HL Deb 28 June 1976 vol 372 cc634-58

5.42 p.m.


My Lords, I beg to move that the House do now resolve itself into Committee on this Bill.

Moved, that the House do now resolve itself into Committee.—(Lord Wells-Pestell.)

On Question, Motion agreed to.

House in Committee accordingly.

[The VISCOUNT GOSCHEN in the Chair.]

Clause 1 agreed to.

Clause 2 [Regulations in connection with s.1]:

Baroness YOUNG moved Amendment No. 1:

Page 2, line 42, at end insert— (" ( ) shall only be exercised in the case of female applicants after consultation with the Equal Opportunities Commission; ").

The noble Baroness said: The object of this Amendment I think must be quite clear, but the point that I am raising is one which I believe to be of great importance because I think that under this Bill we could, unless we are very careful, make it much more difficult for women to become general practitioners. As I indicated at Second Reading, the purpose of the Bill is that after a boy or girl has completed his or her medical training they shall then have three years' prescribed medical experience before they are fully qualified, and I raise the point as to how this will affect women doctors. As I am sure the noble Lord himself is well aware, until the passing of the Sex Discrimination Act there was a very great discrimination against girls wanting to be medical students and, quite rightly, that Act put that right.

We find now in another Act, the purpose of which will be entirely made clear by regulations about which we know nothing at all at the moment, that all general practitioners are going to be required to undergo these three years of prescribed medical experience. The only exceptions are the ones listed by the noble Lord at Second Reading. It seems to me that to ask every women to undergo these extra three years' prescribed medical experience will make it very difficult for many women to qualify completely because it is expecting everybody to undergo nine years' training before becoming a fully qualified general practitioner. I should like to ask the noble Lord whether it is going to be possible for women to undertake this prescribed medical experience part-time? What is to happen to them if they marry and, in the course of their prescribed medical experience, start a family? Is it possible for the one year or eighteen months that they have done to qualify them, and will they be able to continue; and, if they do not undertake the prescribed medical experience having qualified through their medical training, will they be able to come back after a period of time and qualify for it, perhaps 10 years later?

I ask these questions because I must say that I was surprised to discover that neither the Equal Opportunities Commission nor the Medical Women's Federation have been consulted about this Bill and are aware of its contents. I think that once it becomes known that this is going to become law by 1980, many women are going to feel very concerned about it. I therefore put down a simple Amendment, that before the regulations are laid the Equal Opportunities Commission shall be consulted and shall be able to express a view on the effect of the Bill on women who wish to become general practitioners. I hope the noble Lord will be willing to accept this Amendment. I beg to move.

5.47 p.m.


Let me straight away say that I agree with everything the noble Baroness has said. I think women have had a poor deal in the medical profession, in medical training, in medical education and in their admission to medical schools and so on; and as the noble Baroness has said, although we are going to speak about Clause 2 in a few minutes, we have no inkling from the Bill of what is going to happen. I would not quarrel with, but differ slightly from, the noble Baroness over the wording of the Amendment. I think myself that " women doctors " is a nicer term than " female applicant "—and that should have come from her rather than from me. Then, whether the Equal Opportunities Commission is the right body to be consulted about this, I am not quite sure. I should require guidance. It seems to me a little as if referring to the Equal Opportunities Commission is making rather heavy weather of what we are trying to do, and if it could be done in another way it might be better.

I am absolutely aghast to find that neither the Equal Opportunities Commission nor the Medical Women's Federation, which to my certain knowledge has been a reputable and distinguished body for at least 50 years, has been consulted so far. When we come to Clause 2, I may have something further to say about the Medical Women's Federation and another body which I shall then mention which I think should be consulted. I am really very unhappy about this altogether.

As I said on Second Reading, having been on the Royal Commission on Medical Education I am, in general, in favour of a longer period of training before becoming a principal in general practice. But I share the misgivings of the noble Baroness about what this could mean to women, and I hope it will be clear that some of this time could be spent in part-time training and not full-time training. I think we must look at this very seriously or it may become another raw deal for the women.


I should like to support the noble Baroness in this Amendment. I agree with the noble Lord, Lord Platt, that " women doctors " is a better phrase than " female applicants ". No doubt that could be discussed further. When we were discussing the Equal Opportunities Commission, I remember the noble Baroness, Lady Summerskill—who unfortunately cannot be here today—pointing out how extraordinarily unfair the medical profession had been in the past in many ways to women, and with what pleasure she agreed to the new procedures under the Equal Opportunities Commission. It would be a great pity if on one aspect of medical training in the National Health Service we still see the same discrimination—it may not be intentional—against women in this matter. I hope that the noble Lord will be kind enough to think about that again and ensure that an amendment is made to remove any kind of discrimination such as that mentioned by the noble Baroness and the noble Lord, Lord Platt.


Reference has been made to the Medical Women's Federation and the Equal Opportunities Commission. As well as those bodies, we also have the Women's Commission which has operated under both Governments for a very long time. This Commission meets regularly, and I think it odd if that Commission is not taken into consideration and asked for its views. It seems to me that Governments do not know about such organisations which deal with these matters. It would have been much more appropriate to have consulted the Women's Commission. Both Mrs. Thatcher and Mrs. Barbara Castle have been chairmen of this very important Commission. It would have been more appropriate to have consulted that Commission than the Equal Opportunities Commission. The Women's Commission has representatives over a wide field. I am not sure whether this is the right time to raise this matter, but if it has not been consulted I should like to know why. Its advice would have been valuable, and I should like the Minister to tell me why the Commission has not been consulted. My own view is that the Amendment does not cover a wide enough field and wise advice ought to have been sought from that Commission.


I should like to support the Amendment. As it was a woman doctor who saved my life, I suppose it is not surprising that I am in favour of it. The noble Baroness pointed out the difficulties that face any woman who marries and starts a family. Those are facts of life which no legislation can afford to disregard. It would be totally unfair to do that. I feel that that aspect should be considered and that women in that position should be given a proper chance.

5.55 p.m.


I must confess that I am a little surprised that there should be a feeling existing in this Committee that this Government are going to stand idly by and see women doctors get a raw deal. If the noble Baroness, Lady Ward of North Tyneside, will allow me to say so, I do not know whether she was present at the Second Reading of the Bill. If so, she would have recalled that I made it perfectly clear that discussions were only just beginning. Often the whole object of Governments is to get a Bill on the Statute Book and, while it is passing through the procedures of both Houses, to have discussions on certain matters and then lay the regulations before Parliament. I want to make it perfectly clear to the noble Baroness that discussions have only just begun and are going to continue for some considerable time. Before the noble Baroness rises to speak again—as I am sure she will—may I point out that we are concerned with a specific contribution by a specific group of people; namely, women doctors.


I am grateful to the noble Lord for recognising that I should like to say something else. I do not remember whether or not I was present at Second Reading. I am a little surprised that, with all their great experience and knowledge, the women Members of this House were not asked to come together to discuss the matter. Nowadays a great deal more notice is taken of what women think about matters, and I am sure the present Government as well as my own Party are concerned with these issues. The noble Baroness moved the Amendment in very good terms, and I am surprised that she did not think it advisable to get all the women Members of this House together to discuss the matter, to see whether anybody had any views as to whether women were not being properly protected in the Bill.

I do my best to be in this House as often as I can. I am not in favour of " Women's Lib.", but I believe in experience. As has been pointed out, women doctors have known many occasions when their experience has not been taken into account. I am always willing to join in any consultation; I am only too delighted to do so. But I represent a part of the world very far removed from here. I attend this House very regularly and I am not sure that my own Party realise that I attend so often. So I hope the noble Lord will not think it extraordinary if I take any action in this matter. I would never be able to do anything in my part of the world if I attended here all the time. The people in my part of the world like to see me from time to time.


I can assure the noble Baroness that she is now in a civilised part of the country, and, because it is a civilised part of the country, she can rest assured that not only this Government, but also the noble Baroness opposite, will see that the right steps are taken to safeguard the interests of women doctors. As I understand the situation, the noble Baroness, Lady Young, raised this matter simply because she wanted to draw attention to the fact that the needs and interests of women doctors should be adequately protected and safeguarded. This is an intention of the Government. The noble Baroness, Lady Young, made a comment about " nothing known at all about what is going in the regulations ". The noble Baroness should know better than anybody in your Lordships' House that such a thing is not unusual. I seem to remember that when she was Parliamentary Under-Secretary of State in the Department of the Environment she introduced a number of Bills and then said that the regulations would follow. This is the normal procedure and there is nothing surprising about it. It has been going on for many decades. Your Lordships will know that once the regulations are laid, if they are not satisfactory in this case, they will be subject to the Negative Resolution procedure and can be prayed against, and there could be a debate upon them at that stage. I am not saying this is what one wants, but I am saying that the Government are not unmindful of the need to watch carefully the position of women doctors, because of the special difficulties in which many find themselves, and that they should not in any way be prejudiced by this vocational training.

Having said that, I cannot accept this Amendment because, with the greatest respect, the Government do not think it is necessary. The reason is that we can be very certain that, during the discussions that have been started and will continue for some considerable time, the very matters which are of concern to all who have spoken will be taken into account. As I understand the situation, one of the difficulties in accepting this Amendment would be that we should be required to consult with the Equal Opportunities Commission on practically all matters set out in Clause 2(1)(a) to (g), and I am sure that the noble Baroness will come to the conclusion that this is not necessary when she reads what is there.

I fully appreciate—and I speak with the authority of the Government on this—the concern underlying the Amendment. We have long recognised that women doctors can and do face very special problems because of domestic commitments. Already we have arrangements to help women doctors and hope to improve these considerably. I will return to that matter in a moment or two. The effect of the Amendment would be to require separate regulations for women, and in fact that could lead to the creation of discrimination. I do not think that was in the mind of the noble Baroness.

It introduces discrimination also in respect of a particular body for consultation. Noble Lords will appreciate that there are a number of bodies which will need to be consulted, all of them with very important contributions to make. The Bill, as drafted, gives freedom to include every one of them; there is no restriction whatever in the Bill. It does not preclude consultation with any body. The Equal Opportunities Commission's concern will be with the opportunities for acquiring the experience, and we feel that in our consultations we can consult the very people who really know the problem of women doctors when they get married and take time off to have a family and then want to return to their profession. This is peculiar to the profession, and the Government can explore it quite fully.

This leads me to explain some of the wider provisions already made to help doctors with domestic commitments. In 1969 health authorities were advised of the need to make part-time hospital training posts available for women doctors. In 1972 the Women Doctors Retainer Scheme was introduced to help them to maintain contact with medicine. In this, the women doctor works up to two sessions a week either in hospital or in general practice, for which she is paid in the usual way. She also receives a grant to cover such expenses as registration and for professional journals. Since 1973, about 300 part-time training posts have been provided, and nearly 500 women doctors have passed through or are members of the Retainer Scheme. There are also provisions to pay fees, subsistence and other expenses of doctors taking courses arranged by post-graduate deans to help them to return to general practice after absence because of home commitments or, in some cases, of working abroad. Last July my right honourable friend the former Secretary of State for Social Services held a conference at Sunningdale about the problems of women in medicine. That was less than a year ago. Copies of the report of the proceedings have been placed in the Library of your Lordships' House. We are now discussing possible improvements to the present schemes and the revision of the existing guidance with the medical profession.

I hope your Lordships will accept my apologies for perhaps having taken up some time in setting out the detail, but I think it is important to reassure your Lordships that we are pursuing an active policy to ensure that the skills of these doctors are not wasted. I can go so far as to say that we are looking to a time in the future when 50 per cent. of the medical school output will be women. We are working towards that—a 50 per cent. output.

Baroness SEEAR

My Lords, would the noble Lord allow me to intervene? Surely he is not saying that the Government are committed to a system of quotas?


My Lords, a system of quota, if it means higher than it is at the present moment, yes. There is nothing wrong with a quota if it is the right quota or a better quota than one has at the present moment. In the interests of women doctors and, still more if I may say so, in the interests of the National Health Service, we have to realise that we need their skills more and more, as those of us who have a close identification with the National Health Service will know.

Our consultations on the regulations to be made under the powers conferred by the Bill will certainly have these matters in mind, and since the noble Baroness raised this matter on Second Reading I discussed what we are doing in the Department. I may say that we shall leave no stone unturned to ensure that adequate provision is made for the training of women doctors who want to enter the National Health Service as principals, and to offer them every possible facility to do so.

I think the only question I have not asnwered concerns that put to me by the noble Baroness as to whether, if there is a break in training, a woman doctor will be able to return to it, and also what her credit will be for what she has already done. If the woman doctor takes the National Health Service vocational health training and has to withdraw from it at any stage and for any reason, she will be able to return to it at any stage convenient to her and, if I may put it this way, she may merely carry on where she left off. She will receive whatever credits are due to her.

There has been preliminary consultation with the General Medical Services Committee. On that Committee, I understand there is a member of the Medical Women's Federation. Of course, it could be argued that there is only one member of the Federation but, as I tried to point out, under the Bill there is nothing to prevent the Government from holding consultations with every body and every concern which has an interest in the matter or something to say on it. I can assure your Lordships that that is the intention of the Government.

I hope that, in the circumstances, the noble Baroness will feel that it is not necessary to press her Amendment to a Division. I would again remind your Lordships that the regulations will be laid, and if on reading them there is any serious doubt in your Lordships' minds as to their worthwhileness, there is no reason at all why the normal procedure should not be adopted and why we should not debate them.

Baroness YOUNG

I am very grateful for the reply of the noble Lord, Lord Wells-Pestell, and I am particularly grateful for the general support which my Amendment has received in the Committee this afternoon. I feel that it was well worth while to put it down, in order that we could have a very full debate on this point. I am bound to say that I am not very happy with the noble Lord's reply. I absolutely accept his good faith in this matter, and that of the Government, in that they want to ensure that as a result of this Bill the position of women doctors is not made more difficult than it is at the present time. On the other hand, it is very easy to say that discussions are continuing, that the Government will lay regulations which we can all read and that these will be subject to the Negative Resolution procedure so we can vote against them.

The real difficulty, as he knows, about voting against Statutory Instruments is that we have to vote against the whole regulations and cannot amend them in the way that we can amend a Bill. What the noble Lord is saying to us is that we must buy this Bill blind, because we do not know what will be in the regulations. He has told us that he cannot tell us precisely what will be in them, because consultations are continuing. He has also said that we must wait until we see the regulations and then, if we do not like what we see, we can vote against them. But I do not believe that that is a very satisfactory way of legislating. It may well be that when I myself was responsible for introducing Bills I introduced similar provisions, but I cannot recall a single instance of a Bill which entirely hinged on regulations to be laid which had not been seen. I am sure the noble Lord will agree with me about this Bill. It has only five clauses in it and the only one of any significance is Clause 2, because the rest of it is completely descriptive. So that its core will lie entirely in the regulations which lay down what the prescribed medical experience will be.

This afternoon we have to accept good faith that the Women's Medical Federation will be consulted, that the Equal Opportunities Commission will be consulted—if that is considered right—and that the needs of women doctors will be taken into account, so if we have all those assurances we need not worry at all. But I have lived long enough in politics—not that I doubt the fact that the noble Lord means to do all he can—to know that that is not a very satisfactory way of safeguarding the real interests of women doctors.

Of course, I was very pleased to know about the numbers of consultants in part-time posts since 1969, and this is very much to be welcomed. I am glad to know that they are on the increase, but I think we can take that as an indication of what will happen to women who want to go into general practice, because my guess—although I do not have the figures—is that far more women want to go into general practice than into hospital work, because general practice has a particular appeal to women doctors and they are very good at it. My suspicion is that the doctors will say, as they say now, " There is not much real need to train more women doctors, because they marry and have families and do not practice as much as men doctors, so we do not need so many in medical schools."

A Bill like this will make it more difficult for them to practice, because they must have not only six years at medical school, but have gained three years' prescribed medical experience. I accept that they will be paid during that period, but the reality of life is that they will not be fully qualified until they have gained the experience, and if they are working part-time it may take them six years. So that for many women it could be up to 12 years before they were fully qualified, which could make things much more difficult for them. This is a very real point which ought to be considered, but we are asked to have faith in the regulations.

I accept that my Amendment is not very well worded. I take absolutely the point of my noble friend Lady Elliot, and of the noble Lord, Lord Platt, that " female applicants " is not a very good term. The difficulty about wording Amendments rather late at night, in order to get them down in reasonable time, makes one realise on reflection that one could have done better, and it would also have been better to use the term " Women's Medical Federation " instead of " Equal Opportunities Commission ". So in those ways the Amendment could be improved. What I should like to do now is consider what the noble Lord has said. I shall read Hansardvery carefully, and take the opportunity to consult with some of my colleagues to see whether we should return to this matter on Report. Therefore, I shall not press the Amendment this afternoon, but I shall consider the situation very carefully when I have read the report of the discussion.


Before the noble Baroness sits down, may I say that I am very grateful to her for taking the line she has taken. But it would be helpful if the Government could have an indication of how she feels this matter could be dealt with more adequately. I am not being facetious when I say this, but I do not see any other way of proceeding and I have given the Government's assurance that exhaustive consultations will be held. If the noble Baroness can make a suggestion whereby we can overcome some of her reservations, then we shall be very glad to have it. One must hear in mind that not all women doctors will want to have this. They are obliged to have it only if they want to enter the National Health Service as principals. Many of them work on a sessional basis or as assistants, and will continue to do so. It will be obligatory only if they want to be principals in general practice.


Before my noble friend withdraws the Amendment, if that is what she intends, I hope that she and her colleagues on the Front Bench will look at this matter very carefully when it arises again at the next stage. I accept the point of the noble Lord, Lord Wells-Pestell, that government by regulation is an accepted and proper form nowadays, but, even so, it is a blank cheque. Therefore, it is vital that some kind of indication should be given as to the possible line which such regulations will take. My noble friend made the point very clearly that in practice it is very difficult to deal with regulations, once power has been given for them to be issued. They cannot be amended and one can only pray that the whole measure is removed, although one may not want that. It may well be that 80 per cent. of what is in the regulations is acceptable and right, but 20 per cent. is not—and that may be the vital 20 per cent.

While the noble Lord, Lord Wells-Pestell, inspires a lot of confidence by his manner and the way he always presents his case, he may not be in the Department when the regulations are put into operation; he may well be in another Department. So we have had an undertaking from someone who has given us confidence, but he may not be there to justify the confidence that we have placed in him. It is for that reason that, before a Government should ask for power to legislate by regulation, they should give clearer indications than have been given on this issue as to the line that they are likely to take.

Indeed Governments sometime use any argument here against Opposition. There was an example in the other place when one of the leaders of the Government Party was questioning Mr. Churchill in opposition, as he then was. He said, " You have not put the words very clearly. The words you threaten to put on the Order Paper ought to be known now by people. Can you not give us a clearer line on what it is all about?" Mr. Churchill replied " That is quite true. The words are not there in detail, but the general line will be tyranny, conceit and incompetence. That will be the general line ". We have not had even a " general line ". We have not even had that from the noble Lord, Lord Wells-Pestell.

I believe that before one asks for power to use the blank cheque method of government, a clearer indication ought to be given of the figures which will be put on the cheque. I hope that my noble friend will watch this point very carefully—not in this instance, because I am not au fait with the women doctors' point of view and cannot help, but in terms of how we use our Governmental procedure. This is vital, because if precedents are set up and one is allowed to go through, it is much more difficult to deal with it on a future occasion.


Before my noble friend replies, I wonder whether he could also give the Committee an assurance that so far he has not received any representations along the lines of this proposed Amendment from the Medical Women's Federation, for this is the professional body that is most closely involved? I am convinced that the Medical Women's Federation are closely watching the progress of the Bill and the provisions included in it. It would reassure the Committee if my noble friend could tell us that so far the Medical Women's Federation have not made any representations about this issue to the Government.

Baroness SEEAR

Would not the Minister agree that the position will be met only if it is embodied in the Bill that the experience need not be full-time experience? I have not worked out an Amendment, but if we look at Clause 2(1)(a) surely it would be possible to add some words. The paragraph refers to " medical experience ", indicating that the experience need not be on a full time basis. We would all be much happier if a safeguarding provision were incorporated in the Bill. This is the crux of the matter. Surely it ought to be possible to incorporate a safeguarding provision in the Bill.

6.22 p.m.


First in reply to my noble friend Lord Segal, may I say that up to the present time no representations have been made to the Government by the Medical Women's Federation. With regard to the matter raised by the noble Baroness, Lady Seear, I should like to look at what she has said and have discussions within the Department about her proposal. However, my understanding of the situation is that even at the present time it is possible for a woman doctor to be a principal in the National Health Service, even though she is not working full time. I ought not to guess at figures but I will do so and then write to apologise if I am wrong.

I think that at the present time a woman doctor can be a principal within the National Health Service, even if she has a list of only 1,000 patients which, as the noble Baroness knows, is considerably fewer than the lists of many other doctors. Therefore I do not envisage any future difficulties about this, because presumably the same conditions will apply. However, I should like to consider what the noble Baroness has said, and certainly I shall not hesitate to write to her if I have to change some of the points I have made or if there is anything that I can add to them.

May I say in reply to the noble Lord, Lord Harmar-Nicholls, that I dealt with this matter at Second Reading. However, I think that I can deal briefly with it at this stage. Already we have had preliminary views from the General Medical Services Committee, the Royal College of General Practitioners and the Council for Post-Graduate Medical Education. In prescribing the medical experience necessary, the Secretary of State will take advice from the joint committee on postgraduate training for general practice. This committee is composed of representatives of the General Medical Services Committee—on which, as I have already said, the Medical Women's Federation is represented—the Royal College of General Practitioners, the Conference of Regional Advisers in General Practice, the Conference of Postgraduate Deans, the Association of University Teachers in General Practice and the Armed Services General Practice Approval Board. Professional committees will also be responsible for issuing certificates of prescribed experience, but I think that the noble Lord will agree that we are to have consultations with a very wide field. As I say, the Government are always open to advice, particularly in matters of this kind where there are so many members of the medical profession in your Lordships' House. If there is anybody that we ought to be thinking about, then I hope that Members of your Lordships' House will not hesitate to let us know.

Baroness YOUNG

I am very grateful to hear that list of people who are to be consulted over the laying of the regulations and I am very glad to know that in no way is it going to be restricted. One of the difficulties at the moment is that people have not given evidence to the Government because they did not know that the Bill was going through Parliament and had arrived at your Lordships' House. Therefore one has to be a little careful about saying that just because evidence has not been produced it would not have been forthcoming had it been asked for.

I do not feel we could accept the argument that a woman doctor could be an assistant and therefore need not worry about not being a principal in general practice. I do not intend to repeat all the arguments that were used on this kind of point during the course of the Sex Discrimination Bill. It merely goes to show that women have more difficulty in qualifying and therefore tend to end up in the less good jobs. One must be realistic about this. It could well mean that in a general practice the woman doctor would be the general dogsbody because she was not so well qualified as everybody else. This is a situation which I am sure we should all want to avoid. It is for that reason that one wants to enable women doctors to qualify to become principals without too much difficulty.

I am most grateful to the noble Baroness, Lady Seear, for her suggestion of an Amendment. I am also grateful to the noble Lord, Lord Wells-Pestell, for his offer to consider any Amendment that would meet this point. T shall think about it, and I am certain that the noble Lord will in general terms consider the Amendment that has already been suggested. As I say, I will read what has been said in Hansard and consider this matter before the next stage of the Bill. In the meantime, I beg leave to withdraw my Amendment.

Amendment, by leave, withdrawn.

On Question, Whether Clause 2 shall stand part of the Bill?

6.27 p.m.

Baroness YOUNG

As I have already indicated, Clause 2 is the core of this Bill and it would be very helpful to know something about the kind of regulations that the Government intend to lay. There are, therefore, three general questions that I should like to ask.

First, what is meant by " prescribed medical experience "? For example, does it mean that doctors will be sent to various areas of the country and that the real intention is to operate a kind of quota system so that the less attractive parts of the country will be able to get general practitioners? It may be that I have a suspicious mind, but it would be helpful to know that this is not the intention of the regulations. Certainly some doctors have said this to me. Of course, one knows that there are parts of the country where it is very difficult to get general practitioners and that the temptation to say, " You will do your prescribed medical experience in X, because we cannot get any doctors there ", would be very great. The " prescribed medical experience " would be rather like the teacher quotas of local education authorities. This is a very good way of making quite sure that qualified teachers are distributed around the country so that the popular areas are not able to get more than a certain number. I think it would be helpful to know that this is not the intention of the Government over prescribed medical experience.

Then I should like to know what the ratio between hospital experience and community work is to be, and in this connection what will be included in community work? For example, will doctors be required to work with social services departments. Will they, for example, be required to have a period of time in an old people's home, so that they would know some of the problems of geriatrics and some of the very complicated problems of dealing with old people in the community? Will they get some experience of working with other medical services? Will they, as it has been put to me, learn about a community approach; for example, finding out the number of preventable diseases within a practice?

The second general question I should like to ask is who is to be the prescribed body which will determine the prescribed medical experience? Thirdly, how will the prescribed medical experience be assessed? Is this to be assessed by the prescribed body by examination?


Will the noble Baroness repeat what she said a sentence or two ago?

Baroness YOUNG

The second question that I asked is, who is to be the prescribed body? And the third question is how will the prescribed medical experience be assessed? For example, will the general practitioner, before completing this course, have to sit another examination? Will he, for example, have to write a dissertation? Will he, for example, have to do some kind of study in depth on some particular medical point? Will there be an assessor, or will the body working out the prescribed medical experience have the final say? What happens in the case (which is not unknown) of a doctor who, for perhaps perfectly good reasons, happens to fall out with the prescribed body? Will there be an outside assessor to whom he may appeal to make quite sure that justice is done?

I am not asking all these questions simply to take up the time of the Committee, but as I have already indicated, this is all going to be laid down in regulations and it is very difficult to do anything in detail at that stage. Therefore, I feel it will be helpful to have some information about what the Government really believe is to happen under Clause 2.


I should like to endorse much of what the noble Baroness, Lady Young, has just said and also to ask a couple of questions which I hope will be thought relevant and succinct. In passing, may I say that I do not think my noble friend in any way wanted to denigrate the ability of women today. Indeed, I should be the last to denigrate the constructive abilities of the noble Baroness, and certainly of the noble Baroness who speaks so logically and so cogently from time to time in the House.

This question is important to those of us who have lived in the mining and anthracite areas, for instance. What is the prescribed medical experience there, where we have the disease of pneumoconiosis? Such diseases are not easy to diagnose by X-ray. What qualifications are needed in an Area Health Authority in a mining region where we have problems? For instance, two miners can work together on the same coal face and miner " A " will get pneumoconiosis whereas by some strange quirk of working conditions miller " B ", working side by side with him, may not get it. Now there is so much progress in analysis and time is needed for Sabbaticals. Whether it be a woman doctor—I prefer the word " woman " to " female "—or a man who comes into a mining area straight away, a lot of training and experience is needed before they can deal with these problems, particularly now, with the advance in endoscopy—which is a British discovery, more or less, that has gone out of this country and now the Japanese more than anybody else produce the filaments which enable an examination to be carried out inside a duodenum or inside the stomach of an individual.

All this is a great advance which is being made in the analysis of diseases, and particularly in areas in which, because of the nature of the job, people are subject to duodenal ulcers, the advanced knowledge of endoscopy and analysis of the conditions of the duodenum and the stomach through pictures and photographs, has progressed. In other words we are in an area where we have a science and an art moving so rapidly that, were I qualified, I would not like to be one of the people who had to lay down these regulations. In other words, there must be latitude and understanding.


May I suggest to the noble Lord, Lord Davies of Leek, that his scheme for post-graduate education would take the whole lifetime of the doctor and we should then have no principals in general practice at all, and that would settle the issue.


I would not for a moment dare to contradict the noble Lord. That is one of the difficulties of the area in which we are dealing. That is all I have pointed out, and I think the noble Lord has confirmed it by his constructive remarks.


I had intended to make one or two remarks, but really everything I could have said has now been said by the noble Baroness, Lady Young. As to the question of government by regulation, we all know and agree that it has to happen to a large extent, but I myself do not remember—and I have now accumulated a little experience of legislation—a Bill in which I really knew nothing at all about the intentions or what the prescribed body was and what the Government had in mind. Surely it is quite common in regulations to say something about the prescribed body, such as " it shall consist of no less than so many people ", or something of that kind, and that regulations shall not be drawn up without consulting certain bodies. Also if you do not like to name an actual body, such as the Medical Women's Federation, which is the one that really should be consulted, and of course the Royal College of General Practitioners, and in particular if you do not like to name certain bodies in the regulations it is not unusual to say that some of the bodies should be those particularly concerned in the education and training of women doctors. Something like that could go down, surely; and why the Negative Resolution procedure, which, as we know, is so extraordinarily unsatisfactory?

Baroness SEEAR

I notice that this Bill has no Schedule. Surely many of the matters which have been raised, instead of being dealt with by regulations could be incorporated in Schedules, and then we should have them in the Bill and we should be able to discuss them during the passage of the Bill through your Lordships' House.


I do not think I can give a satisfactory answer to the noble Baroness, Lady Seear. I can only assume that this matter has been considered by Parliamentary draftsmen and we have taken advice on this and it has been considered to be the best way of proceeding. I will go into the matter and will let her know what the reply of the Government is in respect of this, but it certainly had not occurred to me that it was an unusual way of dealing with it.

I shall try to reply to the noble Baroness, Lady Young. May I say that in some respects we are glad that she spoke in this way because we feel it is desirable that we should be able to give as much information as we can at the present time about the nature of vocational training. Perhaps I may preface my remarks by saying that in laying down detail in the regulations, as I said earlier on, we shall want to consult very closely all the educational and medical bodies within the medical profession; but we expect that the general pattern will be a period of, say, two years in a hospital, normally in a senior house officer post, and a period attached to an established general practitioner for about one year, he having been approved by the general practice sub-committee of the regional committee for post-graduate medical education.

The pattern of training undertaken voluntarily by many young doctors at present is greatly influenced by the requirements of the vocational training allowance, payable to principals during their early years in practice. At the present moment, these involve three years, including the pre-registration year. During that time, the doctor occupies a post in a number of specialties. He may spend either six or 12 months in each of several specialties so as to get the broad base of experience which is obviously very valuable to the general practitioner. There are some posts which provide for rotation through a number of departments for shorter periods.

At the moment I am talking about the present training scheme, but this is broadly the pattern on which the vocational training will be developed. In order to qualify for the vocational allowance, the doctor must include at least six months in two or more specialties from a specified list, which includes general medicine, chest medicine, traumatic surgery or accident and emergency work, obstetrics and gynaecology, paediatrics, psychiatry, geriatrics, dermatology, ophthalmology, anaesthesia and otorhinolaryngology. But as the noble Lord, Lord Platt, said, there is a limit to what one can do in three years! We are not going to pretend that we can have a curriculum which will equip a doctor in every possible field. It may be that when we consult the profession, they may wish to amend the criteria in the light of experience. However, I think that this will give noble Lords a general picture of what we have in mind.

In hospital, the potential general practitioner does the same kind of work as his colleagues who are planning a hospital career. In fact, he is a hospital junior in that speciality. However, in addition, throughout his training he may attend such lectures and courses arranged by the local clinical tutor in consultation with the regional postgraduate dean and general practice sub-committee.

During the year in general practice, the trainee gains practical experience of the work of the primary health care teams, the links with local authority services and the whole pattern of the organisation and delivery of primary health care. He will have an individual training programme designed for him by his trainer. This is a matter which the noble Baroness, Lady Young, raised. As she knows, there are fourteen Regional Health Areas in the country. Each of them will have a vocational training set-up with trainers, and this will work on a regional basis. The trainee may participate in visits and consultations with the trainer, or undertake them on his own. At all times, he will work closely with his trainer and other members of the team, in order to gain a deeper understanding of the medical and social problems involved in the medical care of a patient and his or her family. Something which commends itself to the noble Baroness, because it commends itself to me, and I know how she feels about this, is that he may be seconded for short periods to other practices, and recently, some short experimental attachments to social service departments have been arranged. We are hoping that this can be a particular factor in the training, and that it will be much more widespread in the future than it is at the present moment.

We do not wish to make the regulations so inflexible that all doctors must follow the same training pattern. We think there is some merit in leaving some of the training for the trainer himself to develop in the various regions. This is why we have provided for, shall I say, an alternative route; that is, the certificate of equivalent experience. A postgraduate medical dean and regional adviser in general practice may wish to experiment with different specialties, to give your Lordships an example. Doctors coming from overseas need to have their experience individually assessed. There is also the question of doctors who can train only part-time. I have already touched on this in referring to the training of women doctors in the first Amendment. Clearly, the regulations will need to provide for part-time training.

Part-time junior hospital posts already exist, but we shall be emphasising to health authorities the importance of planning for the needs of these potential general practitioners. Similarly, part-time training in general practice also occurs, and we see no problem at all in extending this. We will keep the operation under review while we are having discussions. That is why the details of training arc more appropriate, we think, to regulations where changes can be more readily made than if they were included in a Bill.

The question of assessment was raised. There is provision for an appeal, but I just cannot remember to whom the appeal will be made. The noble Baroness, Lady Young, raised a question as to whether there is an appeal. There is, but I just cannot remember the body to whom the appeal will be made. There is not an examination as such. The prescribed body must be satisfied that experience has been acquired. The trainee doctor will most probably produce a statement from whoever has been supervising the trainee, to the effect that he has not only taken it, but has acquitted himself satisfactorily. If the supervisor refuses such a statement, or the prescribed body refuses a certificate—I see I have the answer here—the trainee will be able to appeal to a body advising the Secretary of State, but I cannot say at this stage who the body will be.

We want to discuss the question of the prescribed body further, but our general view is that this will be the regional postgraduate education committee operating on the advice of the Joint Committee for Postgraduate Training for General Practice. That will be in the areas. I think I have answered the three questions put to me by the noble Baroness, Lady Young. I hope she will feel that her Amendment to delete Clause 2 has been satisfactorily dealt with, and that it is not necessary for her to proceed with it.

Baroness YOUNG

I am grateful to the noble Lord, Lord Wells-Pestell, for giving a full answer to my Amendment. I am bound to say that I feel I was completely justified in putting it down because now we have had a much clearer picture of what this Bill entails. I am somewhat worried that so many important points are still to be determined, the details of which, after the Bill becomes law, we shall not be able to find out and really will not be able to alter, even if it seemed to us that they were not very satisfactory. I shall read very carefully what has been said, and it may well be that in the light of my study of HansardI will come back with a further Amendment on Report.

I should like to consider the question—and perhaps the noble Lord, Lord Wells-Pestell, will consider it, too—as to whether there is not anything more that he and his advisers could put into the Bill to tell us about this prescribed medical experience; to tell us about the body that will be responsible for administering it, who it will consist of, and the numbers. I take his point that this is to be done by Regional Health Authorities and a particular person or committee advising them, but it is really unclear to me at this point as to exactly what it is intended should happen. The noble Lord may well say that of course this is still all subject to consultation, and then we shall be back in the same argument about regulations. But he might like to consider that it would be worth while for the House to have by the next stage a little more detail written into the Bill. I believe that in an extremely important situation we know extraordinarily little, and we are taking it all—except for what we read in Hansard—absolutely on faith. I do not intend to press this Amendment to a Division this evening, but I hope the noble Lord will consider what I have said before the Report stage of the Bill, when we can return to it, if necessary.

Clause 2 agreed to. Remaining clauses agreed to.

House resumed: Bill reported without amendment.