HL Deb 24 January 1978 vol 388 cc276-308

3 p.m.

Report received.

Lord HUNT of FAWLEY moved Amendment No. 1: After Clause 4, insert the following new clause:

Guidance on professional conduct or medical ethics.

(" .The powers of the General Council shall include that of providing, in such manner as the Council think fit, guidance for members of the medical profession on standards of professional conduct or on medical ethics.").

The noble Lord said: My Lords, the long list of Amendments tabled in my name must seem formidable, but I promise not to delay your Lordships for long. Many of them have been agreed; others are to be taken in groups. I shall speak only to three of them at any length and then for only a few minutes on each. Noble Lords will recall that on 13th December we discussed in Committee three Amendments which I put forward on the functions of the General Medical Council, the duty of its education committee and on the experience required for full registration. On behalf of the Government, the noble Lord, Lord Wells-Pestell, accepted those Amendments of mine in principle, on condition that they were examined carefully and redrafted as necessary by Parliamentary Counsel and reintroduced on Report.

That has been done and the redrafted versions, in effect with the same meaning as the originals, are before the House today as Amendments Nos. 1 to 6 and 11 to 24. I spoke to them in Committee and your Lordships discussed them then, so I shall say very little about them now, except that I am of course prepared to accept the revised wording of them all. I wish to thank Lord Wells-Pestell and my noble friend Lord Sandys for all their help, patience and kindness to someone like myself who is comparatively new to the intricacies of Parliamentary procedure. I also wish to thank Parliamentary Counsel for their forbearance and co-operation in redrafting these Amendments which I know have given them much extra work.

The purpose of my first Amendment is to make it clear that the General Medical Council should not only have a judicial role in relation to professional conduct but also he entitled to give guidance to members of the medical profession on standards of professional conduct and medical ethics. I am sure that this power will, by helping the Council to promote high standards of professional conduct, both serve the public interest and contribute to the efficiency of the medical profession.

Lord SANDYS

My Lords, I support the Amendment, which was ably moved by my noble friend Lord Hunt of Fawley. I join with him in thanking the noble Lord, Lord Wells-Pestell, for the great amount of time and trouble he has taken with Parliamentary Counsel, to which my noble friend referred, and his colleagues in the Government, because this has been a formidable task and it has beer achieved in the short time between Committee and today.

An analogy has been drawn between the Highway Code and what is proposed in this Amendment, and it appears that this would be one of the best forms of guidance to which the GMC could direct its attention in the important matter of professional conduct on medicine and ethics. The Amendment follows closely on the report of Sir Alex Merrison, paragraph 268, and I think it meets all the requirements to which he and his colleagues referred. I do not think it is necessary to add to the argument, but I believe that as a result of what was said in Committee and of the further discussions which have taken place the matter has now been set in the right context.

Lord WINSTANLEY

My Lords, I too commend the noble Lord, Lord Hunt of Fawley, for all his efforts to improve and strengthen the Bill, and I join with the noble Lord, Lord Sandys, in thanking the noble Lord, Lord Wells-Pestell, for his extremely conciliatory and co-operative attitude towards the attempts to improve the Bill. Having said that, I am bound to say that I have considerable reservations about this Amendment. This matter was discussed very briefly in Committee, and at that time the noble and learned Lord, Lord Gardiner, drew a parallel between the General Medical Council and the Law Society and Bar Council, and rightly pointed out that lawyers in difficulty could seek advice in advance from their respective bodies, could find out the right course to pursue and not suddenly find themselves in jeopardy at a later stage, as has sometimes happened with doctors. However, there is a difference. Those two bodies, the Law Society and Bar Council, are entirely under professional control, whereas the GMC has been set up by Parliament to exercise functions which are primarily not professional functions but are functions for the protection of the general public. My fears about the Amendment are lest it should encourage the GMC to intrude into the making of decisions which have not yet been firmly made and which are, in my view, more properly decisions for Parliament or the courts.

In this connection, I would remind the House briefly of two cases, and no doubt others will come to mind. Noble Lords will recollect the case of Dr. Alec Bourne who, many years ago, performed an abortion on a girl who had become pregnant as a result of rape, and later the courts upheld his action and, by so doing, the law on that matter—the law in relation to rape and the law in relation to the consideration of the mental health of the mother—was changed for all time. There is not the slightest doubt that had Dr. Bourne sought the advice of the General Medical Council at that time as to whether he should do what he did, they would have replied, "No"; and knowing of course that the GMC was to be the body that would later decide whether or not he had acted professionally and properly, a wise doctor would heed that counsel if it was given.

Another example: a distinguished surgeon from my area, Manchester, Mr. Wilson-Hay, many years ago took it upon himself to provide morphia and syringes to members of mountain rescue teams and indeed to put morphia in mountain rescue first-aid posts for use in emergencies with extremely shocked casualties. At a later stage his action was upheld in the courts and, as a result, mountain rescue teams are now able to have morphia. There is not the slightest doubt that had Mr. Wilson-Hay at that time put to the GMC the question, "Can I give these people morphia?", they would have replied "No", and probably Mr. Wilson-Hay, as a law-abiding surgeon, would have acceded to their reply.

Noble Lords do not need me to prompt them about possible future cases, so I will merely refer to a few. We now have doubt as to what actually is the law regarding the determination of death in relation to the taking of human tissue and human organs for transplant purposes. That matter will undoubtedly have to be decided firmly and finally. But surely it should be decided by Parliament and the courts and should not be left to a decision to be taken by a GMC which has not been specially constituted and which is not necessarily properly equipped to take that kind of decision. No doubt in the future we shall have arguments about euthanasia and matters of that kind. Maybe further arguments will arise on the abortion law. Again, in my view these are matters to be decided by Parliament or the courts, and not by the GMC.

I appreciate that the Amendment is loose and does not require the General Medical Council to take those decisions; but my feeling is that if it is once invited to do so, the likelihood is that it will take those decisions. If it subsequently transpires that the GMC gives firm advice only to those doctors who seek advice about matters which have already been firmly decided, that is one thing; but if the newly-constituted GMC should then take it upon itself to tell a doctor, "You may do this" or "You may not do that", when these matters have not been finally decided in the proper way, then that seems to me to be a rather different thing.

I hope your Lordships will have those thoughts in mind when considering this particular Amendment, and if the Amendment is later accepted then I hope that those remarks of mine will be considered at a later stage, especially when the GMC are deciding what note to take of these particular powers if they are later given them.

Lord SEGAL

My Lords, the wording of this new clause states: The powers of the General Council shall include that of providing … guidance …". Would my noble friend state when he comes to reply, perhaps, what action, if any, the General Medical Council are expected to take if any doctor does not comply with the guidance that they may give? It is simply a directive to provide guidance, and does not impose any penalties upon a doctor who does not necessarily follow that guidance.

3.12 p.m.

Lord WELLS-PESTELL

My Lords, I wish to crave your Lordships' indulgence for just a few minutes before I attempt to reply to those noble Lords who have just spoken and before I say anything with regard to the Amendment now before your Lordships' House. It must have occurred to those of your Lordships who have very carefully followed this Bill through both Second Reading and Committee stage that a very fundamental change in the character of the Bill itself has taken place. I have already been reminded that at Second Reading I was very forthright in so far as I said, not only that this was a simple Bill which was acceptable in toto to the General Medical Council and various other people concerned but that the Government could not see their way clear, for a whole variety of reasons—and I gave your Lordships those reasons at the time—to extending the Bill. I mentioned that many of the proposals would have far-reaching and deep-seated consequences, and that it would take time to discuss with the various bodies concerned what really ought to be done; and I repeated this at Committee stage. Those of your Lordships who have looked at the Bill and, since, at the Amendments before your Lordships' House this afternoon will have seen that it appears that either I or the Government, or both, have done a complete turnabout, and I feel I owe it to your Lordships to explain what has taken place.

What I said on that occasion was that the Government could not contemplate including certain matters in the Bill. I said that, not because the Government wished to be obstructive or to drag their feet over this important issue but just because there were a lot of important questions to be settled, agreement on which had not at that time been reached and as to which there was some reason to believe agreement might not be reached. The Government said as long ago as July of last year that they accepted the Merrison recommendations on this issue in principle, but did not wish to rush into legislation if there was any danger that the General Medical Council or the medical profession, including, of course, doctors from overseas, were not content with the various proposals. However, during the last month circumstances have changed dramatically and, I am inclined to say, at an unprecedented speed. I have never known so much agreement to be achieved in so little time. The General Medical Council, the British Medical Association and the Overseas Doctors' Association felt it so important that the Bill's provisions should be extended to implement Merrison's recommendations on a variety of matters that an unexpected consensus has emerged on these matters among these groups as to the form the provisions should take.

This consensus is to son e extent reflected in the Amendments of the noble Lord, Lord Hunt; and, as he himself has been good enough to say, the Government have given a great deal of time to a consideration of them. We have been able—and I speak now on behalf of the Government—to satisfy ourselves, not only that these Amendments reflect the Government's views on these matters but that they are also acceptable to the various bodies concerned, some of which had serious reservations about some aspects of the Merrison Report when they first came out. It is because of these changed circumstances, because there has been this consensus and because there has been a good deal of work done, particularly by my Department and by Parliamentary Counsel, that I was able to say at the Committee stage that certain of the Amendments of the noble Lord, Lord Hunt, we accepted in principle, but they needed redrafting. That promise has been fulfilled. In the spirit of all the Amendments of the noble Lord, Lord Hunt, we have redrafted the particular Amendments he will be moving today, and there is no Government opposition to them. In fact, if I may be permitted to say so, there is no Government opposition to any of the Amendments before your Lordships today, with the exception of the one in the name of the noble Earl, Lord Kinnoull. I felt I owed this explanation to your Lordships because noble Lords may have wondered (as some did, because they so indicated to me privately) at the changed nature of this Bill.

Now, my Lords, the Amendment which is before us is one of the Amendments which the noble Lord, Lord Hunt, put down at Committee stage which we accepted in principle and said we would redraft. This we have done; and the Government's attitude towards it has not changed at all. We accept this Amendment, which, as I say, we have redrafted. If I could attempt to answer the noble Lord, Lord Winstanley, briefly, as I understand it there is nothing in the new clause which will prevent matters of the kind which he described still being for the courts to decide if there is a question of transgression of the law. I think this must always be an overriding factor in any legislation which comes before Parliament: that in the last analysis, if there appears to have been any transgression of the law, it is for the courts to decide.

As to the point raised by my noble friend Lord Segal, I think I can only say that the purpose of this Bill, or perhaps one of the purposes of this Bill, is to give the General Medical Council an opportunity (I hope this will not be misunderstood) to, I was going to say, put their house in order. I do not really mean it in that sense, but to give them an opportunity to do things which they themselves, I think, consider long overdue and which certainly the British Medical Association consider to be long overdue; and I think one must give them an opportunity to do what they feel is required to be done to meet the needs of the day. It is on those grounds that the Government offer no objection to this Amendment. In fact, they accept it, my Lords.

Lord SEGAL

My Lords, can my noble friend answer another point? Will the General Medical Council automatically have to take action in the case of a doctor not observing the guidance given to him by them?

Lord WELLS-PESTELL

My Lords, I am grateful to my noble friend. I had the feeling that there was something I had not answered. With respect, I suggest that this matter is one entirely for the General Medical Council. If they issue certain instructions or certain directives which are considered by the General Medical Council, as a body, to be relevant to the practice of medicine and the conduct of the doctor, then, if any member of the medical profession decides to ignore it, I would suggest that it is for the GMC to decide whether there should be some kind of disciplinary action.

On Question, Amendment agreed to.

Clause 14 [The Education Committee of the General Medical Council.]:

3.20 p.m.

Lord HUNT of FAWLEY moved Amendments Nos. 2 to 5: Page 16, line 36, at end insert ("having the general function of promoting high standards of medical education and co-ordinating all stages of medical education"). Page 17, line 4, at end insert— (" (3A) For the purpose of discharging their general function under subsection (1) above the Education Committee shall—

  1. (a) determine the extent of the knowledge and skill which is to be required for the granting of primary United Kingdom qualifications and secure that the instruction given in universities in the United Kingdom to persons studying for such qualifications is sufficient to equip them with knowledge and skill of that extent;
  2. (b) determine the standard of proficiency which is to be required from candidates at qualifying examinations and secure the maintenance of that standard; and
  3. (c) determine patterns of experience which may be recognised as suitable for giving to those who have passed a qualifying examination general clinical training for the purposes of the practice of their profession.
(3B) The determinations of the Education Committee under subsection (3A) above shall be embodied in recommendations which may be directed to all or any of the universities or other bodies which are concerned with medical education. (3C) In the Medical Acts 1956 to 1969— Page 17, line 5, after ("below") insert ("and to the amendments made by Schedule 5 to this Act,") Page 17, line 23, leave out ("this section") and insert ("sub-section (4) above").

The noble Lord said: My Lords, with the leave of the House, I beg to move Amendments Nos. 2 to 5 en bloc. These correspond to Amendments that I moved at Committee stage. They are intended to give a general function to the education committee of the reconstituted General Medical Council to promote high standards of medical education, to co-ordinate all stages of medical education, and to provide a more flexible machinery for the determination of the standards to be required during the undergraduate curriculum and on qualification. The Amendments, as redrafted by Parliamentary Counsel, are considerably longer than those which I originally moved. I am, however, assured that the new wording is intended to achieve the same results, but in places it uses a different phraseology.

In particular, the proposed new Clause 14(3A)(c), in Amendment No. 3, proposes that the education committee should determine patterns of experience which may be recognised as suitable for giving to those who have passed a qualifying examination general clinical training for the purposes of the practice of their profession".

I understand that this refers to the suitable combination of posts to be held by the young doctor during his pre-registration year and not to any subsequent period of general professional training. This is important because we do not want to interfere in any way with the work of the universities and the Royal Colleges. If any noble Lord should feel any doubt as to the clarity of this wording, I am sure that the noble Lord, Lord Wells-Pestell, will bring the matter to the attention of his colleagues for consideration in another place.

Lord SANDYS

My Lords, I should again like to support my noble friend Lord Hunt of Fawley in these redrafted Amendments. Your Lordships will recall that they follow very closely on the pattern of Amendment No. 3 in Committee and, of course, on paragraphs 67 and 70 in the Merrison Report and the later comments by Merrison on this highly important subject. Great skill has been displayed—if that does not sound too patronising a comment—by those concerned in the Parliamentary Counsel office, because these Amendments now skilfully enable those bodies concerned, including the Royal Colleges, to accept them as they stand. I feel that a great many people should be heartily congratulated on achieving agreement in this difficult field.

Lord WELLS-PESTELL

My Lords, there is no need for me to detain the Committee longer than to say that this has been looked at very carefully by Parliamentary Counsel even since the redrafting. It is our view that there is not likely to be any conflict between the phrase "general clinical training" and "general professional training". We would hold that it is patently clear that they are two entirely different things. What we are going to do, notwithstanding the fact that we have already looked at them since they were put down, is to look at them again and will get further advice, if it is necessary and if there is the remotest chance of confusion, so that steps can be taken to provide the necessary Amendment in another place.

On Question, Amendments agreed to.

Lord HUNT of FAWLEY moved Amendment No. 6: After Clause 14 insert the following new clause: .—(1) In section 15 of the Medical Act 1956

Experience required for full registration

(pre-registration experience) the following amendments shall be made.

(2) For subsection (3) there shall be substituted the following subsection— (3) A person who has been employed as aforesaid may apply to his examining body for a certificate under this section, and if that body are satisfied—

  1. (a) that during the time he his been so employed he has been engaged in at least two branches of medicine prescribed for the purposes of this paragraph for the minimum period prescribed for each branch;
  2. (b) that the terms on which he has been so employed were such as to provide him with the experience required by a prescribed pattern of experience recognised by that body as applicable to persons for whom they are the examining body; and
  3. (c) that his service while so employed has been satisfactory,
they shall grant him a certificate in the prescribed form that they are satisfied as aforesaid".

(3) After subsection (3), there shall be inserted the following subsections— (3A) The Education Committee may, if they think fit, appoint persons to visit any approved hospital or approved institution. (3B) It shall be the duty of visitors appointed under subsection (3A) above to report to the Education Committee on the extent to which the general clinical training given by employment in a resident medical capacity in the hospital or institution is such as to provide the experience required by one or more prescribed patterns of experience. (3C) If the Education Committee is of the opinion that—

  1. (a) an approved hospital or an approved institution does not provide experience required by any prescribed pattern of experience; or
  2. (b) a pattern of experience recognised as applicable to persons by then examining 287 body is not a prescribed pattern of experience; or
  3. (c) employment of persons on terms of a particular description which is accepted by their examining body as providing persons employed on terms of that description with the experience required by a prescribed pattern of experience does not in fact provide that experience,
then the Committee shall notify their opinion to the university or body concerned and that university or body shall have regard to that opinion in discharging their functions under this section.".

(4) Subsections (4) and (5) shall be omitted.

(5) In subsection (6) for the words "surgery or midwifery required" there shall be substituted the words "a branch of medicine prescribed" and for the words from "medicine" to "in his case" there shall be substituted the words "some other prescribed branch of medicine (whether or not one in the practice of which he has already had experience)".

(6) In subsection (8), in the paragraph defining the expression "approved", after the words "this Act", there shall be inserted the words "as providing experience required by one or more prescribed patterns of experience", in the definition of the expression "prescribed", after the word "means", there shall be inserted the words" (except in the expression "prescribed pattern of experience")" and, in the paragraph construing references to employment in a resident medical capacity, for the words "medicine, surgery or midwifery" there shall be substituted the words "any branch of medicine prescribed for the purposes of this section"."

The noble Lord said: My Lords, I beg to move Amendment No. 6 which stands in my name on the Marshalled List. The first purpose of this Amendment is to strengthen the powers of the universities in supervising their graduates during the pre-registration year which follows graduation and precedes full registration. The clause also gives to the education committee of the new Council more explicit powers to control the nature of the experience to be gained during this part of the young doctor's training.

The clause also removes the option of midwifery at this stage of the doctor's training but leaves it open to the education committee and to the universities to arrange, if they think it right, more flexible patterns of experience.

Lord WELLS-PESTELL

My Lords, I do not think I can usefully say anything other than what I have said earlier: that this is an Amendment which has been redrafted and that we are perfectly satisfied that it meets what the noble Lord, Lord Hunt of Fawley, intends.

On Question, Amendment agreed to.

Lord HUNT of FAWLEY moved Amendment No. 7. After Clause 14 insert the following new clause:

Requirement of linguistic knowledge for the registration of overseas qualified doctors.

. In section 18(1)(b) of the Medical Act 1956 as amended by the Medical Act 1969 the word "and" shall be inserted at the end and the following paragraph shall be added— (c) that he has the knowledge of English specified in section 7B(1) of the Medical Act 1956 as amended by the Medical Qualifications (EEC Recognition) Order 1977.".

The noble Lord said: My Lords, I beg to move this Amendment which stands in my name. Your Lordships will recall that at the Committee stage of this Bill I withdrew at the suggestion of the noble, Lord, Lord Wells-Pestell, four Amendments about the language difficulties of some overseas-qualified doctors and about the part that the General Medical Council might play in their registration. I did not then speak to these Amendments and they were not debated because it was said that they concerned "matters dealing with a complex situation". I told your Lordships I had intended to put them forward as probing Amendments and Hansard reported me as saying then: I hope that some of the difficulties may be ironed out and that it may be possible, perhaps on Report, to introduce one or two clauses about the registration of overseas-qualified doctors."—[Official Report, col. 2049; 13/12/77.]

That is what I am doing now in the next three Amendments which are before the House for consideration. I should like to speak to each of them separately for a very few minutes because they impinge upon some very important matters which we have not debated so far and which I think it might be helpful at this stage to put on record. It is possible, if your Lordships wish, that a short discussion on each might prove helpful.

This Amendment No. 7, refers to the linguistic difficulties of overseas-qualified doctors. A whole chapter of the Merrison Report was devoted to criticisms of the present arrangements for the registration of doctors who had qualified overseas, with suggestions for remedying this situation. Many of these doctors, as we all know, speak English extremely well and have done magnificent work for us. Our National Health Service could not have developed as it has, and might even not exist now, without the help they have given us.

The Merrison Report, two and a half years ago, said that a number of them had been admitted to registration in Britain when their ability to speak English was seriously in question. In putting forward this Amendment, I am trying to help our patients and their doctors together; and as soon as possible. Our patients must have first priority. It may be felt that they have not been considered quite enough in our deliberations so far on this Bill. So far as I can tell, they were mentioned only once during our two and a quarter hour debate in Committee. A language barrier between patients and their doctors may be extremely frustrating for both when they misunderstand one another, and find themselves talking at cross-purposes; sometimes it may be a very serious matter indeed, if a patient is gravely ill.

A person, especially a shy young woman who is nervous, with an embarrassing and personal complaint, may do her best to avoid going to her doctor anyway. If she feels that he is unlikely to understand or follow properly what she wants to tell him, and that she, in her turn, is likely to be unable to grasp his advice, she may never go at all. I, myself, have every sympathy for patients and their doctors in these situations. I was born in India, and I am told that when quite young I learnt more Hindustani from my "ayah" (my Indian nannie) than I did English from my parents. I have forgotten it all now. I suspect that I should be more than unhappy and unsure of myself, even after a six-month language course, trying to take a complicated medical history in Hindustani (especially colloquial Hindustani), or advising a patient on a very personal problem in that language.

Colloquialisms are common enough in English medicine, such as: "It's my water-works, doctor", "My ticker is playing me up"; and the more subtle misunderstanding of a patient of mine when she attended an eye hospital for early cataract: "What's the trouble, madam?" the doctor asked. "I can't see quite so well in the dark", she replied. Whereupon the doctor went to the window, drew the curtains across, and said "None of us can, can we?".

In June last year the Medical Acts were changed by the Medical Qualifications (EEC Recognition) Order 1977 (Statutory Instrument No. 827 of 1977) which required that a British- or EEC-qualified doctor applying for full registration must satisfy the Registrar of the Council that he has the necessary knowledge of English, that is, the knowledge which, in the interests of himself and his patients, is necessary to the practice of medicine in the United Kingdom". This requirement now applies to doctors qualifying in any Member State of the EEC, such as France, Germany or Italy, including the United Kingdom and Ireland. But it does not apply to doctors seeking full registration from other countries, such as India, Sri Lanka, South Africa and other African States, or anywhere else overseas. The General Medical Council, through reciprocal agreements, still has, by law, to grant full registration to doctors holding recognised qualifications granted in India before May 1975, however much or little English they can speak. During 1976 it registered 1,750 such doctors, and last year 1,335. None of these could be required to take a language test. This will go on until the law is changed.

I must make it quite clear that in this Amendment I am not seeking to discriminate against overseas-qualified doctors from any country in the matter of language, but merely to ensure that they all meet the same requirements. I understand that almost everyone concerned with the medical profession in this country has now accepted that such arrangements are desirable.

My Lords, I am most anxious that neither our patients nor their doctors should have to wait too long for help over this matter of language. In this Bill we have a good chance to put things right quite soon, rather than having to wait for a second Bill to reach the Statute Book; something which we know may take a considerable time. I beg to move Amendment No. 7.

Lord WELLS-PESTELL

My Lords, I am in some difficulty because I thought that the arrangement with the noble Lord was that he would move Amendments Nos. 7, 8 and 9 together as they relate more or less to the same matter, and then would reply to all three. I did not want to give the same reply to each of the Amendments in turn. I do not know whether the noble Lord is prepared to agree to this arrangement. If so, I shall make the one reply covering all three Amendments.

Lord FERRIER

My Lords, may I interrupt? The next Amendment, Amendment No. 10, is in the name of my noble friend Lord Kinnoull. I happen to know he is on his way here because we flew down in the same aeroplane from Scotland, and if we can "spin out" the discussion he may be in his place at any moment for the next Amendment.

Lord WELLS-PESTELL

My Lords, Lord Kinnoull's Amendment is Amendment No. 10. I am now talking about Amendments Nos. 7, 8 and 9.

Lord FERRIER

Exactly.

Lord HUNT of FAWLEY

My Lords, I am very happy to move Amendments Nos. 8 and 9 now, if the House agrees.

3.36 p.m.

Lord HUNT of FAWLEY moved Amendments Nos. 8 and 9:

After Clause 14 insert the following new clause:

Limited registration of overseas qualified doctors. (". For section 25(1) of the Medical Act 1956 as amended by section 12 of the Medical Act 1969 there shall be substituted— 25.—(1) Where a person satisfies the Registrar:

  1. (a) that he holds, has held, or has passed the examinations necessary for obtaining, some Commonwealth or foreign qualification or qualifications recognised for the time being by the Council for the purposes of this section: and
  2. (b) that he complies with such other requirements as to proficiency in English, professional knowledge and competence, good character, and experience as the Council may think to impose,
the Council may if they think fit give a direction that he shall be registered under this section for such period, and in relation to such employment or range of employment as may be specified in the direction.".") After Clause 14 insert the following new clause:

Progress from limited to full registration.

.After section 25 of the Medical Act 1956 there shall be inserted— 25A.—(1) Subject to the provisions of this section no person shall be granted registration by virtue of the foregoing section after the appointed day for any period which exceeds five years or which, when added to periods of such registration granted to him after the passing of the Medical Act 1978, would in the aggregate exceed five years. (2) Where a person satisfies the Council:

  1. (a) that he holds a qualification recognised by the Council for the purposes of the foregoing section, and
  2. (b) that he has the knowledge of English specified in section 7A of the Act, and
  3. (c) that it would be proper to grant him full registration having regard to:
    1. (i) the standard of the qualification referred to in paragraph (a) of this subsection and of any further qualification of qualifications which he may possess, and
    2. (ii) the range and nature of the professional experience which he has acquired while employed either in the United Kingdom or overseas or both and the standard of professional knowledge and skill which he has exhibited while so employed,
the Council may, if they think fit, direct that he be granted full registration by virtue of this section.".

The noble Lord said: My Lords, I beg leave to move Amendments Nos. 8 and 9. Amendment No. 8 deals with the limited registration of overseas-qualified doctors. It seeks to give effect to important recommendations in the Merrison Report that the present system of temporary registration should be replaced by a new and more flexible system of limited registration. Arrangements for temporary registration were first introduced by the Medical Practitioners and Pharmacists Act 1947. For some years after that few overseas-qualified doctors took advantage of these arrangements but, recently, the number of doctors seeking temporary registration has increased very substantially.

During 1977 the General Medical Council granted no less than 11,186 periods of temporary registration to overseas-qualified doctors. The number of such doctors holding temporary registration at the beginning of 1978 was 5,982. Amendment No. 8 would change the present statutory arrangements in the following ways. It would enable the Council to continue to adopt a flexible attitude in recognising qualifications for the purpose of limited registration; at the same time it would specifically authorise the Council to impose requirements as to proficiency in English, professional knowledge and competence, good character and experience which at present can be used only by the Council exercising its general discretion for this purpose. In this respect, Amendment No. 8 would simply be tidying up the present law and bringing it more into line with practice.

The present legislation is restrictive in that temporary registration can be given only for the purpose of holding a specific appointment. Accordingly, it needs to be renewed every time the doctor changes his job. This gives rise to a great deal of work, and the cost of this has to be recovered from the fees charged to doctors holding temporary registration. It is of course desirable that the Council should be able to ensure that temporary or limited registration is granted only in respect of work which the doctor is capable of performing: but it is not necessary for this purpose in every case to limit the grant of it to a particular job. Very often the doctor's training and experience are such that he could safely be permitted to engage in a special branch of medicine—for example, paediatrics or anaesthetics—in which he may do several jobs, up to an agreed level of responsibility in the National Health Service, so long as he does not seek to hold appointments in other branches of medicine for which he has not received appropriate training and experience. Amendment No. 8 would therefore enable the Council to be more flexible in this respect. This would save the doctors concerned a great deal of trouble, and benefit them financially; it would help the hospitals for which they work, and it would lighten the burden of the General Medical Council, enabling it to perform its functions more efficiently in this field.

I have been assured on good authority from several sources that the General Medical Council, the executive of the BMA and the Overseas Doctors' Association approve of these Amendments, as the noble Lord, Lord Wells-Pestell, suggested. I should like to express thanks for all the help I have received from them. In a letter to the editor of the British Medical Journal just over a month ago —17th December — the general secretary of the Overseas Doctors' Association in the United Kingdom wrote:— I welcome any suitable and just method of assessing the standards of overseas doctors before entry to Britain and the National Health Service… Temporary registration should be abolished and a more flexible system of registration adopted. After the Temporary Registration Assessment Board test overseas doctors should be able to pursue their training and career objectives without the inconvenience or hindrance that results from the system of temporary registration, and should also be able to progress to full registration after some time in the light of their experience obtained in this country… And he continued in his letter to the editor: As you say, it is still not too late to include this clause in the present Bill, and I only hope and pray that the Government is able to do it; otherwise overseas doctors are going to be terribly dissappointed.

Amendment No. 9 deals with progress from limited to full registration. It seeks to implement another recommendation in the Merrison Report—paragraph 197— and is designed to be complementary to the two which I have moved earlier. Like those Amendments it has the support of the General Medical Council, of the British Medical Association, and also of the Overseas Doctors' Association. This Amendment is directed to two different purposes. Subsection (1) of the proposed new clause would impose an overall time limit to the period for which, after the passing of the Bill, a doctor could hold limited registration. The purpose of this Amendment is to avoid the perpetuation of a sort of second-class doctor, holding limited registration only, as a permanent feature of the medical profession in this country.

The original idea of temporary registration was to meet the needs of doctors who came here temporarily for postgraduate study. It is certainly not my intention to place any obstacle in the way of this entirely legitimate and most desirable practice. Indeed, if my Amendments are accepted, the majority of doctors who will be granted limited registration in future, will be here temporarily before returning to their own countries to practise. The precise length of time which is necessary for this purpose of postgraduate education is open to debate. I do not think that it should be less than five years, which is the period mentioned in this clause.

Many programmes of postgraduate training would require up to that time. However, if it were thought that five years is an insufficient period I personally would have no objection if it were extended to, say, seven years. But I think there is general agreement that there ought to be some limit of time beyond which it is not open to the Council to grant limited registration to any overseas-qualified doctor who intends to stay in this country for good. This Amendment will have the effect of compelling those who wish to make a permanent career in this country to equip themselves for full registration.

The second part of this clause provides a much more practicable and sensible avenue for this purpose than exists at present. Now, a doctor whose qualification is recognised only for the purpose of temporary registration can obtain full registration only by entering and passing the examinations for a primary medical qualification such as the MRCS, LRCP of the Conjoint Board, a general medical and surgical examination which is appropriate for a young graduate leaving his medical school. This can be a very real and rather unreasonable hurdle to a doctor in the middle of his career, especially if he has been working for some years as a specialist in one particular subject.

How many of us professional men—doctors, lawyers, accountants and so on—would relish the idea, in the middle of our careers, of going back to the beginning to take our qualifying examinations once again in another country? And yet this is what we are now asking some of our overseas-qualified doctors to do. At the present time the General Medical Council can recognise an overseas qualification for the purpose of full registration only if the country in which it was granted makes available reciprocal privileges of practice to British-qualified doctors—recognising each others degrees and diplomas, which, briefly, is what reciprocity means. As a result of this the Council is unable to recognise for full registration many reputable qualifications granted in the United States of America or in Canada, and doctors holding those qualifications, however good, can become eligible for registration here only by taking again a qualifying examination.

The Morrison Report recognised that this was unsatisfactory and the second part of my Amendment is designed to remedy that situation. It provides that the Council may grant full registration to a doctor holding limited registration if he can show that he has the necessary knowledge of English and if he has obtained a higher degree or diploma such as, for example, the MCh or FRCS, the MRCP, the MRCOG, or MRCGP, which can be taken into account. He or she must also show that the range and nature of professional experience (acquired either in this country under limited registration or overseas, or both) and the standard of professional knowledge and skill exhibited while so employed are sufficient.

Before leaving the subject of full registration I should mention that the Merrison Report recommended the discontinuance of the system of reciprocity. While I agree with that recommendation I have not on this occasion put down an Amendment to implement it, as I understand that the Government take the view that this must be preceded by consultations with the other countries concerned. Needless to say, if and when the Government introduce a clause to cover this point I should welcome it.

If this Amendment No. 9 is accepted it would mean that all those overseas-qualified doctors in this country who are at present confined to temporary registration would, if their individual qualifications and attainments justify it, but not otherwise, be permitted to proceed to full registration. So far as registration is concerned, this would place them in a position of equality with their British-qualified colleagues and with doctors in the EEC and other reciprocating countries with no discrimination against any group. The decision whether a particular doctor could properly be granted full registration would lie with the only body with which it could properly lie; that is to say, the reconstituted General Medical Council.

My Lords, as I have indicated, these last three Amendments are closely related. If they or smilar provisions, are included, in this Bill the task of the reconstituted General Medical Council in relation to the registration of overseas-qualified doctors will be made much easier and those doctors will receive much fairer treatment than is possible under the present legislation. Therefore I very much hope that, subject to any minor modifications which they think desirable, the Government will agree that these matters, which really are urgent, should be included in this Bill. I beg to move Amendments Nos. 8 and 9.

Lord SANDYS

My Lords, in rising to support my noble friend Lord Hunt of Fawley on these three Amendments taken together I should like once again to thank the noble Lord, Lord Wells-Pestell, and his colleagues for their very swift and helpful attitude to these three Amendments. It has been a matter of great concern how the 19,000 overseas qualified doctors should be placed in the situation as it stands today, especially in regard to the EEC recognition procedure.

This series of Amendments, as my noble friend has said, enables the position to be obtained whereby overseas qualified doctors are on all-fours with colleagues in the EEC. Let us look back at the position prior to the Merrison Report. We had on the Statute Book the whole of Part III of the Medical Act of 1956. If one reads through Sections 18, 19, 21, 22, 23 and 25 of that Act, one realises what a formidable set of qualifications would be needed and, further, the intricate pattern which had been developed hitherto. The process has now been made more flexible and very much more sensible, in our belief, by having the process referred to; that is, limited registration. We believe that the Merrison recommendations are ones which required early implementation and we are particularly grateful to the Government for acceding to this. Further, we are very pleased that the Secretary of State, in his discussion with the Overseas Doctors' Association only last Friday, reached such a measure of agreement and that it has been possible to proceed on this basis.

Lord WINSTANLEY

My Lords, I rise merely to express my delight and astonishment on learning that agreement has been achieved on this very complex matter so very rapidly. It always seemed to me that the situation concerning overseas doctors was probably one of the most urgent with which this whole business dealt. At the same time, with many other noble Lords, I was well aware that there was considerable disagreement among all the different parties concerned about precisely what ought to be done. I am sure that your Lordships are aware that you have only to have three doctors together for five minutes for them to arrive at a situation of total disagreement about almost anything, and when in addition they come from different countries perhaps disagreement a dses even more rapidly. But there is no doubt that there were very considerable divergencies of opinion among the many bodies who had a legitimate interest in these proposals The matter is urgent. As the noble Lord, Lord Hunt, has said, it is very urgent from the point of view of the patient, and it is also urgent from the point of view of the many overseas doctors who have had to continue in a situation of great uncertainty for far too long.

I am delighted to hear that we are now coming towards the end of that situation and I am sure that everyone will benefit. It is not only a question of the language problem: that affects many things. It is a fact that many British doctors with no linguistic ability whatsoever in certain particular disciplines—for example, anaesthetists and radiologists—who do not greatly depend on actually talking to patients, are disappearing to Holland and West Germany almost daily. In those disciplines, they are coping perfectly satisfactorily with their jobs. So the language problem varies according to the discipline, and though there are many areas, of course, in which linguistic ability is crucial there are other matters in this field which are of ever greater concern. The position which has compelled many highly competent and able doctors from overseas to remain in an almost continuous state of uncertainty is not one which I think ought to be tolerated much longer, and I am delighted to hear that we are now coming to a time when it will not have to be tolerated.

Lord SEGAL

My Lords, one matter has already been raised by the noble Lord, Lord Hunt of Fawley; that is, the question of reciprocity. Perhaps my noble friend could, to some extent, enlighten the House on this, although I can fully understand, of course, if this question is put to him somewhat prematurely. The new Clause 25(b) requires: … that he complies with such other requirements as to proficiency in English … ". I wonder whether my noble friend could inform the House whether other countries of the EEC such as France, Germany and Italy have already laid down any requirements for proficiency in their respective languages with regard to English doctors who may wish to settle in their countries. If any such legislation has been or is to be carried through in those countries, ought not some degree of uniformity to be reached by all the countries of the EEC as to the language requirements, before any doctor rather precipitately expresses a wish to settle in one of those countries?

Lord PLATT

My Lords, just before we decide on these Amendments, I should like to say on my own behalf that I think they are on the whole very wise ones and that I am really surprised at the way in which they seem to be woven into this present Bill: that is something I never thought would be possible. I hope, and indeed have reason to understand, that the Government will accept them, at any rate in principle, perhaps with some minor modifications. I am sure they will ease the position of the overseas doctors very much indeed, to the benefit of ourselves and of the doctors themselves.

3.56 p.m.

Lord WELLS-PESTELL

My Lords, the noble Lord, Lord Hunt, knows that these three Amendments are similar to the ones he tabled at Committee stage. At that time I made it perfectly clear that the Government could not then accept them. We have had the opportunity of looking at them again and I would say, not only to the noble Lord but to your Lordships as a whole, that we are unable to accept these three Amendments in their present form.

A number of details remain outstanding as the noble Lord knows; but I have already informed the noble Lord, Lord Hunt, that, so far as these three Amendments are concerned, we accept them but not in their present form. We accept the spirit and the principle behind each of them, but it will be necessary for Parliamentary Counsel to give them very careful consideration. That has not been possible up to the present moment and it will not be possible in the foreseeable future because of the pressure under which Parliamentary Counsel have been working. We have had to take up a great deal of their time in order to deal with the other Amendments about which we have already spoken and which the Government have accepted. I want to give not only the noble Lord, Lord Hunt, but also your Lordships the assurance that the Government will be putting down these Amendments when they have been redrafted, preserving, as I say, the principle and the spirit of them, when the matter comes before the other place. I believe that position is in fact acceptable to the noble Lord, Lord Hunt.

I think the only thing I need to mention is this: my honourable friend the Minister of State for Health did meet representatives of the Overseas Doctors' Association and discussed this matter with them at some considerable length. Your Lordships will know that Amendment No. 7 contains a requirement of linguistic knowledge for the registration of overseas qualified doctors. Amendment No. 8 deals with limited registration of overseas qualified doctors and No. 9 deals with progress from limited to full registration. As these matters have been dealt with fully by the noble Lord, Lord Hunt, I do not intend to cross his t's or dot his i's. I think the explanation given has been quite full. We are glad that this has been possible. It is another instance where we did not expect, as the noble Lord, Lord Winstanley, said—and if he can say this, as a doctor, perhaps I can be forgiven for saying it too—such complete agreement in so short a time from members of that profession. But we got it, and I am glad that we have got it. As I say, if the noble Lord, Lord Hunt, will be good enough to withdraw these Amendments, as he knows that this is what the Government want, we will put them down in another place when the Bill reaches there.

In reply to my noble friend Lord Segal, the position with regard to the EEC is that, as your Lordships know, any doctor is entitled to come to this country and, as I understand the situation, we cannot impose any test whatsoever, under the Treaty of Rome. As matters stand at the moment, doctors are entitled to come here for a period of six months before any test is applied. I do not know whether that will stand up in the future, because it has been thought by some people to be contrary to the terms of the Treaty of Rome. But this is a matter which will have to be dealt with as and when the time arrives. However, the position is that doctors are permitted to come from the EEC without their having any test, other than the fact that we ourselves apply one after six months.

With regard to reciprocity, we are planning to introduce an enabling clause in the House of Commons to terminate reciprocal agreements, after consultation with the countries concerned. I do not think I need say anything further, other than that, following the conversations that we have had, I hope that the noble Lord will feel able to withdraw these Amendments, on the undertaking which I have given not only to him but to all of your Lordships.

Lord HUNT of FAWLEY

My Lords, I am happy to withdraw these three Amendments, in view of the Government's acceptance of them (subject to redrafting by Parliamentary Counsel) and their undertaking to include them in this Bill. But before doing so, may I say, with your Lordships' permission, that I think the addition of these and my other Amendments has strengthened this Bill enormously. The great majority of the recommendations of the Merrison Report are now in it, and I feel sure that this will please many members of the medical profession. On their behalf, I should like to thank your Lordships. I beg leave to withdraw these three Amendments.

Amendments, by leave, withdrawn.

Clause 17 [Short title, citation, commencement and extent]:

The Earl of KINNOULL moved Amendment No. 10: Page 18, line 27, after ("day") insert ("(not being later than one year after this Act shall have received the Royal Assent)").

The noble Earl said: My Lords, I must apologise to the House for not being in my position at the start of the proceedings on the Report stage. This Amendment is familiar to the House, since it came up in identical form during the Committee stage when it was moved by the noble and learned Lord, Lord Gardiner. He described it as a probing Amendment, but I am sure the House will agree that it tackles a very serious principle. The noble Lord, Lord Winstanley, was good enough to support it at the time. I hope that my raising this Amendment again will give a chance to the noble Lord, Lord Wells-Pestell, to say a little more on the timing and, eventually, to agree some limit.

The noble and learned Lord, Lord Gardiner, pointed out in Committee that there is now an increasing feeling that the Executive is taking far too much power in these Bills, and that the power of Parliament is decreasing. What he was really citing was the fact that we are passing Bills which allow the Minister in charge to bring them into force when he wishes to make an order. He referred, in particular, to the Bail Act and I think the whole House will agree that that is a very sorry state of affairs. That Act was brought in in 1976 to meet the overcrowding problems of prisons, but not one section of it has yet been brought into force. Despite the probing of the noble and learned Lord, Lord Gardiner, we are told from time to time that the Government have still been unable to appoint various boards in order to proceed with the Act.

I am sure that this House, and Parliament as a whole, will agree that the principle of some time limit is an important issue. I think it was of interest when the noble and learned Lord, Lord Gardiner, disclosed to the Committee that he had discussed this matter with the noble and learned Lord the Lord Chancellor, whose words were: It is entirely Parliament's own fault; they ought not to let these clauses go through but should insist that there must be a limit." — [Official Report, 13/12/77; col. 2058.]

This Amendment suggests one year, but I do not necessarily suggest to the noble Lord, Lord Wells-Pestell, that one year is satisfactory, as I understand that the appointment of the new General Medical Council will take time. But I think that there should be a limit, and I suggest to the noble Lord that, if one year is not satisfactory, two years might be inserted into this Amendment. My Lords, I beg to move.

4.6 p.m.

Lord WELLS-PESTELL

My Lords, as the noble Earl, Lord Kinnoull, said, this is a matter which was raised initially by my noble and learned friend Lord Gardiner, who put down an Amendment in, I believe, precisely the same terms. I think that many of us share the view of my noble and learned friend about this kind of provision being in Bills, as a general run. But I think that this is perhaps somewhat different from the normal run of Bills which come before your Lordships' House. We looked at this matter and considered it very carefully, and I wrote to my noble and learned friend Lord Gardiner, sending a copy of that letter to the noble Earl, Lord Kinnoull.

I think that the position is this. Because this Bill is an enabling Bill and its provisions are rather broad, there are a number of orders which can be made under it which will require consultations not only with the General Medical Council but with the profession as a whole. Some rules are to be drawn up by the General Medical Council—this is really what the whole Bill is about: to give them an opportunity of being able to change certain practices and to introduce others—and we have to take into account the fact that they will lose no time over this, because this is what they want. Therefore, the point I want to make is that the speed with which this Bill is implemented is not in the Government's hands; it is rather in the hands of the General Medical Council. Therefore, in the circumstances, it would be unreasonable to impose a condition that could not possibly be met, and it raises the question: if a time limit is imposed but is not met, what happens then? I just do not know. What happens to that part of the Bill which has not been implemented?

Within the time scale of two years, it should be possible to reconstitute the General Medical Council on the lines set out in Clauses 1 and 2; it should be possible to set up branch councils under Clause 3, and it should be possible to appoint members of the education committee under Clause 14. It should also be possible to set up the three new committees to deal with professional conduct and fitness to practise. I would remind your Lordships that there are no fewer than eight clauses dealing with this matter alone. It is not something that will be done very quickly.

As regards Clause 4 and the 1927 Agreement with the Republic of Ireland, this is a matter between the United Kingdom and Eire Governments and I cannot give any undertaking that that clause would be implemented within a specific period. Most of your Lordships know how long it takes Government Departments to come to some kind of decision, and it takes even longer when one is dealing Government by Government. Therefore, I would say to the noble Earl, Lord Kinnoull, that we are aware of the position. If there is anything that the Government can do to expedite matters, once the Bill gets on to the Statute Book, I rather imagine—whichever Government are in power—that they will do so. But this, as I say, is primarily a Bill to enable the General Medical Council to reconstitute itself. One imagines that because this is what they want they will get on with it. In the light of the fact that I seem to have satisfied the noble and learned Lord, Lord Gardiner, I hope that the noble Earl will feel that I have satisfied him, too, if only with reservations.

The EARL of KINNOULL

My Lords, I am not sure that the noble Lord has satisfied the noble and learned Lord, Lord Gardiner, but as he is not here to challenge that remark I cannot speak for him. I was hoping to receive as satisfactory an assurance as that which the noble Lord, Lord Hunt of Fawley, received on his previous three Amendments. The noble Lord is sympathetic towards the issue but has pleaded a special case for this Bill. He asks what would happen if a time limit were imposed which was not then enforced. I should have thought that there was a simple answer to that question. The Minister responsible would have to come to Parliament to amend that time limit, and that would be an excellent thing to happen. I do not intend to press the matter, but I hope that the noble Lord accepts that this is a strong principle which other Bills must follow.

Lord WELLS-PESTELL

My Lords, if the noble Earl is thinking of withdrawing this Amendment, may I say to him that in view of the fact that he has raised the matter today I will ask my right honourable friend to look at it to see whether anything further can be done along the lines suggested.

The EARL of KINNOULL

My Lords, I am most grateful for the noble Lord's assurance, and I beg leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

Schedule 5 [Minor and consequential amendments of enactments]:

Lord HUNT of FAWLEY moved Amendments Nos. 11 to 24: Page 29, leave out lines 7 and 8 and insert ("MINOR AND CONSEQUENTIAL AMENDMENTS RELATING TO EDUCATIONAL FUNCTIONS"). Page 29, leave out lines 25 to 31 and insert— ("2. In section 9(1) of the Act of 1956 the words "not being members of the Council" shall be omitted. 3.—(1) In section 10 of the Act of 1956 the amendments specified in this paragraph shall be made. (2) Subsection (1) shall be omitted. (3) In subsection (3), for the words preceding "may appoint" there shall be substituted the words "For the purpose of securing the maintenance of the prescribed standard of proficiency the Education Committee". (4) In subsection (4), for the words preceding "may attend" there shall be substituted the words "Any member of the General Council and any person deputed for the purpose by the Education Committee". 3A.—(1) In section 11 of the Act of 1956 the amendments specified in this paragraph shall be made. (2) In subsection (1), in the words preceding paragraph (a) the words "in medicine, surgery and midwifery" shall be omitted and in paragraph (d) for the words from "a qualification in medicine" to the end of that paragraph there shall be substituted the words "a primary United Kingdom or primary Irish qualification in a branch of medicine prescribed for the purposes of this section by regulations made by the Education Committee and one at least entitled to grant such a qualification in a different branch of medicine so prescribed". (3) In subsection (2), for the words from "a qualification in medicine" to "so registrable" there shall be substituted the words "a qualification registrable under this Part of this Act in a branch of medicine prescribed for the purposes of this section by regulations made by the Education Committee and one at least is entitled to grant a qualification so registrable in a different branch of medicine so prescribed". (4) In subsection (3), the words "in medicine, surgery and midwifery" shall be omitted. (5) In subsection (4), in paragraph (b) for the words from "standard" to "qualifying examinations" there shall be substituted the words "prescribed standard of proficiency" and at the end of paragraph (c) there shall be added the words "with the approval of the General Council". 3B. In section 13 of the Act of 1956 the following amendments shall be made—

  1. (a) in subsection (1), for the words from "secure" to "profession" there shall be substituted the words "equip persons going through the course and examinations with the prescribed knowledge and skill"; and
  2. (b) in subsection (2), for the words from "in medicince" to "insufficient" there 306 shall be substituted the words "required from candidates at any qualifying examination does not conform to the prescribed standard of proficiency".
3C. In section 14(1) of the Act of 1956, for the words "medicine or surgery" there shall be substituted the word "medicine". 3D. In section 16A of the Act of 1956, for paragraph (b) there shall be substituted the following paragraph— (b) is the holder of a primary United Kingdom or primary Irish qualification and also of a qualification granted outside the United Kingdom and the Republic of Ireland which is recognised by the General Council for the purposes of this section as furnishing a sufficient guarantee of the possession of knowledge and skill corresponding with the prescribed knowledge and skill"; and for the words "medicine and surgery, or medicine, surgery and midwifery" t acre shall be substituted the word "medicine". 3E. In section 20 of the Act of 1956, for the words from "the requisite knowledge;" to the end there shall be substituted the words "knowledge and skill corresponding with the prescribed knowledge and skill". 3F. In section 22(2) of the Act of 1956 the following amendments shall be made—
  1. (a) in paragraph (a), for the words "paragraphs (a) and (b)" there shal be substituted the words "paragraphs (a) and (c)" and after the words" that section" there shall be added the words" and that the terms on which he has been so employed were such as to provide him with the experience required by one of the prescribed patterns of experience"; and
  2. (b) in paragraph (b) for the words "medicine and surgery, or medicine, surgery and midwifery" there shall be substituted the word" medicine".
 3G. In section 25(1)(b) of the Act of 1956, for the words from "the requisite knowledge" to the end there shall be substituted the words "knowledge and skill corresponding with the prescribed knowledge and skill". 3H. In section 26 of the Act of 1956, for the words from "the requisite knowledge" to "midwifery" there shall be substituted the words "knowledge and skill corresponding with the prescribed knowledge and skill". 3J. In section 27(1) of the Act of 1956, for the words "medical or surgical" there shall be substituted the word "medical". 3K. In section 28(3) of the Act of 1956, for the words "medicine or surgery" there shall be substituted the word "medicine".") In sector 28(3) line 38, at end insert ("and in paragraph (b), for the words "a sufficient" there shall be substituted the words "the prescribed"") Page 30, line 9, leave out ("place in alphabetical order the following definition") and insert ("places in alphabetical order the following definitions") Page 30, line 11, at end insert— Page 30, leave out lines 16 to 19 and insert— ("7. In section 11(4) of the Medical Act 1969 (in this Schedule referred to as "the Act of 1969") for the words from "medicine, surgery and midwifery" to "or surgery" there shall be substituted the words" any branch or branches of medicine". 7A. In section 18(1) of the Act of 1969 the following amendments shall be made—
  1. (a) for the words "the General Council" there shall be substituted the words "the Education Committee";
  2. (b) the words "in medicine, surgery and midwifery" shall be omitted; and
  3. (c) for the words from "qualifications" to "Act of 1956" there shall be substituted the words "United Kingdom qualifications does or will conform to the prescribed standard of proficiency "and for the words "that Act" there shall be substituted the words "the Act of 1956.")
 Page 31, leave out lines 1 to 3. Page 33, line 5, at end insert— ("24A. Section 56(3) of the Act of 1956 shall cease to have effect.") Page 34, leave out lines 9 and 10. Page 34, line 14, at end insert— ("42. In paragraph 8 of Schedule 3 to the Act of 1969, after the word "primary" there shall be inserted the words United Kingdom or primary Irish".")

Schedule 6, page 35, column 3, line 5, at end insert— ("In section 9(1) the words "not being members of the Council".")

Schedule 6, page 35, column 3, leave out line 7 and insert— ("Section 10(1) and (7) In section 11(1) and (3) the words "in medicine, surgery and midwifery".")

Schedule 6, page 35, column 3, line 17, at end insert— ("Section 56(3).")

Schedule 6, page 35, column 3, leave out line 32, and insert— Schedule 6, ("In section 18 in subsection (1) the words "in medicine, surgery and midwifery" and subsection (3).")

The noble Lord said: My Lords, I beg leave to move Amendments Nos. 11 to 24 which stand in my name. They have all been drafted by Parliamentary Counsel under arrangements kindly made by the noble Lord, Lord Wells-Pestell, and they are all consequential on the earlier Amendments which noble Lords have accepted concerning the functions of the education committee of the reconstituted General Medical Council and related matters. Their purpose, as I am advised, is to make the various corrections necessary in the provisions of the present Medical Acts and the Bill in order to be consistent with the Amendments which noble Lords have already accepted. With the leave of the House, I shall move them together. I beg to move Amendments Nos. 11 to 24 en bloc.

On Question, Amendments agreed to.

In the Title:

Lord WELLS-PESTELL moved Amendments Nos. 25 and 26: Line 1, after ("constitution") insert ("and functions") Line 2, leave out from ("Council") to ("and") in line 10 and insert ("and certain committees of the Council and to amend or provide for the amendment of the Medical Acts with respect to medical education, the registration of medical practitioners and their professional conduct and fitness to practise")

The noble Lord said: My Lords, I beg to move the Amendments standing in my name. I can deal with them very simply. It will be apparent to all noble Lords who have followed consideration of this Bill that, because we have gone beyond the contents and the intentions of the present Long Title, it is necessary to change that Title. In order to make what we have done fit the situation. I beg to move Amendments Nos. 25 and 26.

On Question, Amendments agreed to.