Smithers, Professor of Radiology at what was the Royal Cancer Hospital and is now the Royal Marsden Hospital, the son of Sir Waldron Smithers, and one of our leading radiologists, has approached me about this; he has asked whether it would not be possible to make sure that on the board for this particular subject there could be guaranteed to be representation of at least one therapeutic radiologist and one diagnostic radiologist. There are, in fact, three doctors appointed by the Royal Colleges who might fulfil these criteria. I hope we may have a guarantee of this, because it is very important indeed that the public and the radiographers themselves should be safeguarded in this way. Apart from this point, the Council and the Board are about right as to numbers and composition.
As the noble Lord has said, the only point of serious controversy has been about the balance between the different professions, but we are generally happy with the solution which has been arrived at. I should add that in another place the Government have been most generous in meeting the points which my honourable and my right honourable friends have raised, and there is little in the Bill as it stands with which we do not wholeheartedly agree.
67 Much has been said in another place about the value of the services to the community of chiropodists, dieticians, occupational therapists, physiotherapists, radiographers and remedial gymnasts. We, too, add our praise and gratitude for the fine work they are doing. Without them, modern medicine could hardly function. I should like to make a special mention of the chiropodists. I remember that when my wife was Governor of Holloway they got a chiropodist in, and it was a thing which made the biggest difference to the life of the women in Holloway. It would seem a silly little thing, but it was a matter of major importance. I found exactly the same in industrial medicine. If there was one service the women workers particularly appreciated it was chiropody.
I should also like to pick out for extra comment, since they were not mentioned in another place, the medical laboratory technicians. Most people do not see much of them, but they are very important people indeed. They work under the clinical pathologist, and he is one of the most important folk in modern medical diagnosis. Most of his work is, however, done for him by the medical laboratory technicians. In a sense the clinical pathologist is the architect and the medical laboratory technician the master craftsman. He is in fact very much like the mediæval craftsman in the way he goes about his job, and I like to think they are the same sort of people. They play a great part in research and the advancement of medicine. In my own first research work I was immensely helped by the medical laboratory technicians. I have always looked on them as colleagues and one is delighted to welcome them to-day as fellow professional workers.
There is a danger of overdoing professionalism. It is natural enough that each and every group in the National Health Service should now want to have professional status—for example, the operating theatre technicians. One might imagine that operating theatre technicians were surgeons or anæsthetists. In fact they are theatre porters. They have a real value to society, but I do not think there is a proper body of knowledge which can be passed on and for which people can be trained—there may be one day, but there certainly is not yet. The question 68 may arise in the not too distant future as to whether dental hygienists should be included, especially in view of the shortage of dentists, and I would ask the Government whether they could be included under this Bill or whether they are adequately covered by the Dentists Act, 1957. The other groups, about whom I am wondering whether they could come in, are the social workers and the psychiatric social workers; the Bill might be a valuable way of granting them the kind of status they so badly need to do their jobs in future.
Clauses 8 and 9 give the Boards disciplinary powers. Some people are a little worried about this power to strike off the register. But, of course, it is not an exclusive register. There are two kinds of professional register. There is the medical kind of register, which is a list of people entitled to call themselves doctors, and the nurses' register, which is a list of people entitled to call themselves State Registered Nurses. But other people are allowed to nurse and be doctors. On the other hand, there is the exclusive register, the kind that the dentists have, when no one can practise dentistry except a dentist or a doctor. The registers under this Bill are of the non-exclusive kind; they merely register the title of registered chiropodists, or whatever it may be; but people can still practise without being on these registers, so striking off is not such a terrible thing.
But it is interesting to wonder exactly what they will be struck off for. If a chiropodist "cuts one to the quick", is that a ground for being struck off? One can just imagine unprofessional conduct on the part of a masseuse, but what about my friends the medical laboratory technicians: how does one commit unprofessional conduct when doing a blood count or perhaps taking blood? I suppose it is possible. What about the remedial gymnast who is drunk in charge of a car, or the dietician or occupational therapist who gets caught shoplifting, or the radiographer who gives a Press interview? But these are really matters which will have to be worked out by the boards and the Council. The noble Lord, Lord St. Oswald, mentioned the power to subpœna. We entirely agree with the necessity for the disciplinary committees or boards to have the power recommended by the Simonds Committee. We 69 think the Report is very sensible, and if there are to be professional inquiries there must be a power to get the evidence to make these inquiries a reality.
There is one serious matter of considerable public importance which was not exhaustively discussed in another place, and that is the matter of registration fees. For the professions there are again two types of registration fee. There is the once-for-all registration fee which we as doctors pay; we pay, I think, 12 guineas when we qualify, and we are in for life unless we are struck off. Then there are the annual or periodic registration fees; you pay them every year or every other year as the case may be. Nurses, incidentally, are of the same group as doctors; they pay once for all; whereas midwives have to register every year. It is a very undesirable thing that people should go off the register simply because they fail to pay the fees. In the groups we are dealing with, the people are relatively poorly paid, and many of them are women, and I think that in every case there is a serious shortage. What happens is that the women get married. In the case of the physiotherapists there is an enormous exodus from the profession by the age of about 27, and it is the same in these other groups, the radiographers and the chiropodists. We want them back as soon as we can have them, after they have finished having their families. A few minutes ago, my noble friend Lord Pethick-Lawrence was encouraging women to go back to work early after having had a baby. These are just the sort of people we want to get back to work. They will have to make a choice: they will have to reregister and pay a fresh fee, or they may go off and do some quite different job, and that would be a national loss.
But this does raise the question of cash. The Opposition cannot amend the Bill in this respect in this House. Only the Government could do anything about this, and they would have to do it having regard to the need to put the Bill through the other place, if we were going to make any cash help for the Council. In medicine we have built up a nest-egg for our General Medical Council by the large influx of fees when the doctors all had to register for the first time. The result is that the General 70 Medical Council have a fair nest-egg, bringing in annual income, enabling them to carry on with annual fees only. I would ask the Government, most earnestly and sincerely, to consider whether they could not make a small grant to start this Council off. I have in mind no great sum of money—perhaps £25,000, or even less than that. If they could do it, I think it would enable the Council to start without having to impose an annual charge on all the registered professions. I believe it would be an enormous help to them.
That is all I want to say about it. We welcome our new professional colleagues. We welcome this Bill. We hope they will set their standards high and build up and maintain worthy traditions. At present they are still all too poorly paid, but in the long run professional status will help them to get the financial recognition which is their proper due. More important, it will enable them to do better the work they are already doing well.
§ 5.37 p.m.
§ LORD AMULREE
My Lords, before I say the few words I propose to say in support of this Bill should like to declare an interest in the professions concerned. I have just completed five years as President of the Occupational Therapists Association, and at the same time I am one of the members of the management committee for the London Foot Hospital, which is one of the biggest chiropody training schools in the country. That is as far as I go there.
I think that the Bill we are discussing now is a very good Bill. It will do a great deal to encourage the supplementary professions. It has always seemed to me that when a professional body of people come to the stage when they become registered, it is a sign that they have got a form, have matured and have really taken their place in the world. They know what their work is; they know what their responsibilities are going to be, and they can now take their place among the other registered professions. I agree with the noble Lord, Lord Taylor, in welcoming to our ranks seven more professions. It is quite a big number, coming all at once, when there have been only four or five for so long. I am sure we welcome them warmly. There has been, I know, a certain amount of doubt among some of the professions as to whether they should come into this 71 Bill or not—whether they wish to form a register. They have, I am pleased to say, come into the Bill. They have joined with their colleagues and, although they did not particularly want to when it was first discussed, I am sure that, as time goes on, they will find that they have done a valuable thing and will not look back with any sorrow that they name into the Bill and co-operated with the Minister in trying to get this legislation on the Statute Book.
The first months or a year following the registration of a profession are bound to be difficult, because some people will probably come on to the register who would not have come on were the register not being formed for the first time. There are bound to be a number of people who are doing and have done good work, and who will do good work in the future, but will not have had the professional training that they should have had. They must come on the register because their work is just as good as that of the trained people. They have acquired their skill by experience and not by being trained by any particular course. That is a state of affairs which causes some trouble and disquiet at the start; but it does not go on for long, for these people will soon become absorbed into the register, and no new people will come in who have not been through one of the approved courses. So, although there are difficulties, I do not think they will be serious or will last for long.
I should like to support what Lord Taylor said about the difficulty in regard to the registration fee. When the medical profession first acquired its register, a long time ago, there were enough doctors in the country to pay a big enough fee to enable the General Medical Council to be set up. That Council have continued in being ever since by reason of doctors paying a fee of either 10 or 11 guineas a year. Naturally, the Council say that they have not got any money, but they manage to continue, and there is no call upon a doctor to pay more than one registration fee. It seems to me that if you are going to pay a fee every year it is a rather discouraging expense. I do not know what the fee is going to be, but I imagine it will be something of the nature of £2 or £2 10s., or something of that sort. Supposing 72 that one's total salary is between £400 or £500 a year, or, it may be, £600, that comes to quite a large fee; and when at the same time one has to pay a fee to keep up membership of a professional association, which will probably be about 4 or 5 guineas a year, it means a total expenditure of 7 or 8 guineas a year.
I should like to support Lord Taylor in his plea that the Government might be able to help to set up the Council. Failing that, it might be better if the professions were themselves to charge a rather bigger fee to start with. People would not mind paying a big fee when they have just passed an examination, because they would be pleased and excited at having got that part of their work done. Alternatively, their parents might pay it. I think the imposition of a yearly fee on these unfortunate people is to be deplored. Another course would be for their salary to be increased. Again, I think that that is a matter which will probably have to occur, because they are doing extremely good and valuable work for little money. That matter does not arise out of this Bill, but it is worth mentioning.
Supposing they have to pay these two fees a year, it is quite possible that they might think it simpler to pay the fee for registration, which they must pay by Statute, rather than to continue with their professional association. That, I think, would be a real disaster, because I am sure that by being a member of a good professional association they learn to keep up standards. I think it would be a disaster if these were to fall by the wayside because of the fee that their members may have to pay. One of the recommendations of the Cope Committee—I think it was in paragraph 89—was that the cost of the Council and the professional administration expenses should be met from the National Health Service. No doubt that was merely a recommendation in the Report, but it shows that the matter was carefully considered by this body and was thought to be a perfectly right and proper thing.
The other point which Lord Taylor raised and which I should like to support is that it is difficult for women who get married and go away and have a family, and are thus forced to give up their profession during that time, to have to pay another fee when they want to come back. 73 They have to get themselves put back on the register because they have lapsed from it merely because they have been engaged in other work which is quite as valuable—having a family. When they want to come back they have to go through the formality again of applying to come back, and they have to pay a fee once more. When a doctor who does not wish to practise for four or five years wishes to exercise his profession again, he has no formalities at all to go through.
The last point I should like to make is again one in support of what Lord Taylor said. He spoke of the great difficulty in regard to radiographers. They deal with one of the many dangerous things in the modern world of today. I believe it to be one of the most dangerous of all. I think it would be a great advantage if somebody from the X-ray profession was permanently on the Board, if not on the Council, so that he can really see that those people get some help in dealing with what is, as I have said, one of the most dangerous things in the world. It would probably be necessary to have more than one person; the work of the diagnostic X-ray people is so different from that of the therapeutic X-ray people, and it might be necessary to have advice from both sides of the profession. Those are the few points upon which I wished to make some observations in giving a welcome to this Bill. I hope that your Lordships will give it a Second Reading and will allow it to pass into law without undue delay.
§ 5.48 p.m.
§ VISCOUNT SIMONDS
My Lords, I propose to direct my observations to a single point, and to do so very shortly. The noble Lord, Lord St. Oswald, who introduced this Bill in a speech of admirable clarity and, if I may say so, enviable audibility, indicated the point upon which he expected me to make a few observations. It is just this. The Bill establishes a disciplinary committee with most formidable penal powers—a power to deprive a member of the particular profession, at any rate, of the best opportunities of earning his livelihood in his chosen profession. It is quite true, as the noble Lord, Lord Taylor has said, that though he be removed from the register he yet can practise. But nobody, I suppose, would doubt that his chances of earning 74 eminence in his profession will be greatly marred; and there is no doubt also that he will be damaged in his profession if, when he is brought before this disciplinary committee, he suffers an adverse decision.
How, then, can it be just that all the available evidence should not be brought before that committee? I venture to think it is quite elementary. Ask yourselves, if you will, what is your position if you, being a member of that profession, are charged with an offence which may result in serious consequences; if you know that there is evidence available, if the witness would but give it, which might turn the event in your favour, but he, because he is callous, ungenerous, does not want to be bothered, or for whatever other excuse a man may choose to give, refuses to come, with the result that you stand in grave jeopardy. I say beyond all doubt there should be a power to issue a writ of subpœna to compel such a man to come forward. Undoubtedly, it is an inconvenience, but there are many inconveniences in life. I suppose nothing can be more inconvenient than the public duty of sitting on a jury, but this is one of the inconveniences that a man may suffer.
Now I ask your Lordships: what is the position, not of the man charged but of the prosecuting body whose interest it is to maintain the honour of their profession and to see that a man who, as they think, is unfit to practise it should not continue to practise it to the great detriment of the public? They have information which leads them to believe that a certain person is not fit to practise. They take proceedings against him, and then, it may be at the last moment, the very evidence on which they are to rely is not forthcoming. Again, for whatever reason it may be, a potential witness refuses to appear, and so it will happen, to the great disadvantage of the public, that somebody will be allowed to continue to practise when he ought not to be allowed to do so. It is clear that in that case, again, the man should be compelled to come forward and give evidence.
Then look at this matter from the point of view of the disciplinary committee themselves, who are exercising a judicial function. Perhaps I could speak of this more clearly than I can of the position 75 of a prosecutor or an accused. What is the position of a tribunal, faced with the plea from one side or the other: "If only there were the evidence available I could convince you"? That might be true or it might be false. But what are the Committee to do except decide on the evidence before them and come to a decision which they must know they might not have reached had there been other evidence? Where a tribunal of this kind is set up everything demands that evidence should be available; otherwise justice is not done.
That was the conclusion reached by a Committee over which I had the honour to preside, consisting only of my noble and learned friend, Lord Morris of Borth-y-Gest and myself, and, so that Scotland should not be left out, Lord Thomson, now Lord Justice-Clerk, formerly Lord Advocate in the last Government. We reached that conclusion unanimously. I am very pleased to hear from the noble Lord, Lord St. Oswald, that Her Majesty's Government propose to adopt our Report and to replace in the Bill the provision in regard to subpœnas. I was glad to hear from the noble Lord, Lord Taylor, that the proposal was supported on his side.
I want to occupy the House for two further minutes to say something on one aspect of the Report relevant to the Bill on which there has been a great deal of misunderstanding. The last words of the appointment were:In particular, to consider whether subpœnas should be issuable to secure the production before such tribunals of evidence obtained by police officers in the course of criminal investigations.For some reason that I have not been able to discover, that has been thought to have something to do with telephone-tapping. Of course, it has nothing at all to do with that: it is a question of whether a policeman, like any other man, should be amenable to the jurisdiction of the court and be compelled to give evidence of matters which come under his personal observation. A policeman, of course, is a civilian, if in uniform; and whether or not in uniform he should be amenable to give evidence on matters which come under his observation. That does not mean in any sense that the police authorities need volunteer information to professional bodies, or 76 even that they need give information if asked to do so.
What is meant is that a policeman who has seen or heard something which is material should be compelled to come and tell the tribunal of it. That does not mean that he may not have a good ground of privilege for refusing to give an answer, for the question of privilege is not touched upon here. It may be that if the information he has has been obtained by telephone-tapping, that is a reason why he should claim privilege. On that I say nothing. The question is whether a policeman should be amenable to subpœna to come and give evidence. I believe that he should, and I hope that there will be no qualification of any kind when this new provision is inserted in the Schedule to the Bill. Upon that, if necessary, I shall have an opportunity of saying something more when the Bill is in Committee, should Her Majesty's Government propose to reintroduce the Clause. I hope that when the matter is introduced there will be no doubt about that.
§ 5.55 p.m.
§ LORD FRASER OF LONSDALE
My Lords, I congratulate Her Majesty's Government upon having brought this Bill forward and secured its friendly passage through another place, and having presented it to your Lordships to-day for Second Reading. I consider that the structure of the Bill is a sound one. The supervisory or co-ordinating Council, with a nice balance between the old and the new professions and the layman, is good, and the Boards or Committees with a majority of the supplementary workers is satisfactory.
I am glad that the supplementary professions stood up against the doctors in this matter and refused to be browbeaten and placed in a minority by them. Doctors are most important people, but they are not the only people who can do us good; and oftenA little of what you fancy does you good.I am glad, therefore, that those in these supplementary professions have been given their majority on the Committees, not only because of their dignity and status but also, as I think, because of their wisdom. That is not to say that I am in any way opposed to doctors, but. I am glad in this instance to see what 77 is put in the Bill. The Register will bring protection to the entrants into this field, as well as prestige, and I welcome it on both those grounds.
I should declare my special interest in this matter which arises out of no financial interest, direct or indirect, but because it has been my duty and pleasure in the last 40 years to help a particular group of workers who are to be included on the Register. They are, broadly speaking, the physiotherapists generally, and especially among their number blind physiotherapists, and particularly among them, the blinded soldier physiotherapists who have been my protegés. Bodies representing physiotherapists—the Chartered Society of Physiotherapists, the St. Dunstan's Organisation and the Civilian Blind organisation—have now worked in harmony for a very long time and have done much to uphold the status of the profession and encourage those who have taken the examinations from year to year to take longer courses and learn more complicated subjects, and to get a very good grounding so that they become very expert, with sometimes three or four years' training. That has been a splendid work upon which, I believe, we ought to congratulate the bodies concerned, and particularly the Chartered Society.
The noble Lord opposite rightly said that most practitioners in most of these professions—and especially is this the case with physiotherapy—will be working for the National Health Service. That is true, but do not let us forget that there are still a good many in private practice. I am glad to say that in spite of the expectation that the National Health Service would put the private physiotherapist out of business, it has not done so—at least, not so far as my St. Dunstan's friends are concerned. There are 110 of them in this country, 28 in other parts of the Commonwealth, and about 200 other blind persons, and more than half of them are in private practice. They include many young men blinded in the Second World War. And very good they are, and very successful. Nevertheless, if we add together all the blind men and the sighted men who work in the physiotherapy profession we shall still find, when the register comes to be set up, that the women will outnumber the men by 9 to 1. That cannot be helped. I am not 78 even prepared to say it is a pity. I think it is just one of those things. But I very much hope that the women, though they must outnumber the men, will not swamp the men. And I make a plea that when the Government set up the first Committee, which they will do by arbitrary methods before the elections come along at a later stage, they will set a good example by trying to make sure that at least one man—and preferably, as I should wish, a St. Dunstan's man—might be a member of the Physiotherapy Committee.
It is a pleasant thought that as a minor aspect of our passing this Bill to help these professions generally we may be doing a good turn to this group of men who have themselves done so well. It is 40 years since the Chartered Society of Physiotherapists started their campaign to get recognition and registration for their members; and these 40 years caused me to look up the words of an old song which will be familiar to some Members of your Lordships' House, one verse of which says:Forty years on, growing elder and older,Shorter in wind as in memory long,Feeble of foot and rheumatic of shoulder,How will it help you that once you were strong?My Lords, it will help you when you are suffering from the debility caused by your arduous labours in this House if you will aid these auxiliary or supplementary persons the better to do their job by establishing this register; it will help you, if I may say so without offending the doctors by advertising my friends the "St. Dunstaners", if you would like to ask me for the name and address of one of them; and it will help you if you give a Second Reading to this Bill.
§ 6.3 p.m.
§ LORD SILKIN
My Lords, like every other speaker who has taken part in this debate, I should like to extend a general welcome to this Bill. That is not to say that there are aspects of it which I think cannot be improved, and some of them I think are debatable. I have a slight interest in this matter because for some years I was President of one of the institutes of chiropody, and therefore I can, I hope, claim to have some idea of the aims and desires of that particular group of people who are dealt with in the Bill. My noble friend Lord Taylor referred to the question of the closed 79 profession; and I feel that we ought to ask ourselves what is the purpose of registration under this Bill.
Presumably, everybody who is to-day practising at all will be able to secure registration. The terms of the Bill are so widely drawn that it is difficult to see who can be excluded under the provisions. People need have no particular qualifications. At the worst, they have had no academic qualification and merely have been engaged in practice for some time: they have experience. To-day people become chiropodists in a variety of ways. There are people who take a three-year course, and there are a two-year course and a one-year course, and there is even a correspondence course which lasts six months. One can become a chiropodist by having that course, and then one need not take any academic course at all. One can become, as a few people are, even a part-time chiropodist. There is one case I heard of, of a person who is normally a lorry driver but who carries on chiropody as a sideline. I presume that that person is going to be registered. If he is not registered, if the members in their wisdom decide that such a person has not the requisite experience—and for all I know he may have; he may have been carrying on this series of operations for years—what then? He can still carry on as a chiropodist. And the same applies, of course, with the other professions.
As regards the ordinary public, the noble and learned Viscount, Lord Simonds, made play of the fact that it might be a serious matter to be struck off the register. I should not think so. I should think that a person who is normally described as a registered chiropodist (the same applies to a registered member of any of the other professions) can go on calling himself a chiropodist, and the public on the whole would be no wiser. I should have thought, therefore, that it would have been preferable to come to a decision that registration is essential to enable a person to practise one of these professions. I recognise that there are arguments to the contrary. I do not think that they are very strong, and I will not debate it at this stage because one can more appropriately deal with the matter in Committee. But I think that the balance of 80 advantage for the protection of the general public requires that only registered members of these professions should, after a certain time, be able to carry on their profession, and that without registration they cannot carry on. That is the first point I wanted to make.
The second is that I am not too happy about the provision for discipline. The Bill does not attempt to define "infamous conduct", one of the grounds upon which a person can be struck off the register. It leaves it to the disciplinary committee from time to time to decide what is to be regarded as infamous conduct. It is far too vague a term, and I consider that we should be rather more definite in this matter, instead of using these vague words. I am also a little apprehensive about the powers of the Board. They are going to be men of little or no experience. It is true that in course of time, by making mistakes, they will learn; but in the course of those mistakes a good many people may suffer. Although I am not prepared to-day to say what is a more appropriate alternative, I have some doubts as to the wisdom of setting up seven disciplinary bodies and seven bodies which will advise as to whether there is a case, and then leaving it to them, subject, I agree, to an appeal to the Privy Council.
I was very interested to hear the speech of the noble and learned Viscount, which was both audible and clear. Those are two descriptions which he regards as a merit on the part of the noble Lord, Lord St. Oswald, which I wholly approve of, and certainly he set a very good example. I agree with nearly everything that he said. I agree that it is important that both the person accused of infamous conduct and the boards should have the right to subpœna witnesses. I was not altogether in agreement with him as to the pronunciation of the word "disciplinary". I prefer that to "disciplinary", but that is a matter of taste and opinion.
At this stage, may I congratulate the noble and learned Viscount on having produced this very valuable Report, which I am sure will be appreciated by all members of the professions which have to deal with these problems? The noble and learned Viscount rather complained of some misunderstanding about 81 the last words of his Report, but I can assure him that there is a certain amount of apprehension about police evidence, and particularly police evidence that is obtained by tapping the telephone. There was a case recently—and the noble and learned Viscount will remember it—where a member of a profession was struck off the register of membership of his profession almost entirely on evidence obtained through police tapping of the telephone.
§ VISCOUNT SIMONDS
My Lords, if the noble Lord will forgive me, that was not a case of telephone tapping at all, I think. In any event, if he is thinking of the same case as I am, it is a case which is very shortly coming before the Judicial Committee of the Privy Council; and therefore I, as least, was careful not to say anything about it.
§ LORD SILKIN
In fact, my Lords, I was not going to say anything more about that particular case, but I feel that there is a general sense of abhorrence as to any evidence obtained and given in proceedings in that way; and while it may be that the Report of the noble and learned Viscount does not specifically deal with this question, I think we ought to be extremely careful to ensure that somehow such evidence is not acceptable if given by police witnesses in the course of hearings on discipline.
As I said at the outset, I am sure that, broadly speaking, all the professions which are covered by this Bill welcome it. I think many of them would prefer to be in a position to exclude those who are not qualified to be registered, and I consider, as I have said, that in the interests of the public that should be the case. However, these are matters which we can deal with at a further stage of the Bill; and in the meantime we certainly feel that this Bill should receive a Second Reading.
§ 6.14 p.m.
§ LORD GEDDES
My Lords, there is little to add to what has already been said about this Bill, but there are one or two points which still seem to call for additional emphasis. It is sometimes difficult to decide whether or not one has a declarable interest when addressing your Lordships' House, and while I have no interest to declare in the tech 82 nical sense, I have a close personal interest in the profession of occupational therapy through a student who is just completing the three-year training course. Through that introduction I have had an opportunity on several occasions to meet the leaders of that profession, both in London and in Edinburgh, and my remarks are therefore primarily a reflection of their views, although I have been informed that the Bill also has the full support of the other six professions affected by it.
In considering this Bill it is important to bear in mind how widely different are the professions affected by it; and, again, how widely they differ from the profession to which they are supplementary. It is almost as though one were to go to the zoo and find one cage for the lions, another for the tigers and another for all the other animals; for your Lordships will realise that there is little in common between a medical laboratory technician and a remedial gymnast. Having said that, however, I must add that it cannot be denied that this is a good Bill, although its value may be much greater to some of the professions concerned, some of whose members may have learned their trade merely by practice, than to the more highly scientific professions included within its provisions. There was at an early stage the proposal that the medical profession should have at least equality on the Council for Professions Supplementary to Medicine. The present Bill gives these seven assorted professions a bare majority, provided that in a vote they are unanimous among themselves. This would seem to be the least they can ask, and it is hoped that on this important point there will be no change in the present pattern of the Bill.
The greatest danger in the working of this Bill arises through the provision that these seven professions must be saddled with the cost of its operation. Unlike the great professions, these are little professions of relatively little people—and, as has already been said, they are relatively lowly paid. After three years of training, an occupational therapist is entitled to a basic pay of £500 per annum; which, after statutory deductions, leaves a net income of the order of £8 5s. 0d. per week. This ill compares with the remuneration of an unskilled labourer. And, after a lifetime 83 of work, the occupational therapist can expect a remuneration of only roughly £1,000 a year, or considerably less than half the average earnings in the great professions. From such meagre sums he or she must live, and in some cases support a family. Already, as has been said, there is the payment of roughly four guineas per annum for membership of the professional association; and now, in addition, another charge is to be levied for registration which might be of the order of £2 per annum. This, my Lords, may seem a trifling sum, but it is a large proportion of a week's pay at £8 a week. Indeed, it is so large as to have caused some misgivings that the young graduate might feel unable both to pay it and to support the professional association.
But it is thought that the running charges can be met, and the profession does not at present seek a continuing subsidy. However, there will be an initial expense to establish and equip the respective registries. As has been said, a rough estimate suggests that a sum of the order of £20,000 to £25,000 will have to be found for this purpose, and among these professions it is very hard to see where such a sum can come from. In paragraph 89 of the Cope Report there was a recommendation that assistance should be provided from National Health Service funds to meet these initial expenses; and, with the noble Lords, Lord Taylor and Lord Amulree, I would ask Her Majesty's Government whether they would not reconsider making an initial grant to help in the establishment of the registries if the professions themselves undertake to maintain them thereafter. Having said this, I commend this Bill to your Lordships for a Second Reading.
§ 6.18 p.m.
LORD ST. OSWALD
My Lords, I am most grateful for the welcome that has been given throughout the House to this Bill. I will try to answer most of the questions put to me in the course of the debate. My noble friend Lord Taylor asked me why the limitation of twelve was placed on the possible future number of professions under these provisions. The reason is simply this: that it is considered that a greater number would be too unwieldy for one piece of legislation or for one Council, and if the 84 Council and the number of boards grew any greater, it would no longer be workable.
§ LORD TAYLOR
My Lords, on that point, may I ask my noble friend this question? If a new profession is added, is there any alteration in the constitution of the Council? I do not think there is, but perhaps he would confirm that.
LORD ST. OSWALD
Should a new profession be added, there is provision in Clause 10, subsection (2), paragraph (c) for the Privy Council by order to vary the constitution of the Council.
The noble Lord also asked about specific professions possibly joining this registration scheme—namely, dental mechanics, social workers, and psychiatric social workers. If these three professions made application, their applications would be considered under Clause 10. They would have to be approved by the Council, by the Privy Council and then the matter would come before Parliament as an Order for the approval of Parliament.
The noble Lord and the noble Lords, Lord Amulree and Geddes, were worried about the whole question of fees and expenses of the registration boards. I know that these fears are shared by certain of the professions who are worried that perhaps their members, since they have to pay a registration fee, might be unable to keep up their contributions to the professional society, which might dwindle away or be unable to carry on with its useful functions. They are worried, I know, about such questions as whether attendance fees at Council meetings will be payable and therefore would be chargeable against the Council and whether the Council will tend to be extravagant. But the answer—at least, the potential answer—to these questions is that the professions will have influential representation on the Council and, I should have thought, will be able to make their own desires about economy felt. It is laid down that fees shall be such the Council consider will produce not more than the sums required to defray the reasonable expenses of the Council under this Act. This point was made to meet the anxiety of the professions concerned and is intended to safeguard them against the building up of unnecessary credit balances.
85 I am aware of the Cope Committee's recommendation that the administrative expenses of the registration machinery arising from its general and supervisory activities should be met from National Health Service funds, while the expenses of maintaining registers should be met from fees. But in the view of others who have studied this proposal, it is doubtful whether it would be possible. The main objection is that professions are always expected to meet the full cost of their registration machinery; indeed, they are normally anxious to do so. This whole question came up in another place, and my honourable friend Mr. Charles Doughty put forward his opinion that it would be quite wrong for the professions to accept Government money in the form of a grant and thereby lose an element of their independence.
In the course of the last few days, I have interviewed representatives of all these professions, and I am bound to say that the great majority of them agree with that view, and positively stated that they objected to accepting even an initial grant from the Government to start them off. I hope that I am not directly contradicting my noble friend Lord Geddes on this point, because, when he mentioned his own interviews with representatives of these professions, I was not absolutely clear whether he meant that everything that followed was by agreement with them. My own conversations with them gave me a different impression.
§ LORD TAYLOR
My Lords, when the noble Lord says "representatives", does he mean persons officially representing the professions or representative members selected, as it were, by chance?
LORD ST. OSWALD
My Lords, I mean officially representative members of the societies representative of these professions. As regards expenses and the general financing of the registration scheme, it is thought that the initial register may contain something like 25,000 names and that fresh registrations may come in at the rate of 2,000 annually. It looks as if it will be necessary to levy both an initial registration fee and an annual retention fee. But it is thought that the latter could be quite small. Something in the nature of three guineas for the registration fee and an annual fee of one guinea ever after would more or less fit the book.
§ LORD AMULREE
My Lords, I wonder whether the noble Lord would think about the point I tried to make—namely, whether it would be better to charge a bigger fee at the start, and so build up the Council, and not charge a fee for subsequent years.
LORD ST. OSWALD
My Lords, I think that I am right in saying that under the terms of the Bill, the Council, who have the responsibility of fixing fees, would be free to do that; but I do not think that at the moment it is the wish of the professional representatives that this should be done. In any case, as the noble Lord will agree, it is not a matter for the Government to decide here. I hope that to some extent I can meet the anxiety of the noble Lord, Lord Taylor, about the possible dropping away of members of the professions by saying that there is nothing in the Bill, or in the Government's mind, against the introduction of two rates, one for those actually practising and a lower rate for those not practising, or even conceivably no subscription at all but a slightly higher re-enrolment fee, though not so large as the original registration fee.
§ LORD TAYLOR
My Lords, would there be anything against raising the initial registration fee, in order to have life members, and a lower annual subscription?
§ LORD TAYLOR
If the noble Lord would excuse me: I am suggesting the alternative of a big life membership fee—say eight or ten guineas—and a smaller fee annually.
LORD ST. OSWALD
My Lords, I see the noble Lord's point, but I think that that is a matter for the Council when they meet, and one which could not possibly be decided at this Despatch Box. The noble Lord, Lord Taylor, mentioned that the number of medical representatives on the Radiographers' Board should be unchanged but that some of them should be nominated by the Faculty of Radiologists. This is a point which I am perfectly certain could be sympathetically considered before the next stage of the Bill.
The noble and learned Viscount, Lord Simonds, as I foresaw, gave, in a few 87 lucid and compelling words, the reasons for bringing back the powers of subpœna into the Bill at the next stage. The noble Lord, Lord Silkin, felt that the terms of the Bill were drawn so widely that nobody could be excluded, and that even if they were, it would not matter to them. I do not think that I can go into the matter of why I disagree with him. I can only remind him that many of these professional people are employed in the National Health Service and that the provisions of this Bill take the place of the 1954 Regulations, which exclude from employment with the National Health Service anyone who is not qualified. I presume that the provisions are as strict as the Regulations, but the strictness or laxness of the qualifications accepted is very much a matter for the professions themselves. I should have thought that their professional colleagues would be the first to insist that proper standards of professional conduct and achievement were maintained.
§ LORD SILKIN
My Lords, I have no doubt that proper standards will be laid down and observed. I was not making any point on that. My concern is that, having laid down these standards and having said that everyone who is registered must comply with them, there is nothing to prevent any member of any of these professions from carrying on practice without registration. I presume that registration will be refused because people do not comply with the standards laid down. Nevertheless, they can practise on the public, although admittedly they will not practise under the National Health Service.
LORD ST. OSWALD
I do not know to what extent that could be called a matter of opinion, but I should have thought that if there were an official standard recognised and set, and this system existed of maintaining professional standards among those who were within it, people seeking professional treatment of this nature would insist upon a registered professional. As has been emphasised in the course of the debate, most of these professions—although I agree not the chiropodists—work under a doctor or through the advice of a doctor; those out in the cold would be very much out in the cold, and it would be due only to the casualness 88 of the patient if he did not insist on the best treatment, which would presumably be from a professional enrolled under one of the registration boards. That is all I have to say. I should like to thank all those who have taken part in the debate for giving this Bill such an encouraging welcome.
§ On Question, Bill read 2a, and committed to a Committee of the Whole House.