§ Debate resumed.
§ 7.0 p.m.
§ THE EARL OF PERTH
My Lords, I am for joining the Common Market, and in this I have been very much encouraged by listening to the debate to-day, because of those who have spoken I think the numbers are: eight in favour of it and one, if not against, at any rate very hesitant. I am in favour of it not only because I believe that it will benefit ourselves but because it will benefit, and benefit very greatly, the Commonwealth. It is on this particular side that I want to talk to your Lordships a little this evening. Why do I believe it will benefit the Commonwealth? It is because I believe that a larger European Community will lead to an increased demand for Commonwealth products. Furthermore, it will mean that, if we are prosperous, we shall be able to do more to provide capital for the Commonwealth countries—and that they want from us above all other things. Furthermore, I think there will be a fair chance of the European Community itself also helping in the provision of this capital for the development of the Commonwealth and of the Colonies.
Why do I believe that a larger unit will increase prosperity? Very simply, for this reason: in this day and age, as the noble Earl, Lord Home, has said, we must have larger home markets. In our great industrial nation, agriculture is important, but let us remember that, in spite of all that it does, it is only 4 per cent. of the gross national product. Basically, our agriculture and everything else depends on industry, and industry to-day takes a new form. Vast amounts 339 have to be spent on research and on tuning up for new products, whether a motor car, supersonic aircraft or products for the use of space. For all of these things we have to have larger units.
What have we to-day? The United States of America numbers nearly 200 million; and it is the same for Russia. The European Economic Community as it is to-day has not far short of that number. We, even with EFTA, would have less than a half that number; and if we were alone we should have only a quarter of the number in these other units. I just do not believe that in this day and age we, as an industrial nation, could continue on that basis. On the other hand, if we can join the European Common Market, then, with 250 million of us, indeed the outlook is good. We have, or would have, a greater number of skilled men than any other unit in the world, and that, I believe, would offer great prospects. Of course, all of this would involve change, and in changing some will suffer and others will benefit. But even those who suffer have until 1970, in many cases, to make their adjustment.
The important thing from the point of view of the Commonwealth is that we should protect their vital interests, and again and again we have said that we would do this. If one looks very quickly at what has happened so far, I think we can say that, for the Colonies and for the recently independent Commonwealth countries, there will be the chance of the status of associated overseas territories. Then there are the Asian countries. I know that useful talks have been held already about those countries; and if one wants proof that the European Community already recognises the importance of the Asian countries, it is in the announcement only yesterday of the further help that is coming from Italy, France, and so forth, for Indian finance.
There remain what I would call the old Dominions: Canada, Australia and New Zealand. It is on them that at this present time the main problem arises. Negotiations are going on, as we know, about wheat, meat and dairy products. Many people have argued that what we should ensure is that for these products there should be guaranteed comparable 340 outlets. We have already heard several noble Lords say that the idea of a guarantee is just not "on"; it is not something that we ourselves have ever given: so I think that the idea of guarantee is something which should be dropped. Then the question arises about comparable outlets. I am not quite clear what "comparable outlets" would mean, but I suppose it would mean that they should be able to sell the same amount of products to the European Community as they have been doing to ourselves over the last years.
My Lords. I think that if we examine that we realise how tremendously things change. Let us take the example of meat—of great importance to Australia. Two years ago (I think I am right in saying) our imports of Australian meat were some £46 million and those of the United States were some £22 million. Look at the figures to-day: they are exactly the other way round. Or, again, let us take the case of wool. What was the position in regard to wool before the war? We took five times as much wool from Australia as Japan did. What is the position to-day? They get twice as much as we do, although we still take some £45 to £50 million worth. That shows how one cannot or should not seek comparable outlets. But, even if you wanted to, what does it mean? Does it mean the quantity or the value? In 1959, I think it was, New Zealand exported some £59 million worth of dairy products to this country: last year she exported some £36 million worth. In tonnage the amount was exactly the same. Is this what is meant: that the quantity should be the same? New Zealand would certainly say, "No". I think the only certain thing there is about the export of these products is that it will not be at all the same in 1970; and it will be the greatest possible mistake to put the Commonwealth or ourselves into a straitjacket, which was the point made by the noble Earl, Lord Home.
Now, what do we want? I suggest that we want assurances that the European Community will be outward-looking in its policy. It is precisely on this point that our delegation, led by the Lord Privy Seal, has done such great work already. I very much agree with the right reverend Prelate who spoke and who expressed admiration and good 341 wishes to the Lord Privy Seal. He does, indeed, deserve the thanks of us all for the skill with which he has conducted the negotiations so far—and we have made very real progress. After all, (the Six have accepted and recognised publicly the great importance of the Commonwealth. Furthermore, they have said that if, as a result of our joining, any member of the Commonwealth got into difficulty or was hurt—and, of course, we all have in mind, as they have, the possible case of New Zealand—then they will talk about the measures to be taken to remedy this. Moreover, they have said, in more general terms, that if they cannot get commodity agreements (which is What they seek for these types of products) by 1970, then they are ready to discuss with those Who want to take part in those commodity agreements measures to embrace them in them, and they have said that particularly in regard to the Commonwealth. So there we are: great progress has already been made.
All the same, it is right and we should continue to press for further assurance on these points. It is no good trying to get all the i's dotted and all the t's crossed and have all the pressure groups satisfied about what is going to happen to them now and afterwards. Rather—I agree with so many noble Lords who have spoken—what counts is the spirit behind this and the trust that we may have in those with whom we are hoping to work. Trust in them, trust in the Europeans, is something which, for example, the isolationists find difficult. They are therefore opposed to, or nervous about, going in. I would only say this to them: they should think very seriously of the implications of the fact that the Russians are against our going into this European Community.
Then, another group who are against this are those who are afraid of change. I think that that should not be, and is not, the spirit of this country. Here we have a great chance, after 900 years, of seeing Europe and ourselves together again after the tragic divisions of all that time. Naturally, such a tremendous step gives cause for hesitation. It needs great thought before we make the move. But supposing we miss—what happens? If we miss out, then the United Kingdom must decline relatively and become—I 342 think the expression was—an off-shore island. We should have to try to go it alone, and in doing that we should surely not be able to play our part with the Commonwealth either in taking their products or in giving them capital for development. So, my Lords, I feel it is essential that we in EFTA should try to join with the Common Market.
Then let us not forget that we all have a great opportunity to play our part in influencing the policy of the Six. As the noble Lord, Lord Gladwyn, said, we have a vote, and while we may think of it partly in a negative way so as to protect ourselves, we shall—this is more important—have a positive rôle to play, and I for one believe that we shall be able to play it for our own benefit, for that of the Commonwealth, and indeed, in time, for that of the whole world. I am all for this adventure—the term used by the noble Earl, Lord Home—and I have confidence in ourselves and in our children in being able to carry it out.
§ 7.13 p.m.
§ LORD COHEN OF BIRKENHEAD
My Lords, one of my friends in your Lordships' House, scanning the list of speakers at my side this afternoon, turned to me with unfeigned surprise and exclaimed: "Que diable faites-vous dans cette galére?" My presence here is essentialy due to the fact that his comment reflects a widespread view that the Common Market is the concern solely of politicians, of lawyers, of economists and of industrialists. But the Treaty of Rome has profound implications for all those professions in this country which are registrable under the law of this country: for doctors and dentists, for nurses and midwives, for vets, for pharmacists and indeed for all those whose professions demand a registrable qualification, and these should be more widely known. Yet in no debate on the Common Market in this House or in another place have the implications of the Treaty for professions been mentioned on a single occasion.
Let me stress at the outset that it is not for doctors or for dentists or for any industrial or other group to seek in their own interests to deflect the Government from a course which they believe to be right in the national interest and which will make a contribution to the prosperity 343 and peace of the world; and yet it is right that those of us who have experience and responsibility should make known on behalf of our colleagues some of the anxieties which are in our minds. Briefly, for professions, and especially for the medical profession, the disturbing article is Article 57. Section 1 of Article 57 lays down—and I quote from the old version, since I have not had an opportunity of reading the new:The Council … shall, in the course of the first stage by means of a unanimous vote and subsequently by means of a qualified majority vote, act by issuing directives regarding mutual recognition of diplomas, certficates and other qualifications.This may mean that a medical or other professional qualification obtained in any of the member States of the European Economic Community will be acceptable without scrutiny in this country as a criterion of a registered medical practitioner; and vice-versa we shall be recognised in the Six. I do not propose to deal with other articles of the Treaty, which are concerned with the practice of medicine, although there are many dealing with the right of establishment and with the health and social welfare services and their harmonisation. But I feel that I should confine my comments to Article 57, because this has given rise to grave disquiet in the medical and the dental and the paramedical professions in this country.
From the medical viewpoint—and I speak as President of the General Medical Council—I should like to sketch in a few sentences the historical background to our misgivings. Your Lordships will be aware that in "his country any unqualified person can practise medicine with certain limitations, and this led in the past to such grave consequences that for a period of nearly 40 years there was great discussion, and before Parliament were at least eight Medical Bills—all of them, I regret to say, abortive—which took note of this anxiety. But in 1858 there was passed the first Medical Act, and its purpose is explained in its Preamble. Its Preamble said that it was expedient that persons requiring medical aid should be enabled to distinguish qualified from unqualified practitioners. For this purpose the Medical Register was set up and the General Medical Council was established.
344 Perhaps I should here interpolate, since much confusion arises, that the General Medical Council is not the British Medical Association. The British Medical Association is a voluntary association of doctors with like purpose and like interests and they work to advance the interests of the medical profession. The General Medical Council is the body charged by Statute with keeping the Register and with maintaning standards of medical education. Notice that the control is in the hands of a statutory body. It is not, on the one hand, in the hands of a Government Department, although the General Medical Council has close relations with the Privy Council; nor, on the other hand, is it in the hands of a purely professional organisation.
Subsequent Acts, those subsequent to 1858, the last being the Consolidated Act of 1956, have underlined the purpose of the General Medical Council to protect the public. They have widened our scope, and in fact for nearly 80 years on the basis of reciprocity we have been able, through our particular machinery, Part III of the Medical Act, to recognise suitable qualifications in any Commonwealth or foreign country. That does not mean that we recognise the country. We recognise those qualifications which we think in that country are comparable to our own standards. We do that by appointing visitors who are not members of the Council, or inspectors, to report on the facilities for medical education and on the standards of examinations of the medical schools. We apply this machinery almost daily to the recognition of qualifications in Commonwealth and foreign countries.
If existing or analogous machinery were allowed to determine the suitability of medical qualifications for practise, if and when the United Kingdom join European Economic Community, then the public could be satisfied that any doctor so recognised from a Common Market country possesses a qualification and experience which furnish, in the words of Section 20 of the Medical Act,a sufficient guarantee of the possession of the requisite knowledge and skill for the efficient practice of medicine, surgery and midwifery.345 But it follows that if mutual recognition of qualifications ware accepted indiscriminately, then there might be some threat to the standards which the General Medical Council has existed since 1858 to achieve.
Let me remind your Lordships of but one example of the potential hazards. One of the present members of the E.E.C. applied for reciprocity with this country after the war and a very distinguished medical inspector reported. First, he said that the entry to each of their medical schools was nearly 1,000, except in one or two smaller schools, Where the number was about 200 per year. These are one or two extracts from his report:The students entering were utterly without any admissable primary educational standard, the selection for education in the last ten years being practically entirely on political grounds.The standards of education everywhere were farcical.The want of professional knowledge was deplorable.And so on, in like vein.
In 1948, the question of reciprocity with that country was revived from high quarters and a further independent report was obtained. Let me quote one or two items from that:The oral examinations had degenerated, generally speaking, to a complete farce. Series of pupils are often examined and passed in classes.I know of other cases in which students have taken a medical degree. They have told me quite candidly that, although they have been awarded a medical degree and could take up practice, they had never in fact walked a hospital ward during their whole training.The gaining of a degree in medicine, therefore, means very little at the present time. The man who gains it may or may not be a competent doctor. His degree is really not a measure of his ability to practise medicine.It may well be argued that no such adequate evidence exists at the present day because the General Medical Council has not been invited to inspect the schools of this country; but let me remind your Lordships that those who qualified under that régime, if we have indiscriminate recognition of their qualifications, have a potential life as doctors for another 25 or 30 years, and we should have to recognise those also. They may well be able to have their qualifications recognised in other countries and we should not have the same ease of recognition of Commonwealth 346 qualifications as we have had in the past.
Now you might say that this is an extreme example, but there is another independent yardstick by which we can compare medical education in this country with that in the Six—namely, the examinations which are conducted by the State Board of Medical Examiners in the United States. They conduct examinations of all those who wish to obtain licences to practise in certain States of the United States. In 1959, which is the last year for which I have figures, 80 English doctors took this examination and 75 passed—that is a failure rate of 6 par cent. Those who ware graduates of our own medical schools had a failure rate of only 3 per cent. The failure rate for the Paris medical school was 30 per cant. For the larger Italian schools, the failure rates ware—Rome, 30 per cent.; Naples, 51-9 per cent.; Bologna, 351 per cent., and Milan, 71. 4 per cent. Moreover, it may not be without significance for our National Health Service that in that one year 396 Italian medical graduates took their licenciate examinations in the United States of America. For Brussels the failure rate was 37.5 per cant. In West Germany, out of 343 candidates, the failure rate was 34 per cent. This is not due to differing systems of education or differing languages, because there are countries in Europe whose medical education approximates in some measure to our own and who had similar striking success. For Spain, for example, the failure rate was practically our own—7 per cent.
It seems to the General Medical Council that the only safe procedure is that which is embodied in a resolution which the Council adopted at its May session this year, which said that, in the event of our joining the Common Market,It is desirable in the public interest that any arrangements made in pursuance of Article 57 of the Treaty of Rome to admit medical practitioners from other European countries to practise in the United Kingdom should have regard to the standards hitherto secured by Part III of the Medical Act, 1956.This resolution and relevant passages from my presidential address ware communicated to the Lord President of the Council, the Lord Privy Seal, the Secretary of State for Scotland and the Minister of Health. We did not expect other than a formal aknowledgement; and, indeed, our expectations were satisfied.
347 On March 5 last, in another place, the Minister of Health was asked whether he had been in consultation with the British Medical Association and the British Dental Association about their anxieties that signing the Rome Treaty would have an effect on professional standards in this country and might also affect National Health Service Standards. The Minister replied [Official Report, Commons, Vol. 655, col. 31]:I have had consultations with those two bodies and will have them in future, but there are specific safeguards about these matters in the Rome Treaty ".These safeguards I confess that a careful study of the Treaty has failed to reveal, unless the Minister is referring to Section 2 of Article 57, which if I interpret it aright, would require all doctors, whether native or immigrant, to practise in conformity with the laws of the country. I hope that line noble and learned Lord on the Woolsack, in his summing up of this debate, will inform me, and through me the members of my profession, what these safeguards are
Let me explain quite briefly why anxiety exists. Our English system has been followed, in greater or less degree, in nearly all the countries of the Commonwealth. One finds it in Australia, New Zealand, India, Pakistan, Ceylon, South Africa—until a very short time ago a member of our Commonwealth—in Malaya, Hong Kong, Malta and, in somewhat modified form, in Canada. In nearly all of these countries there are controlling bodies analogous to the General Medical Council, and in most the university medical curricula have close associations with our own. We have long enjoyed close and friendly association with these bodies in the Commonwealth. We could, indeed, with confidence, echo the words of Burke: we hold our Commonwealth countriesin the close affection which grows from common names, from kindred blood, from similar privileges, and equal protection.andthese ties which though light as air, are as strong as links of iron ",are not to be lightly thrown away.
Our British and Commonwealth system of medical education, registration and professional discipline differs from most, if not all, the Continental systems. The 348 Continental systems tend to lay much more stress on Government control, especially in the field of medical education. They have no analogous higher qualifications to ours. They often do not provide the public with a readily accessible medical register. Here we select our students so that the numbers of medical students in our universities can be counted in hundreds, whereas abroad, in the Six, they can be counted in their thousands. The position of specialisation in Europe is, as has recently been described, chaotic.
It is in matters of professional discipline and conduct that there is a profound difference between the Six and ourselves. We have in this country no code of medical ethics. Through the Disciplinary Committee of the General Medical Council, we are accustomed to judge each complaint of conduct on its merits guiding ourselves by precedent and by circumstances in the spirit of the Common Law. The Continent has its strict codes of deontology which seek to define, both positively and negatively, all the responsibilities of the medical practitioner and the breaches of privilege for which he may be punished. There is to many of us an odd omission in most of these. A practitioner may be accused by another practitioner, by a trade union, by a public body or by the disciplinary body itself; but he cannot be accused, and no complaint can be laid against a doctor, by the patient or the patient's friends. Our disciplinary proceedings are conducted in public. You will notice, my Lords, that they have not been neglected in the Press. Moreover, the decisions of the General Medical Council are subject to an appeal to the Judicial Committee of the Privy Council.
My Lords, if I believe in our British system in such matters, it is not simply because it is British, nor because it is necessarily the best sub specie æternitatis. But that system enshrines our experience, our national way of life, our belief in diversity and experiment (I am thinking here particularly of medical education) and our belief that medical ethics and discipline should not be an esoteric secret but are matters in which the common man should have every opportunity of making himself heard and to know and understand what is done. How do these matters stand in relationship 349 to membership of the European Community? Here we encounter a difficulty. The noble Earl, Lord Home, referring to the Six members of the European Community, said on June 21, 1961[OFFICIAL REPORT, Vol. 232, col. 628]:I think it … inconceivable that any of them or any of us, if we all came together, would surrender sovereignty to a point where it infringed and was harmful to our own national institutions.Let me quote the noble Earl again, speaking exactly a year ago in this House in relation to the Common Market, when he said [OFFICIAL REPORT, Vol. 234, col. 119]:… the field … is clearly defined and restricted to economic matters.The question which naturally arises is whether the control in the public interest of standards of medical education and conduct—a control which, I have reminded your Lordships, is secured by Act of Parliament—is included in Lord Home's assurances and later assurances. We do not know. We have not been told. We have to proceed to a large extent on hearsay. It appears from statements made by Ministers that our Government have in principle made no reservations on Article 57 if we join the Common Market, or to its implementation by 1967. Moreover, if rumour be well founded, it appears that a sharp distinction may be in mind as between the Commonwealth, on the one hand, and the Common Market countries, on the other, in that the General Medical Council will continue to sift Commonwealth qualifications according to its present procedure; but under the rigid system of the Rome Treaty, the Council may find itself prohibited from exercising any similar power or discretion in regard to any medical qualification, however, questionable, granted in any present or prospective member of the Economic Community. If that is intended, are we certain that it is in the public interest? Can such an invidious distinction be acceptable to Commonwealth countries? As your Lordships will appreciate from what I have said earlier, the existing safeguards embodied in the Medical Act are devised in the light of long experience to ensure that no registered practitioner Will be free to practise medicine in this country unless he 350 possesses a qualification and experience which furnisha sufficient guarantee of the possession of the requisite knowledge and skill for the efficient practice of medicine, surgery and midwifery ".My Lords, I have confined my comments to medical education and cognate matters because they illustrate a general theme which applies also to dentists, nurses, vets, pharmacists and other registrable professions. Our traditions are flexible and experimental in nature with a limited degree of Government control. It seems that the systems with which we may find ourselves integrated are of a somewhat different nature. If that is so, we must surely ask ourselves: Must we, if we enter the European Community, sacrifice these systems, born of and evolved from our unique experience? Are there not things of great value in this country which we should seek to preserve, and among these should we not wish to see retained, until we are persuaded that they can be bettered, our system of medical education, which has been a signpost to countries all over the globe, our system of clearly defined registration of professional men, designed to assist and to protect the public in many fields, and our standards of professional ethics and discipline administered judicially in accordance with British traditions? These are doubly valuable: they are valuable in themselves, and also on account of the part they play in our links with the Commonwealth.
There is much truth in the old adage, festina lente. The decisions which appear to have already been taken concerning the mutual recognition of professional qualifications within the European Community by 1967 are precipitate. There has been no consultation with the professional bodies most intimately concerned and in the best position to advise. Clearly, there are certain decisions concerning the European Community which urgently press, such as the need to promote trade and investment without impediment between the Common Market countries, and the defence decisions which will save the Community from the hazards of diplomatic and military isolation.
Let me concede once again that it is not for any sectional interest to demur at any sacrifice if, with knowledge Which must of necessity be more complete than 351 ours, the Government hold that both our national interest and the prosperity and peace of the world demand our entry, and there may well be powerful reasons why we should not resist the ultimate aim of political unity. But ultimate unity will be hindered, not fostered, not helped, by imposing uniformity prematurely; and this is the risk to which Article 57, which envisages the mutual recognition of qualifications, exposes both professional education and practice in this country. As Colin Clark, who is a supporter of the Common Market, and who wrote an admirable book, British Trade in the Common Market, says—and this surely instances it:there is danger of the central authority of Brussels attempting, amidst a Parkinsonian profusion of officials, to concern itself with local affairs which should be left to national government.
EARL ST. ALDWYN
My Lords, the time has come when I think we should adjourn during pleasure for the Royal Commission.
§ House adjourned during pleasure. House resumed.